Living, not existing: putting prevention at the heart of care for older people

In its report Living Not Existing: Putting Prevention at the Heart of Care for Older People, the Royal College of Occupational Therapists seeks to show how doing the right thing for individuals can actually reduce their need for expensive care long-term. It calls for an end to the inequality of access to occupational therapy, which is a barrier to people in need receiving high quality, person-centred care that enables people to stay as active, independent and safe as possible.

Recommendations

The report makes three recommendations:

• An end to the inequality of access to occupational therapy. There are pockets of best practice, but too many people miss out on high-quality, proactive social care that promotes independence and self-determination.
• More occupational therapists employed within primary care proactively helping older people adapt to ageing, increasing frailty and health problems. This can delay, reduce or prevent the need for expensive care and support.
• Occupational therapists to be employed to lead on the development of person- and community-centred services that care for older people’s overall health and wellbeing to ensure they can live active independent lives in their communities for as long as possible.

The case for change

The refocus in healthcare delivery from acute, reactive care to a public health approach is happening during a crisis in social care, with estimates of a £1.9 billion funding gap in 2017 between the demand for care and monies available.  This report concentrates on the important contribution that occupational therapists can make to support further integration of health and social care. Sustainability and Transformation Plans (STPs) have been introduced to ensure a pooling of resources within a ‘footprint’. They are designed to strengthen partnerships in order to provide timely and person-centred care. National initiatives, such as pioneer and vanguard sites, are exploring different models of partnership working in order to deliver efficient ways of meeting local need. The Royal College of Occupational Therapists (RCOT) argues that, as experts in occupation, occupational therapists can act as an enabling mechanism for the quality of life and wellbeing of the local population.  As older people are recognised as the main users of health and social care, this report focuses on the value of occupational therapy in enabling them to live well within their communities, both urban and rural.

Why occupational therapy?

It is well documented that occupations offer us choice and control, and support feelings of self-worth and identity. Too often the most vulnerable members of our society are provided with social care packages based on what is organisationally expedient for the provider rather than an understanding of the recipient’s real needs. Occupational therapists identify what each person needs and wants to be able to do and helps them find ways of doing it. They see the whole person and, in doing so, return the autonomy, choice and control.

Occupational therapy is unique in seeking to understand how people have already adapted successfully to change and how they are managing the consequences of frailty and ill health. That might mean helping someone to be able to make a cup of tea for themselves, when they want one. For other people, getting out of the house to a café to see friends will help them to reconnect with their social support network and prevents feelings of depression.

Many older people talk of simply existing, not truly living. This is a sad indictment of how we treat the oldest and most vulnerable members of our society. Finding ways to enable older people to continue to participate in daily life through problem solving, learning or relearning skills and making adaptations not only improves peoples’ lives but also makes more effective use of public money. When people’s needs are not met they come to rely on other services. Too much social care reverts to long-term support, reducing older peoples’ autonomy over how they live their lives day-to-day. This has a dehumanising and disabling effect, which leads to dependence and strips older people of their vitality and self-esteem.

With the importance of wellbeing recognised within legislation, we must refocus on creating services that help older people to do as much as they can for themselves, for as long as they can; seeing a person’s overall wellbeing rather than simply a set of support needs. Short-term, intensive reablement can result in a better quality of life and outcomes for older people, and reduce costs for providers. 

The Royal College of Occupational Therapists (RCOT) is calling for occupational therapy to be incorporated within all 44 Sustainability and Transformation Plans at the next point of review.

Occupational therapists have a role in 3 key areas:

1. Prevention or delaying the need for care and support The RCOT recommends that occupational therapists are incorporated into multidisciplinary teams within new models of care, as outlined in the GP Forward View. For action by: Multi-specialty Community Providers (MCPs), Primary and Acute Care Systems, Accountable Care Systems and Organisations (ACSs and ACOs).
2. Helping older people to remain in their communities The RCOT recommends that occupational therapists are deployed to develop person and community-centred approaches to ensure older people live independently for as long as possible in their communities. For action by: Local authorities, community and health service providers.
3. Ensuring equality of access to occupational therapy The RCOT recommends that partnership agreements are formally developed across local housing, health and social care sectors to ensure all older people irrespective of social, economic or housing circumstance, have access to occupational therapy.  For action by: Local authorities, community and health service providers, care home and housing providers.