Dementia 101

As a Physical Therapist, I don’t actually ‘treat’ dementia. But, I do treat a whole lot of patients with dementia. Why do people with dementia end up on my caseload? Frequently, people with dementia fall and have fall-related injuries that require physical therapy. People with dementia are also at increased risk for social isolation, malnutrition, inactivity and inevitably, functional decline. And more than anything, because I treat older adults as a specialty, dementia is simply one of the common diagnoses I find on that long list of age-associated diseases that follows my prompt for past medical history.

Now while we all learned about dementia in PT school, and as I’m sure any physical therapist can attest to, knowing the pathophysiology and clinical features of this disease does not inherently make you good at working with someone living with it. The challenge of working with someone with dementia is not knowing what they need (that’s the easy part), but in your ability to actually get a person with dementia to ‘do’ the things - to complete a motor task or physical activity - and even more so, to modify it, progress it, or make it safer for their bodies. This is the part that even the experienced physical therapist (quietly raises hand…) can actually find really challenging.

The Cold Hard Truth

I spent the first five years of my career working as an outpatient neurorehab therapist. The next seven, I spent as a homecare therapist seeing older adults with a wide variety of injuries, illness and sources of of their physical decline. I went to an excellent graduate school (shout out to MGHIHP!). This is not said to impress you, but to lay the ground work that even the most experienced and well-educated therapists may share some of the challenges, preconceived notions and perhaps even prejudices about working with people with dementia that I had. Here’s the Cold Hard Truth: working with people with dementia is HARD. PTs are BUSY. And sometimes, combining a patient whose diagnosis makes them more challenging, with busy schedules and the productivity demands commonly placed on physical therapists, leads us to draw the following common conclusions when we see that word ‘dementia’ on the laundry list of comorbid diagnoses:

“Oh, they have dementia, they won’t have any carryover.”

“This will be quick, I’ll only be in a few sessions.”

“I’ll just do the basics and get out of here.”

“Dementia means they have no potential to get better. I’ll focus on family teaching instead.”

Have you had some of these thoughts, too? Does this make us horrible therapists? Does it make us horrible people? NO! It makes us busy therapists trying to do our best for a large population of people with the resources (time, education, energy, sanity, empathy) that we have. Could we do better? Sure could. Before I dive into how, I want to give you a brief primer on this common brain disease.

Dementia 101

Dementia is not a specific diagnosis, but an umbrella term that accounts for variety of diseases that impair cognition, memory, processing and behavior. While impaired memory may be the classic sign, people with dementia experience a wide breadth of symptoms that progressively impacts their ability to care for themselves and others, to function within their communities, and to remain independent, mobile and healthy. While Alzheimer’s Dementia makes up the majority of dementia cases (60-80%), other types including Lewy Body Dementia, Frontotemporal, Vascular and Multinfarct Dementias are also commonly encountered by physical therapists. While some dementias are reversible (such as dementias due to dehydration or nutritional deficiencies, depression, medication toxicity or metabolic encephalopathy), the majority have a slow, insidious onset and progressive nature. There is, of course, some natural slowing of reaction time and processing associated with aging, and in the pathological realm, a condition known as ‘mild cognitive impairment’ that may share features with dementia, but they remain separate entities nonetheless. There are two key features that distinguish normal age-related cognitive changes and mild cognitive impairment with a true dementia:

1. The individual must demonstrate a decline from previous level of functioning.

2. The impairments must significantly interfere with work or usual social activity.

Early Signs and Symptoms of Dementia

Identified by the Alzheimer’s Association, the following ten signs are commonly seen in early Alzheimer’s disease and other dementias. Of course, many of these can also often be a symptom of other diseases and disorders, so if you find any of these signs concerning, it’s always best practice to bring your concerns to your primary care team.

