Occupational Therapy in Home Health

Introduction[edit | edit source]

Occupational therapy (OT) is a healthcare profession that helps individuals build or improve skills for everyday activities such as self-care, productivity, work, and leisure activities such as hobbies and socialising, utilising various techniques, exercises, and interventions to enhance independence and functional abilities, [1]including adaptive strategies, assistive devices, and customised treatment plans.[2] Occupational therapy practitioners play a crucial role in the home health rehabilitation team, providing support to patients transitioning from acute care to home.[3] Occupational therapy's role in home health care goes beyond the confines of a medical setting, extending into the heart of individuals' lives and their living environments. The combined efforts of occupational therapists, patients, and their families result in transformative outcomes—allowing individuals to regain lost abilities, adapt to new challenges, and rediscover a sense of purpose within the comfort of their homes.[3][4]


As the interdependent relationship between occupational therapy and home health care continues to evolve, its impact on the lives of individuals remains a testament to the power of personalised care and the pursuit of independence.[4][6]

Conditions Managed at Home[edit | edit source]

OT in home health care provides services for the following conditions for patients:

Musculoskeletal and Orthopaedic conditions: Occupational therapists address conditions such as fractures, joint replacements, and injuries that affect mobility and range of motion. They design personalised rehabilitation plans to restore strength, coordination, and functional mobility, enabling patients to navigate their homes with confidence.[7]

Neurologic conditions: OT in Home health care assists individuals recovering from stroke, traumatic brain injuries, dementia,[4] and other neurological disorders. By targeting fine motor skills, balance, and cognitive function to help regain control over their lives and daily routines.[4]

Paediatric developmental delay: OT in home health involves working with the child, the parent, and the family unit[8]—the paediatric population with developmental delays—by fostering age-appropriate skills. Through play-based interventions, therapists enhance sensory integration, motor coordination, and social engagement, ensuring children reach their developmental milestones.[8]

Occupational Therapy Assessment[edit | edit source]

Occupational therapy practises have a person-centred approach and carry out their practice based on evidence (evidence-based health care).[9]

Occupational therapists use clinical history, observation, interviews, standardised testing, and assessment of daily living, work, and leisure skills to identify individuals with impairments, functional limitations, and disabilities.[10] The outcome of these is used to design an individualised treatment plan, performed under the supervision of a skilled, qualified occupational therapist. OTs conduct home assessments to identify any deviations from normal and enhance patients' safety and independence. Implementation of recommendations is crucial for the success of therapy interventions.[10]Some of the assessment tools used in home health include, but are not limited to:

  • Non-standardized assessments: general observation, assessment of activities of daily living, observation of home safety, fall risks, and transfer [3][10]
  • Measures of occupational performance: assessed using the Barthel Index or modified Barthel Index and the Functional Independence Measure[3]
  • Measures of cognition: Mini-Mental State Examination, Saint Louis University Mental Status Exam, Montreal Cognitive Assessment, Allen Cognitive Level Screen Assessment, Short Blessed Test, and Test of Visual-Motor Integration [3][11]
  • Measures of mobility and balance: Timed-up-and-go test, functional reach, Tinetti Balance Test, Berg Balance Scale, Fall Efficacy Scale, and Activity-specific-Balance Confidence Scale[3]
  • Measures of body structure and function: Grip strength, Manual Muscle Testing, Range of Motion, Hole Peg Test, and, 2-minute Step Test[3]

Treatment Approaches and Techniques[edit | edit source]

Assistive device training and education: Occupational therapists often recommend and train individuals in the use of assistive devices such as adaptive utensils, dressing aids, and mobility aids like walkers or canes. These tools enable individuals to perform tasks that might otherwise be challenging due to physical limitations.[3]

Adaptive strategies and activities of daily living retraining. OT develops creative solutions to enable individuals to adapt to daily tasks. These strategies might include modifying how tasks are completed, breaking down activities into manageable steps, or teaching energy conservation techniques to enhance efficiency.

Cognitive strategy: For individuals with cognitive impairments, OTs employ memory-enhancing techniques, problem-solving exercises, and cognitive training activities to promote mental acuity and support independent living

Fall prevention and home safety strategies: The home environment is assessed for safety and accessibility. Occupational therapists suggest modifications such as installing grab bars, ramps, and handrails to minimise the risks, ensure individuals can navigate their homes with ease, and facilitate functional mobility transfer

Exercise programme: Occupational therapists develop tailored exercise routines that target specific functional goals. These exercises may focus on improving strength, balance, coordination, and range of motion, all of which contribute to enhanced independence.

Resources[edit | edit source]

References[edit | edit source]

  1. Raymond MH, Feldman DE, Demers L. Referral Prioritization in Home Care Occupational Therapy: A Matter of Perspective. Canadian Journal of Occupational Therapy. 2020 Jun;87(3):182-91.
  2. Rexe K, Lammi BM, von Zweck C. Occupational therapy: Cost-effective solutions for changing health system needs. Healthcare Quarterly. 2013 Jan 1;16(1):69-75.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Liu CJ, Burch H, Glover S, Donofrio A, Oliveros G, Demeo G. CURRENT PRACTICE PATTERNS IN HOME HEALTH OCCUPATIONAL THERAPY. Innovation in Aging. 2022 Nov 1;6(Supplement_1):708-.
  4. 4.0 4.1 4.2 4.3 Bennett S, Laver K, Voigt-Radloff S, Letts L, Clemson L, Graff M, Wiseman J, Gitlin L. Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ open. 2019 Nov 1;9(11):e026308.
  5. Avera Health. Bringing Occupational Therapy to Patients at Home - Medical Minute. Available from: http://www.youtube.com/watch?v=https://www.youtube.com/watch?v=9Ijq1mw20_s 29/08/2023]
  6. De Coninck L, Bekkering GE, Bouckaert L, Declercq A, Graff MJ, Aertgeerts B. Home‐and community‐based occupational therapy improves functioning in frail older people: A systematic review. Journal of the American Geriatrics Society. 2017 Aug;65(8):1863-9.
  7. Clark BM. Rheumatology: 9. Physical and occupational therapy in the management of arthritis. CMAJ. 2000 Oct 17;163(8):999-1005.
  8. 8.0 8.1 Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian occupational therapy journal. 2019 Jun;66(3):258-73.
  9. Harper KJ, McAuliffe K, Parsons DN. Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review. Australian Occupational Therapy Journal. 2022 Oct;69(5):599-624.
  10. 10.0 10.1 10.2 LCD - Home Health Occupational Therapy (L34560). (n.d.). https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34560
  11. Manee FS, Nadar MS, Alotaibi NM, Rassafiani M. Cognitive assessments used in occupational therapy practice: A global perspective. Occupational therapy international. 2020 Aug 26;2020:1-8.