This case study highlights how a collaborative approach between mental health occupational therapists (OTs) and housing OTs can lead to successful home adaptations for older adults with learning disabilities and complex needs, enabling them to live independently and safely in their own homes.
[Music]
So now I'm going to welcome um Diane
who's um spoken before one of our our
road shows. But um Dian's got a case
study for us. So um over to you Diane.
>> Hello everybody and thank you very much
for asking me to come along today. um
really really interesting um some
interesting discussions and also in the
chat um and my case study today is um
actually somebody who's an older adult
um though I would echo what um previous
people have said is we are seeing
increasing numbers um of people coming
through young people where we're having
to look really carefully at home
environments but I'm an OT working in a
mental health learning disability team
And until about five or six years ago, I
had very little experience of housing at
all. So in some ways, this is brilliant
timing for me and some of my colleagues
because it's something we are
increasingly looking at as I think that
statistic was really shocking, wasn't
it? About was it 48% of discharges are
delayed because of housing issues, which
is um truly terrible really. Um but I um
wanted to talk about a gentleman I've
been working with who's in his 70s
actually. um with a learning disability,
autism, and a diagnosis of PA. And I
don't know if anybody everybody knows
that, but Pika is basically the um
ingestion of non um edible items. And
he's been living in his own ground
floor, which is part of a supported
living service for over 27 years. Um but
with very, very specialized support and
there are service that are almost
attached to our trust. So there's good
access to a range of other health
professionals as part of that.
And unfortunately, oh sorry, I nearly
left then. Um he um had a period last
year of being in hospital in a
mainstream hospital with pneumonia for
about I think he was in hospital about
over six months in the end because it
was found on X-ray um that he wasn't
recovering in the community to
antibiotics. And when they did the
X-ray, they realized he had actually
ingested, I think it was a five piece
that was lodged in his lungs. Um, and
some of the other things that we were
seeing was just increased frailty. Um,
becoming older, finding just everyday
task more difficult, needing more
support, his mobility was decreasing,
um, and just basic functional skills. We
were seeing a decline really. Um and
when he was in hospital, there was a lot
of discussion at that time about whether
or not this was a time um mainly social
services were looking at this, whether
or not he should be returning to his own
um flat or whether or not it was time to
look at him moving to more residential
care really where there would be um like
you know more staff around possibly
somewhere with nursing support. And one
of the things we looked at, we developed
a tool locally some time ago called the
safe home environment assessment. Um,
and we looked at this in terms of um,
what were the risks about him going home
to his own home where he'd been very
happy, very settled, very few incidents
actually in the latter few years and
where he had really really skilled
support and I think one of the earlier
speakers mentioned Coral might have been
that we have to look at it's not just
always sometimes a physical environment.
Um if we'd have gone to the residential
care option, it could have been we could
have made you know more um we could have
had a bit slightly more easier to manage
physical environment but what we would
have lost was the skilled staff who were
around him and that really constituted
what we thought was like a capable
environment for this gentleman and he
had staff working with him. He didn't
actually have family and most of his
families had died or weren't around
anymore, but some of the staff team had
known him over 20 years and they were
really brilliant actually at advocating
and knowing him really really well. So
when we looked at the risk within his
environment, they were brilliant in
actually being able to very quickly
identify what we could do within his his
existing flat um to make it more um like
to future proof it really. And because
it was a it was one of those big
Victorian houses that was carved up many
years ago, it was looking very tired and
was no longer meeting his needs. And
part of that was because I think he had
very poor tolerance of people going into
his environment. Even doing things like
decorating was hugely traumatic for him
actually. Um but following admission to
hospital, we really looked very closely
at what could we do within his actual
flat to make it a safer place for him to
return to rather than um looking at him
having a really really tra traumatic
transition to a completely new setting
but with staff who wouldn't know him. um
as well as his existing staff deemed
did. Um and as you can see, this is just
a picture of his bathroom at the moment.
