One of the things I did not expect when Mom moved into her AL community was that she would start physical therapy and occupational therapy almost immediately. At first, I thought it was ‘event based’ and the change in her living situation was the event. I learned, however, the reason is for the safety and comfort of new residents as well as to serve as a baseline for the resident and staff. The baseline helps to prevent future problems and can determine if new or additional mobility equipment is needed. Evaluations of Activities of Daily Living (ADLs) like transfers, bed mobility, toileting, dressing, grooming and self-eating establish coverage going forward for Medicaid. A resident’s baseline is also used to ensure the community is budgeting appropriately for the disease management of their residents.
Lindsay DeLong, founder of EquipMeOT is an Occupational Therapist (OT) with ten years of experience. She has worked in both a world class rehab hospital and as a home-based therapy provider, specializing in trauma recovery and neurological rehabilitation. Working with assistive technology and custom equipment specialists, Lindsay realized families are forced to make increasingly complicated decisions about home equipment and are often not give much education on how to use it. Her website, EquipMeOT, is a companion site to her corresponding YouTube channel where she shares how-to tutorials, instruction and helpful tricks for installing, assembling and using home-based medical equipment. I wish I had known about Lindsay’s work when I was caring for Mom at home. I really could have used her video, How to Sleep in A Recliner.
Setting a baseline at the start of a resident’s stay can have one of two trajectories. The first is possible improvement. Therapists evaluate strength and mobility along with use of mobility aids like walkers. The decision may be to offer exercises to regain strength, not fall back or improve compensatory needs like transfer to a commode. From an Occupational Therapist perspective, it is less about exercises and more about establishing modifications integral to daily life.
The second trajectory is comfort and safety. The baseline helps determine the emotional and physical safety of the resident. Just as important is the education of staff on the equipment a resident is using and how to handle them safely.
Lindsay is a proponent of understanding the person beyond their medical needs. Knowing who each resident is and what would make their time in the community pleasant is the goal. Family members are welcome advocates with their ability to offer additional insight into the resident.
Unfortunately, the additional time needed to understand personal well being is minimal. A therapist finds themselves always asking questions about what it takes for the person to feel supported. Little issues like, “can the resident manage the remote” all the way up to safety concerns like, “ is the commode situated beside the bed in the optimal place and can they transfer without the fear of falling” can make such a big difference in the safety and security of the resident. The Physical and Occupational Therapist will partner to build the best environment and then work with caregivers. Again, family members can add so much to this discussion.
The sad truth, and one of Lindsay’s biggest frustrations with the current model, is that the exercise portion of therapy gets priority because you can set measurable goals. These goals have time frames attached to them and that documentation is what allows the service to get billed to insurance. Strength is a metric with a return on investment and that is what insurance companies focus on.
Lindsay’s work is driven by the principal of value driven care, that is, providing services that bring the highest value of return for a person’s social and emotional health. It means helping a resident to understand that the goal of using a rollator is not to gain strength, but to be able to go out to breakfast once a month. The purpose of exercise needs to be understood and accepted as one that is tangible and has value. Families can help by working with the OT and PT not only to understand the person, but also to create value driven goals that are meaningful, like attending a family wedding.
Family involvement is particularly important because so many of these services are handled by an agency and not in-house therapists. Major changes in Medicare coverage over the last ten years have changed the landscape drastically across the board. Because agency staff is not part of the communities’ culture, and don’t know the staff or residents personally, it is hard for them to build rapport and trust. When a family helps build that bridge between resident and therapist, everyone is better off.
Lindsay is collaborating with Benjamin Surmi, director of education and culture at Koelsch Communities, a third-generation family business that operates memory care, assisted and independent living communities across eight states. On March 21 they will discuss Affordable Tools for Unexpected Injuries. Here is a link to sign up for the program on March 21: https://www.youtube.com/live/mIPNOwcbTXI?feature=share
strong>Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.
Deb is the author of “Your Caregiver Relationship Contract and “A Relationship Contract for Dementia Caregivers.” Your Caregiver Relationship Contract is available in both English and Spanish. It explains how to have an intentional conversation and the how unspoken expectations can cause problems during caregiving. A Relationship Contract for Dementia Caregivers explains how important it is to learn how your person wants to live their live out and how you, the caregiver is the most important person in this relationship, giving you tips and tricks for this journey.
Click here to learn more about Your Caregiver Relationship Contract or here for the Spanish version: Su Contrato de relación como cuidador de un ser querido. Click here to learn more about A Relationship Contract for Dementia Caregivers.
Deb is available as a caregiver consultant. She will answer the question: “Where do I start?” and find the resources to alleviate your stress. If you would like to invest a half hour to learn how she can help you, please contact her at: Free 30 minute consulting call