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Occupational Therapy in Primary Care: An Untapped
Resource
By Georgia de las Pozas, MSOT, OTR/L
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1. Explore the current concept of primary care as an integral component of health promotion and wellness of the older population.
2. Identify possible barriers of incorporating occupational therapy into geriatric primary care in our area.
3. Discuss a model for addressing the concept as well as the challenges of individuals when designing their “Aging in the Right Place Plan”
Learning Objectives
I wear many hats
I am a mother, a daughter, a clinician, a teacher,
a caregiver, and, and, and…..
It has taken me years to get where I am right now
I firmly believe that “The Best is Yet to Come”
A Little About Myself
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It’s Personal For Me
I share the care of my 93-year old mom with my siblings.
It is both challenging and rewarding.
I often find myself at a loss on how to navigate our complex health care system for my loved ones and myself.
It’s quite an adventure!!!
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● I have over 20 years of experience as a licensed occupational therapist
● I teach occupational therapy at Keiser University
● I am a practicing clinician in Miami-Dade● I have been working with older adults and
teaching geriatrics for many years
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Past & Present
● My interest is helping older adults to continue to remain living productive lives
● I established OTCareHelp with that intent● Over time, my mission has expanded to
include forward-thinking younger adults who want to plan for the future
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Looking Forward
How do Occupational Therapy and Primary Care Fit Together?
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“ Primary health care is a whole-of-society approach to health and well-being centered on
the needs and preferences of individuals, families and communities...and focuses on the
comprehensive and interrelated aspects of physical, mental and social health and wellbeing.”
World Health Organization
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Addressing broad health factors
Meeting individual needs
Empowering self-advocacy
Components of Primary Care
Components of Primary Care
1. “Meeting people’s health needsthrough comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course, strategically prioritizing key health care services…”
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Components of Primary Care
2. “Systematically addressing the broader determinants of health(including social, economic, environmental, as well as people’s characteristics and behaviours) through evidence-informed public policies and actions across all sectors…”
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Components of Primary Care
3. “Empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self-carers and care-givers to others.”
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“ Primary care is the provision of integrated, accessiblehealth care services by clinicians who are accountable for addressing a large majority of personal health care needs,
developing a sustained partnership with patients, and practicing in the context of family and community.”
National Academy of Medicine (Formally-Institute of Medicine)
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General Benefits of Primary Care
• Greater access to healthcare
• Better quality of healthcare
• Greater focus on prevention, including but not
limited to early management of health problems
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General Benefits of Primary Care
• An accumulative effect due to practitioners
looking at the individual more than treating a
disease
• Reduction of overuse of unnecessary specialized
and sometimes harmful procedures
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What Makes Primary Care Valuable to the Patient?
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• Accessibility to a variety of immediate healthcare services
• Integration with patients’ families and communities
• Referrals to other healthcare professionals as needed
• A more client-centered approach
• Participation of patients in decision making
• Early detection & disease prevention and health promotion
Primary Care Facilitates:
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Primary Care Providers for Adults
• Physicians
• Family practitioners
• General internists
• General practice
• Geriatricians
• Non-Physicians
• Nurse practitioners
• Physician assistants
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Primary Care Providers Statistics
Projected shortage of primary care physicians from21,000 to 55,200 by 2032
75% of nurse practitioners are in primary care
Physician assistants however, are moving away
from primary care to specialty care
In 2018 the ratio of primary care physicians nationwide is 76 per 100,000 persons , in Florida the ratio is 65 per 100,000
Shortage of Primary Care Providers
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Other Issues Impacting Services Provided by Primary Care Providers
• Primary care physicians spend an average of 16.5 (+/- 9.2)
minutes of face-to-face time with patients
• In a 2018 survey by the Physicians Foundation, doctors
reported an average workload of 20 patients a day
• Almost 25% of their time was taken by non-clinical paperwork20
Primary Care Physicians & Geriatricians
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State of Florida
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What is a Geriatrician?
• They are the best trained physician to treat the
older adult
• In 2017, there were only 7,279 geriatricians in the
US
• The projected shortage of geriatricians
nationwide is 23,000 by 2030
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More About Geriatricians?
• They are among the lowest paid of medical
specialists.
• Possibly, one of the reasons for the low interest
in the field among medical students.
Percentage Shortage of Geriatricians
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Healthcare for the Older Adult
“ No one can avoid aging, but aging productively is something else.”
Katharine Graham
In the US10,000 people turn 65
everyday
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78,000,000Number of boomers by 2030
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Leading Causes of Death in Older Adults
Statistics
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● 6 in 10 adults have one
chronic disease
● 4 in 10 adults have two or
more chronic diseases
● The leading causes of death
from chronic conditions in
the US are heart disease,
cancer & diabetes.
