By Caitlin Brady, PT, DPT
Physical Therapist, Central New Jersey and
Maureen Colket, MA, CCC-SLP
Speech-Language Pathologist, Pennsylvania Southwest

In 1948, the World Health Organization declared, “Health is a state of complete mental, social and physical well-being, not merely the absence of disease or infirmity.” Nearly 80 years later, the COVID-19 pandemic has given us all pause to ponder our health and well-being. 

These experiences of the past two years have caused many of us to re-evaluate how we spend our time and efforts — both in our personal and professional lives. Some are prioritizing time with family, others nurturing positive relationships, others still focusing on work/life balance.

As FOX clinicians, we are uniquely positioned to consider all elements of the past, present, and future to optimize the health and well-being of our older adult patients. 

Social Determinants of Health – What Role Do Clinicians Play?

If social determinants of health (SDoH) “account for more than 80% of health outcomes” according to Modern Healthcare and our aim as therapy providers is to improve our patients’ health, it stands to reason that we must address these factors if we are to be successful. But first, what are the social determinants of health? 

SDoH include “the conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. These are non-medical factors and include things like food security, safe housing, reliable transportation, social and community support systems, quality education, and economic stability. 

As FOX clinicians, when we visit our patients in their homes, we are able to observe what social determinants might present barriers to optimal health and wellness for them. The skills and knowledge we have as therapy providers can be leveraged to address these barriers and help to break them down. We are constantly gathering information regarding a patient’s home safety, their ability to access and engage in their community and with family and friends, their health literacy and self-efficacy with health management. 

Consider the following examples of questions we can ask that link social determinants with potential functional therapeutic goals:  

• Can the patient safely enter and exit their home to access transportation for grocery shopping, medical appointments, social outings, spiritual gatherings, etc.? 
• Are safety hazards present in the home that can be remedied? 
• Is the patient aware of the community programs and resources available to them? Are they comfortable using a smart device or computer to access resources? 
• Do they understand what a healthy balanced diet looks like? If not, is education sufficient or would they benefit from a referral to another appropriate provider? 
• Is meal planning and preparation safe and easy for them? What about self-feeding and swallowing? 
• Can the patient effectively communicate their needs and concerns to loved ones? 

By asking questions like these and working with our patients to answer and address them, we can have a direct impact on long term health outcomes. We may need to think outside the box a bit, but health promotion is certainly inside our scope of practice. 

Develop a POC Geared Toward Patient Health and Empowerment

Empowering patients to engage in health-promoting behaviors falls in line with the therapeutic goals of PT, OT, and SLP. Addressing patients’ individual goals in PT, OT, and SLP typically results in greater participation in societal roles and responsibilities. We work to improve our patients’ abilities to be resilient, “be stronger, and live better longer”. PTs can help a patient return to a more independent, active, and mobile lifestyle. OTs can promote patients’ abilities to care for themselves and engage in meaningful hobbies and occupational roles. SLPs can address cognitive, swallowing, and communication issues to enable patients to maintain relationships, consume a safe and nourishing diet, and interact effectively with others and their environment. 

As we have pushed through the pandemic, FOX clinicians have, at times, been the sole healthcare providers physically present with our patients. In non-pandemic times, FOX clinicians as “house call” providers spend hours with patients in their home environments. In either case, this insight and knowledge of our patients is vital to holistically assess them and share information with other interdisciplinary team members such as primary care physicians or neurologists. This has also been a period of time that calls upon the creativity of clinicians to ensure needs are met despite the challenges of the pandemic. For example, an OT might assist a patient in fine motor control to use a phone application for grocery delivery. 

It is best practice for clinicians to screen patients during the initial evaluation as well as ongoing for other medical concerns (e.g., poor nutrition). The lines of communication regarding our investment in our patients’ health and wellbeing are open on day one. From there, clinicians can continue to build rapport and become trusted advisors to our patients regarding personal health behaviors (PHBs). We can identify barriers that may exist to patients engaging in healthy behaviors and develop a plan to address them. It is important to connect with and learn about the patient before jumping to conclusions and providing premature advice. Only after developing this strong rapport and observing/assessing patients’ needs should we move to provide recommendations. 

How to Promote Patient Engagement in Personal Health Behaviors

Due to the nature of our current healthcare system, other primary care providers (e.g., nurses, doctors, specialists) are unable to spend the amount and quality of time with patients that we do. We build more than trust and rapport with our patients throughout an episode of care. We build relationships with them. This relationship is a therapeutic alliance through which we can help our patients achieve their immediate therapeutic goals, but also long-lasting health and wellness. 

In addition to an acute change in function, our patients are likely also coping with at least one, if not more, complex chronic medical issue. As therapy providers, we are meeting them in a particularly vulnerable state and must remember to use a patient centered approach not only in developing goals but in coaching a patient to achieve those goals. 

