Physical Therapy and Aging Parents

Transcript of Interview: “Physical Therapy and Aging Parents”

Mike Barnes:

You know, I think as we all get a little bit older, things start to slow down a little bit. If things happen to us, we need to have rehabilitation to stay at the top of our game, even when you are getting up there in the United States.

Kim Barnes:

Yeah, and today we have Jason Decesari from Fox Rehab to talk with us. You are a physical therapist, and you are very passionate about the fact that just because you get older doesn’t mean you need to slow down.

Jason Decesari:

I am. As you said, we’re all getting a little bit older day by day, and I look at it from the perspective of where I want to be when I reach my 70s, 80s, 90s. I think we have a responsibility to hold ourselves accountable to that for our loved ones, too. I think the old days of getting older meaning sitting in a wheelchair or using an assistive device and honestly being unable, I think, are gone. And I hope so for my own sake and for everyone’s.

Kim Barnes:

A lot of times, if your parent breaks a hip or has a stroke, those are things that you automatically assume will involve some physical therapy, occupational therapy, maybe speech therapy. But those are the kinds of things we typically think of when our parent needs physical therapy or some sort of rehabilitation.

Jason Decesari:

Absolutely. And they absolutely do in those cases, but I think where we need to make a change is being more proactive in the rest of healthcare. Caring for a loved one who’s aging means recognizing the small changes and then advocating for them with their physician or whoever may be involved in their care to get them the care they may need. Noticing things like having more trouble getting up and down from a chair, those little losses of balance—it’s really easy to put off and be like, “Oh, well, it happens, but Mom caught it, it’s okay.” Those are things we can objectively test to measure their likelihood of a fall or hospitalization in the near future and identify it before it happens so they get to maintain not only quality but quantity of life. One of the big predictors of a decline in quality and quantity of life is a hip fracture. We know after someone falls, they’re more likely to pass away in the next year, unfortunately. We need to intervene before then, not after.

Mike Barnes:

Yeah, my dad had COVID a couple of years ago, was in the hospital for three days, and I’m a big fan of rehabilitation because I saw how weak he was after that and how much stronger he got because of going through a little bit of rehab and physical therapy. Walking around the independent living place where he lives, always taking the stairs up to the second floor, it made him stronger, and I’m a big fan because of that.

Jason Decesari:

Well, COVID has exacerbated a lot of the role of rehabilitation more so than anything I can think of in the past. It’s contributed to isolation, and when folks are isolated, they’re less likely to be active. Folks were scared, they sat in their room in independent living because they didn’t want to catch it. It’s scary, and what happened is they used to walk to three meals a day, participate in activities, and do all these sorts of things that kept them well. They didn’t, and we saw them decline even more. Then, God forbid they did get COVID—afterwards, that was a trauma on their whole system, and with that, they lost strength, endurance, and balance. Rehabilitation can help with that and give people that life back.

Kim Barnes:

As the adult child, as we’re watching our parents, and I love that you said to watch for those small changes—if they’re having trouble getting up or those kinds of things—how do you know when it’s time to suggest that they might need some physical therapy or occupational therapy when it’s not because of something specific?

Jason Decesari:

For me, it’s anything that is causing a change in their abilities. I’m a physical therapist, so I always speak from the perspective of a PT, thinking about things like balance, strength, and mobility. But occupational and speech therapy as well—are they having trouble doing their activities of daily living? Are they having trouble with memory and recall, producing language, or swallowing? Those sorts of things indicate a need to at least have the conversation. I’m a big believer in asking because you might find out that it’s not necessary, but you might find out that it is. I have a really great relationship with my own primary care physician. I advocate people finding one that they actually get along with and like because then it’s a comfortable conversation to say, “Hey, I’m a little bit worried about this. Do you think we should do something?” The squeaky wheel gets the grease, right? If you don’t bother to ask, you’re not going to find out if there’s a need. Hopefully, you’ll get some reassurance from that person that you don’t need it, but if you do, hopefully, by asking, you get it earlier, not later.

Mike Barnes:

Any suggestions for what we do if our aging parents are a little resistant to this? If they aren’t motivated to get better, walk better, or get up better, how do we get them to enjoy rehab?

Jason Decesari:

That’s the hardest part of what I do. I always joke and say, in choosing a path in healthcare, I chose one of the hardest ones because my intervention isn’t a pill or an injection. It’s not anything easy. I have to get buy-in and get the person to want to do it. For me, it’s about understanding what that person actually cares about. I think the mistake that clinicians and therapists make is setting goals for the patient: “I want you to walk 500 feet, I want you to do this.” Who cares what I want? It’s not about me; it’s about the person sitting in front of me. I’m very much focused on finding something they actually care about on day one. One question I ask every patient I work with on the first day is, “Tell me what you want back. What is the most important? What will success in our plan of care look like?” If you do that, I think it’s a lot easier to get buy-in. For you, as the person caring for a loved one, it’s knowing that loved one and saying, “Dad, you really used to love to go to my daughter’s soccer games. You aren’t able to do that now because you’re nervous to walk on the grass. Why don’t we get someone in here to help with that?” Or, “You love to participate in the gardening club at your independent living. Well, you’re not doing that anymore because you don’t have the endurance to get there. We can help you get that back.” It has to be real. When we make these goals that are 13 steps with minimum assistance on a unilateral railing, that’s great for the therapist but not meaningful to the patient. It has to be real.

