- Changing New Grad Perspectives: Creating an Excitement to Work in Geriatrics. Todd Bzdewka & Heather Cronin. Educational Session.
The most successful teams in history were those that were tough, helpful to each other and allied toward the goal of making things go right. In order to make things move correctly, the team members had to demand a standard of performance from each individual in the team. They could not allow someone unwilling or incapable of taking responsibility to be part of the team. They cared about the other team members as well as the success of the group as a whole. To win, they knew all members needed to work hard, have knowledge of their post functions and the skill to perform those functions excellently. Working toward that end creates a pride in themselves and their group.
Ageism is a discrimination against successful optimal aging. Many practitioners today, even those presumably trained in the care of older adults still don’t fully understand the evidence or the age based normative values that should be applied to an older adult.
Our mission at FOX is to believe in our clients to achieve what they once thought impossible – optimal function to rehabilitate their lives. This mission is important because it talks about the clinician/client relationship. It speaks to the fact that it is the clinician’s duty, after the initial examination, to educate the client on what their true abilities are, what it is that they can achieve and the things they can accomplish that they once thought impossible.
Our approach is to go back to the “pre-episodic level” of function. As all of our clients are chronic and have multiple chronic conditions and medical complexities, it is vital to determine the client’s pre-episodic level - that date and time of a client’s previous level of function that we strive to return to.
At FOX, we believe we should look back 12 months or greater—as the conditions are chronic and worsen over time, and we can’t expect the functional conditions we treat to instantly snap back in 8 weeks. We believe our clients deserve to recapture their level of function from 12 months prior, before the dysfunction and disability was caused by the chronic condition.
We believe this is the essence of ageism— when practitioners don’t really understand this look-back period and as a result don’t set appropriate goals. In order for ageism to be completely removed, the proper goals need to be determined and then combined with lots of different variables and data points – functional outcome measure results, age based normative values, clinical examination, patient desires and wishes. All of these variables must be taken into account. But it is the practitioner, truly trained in geriatrics, who understands how to put these variables together to achieve functional wellness for our clients. Then and only then are we truly doing what is right for the client and taking a stand against ageism.
Bending over backwards.
Going the extra mile.
Giving the extra 10%.
Life is a series of exchanges between people. Each day we exchange something, whether it’s communication, goods, resources, money etc. Those exchanges can be categorized into three buckets:
• Criminal exchange
• Fair exchange
• Exchange of Abundance
Have you ever been ripped off? Did you ever feel as though you did not receive what you paid for? Have you ever left a healthcare or service provider feeling as though you didn’t get the care or attention you deserved? It doesn’t feel good. That is a criminal exchange. We do not believe in criminal exchanges at FOX.
We like to refer to the grocery store here. You go to the store, fill your shopping cart with groceries, and take them to the cashier. You give the cashier money and you take your groceries home. In that exchange, you get exactly what you pay for. Goods for money. For the most part, it’s a pretty fair exchange, where each side gets exactly what is expected.
Exchange of Abundance:
Have you ever been wowed or knocked off your feet? Did you ever go to a restaurant or service provider, where you have had a fantastic experience, and the first thing you do the next day is call your friends and family to recommend that restaurant or service provider? You leave that exchange feeling energized, emotionally happy and well. This exchange, where you get more than you expect, is considered an Exchange of Abundance.
Exchanges of abundance are lacking in healthcare today. But not at FOX. One of the most important goals at FOX is to make each interaction an Exchange of Abundance no matter the customer - clients, physicians, other healthcare practitioners, or each other. Each interaction should be an Exchange of Abundance where the recipient walks away feeling emotionally happy and well.
Imagine being a recipient every day of an organization that exchanges abundance in everything that they do. We expect that every person at FOX exchange in abundance in every interaction. We consider it a part of our work, part of our hat and job descriptions.
It’s pretty amazing and powerful.
Exercise is viewed as beneficial for America’s youth and younger adults, but is met with skepticism in older adults. Research shows that exercise is effective in older adults with little risk of adverse events.
Therapeutic exercise is the concentrated provision of exercise to address specific impairments. These impairments may be related to the reduction or loss of
- Muscular endurance
- Muscular concentric or eccentric strength
- Muscular power
- Range of motion with or without subsequent pain
Medical literature reports a 10% decline in strength per decade after age 30. This means that an individual in their 80s or 90s will lose 50-60% of their strength without intervention. Reduced strength leads to complications such as reduced quality of life, higher healthcare costs, and potential death from falls and other sequelae of poor or limited movement.
