OT and OTA Students

Occupational Therapy in Hospice: A Guide for OT & OTA Students

Hospice care focuses on supporting individuals with life-limiting illness while prioritizing comfort, dignity, and quality of life. Occupational therapy practitioners play an important role in helping clients continue to engage in meaningful activities and maintain valued roles during the end-of-life stage. For OT and OTA students, understanding how the occupational therapy process adapts within hospice settings can help prepare you for practice in palliative and end-of-life care.
AOTA Podcast on Hospice

The OT Process in Hospice Care

1. Occupational Profile

The occupational profile helps practitioners understand what matters most to the client. This includes exploring daily routines, meaningful activities, life roles, values, and priorities. In hospice care, conversations may focus on what brings the individual comfort, connection, or meaning during this stage of life. 

2. Assessment

Assessment tools can help identify the client’s current level of functioning and participation. Two commonly used tools in hospice settings include the Canadian Occupational Performance Measure (COPM), which identifies meaningful occupational goals, and the Palliative Performance Scale (PPS), which measures functional decline.

3. Goal Setting

Goals in hospice care differ from traditional rehabilitation settings. Instead of focusing primarily on improving function, goals emphasize maintaining engagement, maximizing comfort, and supporting participation in meaningful occupations that enhance quality of life.

4. Intervention Planning

Interventions are individualized and may include activity adaptation, environmental modification, compensatory strategies, and caregiver training. The goal is to support participation in meaningful activities while reducing physical strain or discomfort.

5. Reassessment

Because hospice clients may experience rapid changes in health status, reassessment occurs frequently. Practitioners continually adjust interventions to ensure they remain aligned with the client’s priorities and evolving needs.

Common OT Intervention Strategies in Hospice

Physical and Environmental Adaptations

Occupational therapy practitioners may simplify tasks, modify daily routines, adjust positioning for comfort, and recommend energy conservation strategies. Environmental modifications can help clients safely navigate their home while reducing fatigue.

Adaptive Equipment and Assistive Technology

Assistive devices such as grab bars, shower chairs, dressing aids, and adaptive feeding utensils can support independence and reduce caregiver burden.

Symptom Management and Comfort

OTs often address pain, fatigue, and decreased mobility through positioning techniques, relaxation strategies, and training in safe movement patterns. Supporting social participation and meaningful occupations can also promote emotional well-being.

Caregiver Education and Support

Caregivers are a vital part of hospice care. Occupational therapy practitioners provide training in safe transfers, body mechanics, adaptive techniques, and energy conservation strategies. Supporting caregiver occupational balance and providing strategies to reduce stress can help prevent burnout.

Reflection Question

Reflection Prompt: Think about a meaningful daily occupation that someone might want to continue during the end-of-life stage (for example: cooking, writing letters, listening to music, or spending time outdoors).

Question:

How could an occupational therapy practitioner adapt or modify this activity so the individual can continue participating despite physical decline?

Consider:

  • Environmental modifications

  • Adaptive equipment

  • Task simplification

  • Energy conservation strategies

Case Scenario

Mrs. L is a 72-year-old woman receiving hospice care at home due to advanced cancer. She experiences significant fatigue and shortness of breath with minimal activity. Cooking has always been one of her most meaningful occupations, especially preparing traditional holiday meals for her family. During an occupational therapy visit, she shares that she is saddened she can no longer cook and worries that her grandchildren will forget the family traditions she created. Mrs. L also reports limited sitting tolerance and requires frequent rest breaks throughout the day.

 

What potential strategies, activity modifications, or alternative occupations could support her participation while respecting her limited endurance and energy levels?