Dear Friends and Colleagues,
During this unprecedented time, I wanted to check in with you and share some observations and tips on remaining healthy. I’ve had many conversations with friends and family about how they are handling the impact on their lives from COVID-19. One positive, is that some people are slowing down from crazy work schedules and participating in family activities they have not enjoyed in years.
Sharing jokes is a way of cheering each other up and commiserating. In jest, one of my clients isolated to his room at an assisted living facility, told me how “lucky” he was to leave his facility for dialysis three times per week, while the other residents were on “lockdown” in their rooms.
This is a challenging time for many. A client I’ve known for many years (“Susan”), has a neurological disease. She is dizzy when standing, dependent on oxygen, and only able to walk short distances with a walker. Susan, having not been out of her apartment, has only seen her caregiver, as she is “high risk.” With only limited calls to family and friends, Susan spends more time sleeping, versus outings she used to make with friends in her wheelchair. When speaking with Susan, it was evident she was depressed. She was also confused, something I have not observed in the years I’ve been treating her. As a practitioner, I consider the link between mental, emotional, and physical well-being. This is discussed more in Tackling Challenges from Social Isolation. Ideas are presented in Ways to Stay Engaged When Socially Isolated.
Instead of heeding social isolation recommendations, Susan requested I resume treating her. In addition to her neurological disease, she has severe arthritis in her knees and shoulders, which had been causing increased pain. Ethically, I was torn. For years, I’ve had the luxury of going into peoples’ homes, using touch to manage pain and facilitate normal movement, to improve the quality of their lives. Now, those methods of treatment may endanger a person’s well-being.
While Telehealth may be an option for some, it was not a feasible option for Susan, as she literally requires a “hands-on approach.” One of the benefits of Home Health Physical Therapy is prevention of hospital admissions, which is even more significant now. Home Health Physical Therapists decrease hospital readmissions by 84% by evaluating, treating, and preventing medical problems from becoming serious. Read more about this in Why Choose a Home Health Physical Therapist Now.
These circumstances have caused me to reflect on how to provide a crucial medical service with the same quality of care, while safeguarding my clients’ health. New policies and procedures needed to be implemented. Currently, the therapists at Home Health Boutique have no known exposures to COVID-19, and will not treat clients if they demonstrate any symptoms. Refer to Home Health Boutique’s Model for Safe Home Treatment. This model will evolve as necessity requires.
My final comment, as a physical therapist, is to reinforce the importance of exercise. I walk, and perform yoga and Pilates. I’ve put together a short video to give you a stretch and relaxation break. Please feel free to email or call me with any questions/comments, or to say hello.
Warm regards,
Dyan
Tackling Challenges from Social Isolation
by Dyan Chaney, DPT, MPT
As we continue to follow the news, we have a clear understanding that social distancing is key to containing the COVID-19 virus. While scientists are rushing to understand how the coronavirus works, two words describe the unintended consequences of social distancing: isolation and uncertainty. Loneliness from social isolation can take a toll on the body. People who do not feel connected to others are more likely to catch a cold, experience depression, develop heart disease, have lower cognitive function, and live shorter lives.1
Since seniors have a higher risk of experiencing more severe COVID-19 symptoms, they have more stringent isolation recommendations. Therefore, they have a greater chance of being afflicted with the adverse effects of social isolation. Many residents in senior communities have been instructed to remain in their rooms. Meals are delivered, and friends and family have not visited in several weeks. Some of my clients have confirmed these experiences. In many cases, their isolation has led to inactivity, and reported increases in pain, weakness, and unsteadiness.
Risk factors associated with dementia, including age, genetics, and diabetes, are unavoidable and difficult to control. However, according to the World Health Organization2, risk factors such as social isolation and lack of cognitive activity, are controllable. So, while social distancing mitigates exposure to the COVID-19 virus, it negatively impacts cognition and mental health.
The good news is that physical activity and exercise have been shown successfully treat both depression and dementia. Physical activity and exercise also help prevent cognitive decline in those where none is present, and may reduce further progression in those with only mild cognitive impairments.3 Physical activity is different than exercise; it is defined as any bodily movement that results in an energy expenditure. It includes household activities, sport, and recreation. Exercise falls under the general term of physical activity, and consists of structured and repetitive movements. Exercise is preferred, but some movement is better than none!
