The emotional toll of a medical diagnosis can add another wrinkle to an already stressful circumstance. In particular, when declining health makes favorite or even routine activities seem out of reach, patients may spiral into depression. For family and caregivers doing their best to help, a once-vibrant person can seem to become someone totally different, presenting added physical and emotional barriers to their loved one’s well-being.
Read on to discover how Occupational Therapist Mary, as part of one patient’s Residential Home Health care team, discovered and remedied medication errors that were causing debilitating headaches, implemented a specialized exercise program, and worked with family to create a safe and comfortable home environment — all of which helped a depressed patient return to her lively self.
Mary discovered that her new patient, who had been diagnosed with Parkinson’s disease, was staying in bed most of the day with the shades drawn. The patient’s family knew her to be a vibrant, active woman, but she had become increasingly depressed. According to the patient, she remained in bed because of severe headaches that were aggravated when she stood up. However, staying bed-bound was causing her strength, balance, and activity tolerance to decline.
Safety concerns and compromises
The priority of Mary’s initial plan of care was to improve safety within the home (a one-story condo where the patient lived with her husband) and decrease fall risks, identifying what could be done to encourage the patient to get up and participate in meals, conversation, and other activities of daily living. She was able to identify and then address three chief concerns.
Concern: In the patient’s bathroom, the toilet seat and shower chair already in place would not provide adequate safety and comfort, limiting her access to the commode and shower.
Compromise: Mary consulted the tablet she uses for patient care in order to access a number of catalogs from medical supply companies, letting the patient choose from numerous grab bars and elevated toilet seats that would be most beneficial. In collaboration with the patient, her husband, and the rest of the Residential care team, Mary was able to create a safer and more comfortable configuration, installing new equipment and adjusting the existing shower chair to the satisfaction of both the patient and her husband.
Concern: At major entrance ways and near the patient’s bed were several scatter rugs, each of which posed additional risk for slipping and falling.
Compromise: With the patient’s input, Mary was able to relocate the scatter rugs, finding places where they could still be seen, but were no longer immediate fall risks.
Concern: The patient’s husband was ill himself and required supplemental oxygen, with tubing that was very long and often directly in the pathway between the bedroom and the rest of the home.
Compromise: The husband was adamant about keeping the cord length and preserving his own mobility, and the patient similarly did not see this as a problem. Mary took the time to discuss this safety concern in depth, and they eventually arrived at a team-wide compromise: the cords were moved off to one side, and Mary as well as the Residential Physical Therapist provided additional instructions on maneuvering and cord management, equipping the patient and her husband to successfully keep their pathways clear.
New exercise practice
The patient’s Residential Home Health care team, including Mary and her Physical Therapist and Registered Nurse, also considered whether the patient might benefit from Lee Silverman Voice Treatment (LSVT), a proven, specialized program that can help patients with Parkinson’s disease or other neurological disorders walk and talk to their fullest potential. The patient appeared reinvigorated and engaged while performing the LSVT exercise routine, and as she progressed in the program, she required less and less physical assistance and verbal cueing.
As an additional measure, the team recorded a DVD of Mary and the patient completing the LSVT exercises according to protocol. The patient’s husband could hardly believe that after several weeks, she would come out of her bedroom without any encouragement, play the DVD, and practice the exercises with him or their daughter, even on days without a scheduled therapy visit. Over time, she committed the routine to memory and was extremely proud of her ability to perform her exercises without being prompted.
As the patient progressed, Mary was able to incorporate the LSVT program into kitchen and laundry tasks as well. The patient could stand at the sink and put away dishes, keeping one hand on the counter for support. And although she left the task of washing clothes to her daughter, she began using LSVT strategies like BIG, larger-amplitude movements to fold the clean clothes, moving them from one basket to another while in a seated position.
Medication red flags
In the course of routine care, the Residential team discovered a red-flag issue: a significant number of the patient’s medications had expired, several as long as a year before. One of these medications was prescribed to control the patient’s severe headaches, which were preventing her from getting out of bed; another was prescribed to control her blood pressure.
The team pointed out the problem to family members and physicians, who were able to arrange a follow-up visit with the patient’s primary physician, resulting in an update to her prescriptions.
Within one week of discovering the expired medications and updating the prescriptions, the patient’s headaches and dizziness dissipated, removing another barrier to getting out of bed and performing everyday activities.
In a very short time, after proper training and practice facilitated by the Residential care team, the patient regained a significant amount of independence and could safely get in and out of the shower and on and off the commode. What’s more, she would routinely sit at the kitchen table for all three meals to eat and converse with her husband.
The benefits of the work done by the Residential care team were clear to the patient’s husband, who repeatedly expressed to Mary how happy he was with the results. Whereas a previous home care agency “came in and worked like robots with no genuine concern or care” for his wife, he said, “the Residential team went above and beyond in their care.”
Through the entire course of her therapy, the patient was never readmitted to the hospital and met each and every goal set in her plan of care. Both her husband and her daughter felt that their wife and mother from years past had returned. She was back to truly living, participating in a more engaging and healthy life.
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