Occupational Therapy at Home

Occupational does not mean work

The word confuses almost everybody, including people already receiving the service.

In this context an occupation is not a job. It is any of the ordinary activities that occupy a day: washing, dressing, eating, cooking, using the bathroom, getting in and out of a chair, managing medication, getting to the store.

An occupational therapist's job is to get someone doing those things again, safely and as independently as possible. Sometimes by rebuilding the ability. Sometimes by changing the method. Sometimes by changing the environment so the ability is no longer required.

That third route is the one families never anticipate and the one that often works fastest.

The difference from physical therapy, concretely

Both are useful. They do different things and most people receive both.

• Physical therapy works on the body itself: Strength, balance, range of movement, walking, getting up from the floor. The goal is capability. See physical therapy at home.
• Occupational therapy works on the task: Actually getting into the bath, actually getting dressed with a frozen shoulder, actually making lunch with one usable hand. The goal is function.

Put simply

Physical therapy asks whether you can raise your arm. Occupational therapy asks whether you can wash your hair.

Someone can improve considerably in physical therapy and still be unable to manage their own bathroom, because the bathroom is the problem rather than the leg.

Why the home visit is the whole point

An OT seeing someone in a clinic is assessing them in a room they will never have to live in.

At home, the same clinician sees the actual conditions. Where the light switches are. Which chair he actually sits in. That the toilet is too low. That the kitchen cupboards need reaching above shoulder height. That the shower has a lip she cannot step over any more. That the walker does not turn in the hallway.

None of this appears in a clinic assessment, and all of it determines whether someone manages at home.

Typical things an OT changes on a first visit: rearranging where things are kept so nothing needed daily is above head height or below knee height. Raising a bed or a chair. Specifying a shower seat, a raised toilet seat, grab rails in the places actually used. Removing or securing rugs. Improving lighting on the route from bed to bathroom, which is where most night falls happen. Teaching a different way to get dressed, get up, or transfer.

Most of it is unglamorous and cheap. Collectively it is often the difference between coping and not.

When occupational therapy helps most

• After a stroke: Relearning dressing, eating and washing with one side affected, and adapting the environment for what does not fully return.
• After a fall: Both the physical recovery and the fear, which is frequently the bigger obstacle. An OT addresses the confidence as well as the hazard.
• After hip or knee replacement: Specific techniques for getting in and out of bed, the car, the bath, and the chair without breaching movement restrictions.
• With dementia: Simplifying tasks, using visual cues, and reordering the environment so familiar routines stay possible for longer. See Alzheimer's and dementia care.
• With Parkinson's, arthritis or multiple sclerosis: Adapting method and equipment as capability changes, and staying ahead of it rather than reacting.
• Before a discharge, ideally: A home safety assessment before someone comes home is worth considerably more than one after the first fall. See hospital to home care.

The visit nobody asks for

If you take one practical thing from this page, ask whether a home safety assessment is available.

It is a single visit. It costs comparatively little. It routinely prevents the fall that leads to the hospital admission that leads to the nursing home, and it is the most under-requested service in home health.

Ask the discharging clinician, the physician, or us.

How to get occupational therapy at home

OT at home is a skilled service, which means it begins with a physician's order rather than with us. Call the doctor before you call anyone else.

Medicare covers occupational therapy under the home health benefit when a physician orders it and the patient meets the eligibility requirements, including being homebound. The rules on whether OT alone can establish that eligibility, as distinct from continuing it, are technical. Ask the physician, or ask us and we will explain how it applies to your situation.

Florida Medicaid and most private insurance also cover it in various circumstances. We verify coverage at no charge before care begins.

Where no order is forthcoming, a home safety assessment can usually be arranged privately, and it does not cost much.

What we can tell you about our therapists

Thirty-five occupational therapists are on the Focus Family Care roster, covering every one of the seven counties we serve.

Once a physician's order arrives, the typical time to a first visit is 48 hours.

Where we provide occupational therapy at home

Occupational therapy at home across Palm Beach, Broward, Miami-Dade, Martin, St. Lucie, Indian River and Okeechobee counties, alongside physical therapy and speech therapy at home.