|Center for the Health Professions, Health Professions Campus, USC|
Tina has always been interested in working in the field of gerontology and took her BSc in the subject, then completed her Masters & Doctorate in OT. For her OTD she carried out a Lifestyle Redesign programme for residents in an assisted living facility. Later she was Director of Rehabilitation at a nursing home for a few years and now works part time as an adjunct at USC on a project looking at falls prevention in assisted living facilities and part time seeing private clients.
In the assisted living project, the people she worked with were typically fairly physically able, but many had a degree of cognitive impairment. Tina explained that some cognitive impairment does not mean that Lifestyle Redesign cannot be a useful technique as the 'here & now' aspect of taking part in the sessions can be of benefit, even if all the details are not remembered. It was felt to be important to encourage active and positive engagement in personally meaningful occupations instead of the more passive activities, like watching TV, that were on offer. Building a rapport with the clients individually and as a group helped to identify suitable activities. Some constraints are inevitable in any form of institutional setting e.g. meal times are pre-set and not easily changed. The group went on 2 field trips, one to the local library and one to a museum, both opened up new horizons in the local area that residents would be able to consider visiting again, either with their families or, for some, on their own. Many residents were avid readers and at the library there was great enjoyment in browsing and choosing books themselves, rather than having what someone else chose for them.
At the museum, one resident reawakened his previous passion for photography and was so engrossed in the 'flow' of the activity that he was able to walk further and get into many positions that he would normally have thought beyond him!
We talked about the potential for Lifestyle Redesign to be used in any area of OT practice. Tina, as others have done, stressed the importance of occupational storytelling and occupational story making in the transformative process. The skilled clinician needs to be able to identify when an individual is ready for change and facilitate the process. Sometimes it seems that foundations are laid during a programme, but the change may take place at a later date. Lifestyle Redesign has many 'layers'; giving people the right information and allowing them to see a different perspective on an issue can be the beginning of the change process and can be incorporated into interventions even if they are not 'full' Lifestyle Redesign programmes.