10/11/2025
Round 2 ding ding đïž
UNPOPULAR OPINION #2
This is probably going to go down like a lead balloon - but hear me out.
Occupational Therapists (OTs) are highly skilleded allied health professionals who help people of all ages perform daily activities and live more independently. They assess functional limitations from illness, injury, or disability and provide therapy using techniques and equipment to improve a person's ability to participate in daily tasks like self-care, work, and leisure activities. OTs work in many settings, including hospitals, schools, and homes, and can help with a wide range of issues, from physical and developmental challenges to mental health concerns.
This works well when the limitation to function is stable or has a goal of improving. Expert input from an OT in the early stages of life-limiting or terminal diagnoses is wonderful.
However, the system as it stands hamstrings OTs and families in providing rapid access to aides and equipment when someone is in end of life care (approximately the last year of life) or terminal phase (last week/days/hours).
That is because caring for someone in end of life care is a changing landscape - with adjustments and new problem solving needed rapidly and usually âafter hoursâ.
Unless the family has the health and death literacy (and money!) to know what they need and access it, they can be faced with extremely long wait times for even simple pieces of equipment.
Last week, we had several clear examples of this with are service provider (who specialises in support for people at risk of homelessness) saying they were waiting 8months to get approval for a shower chair (approx $120 to buy). Now, if their clients had money, they could walk into an equipment shop and buy one.
We are aware of families who have purchased hospital beds, hoists, oxygen concentrators and simple 4wheel walkers because they knew that the system couldnât react in time.
âBut what if they buy the wrong thing? Surely it would be better to wait for the OT to see them?â
Yes - Iâm an ideal world where OTs werenât run ragged seeing people, preparing endless reports and fighting to get aides and equipment for their patients through NDIS or the new Support at Home program.
But as a very wise man once said - âYou can have it fast, free or perfectâŠ. Pick two!â
The gap between identifying a need and getting equipment delivered often is hours in end of life care. Never seen it happen that fast involving an OT.
When it comes to keeping people in their own homes for their last days, palliative care services are very good at reminding the clinical team at large that if the person has the capacity to make the decision to use a ramp that is 3 degrees too steep and understands the potential issues - then it is no oneâs business but the person.
Itâs called âdignity of riskâ.
Another handy phrase is âbetter than nothingâ.
If you can loan someone a wheelchair that might not be what the OT has suggested but gives that person the ability to get to his grandsonâs footy grand final for the last time - that is better than them missing out and respecting their dignity of risk.
âOh but sheâs lifting him onto an office chair. So unsafeâ.
Yup - and they have probably lived that way for longer than you have been alive. All health professionals - including OTs can give advice and suggestions but they are not orders or law. They have ad much right to inspect and approve your fridge contents as they do in approving something you did to âmake it workâ when your loved one was dying
So, to wind up this rant for the one person who is still reading (Hi Mum!) - I would encourage everyone who works in health to have a think about what they would do for their loved ones if they couldnât access aides and equipment in a timely and affordable manner. Would you leave them sitting in a hospital bed (which costs the taxpayer upwards of $2,000 a day - just saying) OR would you move heaven and earth and accept something slightly less than perfect for those precious and ever changing last days?
Save our precious OTs for other areas - donât make them an extra hurdle for families to clear in end of life care