One of the um he does look very tired,
doesn't it? So, um he had a perpetual
issue of tearing off toilet seats and
the staff team had tried loads and loads
of quite innovative things to kind of
manage this behavior. But one of the
real concerns was one functionally it
wasn't very nice him sitting on this
toilet without a toilet seat but every
time they replaced it it got pulled off
and um there was a real concern around
the screws and the risk of him ingesting
these these um like bits of the toilet
seat because I think they were found he
also had bits of plastic in his stomach
when he was in hospital. So one of the
things we did was this has come about a
really brilliant timing for us because
we were looking at how could we do these adaptations
adaptations
and fortunately um have very very good
local housing OT's who we have who have
tons of expertise around DFGs who we
managed to speak to and um together
actually and I think that's true it's
about the collaboration isn't it of us
really knowing him really well but them
really understanding the processes is um
and this isn't a before and after. This
is but this is kind of what we're aiming
for. We've gone for an integral toilet
um similar to what you might actually
see in a hospital because it's referred
to as um religure resistant but the idea
it's an integral one allin-one system.
So there's nothing to pull off. There's
no bits. There's no screws. And then
looking very much a very standard
adaptation actually in in terms of DFGs.
looking at um just putting in a level
access shower, but also this bathroom
has no windows. It's very kind of dark.
It's in the middle of the flat really.
Is looking at well, what can we do
around the sensory aspects of this to
make it a nicer environment for him so
that we can actually support his
independence within his own home for
much longer. Um, and also reduce the
need for the staff having to go and
support him because at the moment he's
really struggling to get in and out of
the bath. And I'd already tried before
his admission to we've done the bath
balls, we did the bath seat. None of
those he really tolerated. But when he
was in hospital, he actually managed to
tolerate the show. So we kind of
thought, well, that seems to be the next
logical step really for us. Um, and this
is kind of an example of us working more collaboratively,
collaboratively,
um, sharing our skills and us
understanding some of the sensory
elements of behavior. um having access
obviously to the the whole of the MDT
which is obviously a massive advantage
but then working with local experts like
our housing OT's who've been brilliant
because they came up with loads of
things we hadn't even considered such as
how we're going to manage the work, how
we going to do this, how long would the
work likely take, how to um facilitate
people going in and getting the quotes
done. there was a whole load of planning
we've had to do around even where's he
going to be living while we do this
work. Um and they were really good
because they' had all the skills and
experience of having done this many many
times before and knowing kind of what
can go wrong. Um so that's what we kind
of did. We looked at the DFG as being
the a really good funding opportunity
because we weren't even sure how we were
going to even get the funds to do this.
Um it's enabled him to live in his own
home for a longer period with all those
familiar skills supports. Um future
proofing it so we can actually think
about as his skills are deteriorating
we've been able to kind of think about
making sure we can maintain his
independence for as long as possible. Um
and also reducing the risk of another
really lengthy and traumatic hospital
admission by making sure that we've kind
of we've almost gone through and thought
of every possible risk we can see in the
environment in terms like kitchen. We've
had to put in restrictions but that's
going through C of protection um in
terms of looking at what the least
restrictive options are but some that
we've had to do like locking fridges
actually which was something we hadn't
had to do before. Um and also it's been
a really great opportunity to work more
collaboratively with our local housing
OT's and that's been helpful in terms of
um kind of looking at some of the cases
that they're getting through which are
younger people which were now thinking
how do we you know we we start to work
with people when they're 19 but we've
actually had a few cases recently where
we've gone down a bit to kind of do a
bit preventative work where we've we've
come across people who are really
struggling with, you know, their
families are really struggling and
working more collaboratively as a
broader system actually, which seems
like totally sensible and like somebody
said, it saves so much time um and
distress to everybody if we can be a bit
more pro pragmatic about this sometimes.
Um and it's made we've learned lots of
skills that we didn't have as OT's
working and learning disabilities in
terms of what's possible. The um
community of practice I would echo has
been brilliant. Um, and I think it is
that idea that we can all bring our
different skills and expertise and share
that in a kind of open way in terms of
what works and what doesn't. Um, and I
think that was pretty much all I wanted
to say, but the good practice guide is a
really brilliant initiative in terms of
kind of helping people work through that
process. Um, and so I look forward to
reading in more detail as well. So
that's all I was going to say really.
It's a very short case study. So
>> great. Thank you D. But I think kind of
really useful for bringing out some of
the points that we've um we've kind of
already discussed and kind of touched on
this afternoon. kind of giving given a
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