The Memory Unit OT

I think is (unfortunately) something we’ve all dealt with. We’d like to think that every Patient, Family Member, and Staff we encounter will understand our skills and knowledge. That they will always view our recommendations as important and worth it and will always follow through. But that’s just not the reality.

There’s no perfect formula or magic fix, but I’ve found a few things that have helped me over the years.

Carryover Among Patients & Residents

The bottom line is, our Patients are only going to do as much as is meaningful and (if we’re being honest) convenient and feasible for them to do. I myself have been to physical therapy, after becoming a therapist, and didn’t perfectly carryover my HEP.

So what do we do?

First, we don’t me the HEPs and the recommendations super complex. We prioritize the best 3-5 exercises that an individual can safely do at home, with either minimal equipment or the equipment we provide.

Second, we keep the recommendations we make relevant to the Patient. It’s the practical example of what OTs mean when they say “person-centered care”. If my Patient is expressing a lot of stress around shower transfers and balance in the shower, the bulk of my recommendations are going to be around showering. I’m not going to neglect safety in other areas, but I’m going to focus on the things that I know my Patient is more likely to remember and use because it relates to a task they are directly concerned about.

Among Residents, it can be a little harder. Particularly when we’re talking about Residents living with cognitive and/or memory impairment. If a Resident cannot recognize a need within themselves, they’re likely not going to carryover of the recommendations you make. This is where family and/or staff education comes into play.

Carryover Among Families

There are some families who realistically recognize their loved one’s current status and there are others who don’t. Now, I’m not referring to the families who advocate for as much independence as possible. I’m referring to families who have unrealistic expectations for their loved ones or the families who become argumentative when we report observations we’ve made during sessions.

My biggest tip to collaborate with families is to provide them with tangible evidence. Invite them to observe sessions. Take before & after photo/video (with permission of course!). Share the objective data you’ve collected from any assessments you’ve done.

It can also help to get the entire care plan team involved in discussions with the family. Having reinforcement from the doctor, nurses, and social work can make a huge impact on a family’s overall understanding of why these recommendations are necessary and meaningful.

Carryover Among Staff

I think we’ve all encountered staff members who view our recommendations as excess work and therefore will not follow through with things we recommend.

There are three major things that have helped me so much with my rapport with staff.

First, I try to keep in communication with staff from the very beginning. I don’t wait until the end to provide a summary of everything I’ve covered since the start of care. At the time of my evaluation, I’ll approach the staff and say “Hey, Mr. So-and-So has been referred to me for XYZ and I’m just wondering what your thoughts are on that”.

It’s crucial to treat the staff like an active and valuable member of the care team, because that’s exactly what they are. Ask them what they’re noticing. Get their input on what they think is working and what could be improved. Create a Restorative Program with the staff.

Don’t wait until the last day of treatment to provide training. Invite the staff into your sessions throughout the entire course of treatment, demonstrating and educating on recommendations as you’re actively treating the Patient or Resident. If there’s a recommendation you’ve made that isn’t quite making sense or working out for the staff, collaboratively make changes that will still lead to the same outcome and goal.

In the end, know that you’re not solely responsible for the outcomes each Patient and Resident reaches.

This is a collaborative effort, that requires equal effort from every member of the team. Bottom line: as long as the Patient is safe and living a life of quality, you’ve done a good work.