Rehabilitation at Home: Regaining A “Personal Best”

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Rehabilitation at Home: Regain Independence

Bill W. was pretty sick when he was admitted to the hospital recently. He spent time in Intensive Care and was treated with IV antibiotics for septic shock due to an infection of a non-healing wound on his leg. He spent 5 days in the hospital recovering from serious illness. He was encouraged to keep working on his recovery when he transferred to the general medical surgical unit. Bill didn’t feel so great though and was not always welcoming of the help of therapists who came to see him at his bedside.

“Don’t they understand I am sick? I can’t be bothered with walking or washing myself. I’m in the hospital. Shouldn’t they be doing that for me?”, he wondered as the Occupational Therapist talked about bathing at the bedside. So he told the therapist that he “didn’t feel like it today”.

 

When the Physical Therapist stopped by to take him for a walk he hesitated because he felt weak. Her explanation that it would help him be strong enough to go home helped, so he took a short walk down the hall and back to his bed.

Bill’s daughter and son both visited every day in the hospital and did their best to encourage their dad. When the case manager called Bill’s daughter, she recommended Bill go to rehab to recuperate for a short time after his hospital stay. He had been in bed for an extended illness and she was afraid he was too weak and might fall if he went straight home. Since Bill passed the walking test with the physical therapist, and refused occupational therapy, insurance did not consider him a candidate for inpatient rehabilitation. While they appealed the insurance company decision, Bill’s kids requested home health, in case he didn’t win the insurance appeal.

“I don’t need help,” Bill protested. Unfortunately, Bill didn’t win the insurance appeal and plans were made to go home. When Bill got home, he wasn’t able to make it up the steps to get into his house, so his family was forced to take him back to the hospital. Bill was readmitted to the hospital and received therapy services at the bedside for 4 more days until he was strong enough to do the steps to get into his house.

When Bill went home this time, his daughter Vickie and her mother did their best to help her dad settle in safely at home. Vickie stayed home from work the first 24 hours to help since her mom has health problems of her own. Vickie noticed Bill was pretty tired and  short of breath with the most minimal activity, and she saw his balance was off while he stood to put on a sweater that first afternoon home.

Vickie was pleasantly surprised that the home health agency didn’t just send a nurse out to see her dad. The nurse told the family that Bill would also see a Physical Therapist and Occupational Therapist right away as she also observed his poor endurance and balance problems, too.

Bill, the nurse and therapists formed a bond. Bill and his wife committed to the agency’s home equipment and safety recommendations, and allowed these former strangers into the home to treat his wound, and provide therapy to make him stronger. While some refer to a “personal best” in relationship to fastest sprint or run time in a race, Bill was back to his “personal best” self in his ability to care for himself, with independence, in 3 weeks.

Independence gained or retained through rehabilitation is priceless.

Rehabilitation services occur in many settings. As this website demonstrates,  rehabilitation provides a total approach to treatment and care for people with short term as well as long term mobility and self-care needs for recovery. Some additional rehabilitation facts:

  • Rehabilitation services occur in hospitals, rehabilitation hospitals, nursing facilities, at home with home health agency visits, and outpatient clinics.
  • Nearly 50 million Americans are disabled. Disability may be temporary or permanent. Disability does not discriminate – every person is at risk of disability. Therefore, everyone is a potential candidate for rehabilitation. Rehabilitation lessens the long term impact of disability.
  • Most Americans will require at least one rehabilitation service at some point in their lives.
  • Rehabilitation is an integral part of healthcare and a tremendous component in providing patients with positive outcomes.
  • Rehabilitation saves money and improves lives. For every $1 spent on rehab care, it is estimated that $11 are saved on long-term disability costs. People participating in rehabilitation programs of care are able to regain productivity and return to work, school and independent living.
  • Rehabilitation is individualized so every patient can progress at his or her own ability level.
  • Rehabilitation can lengthen life, improve the quality of life and reduce subsequent illness.

Alzheimer’s drug may be promising treatment for traumatic brain injury


There is some promising research results for treatment of patients with traumatic brain injury. Treatment for Traumatic Brain Injury (TBI) is often elusive. While it's a major cause of disability and death, finding treatment with medications has generally failed. A new study found that memantine, a drug that is used to treat dementia associated with Alzheimer's disease, may be a promising therapy.

