Members Article – Setting up a Private Practice

As many of us are aware, client’s families are needing more help to keep their older family members at home, and more importantly engaged in meaningful activities. At present, Diversional Therapy for older clients is mainly provided within residential aged care facilities and day centres. In-home Diversional Therapy is relatively new, and is a client centred practice. The benefits of in-home therapy are many. Firstly, when clients are visited in their own home, their safety factor is increased, and they are comfortable engaging in activities. This is particularly relevant and convenient for clients with dementia, who may not want to leave their home to attend a day centre. Secondly, the activities delivered can tap into the client’s existing interests and hobbies, which may already be undertaken in the home. Thirdly, meaningful activities of daily living, such as food preparation and household tasks, can be incorporated into a Diversional Therapy activities program.

Therapy may include activities such as:

• Gentle physical exercise, including deep breathing and meditation which can enhance physical health;
• Cognitive interests such word games; crosswords; Sudoku; quizzes which keep the brain challenged;
• Reminiscence which taps into long term memory and can bring back pleasant experiences, even unpleasant memories can be dealt with in the security of home;
• Social pastimes such as discussion and armchair travel, making and sharing a cup of tea, people can feel in command as they are in familiar surroundings;
• Engagement in creative endeavours and re-establishing old hobbies and lost skills.

I started my in-home therapy service because I saw a need in the community. During my previous role in a day centre, I saw a lot people who enjoyed the activities we ran, but because their dementia was moderate, would constant exit seek. One client was particularly engaged in painting, but as soon as she would look up and see that she wasn’t at home she would down brushes and begin to agitate. It was extremely hard to re-engage her from that point on. I’m sure I’m not telling you anything you don’t already know. So, I began to think that if I could provide a service to people in their own homes, they would find the experience much more beneficial.

Whilst the process of providing DT in-home is pretty similar to providing DT in house, (assessment, activity analysis and adaptation, evaluation, documentation etc) the process of obtaining clients is not. Whereas your clients pretty much arrive on your doorstep, the private practitioner has to scour the area and find them. Word of mouth, Facebook pages, tracking down every person you have ever met in the medical or allied health field, talking to friends’ or colleagues who have ageing parents and suggest ways/places to advertise your services, taking out adverts in local papers. As well as all these avenues I had brochures printed and distributed them to GP’s, aged care facilities (hey I’m not in competition with you, I’m a complimentary service that will attend out of hours); aged care facilities are peoples’ homes too; day centres; retirement homes; hospitals; aged care service providers care brokers and Better Caring.

Although I cast many lines I only had a few nibbles. I signed an agreement with an aged care service provider although no clients have come my way; I have had one private client via a care brokerage firm; but by far by greatest success was with a private hospital. This was pure luck, as I happened to be delivering a brochure to them at around the same time as they were looking a contract a DT to provide DT services to outpatients in their day rehab facility. They are very forward thinking as one of the major health fund requires their clients to have 3 hours of (different) therapy when attending rehab and whilst they are already had PT and OT they wanted to add in DT. Right place, right time. A call from, and a meeting with, their Allied Health Manager saw me signing a contract with them to provide DT services to outpatients two hours per day, twice a week.

The process of providing services in private practice is pretty much the same, both within the hospital and with my private client. Assessment (which is pretty done on the fly at the hospital as new patients turn up daily); programming (I have a rough idea of who will be in my sessions in each day) activity analysis and adaptation (especially tricky when a patient turns up with limited English and poor eyesight or hearing) and documentation. Although in truth I know much of this on the day before, there is nothing quite like that first meeting/assessment when you form a general impression of the client. There needs to be many and varied activities in my bag of tricks. So far so good, I have been able to think and plan on my feet (literally) and have received sound feedback both from the hospital; individual patients and the allied health staff I work alongside. They have been very welcoming and supportive, and together I believe we run a great service to the hospital. And of course, there is the clinical note writing and a little bit of admin work. All in all, the work is satisfying, I am my own boss and helping to take the profession into new areas.

Submitted by Terri Flynn

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