Kim Barnes:

Let’s go through the process. If we do see Dad not moving very well or see Mom not getting up very well, what’s the first thing we need to do to get you helping them?

Jason Decesari:

If you’re within the Fox footprint, which we cover older adults in 24 states currently, mostly the East Coast, working our way southwest and northwest, you can go to our website. There’s a referral request link where we will do all the follow-up, reach out to your doctor’s office, and all of that. If you’re going to work with somebody else or if you’re somewhere we can’t serve, I would say the first step is calling the doctor’s office and saying, “Hey, I have some concerns about my loved one’s ability to move around. Would love to try some therapy for them. What do you think?” The nice part is, because we’re not an opioid or a controlled substance, physicians are pretty willing to refer their patients to us. At the end of the day, who doesn’t need more exercise? I know I do, and I do it for a living, so that’s kind of embarrassing. Every January, I make the same decision everyone else does: gotta get back on it. For the most part, people know about the benefits of exercise and are willing to have it if someone is willing to bring it to that patient.

Mike Barnes:

Start with the doctor, and then they would give you the referral or whatever you need to be able to get it?

Jason Decesari:

Absolutely. With our footprint, we can facilitate that for you. We have a team that will go to the doctor’s office and talk about who we are and why we’re there. But if you’re outside our footprint or have another provider you’re comfortable with, you can start by touching base with a physician.

Kim Barnes:

Does the doctor usually refer you to someone, or do you have to find them yourself?

Jason Decesari:

It depends. Some doctors will have someone they have a strong relationship with and have had success with in the past. Others will give you a list of 12 or 15 people and say, “Here, pick one. Doesn’t really matter.” It depends on the situation. Regardless, do your own research about the person you’re going to use. Often, a physician’s office will have a great relationship with a provider group, but maybe they do predominantly sports orthopedics. For your loved one who’s an aging adult, that might not be the best provider. Don’t be afraid to do a little research and take that prescription for therapy where you feel comfortable.

Kim Barnes:

This is definitely a proactive approach to physical therapy or occupational therapy. What about situations where parents have had a fall or stroke, are being prescribed physical therapy, and aren’t wanting to participate? They may be in a rehab community or even back in assisted living, and when the physical therapist comes in, they’ll ask if they want to do physical therapy. If they say no, they say okay and leave. After a couple of times, they just say, “Well, they didn’t want to do the physical therapy,” so they end it. How do we advocate for our aging parents to get their buy-in, and how do we help the therapist know here might be a different approach for our parents?

Jason Decesari:

For starters, the fact that you’re a professional at this stuff came out there. You immediately talked about your role in that. That would be my answer: you have to take an active role in your loved one’s care. Teach that clinician what works for them, what motivates them, what they care about. Be a part of it outside the therapy sessions. I tell my patients all the time that the two or three hours I spend with you a week is nothing compared to the time you spend without me. What you do when I’m not here will always outweigh what you do when I’m here. It’s about making sure the goal is tied to something that matters to that person. It takes a village; everyone involved in that person’s care has to be involved. If they’re in assisted living or independent living, talk to the community members about how they can help. If they’re in their own home, check in, send a text, use an Echo Show to see how they’re doing with their exercises. It’s the little things that make it go right. It’s a family approach; we all have to be a part of it if we want the person to get the result we’re looking for.

As providers, we have to take responsibility. Unfortunately, we’ve all heard a story like what you said. We have to do better. Clinicians and therapists are like everyone else: we’re on a bell curve. There are great ones, not-so-great ones, and everything in between. We have a responsibility to give that person the ultimate opportunity to get better, take the time to understand what motivates them, and help them get back what matters. Our outpatient house calls model fits in because under the traditional home health model, there are times when they can’t continue if the person doesn’t immediately participate and demonstrate progress. In the outpatient setting, we have more flexibility to figure out what motivates that person and understand that, for example, with someone with dementia, we might have a day where we take a step backward, and that’s okay. We’ll come back tomorrow and figure it out.

Mike Barnes:

Long-winded Jason Decesari, some great tips and answers today. Thank you so much for helping everybody.

Jason Decesari:

Thanks for the opportunity to talk to you.

Mike Barnes:

I think we learned a lot here.

Kim Barnes:

Absolutely. You have to be proactive and ahead of the game to keep those aging parents going and help find out what really motivates them. That’s so important. We forget that it’s not just about saying, “You need to,” but understanding why they want to. We all have different personalities, so different things motivate each one of us.

Mike Barnes:

If you’ve got any topics you’d like us to discuss with an expert here, let us know at Parenting Aging Parents.

*This transcript is auto-generated. Please excuse any typos or mistakes.