I was 30 weeks pregnant with my daughter when a routine doctor’s visit uncovered the fact that a disconnected placenta had cut her off from getting food and water. Essentially, she was starving in utero. Later that same day, my girl was born by emergency C-section weighing in at just over 2 pounds.
Her early birth kicked off years of specialized healthcare and education, most of which was therapy to help her walk, talk and manipulate the tools she’d need to do even the simplest things like eat, use a pencil, and play with her toys.
I’m happy to report that today she’s a strapping 5’7” teenager who plays softball and the piano. And, while her gritty personality had a lot to do with her success, so did the physical, occupational and speech therapists working with her.
Obviously, rehabilitation therapies play a big role in helping special needs kids adapt to developmental challenges. They also play an all important role in helping frail older adults recover from surgeries and hospitalizations, maintain their ability to function, and adapt to declining functioning.
If you’re caring for an aging parent, along the way you will undoubtedly encounter therapists. Your mom or dad will be prescribed some form of therapy possibly in a variety of settings. Unfortunately, this means you’ll also have to deal with the crazy and complicated ways in which Medicare pays for therapy.
In this week’s blog, the first in a series on rehabilitation for older adults, we’ll demystify the different types of therapy and what they do.
If you’ve been wondering: What’s the difference between occupational therapy and physical therapy? Or, why does my mom need speech therapy? Or, how is physical therapy different from personal training at the gym!?, Read on….
What All Types of Therapy Have in Common
There are basically three types of therapy for older adults: speech and language, physical and occupational. They are all covered by Medicare – to some extent. And, they can all be provided in the hospital, in an outpatient clinic, at a rehabilitation facility (like an inpatient rehabilitation hospital or a skilled nursing facility) or at home (through the home health benefit).
Therapy is intended to maintain and restore function. This means that therapy can help your parent continue doing the usual daily things they normally do – or help them get back to doing these things after an accident or surgery. All therapies are focused on helping individuals perform very basic activities like eating, walking or getting in and out of a chair without help, as well as more complex activities like cooking or housework.
For everyone, this functioning is essential to independence and safety. And when someone loses functioning, they will need help from another person (or from equipment) — help to do these very basic things.
From a daughter’s perspective, therapy can be really, really important because the better your parent’s functioning, the less you have to worry, the less you have to do to help you parent on a day-to-day basis, and the less money you have to spend on services like home care aides or assisted living.
Physical Therapy
In older adults, physical therapy can help maintain, restore or increase their strength, increase range of motion, improve coordination, and reduce pain.
Some examples of older adults needing physical therapy include: Someone who has fallen and needs help recovering and preventing future falls; someone who’s had a stroke and needs to regain use of a limb that won’t work or possibly someone with a chronic condition like arthritis or Parkinson’s.
If you didn’t know better, you might confuse physical therapy with a personal training regime. That’s because the basis of physical therapy is often exercise performed in one-on-one or small group sessions. But the difference is these exercises are specially designed based on an extensive evaluation and development of a plan of care with the express purpose of achieving functional and recuperative goals.
Occupational Therapy
I’ve found that one of the biggest areas of confusion is the difference between occupational and physical therapy. Occupational therapy is concerned with developing strategies that help people interact with their environments – that is enabling older adults to participate in life despite limitations they may face.
Physical and occupational therapy are often prescribed together or sequentially, especially after a major health incident. Where the physical therapist will focus on your parent’s mobility, the occupational therapist will focus on helping them relearn some of the skills needed to perform daily activities.
The cool thing about occupational therapists is that they not only assess an individual but also their environment. This enables them to recommend changes that will help your parents do things more easily and safely. For example, an occupational therapist might suggest strategically placed handrails or grab bars. My friend and DC Daughterhood Circle participant, Lucy Stein, is an occupational therapist who is also an “aging in place” specialist. She’s trained to work with home contractors to make changes in the home environment so that, even if your parents can’t get around as easily, they can maintain their independence at home with home modifications that help them adapt to their declining mobility.
Like physical therapy, occupational therapy should be delivered under a plan of care with specific goals.
Speech Therapy
A lot of people – including those working in healthcare – don’t really understand what speech and language pathologists (SLPs) do for older adults.
If you think about it, our mouths and throats are SO important for the most basic things we need to be independent: our ability to communicate, eat and swallow. SLPs are experts in helping your parents maintain or recover their ability to do these things.
SLPs are swallowing experts. Swallowing is usually a pretty unconscious process. One you never think about it — unless you’re someone with Parkinson’s, Huntington’s, Alzheimer’s or recovering from a stroke. Then, swallowing becomes a challenge and an SLP can help suggest strategies to make it easier and more successful.
SLPs can also recommend and oversee specific exercises to help improve someone’s speech and their ability to be understood. They can also help improve overall communication skills – making it possible to better understand and respond to others. Additionally, they sometimes work with audiologists – another type of therapist who can help diagnose and treat hearing loss.
All of these therapists work in teams, coordinate with other healthcare practitioners, advocate for older adults and most are very passionate about what they do.
In the next blog, we’ll explore the different places and ways therapy is delivered and how Medicare pays. I know we have a lot of readers who are therapists and/or experts themselves so feel free to share your insights in the comments section.