“Outpatient on Wheels” Addresses Older Adults’ Barriers to Rehabilitation

By Shelly Wolfe, PT

Physical Therapist

I’ve been a physical therapist for nearly 30 years. The settings I’ve worked in include outpatient included outpatient, acute care, school-based, home health, and skilled nursing. For the majority of my career, I have worked primarily with the geriatric population. My desire to serve this population has only increased during my career as I’ve come to realize older adults are frequently under-served and overlooked.

Older adults can be afflicted with many health concerns that respond well to the rehabilitative care that therapists are skilled in providing. However, this population frequently has many barriers that reduce their access to rehabilitative services.

LACK OF TIMELY PHYSICAL THERAPY REFERRALS NEGATIVELY IMPACTS OLDER ADULTS

Timely physician referrals can be a factor that limits a patient’s access to rehabilitative care.

Several years ago my dear uncle developed multiple medical issues. After he retired, he was a school crossing guard and an avid walker throughout the community. He walked several miles a week, always bragging about the money he would find on his daily walks around town. A short time after his retirement, he developed a visual impairment resulting in double vision. This drastically reduced his mobility, and he lost his confidence walking outdoors. The impairment reduced his environment and his overall physical activity. Several years later he developed peripheral neuropathy and an acoustic neuroma, which affected his auditory and balance systems. Balance impairment responds well to timely physical therapy intervention. This clearly demonstrates a situation where connecting with medical practitioners may help to identify elderly adults who would benefit from a therapy assessment. Fox excels at identifying and capturing these opportunities through office visits by clinicians and account managers.

Soon after, he was diagnosed with Parkinson’s disease. All of these issues severely impaired his mobility confidence both outdoors and indoors. To add to his physical ailments, he later developed dementia. At this time his physician did identify the worth of therapy and provided him with a prescription for physical therapy. However, my uncle’s physical mobility was significantly impaired to the point that my aunt was not sure of her ability to successfully transport him to and from the outpatient therapy clinic several times a week as prescribed for proper dosing.

Education and outreach to our communities and our primary care physicians about the value of therapy, especially for the geriatric population, is needed to prevent scenarios like this. FOX Rehabilitation has resources to improve healthcare provider and community awareness regarding the benefits of therapy. Community presentations and screenings performed by FOX clinicians not only educate the community but also identify fall risks. Outreach such as informative lunches, delivery of success stories and client updates to physician offices increase their awareness of what FOX can provide.  As healthcare workers’ roles and ancillary services evolve, ongoing outreach provides a clearer understanding of what clinicians bring to the table for treatment and assessment. This communication is a way to advocate for elderly adults and reduce ageism.

HOW FOX REHABILITATION FURTHER REDUCES BARRIER OF ACCESS

The ability to safely access therapy can also be a barrier to rehabilitative care for older adults. Therapy delivery that reduces the burden on the patient and the caregiver creates increased access. Going to an outpatient clinic proved to be impossible for my uncle.  This was partially due to his physical ailments and partially due to my aunt’s lack of education in handling him safely.  Physically it was difficult for him to walk out to the garage and get into the car. Even more difficult would be getting out of the car and back into the home after a full therapy session. Adding to that was his lack of understanding of the need to “go” given his dementia.

FOX is unique, partnering with home health companies. This ensures access and allows for a seamless transition to home outpatient therapy, maximizing function. FOX also partners with senior living communities. This setup allows for quick identification of therapy needs and easy access to rehabilitation.

Unfortunately, my uncle never truly received the therapy and caregiver training that was critical to keep him in his home. His dementia and physical impairments progressed to a level that he was no longer able to remain home without adequate community resources or social support. My uncle was eventually admitted to a long-term care facility. The transition was difficult given his dementia and his new unfamiliar surroundings. My aunt carries guilt with her as she wishes she would have been better equipped to serve his ever-changing and rapidly declining condition in order for him to remain home. My Uncle would have benefited from geriatric house-calls by having therapists perform home safety assessments, caregiver education, evaluation of assistive devices, assessment of functional mobility and cognitive skills development. Many times patients are so debilitated and frail that by the time they get a therapy referral, just getting to and from the clinic is so physically demanding that they have little reserve to complete an effective therapy session. In my uncle’s case, my Aunt did not feel that she could safely handle getting him to and from the clinic multiple times for several weeks so he could have the indicated dosage. Additionally, if an older adult is able to get to an outpatient clinic, the therapists cannot assess the person’s home environment. FOX’s Geriatric House Calls provide increased access to the care needed to improve a patient’s quality of living, so they can remain in their familiar home environment as long as possible.

House Calls make it possible to utilize their own furniture to assess transitional movements. Sessions are one-on-one. With fewer no shows or cancellations, this setting is shown to increase compliance for proper dosage. Many times a patient’s home can create greater disability through poorly placed or nonexistent grab bars and handrails, poor lighting, and tripping and reaching hazards. By providing in-home therapy, simple home modifications can be quickly identified to reduce fall risk and improve ease of movement.

HOW FOX REDUCES HEALTHCARE COSTS

With timely referrals and increased access to rehabilitative care, healthcare costs can be reduced.

FOX Rehabilitation’s delivery model is ideal to reduce healthcare costs by identifying and reducing fall risks and by reducing hospital re-admissions.

Fall risks are reduced by performing home safety assessments, assisting with the provision of adaptive equipment and assistive devices, and addressing the functional deficits identified via evidence-based practice and clinically excellent care. Hospital re-admissions decrease with educational resources for patients and caregivers to manage chronic health conditions, such as diabetes mellitus, congestive heart failure, and Parkinson’s.

Older adults warrant therapy intervention upon the initial debilitating diagnosis or the first indication of functional mobility deficits. FOX values increasing the fun for community residents and reducing the frailty with its proactive approach. The focus needs to be on reducing ageism that often goes with a “diagnosis”. Negative stereotyping of older adults as diseases or disabled can take away from the success that older adults can experience. I have had several patients tell me, “what do you expect, I’m old”. Ageism can create a self-fulfilling prophecy.

My uncle is the reason that I was drawn to work for FOX Rehabilitation. I wanted to join FOX in its mission to help older adults achieve what they once thought impossible: optimal function.

MY PASSION FOR FOX’S MISSION

My team members have treated me with compassion, kindness, and understanding. This motivates me, encourages me, and makes me feel valuable. When I began working for FOX I asked a lot of questions. I never felt as though I was bothering my local leadership with my rapid-fire questions.   I’ve worked in different settings where there was a lack of respect. In these other places, this makes colleagues and patients feel defeated which is not a good mindset to promote healing.

I want to further the FOX mission by positively changing how the world perceives aging. My enthusiasm to provide for my community has increased with the FOX culture of team spirit and excellence. My hometown community and my work community are what drive me to provide my craft of clinically excellent care I want to provide my patients with the best care possible so they can achieve what they once thought was impossible…