3- FOXcast PT: Our Passion’s Origins: The Future of Geriatrics​​

Jimmy: Welcome to FOXcast where today we’re joined by two members of the team here at FOX Rehabilitation: physical therapist Heather Cronin and occupational therapist Kelsey Swope. The two presented together at the 2017APTA National Student Conclave. We wanted to get into the overview of their presentation and then take a look at their individual viewpoints on several topics. Ladies, welcome to the show. We’ll start with Heather. So what’s the overview? What was the title of your presentation and maybe briefly why did you guys decide to do this and then present it specifically to students?

Heather: It’s all about creating an excitement to work in geriatrics. When I came out of PT school, I knew I wanted to work in geriatrics and I went and researched FOX and one of my big goals after doing the residency program at FOX was, “How do I get other people excited about working with this population particularly as you start to really look at the shifts and demographics within our society?”

I think that as a society we’re going to rely more on physical therapists, occupational therapists, and speech therapists to help people age, and age in the way that they want to age within our society. So, I think the shift of the older adult is really moving away from the institutionalized aging and really transitioning a little bit more to independent aging because as we age we’ve got the baby boomers coming up and they’re a totally different generation. One that is really excited about doing things: physical feats and mental feats and not letting age define them.

Be human. Do all the things that you want to. Be whatever that might be longer. So we really went into just what that kind of shift means and looked at that and we did a presentation similar to this APTA CSM a few years ago, but now, more focusing on how to really create that excitement within our student populations.

Jimmy: So I want to just review this briefly because I think it’s a lot of good information for students or for clinicians. How do you review first generations?

Heather: When we really talk about the breakdown of the generations, it really is all about this shift in regard to the past generations, the present generations, and the future.

And, I still consider myself a relatively newer clinician. I’ve been training for seven and a half years, and I still feel like I’m developing.

One of the things that really stood out to me as I’m practicing during this shift is the shift from the G.I. generation and the mature silent generation into the baby boomers.

When I started practicing, it was a norm to have the little lady who likes to sit in a rocking chair and knit. Today: not so much. Now we have really different clients. I mean, we just had a snow storm last week and I rescheduled five patients with text messaging, which blows my mind because all of my clients have smartphones and they’re using that technology to communicate with me as their physical therapist. Just kind of blows my mind.

Jimmy: It’s nontraditional. It’s not expected, but that’s great that they’re evolving.

Heather: You know, we talk about geriatrics and we talk about treating that geriatric client, but also recognizing that our parents and ourselves are going to be in that geriatric generation in the future and really defining what geriatrics is even looking within ourselves to say, “How would we want to be identified as a member of the geriatric population?”

Jimmy: There’s a great social media hashtag that goes along with this, which is #OldPersonInTraining. Old is not a negative term. It just says you’ve been around for a while and, as you alluded to, we’re all hopefully going to get there. So when you give your presentation you ask, “What do you think of when you hear the word geriatric?”

What are the variety of responses that you get? And what do you think about them?

Heather: So this is really interesting because I’ve done this talk with a lot of different audiences — students as well as at conferences — and I get a very, very wide variety.

But I think the overwhelming majority of the audience will throw out things like wheelchairs, walkers, incontinence. All those negative connotations: dependency, nursing. Even when you think of PT and OT to a degree, a lot of people think of that geriatric side of things.

Sometimes, I’ll get happiness or wisdom; people speaking to the geriatric population from a positive light. But typically when I present this question, I get a lot of negative connotations.

Jimmy: Let’s bring in occupational therapist Kelsey. Kelsey, what’s the response that you get when you ask that same question, “What do you think of when you hear the word geriatric?” and what would you like to hear as a response?

Kelsey: I always get an answer that looks like it’s straight from the game charades. You see that hunched over posture, people trying to pretend they’re using a walker or a cane.

And, obviously, that’s not what our older adults are today. I actually have a client right now who just turned 101 on Friday and she is absolutely phenomenal. She doesn’t use a walker and we were doing jumping jacks and different types of dances around her kitchen and it’s so great to be able to see that that’s allowing people to think of this geriatrics.