1. Memory loss that disrupts daily life.

2. Challenges in planning or solving problems.

3. Difficulty completing familiar tasks at home, at work or at leisure.

4. Confusion with time or place.

5. Trouble with understanding visual images and spatial relationships.

6. New problems with words in speaking or writing.

7. Misplacing things and losing the ability to retrace steps.

8. Decreased or poor judgement.

9. Withdrawl from work or social activities.

10. Changes in mood and personality.

Other types of dementia have their own commonly associated features:

With damage found in the brain’s outer cortex, Cortical Dementia tends to cause problems with memory, language, thinking and social behavior, with memory problems generally appearing first.

With damage to deeper structures, Subcortical Dementia causes more change in emotion and movement, along with problems with memory. In these cases, gait disturbances typically appear first.

The cumulative effect of many small strokes, Multi-Infarct Dementia typically presents with a progressive, stepwise decline in mental function and is typically seen in patients with a history of hypertension, smoking and cardiovascular disease.

Similar to multi-infarct dementia, and sometimes used interchangeably, Vascular Dementia is a result of chronic oxygen deprivation throughout the brain. Vascular dementia presents gradually, often presents with changes in vision, sensation and language deficits.

Lastly, there are some types of dementia that develop alongside of other diseases. Lewy Body Dementia can be diagnosed on it’s own or along with a Parkinson’s Disease diagnosis. With a clinical prognosis generally more worse than Alzheimer’s, symptoms typically include syncope, falls, loss of consciousness, delusions and hallucinations. Parkinson’s can also be associated with mild cognitive impairment with or without an eventual progression to full dementia in around 50-80% of patients with Parkinson’s Disease. Common symptoms of Parkinson's Disease Dementia include trouble with memory and concentration, visual hallucinations, depression and frequently, sleep disturbances. Dementias can also be found in people with ALS, Huntington’s Disease and in the setting of Normal Pressure Hydrocephalus and may be a consequence of an underlying brain tumor.

Communicating BETTER With a Person with Dementia

Getting back to my story here, I had the opportunity this fall to attend a virtual Dementia Friends Massachusetts Training. Dementia Friends is a global movement developed in the UK, which has now become a worldwide effort to change the way people think, act and talk about dementia. While this training was not physical therapy-specific (it is actually designed to educate the lay person in the community about being more compassionate to people with dementia) I found I was able to apply what I learned to greatly improve the way I was able to communicate with my patients with dementia, which in turn, enhanced how effective I was able to be as their therapist. In fact, I found this talk so helpful for my practice as a geriatric physical therapist, that I decided to complete the training to become a Dementia Friends Champion, so I can, in turn, train others. I was pleased to find that when I offered this training to other therapists involved in the geriatric community, the response was overwhelming. I currently have sixty therapists signed up to take this training with me in the month of December, and hope it is as helpful for them as it was for me.

So, what was it that I learned in this session that changed the way I treat? It gave me concrete tools to make communication easier, strategies that now enable me to more effectively teach the functional mobility tasks, therapeutic exercises and balance exercises needed to help these patients get stronger, improve mobility and decrease their risk of falls. It gave me a different sense of compassion then I had previously, allowing me to be a kinder, more empathetic therapist. It impressed on me the importance of teaching these skills - to other therapists, to family members, to the community - to widen the network of understanding individuals that surround people with dementia living in our communities. What follows are my favorite take-home messages from this training that I found most influential in my physical therapy practice. If you want to learn more, I encourage you to sign up for a Dementia Friends training session - and if you want to teach it to others, the Champion training.

Dementia slows processing time, but doesn’t make it impossible.

It can take up to 20 seconds from the time you say something, for it to be processed and understood by a person with dementia. While our instinct may be to rephrase or redirect when our initial direction goes unfollowed, try waiting that 20 seconds first. Often, while we may be trying to rephrase to make it more easily understandable, this actually adds more layers to be processed and makes the process more convoluted to the brain. Wait the 20 seconds, then either repeat the same request - or try an alternative approach.

Keep directions clear and simple. Less words. More demonstration.

