A physical therapist’s perspective
By Fran Moore, PT
When people ask me what I do in homecare, they are often surprised to learn that many of the patients I work with are hospice patients. The first response I often hear is, “It seems that a hospice patient could not tolerate physical therapy.” Patients and caregivers often confuse physical therapy with physical training. And, while it’s true that physical therapists provide “physical training” with some patient populations, the role of the physical therapist with the hospice patient and his caregivers is very different than it is with traditional rehab patients.
Although the expectation in hospice is that the patient will lose strength over the course of care, that decline does not usually follow a straight path. Individual patients enter the hospice program at different levels of physical ability, and they may rally at different levels of function. A physical therapist can assist with a patient’s mobility while contributing toward his goal of improving comfort and quality of life at every level of care.
In most cases, the patient should be in the director’s chair when it comes to setting goals. One patient may want to be able to exercise for as long as he can, while another may want to just be able to get out of bed and walk to the bathroom without falling. Families and caregivers may have goals of providing care to the patient while preventing physical strain or injury to themselves.
Evaluating the Environment
After establishing the patient’s and caregivers’ goals, the therapist evaluates the patient’s home environment and his ability to move around in it. If the patient is able to walk around the house, the therapist looks for ways to make the home a safer place. Sometimes the recommendation is as simple as reversing the wheels of a walker so that the patient can get through doorways more easily. And sometimes the therapist will recommend rearranging the furniture so that it is easier to get the patient from his bed to a favorite chair. Occupational therapy may be added to the plan of care to make recommendations to improve the patient’s activities of daily living, especially when it comes to bathroom or kitchen safety.
The physical therapist can assess and recommend assistive devices. A cane may be more appropriate than a walker in certain circumstances. A physical therapist can work with the patient to assure that he is able to use the walker or cane safely. The therapist can instruct the family in how to safely operate a wheelchair or, if necessary, a Hoyer lift.
Rehab in Reverse
Richard Briggs, PT, MA, Chairman of the APTA Hospice and Palliative Care Group, uses the term “Rehabilitation in Reverse” while describing physical therapy care with the hospice and palliative care patient. A physical therapist may become involved in a patient’s care while the patient is able to walk around the house. The therapist may develop a home exercise program and strategies to prevent the patient from falling. She could provide instruction and exercises to improve endurance and balance. Later, she may be called upon to teach the family member in ways to safely assist the patient in and out of bed. And finally, the therapist can provide treatments such as massage and gentle motion and positioning techniques to help decrease pain and promote relaxation.
Medicare has mandated that occupational, physical and speech therapists be contracted as necessary for care of hospice patients. Which means that physical therapy should be considered as part of any hospice treatment plan. Ask your hospice team if it would be helpful to your loved one.