Contacts
Contact:
Amy Edwards
Professional Affairs Officer
Organisation:
College of Occupational Therapists
106 - 114 Borough High Street Southwark London SE1 1LB United Kingdom
Email:
Case study:
16 October 2011
Occupational therapy: care in the last days of life
Key points
- It is important to establish rapport quickly to enable open discussions
- A safe and timely discharge within a very short timescale was crucial
- It was important to support family members – family and carers have a huge influence on whether discharges can even go ahead, let alone be successful
- It was important to assess for and put in place the right amount of support and input to make it work.
Daphne* was a 64-year-old woman who lived alone (apart from her cats) in her own house. She had been diagnosed with pancreatic cancer and liver metastases. She was admitted to the hospice four months later because she had become drowsy and confused with a high fever. She said on admission that she would like to go home when she was “well enough”.
Eleven days after the admission it was clear to her and her occupational therapist that she was deteriorating and she expressed her wish that, despite her cousin’s misgivings, she wanted to return to her own home to die.
The occupational therapist spent time talking with her to ascertain what this meant to her psychologically and emotionally. They explored what being at home would be like as she saw it. Daphne was very sensible and realistic and it was easy to support her in her request.
She was disappointed that she could not go immediately! However, she was able to understand the need to plan properly. A home visit was planned for the next day to check the environment and Daphne said that, despite her frailty, she wanted to come on the visit.
With a nurse escort the visit was carried out and Daphne’s cousin was also present. She had all the equipment she needed in her lounge already (electric profiling bed, mattress and commode) but the occupational therapist went through her day’s routine and practised use of the lifeline fitted on the visit, which was new to her. Daphne had a very weak voice and the unit needed repositioning, and it took several attempts before success and she managed a loud “help”.
Daphne struggled with the bed controls, so the OT worked with her and came up with a ‘pattern’ that Daphne could follow. The OT also spent time reassuring her cousin about the community support available to them and clearly planning the first few days at home when her cousin would be staying with her.
The outcome was, unsurprisingly, that Daphne wanted to “give it a go” and her cousin was willing, although openly anxious, to support her in this. It was decided that Daphne would be discharged the next day and that her cousin would bring her home by car.
The next day she was very weak and needed two people to help her to transfer so the OT decided to meet them at her home to assist her getting into the house. Daphne was calm and determined and, although it was a struggle, managed to be helped inside and into bed.
The OT provided a detailed plan of the names and phone numbers of the community staff involved and the care agency who were visiting three times daily.
Daphne died peacefully at home two days later with her cat on the bed next to her.
*All names have been changed to protect confidentiality
Author
Sarah Barrett, occupational therapist
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