Visual information is processed in a different area in the brain than speech and words. People with dementia will struggle more and more with explicit direction and declarative learning as their disease progresses. However, the ability to process visual cues, mimic demonstration and learn procedurally remains in-tact longer. Using strategies to promote procedural learning (familiar tasks, repetition, use of functionally-relevant exercise programs) will be more effective than explicitly teaching the task.

Feelings, like emotion, love and happiness, remain the longest.

We’ve all been there. Sitting in a hospital room or an assisted living apartment, with a person with dementia, locked into their own confusion, unable to communicate in any meaningful way. Do we try to communicate or simply work with them in silence? Do we use our tone, words and body language to promote an atmosphere of empathy and caring - or match them with an equal lack of expression. Armed with a better understanding that people with dementia are still able to feel an intrinsic sense of emotion, love and happiness, even without the ability to provide any reciprocity in conversation, I’m far more apt to provide them with a caring smile, accepting body language and efforts to engage them beyond whatever therapeutic tasks I may have planned.

And you know who needs to know this more than anyone? Their families.

The more people that understand these concepts, the better.

How many times do we witness well-meaning family members and friends (even sometimes, coworkers) falling into the pattern of talking ‘above’ their loved one with dementia, as if they aren’t even there? Getting frustrated, even laying blame on lack of effort, or ‘behaviors’ instead of the underlying brain disease that causes it in the first place? Don’t you think if they better understood the cause of these behaviors, and had the tools to communicate with less struggle, that they would be better able to support their loved one in a more compassionate way? There are 5 million Americans living with Alzheimer’s Dementia. There are 16 million others who provide unpaid care for them. Not to mention the community members that interact knowingly or unknowingly these individuals every day. Waiters and waitresses. Medical assistants and other health care professionals. Retail store clerks, librarians and other acquaintances. The more people people we educate, the greater the chance that an individual with dementia can be met patience, empathy and respect.

Ready to become a Dementia Friend?

Check my Upcoming Events page to see if I am offering a training and feel free to join me.

Or, check the Dementia Friends website to find a session local to you.

Core Values

I attended a webinar last night the speaker asked us to identify our core values. What I found particularly interesting, is she specified that our core values should be both relevant to our personal lives and our business practices, because contrary to popular belief that you should keep your professional and personal life separate, a business can be most successful and fulfilling when these values align. As an independent practitioner, I found this concept resonated with me longer, as one of the things I value most so far about running my own practice is that I get to do things MY way. While I started HAE/PT simply as a way to be able to continue to work while meeting the unusual demands I now face at home due to the pandemic, it has transformed into something else entirely. It has given me an opportunity to to use my skills and experience in the best way I know how to help my patients in more meaningful ways. In thinking about it in this light, of course my personal core values should line up with my professional ones, and I can see how making these a regular part of the way I do my business will be the best path to success.

The core values, and the values I strive to live my life by and design my business around, are Strength, Support and Stability.

Strength:

I’ve always found myself striving to be strong. As a person, in my athletic pursuits as a swimmer and as a physical therapy clinician. Strength fosters resilience. When life becomes challenging, physically or emotionally, it is your strength that helps you remain resolute, that helps you achieve your goals and remain whole when you emerge on the other side. This is a value I work on daily in myself. It is an attribute I work on at each visit with my patients. And it is a value I wish for as I develop my business.

Support:

I’ve been in the ‘helping’ field as long as I can remember. My first job was a mother’s helper when I was somewhere around nine or ten. I started volunteering at eleven as a swim teacher for kids with disabilities. I continued in this role until I left for college. I worked at various camps and recreation programs for people with disabilities from my teens into my early twenties and when it came time to choose a career, it felt like a given to make a choice within the helping professions. There certainly weren’t any other careers that piqued my interest, and the only jobs that felt worthwhile to pursue were ones that would allow me to support other people. I strive to support my friends and family when they struggle, and I feel like being able to support my patients as they recover from illness and injuries is best part of my job. In opening my own practice, I have given myself the flexibility to expand the ways I support my patients. I have developed programing to support patients before, during and after physical recoveries and under a greater umbrella of health and wellness, and can now provide support during my visits without the constrains of productivity standards and other factors that limit how I choose to spend my time.

