Caitlin Whyte (Host): A debilitating injury, a stroke or other physical impairment are just a few of the reasons why you might require in-home physical therapy. And in a rural area, the need for in-home services might be even more important. Kim Prestangen from Upland Hills Health in Dodgeville is here today to help explain who needs these services and what care you can expect to receive in your home. She is a licensed physical therapist assistant.

This is the Inspire Health Podcast from Upland Hills Health. I'm Cailtin Whyte. So Kim, great to have you on the show today. To start us off, who needs physical therapy services in their home?

Kim Prestangen: Most of our patients are coming off of an extended hospital stay or they've had a joint replacement, or they might've had an accident or a fall, heart attack. So, they are coming from the hospital and they are in a deconditioned or weakened state and they are choosing to come home rather than go to like a rehab center, because they've got family support or supportive neighbors.

Host: And how old are your patients typically?

Kim Prestangen: They can be of any age, although I've not worked with any infants or children so far. The majority of our patients are probably older adults over the age of, you know, 55, and have had, again, like a surgery, a cardiac condition, a lung issue, an accident, a fall.

Host: Well, when my partner comes home from the hospital, what do I do to take care of them? What if I don't really know how or have any experience?

Kim Prestangen: Our home health team is there to help the patient and their family and their caregivers prepare the home, administer medication; help the patient with activities of daily living, eating, bathing, getting dressed. So, for physical therapy, we're focused on the patient, how that patient is going to safely use a scooter, crutches, a cane, a four-wheeled walker, a two-wheeled walker to somehow get around in their home. So, we will decide, you know, which assistive device is appropriate for that patient. And that's a discussion with the patient and the physical therapist, as well as provide them with exercises that are easy for them to do in their home. That doesn't require special equipment. Exercises could be done while they're seated or standing or holding on to something.

And then, we also kind of look around the home and see if things like handrails are in place at thresholds or in the bathroom or, you know, on a stairway. Are there rugs all over the place? Is there a lot of clutter in the house? And we'll try and work with the family members. And the patient to kind of alert them of like, "Okay, your home situation may not be optimal for success for the patient for the next, you know, what is it, four to eight weeks while they're healing."

Host: Gotcha. Well, what is the biggest challenge a patient faces in their home when they have a temporary or a permanent disability, would you say?

Kim Prestangen: I think it's for the patient to be home and be in this different state, it's not their prior level of function. So, it's how do I get dressed? How do I answer the doorbell? How do I receive my family in my home? How do I prepare a meal? Or, you know, how do I get into my bed?

So, occupational therapy is going to help them with all those activities of daily living, like cooking and bathing and getting dressed. Speech therapy would help them with any, you know, speech problems they have. Physical therapists, again, focusing on the patient's body, their strength, their ability to walk with an assistive device or not, the safety of their home. And then, there's the skilled nurse piece of the home health team and they're helping patient and their family deal with wounds, if they have any, and medications, which is a big piece too.

Host: Well, you mentioned some already, but if you wouldn't mind going through some more, what are some of the hazards, if you will, that you identify in a home setting when you evaluate a patient situation?

Kim Prestangen: You know, we're looking again for throw rugs on the floors, looking at the bedroom, what side of the bed they sleep on. Is there enough room for them to get that walker in that little small space and properly transfer to the bed? Do they need some sort of emergency button so that they can alert family who's away or the EMS services of their town in case they have a fall? Can they get up from the floor if they have a fall on their own? So, just trying to create as many safety things like a hand rail or moving rugs or creating enough space between furniture so that they can safely ambulator walk from room to room as needed.

Host: Well, what happens if a patient is alone or doesn't have someone to help them in the home? Can a physical therapist assist and teach them how to move about safely on their own?

Kim Prestangen: Yeah. Definitely. Again, we are going to focus on the patient. We're going to evaluate how strong they are. Can they get up and down from a chair five times? Can they get down to the floor? Can they get up off the floor? And if they can't, what are the tools that are around them in the home, be it a chair or a bookcase or a coffee table to help them hold on to something to get up from the floor in the event that they would fall?

A lot of our patients are high fall risk. So, we're looking at ways to ensure that they can safely stand up from a chair and hold on to that walker or go from that walker and sit down in a chair or get into their bed. And again, we always have the added piece of giving the patient easy exercises to do that will strengthen those muscles that stabilize hips that give flexibility to the ankles that help with breathing to make them stronger.

Host: Great. Well, Kim, wrapping up here, home health care is delivered by a team. So, who is on that team and what are their roles?

Kim Prestangen: Yeah. And this is a new field for me. I came from the outpatient clinic world. So, home health is a skilled nurse. And again, they will be handling medications, looking at wounds, if you've had surgery or have an incision or you have maybe like an ulcer because you don't move much. And then, there's the occupational therapist who's going to help them with eating, bathing, getting dressed. And then speech therapist, if someone has had maybe a stroke or they have Parkinson's, so they've been diagnosed with Parkinson's disease. They're going to help them enunciate more clearly or use any kind of adaptive device for speaking. And then, physical therapists, that's where I'm at. We are, again, focusing on that patient's body, evaluating it, and recommending exercises and the appropriate assistive device if they need one to walk safely throughout their home.

Host: Thank you, Kim, for explaining these services to us today. It was great to have you on the show. And thank you for listening. If you enjoyed the show, please share it on your social channels. And you can always find out more about these services online at uplandhillshealth.org. This has been the Inspire Health Podcast from Upland Hills Health. I'm Cailtin Whyte.