APTA Home Health Quarterly Report Vol. 56, No. 2

The Quarterly Report

SPRING 2021

Vol. 56 | No. 2

In this Physical Therapy: Where’s the Value?
Issue:
A PT’s value based approach to care could include as part of the evaluation
1 Physical Therapy: and assessment abdominal girth measurements, oxygen saturation readings
Where’s the Value? readings, and education with teach-back to the patient.

2 Did You Hear? By Michelle Mirkovic, PT, MHA
Read All About It!
We have all heard of value-based care, down. She reports that she slept in her recliner
4 Advice From accountable care, or managed care. But what does last night because it was more comfortable.
PT Patient, 100: this all mean for the practice of Physical Therapy?
Eat Well, Get Enough Sleep, A PT who is singularly focused on the
Control Temper Consider Mrs. Smith. She is an 85-year-old task at hand might complete her evaluation,
female who was recently hospitalized with document all of the therapy-related deficits, and
6 EMOM: The Acronym acute symptoms of shortness of breath, extreme set goals to be achieved related to functional
Geriatric Clinicians fatigue and was given a diagnosis of congestive improvement. The goals should be functional
Should Know heart failure (CHF). Her length of stay in and could include improved strength, activity
the hospital was for eight days, then she was tolerance, balance, etc. The PT will contact the
9 Meet Monique Caruth transferred to a skilled nursing facility receiving certifying physician to discuss care and seek
10 Government Affairs care for two weeks. She was discharged home approval of PT orders as part of the plan of care.
two days ago and was admitted to home care Documentation is completed on time. The PT
Happenings: yesterday by a nurse on your team. You are will also contact the nurse case manager, report
performing an evaluation and while assessing completion of the therapy eval, and provide
The Physical Therapy the patient, you observe her ankles don’t appear appropriate updates associated with the case.
Licensure Compact: Is It swollen, but she reports that she has gained two
Right For You? pounds since the nurse was there yesterday. But a PT who has a value-based mindset
She becomes short of breath while walking and is going to think deeper than this. Because the
11 123 Recent Recipients has more difficulty breathing when she is lying therapist who is focused on the larger problem
of the Advanced facing the Medicare Trust Fund will focus on
Competency in
Home Health Continued on Page 3

12 Here’s A Look At
Virtual CSM Accepted
Platforms & Posters

Published by the Home Health Section - APTA Did You Hear?
a component of the American Physical Therapy Association
Read All About It!
Editor
Dawn Widmer-Greaves, PT, DPT Name Change, Rebrand Coming This Summer

Managing Editor/Design This summer, APTA Home Health will, gradually, then
Don Knox suddenly, take on a new identity. It’s a process that’s been several
years in the making.
Publications Committee
Julie Colaw, PT; Zachary Hampshire, PTA; Julie Hardy, Gradually describes APTA Home Health’s rollout of its new
PT, MS; Mary Marchetti, PT, PhD; Olaide Oluwole- designation as an “Academy of the American Physical Therapy
Sangoseni, PT, DPT, MSc, PhD; Aban Singh, PT Association,” an upgrade from our previous status as a section.

Section Officers: Members of the section -- err, academy -- approved the name
President......................................Diana Kornetti, PT, MA change at the academy’s annual membership meeting in late
Vice President............................... Chris Chimenti, MSPT February. After filing the paperwork to make the name change
Secretary.................................. Monique Caruth, PT, DPT official with the national association and with state regulators,
Treasurer............................. Philip Goldsmith, PT, DScPT APTA Home Health will quietly begin changing the name in all
Executive Director..............................................Don Knox sorts of places – on our website, in our myriad documents, on our
trade show booth, even our voice mail box.
The Home Health Section Quarterly Report is the
official publication of the Home Health Section of This extends to our website’s URL – currently,
the American Physical Therapy Association. It is homehealthsection.org – which will become aptahomehealth.org.
published four times per calendar year (Winter, Spring, (The soon-to-be-retired URL will continue to point to the new
Summer, Fall). Statements of fact and opinion are the location.)
responsibility of the authors alone and do not imply an
opinion on the part of the officers or the members of the Then – seemingly suddenly -- we’ll flip the switch on our
Home Health Section. website name change. At about the same time, we’ll also debut our
new logo, color scheme and a refreshed website.
Article & Content Contributions
Guidelines for contributions are available from the Voila!
Home Health Section website. If you have materials you
would like considered for publication, please email them Working overtime
via attachment to the Home Health Section Executive
Director: [email protected]. Of course, the name change, the URL update and the
rebranding aren’t happening suddenly at all.
Advertising
Advertising rates and details are available from the The rebrand is a case in point. APTA decided way back in
Section website, www.homehealthsection.org, or by November 2018 to pursue the strategy of a “branded house” – where
contacting the Section office at 720-459-5559. the national and its 81 components sport logos that are more
“unified, connected, and coordinated.”
Electronic subscriptions to the Home Health Section
Quarterly Report are available at a rate of $100/year. By February 2019, blueprints of the brand were done, and it
Order through the Section's online store. was time to move to design, according to APTA. Over the course of
this phase, the national association explored more than two dozen
Copyright ©2021 by Home Health Section - APTA logo concepts before selecting the concept that—after multiple
thoughtful revisions—was selected to be the association’s new
Postmaster: Send address changes to Home Health national mark.
Section APTA , PO Box 3406 , Englewood, CO 80155.
A new logo -- carrying forward a triangle shape and the color
www.homehealthsection.org teal -- was announced in June 2019. The brand’s official launch was
PO Box 3406 • Englewood, CO 80155 • 720-459-5559 in June 2020.

Page 2 “The brand project is about ensuring that our collective value
is greater than the sum of our parts,” APTA CEO Justin Moore,
PT, DPT, said at the time of the logo’s launch. “It’s also about
committing to a higher level of excellence across all our programs,
products, and member experiences.”

APTA Home Health filed paperwork to begin its rebranding, but
the effort paused while the section considered, then approved, the
academy name change.

Summer of rebrand

Our new legal name – “APTA Home Health, an Academy of the
American Physical Therapy

Association” -- will be displayed on our website, our stationery

Continued on Page 8

APTA Home Health Section

the bigger picture with this patient. The COVID-19 pandemic has are proactive interventions that can lead to a higher quality of life for
weakened the already overly stressed Medicare system. In 2020, the patients and a lower incidence of hospitalization. This should be top
Congressional Budget Office (CBO) changed its prediction that the of mind when assessing your patients. While many interventions will
Medicare Hospital Insurance Trust Fund would become insolvent be related to medication management and/or treatments by nursing,
in 2024 versus its previous prediction of 2026.2 If you believe that physical therapists should take a more proactive role in the overall
the Medicare program is a tremendous benefit to our seniors, then care of their patients. This approach places the physical therapist in
you will hopefully begin to change the way you look at your role as the center of the care of this patient. The PT also becomes an even
a home care therapist. more valuable member of the care team.