Stability:

Stability is successful maintenance of balance. Stability has far reaching implications in all areas of health - mental, physical, emotional and spiritual. While some people yearn for freedom, flexibility, or adventure, and while I also value all of those things, I believe that you can only truly grow when you have a stable base to keep you grounded. I’ve always been drawn to images of trees with giant sprawling roots, and wear a necklace each day with that depicts a tree of life, embellished with my children’s initials. I feel most at peace in the woods, among tall trees, in fresh air, on a clear fall day. While I can’t completely put into words how why I feel this way, I can tell you how it makes me feel. It makes me feel calm. It makes me feel like I can see the ‘forest for the trees’ - it helps me put my problems in perspective and see my world on a larger scale. When I’m stressed, or overwhelmed, I can take a walk in the woods and emerge feeling renewed and optimistic. While I don’t consider myself spiritual, per say, there is a passage that always catches my eye during the high holidays each year. Paraphrased, it reads:

“Will you be troubled every passing wind or be the calm within the storm?”

I strive to live my life as the calm within the storm - and want the very same for my patients. I want for them to experience stability in their health by providing them with an education beyond what a physical typical therapist may provide. I want them to be stable, literally, so they can avoid falls and remain free from injury. I want to be able to support each of them, to help them develop the strength and the stability they need to age successfully. I believe these values, my core values, are what makes HAE/PT special and I look forward to sharing them with you.

Med A, Med B and HAE; Clearing up the Continuum Confusion

Confused about your Medicare benefits? You’re not alone. But breathe easy and read on as I clear up the Continuum Confusion and help you understand the When, Why and Wheres of Med A and B coverage and how HAE/PT can better help you manage your health, wellness and rehabilitation.

The Care Continuum:

My work in rehabs, outpatient centers and home health agencies has made me increasing aware, and frustrated by, the issues that arise when patients are treated within the constraints of the current medical model. Let’s jump right in by letting me describe for you a what a typical patient experience looks like after a fall.

Mary falls at home, breaks her hip and winds up at the hospital. She undergoes emergency surgery to fix the hip, stays in the hospital for a week until she is ready medically stable enough to leave. If she is lucky, and has family support and a lives in a safe environment, she may go straight home with home health services. If home is unsafe or she cannot yet care for herself, she may go to a rehab hospital or skilled nursing facility for another week or two. Once she is home, home health sees her for four to eight weeks to help her heal from the surgery, to get a little stronger and work on the skills necessary to return to her baseline level of function. (Side note: ‘baseline level of function’ does not necessarily mean she was functioning in the best possible state in the first place). In an ideal world, Mary can now go to outpatient PT to continue her recovery. 

However, for many patients, this is where the problems start. Home health PTs are required by Medicare to discharge as soon as a patient is no longer homebound, if they have met their goals or if they are no longer making progress. Mary, and so many other patients like her, are often left simply with the instructions to schedule therapy at an outpatient center and continue with their home exercise program until then. But the reality is that even though Mary may no longer be technically be homebound, getting to an outpatient clinic may remain quite difficult. It requires getting dressed, may involve getting up and down stairs, walking outdoors and finding someone to take her - with a lot of pain in the process. Multiply this by two to three visits a week for another six to twelve weeks and then add in the reality of  life in New England. This may be feasible in spring and fall, but what if you’ve fallen over the  winter? Now you’ve got ice, snow and everything in between to contend with. You’re probably starting to see where I’m going with this.  Before we talk solutions, I will review some Medicare basics, because quite honestly, it’s taken me twelve years as a therapist to even begin to understand them, so I can only imagine the frustration patients feel every day having to make sense of this themselves.

