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Physical therapists and the patients who need them are facing some significant barriers to connection and care during Covid-19. No demographic has been more impacted than older adults.

Vicki Tilley, PT, Geriatric Clinical Specialist“People don’t want to leave their house because of exposure to Covid-19, and, they’re also wary of letting anyone into their homes,” says Vicki Tilley, PT, GCS, Project Facilitator for UNC’s Carolina Geriatric Workforce Enhancement Program and founder of ElderFit In Home Rehab-North Carolina, a private practice providing home-based rehabilitative therapy.

With few clinics seeing patients and few patients hosting visitors, physical therapists (PTs) must primarily pursue patient care through telehealth and video visits. However Tilley estimates that only about half her clients will be successful with video visit physical therapy. Patients with major mobility issues, cognitive issues, or technical issues will need more hands-on care.

A lot of things have to go right for telehealth to help older patients successfully progress in their rehabilitation. Patients must have:

  • the ability to connect with a device that has video access
  • a good internet connection
  • an understanding of how to access the program for the video call
  • a minimum baseline of hearing, vision, and cognitive capacity to effectively interact with the screen

What’s more, patients need to be able to safely perform a range of physical assessments and activities alone in their homes, or with the assistance of a family member or caregiver.

Tilley describes one of her patients for whom physical therapy is critical, an older man who had hip replacement surgery in November. Shortly after coming home, he fell and fractured his femur below his new hip.

Before Covid-19, Tilley had been working with the patient to help him gradually gain strength while healing a delicate area of bone around the fracture and monitoring pain. “As he was starting to gain strength and progress to using a cane, cases of Covid-19 began to increase in the area,” says Tilley. The patient decided to pause home visits. Two short video visits have allowed him to review the exercise prescription and make gradual improvements.

But Tilley says she worries about not being able to see him in person because patients, on their own, can sometimes overdo it. “He really wants to improve and needs support to balance activity with rest. We’ve just been trying to work with what we have, using the video visits.”

“The huge swing to telehealth is pushing us to learn when it will be appropriate and when it won’t,” says Tilley. “The reality of an older adult population is we have patients who need more than telehealth.”

Tilley says that if Covid-19 testing were more widely available, PTs could give patients some assurance of safer home visits through documented negative test results. But neither she nor her staff can be tested.

“As licensed care providers, we have no way to conclusively say whether we have the coronavirus or not. Until testing is widely available and patients can feel more confident about going to a clinic or letting PT providers into their homes, we can’t plan and we don’t know what to tell our patients. I don’t know how this ends, quite honestly.”

For now, Tilley and other ElderFit PTs review patient needs and options case by case, as they constantly adapt care plans. Tilley has also begun teaching her Strong and Steady senior fitness class through Facebook Live. The Strong and Steady class includes strengthening, balance, and postural exercises to reduce falls risk and provide full body strengthening.

You can find Tilley’s class on Monday and Thursday mornings at 10 at: