I sat in my car scanning my notes for my next patient. “Dorothy” was a 75 year old woman with severe Rheumatoid Arthritis. While this would be my first visit, she had a long history of receiving in-home OT and PT visits as her condition progressed. At her door, I knocked and waited, and then knocked again. Had I heard a voice? Sure enough, I heard a women call out that the door was open and I could come right in.
My patient stood about 5 feet back from the door while greeting me and confirming that I was her new occupational therapist. We settled down at the kitchen table to start my assessment. I went through my standard list of questions and an evaluation of her capacity for ADL’s. As we discussed my plan for her therapy, I was bothered by something. You know the feeling, your intuition tells you something is wrong, but you can’t put your finger on it. The time ended, but I still hadn’t figured out what was bothering me. I sighed and packed up knowing it would come to me sooner or later.
As I walked to the door, I realized what was wrong. I turned to Dorothy and asked her why she had called to me rather than opening the door for me. She replied matter-of-factly that she couldn’t open the door. I asked how she got in and out of her apartment. My patient, without the ability to open her only door, was a prisoner in her own home. Dorothy had to call a neighbor or two or three, until she found someone that had a minute to come and open the door. I asked her if this was a recent problem and it turned out that in the ten years she had lived in the apartment, Dorothy had never been able to open her own door.
I asked if she could unlock the door and turn the knob. That was not the problem; she could manage both. The problem was physically pulling the door open. As I tried the door, I found that I even needed to brace myself to tug it open. The door wasn’t all that heavy once it was open, so what was the issue? I discovered the magnetic seal around the door was extraordinarily strong and took more strength than my patient had to break that seal.
I was determined to solve this problem for my patient that day, so I hurried down to my car to see what I had in my trunk of supplies. I returned a few minutes later with an ordinary roll of masking tape. I carefully worked my way around the seal covering about a quarter of the surface with the masking tape. Dorothy gave it a try, but still wasn’t able to open the door. I make another pass around the seal; this time covering about half of the seal’s surface. Trying again, Dorothy opened her front door by herself for the first time in 10 years! Of course the door had a magnetic seal as a fire precaution. So before I left the apartment complex, I asked the apartment manager to inspect the door and followed up with a call to the local fire station. Both agreed that the seal was still adequate.
My advice to all my fellow OTs….
Don’t forget the big picture. I know as an OT providing in-home care my schedule could be incredible tight, and I had much to accomplish in my allotted time. When on a tight schedule, I tended to focus on the task at hand; however, it is important that as OT’s that we step back and really observe the patient’s environment.
Don’t assume because the patient has had multiple courses of therapy that all her needs have been fully identified. Sometimes when you are coming behind another therapist, you assume the first assessment is complete and accurate. But patients change and even the best OT can overlook a need, so try start each visit without any preconceived ideas.
Don’t forget to load your trunk with tools to fuel your creativity. As an OT in home health, my trunk was full of gadgets and tools, so make sure yours is too! I could talk on this topic forever and plan to in an upcoming blog, but for now make sure you add masking tape to your trunk of tools!