Stay Frosty

Dean,

You make excellent points.  We are coming at it from different angles, but actually we'd end up in the same comfort zone (68-76 degrees).  But that 76 is going to be cool for many of those elderly clients.  My assumption was those were the patients of whom Jason was speaking.  I was brainstorming warming techniques for those who fall outside that comfort zone.

The temperature Jason said he prefers is in the comfort zone you mention (70), while the temperature he had an issue with - the temperature the clients preferred - falls 4 degrees outside the OSHAs recommended range (80).  

Still, your points on customer service are well taken and certainly need to be foremost in consideration.  Never more important than in our current economy.  We should always have our patients interests above our own, within reason.  Even when outside of reason, we still need to remember our relationship with them and make sure to weigh our decisions in light of that.

But, your note made me realize I didn't spend any time brainstorming ideas to help cool the therapist who falls outside the other end of the comfort spectrum.  The ice water is a great idea for cooling from the inside out.  There is also an option for therapists to keep cool from the outside in.  If there is a freezer available, you could keep cool packs for the therapists to use.  If you can keep your neck cool, you feel cool all over.  You can make "cool tubes" out of long athletic/soccer socks.  Fill them with rice and stitch them closed.  Then freeze them.  You make them long enough to wear around your neck (I think you may need two socks tied together).  In the ambient temp mentioned, the "cool tube" should have a cooling effect for up to 2 hours.

Another interesting note, the day after I responded to this my mom told me my sister was singing the praises of the maintenance men at her work.  She's always been hot natured.  She sweats bullets when I'm wrapped up in a blanket.  These days it is her workmate who's wrapped in a sweater.  My sister is one who will bend over backwards to accommodate others.  She tried everything to cool off, but was still sweating miserable.  The maintenance men came up with a solution - they actually reconfigured the ductwork to put a vent right over her desk.  So when cold air blows, it blows right down her neck!  She can't be cool all the time, but whenever she sits at her desk, she gets a cold blast.  Her office mate isn't any cooler, but my sister is getting maximum cooling when the air comes on.

I would have never imagined a company would do this, and this company was even more surprising - a government agency!  You'd think it would have taken 2 years of red tape to get that approved.  But they just did it.  You never know unless you ask.

Janey and Jason, it is rare that I disagree with you, but I guess there always has to be a first time. Having worked extensively in home care, I became rather used to the idea that I was in the patient's space and therefore had to respect their wishes within reason. The one 98 year old wrapped in quilts in August in New York City with all the windows closed was an exception because she endangered not only her own health, but my own. It was over 100 in her room!

Right, still haven't disagreed yet, well here goes. The patient is your customer. You will never get the temperature right for ALL of them, but you can for most of them. If you are working with older adults they are often on blood thinning medication, have decreased circulation and / or diminished temperature sensation. The environment needs to take that into consideration.

You're goal in having these individuals come to your gym is to maximize function. How motivated are you when your environment is an uncomfortable one? How likely is it that your clients are thinking more about when they can leave rather than the work they are doing? How likely are they to speak well of your practice or return for follow up visits?

As a business (and you haven't adopted an NHS back home yet, have you?) you must think about customer service. As clinicians you must think about getting the most out of your patient each session. As a former manager, I would try to find an ambient temperature (OSHA guidelines state the min/max temperatures to be 68 - 76 degrees) that please the majority of clients and staff and then allow for staff to make necessary personal adjustments like wearing a sweater or having ice water handy.

Let us not forget...the patient comes first.

Interesting topic.  I've always tended toward the cold side, until about a year ago.  Now I'm the warmer one in the crowd.  One thing's for sure - you can put more on than you can take off.

Because of this, my rule of thumb as the colder party was always to carry a sweater.  In the car I'd carry a throw.  My husband usually drives and I always give temperature preference to the one behind the wheel, so I'll cover up if it gets too cold.

For the patients, there are a few things to consider.  If I was doing bedside, it is their room so I wouldn't touch the thermostat unless they asked me too.  But you specifically asked about the gym.

In the gym, I would go a medium route to suit the majority of therapists - erring on the cool side (again, with the theory you can only take so much off - and keep your job).  The reasoning here for me is that they are coming into "your territory".  Just like I wouldn't ask them to alter their room temp for me, I expect the person who has to be in the environment all day is the one who gets to set the comfort level.  The person who is coming into the room (even if not of their own choice) is the one who needs to adapt.  You can tolerate anything for a short period.  Also, no two patients will be comfortable at the exact same temp.  You can't adjust everytime a new person comes in.  So for me, I would set the temp at a reasonable compromise for the therapists who are working in the gym.

I'd recommend to patients that they bring a sweater or jacket with them.  If your facility has blankets, I'd keep some handy.  Some places have a warmer and that will really help take the chill off for them.  If you start off cold, 20 minutes under a cold blanket isn't going to do as much as 5 minutes under a heated blanket.  

At home I use a heating pad to warm up.  If I can get my feet warm, the rest of me follows.  I didn't think of this when I was in the clinic, and you'd need to clear it with your department head, but the other thing you could try, if it isn't contraindicated, is a hot pack.  Of course it isn't therapeutic, so you wouldn't be charging for it.  But if you could find a way to allow them to access that moist heat while they are doing therapy (on the mat), then that may help keep them warm.  I know that's out of the box, but it might work.