Category: Social and Community Context

29 - Integrating Occupational Therapy into Long Term Service and Support Programs to Enhance Aging in Place

There is a growing imbalance between the resources available and the needs of older adults to effectively age in place. For those experiencing difficulty with activities of daily living (ADL) or instrumental ADL (IADL), the traditional solution has been to provide ongoing long term care (LTC) services that “do for” the individual. However, waiting lists, limited availability of caregivers, and unaffordable out-of-pocket fees have resulted in 60% of older adults who receive LTC experiencing adverse consequences related to unmet needs in their care. (1) Occupational therapy (OT) may be one solution for better meeting the ADL/IADL needs of older adults who wish to age in place. OT intervention introduces compensatory strategies that reduce disability and improve function by enabling clients to “do for themselves” instead of primarily relying on “do for” LTC services as they seek to age in place. (2)

Objective: Examine the feasibility and benefit of integrating OT into an existing long-term service and support (LTSS) care coordination program for aging in place.

Method: Clients referred to OT during a 16-week trial were evaluated using the In-Home Occupational Performance Evaluation and received education on strategies for aging in place. (3) Clients who indicated Readiness for Change were assisted in setting personalized goals to improve ADL/IADL function using Goal Attainment Scaling and received 4 additional OT visits in support of goal attainment. (4,5)

Results: 87% of the program’s feasibility benchmarks were met. 23 clients were referred and 16 clients were evaluated; 37.5% (n=6) of those evaluated indicated a readiness for change, establishing 18 goals with 100% goal attainment over 4 OT visits.

Conclusion: Integration of OT into a LTSS care coordination program was feasible. Benefits of adding OT included a performance-based evaluation that revealed modifiable barriers to aging in place and gave access to a client-centered service to improve function and maximize independence.
1. Freedman & Spillman. Disability and care needs among older Americans. Milbank Q, 2014. 92(3): p. 509-41.
2. Szanton, et al. Home-based care program reduces disability and promotes aging in place. Health Aff, 2016.35: p.1558-63.
3. Stark, et al. In-home occupational performance evaluation. AJOT, 2010. 64(4): p. 580-89.
4. Prochaska, & Velicer. The transtheoretical model of health behavior change. Am J Health Promot, 1997, 12: p.38-48.
5. Kiresuk, et al. Goal Attainment Scaling: Applications, Theory, and Measurement. 1994, Lawrence Erlbaum Associates: Hillsdale, NJ.


Pamela Toto

Pamela E. Toto, PhD, OTR/L, BCG, FAOTA
University of Pittsburgh

Pamela Toto is an Associate Professor and Program Director for the Doctor of Clinical Science in Occupational Therapy at the University of Pittsburgh. She is Board Certified in Gerontology and a Fellow of the American Occupational Therapy Association. Dr. Toto has over 28 years of clinical experience, providing services in the community and in long term care settings. She is an expert in implementing preventative interventions that promote aging in place for vulnerable older adult populations. Dr. Toto’s research focuses on client-centered interventions to promote independence, participation and healthy aging in older adults.She has completed research examining the impact of physical activity on function in older adults and research exploring the feasibility of client-centered goal setting with older adults in primary care. Dr. Toto’s current reserach explores the implementation of behavioral interventions to reduce frailty and frailty-related disability in older adults.

Kelly Dickson

Kelly L. Dickson, CScD, OTR/L
UPMC Centers for Rehab Services

Kelly Dickson is an occupational therapist with geriatric expertise, providing skilled rehabilitation services in both primary care and post-acute care settings. As a requirement for her clinical doctorate, Dr. Dickson successfully designed and implemented a program to intergrate occupational therapy into a long-standing care coordination service that promotes aging in place for vulnerable older adults.