Jackie Pierce, a community occupational therapist in south Dublin, says assessing a patient means examining all aspects of their lives
I came back to work in community occupational therapy four years ago. I took a 16-year break when I was rearing the kids. That was in November 2000. I said I'd try it until Christmas and I'm still doing it four years later. I work three full days a week, starting at 9am.
Our patients are referred to us from public health nurses, physiotherapists, GPs and families and by the patients themselves. The majority are over 65.
The whole emphasis of OT is independence. We try to maintain people in their own homes for as long as possible. We assess the patient in terms of their occupation and occupation isn't how they occupy their time, it encompasses all aspects of their lives from when they get up to when they go to bed at night.
We visit them in their home which gives us a clear picture of how they are getting on. For example, the very first thing we might see would be four or five steps, so if the patients is disabled we have to consider how they can access their home. We look at what equipment we can prescribe to help them. I'd ask them 'can you show me how you get into the bath?', 'how you get in and out of bed?', 'how do you get up and down the stairs?'.
Very often where a patient has had a stroke and can no longer access the stairs or operate a stair lift, we look at adapting the house downstairs. We'd advise them on how to apply for a grant from their local authority and provide them with the right specifications.
I need to be very conscious of family dynamics and how I am being perceived by the patient. Is the person cognitively impaired for example? Are they realistic? Are they aware of their situation?
We must look at whether people's work facilities are going to be suited to their disability.
We also have a paediatric workload, including children with cerebral palsy and spina bifida. We work very closely with agencies such as Enable Ireland.
The nature of the job is extremely challenging. Trying to give people the maximum intervention is challenging. It's about time - we just don't have the time we would like. A visit can take a half an hour; the initial assessment can take an hour, it may take longer. Sometimes you might see five or six patients in a day; sometimes three. It depends on their needs.
There are a lot of elderly women living on their own. They love a chat and very often that can be the most therapeutic thing. Obviously you learn an awful lot by just sitting and having a cup of tea with a patient. By talking to them you also know whether there is a short-term memory problem, for example, or if there's a safety issue. We see people from every socio-economic walk of life and meet fascinating people. You couldn't possible be bored. The majority of patients are wonderful and a joy to visit.