By: Yaffa Liebermann, PT, GCS, CEO
1975-1978 Homecare in Haifa, Israel
I started my adventure in homecare which I see as a must for every therapist. During these years, I gave birth to our daughter and our son. I had the opportunity to work with patients in their home environments and help them tackle their activities of daily living. In patients’ homes, there were varying surfaces and obstacles. One patient had difficulty walking on his rocky driveway; one needed assistance to walk over the threshold; one had difficulty entering his bathroom; another had difficulty getting in and out of bed. Each one needed personalized directions: If there were tight corners in the home, then I would focus on standing balance and pivoting. With all of my homecare patients, I focused on increasing strength and tolerance/duration.
I was fascinated by getting to know the caregiver/family and how that caregiver’s positive or negative tone impacted the patient’s motivation and recovery. Some patients had supportive families who encouraged a faster recovery while other patients lived alone. I was able to see the importance of receiving thorough treatment in acute/subacute settings and how that translated into preparation for being discharged home.
Dealing with the harsh reality of homecare:
When I worked in the hospital and in the outpatient setting, I only saw patients for up to an hour before they went home. I did not get very involved with their family life and did not have a true sense of their financial status. When I entered homecare, I saw the harsh realities of living alone in recovery, living in poverty, and living with chaotic or miserable family members. I was not prepared for that. In school we had only learned about muscles, joints and body movement. We did not learn about how mental health and the environment can greatly affect treatment and recovery of patient, and therapist.
The importance of using your judgement:
One of my homecare patients was a 20 year old male who broke his pelvis and had a cast starting below his ribs reaching down both legs and ending above his knees. During one of our early sessions, we were practicing walking and I noticed that he was becoming fatigued. I started to direct him back to his room so that he could rest, but he insisted on walking further. I imagined with fear what would happen if he fell on the floor. He would have surely broken another bone. I prayed to God to help us.
As he continued to walk, he quickly became very pale. I started yelling at him to breathe deeply and not to faint. My screams helped rouse him and we were able to walk back safely to his bed. I learned two things: The high decibel of my voice helped to keep his blood pressure up & I needed to trust my instinct from then on. If I, the therapist, think that it is too much for the patient, then I need to use my judgment and stop the treatment.
Old age is just a number:
During a homecare session, a patient’s wife said to me, “I am 83 years old; you can see my wrinkly skin and my weak muscles, but my feelings are still the same as when I was 20 years old. I like attention, I want to be loved and I am very sensitive.” I felt honored that she shared that with me. This became my guideline when treating the elderly: They are old in their body but young in their heart.
Our muscle memory:
Another homecare experience of mine that left a strong impression was with a 65 year old female who was recovering from a right hip replacement. We practiced PNF and weight bearing exercises for all of her leg muscles. She was very energetic, followed instructions and performed all of the exercises that I gave her. She did not progress – her right leg muscles did not gain any strength and she did not bear weight equally while walking. I was frustrated and started to feel like a failure.
One day, I asked her to tell me every activity she did during the day. When she described her pool activity she said very proudly: “I’ve been swimming for the last 63 years of my life, and since my surgery, I have been swimming laps without moving my right leg.” A light bulb went off. I asked her with curiosity, “Who told you not to move your right leg while swimming?” She replied, “My friends in the club.”
This was the secret that was holding back her rehabilitation. For her entire life, she went to the pool and swam 80 laps a day. However, since the surgery, she followed her friends’ advice and kept her right leg still while swimming. I explained the necessity to re-incorporate her right leg into her swimming routine, as she was doing prior to surgery. Within one week, she gained her strength back and was discharged from therapy.
Learning experience: We need to learn what the patient was doing prior to his injury and incorporate that movement into his therapeutic exercises. As therapists we always help the patient to get his strength back and adapt to the environment.
These stories above are some of my highlights from homecare. In the next blog, I will tell about our experience moving from Israel to Virginia.