Jana Ferma, pictured above, is an occupational therapist at VHA Home HealthCare. 

Occupational therapists (OTs) in homecare support individuals and families who are recovering from illness or injury, have chronic health conditions or disabilities, or are terminally ill. Although their roles are varied and complex, OTs help clients transition from hospital to home, safely manage activities of daily living and reduce future care needs.

A growing desire of Ontarians to ‘age in place’—combined with other factors including early hospital discharge rates and health human resource issues facing the entire homecare sector—have unfortunately led to an acute shortage of OTs.

As the wait times for OT services continue to grow, VHA Home HealthCare (VHA) recently launched a pilot project to support improving client access to occupational therapy. This was done through the creation of a Rapid Access Occupational Therapist (RAOT) role in the Central East region with a focus in Scarborough.

The RAOT role offers predictable income and centralizes some scheduling of client care for the OT. This is a unique approach that differs from current rehab models. Additionally, to support this position, a Rehab Program Assistant is first assigned to review and field referrals, as well as the initial scheduling and administrative work.

“We know that waiting for services has a measurable impact on a clients’ fall risk, the rate of physical and mental deterioration, lack of confidence in their abilities, as well as on caregiver burden,” said Punita Laurier, Rehab Supervisor and RAOT Lead at VHA. “The RAOT model allows a service provider to focus more directly on client care which, if expanded, has the potential to impact waiting periods.”

Jana Ferma, the occupational therapist who was hired in the RAOT role, joined VHA as a new graduate and OT registrant this past January.

“Referrals for clients in my region are sent directly to me based on specific inclusion criteria regarding their needs, such as home safety equipment, falls prevention, acute surgery recovery and several others,” said Jana.

Working with the Rehab Program Assistant, Neha Matharu, if a client meets the criteria, the visit is booked as soon as possible. Jana says that sometimes that’s even within the same day the referral is received, which has been such a relief for many clients and families.

“Although my clients do have high needs, these can generally be addressed within one to three visits. I am able to see a lot of clients in a day and in the workweek. I can make sure their home environment is as safe as possible, significantly reduce their fall risk with a bath aid or bedrail or prescribe a therapeutic surface to address painful pressure injuries,” Jana said.

As a new grad, this has also been an invaluable way for Jana to learn and develop her skills over time.

“The inclusion criteria, or which clients are eligible to be seen by a RAOT, is meant to be fluid,” Punita clarified. “We already added mechanical lifts to Jana’s services after she completed the required training. This flexibility will allow the role to evolve, grow and expand and I’m excited to see where it goes,” she said.

VHA has started to evaluate if this is something that can be sustained and the viability of expanding this pilot within Central East and other care areas where clients experience longer wait times. Overall, all groups involved reported high satisfaction with this model.

“After exploring the data, what was very clear is that the RAOT sees clients sooner than usual practice. In fact, during client calls, people commented that they were seen much faster than expected,” said Brydne Edwards, Quality Improvement and Evaluation Lead. “We have also seen decreases in missed care and waitlist numbers in the RAOT’s service area.”

“We have been facing a health human resource capacity crisis in all care sectors and professions for some time now and innovative solutions are needed. We need to find ways of delivering quality services across the care continuum. The RAOT model is a way for VHA to address the shortage of occupational therapists specifically as we work towards system change,” Brydne said.

This October, Punita Laurier and Brydne Edwards, on behalf of their co-authors Will Lomas and Jessica Hope, will be presenting these innovative findings at the Ontario Society of Occupational Therapists (OSOT) Conference.