Excellence in Action! – How Modifying Activity Can be a Win-Win

Our facility had a resident admitted with a new diagnosis of congestive heart failure (CHF) and pneumonia. He was still living alone in an independent living facility (ILF), although initially, he was discharged back to acute care for two days due to abnormal labs.

Upon his return, he was placed on the re-hospitalization program and was evaluated using our Don’t Skip a Beat Cardiopulmonary Specialty Program. With big goals to return back to his ILF apartment across town and take his regular walks, it was clear he didn’t see just how much his new CHF diagnosis would affect him. His family and the medical team projected multiple re-hospitalizations, with an assisted living facility (ALF) being the highest discharge level possible. It was decided that a skilled nursing facility (SNF) level of monitoring was the only way he would be able to stay out of the hospital.

Physical Therapy (PT) completed pulmonary testing during the initial evaluation and noted that the resident would desaturate significantly with only one minute of activity after completing a transfer. Our therapy team developed a plan of care to utilize a power chair for use in the facility to allow him to conserve the very little energy he had for therapy sessions. He required PT and Speech Therapy (ST) to navigate his concerns behind the power chair, but through education, he agreed.

Despite his severe shortness of breath, he was amazed at the activities he was able to rejoin under this plan of care. PT discussed using the power chair long-term, to which he, again, agreed. He now recognized that measuring independence in activities of daily living (ADLs) was more important than how he walked. Occupational Therapy (OT) stepped in to maximize safety and conserve energy from a seated position.

Two weeks after being admitted, he had crossed all barriers to discharge back to his ILF with home health. He could complete all ADLs with modified independence implementing the self-pacing and self-monitoring techniques he learned. His shift in focus from gait to overall independence helped him recover from pneumonia and improve overall function.

Three days prior to his planned discharge, he started making big jumps in his pulmonary capacity and oxygen saturations. He presented with an ability to gait 50’ with minimum assist. Despite being cleared to go home, he wanted to stay in the building and receive his secondary therapy here with Part B services stating, “I’m making these gains with y’all. I think y’all can get me walking in my apartment.”

PT and ST continued Part B plans of care to improve his confidence with new diagnoses, and further maximize functional use of available energy/oxygen capacity. Upon final discharge two weeks later, he could walk 150’ with modified independence on 2 liters per minute of oxygen.

The patient was so pleased with his newfound energy, he told our Rehab Director, “I am wheeling out in my power chair, but now because I have to. I am so glad I CAN walk, and I will continue to do that around my apartment. Having this chair is allowing me to do things I haven’t done in years.”