Learn more about Joanna Schechter, Registered Physiotherapist at ALPHA!
Why did you pursue a career in geriatric rehab? (stroke, home visits)
It’s funny that you ask this question. Working with the frail elderly was never my plan after physiotherapy school. I had LOVED my rotations in school in neuro rehab, stroke or spinal cord. However after graduation in 2003 I wanted to do something fun and different with my life and rather then take one of the several contract positions I was offered in Vancouver (where I was from and where I went to school) in acute care hospitals,I decided to take the full time permanent position offered to me in Toronto at Baycrest Hospital on the Geriatric Rehab Unit. My plan was to stay here for 3 years, learn all I can and then apply for a position at the Toronto Rehab Lyndthurst Spinal Cord Facility. However, after a few years at Baycrest, I realized how much I enjoyed the variety of the work with the unit housing equal portions of musculoskeletal, cardiorespiratory, and stroke/neuro clients. I also fell in love with working with younger seniors and with the frail elderly. I found I learned so much about life from these clients. They showed me through their physiotherapy sessions that they understood that hard work and perserverence pays off, that things don’t improve overnight, and there isn’t always a pill that will fix things immediately. They taught me about life before I was around, and how lucky we are to be living in the time we live in. My elderly clients have shown me how important human touch is and human connection.
What is your favourite parts about doing home visits?
Firstly I find that for the frail elderly especially, the home visits are very beneficial. I found that by the time these clients were able to get to a clinic they were often very tired from the drive, the walk up to the clinic, the washroom stop prior to their appointment with walkers,scooters, power wheelchairs, and caregivers, and the waiting at the clinic, to actually participate in the therapy. Or if they did have the energy to participate in the therapy then they did not have the energy to participate in the ‘rest of their day’.
I like being able to arrange my schedule to accommodate my client’s homecare PSW’s, meal schedules, retirement home activities etc… I like to be able to see my clients at the time during the day when they have the most energy.
Finally I like seeing my clients in their own environments. I find it’s important to teach them (and their caregivers) the exercises where they will be doing the exercises. I see the most carry-over and follow through in this manner. Working in a client’s home gives me another window into who this person is and how to best work with them, motivate them and encourage them.
What does a typical home visit session look like?
There are generally two different types of clients that I see, rehab clients and maintenance clients.
The maintenance clients are clients who were rehab clients but who I see on an ongoing basis once or twice a week for maintenance therapy. These clients tend to be those who do not do their prescribed exercises on their own either because they aren’t motivated to exercise, they have mild to moderate cognitive impairment, they or their caregivers don’t feel safe/comfortable doing the therapy on their own, or often the client has mental health issues (anxiety and depression) and they have difficulty initiating activities. These are clients who would deteriorate physically without this ongoing maintenance therapy.These sessions tend to consist of the highest level of exercises that each of these clients achieved in their rehab plus more challenging exercises if they are feeling up to it or appear to be progressing out of their plateau. Sometimes however the client may be having a ‘bad day’ and then the intensity of the session is adjusted. The goal of maintenance therapy is to keep people living as well as they can in their own homes.
Rehab clients usually consist of those who have recently been discharged from hospital with a hip replacement or hip repair following a fracture, knee replacement, shoulder fracture, fall, pneumonia, surgery where they client became weak, or stroke. With the rehab clients a typical session consists of the client/caregiver/family member providing me with the history of the present illness, past medical history, previous level of functioning, social history, any equipment/mobility aids that they have, current level of functioning, current level of assistance required, and goals. Then I do a full assessment. I look at the range of motion and strength of every doing and muscle group. I look at their balance, functional mobility including getting into and out of bed from laying down, transferring from a walker or wheelchair into the bed, walking with a walker/rollator/cane, and stair negotiation. Sometimes a client can get through the full assessment in one session and sometimes it takes a few sessions, but even the assessment is treatment because the client is moving.
Assessment sessions usually take around an hour to and hour and a half. This is when the client and I really get to know each other.