Occupational therapy interventions for homecare clients in Dublin showed promising results in a pilot study. The interventions focused on improving functional abilities for daily activities. Quantitative measures found significant improvements in self-care and mobility scores after therapy. Qualitatively, clients reported gaining independence with activities like dressing, shopping, and social participation. Homecare hours were reduced for some clients, indicating potential cost savings. Larger studies are still needed, but initial findings suggest occupational therapy can benefit homecare clients' independence and quality of life.

1. Effectiveness of Occupational Therapy
interventions for Homecare clients
Dr Deirdre Connolly & Ms. Carmel Cooney: Discipline of occupational Therapy, Trinity
College Dublin
Ms. Avril Carey, Ms. Sinead Crowe & Ms. Ellen O’Dea: Occupational Therapy, Dublin
South Inner city Primary Care team

2. Trinity College Dublin, The University of Dublin
Background to the study
• Increase in ageing population nationally and internationally
• By 2041, there will be 1.4 million people in the Republic of Ireland
aged 65 and over
• Increased incidence of chronic diseases as people age
• Ageing and presence of chronic diseases result in reduced physical,
mental and cognitive functioning.
Subtitle – Calibri Regular 14pt

3. Trinity College Dublin, The University of Dublin
ADL/IADL difficulties
• 13% had difficulty with ADL
• Most difficulty in dressing and bathing
• 11% difficulty with IADL
• Most difficulty with household chores and grocery shopping
• Over 80 years: 32% difficulty with ADL and 25% difficulty with IADL
• Risk factors for ADL/IADL (after age) were pain, taking five or more
medications and depression
Connolly et al., 2016

4. Trinity College Dublin, The University of Dublin
Homecare support scheme
• Introduced to reduce risk of admission to long term care for older
adults and latterly to assist in hospital discharge to home.
• Reduce the proportion of older adults in institutional care; to provide
a greater quality of life for older adults living at home
• Intended for people with medium to high care support needs
• Budgets range from €55m in 2007 to €120m in 2008
• Administered by HSE through local health offices
• Funding reduced and ceased on several occasions over the past 8
years.

5. Trinity College Dublin, The University of Dublin
Homecare support scheme
• Support needs are assessed through a care needs assessment
carried out by Public Health Nurses.
• Provides a range of services but most frequently provides personal
care assistance and home help.
• Initially provided a sum of money for the person to employ their
carer, now carers are provided through nominated private home help
companies.

6. Trinity College Dublin, The University of Dublin
Occupational Therapy Intervention
• Funding obtained for one-year pilot project of home-based
occupational therapy in Dublin-South inner city area
• Occupational therapy aims to improve functional abilities in self-
care, productive and/or leisure-based activities that people want
to, or need to, do over the course of their day.

7. Trinity College Dublin, The University of Dublin
Study aims
• To explore the impact of a dedicated home-based occupational
therapy service on:
• functional abilities of older adults in receipt of HCP
• On allocation of HCP hours
• To explore perceptions of those receiving the service, their families
and other stakeholders involved in the delivery of HCP, on their
perspectives of a home-based occupational therapy service

8. Trinity College Dublin, The University of Dublin
Study methodology
• Mixed methods exploratory study
• Sample:
• 15 people receiving home care services
• Family members
• HCP coordinator
• HCP occupational therapist
• University ethical approval

9. Trinity College Dublin, The University of Dublin
Study measures
• Quantitative
• FIM+FAM (Functional Independence Measure + Functional Assessment
Measure) (Keith, Granger, Hamilton, & Sherwin, 1987)
• Montreal Cognitive Assessment (MoCA) (Nasreddine et al., 2005)
• Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983)
• EQ-5D (Euroqol) (EuroQol-Group, 1990) Health-related quality of life
• Goal Attainment Scale (GAS) (Kiresuk & Sherman, 1968)
• Qualitative interviews with all stakeholders
• Chart audit of nature and duration of occupational therapy interventions.