Medicare A Benefit:

Your Med A benefit pays for services you receive while you are in a hospital, or if you require services after a hospitalization and you are ‘homebound’ and cannot access services in the community. To be considered homebound, leaving home must require considerable and taxing effort. You either require the help of another person or medical equipment to enable you to leave home, or leaving home places you at risk of injury or medical complication. Basically, you only leave home to go to the doctor, to attend a religious service or a family event and only on occasion. It also allows you for you to take trips to the barber shop or hairdresser, which I’ve always found amusing. This part of your coverage pays for services received at the following places:

• Inpatient Care Hospital:

• Inpatient Rehab at a Rehab Hospital or Skilled Nursing Facility Care

• Home Health Services

• Hospice Care

Medicare B Benefit:

Your Med B benefit covers ‘medically necessary’ outpatient physical therapy services. The term medically necessary means a clinician must that certify you require skilled Physical Therapy services to treat impairments and limitations due to illness or injury. Medicare pays for 80% of these costs; you, or your supplemental plan, is responsible for the remaining 20%. You can choose where you use your outpatient benefit. There is no cap on how much Medicare will pay for outpatient services per year, as long as your therapist demonstrates the treatment is medically necessary - and that you have potential to reach your goals and are continuing to make progress. This part of your coverage will pay for you to receive care at the following places:

• Outpatient Rehab

• Mobile PT (like HAE/PT!)

Beyond the Benefit: 

When you no longer qualify for physical therapy services because you have either met all of your goals, or no longer have a skilled need, you can either discharge from therapy and continue with your home program on your own - or you may consider continuing on with a therapist either on a maintenance program or for other wellness programming. The options here are varied, but very worthwhile to consider. You can choose to continue with a clinic physical therapist or a Mobile physical therapist like HAE/PT, under a Medicare-covered Maintenance program if this applies to you , or pay privately for continued services as a Wellness Program if it does not. You could also attend local exercise classes or a join a gym. Either way, it is imperative you find a way to continue to stay active and on your exercise program after therapy ends to maintain your gains, prevent future decline - and stay healthy!

There has got to be a better way…

While these above explanations hopefully clear up the confusion, I want to talk more about the Care Continuum and why I started HAE/PT. After seven years of seeing ‘Marys,’ and so many patients like her, I started to think there had to be a better way. What if there was a PT who continued to come to you, to work not only on healing from your injury, but more importantly, on the thing that got you here in the first place - the deconditioning, progressive weakness and increased fall risk that happens with aging if you don’t stay active! While balance training may be a part of home health PT, it often is just that - a small part. Overall fitness assessment and training is even further out of the realm typically provided by home health services. The role of hospitals and home health is to dealing with the priority needs - addressing your acute injuries or illness exacerbations and reestablishing your functional independence. HAE/PT was born of the idea that we can do better. We can do by better addressing your whole health, your overall fitness level and by helping you to decrease your risk of falls. We can do better by educating you on your health conditions and how you better manage them - and prevent them from getting worse. We can do better by giving you the tools - and the ongoing support - that you need to keep yourself healthy, happy and whole. What if you could have a physical therapist, who gets to know you like your doctor does? A physical therapist who you could check in with when things start to slide a little, or if you start to feel worse or better yet, if you’re still doing great and just want to make sure you’re still performing your Wellness Program effectively. This is why I started HAE/PT. I want to be able to be this physical therapist for you. 

Have more question or want to get in touch with me or to set up a phone consultation? Just ‘say HAE!

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Ten Things I’ve Learned About Therapy That I Didn’t Learn in School

Since Covid-19, like many of us, I’ve had lots of time to think. And what I started to find myself thinking about, is what it would look like if I could practice physical therapy the way I wanted to do it - without any corporate oversight or pressure to take more patients or schedules or guidelines or the rest of the ‘stuff’ that comes with being an employee. What would it look like if it was just me, and my patient, working together to meet their goals? During this exercise, I started to reflect on what I’ve learned in the past twelve years since PT school and how it impacts the way I practice. What I’ve come up with is the following - a list of ten insights I’ve gained about the provision of  physical therapy that influence how I treat every day. The punchline? Not one of them has to do with exercises, range of motion or any of the other skills we had to master to become PTs. 

