Intermittent Care for Physical, Cognitive, and Emotional Needs

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Provide specialized care addressing physical, cognitive, and emotional needs in an intermittent manner. Jennifer Berg-Carnegie, OT Reg. (Ont.), outlines strategies effective in managing these areas for improved overall well-being. This approach supports individuals in achieving optimal functionality and quality of life.

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FORM1: INTERMITTENT CARE FOR PHYSICAL, COGNITIVE AND EMOTIONAL NEEDS Jennifer Berg-Carnegie, OT Reg. (Ont.) March 1, 2023

Presenter Disclosure Conflict Disclosed Name of Speaker: Jennifer Berg-Carnegie, OT Reg. (Ont.) I am disclosing a conflict of interest. I, Jennifer Berg-Carnegie, am the co-owner of Invisible-Care. Inc. www.invisiblecare.ca

Intermittent care Attendant care is not static, and clients needs ebb and flow through out the day and thus pre-set care is not possible to meet all needs. Invisible-Care provides intermittent care to your clients, which is both scheduled at predictable times and provided as needed to meet arising client needs. For example, medication reminders may be anticipated at regular intervals throughout the day, whereas emotional support for coping or cognitive support for planning an action appropriately can occur unpredictably, for various durations, and sometimes through repeated contacts to follow up. www.invisiblecare.ca

Support that adapts to clients Accordingly, interactions may be: one-offs repeated prompts to elicit client responses lengthier dialogues to problem-solve more intensive support such as a telephone/video call or escalation of issues to a treating team. www.invisiblecare.ca

Form 1 and intermittent care Given the variability in how client needs may present, it is important to recognize the role of appropriate time allocations on the Form 1 based on your client s possible needs. When considering intermittent care for your clients including fostering trusting and reliable relationships for those requiring emotional supports, providing comfort measures in times of stress, and facilitating improved function through close monitoring and follow-ups, your Form 1 will directly support or limit the supports we can justifiably provide. www.invisiblecare.ca

OSOT Practice Resource The OSOT Practice Resource was initially researched and developed by a Task Force of experienced Occupational Therapists in 2009 and was last updated in 2014. Although the industry has changed in the last 9 years with the evolution of technology and expansive mental health supports, this resource continues to serve as a valuable tool for practicing occupational therapists in Ontario highlighting important aspects of attendant care needs that require consideration when completing a Form 1. www.invisiblecare.ca

OSOT Resource for intermittent care The OSOT resource highlights that remote cueing and prompting may be beneficial for individuals: Who may have difficulty remembering to complete tasks Who may require assistance with task completion due to cognitive or physical limitations To increase the individual's independence To increase individuals ability to perform ADLs To increase individuals safety by reducing the risk of falls or other accidents www.invisiblecare.ca

Special considerations while completing an Assessment Of Attendant Care (Form 1) Indirect methods may include the client s contact to their attendant via such communication aids as phone contact, Blackberry contact, personal emergency monitoring service/delivery, etc. (page 17) Whether single cues or repeated cues are needed, and whether the cue may be scheduled or will likely be unpredictable (page 17) Pre-existing or concurrent conditions that will affect client response to support, any psychosocial, cognitive or behavioral issues that will impact support needs (page 10) www.invisiblecare.ca

Remote cueing Remote cueing involves providing verbal or visual cues to the individual to remind them to complete a task or to assist them in completing a task from a distance. This can be done through the use of devices such as cell phones, intercom systems, or other technology. www.invisiblecare.ca

Remote prompting Form 1 tasks Prompt examples Feeding Good afternoon, John, remember you need to eat one fruit today. Your mom has packed an apple in your lunch bag. Please text back OK once you have your apple. Remote prompting is similar to remote cueing, but involves a more direct involvement of the therapist, such as the therapist being on the Medication Video call: To watch client take medication phone or video call with the individual to assist with the task. Maintenance of supplies Good morning, John your walker rental needs to be renewed today. Please text Ok when you have called Shoppers Home Health. www.invisiblecare.ca