10. Trinity College Dublin, The University of Dublin
Inclusion/exclusion criteria
Inclusion Criteria Exclusion Criteria
 Over 65
 Recently allocated a home care package
 Have rehabilitation potential as confirmed
by chart review and/or discussion with
primary care team members
 Significant cognitive impairment as
measured by the MoCA: a score < 10/30
 Visual impairment impacting on ADL
safety
 Chronic respiratory issues that are
impacting on ADL participation
 Palliative condition: cancer, COPD, CCF,
renal failure.
 Home care package recently increased or
decreased in the past 3-6 months

11. Trinity College Dublin, The University of Dublin
Participants’ profile
Characteristics Participants (N= 15)
Mean Age: 86 (range 82-91 years) Females 14; Males 1
Marital status
- Single
- Widow
4
11
Living situation
- Alone
- With family
14
1
Education Status
- Attended University
- Attended secondary school
4
11
Median no. of homecare hours pre intervention
(range)
5 (2.5 - 12)
Median no. of health conditions (range) 3 (2-6)
Median no. of medications (range) 8 (5-19)

12. Trinity College Dublin, The University of Dublin
Interventions
Type of goal No. of participants Total no. of goals set per category
Bathing practice 9 13
Use of Equipment 8 19
Meal Preparation 8 11
Transfer practice 7 11
Community mobility 7 8
Community involvement 6 7
Dressing practice 5 8
Fall prevention education 5 5
Self-advocacy 4 5
Memory strategies 4 5
Stair Mobility 4 4
Pressure Care 3 3

13. Trinity College Dublin, The University of Dublin
Functional Independence measure scoresFIM+FAM Item
(Max. Score)
Time 1
Median
(Range)
Time 2
Median
(Range)
Time 3
Median
(Range)
Change
Time1/2
(Sig.)
Change
Time 2/3
(Sig.)
Change
Time 1/3
(Sig.)
Self-Care
(49)
41
(35-48)
45
(33-48)
43
(33-48)
+3
(0.015)
-2
(0.234)
+2
(0.44)
Bladder/bowel (14) 13
(6-14)
13
(7-14)
13
(7-14)
0
(0.713)
0
(0.196)
0
(0.313)
Mobility
(49)
33
(27-45)
40
(27-45)
38
(24-46)
+7
(0.007)
-2
(0.228)
+5
(0.462)
Communication (35) 34
(28-35)
34
(28-35)
33
(27-35)
0
(0.317)
-1
(0.005)
-1
(0.003)
Psychosocial
(25)
26
(21-28)
26
(21-28)
27
(21-28)
0
(0.336)
+1
(0.084)
+1
(0.105)
Cognition (35)
32
(16-35)
32
(16-35)
33
(16-35)
0
(1.0)
+1
(0.438)
+1
(0.677)

14. Trinity College Dublin, The University of Dublin
Improved FIM scores
“The bar on the bed to help me to get out and to hold on to, that was the
best thing”
“I eased off my daughter doing the shopping, I started doing the shopping
myself”.
“I started going walking down the garden when I got my grab rail”
“My mother announced to me one day that she went down to a centre to
play bridge, so she must have heard about that from the OT”.

15. Trinity College Dublin, The University of Dublin
Changes in MoCA cognitive categories
MoCA Normal Mild Moderate
Time one 1 12 2
Time two 4 8 3
Time three 4 7 3

16. Trinity College Dublin, The University of Dublin
Anxiety and depression scores (HADS)
HADS
scores
N=15
Time 1
Median
Range
Time 2
Median
Range
Time 3
Median
Range
Time 1 /
Time 2
P value
Time 2 /
Time 3
P value
Time 1 /
Time 3
P value
HADS
Anxiety
5
(0-8)
3
(0-10)
3
(0-9)
0.858 0.503 0.069
HADS
Depression
6
(3-10)
6
(2-13)
5
(1-11)
0.951 0.501 0.874
“I suppose its because I don’t regard myself as an invalid anymore”.