Lifestyle contributing
modifiable factors:
● Tobacco use and
secondhand smoke
● Poor nutrition
● Lack of physical
activity
● Alcohol abuse
More Statistics: Falls
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● Every 20 minutes an older adult dies of a fall.
● 1 in 5 falls cause serious injuries, such as head
trauma or fracture.
● Less than half of Medicare patients report falls.
● More than 3 million adults a year are treated in the
ER for non-fatal injuries.
CDC Fact Sheet: Falls Are a Major Threat for Your Patients
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When healthcare providers target modifiable risky behaviors, there is a better probability to decrease the prevalence of chronic conditions. This is conducive to a better quality of life for the older population.
$ 31 Billion a year
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Annual medical expenses due to falls of older adults
49 Million falls12 Million injuries
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Prediction for 2030
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• One study concluded that their screening protocol to
determine older adults' fall risk identified the most
probable at risk of fall
• However, screening by itself did not prevent falls. Is
not until implementing a Fall Plan of Care (FPOC) that
falls were actually reduced
A CDC Initiative: Stopping Elderly Deaths, and Injuries (STEADI)
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How Does Occupational Therapy Fit In?
Occupational Therapy: Becoming Part of the Primary Care Solution
What is Occupational Therapy?
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Participate
in everyday
meaningful
life activities
“Occupation” isNOT:
● Your profession● Your job● About your work or your
position● Just for “workers”
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“Occupation” IS:
• The every-day activities that we do at any stage in our life• They can be self-care, care of others, care of our
home
• The things we do that have meaning to us, a purpose, and are important to us• They can be learning, working, loving, having fun,
going to church, making friends, resting and sleeping, participating in the community
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• Occupational therapy is not about your workor your position, but it can help you do your work better and safer
• Occupational therapy is not just for “workers”, it can be for anyone
Occupation is everything we do!
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Occupational Therapy IS:
About Occupational Therapy?
OT “...is the only profession that helps people…do the things they want and need to do…” (AOTA). It helps by facilitating people to participate in the actual DOING.
“...OT Practitioners enable people...to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability” (AOTA)
OT practitioners “...apply their specialized knowledge and skills to recommend...preventive or corrective action that will help people lead more productive and satisfying lives…” (CAOT)
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OT Practitioners are “...trained to understand not only the medical and physical limitations of a disability or injury, but also the psychosocial factors that affect the functioning of the whole person – their health and their wellness…” (CAOT)
Occupational Therapy...
42To not only “fix or adapt if needed, but also to prevent disabilities, so they can continue doing what they want to do!
The Many Faces of
Occupational Therapy
Emerging Areas of OT Practice Related to Older Adults & Productive Aging
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Community Health & Wellness
The Big ChallengeIncorporating OT in Primary Care
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• Occupational Therapy clinicians should work
towards incorporating OT services into the
Primary Care model of healthcare.
• This can facilitate the prevention and
management of chronic conditions, and
other precipitating factors of disability.
•
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What Needs to be Done
Occupational Therapy clinicians need to:
• Educate the 65-year and older population
about what occupational therapy is, OT’s role
in improving and maintaining function, as well
as prevention of disability
• Give PCPs the tools to request these services
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What Needs to be Done
Occupational Therapy clinicians need to:
● Target primary care providers who may be
unaware of reimbursable occupational therapy
services beneficial to their older patients
● Educate providers on the OT role in improving and
maintaining function, as well as prevention of
disability
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What Needs to be Done
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How Occupational Therapy Already Helps with Prevention A few examples
Occupational Therapy and Prevention
Aging in Place and Home Modifications Community
Mobility and Older Drivers Community
Health & Wellness
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Improve functional performanceFor frail older adults in general or for specific physical and/or mental conditions
Help with Caregiving
Primary Outcomes of Home Modifications
Fall Risk Reduction
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Participation of Occupational therapists in Older Driver Family Assistance Networks in New York state
Promoting & hosting CarFit
events
Community Mobility & Older Drivers
Driving evaluations
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Improved functional performance & quality of life Promotion of leisure
participation and social engagement
Community Health & Wellness
Chronic disease self-management
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Back to Primary Care: How Does it Align with Occupational Therapy?
Why Your Primary Care Practice Needs Occupational Therapy
It is client- centered
It meets patients needs by providing
comprehensive medical care
It focuses not only curative intervention,
but also on health promotion and
prevention
It is client-centered
It meets patients needs by facilitating them to
do the things they want and need to do
It approaches to intervention include
promotion, restoration, adapting, maintaining,
and preventing
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PRIMARY CARE OCCUPATIONAL THERAPY
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Addressing broad health factors
Meeting individual needs
Empowering self-advocacy
Components of Primary Care-Revisited
Example of an OT Educational Curriculum Standard for Health Promotion and Wellness
B.4.23 Identify occupational needs through
effective communication with patients, families,
communities, and members of the
interprofessional team ...that supports a team
approach to the promotion of health and
wellness.
