Occupational Therapy and Pharmacy Program Faculty Team Up to Deliver Holistic Care to Independent Living Residents at Mt. San Antonio Gardens

As part of Keck Graduate Institute (KGI)’s developing Occupational Therapy Doctorate (OTD) program, Academic Fieldwork Coordinator and Assistant Professor Dr. Rachelle Murphy is working with Mt. San Antonio Gardens as a member of their interdisciplinary team to help bring an occupational therapy (OT) presence and services to the independent living older adults in their community. Dr. Daniel Kudo, professor of practice for KGI’s Doctor of Pharmacy program within the School of Pharmacy and Health Sciences (SPHS), also serves as a volunteer member of the team.

This project demonstrates KGI’s recent focus on building community-based practices with an interdisciplinary approach while giving back to the local community. However, the seeds were planted 20 years ago when Kudo met Dr. Craig Endo at Pomona Valley Hospital.

At the time, Kudo was Assistant Director of Pharmacy for the hospital, while Endo served alongside his wife as a family practice resident. The two stayed in touch over the years, and Endo—now a family practice physician—recently invited Kudo to participate on his interdisciplinary team at Mt. San Antonio Gardens.

The team also consists of a nurse practitioner, physician’s assistant, social worker, chaplain, administrator, wellness director, and physical therapist. After Murphy and OTD Founding Program Director Dr. Christy Billock joined KGI’s faculty, Kudo felt it was important for KGI to be represented in the occupational therapy specialty, asking Billock and Murphy to join the team on their weekly rounds.

The team eventually brought on another pharmacist, KGI’s Assistant Professor of Clinical Sciences, Dr. Amanda Tran.

“I had initially interviewed Dr. Tran for the position here at KGI, and now I’ve been able to get her the practice that I originally talked about, which was a pharmacist participating with physicians in both a private practice and group practice setting,” Kudo said.

Tran participates in the interdisciplinary rounds at Mt. San Antonio Gardens and in Endo’s private practice in one of the Pomona Valley Hospital medical groups.

“The bottom line is, it’s important to maintain and nurture relationships because they can result in a mutually beneficial opportunity in the future,” Kudo said.

The team works with Mt. San Antonio Gardens to ensure that the residents are in a supportive environment to live independently as long as possible. During their weekly meetings, they discuss health and safety concerns.

“Falls are one of the largest concerns because once they happen, they can have severe consequences,” Kudo said. “Falls are very often associated with a broken hip, and once that happens, very frail patients are less likely to want to participate in the physical therapy associated with their complete rehabilitation. They often become bedridden and thus prone to conditions like aspiration pneumonia.”

Therefore, when it comes to falls, the best strategy is prevention. OT professionals help by ensuring that a resident’s living area is free of potential hazards and problem-solving ways to maintain safe and functional performance in the home.

“Simple changes such as taking a rug off the floor or putting some non-slip adhesives down so it’s not so slippery can make a big difference,” Murphy said. “In the kitchen, you can move some of the more commonly used items down to counter levels so that they’re not having to reach up or bend over because potentially that can become a hazard by causing dizziness or loss of balance.”

The team encourages residents to continue engaging in activities they enjoy while working with staff to keep the common areas safe.

“One recent resident that I worked with shared that she had difficulty with doing laundry because she couldn’t safely bend down to pick up the clothes from the hamper,” Murphy said. “I showed her a technique using an adaptive device called a reacher that allowed her to safely pick up her laundry from the hamper, and the washer and dryer, without having to worry about the potential danger that can come with bending over. Another common recommendation I provide for residents is to use a hand-held shower head and shower chair when bathing and to keep all soaps and bath items within reach. This helps eliminate the risk of a fall by allowing the resident to conserve their energy and limit the amount of movement required to perform the task.”

Kudo and Tran work with the team to troubleshoot issues around medication. For example, many medications cause dizziness and thus can be a contributing factor in falls.

“When most people think of drugs, they think of prescription drugs or narcotics,” Kudo said.

However, over-the-counter medications such as cold medicine containing antihistamines and herbal supplements can also make people more prone to dizziness. Additionally, alcohol can have dangerous interactions with medications that people may overlook. Therefore, a pharmacist must thoroughly evaluate the patient’s medication profile.

Beyond looking out for the residents’ safety, the team takes a holistic approach to ensure that the residents’ needs are met in every area, including mental and emotional health.

“We gave one talk where an occupational therapist teamed up with the physician’s assistants from Cal Baptist to discuss healthy sleep habits,” Murphy said. “Also, I presented to the residents on practical applications for more positive living such as gratitude practices and using humor—things they can do every day based on positive psychology principles to improve their overall health and well-being.”

Once KGI’s OTD program is underway, the team plans to elicit student involvement through fieldwork and capstone projects. On a core level, fieldwork and capstone will allow students to interact with different clients and health professionals while supporting Mt. San Antonio Gardens. Some projects may take a more targeted focus, such as examining the impact of depression or anxiety on residents.

“We’re also looking at not only working with the residents but also developing some employee wellness programs,” Murphy said. “Mt. San Antonio has about 300 employees. Employee wellness certainly includes ergonomics and safety, but we are also going to be infusing principles of lifestyle medicine, looking at nutrition and physical activity, sleep, stress management, social connectedness, and avoidance of risky substances.”

Kudo is working with the team to engage PharmD students in the process, which would expose students to the multidisciplinary team approach while leveraging their expertise.

Overall, the experience has been beneficial for all involved.

“It has been a wonderful opportunity to work on an interdisciplinary team at Mt. San Antonio Gardens to provide holistic care to the residents,” Tran said. “I think it has also been an excellent opportunity to illustrate how each member of the team can contribute to the residents’ care by providing a different perspective. We hope to continue to incorporate other healthcare fields as KGI expands its programs.”