FAQ #3: What DO You Actually Do ???
FAQ: What do you actually do?
(Aka when your PT doesn’t ‘look’ like a normal PT..)
I get it - Physical Therapists who don’t always look and act like ‘normal’ physical therapists can throw you for a loop. Us Geriatric Mobile PT’s don’t have a clinic. We don’t work with aides. Heck, we don’t even own an ultrasound or estim unit (usually!). So what is that we actually do?
FAQ: What do you actually do?
(Aka when your PT doesn’t ‘look’ like a normal PT..)
I get it - Physical Therapists who don’t always look and act like ‘normal’ physical therapists can throw you for a loop. Us Geriatric Mobile PT’s don’t have a clinic. We don’t work with aides. Heck, we don’t even own an ultrasound or estim unit (usually!). So what is that we actually do?
To answer this question, I’ll start with a few things we aren’t:
We aren’t nurses - but we do take your vitals, check your meds and help you manage your chronic diseases.
We aren’t massage therapists - but we do perform soft tissue work, manual therapy and other hands-on techniques to help reduce your pain and improve your movement.
We aren’t occupational therapists - but we do work with you in areas where OTs usually hang out, like to work on transfers in the bathroom, teach you how to move around safely in the kitchen and how to keep your balance while you get dressed.
We aren’t your doctor - but we have ‘direct access’ that allows us to see you first, before you see your doctor, because we have the advanced education, skills and know-how to identify when it is safe to see us - and when you need to see another clinician first.
We aren’t social workers - but we are great resources for how to access support within your community. We have great connections to senior centers, home health agencies and other health professionals and can steer you in the right direction.
We aren’t your therapist - but we are great listeners. We understand that the key to helping you benefit from physical therapy is to find ways to motivate you and get you more confident in your abilities. This requires getting to know you, your life, your goals, the ‘what makes you tick’ stuff. We can’t be effective without understanding this first.
So, back to the original question. What the heck do you do?
Geriatric Mobile Physical Therapists are experts in healthy aging. We understand that Exercise is Medicine and we are masters at finding ways to help you move, despite your limitations, despite your medical conditions, despite the fact that you are getting older and despite the fact that you may be scared, physically limited or simply don’t know where to start.
We are movement and mobility masters. EVERYTHING we do as humans requires movement. Taking care of yourself, your loved ones and your home (getting dressed, taking a shower, cooking, going to the grocery) all requires mobility. Doing all the things you LOVE and ENJOY requires mobility. Golfing, playing tennis, socializing with friends and family, picking up those grandkids and getting to the floor to play with them. These aren’t always easy tasks as we age - but they are the very most important ones. Physical therapists are THE people to help you find ways to keep doing these, without less pain, with less risk of injury and with less risk of falling.
We are illness and injury rehabilitation professionals. It is nearly impossible to grow old without experiencing some bumps in the road. These bumps may be hospital stays, broken bones, strokes or progressive illnesses like Parkinson’s. We are the people to help you find your way back. Back to health, back to moving, back to living, back to being you.
None of this stuff is easy. Growing old ain’t for sissies (direct quote from more than one of my past patients!). Mobile Geriatric Physical Therapists (like me!) make it easier. We help you stay healthy as you age. We help you recover from bumps in the road. We even help you stay comfortable as you progress towards the end of life and help your family learn to care for you if they need to. So, will you get modalities and massages and be given a home exercise program and sent on your way? Nope. Not by a long shot. Will you learn to better care for yourself, care for your loved ones and age more successfully? You bet. Want to know more? Ask us:) #ChoosePTfirst
#haept #stronger #fitter #functional #physicaltherapist #physiotherapist #physicaltherapy #physiotherapy #exercise #health #wellness #aging #healthyaging #optimalaging #successfulaging #exerciseismedicine #insurance #medicare #momboss
FAQ #2: How ‘Old’ Do I Have to be to See You?
FAQ: How ‘Old’ Do I Have To Be to See You
(Hint: It’s a trick question)
I’ll answer this question with another question. Are you older than you were yesterday? Then you’re ‘old enough’ to see me.
FAQ: How ‘Old’ Do I Have To Be to See You
(Hint: It’s a trick question)
I’ll answer this question with another question. Are you older than you were yesterday? Then you’re ‘old enough’ to see me.
As a geriatric physical therapist, I specialize in healthy aging. This means that while I’m a great person to see if you are having age-related issues like pain or limitation from arthritis, or trouble walking or difficulty with your balance, I’m also a great person to see if you want to PREVENT some of this stuff down the road.
There are so many diseases and disorders associated with aging (Congestive Heart Disease, Diabetes, Heart Disease, Osteoporosis and Cancer to name a few), but the key to prevention is making healthy choices, and developing healthy lifestyle habits BEFORE you get older. I’m 38 - and everyday I consciously make choices that will make me a healthier older person when I get there.
So, the answer to this question is you have to be exactly as old as you currently are:)
#haept #stronger #fitter #functional #physicaltherapist #physiotherapist #physicaltherapy #physiotherapy #exercise #health #wellness #aging #healthyaging #optimalaging #successfulaging #exerciseismedicine #insurance #medicare #momboss
Dementia 101
As a Physical Therapist, I don’t actually ‘treat’ Dementia. But, I do treat an a whole lot of people 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 more common diagnoses I find on that long list of age-associated diseases that follows the prompt for past medical history.
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:
The individual must demonstrate a decline from previous level of functioning.
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.
Memory loss that disrupts daily life.
Challenges in planning or solving problems.
Difficulty completing familiar tasks at home, at work or at leisure.
Confusion with time or place.
Trouble with understanding visual images and spatial relationships.
New problems with words in speaking or writing.
Misplacing things and losing the ability to retrace steps.
Decreased or poor judgement.
Withdrawl from work or social activities.
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.
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.
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!