The study examined the effect of the drug on blood levels of neuron­specific enolase (NSE), a marker of neuronal damage. The blood level was significantly reduced by day 7 of treatment.

In addition, the Glasgow Coma Scale (GCS) is commonly used after a brain injury to describe the level of consciousness in a person following a traumatic brain injury. There were marked improvements in traumatic brain injury patients GCS by day 3 of treatment in the study.

Source:
http://newsroom.wiley.com/press­release/journal­clinical­pharmacology/ alzheimers­drug­may­help­treat­traumatic­brain­injury

Celebrate Certified Nurses!


Certified nurses are recognized for the value they bring to their specialty area of practice. On Sunday, March 19, we celebrate Certified Nurses Day.

The American Board of Nursing Specialties (ABNS), the organization that represents nearly a half million certified nurses states:

Specialty nursing certification is THE standard by which the public recognizes quality nursing care. With the increasingly complex patient/client needs within the current healthcare delivery system, care needs are best met when registered nurses, certified in specialty practice, provide nursing care.

Health Calls Home Health Agency Nurse Manager Cindy Dey, BSN RN CRRN, became certified in Rehabilitation Nursing in 1991. Cindy loves rehab nursing and teaching. She started her career working in neurotrauma at an Acute Rehabilitation Hospital. From the beginning, Cindy enjoyed working with patients and their families who needed to be independent with care in order to take their disabled family member out of the building on the grounds or even off-site for a therapeutic day pass, and to ultimately bring them home at discharge. Cindy became proficient and specialized in rehabilitation nursing knowledge and practice, taking the time to really focus on her patients – people suffering from head trauma.

When asked about her career choices, Cindy says,   “I took my career path seriously and wanted to be as proficient as possible with caring for Neurotrauma patients. In order to be certified, you must be experienced by working in rehabilitation for an extended period, and pass a written exam. The definition of rehabilitation nursing has grown and expanded over the years, and its principles of collaborative effort and team work are essential with nursing as a whole. Rehabilitation Nursing focuses on returning patients back to living optimal functional lives, although for some people it is a new normal. The goal is to get patients and the family unit to a functional, independent, active lifestyle. Rehab nurses focus on the whole person and not their  disability. It is something that I have a passion for, it has been the basis for my career in Home Health Nursing and also during my time teaching as an adjunct clinical nursing instructor.”

Cindy’s road to certification unfolded after her inpatient rehabilitation nursing job was completed. While many nurses become certified when working in an inpatient rehabilitation nursing setting, Cindy became certified once she found a home as a home health nurse. Since Rehabilitation Nursing is a specialty area practiced in many settings, Cindy was able to find so much relevance in her home health setting.

Today, Cindy is the On Call and Weekend Nurse Manager for Health Calls Home Health Agency, located in Wyomissing, PA. This job is a combination of many positions. Cindy is responsible for the after hour and weekend management of the agency. She takes all incoming telephone calls, which she proudly says come directly to her, as Health Calls does not have an answering service. “Our patients, nurses, therapists, referral sources, and the community get to talk to a live person, which is rare today.”

Cindy believes her firm rehab background has been very beneficial in Home Health Nursing. Traditional, site-based Rehabilitation Nursing teaches patients and their families about adapting and caring for themselves, or loved one, their health issues,  as well as preventing new problems.

“In a rehab facility there are no unusual structural obstacles or throw rugs, there are large spaces to lay out supplies for treatments and wound care, wide doorways, elevated toilets and handicapped safety railings, no stair cases or narrow hallways to navigate, to either get into your home or to get to your bed.”

“On the contrary, when patients are at home, they learn to adapt, navigate and work around pets, large pieces of furniture, and many obstacles. They learn how to care for themselves and regain their independence. The goals of Rehab Nursing and Home Health Nursing are the same: assessing, treating, assisting, teaching, and guiding patients in the transition back home, which is often a time of crisis. In all settings, rehabilitation nurses help patients and families make a paradigm shift and adapt from a time of dependence and illness to independence and wellness, or to manage with chronic illness, with the assistance of family or with the help of community services. We teach patients and families how to navigate through real life circumstances, and how to adapt to them, as well as who to reach out to in case of a problem”.