Education is an important aspect of patient care. It is necessary to provide our patients with the knowledge and resources they need to “live better longer”. However, the majority of our patients need more than teaching. They need our empathy and our compassion. They need someone in their corner helping them realize their own potential and ability to change maladaptive habits, such as a sedentary lifestyle, poor sleep hygiene, poor oral hygiene, or a lack of a healthy, balanced diet, into health promoting behaviors. 

Motivational Interviewing

Motivational Interviewing (MI) is an integral, evidence-based, and skilled intervention that we can use to facilitate positive behavior change in our patients. MI was developed in the 80s for use in the treatment of addiction. Now, it is utilized across the healthcare industry and in other non-health related fields to bring about desired changes in behavior. 

The MI spirit aligns well with the therapeutic alliance we build with our patients. The basic components of the MI spirit are: partnership, evocation, acceptance, and compassion. A collaborative partnership between clinician and patient is key to achieve long lasting behavior change. Both parties must show up and be engaged in order to attain successful outcomes. The clinician should work to evoke from the patient their own intrinsic desires in order to motivate them, rather than educating them on why they should be motivated. We must practice respect and acceptance for our patients, wherever they are in their health journey, in order to promote autonomy and empower them. Lastly, we must show our patients compassion as they learn, grow, and become better stewards of their own health and well-being.  

The strategies used in motivational interviewing are represented with the acronym, OARS: 

• Open-Ended Questions – Ask questions that cannot be answered with one word, a number, or a date. Questions that start with what, how, and tell me more are common open-ended questions. The goal is to decrease reflexive responses and encourage communication. 
• Affirmations – Statements that point out strengths or values the patient is demonstrating. 
• Reflections – Repeating back what the patient says in different words. Reflections are a way to ensure the patient is heard and understood. 
• Summary – A summary is a type of reflection that acknowledges the barriers the patient has stated but reiterates his/her reasons for change and any potential next steps to pull the interaction together and make sure the patient hears his/her own words stated back. 

Aside from knowing and understanding the multiple aspects of motivational interviewing, a clinician would ideally also gain practice and mentorship in this valuable skill in order to successfully incorporate it into clinical practice. We can start by talking through a patient’s difficulties and barriers to change with them in a non-judgmental and supportive manner, making them feel understood and accepted, and capitalizing on their own unique perspective and strengths. 

How to Get Involved in Health and Wellness Promotion as a Professional

On a professional and personal level, there are many steps we can take to level the playing field and address health and income inequality. Advocating for health and wellness for all can mean: 

• Supporting local community access to safe outdoor and natural spaces for all individuals 
• Becoming more environmentally conscious in our personal and professional lives to address climate change and the effects it can have on “air quality, safe drinking water, sufficient food, and secure shelter,” particularly in lower income areas (Climate change and health) 
• Participating in and promoting diversity, equity, and inclusion efforts (Unlocking Your Potential as a Healthcare Professional Relies on Understanding Diversity, Equity, and Inclusion)
• Volunteering to support the right to vote and access to voting resources 
• Becoming involved in government to promote public health efforts 
• Living by example and prioritizing your own mental, physical, emotional, and spiritual wellness to inspire others to do the same
• Providing education to patients regarding climate sensitive health risks and how to prepare to withstand climate crises 
• Advocating for the physical therapy, occupational therapy, and speech-language pathology professions by being active members of our professional communities, promoting interdisciplinary care, and advocating for patient access to our services 

FOX Rehabilitation Goes Above and Beyond

FOX Rehabilitation takes a multi-faceted approach to promote health and well-being. This occurs both during and outside of treatment. FOX clinicians support our senior living communities by providing in-house therapy including regular screening of residents for functional changes. Additionally, FOX Optimal Living and FOX Stronger Living programs are available to our senior living partners, adding exercise physiology programs to maximize movement of all residents. 

These relationships are proven to reduce incidence of falls as well as hospital admissions. FOX is actively engaged in local communities to encourage individuals to focus on preventative health measures as well as promote the rehab professions. Some examples include the provision of blood pressure screenings in the community and our Virtual Integrated Clinical Experience (ICE) program. The Virtual ICE program allows virtual shadowing by students to spark interest in PT, OT, and SLP professions; moreover, these opportunities target areas of the country which might not have easy access to these learning opportunities in person. 

The argument can be made that now is a perfect time to “realign our healthcare priorities”. Really, if not now, when? It has become abundantly clear that we need to do more to promote health and prevent healthcare issues from occurring, rather than continuing to react to crisis after crisis, providing interventions only after a loss of health or wellbeing has occurred. This is how we can truly help our patients to be stronger and to live better longer!