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Contact:
Amy Edwards
Professional Affairs Officer
Organisation:
College of Occupational Therapists
106 - 114 Borough High Street Southwark London SE1 1LB United Kingdom
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Case study:
16 October 2011
Occupational therapy: care after death
Key points
- When the occupational therapist first met Edith and her daughter it was not expected Edith would die. Having established a therapeutic relationship with Edith and her daughter, it was important the occupational therapist facilitated an appropriate ending to this relationship
- This case study shows the importance of considering the carer’s needs after death. It demonstrates the occupational therapist’s role in offering follow-up and advice to an informal carer after death as well as being aware of other services available for carers.
Edith* was an 88 year-old-woman who lived alone following the death of her husband two years previously. She had a diagnosis of dementia as well as a history of depression and congestive cardiac failure. She had one daughter, Marie, who visited at least three times a week. Marie also had her own family.
Edith was referred by a community psychiatric nurse (CPN) to occupational therapy for an assessment because of concerns about her safety (she had been found wandering in her local community and was reported to have left the gas on in her kitchen). The district nursing service visited regularly to monitor her medication. Edith had refused home care services, saying she did not have any difficulties.
The occupational therapist met Edith for the first time on a joint visit with the CPN and subsequently when her daughter, Marie, was visiting. Having Marie present enabled the occupational therapist to learn more about Edith’s life as well as enabling Edith to become more trusting of her.
Because Edith was having difficulties looking after herself, and she was not accepting home care, there was the risk of a crisis admission. The occupational therapist’s priorities were to reduce this risk while maintaining Edith’s dignity and self-respect.
The aim therefore was to establish a therapeutic relationship, using a person-centred approach. One way was to encourage Edith to talk about her early life, which she enjoyed doing.
A second priority was to liaise with her daughter and other team members. Marie was experiencing stress with the care demands of her mother, so with her agreement, the OT referred her to the Admiral Nurses® service within the trust**.
Over a period of time the occupational therapist was able to develop a therapeutic relationship with Edith. She assessed her domestic and other self-care skills. By working with her, her daughter, the homecare services and district nursing service, Edith eventually accepted homecare.
On one of the visits by the district nurse Edith was found to be physically unwell and was admitted to an acute ward. A few days later she died of chest infection and heart failure with her daughter beside her. The district nursing service informed the occupational therapist.
The OT checked that the home care service were aware of Edith’s death and also informed the CPN and Admiral Nurses® service. She sent a card to Marie, followed this up with a telephone call and arranged a single follow-up visit.
Marie found she had “time on her hands” since her mother’s death. The OT discussed with her other activities she might be interested in pursuing when the time was right. Marie continued to see the Admiral nurse for a couple of months after her mother’s death. The OT kept in touch with her progress by liaising with the Admiral nurse.
*All names have been changed to protect confidentiality
**Admiral Nurses® can be accessed through Dementia UK. For specific information visit the Dementia UK Admiral Nurses webpage
Author
Alice Mackenzie, Lecturer in occupational therapy, Brunel University
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