Home Health Physical Therapists are the ideal health professionals to design and implement exercise prescriptions. Refer to Why Choose a Home Health Physical Therapist Now, and Ways to Stay Engaged When Socially Isolated in this newsletter.
Why Choose a Home Health Physical Therapist Now
by Dyan Chaney, DPT, MPT
While our way of life has recently changed, you might be considering who you should consult when you or a family member needs medical attention. You might have even considered Telehealth. Telehealth, as defined by the American Telemedicine Association, is “ the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” While Telehealth can address some medical issues, there are drawbacks.
A client has to have the equipment (computer or phone) and aptitude to access this care. Also, hearing, vision, and cognition have to be sufficient to receive the medical information. There is also the assumption that any underlying mental impairments won’t prevent a patient from processing and implementing medical advice.
In addition to the above limitations, touch, essential to a Home Health Physical Therapist’s practice, is eliminated when using Telehealth. A patient is touched to assess if they have a fever or if sensation in their feet is diminished. A patient’s leg is tapped to provide cues to facilitate normal movement patterns. A patient is physically supported when they are being retrained to ambulate. And finally, patients are often lonely and appreciate the comfort touch provides. Studies performed by the University of Miami’s Touch Research Institute demonstrate that touch lessens pain, lowers blood glucose, heart rate, blood pressure, and improves immune and pulmonary function4.
One of the main objectives of Home Health Physical Therapy is to prevent hospital admissions. A study with over 1,300 subjects, performed by Wang et al, demonstrated that having Home Physical Therapy decreased hospital readmission rates by 84%5.
Preventing hospital admissions is critical because of concerns of contracting infections not directly related to the cause of hospitalization. Examples include pneumonia, urinary tract infections, or even COVID-19. In addition to this concern, there is evidence in literature indicating that the hospitalization of seniors can lead to functional decline, inability to perform normal daily activities, and death6.
Home Health Physical Therapists minimize hospital admissions by addressing medical errors with medications, ensuring that a patient is functioning safely in their home, monitoring vitals, preventing falls, managing pain, providing helpful resources, and promoting healthier lifestyle decisions. Minor medical issues can be identified and communicated to a physician before becoming serious or life-threatening.
So, the burning question is how do you treat an at-risk population while mitigating exposure to COVID-19? Home Health Boutique has implemented a Model for Safe Home Treatment, which is presented in the next article.
Home Health Boutique’s Model for Safe Home Treatment
How do you know that your medical provider is providing the safest methods possible to deliver care? Because COVID-19 is unlike any virus we have experienced in recent times, it is necessary to refer to sound evidence from the CDC7 and OSHA8 dealing with similar viruses (e.g. SARS). This evidence and information that is currently being discovered about COVID-19, is used to implement procedures to treat patients safely. Following, is the current model Home Health Boutique is using:
Ways to Engage Those That are Socially Isolated
- Play familiar music/ Sing/ Clap Hands/ Dance
- Simple Exercise (e.g. performing sit to stand 10 times)
- Ideas using Zoom or streaming
- Musical concerts and talent shows
- Religious services/classes
- Exercise Classes
- Magic tricks
- Deep Breathing/ Meditation/ Yoga
- Chair boxingToss a ball
- Phone Calls
- Share recipes
- Tell jokes
- Items to drop off:
- Coffee from a favorite shop
- Books
- Crossword puzzle books
- Groceries
- Send a letter via snail mail
References
- https://www.scientificamerican.com/article/how-to-prevent-loneliness-in-a-time-of-social-distancing/
- https://apps.who.int/iris/bitstream/handle/10665/312180/9789241550543-eng.pdf?ua=1
- https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
- http://pediatrics.med.miami.edu/touch-research/research
- https://www.jamda.com/article/S1525-8610(18)30601-7/abstract
- (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422456/
- https://www.osha.gov/Publications/OSHA3990.pdf
- https://www.cdc.gov/coronavirus/2019-ncov/index.html
Great newsletter! If you want any articles on how to find private duty care, advance directives, etc let me know. I will send them to you. We all need to work together.
Thank you! I think that’s a great idea!