Occupation at the heart of Occupational Therapy Home Based Memory Rehabilitation

Blog1

A little about my past

My name is Gail Boniface. I used to work in Cardiff University running its postgraduate Occupational Therapy programme. When I taught students, I was always telling them about the occupation in Occupational Therapy. They probably got fed up with me banging on about that, but I used to think back to when I left my own course with a lot of knowledge of anatomy, physiology, psychology, psychiatry and crafts, but little idea of what the profession actually was or for that matter how to be an Occupational Therapist. Despite having gone through three years of an Occupational Therapy programme, I found I had to work out for myself what the essence of Occupational Therapy was. I was also a little taken aback when other professionals asked me to explain the profession to them. When I became a lecturer on Occupational Therapy courses, I had to teach students about Occupational Therapy and was given the job of translating a beautifully written, theoretical course into practice. I was actually delighted to find that the new curriculum contained a lot of the theory of the profession. I was equally delighted to find that I now had access to this (admittedly mostly United States) theory. Therefore my “banging on”’ about occupation to students, stems from the fact that during my own Occupational Therapy course, I did not know this theory existed. My “banging on” became my attempt to instil an understanding of their profession in the students, not just knowledge of other professions’ theory or discrete skills. Therefore, I think you can begin to tell from this, that I also feel very strongly that if we really want to be regarded as a profession we need to be clear as to what our own profession specific knowledge actually is. And yes, that does include that anatomy, physiology, psychology, psychiatry and sociology: But those to me are the things that help us to make sense of occupations. So, it is the understanding of occupational theory (and now occupational science) that we need to make sure is at the front of our thinking and acting as Occupational Therapists.

What’s all that got to do with a blog post for Alzheimer’s Scotland I hear you ask?

Well allow me to tell you. I left Occupational Therapy lecturing in order to take up a post in the Community Dementia Team based in the Lorn and Islands Hospital Oban. This post is part time (but not very – as one of my previous colleagues pointed out to me) and started off with me engaging in the team-based assessments, Occupational Therapy daily living assessments and the occasional minor adaptation (I had previously been an Occupational Therapist in Social Services –so I knew the ropes on that one). All this was quite satisfying, but somehow not completely so. Then along came the opportunity to join in on something called at that time the Home-Based Memory Rehabilitation Programme (now called Occupational Therapy Home Based Memory Rehabilitation). This is an intervention process which investigates what occupations are important to a person and introduces and encourages a person to use memory-based strategies to enable them to continue with their valued occupations. The strategies are:

  • Writing a “My Memory Book”
  • Remember where you have put something
  • Remembering something you have to do
  • Remembering what people have told you
  • Communication
  • Keep your brain active
  • Out and about

The Occupational Therapist can choose the most appropriate strategies, tailor them to suit the person and engage in what I would call real Occupational Therapy and can then write an occupationally based intervention plan with the person they’re working with.

The exciting thing for me about this was that it is so very clearly occupation based and highly person centred; with the Occupational Therapist not only able but encouraged to personalise the intervention. My previous experience of working with people with memory issues and dementia had been that there was little hope, little engagement in occupations and an emphasis on what was being lost, rather than what was being retained and engaged with. Occupational Therapy Home Based Memory Rehabilitation, for me, brings the emphasis back onto what the person with the memory problems CAN do, rather than how much their memory had deteriorated. Via Occupational Therapy Home Based Memory Rehabilitation the discussion and action is around the things the person does, how they enjoy those things and working on strategies to enable them to keep doing those things. This then brought to mind that views of the professional body that: “Occupational Therapy enables people to achieve health, well being and life satisfaction through participation in occupation.” (COT 2015:2 also quoted by the WFOT in 2017). Thus by, for example, asking someone to write down the things that they do over a few weeks or so, the person can be reminded of what they enjoy doing, remember what they have done and talk about it with other people – that is how I use the “My Memory Book” strategy.

I often use a medication prompt in the strategy around ‘remembering something you have to do’ part of Occupational Therapy Home Based Memory Rehabilitation and try very hard to encourage the person to take responsibility for their own medication (within reason of course). Therefore, I was delighted working with someone on organising taking their own medication, when they took my checklist from me and rewrote it in a way which made sense to them. Alright, we will need to keep repetitiously working on remembering how to take the medication, but the person now owns that process, not me. This means that instead of emphasising how that person cannot take care of their own medication, we are working out how they CAN be helped to do it for them self. The process has become more positive and person centred along the way.

