Reliant Reveal Blog Archives

About 70% of adults in the U.S. have experienced at least one traumatic event in their life.¹ COVID-19 may have resulted in a traumatic experience for many, while for others it may have triggered re-traumatization from past experiences. The experience of trauma or re-traumatization during a patient’s rehab stay cannot only result in physical, psychological, and emotional health conditions, but also impede therapeutic rapport, the patient’s feelings of safety, and the overall healing and recovery process.  By putting into practice the core principles of trauma-informed care (TIC): patient empowerment, choice, collaboration, safety, and trustworthiness, physical therapists can help prevent trauma and re-traumatization while increasing overall patient health and well-being.

Physical therapists have a responsibility to become trauma-informed and respond to each patient’s needs with a holistic approach by preventing re-traumatization and creating a supportive and safe environment for a patient’s rehabilitation journey. When the therapy team has been alerted to a history of trauma or is aware of a particularly stressing event such as loss or isolation during the pandemic, consider this history during the development of goals and treatment approaches.  For example, provide education on the impact and empowerment associated with improving the level of independence with bed mobility or transfers. Assess and modify environmental factors that trigger re-traumatization. Other tips to implement through interventions may include identifying alternative approaches to physical assistance (i.e., sit to stand assistance with equipment support instead of hands-on approach), clearly communicating the purpose and process of the activity before providing manual interventions (i.e., explaining hand placement before intervention initiated), and identifying and respecting preferences (i.e., gender preference with close interactions such as bed mobility tasks).

Many of the patients we serve have a history of trauma or may be experiencing a traumatic experience through their illness or injury.  Some have faced loss through COVID-19, while others may internalize fear and uncertainty through prolonged hospitalization and isolation in response to the pandemic.  Trauma has lasting implications on an individual’s health and well-being. The physical therapist that approaches each individualized plan of care with function and the emotional well-being of the patient first and foremost will demonstrate the distinct value of physical therapy in trauma-informed care.

National Council for Behavioral Health. (2015, Jan 8). Retrieved March 8, 2021, from https://www.thenationalcouncil.org/BH365/2015/01/08/strengthening-personal-community-resilience-mitigate-impact-disaster-trauma/.

To those working on the front lines in nursing homes and skilled nursing facilities, it comes as no surprise to hear that CMS is directing state surveyors to be alert and investigate those residents experiencing a significant decline in their condition during the pandemic particularly those residents with weight loss and/or a decline in mobility. As we know, weight loss and changes in mobility can be a direct effect of increased social isolation resulting from the healthcare emergency.  Essential quarantine and social distancing come with a high cost for our seniors who already experience higher incidences of loneliness and isolation. Healthcare professionals have the skills to address the wide range of challenges that increased isolation has introduced to our long-term care residents.

Decreased taste and smell and diminished appetite can lead to poor eating habits and weight loss, and unfortunately these are often devastating side effects that isolation and various illnesses generate. Weight loss can cause complications ranging from dehydration and increased confusion to increased risk of skin breakdown, all of which inadvertently lead to decreased ADL and functional mobility independence.

There are many ways appetite can be encouraged within your facilities, including the following:

• Offer small meals often including protein packed small meals/snacks several times a day.
• Trend meal intake and maximize snack or mealtimes reflective of better appetite. If you know that a resident traditionally eats more in the evening, use that time to offer favorite, protein-rich foods.
• Train and engage all staff in meal assistance including administrators and activities staff to assist with meal set up and feeding (opening cartons, cutting meat, self-feeding, encouragement).
• As infection control allows, offer the structure of eating at a table as opposed to alone in the room or in bed.
• Remove wrappings, boxes or covers and move food to an actual plate/bowl so that food looks homemade and appetizing.
• Fortify food with things like yogurt, cream, honey, butter, and/or oats to meals to increase caloric intake and boost energy.
• Always have snacks and beverages handy. Make eating a communal event as much as possible while following infection control precautions. Meals should be enjoyable and not rushed.
• Enlist family member support when able.  Have them join the resident virtually for meals.
• Remember that food has to be eaten to count. Honor resident choice and encourage selection of favorite foods, even if it’s cereal for supper!
• Coordinate opportunities with therapy and activities to encourage exercise and activity to help stimulate a healthy appetite.  
• Timing therapy sessions to assist patients in routine daily functions including getting dressed and out of bed for meals to improve alertness and mobility for safe intake of meals/snacks.
• Refer for speech or occupational therapy screening when safe chewing/swallowing or self-feeding or positioning are of concern.

Fun fact: Did you know that the scent of cinnamon, citrus, spearmint, and peppermint can all stimulate appetite and alertness?

As the public health emergency continues, we must continue to rise to our residents’ needs. It is crucial to be diligent about monitoring weight and enriching resident care plans with nutritional and physical activity interventions to prevent weight loss. The keys to successful resident outcomes during a pandemic are knowledge, communication, and collaboration. Reliant Rehabilitation is proud to partner with you, your staff, and your residents!

The holiday brings with it an important time of reflection. As we gather around our proverbial table with you as part of our Reliant family, we pause to remind ourselves that despite the profuse and unique challenges of 2020, there were numerous successes for which to be grateful. While the list of obstacles at times seemed insurmountable, we continued to be a light to our patients – constantly adapting, advocating, evolving, leaning on our interdisciplinary team members, and showing up despite unsettling moments, and at times, heartbreaking losses.

Essential staff have risen as infection control heroes. We protected our residents, ourselves, and our loved ones through diligent processes as vigilance became a top priority. We met these challenges by solidifying our knowledge of infection prevention and control, provision of care for those in isolation, and proper use of personal protective equipment. The procedures and protocols developed this year will, no doubt, continue to ensure everyone’s safety in the long run.

Isolation and quarantine became a daily reality in an attempt to prevent and mitigate infection spread. Reliant clinicians continue to combat this by brainstorming and executing some impressive, heart-warming, therapeutic activities that provide much needed social interactions, safely. For example, our Sterling Oaks Rehab team built an actual lemonade stand to help the residents celebrate the end of summer, Northern Nevada Veterans Home created a resident carnival for their patients, and there were many more examples. They also incorporated daily care needs into their skilled treatment sessions to assist nursing staff. Countless other interdisciplinary teams facilitated “visits” through video calls or even through windows with patients and their families during quarantine.

This year, thousands of long-term care providers and therapists banded together to make their voices heard. Our respective, discipline-specific associations and The National Association for the Support of Long Term Care (NASL) enabled a multitude of health care providers to voice their concerns creating a powerful advocacy force and gateway to facilitate action. Advocacy measures impacted bipartisan legislation to continue to fight against cuts that would affect service provision for those who need it the most, proving that advocacy does matter!

As vaccine and treatment options appear imminent, even on the cusp of again increasing cases, we can go forward with knowledge, confidence, and determination to continue to protect and fight for our residents.  So this year, as we sit around our “Reliant table” and share feelings of gratitude with and for one another, despite having to hold each other’s gloved hands and speak through masks, we hope you feel and sense accomplishment and gratitude, and that you are smiling under those masks, knowing that we stood together on the precipice of the unknown and found resilience, meeting daily demands with continued hope beyond the present circumstances.