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Tag: Physical therapy

  • Some hospitals now provide at-home rehab services 

    Some hospitals now provide at-home rehab services 

    Felice J. Freyer reports for Kaiser Health News on how some hospitals now provide at-home rehab services for patients post surgery. At-home rehab can be helpful to patients who would otherwise have to wait in hospital until a rehab bed opens up for them.

    People with Medicare in Medicare Advantage plans often struggle to get rehabilitation services after a surgery or other procedure that leaves them in pain, unsteady and/or unable to care for themselves. The cost is high and insurers would prefer to deny the care and save money, even when lack of rehab services keeps patients from a speedy and full recovery.

    People in traditional Medicare are more likely to receive rehab services when needed post hospitalization. But, too often there are no rehab beds available. They are forced to sit in hospital until a bed opens up. And, sometimes the facility is located far from their homes and their loved ones.

    At-home rehab gets patients out of the hospital more quickly. Caregivers can more easily visit patients. And, patients are monitored remotely.

    The at-home rehab program is being tested in New York, Pennsylvania and Wisconsin. Some say it is working well. But, there are no rules surrounding how they should work, which patients qualify, or what services should be offered. And, Medicare does not cover these services as of now.

    In short, at-home rehab is only being offered by a few hospitals that are paid upfront to manage their patients’ care. In some cases, a state Medicaid program pays for the care.

    The trade association representing nursing homes and rehab facilities does not support this at-home rehab model. Skilled nursing facilities (SNFs) and rehab facilities are required to provide a range of services to their patients, which the at-home model does not require. Do these requirements necessarily improve patient care?

    Many SNFs and rehab facilities offer precious little to their patients, other than unhealthy meals, endless hours in bed, and a short period of physical and/or occupational therapy. One quarter of patients end up with bed sores, infections or other poor health outcomes. At home, patients could be up and about a lot more and trained on how to navigate their homes safely.

    One at-home rehab program reports no bedsores, infections or other adverse events for their patients. But, this program provides services only when there is also an in-home fulltime family caregiver to help. Consequently, many patients do not qualify for the at-home program.

    Another at-home rehab program enrolls patients living alone and provides them with a call button to speak with a live person when needed. It’s not clear how well this program works. Home alone, patients needing rehab could be at serious risk of falling or otherwise hurting themselves.

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  • Falls are primary cause of harm and death for people over 65

    Falls are primary cause of harm and death for people over 65

    Unintentional falls are the primary cause of harm and death for people over 65 reports the Centers for Disease Control in a new report. You might have thought it was car accidents or cancer. Fortunately, many falls are preventable.

    Nearly one in four older adults (14 million) reported falling in 2021. Fall rates, or at least reporting of fall rates, are higher in some states than in others.  In Alaska, nearly four in ten older adults reported falling in 2020. In Illinois, just under two in ten reported falling. In 2o21, overall, 100 older adults died each day from falling.

    While women fall more than men, men are more likely to die as a result of a fall than women. Just over 91 men out of 100,000 died of a fall in 2020, while 68 women out of 100,000 died of a fall.

    Death rates from unintentionally falling also varied dramatically from state to state. In Alabama, 31 out of every 100,000 people died as a result of falling. In Wisconsin, 177 out of every 100,000 died as a result of falling.

    Here’s what you can do to minimize your risk of falling:

    • Have your primary care doctor assess you for the risk of falling.
    • If your risk is high, determine whether there are any specific causes that can be treated and ask your doctor to check your medications.
    • Get physical therapy–Medicare should cover it in full with a prescription from your doctor.
    • Modify your home to reduce trip hazards such as loose rugs and bedding.

    The National Council on Aging offers a free check-up that you can do yourself to determine if you are at risk of falling. To take the check-up, click here.

