Cutting Through the Chaos: Creating Effective Frameworks for Complex Patients

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist Owner: Healthy Aging Physical Therapy

If you’ve ever worked with, or been, a patient who seems to have more going on that meets the eye, you know how challenging it can be. Fortunately, these are also often the most rewarding patients - and, most importantly, the ones who need us most.

At Healthy Aging Physical Therapy, our team specializes in exactly that: caring for complex patients—people with multiple diagnoses, long medical histories, and functional challenges who often feel like no one knows where to start. They’re the ones who have seen five other therapists, have a dozen specialists, and still feel stuck.

Why Our Patients Are So Complex

When you’re in physical or occupational therapy school, you learn about impairments in isolation.

• A hip fracture? You study how to rebuild strength and balance.

• A cardiac patient? You learn to monitor vitals and improve endurance.

• A neurological condition? You focus on motor control, coordination, and safety.

But real-world patients with geriatric, neurologic, and complex medical needs don’t fit in tidy boxes. The people we serve are living with multiple comorbidities, often taking many medications, and facing social and emotional challenges that go far beyond their diagnosis list.

For example, many of our patients with Parkinson’s disease also experience osteoarthritis, chronic pain, memory loss, anxiety, and depression - and often have a partner who is also aging and managing their own medical issues to boot. Similarly, a patient referred for “hip fracture” is rarely just an orthopedic case. The fracture may have resulted from a fall, which stemmed from a combination of weakness, balance impairments, cardiac symptoms, and home safety challenges. Many live alone, with limited support and a history of sedentary behavior.

It’s no wonder that walking into these homes for an evaluation can feel overwhelming, even for seasoned clinicians.

Many of these individuals have already been discharged from other settings because progress stalled, the situation was too complicated, or insurance coverage ran out. Over time, we’ve become the go-to practice for these patients—the ones other providers refer when they aren’t sure what else to do. In many cases, we become the last stop—the “hail Mary” for patients who are exhausted from circling through the healthcare system.

So, how do we help?

Our Framework for Treating Complex Patients

Through experience and teamwork, we’ve developed a simple, realistic framework that helps our clinicians navigate these challenging situations - one that keeps both patient and therapist grounded, hopeful, and effective.

Whether you’re a therapist reading this, a patient with a complex background, or a caregiver trying to support a loved one, I hope these strategies help you cut through the chaos and find a starting point that leads to progress.

1. Focus on What Matters Most and Not Everything at Once

When faced with a dozen problems, it’s natural to want to fix them all. But that’s a recipe for overwhelm, and, inevitably, an ineffective therapeutic approach.

Instead, we teach our therapists to start by asking:

“What are the top one or two things we can help with right now that will most improve this person’s quality of life, safety, and independence?”

Sometimes that means addressing strength, balance, or mobility. Other times, it’s about helping the patient move again after weeks (or months) of fear and inactivity. Sedentary behavior, whether from pain, fear, or fatigue, triggers a cascade of physical and emotional decline and often, interrupting this cycle can be an important first step. Even small steps toward safe, confident movement can change everything. Sometimes, a compensatory approach is the right starting point: helping a patient obtain the proper wheelchair, walker, or other durable medical equipment to restore access to their home and community.

Time after time, we’ve learned that small wins matter. They build trust, confidence, and momentum - all critical ingredients for rapport and long-term success.

2. Layer in Support

We remind our team (and ourselves) that we can’t fix everything - and that’s okay. Somethings aren’t ‘fixable’ and other things are outside of our scope and capabilities.

Our role is to make a meaningful difference where we can, while also building a web of support around the patient to provide support for ‘the other things’. That often means:

• Connecting patients with mental health providers when mood disorders or anxiety is a barrier

• Coordinating with care team physicians and pharmacists to address medication-related issues

• Referring our patients to trusted home health aides, elder services, or aging life-care specialists

• Providing resources for community programs, support groups, and case managers

It’s not about doing it all ourselves - it’s about building the right team around each patient, one layer at a time.

3. Collaboration Is Key

When you work with a Healthy Aging therapist, you may only see one person walk through your door—but behind that therapist is an entire network of expertise.

