New guidelines for provision of physiotherapy in aged care in New Zealand Providing the best care for older people living in ARC, who have diverse functional abilities, health needs and cognitive function is challenging from Aged Care New Zealand Issue 1 2022 ![]() Physiotherapy New Zealand (PNZ) is soon to release the first NZ guidelines for Aged Residential Care (ARC) managers on the benefits and utilisation of physiotherapy services in ARC, developed by members of the Physiotherapy for the Older Adult Special Interest Group of PNZ. The provision of physiotherapy services in ARC has long been unclear with the contractual requirements being ‘grey’ at best. These guidelines aim to provide managers with information around the immense benefits of a robust and effective physiotherapy service, and the ‘how to’ of selecting and planning high quality physiotherapy services for their residents. Mobility and independent function are highly valued by older people and their whanau and are essential to the wellbeing and health related quality of life of older people. Aged Residential Care is a vital part of our health system where over 50 percent of all individuals will stay for some of their lives. Some people will live in ARC for up to five years or longer, and those years spent living in ARC, can be a very meaningful experience for an older person. Providing the best care for older people living in ARC, who have diverse functional abilities, health needs, and cognitive function, is challenging. Utilising physiotherapy allows facilities to support their resident’s physical functioning, enable their well-being, rehabilitate them from injury and illness, manage long term conditions, and delay the onset of frailty and disability. The newly developed guidelines include:
These guidelines have been needed for many years. A report to Physiotherapy New Zealand on physiotherapy services. The report outlined inadequate provision of physiotherapy service and examples of physiotherapy assistants working without supervision of a physiotherapist. In 2022 physiotherapists see extreme variation in the provision of physiotherapy, ranging from 20 ᐩ hours per week right down to hospital level care facilities with no weekly physiotherapy provision. The urgency for these guidelines was highlighted in the initial response to Covid 19 when New Zealand moved to Alert levels 3 and 4 in 2020 and the country went into lockdown. Huge variation in access to physiotherapy services was seen across the country. Although many facilities engaged with telehealth there were some ARC facilities who did not engage with physiotherapy services at all. On the return of physiotherapy services to facilities there were numerous cases of irreversible loss of mobility and function in residents over the two-month period. These guidelines will not just inform managers but will also be an essential guideline allowing more informed consumers to ask appropriate questions when selecting their ARC facility. Generally, physiotherapy services are listed on Eldernet as “yes/no” with limited information on the physiotherapy services provided. These guidelines will give consumers the understanding to ask detailed questions about hours of physiotherapy each week, what can be expected in terms of assessment and input for themselves or their whanau and allow them to understand how the provision of a robust physiotherapy service can improve their experience of ARC living. Ref: Aged Care NZ, Issue 01 2022 Physiotherapy NZ Older Adult If you are interested in receiving a copy of these guidelines when they are released, please contact [email protected] Therapy Professionals Ltd, Christchurch, NZ has been supplying physiotherapy services since 1985. We understand the needs of the residents, staff and facility.
Phone: 03 377 5280 Email: [email protected] Conscious activity prevents muscle loss Muscle loss might be an inevitable part of ageing, but exercise can slow the process down. From: Aged Care New Zealand Issue 02 2021 ![]() Here’s a sobering fact: one can lose up to 40 percent of muscle mass between your 20s and 80s. That might sound outlandish, but it’s a natural part of ageing. Known as sarcopenia, this is a gradual loss of muscle mass that occurs as we age. Although we can start losing muscles from our 20s, this loss really speeds up once we hit our 60s. At the same time that sarcopenia causes loss of muscle mass, we simultaneously gain fat mass, and see a big drop in strength too. All of this can have a big impact on how well an older person moves. Muscle mass plays a huge role in our health. So much so that sarcopenia and sarcopenic obesity (the combination of low muscle mass and excess fat), and dynapenia (the loss of muscle strength) are associated with a surprisingly wide range of health conditions, from heart disease and diabetes to frailty and dementia. In fact, in people who already have heart disease, those with the highest levels of muscle mass seem to have the best chance of living longer. On the other hand, people with the lowest amounts of muscle seem to be at highest risk of dying prematurely from all causes. This tells us that muscle might play a protective role in heart health. Why this happens, we don’t yet know – but it may have something to do with chemical messengers (myokines) produce by healthy muscles, which can help reduce inflammation throughout the body. Another major benefit of having healthy muscles is that they help protect us from diabetes, which can help reduce inflammation throughout the body. When we eat and digest carbohydrates - such as potatoes, bread or rice – sugar enters our blood stream, a lot