Why is “Good” Home Health Care So Important?

Have you or has someone close to you had a stroke? Do you have a parent who’s been diagnosed with dementia, or a loved one who is simply getting older and has lost their ability to move well due to arthritis, aches and pains or deconditioning? There are many reasons why people can become “homebound” or even “bed-bound”, and the healthcare provided that this point is not just critical to your recovery, your mental state, comfort and wellbeing, but it can even be a matter of life and death. Finding a healthcare provider who can come to the home is easy, but it’s important to find someone who isn’t just there to do the basics, because there are many more factors to consider.

Your whole healthcare team should be monitoring various things, for example:
• are medications being taken and being taken correctly?
• Patients who are homebound, especially the elderly, are more likely to have complications with their medications. Usually they have been prescribed many meds, and sometimes by different doctors who may not know the other medications taken and therefore might prescribe a combination that is contraindicated. They also tend to forget to take their meds on the correct schedule or choose not to take them at all.
• Your healthcare provider, whether it is a doctor, nurse or physio, should be able to review medications for concerns and also identify when their patient is showing warning signs or red flags of a problem. It is also very common for these patients to develop conditions such as UTI’s (urinary tract infection) and with proper care and supervision, the warning signs should be noted, and proper tests and treatment should be done.

Another very important factor is a patient’s level of fall risk.
• Have you noticed any of your older family members, or even yourself, reaching for walls or furniture as they walk around the house for support?
• Or sometimes struggling with your vision and balance to get out of bed and get to the bathroom quickly when the urge to urinate comes at night and there isn’t quite enough time to wake up properly and safely get to the toilet?
• These factors always indicate that there is a high risk of falls.
o You may be thinking to yourself that a fall isn’t such a big deal, but for those over 50 it can often be life threatening.
o In fact, up to 58% of people who fracture a hip will die within the first year after the incident.
o This number can be significantly reduced though with proper aftercare.

So, what should a physiotherapist do to help prevent falls and promote safety and independence with these patients?
1. A physiotherapist will perform a standard physiotherapy assessment to determine what treatments they can give to help with pain relief, strengthening, flexibility, etc. They will subsequently take the patient through a progressive program with their specific goals in mind.
2. They will assess fall risk in the home.
• This means they will evaluate the flooring and other surfaces, the patient’s personal factors such as vision or bladder incontinence, balance reactions and equipment and other assistive devices already present.
• The therapist will also assess the transfers (rolling in bed and sitting up from laying down, sitting on or standing from a chair or toilet, getting into and out of the bath/shower, etc).
• They will then incorporate all of this information into a program that will train both the patient and their caregivers to decrease the risk of falls and improve their ability to do their ADL’s (activities of daily living) as independently as possible.
• They will also make recommendations for equipment and other ways to modify the home in the patient’s best interest.
o For example, they may recommend installing a grab bar in the bathroom for the patient to hold onto or a shower seat for safe bathing.
3. At PCA, our therapists don’t just make recommendations, but they can also supply the equipment and subsequently help to install it and train the patient and caregivers in its proper use.
• For example, a patient may need a toilet seat raiser if getting onto and off of the toilet is challenging because it’s too low.
• Or they may need a bed handle/rail that sits on the side of the mattress to assist in rolling in bed and changing positions to avoid pressure sores or pulling up to sit at the side of the bed.
4. Balance should be evaluated in detail. Most people as they age (already beginning in their 30’s and 40’s) tend to lose their balance reactions and their body’s ability to accept balance challenges.
• *Imagine your ability as a child to tolerate somersaults and riding carnival rides, compared to how well you tolerate those things now*.
• The average older person doesn’t realize balance is a problem, because they are always moving very carefully.
• They tend to stand bent forward with their legs far apart in a protected stance and their head down looking at the floor.
• Falls tend to occur when something happens to change these circumstances, they hear a loud noise and look up quickly and lose their balance.
o Or they are in a situation where the lights are very dim, and they can’t see their path well, leading to a trip and fall.
• Patients who are found to be at risk for falls will need to be advised on the use of an assistive device (such as a walker or a cane) and they will need exercises and training to improve their balance and gait.
5. Lastly, a therapist should be checking for vital signs, mental status and any other indicators of a health emergency at every visit.

If you feel that you or your loved one would benefit from home services, don’t hesitate to call or email us at PCA and schedule a consultation. Our physios can come out and assess both the patient and the home environment to set up a healthcare plan and advise on what to do to minimize fall risk or what equipment can help make life easier and safer.


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