In a skilled nursing facility, the focus is often on function to get the patient back to his home environment. We work on gait safety, fall prevention and strengthening activity to achieve the patient's goal of going home. Shouldn't we be more focused on the patients function so he can perform ADLs and mobility with less risk of falls?
For a joint replacement, I understand the need to go through the exercises and assist with restoration of mobility and initiation of muscle activity. However, those patients who come in related to weakness, confusion or multiple falls in the home would seem to benefit more from something they can actually take with them when they leave -- besides a three-foot-long yellow exercise band and a faded copy of leg exercises.
If I have a patient doing supine leg exercises, I can justify my time with the patient and explain how each exercise directly relates to gait, transfers and increased performance when the patient is mobile. But when put into practice, doing 10 short arc quads is not necessarily going to make my patient any safer at home on the way to the bathroom when it's 2 a.m.
Wouldn't it be wise for therapy to assess a patient's gait when he is most vulnerable to falls? I'm proposing a 24-hour physical therapy department. Three eight-hour shifts, and the focus of the therapy is all about safety and function to ensure the patient safely returns home. Don't MDs and nurses work the night shift? Why should it be any different for the other allied health professionals? If we see the patients when they have the most energy (during the day) and are alert, how are we supposed to truly assess their functional deficits?
We could have the nurses alert us when one of the patients requires assist to use the bathroom, for example. What better way to assess transfers and gait than when the patient is half asleep and more apt to fall, especially in an unfamiliar environment?
There are patients who fall in the hospital and SNF settings because skilled professionals aren't available to assist them with safe mobility. I'm sure a therapist's presence could reduce the number of night falls in a healthcare setting, plus our time is reimbursable. We could specialize in units that care for patients who don't recognize the difference between day and night. I have not seen any rules that say therapy can't be done on an 11 p.m. to 7 a.m. schedule.