The Mind of John Baker

Successful Outcomes in Home Health: Sometimes It Takes More Than a Great Clinician

Posted in The Mind Of John

Sometimes it takes a village.

I recently treated a client who made tremendous progress and experienced very successful outcomes.  It’s a great example of how family involvement can facilitate positive changes with only a few helpful, yet firm, recommendations.

An elderly woman with a history of Parkinson’s disease was referred to home physical therapy by her physician due to multiple recent falls.  She had already had therapy in the home before, but still she continued to fall.  During my first visit to her home, it was immediately clear why she kept falling.

Her house was cluttered- not to “hoarder” status- but so full of furniture and piles of stuff that neither her rolling walker nor rollator could fit through some of the passageways.  Without being able to use an assistive device, she relied on furniture and walls for stability. She also demonstrated some impulsive behaviors, common in many neurodegenerative diseases, which only increased her risk of falling.

I knew that the only way to achieve positive outcomes in this situation was to modify the environment, and that was going to require the family’s help.

I posed the options to the client and family clearly and gently, “Unless this house is decluttered and cleared out, she will continue to fall.  This will lead to a downhill spiral in her general health that could have been prevented with a good spring cleaning.”  I told the family that I couldn’t help her unless her environment improved.  I walked through the house with the family, questioned the necessity of each chair, table, and ottoman, and suggested that anything that wasn’t regularly used be moved to the garage.   These items were largely valued for their sentimental meaning, not for their practical significance.  I told them that on my next visit I expected a clear path into each room on both levels of the house, with wide-open, accessible spaces in each room.

On my second visit, I was pleasantly surprised to see that my recommendations had been followed.  My client was able to use her rollator to travel safely from room to room.  She had space to turn around and navigate around corners and obstacles.  Her risk of falling had been largely mitigated.

On my third visit, I taught my client how to enter and exit the house.  I instructed her how to navigate the three steps to the front door.  I also taught her techniques to alleviate “gait freezing”- the phenomenon that occurs in some people with Parkinson’s disease where they have trouble initiating movement.  She was able to independently use these strategies whenever she got “stuck” and get herself moving again.

On my fourth visit, my client was able to show her family her newfound sense of independence.  The family was amazed at how stable she was when she used her rollator, how easy it was for them to help her enter and exit the home, and how she was able to “unfreeze” herself without falling.

I was most pleased that this level of achievement was accomplished in only four visits, and that the successful outcome was directly correlated to her family’s willingness to make hard decisions and implement changes.  Sometimes just helping people view a lifetime collection of sentimental items as just “stuff”- stuff that gets in the way of leading a safe, productive life- is the best way to be of service to our clients.

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Dr. John Baker | CEO, PT, MA, GCS, NCS, NDT, DScPT
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