Physiotherapy in Care Homes and Assisted Living in Warwickshire

A care home is not a reason to stop rehabilitation, but it is often where it quietly stops happening. Moving in frequently follows a fall, an illness or a hospital admission — exactly the point at which somebody has lost the most function and has the most to regain.

What actually happens to movement in a care home

Good homes work hard at this, but the structure works against it. Staff are busy, and it is faster to help somebody than to wait while they do it themselves. Meals arrive, so there is no walk to the kitchen. There is no shopping to carry, no stairs, no garden to get to. Days involve far less standing up than a life at home did.

Strength responds to what you ask of it. Ask less and it goes, quickly in later life. Within a few months somebody who walked in with a stick can need two people to stand, and it is rarely one dramatic decline — it is the accumulation of small helps.

What private physiotherapy adds

Care homes are not required to employ physiotherapists, and most do not. NHS community therapy will usually see a resident for a specific problem after a fall or a fracture, then discharge. There is often nothing in between that keeps somebody moving.

Private physiotherapy in a home usually involves:

• A proper assessment — what they can do now, measured, so change can be seen rather than guessed at
• A programme the staff can carry on — realistic about the time carers have, written down, and shown to them rather than left in a folder
• Standing and walking practice — the single most valuable thing, and the thing most easily lost
• Transfers — getting in and out of bed and chairs, which affects dignity and staffing as much as mobility
• Equipment and seating — a chair that is too deep or too low does more harm than most people realise
• Falls risk — assessed properly, and reduced where it can be
• Rehabilitation after a setback — a chest infection, a fracture, a hospital stay

Getting somebody home again

Not every care home stay is permanent. Some are respite, some are a step between hospital and home, and in those cases there is a specific target: the level of function needed to go back. Working towards that deliberately, with someone measuring it, makes the difference between a discharge that happens and one that keeps being deferred.

When two physiotherapists are better than one

Most visits are made by one physiotherapist, and for most people that is all that is needed. But where somebody is hard to move safely on their own — heavier to support, very unsteady, or newly home from hospital and not yet confident — a visit can be made by two. It means the work can be done properly instead of cautiously, and it is often the difference between practising standing up and not attempting it at all.

It costs more and it is not needed forever. Ask on the free phone call and you will get an honest answer about whether it applies to you.

How it works with the home

A private physiotherapist works with the home, not around it. That means agreeing visits with the manager, reading the care plan, writing in the notes, and handing the day-to-day programme to the staff who are there every day. Families can arrange and pay for it directly; the home's permission is a courtesy and a practicality rather than an obstacle, and most welcome it.

It is worth asking the home what they already provide. Some have links with NHS therapy teams or run their own activity programmes, and there is no sense paying for something that is already happening.

What families should expect

Be wary of anybody promising to restore independent walking to somebody with advanced dementia or late-stage frailty. Honest goals in this setting are often smaller and more valuable: staying able to stand for transfers, keeping the strength to get to the toilet, being comfortable in a chair, being able to take part in an activity. Those are worth a great deal to the person and to the people caring for them.

Ask for the measurements at the start and again after a block of sessions. If nothing has moved and nothing in the plan has changed, ask why.

Care home visits across Warwickshire

Visits to care homes, residential and assisted living settings are available across Rugby, Nuneaton, Warwick, Leamington Spa, Stratford-upon-Avon and across Warwickshire, at the same rates as a home visit.

About Louis McKenna

Louis McKenna is a mobile physiotherapist (MCSP, HCPC PH124187) who visits people in their own homes across Rugby, Nuneaton, Warwick, Leamington Spa and across Warwickshire. He runs an independent practice, A&M Physiotherapy, alongside fellow physiotherapist Tom Arnold (HCPC PH125635), and A&M can also offer appointments with two physiotherapists where additional support is needed. Much of his work is neurological rehabilitation, and helping people regain strength, mobility and confidence after a stroke, operation, fall or stay in hospital.

Read Louis's profile or call 07402 961786.

Please mention Mobile Physiotherapist.co.uk when you call.