I work as part of the wider team within the hospice and cover the In-patient unit and Day Hospice as well accepting referrals from Out-patient clinics and urgent community visits. My day starts at 8.30am when I go through emails, answer telephone queries and check for any new referrals into the OT service.
At 9 am I have an update on how patients have been overnight in the In-patient Unit, update the team on OT input from the day before and pick up any new referrals.
When a new referral comes from the In-patient unit, I will introduce myself and the OT service to the patient and their family. Often referrals from the In-patient unit are to start planning safe discharge home from the unit. This often involves close liaison with the nursing staff and physiotherapist to understand a patient’s mobility – for example whether a patient can independently transfer on/off their bed, toilet and chair and whether they can manage stairs if they have them at home. I will then look at their home circumstances: whether they live alone or with a relative and how much that patient will need to be able to do for themselves, for example do they need to be able to get themselves dressed, cook a meal, make a cup of tea and collect their own shopping.
If domestic and personal activities may be difficult for the patient then we liaise with the social worker to look at whether a care package may be needed to support the patient at home. Often I will need to carry out a visit to the patient’s home, meet relatives and consider whether any equipment would be beneficial. I consider the patients and relatives wishes first and foremost when planning discharge, as well as ensuring that as a team we put in place as much as possible to provide a safe return home.
I will look at everything that the patient will need, or wants, to be able to do and suggest equipment, minor adaptations (such as additional bannister rail, grab rails) or talk about a package of care that will help, as much as possible. Sometimes a piece of equipment, such a raised toilet seat or bed raisers, will help a patient to maintain their independence as it is often easier to stand from a higher surface as well as using less effort which may help if the patient is particularly suffering from fatigue. I can also arrange for equipment to be delivered if a patient would like to go home to spend the last few days of their life, often requesting items such as a hospital bed and a commode, which can be delivered from Community Equipment Stores very quickly.
Once I have carried out the visit, I will request all recommended equipment and arrange delivery at a time convenient to the family. I will also arrange to revisit to fit equipment such as a raised toilet seat, bed/chair raisers or pillow lifters prior to the patient going home. The home assessment will then be discussed with the wider hospice team and any further concerns that may have been raised by the assessment can be addressed prior to discharge.
Before a patient attends Day Hospice for the first time, I am often asked to visit patients at home to carry out a transport risk assessment for the volunteers who will be driving them, for those who are unable to make their own way to the hospice. This is an opportunity to meet patients in their own homes and check that they are able to safely access their home and request rails, temporary ramps or refer onto the community OT’s for something more permanent, if they are struggling with door thresholds or steep paths.
When patients who are referred from the Day Hospice staff, I will often meet them initially at Day Hospice and then follow them up at home with a visit if they have identified particular issues that they are struggling with. Again I will look at what the patient finds difficult and offer advice, suggest equipment, refer to another professional (e.g. community OT, social worker) or organise a minor adaptation such as a grab rail at the front door or an additional bannister rail up the stairs to help them remain at home and as independent as possible. I can also advise them where they can purchase small pieces of equipment that are not supplied by Community Equipment Stores as well as provide a programme to help manage fatigue if this a particularly problematic symptom of their condition. I am able to discuss any on-going problems with the Day Hospice staff on a daily basis as my office is in the Day Hospice, as well as at our weekly meeting with the wider team including the medical team and social worker.
I also receive referrals from the outpatient clinics (respiratory, cardiac, Parkinson’s and renal) that are held here at St Richard’s – these patient’s nearly always require a home assessment, following issues that have been identified by the team that run the clinics.
No two days are ever the same which is refreshing. I love being part of the hospice team and working so closely with such a wide range of professions.
Sue Stephens OT