Physical therapy (PT) plays a special role in hospice care. To be comfortable, patients must be able to move about, and for that, a physical therapist is needed to help the patient maintain his endurance and range of motion.
For people in the final stages of life, the erosion of their capabilities can be one of the worst aspects of medical decline. They may feel betrayed by their bodies and incapable of doing anything. This might lead to depression and a quickening of their decline as they choose to not engage in any physical task.
This does not have to be the case. The end-of-life stage does not have to be completely static. The addition of a therapist to the patient’s hospice care team can improve that patient’s quality of life by enabling a greater degree of motion, allowing the patient to avoid pain and engage in activities he enjoys. With UCLAH, patients will have the benefit of having excellent PT. Patients who work with our therapists can better control symptoms, exercise greater control over their comfort, and slow the decline of their abilities. This will help the patient maintain a positive self-identity.
Value of Physical Treatments in Hospice
As always, the primary goal of hospice care is to support the comfort and quality of life of terminally ill patients. Our therapists play a crucial part in the pursuit of this goal.
A properly implemented PT plan will help the patient maintain his abilities for as long as possible, reducing pain and the occurrence of pressure ulcers and reducing the burden of care for other health care workers and family caregivers. The plan will include therapeutic exercises the patient can perform to maintain strength, endurance, and range of motion. Techniques to walk and reposition safely and efficiently are vital to maintaining a good quality of life. And the therapist is in the best position to advise other caregivers and family members when helping the patient move about and complete their exercises. Sometimes the therapist’s plan will include making modifications to the home so that a greater range of activity is possible.
The end-of-life phase is not a static event. As the terminal illness progresses, the capabilities of the patient will decrease. Our therapist will reevaluate the patient periodically, modifying the plan to maximize comfort as the patient approaches his final moments.
Duties of a Physical Therapy Aide
When helping the patient directly, our physical therapy aides provide crucial help in maintaining the quality of life. Repositioning the patient is one of the most common tasks hospice and family caregivers will engage in. Simply shifting the body while sitting or reclining can be a difficult and painful task for someone who is seriously ill.
Pressure ulcers, also known as bedsores, are a common complaint among the terminally ill, affecting perhaps as many as 40% of hospice patients. The loss of muscle function and integrity makes it difficult for the patient to shift himself. The skin thins and weakens, making friction and pressure harmful. These problems contribute to the prevalence of bedsores. Unfortunately, bedsores often cannot be entirely prevented, even with extensive care from family and aides. Sometimes, the family feels that the presence of bedsores on the patient represents a failure to provide adequate care. This is not the case; bedsores can be all but unpreventable, even with round-the-clock care.
Frequent repositioning, as planned by a therapist and executed by family, nurses, and home health aides, can delay the onset of pressure ulcers and reduce irritation to existing sores. Padding and specially designed pillows can also reduce aggravating sores.
Posture is also a component of easy swallowing and digestion, so physical therapy and speech therapy share the goal of helping the patient eat and drink.
The physical therapist plays an important role in caring for the terminally ill, but he cannot be at the home all the time to assist the patient. So, UCLAH therapists often take the role of an educator. Not only will they teach the patient how to move safely and efficiently, but they will also instruct family members and home aides on how to best look after the patient.
When to Stop PT
As the patient worsens, repositioning and other movement become more difficult. At some point, the effort of repositioning the patient may be more painful than allowing the patient to rest on a sore. Or the addition of intravenous therapies can make movement too difficult or even hazardous. At that point, it may be best to cease PT. This can be difficult for family members, who often feel a need to do something to help the patient. But remember: the goal of hospice care is to maximize comfort. If the treatment is worse than the condition it treats, then it should be stopped. The patient should be placed in the most comfortable static position possible, and caregivers should focus on aiding him in a way that causes no discomfort.
Psychological Benefits of Therapy
Avoiding injuries and maximizing safety and comfort are critical goals for the physical therapist, but we should not forget the positive psychological effects PT can have on a patient. With greater comfort and range of motion, the patient will feel more relaxed and self-reliant; with pain relief and reduced chance of injury that comes with PT, the patient will need less pain medication and fewer visits from other home health specialists.
Differences between Physical and Occupational Therapists
These two are often mistaken, but they are indeed separate disciplines. Physical therapists are movement specialists. They focus on helping patients move their bodies. This involves strengthening gross motor control and reducing pain, promoting independent living. In a hospice setting, physical therapists will help patients reposition their bodies to bring comfort and minimize strain from being in the same position for too long. Even for bed-bound patients, PT is important to prevent the formation of pressure ulcers.
Occupational therapists focus on improving the patient’s ability to perform specific actions. As terminally ill patients lose their capabilities, occupational therapy can help them perform many basic actions, such as getting dressed and eating. Occupational therapists focus more on fine motor control than gross motor control.
UCLAH believes that total care of a hospice patient will involve both kinds of therapy, occupational and physical. Their benefits and roles are complementary. Together, they allow the patient to maximize self-reliance and keep the greatest amount of control possible during end-of-life.