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  • PACE helps older adults stay in their community

    PACE helps older adults stay in their community

    The Program of All-inclusive Care for the Elderly (PACE) is a home and community-based program designed to keep older adults who are at risk for nursing home placement living in their community.  PACE is a partnership between a local sponsoring organization, and Medicare and Medicaid health insurance programs. To become a PACE “participant,” a person must be nursing home eligible. While a person can pay privately for services, most participants have Medicare, Medicaid, or both insurance programs.

    The PACE philosophy: PACE members are called “participants” because they are encouraged to participate in their care–decision making and active care–whenever possible.  The overarching goal of the PACE Model of Care is to keep people living in the community and out of institutional care.  While an individual does not need to visit the PACE Center, which offers adult day programs with wrap around health services, it promotes socialization and addresses common problems of isolation, loneliness, and boredom.

    Who can get PACE? Programs of All-Inclusive Care for the Elderly (PACE®) serve individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment and live in a PACE service area.

    How does PACE work? PACE works by providing care and services in the home, the community, and at the PACE center. It is team-based care that provides everything covered by Medicare and Medicaid if authorized by your health care team.  If your health care team decided you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.  The team provides comprehensive coordinated care and includes the PACE participant, physician, nurse, social worker, recreational specialist, rehabilitation specialists, and transportation specialists.

    Services: Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to older adults with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:

    • adult day health care that offers nursing; physical, occupational and speech/language therapies; recreational therapies; meals; nutritional counseling; social work and personal care;
    • medical care provided by a PACE physician familiar with the history, needs and preferences of each participant;
    • home health care and personal care;
    • all necessary prescription and over-the-counter medications;
    • medical specialties, such as audiology, dentistry, optometry, and podiatry and speech therapy;
    • respite care; and
    • hospital and nursing home care when necessary.

    See more at: http://www.npaonline.org/policy-advocacy/value-pace#services

    Find a PACE program near you: Currently, there are 144 PACE organizations in 30 states serving 58,000 people. To find out if you or a loved one is eligible, and if there is a PACE program near you, visit www.pace4you.org or www.Medicaid.gov, or call your Medicaid office.

    Beware of for-profit PACE programs: Government audits find for-profit PACE program neglects patients, delays needed care and cancels critical care.

    Learn what to do to ensure safety at home for people aging in their communities. And, see how one new program is helping older adults remain at home with assistance from a handyman, occupational therapist and nurse. For those who like technology solutions, check out how sensors can offer peace of mind to caregivers.

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    This post was originally published on March 2, 2016

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  • Coronavirus: Physical therapy can help reverse the toll of isolation

    Coronavirus: Physical therapy can help reverse the toll of isolation

    There’s a lot of focus on the disproportionately high number of older adults who contracted and died of COVID-19. There’s been far less focus on the number of older adults who have remained COVID-free but for whom isolation during the pandemic has taken a large physical toll. Judith Graham reports for Kaiser Health News on older adults who lost their strength during the pandemic; physical therapy can help reverse the toll of isolation.

    For many older adults, simple tasks have become a lot harder over the last 15 months. Isolation has had serious effects on their mental and physical health. Getting out of a chair now can be difficult as well as getting into and out of a car. It can be challenging for some older adults who had been totally independent pre-pandemic to care for themselves.

    There’s no data yet on the proportion of older adults who have suffered physically and mentally because of the pandemic. But, it’s pretty clear that most of them, like most people more generally, have been less active. Being confined to one’s home necessarily makes it less easy to be active.

    And, some medical professionals are reporting increases in falls among older adults as well as worsening health conditions. Overall, the pandemic was not helpful in ensuring people kept healthy diets or exercised. Without exercise, muscles weaken, people lose their strength and stamina, as well as their range of motion; it becomes harder to walk and maintain balance.

    Rehabilitative therapy can restore people’s physical functioning in many cases. Medicare will pay for rehabilitation at home when it is available and patients qualify. At the same time, getting up and out as much as possible is well-advised.

