The Therapies team at Trinity offers everything from expertise and advice, to equipment to palliative rehabilitation. That might mean providing equipment to help people maintain their independence at home and maintain their access to everyday essentials like their bath or kitchen, or helping to rebuild strength, maintain their balance or manage their breathing. 

Occupational Therapist Ellie joined Trinity in April 2020 from The Royal Marsden, where she worked in oncology and palliative care. Arriving at Trinity during the first wave of Covid-19 and a national lockdown, Ellie has explored new ways of supporting patients in the community while continuing to care for patients on Trinity’s inpatient unit.

“The key to the Therapies team’s way of working is that if we can go in and meet a deteriorating patient’s needs, then we can hopefully avoid a hospital stay. To do that you have to listen and respond to patients’ individual needs. It’s certainly been a challenge but it’s sparked ingenuity and more efficient ways of working and actually there’s so much we can do effectively by telephone, email or video calls. To reduce the risk of COVID transmission we have only been visiting patients at home when we really can’t support them any other way, for instance when someone’s environment or social situation warrants it.” 

Physiotherapist Katie adds: “We launched a series of exercise videos last year, which proved really popular, and that was followed by other videos for yoga and relaxation. We plan to develop more videos focusing on symptom management, advice for fatigue and breathlessness, and perhaps in the longer term, for post-Covid care. The videos have been helpful for people to access and revisit in their own time, but they haven’t worked for everyone, we tailor our care to our patients’ needs. 

“It’s all part of the individualised approach to care we aim for at Trinity. We ask what we can add to a patient’s care from a palliative care point of view. We work with people at their end of life but also with life limiting illness and are able to support people through the different stages of their condition. We support Trinity’s clinical nurse specialists (CNS) by offering techniques that can provide relief to people with fatigue, breathlessness and pain.”

Occupational Therapist Ellie has up to 20 patients on her caseload at any time (although at any one time the hospice is caring for nearly 750 patients). “Interestingly, we’ve found that the ability to be in touch virtually has been positive and families are often more responsive – they feel like there’s someone there for them at the end of the phone, or on email, and some will even ping off an email in the middle of the night – they feel even more connected to us than pre-Covid.” 

Katie, Ellie and their colleagues in the Therapies team have seen the benefits to completing elements of their role remotely, for example first assessments for patients with complex symptoms living at home. “Not only is it more time-efficient, it means I have a clearer understanding before I visit a patient so I can bring things to a first visit that will start helping immediately, a toilet frame or dressing aids for example” says Ellie. 

The pandemic has resulted in more patients wanting to stay at home rather than come into the hospice, hospital or a care home, often because of the strict limits on visitors. This also means more people with complex needs are choosing to stay at home. “In these cases, more problem-solving is needed,” says Katie, “we’ll assess and create a plan across occupational therapy and physio, with the clinical nurse specialists. It’s rewarding when we can make this happen and we’re told by patients or their carers that if it wasn’t for us, they wouldn’t have been able to stay at home with their families. Ellie adds: “We’re used to people choosing care at home over care in the hospice (most do), but you only need to look at the surging demand for moving and handling equipment for example, to see how many more people with complex needs require support to stay at home, and that brings new challenges for us.” 

One carer recently said that until Trinity stepped in, she felt as if her husband had been ‘written off’ and with the help of the Therapies team, he got back on his feet and had a much more hopeful outlook” says Katie. 

Constant dialogue and sharing of skills and information within the team is key in the their role to support patients to be as independent as possible for as long as possible, and to improve their quality of life. “We work well as a team, so if Katie’s visiting somebody for a physio assessment, then she’ll take the measurements I need to arrange a bathing aid, for example. We’ve got even better at making the best use of our time and resources than ever before and I’m sure that’s translating into even more joined up, efficient care.” 

I think for all of us, patients, staff, and the general public included, it feels like last March we were told we just needed to sprint 100 metres and we’d be home and dry. But the distance keeps getting longer. It’s become an endurance exercise, and everyone’s still sprinting! It makes a big difference to be surrounded by a supportive and collaborative team in Trinity, that’s open to new ways of working.

Katie acknowledges that the changes brought about by Covid have certainly changed the way they are all working and will be around for the foreseeable future. “We’re all really supporting each other, and I feel grateful to come into work every day and see colleagues while making a positive difference to people in what can be desperately sad and challenging situations”.

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