Embracing Life and Death as a Geriatric Physical Therapist

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

Today, I attended the funeral of a patient I’ve had the privilege of knowing closely for the past four years. As a geriatric physical therapist, I spend a lot of time with my patients, more than many people might realize. During our visits, not only did we work on her strength, walking and balance, but we talked. We talked about her life, and my life and her thoughts and experiences. We spent hundred of hours together and developed a true connection.

She was a remarkable woman who embodied one of my favorite phrases: "It's not about the cards in your hand, it's about how you play the cards you’re dealt." She was living with a disease that made life incredibly difficult, and she had no immediate family—her husband had passed, and she didn’t have children. Yet, despite all that, she faced each day with optimism. Every time I saw her, she greeted me with a huge smile, always taking the time to ask about my life, my girls, and how the practice was doing. Her capacity for kindness, despite her own struggles, left a lasting impression on me.

Being a geriatric physical therapist has changed my perception of death. It used to be something I feared, something I dreaded, but now I see it as a natural, and inevitable, part of life. This work has taught me that life isn’t guaranteed. Health and quality of life are precious, and either one can change in an instant. My patient lived that truth every day, and I’m thankful for the example she set. She reminded me that no matter what life throws our way, we have a choice in how we respond to it. She played her cards with grace, compassion, and positivity, and I hope to do the same.

As healthcare providers, we deal with loss all the time. Our patients pass, and it’s a reality of our work. Over time, we become very good at putting on a strong face, talking openly about the tough subjects like illness, end-of-life decisions, and death. We have learned how to have these conversations without letting our personal feelings cloud the discussion or influence the direction. We are trained to guide, support, and help families and patients navigate these moments while holding back the emotions that might make it harder for them to benefit from the conversation. From the outside, we may seem strong and stoic, but the truth is that these experiences accumulate. They touch us deeply, and they impact each of us in different ways. Some losses are harder than others, and sometimes, it’s not until later, that we realize just how much a particular patient meant to us. It’s in those quiet moments, when we let down our guard, that we feel the weight of the work we do and the connections we’ve formed.

Through my work, I’ve come to understand that life is about appreciating each day for the gift that it is. I’m determined to approach each moment with kindness, compassion, and gratitude. Helping people, building relationships, and making a difference - that’s how I want to play my cards. And when the time comes, I hope to embrace death as simply another step in my journey, not as something to fear, but as the conclusion of a life filled with purpose and love.

Breaking the Fall Cycle for Fall Prevention Week

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

Falls are a significant health concern for older adults, often initiating a dangerous cycle that can lead to more frequent falls and serious injuries. This Fall Prevention Week, we’re focusing on how the Cycle of Falling works—and, more importantly, how it can be broken with the right interventions.

The First Fall and Fear of Falling

The cycle often begins with an initial fall, leading to significant fear and anxiety about falling again. This fear impacts confidence in movement and results in avoiding daily activities. Nearly 50% of older adults who have fallen report limiting their physical activity afterward, which increases their likelihood of future falls.

At Healthy Aging Physical Therapy, we go beyond traditional therapies by teaching fall preparedness skills, including how to land safely and recover from a fall. Evidence shows that learning these techniques, along with the ability to get on and off the floor, reduces the fear of falling, which in turn lowers the risk of future falls.

Reduced Physical Activity

When fear limits physical activity, muscles weaken, and balance worsens. This sets the stage for more falls, as musculoskeletal strength is essential for stability.

We provide tailored programs that encourage safe, gradual increases in movement, helping individuals regain strength and reduce their fall risk.

Musculoskeletal Decline and Gait Instability

Reduced activity leads to muscle loss, joint stiffness, and decreased mobility, which all contribute to gait instability. This unsteady walking pattern makes falls even more likely.

Our therapists focus on improving strength, flexibility, and gait stability through evidence-based interventions like the Otago Balance Program, a proven exercise regimen designed specifically for fall prevention in older adults. By incorporating Otago exercises, we help patients maintain steady movement, balance, and mobility, significantly reducing the risk of future falls.

