Occupational Therapy at Home

In this final instalment of mosAIC’s home therapy series, read on to learn about how Occupational Therapist, Ms Koh Wee Xin, from TOUCH Community Services, journeyed with previously home-bound Mr Sub’ari to integrate him back into his community.

“My home was like a prison. I had wanted to be self-reliant, not require help to get out of my home, and be free to go wherever I wanted to. Escape, independence and freedom. That was all I could think about,” said Mr Sub’ari, 65, of the time when he was home-bound.

This was how Ms Koh Wee Xin, Occupational Therapist from TOUCH Community Services found him in 2016.

Previously a Project Manager at Phillips, Mr Sub’ari had a stroke at 42, which severely compromised his strength on the left side of his body. A knee surgery in 2014 later rendered him wheelchair-bound. As a result, Mr Sub’ari could not descend the two steps at his front door. He had to use a makeshift wooden plank as a ramp, but it was too steep and unsafe for him to manoeuver without help. Though he was still mentally alert, communicative and physically strong on his right side, the infrastructural barriers prevented him from leaving his home independently and engaging with his community.

Consequently, he was confined to his house except for when he had medical appointments or engaged his friends for help. The isolation and the lack of freedom took a toll on Mr Sub’ari, who was fiercely independent.

“There was nobody to talk to, I would just read books and watch TV. I would go from my kitchen, to my living room, to my front door – every single day and night.”

Getting Help from a Home Occupational Therapist

Occupational therapy helps individuals who face physical, cognitive or mental health problems as a result of disease, accidents or even ageing. It aims to help them find practical solutions that are tailored to their abilities. These include overcoming challenges that they face when engaging in Activities of Daily Living (ADLs)  (such as showering or feeding oneself) and optimising their participation in meaningful activities (such as resuming work after a stroke).

In home settings, occupational therapists also collaborate closely with caregivers to empower them with skills to care for their loved ones, or even lend a listening ear.

As Mr Sub’ari’s home occupational therapist, Wee Xin was able to assess his living situation closely, and witnessed first-hand how the environment prevented wheelchair users from doing something as simple as leaving and entering one’s home.

In Mr Sub’ari’s case, this was further compounded by the common corridor being too narrow to fit a gentle ramp, without obstructing the path of neighbours.

“We considered every kind of ramp - L-shaped, trapezoidal, wooden for Mr Sub’ari. They were not approved each time because they would block too much of the corridor,” said Wee Xin.

Aware of the needs of Mr Sub’ari, his neighbours and the authorities, Wee Xin saw this as an opportunity to find a solution that could be useful to other wheelchair users. It was a triangulated method of seeking help and ideas from various sides.

“I engaged different ramp vendors seeking solutions, brainstormed with my colleagues, spoke to the Housing & Development Board, town council, and even wrote to his MP!”

Eventually, things came together and TOUCH engaged a vendor who had designed and wanted to pilot wheelchair lifters in the community. With his MP’s support, they gained approval to install one at Mr Sub’ari’s front door. Since then, HDB has launched the wheelchair pilot scheme under the HDB EASE programme.

The lifter took two years to actualise, but it was not a one-stop solution. “Even after it was installed, we had to overcome many challenges as this device was new to us and it didn’t come with SOPs,” said Wee Xin.

Problem Solving at Home

For Mr Sub’ari, TOUCH conducted many rounds of training to acclimatise him to using his lifter - a whole hour’s session could be devoted to practising going up and down from his front door. There were also diverse adaptations required to figure out a process that worked for Mr Sub’ari.

“If my door was to swing out while I was on the lifter, the lifter would perceive an obstruction and I could be stuck mid-air.” Wee Xin helped him find cost-effective solutions, like a simple foam stopper to prevent his door from swinging out. It took about 10 minutes for Mr Sub’ari to exit his house, close and lock his front door. Due to the numerous steps involved, Wee Xin added visual aids to guide Mr Sub’ari through the process.

Wee Xin also helped to tailor the lifter to suit Mr Sub’ari’s needs.

“Initially, there were no safety railings on the lifter, and he was nervous about using it. So we installed a yellow bar on the right side – because he’s weak on his left – that he could hold on to.”

In her work, Wee Xin also helps clients by adapting self-care, home management, and community reintegration-related activities to their abilities. This happens through strategies like visual reminders, or assistive aids like motorised wheelchairs. For individuals with rehabilitation potential, she can facilitate strengthening exercises or cognitive training to restore function. She may also prescribe modifications to promote home safety and reduce fall risk.

Another TOUCH occupational therapist also trained Mr Sub’ari to use a motorised wheelchair. This entailed more trial and error – figuring out the best aid to use, the safest and most comfortable way to transfer from one wheelchair to another, and choosing an aid that would fit easily through his front door and on his lifter. Thereafter, she also assisted in retraining Mr Sub’ari to navigate his neighbourhood via buses or finding wheelchair-accessible routes to amenities.

Differences Between Home-Based and Centre-Based Occupational Therapy

Clients who are admitted to home-based OT are generally home-bound due to environmental constraints or physical limitations. When these barriers are overcome, clients with rehabilitation potential may progress to centre-based therapy that offers more intensive intervention to further maximise or maintain function.

Exploration and “expecting the unexpected” is part and parcel of working in home environments versus controlled environments like centres. There are physical environmental considerations – “Everybody’s door, house, and layout are different. I may face dim lighting, clutter, and even pests. All this can compromise the conduciveness of the home as a therapy site,” said Wee Xin.

Social factors like family dynamics, clients’ motivations and emotional state also impact therapy outcomes as much as physical environmental factors. As home occupational therapists face these issues alone with their client, they must learn to think on their feet to find solutions and maximise the client’s rehabilitation potential at home.

Reintegrating Back into the Community

“I was confused at first – seeing all the people walking and talking around me. I slowly got used to it. This is how life has always been for me. Twenty years ago, I was also doing the same,” Mr Sub’ari reflected.

While Mr Sub’ari exercised his courage and confidence to navigate society in a brave new way, Wee Xin pulled together comprehensive support ranging from active, collaborative problem solving to tireless advocacy.

All this paid off as Mr Sub’ari slowly rediscovered his place in his community.

“Now I go to the mosque weekly, and I’ve befriended others also on wheelchairs. I also hang out at the hawker centres and coffee shops. It can really boost your mood and confidence when old friends recognise you and talk to you.”

Wee Xin smiled upon hearing this.

“Empowering and re-enabling seniors helps them regain confidence and dignity in life. Having my clients wave to me at the coffee shop after they have regained mobility and reintegrated into the community is so satisfying!”

The cost of the home-based service starts from $116 before means-testing subsidy. Subsidies ranging from 15% to 80% are available for means-tested Singaporeans and PRs. For more information, please visit https://aic.buzz/HomeTherapy

Here are the first and second instalments of the series: Speech Therapy at Home and Physiotherapy at Home.

Note: Mr Sub’ari passed away shortly after this article was written. He had expressed his wish to advocate for better accessibility within the community for differently abled persons through this interview. The mosAIC team is grateful to him for his heartfelt sharing, as well as to his family for kindly supporting the publication of this article.