FOXcast PT: Top 5 Ways To Reduce Falls Without Touching The Patient

What is meaningful to you? Because if we can tap into what is meaningful to the person. Whether it be their hobbies their family their grandchildren, past occupation. Therapy should be a time of excitement and something to look forward to and something fun. We do that by relating all of our activities and exercises the things that they love to do. So if we can show value to our clients in that way then then overall more rewarding experience for everybody.

This is FOXcast OT, a podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

JIMMY MCKAY, PT, DPT Welcome to FOXcast. I’m your host physical therapist, Jimmy McKay on the program today another colleague from FOX Rehabilitation PT Andrew Harnish. Andrew, welcome to the program.

ANDREW HARNISH, PT, DPT, GCS, CDP Thanks for having me, Jimmy.

Andrew tell the audience a little bit about your role you are a practicing physical therapist but you do some other things as well with older adults too.

ANDREW HARNISH, PT, DPT, GCS, CDP I am I am a the optimal living. Director of rehab what that means desire over the ah rehabilitation and wellness programming in one of our senior living communities. Chestnut Knoll, which is in Bowyertown Pennsylvania. I am responsible for the overall health and well-being of essentially every resident in the building and making sure that they’re operating at their optimal and highest level function of possible. Aging in place successfully avoiding any kind of adverse medical events along the way.

JIMMY MCKAY, PT, DPT So we got you on the phone today to tell the audience a little bit about ways that people can reduce falls. But Andrew you’re going to take the touch out of it. Five ways to reduce falls without ever touching someone? How are we going do that?

ANDREW HARNISH, PT, DPT, GCS, CDP Well it’s a great question. So you know as part of my role as a Director here is accepting new residents as the day they move in. Really we want to take a step back from looking at all the impairments a resident may have looking at them holistically and making sure that we’re giving them all the tools they need to be successful and thrive in the community. Falls are just such a major problem with the older adult. About one in four people over the age 65 are going to fall every single year. The literature shows that once someone moves into a senior living community that these rates actually are a lot higher because usually people are more medically acute what more come morbidities and have a lot more risk factors at play.

JIMMY MCKAY, PT, DPT So this one we’re gonna show off of we’re going to use our heads and really forward thinking to give you five ways to reduce falls without ever touching someone. I got the list here. So let’s walk the audience through it. First off it can’t be this simple right? Watch them walk?

ANDREW HARNISH, PT, DPT, GCS, CDP Yeah yeah. It sounds simple. You know it’s physical therapist. That’s such a major part of what we do. And you know when we’re doing gait analysis and watching how they walk we can gather so much important information. We can suspect where they might have some weakness or maybe where they have decreased range of motion. Is that overall base? Someone who’s moving into a senior living community has probably had some kind of adverse medical event recently or been experiencing some functional decline. So a lot of times it’s not uncommon that they come to us maybe using no assistive device or maybe just the cane but really they need a a walker or some other kind of assistive device. So just getting eyes on them and seeing how they function in their environment. We can gather so much valuable information.

JIMMY MCKAY, PT, DPT Yeah I like how you let off of this one because when you hear gait analysis as as a therapist. Typically you’re thinking about runners or you know active adults looking to get back to jogging or playing a sport but it’s within our scope it’s within our education to assess gait and you brought it up just a second ago hey maybe maybe if it’s assessing the gait to find out if they need an assistive device and they don’t have one or do they need a change or an adjustment on appropriate assistive device?

ANDREW HARNISH, PT, DPT, GCS, CDP Sure yeah. And sometimes it’s just those little things you know maybe adjusting and a little higher, a little lower can make the world a difference and really help prevent a fall.

JIMMY MCKAY, PT, DPT All right. Love that that’s number one move on to number two without using our our hands without touching reducing fall risk, environment. This one seems important.

