Occupational Therapy in Community-Based Practice Settings 2nd Edition by Marjorie Scaffa, Maggie Reitz

Exercise 1

Elaine
Elaine is a woman in her mid-70s who has always been active in her church and community, with music as her passion. After receiving a degree in voice and communications, she married Scott, an Air Force officer, and raised two children. Both children are grown, have their own families, and live at a distance. When Elaine had a major stroke with deficits including left-sided paralysis that required using a wheelchair, left visual field loss and neglect, and voice and swallowing impairment, she felt a loss of selfidentity. "Where is Elaine?" was a common question. She had looked out for her husband, so he was overwhelmed when confronted with the myriad decisions and tasks involved with the onset of a disability. The son and daughter visited as often as possible, but there was a gap in support. When the occupational therapist who had been their small group leader at the church offered to accompany Scott and Elaine through the rehabilitation process, they graciously accepted. Several months later, Elaine was overheard to tell someone that while her church didn't have a parish nurse, it had a parish occupational therapist. Some of the functions carried out by the occupational therapist included the following:
Health Counselor: Throughout the active therapy phase, the faith-community occupational therapist helped interpret interventions provided by the facility therapists and reinforced what was taught. The occupational therapist assisted Scott with the home evaluation form and supplemented information provided by the inpatient program regarding accommodations needed to allow Elaine to return home from the rehabilitation facility. When the dietitian provided education on following a modified diet, Scott and Elaine needed support to learn to read labels, select appropriate foods, and find new favorites to replace items no longer allowed.
Health Advocate: The faith-community occupational therapist supplemented the social work interventions by assisting the couple to fill out forms needed for long-term care insurance. When issues arose regarding care and follow-through in the rehabilitation center and later the skilled nursing facility, the occupational therapist provided advocacy.
Referral Advisor: The occupational therapist helped the family sort through the options available for rehabilitation after Elaine's short hospital stay, as the brief visit by social services was not sufficient for an informed decision. When Elaine was not strong enough to return home at discharge from the rehabilitation center, the occupational therapist assisted the family in planning for continuing care.
Volunteer Coordinator: After Elaine came home with her husband and part-time caregivers, the occupational therapist helped the family determine how and when church volunteers could assist without giving direct care. The primary task selected was providing respite-staying with Elaine so that Scott could continue his involvement in musical groups.
Integrator of Faith and Health: Elaine was able to verbalize that her angst was more spiritual than physical, so the occupational therapist's interventions focused on supporting Elaine's continued involvement in valued spiritual occupations. Elaine appreciated being informed of prayer concerns from each Sunday service, happy to pray for others when she could do little else. Later, when Elaine was able to attend church, the occupational therapist modified the bulletin and hymns by printing them in a large font with narrow columns and a red anchor line on the left. Though she never recovered from her paralysis, Elaine reclaimed her faith and discovered a new sense of self through the spiritual journey she faced in her tenacious style.
After discharge from the skilled nursing facility, Elaine intentionally opted to use the home health agency where the faith-community therapist was the sole occupational therapist. Describe potential conflicts of interest and boundary issues that would need to be very clear for such an arrangement to work.