Written by Simrin Pardal, OT Reg. (Ont.)
In this newsletter, we will be summarizing the findings from a research article as it pertains to the recommendation of 24-hour attendant care by Occupational Therapists (OTs) in Ontario:
Long, B. S., Balakrishnar, K., Mazur, M., Maria, E., Hennessy, K., Rose, M., & Nowrouzi-Kia, B. (2025). Recommending 24-hour attendant care: A qualitative study exploring the clinical decision-making process of occupational therapists in Ontario, Canada. Clinical rehabilitation, 39(6), 819-829. https://doi.org/10.1177/02692155251336574
The researchers in this study sought to explore how OTs determine the need for 24-hour attendant care.
Qualitative research methods were employed, which used semi-structured, one-on-one interviews with a sample of nine Canadian registered OTs that had over 10 years of private practice experience and assessed the need for 24-hour attendant care at least once.
Due to the implications 24-hour attendant care can have on a client and stakeholders, it is important that OTs use clinical indicators and tools during their assessments to get a clear and holistic picture of their client’s present and future care needs.
Long and colleagues (2025) wanted to learn about factors influencing assessment decisions as well as the clinical reasoning involved in interpretation of assessment results.
Thematic analysis was completed, and three main themes were identified relating to the decision-making process used by OTs when assessing the need for 24-hour attendant care.
The first theme was the use of individualized and holistic assessments. Participants mentioned the importance of tailoring assessments to an individual and forming a comprehensive picture of the client’s overall functioning by collecting and integrating data from several sources.
They also emphasized that data collection goes beyond looking at diagnoses or scores obtained from standardized assessments. Gaining in-depth information from clients, family and caregivers, observations during functional activities, using standardized assessments, and reviewing available file information, was all endorsed in terms of gathering information from various methods.
A focus was placed on capturing the client’s struggles and how they are able to manage their care needs and seek assistance.
Functional limitations, personal strengths, and coping strategies must be considered as they are what make each client unique and impact what challenges and capabilities they may have. These must also be taken into account when tailoring support plans, which are effective for clients in terms of promoting as much independence as possible, while also providing an appropriate level of assistance.
Moreover, given the unique needs posed by each client, there is a need for flexibility and adaptability within assessments to accurately reflect clients’ care needs and circumstances.
For instance, standardized assessments may not always capture a client’s performance in real-life tasks when they are not performed in a controlled setting. This necessitates the use of flexibility and adaptability in assessments to gain a comprehensive understanding of a client’s capabilities.
The second theme related to clinical expertise-based decision-making. This involves the use of analytical and evaluative processes, which are rooted in evidence-based decisions. Professional judgment plays a pivotal role in decision-making and is gained through extensive experience with complex cases and diverse clientele.
Participants also mentioned ethical and moral factors involved in their decision-making process. Due to the systemic pressures placed on clinicians to make decisions, which are aligned with their referral source, they often have to reflect on the impact that their decision has on other individuals.
Finally, the third theme was risk assessment in decision-making.
As OTs, prioritizing your client’s safety is essential in the decision-making process. When determining 24-hour attendant care, there must be consideration of imminent risk for the client. This includes risk of the client harming themselves or harming others, as well as the client being able to determine risks and safety concerns appropriately.
Long and colleague’s (2025) study provides a greater understanding relating to the decision-making process employed by OTs in Ontario as it pertains to the recommendation of 24-hour attendant care.
The researchers recognize the limitations of their research, such as the small sample size and that participants were all Ontario-based OTs.
There is mention of the need for further research as well as development of guidelines to provide OTs with support related to the decision-making process for determining 24-hours attendant care.