CAOT Position Statement
Occupational Therapy and Home and Community Care (2008) 

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The Canadian Association of Occupational Therapists (CAOT) believes that home and community care is an essential part of a modern, integrated and client-centred health system. Home and community care services should be publicly-funded, accessible, affordable, timely, sustainable and provided by the most appropriate health professional.

Occupational therapy services offered within home care services effectively promotes health and prevents injury with individuals and families by reducing barriers and encouraging participation in their valued occupations or life activities (CAOT, 2003).

CAOT Initiatives
To promote home and community care services in occupational therapy, CAOT will:

1. Advocate for increasing access to occupational therapy home and community care services for identified populations.
2. Advocate for policies, funding, and legislation that promote occupation-based enablement to meet population health needs in home and community care.
3. Work with coalitions to participate in advocacy initiatives related to home and community care strategies. 
4. Support interprofessional education at entry-level and in professional development initiatives to promote collaborative interdisciplinary practice in home and community care services.
5. Promote profession-specific and interdisciplinary research studies that expand the knowledge base for home and community care in Canada.

Recommendations for occupational therapists
It is recommended that occupational therapists:

1. Inform the public, other health professions and policy decision-makers about the importance of occupation and occupational engagement in home and community care.
2. Advocate for access by vulnerable populations to occupational therapy in home and community care.
3. Advocate for the appropriate allocation of human, financial and material resources to provide quality services.
4. Develop partnerships with relevant organizations and stakeholders to promote access to home and community care service professionals.
5. Promote the development of research among stakeholders that will advance best practices in home and community care.
6. Use research evidence to support the importance of occupation and occupational performance in home and community care.

Background
Home and community care encompasses a wide range of health services delivered at home and throughout the community to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social or therapeutic treatment and/or assistance with the essential activities of daily living (Health Canada, 2005). The goal of home and community care is to enable individuals to receive high quality services at home, in the community, in supportive housing or in long-term care facilities. Support for friends and family who provide much of the care received at home is also needed (Health Canada, 2005).

The CAOT views home care as an essential and critical part of the continuum of health services for Canadians. CAOT advocates for the development of a pan-Canadian framework so that all Canadians have access to quality home and community care services in their own community.
Occupational therapists are university educated, regulated health professionals in all ten provinces of Canada. The education of occupational therapists is devoted to the study of occupation and occupational engagement. As an expert in occupation, occupational therapists use evidence–based processes that focus on their clients’ goals to participate in valued activities (CAOT, 2007; Townsend & Polatajko, 2007).

All provinces and territories in Canada have home and community care programs but there is considerable diversity among the services provided and eligibility requirements. Lack of common terminology and standards for service delivery and insufficient information collection have limited the ability of individual jurisdictions to collaborate and share information regarding home and community care services.

Shorter hospital stays, greater use of outpatient treatment and a growing population of older Canadians with longer life expectancy have increased Canadians' need for home and community care. The number of Canadians living in the community and needing occupational therapy services has also increased dramatically as a result of population aging and advances in medical technology that save and sustain lives.

Occupational therapy home and community services are provided through a complex mix of public and private funding including extended health care insurance, auto insurance, Workers’ Compensation and Veterans Affairs. Residents of Canada have unequal access to occupational therapy services due to a lack of federal/provincial/territorial coordination in both funding and development of a pan-Canadian framework for home and community care. The Canada Health Act (1985) does not require provinces and territories to provide publicly funded health services outside of hospital and physician care. Services formerly available through hospitals, which have shifted to the community, do not have adequate funding for occupational therapy.
Research demonstrates that through occupational therapy, an individual’s use of formal and institution-based care is reduced. Designating occupational therapy as a core and essential service would contain health-care costs by assisting people to become self-sufficient, particularly those with disabilities and chronic illnesses  (CAOT, 2004).

The Commission on the Future of Health Care in Canada (Romanow Commission, 2002) identified home care as a priority health service for the people of Canada. Evidence supports that home care within an integrated continuum of care can increase the efficiency and effectiveness of the Canadian health care system.

In response to Canada's First Ministers Accord on Health Care Renewal (2003), the Government of Canada created a five-year, $16-billion Health Reform Fund targeted to home care, primary health care and catastrophic drug coverage. First Ministers agreed that home care would eventually become an integral part of the publicly-funded system. 