    Some health plans are finding volunteer peer advocates to keep in touch with isolated older adults. The goal is to motivate them to move, to walk more, to appreciate the benefits of not staying put.

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  • How to avoid unintentional injuries

    How to avoid unintentional injuries

    As we age, the risk of unintentional injuries rises. A new Centers for Disease Control study looks specifically at unintentional injuries among older adults. Older people can and should take precautions to help prevent avoidable injuries.

    Each year, about 60,000 older adults die from unintentional injuries. In 2019, the majority of them, 34,000, died from falls. About 8,000, 13 percent, died from motor vehicle accidents. A tiny fraction, 3,000, died from accidental drug overdose or poisoning.

    On top of that, an even larger number of older adults experience unintentional non-deadly injuries, with grave health consequences.  They might experience severe brain injury and inability to care for themselves.

    In 2018, 2.4 million older adults visited the emergency room. More than 700,000 of them ended up hospitalized. More than 90 percent of those visits were caused by falls.

    Women are more prone than men to experience an unintentional injury. They are more likely to end up in the emergency department and to be hospitalized for a fall than men. But, men are more likely to die from an unintentional fall.

    The likelihood of falling increases with age, with one in four older adults falling each year. But, the likelihood of being in a motor-vehicle crash declines. The researchers posit that people tend to drive less as they age.

    You can prevent these unintentional injuries. Falls do not have to be part of aging. Talk to your doctor.

    Sometimes, exercise to improve balance and strengthen muscles can make all the difference between suffering from an unintentional injury and not. Physical therapy visits can also help; Medicare covers medically necessary physical therapy. Eye exams, which Medicare generally does not cover, can detect and correct poor vision. Good vision can help in preventing avoidable injuries.

    Your doctor should also check your feet at least once a year to ensure you have the right footwear to minimize your risk of falling. Medication reductions can also help, particularly reducing use of  benzodiazepines, opioids and anti-depressants.

    Visit this Just Care post to learn how to make your home safer.

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  • Medicare covers physical, speech and occupational therapy

    Medicare covers physical, speech and occupational therapy

    Whether it’s because of an illness or an injury, or simply to improve balance, at some point in our lives, many of us will need therapy to regain or maintain our ability to function. Medicare covers physical, speech and occupational therapy in a variety of settings. Talk to the doctor about whether therapy would benefit you or someone you love.

    Medicare offers several outpatient therapy options. You can receive outpatient therapy services at a Comprehensive Outpatient Rehabilitation Facility, hospital, public health agency or from a private therapist, so long as the provider is Medicare-certified and you qualify for coverage. You can also receive outpatient therapy services from a Medicare-certified home health agency, so long as you qualify for the Medicare home health benefit.

    For Medicare to cover outpatient therapy, you must meet the eligibility criteria:

    • Therapy must be a safe and effective treatment for you.
    • A therapist must deliver the services or direct the delivery of the services.
    • Your doctor must certify you need the therapy to regain or maintain your ability to function and set up a plan of care for you in advance of your receiving services. And, if you need ongoing therapy, your doctor must review it and recertify your need.

    Medicare now covers as much outpatient physical, speech and occupational therapy as people need.

    Traditional Medicare pays 80 percent of the cost of these covered services. Supplemental coverage, such as Medicare supplemental insurance or “Medigap,” retiree coverage or Medicaid,  should pay the rest.

    Medicare also offers several inpatient therapy options. It covers physical, speech and occupational therapy in a nursing home as well as in a rehabilitation hospital. Coverage is limited. If you want inpatient care in a nursing home, you will need to have been hospitalized as an inpatient for at least three days in the 30 days prior to admission. You must receive care in a Medicare-certified skilled nursing facility. (Note: You can spend three nights at a hospital and the hospital may still deem it an outpatient stay.)

    If you simply need rehabilitation services–be it nursing, therapy, social worker help or psychological services–Medicare will cover care in a rehabilitation hospital under its hospital benefit.