We also offer Strong and STEADI balance classes, which focus on improving balance, coordination, and strength to help reduce fall risk. These group classes create a supportive environment for patients looking to improve their mobility and confidence. You can find more information about these programs at Healthy Aging PT Group Classes.

Increased Fall Risk and Repeated Falls

As the cycle progresses, the likelihood of repeated falls grows, leading to a dangerous pattern. Breaking this cycle requires a comprehensive approach.

At Healthy Aging, we offer personalized fall risk assessments and targeted interventions, focusing on balance, mobility, and confidence to stop repeated falls before they happen.

One key aspect of our intervention is the Home Safety Evaluation. Our therapists assess your living environment to identify potential fall hazards and provide practical modifications. These changes, such as securing rugs, improving lighting, or installing grab bars, are crucial in creating a safer home, reducing fall risk, and promoting independent living.

How Healthy Aging Physical Therapy Can Help

We offer a variety of specialized services to address the Cycle of Falling, including balance and fall prevention programs, gait retraining, and strengthening exercises. Our team is committed to promoting safety, independence, and confidence for each individual. Check out more about our Balance and Falls Program here.

If you or a loved one are at risk of falling, take the first step towards breaking the cycle. Call us at (617) 398-4508 or fill out our New Patient Registration Form to schedule a fall risk evaluation.

Mastering Your Fitness Routine: Simple Ways to Meet WHO & CDC Exercise Guidelines at Any Age

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

We all know the importance of regular exercise, but fitting it into your lifestyle can sometimes feel overwhelming. The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend that adults aim for 150 minutes of moderate-intensity aerobic activity combined with 2-3 days of strength training per week, along with balance and flexibility exercises. However, not everyone starts at the same fitness level or has the same lifestyle, so learning to adapt these guidelines to suit your life is key.

What Are the WHO and CDC Guidelines?

The basic recommendations for adults include:

• 150 minutes of moderate-intensity aerobic activity (like brisk walking) or 75 minutes of vigorous-intensity activity (like running) per week.

• 2-3 days of muscle-strengthening activities (targeting major muscle groups) per week.

• Balance and flexibility exercises, especially for older adults, to help prevent falls and maintain mobility.

Reality Check: How Much Are We Actually Exercising?

Surveys show that a majority of adults aren’t meeting these guidelines. According to the CDC, only about 23% of American adults get the recommended amount of both aerobic and muscle-strengthening exercise. Meanwhile, physical inactivity is linked to chronic illnesses such as heart disease, diabetes, obesity, and depression.

The good news is that even small changes in your weekly activity can have a significant impact on your health.

The Benefits of Regular Exercise

Exercise isn’t just about maintaining a healthy weight—it has wide-ranging benefits for both physical and mental health. Regular physical activity:

• Reduces the risk of chronic diseases

• Helps control weight

• Strengthens bones and muscles

• Improves mental health and mood

• Increases your chances of living longer

On the flip side, physical inactivity can lead to higher rates of heart disease, stroke, diabetes, and some cancers. It's clear that staying active is one of the most important things you can do for your health.

What a Balanced Exercise Week Looks Like for Me

Let’s talk about how I fit exercise into my week as an example of how to meet the guidelines. My routine is built around balance, consistency, and flexibility:

• Aerobic Exercise: Three days a week at my local gym, I aim for 30 minutes on the elliptical, treadmill, bike, or rower. Sometimes I do intervals, mixing short bursts of higher intensity with recovery periods. Other times, I do steady-state cardio. My goal is always to hit 30 minutes of aerobic exercise per session, which helps me meet the CDC's weekly guideline.

• Strength Training: I lift three days a week. One day is focused on legs, one on upper body, and the third is a full-body workout. I also mix in core exercises throughout the week. This keeps my strength routine varied and helps me hit the goal of 2-3 days of muscle-strengthening activities.

• Flexibility and Balance: On either Saturday or Sunday, I incorporate yoga into my routine. It’s my way of improving flexibility and balance, which is a key component of the guidelines, especially for preventing falls as we age.