Cindy uses her specialty practice each day. Her typical day includes:

  • responding to critical vital signs in home tele-monitoring units the agency employs with patients with cardiac and respiratory problems,
  • taking calls from patients who are having medical problems,
  • responding to patient and family concerns and questions,
  • talking patients through medication schedule or dose questions,
  • trouble shooting medical problems or symptoms, and
  • problem-solving complex home care equipment with patients and families on the telephone.

Twenty-three years ago, Cindy met her husband, who had recently immigrated to the U.S. from Germany, on a blind date that her cousin set up. Cindy and Stefan have been married for 20 years and have three children: Summer, Jeremiah, and Danielle. Cindy’s 85 year-old mother also lives with the family. Cindy describes herself as chronically early; she hates to be late for anything. She is also a huge history buff and loves to travel. Cindy is the only child of a third generation dairy farmer and a self-professed country kind of girl. She graduated from Widener University.

Making Old Friends As People Achieve Home PT Goals

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Wendy Bergeman, PT, MS has been a physical therapist for over 25 years. She has provided physical therapy in many different settings including hospitals rehabs and outpatient clinics. She started working in home care about 15 years ago and knew on the first day that home care was where she was going to be able to make the most impact for her patients. Home care is a unique setting.

You get to see the patient in their own environment. They show you what is important to them and where they are struggling. Many times patients come home after doing well in rehab, but when they get home it all changes. Each house has its own challenges and the thrill for me and the patient is to work through those challenges and return the patient to independent living and enjoying life again.

The difference you see in these patients from the first day to discharge is amazing. On day 1 they are tired and weak —getting up and walking to the bathroom is a struggle. In a week or two they are taking care of themselves and then on the last day they meet you at the door with coffee and you feel like you are saying goodbye to an old friend. A lot of my patients feel like family by the time they are discharged.

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Wendy Bergeman with her old friend, Mervin Lewis.

Health care is forever changing and today patients are coming home sicker and weaker since they are leaving the hospital faster. There is a huge need for these patients to get physical therapy. Many times without physical therapy, frail patients fail and end up back in the hospital or another type of facility. This is not only a huge cost to the healthcare system but can be devastating emotionally and physically to the patient.

Home physical therapy concentrates on building up strength and improving mobility but also focuses on making that patient safe and functional in their own home. The true goal of a home care physical therapist is to keep a patient in their own home for as long as possible, in the safest way possible. Sometimes this means getting adaptive equipment, making home renovations or hiring help.

This goal: keeping people safely at home, is what makes home care so fun. Each visit is different – somedays it is teaching a patient to get out of bed and other days it is showing them to how to safely take out the trash.

Safety is always the key and falls are always a concern in home care. Falls in the elderly are the leading cause of traumatic hospitalizations and a leading cause of death according to the National Council of Aging. About 25% of the elderly who fall and fracture a hip will die within 6 months and many more will never be able to return to their own homes again. Physical therapy can do a lot to help identify high risk fall issues and intervene to prevent fall injuries. “As home care therapists we stress the need for patients to stay active and safe,” Wendy says.

Wendy has been a member of the Health Calls team since 2013. When Wendy is not working for Health Calls Home Health Agency, she is busy at home. She lives with her husband and three kids- Katie – a senior at PSU, Rachel a Senior at Oley Valley High Cchool,and Richie, an 8th grader at the Oley Valley school district. She spends her weekends at PSU football games, watching Rachel in horse competitions or Richie in sporting events.

Occupational Therapy: Helping People Live Safely At Home


Teri Rothenberger, OTR/L became a licensed Occupational Therapist (OT) because she had an interest in helping people. A high school guidance counselor came up with Occupational Therapy as a possible career that fit Teri’s interests and she now boasts 30+ yrs experience. Teri joined the Health Calls team 6 years ago. As an OT, Teri’s specialties include helping people improve their strength and endurance to be safely independent with the daily activities we take for granted every day like showering, dressing, cooking, and doing laundry.


Teri says it feels great when patients have a “lightbulb moment”, that magic moment when she provides advice that is going to make a difference in the patient’s life. Working in home health, Teri realizes that she is always a guest in the patient’s home.

“I can make recommendations, but ultimately it’s their decision if they follow the advice. I knows it’s not a reflection on how good or effective I am as a healthcare provider if the family doesn’t use my suggestions.”

