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Occupational Therapists in Home Based Primary Care

A man in a wheelchair shows a wooden dollhouse to another man.

David Benthall, OT, visits with Veteran proudly demonstrating woodworking project. Benthall assisted with proper lighting and adaptive visual aids needed for the project.

By Hans Petersen
Tuesday, April 5, 2016

Here’s another positive way teams of VA health care professionals are taking care of a special group of Veterans. And VA’s occupational therapists are key members of those teams.

It’s Home Based Primary Care (HBPC) which is a VA health care program provided to Veterans in their home, Veterans who have complex health care needs for whom routine clinic-based care is not effective.

The HBPC team at the Durham VA Medical Center in North Carolina is comprised of physician, physician assistant/nurse practitioner, social worker, occupational/physical therapy team, pharmacist, dietitian, psychologist and access to chaplain services.

April is Occupational Therapy Month

April is Occupational Therapy Month, an opportunity to learn more about this important profession that helps Veterans across the lifespan do the things they want to do and live life to its fullest.

Occupational therapists focus on “doing,” using occupations and meaningful life activities to help individuals maximize their potential.

Today, comprehensive primary care requires a coordinated team-based approach that promotes shared decision-making, sustained relationships with patients and families, and quality improvement activities.

In contrast to services reimbursed by other funding mechanisms such as Medicare, HBPC provides comprehensive care of the patient often for the remainder of their life.

HBPC targets frail, chronically ill Veterans who require interdisciplinary health care teams, continuity, coordination of care, and the integration of diverse services to cover their complex medical, social, rehabilitative, and behavioral care needs.

To manage the complex health problems of chronically or terminally ill patients, HBPC is provided directly by an interdisciplinary team.

This team promotes collaboration and coordination among all team members. The HBPC team members work interdependently in assessing, planning, problem solving, and decision-making to meet the complex needs of Veterans.

The Role of Occupational Therapy

The use of Occupational Therapy within the Home Based Primary Care at the Durham VA Medical Center is a non-traditional approach for the use of OT services with a proactive focus on prevention, education and wellness. This contrasts from traditional home therapy services which have a short-term, rehabilitative or restorative focus.

Occupational Therapists contribute to the team by performing the initial and ongoing assessments of the Veteran's functional status in the home environment. This allows them to monitor and support clients as they go through the natural aging process and into the end-of-life.

A Veteran in a wheelchair poses next to an accessible ramp to his house

Jim Mathues, OT, coordinated a Home Depot Grant project to improve accessibility in the home of this Veteran who had been limited to living in his basement due to environmental barriers but now can enjoy his upstairs patio with door widening and ramp installation.

Occupational Therapists also evaluate the Veteran’s home for safety and structural modifications needed to make the home environment safe and accessible, including adaptive equipment needs.

Occupational Therapists maximize function and safety in the home environment supporting Veterans’ goal to remain in their home during the aging process.

Important Interventions

Other important interventions include helping with lifestyle modification to minimize the impacts of chronic conditions such as chronic obstructive pulmonary disease, diabetes and dementia. They also focus on safety and falls prevention within the home environment.

There are numerous other unseen tasks involving a lot of important details such as educating the Veteran and their families about access to VA or community resources including grants to assist with modifying their home and automobile for accessibility, home repair resources and community transportation options.

As the largest health care system in the nation, VA is the single largest employer of occupational therapists, whose primary goal is to help Veterans optimize their functional performance in areas that are meaningful to their lives.