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Source: 2018 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide(effective July 31, 2020)
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B.4.27 Evaluate access to community resources,
and design community or primary care
programs to support occupational performance
for persons, groups, and populations.
Example of an OT Educational Curriculum Standard for Participation in Primary Care
Source: 2018 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide(effective July 31, 2020)
Role of OT in Primary Care
Medical management
● Medication compliance● Pain management
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Cognitive-behavioral
● Unhealthy habits● Poor problem solving
Limited engagement (occupational challenges)
● Community mobility● Home management
Mental health
● Substance abuse● Limited resources
OT in Home-Based Primary Care
A visit by an occupational therapist as
a member of the multidisciplinary team can
be beneficial for the frail elder who needs
follow-up for the management of chronic
conditions.
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“ The ability to identify barriers to occupational performance within a primary care team leads to earlier
intervention and decreased risk of preventable hospitalizations.”
60
Benthall, 2017
• Medication management
• Lifestyle modification
• Skin care and assessment of sensation
• Assess fall risk and instruct in
compensatory techniques
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Examples of OT Interventions in Primary Care: Physical Conditions
• Home assessments
• Energy conservation and work
simplification during selfcare, home care,
leisure
• Joint protection
• Recommendations of adaptive equipment
and use of technology62
Examples of OT Interventions in Primary Care: Physical Conditions
• Medication management
• Assist in developing a daily schedule
• Assessment for depression and anxiety
• Train in stress management and relaxation
techniques
• Assess sleep habits and train on
implementing sleep hygiene routine63
Examples of OT Interventions in Primary Care: Mental Health
• Training in self-care, home care, health
management, work and leisure
• Stress management and relaxation
techniques
• Fall risk and fall prevention
• Home mobility while doing activities
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Examples of OT Interventions in Primary Care: General Symptoms
• Fatigue management
• Use of breathing exercises, energy
conservation and work simplification
• Train in physical activity
• Educate and train on healthy habits &
routines, modification of activities & use of
adaptive equipment65
Examples of OT Interventions in Primary Care: General Symptoms
Other Aspects Supporting the Case for OT in PC
• OT in primary care is not meant to substitute
traditional outpatient OT
• OT practitioners area of expertise is occupational
performance (how do people do their “activities”)○ Can they do their activities?
○ How well or not they do them?
○ What supports what they do and what not?
○ Are there barriers?66
Other Aspects Supporting the Case for OT in PC
• How can we help out patients with problems?○ Can we “fix” the problem?
○ Can we adapt, by changing how we do things, or
using devices to help?
• Can we prevent problems or diminish the risks?
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Examples of Medicare Covered Preventive Services With Potential OT Role
• Cardiovascular disease screenings, including one
behavioral therapy visit once each year
• Alcohol misuse screenings & counseling
• Depression screenings
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Examples of Medicare Covered Preventive Services With Potential OT Role
• Diabetes self-management training
• Obesity screenings & counseling
• One-time “Welcome to Medicare” preventive visit
which includes a Falls Risk Assessment and
Yearly "Wellness" visit 69
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The American College of Preventive Medicine and the National Council on Aging are alreadyrecommending that Occupational Therapists assess home hazards
Medicare B may reimburse falls-related services through accepted billing codes or reimbursement may be negotiated with private plans
Fall Risk Assessment
The Value of Screenings
Screenings lead to a better quality of life with early diagnosis, but it’s also good ECONOMICS
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Economic Benefits of Prevention through Primary Care
• Accessibility to primary care services has been deemed
to be a cost-effective approach to healthcare
• One PC goal would be to contain cost (for all stakeholders)
• This could be done by diverting funds from treatment to
prevention of chronic diseases
72
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Economic Benefits of Screenings
• A study conducted by Harvard University found that health
care spending among Medicare-covered individuals age 65
and older slowed from 2005 to 2012
○ About 50% of the reduction is attributed to less
spending on cardiovascular disease
• The researchers were able to prove that preventive
medicine not only had an impact in quality of life, but also
impacted dollars spent
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Estimated Relative Cost-Savings for Common Types of Cancer
Type of Cancer
Ranking in Prevalence
Ranking in Mortality Rate
Average Cost Savings
Breast #1 in women # 2 in women 11.35%
Prostate #1 in men # 2 in men 6.26%
Lung #2 # 1 25.08%
Colo-rectal #3 # 3 22.11%
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Occupational Therapy and Aging in Place
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“We support the expansion and sustainability of
evidence-based health promotion and disease
prevention programs in the community and
online through collaboration with national, state,
and community partners. Our goal is to help older
adults live longer and healthier lives.”