Teri finds that in many homes she visits, people already have safety and adaptive equipment like shower seats and 3in1 over the commode seats. She always checks the height of all these pieces of equipment because most times they are positioned on the lowest height. When Teri adjusts the height to the proper setting for the patient’s height, families wonder why no one else had thought of this. Families also will often report 3in1’s over the toilet seats don’t have the splash guard in place or say it doesn’t fit over the toilet. With some adjustments, such as removal of the back and lid, it usually fits.
Like the tools that she carries to make the appropriate equipment adjustments, Teri has expert tricks up her sleeves. When someone is discharged from a rehab facility to home, it’s difficult for therapists to know exact sizes of bathrooms and shower areas before the patient goes home. At rehab they send home a tub bench (goes inside and outside the tub), but there isn’t enough area to safely place the bench and therefore families often end up not using it. This also happens when showers have built in seats which make it difficult to find room to place an additional seat in the tub. Teri says one issue patients often have with the benches is where to go with the shower curtain so that water is not all over the floor. There is a simple solution, but most people just put lots of towels on the floor. When she shows them her trick for safe bench use to bathe safely, they are very happy.

Teri shared that one of her patients was having difficulty with his current bathroom with a regular tub. Transfers in and out of the tub onto a tub bench required the help of 2 people. The patient and family decided that since the disability was permanent, a full renovation would make the routine safer and easier. Teri made recommendations, met with the contractor and determined the best renovation for his disability. He ended up with a bathroom in a different part of the home. The new bathroom had a wheelchair height toilet with pull down grab bars, a wheel-in shower with hand held shower head and grab bars all around the shower, and wheelchair accessible sink.

In this YouTube video, Teri shows the proper placement and use of grab bars in a shower.

Teri is truly a rehabilitation expert but her work in her profession is only one part of a very full life. Teri has been a widow for 3 yrs and has 2 sons, a daughter-in-law, and a future daughter-in-law (son #2 will be married in 2018). Teri is very excited for her first grandchild to arrive in a few short weeks. Teri is very active with the music program at her church where she sings in the choir and plays the keyboard and organ. Teri also boasts having many other “adopted” kids through the relationships she has forged working with the youth of her church.

Teri is a person of quiet strength and a true asset to the Health Calls team. She serves many well in her professional and personal life with her desire to help and improve quality of living.

When Parents Don’t Want an Advocate: A Caregiver’s Dilemma


Giving up independence temporarily while working to get stronger will improve quality of life.Giving up independence temporarily while working to get stronger will improve quality of life.

 

One morning last month, a registered nurse in my office received a phone call from “Mickey” who was interested in referring her father for home health services. Her dad, an 83 year old man whom we will refer to as “Bill” had been in the hospital recently.

Bill was pretty sick when he was admitted. He spent time in Intensive Care and was treated with IV antibiotics for septic shock due to an infection of a non-healing wound on his leg. He was very lucky to recover.

Mickey did her best to advocate for her dad while he was receiving treatment in the hospital. She asked that he be referred to a rehab hospital to recuperate for a short time after his hospital stay. He had been in bed for 5 days and she was afraid he was too weak and might fall if he went straight home. Since Bill passed the walking test with the physical therapist he wasn’t a candidate for inpatient rehab. Mickey asked for home health to come visit her dad at home but Bill refused.

“I don’t need help,” Bill protested. While Mickey tried to advocate for her father, the hospital failed to consider that her father might have limited idea into his real needs at discharge and the discharge planner didn’t ask his daughter to verify the information he provided.

Mickey told me that even before spending 5 days deathly ill in the hospital, he needed help with the simplest of tasks at home. When Bill went home, Mickey and her mother did their best to help her dad settle in safely at home. Mickey works full time and her mom has health problems of her own. Now, Mickey was completely overwhelmed as she tried her best to hold things together juggling her job, her own home and her parents’ needs. She noticed that her dad was now short of breath with the most minimal activity, like putting on his shirt.

Mickey waited the long week to her dad’s follow-up doctor appointments. Finally, with the audience of the doctor, Mickey shared that things weren’t going well at home and asked some difficult questions. Wound care orders were never provided when Bill had outpatient surgery in the weeks before his hospital stay. While the doctor admitted he didn’t provide the right instructions, he never admitted he was wrong. The doctor insisted that her 83 year old father was capable of doing his own wound care, even after the hospital admission due to infection.

