By Emily Snyder, PT, DPT
Physical Therapist, Pennsylvania

Clear and consistent communication by physical, occupational, and speech-language pathologists in the Senior Living Community assures we provide quality patient care. This essential communication extends beyond our daily duties and includes our contributions to marketing and our participation in health-related community events. 

Below are some of the best practices for clinicians to make sure they’re communicating in the right ways with the right people. 

1. Communication Through the Medical Chart

The patient’s medical chart is our first mode of communication. An older patient’s medical complexities require the input of many healthcare professionals. If changes to the plan of care are not relayed to each professional involved in the case, confusion and oversights occur. 

Clinicians must communicate their initial evaluation findings and any changes or recommendations for a resident’s care clearly and consistently on the patient’s medical chart. 

Communication should include:

• Frequency of interventions
• Recommended durable medical equipment or adaptive equipment
• Assistance levels with functional mobility and ADLs
• Diet changes
• Refusal of services 

Staying active on the SLC’s electronic or paper medical chart is the best way to assure the patient’s essential information is updated and accurate. Constant attention to the medical chart further ensures all caregivers within the building are current on their residents’ needs. Attention to this detailed communication optimizes patients’ safety and independence levels. 

2. Communication with Wellness Staff and In-House Physicians

In addition to chart communication, face-to-face communication with the clinical staff assures the well-being of the residents in the facility. 

Depending on your SLC, daily, weekly, or bi-weekly clinical meetings with wellness staff provide a therapy caseload update and introduce hospitalization move-ins requiring the SLC’s therapy services. Meetings should include information regarding:

• Changes in functional status
• Medical concerns observed during therapy sessions
• New evaluation findings
• Pending orders from physicians 
• Report of falls 
• Observation of cognitive decline
• Upcoming discharges
• New concerns for dysphagia

Utilize our password-protected applications such as Teams where everyone can update information. Also, designate one clinician each week to attend this meeting and take notes to share with everyone associated with the patients. 

Clinicians should also schedule a time to collaborate with the in-house physician each week. At this meeting, clinicians and the physician can:

• Provide progress updates
• express concerns about medical status
• Gain insight into recent referrals 

3. Email Communication

While face-to-face communication is preferred, email is an easy and efficient way to keep the SLC team up to date with the therapy caseload. 

Provide a weekly email including a list of residents on your caseload and be sure to include:

• A brief, yet detailed, description of the patient’s plan of care
• Report on the patient’s progress
• New concerns

Each clinician should stay active on this chart with updates. Designate one clinician to send the weekly email. Below is an example of how your caseload chart should look:

Name	Eval Date	D/C Date	Update
Jane Doe	5/30	7/20	Should continue with group exercise class, supervision with showers, and is independent with ambulation to dining room with rollator walker
John Smith	6/20		PT: to address leg strength, balance, gait; tolerating longer distances of walking (~100 ft) with rolling walker    OT: to address FMC, showers, transfers, arm strength; requiring minimal assistance to complete showers  Recent increase in confusion and LE swelling
Mary Smith			Pending consent from POA

 

In addition to a weekly therapy caseload update email, send regular emails throughout the week to the wellness staff as any issues or concerns arise with residents. 

4. Care Staff Communication

Personal care assistants encourage and support residents to be as independent as possible. These essential team members assure the carryover of safe techniques, compensatory strategies, and functional independence that we teach to our patients in therapy sessions. 

Get to know the personal care assistants and establish an accessible working relationship with them. This will help you:

• Assure care assistants that you are available and always willing to demonstrate safe mobility or ADLs specific to each resident. 
• Educate the appropriate staff member on topics such as transfers, bed mobility, and fall prevention ensuring each patient’s safety.
• Create handouts with step-by-step directions or visuals to improve carryover and allow the SLC to keep these on files to provide to new hires. 

5. Communicate with the Marketing Team

Many older adults and their families seek additional therapy services after hospitalizations and rehab stays because of ongoing weakness and functional limitations. Oftentimes, these older adults are not able to return to their prior living situations because of a change in their functional and/or medical status. Senior living communities are a great option in these cases — especially if the patient requires medically necessary therapy services. 

Clinicians within SLCs can and should collaborate with the marketing team by:

• Assisting with tours with prospective residents and their families.
• Offering visitors a brief overview of therapy services offered. 
• Encouraging a smooth and safe transition into an unfamiliar environment.
• Staying up to date with prospective residents, their needs, and expectations.
• Staying current with the status of prospective residents’ referrals and insurance benefits. 
• Assuring timely therapy services are provided upon move-in if skilled care is warranted and the patient is in agreement.
• Sharing previous rehab success stories. 

6. Communicate with Residents

While communication among staff members is essential, we must focus on our priority — the residents. To address the needs of our residents, we must take the time to introduce ourselves and develop rapport with each resident in the community.  Through personal interaction, we can understand patients’ needs and promote aging in place.

Clinicians within SLCs build rapport with residents by:

• Partaking in community-wide events such as fundraisers, holiday events, and socials
• Readily assisting in patient/family meetings with the SLC team as needed.
• Offering to screen new move-ins and becoming acquainted with the new residents if requested by the facility directors.  FOX clinicians will always educate the resident on their freedom of choice and ability to choose their healthcare provider.
• If treatment is warranted, clinicians will call family members for consent to care in the case of cognitive deficits, seeking information about the patients’ backgrounds, occupations, hobbies, and other interests.
• Providing in-services to residents on topics such as the effects of aging, dehydration, and benefits of exercise. 

Physical, occupational, and speech-language pathologists in senior living communities extend quality patient care by sustaining clear and consistent communication among the staff, patients, families, and communities. This indispensable communication which also includes marketing and partaking in community events, establishes the SLC as an integral part of the patients’ lives, promising them attention, care, and compassion as they face the challenges of aging.

Note: FOX performs all screening in accordance with state and federal laws and regulations including but not limited to the Anti-kickback statute and Physician Self-Referral Law and is always in communication with nursing.