Grab and Go: Redesigning a service delivery model for community-based minor home modification practice

Ainsleigh Whelan1, Jessica Moller1
Gippsland Lakes Complete Health1

ABSTRACT

Background or Problem/ Issue:

Home modifications adapt the home environment to enable individuals to function with maximum independence (Law et al., 1997). Minor home modifications are defined as simple non-structural changes to a home such as installing grab rails in the shower and toilet, installing a hand-held shower, and removal of mats which can cause trip hazards.

People with a disability and/or people who are aging often require home modifications to improve their safety, enable independence and for support services to be provided in their homes. Occupational Therapists (OTs) play a key role in designing modifications and delivering home modification services via government schemes. There are significant workforce shortages in Rural Health settings that confound access and reduce the availability of OT services.

In a rural area ensuring that services are efficient and available is important as waitlists cannot close, and minor home modifications services needed to improve efficiency to meet the needs of the ageing community.

Allied Health Assistant delegation models of practice are used to ensure clinician efficiency, and this workforce redesign project focussed on introducing AHA support for minor home modification processes.

Method or What you did?

This workforce redesign project is influenced by the Specific and Timely Appointment for Triage (STAT) model Developed by Eastern Health in partnership with LaTrobe University and DHHS (Harding et al. 2018).

The community OT diaries have been redesigned to have a designated home visiting day for minor home modifications which was termed “rails clinic”.

Clients received an initial telephone screening appointment prior to receiving face-to-face home visits. If a client was identified through this screening as requiring minor modifications only, they were placed into the “rails clinic”. Appointments in the clinic are brief between 60-90 minutes and limited to a maximum of 4 clients each day to enable sufficient time for documentation of clinical notes and travel.

A clinician is allocated to this clinic each week covering a different geographical area.

An AHA directly supports the OT, whereby they prepare the related administration  from the office, whilst the OT is at the clients homes. Communication is via remote technologies for direct sharing of photographs and measurements taken during the visit.

Results or Outcomes:

This clinic clustering model enables a greater volume of clients to be serviced for a similar assistive technology sub-type, with flow-on benefits for clinicians and clients.

This service model has been operational for 6 months with post home modification survey outcome data to be presented from clients who received this service.

Qualitative feedback from therapists delivering the “rails clinic” will also be presented.

Conclusions or Practice Implications:

Implementing a minor home modification “clinic” model improved client flow through the OT community home visiting service. Clients were grouped into geographical location which improved therapist efficiency and reduced travel time. Allied Health Assistant training and delegation in basic concept drawing reduced paperwork burden on clinicians, thereby supporting more clients to have timely access to an occupational therapy service.


BIOGRAPHY

Ainsleigh is the Senior lead Occupational Therapist at Gippsland Lakes Complete Health. Ainsleigh has broad experience and enjoys redesigning services to improve client care.

Jess is an Occupational Therapist who has been working in public community health settings in Victoria for the past 7 years.

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