That same day, the family visited the family doctor. At this visit, Mickey laid out the hospital stay, how poorly things were going at home and revealed some of her own stress in trying to hold it all together. This time she came away with orders for home therapy and nursing visits. Mickey tells me:

People are going to say no because they are proud. My dad was really struggling at home so he was finally open to receiving help. The nurse and therapists were no longer strangers. These were people who took time to make a personal connection and so my parents were open to their visits. They were helpful without being bossy.

Bill allowed the nurse and therapists to visit, they formed a bond. Bill and his wife committed to the agency’s home equipment and safety recommendations, allowed these former strangers in to treat his wound, and provide therapy to make him stronger. Bill was back to his personal best in 3 weeks.

“What do people do if they don’t have somebody?” Mickey asks. Mickey believes this whole experience has helped reshape her caring relationship with her parents. She feels empowered. In the past, her parents would go to the doctor’s office and she would ask questions about the outcome and get vague answers. They weren’t being evasive; its hard to remember and the experience is overwhelming when you are the patient in the “hot seat”. Instructions provided by health care providers can get watered down in translation while trying to capture everything that’s been recommended. Mickey now realizes these types of errors and omitting important recommendations often lead to hospital admissions.

Now, Mickey goes along to keep notes, and to ask the important questions, understand and follow through on treatment. Fortunately, her parents now see that she has helped them and view her as more credible.

Mickey says the real turning point came when she said to her dad: “You have 2 choices. You can be a grumpy, unhappy old man who has to depend on others to live your life or you can be pleasant and appreciative while Mom and I care. We are not taking your independence away; we are helping you so you can get your independence back. You need to give it up, and work to get stronger, so you can get your independence back”.

Health Calls Home Health Agency recognizes and honors the 39.8 million adults caregivers (2015 Report Caregiving in the U.S. research report conducted by AARP and the National Alliance for Caregiving)  in the United States.

The Power of Rehabilitation at Home


During National Rehabilitation Awareness Week, we pause to recognize the excellence of our therapists. Physical Therapists, Occupational Therapists, Speech Language Therapists and Nurses all work to help people overcome obstacles and accomplish the daily activities we do every day but tend to take for granted.

How can therapists accomplish what is needed when a patient needs to receive therapy at home? Many who are used to the big equipment in a therapy gym often don’t know how therapists adapt therapy to very effectively treat people at home. Home Health therapists have a unique ability to use common household objects for the patient’s therapeutic gain at home. Here are just a few creative ways therapists obtain amazing results with patients in the home setting.

Picnic Cups  are useful for training patients to increase leg strength by encouraging them to step higher, to improve walking balance and to improve the sense the of where feet are while walking. The cups are placed on the floor and the patient walks through or over the cups in an obstacle course, with the mapped path set up to match a degree of difficulty individualized to the patient’s abilities.

Aerobic steppers  and short wooden boxes are useful as a starting place for learning to navigate curbs, thresholds, and steps before advancing on to higher surfaces such as outdoor curbs and stairs.

Yoga stretching strap with loops are helpful to place around the leg while lying down on one’s belly, to stretch the leg into a more flexed position. This is useful, for example in improving a person’s knee range of motion after surgery.

Knee extender is portable and easy to bring to patients for treatment at home. The device is used to extend the knee to 0 degrees, an important goal after a knee replacement.

 

Balance foam creates instabilityImage result for balance foam for physical therapy to challenge balance. Therapists work with the patient on movement while standing on the foam to improve balance and reduce the risk of falling.

 

Image result for heel slides exercises

Image result for furniture sliders for carpetFurniture movers provide a smooth gliding surface and prevent drag resistance against the underlying surface caused by fabric on sheets or bed covers when performing exercises while lying down

Resistance bands are light weight and portable to use to improve muscle strength of arms Image result for therabands for physical therapyand legs and may be used alone or along with weights for therapy.

 

 

The most important benefit of therapy provided at home is providing therapy in the setting where a person lives. (Click on the blue words for additional information).

If a person is at risk for falling or has limited strength and mobility, the kitchen, bathroom, narrow walking paths steep stairs with shallow treads all offer potential hazards and increase the potential for an injurious fall.

Therapists provide a critical eye and make recommendations for adjusting the set-up of a room and how to move through the home environment to improve safety and prevent falls.

Health Calls Home Health Agency’s team of rehabilitation specialists are talented, compassionate, patient, and have tremendous character. We honor the work they do every day to improve the quality of patients lives which supports people to stay where we all want to be: home!