ESCANABA - When a patient is recommended to OSF Home Care Services for rehabilitation or to help reduce fall risks, the course of care will ultimately fall in the capable hands of the physical and occupational staff of OSF Home Care in Escanaba.
Home therapy can include anything from individuals who suffer from COPD (Chronic Obstructive Pulmonary Disease), people with heart failure, people with diabetes, patients following a hospital stay, or people who are fall risks and need work on their balance.
"They can also include people who have undergone transplant surgery and those with neurological conditions, such as Parkinson's Disease," said Rachel Kars, Occupational Therapist at OSF Home Care. All of these conditions can benefit from home therapy. The main focus of physical and occupational therapy for anyone - no matter what their condition - is to allow them to stay safe in their homes or wherever they are living.
Dorothy McKnight | Daily Press
OSF Home Care Services physical and occupational therapists get together to share their techniques and strategies to help improve the physical conditions of their patients. Pictured are: seated from left, Kim Peterson (PT assistant) and Camille Peterson (PT); standing Susan Schneider (OT), Sheila Malloch (PT assistant), Rachel Kars (OT), and Kathie Mishica (PT).
Individuals with COPD are assisted by helping them increase their activity, while at the same time, helping them with energy conservation. Therapists work to increase their activity with leg exercises and gait training, and give them exercises programs they can do in their home between visits.
"Conditions like COPD are chronic," said Kathie Mishica, Physical Therapist at OSF Home Care. "It's not a condition that's 'cured' so it's not going away, so we have to help them learn how to manage and try to keep them out of the hospital."
One of the many functions the therapists is to make sure the patient is supplied with the proper equipment necessary to meet their needs, such as grab-bars and a tub bench for their showers or tubs, wheelchairs, walkers and canes. Along with the exercises, they also stress with the patient the importance of taking rest breaks - particularly if the are feeling extra tired. If 10 minutes of exercise is prescribed per day, the patient can divide those minutes into two sessions - five minutes in the morning and the other five in the evening. Patients are shown how to take their own heart rate to make sure they do the exercises safely.
"We can recommend exercises they can do in a chair while watching TV or standing at the kitchen sink," said Sheila Malloch, Physical Therapist at OSF Home Care.
While exercise and therapy isn't pleasant, each therapist stressed the importance of helping the patient to set goals as a motivation for improvement.
"They usually want the therapist in their home and it's our job to find out what motivates them and what their personal goal is," said Kars. "Maybe they want to get back to fishing or something else they really enjoyed."
Because patients are generally discharged from the hospital a lot sooner than in years past, Camille Peterson, Physical Therapist at OSF Home Care, said many of these patients are a lot sicker and need the extra care to help them improve.
Case conferences are conducted weekly between the therapists and other care providers, including social workers, who set goals and assess where they want the patient to be by the end of their scheduled care. If necessary, programs are altered to help the patient achieve their set goals by making adjustments and getting other care workers involved to help achieve the appropriate level of care for them so they're not just dropped from the program.
Monitoring the patient's progress is also an important part of the therapists' visit and they can easily assess whether the patient is improving or getting worse. In case they are regressing, they are referred to their physician for follow-up. If their condition is deteriorating and they are becoming terminal, they are referred to Hospice.
"A lot of elderly people find it difficult to accept the fact they can't do everything they could when they were younger," said PT assistant, Kim Peterson.
Nodding in agreement, Malloch added, "There's a much higher population in the U.P. who are in their 80's and even in their 90's who are pretty self-sufficient and are still pretty active. But their balance and agility is definitely not what it used to be. As they get older, their functions start to deteriorate, and they have to learn to adjust."
But it's not just the elderly who need follow-up care, according to Kars. "It's easy to blame everything on age, but we get a lot of patients that are younger. Maybe they've had a hip replacement or a knee replacement. Or maybe they're recovering from an injury."
All the therapists said they enjoy the opportunity to see the patients in their own homes.
"Having a therapist come to their home is certainly a change after a stay in the hospital," said PT Camille Peterson. "While there, everything is structured, and when they come home, they have to adjust to being back at home, maybe taking different medications, making their own coffee in the morning and taking care of their own needs and some even taking care of a pet. It can be overwhelming and some actually can regress."
Even though the therapists are in the home for a particular condition, it's part of their job to assess the patient's overall health.
"We take their blood pressure, check their weight and blood sugar, and that's all before we get to their total need," said Malloch.
"You get to see them on a personal level," said PT Susan Schneider. "You can ask such things as 'what type of music do you like to listen to?' and suggest they try exercising to music."
But in addition to caring for the physical needs of their patients, the therapists expressed appreciation for being able to help them on an emotional level as well.
"Some live alone and don't have families living nearby," said Malloch. "When I walk into their home, it's a whole different ball-game than just getting on with the treatment. I once had a man who couldn't find a card that he had telephone numbers written on it, and I spent 20 minutes helping him find the card. That's extra time but for him, it was important."
Because they are assisting the patient in a comfortable environment, the therapists are sometimes able to be alerted to conditions that doctors don't observe during a 15 to 20 minute office visit.
Schneider said she once noticed a patient having difficulty with an arm exercise and her range of motion wasn't what it had previously been. When asked why, the patient informed her about a pain in her neck and down in her arm that could easily have been the symptoms of a serious condition, such as a heart attack or stroke.
But no matter the reason for the therapy or the personality or home environment of the patient, the ultimate goal of therapy is to bring each patient to their highest potential, no matter what their age...whether they are in assisted living, in a nursing home that doesn't have its own skilled therapist, or in any living environment.