bathing - necessity, choice or wellbeing

Bathing – Necessity, choice, or well-being

Rachel Russell MSc, BSc Occupation Therapy

Session learning outcomes

• Explain how previous health and social care legislation influenced the practice of occupational therapy in statutory services

• Describe the difference between bathing as an activity and bathing as an occupation

• Argue how the theory of occupation-focused practice aligns with the spirit of the Well-being Principles underpinning the Care Act

• Identify how occupation-focused practice help us to explain the difficulties an individual maybe having with bathing

• Defend how occupation-focused practice around issues of bathing delivers better outcomes when compared to previous ways of practicing

What you’ll get out of the next 30 minutes

Care Act facts

National Assistance Act 1948Health Services and Public Health Act 1968Local Authority Social Services Act 1970Chronically Sick and Disabled Persons Act 1970Health and Social Services and Social Security Adjudications Act 1983Disabled Persons (Services, Consultation and Representation) Act 1986National Health Service and Community Care Act 1990Carers (Recognition and Services) Act 1995 Carers and Disabled Children Act 2000Health and Social Care Act 2001Community Care (Delayed Discharges etc.) Act 2003Carers (Equal Opportunities) Act 2004Approvals and directions under S.21(1) NAA 1948 (LAC (93)10)National Assistance (Assessment of Resources) Regulations 1992National Assistance Act 1948 (Choice of Accommodation) Directions 1992National Assistance (Residential Accommodation) (Relevant Contributions) Regulations 2001National Assistance (Residential Accommodation) (Additional Payments and Assessment of Resources) Regulations 2001Delayed Discharges (Mental Health Care) (England) Order 2003Delayed Discharges (England) Regulations 2003National Assistance (Sums for Personal Requirements) Regulations 2003Community Care (Delayed Discharges etc.) Act (Qualifying Services) Regulations 2003Community Care Assessment Directions 2004Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulations 2009NHS Continuing Healthcare (Responsibilities) Directions 2009Ordinary Residence Disputes (National Assistance Act 1948) Directions 2010

The biggest “shake up” in Adult Social Care law in the last 60 years

Impact on practice

What it means for OT

Previous legislation and it’s impact on Practice

Impact on practice

The Care Act and it’s potential impact on Practice

Impact on practice

Comparing the Care Act Principles with the definition of Occupational Therapy

How the Care Act supports OT Practice

How the Care Act supports OT Practice

Definition of Occupation

“Occupational therapy is… concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people…to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. WFOT (2012)

9 Principles of well-being from the Care Act

• Personal dignity• Physical and mental health and emotion well-

being• Protection from abuse• Control by the individual over day-to-day life• Participation in work, education, training, or

recreation• Social and economic well-being• Domestic, family and personal relationship• Suitability of living accommodation• The individual’s contribution to society

Applying it to bathing

Pre-Care Act and how we were asked to assess bathing

Personal Care Task

Essential

Appropriate

Reducing Risk

Medical need to bath

Necessary

Safety

Transfers

Applying it to bathing

The Care Act and how we are now asked to assess bathing

Dignity

Development

Play Choice and control

Needs of the family

Activity of daily living

Carer needs

Safety

Transfers

Rest and Replenishment

No Extra Funding…

The challenges of applying what we do to the Care Act

The challenges of applying occupation focused practice to the Care Act

The challenges of applying what we do to the Care Act

…so we need to be able to have skilled conversations with:

• Service Users

• Those who commission services

The challenges of applying what we do to the Care Act

…our OT theory and models of practice can help us to have these conversations….

A quick reminder of what we do!

A quick reminder of the theory behind what we do!

Disablement Process

Persons needs cannot be met by the home environment

Home Modification- Aids to Daily Living- Housing Adaptations- Home Care- Assistive Technology- Re-ablement

Functional Restoration- Medication- Neural Repair- Rehabilitation- Re-ablement

EnablementProcess

Adapted from Brandt and Pope 1997

We improve health and well-being by using assistive technology, design and construction methods to improve, restore, attain, or maintain occupational performance skills.

The challenges of applying what we do to the Care Act

….and using occupation focused assessment tools and outcome measures will help us justify what we are recommending….

The challenges of applying what we do to the Care Act

….which then helps us to generate the evidence base to demonstrate the cost effectiveness of what we do to those who commission or purchase our services

The challenges of applying what we do to the Care Act

….an evidence base we, sadly, currently lack!

CPD Opportunties

CPD Opportunity to explore Occupation-Focused Practice

Mangar Int. and the OT Service

Bathing – overview of the skills and knowledge occupational therapists require when prescribing bathing equipment

Falls – overview of the skills and knowledge occupational therapists require to understand the role of floor recovery equipment for individuals who fall

Session learning outcomes

• Explain how previous health and social care legislation influenced the practice of occupational therapy in statutory services

• Describe the difference between bathing as an activity and bathing as an occupation

• Argue how the theory of occupation-focused practice aligns with the spirit of the Well-being Principles underpinning the Care Act

• Defend how occupation-focused practice around issues of bathing delivers better outcomes when compared to previous ways of practicing

So, hopefully you can now

Thank you