‘Safe as possible or as happy and well as possible, because they might not be the same thing.’ Occupational therapy perspectives of intermediate care risks during COVID-19

Introduction: Intermediate care involves managing risk and employing positive risk-taking. The COVID-19 pandemic introduced new risks; however, little is known about how this impacted services from the perspectives of those providing and receiving occupational therapy. Method: Semi-structured interviews were conducted with people who had experience of intermediate care during and following the pandemic, including occupational therapy practitioners (at novice, semi-expert and expert levels of experience), patients and carers. Themes in the data were developed using Framework analysis. Results: Fourteen participants were interviewed: nine occupational therapists (six experts, two semi-experts, and one novice), two students of occupational therapy (novices) and three members of the public (two carers and one patient). Six themes were developed: (1) Intermediate care perspectives; (2) COVID-19 impact; (3) Disruptive factors, difficulties, and dilemmas; (4) Safety creation and improvements; (5) Facilitators and benefits of occupational therapy; and (6) Personal impact. Positive risk-taking for all participants was impacted by problematic organisational and cross-boundary systems, role blurring, blame culture and, for novices, heterogeneous/unstructured ways of assessing risk. Conclusion: Positive risk-taking is challenging for practitioners, patients and carers/families, sometimes involving dilemmas and conflictive perspectives; and COVID-19 created additional complexity. Occupational therapy risk management could be better utilised in hospitals to support positive risk-taking in intermediate care.