Innovative Solutions to Systemic Trends in Delivery of Complex Wheelchair & Seating Systems

1. Innovative Solutions to Systemic Trends in Delivery of Complex Wheelchair & Seating Systems

2. “Meeting the health care needs of Canadians means having the right number of health care providers with the right set of skills, in the right settings.” CIHI, 2008

3. Trends • Aging population • More complex/chronic medical conditions • Health care funding • Funding structure for ambulatory services • Fiscal constraints • Organizational changes (LHINS, hospital mergers, etc) • Home first initiative • Wait lists/demands for services • Changing OT workforce

4. Need for Innovation Thinking outside of the box • Utilize wheelchair & seating clinics • Use of support personnel • Collaboration • Consultation • Joint partnership

5. Wheelchair & Seating Clinics • Dedicated seating focus • Use of assessment resources • Inter-professional collaboration-established seating team • Increased exposure to products and opportunity for clinical application • Increased exposure to complex seating needs and mobility needs

6. Why use support personnel? • COTO Position on Support Personnel • Practice Profile for Support Personnel in Occupational Therapy (CAOT-2009) • Improves efficiencies in practice • Time – OT can see more than one client • Money – OTA costs less than having a second OT

7. Collaboration “The number of Canadians living with chronic diseases is on the rise, and with it the need for complex collaborative care.” CIHI, 2008

8. Collaborative model-why? • Increased complexity of population serviced • Decreased resources (staff, time, money) • Increased wait times • Movement towards OT as generalist • Environmental barriers

9. How do we collaborate? • Collaborative Model • Working together with community therapists • Capitalize upon skill set and environmental access of community therapist, Seating clinic therapist & Seating Clinic Support Personnel • Seating clinic OT completes initial assessment in collaboration with community therapist and with the assistance of the OTA • Follow up in home by community therapist with feedback to seating clinic • Sharing of paperwork/funding applications etc.

10. Case Study - Collaboration • Client with ALS • Initial assessment occurred with seating clinic OT at ALS clinic visit • Set up of power wheelchair trial in hospital setting • Follow up in home with CCAC OT and Seating clinic OT present • CCAC OT followed client in home to address integration of power device into home environment. • ADP application completed by seating clinic OT with corroboration from community OT • Application to ALS society for non-ADP funding completed by community OT.

11. Consultation • Consultative Model • Provide 1-2 visits with client and community therapist. • In community or at hospital clinic • Seating clinic OT completes assessment together with community therapist and with the assistance of the OTA • Community Therapist can also consult with the clinic for the environmental benefits and for use of Support Personnel to complete assessment. • Community therapist implements recommendations • Seating clinic therapist available for future phone consult or one additional visit

12. Case Study - Consultation • Client with history of MS with postural and positioning needs referred to community OT via CCAC • Unable to assess in home due to environmental factors • Assessed in clinic with assistance of OTA for mat assessment and to trial power w/c with power tilt in safe environment • Further assessment of power mobility in home done by community OT

13. Case Study: Collaborative/Consultative • Client with history of ABI and most recent bilateral rotator cuff tears – compromising manual wheelchair and scooter mobility • Referred by CCAC – OT and second referral by Hospital OT from acute short term stay secondary to falls in apartment • Assessed in clinic with assistance of OTA for mat assessment and to trial power w/c with power tilt in safe environment • Collaboration with Out patient OT for further cognitive/perceptual testing and collaboration with CCAC –OT for integration of power mobility into home environment.

14. Joint Partnership-Community Service Provider Issues identified: • Residential group homes • Aging with disability • Complex seating and mobility needs • Inappropriate referrals sent to seating clinic • Increasing wait list times • Inconsistent follow-up of seating/positioning • Need for staff education

15. Joint partnership-community service provider Solution: • Development of joint partnership • Development of OTA and OT role to provide specialized community based seating and positioning intervention

16. Joint partnership-community service provider OTA ROLE • First point of contact with front line staff • Visits homes monthly to provide: • Seating clinic follow-up • Education • Screening • Monitor need for repairs • Initiates referral process • Attends and assists at Seating Clinic appointments

17. Joint partnership-community service provider OT Role • Supervises OTA role • Facilitates educational supports • Identifies and implements educational in-services to front line staff • Collaborates in policy and procedures related to positioning, transfers etc. • Ensures effective communication between OT/OTA, support staff, family and other stakeholders as required

18. Joint partnership-community service provider OUTCOME • Improved quality of life • Improved staff satisfaction • Reduction of care needs • Reduction in staff/transportation costs • Reduction in clinic wait times • Expanded OTA/OT role

19. Conclusions • Changing societal & health care trends necessitate need for innovation in meeting clients’ complex seating and mobility needs. • Capitalize upon skill sets of all health care professionals: • Seating clinic OT • Community OT • Support Personnel • Consider option for community partnerships with health care facilities

20. Future directions • Continual monitoring of changing trends and their impact on complex wheelchair and seating • Establish ongoing Professional networking and support systems • Consider other community partnerships