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Aging Population

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Creating and growing a successful geriatric physical therapy practice.

By Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST

The decision to open a physical therapy practice with a primary focus on geriatrics cannot be made based only on market research, brainstorming, or simply to replicate another successful niche practice model. A geriatric practice that is created and successfully grown is built on a combination of practical knowledge and focus.

Geriatric rehabilitation requires patience and know-how that are somewhat different than what is required of other outpatient physical therapy practices. Helping someone who is elderly and debilitated stick with what can be a long process of functional rehabilitation takes a great deal of clinical and motivational skill. It also requires a different perspective and knowledge of the business of outpatient rehabilitation.

Physical therapists must build trust and professional acumen in the field of geriatrics. They cannot buy a reputation with a savvy octogenarian who is expecting functional results from rehabilitation. A therapist must earn an excellent reputation and successful practice. Some of the best advice I ever received (in the form of a wish) was, “I wish you all of the luck that hard work can earn.” When creating and growing a geriatric practice, it is important to remember that a strong work ethic and sincere commitment to your geriatric patients can be as important as your clinical skills.

Value-added visits

During each visit, each client is dedicating their time, their financial resources, and their trust in you. What can you do to offer value to them in return? Each visit must include something that is worthy of the client’s time, dollars, and trust in you as a therapist.

Value is conveyed through an individualized and personal approach—at each visit. Conveying objective expectations, evidence-based treatment, and individualized care help create a value-filled therapy session.

Questions to ask yourself

If you have the passion and training to provide exceptional care in geriatrics, and you have established a business plan with analysis of the local market, there are a few questions you must ask yourself:

  • Are you willing to accept Medicare rules and reimbursement, which are much less profitable than commercial rates? You should expect to lose money on some cases and endure both delays and denials throughout.
  • Are you aware of the year-to-year political landscape of Medicare caps, modifiers, rate cuts, and health care trends?
  • Are you able to establish panel membership with insurance companies in your area (e.g., to become in-network)?
  • Can you tolerate and anticipate competition: an infringement on your brand and your profession?
  • Are you prepared to accept that some providers will attract patients due to proximity but provide less valuable care?
  • Can you resist the temptations of headhunters, clinical fads (modalities and approaches), deceptions, and gimmicks?

Be different in a good way

Take pride in your service. Be on time and consistent. Follow the evidence and change the expectations when appropriate. Be approachable and accessible. Follow up with your patients. Be responsive from an accountability and administrative perspective to both your staff and patients.

Give back. Host shadow students and clinical internships. Offer free community education and screening events.

Do not take shortcuts

Stay informed from an administrative and continuing clinical education standpoint. Stay active in the American Physical Therapy Association (APTA). If your geriatric outpatient practice is not as lucrative as you would like it to be, keep in mind that your daily worth (to your patients) will always exceed your net worth (to your bank).

Are you ready?

If you have read this far and you remain interested in opening or expanding your practice to include an outpatient geriatric service line, here are some clinical considerations:

  1. You must be ready to provide an environment that will afford you the opportunity to work with geriatric patients while keeping them safe.
  2. Accessible equipment is a must. Treadmills, cardio equipment, and strength training equipment must be easily entered and exited.
  3. Use objective measurements, not just observations, to motivate your clients. Hold yourself accountable to your outcomes and be open with your patients about what has or has not been accomplished.
  4. Be prepared with the equipment and the knowledge to address a prime challenge for the geriatric population-balance skills.

Therapists must be willing to offer sufficient physical challenges (exercise dosage) to the patient who is over 75 years of age. Many therapists will consistently under-dose exercise patients based solely on their age. Geriatric rehabilitation should be based on individual patient diagnosis and risk factors as well as individual strength, flexibility, endurance, and tolerance to exercise and positioning. No two geriatric patients should have the same rehabilitation program, just as no two patients’ tolerance to exercise, risk factors, and diagnosis is the same. Not challenging the geriatric patient robs real people from achieving a higher quality of life!

A day in the life…four important steps

A typical day in the life of a physical therapy geriatrician includes a variety of diagnoses and a fair-share of problem solving. Topping the list will be patients presenting with balance issues, dizziness, deconditioning, degenerative diseases, joint replacements, and pain reports. Each patient’s functional needs, goals, and interventions are as unique as their thumbprint.

Step one: When considering how to treat a patient, you must understand the home environment, caregiver availability, cognition and hearing, prior experience with health care, access to therapy (financial and transportation), motivation, pain, diagnosis(es), past medical history, medication interactions, expectations (of themselves and you), roles and responsibilities—and then you begin your physical examination. These are the first steps in developing a personal rehabilitation plan for your geriatric patient. Consider becoming familiar with the International Classification of Function (ICF) for a more comprehensive view of this concept.

Step two: Establish the baseline information from which you measure future functional progress. Gone (hopefully) are the days where you say to a person, “You look like you are walking better” as a measure of their progress and the effectiveness of therapy. Become familiar with gold standards in measurement of gait, balance, strength, endurance—and be ready to hold yourself accountable in your documentation/medical records.

Step three: Apply the science of rehabilitation and be willing to implement a rehabilitation plan that is consistent with the patient’s abilities, limitations, and personality. The exercise dosage must be strong enough to have an effect and result in improved functional ability. Yet, remember that this “dosage” must respect the patient’s understanding, safety, and personality.

Step four: Remember the importance of educating your patients. Prepare them for being sore due to the nature of strength training, prepare them to be challenged in the rigors of balance training, and prepare them for some fatigue as the result of endurance training. Encourage your patients to communicate what they are feeling in order for you to strike the appropriate “dosage” balance.

The geriatric physical therapy practice can be very rewarding and professionally satisfying…I wish you all the good luck and joy that hard work can earn!

Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, is the owner of North West Rehab. He can be reached at mike@northwestrehab.com.