Let’s continue to think of Mrs. Smith. If her symptoms were When the Affordable Care Act (ACA) was passed into law in
to persist, she might continue to gain a pound or two each day 2009, it changed the way CMS addressed payment for Medicare
until she returns to the emergency room and is re-admitted to the services. CMS was able to use data to identify inefficiencies in the
hospital. This is a negative outcome for this patient, and it creates delivery of health care including inappropriate utilization. The
a series of problems in the bigger picture. Because according to the ACA established Accountable Care Organizations (ACOs) as a new
2019 statistic from Kaiser State Health Facts, a hospital stay in the payment model under the Medicare program. According to the
U.S. can cost an average of $2,488 per day in nonprofit hospitals.3 Centers for Medicare and Medicaid Services (CMS), ACOs are groups
If Mrs. Smith’s hospital stay is similar to her last admission of eight of doctors, hospitals, post-acute facilities, home health agencies,
days, it could cost over $19,000 and if another skilled nursing stay and other health care entities that volunteer to join a network.1 The
was indicated would add even more to the total cost of her care. goals of ACOs are to provide coordinated, high-quality care and
to avoid costly duplications and medical errors. CMS rewards the
Consider a different approach to your evaluation and plan of success of the ACOs with a share in the savings achieved. Currently,
care. Hopefully, you have a pulse oximeter in your bag to determine there are two ACO Models. One is the Medicare Shared Saving
her oxygen saturation. I stated earlier that her ankles didn’t appear Program (MSSP) and the other is the Next Generation ACO Model.
swollen, but circumferential ankle measurements are a good way The next Model to begin April 1, 2021, is the Direct Contracting
to monitor peripheral edema. However, patients with heart failure Model. All have different payment methods, quality measures, and
could also have abdominal swelling, so it is also important to incentives to improve patient engagement. However, the overall
measure abdominal girth. The fact that she has increased shortness goals of high-quality, efficient care are the same.
of breath when lying down is also an indication of worsening CHF.
At this point, the PT sees the patient as a whole person with multiple CMS allows ACOs several waivers they can employ to reduce
organ system impairments that can be addressed comprehensively. spend and improve quality of care to beneficiaries. One option is
The clear signs of a heart failure exacerbation need to be addressed the waiver of the three-midnight rule for skilled nursing placement.
immediately. A call to the physician with a report of these findings Medicare beneficiaries can transfer to a skilled nursing facility
is vital in effectively managing this patient and potentially avoiding following a three-day inpatient stay, and this is covered 100%
a costly hospitalization and less than favorable outcome for the for the first 21 days. An ACO beneficiary can transfer into a SNF
patient. Care should be coordinated with the nurse case manager to without a hospital stay or following a stay that is less than three
inform him or her of the worsening symptoms. days. This allows patients to transfer directly to a SNF from home
if needed. Under the newest ACO Model, Direct Contracting, ACOs
In consideration of Mrs. Smith, here are just some are allowed to waive the homebound criteria for home health. If a
recommended options for the assessment and plan of care: home health agency is contracted with a Direct Contracting Entity
(DCE), the DCE can approve a patient to receive home care services
• Include ankle and abdominal girth measurements as part of even if the patient isn’t homebound.1 This new waiver will be a
the evaluation and assessment tremendous benefit to our patients who are not homebound but are
still at high risk for hospitalization and need skilled care. Knowing
• Coordinate with nursing to teach the patient how to these important options for ACO patients will allow home health
self-assess using appropriate zone tools therapists to continue to be proactive in making sure their patients
are at the right level of care.
• Include oxygen saturation readings and weight as part
of the evaluation and assessment findings including The Bundled Payments for Care Improvements Advanced
physician-specific parameters if provided (BPCI Advanced) Model is another CMS value-based program. The
goals of this Model are to redesign the care delivered to patients
• Include education with teach-back to the patient on the with certain diagnoses, improve collaboration between health care
importance of daily weights – if patient’s balance makes providers, improve engagement with patients and caregivers, and
this difficult or unsafe, include balance activities to improve to utilize data to drive quality improvements.6 This Model uses
safety for this task a bundled payment methodology that covers a 90-day episode of
care. Payment is based on performance to a target price as well
• Include an assessment of activity tolerance such as the 2 as performance on quality measures. In this Model, a convener
Minute Walk Test4 and include this in the plan of care to organization is financially responsible for the successful episodes of
reassess regularly care for the Model beneficiaries, but the basic goals are still higher
quality and lower cost.
• Avoid bed exercises initially since this exacerbates her
symptoms and perform activities to improve balance, The Center for Medicare and Medicaid Innovation (Innovation
strength, and activity tolerance in sitting or standing Center) is the CMS department responsible for supporting the
various models. I would encourage PTs to go to the Innovation
• Ensure parameters vital sign and biometric parameters
have been discussed with the PTA for measurements of
girth, oxygen saturation, and weight on each visit

Care should be taken by all home health staff members to
continually evaluate Mrs. Smith’s status to foster appropriate
interventions to help avoid unnecessary hospitalization. Often there

The Quarterly Report | Spring 2021 Page 3

Center website7 and learn more about the different CMS initiatives References:
to improve the care delivered to Medicare beneficiaries. 1. Accountable care organizations (ACOs): General Information. Centers for

So, what does all this mean for the home care Physical Medicare and Medicaid Services. Innovation.cms.gov/innovation-models/aco.
Therapist who is just trying to take care of his or her patients Accessed February 8th, 2021.
while meeting the demands of highly regulated documentation 2. Frank R. The uncertain future of the Medicare Trust Fund. The
as well as challenging productivity standards? It means changing Commonwealth Fund. https://www.commonwealthfund.org/blog/2020/
the way you approach your care. As Physical Therapists, we are uncertain-future-medicare-trust-fund. Accessed February 8th, 2021.
highly trained to assess and reassess the patient’s status and 3. Ellison A. Average hospital expenses per inpatient day across 50 states.
progress toward goals. We are taught to recognize changes in Becker’s Healthcare. https://www.beckershospitalreview.com/finance/
condition and make recommendations for additional services or average-hospital-expenses-per-inpatient-day-across-50-states-02282020.
tests. So, we are particularly equipped to treat and coordinate care html. Accessed February 8th, 2021.
for more complex patients. Quality patient care is every clinician’s 4. Bohannon RW. Normative reference values for the two-minute walk test
responsibility! It is important to remember that it is the patient’s derived by meta-analysis. J Phys Ther Sci. 2017;29(12):2224-2227. doi:
plan of care and not the therapist’s plan. The patient’s goals for 10.1589/jpts.29.2224.
care are often broader than just the functional goals. We should 5. Holly R. 52% of surveyed home health agencies say PDGM is forcing a
take a step back from our therapy goals and consider the patient therapy decrease. Home Health Care News. https://homehealthcarenews.
as a whole and work closely with our interdisciplinary team to com/2020/02/52-of-surveyed-home-health-agencies-say-pdgm-is-forcing-
achieve the best possible outcomes. a-therapy-decrease/. Published February 18, 2020. Accessed February 8th,
2021.
About the Author: 6. BPCI advanced. Centers for Medicare and Medicaid. Innovation.cms.gov/
Michelle Mirkovic, PT, MHA, has been a Physical innovation-models/bpci-advanced. Accessed February 8th, 2021
Therapist for more than30 years and has practiced in 7. The CMS Innovation Center. Center for Medicare and Medicaid Services.
the home care setting for 15 years as a clinician and 12 Innovation.cms.gov. Accessed February 8th, 2021.
years in leadership roles. She is the Program Director,
Regulatory and Value-Based Care for Southwestern
Health Resources, Clinically Integrated Network
(SWHR). Her email is [email protected]

Advice From PT Patient, 100:
Eat Well, Get Enough Sleep, Control Temper

By Lauren Susco, PT, DPT

As we spend 2021 celebrating APTA’s centennial, we proudly father was an officer in the Navy stationed in Cuba for much of her

reflect upon the history of our great professional association and infancy, so she lived in a bedroom at her grandparents’ home with

how our predecessors have transformed lives over the past 100 her mom. Growing up, she had one brother and two sisters. Her

years. We commit to continuing their legacy and father eventually went on to buy a lot of land in Eastport,

strengthening our profession over the next 100 years. MD, which is where they were raised. She states she

Reaching this milestone together and making In 1920, only loved their childhood home, because her father planted
such a difference in peoples’ lives, has inspired me 1% of US homes a garden with “many, many vegetables.” They lived off
to reflect on the patients who have made a difference had electricity these vegetables as they didn’t have a lot of money, and
in mine. They have shared their life stories; WWII and indoor they “ate very well,” which helped them grow up strong
veterans, a Medal of Honor recipient, a famous singer/ plumbing1 and active.
songwriter, and a physicist from the Apollo Project.
As young girls, her two younger sisters both were

Occasionally we meet one who leaves an indelible mark diagnosed with Polio. She recalls the day they got sick as

on our hearts. Can you imagine being a young Physical a very hot and humid day. The girls were playing outside

Therapist, and meeting someone who has been alive in the fields and got severely “overheated.” Both of her

as long as your profession which you so proudly represent, and can sisters ended up going to the hospital. The oldest of the two girls was

share her experiences of Physical Therapists over the years? diagnosed with a “bad case of the disease” while the doctors told her

Today I had the unique pleasure and experience of sitting down family that the youngest girl only “had a touch” of it. She remembers

to have a lovely little chat with a beautiful lady named Edna. Edna the youngest sister returning home quickly while the older sister

was born into a family in Philadelphia, PA, in February 1921. Her had to stay in the hospital “for many, many months that it felt like

Page 4 APTA Home Health Section

AGE EVENT IF YOU WERE BORN IN 19213 Bread!” She recalls the day as
a 6 y/o when her mother sent
AGE EVENT her to the store. She bought

8 Stock market crashed 52 American troops leave Vietnam the 4-cent loaf of bread and
12 End of the great depression 62 Internet is born 1983 brought it home. When her
mother unwrapped (the

20 America entered World War II 66 Black Monday bread), they just “laughed and
24 World War II ended 68 Berlin wall came down laughed and laughed because
we had been cutting that bread

33 Brown vs. Board of education 79 International space station opened for all those years.”
37 US launched its first satellite 80 Terrorists attacked US and the twin towers fell At 100 years young,

Edna states she has had

40 Berlin Wall was built 86 iPhone is introduced a beautiful life. She was
41 JF Kennedy assassinated married in 1943 and had one

88 Barak Obama elected as the first African American President daughter. She made her career

47 Martin Luther King assassinated 99 COVID 19 declared as a global pandemic 2020 as a beautician and mother.
48 USA lands on the moon 100 COVID Vaccine becomes available Unfortunately, Edna’s life has
also had its share of sorrows.