• Active Lifestyle: In addition to structured exercise, I like to stay active on my "rest" days by taking a small hike with my kids, mowing the lawn, or doing housework. These activities add to my overall activity level without feeling like a formal workout.

I also teach fitness classes during the week. While I consider these part of my active lifestyle, I don’t count them toward my personal exercise goals because they’re more about helping others increase their baseline activity levels.

Example 2: An Older, Moderately Active Adult

Let’s say you’re an older adult who is still fairly active but may not want or need to hit the gym as often. Here’s how you can structure your week:

• Aerobic Activity: This person could take outdoor walks five times a week for 20-30 minutes each session. That would total 100-150 minutes of moderate-intensity activity for the week.

• Strength Training: Twice a week, they could join a strength training class at their local senior center or gym. There are also great online programs, such as our Club HAPT, that offer guided strength workouts for home use.

• Balance and Flexibility: Mixing in something like Tai Chi or yoga once or twice a week can help maintain balance and flexibility, key elements to prevent falls and stay mobile. Our balance programs can also be done at home to support long-term health.

• Active Lifestyle: In addition to structured exercise, they can incorporate more movement into their daily life by parking further from the store, taking the stairs instead of the elevator, or working outside in the yard. These activities help add to overall activity levels and make it easier to meet the weekly exercise guidelines.

This routine is perfect for maintaining a healthy lifestyle and preventing the decline in muscle mass and balance that can occur with aging. There are also videos available on our Balance and Falls page that offer great exercises that can be done at home to improve stability.

Example 3: A Lower-Level, Sedentary Adult

For someone who is less active or has mobility challenges, it’s still important to find ways to incorporate movement into their week. Here’s how someone at a lower fitness level can meet the exercise recommendations:

• Aerobic Activity: A seated recumbent elliptical like the Cubii can provide low-impact aerobic exercise. Walking in a mall with a walker or doing an aerobic workout on YouTube can also be effective.

• Strength Training: Functional strength training doesn’t have to happen in a gym. Simple movements done in the kitchen or living room—such as sitting and standing from a chair—can provide the necessary strength training. These activities mimic the kinds of things we do during physical therapy and can be scaled to any ability level.

• Balance and Mobility: Balance exercises, such as those done in therapy, can be adapted for home use. Programs like PWR! Moves for Parkinson’s Disease are great for adding in mobility work that supports overall health.

• Active Lifestyle: For someone at a lower activity level, small bursts of movement—sometimes called "exercise snacks"—can be an easy way to build up daily activity. For example, they can march in place during commercial breaks, take an extra lap each time they go to the bathroom, or do 10 sit-to-stands every time they get out of a chair. These small actions add up and help improve overall mobility and strength.

Conclusion: Adapting Exercise to Your Life

No matter where you’re starting from, there are ways to meet the CDC and WHO exercise guidelines that suit your fitness level and lifestyle. Whether you’re hitting the gym, walking around your neighborhood, or working out at home, finding a balance between aerobic, strength, balance, and flexibility exercises is key to maintaining your health as you age. For help creating a personalized plan, you can use tools like the Move Your Way Activity Planner or join us at one of our Group Fitness Classes to get a great mix of everything combined. The most important takeaway is that every little bit helps, and even small steps toward being more active can lead to big health benefits.

Understanding the Complex World of Medicare and Health Insurance: A Behind-the-Scenes Look

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

As a physical therapist and owner of a private practice, I often have conversations with patients and clients about the state of healthcare and the challenges that come with it. Many people aren't aware of the complexities of Medicare and health insurance, and how these complexities impact the care they receive. I wanted to take a moment to provide some "behind the scenes" information about Medicare, health insurance, and the state of healthcare today.

The Reality of Medicare and Health Insurance Reimbursements

Let's start with Medicare. For those of you who aren't familiar, Medicare Part B is the part of Medicare that covers outpatient care, including physical therapy. While Medicare is an incredibly valuable resource for many, it's important to understand that the reimbursement rates for services provided under Medicare Part B have been decreasing steadily over the past two decades. This isn't a trend that's specific to Medicare; health insurance reimbursements, in general, have seen significant reductions over the years.