By engaging myself with Occupational Therapy Home Based Memory Rehabilitation, I have been able to really work with people on their valued occupations as well as their discrete skills and have consequently been able to avoid this pitfall:

“sometimes occupational therapy so heavily emphasizes performance components that it ceases to be occupational in terms of the client’s perceptions”

(McLaughlin Gray 1997:354)

Blog1

References

McLaughlin Gray J 1997 Putting Occupation into Practice: Occupation as ends, occupation as means AJOT May 1998 Volume 52, Number 5 354-364

World Federation of Occupational Therapists 2016 Definition “occupation”. Forrestfield, AU: WFOT. Available at: http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx accessed 22.10.2019

World Federation of Occupational Therapists 2017 Definitions of Occupational therapy from Member organisations: https://wfot.org/resources/definitions-of-occupational-therapy-from-member-organisations accessed 1.07.2019

Contributor

Blog4

Dr Gail Boniface, Occupational Therapist, Community Dementia Team based in the Lorn &  Islands Hospital Oban

My top tips to blog writing & new blogs for 2020

Blog1

Discussion or informational site published on the World Wide WebA blog is described as “a discussion or informational website published on the World Wide Web consisting of discrete, often informal diary-style text entries (posts). Posts are typically displayed in reverse chronological order, so that the most recent post appears first, at the top of the web page”.

There are many benefits of writing a blog.  It provides the perfect opportunity to share the work of the allied health professionals, extending the AHP reach in talking about their work while also helping others gain a better understanding of our role and at the same time emphasis our integrated working with other key partners and health care and social care practitioners. Despite the many benefits of blogs, I also know, when I invite people to write a blog, they are often not sure how to get started so I thought I would share my top tips to blog writing.

  1. Identify your audience. When sitting down to write a blog, I find it helpful to think about who your audience is and write it as if you are talking to them……….
  2. Be creative. You can also develop your blog in creative ways through the use of photos, small videos, inforgraphics, it does not always have to be the written word
  3. Be you. Be real. Be authentic. As well as sharing your ideas and expertise, write with compassion and from the heart.
  4. Appraise other blogs. Have a look at other blogs to get ideas on style and content that you like. We shared our top ten blogs in 2019, have a look at these to see what you think https://letstalkaboutdementia.wordpress.com/2020/01/02/lets-talk-about-dementia-your-top-10-blogs-of-2019/#respond
  5. Start a conversation. Ask discussion questions at the end, maybe no more than three e.g tell us what you think? what did you like?, what would make it better? Questions to invite comments on your blog & begin the conversation …….
  6. Start writing today. Be bold, be brave and start writing your first blog post for 2020……..

Connect with us in 2020

We have some exciting new blogs posts planned for 2020 at “Let’s talk about dementia” including

  • A monthly blog by our @alzscot nurse consultants @AlzScotDNC starting with Sandra from @NHSGGC
  • We will be sharing 5 short film clips from a range of allied health professionals who work with people living with #dementia, sharing their work and proudly saying

“I am an allied health professionals & I know I make a difference to people’s lives every day”

  • Blogs on the 24-month impact report of Connecting People, Connecting Support in action that will be launched on the 2th February 2020. (www.alzscot.org/ahp)
  • A guest blog by @FionaMacNeill on engaging and effective leadership
  • A blog talking about occupation at the heart of occupational therapy home based memory rehabilitation by Dr Gail Boniface

Please let us know what other blog posts you would like to see in 2020.

To continue to join the conversation and read about what our contributors have to say, go to www.alzscot.org/talking_dementia and enter your email address to get new posts by email every Thursday at 8am.   You can also follow on Twitter @AHPDementia and @elaineahpmh.

We would welcome your positive comments and feedback about how to make this blog useful to you and it would be great if you could comment on items we post. If you would like to post a blog get in touch at ehunter@alzscot.org

Thank you for your continued support and we look forward to connecting with you in 2020.

Contributor,

Elaine Hunter @elaineahpmh

National AHP Consultant, Alzheimer Scotland

Blog3

Let’s Talk about Dementia – Your Top 10 blogs of 2019

In no particular order, in this week’s blog we are sharing YOUR all-time Top 10 blog posts of 2019 for you to have a final read & please add any comments to the blog posts.