1. Use your brain - literally. Use neuroplasticity to your favor. Learn about it, love it and make it a part of everything you do.  To make change in the brain, you must perform activities intensely, repeatedly and specifically. They must have meaning to the person doing them. They must be specific; learning how to play basketball won’t make you a good swimmer. They must be intense; the typical ‘do a set of 10 ankle pumps’ isn’t doing anyone any favors. Activities must be performed in a way that provides challenge - if you aren’t working near the point of failure, neuroplastic change cannot occur. And the activities must occur repeatedly. This can be applied to every thing you do as a therapist, from strengthening, to functional mobility to balance reeducation. Turns out, practice does make perfect.

2. It’s not the hand you’re dealt, but how you play your cards. The most inspiring patients I’ve worked with have been those that remain positive and engaged in their lives despite facing the most challenging of circumstances. My years spent working neurorehab taught me that traumatic physical events don’t have end life as you know it, but it may be start of a new one. Yes, life will never be the same after such injury, but different can still be good. I love to be a part of that redirection - helping a patient start to look forward instead of back and focus on how their rehabilitation can help lay the groundwork for their new life. 

3. Age means very little. I’ve met seventy year olds who look like they’re a hundred and centenarians who look (and act!) like they’re seventy. My favorite advice on living a long life came from one of my very oldest ladies: “Avoid men, and drink lots of white wine.” Another told me she has lived to be a hundred by reading the Smithsonian every day and highlighting the important facts. Then there are those who mistreat their bodies and are disabled by chronic illness quite young. Regardless, don’t judge a book by its cover - or a patient by their wrinkles. They may surprise you. 

4. Educate. The average patient knows very little about the body they live in - from their ‘rotary cuff’ to their ‘prostrate’ gland. But knowledge is power. How can we expect them to take care of themselves without knowing why they need to in their first place. Being told to cut out salt to avoid CHF doesn’t mean much until you can understand why it causes volume overload. Who would work through the pain of ROM after a knee replacement if they don’t understand the process of healing and formation of scar tissue? Take the time to teach and it will pay off in dividends.

5. Ask the right questions. I can figure out what someone needs better through a carefully crafted subjective, than an hour of special tests. Asking if you’ve had any falls doesn’t tell you much. But asking where they happen, how they tend to land, how they were feeling before (and the 800 other questions I tend to ask) allows me to identify the patterns and then efficiently address the issue. 

6. Learn everything you can from the people around you. Find a coworker, a mentor, or a PT community and suck all the knowledge you can out of them. Watch your colleagues work. Take note of their ideas and store them away in your toolbox. Read. Take classes. Never stop learning. I am sure I drove my professors and Clinical Instructors crazy with my non-stop questions, but I always got my money’s worth. If you find yourself in a rut, or using the same old exercise routine with patients, that’s the best time to take a class. Pre-kids, I took every class I could get the time off to take. My priorities changed for a while while they were little, but this forced Covid-sabbatical I’ve found myself on has given me the time and reason to start up again. I joined the APTA for the first time in years and signed up for my GCS exam. I’ve been ingesting Podcasts, online courses and journal articles nonstop. I haven’t been this excited to treat in years. If you every find yourself in a rut, make time to learn.

7. Go with your gut. Advocate for your patients. If something doesn’t seem right, chances are, it’s not. This can be anything from vital signs that make you nervous, a patient who ‘just seems off’ or a coworker who isn’t giving a patient what you think they need. Don’t just let it go, because it may be life or death for your patient. This is a competence I didn’t develop fully until I worked in home care. By nature, working in home care entails constantly triaging and independent decision-making. Sure, you can call a manager for advice, but at the end of the day, it’s your eyes, your hands and you have to make the call. Every time I send a patient out by ambulance, I apologize, but tell them I’d rather be safe than sorry, any day of the week, rehospitalization rate be damned. You may feel embarrassed the two of three times the patient ends up fine and gets sent home, but let me tell you, that third time it turns out to be a pulmonary embolism, you’ll never second guess yourself again.