Source: USA Today, Angelo Young and John Harrington, Sept. 6, 2020, She reports she “beat cancer”
“These are among the most important global events to happen annually since 1920” several times and has had
Physical Therapy throughout

a year.” Eventually, her sister was able to come home and they sent the years. I asked her if she has noticed any changes in therapy

Restoration Aides to help continue with her recovery. I asked her to from the Restoration Aides to the Physical Therapy that we do

describe what it was like having these aides in her home and working today, and she states, “It’s very similar. Except there are no large
with her sister. She recalls them bringing “heavy rubber looking rubber braces.” She notes we still motivate and encourage people
braces” to put on her sister’s legs and then teaching her how to walk to get stronger and be more independent. It gave her sister the

again. She states her sister was a very determined young lady and drive and encouraged her to push herself. It has also continued to

refused to give up. Eventually, she was strong enough that she took push Edna to be independent. “I recommend [Physical Therapy] for
them off refusing to every wear them ever again, and she even would anyone who wants it. You have to have the desire to do it, but it will

only wear high heels from that day forward. help you. If you don’t have the desire, it won’t help. It is absolutely

Edna, of course, turned 100 this year. People always wonder valuable.”
if it feels any different when you turn 100 years old. According to As for advice from a 100 year old patient, “Eat well. Get enough
Edna, “I don’t feel any different. I was just surprised that I made
sleep. Try not to lose your temper. Be sure to wash your face every

it, because no one in my family has made it that long.” Over the night before bed to keep a good complexion. Keep moving.” As

years, Edna has seen many changes occur in the world. Besides Edna likes to say, “It’s not like I haven’t paid my dues” to make it
electronics making a huge impact on the way we live now, she has to 100 years old. However, she is strong, has a great mind, and is
a smile spread across her face and a cute little giggle when she tells independent in her ways. When you ask people who know her about

me the story of the most significant change she has seen. “Sliced her turning 100 this year, they are often known to state, “She’ll out

The influence and the hardships brought about by the Great live us all.”
Depression and World War II shaped this generations resilience and
problem-solving ability. Here are some characteristics typically About the Author
associated with the Greatest Generation born between 1901 and 19242 Lauren Susco, PT, DPT, is a Physical Therapist with
Bayada Home Health. She has worked in a range of
Personal The harsh reality of the Great Depression forced many to a settings, with vast experience including acute care
Responsibility higher standard of personal responsibility, even as children. trauma, outpatient, inpatient rehab, and home health,
throughout the US, and Hawaii. She is a graduate of
Humility The Great Depression fostered modesty and humility in Thomas Jefferson University with top honors, and has
many of those who lived through scarcity. led several clinical education and quality programs

Hard work enabled survival during both the depression and throughout her 13 year career. Dr. Susco is currently serving on the
Work Ethic the war. Many jobs at the time were physically demanding, Membership Committee for the APTA Academy of Home Health, and is
a graduate of the Advanced Competency in Home Health. She loves to
with long hours. travel the world, spend time with her family, and compete in marathons
across the country.
Saving every penny and every scrap helped families survive
Frugality through times of shortage. “Use it up, fix it up, make it do, or

do without” was a motto of their time.

Commitment One job or one marriage often lasted an entire lifetime. References:
1. www.aceee.org/files/proceedings/2004/data/papers/SS04_Panel1_
Integrity People valued honesty and trustworthiness, values fostered
by the need to rely on one another. Paper17.pdf
2. www.familysearch.org/blog/en/greatest-generation-years-characteristics/
Self-Sacrifice Millions sacrificed to defend their country or support the war
effort from home.

The Quarterly Report | Spring 2021 Page 5

EMOM: The Acronym Geriatric Clinicians Should Know

By building up a person’s capacity to perform multiple repetitions of this activity it is
possible to decrease the overall difficulty someone will experience performing a task
throughout the day.

By Alexandra Germano, PT, DPT, GCS, CrossFit-L2

Every Minute on the Minute (EMOM) is a well-known workout performed four times.
structure in the fitness community. The EMOM allows for a variety of benefits. First, it can build

These are typically seen in CrossFit gyms, interval training intensity, an often missed variable when programming exercise for
workouts, and weightlifting sets, but truly the EMOM has older adults. Utilizing moderate to high intensity with the geriatric
widespread versatility. These workouts are effective, efficient population is vital to their health and wellness. High-intensity
and can be applied to a variety of subsets within the geriatric interval training can improve various health factors including
population. Table 1 shows an example: hypertension, insulin sensitivity, endothelial function, arterial
stiffness, cardiorespiratory fitness, neuromuscular performance,
Every Minute on the Minute for 16 Minutes and all-cause mortality.1–5 High intensity also offers the participant
Minute 1: Sit to Stands a way to improve overall fitness in significantly less time than
Minute 2: Banded Row a low to moderate program would take. For example, Wen et
Minute 3: Shoulder Press al., described a reduction in all-cause mortality of 35% with 105
Minute 4: Rest minutes of walking versus 25 minutes of running.6 This has major
implications in terms of exercise adherence. Patients will likely be
Table1 EMOM example able to successfully follow short and more intense protocols versus
In this basic example, a patient would complete sit to stands more extended and drawn-out programs.

for one minute, banded rows the next, and so on. Minute 4 would be Other benefits of the EMOM include the ability to objectively
complete seated rest. This type of structure calls for the patient to measure resting intervals and for demonstrating and tracking
complete max repetitions during each minute interval and will be progress. Table 2 shows another example.

Page 6 APTA Home Health Section

Week 1 EMOM Week 2 EMOM Week 3 EMOM

EMOM 12 EMOM 12 EMOM 12
Minute 1: 5 Sit to Stands Minute 1: 7 Sit to Stands Minute 1: 9 Sit to Stands
Minute 2: 20 Marches standing Minute 2: 25 Marches standing Minute 2: 30 Marches standing
Minute 3: 10 Counter Push-ups Minute 3: 12 Counter Push-ups Minute 3: 15 Counter Push-ups
Minute 4: Complete Rest (sitting) Minute 4: Complete Rest (sitting) Minute 4: Complete Rest (standing)
RPE: 5/10 RPE: 5/10 RPE: 5/10

Table 2 EMOM example – set repetitions

Instead of programming each interval to be completed for up to sitting may provide a similar stimulus. The third interval
max repetitions, this EMOM utilizes a set number of repetitions presents an opportunity for increasing heart rate and working on
to achieve during each minute. This type of programming allows speed. Again, scaled over four patients will look different but the
for more rest than a max repetition effort per set, as once the stimulus will remain the same. In Patient A this looks like a “sprint”
repetitions are complete the patient may rest the remainder of attempt or jog, for Patient B down to a fast walk, for Patient C a
the minute. In this example, the repetitions were progressed from march in standing and finally for Patient D a march while supine.
week one to week three. The patient being able to complete more Lastly, interval four is an upper-body exercise. In all four scenarios
repetitions in the same amount of time will indicate improved work the setup is slightly different, but again all challenge upper body
capacity and overall progress. Consider the resting position of the pressing capacity.
last-minute interval has also changed from a sitting position to a
standing position to progress the challenge of the EMOM. Much like Programming EMOMs is a skill that can be developed over
a progressive resistance training program will provide a person with time. Initially, it can be difficult to see the application to all patient
linear progressions week to week, EMOMs can provide a similar populations, but it is achievable for almost every patient clinicians
function and push patients to increase work capacity. encounter. In a case where a patient may require more time, the
EMOM can be adjusted up to two or more minutes per interval.
A commonly perceived problem of the EMOM is that it is too This way adequate time can be given for instruction, cueing, or
difficult for many geriatric patients to complete or, similarly, that rest. Another suggestion for improving the applicability of the
it cannot be applied to lower-level patients. EMOMs are tough EMOM to a lower level patient would be to consider layering seated
to perform, even for the younger population, but are endlessly and standing exercises together in the workout. For example,
modifiable. It takes a certain amount of creativity and clinical performing alternating standing and sitting exercises could provide
ingenuity to match an EMOM to a patient’s function. As a way an appropriate stimulus versus all performing standing exercises,
to demonstrate the adaptability of the EMOM, let’s consider four which may feel unachievable for a patient, or all sitting exercises,
patient populations. (Table 3) which may not be challenging enough.