Blog1

1. How a dementia dog changed my life: by talkingdementia Dementia Dog Project by Henry Rankin in September 2019

Dementia Dog Project is an innovative partnership project with Alzheimer Scotland. The project supports families living with dementia, both at home and in community settings. You may have seen their recent campaign to make sure new families are matched with a dementia dog through the #InThePictureCampaign

https://letstalkaboutdementia.wordpress.com/2019/09/19/how-a-dementia-dog-changed-my-life/

2. Occupational Therapy Home Based Memory Rehabilitation in Scotland – an update by Alison @AliAHPDem January 2019

The start of a new year is usually a time for reflection and thinking about the year ahead. I have been reflecting on the work I have been involved in around enhancing access to the skills of the AHPs in the post diagnostic period (as per Ambition One of Scotland’s AHP dementia policy, Connecting People, Connecting Support, 2017). Part of this work includes the Occupational Therapy Home Based Memory Rehabilitation (HBMR) Programme.

https://letstalkaboutdementia.wordpress.com/2019/01/17/occupational-therapy-home-based-memory-rehabilitation-in-scotland-an-update/

3. Supporting post diagnostic support in NHS Lanarkshire by Gill  @MHOTGill &  Maureen @CossarMaureen

NHS Lanarkshire were keen to make post diagnostic support (PDS) information more accessible to people living with dementia and their families and carers. It was agreed an online resource, that was primarily for use by the person with dementia, but open to everyone would be designed.

https://letstalkaboutdementia.wordpress.com/2019/06/13/supporting-post-diagnostic-support-in-nhs-lanarkshire/

4. Setting up a Cognitive Stimulation Therapy group – experiences of an occupational therapy student by Nicholas, Occupational Therapy student, January 2019

I am nearing to the end of my whirlwind 6-week occupational therapy placement with Alzheimer Scotland and it’s been excellent, but a very quick experience.  I’ve been told that the best placements always go the quickest. My main task while on placement has been to offer two separate cognitive stimulation therapy groups for people with dementia at a day care centre.

https://letstalkaboutdementia.wordpress.com/2019/01/24/setting-up-a-cognitive-stimulation-therapy-group-experiences-of-an-occupational-therapy-student/

5. Allied Health Professionals in Children and Young People’s Services: The missing link for CYP in Scotland #AHPsDay #AHPsDayScot by Pauline @NatLeadAHPCYP, October 2019

What is the most important conversation we need to have for children and young people’s (CYP) health and wellbeing outcomes in Scotland? Three years on from the launch of Ready to Act (Scottish Government 2016) I feel a real sense of urgency. Urgency to inspire as many radical conversations as possible about improvement, innovation, challenge of the status quo & opportunities to forge as many trust based relationships with families and with our partners in making Scotland the best place for our CYP to grow up.

https://letstalkaboutdementia.wordpress.com/2019/10/16/allied-health-professionals-in-children-and-young-peoples-services-the-missing-link-for-cyp-in-scotland-ahpsday-ahpsdayscot/

Blog2

6. My journey to becoming a Dementia Champion by Fiona @Fiona_OTAHP July 2019 by talkingdementia

Hello this is my first ever blog but I was interested to share with you my experience of being a dementia champion as an Allied Health Professional.  Let me set the scene, I am a Band 6 Occupational Therapist with over 23 years of practice, predominantly working with older people in a number of settings.

https://letstalkaboutdementia.wordpress.com/2019/07/18/my-journey-to-becoming-a-dementia-champion/

7. Practical Tips to help my Memory Booklet by Gill @MHOTGill October 2019 by talkingdementia

As Occupational Therapists working in Older Peoples Psychiatry, we noticed that the majority of people diagnosed with Mild Cognitive Impairment (MCI) at the Out-Patient clinics were either reviewed again in a year or discharged from the clinic. Although some people were referred to Occupational Therapy, if they had indicated that they would be interested in taking part in a self-directed memory management programme, many more left with nothing other than their diagnosis.

https://letstalkaboutdementia.wordpress.com/2019/10/24/practical-tips-to-help-my-memory-booklet/

8. Occupational therapy- moving from too little, too late to right time, right place by Karin @RCOT_Karin January 2019 by talkingdementia

The Royal College of Occupational Therapists have been working with Alzheimer Scotland and a group of specialist occupational therapists to consider how we can share occupational therapy expertise more widely. Too often services are designed to only be accessed when people require specialist help. It makes sense to focus a resource such as occupational therapy around people with the most complex needs but many people living with dementia would benefit from strategies, techniques and technology that could be used at an earlier stage that would either prevent or reduce some of this complexity. Could moving away from a 1:1 model of care delivery to freeing occupational therapists to adopt a public health approach be the answer?…….

https://letstalkaboutdementia.wordpress.com/2019/03/14/journeying-through-dementia-designing-post-diagnostic-support-with-people-with-dementia/

Blog3

9. Journeying through Dementia Designing Post Diagnostic Support with People with Dementia by Claire @Lab4Living March 2019