of which is sent to our muscles. Our muscles use this sugar for energy or store it as glycogen in order to maintain stable blood sugar levels. This process is an important part of blood sugar control and explains why people with less muscle are more likely to develop diabetes. In older people, low levels of muscle are also linked with a great frailty, weakness, and being less able to carry out normal daily activities. This means people can have trouble with regular tasks such as getting out of bed, standing up from chairs, climbing the stairs or carrying groceries. All of this can make living independently a lot more difficult. Difficulty moving can also mean people end up moving even less which speeds up muscle loss. People with sarcopenia who lead sedentary lives are also at greater risk of osteoporosis. This is because active muscles send signals to bones that help them stay strong. The drop in strength from sarcopenia means people may be more prone to falls and bone fractures. Again, this fear of falling may make some people more sedentary, which may reduce quality of life and put them at a greater risk of depression ![]() Although sarcopenia is a natural part of ageing, muscle loss is largely accelerated by inactivity. As we get older, we tend to move less. But exercise is one of the key signals that our body needs to keep our muscles strong and healthy. Without that signal our muscles start getting smaller and weaker over time. Eating protein also acts as a signal to grow and maintain muscle. However, as we age, we tend to have smaller appetites and eat less protein, increasing the risk of muscle loss. Lower levels of the hormones, testosterone and oestrogen, higher levels of fat, insulin resistance (where the body doesn’t handle glucose as it should, which can lead to diabetes) and higher levels of inflammation are other reasons why older people lose muscle more easily than younger people. In fact, all of these factors combined lead to something called “anabolic resistance”. This means the body doesn’t respond as well to the signals that normally cause muscles to grow. If that isn't enough, current COVID-19 restrictions may be making muscle loss even more likely. Data from smartphones has shown that people have been more sedentary than usual during lockdown. We also know that people’s sleep quality has declined, and people are probably feeling more stress and anxiety. These factors can also speed up muscle loss by affecting hormones that increase muscle breakdown and encourage weight gain by affecting appetite hormones, causing people to eat more processed foods that have more calories. This is called a ‘catabolic crisis’ – a brief period of time when conditions come together to make muscle loss much more likely. Another example of a catabolic crisis would be if someone was hospitalised or forced to spend days, or even weeks in bed. COVID-19 could very well create a catabolic crisis for many adults after lockdown. ![]() Muscle loss can be prevented – or at least slowed – with a few lifestyle changes, namely exercise activity and diet. Resistance exercise, such as lifting light weights or using elastic resistance bands, helps keep muscles strong and healthy and regular walking can help too. High protein diets, containing foods such as lean meats, fish, eggs and low-fat dairy products can also help to build and maintain more muscle than exercise alone. Getting at least 25-40 grams of protein each meal is especially important. On top of that, widely available supplements including Vitamin D, fish oil and creatine (a naturally occurring substance found in the muscles which helps them produce energy) may help people hold on to more muscle and improve their quality of life as they age. During the pandemic, when muscle loss is more likely, prioritising regular exercise and a healthy diet can make a big difference to long-term health. Authors:
Richard Kirwin, PhD Researcher Clinical Nutrition and Physiology, Liverpool John Moores University and Claire Stewart, Professor of Stem Cell Biology, Liverpool John Moores University. From: Aged Care NZ Issue 02 2021 Here at Therapy Professionals Ltd our friendly therapists can assist you to improve your diet and exercise to slow down the loss of your muscle bulk. Just phone: 03 377 5280 or email us at [email protected] Seating people comfortably ![]() Many elderly and disabled people in care sit for long periods of time. Some are able to move themselves while others are not able to move without assistance. For those of us caring for the elderly and disabled we need to think carefully about how we seat those in our care. We need to consider things like:
Good posture is important to prevent back pain, encourage mobility, assist swallowing and prevent chest infections. When choosing a chair for a client it needs to be supportive to prevent them from slumping over. When sitting for long periods of time without being able to adjust your position, circulation to areas on a person’s bottom, legs and back can be cut off causing discomfort and, if left, pressure sores. ![]() Pressure relief is important. Some chairs have pressure relief features built into them; we recommend these, especially for people who are unable to change their position. Alternatively pressure cushions can be used. Air filled pressure cushions (Rohos) can be problematic. They can be slippery causing a person to slide forward into a slumped posture. A slumped posture is uncomfortable, can make it hard to swallow and breathe effectively and take part in activities. The cushions raise the height of the seat, which may cause the feet to dangle, leading to discomfort