In this application, the EMOM was modified over four different EMOM programming is a fantastic tool for therapeutic exercise
patient levels. The intention of exercise one was for lower extremity but can also translate to home exercise programs very easily. Home
pushing. For the highest level patient, this was performed with exercise programs should be manageable and efficient for patients
loaded squats and for the lowest level patient was performed with to complete. Teaching patients how to self-program EMOMs can
supine leg press. The second interval of the EMOM was meant to create more adherence and a better sense of self-efficacy while
work on large movement patterns such as floor transfer. This may performing home programs. First, program the EMOMs in front
look like reaching towards the floor for the lower-level patient of the patient during the session on either a whiteboard or paper
and standing back up or performing this in a seated position. For pad. To improve their understanding of the EMOM, talk about each
a patient who may be performing the EMOM in bed, a transfer exercises’ goals and how to modify an exercise appropriately. For a

Patient A Patient B Patient C Patient D

Independent in all ADLs, Independent to MinA for all ModA to MaxA for all ADLs, MaxA to Total for all ADLs,

community ambulator with no ADLs, ambulates in-home non-ambulatory, can sit non-ambulatory, stays in a

device, can stand in a single- and community with a walker, supported and stand for short hospital bed during the day

leg stance for a short time unable to stand tandem durations

EMOM 20 EMOM 20 EMOM 20 EMOM 20
Min 1: Loaded Squats Min 1: Sit to stands Min 1: 3 sit to stands Min 1: Supine leg press
Min 2: 2 Floor transfers Min 2: Reach to floor and Min 2: Seated reach floor to Min 2: Supine to sit to supine
Min 3: Shuttle “sprints” overhead overhead Min 3: Supine march
Min 4: Dumbbell shoulder Min 3: Walk 20 feet Min 3: 10 Standing March Min 4: Dumbbell chest press
press eyes closed Min 4: Dumbbell shoulder Min 4: Dumbbell shoulder Min 5: Rest
Min 5: Rest press press seated
Min 5: Rest Min 5: Rest

Table 3 EMOM – modifications based on patient

The Quarterly Report | Spring 2021 Page 7

follow-up session, have the patient prepare an EMOM themselves The EMOM is a functional, fun, and engaging tool to program
and provide feedback about their exercise selection and timing. an exercise efficiently. It can help build up intensity in sessions, a
This can create a great sense of self-efficacy when it comes to necessary factor missing from many exercise programs. EMOMs are
programming home exercises. infinitely scalable and are appropriate for the active older adult and
the patients who may be confined to a room for COVID-19 isolation
EMOMs also can improve a person’s overall fitness level for precautions.
specific activities of daily living. By building up a person’s capacity
to perform multiple repetitions of this activity it is possible to About the Author
decrease the overall difficulty someone will experience performing Alexandra Germano, PT, DPT, GCS, CrossFit-L2,
a task throughout the day. The task of performing laundry can be works as a Geriatric Clinical Specialist providing
arduous and take up a great deal of a patient’s energy. They may outpatient on wheels services in the Annapolis, MD
avoid performing other activities that day due to fatigue built up by area. Alex has been practicing physical therapy since
performing a household chore. To help increase a person’s physical 2017 and is a CrossFit coach with over 11 years of
reserve for a laundry task, an occupational or physical therapist experience. Additionally, she is a teaching assistant
may consider performing an EMOM as listed in Table 4. This EMOM with the Institute of Clinical Excellence for the Modern
uses the principle of 2-minute intervals to allow for increased rest. Management of Older Adult courses.

Laundry EMOM References:
Every 2 Minutes for 36 Minutes: 1. Ciolac EG. High-intensity interval training and hypertension: maximizing the
Interval 1: 10 weighted Deadlifts
Interval 2: 15 weighted step-ups benefits of exercise? Am J Cardiovasc Dis. 2012;2(2):102-110.
Interval 3: 10 Medicine Ball Twists 2. Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association
Interval 4: 100 foot weighted carry
Interval 5: 10 weighted step downs of Cardiorespiratory Fitness With Long-term Mortality Among Adults
Interval 6: Complete Rest Undergoing Exercise Treadmill Testing. JAMA Netw Open. 2018;1(6):e183605.
3. Adamson S, Kavaliauskas M, Lorimer R, Babraj J. The Impact of Sprint
Table 4 EMOM – 2-minute intervals Interval Training Frequency on Blood Glucose Control and Physical Function
of Older Adults. Int J Environ Res Public Health. 2020;17(2). doi:10.3390/
In this EMOM you can consider the deadlift task will relate ijerph17020454
to lifting the laundry basket to and from the floor. The step-ups 4. Costa EC, Kent DE, Boreskie KF, et al. Acute Effect of High-Intensity Interval
and step-downs will help improve a patient’s capacity to walk up Versus Moderate-Intensity Continuous Exercise on Blood Pressure and
and down their stairs to reach the laundry room with a basket Arterial Compliance in Middle-Aged and Older Hypertensive Women With
in hand. Medicine ball twists can improve a person’s strength in Increased Arterial Stiffness. J Strength Cond Res. 2020;34(5):1307-1316.
moving laundry from washer to dryer. Lastly, the weighted carry 5. Milanović Z, Sporiš G, Weston M. Effectiveness of high-intensity interval
mimics a person walking with their laundry basket. If a patient can training (HIT) and continuous endurance training for VO 2max improvements:
complete an EMOM of this nature, they will notice increased ease of a systematic review and meta-analysis of controlled trials. Sports Med.
performing laundry or other functional tasks. 2015;45(10):1469-1481.
6. Wen CP, Wai JPM, Tsai MK, Chen CH. Minimal amount of exercise to prolong
life: to walk, to run, or just mix it up? J Am Coll Cardiol. 2014;64(5):482-484.

Continued from Page 2

and our official documents. Our shortened name, “APTA Home Health,” will take center stage everywhere else.
APTA Home Health’s executive committee met recently with design gurus Randell Holder and Renee Malfi of Tenet Partners, as well

as APTA branding and graphics experts Alicia Hosmer and Carrie Jones. The discussion centered on core attributes of APTA Home Health’s
current brand, our key target audiences, and things that make us similar to and different from other APTA components.

Things will move relatively quickly from this point, Holder and Malfi said. Academy leaders will get their first look at designs on or
about June 28. If a suitable logo is identified, design guidelines will quickly follow, and the new APTA Home Health logo could be in place
by summer’s end.

In the meantime, please be sure to read the eHouseCalls newsletter for updates on our progress!

Celebrating APTA’s 100th Birthday, Home Health Style!

Founded by Mary McMillan 100 years ago, the American Physical Therapy Association was born on January 15, 1921. Let us celebrate
by sharing our Home Health Physical Therapy practices 100 years later!

Please join your colleagues in celebrating our APTA Centennial year like only Home Health Therapists know how! We will be
promoting several ideas to help you celebrate and we welcome all ideas you may have to celebrate as well!

To start our year of celebrations, we would like to show our support in every state by having Mary McMillan, our founding Mother of
the APTA, travel across the country in “Flat Stanley” Style. We will have monthly prizes for the most adventuresome and most depicting
the “Day in the life of a Home Health PT/PTA.”

