At 8:15 a.m., Kait, a home care physical therapist, begins her Friday. With coffee in one hand, her phone in the other, and a laptop on the table she organizes her day.
"I synchronize my laptop to get updated patient information and check voice mail for any changes in my schedule. The first thing I do is prepare a list of telephone calls and visits that need to be made." Kait calls her patients and confirms windows of time when she expects to visit. With her to-do lists written, she is off to her first visit. Much to Kait's delight, a few of her visits are in the countryside today out of her normal area, not far from her suburban home in southern New Jersey. Her car winds along one-lane roads past cornfields, vineyards, and tomato farms. Many older people have retired to southern New Jersey after living and working in Philadelphia across the river.
Shortly after 9:00 a.m. she arrives at the home of Jack, a cranberry farmer. He lives alone and has a right tibial plateau fracture, the result of a farming accident. Kait begins the visit by taking Jack's vital signs and discovers that his blood pressure is on the high side. After determining that he is stable, she proceeds to teach him exercises to strengthen his right leg while awaiting weight-bearing orders. Kait tells Jack she will leave a message with his physician and the occupational therapist scheduled to visit later today. Jack, anxious to return to work in the cranberry bogs, promises to continue his daily home exercise program.
Next she heads off to see Betty, a 70-year-old who recently had a knee replacement. As she drives through the pine barrens, she cannot help but keep an eye open for the legendary and elusive "Jersey Devil," said to inhabit this dense forest. Arriving at Betty's home, Kait begins to progress Betty's range-of-motion exercises and gait pattern and work on stair climbing. As expected, Betty is making great progress postsurgery.
In the car, Kait receives a phone call from her fourth scheduled patient for the day. Mr. Robinson is obviously upset and concerned that he is unable to get his wife out of bed this morning. "Mrs. Robinson fell yesterday and now she can't move her arm very well," he states. Kait instructs him to take her to the emergency room to be checked for fractures. Mr. Robinson refused, stating "I want you to come out and check on her first." Kait tells him she will be there.
Kait's third patient is Harriet, an 82-year-old with heart failure. Harriet is very forgetful and lives alone, requiring Kait to be creative in her home exercise program. As Kait enters the home Harriet smiles, happy to have company. After assessing Harriet they begin working on balance activities. She contacts Harriet's daughter to give her an update and adds some word cues to Harriet's exercise sheets to help her remember what she is supposed to do.
Arriving next at the Robinson's, Kait takes a deep breath. Mrs. Robinson was referred to home care with bladder cancer. She recently underwent radiation and suffers from general weakness and fatigue. Today Kait finds her sitting up on the side of the bed. "Good afternoon Mrs. Robinson," Kait says as she approaches her bed. Kait notes her response, her smile symmetrical but a noted grimace when she reaches for a glass of water. After completing her assessment and assisting Mrs. Robinson to and from the bathroom, Kait calls the physician to update him on the fall and to get an order for the nurse to resume visits. Mrs. Robinson now has an open wound on the leg and her gait is very shaky. "I will ask the nurse to visit you today to take a look at your wound." Mr. Robinson tells Kait how much they appreciate her coming to the house. "We don't like to go to the emergency room. Thank you for coming."
Sitting in her car, Kait makes notes from her extra-long visit with Mrs. Robinson and heads to her fifth visit of the day, Harold, a 71-year-old veteran with stomach cancer. She pulls into his driveway and prepares herself for what she may face. Harold participated very little in therapy during her last visit. His activity tolerance was quite diminished.
"Good afternoon Harold," Kait says as the aide lets her in. She works with Harold, who makes progress today doing stair training. Harold has a physician's appointment on Monday and is motivated to get stronger so he can get out of the house.
Finally, Kait drives back to her last patient, Diane, a 65-year-old woman with a total hip replacement who lives closer to Kait's home. She has been progressing well, and Kait thinks she is ready for discharge. "I am feeling good today," Diane tells Kait as they work on gait training and stair climbing without handrails. Kait provides Diane with a copy of her transfer to outpatient therapy. Diane reaches over to hug Kait and says "Thank you so much for helping me through this."
Traffic to the office is too congested with people driving to the beautiful Jersey shore for the weekend, and home is too distracting, so Kait heads to the local library to finish her paperwork. She ensures that her schedule is updated for next week and that she has addressed all the items on her to-do list. Of course, items have now been added to Monday's list, including picking up needed supplies. Before heading home, Kait synchronizes her laptop again.
"Today was a good day," Kait says. "Most of my patients showed progress, but you have to be very flexible and respond to change quickly. Being a physical therapist in home care has offered me many opportunities to develop my clinical skills as well as tap into my creativity and resourcefulness in adapting treatment sessions for each patient. Probably the most important benefit of home care is generally at the end of the day, I know I have helped someone in some way, and therefore my job is professionally and personally very rewarding."