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Personal Assistance Services: Occupational Therapy's Role and Responsibility to Support Self-directed Living

Personal Assistance Services: Occupational Therapy's Role and Responsibility to Support Self-directed Living
Rita Fleming-Castaldy, PhD, OTR/L, FAOTA
May 20, 2015
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Learning Objectives

For today, my focus will be to help you identify the conceptual foundations of self-directed personal assistance services and their congruence with occupational therapy’s commitment to participation and quality of life.  As I will talk about later, it is one thing to be able to get people to do things on their own, but many of our clients are not able to do many things on their own, and they rely on personal assistance services.  Without personal assistance services, often their quality of life is impaired and participation is not enabled.  My focus is to help everyone understand that link between personal assistance and the goals of OT. 

The other thing I want to talk about is that relationship between personal assistance services and family and work life balance.  We talk about quality of life and balance in occupational therapy.  How do we help people actually attain that through the use of personal assistance services?  How do we help relieve caregiver strain and burden and increase self-directed living and improve life satisfaction? 

I will also talk about why people need this and the different modes of service delivery that are available for participants to be cognizant of the choices.  I will also talk about some pragmatic strategies for integrating personal assistance services throughout the OT process so we can support life balance, empower people, and enable well-being for clients and their families.  Those are our goals today. 

Participation and Life Balance

These are two key components of occupational therapy.  As Moyers and Dale (2007) stated, OT’s unique purpose as a profession is “facilitating participation of all ages in their chosen occupations and activities, and designing contexts, environments and policies for individuals and communities that recognize and support differences in opportunities for participation.”  That is one of the key differences when someone has to rely on other people to help them with their basic activities of daily living.  It impedes participation.  How do we design contexts, environments and policies that support personal assistance services, which then enable participation?  That is a key focus of OT.  Matuska and Christiansen (2008) defined a balanced lifestyle as a “satisfying pattern of daily activities that is healthy, meaningful and sustainable to an individual within the context of his or her current life circumstances.”  I added the italics to the word sustainable because often that is the one thing that is a concern when you need long term personal assistance services.  How do we sustain this over time?  Families are often able to do things on a short-term basis when someone has a hip replacement, for example.  However, when someone has a long-term disability that is not going to be remediated, the sustainability of maintaining that pattern of daily activity can become a strain on families when looking at the context of someone’s life circumstances and the permanence of needing personal assistance service.  

Challenges to Participation

The literature tells us that people seek stability and routine in their lives, but that can be very elusive, and even small changes within one’s daily routine could have wide range implication.   An upset in one member’s routine can have an effect on the entire household.  There are changes in routine that have to be adjusted around the person’s need for personal assistance services.  The other thing in contemporary Western society, which the United States exemplifies, is that we do not have enough time to meet life’s routine demands, engage in desired activities, and rest and sleep.  This leads to increased stress.  Now with so much technology, people are not even walking away from their jobs.  People used to go to work, go home, and focus on family.  But now, it is go home, focus on family and in between check emails, respond to text messages, and complete a report to send back to someone.  This adds to the perception that there is not enough time.  

 

Figure 1.  My brother Kevin.

Learning Objectives

For today, my focus will be to help you identify the conceptual foundations of self-directed personal assistance services and their congruence with occupational therapy’s commitment to participation and quality of life.  As I will talk about later, it is one thing to be able to get people to do things on their own, but many of our clients are not able to do many things on their own, and they rely on personal assistance services.  Without personal assistance services, often their quality of life is impaired and participation is not enabled.  My focus is to help everyone understand that link between personal assistance and the goals of OT. 

The other thing I want to talk about is that relationship between personal assistance services and family and work life balance.  We talk about quality of life and balance in occupational therapy.  How do we help people actually attain that through the use of personal assistance services?  How do we help relieve caregiver strain and burden and increase self-directed living and improve life satisfaction? 

I will also talk about why people need this and the different modes of service delivery that are available for participants to be cognizant of the choices.  I will also talk about some pragmatic strategies for integrating personal assistance services throughout the OT process so we can support life balance, empower people, and enable well-being for clients and their families.  Those are our goals today. 

 

rita fleming castaldy

Rita Fleming-Castaldy, PhD, OTR/L, FAOTA

Dr. Fleming-Castaldy is an Associate Professor in the occupational therapy department at the University of Scranton. She has edited several seminal texts, authored numerous text chapters and journal articles and presented nationally and internationally on a diversity of professional issues. In her written work and presentations, Dr. Fleming-Castaldy combines her personal experience as a long-term family caregiver with her OT professional expertise to promote OT’s role in ensuring that all persons with disabilities are able to pursue meaningful occupations within their environments of choice. In 2002, she received the honor of being named a Fellow to the American Occupational Therapy Association for innovation and leadership in education and advocacy. Many of Dr. Fleming-Castaldy's works are referenced under her former name of Fleming Cottrell.



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