Aging in Place, Energy Conservation, Discharge Planning & OT Interventions – Comprehensive Class Notes

Course & Session Schedule

• Today’s date in transcript: 10th (likely July 10)
• Upcoming synchronous (“sync”) sessions
  • 17th & 24th – led by Dr. Altehif (expert in outpatient / home-health)
  • 31st July – no Zoom; cohort will be on-site
  • 1–2 Aug – on-site practical learning days
  • 7 Aug – full-hour wrap-up / debrief

Administrative & Housekeeping Items

• Canvas/Zoom calendar glitch: session still shows 2 AM for some; instructor working to “hack” the calendar.
• Recording protocol: instructors start manual recording each session.
• ICE video questions clarified (hip vs femur fracture, etc.).

Key Medical Terminology Clarifications

• “Hip fracture” (lay term) ≅ fracture of the proximal femur
  • OT follow-up questions: pinning vs total hip arthroplasty vs hemi-arthroplasty?
• “Wrist fracture” (lay term) ≅ distal radius fracture
  • Common mechanism: FOOSH – Fall On Out-Stretched Hand

Concept: Aging in Place

• Definition: Enabling clients to remain safely, comfortably, and independently in their own homes for as long as they desire.
• NOT synonymous with expensive renovations; can involve small, low-cost environmental tweaks.
• Closely tied to AOTA’s Productive Aging practice area.

Illustration

• All-white bathroom → client with low‐contrast vision cannot locate toilet → $10 fix: black toilet seat & matching rug for contrast.

Certification Spotlight – CAPS (Certified Aging-in-Place Specialist)

• 3 online, live-zoom courses (≈4–5 h each) + short exams.
• Overseen by the National Home Builders Association (NAHB).
• OT students can earn it before licensure; augments résumé for adult/geriatric practice.

OT Role in Aging in Place

• Comprehensive home assessment & modification
  • Safety (fall hazards, lighting, contrast, grab bars)
  • Task simplification (reorganizing kitchens, closets, bathrooms)
  • Adaptive equipment selection & client training
• Collaboration with social work / case management for services (Meals-on-Wheels, transport, medication delivery).

Energy Conservation (Four P’s)

1. Planning – organize activity sequence, cluster tasks.
2. Pacing – built-in rest breaks; “tortoise beats hare.”
3. Prioritizing – complete high-value tasks during peak energy times.
4. Positioning – sit vs stand; keep frequently used items at waist level.

COPD Example

• Client can ambulate only ≈15 ft before 3-4 min rest.
• OT strategies
  • Place chair/bench every 12–15 ft along usual routes.
  • Create one-stop “dressing station” to avoid multiple closet/dresser trips.
  • Kitchen “work triangle” → move plates, cups, skillet to counter height.

Psychosocial & Cultural Considerations

• “Stubborn farmer” / highly independent identity → may resist pacing & break schedules.
• Every patient is a mental-health patient
  • Anxiety, depression, financial stress, workers’ compensation status all ↑ therapy visits.
  • Address occupational identity loss, caregiver stress, lifestyle change grief.

Continuum of Care & Discharge Planning

• Acute Care → Inpatient Rehab (IRF) → Skilled Nursing Facility (SNF/ECF) → Home Health → Outpatient.
• IRF admission rule: must have goals in ≥2 of 3 disciplines (OT, PT, SLP).
• SNF when: lower functional level, longer LOS expected, or inadequate social support.
• OT must be ready to answer MD/family rapid-fire questions:
  • Current functional status?
  • Projected discharge environment?
  • Recommended equipment & services?

Clinical Example – 77-Year-Old Female, R Hip ORIF

• Mechanism: Tripped on flip-flops + throw-rug in kitchen.
• Post-op day 3; Toe-Touch Weight-Bearing (TTWB) on RLE.
  • Client education wording: “Only rest toes on floor for balance—no real body-weight.”
  • OT tricks:
  • Shoe on unaffected LE, sock on affected → natural WB cue.
  • Therapist’s foot under client’s toes = live pressure gauge.
• Present level in SNF: Min–Mod A for most ADLs.
• Goal-writing pearls
  • Break complex tasks into separate functional goals.
  • Always link to occupation (commode transfer, kitchen ambulation, car transfer).
  • Avoid “straight ambulation” goals (PT domain) unless tied to OT task.

Sample Short-Term Goals (illustrative)

• Client will complete lower-body dressing from edge of bed using dressing stick, at Mod I within 7 days.
• Client will perform RLE TTWB sit-to-stand transfer to bedside commode with **
  A≤ 25\% verbal cues** for hip precautions within 5 days.
• Client/caregiver will list ≥3 home fall hazards and state 2 energy-conservation strategies prior to discharge.

Goal-Writing Best Practices

• Use SMART framework (Specific, Measurable, Achievable, Relevant, Time-bound).
• Keep to one functional outcome per goal to avoid partial-credit issues.
• Embed measures (distance, % assist, cue frequency, time, repetitions).

Practical Techniques & Tips Mentioned

• Contrast fixes (dark seat/rug) for low-vision bathrooms.
• Remove small throw-rugs; recommend non-skid backing or tape if essential.
• FOOSH education for wrist-fracture prevention.
• Seating options along household routes; fold-down shower seat.
• For clients who “push until collapse,” introduce **
  (\text{work:rest} = 1:1)** early, then grade.

Exam / Fieldwork Reminders

• Expect to create discharge recommendations on the fly during on-site.
• Practice quick verbal summaries: “big-picture, 3 sentences” for MD rounds.
• Review ICE simulation videos; know femur vs hip, distal radius vs wrist, etc.
• Study mental-health overlays; anticipate extra visits for anxiety/depression.

Upcoming Mini-Assignment (Informal)

• Instructor will email 3 home photos (cluttered kitchen, luxury bedroom, typical bedroom).
• Spend ≈10 min each: jot OT modification ideas (accessibility, safety, equipment).
• No submission required, but be prepared to discuss next session.