By engaging clients in goal-centred rehab, which begins at the earliest stage possible, strong outcomes can be achieved in both their physical and mental health, says Kate Sheehan. NR Times meets the occupational therapist whose person-centred approach was recently seen in ITV’s Finding Derek documentary, in her work with the family of TV presenter Kate Garraway
The photo of the woman skiing with her daughter is one Kate Sheehan will always remember.
“Got there. Thank you,” read the accompanying message.
Five years prior to that picture being taken, occupational therapist Kate had sat by the woman’s bedside in Stoke Mandeville hospital, following major surgery on a spinal injury.
“I sat with her and asked what she wanted to do, what was her goal. She said she wanted to go skiing with her daughter,” recalls Kate.
“I was the first person who had asked this – at that point, the focus was on how she would go to the toilet, get washed, what were her passive range of movements.
“But it’s so important to have an end goal and then work out how to get to that point. Sometimes it may take years, but it is critical for a person’s mental health to have something to aim for when they engage in their rehab.
“People need and want hope.”
The fact this woman achieved her goal, set in the earliest stage of recovery, still resonates with Kate, director of The OT Service, based in Northumberland.
“It was really lovely to know that. For me, having client goals is the most important thing and that’s what rehab should be about,” says Kate, who has over 30 years’ experience in occupational therapy.
“While we routinely work with clients for many years, often they’ll reach the point where they don’t want, or maybe feel they don’t need, professionals around them, so they’ll take a break. But they know where we are if they want to come back.
“I have one client who I’ve known since he was five years old, we supported him through his A-levels and university through to him moving into his own property. Recently he came back to me having been married, and told us his wife is pregnant and could we help him in preparing for the future.
“For some people, it might just be an hour on the phone occasionally, for others they might need more, but sometimes knowing who to speak to when you need some support or advice is the main thing. We’ll always do all we can to help.”
Getting a client back into their own home is vitally important to rehabilitation, says Kate, whose recent appearance in the ITV documentary Finding Derek – where she supported TV presenter Kate Garraway in preparing for her husband, Derek Draper, returning home having been hospitalised for a year with COVID-19 – showed her commitment to achieving this for a client.
“Going home is something that means so much to someone, but if a person who had been catastrophically injured returns home to one room with a commode, that’s not going to aid their recovery,” says Kate, whose own specialism is housing.
“If they can return with a series of minor adaptations, with a view to major renovation going forward, then this is something we can work with. If the person is now a wheelchair user and always loved to cook, but now their kitchen isn’t suitable for this, then we can look at how to achieve that, both short term with equipment and minor changes or long term re designing the kitchen to meet their own needs.
“We have one client in this exact position, where we have ordered a standing wheelchair, so she’ll be able to get back to cooking in her own environment.”
While privately-funded rehabilitation enables people to access the bespoke support they need, the ongoing resource issues around community rehab continue, with pressure building even further from the impact of the COVID-19 pandemic.
And with the already significant demand being exacerbated by the newly-recognised need from Long COVID patients, Kate believes action must be taken to enable earlier and more lengthy community support.
“Rehab needs to begin early, the earlier the better. If someone has had a catastrophic injury, where their whole world appears to be falling down around them, the wonderful medical team are there to save their life – but so many of our clients say they feel like a human body, not a human being at that point,” she says.
“There isn’t enough rehab provision in the statutory sector and it’s such a postcode lottery too. In some parts of the country, someone could get six to eight weeks, whereas in others that could be only one or two.
“Most people don’t need rehab for a short period of time, it’s much more longer term, and while getting them home and out of hospital is very important, we want them to get back to doing the things they want and need to do. Some people may need 18 months to rebuild their strength and functional skills, and that’s how long they should be supported for.
“The long-lasting effects of COVID – including everything from the fatigue and brain fog, through to the trauma of being ventilated and of the illness itself – are probably going to be with us for decades, and people need to be supported.
“I really wish the Government would see beyond the pounds and pence of care costs and look at the bigger picture. The personal impact on someone who is unable to work, who has problems with their mental health and probably other health issues too, is going to be very significant and have potentially long term care needs if suitable rehabilitation is not available to them.
“If we can support people from the earliest stages to get back to work, to rebuild their lives, perhaps even to save their relationship – separation, very sadly, becomes more likely after serious injury – then that is much better all round for society.”