I first met James McKillop back in 2001, not long before the publication of his book, ‘Opening Shutters, Opening Minds’. We shared a love of photography and had a similar sense of humour. It was James who introduced me to the Scottish Dementia Working Group (or Working Party as it was called then). I was inspired by their philosophy, by their work and what they had achieved in a relatively short time but at the same time remember feeling very challenged as an occupational therapist to why we were not learning from this in other areas of practice……

https://letstalkaboutdementia.wordpress.com/2019/01/31/occupational-therapy-moving-from-too-little-too-late-to-right-time-right-place/

10.  My Dementia Champion Journey – Part 1 by Susie August 2019

As an Orthotist working within NHS Greater Glasgow and Clyde (GGC) there is scope to work with patients of all ages, however, I have particularly enjoy working with older people the most.  I really welcome their wisdom and learning about their lives is especially fascinating….

https://letstalkaboutdementia.wordpress.com/2019/08/29/my-dementia-champion-journey-part-1/

Blog4

Let’s talk about dementia, a weekly blog

Blog1

Our weekly blog was launched in June 2014, hosted and supported by Alzheimer Scotland and led by Elaine Hunter, national allied health professional consultant at Alzheimer Scotland. To date we have posted 320 blogs, reaching over 140 countries including Nepal, Finland, Singapore, USA and the UK. In this week’s blog I am sharing a brief overview of the blogs in 2019 which have included:

  • Sharing AHP students practice placement experience in Alzheimer Scotland from art therapy, occupational therapy and physiotherapy students
  • 6 blogs by the Scottish Dementia Working Group, co-written with our Alzheimer Scotland occupational therapy intern
  • a “blog a day” during dementia awareness week (Scotland) and national AHP day
  • blogs from Royal College of Occupational Therapy, College of Podiatry, Alzheimer Scotland nurse consultants, the Weekday Wow Factor and as far afield as Singapore
  • 6 blogs sharing our national AHP WeBEX’s
  • blogs sharing the AHPs contribution to post diagnostic support including online resources and technology
  • 4 blogs sharing projects as an outcome from the AHP MSc module on rights-based practice
  • Sharing the work from a range of AHPs including speech and language therapy, podiatry, dietitians, physiotherapy, occupational therapy and for the first time ever, an orthotist, all talking about dementia.

Have a look out for next week’s blog when we are sharing YOUR all-time Top 10 blogs of 2019. All that is left for me to say, in our last blog of 2019, is thank you to all our blog contributors and all our blog readers. Keep following and supporting us in 2020 so we can keep talking about dementia.

Blog2

Contributor, Elaine Hunter @elaineahpmh

Blog3

Keeping well this winter: A checklist to help you stay healthy

Winter can bring its own set of challenges instead of additional challenges with fewer hours of daylight, poor weather conditions and increased risk of illness.

Below is a checklist to make sure that you are prepared for the change in season.

  • Ask your GP practice about the flu jab. It’s freely available to people over the age of 65, and to many adults with pre-existing health conditions, between October and March.
  • During winter months the risk of a power cut increases so have a big torch available in an easy-to find place and keep an extra supply of batteries.
  • Order any medication in advance of your GP practice closing for the festive period.
  • Ensure you have a supply of warm, nutritious meals and freeze any extras – these will be easy to heat up quickly.
  • Wear extra layers of clothing and keep extra blankets at home to keep you warm.
  • Check that your central heating is in working order and turn the temperature up slightly higher for the winter months.
  • Have a pair of winter shoes or boots that have a strong grip. This will reduce your chances of slipping on ice or snow and have a hat, gloves and a scarf available too. Keep them close to the door as a visual prompt to put them on before you leave.
  • Have important contact numbers close to hand such as relatives, friends or services (for example a heating engineer or plumber) should anything essential fail like your heating or cooker. alzscot.org/useful-products may have some helpful products to help you keep this information handy.
  • Find out about what support and services are available in your local area. Alzheimer Scotland has a wide range of community support and there are lots of other charities and organisations also available where you have the opportunity to chat with others and have a bite to eat in a warm, sociable environment.
  • During winter months the risk of a power cut increases so have a big torch available in an easy-to find place and keep an extra supply of batteries.

If you need medical advice during times when your GP’s surgery is closed, NHS24’s freephone helpline is available 24 hours a day. Just call 111. Alternatively, call our 24 hour Freephone Dementia Helpline on 0808 808 3000. 

Contributor Tilda McCrimmon, Alzheimer Scotland Dementia Nurse Consultant, NHS24 and Golden Jubilee Foundation and Dr. Barbara Sharp, Policy and Practice Advisor, Alzheimer Scotland

This checklist was originally published in Dementia in Scotland Winter edition 2019 can you can see the full magazine here.