Making a

DIFFERENCE

Susie Lowden discusses the positive impact an occupational therapist can bring to patients and their loved ones under hospice care

“T hat must be really depressing.” I hear this a lot, people think working in a hospice is going to be sad and upsetting, but that couldn’t be further from the truth. I started off my career several years ago, as many do in a hospital, rotating through the various wards and departments to get a rounded experience of OT life. To further my knowledge base, I then spent some time working within a mental health setting, which helped me understand the cognitive challenges our patients face as well as the physical. This set me up nicely for a role in social services which I found myself in for a decade. I loved how varied and different each day could be, with each client bringing their own set of problems and difficulties to solve. It was during this time that I had my first encounter with what I would consider an ‘end of life’ experience. This was a brand-new experience for me, and I spent several hours working with the family with practical tasks, moving furniture, getting a profiling bed in place and making the patient comfortable. I ended that working day feeling like I’d made an immediate and significant impact on that patient and their loved ones’ lives. At the end of that day, I went home and looked up palliative care jobs. That was the beginning of a whole new chapter in my career.

AN OT’S ROLE IN A HOSPICE

I’d never stepped foot in a hospice myself; I’d always assumed it was a place where people go to die. I didn’t think there would be a role for an OT in this setting.

I was lucky that I had a cousin who was a physiotherapist working in hospice care, so spent many hours on the phone to her trying to understand the role of allied health professionals in hospices. I learned that hospice care is not just the last few days or weeks of life, but rather it is also about working with the patient over months to help them with symptoms, house preparations and supporting families in a fully holistic way. HOSPICE IN THE WEALD

I started working at the Hospice in the Weald over six years ago and I work with some of the most amazing and kind-hearted people. The hospice cares for patients in the last year of life, and their loved ones, across our In-Patient Ward, Living Well Service, Hospice Outreach Service (seeing patients in their own homes), Counselling and Support, and Cottage Hospice (a pioneering service to support patients and their carers to die in a more supported location which feels like a home from home). We will also launch our first service for children in 2022. The occupational therapy team covers all services at the hospice, which does mean a lot of travel across the large catchment area, but also brings with it a great deal of variety. We see patients at all stages of their time under the hospice - we could be providing simple equipment to enable someone to continue bathing or assist with toileting; we might be helping them to manage their fatigue; or we might be seeing people through to end of life care when we could be providing hospital beds and complex moving and handling equipment. Our days need to be flexible and can be unpredictable. People’s needs can change quickly, and rapid assessment and provision can have a big impact on the type of death someone has. Since working at the hospice, I have seen firsthand how a “positive death” can have such a big impact on the patient themselves, but also the family and friends left behind, but what does a “positive death” look like? Of course, patients want to be free from pain so working with them using medication, looking at positioning and complementary therapies, are all things the hospice can offer to ensure they are comfortable. It is important to support patients and those important to them with coming to terms with their diagnosis, preparing them for potential changes and deterioration, and to support them emotionally and spiritually. We have probably all experienced bereavement in some form, and often our memories go back to the last few months with loved ones. OTs can enable people to create memories and enjoy their time together, allow wives to be wives and husbands to be husbands rather than just a carer patient relationship. We can help make transfers easier so they can still go out, or at least sit out of bed and enjoy their gardens. I remember one patient I visited was staying on our in-patient ward, she was in bed due to a pathological fracture of her femur, but we managed to to get her out of bed using a Sara Stedy transfer aid. When looking at discharge planning, the family talked about how much they loved going to the beach, but it wouldn’t be possible to get their mum in the car. We ordered an Ambiturn transfer aid and then worked with the patient and her husband to practice this transfer whilst putting no weight through her affected leg. It worked well and within a few weeks we had a letter to tell us about all the lovely trips they had been on! I know a lot of people panic at the mention of referral to a hospice, because of common misconceptions about what we do. A hospice can help a family to navigate the many health professionals involved, help to manage the symptoms that people may experience, and ensure that people are supported in making the right choices for them. Occupational therapists play an integral part of people’s hospice experience, and make a real difference to people and families at the end of life.