In adult social care, occupational therapists increase people's independence and optimise care packages by advising on equipment provision, adaptations and manual handling. 

The provision of the service is however limited by, uh, waiting lists and staff resources. OT waiting lists are mentioned as an area of improvement in South Gloucestershire Council's CQC rating and there is currently a seven-month waiting list in the locality teams to see an occupational therapist. 

We wanted to know more about the impact of waiting lists on people's care outcomes.

So, they came to Emily and to me, and what we did was we came up with the research question for this, which was, ‘what impact does timely access to home adaptations provided by OT services have on people's care outcomes  in adult social care?’ 

And what we did was we looked at academic journal databases, so the British Journal of Occupational Therapy (BJOT), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and the Scandinavian Journal of Occupational Therapy. And what we were looking for were relevant reviews and studies published in English since 2015, and any relevant professional guidance as well. And we were defining timely access as provision of minor or major home adaptations following referral by an OT or an OT assistant. 

And in terms of what we found, we found, um, a feasibility randomised control trial. So that is like a pilot that is done before a larger scale study. And you're going to hear more about that, um, study in this session in a moment. Um, and that focused on people aged 65 plus who'd been referred to a single local authority for an accessible level shower. 

They were randomised to two groups, one which got the adaptation immediately and the other, um, with the usual wait, which at the time was about three to four months. 

Um, and the outcomes were assessed at three, six, and nine months afterwards. We found a systematic review, um, which is literature. It gathers together literature published on this topic. Uh, we found a mixed method study and that focused specifically on people with Motor Neurone Disease (MND) and was conducted in Scotland. 

And then we also found four qualitative studies. So studies that focused on people's experiences and perceptions of the adaptation. Two of those were conducted in Australia, one in England, and one in Wales. 

So, we found multiple outcomes were impacted by timely access to home adaptations. And we grouped these outcomes into four key areas, which were wellbeing, quality of life, health and safety, and ongoing care needs. As quality in life and wellbeing are similar themes, we define these differently, um, by defining wellbeing as the overall state of a person's physical, mental, and emotional satisfaction with life. Um, and we define quality of life as an individual's perception of their position in life, in the context of culture and value systems in which they live in relation to their goals, expectations, and standards. 

So, um, multiple studies commented that people's wellbeing and quality of life were impacted when there were delays. And both these areas improved when people had timely access to them. So, people said there was an emotional toll when there were delays. Um, for example, a person with MND stated that being trapped in their home whilst waiting for adaptation was emotionally challenging when they wanted to spend the end of their life making memories with family. Um, and other people reported that they felt, um, they were delaying everything they can, um, and were just holding out until I passed away so that they don't need to do anything. 

Um, people also reported that loss of confidence or independence in one area also impacted confidence and reduced activity participation in other areas. So, when people couldn't access their washing facilities, um, they also went outside less due to fear of smelling. People also said they felt embarrassed asking for family members for help with washing. Um, and so it impacted their social relationships. 

Um, and then also people said that they felt a loss of control and the ability to plan for the future was impacted. Um, and this was compounded by the fact that people take time to adjust to adaptations. Someone said that my husband passed away nine and a half months from diagnosis and the ramp hadn't even begun. 

Um, so, um, people reported that when, um, adaptations were provided before people needed them, it gave them, uh, peace of mind. Uh, however, some councils only considered providing adaptations when the needs presented themselves, which led to needs being, uh, unmet sometimes. 

Um, and also people would fund the adaptations themselves, um, even if they were eligible for funding, um, due to delays. 

And then finally, people reported a, uh, impact on their dignity. Um, so some people would wash on decking with buckets of water, um, to wash themselves as well. 

So other themes on the findings as well as wellbeing and quality of life were health and safety and care. So, in health and safety, there were multiple studies that reported increased falls during the delays. Um, so people had broken bones, there were more hospital admissions and an increase in paid care. 

Uh, one of the examples that somebody, um, highlighted was they said, instead of making my quality of life better, it has made it worse over the last year. I ended up in A& E with a split head because I fell down the steps at my front door due to the ramp not being started back in December. And then it also exacerbated, um, other physical health issues, um, due to that adaptation in the way that people, um, undertook things, their coping mechanisms. So, an example there was somebody who started washing on their hands and knees in the bath while they were waiting, and that then exacerbated their arthritis. Um, similarly, some people just didn't wash at all for fear of, uh, falls. So that, um, impacted on their hygiene. And as Emily said, that then has an impact on their social life. 

Um, and then in terms of ongoing care needs, uh, we found that there were increased difficulties for each consecutive month that people were waiting for adaptations. Um, so difficulties with everyday tasks, um, increasing all the time. And then in contrast, um, less care and support was needed once an adaptation was completed. So that suggests that the longer the delay for an adaptation, the longer the time is needed to support in the longer term as well as potentially a greater level of support needed for longer. 

So overall, we're moderately confident about the trustworthiness of the studies, analysing the briefing. Um, we should note however, that inferring transferability of these findings to all adults with disabilities should be done with caution as most of the papers referenced focus on the impact on specific groups such as older adults or people with MND who might have had different outcomes to the wider population that we were considering in this paper. 

Um, so the implications on practice from this research is that when developing adaptations provision, local authorities, um, should consider fast tracking procedures for people with rapidly progressing conditions. Um, local authorities should also consider investing in working preventatively rather than reactively to need. Um, local authorities should increase public awareness of adaptations to increase prompt referrals and manage expectations of what services can provide. 

And workers should maintain communication with service users throughout the process to improve outcomes and manage expectations as well. 

And then finally, services, um, should ensure that they, uh, have workers with knowledge of adaptations at the front door as well. 

So, we have a slide at the end with some references for further reading, uh, which will be sent to you as well, so you can read some more in your own time.