Amanda Wilde (Host): If you've had surgery, an accident, or a fall, you may be prescribed in-home physical therapy to get you back to your prior level of function. We'll explore in-home physical therapy and how it works with Kim Prestangen, Licensed Physical Therapist Assistant at Upland Hills Health. This is the Inspire Health podcast from Upland Hills Health. I'm Amanda Wilde. Kim, welcome to the podcast.

Kim Prestangen, LPTA: Thank you. Happy to be here.

Host: I'm excited to talk about PT because I know it can be life changing in terms of regaining mobility and general independence of movement. Tell me, what is the difference between physical therapy in the home versus physical therapy in a clinic or a hospital?

Kim Prestangen, LPTA: We are meeting the patient in their home in the environment where they will be recovering from their injury or their illness or their accident, whatever brought them to the hospital and then back to their home again. So we have a chance to assess the safety of the home. We get to meet family members if they are there in support of the patient.

Or we may meet neighbors or friends who are coming to stay with the patient while they are recovering. So, we get to see how many stairs that person has to climb to get in or out of the house or to their bedroom. Are they sleeping in a bed or a recliner? How tall or low is that bed? What are the chairs like in their home?

What are the pathways like? Is there clutter in the home? So we get to meet the patient where they're at.

Host: In their own environment. I said physical therapy can be prescribed. Who are those patients who have PT prescribed to them in the home?

Kim Prestangen, LPTA: It would be a patient that a doctor would refer to physical therapy services. And again, we do in-home physical therapy as part of the home health team. So it would be patients who have had surgery and they're going home and they need to recuperate from that surgery at home. Think of like a knee or a hip replacement or a shoulder replacement.

It could be someone who's had a motor vehicle accident and they have multiple injuries so they are going to be recuperating for a while at home. It would be someone who maybe had a fall or has generalized weakness from maybe a stroke or another illness. They've had a long hospital stay perhaps, or it could be someone who went to short term care after surgery and they still need some help to navigate their home.

Maybe they don't have family support in the home, so they need to get stronger. They need to be prescribed an assistive device. So we work with the patient's doctor and we work with other members of the home health care team; occupational therapists, nurses, and speech therapists to get that patient back to their prior level of function in their home.

Host: Mm hmm. And you see mostly rural, independent patients in their homes, and they face their own set of challenges, don't they, living alone in more rural areas?

Kim Prestangen, LPTA: Yes, that's true. Because these patients generally are not well enough to drive, that's kind of one of the requirements of being homebound is that you are not able to leave your home easily because of your surgery or your injury or accident or generalized weakness.

So, we are driving long distances to meet someone in their home out in the country. The other thing that makes it a little different in a rural setting, is that maybe it's not as easy to find a ride through a rideshare program or the county ride assistance program, their neighbors might live farther away.

Family members might be farther away. So it's a pretty special environment to meet someone who is living maybe 30 miles from the hospital in a home where the closest neighbor is maybe a quarter mile away.

Host: Are these patients with whom you have to work extra hard to gain trust?

Kim Prestangen, LPTA: You do want to earn their trust. So it's done by assessing the patient, knowing what their injury or accident or status is, as, and that would come in the information that the doctor put in the referral. In the evaluation, the physical therapist will ask the patient many, many, many questions about their health history, about what help they have in the home and then discuss with the patient kind of what the goals will be. Are they going to do any more therapy after they're finished seeing a physical therapist or a physical therapist assistant in the home?

Or are they going to go on to outpatient therapy? Is there a goal to be able to drive when they're finished with their home health physical therapy? We don't specifically train people to drive, but our main goal is to get patients to be able to move in their homes with an assistive device or without one, and that includes getting in and out of the front door, going from room to room in the house, going up and down stairs, getting in and out of a car. So, we're working closely with the patient to understand where they want to go or what their goals are as far as how they can move about in their home environment.

Host: Hmm. So you work together as a team to set goals for the therapy. Backing up a bit, can you describe what happens on the first visit to a patient who is in their home?

Kim Prestangen, LPTA: Sure. The first visit is always going to be with a physical therapist, a licensed physical therapist and the patient and any family members or friends or neighbors who are going to be helping that patient. So, the first visit is to take a lot of information from the patient, take their vitals, understand their pain level, understand how easy or not easy it is for them to move about in their bed, or going from a chair to standing, or moving across a room, or getting in and out of their home.

Most of our patients cannot drive due to medication they're taking, or to their physical ability. So we do a very thorough assessment. And then the patient and the physical therapist will talk about what the patient's goals might be. And then the physical therapist comes up with a plan of care.