Our team includes specialists in neurology, orthopedics, geriatrics, vestibular therapy, and cardiopulmonary rehab. We collaborate behind the scenes through discussion boards, case consults, and joint visits - bringing fresh ideas, new eyes and diverse perspectives to every complex case. Sometimes that collaboration means I’ll step in for a Complex Case Visit, working alongside the treating therapist to strategize solutions. Other times, the team shares insights online, helping each other troubleshoot mobility challenges, medication effects, or behavioral barriers.

That culture of teamwork is one of our greatest strengths—and one of the biggest reasons I feel our patients make progress where others have stalled.

4. Think Long-Term

Complex patients rarely fit neatly into a six-week plan of care. Their needs evolve, new issues arise, and maintaining stability often becomes the goal as much as improvement.

That’s why we emphasize continuity - treating each patient as someone we’ll likely know for years. When a patient is ready to discharge, we make sure:

• A comprehensive post-discharge home program is in place

• The patient has been connected with the appropriate community and medical supports

• We have established a clear plan for future follow-up

For many, we transition them into a Maintenance Plan of Care under Medicare Part B, or into our Wellness program, Wellness365, where they continue to receive guided exercise and ongoing support to prevent decline.

Because our ultimate goal isn’t just short term rehab - it’s recovery and resilience.

What This Means for Patients and Families

If you’re a patient, caregiver, or family member feeling frustrated that “no one knows how to help,” please know: you’re not alone, and your situation isn’t hopeless.

Working with complex conditions takes time, teamwork, and the right perspective. The most important first step is finding professionals who know how to cut through the chaos - and, most importantly, who see you as a person first, not just a list of diagnoses, which is the heart of what we do at Healthy Aging Physical Therapy.

Why More Seniors Are Choosing At-Home Physical & Occupational Therapy

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and

Owner of Healthy Aging Physical Therapy

At Healthy Aging Physical Therapy, we specialize in bringing expert care to your doorstep. Outpatient at-home therapy means you get the same high-quality physical or occupational therapy you'd receive in a clinic — but in the comfort, safety, and convenience of your home.

So, why do patients (and their doctors!) turn to us?

Here are the Top 5 Reasons we get referrals for outpatient at-home PT and OT:

1) Fall Risk & Balance Issues

Let’s start with the biggest one — fall prevention.
Falls are the leading cause of injury and hospitalization in older adults, and 60% of them happen at home.

By treating balance issues where they happen most — in the actual environment you live in — we can make a major impact on your safety. Our therapists assess your home for hazards, recommend simple modifications (like grab bars or lighting changes), and provide targeted balance training to reduce your fall risk and keep you confident and independent.

This is our #1 reason for referral — and for good reason. Learn more about our Balance and Falls Program Here

2) Difficulty Leaving the House

Getting to the clinic isn’t always easy. Many of our patients no longer drive, rely on family or caregivers for rides, or find the process of getting ready, getting out, and getting home exhausting.

With outpatient-at-home therapy, we eliminate the transportation barrier and bring care straight to you.
That means you get to use your energy for your session — not the drive — and caregivers get a break from extra errands and logistics. Plus, we often find better focus, higher participation, and more consistent follow-through when therapy is done at home.

3) Parkinson’s Disease

We specialize in helping individuals with Parkinson’s Disease live fuller, more active lives.
Our therapists and trainers are certified in PWR! Moves, an evidence-based therapy program designed specifically for people with Parkinson’s — and our PD program goes far beyond just therapy.

We offer:

• Individualized PT & OT

• Group fitness classes tailored for Parkinson’s

• Personal training with PD-certified instructors

• Complex case management

• Home safety evaluations and cognitive support strategies

From diagnosis to long-term maintenance, we’re with you every step of the way.

📘 Learn more about our Parkinson’s Program Here

4) Recent Hospital Stay

Even a short hospital stay can cause serious weakness and deconditioning in older adults. Research shows that just 48 hours in a hospital can lead to muscle loss, reduced balance, and increased fall risk.

Whether you were hospitalized for an illness, injury, or surgery, therapy is often essential to helping you get back on your feet — and back to your prior level of function.

We meet you at home as soon as you're ready, and help build a plan to regain your strength, restore your confidence, and safely resume your daily routines.

5) Back & Joint Pain

As we age, it’s common to experience arthritis, spinal degeneration, and general wear-and-tear that leads to aches, pains, and stiffness.

