1. 2014 PPE Disclosure Statement It is the policy of the Oregon Hospice Association to insure balance, independence, objectivity, and scientific rigor in all its educational programs. All faculty participating in any Oregon Hospice Association program is expected to disclose to the program audience any real or apparent affiliation(s) that may have a direct bearing on the subject matter of the continuing education program. This pertains to relationships with pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter of the presentation topic. The intent of this policy is not to prevent a speaker from making a presentation. It is merely intended that any relationships should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. This presenter has no significant relationships with companies relevant to this presentation to disclose. 1

2. JEANETTE SCHÄCHER, DPT LOWER COLUMBIA HOSPICE Rehab In Reverse: Utilizing Physical Therapy in Hospice

3. The Objectives 1. List the benefits of physical therapy to hospice patients. 2. Understand the role of a physical therapist in hospice. 3. Learn how to orient a physical therapist to hospice. 4. Offer physical therapy services to patients, families and staff well beyond the requirements of Medicare.

4. Why do we need to offer Physical Therapy at all? § 418.72 Condition of participation: Physical therapy, occupational therapy, and speech language pathology. Physical therapy services, occupational therapy services, and speech-language pathology services must be available, and when provided, offered in a manner consistent with accepted standards of practice. **§ 418.74 Waiver of requirement—Physical therapy, occupational therapy, speech- language

5. Why should we want to offer physical therapy?

6. Hospice patients can have goals for improvement!!! If they want to improve their level of pain…hospice helps them. If they have spiritual or social issues and want to improve their level of distress…hospice helps them. If they have a wound and want it to get better…hospice helps them. SO if they want to improve their physical function WHY can’t we help them??

7. Improvement in function is NOT life sustaining treatment!

8. Bottom Line Goal of Hospice Care To support the highest quality of life possible for whatever time remains.

9. What is Rehab Potential? Rehab potential is NOT defined as the likeliness for the individual to return to their prior level of function (or higher.) Rehab potential is the likeliness that the patient will be able to achieve their goals. What are their goals?

10. What can Physical Therapy Offer? Pain relief and management Endurance training & energy conservation Gait training, stair climbing, transfers & safety instruction Therapeutic exercise

11. What can Physical Therapy Offer? Edema management Positioning  To prevent pressure sores  Decrease pain  To help prevent contractures  To aid in breathing and digestion Equipment recommendation, modification & training Home Modification

12. The Role of the Educator Patients  Strengthening  Movement patterns Families & caregivers  How to assist safely  How to use equipment  How to set up a home Staff & Volunteers  Body mechanics  How to assist safely

13. Will any PT do? Well, NO! There is a need for a fundamental role change for a PT working with hospice patients vs. other patients. Controller Listener Problem Solver

14. How to you prepare a PT for Hospice? Attitudes toward death & dying An appreciation for the needs of  The patient  The family  The caregivers A change in pace at which therapy can be administered and the goals that are set Interactions with other health-care personnel  Professional  Volunteers

15. Can we afford to offer PT services? Can you afford not to? Hospice Patients Alliance  www.hospicepatients.org Consideration of sharing a PT:  Shared with hospital system  Per diem  Shared with other hospices

16. Moving forward with the profession Working collaboratively with PT schools Encouraging more end of life exposure to PT students

17. “Dying is the experience of a lifetime. Such an assignment demands that we as physical therapists consider our roles in that experience and how the demands of that role can best be met.”

18. Contact Info: Jeanette Schacher, DPT jschacher@columbiamemorial.org 503-338-4507