Does Occupational Directed Services in Long-term Care Maintain a Resident's Self Performance in Activities of Daily Living: A Pilot Study

A pilot study to determine if Occupational Therapy (OT) directed service in long-term care maintain a resident's self-performance in activities of daily living: Study protocol for a single-site trial

INTRODUCTION AND BACKGROUND

In Canada, a significant gap exists in providing resident-focused services to individuals in long-term care homes (LTCHs) to promote maintenance of function and participation in activities of daily living (McArthur et al., 2015; Ontario Society of Occupational Therapy, OSOT, 2020). People who live in LTCHs are frail, have some form of cognitive impairment, and live with at least one chronic health condition (McArthur et al., 2017; Ontario Long-Term Care Association, OLTCA, 2019, Shakeel et al., 2015). Upon admission to an LTCH, an alarming number of individuals experience a stark decline in function in activities of daily living (Crocker et al., 2013). Furthermore, the number of residents who require extensive assistance with activities of daily living (ADLs), such as grooming, getting dressed, and eating is also rising. For example, in 2018, 86% of long-term care residents in Ontario required extensive assistance with ADLs (OLTCA, 2019). However, this alarming trend may bring to question if this is an accurate representation of residents' true abilities or possibly the lack of resident-focused services that support a restorative care philosophy, in which allows individuals to maintain current abilities or decelerate functional decline after admission to LTC.

The lack of rehabilitation services in LTCHs is disturbing. Residents should have access to services that aim to prevent further rapid decline in function or participation in activities of daily living (ADLs). The LTCH Act in Ontario states that "Every resident has the right to receive care and assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible." (Long-Term Care Homes Acts, 2007, 2-3). Nationally, OT accounts for only 4.0% of the rehabilitation services presently provided within LTCHs. Ontario has the lowest percentage of LTCH residents' access to OT across Canada (Canadian Institute of Health Information, 2019). OT-directed services in LTCHs can address specific resident needs related to daily living activities by identifying and help to lessen risks residents are face with in LTCH, which often result in increased care demands for the LTCH team (OSOT, 2020). Evidently, long-term homes in Ontario are challenged to pilot alternative ways in which a restorative care approach can be modelled and delivered in LTC for residents to fulfill this mandate.

According to the 2021 Ontario budget announcement, the province pledged to increase the average direct care to four hours a day in long-term care and hire more than 27,000 new staff positions, including allied health professionals (Ontario Ministry of Finance, 2021). With this influx of new funding and additional human resources, the current delivery model of rehabilitation services in long-term care must be re-considered. Furthermore, a pilot to test an innovative model of OT-directed service delivery to facilitate a restorative care philosophy is necessary to maximize resident function and level of participation in daily activities.