11th January 2023
Kirsty O'Connor, Occupational Therapist
An important part of the role for many occupational therapists is to assess older people for suitable seating which meets their seating, postural and pressure care needs. Most residents in care homes spend long hours sitting in a chair and appropriate therapeutic seating is important for physiological benefits (respiration, digestion, reducing risk of pressure sores and contractures), and psychological benefits (improving sense of worth, independence and quality of life). There has also been a noted reduction in levels of agitation and aggression by staff, when the seating needs for people living with dementia have been assessed and provided.
It has been my experience as an occupational therapist, that following some occupational therapy seating assessments, residents of private nursing homes are unable to obtain a recommended therapeutic chair. This can occur due to a number of reasons; the nursing home have limited funds or are unwilling to pay, the resident cannot afford to pay, or because the HSE primary care will not accept the majority of referrals from private nursing homes. A HSE referral for seating in private nursing homes will only be accepted if a complex, bespoke seating system is needed. Many residents in private nursing homes, particularly those availing of the Fair Deal Scheme, have limited funds themselves, and are unable to obtain appropriate chairs.
It is important that patients, families, and nursing home managers are provided information on the benefits of appropriate therapeutic seating both for the residents and for their service and staff. Appropriate therapeutic seating can reduce workload (secondary complications increase client care needs), risk of injury to staff (reducing manual handling issues), and reducing risk of falls in their nursing home. I recommend chairs which are cost effective, meet short and long term client needs, and are durable within the care environment.
Ideally, following a comprehensive OT assessment, the Fair Deal Scheme should include funding, or at least pay a contribution towards therapeutic seating. This would cover the cost of the assessment and the chair, to provide older people with seating that meets their seating, postural and pressure care needs. This would enable many older people with suitable equipment and benefit both the patient and care facility.
The Fair Deal scheme states that it covers "the level of care appropriate to the individual". However, as residents are often not assessed or provided with suitable seating, the level of care provided for seating is not meeting their needs.
Clinical Seating is particularly important for any person that is at risk of a pressure injury. The International pressure injury guidelines highlight that individuals with limited mobility, limited activity and a high potential for friction and shear to be at risk of pressure injuries. They recommend to select a seat and seating support surface that meets the individual’s need for pressure redistribution with consideration to: Body size and configuration, Effects of posture and deformity on pressure distribution and Mobility and lifestyle needs. I have observed that the provision of seating related to those that are a part of the Fair Deal Scheme is not aligned with the guidelines.
Many elderly people today are sitting in unsuitable, uncomfortable chairs, contributing to pressure sores, contractures, reduced function and independence, challenging behaviours and falls. These increase the risk of secondary complications, decreasing quality of life and potentially bringing forward mortality. This also creates an increased workload for healthcare staff, and also increased healthcare costs. Elderly residents in Irish nursing homes deserve to be provided adequate care and respect, including provided with OT seating assessments and the provision of suitable seating, that can transform their latter years in Irish care homes.
Written by Kirsty O'Connor
Occupational Therapist & Seating Matters Clinical Training Manager
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