Background
A 56-year-old man was referred to 1to1 Healthcare’s Occupational Therapy service following a significant decline in mobility and self-care after a major stroke. He lives with his wife and two teenage children in a three-storey family home. Since his stroke, he has developed severe physical weakness, cognitive impairment, and ongoing fatigue due to end-stage renal failure, for which he attends dialysis three times a week.
He is fully dependent on carers for all transfers, mobility, and personal care, using a standing hoist for most movements. Although he receives a four-times-daily, double-handed care package, his wife continues to play an active role in supporting his daily routines and advocating for his needs.
Despite this strong family support, the situation has placed considerable emotional and physical strain on the household. The man currently sleeps in the living room, which doubles as his bedroom. The family no longer has a shared space to relax together, and his wife expressed growing concern about privacy, hygiene, and her husband’s loss of dignity.
Assessment and Findings
The occupational therapist carried out a comprehensive home assessment to explore how the living environment could better support the man’s complex needs while promoting his wife’s wellbeing as a carer.
Key findings included:
- The client is bedbound and reliant on hoist transfers.
- The family living room is being used as his permanent bedroom, leaving little space for family life.
- He is unable to access the stairs, bathroom, or bedroom.
- Current strip washes are not sustainable for hygiene or dignity.
- The family dynamic is affected by limited space and privacy.
- The client shows emotional distress and tearfulness, likely linked to cognitive impairment and loss of independence.
- The occupational therapist recognised that while the family was managing well under pressure, the current setup was no longer suitable for long-term care.
Person-Centred and Strength-Based Approach
Following the Care Act 2014 principles, the assessment focused on wellbeing, prevention, and supporting independence. The therapist worked closely with the client’s wife to identify what mattered most to the family — privacy, dignity, and restoring their home as a shared space.
Although the client’s rehabilitation potential was limited, the OT aimed to maximise comfort, safety, and carer sustainability, recognising the wife’s strength and dedication as central to the care plan. The process was collaborative, transparent, and guided by the family’s preferences and values.
Collaborative Working
The occupational therapist coordinated with multiple professionals to ensure a holistic and sustainable solution:
- District Nurse: To review pressure care and skin integrity.
- Social Worker: To initiate a Care Act assessment and explore adaptation funding.
- Adaptations and Housing Team: To review feasibility for a ground-floor extension with en-suite facilities.
- Care Agency: To ensure moving and handling practices were safe and appropriate.
- GP and Renal Team: To provide updates on physical and emotional health, supporting continuity of care.
This joint approach demonstrated true integrated working within adult social care — combining expertise, resources, and compassion to achieve the best outcome for both the individual and the system.
Intervention and Recommendations
Creation of a Ground-Floor Bedroom with En-Suite Shower
A ground-floor adaptation was recommended to provide the client with direct access to washing and toileting facilities. This would restore dignity and privacy, improve hygiene, and allow the family to reclaim their living room as a shared space.
Provision of Ceiling Track Hoist
To improve safety and efficiency of care, the occupational therapist recommended and facilitated installation of a ceiling track hoist system in collaboration with the local council and the client’s care agency.
This intervention had a significant impact: it allowed safe, single-handed transfers, reducing the care requirement from two carers to one. By working jointly with the care agency and adult social care commissioning team, the OT ensured that the equipment met all moving and handling standards while maintaining the resident’s safety and comfort.
This approach not only supported the family’s independence and reduced disruption at home but also provided the council with a more cost-effective long-term solution, reducing care expenditure while maintaining quality and safety of care.
Ongoing Emotional Support and Advocacy
The OT provided reassurance and emotional support to the client’s wife, helping her navigate the adaptation process and access formal carer support through a Carer’s Assessment. The OT’s involvement helped the family feel heard, informed, and supported throughout.
Outcomes and Impact
The combined physical and emotional interventions achieved meaningful change. The bath board allowed her to maintain a level of independence immediately, while plans for permanent adaptation were progressed through the local housing adaptations team.
As her confidence grew, she began managing more of her personal care independently. Her anxiety reduced, and she described feeling “more like herself again.” Regular input from the community mental health team helped her manage PTSD symptoms more effectively, while the planned shower installation provided reassurance and hope for long-term stability.
Impact and Reflection
The interventions achieved several key outcomes aligned with Care Act 2014 principles:
Wellbeing: Improved safety, privacy, and quality of life for the client.
Prevention: Reduced carer strain and safeguarded against breakdown or crisis.
Independence: Enabled dignified, hygienic care within the home environment.
Cost-Effectiveness: Reduction from double to single-handed care supported efficient use of public resources.
Partnership Working: Coordinated multi-agency input to deliver sustainable, person-centred solutions.
The result was a safer, more functional home that met both the client’s care needs and the family’s emotional needs.
Reflection
This case highlights the transformative role of occupational therapy in adult social care. By combining clinical reasoning, creativity, and collaborative practice, the OT helped deliver a holistic solution that improved quality of life and reduced long-term costs for the local authority.
It reflects the essence of person-centred, strength-based practice — empowering individuals and families to live with dignity and purpose, even in the face of complex and life-changing conditions.
Conclusion
At 1to1 Healthcare, our occupational therapists work with compassion and professionalism to find solutions that make everyday life safer, easier, and more meaningful.
Through joint working, innovative problem-solving, and commitment to the Care Act’s core principles, this case demonstrates how effective occupational therapy can restore dignity, promote wellbeing, and deliver real value — for both families and the wider care system.
This is what quality; person-centred care looks like in action.
