Estimating domestic assistance requirements in medico-legal practice: Australian occupational therapy perspective

Occupational therapists are experts in determining domestic assistance levels. It is a complex multi-dimensional process resulting in different opinion regarding care hours.

Therapists providing medicolegal reports on domestic care for the courts within Australia were surveyed.

58 occupational therapists responded with most aged between 41 to 50 years of age. There was a strong correlation between years of clinical and medicolegal experience (r = 0.730, n = 58, p = 0.000) as well as between years and numbers of medicolegal assessments conducted in 2017 (r = 0.264, n = 58, p = 0.420). Assessment based on occupational analysis interview combined observation of the claimant performing tasks in their home, medical information, and contextual factors such as family expectations. Translation of data to hours of care was based on therapist's clinical experience of medical diagnosis (x² 6.89, p = 0.009) and claimant's statements of performance combined with therapist's clinical experience (x² = 5.58, p = 0.18). Therapists providing defendant only reports often use their own time to perform housework as a guide. Triangulation data combined confirmation of the person's statements through observation of performance, the environment in which they lived, and the occupational therapists own clinical reasoning skill.

Documenting all the factors influencing the occupational therapist's decision is the key to understanding clinical reasoning.Implication for rehabilitationWhen estimating domestic care occupational therapists should:•Provide written documentation that clearly explains the assessment methods used, the results and conclusion made regarding domestic care.•Triangulate data including claimant's statements of performance, confirmation by observation on tasks, medical report information in the context of the claimant's environmental and contextual factors.•Be aware their own years of experience do not equate to level of expertise.