Home-Based Occupational Therapy Visit Note

Purpose of Home Visit:

• Post-discharge home environmental safety assessment and functional ADL/IADL review following R total hip replacement (THR) on 12/05/2026.

Present at Home Visit:

• Arthur Pendelton - Client
• Margaret Pendelton - Wife/Primary Caregiver
• Sarah Jenkins - Occupational Therapist

Subjective:

• Pt reports 4/10 dull ache in R hip, managed with paracetamol 1,000 mg PO QID and celecoxib 200 mg PO OD.
• Adheres to hip precautions conceptually, though forgets during transitional movements.
• Wife reports anxiety regarding pt showering independently due to a small step-in shower recess.
• Priority goal: Independent and safe toilet and shower transfers without breaching posterior hip precautions.

Objective:

• Mobility: Ambulates indoors with 4-wheeled walker (4WW), supervision required for obstacle negotiation. WBAT on R LE.
• Transfers: Bed transfer requires SBA and verbal cueing to avoid hip flexion > 90 degrees. Toilet transfer unsafe due to low pan height (400 mm) and lack of bilateral support.
• ADLs: Lower body dressing requires min A from wife; pt currently lacks long-handled aids.
• Environment: Single-storey brick home in Subiaco. 2 steps at front entrance with unilateral rail on L. Bathroom features hobbed shower (150 mm step) with no grab rails. Loose scatter rugs noted in hallway and living room.
• Assessment: Falls Efficacy Scale - International (FES-I) score 38/64 (high concern regarding falls).

Assessment/Analysis:

• 74yo male 6 days post-R THR demonstrating reduced functional independence in personal ADLs (toileting, showering, lower limb dressing) secondary to post-op pain, ROM restrictions, and environmental hazards.
• High falls risk due to unadapted bathroom environment, clutter/rugs, and occasional cognitive lapses regarding hip precautions.
• Ongoing OT intervention required for assistive technology prescription, minor home modifications, and adaptive ADL retraining to prevent dislocation and falls.

Intervention/Treatment:

• Equipment trial and fitting: Installed over-toilet frame (OTF) adjusted to 520 mm height. Trialled stationary shower chair in recess.
• ADL retraining: Practised sit-to-stand transfers from OTF and bed using 4WW, emphasizing R leg extension prior to sitting/standing.
• Lower limb dressing: Introduced and practised use of long-handled reacher, sock aid, and long-handled shoehorn.
• Environmental modification: Removed 3 scatter rugs from main walkway with wife's consent to ensure clear path for 4WW.
• Education: Provided verbal and written education on posterior hip precautions (no flexion > 90 degrees, no internal rotation, no adduction past midline) to pt and wife.

Response to Intervention/Progress:

• Pt demonstrated safe, independent transfers on/off OTF after 2 verbal cues regarding hand placement.
• Successfully donned socks and slip-on shoes independently using adaptive aids while seated on bed edge, maintaining precautions throughout.
• Expressed increased confidence with shower chair setup; however, still requires SBA to safely clear the 150 mm shower hob with R LE.

Plan:

• Short-term goal (2 weeks): Pt to complete shower transfers and washing with supervision/SBA and nil breach of hip precautions.
• Submit Commonwealth Home Support Programme (CHSP) minor modifications request for installation of 2x grab rails (vertical at shower entry, diagonal internal) and 1x external bilateral wedge ramp.
• Pt to hire OTF and shower chair from local pharmacy for 6-week post-op period.
• Homework: Pt to practise lower limb dressing daily using long-handled aids under wife's supervision.
• Follow-up home visit scheduled for 25/05/2026 at 10:00 AWST to review actual wet-area shower transfer and check rail installation progress.