Physical therapists crossing a line.

Thanks for your comment, Linda, that I should try to consider becoming a therapist or assistant - I would love to do just that, as that is my real interest and passion - This is a new topic, I apologize, but wanted to follow up for now on Linda's comment. I only started Home Health Care work with elders, as a transition job - 15 years ago. Meanwhile I have held full responsibility for my adult brother, born with brain injury (mobility, neurological, memory, epilepsy issues, as well as isolation from peers due to being over protected and isolated, unaware of his ability to listen, follow, remember, learn. Long story. learned lots of skills, first one being we both survived, now 40 years later. I WISH I could figure out how to transfer some of my skills, rather than pay for a whole 2-3 years of additional schooling. Will start exploring soon. Thanks!

duh, "ambulation." And, in this person's situation, it would be wheelchair training I guess. Maybe they could seek an O.T. order, to do "functional mobility" cognitive training for safety. It is an activity of daily living, and any creative O.T. can write the goals to cover her getting outside in the chair to practice safety, assuming there are no access barriers. The question is whether or not she would have carryover of those skills, and not forget to be supervised on outings until determined safe to be alone....

Castle, you really should consider becoming a therapist or assistant - you really get this rehab stuff! Actually, my MILs Physical Therapist made walking the dog into the ambulantion and endurance training, which worked well for everyone, including her dog! Being an Occupational Therapist (our theoretical foundation is to use human occupation as the method of delivering increased functional independence, along with the strength, range of motion, endurance and cognitive skills), I do anything I can to sneak the therapy into daily life skills, and I think Physical Therapists have a greater tendency to do the same now, especially in the home care setting, where it makes sense. You're right, the primary concern is always safety. Good luck in your career; home health aides are a very important part of the team.

Oh - I misread the part in the post about the children coming to walk the dog - if it is the PT's children, then that IS too much of an intervention - I read it at first, that it was the Mother In Law's children walking the dog, and I thought that all the PT did, was suggest putting in a ramp. Not that this was a small change, but if she just made the suggestion without taking any step further than making a comment, I like to think she did not "cross" any lines. All voices need to feel free to suggest, and the time to insist on process is if any plan is going to be considered, and that would involve full process with professionals and family involvement. But if it's the PT's high school kids walking the dog, the family need to think clearly about what plan is best for that - is there any way the MIL can be empowered to walk them? Is this advisable? Possible? How Independently and if Safely. It's great if ongoing activity and stimulation can be built into a natural routine, such as times when the dogs need to be walked . Sounds like some plans are worth discussing, and I'd hope the PT's suggestion can be taken in good faith, while still controlling the decision and further conversation. Natural-procedures ideas from rehab people are jewels that can help families a lot, so it's worth avoiding rush to decide, but consider them - as Linda says, there's an important time process for exploring sorting variables, and responsibilities are clear when professionals, their agencies and family members involved, are lined up together.

Oh, and one other thing - only a physician can write a prescription for a wheelchair ramp (or bedside commode, or splint, or most other items reimbursed by a third party). Therapists often fill the thing out, and list all the details, but it still must be signed by an MD. If you do want ADA adaptations made to increase you MILs independence, you'll need MD approval unless you intend to self-pay. Just FYI...