For example, due to legislative changes like the Balanced Budget Act of 1997, there have been continual cuts to Medicare reimbursements. Over the last 20 years, Medicare payments for outpatient physical therapy have been reduced by about 25%. These reductions are compounded by annual updates that often fail to keep pace with inflation or the rising cost of delivering care. In fact, it's projected that in the coming year, there will be another reduction in Medicare reimbursement rates, which could be as much as 4.5%.

In addition to the cuts in Medicare reimbursement, many therapy practices, including ours, are also going out of network with certain managed care plans. The reason for this is twofold. First, these plans often come with significant administrative burdens, requiring extensive authorization processes and paperwork just to begin or continue care. This not only takes time away from providing hands-on patient care but also adds to the overall cost of running a practice. Second, the reimbursement rates from many managed care plans are exceedingly low, often averaging only 60-70% of what Medicare reimburses, which is simply unsustainable for many practices. You may have seen recent news about large hospital systems going out of network with certain Medicare Advantage plans for similar reasons. These plans frequently offer even lower reimbursements and add layers of red tape that can hinder timely patient care.

However, even though we are out of network with these plans, we strive to remain as accessible as possible by accepting out-of-network coverage when your plan offers it. We frequently see patients with Tufts Managed Medicare, UHC/AARP, Humana, and other managed Medicare plans, and we currently remain in-network with BCBS. This approach allows us to continue providing high-quality care without the limitations imposed by the low reimbursement rates and administrative burdens of managed care plans. We encourage you to ask about what out-of-network benefits your plan may have, and we are always happy to check on this for you if you are interested in receiving care with Healthy Aging Physical Therapy.

The Impact on Private Practices

So, what does this mean for private practices like ours? Simply put, it's becoming increasingly difficult for practices to accept insurance and remain financially viable. Each year, while the reimbursement rates go down, the costs of running a practice—like rent, utilities, supplies, and fair wages for our staff—continue to rise. It's a challenging balance to strike.

Despite these challenges, we at Healthy Aging Physical Therapy have made the decision to continue accepting Medicare Part B. Why? Because we believe deeply in providing high-quality, concierge-level care to those who need it most. Our commitment is to serve our community, especially those who rely on Medicare for their healthcare needs. However, we also recognize the financial realities that come with running a small business in today's healthcare environment.

The Role of Cash-Based Services

This brings me to an important point about why you might see therapy practices, including ours, offering cash-based services like our Fitness and Wellness programming. I know it might seem surprising at first—after all, isn't insurance supposed to cover everything? The reality is that insurance often dictates not only how long we can see a patient but also what types of services we can provide. There are many scenarios where patients would benefit from additional or ongoing care that isn't covered by insurance.

By offering cash-based services, we are able to supplement our revenue, ensuring that we can continue to provide quality care, pay fair wages to our therapists, and keep our doors open. These services—whether it's our fitness coaching and personal training programs, therapy wellness sessions, or virtual and in-person fitness classes—allow us the flexibility to meet your needs beyond what insurance covers. They also empower us to provide long-term care that supports your overall health and wellness, beyond just your immediate therapy needs.

Supporting Local Healthcare and Small Businesses

I want to take a moment to thank each of you for your continued support of Healthy Aging Physical Therapy and other small businesses and private practices. We know that the healthcare landscape can be confusing and that there are many factors at play that affect both providers and patients. We hope this post has shed some light on the current state of healthcare and why practices like ours are making the decisions we do.

We're committed to continuing to provide the best possible care to our community, and we're excited to offer a range of wellness programs to support your health and wellness journey. Thank you for being a part of our community, and for supporting small, locally owned businesses that are dedicated to your well-being.

As I tell all of my Healthy Aging therapists when they start with us, I value kindness and transparency above all else, so hopefully this helped make our complicated healthcare landscape a little more transparent for you. If you have any questions or would like to learn more about our post-discharge wellness programs, please don't hesitate to reach out. We're here to help you live your healthiest life!

