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Submission For The Record of American Occupational Therapy Association

The American Occupational Therapy Association (AOTA) submits this statement for the record of the May 9, 2007 hearing.  We appreciate the opportunity to provide this information regarding the use of occupational therapy in long-term care in the Department of Veteran Affair’s long-term care programs.  With the aging of our nation’s Veterans, quality long-term care programs to assist those who are in need should be a priority for our country.  Occupational therapists and occupational therapy assistants work in long-term care settings, including home and community based settings, to increase the independence and quality of life of their patients. 

AOTA is the nationally recognized professional association of 35,000 occupational therapists, occupational therapy assistants, and students of occupational therapy.  Occupational therapy is a health, wellness, and rehabilitation profession working with people experiencing stroke, spinal cord injuries, cancer, congenital conditions, developmental delay, mental illness, and other conditions. It helps people regain, develop, and build skills that are essential for independent functioning, health, and well-being.  Occupational therapy is provided in a wide range of settings including day care, schools, hospitals, skilled nursing facilities, home health, outpatient rehabilitation clinics, psychiatric facilities, and community programs.

Occupational therapy professionals assist those with traumatic injuries—young and old alike—to return to active, satisfying lives by showing survivors new ways to perform activities of daily living, including how to dress, eat, bathe, cook, do laundry, drive, and work.  It helps older people with common problems like stroke, arthritis, hip fractures and replacements, and cognitive problems like dementia. In addition, occupational therapists work with individuals with chronic disabilities including mental retardation, cerebral palsy, and mental illness to assist them to live productive lives.   Occupational therapy practitioners also provide care to Veterans who suffer from traumatic brain injuries, post-traumatic stress disorder, spinal cord injuries, and other conditions.  By providing strategies for doing work and home tasks, maintaining mobility, and continuing self-care, occupational therapy professionals can improve quality of life, speed healing, reduce the chance of further injury, and promote productivity and community participation for Veterans. 

The Department of Veterans Affairs (VA) offers a spectrum of geriatric and extended care services to veterans enrolled in its health care system.  More than 90 percent of VA’s medical centers provide home- and community-based outpatient long-term care programs.  This patient-focused approach supports the wishes of most patients to live at home in their own communities for as long as possible.  In addition, nearly 65,000 veterans will receive inpatient long-term care this year through programs of VA or state veteran’s homes. 

Occupational Therapy’s Role for Veterans in Long-term Care Programs

Occupational therapy practitioners provide care in a number of settings and programs, including both institutional and non-institutional programs.  Veterans long-term care programs include options to receive care in the home and community as well as in nursing homes.  Regardless of setting or program, it is proven that elderly individuals benefit from occupational therapy services [Journal of the American Medical Association (JAMA)  “Occupational therapy for independent-living older adults: A randomized controlled trail.”  JAMA, Vol.  278, No.  16, p.  1321-1326. 1997].  Occupational therapy practitioners can provide a unique and valuable service in supporting Veterans in long-term care programs, in their occupations and activities of daily living, and in their efforts to remain independent and to successfully age in place.

Activities of Daily Living (ADLs) are basic self-care activities that need to be completed on a daily basis (for example self-feeding, grooming, bathing, dressing, and toileting).  Instrumental activities of daily living (IADLs) such as reading and managing money are also critical.  Occupational therapy practitioners work with Veterans to gain the skills that are needed to accomplish their ADLs and pursue IADLs as appropriate.  Occupational therapists and occupational therapy assistants are experts at identifying the causes of difficulties limiting participation.  Their expertise enables them to consider client needs and environmental factors to develop effective strategies that will maximize quality of life as well as independence in those daily activities that are important to each Veteran. 

Veterans who wish to age in place in their home or community look toward occupational therapy as a means to achieve their goals.  Occupational therapy plays a key role in identifying strategies that enable individuals to modify their homes and environment to meet their goal of aging in place at home and in the community.  Aging in place refers to the ability to remain in the home even if the client’s abilities have declined. 

Home modifications are adaptations to living environments intended to increase usage, safety, security, and independence for the user.  As part of the home modification process, occupational therapy services include assessing needs, identifying solutions, implanting solutions, training in the use of solutions, and evaluating outcomes that contribute to the home modification product.  Occupational therapy practitioners may recommend the installation of chair lifts for stairs or adding railings or grab bars to bathrooms or other walls to provide support.  Occupational therapy practitioners can enhance Veteran’s well-being and participation by serving as a resource in home modification.

Occupational therapy is also recommended to help keep individuals mobile and independent, helping to ensure meaningful participation in the community.  For some people, some forms of transportation, such as driving, become less safe, and many Veterans will need to address alternatives to driving at some point in their lives.  Occupational therapy can optimize and prolong an older driver’s ability to drive safely, and ease the transition to other forms of transportation if driving cessation becomes necessary.  By identifying strengths as well as physical and cognitive challenges, occupational therapists can evaluate an individual’s overall ability to operate a vehicle safely and recommend assistive devices or behavioral changes to limit risks.  The goal of assessing individuals for driving is to enable them to stay in the community and reduce the need for nursing home care. 

Veterans who receive care in nursing homes also benefit from occupational therapy services.  Occupational therapy starts where the person is, looks at their desires and potential, and facilitates diminishment of frailties and support of abilities.  As Veterans are treated in nursing homes, their needs range widely.  Occupational therapy is there to assist and enable them to overcome or heal from disability and illness.  It is a critical component to achieving quality of life which is the goal of the Veteran Affair’s long-term care programs.  The Veteran population will continue to grow and nursing homes will remain an important site of care for Veteran’s who require constant nursing care and have significant deficiencies with activities of daily living. 

People in the United States are living longer, and that includes our nation’s Veterans.  For some, a consequence of increased longevity is increased frailty and dependency.  Many Veterans live alone, have limited resources, and require special services for meeting everyday needs.  Helping elderly persons to maximize their independence and enabling them to continue to perform activities of daily living is crucial.  The Department of Veterans Affairs long-term care programs are structured to provide care to our country’s Veterans as they age and need help with various areas of their lives.  Occupational therapy is a unique and valuable service that can help Veterans achieve their goals of living a healthy and independent life. 

AOTA hopes that Congress will continue to look at occupational therapy as a service that benefits all Americans.  We look forward to discussing how we can better serve our nation’s Veterans and all aging Americans. 

Contact:  Daniel R. Jones