Background
A 73-year-old woman from London area, was referred to 1to1 Healthcare Occupational Therapy after her health and mobility declined due to metastatic brain cancer, secondary to lung cancer. Alongside radiotherapy treatment, she lives with the effects of significant fatigue, cognitive changes, and loss of physical strength.
She shares her home with her husband, who provides all her daily care — from washing and dressing to managing medication, meals, and household tasks. The couple have lived in their home for over 40 years. It is where they raised their family and built a life together, and both were determined to stay there, even as her condition progressed.
When the referral came through, her husband had been struggling quietly for months. He was lifting and guiding her up and down the stairs several times a day, often without any formal equipment or support. His love for his wife was unquestionable — but so was the risk. Both were at real danger of falls and injury, and the emotional and physical strain was taking its toll.
Identifying the Challenges
During the initial assessment, our occupational therapist quickly recognised that this was about more than equipment — it was about preserving dignity, maintaining safety, and supporting the strength of a devoted carer.
The main concerns were:
- Unsafe stair use and transfer risks for both
- Lack of access to upstairs bathroom facilities
- Physical strain and emotional exhaustion for the carer
- Inadequate equipment to meet changing needs
- No formal care or respite support in place
Despite these challenges, what stood out most was the couple’s resilience and commitment to caring for each other. This became the foundation for a person-centred, strength-based intervention.
Our Approach
The assessment was carried out sensitively, with her comfort and emotional state prioritised throughout. While she was unable to express herself fully in words, her gestures and responses guided the conversation. Husbands deep understanding of her needs played a central role in shaping the care plan.
Working within the principles of the Care Act 2014, the focus was on promoting wellbeing, preventing crisis, and ensuring both client and her husband had the right support in place to stay safe and independent at home for as long as possible.
What We Did
Home Adaptation: Through-Floor Lift
A stairlift was ruled out due to her limited balance and memory. Instead, a through-floor lift was proposed to enable safe and dignified access to the first-floor bedroom and bathroom. A technical survey was arranged to assess feasibility, and the husband was fully involved in the design and planning process.
Essential Equipment
- Two commodes, one upstairs and one downstairs, to reduce the need for stairs and maintain comfort and privacy.
- A double bed mattress variator to help the client sit up and reposition easily, reducing pressure risk and supporting safe care from her husband.
- Continued use of riser-recliner chairs, which were well-suited for her needs.
Multidisciplinary Referrals and Support
- Physiotherapy referral to reassess mobility and provide safer walking aids.
- Social work referral for a full Care and Support Assessment to establish a formal care package.
- A Carer’s Assessment for husband to address his emotional wellbeing, explore respite options, and connect with local carers’ support services.
- Palliative care and district nurse input were also recommended to ensure Theresa’s comfort and symptom management as her condition progressed.
Emotional and Practical Support
Throughout the process, our occupational therapist maintained regular contact with husband, providing reassurance, guidance, and emotional support. Every recommendation was discussed and agreed with both of them, ensuring decisions were collaborative and respectful.
The Outcome
Within weeks, the first pieces of equipment were installed, reducing the strain of day-to-day care. Husband reported feeling “more supported and less anxious” about managing on his own. The prospect of the through-floor lift brought visible relief, as it meant they could remain together in their home safely — without the daily fear of accidents on the stairs.
Clients comfort improved significantly. The mattress variator allowed her to rest more easily and maintain a more upright position when needed, reducing discomfort and helping with breathing. Most importantly, husband regained a sense of confidence and control in his caring role.
The case was later picked up by social services for ongoing care coordination and monitoring, ensuring the couple had continued access to professional and emotional support.
Reflections
This case is a strong example of how timely, compassionate occupational therapy can transform life at home for people living with complex and end-of-life conditions.
By combining clinical expertise with genuine empathy, 1to1 Healthcare delivered a plan that was both practical and deeply personal. It supported safety and wellbeing but also honoured what mattered most to client and her husband — staying together, in their own home, surrounded by familiarity and love.
Our approach was guided by the Care Act 2014, promoting:
- Wellbeing and dignity for the individual
- Support and recognition for unpaid carers
- Prevention of crisis through early, proactive intervention
- Collaboration across health and social care services
Conclusion
At 1to1 Healthcare, we believe that care should never be about systems alone — it should be about people, their values, and their stories.
Client and her husband’s journey shows how the right support, provided with compassion and understanding, can bring peace of mind, safety, and dignity — even in the most difficult moments of life.
