When Home Becomes a Barrier to Rehabilitation

By Kate Sheehan, occupational therapist

I had the great privilege to meet some inspirational people this week during filming for Open Road Access discussing how accessible transport can impact a client’s rehabilitation outcome, enabling them to access with ease any essential medical and therapy appointments. 

The discussion developed into the impact of poor transport on a client’s social life. Martyn Sibley reminded us that limited access to family, friends, social activities and the local community can significantly affect an individual’s overall well-being and may indirectly influence the success of any agreed rehabilitation programme. If restrictions on participation in necessary or meaningful activities are prolonged due to circumstances beyond our clients’ control, are we potentially contributing to occupational deprivation?

The day prompted me to revisit the Rehabilitation Code 2015, which sets out best practice for collaboration between insurers and solicitors to ensure that clients involved in the litigation process receive timely and effective rehabilitation.

The Code is underpinned by several core principles

1. Early Intervention: Encourages the early identification and provision of rehabilitation needs, preferably at the outset of the injury claim process.
2. Collaboration: Promotes a cooperative approach between insurers, solicitors and rehabilitation providers, with the aim of streamlining access to essential services and ensuring an efficient rehabilitation process.
3. Injured Person’s Well-being: The health, welfare and recovery of our client is placed at the centre of the rehabilitation process, ensuring personalised care.
4. Cost-Effectiveness: While prioritising the client’s recovery, the Code also recognises the importance of managing costs. It supports cost-effective rehabilitation solutions that provide quality and effective outcomes.

The Code’s core principals encouraged me to reflect on how a client’s home environment can influence their rehabilitation journey, support the achievement of their goals and enable them to maximise their occupational performance.

Following a traumatic injury, a client’s primary goal is often to return home as soon as possible and begin re-establishing a sense of normality in their life. However, the reality is that their home environment may now present daily barriers to mobility, personal care, family life and participation in meaningful occupation.

When a client’s home becomes a barrier to engagement in rehabilitation, it raises important considerations for how the multidisciplinary team can adhere to the Rehabilitation Code. If a client cannot safely access key areas of their home, or there is insufficient space to deliver recommended therapy or accommodate specialist equipment, how many opportunities for rehabilitation are lost or compromised? Can the multidisciplinary team truly deliver the most effective and cost-efficient rehabilitation programme if the home environment itself is limiting progress and preventing the client from regaining function, developing skills and participating fully in everyday life?

It would therefore be beneficial for the multidisciplinary team to develop a comprehensive understanding of the client’s home environment at an early stage following injury. This would enable therapy interventions to be tailored realistically within their home and where the home is unsuitable, allow timely consideration of alternative accommodation.

What should early intervention under The Code look like? 

Early intervention must include the critical medical interventions required to support physical recovery and the therapeutic programmes that enable an individual to regain function. However, it should not stop there. Practitioners must also consider the suitability of the client’s home environment, their access to activities that bring them meaning and purpose and remember that without considering all of the above it will significantly impact our client’s occupational deprivation and their ability to recover.