If occupational therapy for an elderly patient is provided in only one setting for a short period, the therapist may not have the resources to repair diminished self-esteem and self-confidence, both of which the patient must have to achieve autonomy. Many elderly patients, once discharged from therapy, will retreat into their homes and will backslide because they lack a sense of purpose and a belief in their own effectiveness. A vicious cycle of decreasing ability and increasing dependence then begins (Kuypers & Bengston, 1973).
The following case report describes an occupational therapy program that provided continuity of patient care from a home care setting to a community setting. Patient care in the community setting was provided through a community wellness program. This program, by furnishing a supportive environment, made it possible to progress from the therapist saying to the patient, "You can do it," to a group of people saying to the patient, "You can do it," to the patient herself finally saying, "I can do it." The program therefore solved the problem of the patient's self-imposed isolation, enabling her to resume her place in the community.
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