ABC’s of OT: IADL training in the SNF

Real quick before we dive in, let’s talk about the difference between an ADL (activity of daily living) and an IADL (instrumental activity of daily living). In short…

ADL = tasks to take care of you, IADL = tasks to take care of you and others

When we talk IADL, we’re talking about meal prep, laundry, housework, money management, medication management, pet care, child care, etc. The realm of IADL can be as broad or as narrow as you want. Today, I’m outlining the IADL I most frequently address in the SNF setting.

Meal Prep:

Our facility is relatively small; we don’t have a therapy kitchen or an easily accessible household stove top, so I try to simplify meal prep as much as possible. My favorite is cookie in a mug (linking my favorite recipe here!) This is a single serve chocolate chip cookie that you mix in a mug and microwave on high for 40-60 seconds. Requires the patient to follow directions, sequence, and problem solve, and can be done in sitting, standing, individually, in groups; there are so many options! Plus there’s a fun treat at the end!

Laundry:

Again, we don’t have a physical household washer and dryer on site, so we do our best to simulate by using industrial-sized laundry baskets and donated clothes. Laundry tasks are a great way to teach patients how to safely manipulate a walker or cane around tight spaces, as well as how to maintain appropriate standing balance when reaching down to grab that last sock at the bottom of the washer.

A reacher can be easily incorporated into the task to limit bending/reaching outside of the base of support. And don’t forget that those clothes are going to be heavy when wet, so attaching a 1/2 pound weighted cuff to the end of the reacher can help to simulate the weight of the clothing if you are unable to physically wash the clothes like us.

Fun tip: a compact-sized mirror can be hot glued to the end of the reacher to help the patient check for those remaining socks that might be stuck in the bottom of the washer or dryer.

Housework:

Grab some cans and transfer them to a high shelf. Sprinkle some cotton balls on the floor and help the patient sweep them up. Distribute some shaving cream across a counter-top and use a wet wash cloth to clean it up. Coat some white plates with a thin layer of chocolate cake frosting and hand wash them in the sink. Any housework task that the patient is responsible for, work on. The options are endless.

Medication Management:

I have a whole post about this, but in short, find some colorful beads, some empty pill bottles and the patient’s medication list and fill a pill organizer.

My top tip for IADL task training: do as much of the task as you possibly can within the clinic. Whatever tasks the patient will be responsible for at home, practice. Repeatedly. And mix it up. Work on these tasks in sitting, in standing, in groups, on balance pads, with weighted cuffs on the wrists. Be creative and make it meaningful. You’re an OT, that’s your specialty.

 

What are you best IADL interventions?

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