YOUNGSTOWN, Ohio – Physical therapy services for nursing homes, assisted living campuses and at private treatment centers are doing their best to make adjustments as COVID-19 continues its rampage across the country.
While therapists have had to adapt to new protocols such as wearing masks, social distancing and delivering rehabilitation services amid quarantine, some are noticing patients with conditions brought on by a sedentary lifestyle since the pandemic hit in March.
“We’re seeing a ton of neck and back pain as a result of the home office,” says Stephanie Porter, a physical therapist at Ohio Sports & Spine Institute in Boardman. More companies are encouraging employees to work remotely if possible in an effort to suppress the spread of COVID. But, those accustomed to working in an office with ergonomic chairs, tables or desks have found it hard to physically transition to working at home, she says.
“People are sitting in these horrible postures. They’re looking down all the time at their laptops,” Porter says. “I think that’s the thing I’ve seen the most – neck and back pain from people who are sitting at their computer longer than they’re used to.”
Repetitive motion and posture is often the culprit behind pain and stress on the body, Porter says. Poor posture over an extended time without stretching or mobility often leads to tension headaches, knots in the neck or a strain on back muscles, she says.
For those patients working from home, for example, Porter says she has suggested remedies such as elevating a laptop, taking measures to lift one’s legs and feet, or using lumbar support accessories on a chair to help alleviate pressure on their back. “Or, I’ve talked to patients about having a stand-up desk at home,” she says. “Having people change their positions more often to have much better posture throughout the day is huge.”
Moreover, people have chosen to remain at home instead of visiting their local gyms because of the threat of COVID, Porter says, reducing their level of activity. “With the weather changing and the pandemic worsening, we’re going to find a lot more people de-conditioned over this winter,” she says.
Which is especially concerning for older adults, Porter says. Although older men and women may require more conditioning and exercise, they’re more reluctant to patronize fitness clubs since they are part of a high-risk demographic for the disease. “They’re just afraid to go to the places they would normally go to get their exercise or workout,” she says. “Our older adults want to be active, but are tentative because they’re scared.”
Providing physical therapy for this vulnerable population has also been challenging for the region’s skilled nursing and assisted living centers, industry professionals say.
“We were forced to develop several new protocols to reduce the spread of COVID-19,” says Diane Reese, president of EDM Management Inc. EDM operates Briarfield Manor and Briarfield at Ashley Circle, skilled nursing centers that provide physical therapy services for residents.
Among the biggest changes is a halt to group therapy sessions, Reese says. “Patients enjoyed coming to the therapy gym to socialize,” she says.
Instead, therapy is administered one-on-one in the gym once a patient has been quarantined for 14 days after admission, Reese says. “This reduces the risk of spread just in case the patient was exposed prior to admission,” she adds. During the quarantine, physical therapy is delivered in the room privately.
“These isolation precautions are also used when patients have appointments outside the facility,” she says. “Patients definitely miss the interaction. But one-on-one time with their therapist is growing in popularity.”
Reese says that therapists have become more innovative in how they administer physical therapy. “We’ve become more creative with our in-room treatments to help residents engage in activities that promote progress,” she says.
Since the pandemic struck, Reese says, more skilled nursing facilities are using virtual or telehealth therapy services, which could indicate how this particular segment of health care is changing. “This does not match the benefit a patient may get from an in-person visit,” she cautions. “But, it does open up a whole new avenue for therapy services in the future.”
All of these measures are put in place with one goal in mind: patient safety, says Eric Murray, executive director of senior care and services at Heritage Manor/Levy Gardens, a skilled nursing and assisted living campus operated by the Youngstown Area Jewish Federation.
A trained physical therapist himself, Murray says therapists can provide effective treatment in a patient’s room by focusing on fundamentals and temporarily replace a rigorous exercise session with a more function-based platform. “It does challenge the therapist. But as a therapist, your job is to adapt and overcome it,” he says.
Murray says that there is no evidence that the disruption caused by COVID has prolonged patient recovery periods or complicated their rehabilitation. “It’s all about outcomes and functions,” he says.
Providing therapy services in a patient’s room has its limitations. But it also brings the benefits of singular attention to the resident, says Dan Rowland, director of marketing at Windsor House Inc., Girard, which operates assisted living and skilled nursing centers in the region.
“It’s really personalized. The therapist can really focus on them,” Rowland says. Since rooms are more confined than a large gym, therapists have adapted regimens that allow patients to receive treatment on a smaller scale that is still effective, he says.
Instead of using a full set of stairs as is available in the gym, for example, therapists can use smaller step stools and achieve the same outcome during the 14-day quarantine period, Rowland says.
“We also use bands and weights in the rooms,” he says.
Other therapy sessions concentrate on assessing the patient’s range of motion and speech while using everyday objects in the room as tools to help with their transitions home, he says.
Still, in-room therapy at skilled-nursing centers can present its set of challenges, says Danielle Procopio, director of marketing and case management at Shepherd of the Valley Lutheran Retirement Services. “Patient rooms are smaller, more cluttered. So our therapists have had to go back to basics,” she says.
That leaves most therapy during a quarantine period limited to functional exercises, such as getting in and out of bed, toileting and daily- living activities, Procopio says. “Our therapy team is learning to be much more flexible and to think on their feet,” she says. And, since Shepherd of the Valley contracts with an outside therapy service, it’s essentially limited therapists’ mobility from one Shepherd campus to another, she says.
“Traveling therapists could be agents of infection,” Procopio says. “There are so many layers to what COVID has brought.”
Once patients observe the 14-day quarantine and have tested negative for COVID, then residents can use the traditional therapy room for rehab, Procopio says. “It’s a real highlight for them since their activities have been restricted,” she says.
Using the therapy room takes a great deal of preparation, Procopio says, especially if individual sessions run concurrently. “We maintain social distancing. So we’re having to map everyone out and be careful how we schedule our day,” she says. Part of this includes allowing time for the staff to sanitize the equipment after each use, she adds.
If there is one bright spot, it’s that COVID has yielded temporary changes in Medicare rules when it comes to skilled nursing admissions, Procopio says. Normally, Medicare requires a three-day hospital stay before it would cover nursing home expenses.
“They waived that in March,” she says. As such, it’s enabled hospitals to free up room that could be used for serious COVID patients if necessary. “It’s been critical for our hospitals. It’s a silver lining to everything that’s happened.”
Pictured: Stephanie Porter, physical therapist at Ohio Sports & Spine Institute, Boardman, works with a patient to build strength and increase mobility.