Comparing occupational therapy vs. physical therapy in hospice care. How are the two therapies different, and how can they help hospice patients?
Occupational Therapy Vs. Physical Therapy
For hospice patients to have the best possible quality of life, they must be able to do things for themselves. So many things that able-bodied folk take for granted become difficult for someone with a terminal illness, but home hospice providers include on their staff a variety of expert therapists who can help patients live their best lives. This post will examine two complementary but distinct therapeutic disciplines, comparing occupational therapy vs physical therapy (OT vs. PT) we will look at their differences, their similarities, and why they are both necessary parts of a home hospice service.
How Are They Similar?
Outside of hospice care, both of these therapies are sometimes referred to as rehabilitative care and are often used to get a person to regain his strength and other physical capabilities after being waylaid by surgery, injury, or a severe illness. In hospice care, making patients stronger and more flexible is usually not possible, so the therapists’ efforts are dedicated to slowing the decline and maintaining the capabilities already possessed.
Both kinds of therapist involve hands-on care from well-educated professionals. They both teach patients how to move safely and efficiently, and how to keep doing the things they need to do. Managing energy expenditure is a preoccupation for both, so they will each within their own fields look for ways to allow the patient to do what she needs to do without using up her entire store of energy.
Working together, they can make many tasks easier for the patient. For example, take bathing. PT will accommodate the patient accessing washing facilities:
- The washroom is not far from the patient’s room.
- The washroom has an accessible shower. Walk-in showers are best. Bathtub rims are hard to step over, but safety bars can help here.
- The toilet seat is not too low and has a convenient bar or another graspable surface to help the patient lift herself.
- The shower has a seat secured to the shower floor.
- And much else to help the patient access the facilities.
OT will focus more on matters concerning the patient’s manual ability.
- The door to the bathroom has a lever, not a knob. Round doorknobs are notoriously difficult to manipulate for those with arthritic hands and other manual impairments.
- Similarly, the shower controls are not stiff and otherwise easy to work.
- Detachable shower heads can obviate a lot of shuffling.
- Any needed supplies are easy to reach and don’t require reaching deep into cabinets or fussing with difficult packaging.
Each alone might not be enough to aid the patient and keep her independent, but together, both therapies can allow the patient a measure of self-sufficiency she otherwise would not have.
Both OT and PT involve stretches and exercises designed to help patients maintain their physical abilities. Both therapists are knowledgeable about the process of aging and dying, and both know that they will have to regularly consult with the patient and adjust care plans to meet the needs of declining patients.
Most importantly, both provide valuable, necessary help to hospice patients, allowing them to maximize their quality of life during their last months. But each discipline focuses on different aspects of patients’ lives and abilities, so we will explore some of those differences in the remainder of this post.
How Are They Different?
In broad strokes, physical therapists are movement specialists. They focus on improving balance and strength so that the patient can safely move about in her environment. They assign stretches and exercises to help the patient maintain her abilities and may suggest modifications to the home for the ease of the patient, such as clearing tripping hazards and installing handrails near where the patient will need to go.
Occupational therapy, in contrast, focuses on the patient’s ability to perform specific tasks. Occupation, here, refers not to job and careers but to activities that the patient finds meaningful. These can be necessary daily tasks that we all participate in, such as bathing, dressing, and eating, or they can be tasks more specific to the patient, such as sewing or playing the piano. What’s important is that the occupations are meaningful and that being able to do them is important to the patient.
What Do Physical Therapists Do?
Physical therapists are valuable in hospice care, no matter the capabilities of the patient. If the patient is ambulatory, a properly implemented physical therapy plan will slow the patient’s decline, allowing her to stay active for as long as possible. If she is capable enough, stretches and exercises can be performed by the patient alone; if not, family caregivers can help, or a physical therapy aide can be brought in to assist.
Physical therapy can lessen a patient’s dependence on pain medication. Stretching sore limbs can reduce pain, and often, the simple act of exercising is an invigorating distraction for the patient, taking her mind off her discomforts and buoying her mood.
It is the nature of terminal illnesses to degrade the patient’s physical capabilities over time. Physical therapists know this and know that the patient’s exercise regimen must be regularly revisited and altered to suit the patient’s declining abilities. An exercise that is too difficult will discourage or even hurt the patient, and one that is too easy will provide limited benefits and be seen as a pointless waste of time. The careful assessment of a patient’s abilities requires considerable expertise, and the therapist will ensure that family caregivers and the hospice team know what her exercise regimen is.
Should a patient become bed bound, the physical therapist must turn his professional capabilities to the prevention of pressure ulcers. Unfortunately, it is rarely possible to prevent ulcers from forming entirely, but the therapist can craft a plan to regularly shift and adjust the patient in her bed, lessening the pain caused by sores. Bed bound patients must be treated very delicately, and the physical therapist will inform all the other caregivers on the best way of moving the patient that will not inflict greater discomfort.
What Do Occupational Therapists Do?
If you think of a physical therapist as helping a patient move herself—walking, sitting and standing, shifting in bed—then the occupational therapist helps her move other things. In general, OT helps the patient complete activities that require fine motor control as opposed to the broader movements involved in physical therapy.
The occupational therapist, when first meeting a patient, will identify the patient’s meaningful life activities: these are the things that the patient feels she has to do to feel like a complete person. Some of these are meaningful to all of us; some are unique to the patient A few examples are
- Grasping cups and utensils
- Leisure activities (flipping through books, dealing cards, sewing, playing instruments, and so on)
Every patient has different capabilities; each struggles with some tasks but not others, and the therapist will quickly identify what is important to the patient and look for solutions that will allow the patient to do as she pleases. This might involve stretching and dexterity-building activities designed to limber the hands and reduce discomfort. But sometimes the easiest solutions involve simply changing the patient’s possessions.
Take dressing, for example. Tiny buttons and stiff metal zippers can be a painful hassle for people who struggle with pinching tiny objects. A simple solution would be to select clothing with wide buttons or larger, less unforgiving zippers, allowing for easier fastening. Loose clothing that can simply be pulled on over the head might be best for those with troubled hands, but keep in mind the difficulty of reaching the arms overhead to don clothing.
Mugs and textured cups are easier to grip than smooth drinking glasses. Utensils with big handles are easier than skinny-handled ones. It’s easier to scroll through pages on a lightweight, touchscreen e-Reader than to thumb through the pages of a heavy hardcover book one by one. (The ability to increase font size is useful, too.) Such simple alterations to a patient’s things can be the difference between contentment at doing things for oneself and despair at not being able to enjoy even simple pleasures.
Both Are Needed
Some able-bodied people might not realize how different OT and PT are, or that such “rehabilitative therapies” are widely used in hospice care. They are not two different terms for the same sort of treatment, and the comparison of occupational therapy vs. physical therapy involves more differences than similarities. They both, however, contribute to the well-being of home hospice patients, and they both are necessary to provide the excellent care we pride ourselves on. For that reason, UCLAH keeps several of each therapist on staff. Almost all our patients make use of both OT and PT, and all are glad for the independence and comfort that their therapies provide.