Aging in Place
SnapshotAging in place means having the health and social support and services you need to live safely and independently in home or your community for as long as you wish. (Social Development Canada, 2016)
Occupational therapists (OTs) work with seniors to facilitate aging in place by assessing their engagement in everyday activities in their homes and communities. OTs help seniors stay at home for longer periods of time by adapting their home environment to optimize functioning and independence (Lantz & Fenn 2017) and by providing needed supports through home modifications and assistive devices to make homes accessible for a wide variety of increasingly complex needs. (Muir, 2012).
According to the results of the 2016 census, Canada is home to 5.9 million seniors (Statistics Canada, 2016). Over 85% of aging seniors would prefer to “age in place” in their homes and communities, however many homes and communities lack the structural features and support services to make this a safe, realistic option (Lantz & Fenn 2017). The increasing prevalence of chronic conditions, and the ensuing cognitive decline, pain, injury risk and caregiver burnout may also precipitate a move to residential care, if homes do not have the needed supports. OTs, through their interventions, address these barriers to participation in everyday activities (Muir, 2012) that may prevent seniors from aging in place. The Government of Canada has made aging in place a priority by increasing funding to home and community care, with a $6B investment in home and palliative care announced in Budget 2017, and by appointing a federal Minister for Seniors. The Government has also introduced legislation that sets the framework for a barrier-free Canada, which includes meeting the accessibility challenges in physical environments. Accessing OTs for home and community care as part of primary care teams is both cost-effective and evidence-based, and supports the autonomy, dignity, and quality-of-life of Canada’s seniors.
Facts on Falls:
Home modifications or renovations may be necessary to enable seniors to stay in their current homes. OTs have a unique understanding of how individuals function in their living environment and can collaborate with design/renovation professionals to ensure seniors’ needs and preferences are met in the process. Home modifications or renovations can be permanent structural changes, or more temporary alterations to the environment to enable safety, such as:
- Level-access showers
- Stair lifts
Adaptations and devices
OTs can recommend adaptations and assistive devices that can assist seniors to safely age in place. Additionally, and unique to occupational therapy, aging in place means clients can both remain independent in their own home and receive help in overcoming barriers to participation in socializing activities like visiting with friends and family in their home and community.
OTs can assess an individual’s mobility and home environment to determine if a mobility device could help them to navigate their homes more safely. Examples of commonly recommended mobility devices include:
- manual wheelchairs
- power wheelchairs
- CAOT hosted a Professional Issue Forum (PIF) entitled ‘Aging in Place: Working Together to Bridge the Gap” at CAOT Conference 2019.
- CAOT presented and attended a booth at the Family Medicine Forum (FMF) in Toronto and met with family physicians across Canada to discuss the value of having an OT on inter-professional care teams, including allowing seniors to age in place.
- The Canadian Association of Occupational Therapists (CAOT) submitted a written brief to the Standing Committee Standing on Human Resources, Skills and Social Development and the Status of Persons with Disabilities (HUMA) in response to its study of Bill C-81, an Act to ensure a barrier-free Canada, with the recommendation that the Government of Canada support the role of occupational therapists in making built environments accessible and barrier-free.
- CAOT is developing a revised Position Statement on Aging in Place in collaboration with experts and is developing a Professional Issue Forum (PIF) on Aging in Place that will take place at CAOT’s 2019 Conference in Niagara Falls.
- CAOT issued a congratulatory and introductory meeting invitation to federal Minister for Seniors, the Hon. Filomena Tassi. The inclusion of a dedicated cabinet role for seniors is a win for many organizations, including CAOT, who advocate on behalf of seniors. CAOT also wrote a congratulatory letter to the Minister of Public Services and Procurement and Accessibility, the Hon. Carla Qualtrough, who was appointed to oversee the additional portfolio of Accessibility.
- CAOT participated in the Health Canada consultations pursuant to the passage of the CAOT-supported legislation, “ An Act providing for the development of a framework on palliative care in Canada”, CAOT advocated for the framework to include OTs on inter-disciplinary health care teams that provide end-of-life care, particularly as the majority of Canadians wish to die in their homes. The Framework on Palliative Care in Canada is set to be tabled in Parliament in December 2018.