Exercise Intensity and Older Adults: Finding the Balance

Written By: Dr. Brittany Saia, PT, DPT, GCS and Healthy Aging Physical Therapist

You’ve done it! You started your exercise routine and you’re sticking with it (well, most of the time.) But are you getting the most out of yourself and the full impact that exercise can achieve? In this post, we’ll discuss exercise intensity, and if it’s safe when considering exercise in older adults.

The Changing Landscape of Aging

Aging brings about various physiological changes, including a decline in muscle mass, bone density, cardiovascular function, and metabolism. As a result, older adults are more susceptible to issues such as sarcopenia (muscle loss), osteoporosis (brittle bones), cardiovascular diseases, and metabolic disorders like diabetes. However, regular exercise has been shown to mitigate these age-related declines and improve overall health outcomes.

Understanding Exercise Intensity

Exercise intensity refers to the level of exertion during physical activity. It's commonly measured using parameters such as heart rate, perceived exertion, or metabolic equivalents (METs). For older adults, exercise intensity plays a crucial role in achieving desired health benefits. While low-intensity activities like walking or gentle yoga provide some benefits, higher-intensity exercises offer additional advantages that are particularly valuable for older adults.

Benefits of High-Intensity Exercise for Older Adults

1. Muscle Strength and Mass: High-intensity resistance training stimulates muscle growth and enhances strength, which is vital for maintaining mobility and independence as we age. Strong muscles also help support joints and reduce the risk of falls and fractures.

2. Bone Health: Weight-bearing and high-impact exercises promote bone density, reducing the risk of osteoporosis and fractures. Activities like jumping, running, or strength training with weights can help preserve bone health in older adults.

3. Cardiovascular Fitness: High-intensity aerobic exercises, such as cycling,

   swimming, or interval training, improve cardiovascular function, lower blood

   pressure, and enhance circulation. A robust cardiovascular system is essential for maintaining overall vitality and reducing the risk of heart disease.

4. Metabolic Health: High-intensity interval training (HIIT) and vigorous aerobic

   activities can improve insulin sensitivity, glucose regulation, and metabolic rate, thereby reducing the risk of type 2 diabetes and obesity-related complications.

5. Cognitive Function: Emerging research suggests that high-intensity exercise may benefit cognitive health by promoting neuroplasticity, improving brain function, and reducing the risk of cognitive decline and dementia.

Finding the Right Balance

While high-intensity exercise offers numerous benefits, it's essential to strike a balance and consider individual fitness levels, health conditions, and preferences. Older adults should consult with a physical therapist a PCP before starting any new exercise program, especially if they have pre-existing medical conditions or concerns.

Incorporating High-Intensity Exercise into Your Routine

1. Start Slow: Begin with low to moderate-intensity exercises and gradually increase the intensity as your fitness improves. Especially if you’re new to exercise, starting slow can help prevent overly sore muscles and help build confidence in your abilities.

2. Mix It Up: Incorporate a variety of activities, including strength training, aerobic exercises, and balance exercises, to target different aspects of fitness.

3. Interval Training: Incorporate intervals of higher intensity into your workouts,

   alternating between bursts of intense activity and periods of rest or lower

   intensity.

4. Listen to Your Body: Pay attention to how your body responds to exercise and adjust the intensity accordingly. It's essential to challenge yourself while also respecting your limits and avoiding overexertion.

5. Stay Consistent: Consistency is key to reaping the benefits of exercise. Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week, spread across multiple days.

Embracing the Power of Exercise Intensity

In conclusion, exercise intensity is a critical factor in promoting health, vitality, and longevity in older adults. By incorporating high-intensity exercise into their fitness routine, older adults can enhance muscle strength, bone density, cardiovascular fitness, metabolic health, and cognitive function. However, it's essential to approach high-intensity exercise with caution, gradually increasing intensity and listening to your body's signals. With the right balance and guidance, older adults can harness the power of exercise intensity to thrive in their later years.