17. Trinity College Dublin, The University of Dublin
Health-related Quality of Life
EQ-VAS
scores
N=15
Time 1
Median
(Range)
Time 2
Median
(Range)
Time 3
Median
(Range)
Time 1 /
Time 2
P value
Time 2 /
Time 3
P value
Time 1 /
Time 3
P value
EQ-VAS 70
(0-100)
80
(60-100)
70
(40-100)
0.05 0.02 0.92
“They went out on a day trip one day.. she really got a buzz out of it ..so it was
like a little outing. The O.T. went on that trip with her and they got on and off the
bus, and after that my mother felt that she was well capable of doing it. It was
about giving my mother back her confidence.”
(Family member)

18. Trinity College Dublin, The University of Dublin
Difference between under and over 85 year olds FIM scores
FIM+FAM
scores
Time 1 /2 Time 2/3 Time 1/3
85 and under
Mean change
Sig. (p value)
183/192
+9
p=0.03
192/187
-5
p=0.176
183/187
+4
p=0.344
86 and over
Mean change
Sig. (p value)
173/176
+3
p=0.553
176/174
-2
p=0.325
173/174
+1
p=0.726

19. Trinity College Dublin, The University of Dublin
Health-related Quality of Life: under and
over 85 years
EQ-VAS scores Time 1 /2 Time 2/3 Time 1/3
85 and under
Change
Sig. (p value)
58.6/80
+21.4
0.038
80/61.5
-18.5
0.042
58.5/61.5
+3
0.58
86 and over
Mean change
Sig. (p value)
72.5/80
+7.5
0.50
80/73.75
-6.25
0.24
72.5/73.75
+1.25
0.87

20. Trinity College Dublin, The University of Dublin
Changes in Homecare hours
Participant Care hours (per week)
before intervention
Care hours (per week)
post intervention
Reduction in care hours
(per week)
1 3 1 -2
2 4 2 -2
3 3.5 3.5 0
4 7 3.5 -3.5
5 9.5 7 -2.5
6 7.5 7.5 0
7 7 4 -3
8 12 8.5 -3.5
9 4 4 0
10 8.5 7 -1.5
11 3 2 -1
12 10.5 10.5 0
13 2.5 2.5 0
14 4.5 4.5 0
15 5 5 0
Total 91.5 73.5 19 (p=0.012)

21. Trinity College Dublin, The University of Dublin
Reactions to reduced hours
P1: “I suppose you have to go and do it yourself, you have to clear up after
your breakfast, whereas the carer would have done it. It was put upon me
to do it and I did it. And got into it. I wasn’t complaining. ..you had to get
out of that sick mode you were in and get on with it. My daughters are
delighted with the way I have recovered.”
FM10: “I think The O.T. arrived on the basis of “lets have a good look at
what the system is doing and see if we can tweek it” specific to my mother.
My understanding was that OT intervention aimed to give my mother her
life back before the fall and as quickly as possible, and to do it in an
organised way and that we sit down and talk to her and say “what is it that
you would you like the carers to do? Would you like them to put your to
bed or not put you to bed?”. In the end, for me it was about her getting to
the point where she didn’t need the carers”.

22. Trinity College Dublin, The University of Dublin
Costs of occupational therapy interventions
Costs
OT Salary € 50,134.00
Equipment provision € 3,757.59
Reduction in homecare
hours
- € 22,742.00
Total cost of OT service: €31,149.59

23. Trinity College Dublin, The University of Dublin
Conclusions and implications
• Significant changes in self-care activities and mobility – identified as areas of highest
difficulty for Irish older adults
• Improved mood and quality of life: risk factors for functional decline
• Those under 85 years made more statistically significant gains than those over 85-years
• Significant gains not maintained at 3 month follow up assessment – indicates a need for
‘top-up’ interventions
• Rehabilitation is rated as a low priority for primary care teams – pressured with higher
ranked priorities
• Intensive occupational therapy intervention reduced HCP hours: Eighteen hours reduced
for eight participants = €22,742.00
• Need a larger study with a comparison group to validate these findings

24. Thank You