To get started, go here -- https://aptahhs.memberclicks.net/apta-centennial-flat-mary-contest -- to download “Flay Mary” and submit
your photos!

Some sneak peeks of other celebrations are, “PPE fashion Show” and “Vaccination Fascinations.” More details for each will be coming
soon! So send us your pictures and let’s have some fun as we celebrate the birth of our American Physical Therapy Association!

Page 8 APTA Home Health Section

Meet

Monique Caruth

Secretary for the Board of Directors of the
American Academy of Home Health
Physical Therapy

Interview by Zach Hampshire

What motivated you to enter the profession of physical therapy?
I grew up on the island of Trinidad and Tobago and had a great love of sports. One day I was watching a cricket game and saw one of

my favorite players suffer an injury. A Physical Therapist from India attended to the player on the field. Watching the therapist treat the
player first inspired me to become a Physical Therapist.

What is your current job/role/work in Home Health?
I’m the owner/founder and a practicing physical therapist for Fyzio4U Rehab. The company is a home health staffing group in

Maryland. We supply Physical Therapy, Occupational Therapy, Speech Language Pathology, and Social Workers for local home health
agencies.

What does Home Health look like in the future? What looks different? What stays the same?
It will look somewhat different with an increased appreciation of the value of home health, especially since the onset of the COVID-19

pandemic. We are demonstrating that home health can provide greater acuity of care. Hospitals are discharging patients home sooner
and patients are choosing home health over skilled nursing facilities. Through home health services, patients are experiencing improved
outcomes. This is demonstrating that greater amounts of care can be performed in the home which I believe will continue to grow into the
future.

What are your roles and responsibilities within the section, what is your favorite part of your role within the section?
I’m the secretary of the home health section, which I began in February of this year. It is a fun challenge that I look forward to. Before

becoming the secretary my main role was as a member of the public relations committee. This committee helped to promote the role of
home health physical therapy, which I greatly enjoyed participating in.

What does the section most need from the membership?
Engagement. As more members from new grads to experienced therapists become engaged there is a mutual benefit. New ideas and

increased collaboration will allow for the section to grow and advance.

What would you say to a new therapist who may be contemplating joining a committee or entering the home health
environment?

I would welcome it; we always need fresh ideas. This will make the section, more diverse and inclusive. Joining is a great opportunity
for advancement and having a greater involvement in the future of home health.

I started working in home health about twelve years ago. To anyone wanting to enter this field, go for it! Since transiting to home
health, I have had no regrets and found it very rewarding. I wouldn’t choose to do anything else.

About the Interviewer
Zachary Hampshire, PTA, is a physical therapist assistant and works for
P.T. Services at Promedica Memorial Hospital and Mercy Tiffin Hospital.

The Quarterly Report | Spring 2021 Page 9

Government Affairs Happenings:

The Physical Therapy Licensure Compact: Is It Right For You?

Is the Physical Therapy Licensure Compact right for you? Here administrative body overseeing the implementation of the Physical
are some resources to assist you in making that decision. Therapy Licensure Compact in states that choose to participate.
Each participating state has a representative on the Commission
Centers for Medicare and Medicaid Medicare Learning who must be either a current member of the state’s physical therapy
Network (MLN) licensing board (PT, PTA, or public member), or the licensing board
administrator. APTA and the Federation of State Boards of Physical
CMS is aware of a new trend in medicine involving interstate Therapy are also each provided a nonvoting representative on the
license compacts. An interstate license compact offers a Commission’s Executive Board. The Commission administers the
new, voluntary, expedited pathway to licensure for qualified compact through its adopted rules and bylaws and operates the
physicians and non-physician practitioners who wish to practice system through which member states share information about
in multiple states. their licensees and through which licensees may purchase compact
privileges. Compact privileges are issued by the Commission to
A physician or non-physician practitioner working under eligible PTs and PTAs in participating states who apply through
the authorization of a compact must meet both the licensure ptcompact.org. The Commission also sets fees for compact privileges.
requirements outlined in the primary state of residence
and those established by the compact laws adopted by the A compact privilege is the authorization to work in a PTLC
legislatures of the interstate compact states. Currently, CMS member state other than your home state. To qualify for a compact
has been made aware of the Physician, Physical Therapy, privilege, a PT or PTA is required to have a license in their
Occupational Therapy, Speech Language Therapy, Nurse home state and meet other eligibility criteria, such as having no
Practitioner, and Psychology interstate license compacts, but disciplinary action against any license for at least 2 years. When
more may be underway as new legislation is passed. eligibility is verified and all fees are paid, the licensee receives
the compact privilege and may begin legally working in the other
CMS has determined that the interstate license compacts, for “remote” state.
the above provider types, will be treated as valid, full licenses for
the purposes of meeting our federal license requirements. Your PTs and PTAs who want a compact privilege in a participating
MACs will accept CMS-855 enrollment applications from providers state may apply to the Commission through the Commission’s
reporting an interstate license compact. In addition to meeting the website. The Commission currently charges a fee of $45 per state
licensure requirements in the practitioner’s primary state, they in which the individual chooses to obtain compact privileges. An
are required to meet the licensure requirements established by the individual who meets eligibility criteria can choose to obtain a
interstate compact laws adopted by state legislation. compact privilege in as many states as are participating in the
compact. Additionally, each participating state may choose to
PT Compact impose its own fee, separate from the Commission’s fee.
The ever-increasing mobility of the American workforce, the
The Compact doesn’t change the process for obtaining an
need for better access to physical therapy in under-served areas, initial license after graduation from an entry-level PT or PTA
and the rise of telehealth prompted development of the Physical education program, or for foreign-educated PTs and PTA to seek
Therapy Licensure Compact (PTLC) which gives PTs and PTAs the their initial state license in the United States. New graduates
ability to provide services across the jurisdictional boundaries of still must submit an application and evidence of having
participating states. The Federation of State Boards of Physical completed an accredited entry-level DPT or PTA education
Therapy with the support of APTA has developed a compact that program, must pass the applicable National Physical Therapy
would allow licensees to practice in several states through this Exam, and must meet all other state-specific requirements
plan. Participation in multiple state practice is optional for each in their home state. Individuals seeking their initial license
licensee but the state in which they reside must be a member of in a compact-participating state must undergo a background
the compact. Practitioners must be licensed in their home state check whether or not they are seeking compact privileges.
and those who choose to participate must pay a fee which is (Nonparticipating states may or may not require background
considerably lower than the renewal fee for each additional state. checks.)Foreign-educated PTs and PTAs seeking their first U.S.
The PTLC creates a new way for PTs and PTAs to practice or work in state license still must complete the licensure process required
multiple states. In order to participate in the compact, states must by that state. Once they hold a license in their home state, they
opt in by adopting the compact through legislation. PTs and PTAs can apply for compact privileges in participating states. The
in participating states will have the option of obtaining a “compact compact also does not change scope of practice in any state. PTs
privilege” to practice or work in another participating state if they and PTAs delivering physical therapist services in remote states
meet certain criteria.

The Physical Therapy Compact Commission (PTCC) is the

Page 10 APTA Home Health Section

under a compact privilege must function within the laws and • Compact privileges increase consumer access to physical
rules of the remote state in which the patient is located. therapist services by reducing regulatory barriers to
interstate mobility and cross–state practice.
Advantages:
While PTs and PTAs in compact-participating states retain the • Compact privileges require only one set of continuing
education requirements. Whether a licensee holds compact
option of going through the traditional licensure process to practice privileges in a single state or 20, the only set of continuing
beyond their home state, obtaining a compact privilege holds some education requirements he or she must meet for renewal are
advantages over traditional licensure in two or more states. those required for the home state license.

