Occupational Therapy: Helping America Age in Place
By Stephanie Yamkovenko
As people age, more than four in five Americans 45 years of age and older say they would like to remain in their homes for as long as possible, according to AARP (2003). Meanwhile, only one in six home owners has made home modifications that would allow them to be safe and comfortable in their home as they age (O’Neal, 2008). One’s home must be able to accommodate the natural changes and needs that come with getting older, and occupational therapy practitioners can assist individuals to adapt their environment to accommodate individual aging factors.
“As more people start nearing retirement age, we need to prepare ourselves now,” says Carolyn Sithong, OTR/L, CAPS. “The profession of occupational therapy needs to start ahead of time to have practices and assessments established so we can better serve this aging population.”
Aging in Place: The Goal and Vision
The goals of aging in place are twofold. One is to enhance the quality of life for elderly persons so they are comfortable in their environment and more able to participate in activities both in their homes and in their communities. The other is to ensure that people of all ages who plan to stay in their homes as they age would make the necessary modifications now to ensure their ability to age in place. A part of the 2017 Centennial Vision of the American Occupational Therapy Association (AOTA) is to meet society's occupational needs. Occupational therapy practitioners can meet the needs of an aging population by helping them age in place, stay healthy, and lead full lives.
By looking at a person holistically, occupational therapy practitioners can adapt an environment so that it allows the client to function at his or her highest level of independence. “A lot of people can do home modifications,” says Sithong. “Our ability as OTs helps us to focus uniquely on our client’s activities of daily living. This enables us to generate ideas for creating a unique environment that is totally centered on the client’s capabilities.” Environmental adaptation does not just occur in the home, but can be applied to any environment—whether it is a hospital, an assisted-living facility, or a nursing home, according to Sithong.
Sithong got involved with aging in place after she overheard a client’s daughter asking a neighbor to build a ramp for her father, who was recovering from a stroke. “I was thinking, ‘it’s going to be nice when he can use the ramp to have access into his home, however, how is he going to function once he is living inside with other physical barriers?’” says Sithong. “When I went to find out who was available to assist him to create an accessible environment, I realized there was nobody in the area who could do that.”
Aging in Place: The Need for a Team of Professionals
Occupational therapy practitioners generally work with physicians, social workers, nurses and others in the medical field and other practice areas, but they rarely have a contractor as a part of their multidisciplinary team. When a client needs home modifications, occupational therapy practitioners may need to recommend remodelers who create the appropriate physical environment. Sithong realized that she needed to work with building professionals to not only meet the needs of her clients, but also to help explain how occupational therapy could assist them with creating home designs for elderly persons and persons with disabilities.
Her education and perspective as an occupational therapy practitioner gave her a foundation of skills, but she also pursued her Certified Aging in Place Specialist (CAPS) designation from the National Association of Home Builders (NAHB)—a program in which AOTA collaborates with NAHB. AOTA President Penny Moyers Cleveland sits on the NAHB Certified Aging in Place Specialist Board of Governors as an advisor assuring that occupational therapy is fully integrated into the training.
Sithong then wanted to host an event that would bring together occupational therapy practitioners with other professionals in her community in Central Florida who could benefit from partnerships to assist with aging in place. The National Aging in Place Council (NAIPC), a group of professionals dedicated to increasing an individual’s ability to remain safe and independent in their home as they age, organizes an annual National Aging in Place Week to build coalitions of allied business professionals and to organize educational activities to highlight services that enable seniors to successfully age in place. Sithong organized the event “Homes That Work…Now and Later” during the National Aging in Place week last year. The seminar was free and more than 100 attendees participated—including consumers, caregivers, health care professionals, government officials, builders, and interior designers. The event was sponsored by AARP, and several other organizations assisted, including Meals on Wheels, the Home Builders Association, the Senior Resource Alliance, and the Winter Park Health Foundation.
In the spirit of multidisciplinary teamwork, a panel convened after the keynote address that consisted of Sithong, representing occupational therapy, an interior designer, a contractor, a lawyer who specializes in elder law, a representative from the Center for Independent Living, and the mayor of a nearby city. The panelists each discussed how their profession or position could help meet the needs of seniors who want to age in place and answered questions from consumers in the audience.
“The most exciting part of the event was the joining of the building community and the health care community,” says Sithong. “Reaching out to those who build the communities seniors live in poses an opportunity to advocate for the profession of occupational therapy and for the people we serve.”
Florida ranks number one in the country in the total percentage of population over both 65 and 85 years of age, according to the U.S. Census Bureau (2008a,b). Recognizing the large aging population in Florida, and the fact that baby boomers are nearing retirement age, one major outcome of the event was to establish an Orlando, Florida, local chapter of the NAIPC. The local chapter is a direct result of Sithong’s advocacy. Now the group brought together at the first conference will host an annual event each year during the Aging in Place Week and will work year round on issues affecting elderly persons, such as community mobility, legislation, and relationship building with other local organizations.
Advocate for OT by Paving New Roads
Ultimately, Sithong saw the event and the interest in aging in place as an opportunity to advocate for occupational therapy and to offer services in a market that doesn’t usually garner referrals.
“You hear that you can apply your OT training everywhere,” says Sithong. “I just can’t believe the level of need for OT among seniors. I’m so excited to advocate my profession to people who haven’t heard about it. It’s really an opportunity to praise the profession and provide new avenues to apply occupational therapy in areas where it might not have been before.”
Occupational therapy practitioners who are interested in learning more about aging in place and want to help serve the needs of seniors in their own communities have several opportunities to get involved. Like Sithong, they can earn their CAPS designation through the NAHB, which teaches technical, business management, and customer service skills necessary to participate in the residential remodeling industry for home modifications for aging in place.
AOTA offers an Environmental Modification Specialty Certification—available to both occupational therapists and occupational therapy assistants—that covers implementing environmental modifications in senior housing, assisted living, long-term-care facilities, and homes. Occupational therapy practitioners can also join the National Aging in Place Council.