8. Treat holistically. You’re treating a person, not an impairment or even a functional limitation. Their needs will always span past ROM, strength deficits or even pain. A lot of people just need to be heard. Many rarely find people who know how to listen without judging, or don’t want to burden their loved ones with their stress so they hold it all in. Others desperately need community referrals or education about their medical condition or any other list of non-PT activities you may find yourself doing. During home care visits, I’ve taken out trash, opened up stuck jars, looked up addresses on google - and more often than not, it’s these small things that are more helpful than even the most well planned session you can provide.

9. Talk to your patients. It’s the science that brings us here, but it’s the people who keep us around. You’ll learn amazing things from your patients. The oldest among them have seen things and experienced things that you can’t even fathom. They’ve bought houses for $5000 that are now worth half a million. They’ve met spouses at USO events and then went off to war. They’ve had babies at home. They’ve experienced unimaginable losses. They have stories that could be written into New York Bestsellers and they give amazing advice. One of my favorite questions to ask my older couples is what is their best advice for a successful marriage.  My all-time favorite response came in very simple older gentleman who responded “just stay married.” Think on that one for a bit…

10. Don’t be afraid of change. I’ve always been the kind of person to keep a job forever - I literally held the same job from the age of eleven until I finished college. Straight out of graduate school, I took a job with the rehab hospital I had been interning for. Twelve years later, I’ve held six different positions between six different hospitals, skilled nursing facilities, outpatient centers, home health agencies and private practices. I would never have predicted this trajectory for myself, but between moves, and babies and life, this is where I’ve ended up. But the beauty with all of this change is that I’ve gained something special from each place I’ve worked. It is this mix of experiences that has made me the clinician I am today. I’ve gotten to see what life is like along the continuum for patients after they experience an illness or catastrophic event from the rehab to the discharge home to the transition back to community. I’ve learned from amazing mentors and colleagues and made friends and strong networks. I’ve developed a different set of skills to function in each setting, and had the ability to adapt these to benefit patients I treat in the next. I truly think the rich variety of experiences has made me a stronger therapist, a more mindful clinician and helped me be more empathetic to the patients with whom I work. The funny thing is, among all these travels, never once have I considered opening my own practice. I’ve been asked by friends and family if I’d ever considered it, and my answer has always been a staunch no (‘I want to work, come home and not deal with any extra stress I don’t have to.’) But, as we’re all too keenly aware, this year, the notorious 2020, has forced us all to take stock, assess our lives and make changes we never expected to have to make. Leaving my home health job of seven years was something I hadn’t even been considering. I love the work, I love the company, it worked well with my life and I honestly assumed I’d be there till I retired. But, with my needs at home taking priority, I found myself on extended leave, at home, ‘crisis schooling’ my kids. Ten weeks at home later, with nothing to do but think, sleep and watch Netflix, I found myself considering heading in a different direction. What if I could combine all the things I loved about treating in outpatient with all the things I loved about treating in home into one? What if I could do this on my own, fit the hours in around my family’s needs - and be able to work through the upcoming and very uncertain year? As you can imagine, the next thing I knew (and if you know me at all, I’m sure you can  imagine because you know I’m a crazy person once I come up with an idea), I decided to launch HAE/PT and created a new plan for myself. So, long story short, without change, we can’t grow. Don’t be afraid of change - it’s a part of life, it’s definitely a part of being a PT and in closing, I’ll leave you with one of my favorite passages:  “Will you be troubled by every passing wind, or will you be the calm in the storm?” By accepting change, you’ll not only be the calm, but you’ll be able to make it work to your advantage. 

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