    Medicare also covers cardiac rehabilitation care.  Click here to read more about this coverage.

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  • Think twice before getting a knee replacement

    Think twice before getting a knee replacement

    Liz Szabo reports for Kaiser Health News about the high proportion of people who get knee replacements and wonder whether they should have. For about one third of people, knee replacements do not ease arthritis pain. Better treatments include pain relievers, diet changes, and physical therapy.

    Knee replacements are fairly common procedures, considered safe and effective. More than 750,000 people receive them each year. But, in some cases, they may cause more harm than good. Doctors and hospitals make money from knee replacements and may not warn you about their risks.

    People get knee replacements to address chronic pain, But, a knee replacement is not always a cure for pain. Indeed, it can bring on more knee pain, which can spread to your hips and back.

    Knee replacement surgery has serious risks. The data suggests that as many as one in three people suffer chronic pain as a result of a knee replacement. About twenty percent of people who have the procedure are unhappy with the result.

    People who get knee replacements are far more likely to develop complications than people who use non-surgical treatments such as pain relievers and physical therapy to relieve their pain. Infections, blood clots and knee stiffness are all too common side effects of surgery and may lead to the need for another medical procedure. Between one and two percent of people who get knee replacements die within three months.

    You may not want to get a knee replacement if  you have mild arthritis. A BMJ study found that quality of life does not tend to improve for people with mild arthritis.

    And, you probably do not want to get a knee replacement in order to be able to engage in heavy duty sports, such as basketball. Artificial knees tend not to be meant for heavy duty exercise.

    Finally, if you are relatively young and believe you would benefit from a knee replacement, keep in mind that artificial knees only last about 20 years before they must be replaced. They can wear out and leave particles that inflame the knee area. They also can loosen and separate from the bone. If you need to replace an artificial knee, the risk of complications is higher.

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  • Why aren’t hospitals designed with older patients in mind?

    Why aren’t hospitals designed with older patients in mind?

    Last Saturday, I was with my mother-in-law at the rehab facility to which she had been sent for physical therapy the previous evening, post hospital discharge, to regain the strength she needed to use her walker. She was lying in bed, told not to walk on her own, and expected to wait until Monday for the physical therapy she needed. Like this rehab facility, hospitals are poorly designed for older patients, reports Dr. Louise Aronson, a geriatrician, in StatNews. Why aren’t hospitals and rehab facilities designed and operating with their older patients in mind?

    The US should do more to equip hospitals in ways that optimize care for older adults. Older adults represent almost 40 percent of people in hospitals. Dr. Aronson’s thesis is that if hospitals were designed to better care for older adults, it would promote the greater good of hospital inpatients of all ages and their families.

    But, strangely, hospitals tend not to consider the needs of older patients in their design. Corridors tend not to have handrails or seating to allow people to rest. Much like most dinner menus at restaurants, signs tend to be hard to read. Simple evidence-based fixes would go a long way to providing older adults and others better care.

    For example, at the University Hospitals of Cleveland, the Acute Care for Elders program has hospital wards for older patients designed to get them out of hospital faster and with fewer complications. Of note, not only is the program better for older patients, it shortens their hospital stays and costs less. The Hospital Elder Life Program (HELP) helps to prevent delirium in older patients.  And geriatric emergency departments work to get older patients safely back home post emergency instead of admitting them to hospital.  

    Age-Friendly Health Systems should be our goal for older adults. They are designed to ensure older adults get the best care possible and to avoid health care-related harms. Their objective is for older patients to be satisfied with their care. For example, they might have staff call buttons that are voice-activated so they are easier to use.  They might have an extra bed for a family member to stay with the older patient.

    I was stunned that my mother-in-law, who needed more than anything else to get moving after her hospital stay, was forced to lie in bed for two days at the best-in-class rehab facility in her town, with her muscles further atrophying, because no physical therapists were on duty over the weekend. Dr. Aronson observes similar unnecessary challenges for older patients in hospital. Is this about the facilities saving money? It is certainly not about meeting the needs of patients. What will it take for this to change?

