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The Interdisciplinary Team

The Role of a Physical Therapist

Mimi Jacobs, PT, OCS, CSCS

hysical therapy (PT) services Medicare Part B, the resident does modes, canes, walkers, and wheel-

P strive to maximize functional

independence in the assisted
living (AL) environment and com-
not have to be homebound. The
goals of this type of PT are to max-
imize the daily function of the resi-
chairs. Such equipment can help
maximize a new, independent, and
safe functional level for a resident.
munity by restoring functional mo- dent in their own environment and Staff education, especially of di-
bility and preventing disability. The the community. Companies that rect caregivers, about residents’ ca-
role of a PT in AL is two-fold. For provide Medicare Part B outpatient pabilities, safety issues, and new
the resident, the provision of PT PT in the home are not as common functional levels is an integral part
services is an extension of tradition- as VNA companies, but may be of PT services. This interdisciplinary
al home care medical services. For worthwhile investigating. approach to resident care maxi-
the interdisciplinary team, consist- mizes carry-over throughout the re-
ing of administrative, medical, and Restoration of habilitation process and encourages
caregiver staff, the PT brings ex- Functional Mobility residents to achieve their functional
pertise and insight to the functional A common reason for referral to PT goals.
level of each resident, as well as to is the functional decline of a resi-
facility-wide programs, including dent after the occurrence of an ad- The Proactive Approach:
fall prevention, group exercise verse event, a fall, or hospitaliza- Preclude Disability
classes, and staff education. tion. A PT is able to design a The interdisciplinary team has the
An AL residence is considered progressive therapeutic exercise opportunity to be proactive in the
the resident’s home. Medicare ac- program to improve mobility, care of their residents. In the ab-
knowledges 2 types of home care strength, balance, and cardiovascu- sence of an adverse event or hos-
PT services. First, traditional home lar endurance. The PT can also pro- pitalization, the team should ac-
care services through a visiting vide training to improve a resident’s tively screen for risk factors that
nurse association (VNA) company abilities in the areas of bed mobili- may result in a resident’s function-
can be billed under Medicare Part ty, transfers, and ambulation in or- al decline.
der to facilitate A PT can play a key role in fall
their return to prevention, providing a fall risk as-
leisure activities in sessment that includes an extensive
the AL home and balance evaluation with objective
community. For ex- tests to quantify a resident’s fall
ample, instruction risk. A PT is then able to develop
in safe and efficient an individualized therapeutic exer-
gait patterns to pro- cise program to improve strength
mote dependable and balance and reduce the resi-
mobility and im- dent’s risk and fear of falls. For a
proved gait en- resident with an unsteady gait, a PT
durance may help may recommend the introduction of
a resident achieve an assistive device and proper gait
their functional training to further reduce the risk of
goal, whether it be falling.
ambulating to the In collaboration with the inter-
A. The goals of this type of PT are dining room or going out to lunch disciplinary team, a PT can design
to maximize function and safety in with family and friends. a group exercise program that
the home only, and the resident If a resident does not demon- includes strength, flexibility, and
must be homebound. Second, un- strate the potential to return to their balance exercises to maintain a safe
der Medicare Part B, the resident prior level of function, a PT can functional level in all residents.
can receive PT services on an out- recommend and assist with the pro- Furthermore, PT interventions can
patient basis, with the site of serv- curement of adaptive equipment, be utilized in pain management to
ice being their AL home. Under including transfer benches, com- (continued on page 43)

July/August 2006 Assisted Living Consult 39

The Interdisciplinary Team manage challenging behaviors.
Roundtable (continued from page 39)
Severe Cognitive Impairment
Update reduce the functional decline and
disability in AL residents with
When a resident demonstrates se-
vere cognitive impairment and can
chronic pain. Lastly, education of no longer ambulate safely, a PT can
Medco Removes individual residents, as well as staff, recommend and assist with the pro-
Prior Authorization for on safety, fall prevention, transfer curement of a custom wheelchair
Alzheimer’s Drugs techniques, joint and energy conser- and seating system. A resident is of-
In response to a June 12, 2006 vation, general health and wellness,
Alzheimer’s Association letter to and the effects of immobility is also
the Centers for Medicare and within the scope of PT services.
Medicaid Services (CMS), Admin-
istrator, Dr. Mark B. McClellan, PT for Residents with A PT can teach residents
Medco removed its prior authori- Cognitive Impairment
with mild cognitive
zation policy for Alzheimer’s As the disease process progresses,
drugs for Medicare Part D benefi- the functional needs of a resident impairment strategies to
ciaries over age 65. As of July 15, will change. Consequently, the role maintain their level of
2006, Medco no longer requires of the PT and the goals of therapy
prior authorization for all FDA-ap- will also change to reflect the pro-
proved drugs to treat Alzheimer’s gression of the disease process. Fre-
disease. quent interdisciplinary communica-
The Alzheimer’s Association ap- tion and education of the direct
plauds Medco for making this im- caregivers are essential aspects of ten able to safely self-propel when
portant change to its formulary PT interventions for cognitively im- properly fitted in a wheelchair. As
policy. With Medco’s policy paired residents. the disease progresses to its end
change, only 2 national plans still stage, a custom wheelchair can en-
require prior authorization: RxAm- Mild Cognitive Impairment courage proper posture, resulting in
erica and Silverscript (Caremark). In residents with mild cognitive im- improved breathing, feeding, and
However, Silverscript (Caremark) pairment, a PT can provide a fall socialization. Pressure relief and
is in the process of developing a prevention assessment, including a wound prevention are also poten-
modification to its prior authoriza- balance evaluation, and initiate an tial benefits of a custom wheelchair
tion requirements and is in dis- exercise program to maintain mo- and seating system.
cussion with CMS. bility, strength, balance, and gait. A
The Medco policy reversal is a PT can also teach residents with Final Thoughts
significant advocacy victory. It is mild cognitive impairment strate- PTs are experts in safe functional
the Alzheimer’s Association’s posi- gies, including verbal and visual mobility and its components, includ-
tion that the doctor-patient rela- memory cues, to maintain their lev- ing gait, balance, fall prevention/
tionship should be at the core of el of independence during function- management, transfers, cardiovascu-
medical treatment, and that only al activities. lar endurance, strength, flexibility,
the clinical judgment of the treat- wheelchair mobility, and therapeutic
ing physician in conjunction with Moderate Cognitive Impairment exercise. The utilization of PT serv-
the patient/family should deter- As a resident’s mental status pro- ices by residents and interdiscipli-
mine the appropriateness of a gresses to a level of moderate cog- nary teams can be beneficial in
drug for a patient and how long it nitive impairment, repeated fall pre- maintaining safe functional inde-
should be used. vention assessments are indicated. pendence and maximizing the quali-
For more information about this Balance and gait training that in- ty of life for AL residents. ALC
topic, access the Alzheimer’s Asso- cludes the use of an assistive de-
ciation Fact Sheet, “Important vice, additional caregiver education, Mimi Jacobs, PT, OCS, CSCS is a physi-
Things to Consider When Choos- and modifications to the environ- cal therapist and the Director of Re-
ing a Medicare Drug Plan for Peo- ment may be warranted. A PT can search and Presentations for Fox Reha-
ple With Alzheimer’s Disease,” educate the caregiver staff on how bilitation, providing rehabilitation
available at: to best assist the resident with services to multiple AL facilities in the
Resources/FactSheets/MedicareRX_ functional activities, as well as rec- New York, New Jersey, Pennsylvania
PWDChooseplan.pdf. ALC ommend strategies to prevent and tri-state area.

July/August 2006 Assisted Living Consult 43