Safeguarding Home Independence

Keeping seniors out of skilled care settings reduces costs and elevates quality of life

Vol. 27 • Issue 6 • Page 19


The U.S. Centers for Disease Control and Prevention reports that as of 2014, 12,400 home health agencies have been set up to serve patients who are either housebound or choose to remain in the home.

This number, and the number of people they serve, is only projected to increase as the Baby Boomer population ages. Physical therapists in the home healthcare system can be an integral part of keeping patients independent, safe, and comfortable in their own homes.

“Our main purpose with physical therapy is to get the patient as independent as possible. After the therapist goes in and does their initial assessment and develops a treatment plan and home exercises, [home healthcare] is really to teach and reinforce the exercises to get them as independent as possible,” said Nancy Helenek, RN, MSN, MBA, FABC, administrative director of care continuum at South Nassau Communities Hospital, Oceanside, N.Y. “Our purpose is not to go in and do the treatment for the patient per se; the ultimate goal is to get the patient independent.”

Home healthcare has many benefits, but the biggest one, according to Travis King, PT, DPT, GCS, ACCI of FOX Rehabilitation, Devon, Pa., is simply that patients tend to be more comfortable and can better navigate their own environment. FOX Rehabilitation is a private practice that can provide house calls for patients who need it.

“With home healthcare, you have the beauty of walking into a client’s home and assessing that living environment and tailoring the approach to that client,” King said. “You’re teaching the client to go up and down the steps of the clinic when the steps at home may be spaced completely differently. With home healthcare, [we work] to get the client functioning in the environment they’re comfortable in and keeping their independence.”

At-Home Care

While many facilities focus on providing home healthcare to the geriatric population, with the majority of patients aged 80 or older, there is no longer an “average age” for who typically receives treatment in the home.

“We treat patients as young as 19 years old,” said Bernadette Ward, PT, director of rehab at NVNA and Hospice, Norwell, Mass. “There are a lot of reasons that someone may be homebound or want to receive home healthcare, from car accidents to cystic fibrosis.”

Ward did note that her facility’s most commonly addressed diagnosis is aftercare for total knee and hip replacement. However, these tend to be her healthiest patients and take the shortest amount of time to heal.

“Our aftercare joint patients: They don’t want to be at home. They want to be off and running to outpatient and getting back on the golf course,” Ward said. “Chronically ill, medically complicated patients are the ones we work the hardest to keep at home independently. These patients are usually frailer and tend to be older.”

King sees similar patients, many of whom receive physical therapy treatment for functional abilities including walking, getting in and out of their homes, bathing, getting dressed, and ascending and descending stairs.

“We are in the business of maximizing the independence of clients that we see from a functional perspective. In order to do that, we thoroughly evaluate and assess a client for their strength, their mobility, and their neurological abilities,” King said. “Then we develop a tailored plan of care that will focus on the client’s goals as well as the areas of deficit that the clinician identifies, so we can put together a comprehensive plan of care in order to maximize the independence of the patient.”

Where We Are Now

As more people decide to remain in their homes as they age, physical therapists have had to adapt to meet their unique needs. These include rigorous home exercise routines and monitoring, as well as screening from a medical perspective to ensure independence.

“It is vital to get the older adult, no matter the age, the properly dosed intensity of therapeutic exercise. You might think, ‘I don’t want to work an older adult client very hard because maybe they’re frail or maybe their cardiovascular system can’t handle it.’ But in fact, the literature has been out for quite some time and indicates that high-intensity training and using the overload principle of therapeutic exercise prescription is absolutely a necessary part of a plan of care,” King explained. “We have to look at the literature and apply evidence to our older adult clients. This advances our plan of care and gets people better, faster.”

Ward noted the importance of knowledge in specialized fields, such as dementia practitioners, vertigo treatment and care, as well as cardiopulmonary education. This education helps therapists treat more patients more effectively.

“The extra education is imperative to keeping people home longer and as independent as possible,” Ward said, stressing the importance of multidisciplinary treatment. Physical therapists can make tremendous progress in home health by working together with occupational therapists as well as skilled nurses, speech-language pathologists, medical social workers, dieticians, and wound care specialists.

“The key to successful home healthcare is interdisciplinary teamwork,” Ward said. “The combination of a little home modification, a lot of education, and strengthening alongside the help of other disciplines creates a safe environment for our patients.”

Many home health treatments can promote mobility and independence. The outlook for a physical therapist’s role in the field looks bright.

“I think physical therapists play a key role. With the aging population, more and more patients will require home care services,” Helenek said. “We’ve seen growth in our program over the years. With the graying of America, our services are really growing.”

The Future of Home Health

Many factors affect the way healthcare is practiced and received, including improvements in educational standards and innovations in technology and research. While home healthcare is trending, there are still improvements that practitioners would like to see in the near future to promote healthier lifestyles and independent living.

King believes that by promoting physical therapists’ services and unique skill sets, practitioners are able to be “owners of functional wellness.”

“There are a tremendous amount of healthcare providers that are very good at medical wellness, or the ability of a client to be treated for a chronic condition with medication, screenings and more. However, the industry is missing a piece of the puzzle,” King said. “When a client walks into a primary physician’s office with a complaint about their chronic condition, I think it may be overlooked that they are now using a walker instead of a cane, or a cane instead of no-assistance device. That is an indication of functional decline, which is a very slippery slope. I think that I would like to see healthcare providers and therapists in general identify early that a client has suffered or experienced some decline in their functional ability.”

Ward predicts a more multidisciplinary approach to home healthcare, with collaboration between PTs, OTs, and speech-language pathologists, as well as other healthcare professionals. She would like to see physical therapy utilized more on the patients her facility treats.

Helenek agrees with Ward’s goals. “Physical therapists are an integral part of the home healthcare team that includes physicians, nurses, occupational therapists, speech-language pathologists, social workers, and other ancillary services,” Helenek said. “Working collaboratively with the team, we provide patient-centered care using evidence-based practice to ensure patients have positive health outcomes and a positive patient experience.”

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