- CAOT attended the Age-friendly societies forum: “Towards a world adapted for older adults: Maintaining Quality of Life” hosted by the LIFE Research Institute and the International Longevity Centre Canada. This event brought together leaders from academia, policy, business and civil society to inform a blueprint for an age-friendly society. CAOT participated in discussions to ensure an OT perspective was reflected in draft action plans for age-friendly approaches to health care, homes, retail and travel.
- Former CAOT President and Executive Director appeared before the Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities on their study “ Advancing Inclusion and Quality of Life for Seniors” and recommended that as part of the $5B in federal transfers to provinces for home care, that provinces be mandated to ensure that occupational therapists are an integral part of all primary care teams and home and community care service teams that provide services to seniors.
- CAOT co-hosted the first-ever Canadian National Driver Rehabilitation Conference in 2017, convening driver rehabilitation and transportation specialists – educators, innovators, clinicians, researchers and equipment manufacturers - to advance knowledge and skills in driving assessment and rehabilitation in support of seniors and those with disabilities.
- CAOT exchanged information, offered assistance and strategized with Members of Parliament involved in supporting the health and well-being of Canadian seniors.
- CAOT was asked to participate on the Canadian Home Builders Association (CHBA) Home Modification Council – the only health organization asked to participate- and CHBA committed to connecting OTs with renovators and their customers, underlining the important role OTs play in ensuring that appropriate renovations are specified.
- CAOT has signed on to the “Demand a Plan” alliance of over 50 organizations, calling on the government to develop a National Seniors Strategy by 2019.
- CAOT continues to work with coalitions such as Organizations for Health Action (HEAL) to advance the OT perspective on seniors’ issues.
- CAOT contributed to the “Home & Vehicle Modification Guide.”CAOT developed CarFit which offers older adults the opportunity to check how well their personal vehicles "fit" them. Older drivers can improve their safety and the safety of others by ensuring their cars are properly adjusted for them. OTs are also trained on how to address driving retirement by advising on alternate transportation plans.
- To support a greater number of Canadian seniors to age in place through OT interventions.
- To advocate for the inclusion of OTs on primary care and inter-disciplinary teams in order to make recommendations focused on occupation that allows seniors to age in place.
- Promote occupational therapy as a core and essential service for seniors looking to age in place in their homes and communities.
- Collaborate inter-professionally and with non-traditional partners such as contractors, architects, home design and car retrofit professionals to further the reach of occupational therapy solutions for aging in place.
- Develop educational resources and training to ensure that enough OTs are ready for the demands of the workplace as it evolves to support seniors aging in place.
Occupational therapy value proposition
- A May 2017 report entitled “Re-Shaping the Housing Market for Aging in Place ” by the Canadian Home Builders Association cites the value proposition of OTs in home modifications that facilitate aging in place compared to the high cost of residential or hospital care. According to Home Modification Canada, the cost of including 75% of the required accessibility features in new homes costs less than $500 per home.
- Housing adaptations reduce the need for daily visits and reduce or remove costs for home care (savings range from $2,000 to $ 50,000 a year) (Heywood et al, 2007)
- Postponing entry into residential care by just one year through adapting peoples home saves $48,000 per person (Laing and Buisson, 2008).
- A year- long study (2016) undertaken by the Wales College of Occupational Therapists, found that using occupational therapists’ services resulted in avoidance of unnecessary hospital admission and/or reducing hospital stay. Savings were in the order of 15, 000 bed days.
- A recent study by John Hopkins University identified that occupational therapy was the only category of health spending within hospitals where increased spending resulted in reduces re-admission rates (Rogers et al., 2016). Study results link these lower readmission rates to the occupational therapy focus on assessing whether a client can be discharged safely and addressing potential barriers in the home and community environment. Through focusing on client factors outside of the hospital, including living situation, home accessibility and social supports, OTs are well-positioned to address risk factors for readmission.
- The Royal College of Occupational Therapists (2016) (United Kingdom) estimated that OTs’ services resulted in avoidance of unnecessary hospital admission and/or reduced hospital stays, saving an average of $15 M annually. OTs who see individuals in hospital commonly refer them for occupational therapy services within the community, so that an OT who has the capacity to visit the individual in their home can assess their safety and needs within the home.