We at FOX Rehabilitation use the most current evidence to provide patient-specific and skillfully-dosed exercise that adheres to the overload principle. In order to make a true physiological change, the client needs to be pushed past their current level of ability. This aspect of exercise is so important that it was identified by the American Physical Therapy Association (APTA) as a significant problem within the profession. We promise to provide therapeutic exercise in this manner with every client every time.
Balance is a fundamental component of mobility that is required to participate in meaningful activities and maximize the quality of life in older adults. Poor balance puts one at risk for falls and fall-related injuries; therefore, poor balance is a direct threat to optimal participation in everyday life. Physical and occupational therapy regularly assesses balance and how pathology, impairments, functional limitations, behavioral patterns, and environmental factors affect the ability to move in space. Once an appropriate assessment has been performed, a subsequent tailored treatment program is imperative to fall prevention and continual participation in everyday life.
Differential diagnosis is the “distinguishing of a particular disease or condition from others that present with similar symptoms”. As practitioners that see clients in the home setting, this is a necessary skill. Therefore, differential diagnosis is a clinical pillar at FOX, and frequent education is provided to clinicians from the Quality Assurance and Professional Development Division.
We as physical, occupational, and speech therapists do not diagnose medical disease. However, we are trained to identify “red flags” or clusters of symptoms that indicate an acute change in the client or a disease/condition that falls outside of the scope of our practice. In these instances, we appropriately refer to the necessary medical professional to ensure patient safety and comfort and to optimize their potential for meaningful functional improvement.
Cognition impairments include deficits related to specific cognitive processes and systems (e.g., attention, perception, memory, organization, executive function). Areas of function affected by cognitive impairments include behavioral self-regulation, social interaction, activities of daily living, learning and academic performance, and vocational performance.
Cognitive impairments may be a result of a stroke, brain tumor, traumatic brain injury, anoxic or toxic encephalopathy, and non-degenerative and degenerative neurologic diseases (including the dementias).
Restorative and/or compensatory treatment approaches are essential in working with those with cognitive deficits. Restorative treatments help to improve the cognitive functioning related to a wide variety of activities, whereas compensatory treatments teach and train strategies related to specific problem areas.
The clinical team members (PTs, OTs, and SLPs), assume a variety of roles when working with individuals with cognitive impairments. These roles consist of:
- Identifying needs
- Providing assessments
- Developing interventions
Given the high incidence and prevalence of cognitive impairments and their potentially serious consequences—including negative impact on social, academic, and vocational success; on quality of life; and on caretakers and personal finances—appropriate preventive efforts, assessment, diagnosis, and management are critical.
Seating and positioning is extremely important when promoting optimal participation in meaningful activities and maximizing the quality of life in older adults. Appropriate positioning, whether it be in a chair, wheelchair, bed, or another surface, is critical for tone normalization, postural control, skin integrity, and the reduction in the use of restraints. The environment plays a vital role in how one's seating and positioning can directly affect function and daily participation in occupations. Physical and occupational therapy as well as speech and language pathology provide ongoing assessment and intervention of one's current seating and positioning while, incorporating the goals of the client and family, along with the client factors that affect the ability to function in their environment.
Documentation plays a critical role in communicating to third-party payers the need for evaluation and treatment services (medical necessity) and why those services require the skill of the clinician (PT, OT, or SLP).
Medicare outpatient therapy documentation guidelines serve as the standard for many other insurance plans. Medicare also requires documentation to comply with requirements related to functional outcomes reporting for outpatient therapy services (G-codes) and quality outcomes reporting (Physician Quality Reporting System [PQRS]).
Documentation components required by Medicare include:
- Plan of care
- Long-term goals
- Frequency and duration of care
- Treatment notes
- Progress reports
- Discharge note
Medicare (and other plans that adopt Medicare documentation guidelines) stipulate that services eligible for reimbursement must be at a level of complexity and sophistication that requires the specific expertise and clinical judgment of the qualified health-care professional, thus meeting the definition of skilled services.
The FOX culture is all about people. Our clinicians. Our patients. Our support staff. Working together to reinvigorate and restore these lives is the cornerstone of our achievements. Our immersion in advocacy, professional advancement, and education sets the stage for autonomous success. If you give people the respect and tools they need to succeed, they will never cease to amaze you.