But here’s the difference: While orthopedic clinics often treat just the pain site, our geriatric specialists take a whole-body, whole-person approach — looking at your posture, strength, mobility, balance, and lifestyle. We help you reduce pain and improve how you move, so you can stay active and avoid future injuries.

Why At-Home Therapy Works

Outpatient-at-home therapy is not home health care — it’s the same outpatient services you’d receive in a clinic, but delivered at home. We’re fully licensed, accept Medicare Part B and most managed Medicare plans, and provide:

• 1:1 focused sessions

• Expert therapists and assistants

• Continuity of care with the same provider

• A personalized, goal-driven approach

📘 Learn more about Outpatient at Home Physical Therapy or Occupational Therapy here.

Want to Learn More?

📞 Give us a call or talk to your provider about a referral. You can register online for a new evaluation by following the link below:

Ready to Supercharge Your Rehab from Home? Meet Motus Nova!

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and Owner of Healthy Aging Physical Therapy

At Healthy Aging Physical Therapy, we’re always exploring innovative ways to help our patients stay strong, independent, and thriving — and Motus Nova may be the perfect complement to therapy for those recovering from stroke, injury, or facing challenges with hand or foot mobility.

We recently had a fantastic Lunch & Learn with Alyssa Carmell, Occupational Therapist, who introduced us to this cutting-edge robotic and AI-powered rehabilitation tool. We left feeling inspired, informed, and excited about the possibilities it opens up for our patients.

So we wanted to share it with you — because Motus Nova isn’t just an exciting new rehab tool that can improve fine motor control and ankle function… it’s also covered by Medicare!

What is Motus Nova?

Motus Nova (“Nova” means new) is a robotic rehabilitation system originally designed for hospitals and rehab centers — but now available for use right in your living room!

There are two devices:

• Motus Hand – helps improve grip, strength, and fine motor control in your wrist, hand, and fingers

• Motus Foot – helps with ankle strength, balance, walking, and foot control

Each device uses advanced robotics and fun, game-like exercises to help retrain your muscles and brain. You don’t need to be tech-savvy, and our team can work directly with Motus Nova to help get everything set up and adjusted just for you.

Who Can Benefit from Motus Nova?

Motus Hand or Motus Foot may be a great option if you’ve experienced:

• A stroke, even many years ago

• Weakness or stiffness in the hand, arm, foot, or ankle

• Difficulty with grip strength, balance, or walking

• Challenges with rehab after injury or surgery

• High or low muscle tone

Whether you’re still in therapy or it’s been a while since you worked on recovery, Motus Nova gives you a chance to continue improving from home — on your schedule.

Why We’re Excited About It

✔️ More reps, more often – Use it daily at home, increasing intensity without exhausting yourself
✔️ Engaging and fun – Play games while getting stronger!
✔️ Designed for home use – No travel, no need for Wi-Fi, and therapist-supported setup
✔️ Customizable – Works for people with no movement or for those who need to fine-tune strength and control

Alyssa shared how patients using Motus Nova have made real, meaningful gains in their independence — and how adding this tool can jumpstart progress when clinic visits alone aren't enough.

Want to Try It? Here's How

If you're working with one of our therapists and we feel that Motus Nova might be a helpful addition to your care, we can arrange a free in-home demo so you can try it out for yourself.

We’ll guide you through setup, talk about how it fits into your rehab or wellness plan, and help you decide if it’s something you want to continue with. No pressure — just options and support.

We’re so grateful to Alyssa from Motus Nova for sharing her time and expertise — and we’re even more excited to share this resource with all of you.

📞 Want to learn more or set up a demo? Call our office to set up an appointment or ask your therapist at your next visit for more information.

Don’t Fall this Fall! Your Guide to Preventing Falls and Staying Strong

As the leaves begin to fall, let’s talk about a more serious kind of fall - one that affects 1 in 4 older adults each year. Of those, 1 in 5 results in serious injury, including broken bones and head trauma. Even more concerning: once someone experiences a fall, their risk of falling again doubles.

But here’s the good news - falls are not an inevitable part of aging. There are proven, evidence-based strategies that can help reduce fall risk, improve confidence, and even teach people how to fall more safely when accidents happen. And Healthy Aging Physical Therapy is here to help you or your loved ones put those strategies into action.

