FEATURE REHABILITATION
more accurate assessment of how Chris would manage being away from a more structured ‘ clinical environment ’.
The flat was used to assess how he would manage independently at home with his activities of daily living and manage risks . This allowed for him to ‘ run ’ his own household as independently as possible , while still having staff available to oversee this and assist him should he require it .
Functional tasks , for example personal care , meal preparation and community access , were completed in a graded way and enabled Chris to demonstrate his ability to live more independently .
It also allowed the team to assess his ability to self-occupy and to incorporate compensatory strategies into everyday life ; for example managing appointments , using shopping lists and initiating using memory aids for sessions .
Chris described his time in the flat as ‘ like living independently on the grounds , but being detached slightly from the main building , so you ’ ve got that extra bit of independence whilst having the support there if you need it ’.
Chris was discharged home to his family after staying at Redford Court for just over 12 weeks , six weeks of which were spent in the independent living flat . In the absence of graded home leave and to aid his transition home , a series of daily telephone calls and virtual sessions were completed , in addition to a referral to the community neuro rehabilitation team to help embed compensatory strategies .
Creating a more ‘ home-like ’ environment In May 202 , 57-year-old Julie * had a cerebrovascular accident ( CVA ), with resulting expressive and receptive aphasia , upper limb weakness , and cognitive deficits .
Julie had reduced motivation to complete cooking and domestic tasks on the main unit due to the onsite dining room , industrial laundry facilities and high level of staff presence . In addition , communication difficulties and reduced insight significantly impacted the occupational therapist ’ s ability to assess generalisation of skills to the home environment .
The purpose of Julie ’ s move to the independent living flat was to : assess her potential to be discharged home through assessing her ability to manage a home environment ; to increase motivation for preparing meals and completing domestic tasks ; and to assess her ability to self-occupy and determine what level of care package would be required .
Unfortunately , Julie requested to return to the main unit after two weeks due to low mood . During these two weeks , Julie frequently refused to let staff into the flat , displayed reduced personal hygiene , had difficulty self-occupying and had a decrease in mood when in this environment .
Although the outcome was not as hoped , this period within the flat enabled the team to gain a more accurate representation of her function within a more ‘ home-like ’ environment , emphasising the need for support and encouragement to manage her personal hygiene and daily activities , and the importance of staff consistency and rapport building to reduce care refusals .
The subsequent reduction in social interactions that living in a self-contained flat entails further highlighted the importance of providing her with mental health support on discharge .
The past year has heightened our appreciation of the resources available to us . The pandemic , in conjunction with an increase in occupational therapy provision within the service , has enabled us to consider the role and purpose of our independent living flats .
For example , they can be a stepping-stone for higher functioning individuals , a ‘ home-like ’ environment to regain confidence in activities of daily living and embed compensatory strategies .
They can also act as a valuable tool to increase insight and to help individuals identify areas that they need to develop and a greater appreciation of what a return home would be like .
Our desire now is for others to see the value and possibilities of this resource . We intend to promote this more widely to referrers , such as commissioners , social workers and case managers , in the form of case study-based presentations and attendance at conferences .
References
Royal College of Physicians and British Society of Rehabilitation Medicine ( 2003 ) Rehabilitation following acquired brain injury : national clinical guidelines ( Turner- Stokes L , ed ). London : RCP , BSRM
Whitehead P , Fellows K , Sprigg N , Walker M and Drummond A ( 2014 ) Who should have a pre-discharge home assessment visit after a stroke ? A qualitative study of occupational therapists ’ views . British Journal of Occupational Therapy , 77 ( 8 ): 384-391
Stuart Wilkin , Serena Conway and Rachel McLaughlin , occupational therapists at Redford Court , The Disabilities Trust . * Name has been changed
48 OTnews May 2021