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This section dives into the continuum of care contexts where older adults may receive healthcare services. Before embarking on the continuum however, it is important to understand the nuances of evaluation and assessment for the older adult. The remaining chapters are structured on the basis of healthcare systems that, in an ideal world, would provide care transitions as needed to maintain a person’s highest level of function. Please note that the use of the terms “client,” “patient,” or “resident” is intentionally different in each chapter, reflective of the unique care contexts. Readers will follow case studies from Part II to integrate understanding of treatment contexts to the conditions formerly discussed.
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A substantial challenge for individuals needing care and the institutions that provide that care is the unfortunate lack of coordination among those systems. Gaps remain and can cause significant hardship to individuals and their families. Even when the transition is relatively smooth, movement from one system to another requires the transfer of information, which may or may not happen effectively, separate evaluation to conform to system regulations, expensive transport that may not be covered by any source of funding, and adjustment by the individual—often in a weakened and confused state—to a new environment and new carers. Such transitions can result in complications and excessive stress for the individual. Single-payer systems, such as those in Canada and the United Kingdom, can provide more predictable and sustained care based on guaranteed payment for specific kinds of intervention.
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The rise of chronic noncommunicable conditions, such as diabetes, heart disease, and cancers, will have social and economic costs to healthcare. Options for community-based, home, congregate, and institutional care will continue to expand (International Federation on Aging, 2018). Aging in place and “living well” in the community may be optimal choices for some but may be out of reach for those with catastrophic health challenges.
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Meaningful occupation is necessary to life in all contexts. Occupational therapists play a critical role in addressing wellness and quality of life throughout the care continuum. While reading the chapters that follow, reflect on how advocacy for clients and expansion of services are important roles for occupational therapists. Identify how occupational therapy evaluation and occupation-based interventions can be designed to help individuals remain functional and satisfied with their quality of life. It is inevitable that those who live long enough will need help.
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The last chapter forecasts change in aging care, including climate change, social trends, healthcare innovations, and emerging technologies. Futurist interventions have implications for both family and professional caregiving. Occupational therapists, with their holistic understanding of individuals and community, are well positioned as leaders in the healtchcare of older adults.