SERVICES PROVIDED BY OCCUPATIONAL THERAPISTS IN A

DAY CARE CENTRE FOR THE ELDERLY

SARA SHEIKHOT STUDENT

DOW UNIVERSITY OF HEALTH SCIENCES

WHAT IS A DAY CARE FOR ELDERLY?

A facility for the supervised care of older adults, providing activities such as meals and socialization one or more days a week during specified daytime hours. The participants, primarily persons with physical and/or mental limitations who need socialization, physical assistance, and/or psychological assistance, return to their homes each evening. The program is often used as respite by family members caring for an older person who cannot be left alone safely in the home.

WHAT AN OT CAN DO IN THIS SETUP?The main goal of setting a day care for elderly is to motivate them to move

out of their possible isolated, depressed state, therefore an Occupational therapist can:

• Set the daily routine and strategies• Engage the elders in activities of their interests in a friendly and co-

operative environment• Evaluate them and make engagement plans for each individual• Socialize them by making them do work in groups• Talk, talk, and listen, listen, listen to them• Counsel them in order to reduce their depression• Make adaptations in equipments used by the elders according to their

needs.• Help and teach them to get through their routine at the day care and usage

of possibly new equipments (adapted).

Can also assign Home ProgramAn Occupational therapist can guide an elder through:• Transfer techniques in case of wheel chair bounds• One bowl method, Work-Rest-Work rule• Energy conservation techniques (correct posture, doing jobs sitting, using

both hands, slow movements etc.)• Instructions to maintain weight, avoiding strenous work or exercises, or to

use a mask when on road or near someone smoking, esp. to cardiac, hypersensitive and patients with respiratory prob.

• Teach an elder with memory or orientation problems to keep a diary, or cues (tying a knot on a finger) to remember important tasks. A card having his name and address should be placed in one of his pockets. Family can also be instructed on that.

• If the elders agree, adaptive equipments or slight modifications in the home should be made.

• Those with incontinence problems should be taught to take care of catheters/diapers. Those having constipation should be instructed to drink more water

OVERVIEW OF ROUTINE ACTIVITIES TASK TIME/SETTINGBREAKFAST Preferably in group; Greetings offered

TALK/DISCUSSION From newspaper or last night news on TV; Quizzes

LIGHT EXERCISES Refreshing ( ½ hour max.)

CONSTRUCTIVE WORK According to individual interests ( 2-2 ½ hours); Rest periods will be allowed

LUNCH Preferably in group; Light talking

REST PERIOD ½ hour- 45 mins.

SPARE TIME Watching TV; Group Sessions; Individual Counseling etc.

TEA Plans for next day, etc.

Monitoring Medicine schedule, Vital signs and Sugar level are also routine tasks.

BREAKFAST SERVICESA large table with chairs around it should be placedin a spacious room so that elders may become socialby meeting other elders. But, in case any elder wants to have breakfast alone, either out of first visit shyness or any other reason, a separate breakfast table, or a separate cubicle should also be provided in the setup. But this habit should be broken up as soon as possible. Greetings should be offered to each other and sharing (passing the marmalade, talking about the taste of minced meat etc) should be encouraged.

TALK/DISCUSSIONDiscussion on news from the morning newspaper or last night TV program can be carried out. It should be short, for instance 20-25 mins. Orientation and memory can also be checked in it by asking the current date, day, or asking how the people liked the breakfast (asking names of things they ate) etc. If hints are required, a calendar, a wall clock should be present. A digital clock can also be given to the person to set the correct date so they remember it.

LIGHT EXERCISES

Exercises as “up, down”, trunk rotation and gross arm and leg movements may serve as warm up exercises and prepare the elders to deal with the whole day in the day care.

Care should be taken to keep the exercises light, as vigorous exercises will result in fatigue and idleness.

CONSTRUCTIVE WORKAll elders will be given activities acc.

to their interest and abilities which will help them feel useful and involved. Males can be given some light mechanical work and females can be given straw to make baskets. Gardening, canvas painting, playing music are some options. They can even help in preparation of lunch by cutting vegetables and meat, or choosing or setting crockery. Equipments (brushes, knives, flutes, saws etc) should be adapted acc. to patients’ needs and problems.

Short rest periods are necessary during work time, so the elders may not get fatigued very

early and will start work anew, willingly.

LUNCH

An appetizing lunch should be served to them on the same breakfast table, the therapist talking and asking them about the day and other light subjects. The elders who helped in preparing lunch should be praised accordingly.

REST PERIOD

Beds and couches should be available as elders need more rest than young adults. Warm quilts should also be provided as old people feel cold.

Moreover, dressing tables with combs, puffs etc should be provided. Care should be taken to adapt these equipments with long handles or adjusted angles.

SPARE TIMEWATCHING TV/VIDEOS:

A television and a multimedia with computer should be present in a large space where everybody will cluster about and watch programs, presentations or videos together and discuss them later. Elders should be encouraged to bring movies of their memorable moments to share with others

SPARE TIME

COUNSELLING SESSIONS:Short counseling sessions may

be carried out with/without psychologist to improve the self-esteem and sense of involvement and reduce depression, aggression and negative behaviors and thoughts.

Breakfast table shyness, lack of interest in discussions or work can be addressed.

SPARE TIMEMEDITATION/IMAGERY:

These are necessary to refresh the elder minds and will help us achieve our ultimate goal. These sessions maybe fitted in with the time table thrice a week.

Light music, pleasant sounds (birds chirping, stream running etc), or the therapist’s low, calm voice can be used as imagination stimulating aids.

SPARE TIME

GROUP SESSIONS:An occupational therapist can

assemble elders suffering from a same ailment or elders belonging to similar age group (60s, for instance) and give them counseling, or activities requiring co-operation of the whole group.

TEA

Tea time should be a fun time for the elders, as they will soon be leaving for their homes. Feedbacks maybe taken and plans for the next visit maybe discussed.

MEDICINES/VITAL SIGNSEvery elder/family should be asked,

on admission, for a list of necessary medicines, their quantities and the schedule of using them. The therapists (in case no nurse is present) will be then responsible to ensure that every elder is getting medicines on time.

Regular BP, pulse rate, sugar level should be noted for each elder, especially for those with hypertension, cardiac or respiratory problems and diabetes. BP apparatus, Glucometer, Thermometer should be available.

EXTRA SERVICES AN OT CAN PROVIDE

BATHROOM/BED ADAPTATIONS:

• Can make use of non-slip mats, hand railings, raised toilet/bath seats etc in washrooms.

• Can adapt the height of bed, attach railings on either side, or even place a side table.

EXTRA SERVICES AN OT CAN PROVIDE

OUTINGS/FIELD TRIPS:• Taking a group or an

individual for a walk in the park

• Arranging a trip to a famous place, historical relic or even a cozy restaurant or tea house

EXTRA SERVICES AN OT CAN PROVIDE

EXHIBITIONS:An occupational therapist can

organize exhibitions of the objects made by the elders. The elders maybe motivated to deal with the visitors so that they may be socialized and feel contented.