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Toni Talks about PT Today

Not All Patients Work on the Weekend

Published March 12, 2013 4:03 PM by Toni Patt
This morning while I was walking a patient, I overheard another patient walking behind us. She was telling the CNA taking her to the dining room that she recognized me from the weekend. She was upset with me because I came to take her to therapy and she refused. Her daughter was coming later that day and she didn't want to get up.

I don't know what was funnier. She was appalled that I'd even suggest therapy on the weekend. She was also shocked that I didn't immediately understand that her daughter coming later was more important than therapy could ever be. I didn't say anything to her but wanted to. It amazes me how some people arrange their priorities.

This was a SNF. Patients are admitted there specifically for therapy. That implies they are expected to participate in therapy. I guess no one explains that to patients before they're admitted. The same thing used to happen when I worked in inpatient rehab. Patients were routinely shocked when we came to get them for therapy on Saturdays.

These are the same patients who refuse because a television show is on or they want to take a nap. I've been standing patients in the parallel bars only to have them let go of everything to answer a ringing cell phone. They're then shocked that I want to continue therapy. I had one woman who wouldn't leave her room without her cell phone. Later I'd hear her complaining that she was trying to talk on the phone when I wanted her to try to walk.

Research with animals is showing hundreds and hundreds of repetitions are needed for motor recovery. It's a given we aren't able to do enough with our patients. We don't get enough visits. We don't have enough time in the day. Entire courses are devoted to getting more out of our patients in the limited time we have with them.

I long ago realized there's nothing I can do to motivate these people. They'll do what they want. Sometimes they aren't able to go home because they didn't make enough progress. I've yet to hear one of them admit to any responsibility for that happening. So this morning I had a good chuckle to myself. I don't know if she did therapy today since she wasn't on my schedule. I'm sure whoever did have her heard how ridiculous therapy on the weekends was.


Toni, I've been working in this field for 30 years. 10 of them in SNF, 6 as a rehab manager. I'd like to respond to your essay and perhaps give some idea's to help your patients own their therapy.

1) Patients are usually placed in an SNF due to an illness or injury they had no control over. What is the first thing they lose in a SNF? Control. They may get a 5 min speech from their hospital case manager as to where they are being placed after their hospital stay, most are not told just what to expect. Some do come in well versed and know that to recover they need to get the rehab time in. If they are residents they need to know why they are having therapy, what the goals are and we need to respect that we are working in their HOME. They have every right to tell us to go fly a kite. And they have a right to know what may happen if we do fly that kite.

2) I would encourage you to use family and visitor support to your advantage. Family IS a priority to these patients. Those visits may be the thing that helps them not dive in to depression of which no amount of "motivated" therapy can help with. Invite the family to walk with you, invite them with the patient's permission to go over the exercises and have the patient demonstrate what they have learned. You can bill for that.

3) Invite the patient to own their program. Have them set the goals for the next day. "What walking distance today would make you feel successful? Can you see how this helps attain your goal of returning home?" "How would it feel to increase those reps knowing they are strengthening your legs?" I noticed you were having difficulty with your balance. We could try one of these exercises ..which of these would you like to try today. I think this one is very effective etc.

4) Cell phone. Make sure you set a good example and respect their need to have the cell by them if a family member they don't often hear from may call. They will resent you otherwise. Most of my patients will tell the caller they are in PT and will call back.

5) If they have worked all week, been to numerous appointments and have the notion in mind that they have Saturday's free that should be honored unless they are in a Ultimate high rug rate for all the right reasons. The body, mind and spirit do better with adequate amounts rest/work. We are one of the few industries that don't follow or practice what a healthy life style looks like.

6) Just a pet peeve of mine. NEVER, EVER see a patient just to get "minutes" in when seeing them on weekend is not appropriate. This is fraud and does not promote good practice. Also, don't say to the patient "I have to work with you 60 minutes today so I want you to do x,y,z. " Instead review the goals the patient has set with you and say "We have 60 minutes we can work TOGETHER today, how do you think we can best utilize them to reach your goals?".

When the patient owns their progress your job is a snap and fun and productive. Its not about us. Its about them, how they feel, and hold them accountable to their goals through our education.

Hope this helps. KJ

Karla Grimmett, Physical Therapy - PTA, Holiday Resort March 12, 2013 5:10 PM
Council Grove, KS KS

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