This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

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Be Inspired-
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Saturday, 21 January 2012

Pressure Ulcer Prevention Study- lifestyle issues

The regular meeting focused today on some of the problems the therapists face in carrying out interventions, and also the problems that many clients have in their lives that can make it difficult to adhere to long term self management of presssure risks.
A recent LA Times article about law suits currently in progress about alleged abuse and poor facilities for prisoners with disabilities was discussed, you can read it by following this link.

Some of the issues discussed this morning were:
  • what the OT interveners should do if they turn up for a session with a client who is under the influence of alcohol or drugs. There was general agreement that this need to be established as a 'ground rule' for therapy at the outset, but it can be difficult to apply as many clients routinely use alcohol and in addition to street drugs, many use 'medical marijuana'- legal in the state of California if prescribed by a doctor and readily available from numerous outlets in the form of joints, cup cakes, cookies etc. The picture of 'Mr Green's' below is the outlet at the bottom of the street where I am staying. One OT described how his client remains a gang member and drinking with other gang members is very much part of that lifestyle and is an aspect of it he can still participate in.
  •  safety for a client who is unable to get out of bed or mobilise alone but spends a large part of every day locked in the house while other family members are at work. The neighbourhood is too unsafe to leave a door open and assistive technology that would allow control of door opening is beyond the equipment budget of $400 per client.
  • conflicting priorities in use of the budget. Some clients want equipment that is seen as less of a priority by the OT and this can cause difficulties in the therapeutic relationship.
  • unstable or frequently changing life situations, frequent moves and periods when not in contact with OT, some clients may go into jail, others may be admitted to hospital without the OT being aware of it.
One of the OT interveners who works with clients who may be gang members or homeless described his approach to some of these issues as 'this is your lifestyle, let's go with what we can realistically do [for you to manage your pressure ulcers] with you living this way'.

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