An Occupational Therapist's Perspective on Environmental Adaptations for the Disabled Elderly.

Services for the elderly and the handicapped despite their separate funding sources have much in common. A review of legislative mandates for each population as well as an overview of their common environmental needs and concerns is provided with special attention to housing. The relative merits of designing a barrier free environment versus adapting a residence to meet an individual's needs are explored and examples of both types of support are given. The role of the occupational therapist in the treatment of the disabled elderly is based on the premise that independence in daily living tasks promotes increased competence and can delay deterioration and institutionalization. Occupational therapists, because of their knowledge of functional independence as well sa their experience adapting environments, are invited to take on larger responsibilities bridging the gap between these two populations.

After treatment what?

Until very recently, occupational therapy services have been provided in institutional settings and have followed the medical model. The escalating costs of hospital care have been the primary incentives for moving patients out of acute settings and thus increasing the need for occupational therapy services in the community. Yet, relatively few therapists have moved from the medical model even though the need exists and legislation encourages that service be provided in the least restrictive alternative. Further, occupational therapists have been slow to adopt distinct strategies for planning with patients for their roles and needs after treatment even though the heart of the occupational therapy philosophy centers on adaptation to life roles. This paper explores the current trends away from institution-based health care and towards a continuum of health and social services, and the roles for occupational therapists in community settings. Occupational therapists are urged to act as facilitators in assisting patients to move successfully from active treatment to independence in whatever settings they find themselves.