May 13, 2009

Health care providers use team approach

By Lisa M. Petsche

Older adults admitted to hospitals or long-term care facilities often have complicated health conditions necessitating the intervention of professionals from a variety of disciplines. Service delivery by health care teams ensures a coordinated, holistic approach to assessment and treatment.

Team membership typically consists of the following health care professionals: case manager, physician, nurses, physical therapist, occupational therapist, dietitian, speech-language pathologist, social worker, recreation therapist and chaplain.

Here is an overview of each member’s role.

• Case manager
As team leader, the case manager—sometimes known by other titles such as primary care coordinator—is responsible for overall planning, coordinating care and evaluating outcomes. Inpatient case managers are usually registered nurses.

• Physician
Physicians diagnose and treat medical problems in consultation with the team, ordering investigations and treatments as needed. They make referrals to specialists—for example, geriatrician, psychiatrist, urologist, orthopedic surgeon—as needed.

• Nursing staff
Depending on their level of training, nursing staff develop and monitor a plan of nursing care, help assess patients’ health status, administer medication and other physician-ordered treatments and assist with personal care.

• Physical therapist (PT)
The physical therapist evaluates patients’ functional ability and works with them to improve (or in some cases simply maintain) ambulation, balance, endurance, range of motion, strength and flexibility. He or she recommends mobility devices such as canes and walkers and trains patients in their proper use.
PTs also develop customized exercise programs for patients to follow after active therapy is completed, in order to continue the benefits gained.

• Occupational therapist (OT)
Occupational therapists teach people with disabilities alternative ways of carrying out daily living activities and recommend adaptive equipment where appropriate. Basic activities of daily living (ADLs) include feeding, toileting, washing, dressing and grooming. Higher level skills, known as instrumental activities of daily living (IADLs), include getting to places beyond walking distance, using the telephone, grocery shopping, preparing meals, doing housework, managing money, problem-solving in emergency situations and accessing the community. For patients planning to return home, OTs may perform a home assessment to identify environmental obstacles and hazards and recommend home adaptations.

• Dietitian
A specialist in nutrition, the dietitian evaluates the patient’s nutritional status and recommends necessary dietary changes as a way of helping to treat various diet-related health problems, such as diabetes, high cholesterol, constipation, obesity and excessive weight loss.

• Speech-language pathologist (SLP)
The speech-language pathologist assesses and treats difficulties related to hearing, speech, language (both expression and understanding) and swallowing.
He or she performs hearing screenings, provides speech therapy, gives training in alternative methods of communication, and recommends modified food textures or specific feeding techniques as necessary.

• Social worker
The social worker assesses the social, emotional and personal implications of health changes for patients and their families, and helps them learn how to cope more effectively with losses, emotional issues, family problems, financial concerns, depression and behavioral changes. He or she also links patients and caregivers with community resources, including when discharge is required.

• Recreation therapist
In long-term care facilities, recreation therapists coordinate activities from bingo, pet visiting and barbecues to arts and crafts and news groups. Their work fosters quality of life by providing opportunities for fun, creativity, socialization and learning. They match new residents to facility programs based on their previous hobbies, interests and cultural practices. They also organize community outings such as shopping excursions and trips to cultural events.

• Chaplain
The chaplain provides spiritual guidance and support to patients and families, addressing issues around faith, meaning and purpose. Chaplains also facilitate contact with religious leaders in the community when desired by the patient or family.

Lisa M. Petsche is a clinical social worker and freelance writer specializing in health and adult care issues.