ANDREW HARNISH, PT, DPT, GCS, CDP Yes again as an FOL director in a building. I try to see how the person functioning in all the environments they’re going to be in throughout the day. Of course the biggest one being their bedroom and the bathroom. So we want to make sure we look at everything. Is their a bed too high or too low? Or maybe they need a hospital bed to make transfers a little bit easier. What’s the bathroom setup? Do they have grab bars? Or maybe they need an over the toilet commode to raise up the toilet seat and give them you know armrests to make it a little easier. Is there proper lighting? Vision changes are so common in the older adults that we need to make sure we’re using objects that have high contrast so people can see them whether it might be a lift into the bathroom or maybe objects that they need to use for their activities of daily living things of that nature. And of course we want to look at is there any tripping hazard? The use of throw rug for any therapist that might be treating out in the home. Is there toys from the grand kids? Or maybe toys from a dog or treat things of that nature. We just want to try to remove every hazard that we can in order to set up the person that was possible.

JIMMY MCKAY, PT, DPT Yeah I love that when we talk to other Fox clinicians who might be working in the home as you mentioned. Man what what a great place, what a perfect place to actually be assessing not only the human that we get to work with but also the environment that they’re going to inhabit most of the time.

ANDREW HARNISH, PT, DPT, GCS, CDP Exactly. Exactly. For me there’s no better setting than treating the older adult in their home. Because like you said that is where they’re saying the majority of their time and there are so many other factors at play now we can really say you know what is the setup of the stairs.  Is it steep? Is there a railing only on one side? Their kitchen is really small and hard to maneuver around. Things of that nature when you can really dissect how the person is going to function on a day to day basis for really doing everything we can to mitigate as many factors as possible.

JIMMY MCKAY, PT, DPT Love that. So work on the environment there for number two. Moving to number three. Review in the medical chart. This seems like a great suggestion.

ANDREW HARNISH, PT, DPT, GCS, CDP Yeah. You know you have a resident or client sitting in front of you. Of course that’s not always going to tell the whole story. But by looking at their medical chart things they’ve been hospitalized for in the past. What medications they’re taking. What other comorbidities is they may have we can gather a lot of information and from there we just want to make sure we’re triaging through appropriate providers in order to set up a comprehensive multidisciplinary team of all different types of providers to ensure we’re serving this client as best as possible. Maybe if they’ve had a recent functional and cognitive decline they’re a great candidate for physical, occupational and speech therapy. Maybe if they have a neurological condition maybe like Parkinson’s or a history of stroke or dementia then we need to make sure they’re seeing a neurologist ongoing. Social workers, psychologists things of that nature we just want to make sure that we’re letting the expert do their job in their respective field.

JIMMY MCKAY, PT, DPT I like that. Yeah. Really bringing in taking a look at the whole human being there and all the different things that might be going on with them and taking that into consideration when looking to reduce those fall risks. Yes. Now moving to number four I like this because now we’re moving towards the other people in our in our patients lives. Educating caregivers.

ANDREW HARNISH, PT, DPT, GCS, CDP Yeah. This is a huge one. As clinicians in the field physical, occupational and speech therapists we’re experts on the way people move ensuring that they’re safe in their environment helping them with transfers and ambulation and their general mobility. But sometimes for caregivers and care staff that work in the building and help take care of these people. You know for a new resident they might be lost on how to appropriately guard them or how much assistance to provide to really ensure that they’re on a of course as safe as possible. But we want to do everything we can to facilitate independent others. A saying we use in our building and is what you do for me you take from me. So what that means is we want to allow our residents to do as much as possible on their own for everything because once they become dependent on the caregivers to help them then we see a lot of learned helplessness and can facilitate a downward spiral in an overall functional decline over time. So if caregivers know what the new resident is able to do then they’re able to facilitate that rather than hinder it and hold them back.

JIMMY MCKAY, PT, DPT And sometimes that’s hard. I love that saying right there what you do for me you take away from me. I know that was stressed upon me by several professors in the PT school. It can be hard but when you when you can stop and thinkin and recognize that you’re actually doing them a service by letting them do more. It becomes a little easier anyway.

