CharK60 Asked May 2018
Is it true that care homes don't demand physical therapy for their patients?
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I'm told that at most nursing homes the residents can refuse to exercise if a physical therapist is even on staff. At best they may be seated in wheelchairs and allowed out of their rooms. The ones that are not considered mobile. Can this be so?
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My Mom [98] after having a serious fall with head trauma was placed in a Rehab facility until it was decided that Mom's brain injury wasn't allowing her to stand or walk. She was then transferred to long-term-care. No, she was no longer getting physical therapy as it wasn't helping her at all.
My Dad lived in Assisted Living/Memory Care and he had weekly physical therapy by a group that came to the facility. Dad needed help with keeping his balance and strengthening his arms, and the therapy was helping him.
Someone in a NH for rehab must meet Medicare criteria or Medicare will not pay. Therefore , the person must participate. For residents of a nursing home, Physical Therapy is not an everyday thing. It may be ordered to help regain strength in which case, the patient must cooperate or (typically) medical insurance won't pay.
The NH had a PT room, and at least one full time therapist. (They served people from the community, too.) From time to time residents would be signed up for therapy for some particular need. If the resident refused, the therapy was stopped. Only therapy that actually took place was billed to insurance.
It is not necessary to be a PT to assist people with basic exercise. Physical therapy is to remedy a specific medical problem. Care centers that don't have them on staff typically bring them in as needed.
My daughter's job at the nice ALF she works at is to see that residents who sign up for it (private pay, as an extra service) get help with exercise, such as a daily walk, or riding a stationery bike. That facility has physical therapists come in when residents have injuries or special needs. As in the NH, no ALF residents have to participate.
I imagine that most care centers encourage some form of exercise. None of them can force residents to participate.
Mom's NH encouraged people to get out of their rooms, by offering at least one activity each morning and each afternoon, plus religious activities. My mother (who was not mobile) went to virtually everything offered, except mass. Her roommate went to almost nothing and stayed in her room watching television. No one took meals in their rooms unless they were sick.
She does participate in the chair aerobics once in a while, I have done it also if I happen to be there and it works the muscles. Staff tries to get everyone to participate in activities. I think they get everyone out there when a music program is going on, they have a lot of music programs available. I know there are a few Residents that have their meals in their rooms. I know when I worked as a CNA, we had a few who ate in their rooms, for whatever reason.
I finally got the senior here to take daily walks and he'll do pt if I'm present. He was just going through the motions to appease me at first now I think he sees some benefit but you have to be regular. That's what many seniors or younger people don't understand, pt/fitness is part of your daily life, not 'something to do' on occassion nor will on workout last a week.
Also it's important to keep seniors active throughout the day. The senior her just wants to walk, do errands and pt with in one 1-2 period during the day. He wants the rest to be couch or chair time. By spreading things out there is less chance of the person tiring and doing things with sloppy or poor form along with squeezing in more total activity.
There are usually 2 types of “physical or occupational therapy”. One is the official therapy done by a licensed therapist at the recommendation of a doctor or staff, or even a family member. This could be done in a therapy room or in the residents room/ floor whatever’s appropriate. This would be billed to their insurance and progress reports would be made to continue it. If resident has plateaued, therapy stops until there’s a trigger like a fall or observable decline. Then it could start up again. Mom had another 2 weeks of OT to get a new baseline after her vision loss.
Yes, residents can refuse. I think after 3 attempts and refusals, they quit asking.
The other type is “recreation therapy”. This is provided daily by a recreation team in a common area. There’s usually a calendar of events all day long. Like bingo, bocce, table bowling, balloon volleyball, singalongs, baking, etc. These folks are not therapists but the activites have been designed to help movement and dexterity and cognition.
Theses activity people usually go around and physically try to drum up partcipants. Yes residents can opt out of this too.
Their life, their choice. No demands. But in Moms NH I wouldn’t say “ at best they’re allowed out of their rooms.”
Maybe we can be provide better answers if we knew why you are asking.