For some, long term care (LTC) is synonymous with the last chapters of older adults’ lives. But today’s nursing care center can become a new community where roles and routines are transformed and redefined: how older adults will live, where they live, whom they interact with, and the quality of care provided daily.

The quality of care is dictated by the competency and range of skilled and ancillary services provided within the nursing care center, and that includes the occupational therapist (OT), who should play an important role on the interdisciplinary team. OTs offer unique perspectives focused on the older adult’s functional level of performance of daily roles and routines in the skilled nursing setting.

Clarifying The Discipline

OTs are often asked what their profession truly does. To clarify, OT does not assist older adults with securing employment, as health care providers, families, and residents have inquired. Physical therapy and speech therapy are afforded professional titles that are self-explanatory and widely understood. However, the majority of health care providers do not wholly understand the scope of OT practice.

OT is typically associated with providing skilled services in the areas of assistance with daily living and wheelchair seating and positioning. While this is true, OT expertise is specialized, comprehensive, and diverse, offering a  much wider range of skilled services provided to LTC residents. 

An Underutilized Resource

OT plays a vital role in the provision of skilled health care services. The therapist is instrumental in determining the health care needs of LTC residents and providing services that ultimately enhance their quality of life and health.
While OT is common in skilled nursing centers, literature suggests medical staff don’t understand OTs’ roles and scope of practice in LTC. This is unfortunate given the OT’s potential to help enable individuals to achieve and maintain an independent, functional, and meaningful life.

While OT is offered as a resident service alongside physical and speech therapy, research suggests OT is the most misunderstood and under-appreciated of all three disciplines. This malignment of the profession is important to note, because practicing in an interdisciplinary setting with limited or inaccurate information presents significant barriers to the best possible care for the LTC resident. Knowledge deficits include the understanding of splinting, physical agent modalities (PAMs), and evidence-based practice.

What OTs Actually Do   

Using specialized skills in assessment and treatment, OTs provide care to long term residents to prevent injury or impairment, restore functional activity, and enhance participation in daily life. Splinting—temporary immobilization of a limb—is a crucial component of a comprehensive long-term rehabilitation program. Its early, effective, and consistent use is recommended for successful prevention and management of upper extremity deformities.

Researchers have found that LTC splinting: 1.) reduced treatment time; 2.) eliminated the need for multiple medical providers; 3.) promoted faster recovery resulting in decreased medical costs; and 4.) resulted in functional outcomes ensuring a faster return to productive lifestyles.

PAMs represent interventions that address a broad range of prevalent conditions, including pain, edema, neuromuscular dysfunction, stroke recovery, contracture, arthritis, urinary incontinence, slow-healing wounds, carpal tunnel syndrome, peripheral neuropathy, chronic obstructive pulmonary disease, and fall prevention, according to R. Richards in a 2011 article on PAMs in therapy in Advance magazine. These interventions optimize treatment outcomes and improve quality of life without use of surgery or medications. PAMs do not replace therapists, but do represent valuable clinical tools that can enhance outcomes for a range of conditions.

Evidence-Based Practice

OT fall prevention programs are multifaceted interventions that increase residents’ self-confidence during daily functional routines, lower the frequency of falls during functional mobility, reduce rates of injury and re-injury, improve perceptions of environmental safety within LTC units, and enhance residents’ sense of self-efficacy and well-being.

Similarly, OT bed and wheelchair positioning programs significantly decrease risk of wound occurrence and amount of healing time, increase adherence to positioning protocols for high-risk residents, and improve quality of life due to decreased pain.

The Time Has Come

Medical and other interprofessional disciplines are positioned as critical liaisons to OT services. Medical staff initiate requests for OT through the referral process that connects residents to therapy services. Overlooking residents who are appropriate for OT and inaccurately identifying needs minimizes residents’ opportunities to enhance quality of life and mastery within their environment.
OT practitioners play a vital role in providing client-centered, short-term, and long-term rehabilitation services to individuals in skilled nursing centers that enhance the client’s participation in meaningful roles and occupations of daily living. They also provide consultative services to facility staff and residents to improve quality of life and client satisfaction. The time has come to recognize their services.
Richard Dressell III
Richard J. Dressel III, OTD, OTR/L, is an occupational therapist at Westminster Village at Dover with Select Rehab. He can be reached at and (302) 980-8333.