IC Supports Activities of Daily Living Activities of daily living (ADL) the essential tasks that individuals need to perform, on a regular basis, to sustain basic survival and well-being. Invisible Care focuses on providing support that promotes meaningful activities and is purpose driven for everyone. What is meaningful activity to one individual might not be for another. No two people are alike! Invisible-Care appreciates that difference and takes individuals as a whole into consideration including their personalities, likes or dislikes, age, culture, functional tolerance, social supports, and environmental factors. www.invisiblecare.ca

Human Care Paired with Technology www.invisiblecare.ca

Occupational Therapy Assessment Occupational Therapy assessment of client needs will often be articulated in the written report that accompanies their Form 1. When client needs are identified and described in terms of the considerations in the previous slides, it goes a very long way in getting clients the funding they require to access meaningful and goal-oriented supports. Addressing the cognitive and emotional needs of clients in the OT assessment can substantiate the level and hours of support needed. www.invisiblecare.ca

Form 1 recommendations Part 1 Level 1 Attendant Care Recommendation & Reasoning Feeding Jane Doe requires daily prompting to eat breakfast, lunch, and dinner. vs. Jane Doe has impaired recall, problem-solving, and planning abilities that affect her abilities to recall when to eat, select a meal based on food options available to her at home, and organize the steps required to complete a multi-step meal. www.invisiblecare.ca

Form 1 recommendations Part 2 Level 2 Attendant Care Recommendation & Reasoning Hygiene Jane Doe experiences low mood and negative thoughts. Assistance for providing comfort, safety, and security is recommended for Jane who lives alone vs. Ensures comfort, safety, and security in this environment Jane Doe lives alone and has an absence of social support to check-in on her. Her low mood, tendency to feel judged or criticized, and attempts to preserve her self-image significantly impair her ability to reach out to her son when feeling anxious. Assessment findings and collateral interview indicate that her mood spirals negatively without intervention. She benefits from regular check-ins to reassure her of support availability as well as on-demand intervention to break the cycle of negative thoughts that she cannot manage on her own. Historically, Jane has required high levels of daily intervention followed by short periods of periodic stability. www.invisiblecare.ca

Form 1 recommendations Part 2 Level 2 Attendant Care Recommendation & Reasoning Basic Supervisory Care Jane Doe requires 24-hour basic supervisory care due to safety concerns vs. Jane Doe has cognitive and psycho-emotional impairments per assessment findings. She requires 24-hour basic supervisory care to ensure safety during an emergency situation and to provide custodial care for completion of necessary routines that she previously completed independently and would continue to do had it not been for her injury-related impairments including managing therapy/medical appointment information, initiating her night- time sleep routine, and managing her mood in the presence of stressors. www.invisiblecare.ca

Form 1 recommendations Part 3 Level 3 Attendant Care Recommendation & Reasoning Exercise John Smith has a prescribed physiotherapy exercise program which he must complete daily. Assistance is recommended. vs. John s ability to recall, sequence, and persevere through his prescribed exercise program is affected and limits his completion of required exercises. He requires assistance to plan an appropriate time of day for exercise, initiate his exercise session, and progress from one exercise to the next. As per his treating physiotherapist, he requires assistance to monitor his form as he fatigues. www.invisiblecare.ca

Form 1 recommendations Part 3 Level 3 Attendant Care Recommendation & Reasoning Medication John Smith requires cueing to take prescribed medication and supplements 4 times per day. vs. John takes prescribed medication and supplements 4 times a day, which are blister packaged. Despite the packaging, impairments in attention and memory result in frequently forgetting to take medication, confuse dates, or occasionally over-consume doses. Sleep impairments often lead to missed morning doses and napping affects afternoon doses. At present, John requires frequent and repeated cueing and follow up to adhere to his medication prescriptions. www.invisiblecare.ca

Case Laws Affirming the role of intermittent and indirect care through technology are two court rulings: Shawnoo v. Certas Direct Insurance Co. 2014 ONSC 7014 & Watters v. State Farm (FSCO A13-006328) www.invisiblecare.ca