• Getting a compact privilege is much faster and easier than • Compact privilege renewal is tied to the home state license.
is going through a state’s traditional licensure process. Compact privileges expire along with expiration of the
Under the current state licensure system, applying for home state license, so licensees need not keep track of
a license in another state involves many steps and lots different renewal dates for different states. There’s only one
of documentation, which can take considerable time to renewal date to remember.
compile and submit. Test scores, transcripts, and validation
of holding a current state license all must be submitted, • Gaining compact privileges typically is cheaper than is
along with a separate application to each state in which the going through a state’s traditional licensure process. While
individual wants to become licensed. It can take weeks or compact privilege fees vary by state, on average the fees are
months for all of this to be processed and a license to be much lower than are the license fees for the same state.
issued. In contrast, a licensee in a compact-participating
state can simply visit ptcompact.org, complete the online The PTCC is constantly updating and adding new states. The
application process for compact privileges in any or all Compact was officially enacted in 2017 and has steadily expanded
other compact-participating states, and pay the required across the country. Today, 70% of the country is part of the
fees. The system uses licensee data submitted to the PTCC Compact or taking step to become member states. As of September
by member states to determine a licensee’s eligibility for 2020, twenty states are currently issuing compact privileges. Eight
compact privileges. Once that online process has been states and DC have enacted legislation but are not yet issuing
completed, the individual is immediately issued compact or accepting compact privileges. Five states have introduced
privileges in the selected state or states. legislation but not yet enacted that legislation. You may visit
ptcompact.org, for a detailed updated map.

123 Recent Recipients of the
Advanced Competency in Home Health

APTA Home Health’s Advanced Competency in Home Health (ACHH) certification program synthesizes current evidence-based
practice and tailors it to the unique physical therapy setting of home health. This program enables home health agencies, outpatient
practices that provide home care physical therapy, and individual clinicians to enhance efficacy and efficiency of treatment of their home
health patients and clients.

This program is for licensed physical therapists and physical therapist assistants. A list of recent certificants, in alphabetical order by
last name, follows:

A Ajay Agrawal, PT, MS, Lewisville, TX; Ayesha Ahmed, PT, C Anthony Cali, PT, Peoria, IL; Laura Chevreaux, PT, WCC,
MHS, COQS, Voorhees, NJ; Kay Aiken, PT, DPT, Stevens Point, Montrose, CO; Jeffrey Child, PT, MPT, CEEAA, Winchester,
WI; Erika Albertini, PT, DPT, Hollywood, FL; Michael Appell, VA; Joshua Clare, DPT, North Kingstown, RI; Michelle Clark, PTA,
PT, Louisville, KY; Heather Arndt, PT, DPT, Hudson, IL; Aylmer Albuquerque, NM; Michael Collison, PT, DPT, Bemidji, MN
Asuncion, PT, DPT, West Hills, CA;

D-E-F Anthony Daffner-Milos, PT, DPT, Marco Island,
B Melissa Balter-Polaski, PT, Friedens, PA; Beverly Beduya, DPT, FL; Monicka Dang, PT, DPT, Brooklyn Park,
Granada Hills, CA; Jordan Bennett, DPT, CWT, Petal, MS; MN; Loren Daniel, PT, Highland, NY; Alicia Demchak, PT, DPT,
Melissa Bley, PT, Greenwood, SC; Tamera Bowers, PT, Lander, WY; Mars, PA; Estee Denbo, PT, DPT, Grand Rapids, MI; Melanie di
Sherlyn Braga-Murcks, PT, Cullman, AL; Maria Indira Braxmeier, Carlo, DPT, CLCP, CCM, San Francisco, CA; Jill Dienes, PT, Oxford,
PT, DPT, Allentown, PA; Maureen Bridges, PTA, Colorado Springs, MI; Amy Dossey, MPT, Folsom, CA; Rasha Dove, PT, Weston, CT;
CO; Carolyn Buckley, PT, MSHP, Cypress Mill, TX; Betty Bugaj, PT, Heather Farkas, PT, DPT, Lewes, DE; Neal Finkelstein, PT, MPT,
MS, DPT, Oakland, CA MS, LMT, CEAS, Jacksonville, FL; Cheryl Fletcher, PT, Forest Grove,
OR; Heather Ford, MSPT, Oak Ridge, NC; Kuanyan Franz, PT, DPT,
Santa Rosa, CA

The Quarterly Report | Spring 2021 Page 11

G-H-I Amy Garfinkle, PT, Piedmont, CA; Cary Gerdes, P-Q-R Jennifer Paul, PT, DPT, Chestertown, MD; Erin
PT, MSPT, Lennox, SD; Brenda Gerlach, MPT, Pazour, PT, Cedar Rapids, IA; Mary Perlstein,
Wausau, WI; Paras Goel, PT, DPT, MEd, Milpitas, CA; Samantha PT, MBA, Oldsmar, FL; Xiaoxu (Freeman) Qu, PT, Bella Coola, BC,
Graves, PT, Hudson, IL; Kristen Groenhout, PT, MPT, Caledonia, Canada; Adam Rabatin, DPT, Cresson, PA; Denise Rematt, PT,
MI; Marie Gruenes, PT, CEEAA, Fremont, NE; Lisa Guillory, DPT, Northern Cambria, PA; Ann Reppermund, PT, Allison Park, PA;
CEEAA, New Orleans, LA; Bianca Guzman, PT, San Francisco, CA; Mary Richardson, PT, DPT, Menlo Park, CA; Rahul Rikhy, DPT, San
Susan Haire, PT, DPT, Lakewood, CO; Zachary Hampshire, PTA, Ramon, CA; Amy Roberts, PT, Stillwater, OK; Jacki Ruskay, PT,
Fremont, OH; Lisa Hatlen, PT, Pacifica, CA; Tracey Hawk, MPT, Elizabeth, PA
Tacoma, WA; Sara Holland, PT, DPT, Watervliet, NY; Jennifer
Holley, MPT, Knoxville, TN
S Katelyn Sandy, PT, DPT, San Francisco, CA; Lindsey Schrader,
PT, DPT, IPNFA, Napa, CA; Analee Serena, PT, DPT, OCS,
J-K-L Keri Jackson, MSPT, Austin, TX; Torbjorn Jonsson, Renton, WA; Walter Sharon, PT, MPT, Spokane, WA; Amy
PT, Lincoln, KS; Kathy Kappelle, PT, Anadarko, OK; Shevlin, PT, DPT, Smithton, IL; Dwayne Shillingburg, PTA,
Rosemary Keller, PT, Bozeman, MT; Cynthia Kitani, PT, Alameda, CA; Oakland, MD; Michelle Sierk, MPT, Greensburg, PA; Peter Sims,
Sarah Kretman, PT, DPT, NCS, Prior Lake, MN; Renee Lach-Sharon, PT, MS, Evanston, IL; Wendy Smith, PT, DPT, Kewanee, IL; Kylie
PT, MSCS, Spokane, WA; Terry Lester, PT, Forest Grove, OR; Deborah Smith, PT, DPT, Louisville, KY; Sondra Stikeleather, MS PT, PhD,
Levin, PT, Seattle, WA; Brett Lezamiz, DPT, Seattle, WA; Maribeth Brownsburg, IN; Lauren Susco, PT, DPT, Pittsburgh, PA; Judith
Lungay, PT, DPT, Katy, TX Swift, PT, MPT, MHA, Phoenix, AZ; Jennifer Syverson, DPT,
Glyndon, MN

M-N-O Trinity Martin, PT, DPT, Smyrna, GA; Jean-
Marie McCauley, PT, MHA, Hernando, FL; T-U Alan Tang, PT, DPT, San Jose, CA; Kayla Termeer, PTA,
Kathleen Mengel, PT, East Troy, WI; Michael James Mercado, Eudora, KS; Peter Thoresen, PT, DPT, OMPT, CEEAA,
PT, Roseville, CA; Anne Milburn, PT, Martinsville, IN; Casey , Sheboygan, WI; Steven Torcoletti, PT, Missoula, MT; Gretchen
Mokres, PT, MPT, GCS, Oakland, CA; Michael Monteiro, PT, DPT, Trumpf, PT, Long Beach, CA; Valerie Twymon, PT, San Leandro , CA
Fairhaven, MA; Gerald Morigerato, PTA, Buskirk, NY; Cassandra
Movinsky, PT, DPT, Clymer, PA; Saichellam Nattu, PT, New Hyde
Park, NY; Vicki Naugler, PT, DPT, CLT-LANA, Sarasota, FL; V-W-X-Y-Z Ingrid Van Anrooy, PT, GCS, CEEA,
Malorie Novak, PT, Ph.D., DPT, Augusta, GA; Connie Oliphant, PT, Spokane, WA; Alisa Waibel, PT,
GCS, CEEAA, Richmond, MO DPT, Forest Grove, OR; Kathleen Walter, PT, Lexington, SC; Laura
Weigand Mendoza, PT, DPT, San Diego, CA; Rosemary Wendt, PT,
DPT, Hanover, MI; Rebecca White, PT, DPT, Golden, CO; Elizabeth
Williams, PT, San Francisco, CA; Jared Woods, PT, DPT, Ukiah, CA;
Derek York, PTA, Spotsylvania, VA; Amy Yurkovich, PT, Elizabeth,
PA; Meina Zhu-Chhimi, PT, DPT, Ridgewood, NJ

