Entrepreneurial occupational therapists (OTs) are finding rich rewards by providing both rehabilitation and consulting services to assisted-living facilities and their residents.
Assisted-living facilities occupy a niche between independent-living facilities and more-expensive skilled nursing homes, catering to people who are fairly independent but who need some assistance with activities of daily living (ADLs) or who suffer dementia or incontinence.
As society ages -- and as assisted living becomes a more popular long-term-care choice -- millions of people are expected to need help with ADLs in these settings. Of the more than 1 million current assisted-living residents, 81 percent need help with at least one ADL.
In a competitive marketplace, facilities are eager to meet residents' needs, maintain a high level of satisfaction and, of course, attract new residents. OTs are well-suited to help facilities achieve these goals through programming, staff training and expert consultation. For those reasons, the American Occupational Therapy Association (AOTA) calls consulting to assisted-living facilities a "wide-open opportunity" and an emerging trend in OT practice.
Applying the OT's Skills
"Occupational therapy helps people deal with ADLs, and people move to assisted-living facilities because they have problems with ADLs," says Mary Kay Buysse, director of patient-care solutions for Hinsdale, Illinois-based Life Services Network. The typical assisted-living facility resident is an 86-year-old woman who needs assistance with approximately two ADLs.
OTs can serve assisted-living facilities by:
- Designing and overseeing group wellness programs for residents.
- Advising architects, contractors and facilities managers on environmental modifications and universal design.
- Assessing and screening residents for proper placement.
- Establishing and running on-site adult day-care programs.
- Training staff therapists and nursing aides.
- Develop fitness and water aerobics programs.
Blazing the Trail
In the mid-1960s, OT Nancy Richman struck out on her own instead of accepting the then-traditional 9-to-5 job. Her business grew, and in the mid-1980s, she joined forces with fellow OT Corky Glantz. Today, Glantz Richman Rehabilitation Associates employs nearly 80 OTs, physical therapists, speech and recreational therapists and social workers, who offer a range of services to care facilities in the Chicago area.
On the West Coast, Mary Foto, OT, FAOTA, CCM, a former assisted-living facilities consultant, has carved out a thriving consulting practice. Through The Foto Group, she and others consult with Blue Cross of California, providing catastrophic case management, policy development, utilization review and retrospective medical reviews. She also provides individual rehabilitation services through her San Bernardino, California-based company, Rehabilitation Technology Works.
Lisa Fagan, a licensed registered OT (OTR/L) and licensed assisted-living facility administrator, consults with facilities in New Jersey and Pennsylvania on quality-of-care issues, regulation compliance, program development, environmental modifications and staff training.
OT Consulting Success Factors
Based on their experiences, these established consultants identify factors for consulting success:
- A Track Record: Consulting is not for recent grads or beginners, emphasizes Foto. Richman concurs. "Consulting calls for a very thorough knowledge of geriatrics, especially dementia, and an advanced level of skills gained through direct therapy work and continuing education," she says.
- Business Skills: "Very few OTs are good businesspeople," says Foto, a past president of the AOTA and a board member at the University of Southern California's School of Occupational Science and Occupational Therapy. "They need practice-management skills. Many OTs may not fail as consultants, but they aren't nearly as successful as they could be, because they don't understand business issues." The solution: Attend practice-management workshops at conferences and get sound legal and accounting help.
- Salesmanship: OT consultants must generate their own business by showing facilities how their services can benefit the bottom line. As part of that effort, they must communicate why an OT can do a better job than other potential providers, such as recreational therapists, exercise trainers and certified gerontologists. "You've got to make people realize they need you," Richman says.
- Income: Building a business takes time, so have supplemental income sources until your consulting practice is established. While Medicare and private insurance reimburse for direct rehab services, OT consulting fees are generally borne by the facilities.
- Visibility: "Becoming active with the Assisted Living Federation of America and speaking at industry conferences and meetings has helped build my credibility," Fagan says.