OTpall

Welcome to OTpall !

Your "pall" in all things OT and end-of-life care.

OTpall is a free-to-access, online resource for OT practitioners looking to learn more about OT's role in hospice and palliative care and develop a sense of confidence and competence when working with seriously ill clients.

Whether you're currently working in an end-of-life setting, working in another setting where your clients have serious illness diagnoses, or are simply interested in learning more about OT's role, OTpall is here to support you.

When putting together this collection of resources, our focus was on selecting resources that were accessible, relevant, and easy to use. Each entry's basic information and hyperlink have been provided. 

We hope you find these resources helpful for your practice and personal growth, and that you can join us in advocating for greater inclusion of OT services in hospice and palliative care.

As you explore the resources offered by this site, it will be helpful to understand some key terminology...

OTpall uses definitions from the Clinical Practice Guidelines for Quality Palliative Care (4th ed.) as published by the National Coalition for Hospice and Palliative Care (NCHPC, 2018).

Serious Illness

"[A] health condition that carries a high risk of mortality and either negatively impacts a person’s daily function or quality of life or excessively strains their caregiver" (Kelley and Bollens-Lund, 2018, as cited in NCHPC, 2018, p. i).

Alternative terms you may see:

• Life-limiting illness: "a condition, illness or disease that is progressive and fatal, and the progress of which cannot be reverse by treatment" (International Association for Hospice & Palliative Care, n.d.-a).

• Life-threatening illness: "a condition for which curative treatment may be feasible but can fail” (International Association for Hospice & Palliative Care, n.d.-b).

"Serious illness" is used by OTpall to be inclusive of all conditions at any stage of their disease trajectories.

End-of-Life Care (EoLC)

A term used to collectively describe hospice and palliative care.

Palliative Care

Palliative care works together with the primary treatment being provided to provide relief from the stress and symptoms associated with serious illness. At its heart, palliative care is about quality of life, client- and family-centered care, and continued engagement in a suffering- and pain-free life (American Occupational Therapy Association, 2016; NCHPC, 2018). Palliative care is holistic, anticipatory, interdisciplinary, and follows the client’s lead.

According to the National Coalition for Hospice and Palliative Care (2018), palliative care is:

• "Appropriate at any stage in a serious illness, and it is beneficial when provided along with treatments of curative or life-prolonging intent.

• Provided over time to patients based on their needs and not their prognosis.

• Offered in all care settings and by various organizations, such as physician practices, health systems, cancer centers, dialysis units, home health agencies, hospices, and long-term care providers.

• Focused on what is most important to the patient, family, and caregiver(s), assessing their goals and preferences and determining how best to achieve them.

• Interdisciplinary to attend to the holistic care needs of the patient and their identified family and caregivers" (p. i).

For OT practitioners to note, "palliative care principles and practices can be delivered by any clinician caring for the seriously ill, and in any setting" (NCHPC, 2018). OT practitioners can incorporate these principles into their own practice (and practice settings) to better understand and meet the unique needs of their seriously ill clients. 

OT practitioners working in palliative care or with clients using palliative care services will benefit from reframing their practice away from a biomedical frame of reference. A rehabilitative approach may still be desired by and be appropriate for these clients. However, approaching care with an additional palliative lens can support OT practitioners in planning not just for possible recovery but also anticipated functional decline. Symptoms of serious illness can fluctuate day to day and treatment may not always be successful; anticipating needs and following the client's lead are two of the most valuable roles OT has in palliative care.

Fast Facts:

• Palliative care is covered under Medicare Part B and by most payers.

• Reimbursement for OT is generally billed as a separate service. Clients are more likely to receive referrals from their care team for outpatient or home health OT, which may then be covered under Medicare, Medicaid, or private insurance. 

  • • • Clients may also request an OT referral or seek OT services independently.

Useful Resources:

• GeriPal Podcast - visit 'Podcasts' page for more

• Hard Choices for Loving People - Hank Dunn - visit 'Books' page for more

• The Role of Occupational Therapy in Palliative and Hospice Care [Video] - Dr. Frederick Covington - visit 'Film & Video' page for more

Hospice

Often referred to as "comfort care," hospice is specialized care provided to people with a terminal diagnosis who are no longer seeking curative treatment. Hospice focuses on caring over curing, ensuring clients are as comfortable as possible during the dying process. Hospice care attends to pain management, medication management, emotional and spiritual support, symptom management (for symptom control or relief, not for curing), and caregiver training.

The dying body undergoes many changes and hospice ensures the client and their loved ones are as prepared as possible. A client's abilities and needs fluctuate, sometimes daily, and may change rapidly and/or unexpectedly. Hospice requires a flexible, anticipatory, responsive approach and compassionate, person-centered care. 

OT practitioners working in hospice or with clients using hospice services will benefit from reframing their practice away from a biomedical frame of reference. Rather, the focus will be on maximizing participation in occupation (daily life, meaningful activities), safety, caregiving training, and adaptations to the occupation and/or environments. Additionally, OT practitioners can support clients in legacy work, seeking closure, and making practical preparations for the end of life. The goal isn't to regain or remediate function but to empower clients to live a life worth living despite an inevitable death.

Fast Facts:

• To qualify for hospice under Medicare Part A, the client must:

  • • • Have a life expectancy of 6 months or less, as certified by their provider.

      • No longer be seeking curative treatment.

      • Provide a signed statement indicating selection of the hospice Medicare benefit over other Medicare-covered treatments.

• Hospice care is covered under most payers, including Medicare, Medicaid, most private insurers, HMOs, and managed care organizations.

• Hospice agencies are required to offer OT services under the Medicare hospice benefit, either directly by the agency or arranged elsewhere.

Useful Resources:

• End of Life Guidelines Series - Barbara Karnes, RN - visit 'Books page for more

• Hard Choices for Loving People - Hank Dunn - visit 'Books' page for more

• End Game - Netflix - visit 'Film & Videos' page for more

References

American Occupational Therapy Association. (2016). The role of occupational therapy in end-of-life care. American Journal of Occupational Therapy, 70(Suppl. 2), 1-16. https://doi.org/10.5014/ajot.2016.706S17

International Association for Hospice & Palliative Care. (n.d.-a). Life-limiting condition. In Pallipedia. Retrieved July 28, 2023, from https://pallipedia.org/life-limiting-condition/

International Association for Hospice & Palliative Care. (n.d.-b). Life-threatening condition. In Pallipedia. Retrieved March 13, 2022, from https://pallipedia.org/life-threatening-condition/

Kelley, A. S., & Bollens-Lund, E. (2018). Identifying the population with serious illness: The "denominator" challenge. Journal of Palliative Medicine, 21(S2), S-7–S-16. https://doi.org/10.1089/jpm.2017.0548

National Consensus Project for Quality Palliative Care. (2018). Clinical practice guidelines for quality palliative care (4th ed.). National Coalition for Hospice and Palliative Care. https://www.nationalcoalitionhpc.org/ncp

Banner Image: Angel's Rest Lookout, Oregon (OTpall, 2021)