HOW TO GET THE MOST OUT OF THERAPY FOR THE ELDERLY

What kind of therapy can a person get?

Therapy is determined by two things. The benefits that are available from Medicare A, and B as well as the individuals insurance co-pay, is always the first consideration. The amount of time actually used for therapy is as important as the payer source, and is determined by the individual’s progress in therapy. Medicare and private insurance do not pay for maintaining function or ability, they only pay for improvement. Once it has been determined that the patient has reached their full potential they are discharged.

How often do you get therapy?

Many family members think that the more therapy a person receives, the faster they will recover. However the person who tires easily, and also may be receiving more than one form of therapy, will have to be scheduled according to their energy levels. Their energy may depend on what time of the day it is, as well as how long a therapy session they can tolerate. This is why therapy is scheduled in minutes, and charged to Medicare in that way. Making good use of the their therapy time, results in better use of therapy funds.

Types of therapy:

  • Geriatric therapy – for the elder who is fragile due to age. Therapy can provide strengthening exercises working closely with the a dietitian to provide increased nutrition.
  • Therapy following stroke, head injury, nerve injury – the therapies work through the re-educating of muscle groups. The patient is provided services in physical therapy, occupational therapy and speech therapy. Most of the time these patients requires all three therapies.
  • Pain management – for the patient with stiff joints resulting from disease processes as well as soft tissue injuries physical and occupational therapies will help. As well as for pain that is associated with other physical and chronic disorders.
  • Edema therapy – the therapy department monitors excessive fluid in extremities and provides therapy to conservatively control this fluid imbalance.
  • Orthopedic rehab – whether it is a hip replacement or a fracture the therapy department through assessment and evaluation develops a personalized program reflecting the patients’s strengths and needs. So if the patient is returning to work therapists would want to know what kind of work, so that the program could reflect what the person previously did.

In order to create that personalized therapy program, the patient or family, will have to think about what is their goal for this person. The goal may be that the elderly person with dementia can once again eat independently. Or, that the person with a debilitating stroke will once again be able to use a toilet.

When the therapy team knows the patient’s goal they can begin to develop that very personal, therapy plan of care.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

FOR THE ELDERLY – TO WALK OR NOT TO WALK – THAT IS TOO OFTEN THE QUESTION

“Sit down Gladys, please sit down.” Gladys was the 102 year old former Army nurse living in a small 15 resident, senior care cottage in Clearwater, Florida. Yes, Gladys was a little confused at times, and she did forget that she needed help to walk. But from the time she was up in the morning,(dressed for the day in one of her many flowered dresses and comfortable, sensible shoes) all she heard was to “sit down.”

It is not surprising that people age two want to walk. Or that people twenty-two, fifty-two, and sixty-two, want to walk for that matter. No matter what your age, walking means independence. Walking builds the kind of strength you are not able to build any other way. Walking provides weight bearing that builds bone and protects against osteoporosis. Walking gives any person the chance to feel their muscles move, and know they are alive.

Walking for the elderly, is protective of their overall health in so many ways. Walking reduces the incidence of urinary tract infections, protects against pneumonia, supports appetite, maintains muscle mass, gives the elderly opportunities for socialization and most of all maintains the ability to walk.

The good news for Gladys was that her attempts to stand, and then to sit down again several times daily, was maintaining her thigh muscles. She instinctively reached out for the arms of her chair when she stood and because of the constant practice she was quite steady going from sitting to standing. But more than that, no matter how many times she was asked to sit back down, Gladys’ spirit was still visible in her ongoing attempts to get going.

It was kindly pointed out to Gladys’ direct caregiver, that going out first thing in the morning and taking a walk, before it became hot might be a good idea for Gladys. All she needed was someone to take her arm and give just a little support from time to time to help with her balance. Didn’t seem too much to ask for this woman who had given so much, to so many, during her career. But no, now that twenty-something girl was in charge of her and the “girl” didn’t think Gladys needed to walk. So it began again, “Gladys please, please sit down.”

If you know of a Gladys who wants to walk but everyone around her is afraid she will fall please go to www.merrywalker.com and see some safe ambulation devices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

FALLS, SENIORS AND NURSING HOMES

Phil lives alone unless you count his dog, Clare. Phil now is seventy-three and most people would have considered him in better than average shape. He is not one for exercise but he always has watched what he eats, and was blessed with good genes. However, Phil made some very bad decisions.