Unfortunately I think the exposure that our nation has to older adults is that they think of nursing homes, they think of hospitals and it’s so much more than that and luckily I do think that as physical therapists and as occupational therapists we are really working to change that mindset.

Jimmy: So, Heather as a physical therapist and somebody who’s pretty passionate about the older adult population, what are the words you’d like people to say in response to that question? “What do you think of when you hear the word geriatric?”

Heather: “Fun”. I mentioned the word “wisdom.” Looking at this population as a people that we can learn from but also a population that really has the ability to be empowered to live independently.

Jimmy: Yeah, I like that a lot. I think that’s what a majority of the therapists out there in any of the three disciplines aim for, especially if they work with older adults.

So there’s a giant shift in the population, more people now living that are greater than 65 years old than less than five years old and current society. I think that’s a great nod to medical care. You know, we can keep people living longer but as therapists we see this as an opportunity to help them have more life in their years.

Heather: Absolutely. It’s really interesting when you look at that shift because it’s the first time ever in human history that we’re seeing more people over the age of 65 than under the age of five. And like you said, it has a lot to do with our medical advances. This is a worldwide statistic and it’s really going to drive the shift in our societal health care.

Jimmy: We like to highlight those amazing geriatric people like where we talk about how do you get something to go viral on the Internet? And it’s always great to see a story or a video of an older adult maybe somebody who’s 60 or 70 years old deadlifting or competing in an Ironman triathlon. For the future, I’d like to see that not be such an outlier and be more of the norm and I’m sure that’s true for many therapists in all three disciplines. That’s their goal when working with older adults.

Heather: Absolutely. And we highlighted some of them and some of the feats for individuals over the age of 65. I’m constantly seeing in my social media feeds the older adult that does amazing physical and cognitive feats.

You have Don Pellmann out in California who’s a track star and is more than 100 years old and it’s just amazing things that these older adult athletes are able to accomplish. It just blows my mind and really inspires me as a PT to be able to get out there and work with clients and hopefully find somebody that I can motivate them and get them back to their life with their family.

Jimmy: Sure. Using that was a great example. Using someone like Don the track star to just say, “Hey look, there’s no mold you have to fit into anymore.” You can be a track star if you want.

And whatever that means to you. And I like the stories that people have been doing in activity for their whole life and their age doesn’t slow them down. I also love the stories of someone who picks up a new athletic or cognitive hobby later in life and excels at it.

Heather: Exactly, there’s nothing to say that you can’t do it.

Jimmy: Absolutely. So what are some of the setting options in working with older adults?

Heather: There are a lot of different setting options. You have the traditional — what we think of when we think of geriatrics. We think about skilled nursing facilities, home health, long term care, acute care.

But, I think what a lot of people don’t realize is how many geriatric clientele exist in the outpatient world and then piggybacking off of that outpatient world of geriatrics is Part B house calls and that’s what we do here at FOX — that outpatient therapy that is provided in a client’s own environment, which does not necessarily mean that they need to be in that brick and mortar institution.

Jimmy: The next topic: How important is mentoring? What do you mean by that?

Heather: Mentoring is a really big catch phrase that exists out there today in the recruitment and employment world.

Most new grads are looking for mentoring and therefore most employers use that term when they’re trying to recruit a new grad. As a new graduate, make sure to look more in-depth at mentoring opportunities and what they really entail.

I think it is really important because mentoring is so vital to the development of a young clinician. If they’re not provided with the proper mentoring, it can leave a new clinician feeling stranded and potentially burnt out. It breaks my heart to see anybody in this profession talking about career burnout. And I think we’ve all seen it. It exists.

It blows my mind that it exists, particularly since you know I’m seven and a half years out and I love what I do. I really, genuinely have a passion for being a physical therapist, particularly working with the older adult. And so the things that we really emphasize is interviewing your prospective employer when it comes to a mentor program and asking difficult questions, demanding to see proof and evidence, asking who is going to be my mentor.

If they can’t identify that during the interview process, I would throw up a red flag. Asking, “What does that mentor get for mentoring me,” because I think that’s a big question. You know, we could have the highest level of productivity demanded on us as therapists and then they come in and they say, “Guess what, we just hired a new grad and you’re going to be their mentor.”

“Well OK. Is that just an additional responsibility or am I going to get any reductions in my productivity in order to allow time to foster that mentoring relationship?” As well as going into what are those productivity expectations. “Will there be any ramp-up period associated with the mentor program? And what are those productivity expectations in relation to salary? Are there any salary adjustments in the beginning?”

These are really important questions to ask. I don’t think a lot of people think about it now.

Jimmy: I don’t think I need to ask if you’re pro- or anti-interprofessional collaboration. The fact that you and Kelsey did a presentation together; you work at a practice like FOX where it is physical occupational therapy and speech language pathologists all working together. But what does interprofessional collaboration mean to you? How is your view on it changed in your years of practice?

Heather: You know I think coming out as a new grad I didn’t quite get it, honestly. It wasn’t something that I thought when I was coming out of school, like I’m going to be working with OTs on an everyday basis.

After I’ve been out in the field, I see it.

It’s one thing when my clients tell me, “Oh, I don’t need OT.” I have to take a step back and really educate that client and let them know the benefits of that collaboration together because I have some community clients that would probably do very well if I were just out there alone. But, by connecting myself with the occupational therapist and then the two of us working together towards common goals.

If we are able to get that client into much better shape, that’s going to help foster their independence moving forward and hopefully less dependency on the health care system in general.

Jimmy: Kelsey, what do you think same question?

Kelsey: I think that as students, we learn so much. We really focus on who we are as occupational therapists. It’s challenging because we don’t get as much of that interprofessional collaboration that’s so very important because we use it in the field.

When I started doing my rotations, I started to get a little more exposure to that, but it wasn’t until I was truly in the workforce that I was able to realize how important it is. And no matter who you’re working with or what setting you’re in, multi-disciplinary approach is by far the most important thing.

The more I can learn about my client and how they’re interacting with the other disciplines or what they’re doing with them, the better I’m going to be able to treat them. So if I’m not taking that time to learn what they’re doing with them then I’m not really doing the best job that I could potentially be doing.

Jimmy: Kelsey, we will stay with you for this one. I wanted to get into some examples of how you might creatively challenge clients that you work with.

Kelsey: I think when we think about older adults, again goes back to that ageism, a lot of times people assume that they’re not going to be able to do as much as they potentially could. And I think that it’s really pushing them.

And, when you say the word, “creative,” I think as an Occupational Therapist that I’m working on the most functional and client-centered goals that I can think of. So, thinking about if I need to work on them being able to improve range of motion, I’m not just going to be doing a shoulder exercise.

I actually went and shadowed a new therapist today with FOX, and it was so neat because she actually had the client rearranging pictures on her fridge because they were scattered everywhere but it was so neat because were able to improve standing tolerance and we improved balance and range of motion all at the same time.

We also got to learn a lot about her life. I think that’s something else that’s so important as a clinician, getting to really know your clients and build that rapport and that’s how you’re going to make things creative and motivating to them.

So, it’s really neat to see other people do it, but definitely the more creative you can get, the more they’re going to want to complete your therapy session and really learn and grow, improving their skills whatever their functional tasks are or that they need to get better at.

Jimmy: Heather, we’ll come to you on this one. Creatively challenging patients: What does it mean to you?

Heather: So, this is something that I actually put myself into a very uncomfortable situation during the presentation because I am not a dancer. I’m not. But you know what? I dance with my clients.

You don’t have to be a pro at anything to be able to utilize this stuff in treatment. So, during the presentation we turned on a song and we got up and started dancing and we really kind of broke it down. To show students that you can use creativity in the clinic.

You don’t have to do seated therapy exercises, progressing to standing therex, and then progressing to weights. You don’t have to do three sets of 10. You can utilize and incorporate balance, strength training and cognitive components of balance into one activity that is fun and engaging for our clients.

