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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
Email:
Case study:
16 October 2011
Occupational therapy: discussions as the end of life approaches
Key points
- The occupational therapist worked with the client and her husband to find a ground floor flat which would better suit her needs
- Although the physical needs had been met through modifications to their existing house, the couple’s social and psychological needs had not been met
- The case study shows that re-housing at the end of life may be a potential solution to a client’s needs.
Sue* was a woman in her 60s who had been diagnosed with lung cancer; there had been metastatic spread to her pelvic bone, and she was awaiting an opinion as to whether an internal fixation for this was possible. She lived with her husband in their own house and was also supported by two daughters who lived nearby. Her husband was also experiencing mobility problems and was awaiting a hip replacement.
Sue was initially referred to the occupational therapist by the Macmillan nurse as she was having difficulty with climbing stairs. Although the occupational therapist worked with Sue to find solutions for many of the functional problems which the pain and reduced mobility caused, one of the most important aspects was the assistance provided with re-housing.
Sue and her husband submitted a housing application to the local housing office, which was directed to the medical re-housing team. The occupational therapist was able to advocate for her client, requesting provision of level access to bedroom, bathroom and toilet facilities. As Sue’s condition progressed, she received the orthopaedic opinion that it was not possible to internally fixate her pelvic fracture. This, combined with her deteriorating mobility, made the need for re-housing more imperative.
A one-bedroom ground floor flat became available to the couple in an area that was close to their family support network and across the road from local shops. The flat had level access and although small, had good turning space for the use of a wheelchair. The bath could have been adapted with a swivel bather bath seat to enable the client to transfer over the bath side to use the shower. However, the client’s husband wished to adapt the bathroom to a wet room to meet both their needs.
Although the couple had concerns about the size of the flat reassurance was given that the circulation space within the flat was good. A key role was played securing a little additional time for the couple to make a decision about whether or not to accept the flat.
Sue and her husband made the decision to move to the ground floor flat and funded the level access shower adaptations privately, to ensure the work was completed before they moved in. Recommendations were given about the facilities that would be needed, working in partnership with the adaptations agency.
The move improved the client’s and her carer’s quality of life, since they were no longer obliged to sleep in different rooms.
Reflective analysis
Although re-housing can be stressful, particularly in the context of living with a palliative illness, the client and her husband had already been considering re-housing prior to Sue’s diagnosis, in order to maintain their independence. They were therefore psychologically prepared to leave their family home and were focusing on the future, both short and long term, as Sue’s husband had been struggling with the stairs already.
The speed of re-housing and the availability of a property in an area which maintained support systems (as their family lived close by) was crucial to the success of re-housing. Although Sue’s physical needs had been met with the provision of a profiling bed and commode on the ground floor of their existing house, the couple’s social and psychological needs had not been met, and these were not resolved until they were able to sleep in the same room when they were re-housed to the flat.
Although Sue’s long-term needs were addressed early on in the assessment process, continued reassessment ensured that Sue remained at home until the last week of life. Admission to a hospice was required in the last week but this was for pain management rather than the client’s or family’s ability to cope with increasing dependency.
Re-housing can be perceived as a stressful life event but in this situation it had a positive impact on the quality of life for Sue and her carer at the end of life. Re-housing at the end of life should therefore not be dismissed as a potential solution to meeting clients’ needs.
*All names have been changed to protect confidentiality
Author
Margaret Houghton, occupational therapist (specialist palliative care)
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