Occupational therapists can save money for commissioners of older people's services
Occupational therapists provide cost effective solutions for older people's care and can support older people with reablement, preventing falls, remaining safe and independent at home and public health. Occupational therapists’ training includes understanding the medical, physical and psychological impact of disability or injury, as well as rehabilitative techniques in restoring and aiding recovery. Occupational therapists are therefore pivotal in ensuring reablement services are efficient, effective, and reduce dependency (College of Occupational Therapists 2010).
Occupational therapists provide advice for older people to reduce the risk of falls by promoting safety awareness around the home. There has been over 40% reduction in falls for older people receiving occupational therapy intervention.
A fall that leads to a hip fracture costs the State c. £28,665 per person. This is 4.7 times the average cost of a major housing adaptation and over 100 times the cost of fitting hand and grabs rails to prevent falls (Heywood and Turner 2007).
Home safety programmes delivered by occupational therapists make a significant difference in reducing falls (Campbell et al 2005). A short stay, in-patient rehabilitation programme is effective in reducing hospital re-admission rates. This type of rehabilitation service may be important for elderly patients as well as for patients with more functional deficits than others (Ip et al 2004).
Remaining safe and independent at home
Research into the Independence at Home service demonstrates that the involvement of occupational therapists can enhance older people’s independence and functioning (Littlechild et al 2010). Norfolk County Council’s reablement scheme led by occupational therapists found that care hours were reduced by 90% for those going on to longer term care (Allen and Glasby 2010).
Occupational therapists can postpone entry by one year for older people needing to go into residential care by adapting their homes, saving £28,080 per person (Laing and Buisson 2008).
Community occupational therapy interventions for patients with dementia and their caregivers are successful and cost effective, especially in terms of care giving (Graff et al 2008).
A randomised controlled trial (RCT) established the cost effectiveness of occupational therapy with a trend towards decreased medical expenditure with independent-living older adults (Hay et al 2002).
The promotion of good health for older people reduces the need for more costly medical interventions and improves quality of life. Occupational therapists have been identified as key to promoting mental health and wellbeing for older people in the NICE Public Health Guidance 16 (NICE 2008).
A RCT in independent-living older adults (the Well-Elderly Study) found significant health, function, and quality of life benefits attributable to a 9 month occupational therapy programme. There was a 50% reduction of post intervention healthcare costs for the occupational therapy groups ($967) compared to the control group ($2,593) (Hay et al 2002).
Occupational therapists are health and social care professionals who help older people with reduced physical or mental abilities to remain independent and safe in their own homes, undertaking their favourite pastimes and making the most of life, living and wellbeing. Occupational therapists can identify potential risks in the home and provide equipment and home adaptations . If the older person’s memory is poor, occupational therapists can suggest different ways to counteract forgetfulness and absentmindedness. In the UK:
- there are more people aged 60+ than people aged under 18
- over 1.3 million people are aged 85 or over
- the number of people over 85 is predicted to double in the next 20 years and treble in the next 30 years
- people aged 65 have an average life expectancy of 82-85 years, the last 7-9 years with a disability
With this demographic shift, there is greater demand for care and support for older people. The traditional approach of residential care homes and hospital stays are no longer viable. Community based services are needed to support independent living and promote the health and wellbeing of the growing population of older people.
College of Occupational Therapists (2010) Reablement: the added value of occupational therapists (Position Statement). London: COT.
Glendinning et al (2011) Home care re-ablement services: investigating the longer-term impacts (Research Works, 2011-01). York: Social Policy Research Unit, University of York.
Campbell et al (2005) Randomised controlled trial of prevention of falls in people aged > 75 with severe visual impairment: the VIP trial. The British Medical Journal, 331(7520),817.
College of Occupational Therapists (2006) Falls management. London: COT.
Ip et al (2004), Short-stay in-patient rehabilitation of elderly patients with chronic obstructive pulmonary disease: prospective study. Hong Kong Med J Vol10 No 5 October 2004.
Remaining independent in the home
Allen K and Glasby, J (2010) ‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes. Birmingham: Health Services Management Centre, University of Birmingham.
College of Occupational Therapists (2009) Occupational therapy and equipment. How equipment can make your life easier. London: COT.
College of Occupational Therapists (2008) The value of occupational therapy and its contribution to adult social service users and their carers (Position Statement). London: COT.
College of Occupational Therapists and Housing Corporation, (2006), Minor adaptations without delay. London: COT.
Graff et al (2008) Community based occupational therapy for older people with dementia and their care givers: cost effectiveness study. British Medical Journal, 336 (7636): 134-138.
Heywood F and Turner L (2007) Better outcomes, lower costs: implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. London: Stationery Office.
Laing and Buisson (2008) Care of elderly people: UK market survey 2008. London: Laing and Buisson.
Littlechild R, Bowl R, Makta E (2010) An independence at home service: the potential and the pitfalls for occupational therapy services. British Journal of Occupational Therapy, 73(6), 242-250.
College of Occupational Therapists (2007) Activity provision: benchmarking good practice in care homes. London: COT.
College of Occupational Therapists (2008) Continue to have an active life as you get older. London: COT.
College of Occupational Therapists (2008) Health promotion in occupational therapy. London: COT.
Hay Jet al (2002) Cost effectiveness of preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society, 50(8), 1381-1388.
National Institute for Health and Clinical Excellence (2008) Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care (NICE Public Health Guidance 16). London: National Institute for Health and Clinical Excellence.