Speaking as a therapist - OT and not PT (although we more often tend to make recommendations for home adaptations, so I'm quite familiar with that turf!), I have to first say that "Castle" and "Purplesushi" make good points and I agree with them. The problem I often encounter is that a senior patient wants things that make them feel more independent, and the therapist wants to find a way to make it happen, HOWEVER, when there is a family available to provide input regarding things I can't know about (like traffic safety, bad habits, intermittant dementia, etc.), I want and NEED to know! Although my patient is my client, it is also my responsibility to collect all the information possible before making or following through on recommendations. Often, I encounter family members that are just plain resistive (i.e. recently, about me using 3M tabs to tack down "trip hazard" edges of a large braid rug that their mother insisted on keeping), and dismiss even small changes that they don't think will work. But just as often, I get feedback that shows me the whole picture, such as what was tried before (and failed), etc. This is meant to be a give and take, and communication is essential to good patient care. After all, the family is crucial to the success of therapy, especially after we leave! INSIST that the therapist discuss any significant recommendations (like a ramp) with you, to get your ideas before implementation, and do your best to listen to their opinion also (some of us have been doing this stuff for a long, long time). BUT, and I can't emphasize this enough, DO NOT allow any non-professional interventions, like therapist friends or family members getting involved!!!!!! You should change providers immediately - that type of behavior is unethical, and is a strong conflict of interest. All of us therapists are licensed by the state we practice in, and you can ultimately address any concerns to the Health Professsions license bureau in your state. But, please talk to their employer first, and give them specific information (like the names of the people the therapist has coming there, unauthorized by you). This type of situation needs to be reported, pronto. A therapist can suggest agencies and other professionals, but never never never do what this one is doing. There is a possibility, if this is a "new grad" who hasn't been in practice long, that they are being over-zealous in their strong desire to help solve a problem. They might not realize that they are dong something highly unprofessional and unethical and unacceptable. If that's the case, the agency that employs them can educate them. I wish you all good luck with this situation and hope it resolves in a way that does no harm to anyone. But please do take action!

Good idea to ask if Mom requested it!
When an Elder lives in a housing complex---any configuration of apartments means they don't control whether or how much ADA changes can have done to the property to accommodate her.
EVEN though buildings are supposed to be ADA,
and even bldgs supposedly meant to house elders and those with disabilities,
are more often than not, still barely accessible for anyone beyond using a walking stick or a modest walker; just ask anyone in a wheel chair or with mobility limitations!
She MAY have asked the PT to write a prescription for a ramp, so she could get a ramp she could use--dog or not.
A building manager often 1st needs a prescription for things like that, before they can act on either doing it, or hiring it done, or allowing family to do it.

Your mother probably WANTS to go outside and walk her dog herself, and has expressed this to the physical therapist. It is not unwanted advice, from your MIL's perspective - she may have asked them to say something because her voice is not being heard. No one likes to be cooped up in the house all day long. Can she move to a different unit in the complex that is more accessible and will be easier to put a ramp in? You are mentioning "your" concerns, and not your MIL's feelings on the matter. Just a thought.

I have struggled with this type of issue from the perspective of the incoming health worker, though my role has been more confused because I'm home health aide, not a physical therapist. But I learned rehab and prevention focus when I was responsible for my own youngest brother's adult care. I learned the value of home adaptations, and found it greately more healing over time, mentally and physically, for someone to have a way to get themselves mobile, rather than have to wait for others. Waiting most of the time, they often lose skills and mental alertness fast. So often we worry about what elders will find that they can still do to fill their time, yet don't set them up to get themselves safely mobile. Yes, that's the key word of course, safely. If I had made the suggestion to you, I'd like it best if the family said, "Thank you for the idea, the concept is good. I am not comfortable with the actual location though, so I won't accept that suggestion as it is now. If you can think of a way to solve that one, give me another suggestion! If you find her manner overbearing, you can ask her to email you if she has another suggestion, or leave you a phone message, or tell someone else who will tell you. Communication on teams is a major challenge, and it is so much better to welcome it and channel it, than to shut it out. You may need her insights in another time. I find the rehab focused people often find their preventive suggestions minimized by healthcare professionals who focus on cures after injuries, not prevention. Many have eyes that see solutions, and it's not easy to be in the role of suggesting changes, for most people's first reactions to change is "no".

I would find out what prompted this advise. If it was concern from your MIL that the dog was not get out often enough, or that your MIL was not feeling independent and felt the need to be able to "walk" her own dog, I would investigate ways to make sure the ramp would be safe for her to get outside on her own. As far as people you don't know coming over? I'm with you. If the dog needs to be walked more often, you can do it. Keep the high school kids out. That's just asking for trouble, IMO.