It happened on a very nasty night in the Midwest. There was a ugly ice-sleet storm raging outside when Clare needed to go out. Phil did his usual thing at night he took Clare out into the backyard. Too bad his usual thing was to walk Clare in his underwear. So when Phil fell, he was too embarrassed to call out to his neighbors for help.  So there he lay with an injured leg, shoulder and arm, out there on the ice.

Because Phil didn’t want to call for help it took him two and a half hours in the cold, on the ice, to pull himself to his back door and drag himself in.   This experience caused Phil to be hospitalized for five days and is now in a nursing home due to the pneumonia that set in while hospitalized.

What seniors can do to protect against falls:

  • if you live alone (and are even if in very good condition like Phil) wear an alert button
  • think ahead, make good decisions and be proactive – is it really a good idea in any weather to be outside in your underwear
  • prepare for the weather – when in snow, ice, sleet – carry a small bag of salt, sand or gravel to throw out in front of yourself as you walk
  • for those who have to go out in all weather – consider rubber ice cleats that easily attach to the bottom of any shoe or boot – they are easy to put on and off and very in expensive

It really didn’t seem like it would be Phil who would be in a nursing home, at least not until a very old age. Bad weather got him there, and a fall, but more than that it was bad choices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

THE NURSING HOME – WHY THE FAMILY IS AN IMPORTANT PART OF THE TEAM?

PART III

(Four things to notice when visiting an elder in a nursing home, cont.)

2. Observe the elder’s skin. Skin is the largest organ of the body. In the average person, the skin stretches about two square yards and is about 15 percent of the individual’s weight. We consider the skin the first line of defense against environmental factors. Skin is also a barometer of health. We want to be aware of any redness, warmth, or swelling. It is perfectly appropriate for family members to ask the nurse or nursing assistant “Does Mom have any skin breakdown?”

When elder sit for hours in a wheelchair or are unable to move themselves independently, they may be at risk for skin to break down because of decreased circulation. Nursing homes may provide special pressure-relieving mattresses to prevent skin breakdown. A special pressure-relieving gel cushion is an excellent aid for wheelchair-bound elders.

3. Report any significant change. The rule of thumb is that a dramatic change in any body system must be reported to the physician immediately. This includes an abrupt change in:

  • Behavior
  • Difficulty arousing the elder
  • High fever
  • Dizziness or unsteadiness
  • Sight or hearing
  • Ability to communicate or speech pattern
  • Personality
  • Eating
  • Difficulty swallowing
  • Weakness or decreased use of an extremity

Book excerpt from: Please get to Know Me – Aging with Dignity and Relevance Available on Amazon.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

FALL PREVENTION GUIDELINES FOR SENIORS IN WINTER WEATHER

Of course the elderly and seniors are afraid of falling, but Beth was only 31 when she fell on ice in a parking lot. Beth was late for work and walking much too fast for the slippery conditions in the parking lot that day. And the parking lot as slick as it was, made her fall even harder, resulting in a fractured wrist.

Walking in winter weather calls for extra diligence in:

  • Taking care of your body, for it to function as limber and flexible as possible. Warm up your legs, feet and knees before you go out in snow and possibly slippery conditions. A great way to warm up feet is with a warm water soak in Epsom salts. Difficulty walking can be due to inflammation which will make tissue painful, tight and stiff. Knees, legs and feet can be especially vulnerable to inflammation, and that inflammation can be tracked back to poor food choices. Avoid inflammatory foods; sugar, white flour, white potatoes, white rice, and pretty much anything that is white.
  • Exercising – to improve strength and balance. Maintain a regular exercise routine and on days when the elderly cannot get out, it is even more important to exercise. Stretch before going out, stretching improves circulation and limbers the joints and muscles.
  • Careful, but appropriate use of pain medications. Just as a person in a healthcare situation would take a pain medication before going to therapy, so also medicating before walking outside maybe just as appropriate. Arnica gel is a great topical for pain, swelling and stiffness. There are new reports all the time on the benefits of Ibuprofen medications for inflammatory pain relief.
  • Dressing for the weather. Now that you have those legs, knees and feet warmed up, keep them that way. Three light layers of clothes are preferred to one heavy layer. Be aware of any clothing that might be too restrictive, and actually decrease the ability to move. I personally love the new warm light weight fabrics – long underwear anyone?
  • If the elderly use a cane or walker they should also use that walking device, in winter weather. However caution needs to be taken when rubber tips on canes/crutches become wet – they can be extremely slippery on a hard surface indoor floor.

Many elderly people become isolated in winter and suffer from depression. Going outdoors, enjoying fresh air, nature and socializing is so necessary to protect against depression in winter.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing