Older adults living in skilled nursing facilities (SNFs) and long-term care facilities are particularly susceptible to the coronavirus disease 2019 virus and face unique challenges during their rehabilitation process. This case report highlights the disease and rehabilitation course of an older adult who received all of his medical and rehabilitative treatment while residing in a SNF. The occupational therapy evaluation and intervention processes, as well as the client’s response to intervention, are described. The client’s positive outcomes are linked directly to occupational therapy’s ability to incorporate medical, physical, and psychosocial aspects into part of the interdisciplinary model of care in a SNF.

OBJECTIVE. The purpose of this study was to investigate patients’ perspectives of the validity of the Self-Identified Goals Assessment (SIGA), which is designed for use by occupational therapists working in subacute rehabilitation and skilled nursing facilities. The SIGA has two primary purposes: (a) to help the patient identify personally meaningful occupational goals to be addressed in therapy and (b) to evaluate changing levels of patient-defined success in desired occupations. METHOD. Participants (20 women, 10 men) were patients with varied diagnosed conditions at a hospital-based subacute facility. Their mean age was 73.4 years (SD = 12.2). The SIGA was administered by the patients’ regular occupational therapy practitioner after admission and before discharge; a graduate student followed up each administration of the SIGA by asking participants fixed-alternative and open-ended questions about the usefulness of the assessment. Fixed-alternative questions were analyzed as simple dichotomies, and open-ended questions were analyzed through categorization into convergent and divergent themes across participants. RESULTS. Twenty-nine of the 30 participants confirmed the personal meaningfulness of goals identified in the SIGA admissions interview, and 28 reported that they thought the SIGA helped the therapist realize what was personally important to them. On admission, 9 participants reported difficulty quantifying their performance on the 0-to-10 scale; however, 27 reported that their scores were accurate self-assessments. Participants’ perspectives of the SIGA tended to be particularly positive at discharge. CONCLUSION. Given the lack of efficient, structured approaches to the measurement of self-identified goals in subacute and skilled nursing facilities, the SIGA tentatively is recommended for use in these settings, pending future research.

OBJECTIVE. This study examines psychometric characteristics of the Melville-Nelson Self-Care Assessment (SCA), which is designed for occupational therapists working in skilled nursing facilities (SNFs) and subacute rehabilitation. Like the federally mandated Minimum Data Set, the SCA assesses seven self-care occupations in two ways: self-performance and support needed. METHOD. Participants were SNF patients receiving subacute rehabilitation. Primary and secondary diagnoses varied widely; mean age was 76.5 years (SD = 9.8). Using the SCA, the Functional Independence Measure (FIM™), and the Klein-Bell Activities of Daily Living Scale, four teams of raters independently and simultaneously assessed 54 women and 14 men at admission and discharge; 40 participants were available for reassessment in their homes after discharge. RESULTS. Total self-performance scores on the SCA showed (a) interrater reliability (mean ICC = .94); (b) concurrent validity with relevant areas of the FIM (rho = −.85) and the Klein-Bell (rho = −.86); (c) responsiveness in detecting change from admission to discharge, t(67) = 6.3, p < .001, with a large effect size of 1.10; and (d) moderate predictive validity of caregiving time in the home (rho = −.44) and overall function in the home as measured by the total FIM (rho = −.55) and total Klein–Bell (rho = −.54) scores. The self-performance and support measures for the seven self-care areas all had acceptable interrater reliability and concurrent validity. Eating, personal hygiene, and bathing showed little or no responsiveness to change from admission to discharge, whereas positive change was substantial in bed mobility, transfers, dressing, and toileting. CONCLUSION. This instrument is recommended for use as part of a comprehensive occupational therapy model of practice in SNFs and subacute rehabilitation.