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  • How your doctor can help you age in place

    How your doctor can help you age in place

    We all know the expression, “If you don’t ask, you don’t get.” It is as true in the health care realm as everywhere else. Even I, a health care advocate, who thought I was on top of my dad’s health care issues, have just relearned that lesson. Here’s how your doctor can help you or someone you love age in place . . . if you ask.

    Until last week, I had never asked my 96-year old dad’s doctor about either his need for a physical therapist or how he might get additional companionship. My dad has had balance issues for some time now. But he walks quite well, with neither a cane nor a walker, so I had not taken them as seriously as I should have. And, while I see my dad and speak with him as much as I can, I knew he would benefit from engaging more with others–buddies are important.

    Luckily, I do know the value of accompanying my dad to his doctor’s appointments. He likes me to be his buddy at the doctor’s office because I speak up about health issues that might skip his mind or that he thinks are too minor to raise himself, such as a growth on his arm or pain in his feet. I like it because I can make sure that his doctor knows about health issues my dad might not be aware of–such as his periodic inability to remember where he is or his declining handle on numbers.

    At my dad’s recent appointment, I expressly asked whether the doctor might prescribe him physical therapy because of the difficulty my dad was having raising his right arm. I mistakenly was only thinking about this acute issue. That said, he has taken mild falls multiple times and lives in a home where he is required to walk a flight of stairs to get to his bedroom. While we modified his home in several ways and installed chair lifts where possible, one curving flight of stairs could not accommodate a stair lift.

    As soon as I asked–but only because I asked–the doctor made arrangements. As it turned out, my dad wanted the physical therapy and companionship way more than he had ever expressed or I had ever imagined. The physical therapist immediately prioritized improving his balance over addressing his arm because of his risk of falling. The physical therapist also suggested that an occupational therapist visit his home to see how he manages on a daily basis and what additional home modifications would make his life easier. And, the hospital social worker, where his doctor works, arranged for a volunteer to visit my dad in his home weekly. My dad (and I) could not have been happier.

    I remain surprised that my dad’s cracker jack doctor did not suggest these services on her own and mortified that I waited so long to ask for them.

    Lessons learned: A health care buddy should explore ways to minimize a loved one’s risk of falling and to ensure the loved one is as socially engaged as possible. As a buddy, you should speak up about these issues early and often.

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  • For-profit nursing homes more likely to deny residents hospice care at the end of life

    For-profit nursing homes more likely to deny residents hospice care at the end of life

    A new study published in the Journal of American Medical Directors Association finds that for-profit nursing homes are increasingly offering their most vulnerable residents high-cost therapy at the end of life rather than hospice care. If someone you love is terminally ill in a nursing home, you may want to speak with the nursing home about different treatment options.

    Because hospice care provides comfort at the end of life and does not involve curative treatments, nursing homes make far less money on providing hospice care to their residents than other treatments such as physical therapy. Not surprisingly, researchers found that for-profit nursing homes in particular tend to steer away from delivering hospice care. Rather, these nursing homes provide a large number of therapy services—high volume at great intensity—to their dying residents, which generates more income.

    Over the last few years, a number of studies have found that for-profit nursing homes may not be providing as good care as non-profit nursing homes. A Kaiser Family Foundation report highlighted the many issues with chain nursing homes, which people should beware of. Another study found that Medicare Advantage plans were more likely to steer their patients to for-profit chain nursing homes. Yet another study revealed that Medicare’s nursing home ratings can be misleading and that you should not assume a five-star rating means good care.

    The JAMDA researchers studied care provided to nursing home residents in New York State in the 30 days before they died. There is every reason to believe that nursing homes in other states behave similarly to those in New York. The financial incentives are identical.

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