Background
Maria (pseudonym), a Romanian-speaking woman in her late seventies, was referred to 1to1 Healthcare’s Occupational Therapy service after her physical health declined sharply. She was finding it increasingly difficult to move around her home and manage the stairs safely.
Maria lives with her daughter, Erica, who provides full-time care and acts as her interpreter. English is not Maria’s first language, so the assessment relied heavily on Erica’s translation and support. Despite the language barrier, Maria’s warmth and gentle humour came through clearly — her focus throughout was not on her own comfort, but on her daughter’s wellbeing.
Maria has multiple complex health conditions including advanced heart failure, Type 2 diabetes, and chronic kidney disease. She is on an end-of-life pathway due to cardiac failure, though this prognosis has not been directly shared with her at her family’s request. The occupational therapy visit was carried out with sensitivity to cultural and emotional factors, ensuring her dignity and comfort were maintained at every stage.
Assessment and Approach
The assessment was conducted in Maria’s home, where the living room had been converted into a bedroom to minimise movement and fatigue. A level-access shower and stairlift were already in place, reflecting the family’s efforts to keep her safe and comfortable.
The occupational therapist focused on two key priorities:
- Maria’s physical comfort and safety, especially during transfers and rest.
- Her daughter’s capacity to continue caring safely, recognising the risk of carer fatigue and emotional strain.
During the assessment, Maria spoke softly but clearly about her concern for her daughter’s wellbeing, saying she worried about how much Erica was managing on her own. Erica, in turn, described growing physical difficulty with bed transfers and increasing anxiety about her mother’s declining condition.
In line with the Care Act 2014, the approach centred on promoting wellbeing, preventing carer breakdown, and ensuring both voices were heard.
Interventions and Recommendations
The occupational therapist adopted a person-centred and strength-based approach, focusing on the family’s existing resilience and support network. Maria’s ability to communicate through her daughter was recognised as a strength, as was Erica’s dedication and understanding of her mother’s care needs.
Working collaboratively with health and social care partners, the therapist coordinated several key interventions:
- Hospital profiling bed: Recommended and arranged to enable safe transfers, improve comfort, and reduce physical strain on the carer.
- District nurse and palliative care referral: Initiated urgently to ensure holistic symptom management, pressure care, and emotional support for both mother and daughter.
- Carer’s Assessment: Requested for Erica to ensure her own health and emotional wellbeing were formally supported, and to explore respite options.
- Social work referral: Initiated for a Care and Support Assessment and benefits check, recognising the financial impact of full-time unpaid care.
This integrated, multi-disciplinary approach ensured that both the service user and carer were supported in line with Care Act principles — promoting wellbeing, preventing crisis, and ensuring choice and control.
Outcomes
Within two weeks, a hospital bed was delivered and installed in Maria’s ground-floor living space. This single change transformed the way care was provided. Transfers became easier and safer, and Maria was able to rest in greater comfort.
The district nursing and palliative care teams began regular visits, providing ongoing medical and emotional support. The new equipment reduced physical strain on Erica, who said she finally felt she could “breathe again” knowing her mother was safe and comfortable.
Maria expressed that she felt more secure and rested. Her comfort improved noticeably, and the peace of mind of seeing her daughter less anxious gave her renewed emotional strength.
Reflection
This case shows how timely occupational therapy can make a profound difference to end-of-life care — not only through practical equipment but by restoring dignity, safety, and emotional balance for both the person and their carer.
The intervention reflected the values at the heart of 1to1 Healthcare:
- Personalisation: The support was tailored around what mattered most to Maria and her daughter — staying together at home, in familiar surroundings.
- Prevention: Early action reduced carer strain and prevented avoidable crisis or hospital admission.
- Partnership: Collaboration across health and social care professionals ensured holistic and sustainable care.
- Dignity: Every decision respected Maria’s privacy, cultural background, and autonomy.
Key Outcomes
- Safer and more comfortable home environment
- Reduced manual handling risk and carer fatigue
- Engagement with district nurse and palliative care teams
- Emotional reassurance and confidence for the family
- Enhanced dignity and quality of life in the final stage of care
Conclusion
At 1to1 Healthcare, we understand that end-of-life care is about more than medical support — it’s about compassion, dignity, and the human connection that matters most.
By listening carefully, responding holistically, and acting swiftly, our occupational therapy service helped Maria and her daughter find peace and comfort at home during a deeply sensitive time.
Their story reflects the heart of what we do: supporting families to live — and care — with dignity, safety, and love.