CDC STEADI Initiative and Fall Prevention

According to the CDC’s STEADI Initiative (Stopping Elderly Accidents, Deaths and Injuries), the key pillars of fall prevention include:

• Screening for fall risk using tools like the Timed Up and Go (TUG) or 4-Stage Balance Test

• Strengthening and balance training that’s appropriate for age and ability

• Medication review and management

• Vision and vestibular assessment

• Home safety modifications

• Education on what to do in the event of a fall

[Source: CDC STEADI Program – https://www.cdc.gov/steadi/]

At Healthy Aging Physical Therapy, we’ve structured our programs around this proven framework to deliver the most effective strategies for fall prevention. Keep reading to learn how we put each pillar into practice.

Screening for Fall Risk

During our therapy evaluations, our licensed physical and occupational therapists conduct standardized, evidence-based fall risk screens, using tools like:

• Timed Up and Go (TUG)

• 4-Stage Balance Test

• 5 Times Sit to Stand

• Berg Balance Scale

• Backwards Walking Speed

• Gait speed analysis

These assessments help us identify your current fall risk level, evaluate your balance and mobility, and guide the creation of a personalized plan of care. At Healthy Aging, we believe knowledge is power—so we don’t just give you a score, we help you understand what it means. Using age- and gender-based normative values and clinically validated cut-off scores, we compare your results to your peers and determine what they indicate about your individual fall risk. From there, we build a care plan that addresses specific areas of deficit and set clear, measurable goals. These goals allow us to track progress, ensure what we're doing is effective, and pivot when needed to keep you moving forward safely.

Strengthening and Balance Programs

Strength and balance are woven into nearly everything we do here at Healthy Aging Physical Therapy, because we know just how critical they are to aging well. Every Physical Therapy and Occupational Therapy plan of care we create includes targeted interventions to build strength, improve balance, and reduce fall risk. But we also go above and beyond traditional therapy by offering extended support through our Wellness365 program, where specially trained personal trainers work with older adults to maintain and build strength long after therapy ends. For those who enjoy the energy of group fitness, we offer evidence-based classes like Strong and STEADI, which blends balance training, reactive strategies, and floor recovery skills, and Fit & Fearless, our adaptive martial arts program that teaches safe falling techniques and improves agility and body control. Whether you’re just getting started or continuing your wellness journey, our strength and balance programs provide the foundation for safer, more confident movement.

Medication Review and Management

While we don’t prescribe or manage medications directly, our therapists play an important role in identifying potential medication-related fall risks. During every evaluation, we review your current medication list and screen for drugs that may contribute to dizziness, fatigue, or low blood pressure—such as sedatives, antihypertensives, and certain pain medications. When we identify red flags, we collaborate with your physician, nurse practitioner, or pharmacist to recommend a formal medication review or suggest adjustments that may reduce your risk of falling.

Vision and Vestibular Assessment

Our Vestibular Therapy services are provided by clinicians specially trained to treat conditions such as BPPV, vestibular hypofunction, and motion sensitivity. Addressing these issues can significantly improve stability, reduce dizziness, and restore confidence in movement, particularly during sudden turns, head movements, or nighttime activities when balance is most challenged. In addition to vestibular care, we also consider vision as an important piece of the fall prevention puzzle. While we don’t provide eye exams, we screen for vision impairments during PT and OT sessions and refer to optometry or ophthalmology when needed. We also help patients address visual-vestibular integration challenges and provide guidance on modifying the home environment to better accommodate vision changes. Want to learn more? Check out our Vestibular and Dizziness page here.

Home Safety Assessment and Modification

At Healthy Aging Physical Therapy, home safety is an essential part of every plan of care. Our Physical and Occupational Therapists assess your living environment during therapy visits to identify potential fall hazards and barriers to independence. We evaluate factors such as flooring, lighting, stairways, bathroom access, and furniture layout, and we provide tailored recommendations to improve safety and function. When modifications are needed, we help coordinate referrals to trusted professionals who can install grab bars, ramps, railings, and other accessibility features. For those seeking a more in-depth evaluation, either in conjunction with therapy or on its own, we also offer our Home Assessment & Resource Program (HARP). This program provides a focused, expert evaluation of your home environment with personalized safety recommendations and resource navigation to support aging-in-place confidently and safely.

