On a Friday morning in late August, 29 first-year Occupational Therapy (OT) students are getting a lesson in working with adult clients in a home setting.
Divided into teams of three, each team in succession sits around a table opposite a client to determine what assistance is needed to improve the client’s life.
The scenario is not real life, but it is as close to it as possible.
The students are in the simulated home environment in the Center for Healthcare Improvement and Patient Simulation (CHIPS) at the University of Tennessee Health Science Center. The state-of-the-art facility on the Memphis campus is a 45,000-square-foot hub for health care simulation and interprofessional education.
Each floor of the three-story building is dedicated to a different aspect of simulation to train students from all six colleges at UTHSC. In this simulated apartment setting on the first floor, students can practice delivering in-home care. The space includes a kitchen with cabinets that are adjustable for patients who are standing or seated in a wheelchair. The bathroom is Americans with Disabilities Act compliant. A Murphy bed pulls out from one wall, turning the den into a bed-care area.
The intentional design makes the space ideal for helping students learn how to assess patient needs in a home setting and care for patients based on those assessments.
“It’s prepping our learners to be able to do things for home health care,” says Jamie Pitt, assistant director of education for standardized/simulated patients. “We wanted it to look like someone’s home.”
In this training, OT students learn to assess a patient’s needs by interviewing a standardized patient, an actor who is portraying someone with multiple sclerosis.
After learning about multiple sclerosis in a course taught by Stephanie Lancaster, program director and associate professor in the Department of Occupational Therapy, students were provided with background information on the patient and met with Lancaster to prepare for their visit with the patient.
During their interaction with the patient, students used clinical observation to assess the patient’s skills, particularly in relation to challenges often experienced by individuals with a multiple-sclerosis diagnosis. Each simulation is followed by a debriefing and a written reflection on lessons learned.
Occupational therapists “help people become more independent,” explains Lauren Woods, assistant professor and admissions chair in the Department of Occupational Therapy. The home is a natural context for doing that. This could be a personal home, a care home, a rehabilitation facility or a transitional home.
“The places that we would interview people would be a common area like a dining room, kitchen area, something like that, because we won’t necessarily go in their rooms because that can break boundaries,” Woods says. “The home environment in the CHIPS center is perfect because we can make it look just like the transitional homes that we go into and do the interviews, and it allows a way for the students to get that experience.”
Students learn how to do semi-structured interviews with clients, determining their wants, needs, strengths, goals and what they need to work on. Instructors and the staff of CHIPS work together on a script for each simulation so it is as realistic as possible, Woods says.
OT student Emily Morse of Cordova was a member of a group that engaged the standardized patient with a game. As they batted a balloon around, they built rapport with the patient and were able to assess mobility, energy, endurance, mood and other factors that would assist in developing a care plan.
“I like how the simulation gives me an opportunity to practice becoming the occupational therapist I want to become,” Morse says.
“During each term throughout the curriculum in our program, students participate in multiple learning experiences in CHIPS,” Lancaster says. “Each encounter is strategically designed to reinforce aspects of professionalism, communication and clinical skills in order to prepare learners to enter the field of OT.
“Students report a great deal of learning during these encounters and appreciate the opportunity to apply things they are learning in the classroom. The No. 1 places that injuries occur are the bathroom and the kitchen,” Woods says. “So we want to make sure that, when they’re caring for their loved one, that they’re set up for safety in the bathroom, or for bathing purposes they have all the equipment they need for that. And then, if that person is going to be cooking, is that kitchen set up for safety?”
“Those kinds of problem-solving things are really, really important,” Williams says.
Woods added that caregivers must remember their own self-care.
“Caregiver burnout is real,” she says. “Just like when you’re on an airplane and they say put your mask on first, you’ve got to make sure that you’re able to physically help with that person, but also, do you have the coping and mental health to be able to take care of that other person?”
She suggests accessing community services such as transportation, respite care and community centers to help ease caregiver stress and provide an outlet for those receiving care.
The lessons learned and practiced in CHIPS train the health care professionals of tomorrow. However, current practitioners at UTHSC are glad to offer advice that applies to anyone who is being cared for or caring for someone at home.
- Start by having a professional come to your home for an assessment, says Lee Williams, assistant professor in the Department of Occupational Therapy. This is often done by a physical therapist or an occupational therapist with a referral from a physician or care home. Depending on the needs of the patient, the health care professional can identify fall hazards like throw rugs, small pets or extension cords, and make recommendations for equipment, like a tub bench to make bathing easier or a hospital bed or a portable oxygen tank. A professional will also determine if modifications, such as better lighting, a ramp, or smart-home or voice-activated technology are needed.
- Keep important numbers on speed dial or carry your phone on a lanyard around your neck in case of emergency. This will allow for easy and quick access to safety-net numbers when needed.
- A single-floor dwelling is ideal but not always possible. There are modifications that can be done, such as moving a bedroom to the first floor, adjusting bathroom-door thresholds to accommodate a wheelchair or walker, or changing out a glass shower door that could break in a fall for a shower curtain.
- Clear the clutter. Even designated junk rooms can present a challenge for those with restricted mobility. This can be a challenge for seniors who have spent a lifetime accumulating possessions that are meaningful to them. Woods advises decluttering in a way that is empathetic.
- Establish a good communication system with neighbors. Perhaps a designated neighbor checks in at a certain time each week to make sure everything is OK. Also, give someone trusted an extra key to the house in case a fall prevents access to the phone.
- Design an evacuation plan for emergencies so both caregiver and patient can exit safely.
