Innovative Solutions to Systemic Trends in Delivery of

Complex Wheelchair & Seating Systems

“Meeting the health care needs of Canadians means having the right number of health care providers with the right set of skills, in the right settings.”

CIHI, 2008

Trends

• Aging population • More complex/chronic medical conditions • Health care funding

– Funding structure for ambulatory services– Fiscal constraints

• Organizational changes (LHINS, hospital mergers, etc)– Home first initiative– Wait lists/demands for services

• Changing OT workforce

Need for Innovation

Thinking outside of the box• Utilize wheelchair & seating clinics• Use of support personnel• Collaboration• Consultation• Joint partnership

Wheelchair & Seating Clinics

• Dedicated seating focus• Use of assessment resources • Inter-professional collaboration-established

seating team• Increased exposure to products and

opportunity for clinical application• Increased exposure to complex seating

needs and mobility needs

Why use support personnel?

• COTO Position on Support Personnel

• Practice Profile for Support Personnel in Occupational Therapy (CAOT-2009)

• Improves efficiencies in practice– Time – OT can see more than one client– Money – OTA costs less than having a second OT

Collaboration

“The number of Canadians living with chronic diseases is on the rise, and with it the need for complex collaborative care.”

CIHI, 2008

Collaborative model-why?

• Increased complexity of population serviced• Decreased resources (staff, time, money)• Increased wait times• Movement towards OT as generalist• Environmental barriers

How do we collaborate?

• Collaborative Model– Working together with community therapists– Capitalize upon skill set and environmental

access of community therapist, Seating clinic therapist & Seating Clinic Support Personnel

– Seating clinic OT completes initial assessment in collaboration with community therapist and with the assistance of the OTA

– Follow up in home by community therapist with feedback to seating clinic

– Sharing of paperwork/funding applications etc.

Case Study - Collaboration

• Client with ALS• Initial assessment occurred with seating clinic OT at

ALS clinic visit• Set up of power wheelchair trial in hospital setting• Follow up in home with CCAC OT and Seating clinic

OT present• CCAC OT followed client in home to address

integration of power device into home environment.• ADP application completed by seating clinic OT with

corroboration from community OT• Application to ALS society for non-ADP funding

completed by community OT.

Consultation

• Consultative Model– Provide 1-2 visits with client and community therapist.– In community or at hospital clinic– Seating clinic OT completes assessment together with

community therapist and with the assistance of the OTA

– Community Therapist can also consult with the clinic for the environmental benefits and for use of Support Personnel to complete assessment.

– Community therapist implements recommendations – Seating clinic therapist available for future phone

consult or one additional visit

Case Study - Consultation

• Client with history of MS with postural and positioning needs referred to community OT via CCAC

• Unable to assess in home due to environmental factors

• Assessed in clinic with assistance of OTA for mat assessment and to trial power w/c with power tilt in safe environment

• Further assessment of power mobility in home done by community OT

Case Study: Collaborative/Consultative

• Client with history of ABI and most recent bilateral rotator cuff tears – compromising manual wheelchair and scooter mobility

• Referred by CCAC – OT and second referral by Hospital OT from acute short term stay secondary to falls in apartment

• Assessed in clinic with assistance of OTA for mat assessment and to trial power w/c with power tilt in safe environment

• Collaboration with Out patient OT for further cognitive/perceptual testing and collaboration with CCAC –OT for integration of power mobility into home environment.

Joint Partnership-Community Service

Provider

Issues identified:• Residential group homes• Aging with disability• Complex seating and mobility needs• Inappropriate referrals sent to seating clinic• Increasing wait list times• Inconsistent follow-up of seating/positioning• Need for staff education

Joint partnership-community service

provider

Solution:• Development of joint partnership• Development of OTA and OT role to provide

specialized community based seating and positioning intervention

Joint partnership-community service

provider

OTA ROLE• First point of contact with front line staff• Visits homes monthly to provide:

– Seating clinic follow-up– Education– Screening– Monitor need for repairs– Initiates referral process– Attends and assists at Seating Clinic

appointments

Joint partnership-community service

provider

OT Role• Supervises OTA role• Facilitates educational supports• Identifies and implements educational in-

services to front line staff• Collaborates in policy and procedures

related to positioning, transfers etc.• Ensures effective communication between

OT/OTA, support staff, family and other stakeholders as required

Joint partnership-community service

provider

OUTCOME• Improved quality of life• Improved staff satisfaction• Reduction of care needs• Reduction in staff/transportation costs• Reduction in clinic wait times• Expanded OTA/OT role

Conclusions

• Changing societal & health care trends necessitate need for innovation in meeting clients’ complex seating and mobility needs.

• Capitalize upon skill sets of all health care professionals:– Seating clinic OT– Community OT– Support Personnel

• Consider option for community partnerships with health care facilities

Future directions

• Continual monitoring of changing trends and their impact on complex wheelchair and seating

• Establish ongoing Professional networking and support systems

• Consider other community partnerships