under the thighs. While sitting it’s important to have feet on the floor or a footrest. ![]() For more information on pressure injuries follow this link. https://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/skin_injuries_caused_by_pressure.pdf Keeping people mobile as long as possible is in everyone’s best interests. If you are caring for someone who can still stand themselves up or better still walk safely, it’s important you choose a seat that encourages them to stand and get out of easily. This means their feet must be flat on the floor, the chair has armrests at the right height to push up from and the seat surface is firm enough to wriggle forward. The ideal seat for a person, maintains an upright posture with their bottom back in the chair and hips at a 90 degree angle. The chair needs to support the spine, thighs with a gap behind the knees and the armrests should support the arms with relaxed shoulders. Feet need to be flat on the floor or supported on a footstool. For more information on choosing a seat follow this link https://www.therapyprofessionals.co.nz/uploads/4/9/5/2/49523375/choosing_a_comfy_armchair__.pdf If you need some help seating the elderly or disabled in your care our friendly Physiotherapists and Occupational Therapists can help just contact us at Therapy Professionals. Ph: 03 3775280 Email: [email protected] Oral Care For those without teeth or are tube fed ![]() Many people mistakenly think because they or the people they are caring for have no teeth or are fed via tube, there is no need to clean their mouths. This is simply not true. Oral and dental diseases can be a contributing factor to pneumonia as the levels of bacteria in the mouth and saliva are increased. If saliva or food/fluid contains these bacteria and enters the lungs (aspiration), it can increase the risk and severity of chest infections. If oral care is not maintained oral and dental disease is more likely and so are chest infections including pneumonia. Is oral care for everyone? Yes. Each individual should have a plan for oral care including anyone without teeth and even those who do not eat/drink orally (ie are tube fed). Why is oral care important?
How often?
Equipment that can assist with oral care:
How to do oral care/tips: Sometimes it can be hard to remember to do oral cares
If you are having any trouble implementing oral care, please don’t hesitate to seek help either from an oral hygienist, dentist or our friendly Speech Language Therapists. For advice especially for those with disabilities talk to our friendly Speech Language Therapists who are experienced with disabilities. Just contact us at Therapy Professionals
Phone: 03 3775280 Email: [email protected] Website: www.therapyprofessionals.co.nz Home away from home While many seniors like to be independent, they need thoughtfully designed spaces to be able to live in comfort and safety? from Aged Care New Zealand Issue 2 2021 ![]() Creativity can be put to the test when decorating a space for senior citizens. Whether it’s a single room, studio apartment, patio home or other living quarters, senior citizens have particular needs regarding their décor. While aesthetics and comfort are important, safety is paramount. A proper room layout and furniture arrangement is crucial to a senior’s wellbeing. Most nursing home rooms are modestly sized and bringing in too many personal items can make the room cluttered and dangerous. Keep walkways wide and clear to allow ample room for walking. Older people confined to a wheelchair or those that need the assistance of a walker or cane require even broader passageways. A single-level residence on the ground floor offers an optimal abode for seniors who have difficulty climbing steps. Even a single step that transitions from a kitchen to a sunken living area can be problematic for the elderly. Install a handrail on each side of the step as a reminder that it’s there as well as to aid for going up and down it. If it is a skilled nursing facility, then there may be a certain amount of medical equipment in place. When decorating, one can’t simply take it out because it is ugly. You also shouldn’t attempt to hide it behind other objects, as staff may need to access it quickly in an emergency. You may not be able to move furniture either. It is placed so that there is access to the appropriate outlets. What you can do, is take advantage of spaces that already exist, such as the bed, walls, furniture and windows. You can customise the décor to suit the individual’s personality and interests just by adding a few special touches. If it is a shared room, then the other’s privacy and territory must be respected too. One person’s possessions shouldn’t trickle over into the other side of the room, their lamps shouldn’t be pointed at the other person’s bed or reading chair, and one should make sure that any items that might be offensive or disturbing to the roommate are placed so they are not easily visible from their side. Shared rooms mean less space on either side of the divider too, so you will want to limit items that take up floor space, as well as things that are in ‘elbow space’ (tabletops) that they may need for other purposes, such as eating, writing, or working puzzles. ![]() Safety Decorating a senior citizen’s residence with safety features should top the design list. Many older people don’t move around as well as they did in their younger years. Remove scatter and area rugs from the floors. Safety and ease of maintenance should be important considerations when choosing the right flooring for the elderly. For elders with an unsteady gait, a non-slip surface is a must.
