Why does there seem to be 'less' physical therapy given to the elderly of a certain age group? - AgingCare.com

Why does there seem to be 'less' physical therapy given to the elderly of a certain age group?

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I ask this question because my mom (who's 83) has been in 'acute rehab' twice, and only gets '25' to "almost" 30 minutes of physical therapy, but is then placed in a wheel chair for the rest of the day with NO CNA workers to walk her around her room, or even in the hallways to gain some strength. When she's given 'therapy at home', the results are much 'better'. Why is this when the 'rehab' is "supposed" to help them get back on their feet, and go home??
P.S. The nursing rehabs and hospitals seem almost 'mystified' when I tell them that in spite of my mom's 'memory issues', she DOES get around at home on her own with her 'walker'.

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Sometimes it is the specific facility and their approach! When My 96 year old Mom needed rehab, I called and did a phone interview for 5 different places. The differences were amazing. The one I selected gave an hour a day (each) of PT and OT. Most dementia patients also qualify for speech therapy. Sometimes, if Mom wasn't following, they stopped the session and came back later to complete it. As you know, dementia patients can be very different at different times of the day!. When My MIL needed rehab, her family chose a different rehab place. They gave her 30 minutes of PT a day! I'd advise everyone to check around to see what is offered by places you may be considering!
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You are expecting them to recover and get back to where they were, but the facility doesn't have the same high expectations. I think they also are just used to seeing seniors rot away sitting, so they don't know that YOUR senior should be getting up & about (some facilities are a lot better than others). It's up to the family to squawk if a senior isn't getting enough rehab.
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Thanks for that informed answer, Ryan. In some cases the downside of PT at home is a resistance to follow-up activities. Some elderly patients are more likely to cooperate with a PT, PTA, nurse, or someone else with scrubs on than they are with a wife or son. I was lucky that my husband was really motivated to regain/maintain his strength and ability to walk, and we had a PCA he liked and who would do the exercises with him. But from reading many posts here I don't think every caregiver is that lucky!
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Thank you, sisters2 for your question. I’m very sorry to hear about your mother’s experiences in the acute rehab setting. As you and many other patients and families report, more positive results are often found in the home environment. Why is that the case? I believe it comes down to a couple key factors. The first is insurance reimbursement. Healthcare reform coupled with an increased cost to do business, has led to reduced funding for each patient’s care. As cuts to Medicare continue, rehabilitation facilities also must re-evaluate how services are provided which may include hiring care extenders such as CNA whose skills and training are not at the same level as a nurse or therapist. Since many times the patient is at a falls risk, it is safer option to have them sit in a wheelchair than walk with someone who doesn’t have the skill necessary to safely work on mobility. As the complexity of the patient medical conditions increase, eg. Cognitive decline, the ability to provide top notch skilled care can be affected. This is why we are currently going through a shift in healthcare to return patients home as soon as possible. From a healthcare provider standpoint, in the home there are fewer overhead costs and thus more time is able to be spent with the patient. This brings us to the second key reason. Doesn’t just being home make you feel better? While at home, the patient is in a familiar environment which immediately makes mobility safer. Family members, caregivers, and medical professionals are focused on just the one person and can more easily adapt the plan of care to the patient’s needs and wants. A positive outlook can really go a long way in overall health. So sisters2, you can see how there is “no place like home,” but while in a facility the best thing to be is an advocate for care and keep pushing to ensure best quality for your loved one!


Ryan Cummings, PT, MS, OCS
Physical Therapist
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