Mar 29 2018 Going Above and Beyond in Home Health Physical Therapy
By Megan Palumbo, MSPT
As a physical therapist who had 12 years of experience in the outpatient setting, I thought I knew what I was doing. Boy, was I wrong.
PT Visits Require Assessing the Patient’s Entire Home Environment
Visiting Nurse Health System’s home health physical therapists (PTs) are skilled in all the traditional ways that our schooling provides. However, in homes where we have to think on our feet, the real training begins. We have to be adept at spotting safety issues, medications that may be impacting the patient’s progress and abilities, and coming up with ideas that work for each particular individual. Most patients don’t plan on having a sudden illness or injury; they haven’t ever looked at their shower and been afraid of falling. Simple tasks such as getting dressed can seem like it requires the energy of a marathon. This is where the home PT excels. Having the knowledge base and creativity to determine what each patient’s goals are—and then figuring out how to make it work—is our passion.
I had been seeing the patient “Ken” for a few months. Ken had suffered a stroke and developed pneumonia due to lack of movement. His nurse had called earlier that day and asked me to listen to his lungs again as she had a hard time rolling him onto his side. Since one of Ken’s plan of care goals was working toward sitting on the edge of the bed, I helped Ken sit up and used the stethoscope to check his lungs. His lungs sounded clear, and once I checked his oxygen saturation I gave the okay to transfer Ken to a wheelchair. Great, they were on their way to getting Ken out of the bed and back to living! We wheeled him out of the house and showed his caregiver how to set up the wheelchair ramps. For the first time in months, Ken saw the sun.
On the way back into the house, Ken’s wife “Alice” said she had a bad headache. I observed Alice and noticed her face looked red. “Sit down, let me check you out,” I instructed her. Alice had been taking care of her husband non-stop for days. With the dedication of an ICU nurse, Alice had begun to neglect herself. Her blood pressure was 200/110. I immediately called their primary care physician, who I knew well as they had been in contact with me regarding our mutual patient many times. The physician asked questions: what was her pulse rate, how did she appear, any other symptoms? After I answered, the physician gave Alice strict orders to change her blood pressure medication and, as this was a Friday, to visit his office on Monday. His exact words were “that was an astute therapist.”
In home health, it’s never boring. Home health PTs look at the entire patient, including the structure of the home, the personalities that make up their families, and their individual needs and goals. There is a bond and trust that is established when a patient lets a Visiting Nurse PT into their home. We arrive with understanding, with compassion and with knowledge that is free of judgement. Our greatest joy is the success of our patients… and their loved ones.