To date, the Health Council of Canada (2008) discovered that many jurisdictions are making efforts to improve access to home care. Renewal efforts include universally accessible, publically funded home care programs initiated and targeted towards specific populations. They also note a growing concern among Canadians about access and quality of primary health and home care. Care is not always available when people need it and is not always as comprehensive or well coordinated as it should be. 

Canada needs a national framework for home and community care. A national framework can ensure that all residents of Canada have access to equitable services and protect the most vulnerable populations from sub-standard treatment by supporting health professionals to plan and deliver quality services. Finally, a framework would facilitate funding of core services such as occupational therapy.

Glossary of Terms
Enabling (verb) – Enablement (noun):  Focused on occupation, is the core competency of occupational therapy – what occupational therapists actually do – and draws on an interwoven spectrum of key and related enablement skills, which are value-based, collaborative, attentive to power inequities and diversity, and charged with visions of possibility for individual and/or social change (Townsend & Polatajko, 2007).

Enabling occupation: Refers to enabling people to ‘choose, organize, and perform those occupations they find useful and meaningful in their environment” (CAOT 1997, 2002, p. 180).

Occupations: Groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture; everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure) and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy (CAOT, 1997, 2002); a set of activities that is performed with some consistency and regularity; bring structure and are given meaning by individuals and a culture (adapted from Polatajko et al., 2004 and Zimmerman et al., 2006).

Occupational therapy: The art and science of enabling engagement in everyday living through occupation; enables people to perform the occupations that foster health and well-being; enable a just and inclusive society so that all people may participate to their potential in the daily occupations in life.

References
Canadian Association of Occupational Therapists (1997; 2002). Enabling occupation: An occupational therapy perspective (Rev. ed.). Ottawa, ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists (2007). The Profile of Occupational Therapy Practice in Canada. Retrieved on April 16, 2008 from http://www.caot.ca/default.asp?pageid=36.

Canadian Association of Occupational Therapists. (2004). Home care marketing kit.  Retrieved on April 16, 2008 from http://www.caot.ca/default.asp?ChangeID=5&pageID=616

Canadian Association of Occupational Therapists. (2003). Position statement on everyday occupations and health. Retrieved on April 16, 2008 from http://www.caot.ca/default.asp?pageid=4

Government of Canada (1985). Canada Health Act. Retrieved April 16, 2008 from http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2002/2002_care-soinsbk4_e.html

Health Canada (2003). First Ministers’ Accord on Health Care Renewal. Retrieved April 16, 2008 from http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/index_e.html.

Health Canada. (2005). Home and continuing care. Ottawa, ON: Health Canada.  Retrieved on April 16, 2008 from http://www.hc-sc.gc.ca/hcs-sss/home-domicile/index_e.html.

Health Council of Canada (2008).  Fixing the Foundation: An update on Primary Health Care and Home Care Renewal in Canada. Toronto: Health Council. Retrieved on April 16,2008 from http://www.healthcouncilcanada.ca/en/index.php?option=com_content&task=view&id=214&Itemid=10

Polatajko, H. J., Davis, J. A., Hobson, S., Landry, J. E., Mandich, A. D., Street, S.L. et al. (2004). Meeting the responsibility that comes with the privilege: Introducing a taxonomic code for understanding occupation. Canadian Journal of Occupational Therapy, 71(5), 261-264.

Romanow Commission (2002). Building on values: The future of health care in Canada. Retrieved on April 16, 2008 from http://www.hc-sc.gc.ca/english/care/romanow/hcc0086.html.

Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa, ON: CAOT Publications ACE.

Zimmerman, D., Purdie, L., Davis, J., & Polatajko, H. (2006, June). Examining the face validity of the taxonomic code of occupational performance. Presented at the Thelma Cardwell research day, Faculty of Medicine, University of Toronto, ON, Canada. Retrieved March 28, 2007, from http://www.ot.utoronto.ca/research/research_day/documents/rd_06_proceedings.pdf

Position statements are statements on political, ethical and social issues that impact on client welfare or the role and practice of occupational therapy, or that affect the Association. They are frequently time-limited and persons wishing to use them more that two years after publication should confirm their current status by contacting the CAOT Director of Professional Practice by e-mail: practice@caot.ca

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