You know, we talk about those generations and we circle back in a lot of that mature Silent Generation. You go into their home and you make a mention of doing exercise or you go into their room and they’re going to say, “No! I don’t want to exercise.” But, you go in with music in your pocket and you’re playing a song that they recognize and they’re going to get excited like, “Oh my gosh I remember this song!”

Then we can ask, “Why don’t we stand up? How about we just dance?” Which is exercise and we’re going to bill it as exercise, but it’s going to be fun to the client. It’s not going to feel like they’re “exercising,” it’s not going to be that “boring exercise.” So really getting creative to engage our clients.

Jimmy: Here’s one quote I wanted to pull out your presentation. I love it: “Strengthening without rationale or adequate stimulus is tantamount to malpractice.” I just love that quote. Why did you include it?

Heather: Because I think it is so important. I saw recently on one of the Facebook boards somebody talking about “typical home health.”

The unfortunate thing with that is “typical home health,” which is that it should not be typical. But, they didn’t challenge the client to anything. It was really very limited value I think that was provided by this therapist that went into the home. And that to me is a complete waste of resources, time, and Medicare dollars, and we’re all out there trying to fight for these reimbursements, fighting to get rid of the cap.

If we’re not standing up for ourselves as a profession and truly challenging our clients to the appropriate level, then how can we say that we’re valuable? Especially starting from the ground up, go to our students make sure that they understand if they go into the clinic and their CI says, “Well, we start with seated therapy exercises because that’s what we do.” Challenge them. “Why does this client who’s working on gait training need to do seated therapy exercise? If we’re working on gate training should we not have them up in standing for the strengthening exercises to begin with? Is there a purpose to doing the seated exercises?”

Not saying that there isn’t, because yes, there very well might be. But let’s take a look at that and challenge ourselves to be better and continually try to challenge our clients to be better to be better.

Jimmy: I like it. Since you work in a very different, or I should say, nontraditional physical therapy environment. What do you bring with you? What’s in your your treatment back?

Heather: This is something that I get asked all the time.

“What do you take with you?”

And, I don’t take that much to be completely honest. I take my blood pressure cuff and my stethoscope. I always have my goniometer. I always have monofilaments because I think that they’re really great to have out in the community.

In working in the community and anybody out there who’s done health of any sort kind of gets that, during an evaluation, you always take off their socks and shoes and you check the sensation on their feet. I keep pretty minimal stuff with me: a bag of balloons, a deck of cards, maybe a tennis ball.

You go to conferences and you pick up those stress balls all the time and a few TheraBands. But for the most part I utilize what clients have in their homes because I feel that if I’m able to get in touch with what motivates them, what is in their environment, what they need to be able to exercise. I’m going to have a better chance of them being compliant with my home exercise program.

So, if I can incorporate their environment and incorporate things that they already have at their home versus a stationary bike in a clinic. So I try to really involve what they have in their environment to create better compliance.

Jimmy: Use the environment you have — going MacGyver a little bit.

Heather: Exactly.

Jimmy: If you had someone out there listening who was either a practicing clinician or a student and they were thinking about working with the geriatric population and you’ve got 30 seconds, what would you say to convince them this is a population that deserves their time and care and focus?

Heather: I would absolutely say that the geriatric population is the most rewarding population that you can possibly work with.

I have been practicing for seven and a half years. I absolutely love what I do as a physical therapist. I absolutely love working with this population. You really have the opportunity to come out, use creativity to challenge clients, and feel reward for what you do as a therapist.

So, not only does the geriatric population really need great qualified therapists to come out and make a world of difference in their lives, this population really has the ability to inspire our young therapists to become better clinicians just overall.

Jimmy: Alright, Kelsey, the last 30 seconds are with you. 30 seconds to convince somebody to work with the older adult population. What would you say?

Kelsey: The rapport and the relationship that you get to build with them is truly so unique and so special. I would say that it is the most rewarding population that you could work with because you get to learn so much about their lives and they also change your life.

Jimmy: Thanks to physical therapist Heather and occupational therapist Kelsey both from FOX Rehabilitation for being here on FOXcast.

Thanks for listening to FOXcast, a clinically excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes, or read articles and position papers at foxrehab.org.