ANDREW HARNISH, PT, DPT, GCS, CDP It certainly does. We want to try to remove any kind of ageism bias or frailty bias just when we’re you know sitting with someone that’s in front of us because working with the older adult we’ve all experienced that at some point you may have your judgment on what you think someone may be able to do and then they surprise you and are able to do so much more which is always a rewarding experience. I try to be as hands off as possible at first just to see how they’re truly able to function without any assistance at all and then facilitate and guide them however I can in order to help them.

JIMMY MCKAY, PT, DPT And yeah mentioning hands off right there again and that’s what we’re doing up to the number five way to reduce false risks without ever touching someone more education but educating family on the value of exercise and therapy.

ANDREW HARNISH, PT, DPT, GCS, CDP Yes. This one can definitely not be understated. A lot of the time people move in and maybe they say yeah you know my mom or dad just had therapy in the past but they didn’t they didn’t really follow through on their home exercise program and you know the literature really does support that. There is unfortunately very poor follow through and carryover of home exercise programs after discharge from therapy. What we did in our building here is launch a program called Family Fitness. What that allows us to do is to set up a home exercise program with the patient and then also sit down with the family and teach them the home exercise program. Because oftentimes we notice maybe a family member might come in and visit and they’ll sit and talk and watch TV but they feel like they have a loss of things to do and ways to engage their loved one. So we use it this to try to springboard and teach the family. Here’s some exercises you can do with them. You know why don’t you be a part of their functional recovery. Help them get better. You know you get some exercise with it and it seems to be really rewarding and everybody seems to really enjoy this. We’ve had multiple people where if it was not for this program and receiving the additional help from therapy and the family. Then this program then these people would not have done nearly as well as they did in the traditional outpatient or rehab setting. Just for any family that has not had periods of therapy in the past you know everything is brand new to them. So I love having a clean slate because we have so many great services and we provide so much value to all of our clients that we can essentially train them early on and say you know how it’s going to be this is the culture that we perpetuate in this building and we get them on board. And it’s been really successful.

JIMMY MCKAY, PT, DPT Trying to change a habit into something we do regularly is way easier when you have the people around you on board and you know being a part of that makes it way easier.

ANDREW HARNISH, PT, DPT, GCS, CDP It certainly does, that’s one of the amazing aspects of the FOXcast Living program here is that the partnership between Fox and the building, Chestnut Knolls, is so amazing. You know we would not be able to be as successful as we are if we didn’t have really all employees on board. So that trickles down from you know at the executive director and all the managers all the way down to the care staff and frontline staff because you know at the end of the day we all want what’s best for the residents and we want them to have the best quality of life as possible. So if everyone is on the same page and everyone is fighting for the same team then we’d see much better outcomes.

JIMMY MCKAY, PT, DPT There you have it your five ways to reduce fall risk without ever touching someone. Andrew appreciate you going through that list with us. Last part of the show is our tradition here it’s our FOXtale you ready for yours?

ANDREW HARNISH, PT, DPT, GCS, CDP Sure.

JIMMY MCKAY, PT, DPT What about older adults really drew you win and made you want to make it your career. What what about that population really excited you?

ANDREW HARNISH, PT, DPT, GCS, CDP Really just all the knowledge and wisdom that they have to share with us. I take pleasure in building a positive rapport with my clients especially early on in the beginning session where, what is your life story? What did you do for work or where are you from? What have you done over your your life and what is meaningful to you? Because if we can tap into what is meaningful to the person whether it be their hobbies their family their grandchildren, past occupations therapy should be a time of excitement and something to look forward to and something fun. We do that by relating all of our activities and exercises to the things that they love to do. So if we can show value to our clients in that way then that overall more rewarding experience for everybody.

JIMMY MCKAY, PT, DPT Dr. Andrew Harnish Fox Optimal Living director and a physical therapist with us here at Fox rehabilitation. Thanks for going through the list with us and appreciate your insight this afternoon.

ANDREW HARNISH, PT, DPT, GCS, CDP Yeah appreciate it, thanks for having me.

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