Here’s A Look At
Virtual CSM Accepted
Platforms & Posters

The recent virtual Combined Sections Meeting presented an CURRENT SECTION: Home Health
opportunity for abstract submissions to the APTA Home Health AUTHORS: William H. Staples, Alyssa Marie Logan, Colin Cabage,
Section. Presented here are those accepted as platforms and posters. John R. Rogers
Platform presentations were oral presentations of approximately 5-15
minutes. Posters were displayed throughout the conference. ABSTRACT BODY:
Background and Purpose: The purpose of this case series was to
PLATFORMS explore the possible development of post-traumatic stress disorder
(PTSD) in people that have suffered a traumatic hip fracture.
TITLE: Post-Traumatic Stress Disorder in Older Adults Following There are limited studies regarding possible correlations between
Traumatic Hip Fracture: An Exploratory Case Series PTSD and hip fractures. This study is a prospective, exploratory

Page 12 APTA Home Health Section

case series that uses subjective and objective measures to explore readmission rates for individuals with COPD.
the similarities and differences between two participants who
recently experienced a traumatic hip fracture that required Number of Subjects: N/A
surgical repair.
Materials and Methods: A literature search of EBSCO, PubMed,
Case Description: The two participants were recruited through ScienceDirect, & Proquest was conducted using the search
convenience sampling through a local hospital system. Participant terms: (“Chronic Obstructive Pulmonary Disease” OR COPD)
1 was a 67-year-old female, employed, and lived at home with her AND (Readmission OR “Hospital Readmission”) AND (“Physical
spouse. Participant 1 reported that she fell backwards climbing up Therapy” OR Rehab OR Rehabilitation OR Physiotherapy) AND
steps in her garage. Participant 2 was a 75-year-old, retired male (“Home Health” OR “Home Care” OR “Home Healthcare”). Search
who lived at home with his spouse, and ambulated with a rolling limits: English, peer-reviewed, and human subjects. Study designs:
walker prior to injury. Participant 2 reported that his fall resulting RCT, quasi experimental, and cohort studies. Selection criteria:
in a hip fracture occurred at a local gym. Adults 18 years or older with COPD receiving HH PT at least once
a week and included a primary outcome of readmission rates
Outcomes: The participants were seen within two weeks of the defined as any acute exacerbation leading to a hospital readmission
date of their fracture, three months +/- two weeks following their following discharge. Primary outcome: readmission rates, any
fracture, and six months +/- two weeks following their fracture. The acute exacerbation leading to a hospital readmission following
outcome measures used were the Peritraumatic Distress Inventory, discharge. Each study was independently assessed by two reviewers
Falls Efficacy Scale-International, Geriatric Anxiety Scale, Geriatric for methodological quality and came to consensus based on Oxford
Depression Scale - Short Form, Posttraumatic Stress Disorder Levels of Evidence (2009).
Checklist - Civilian, Ten-Meter Walk Test, Timed “Up & Go” test,
Montreal Cognitive Assessment, and grip strength. At the initial Results: A total of 267 articles were screened for eligibility. After
visit, participants completed the subjective outcome measures detailed appraisal, 5 studies met selection criteria which included
relating to mood as well as an objective measurement of grip 3 RCTs, 1 retrospective cohort study, and 1 case-control study.
strength. The participants completed the same subjective tests for Levels of evidence ranged from 2-4. Samples ranged from 50-15,030
mood, additional objective measures of physical functioning, and (15,476 total) with the mean age of 73.4 (18-92 years) with all
grip strength testing during the three month and six-month follow participants having a confirmed diagnosis of COPD and a previous
up visits. hospital admission that year. HH treatment parameters varied
widely with durations ranging from 1-5 times per week lasting
Discussion: Participant 2 demonstrated increasing scores for anywhere from 8 weeks to 2 years. No adverse events were reported.
tests of mood as time progressed, indicating worsening feelings Four of the 5 studies reported statistically significant reduction in
of anxiety and/or depression. He also demonstrated worsening readmission rates (27% of the collected sample population were
functional abilities as noted by changes in the outcomes that readmitted). One study reported less days in the hospital for the
measure mobility. Participant 2 also demonstrated an 11-point HH group compared to the control group (0 vs 7 respectively).
increase in his PCL-C scores from the three-month to six-month Interventions with the most success (50% reduced hospitalizations)
visits, which exceeds the calculated MDC of 4.47, indicating a real incorporated respiratory therapy and specific exercise training to
change and the potential development of PTSD. Participant 1 target dyspnea symptoms.
demonstrated no regression in scores of tests of mood or worsening
scores in tests of functional abilities related to the injury. Conclusions: There is moderate to strong evidence that HH PT,
with individualized discharge plans, decreases hospital readmission
It is feasible for older adults to develop PTSD after suffering rates in patients with COPD. Limitations included small sample
a traumatic hip fracture requiring surgical repair. An increase in size and vague description of interventions. Future research should
reported anxiety and depression along with a decrease in physical utilize a larger sample size, in depth intervention descriptions,
functioning may contribute to the potential development of and high level study designs, such as a prospective study. These
PTSD in older adults. Therefore, a better understanding of the adaptations will allow for a more proactive approach in analyzing
relationship between a traumatic hip fracture and a patient’s ongoing influences on readmission rates.
psychological well-being is crucial in connecting patients with
resources to address concerns outside of the scope of physical Clinical Relevance: Hospital readmission rates for patients
therapy to ensure they are getting optimal, well-rounded care. with COPD experience a significant increase in the absence of
appropriate HH PT that emphasizes the fundamental strategies
CONTROL ID: 27430 tailored to this specific diagnosis. Clinicians should consider Home
TITLE: Impact of Home Health Physical Therapy on Readmission Health PT as part of the discharge plan for patients with COPD to
Rates for Individuals with COPD prevent hospital readmission.
CURRENT SECTION: Home Health
AUTHORS: Tracey L. Collins, Michele Calogero, Michael Thomas CONTROL ID: 27431
Frawley, Stephen Richard Kalinoski, Johanna Marie Levine TITLE: The Use of Smart Homes to Assist Older Adults with Mild
Cognitive Impairment
ABSTRACT BODY: CURRENT SECTION: Home Health
Purpose/Hypothesis: The purpose of this systematic review AUTHORS: Kaitlyn Brogan, Tracey L. Collins
is to determine the impact of home health (HH) PT on hospital

