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Introduction

"If a lifetime…follows a path, there is a need for a leader. In the progressive phase where the path leads upward to greater skill, the leader is a teacher; in the regressive phase when tasks need simplifying the leader is a caregiver or therapist."

—Barbara B. Dreher, 1997

LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

  1. Name and describe critical legislation that created the modern nursing home.

  2. Describe the types of residents typically found in long-term care settings today.

  3. Describe the occupational needs of residents in long-term care.

  4. Explain principles of occupational therapy as they relate to occupational performance in long-term care settings.

  5. Discuss principles of physical therapy in long-term care settings.

  6. Discuss interdisciplinary care in nursing home settings.

  7. Discuss reimbursement and regulatory issues involved with delivering occupational therapy and activities services to residents in long-term care.

  8. Describe the application of strength-based approaches in long-term care.

Clinical Vignette

Arthur Rogers is a 73-year-old former machine worker who retired at age 60. He had lived with his wife of 51 years in a small two-story bungalow until 3 weeks ago, when he experienced a cerebrovascular accident that left him with right hemiplegia and expressive aphasia. He spent a week in an acute care facility and then was transferred to a rehabilitation center. He made little progress and has now been moved to a long-term care facility.

  1. What are some possible reasons Mr. Rogers might not have been discharged to his home?

  2. Are any of those reasons factors that might be modifiable to enable him to return home?

  3. What issues would be most critical in helping Mr. Rogers adjust to his new circumstances?

This chapter considers occupational performance in long-term-care settings. It describes how the nursing home industry has been changed by federal regulations in the past 30 years and provides a description of typical nursing home residents. This is followed by a discussion of the role of occupational performance in the nursing home setting. In particular, it emphasizes the ways in which interventions to enhance performance skills are implemented, regulated, and reimbursed. The chapter uses the term "occupational performance," which is consistent with occupational therapy (OT) usage. It is important to keep in mind that physical therapy (PT) is equally important to quality of life, and the chapter considers the ways in which PT conceptualizes resident needs, evaluates skills, abilities, and deficits, and provides interventions to enhance quality of life.

The next section of the chapter specifies some recent innovative trends in activities implemented in long-term care, including a discussion of how to use activities as interventions and mechanisms for rehabilitation in long-term care. The chapter concludes with a summary and a depiction of challenges still facing implementation of PT and OT as well as occupation-based programming in long-term care.

The chapter focuses primarily on long-term care ...

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