Caregiver Satisfaction with a Video Telehealth Home Safety Evaluation for Dementia

Family caregivers are vital to telehealth-delivered dementia care. The objective of this mixed methods descriptive study conducted in the VA Bedford Healthcare System was to examine caregiver satisfaction with a video telehealth dementia home safety occupational therapy evaluation. Ten caregivers of Veterans with dementia participated. Ratings of caregiver satisfaction, measured by nine Likert scale items including ability to see and hear, were examined in relation to person and visit-related contextual factors extracted from RA field notes, to develop an in-depth understanding of caregiver experience. Person factors included caregiver age and gender and Veteran cognitive status. Visit-related contextual factors included occurrence  of technical glitches. Caregiver visit satisfaction was overall positive, with exceptions related to technological glitches and the presence of the person with dementia during the visit. Veteran cognitive status appeared to influence caregiver satisfaction. Implications of the study are that proactively addressing technical glitches and incorporating dementia stage-specific approaches may optimize caregivers’ telehealth experience.

Occupational therapy and advanced dementia: A practitioner survey

Aims: There is a gap in research about the role of occupational therapy (OT) in the United States with clients with advanced dementia. The purpose of this study is to explore OT practice with clients with advanced dementia within the United States by surveying practitioners. Study questions addressed interventions, including frequency and perceived effectiveness, intervention priorities, and barriers to practice. Methods: Survey methodology was employed to obtain the practice experience of the United States OT practitioners working with clients with advanced dementia. Results: Respondents (n = 95) were mostly occupational therapists with 10 years of practice experience, some reporting dual roles as administrators or fieldwork educators, working in long-term care settings. Respondents spent minimal time per week with clients with advanced dementia, providing primarily one-to-one interventions with varied perceived effectiveness. A wide range of interventions were aemployed. Therapist and perceived facility intervention priorities differed. The most frequently reported barrier to practice was client factors, followed by institutional barriers. Thematic analysis of qualitative questions further elucidates the practice experience of respondents. Conclusions: Findings provide insight into occupational therapy practice in the United States with clients with advanced dementia. This study describes interventions utilized with this population, barriers to practice, and perceived effectiveness of interventions. Qualitative entries describe care approaches for this population and challenges to providing care. While this study adds to the evidence base for occupational therapy's role in serving clients with advanced dementia, there remains a need for more research in this area

Caregivers’ Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners

BackgroundOlder adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults’ health- and technology-related challenges may necessitate caregiver assistance. ObjectiveThis study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). MethodsA web-based national survey of VHA OT practitioners about caregivers’ role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. ResultsOf approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ≥65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. ConclusionsCaregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers’ challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients’ access to video visits