And all that is documented and shared with any other physical therapist or physical therapist assistant, like myself who will see the patient going forward. Sometimes a patient will see the same physical therapist for their entire round of physical therapy which could last anywhere from four to six weeks in the home. Or they might see a couple other therapists along with that very first therapist.

Host: So in-home physical therapy is really a very crucial step to recovery. Setting those goals, meeting those goals, whether the condition is temporary or is becoming permanent, how to navigate in the home and other places. And do you also work to involve family members? I mean, you mentioned that friends and family might not be super close by, but if there is some support system, do you weave that into your plan?

Kim Prestangen, LPTA: Absolutely. Many people have a spouse who is home. Many of our patients have adult sons and daughters who are close by, even grandchildren who are of driving age or, their teens or their 20s. So, we also educate anyone who's around that patient how that patient should use that assistive device like two wheeled walker or a four wheeled walker or a straight cane or a slide board.

Maybe someone has broken a bone in their lower leg and they are not supposed to put any weight on that leg. So now how is this person going to get from a chair to standing and getting to the bathroom? You know, what are the devices? Is it a wheelchair? The patient has to transfer from a chair to a wheelchair, and then from the wheelchair to the commode.

And how does a family member help that patient do that until the bone has healed enough where the patient can now put weight onto that bone? So we educate the family members or friends or caregivers you know, that critical piece of mobility with an assistive device, ambulation or walking.

And then we also give the patient home exercises and it's usually helpful if a family member can be there, or a friend or a caregiver so that we can instruct them on how the exercises should be done and how often, so that the patient will have someone there who can prompt them or count reps or just cheer them on.

Host: It's great how you really make an individual action plan for each person and each person's unique situation. Maybe they have family members, maybe they don't. And your professional expertise allows you to really see what's needed. As a patient I might not know, I have to think out how I get from the bed to the bathroom and things like that. You as a professional, can come in and say, okay, let's take you through your day and see each physical movement that needs attention.

Kim Prestangen, LPTA: Yes, absolutely.

Host: Well, this has been a great overview of in-home physical therapy. Are there any additional thoughts that you would like to add as we wrap things up today?

Kim Prestangen, LPTA: I think that the reason I offered to come on to this podcast for Upland Hills Health and specifically representing the home healthcare team is that I would like patients to feel comfortable accepting home health service staff into their home and know that this is a unique opportunity to have Physical Therapists and physical therapist assistants sort of at your disposal.

We're coming to meet you where you are. And we are, like you said, everything is specifically tailored for that patient. So we're not coming in to give them just some sort of cookie cutter plan. We evaluate the patient. We assess the patient. We set goals with the patient and then a plan of care is put in place.

And whether that patient is seeing that one physical therapist that they met at their initial assessment, or they might work with me too. I'm a physical therapist assistant and we work under the supervision of physical therapists. All of us are on the same page communicating with that patient, the patient's family, the patient's doctor if needed

to make sure that the activities and the sort of skilled exercises and care we're providing that patient are all furthering that patient to become more independent, stronger, with less pain, and more comfortable to move about their home and think about getting out of the home again, maybe driving their car, going in a car somewhere, maybe they're going to go to outpatient physical therapy because they want to work on some more goals.

That might involve, getting stronger or walking longer distances or other aspects of prior level of function, maybe getting ready to go back to a job that is physically demanding. So it's a unique experience, I think, for a home care patient.

Host: It's almost like concierge care.

Kim Prestangen, LPTA: Mm hmm. It is very brief. It is not something that goes on for weeks and weeks. And it is kind of this short window of time that we're taking someone who's in sort of a fragile or painful or early part of the recovery in that kind of state and getting them to a place where they feel more like their self prior to their accident or surgery or fall.

Host: When you're recovering, you're not a hundred percent, so it is motivating and reassuring to have a team and know that the team sees you like you said, where you are. And that makes this really vital service for support for recovery and independence.

Kim Prestangen, LPTA: Yes, absolutely.

Host: So thank you, Kim, for providing such a vital service.

Kim Prestangen, LPTA: I'm happy to do it. I love my work. I feel very honored to work with patients in their home.

Host: It is great learning more about in-home physical therapy and just how it works. Really amazing. Thank you. That was Kim Prestangen, Physical Therapist Assistant at Upland Hills Health. For more information, visit uplandhillshealth.org/services/therapy-wellness. And if you found this podcast helpful, please share it on your social channels.

This is the Inspire Health podcast from Upland Hills Health.