The colour of the flooring tile is also an important consideration. Whites and light colours so not show up water spills, and even a little water on the floor can cause a nasty accident. Sofas and chairs that aren’t too low, deep or plush makes it easier for seniors to sit down and get up. In addition make sure the seating has stable arms that are tall enough for them to grab onto. A reclining chair supplies a comfortable seat that an elderly person can adjust to her own personal preferences. Substitute an upholstered ottoman for a traditional coffee table. An ottoman has no sharp edges or corners to scrape bare legs or bang your shins on and they are great for storing knitting supplies, magazines, a spare blanket and other odds and ends of clutter that make the room feel too claustrophobic. A bed with comfort level controls allows an older couple to adjust each side of the bed to suit individual needs, such as mattress firmness and reclining positions. All items inside the wardrobe should be easily accessible; a pulldown wardrobe lift is a useful accessory if rods are too high to reach. Decorate with dining, bedside and accent tables that have rounded corners for increased safety against sharp corners. Just aim for sleek designs that will fit well into any space and are easy to clean. Soft, woven furniture throws, lumbar pillows and dimmer switches add comfort to a senior’s home. Aesthetics Aesthetics plays a significant role in making an older person’s residence feel homey. If possible, paint the walls a warm but neutral colour – warm beige, sage green, creamy caramel – to generate a soothing ambiance. The wall colour should be a distinctly different hue than the floors so that seniors with weakening vision can readily discriminate between the two. The same principle applies to bedding; purchase contrasting bottom and top sheets for ease in differentiating between them. Senior citizens have often collected a ton of decorative items throughout their lifetime, which can quickly lead to a cluttered environment. Display only a few favourite articles on wall shelves and group small collectibles together for display in a lighted curio cabinet. Rather than putting all the favourite photos and knickknacks in a room at once, use very few at a time, then switch them around every so often to help the room look fresh and new. This is an especially good way to celebrate the changes of seasons. Health A very real consideration in an aged care environment is hygiene. If the person has any type of respiratory or contagious illness or infection, then you want to make sure all surfaces are something that can be wiped easily with a sanitising agent. This is not the best time to decorate with ornate scroll work that takes too much time to clean. Nooks, crannies, porous surfaces and linens that can’t be washed in hot water may harbour dangerous bacteria and re-infect or cause illness to others. Where, dementia is a factor, one may need to avoid overloading the room, since this can add to confusion. Busy prints are not a good idea, as they can appear to ‘crawl’. Choose furniture and storage containers that can be labelled, since photo labels can sometimes help the individual find items they need or want. ![]() Lighting As we age, our eyesight deteriorates. Lighting should be cool and bright, and white light is preferred over yellow light. Plan to add adequate ambient lighting for safe navigation around the house, and task lighting for reading books or other hobbies.
Open up the views
As many elderly people are restricted to a room or the indoors, large windows or balconies are a lovely way for them to keep in touch with the outdoors. They should be able to get street views and views of the garden as much as possible. Windows should only have light shades so they get their daily dose of Vitamin D without needing to get outside. To sum up, it’s important to ensure that our senior citizens can live individualised spaces with a high degree of independence and dignity. It can also serve as a reminder to them, as well as to visitors, that they are more than just another resident. They are individuals with their own ideas and likes. Are your shoes safe? As we age our risk of falls increases. When we do fall, we are:
Making us more likely to fall again. There are many reasons falling occurs with ageing, it may be because of:
Falls are preventable. One of the many ways in which you can reduce your risk of falling is by changing the types of shoes you wear. Please take a few minutes to complete this checklist. It outlines characteristics of shoes that make them safer. Do your shoes fit well? Yes No (Shoes that are too tight or too loose can be dangerous) Do you mostly wear flat shoes? Yes No (High heels can be very dangerous) Does the sole of your shoe bend at the ball of your Yes No foot, not at the arch? (This is better for walking on uneven surfaces) Does the sole have a bit of bounce? Yes No (This helps prevent jarring to your foot) Does the sole have some grip? Yes No Does the heel have a rounded edge? Yes No (Sharp shoe edges can slip easily on wet or shiny surfaces) If you circled No to any of these questions, you may be at increased risk of falling. Please take this checklist to your Podiatrist, family doctor or practice nurse so that you can discuss ways to reduce the risks.
