Physical Therapy.

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My husband and I are taking care of his very elderly, frail, 95 year old who is completely dependent on our care, and has been for a year now. Needs 100% assistance getting into bed and out of it, along with getting off the couch, and back on. Walks with a walker for short distances, needs to be in a wheelchair for long distances. She's had physical therapy three times now and there was no progress made in regards to her being able to at least get off the couch on her own to go to the bathroom. Her Dr says its a good thing for her because it will give her a sense of "accomplishing something" when nothing of the sort has happened in the past. She's come home from therapy each time in pain, and at times cant even move as a result of the pain. Even if she was able to move around on her own again it would be too dangerous. Is her Dr crazy for thinking this is good thing to do even though it will accomplish nothing?

9 Comments

Yes, sometimes pt can be worse than doing nothing. Why continue when it only causes her pain and you see no positive progression in mobility. It is hard but there comes a time when we just have to accept what is and make our loved ones as comfortable as possible. My Mom is in the same situation!
Yes. The doctor is crazy.

I'm surprised the PT clinic will continue with her when she is not showing progress.

Don't get me wrong. I think PT is very beneficial in many circumstances. I've just gone through a course of PT myself. My husband (86, dementia) just completed several months of PT intended to strengthen his legs to help prevent falls. So I certainly think there is a time and place for physical therapy! But in the situation you describe? Ya, that is pretty crazy.
Some therapists are better than others, but all need to set realistic goals. Has the PT explained to you and your mom what the goals are? Like to strengthen arms and legs to assist with transfers and prevent further deterioration of muscles? You should ask the dr about the pain situation and the PT. Everyone needs to understand what PT or OT is supposed to accomplish with that specific patient so no one is disappointed or safety is a concern due to elder person thinking they can walk alone. And it's probably going to take more than 3 sessions to accomplish anything if the person has not been very active. Have you attended the therapy sessions and watched? That might help you determine if you have a good therapist. If insurance pays, you might want to try in home therapy b/c there you , the patient and the pt are in a real life day to day situations and the therapy lessons can be centered around what needs to be focused on to ensure safety and assist caregivers in transfers.
If my husband has her go back to therapy, he did ask the Dr for another prescription so that Medicare and her supplement will pay for more therapy, this will be round 5 of PT. The first time was in home, got nothing accomplished. The second in assisted living, again nothing. The third was again in home, and the fourth at at actual PT facility. The last attempt was a full 2 months of it, and she was going 2 days a week, each for an hour, and there wasn't anything what I would consider being leaps and bounds of progress made at all. I attended a few of the sessions with my husband and it was all basic stuff they had her do sitting in her wheelchair, with some very short distance walking thrown in there. None of the excersises required any special equipment, and were easy enough for her to do sitting on her couch at home. The goals were to just strengthen the body as a whole, needless to say, nothing has changed or gotten better.
You know the situation best whether anything worthwhile is getting accompllished or they are just draining insurance money and your energy and hers taking her to therapy. My mother has had some good physical therapists and some lazy ones. The good ones can motivate and make the patient feel like they are enjoying the sessions. The bad ones keep them doing the same thing over and over (often just leaving them in the bed) and the patient feels like they are getting nowhere. And a lot has to do with the patient, how motivated they are, their physical limitations, etc. I've had physical therapists print out exercises and show me how to do them with my mother so, if you don't want to keep up the insurance sessions and you have time, you could ask for instructions and print out of appropriate exercises and do a little therapy with her on your own to keep her muscles in shape. At 95 I'm not sure you can expect too much. At least she can walk with assistance. Does she have chair/couches that sink in, b/c that would make even a younger person have trouble getting out of them. I've put booster cushions or even folded bedspreads to make seating firmer to get up out of. Since total ambulatory independence doesn't seem possible, I would emphasize safety training and how you and your husband can transfer her with the least amount of effort and most safe methods. That type of info helped me often more than the sessions helped my mother. Again, assuming you have a good therapist who will work with you.
My father's doctor put him on PT and OT a couple of months before he died. It was the most useless thing. We appreciated someone coming in to give Dad showers -- it was the help needed -- but the PT and OT did more harm than good. Medicare has it written up that in order to get assistance in the home PT and OT has to be included. I believe my father had a stroke one time when the physical therapist was working with him. She was rough. The nurse came in at that time, too. They chattered among themselves and didn't even seem to realize the distress my father was in, though he looked and felt like a ghost. I canceled PT after that.

The week my father died, the hospital was doing PT and OT on him. I couldn't figure out why. It is almost a knee-jerk way with healthcare now. I knew he was going to die. They knew it. So why? The insurance company told them no to further rehab because it wouldn't do him any good. I agreed completely, particularly because he died that day.

Sometimes I hear people worry about losing their "quality" healthcare in the USA. They must have better doctors than I've seen.
IF the therapy has legitimate goals, its justified - but if it hurts and saps all energy it may be too much or the wrong thing entirely. On occasion, we do things that may hurt, such as stretching for burn contracture and sometimes orhtopedic rehab after a procedure or a severe sprain, and if pain is not avoidable then pain medication should be given before and after. Not doing therapy when its needed and could help is bad, and doing therapy when it's useless or harmful is bad too. Just my $0.02!

My mom had a stroke in therapy too...but I don't think it was the therapy that caused it. Several times she maxed out with no progress because she often didn't want to make the effort though she said she wanted to acheive the goal, once she got no therapy because someone wrote down that she was "total care" at baseline and that wasn't true, and once they just flat out used up her hundred days and then quit, though she was still improving some; at that point they admitted some of the goals we had were not acheivable but right up to day 100 they never came out and said so. I wish everybody cared about the patient first, second, third, and fourth, and maximizing profits was a priority wasy down the line somewhere after first doing no harm and making sure you helped as much as you could...
most 95 year olds have limited goals and physical/mental constraints too. PTs are professionals in evaluating these and devising programs to address these problems. many lay people cannot do this. there are so many factors that are involved, that to blame one for failures cannot possibly be right. frankly, 3 visits to develop strength for anyone is impossible. human bodies do not work that way. anatomy, physiology, genetics, acquired injuries and limitations all come into play. talk to your PT, all involved. professional athletes in the prime of their physical lives train for many months and years to perform their physical tasks. you cannot expect someone physically sapped and chronically weakened, limited in motion and having the usual accumulative wear and tear of their body to magically achieve goals quickly or possibly ever. be realistic with your PT, MD, yourselves and the patient.
My mother in law had gone 2x a week for 2 months solid, no leaps and bounds and progress made. Was instantly in pain after therapy, and no less than 48 hours later could barely move as a result.

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