Occupational therapists tackle obstacles in the home, from support to cook a meal, to navigating public transport

Occupational therapists (OTs) have been in the spotlight this month after the National Disability Insurance Agency (NDIA) froze NDIS payments for these services at $193.99 per hour for the sixth year.

The NDIA also cut travel payments for OTs who visit people in their home and community by 50%.

Health Minister Mark Bulter says it’s important people on the NDIS aren’t paying more for therapy and support than they would pay in the health or aged care system.

But OTs are concerned this could affect therapists’ viability, including their ability to support people with disability in their homes and communities.

But what can OTs actually do? And why is it often better to do this in a person’s home and community?

Who might see an OT?

Imagine trying to get back to your daily life after a major health setback, such as a car accident or stroke, or an episode of a long-term condition or disability, such as depression or arthritis. The things you used to do with ease can become difficult and exhausting.

After such a setback, your home or community can also feel like an obstacle course. Maybe you can’t carry the laundry basket out to the line anymore, or you’re struggling to keep up with your children.

This is where occupational therapy can make a real difference. OTs are health professionals that enable people to do the things they need, want and love to do in daily life, from getting dressed to cooking dinner, gardening to driving.

Occupational therapists work with people of all ages. They overcome barriers by changing the environments and objects we use, teaching new skills, rehabilitating old ones and tweaking the way we tackle tasks.

What can OTs do in the home and community?

Seeing people in their own homes and communities allows the therapist to get a more accurate picture of a person’s strengths and abilities, which can be difficult to understand in a clinic.

OTs use their skills and creativity to provide personalised care, tailored to individual needs and circumstances.

An older person with dementia might, for example, cause alarm by putting a plastic kettle on the stove of a hospital kitchen. But they could make their cup of tea perfectly safely at home with their stove top kettle.

OTs can support home and community mobility, such as checking a wheelchair passes smoothly through doorways and can manoeuvre in tight spaces such as bathrooms.

But they can also advise on kitchen aids and seating to save energy for people with conditions such as multiple sclerosis, to support them continuing to cook family meals.

In their work with neurodivergent people of different ages, an OT might help an autistic teen develop sensory strategies to deal with their busy and noisy school day.

For other people, OT support might help them navigate their local public transport system. Learning and practising skills where they’re used makes it easier to carry them over into everyday life.

What does the research say?

Research shows home and community OT can lead to better activity and participation than clinic-based therapy. It’s also cost-effective.

For stroke survivors, OT makes everyday tasks like showering or getting dressed easier.

OT at home eases burden and stress for the parents of children with cerebral palsy and carers of people with dementia.

OT at home helps older people with ongoing health issues to be more actively involved in their communities.

Community OT is also effective in supporting recovery for people with mental health problems, enabling them to enjoy community and leisure activities, seek and maintain employment and enhance physical activity.

OT focuses on helping you do the things that keep you well and independent, which means fewer trips back to the hospital. OTs can spot and solve trip hazards within homes, for example, before a frail person has a fall.

People who get OT at home soon after leaving hospital are less likely to be readmitted. Emerging research also suggests OT can work jointly with paramedics when someone falls at home by visiting and offering immediate treatment that prevent avoidable hospital stays.

There are some downsides, such as limited access in disadvantaged communities. While telehealth can address some barriers, it is not suitable in every case.

How do Australians access OTs?

There are many pathways to access OT services, but the complexity of the health-care system means the process is challenging to navigate.

OT services can also be costly, due to severely limited funding, equipment and transport costs.

OT is available as part of Home Care Packages and the Commonwealth Home Support Programme for older people.

OT has also played a key role in supporting NDIS participants since the scheme’s inception. However, waiting lists often stretch for many months and not everyone knows about what OT can offer.

You can also access community OT through Medicare Chronic Disease Management plans, local community health centres and councils and through private health insurance rebates.

Thanks to Lana O’Neil (Occupational Therapist at Western Health in Victoria) and Sarah McCann (Senior Occupational Therapist at Western Health) for sharing their clinical expertise for this article.