The problems associated with institutionalized care of the frail elderly are complicated and require interdisciplinary problem solving. This paper explains the conceptual framework and initial implementation of the Lazarus Project, a pilot project in a nursing home that offers an alternative governing philosophy for residential living. The framework is a community model based on democratic governance, which empowers those who work and live within the nursing home facility. Implementing a community model in an institution is a political process that requires an awareness of power relationships and structures. Strategies for institutional change are directed at alteration of the hierarchical power structures so that power is shared and decision making collaborative.
This article discusses the importance of team building between occupational therapists and occupational therapy assistants and the relationship of teamwork to the effectiveness of service delivery within the profession of occupational therapy. If team members’ needs are not satisfied, dysfunctional intraprofessional teams result. Team building is based on the satisfaction of three areas of individual need: (a) ministration, which leads to mutual respect; (b) mastery or effective performance; and (c) maturation or personal growth and professional socialization. A better understanding and appreciation of the roles of therapist and assistant and their relationships can resolve the team deficits. A developmental team chart that uses a systems theory model as an organizing framework is presented as an action plan for team building. Suggestions are made to academic and fieldwork educators and professional and technical clinicians to strengthen intraprofessional relationships in occupational therapy.