In 2009, the Neurology Section's then-President, Kathy Sullivan wrote a call to action for neurologic physical therapists to advocate for health care reform and, more importantly, for the rights of patients to equal access to physical therapy services.1 With the advent of the Affordable Care Act,2 this call to action is more critical now than ever. Physical therapists need to be at the forefront of defining the health care models of the future, and each of us needs to be part of the political movement for change.
I have to admit that over the years I have been an inconsistent advocate, more likely to invest my time and letter writing in issues related to direct access or educational change than those related to payment or models of care. The last 3 years on the Board of Directors for the Neurology Section and 2 years as the Section's delegate to the House of Delegates (HOD) has made it infinitely clear that effective advocacy needs all therapists, not just those in the HOD or in the APTA Board of Directors, to take action.
In this year's HOD, the profession will consider a new Vision for beyond 2020 and look at the development of care and payment models that will meet the needs of people of all ages with mobility impairments. Our new vision should emphasize the profession's contribution to quality of movement across the lifespan that encompasses prevention of mobility impairments, rehabilitation to recover mobility, and long-term care for those with chronic disabilities to prevent deterioration of mobility. Notably, to support this vision, there are motions for eliminating the episode of care model of treatment delivery in favor of long-term management of chronic conditions that can be provided across time or in a series of intervals, separated by undefined periods of time.3 This change in philosophy from episodic care to longitudinal needs-based care may be more salient for neurologic physical therapists than for any other group. Yet, having the HOD support this motion is only the first in a long series of steps needed to transform care. So, it becomes imperative that physical therapists across practice arenas, and specifically neurologic physical therapists, advocate for the development of a care and payment system that optimizes access to physical therapy for those at risk for mobility loss (ie, aging adults), those with newly acquired mobility impairments, and those with chronic mobility disorders.
Recent US Census Bureau estimates reveal that close to 58 million noninstitutionalized Americans are living with a disability, and of these, almost 13% have a severe disability that could be attributed to 1 or more of the categories outlined in Table 1.4 Employment limitations were extremely high (up to 72.5%) in those with severe disability and many were living in poverty (25.5%) for part or all of the 2-year tracking period, and 20.2% lacked insurance for some or all of that time period.4
With the aging population, it is neither surprising that an increased number of people with severe disabilities are in older age groups,3 nor should it be surprising that many of those with the poorest quality of life have neurologic conditions such as Parkinson disease,5 multiple sclerosis,6 and stroke.7 Thus, a model of care for disease/disability management that would support ongoing care to prevent further loss of function and promote fitness is necessary to promote and prolong independence in those living with disability, with specific attention paid to those living with severe disability, especially those living in poverty with limited or no health insurance. Fitness programs have been found to mitigate physical deconditioning poststroke and may have similar effects for other chronic conditions.7
The call to action issued by Dr Sullivan has never been more critical than it is now, in the face of rapid health care reform, and it is the responsibility of every practicing physical therapist, especially those in neurologic physical therapy settings, to advocate for policy change so that we can ensure preventative and rehabilitative care for all people at risk for or living with mobility disorders, especially from acquired or chronic neurologic conditions, and particular attention should be paid to the access to care for those living in poverty.
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