"Health Care Teams: An Overview "
By Lisa M. Petsche
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Older adults admitted to hospitals or long-term care facilities often have complicated health conditions necessitating the intervention of professionals from a variety of disciplines. Service delivery by health care teams ensures a coordinated, holistic approach to assessment and treatment. Members consult and collaborate on an ongoing basis in order to determine needs, develop care plans and assist patients in achieving identified goals.
Team membership typically consists of the following health care professionals: physician, nurses, physical therapist, occupational therapist, dietitian, speech-language pathologist, social worker, recreation therapist and chaplain.
Depending on the setting, some disciplines may be considered core team members while others are consulted on an as-needed basis.
Following is an overview of each member's role.
As team leader, the case manager - sometimes known by other titles such as primary care coordinator - is responsible for overall planning, coordinating care and evaluating outcomes. Inpatient case managers are usually registered nurses.
Physicians diagnose and treat medical problems in consultation with the team, ordering investigations and treatments as needed. They make referrals to specialists — for example, geriatrician, psychiatrist, urologist, orthopedic surgeon — as needed.
Depending on their level of training, nursing staff develop and monitor a plan of nursing care, help assess patients' health status, administer medication and other physician-ordered treatments and assist with personal care.
Physical Therapist (PT)
Physical therapists are exercise specialists who “restore, maintain and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health” (American Physical Therapy Association). The PT evaluates patients' functional ability and works with them to improve (or in some cases simply maintain) ambulation, balance, endurance, range of motion, strength and flexibility.
He or she recommends mobility devices such as canes and walkers and trains patients in their proper use.
PTs also develop customized exercise programs for patients to follow after active therapy is completed, in order to continue the benefits gained.
Occupational Therapist (OT)
Occupational therapists teach people with disabilities alternative ways of carrying out daily activities and recommend adaptive equipment where appropriate. Basic activities of daily living (ADLs) include feeding, toileting, washing, dressing and grooming.
Higher level skills, known as instrumental activities of daily living (IADLs), include getting to places beyond walking distance, using the telephone, grocery shopping, preparing meals, doing housework, managing money, problem-solving in emergency situations and accessing the community. For those unable to walk, OTs recommend wheelchair seating that meets their particular needs in terms of independence, safety and comfort.
OTs also have expertise in bed positioning techniques that minimize skin breakdown and other problems. For patients planning to return home, OTs may perform a home assessment to identify environmental obstacles and hazards and make recommendations — home adaptations or purchase of medical equipment — to address them.
A specialist in nutrition, the dietitian evaluates the patient's nutritional status and recommends necessary dietary changes as a way of helping to treat various diet-related health problems, such as diabetes, high cholesterol, constipation, obesity and excessive weight loss.
Speech-Language Pathologist (SLP)
The speech-language pathologist assesses and treats difficulties related to hearing, speech, language (both expression and understanding) and swallowing.
She provides speech therapy, gives training (to the patient, family and staff) in alternative methods of communication where necessary and performs hearing screenings. Where problems exist with swallowing, she may recommend modified food textures or specific feeding techniques to minimize the risk of food ending up in the lungs (a phenomenon known as aspiration), which can lead to pneumonia.
The social worker assesses the social, emotional and personal implications of health changes for patients and their families, and helps them learn how to cope more effectively with losses, emotional issues, family problems, financial concerns, depression and behavioral changes.
He or she also serves as a patient advocate, and links patients and caregivers with community resources, including when discharge is required.
In long-term care facilities, recreation therapists coordinate activities that are enjoyable, therapeutic and educational — from bingo and pet visiting to birthday parties and pub nights to horticulture and news groups. They attempt to match new residents to facility programs based on their previous hobbies, interests and cultural practices.
They also organize community outings such as shopping excursions and trips to cultural events. Their work fosters quality of life by providing opportunities for fun, creativity, socialization and learning.
Together, the various disciplines work with the patient and his or her family to help achieve the highest possible level of health, independence and quality of life.
The chaplain provides spiritual guidance and support to patients and families, addressing issues around faith, meaning and purpose. Chaplains also facilitate contact with religious leaders in the community when desired by the patient or family.
Lisa M. Petsche is a medical social worker and a freelance writer specializing in health and elder care issues.