Canadian Association of Occupational Therapists

Far and away: Challenges of home care in Yellowknife
by Marnie Lamb

In her role as the only home care occupational therapist in Yellowknife, Marjorie Sandercock is also a teacher, an equipment installer, a counsellor and a troubleshooter. “I wear a lot of different hats,” she laughs.

Working for the government-funded Yellowknife Health and Social Services Authority, Marjorie sees clients with a variety of chronic conditions. Most of her clients are referred through nurses, but clients can be referred by themselves or by other health care professionals. Like other home care occupational therapists, Marjorie assesses clients in their homes and considers such issues as home modifications and mobility needs in determining the best way to help clients perform the activities they want to perform, such as preparing meals, caring for children and being able to get around in their home and community.

Yet although Marjorie has the support of a multidisciplinary team which includes a full-time medical social worker and home support workers, she often finds herself wearing hats that most other occupational therapists do not wear. For instance, the nearest equipment vendor is in Edmonton. Having to constantly order even basic adaptive devices from another province is frustrating, so Marjorie started up a “loan cupboard” with such equipment. A client can borrow a device until he or she either no longer requires it or has obtained one from Edmonton. The lack of vendors means that Marjorie, the only person familiar with such devices, is called upon to install them in the client’s home and to troubleshoot when the installation is not quite right or the client is having trouble using the device.


Some of Marjorie’s clients have dementia, and she offers them two major services. The first is a cognitive assessment, which evaluates a client’s memory, judgment and reasoning. This assessment gives her a sense of how much support the client will need and what kinds of activities would stimulate the client without frustrating him. For instance, a client with functional problems who enjoys knitting might be unable to make an afghan but might enjoy winding balls of yarn. This stimulation is vital for those with dementia.

The second service Marjorie offers is a home safety assessment. Clients with dementia face distinct difficulties, one of which is wandering. These clients are often hit with short-term memory loss, and hence might forget that their current address is actually their home, thinking instead that their childhood home is where they live. Clients will wander outside and try to find their homes, a great concern in a place like the Northwest Territories, with its harsh weather. To guard against this, mini-alarm systems can be installed in a client’s home so that if the front door is opened from the inside, an alarm will sound, alerting the family that their loved one might be trying to leave. Such clients can also be referred to the Alzheimer’s Society Wandering Registry, a national database that the RCMP can access. The potential wanderer is given a “medical alert”-like bracelet engraved with his or her name and the words “memory loss.” These tools help locate missing persons.

Because of a lack of resources—no permanent or visiting geriatrician, for example—an early diagnosis of Alzheimer’s is extremely difficult in the Northwest Territories. Most of Marjorie’s clients are in the middle stages of the disease. As a result of a lack of long-term care facilities or day programs for such clients, she often finds herself caring for those in the later stages too. One client moved from a rural location in another province to live with her daughter, who suspected that her mother had Alzheimer’s. The family physician to whom the daughter brought her mother diagnosed the mother as having “dementia, probably of the Alzheimer-type.” After assessing the client and discussing her daily behaviour with the daughter, Marjorie agreed that the client could benefit from occupational therapy.

The daughter faced a dilemma: to send her mother back home to a place she knew but where she had no help; or to keep her in Yellowknife, where she could obtain help more easily but was in an unfamiliar environment. Neither location offered long-term care. Marjorie helped the daughter weigh the pros and cons, and ultimately, the daughter decided to send her mother home, but with a twist: she paid neighbours to act as home support workers for her mother. Marjorie praises the solution as enterprising but worries about its sustainability: “What happens in the future?”

Certain components of the home care program are well funded in Yellowknife; unfortunately occupational therapy is not one of them. Marjorie’s position is only half-time and as a result, her “non-urgent” cases may wait several months before seeing her.

Photo: David Dolsen

Back to OTworks.ca 

Back to top

Back to Table of Contents