Fall Preparedness Education

At Healthy Aging Physical Therapy, we also believe fall preparedness is just as important as fall prevention—because even with the best strategies in place, accidents can still happen. That’s why our therapists receive advanced training in fall preparedness education, including safe falling techniques, floor recovery strategies, and how to respond if a fall occurs. We routinely make getting on and off the floor a core part of therapy, recognizing that this essential skill is often overlooked in traditional rehab settings. Whether someone is learning to recover independently after a fall or safely call for help when needed, our goal is to build both skill and confidence. For those who want to go even deeper, our Fit & Fearless program offers a supportive group environment where participants practice safe landing techniques, controlled descents, and reactive balance drills inspired by adaptive martial arts. It's an empowering, innovative approach to fall preparedness that helps older adults feel strong, capable, and ready for whatever life throws their way.

FIT + FEARLESS: July Foundations Session Recap

Today, we wrapped up our very first Fit & Fearless Foundations class series — and wow, what a four-week journey it was.

Together, we dipped our toes (and knees, and elbows!) into the world of adaptive martial arts with a Healthy Aging spin on fall landing and recovery skills. We learned beginner Muay Thai skills, jabbed and kicked the heavy bags, practiced grappling with Coach Dave, and most importantly, we tackled one of the most essential life skills: how to safely up and down from the floor. Each week, we focused on a new skill: falling backwards, forwards, and laterally, all while building strength, confidence, and body awareness.

At the end of our final class, we asked everyone to shout out one word that captured how they felt about the experience. We heard Proud! Confident. Intense. Empowered. Educated…and Ouch! (We never said this was going to be easy!)

But Coach Dave and I? We both quickly said IMPRESSED - and that doesn’t even begin to cover it.

Lessons Learned

As with all firsts, there were some humbling, and hilarious, first round lessons:

• Lesson 1: Turn OFF the fall alerts on your Apple Watch. Unless you want an EMT surprise visit mid-backward-roll.

• Lesson 2: Teaching ten people to fall is not the same as teaching one. We learned quickly how to break movements down into smaller, more accessible components, and we’re already refining our methods for September to make the next round even better.

But beyond logistics, what Dave and I left with was a deep sense of awe and appreciation for this group. Every single person walked into that first class with some level of fear or hesitation. But they showed up. They did hard things. They did scary things. They let themselves fall - and each time, they got back up! Every single participant walked out stronger and more confident in their ability to fall safely and recover effectively. In a word? They got FEARLESS!

Why Fit & Fearless?

Falls happen. In fact, 1 in 4 adults over 65 falls each year - and while many falls are preventable through a combination of exercise, behavioral choices and environmental modifications, many falls just simply aren’t. And for the falls we can’t stop? That’s where fall landing skills come in.

In this class, we focus on two key goals when it comes to falling:

Goal 1: Change the Position

Avoid landing on high-risk areas (head, spine, hip, outstretched arms).

Goal 2: Change the Force

Use techniques to spread the impact — rolling, redistributing, and softening the fall to reduce injury risk.

How the Program Works

• We progress week by week, starting with education and movement basics and working our way into our adaptive martial arts and fall landing practice.

• Each week, we focus on a different skill: floor recovery, backwards falling, forwards falling and lateral falling.

• We provide guidance and adaptations to meet all fitness levels and encourage you to honor your pace, ask questions, and modify as needed.

Most importantly, this class isn’t just about falling - it’s about changing the way we think about falling. Instead of viewing it as a scary event that “just happens,” we begin to see it as something we can prepare for, influence, and even control. It’s about building the kind of confidence where the ground no longer feels threatening - it becomes familiar, manageable, and within your ability to navigate. And when we fear the ground less, research shows our balance confidence improves - which, in turn, can actually reduce our risk of falling in the first place (#mindblown)!

Ready to Get Fit & Fearless?

Our next round of Fit & Fearless begins this September, and we can’t wait to take everything we learned in July to make this session even more influential.

If you're ready to:

• Build strength and confidence

• Learn practical skills to reduce your fall risk - and your risk of injury from falls

• Master how to fall safely - and get back up with control

• And do it all in a fun, supportive environment...

Then join us at Fit and Fearless!

Registration is now open for our September session. Click the link below to reserve your spot —space is limited, and this class fills up fast. Confidence doesn’t come from avoiding falls - it comes from knowing you can handle them.