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Veterans Affairs Health Care System

• Largest integrated US health care system
• Serve and honor our veterans
• Acts as own health insurance provider
• Accountable to
– Federal and state regulations
Occupational Therapy at a VA Hospice Setting – Hospital accreditation standards
Janice Kishi Chow, MA, DOT, OTR/L
Palo Alto Veterans Affairs Health Care System • Not reimbursed by Medicare
Boston University Pi Theta Epsilon Omicron Chapter Webinar Series
April 24, 2018

What is possible? Learning Objectives

• VA offers opportunity • What is hospice and palliative care?
– Expand use of occupation-based interventions • What is the value of occupation at the end of life?
– Provide innovative health care options • What is the value of occupational therapy?

– Meet growing needs of people with chronic and • What does occupational therapy look like on an
terminal illness inpatient VA hospice unit?

What is hospice and palliative care? What is the value of occupation?

Wellbeing Occupational
Jacques & Hasselkus,
2004
Challenge
Schultz & Schkade, 1992
Park Lala & Kinsella,2011
Curative Treatments

Palliative care to manage symptoms Hospice

Adaptation
Diagnosis <------------------------Palliative care-------------------------------------------> Death Mastery in context
Schkade & McClung,
2001
of decline
Bontje et al., 2004;
National Consensus Project [NCP], 2009; Yennurajalingam & Bruera 2011 Sviden et al., 2010

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What is the value of occupational

Effects of Dysadaptation
therapy?
Loss of Loss of Isolation and
Occupational Autonomy & Despondency
Roles Social
Membership
Keesing & Rosenwax, 2011 Keesing & Rosenwax, 2011 Keesing & Rosenwax, 2011;
Schultz & Schkade, 1992 Schleinich et al. 2008
Schultz & Schkade, 1992

What is the value of occupational What does OT look like at a VA

therapy? inpatient hospice unit?
Loss of Loss of Isolation and
Occupational Autonomy & Despondency
Roles Social
Membership

Occupational Relative Occupational

Challenge Mastery Engagement
Occupational Adaptation
Schultz & Schkade, 1992

Phases of Intervention Case Study

1: Client determines need for intervention.

2: Occupational Challenge Selection

Co-exist with dying (Hammill, Bye, & Cook, 2014)
Prepare for dying (Hammill, Bye, & Cook, 2014)

3: Occupational Adaptive Response Process

Phase 1 & 2

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Case Study

Phase 3

Outcomes Conclusion
• Occupational challenge at the end of life • Occupation engagement is essential

• Relative mastery • The VA offers opportunity to cultivate

occupation-based interventions
• Internalized adaptive response
• OT supports occupational engagement
• Meaningful new role
through an occupational adaptive process
• Well-being
• How we can further support occupation-based
• Legacy interventions throughout hospice care?

References
• Bontje, P., Kinebanian, A., Josephsson, S., & Tamura, Y. (2004). Occupational adaptation: The experiences
of older persons with physical disabilities. American Journal of Occupational Therapy, 58(2), 140-149.
doi:10.4014/ajot.58.2.140
• Centers for Medicare & Medicaid Services. (2015). Medicare hospice benefits. Retrieved from
https://www.cms.go/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c09.pdf
• Hallenbeck, J. L. (2003). Palliative care perspectives. New York, NY: Oxford University Press
• Hammill, K., Bye, R., & Cook, C. (2014). Occupational therapy for people living with a life-limiting illness: A
thematic review. British Journal of Occupational Therapy, 77(11), 582-589.
doi:10.4276/030802214X1415078348594
• Jacques, N. D., & Hasselkus, B. R. (2004). The nature of occupation surrounding dying and death. OTJR:
Occupation, Participation and Health, 24(2), 44–53. doi:10.1177/153944920402400202
• Keesing, S. & Rosenwax, L. (2011). Is occupation missing from occupational therapy in palliative care?
Australian Occupational Therapy Journal, 58, 329-336. doi:10.1111/j.1440-1630.2011.00958.x
• National Consensus Project for Quality Palliative Care. (2009). Clinical practice guidelines for quality

Questions or comments? •
palliative care, 2nd edition. National Pittsburgh, PA: National Consensus Project for Quality Palliative Care.
National Health Council. (2014). About chronic diseases. Retrieved from
jchow1@twu.edu http://www.nationalhealthcouncil.org/sites/default/files/NHC_Files/Pdf_Files/AboutChronicDisease.pdf

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References
• Park Lala, A., & Kinsella, E. A. (2011). A phenomenological inquiry into the embodied nature of occupation
at end of life. Canadian Journal of Occupational Therapy, 78, 246-254. doi: 10.2182/cjot.2011.78.4.6
• [Photograph of Palo Alto VA building 100]. Retrieved from www.paloalto.va.gov/locations/directions.asp
• Schkade, J., & McClung, M. (2001). Occupational adaptation in practice. Thorofare, NJ: SLACK
Incorporated.
• Schleinich, M. A., Warren, S., Nekolaichuk, C., Kaasa, T., & Watanabe, S. (2008). Palliative care
rehabilitation survey: A pilot study of patients’ priorities for rehabilitation goals. Palliative Medicine, 22,
822-830. doi:10.177/026921630896526
• Schultz, S. & Schkade, J. K. (1992). Occupational adaptation: Toward a holistic approach for contemporary
practice, part 2. American Journal of Occupational Therapy, 46(10), 917-925. doi:10.5014/ajot.46.10.917
• Spencer, J. C., Davidson, H. A., & White, V. K. (1996). Continuity and change: Past experience as adaptive
repertoire in occupational adaptation. American Journal of Occupational Therapy, 50(7), 526-534.
doi:10.5014/ajot.50.7.526
• Sviden, G. A., Tham, K., & Borell, L. (2010). Involvement in everyday life for people with a life threatening
illness. Palliative and Supportive Care, 8(3), 345-352. doi: 10.1017/S1478951510000143
• US Department of Veterans Affairs (2018). Providing health care for veterans. Retrieved from
https://www.va.gov/health/
• Yennurajalingam, S. & Bruera, E. (2011). Research in terminally ill patients. In S.Yennurajalingam & E.
Bruera (Eds.), Oxford American handbook of hospice and palliative medicine, (pp. 439-447). New York, NY:
Oxford University Press.