Therapy Professionals Ltd friendly physiotherapist can help, just contact us on phone 03 3811741 or email: [email protected] to make a time. Ref: Adapted from Public Health Division © Health Department of WA 1999 SOYF What can you reasonably expect of your physiotherapist in aged care? ![]() Aged care residential services have changed greatly, expectations are greater and funds are less generous. Once many aged care facilities provided maintenance and rehabilitation physiotherapy services, now the budget doesn’t allow for rehab. What is Maintenance Physiotherapy - assessment, planning and review of:
The implementation of most of these plans will be done by care staff not the physiotherapist. So what happened to rehabilitation? Most facilities can’t afford the intensive hours of individual physiotherapy to rehabilitate someone following a stroke or recovering from a fractured neck of femur. How might this be managed? Strokes – either gain service from the Health NZ. OR many families can pay privately for a burst of intensive physiotherapy. Fractured Neck of Femur – Treatment is subsidised by ACC for 12-16 treatments. Most physiotherapists will require a co-payment. The facility or family would need to pay for this. Individualised Wheelchairs? These can be very time consuming at up to 6-8 hours per individual. We would suggest it’s not the most equitable use of your budget. Health NZ has a wheelchair and seating team, a physiotherapist can access this. However there is often a long waiting list. OR your clients can pay privately for a physiotherapist to prepare for and organise an appointment at the Enable equipment clinics. How do you know your therapy services are value for money? It is hard to know if you’re purchasing quality. What can you, the purchaser of services, do to ensure you are purchasing good quality, value for money services? The same due diligence is needed when employing or contracting for physio services as you use for any of your staff. Things to consider ![]() Efficiencies are made with experience, good systems and the use of an indirect therapy model. An expert in any area may cost more per hour however their experience brings savings in time, supervision and training costs as their knowledge is deep and at their fingertips. They get more work done per hour. Employing vs Contracting Many employers when deciding on whether to contract or employ make the mistake of comparing the contract hourly rate with the hourly rate. They forget to include other costs of employing eg leaves, ACC levies, staff training, support and supervision, insurances, Kiwi saver, general management and administration costs. When comparing costs the general rule of thumb is to multiply the recommended hourly wage rate by 2.5 and you get a rough estimate of the cost of employing. Additional costs to consider are:
![]() Comparing potential contractor’s price
Check:
Seating Advice for Residential Care The frail elderly and disabled in care spend much of their day sitting, often in unsuitable chairs, which restrict their mobility and cause them to adopt slumped postures. Correct seating allows clients to:
When a resident has difficulty rising from an armchair, consider the seat height, depth, width, slope and firmness, and the armrest height. When choosing an armchair for your residents consider these things: ![]() a) Height: For comfort and ease of getting out of the chair:
b) Width: There needs to be a space of 2-3 fingers either side of the body to allow wriggle room and to keep the armrests comfortable. c) Depth: The depth needs to ensure a good upright posture and for ease
![]() d) Back rest needs to:
e) Arm rests need to:
Residents come in all shapes and sizes, we recommend Residential Providers
Choosing wheeled chairs For staff safety when choosing wheeled chairs, ensure the wheels are larger enough to push easily on all floor surfaces while allowing the ambulant person’s feet to rest on the floor so they can stand easily. If your current wheeled chairs are hard for staff to push, see if you can get larger castors or wheels, or check that fluff is not restricting the wheels.. Couches We don’t recommend couches as they are harder to get out of and harder to assist someone to stand. Skin injuries caused by pressure |
AuthorShonagh O'Hagan Archives
July 2024
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