Occupational Therapy Predischarge Home Visits: A Study from a Community Hospital

Abstract

The characteristics of 79 patients in a community hospital having an occupational therapy home visit during a period of one year were monitored. The processes of the home visit were examined and, in particular, the relationships of diagnosis and overall measures of levels of functioning – the Physical Self-Maintenance (PSM) and Instrumental Activities of Daily Living (IADL) scales – with the recommendations of the occupational therapists were analysed. The 79 patients had a mean age of 78.5 years; 27 (34.2%) were male and 58 (73.4%) lived alone. The mean time spent in the home by the occupational therapist was 49 minutes and the mean time for the whole visit including travelling time was 108.4 minutes. Only one patient (1.3%) was completely independent in all six PSM categories and no patient was completely independent in all eight IADL items. Seventy-two (91.6%) patients were eventually discharged to a non-institutional setting, mainly the patient's own home. Current diagnosis, except for cerebrovascular disease, was not significantly related to higher overall dependency, recommended equipment or carer visit frequency. Higher overall dependency showed significant relationships with recommended carer frequency and time spent assessing the patient in the home, but not consistently with recommended equipment or home adaptations. When specific categories of equipment were considered, for example that for use in the kitchen, overall low dependency was significantly related to the recommendation for this type of equipment. The study confirms the need for assessments beyond those of diagnosis alone in rehabilitation. Overall measures of levels of functioning, although useful in measuring outcomes, are of less certain value for assessment. Specific subcategories of dependency scales are probably of more value than overall scores for occupational therapy assessment.