The Quarterly Report | Spring 2021 Page 13

ABSTRACT BODY: ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this systematic review was Purpose/Hypothesis: Frail older adults make up a large percentage
to assess the potential uses of smart homes within the older adult of the population seeking care, and this percentage is predicted
population with MCI to support aging in place. to increase over the next two decades.1 Frail older adults are at
an increased risk for negative health outcomes including falls,
Number of Subjects: N/A disability, long-term care, and mortality.2,3 One of the major
costs related to caring for individuals with frailty is the cost of
Materials and Methods: A literature search of PubMed, institutionalization, as frailty is one of the major predictors of
ProQuest, Cochrane, and CINHL was conducted using the search institutionalization.4 Aging in place can serve as a cost effective
terms: (“smart home” OR “smart house” OR “home automation” alternative to institutionalization as it aims to prolong the
OR “smart home technology” OR “internet of things”) AND independent living status of frail older adults.3 In addition to
(“independent living” OR “aging in place”) AND (“mild dementia” decreasing healthcare costs, home health physical therapy via
OR “mild cognitive impairment”). Search limits: English, peer an aging in place policy can increase patient satisfaction. It
reviewed, human subjects. Selection criteria: Adults with mild allows patients to remain functionally independent in a familiar
cognitive impairment and interventions included smart home (SH) environment and maintain their normal social networks; which
technology to support aging in place. Each study was independently results in an overall increase in quality of life.4
assessed by two reviewers for methodological quality based on
MINORS Guidelines. The purpose of this literature review was to evaluate the value
of home health physical therapy services for community dwelling
Results: 103 articles were screened for eligibility and 10 articles older adults living with frailty.
met the selection criteria, including 4 proposed SH technology, 1
computer simulated data, and 5 trials with human subjects. MINORs Number of Subjects: N/A
scores for 9/10 non-comparative studies ranged from 2-10/16 (avg.
4.78) and 1 comparative study scored 17/24. Sample sizes for 5/10 Materials and Methods: A literature search was conducted in
studies with datasets ranged from 1-94 (214 total) of patients CINAHL, Cochrane, Proquest and Pubmed databases using search
ages 50+ with mild cognitive impairments. Interventions varied terms: (frail OR “frail elderly” OR “frail older adults”) AND (“home
widely including use of an iPad as central hub and already existing health” OR “home care” OR “home-based rehab”) AND (physical
technology. The primary outcome investigated was aging in place. therapy OR physiotherapy OR rehabilitation) AND (value OR
One survey investigated prominent user needs to age in place and “patient experience” OR “patient satisfaction” OR “quality of life”).
results were: falls, safety outdoors, able to orient at night, large A total of 120 articles were screened for eligibility. Two articles were
buttons, social contact, safety, & autonomy. Most (70.45%) patients found to include value related outcomes for home health physical
wanted to continue use of smart home after study. Two studies found therapy services for individuals with frailty, published within the
that patients with MCI require prompting from the smart home, but last ten years.
verbal prompts were sufficient in both single & multi-domain MCI. A
significant secondary outcome was decreased caregiver stress. Results: The first article had a sample size was 299 participants
in baseline characteristics of an RCT study. Inverse relationships
Conclusions: There is low to moderate evidence to support smart between frailty and health-related quality of life (HRQoL) as
homes to enhance aging in place in older adults with MCI. Features well as frailty and FIM scores were reported. The second article
should include both user input and prior success. Features that were described a study protocol of home-based physical therapy RCT
user positive and successful included smoke detector, smart front including 12 weeks of physical therapy sessions delivered in the
door, automated lights, reminder/prompt service, outdoor sensor home two times per week. Sessions included a warm-up, strength,
system, memory stimulation (games, family pictures), and caregiver flexibility, and balance exercises as well as functional training.
communication with alert system. A major limitation in this area Outcomes to be assessed at baseline as well as 3, 6, 12 and 24
is feasibility of implementing a smart home and lack of consistency months after start date.
large scale studies. Further research is needed to determine a cost
efficient, feasible, system that can be widely implemented Conclusions: There is very little current research on cost related
and patient experience outcomes as components of the value of
Clinical Relevance: Adults with MCI and caregivers were satisfied home health physical therapy for older adults living with frailty.
with the use of smart homes to support the person’s aging in place The lack of evidence found in this literature review indicates the
and increase safety of the person, while reducing stress on the need for research regarding the value of home health physical
caregiver. Clinicians should be prepared to educate patients on therapy services for individuals living with frailty.
the resources and options available with smart homes to provide
optimal aging in place for those with MCI. Clinical Relevance: Physical therapy services delivered in the
home may help decrease health care costs and increase patient
CONTROL ID: 27435 experience for individuals living with frailty. Home health
TITLE: The Value of Home Health Physical Therapy for Frail Older physical therapy may help prolong duration of home living for this
Adults: A Literature Review population.
CURRENT SECTION: Home Health
AUTHORS: Kathleen Elizabeth O’Reilly, Tracey L. Collins

Page 14 APTA Home Health Section

POSTERS: physical therapy (PT) in the rehabilitation of these patients is
expected to be vital, yet due to the novel nature of the pandemic
CONTROL ID: 27194 the exact role of PT, especially in the home-health setting, is yet to
TITLE: Home-Based PT Interventions Following Atypical Deep be determined. The purpose of this case report is to shed light on
Brain Stimulation for Hand Tremor: A Case Report the potential benefits of PT post-COVID-19.
CURRENT SECTION: Home Health
AUTHORS: Valeria Paola Niehaus, Dennis W. Klima Case Description: The patient is an 88 y/o female diagnosed
with viral pneumonia secondary to COVID-19. Patient was
ABSTRACT BODY: hospitalized due to severe shortness of breath and significant
Background and Purpose: Deep brain stimulation (DBS) decrease in functional mobility.5 Her total hospital LOS was six
is performed to reduce tremor in persons with Parkinson’s days, including two in the ICU. Past medical history included
disease, but in rare cases for tremor resulting from prolonged Parkinson’s disease, COPD, and hypothyroidism. Prior to
neuropsychiatric medication use. The DBS procedure, however, hospitalization, patient was independent with all ADLs, including
can cause adverse effects, such as balance and gait deficits that stair negotiation, and ambulation without any assistive devices
warrant physical therapy interventions. The purpose of this case (AD). Patient was discharged from the hospital with a referral for
report is to assess the efficacy of a home-based multidimensional home-health physical therapy. Upon evaluation, patient was found
mobility program for gait and balance deficits following a DBS to require minimal assist for bed mobility, moderate assist for sit
procedure to manage bilateral drug-induced hand tremor in a to stand transfers as well as ambulation activities using standard
64-year-old female. walker. Patient could only walk for 10-feet and had to stop due to
significant shortness of breath. Patient was unable to negotiate
Case Description: The patient was a 64-year-old female with the stairs. Patient was limited due to significant dyspnea on exertion.
diagnosis of bipolar disorder and associated depression, with a Physical therapy was initiated with goals focusing on return of full
history of prolonged use of neuropsychiatric medications resulting functional independence, including ambulation without any AD,
in a bilateral upper extremity tremor. The patient underwent DBS and stair climbing. Patient received a total of 8 PT visits during a
to ameliorate the tremor, and experienced subsequent balance and 5-week period.
gait deficits requiring home rehabilitation. The patient performed
a multidimensional dynamic balance and gait, functional Outcomes: Upon evaluation, patient scored 42-seconds on the
strengthening, and self-directed home ambulation program twice timed up and go (TUG) test, 0 repetitions on the 30-second chair
weekly for four and a half weeks. stand test (30CST), and 3 on the Tinetti-Performance Oriented
Mobility Assessment (POMA) test. Patient was rated 3-/5 for both
Outcomes: Functional tests at the ICF activity level demonstrated lower extremities using gross manual muscle testing (MMT).
significant improvement surpassing Minimal Detectable Change Patient scored 85 on the Functional Independence Measure
(MDC) values for all outcomes administered at discharge. The (FIM). Upon discharge patient scored 10-seconds on the TUG, 10
patient effectively progressed on the Short Physical Performance repetitions on the 30CST, and 25 on the Tinetti-POMA test. Gross
Test (pre 9/12, post 12/12), Timed Up and Go Test (pre-16 seconds, MMT of bilateral lower extremities was 4+/5. Patient improved her
post-9.4 seconds) and Tinetti Performance Oriented Mobility FIM score to 124.
Assessment (pre-16/28, post-28/28). ICF participation goals
attained included the return to work part-time. Discussion: This case study demonstrates the role and benefits
of home-health physical therapy in providing exercise training,
Discussion: A multidimensional home-based physical therapy functional mobility training and patient education in the
program with procedural and patient education interventions rehabilitation of patients with COVID-19. The patient presentation
including balance, gait, strengthening, and self-directed walking at evaluation demonstrates the significant functional impact of
can target and improve physical performance following atypical COVID-19 on geriatric patients. The outcomes of this case report
DBS management and complications. support the importance and efficacy of physical therapy in the
home health setting in the rehabilitation of patients afflicted with
CONTROL ID: 30339 the current pandemic.
TITLE: The Impact of Physical Therapy Management on a Patient
Post-COVID19 in the Home-Health Setting
CURRENT SECTION: Home Health
AUTHORS: Karim Elalfy, Ahmad Samir Sabbahi

ABSTRACT BODY:
Background and Purpose: The implications of the 2019-2020
coronavirus (COVID-19) pandemic have significantly impacted
the geriatric population.1 These implications include greater
mortality and hospitalization rates.2,3 Complications associated
with intensive care unit (ICU) admission and hospital length of stay
(LOS) are well known and accepted;4 however, the full spectrum
of post-COVID-19 complications remains unknown. The role of

The Quarterly Report | Spring 2021 Page 15

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