The National Council of Aging Center for Healthy Aging
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Google “Aging in Place”
Where older adults live is of obvious importance, providing a sense of well being and life satisfaction
● The importance of “aging in place” is widely recognized
https://www.aginginplace.org
https://www.seniorliving.org/aging-in-place/
https://www.nia.nih.gov/health/aging-place-growing-older-home
www.ageinplace.org/
https://aginginplace.com/
https://ageinplace.com › Aging in Place
https://en.wikipedia.org/wiki/Aging_in_place
https://well.blogs.nytimes.com/2016/05/02/aging-in-place/
https://www.theseniorlist.com/aging-in-place/
https://www.retirementliving.com
The 55 + Crowd
Boomers ≠ Previous cohorts
• The expectation is to live in the community
• They remain healthy longer and actively work at it
• They want a variety of living options
• Usually they are more educated and informed.
• They are a more racially and ethnically diverse
population78
The Case for an OT Baseline at 65
Let’s again consider the evidence:
• Screening tests are conducive to early diagnosis and
treatment of medical conditions
&
• Screening and early detection have an impact on
spending of more costly medical treatments...79
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THEN…Health care clinicians must identify and target any decline in
function in the older adult early, with the goal of maintaining
health and quality of life and to be able to “Age in Place”.
Being proactive instead of reactive of a serious health
problem will help contain health care costs for more costly
medical care and living arrangements
An Occupational Therapy Assessment that determines a functional baseline at age 65 could detect either functional deficits or risk areas that:
• NO OTHER health professional could asses. • This could be a part of the “Welcome to Medicare” preventive
visit. It could include among other aspects:
81
● A home assessment and fall risk● Evaluation of the need of adaptive equipment● Community mobility & age-related driving
recommendations● Referrals to other professionals or community
resources
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Beyond the Baseline
For Those Not Yet 65
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“ReThinkingAging”• The National Aging in Place Council provides a template to assist in
developing a plan for aging in place
• However, this is often not a priority for many, and when it becomes one, it may be too late to make meaningful changes
• It falls on us, as health care professionals to guide not only persons 65 and over, but imperative to do so for persons as young as 50
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“ReThinkingAging”• ReThinkingAging is a process that was designed in order to address all
issues related to the already existing push for aging in place
• ReThinkingAging is intended to assess and initiate planning well in advance of actual need• This allows for an individual to truly have the tools to age in place
(wherever that might be)
• ReThinkingAging helps individuals develop and reach smart goals
85
“ReThinkingAging”
• It can also be for the caregivers
• It can be adopted by health care providers who wants to enhance their services by exercising a holistic view of aging
It’s never too early to plan for your next 20, 30, 40 years of your life
86
“ReThinkingAging”Aspects to Consider when Planning to “Age in The Right Place”
87
The “SILVER Plan”
Occupational Therapists are:
● Well trained in establishing goals
● A good choice for helping patients establish good SMART goals towards “Aging in the Right Place”
● Well prepared to teach & train
Guiding you through an early start to planning for the future
88 Adapted from: Donnelly, Brenchley, Crawford & Letts (2013)
Understanding of OT
Culture of Collaboration
Contextual Factors
* Educating Team* Engaging PCP* Research &
Teaching
* Alignment of OT Roles with Practice Care Programs
* Collaboration with other OTs
* Single & Accessible EMR
* Physical Co-location
* Interdisciplinary Collaboration
Supporting Factors for OT Integration in Primary Care
Barriers to OT Integration in Primary Care
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Lack of Understanding of
What is OT
Insufficient OTs in Private Practice
Reimbursement and Billing
* Nationwide* Statewide * Individual
Practices
* OTs traditionally have been employed in other settings
* Lack of understanding of OT role in PCP
* OT not reflected in the PCP EMR
* Giving priorities to other disciplines
* Accurately documenting billing code
90
Aging in Place* In the Right Place
My Vision of Occupational Therapy in Primary Care for Older Adults
In Summary: My Vision for Occupational Therapy in Primary Care for Older Adults
Functional baseline at age 65
OT early intervention when change
occurs
Establish SILVER plan through the
ReThinkingAgingprocess
91
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“ Planning is bringing the future into the present so that you can do something about it now.”
Alan Lakein
93
Mentions
Also thank you to all the people who made and released many of resources for free:▪ Presentation template by SlidesCarnival▪ Some photographs by Unsplash
Thank you to my fellow masterminds:
Colleen Blankenship B.S., OT/L
Zeida Gutierrez Ph.D., MHS, OTR/L
Kay Richardson B.S., OTA/L, Business Coach
www.otcarehelp.com
Any questions?
94
THANK YOU!
You can visit www.otcarehelp.com
95
#otinprimarycare#otcarehelp #aginginplace
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