19 Jul Does Physiotherapy have a place in Care Homes?
There is a lack of recent data to estimate the number of care homes that offer regular physiotherapy input outside of the NHS. The last survey which showed that across 274 private care homes in the UK only 10 % of them had regular physiotherapy input. This was recorded in 2001 and we have undoubtedly seen an increase in these figures as care homes become more competitive in a growing market as the population continues to age. Some care home managers are proactive and provide regular physiotherapy for their residents so that they are maintained instead of waiting until their resident’s mobility decreases.
According to Age UK, 1 in 3 people over the age of 65 fall at least once a year. Falls in the elderly can lead to loss of confidence and fearfulness, broken bones requiring operations and lengthy hospital stays. In fact, many people end up being looked after at a care home as a result of a serious injury after a fall or after a series of falls.
We know the importance of a multidisciplinary approach in management of falls in the elderly and many care homes have their own set of policies and practices on falls prevention in place. The NHS even set up a group called Care Home Support Services which includes a team of nurses, physiotherapists, Occupational Therapists, health care assistants and mental health specialists. They ensure that care home residents get support from the team after a fall or during sickness to unsure people stay healthy and out of hospital, or by helping them get admitted to hospital at the right time and help coordinate their discharge out of hospital and back to their care home.
However, this service although quick, mainly focuses on assessments so that appropriate referrals can be made to other NHS care services. For example, their physiotherapist will assess someone’s mobility after a fall and make some one-off suggestions and then refer them to the local domiciliary physio team to carry out the rehabilitation exercises. Sadly this service is slow due to lack of resources and people have to wait a long time to get regular physiotherapy input, and the frequency, duration and intensity varies greatly.
Some people may not see the need for regular physiotherapy input in care homes as people go there to be looked after, and the main reason they are in a care home and not at home is because they can no longer do things by themselves. Therapies on Thames has been working in local care homes in Berkshire and Oxfordshire since 2012 and have recently been providing regular input at St David’s at The Priory in Ascot. We have found that physiotherapy and Occupational Therapy intervention in care homes can make a significant impact on the quality of life of the residents.
There are 4 scenarios that we commonly come across and help people with when working in care homes.
Scenario 1 is that a resident can no longer perform a physical activity or task due to a deterioration associated with age or after an illness or hospital stay. The nurse reports that Mr Smith used to walk to the dining room with the frame and supervision of one carer. Now he is struggling to stand and can’t walk and can only transfer to the wheel chair and be taken to the dining room. His mobility worsened after a recent chest infection. Our input would be to help Mr Smith regain his previous level of mobility and independence with the frame.
Scenario 2 is working with residents with long term health issues. For example, a resident may have had a stroke 5 years ago and is bed bound and requires a hoist transfer to get into a specialised wheel chair. This person may not have rehabilitation potential, or the capacity to walk again or live independently. However, we can provide ongoing maintenance support to help stretch out their limbs that they are unable to move and help the staff sit them in the best position in the wheel chair. Another example would be to continue to practice walking with a frail resident in the hope that our input will help them to remain mobile and healthy for as long as Possible.
Scenario 3 is working with local hospitals to identify people who are less mobile and want to recover in a place where they will be looked after and offered rehabilitation. These people will stay in the care home for 2-6 weeks and be offered respite/rehabilitation and will aim to achieve certain goals independently before they can go home.
Scenario 4 is work closely with the care home themselves to provide a holistic service that looks to provide proactive solutions to clinical governance related topics. For example, we may assist the home in purchasing the right manual handling slings for the individual care needs of each residence or offer staff training on moving and handling for some of their more complex residents.
By working closely with the managers, nurses and carers at St David’s, we have been able to help provide excellent quality of care by taking into account the mobility needs of their residents. We have been able to review a number of things including; seating and wheel chair improvements, hoist and sling advice, splinting ad posture management, advice and training to staff and to provide regular exercise and mobility practice for their residents.