physical therapy

[saraesth]

i had a stroke in december of 2005.  my insurance is exhausted for pt and ot now.  are there any therapists that work on a sliding scale payment wise?  i feel i need more therapy my left side is affected.

[caregiver222]

There are several inexpensive devices out based on the principal of centifugal body stimulation. There are no controlled double blind studies, but in my opinion these devices can be extremely useful to prevent muscle atrophy during stroke rehabilitation. Plus, they don't require a prescription. Do a google search.

[caregiver222]

Craigs list is a free service that has a health care aide section. Check in your area for "ESL schools. These are schools that teach adults a second language. They usually have bulleten boards for students looking for work. You will generally find some very bright people at these schools.

[lahinva]

But what we need to know is how to find these aides without going through an agency.

[caregiver222]

When you get new people who haven't been involved as aides before you solve the problem of having them unlearn bad habits. The first thing to tell them is the goal of their presence is rehabilitation, first and foremost. Have these conversations out of ear range of the patient. Every meal, for example, is an opportunity for physical rehabilitation. Every trip to the toilet is an opportunity. I have a three times meal schedule at 0800, 1300 and 1800 HRS, with the proviso that the patient is asked if they want to eat, and if the say no, the meal is pushed foward. Initially I like the corning ware transparent glass, because the small bowls have vertical sides against which the patient can push food. A small ceramic coffee cup with SLANTED sides is also necessary. This is only filled 3/4-7/8 full. A tissue box is always available. And, of course plenty of bananas, the universal stroke recovery food. A television is set up in front of an easy chair. The patient is never allowed to watch television from bed. A big no-no. In the morning assist the patient assisted to the chair to watch television while breakfast is prepared. Morning toilet is performed. They are provided with a thin fluid challange and swallowing is observed. Breakfast is then prepared. The patient is not fed in the chair but at a regular table. The patient is never left to face the wallor an empty table while the aide removes the food. Nor does the patient every wait at the table for food. In this case walking practic is from the chair to the wheelchair. Then the wheelchair is wheeled to the table for breakfast. I tell the aides to stop thinking of themselves as aides and imagine they are provide food service in the finest of hotels. Do not trust them to be able to make the simplist of foods. My sweet 101 year old gets breakfast of scambled eggs, with either minced ham or topped with melted cheese, toast with butter, four varieties of juice, oatmeal with butter and cream, and a half hour later, coffee (with caffeine) and a small piece of banana or jelly donut. She likes maple syrup over everything. The little rectanglesof toast are cut from regular bread, with the edges removed. Think thick slabs of butter. The thing to remember with stroke patients is that they take along time to wake up. And take a long time to respond. I use the chalkboard to state "Breakfast in five minutes!" The breakfast is brought down and shown to the patient, so they understand why they are being moves. Bring the breakfast on a tray to the table and then you have the opportunity for an exercise session in moving the patient nto the table. After breakfast there is an exercise session bringing the patient back to the chair. So with three meals, you have the opportunity for three structured exercise sessions. The skills to be developed include (a) coming to a standing position from the chair (b) walking across the room supporting his/her own weight (c) rotating to sit down on the wheelchair. Initially you will have to entirely support the patients weight. Do not hurt yourself. The aide position should include the responsibility of providing these six exercise sessions. You will often find resistance from the aides or the care agency in combining exercise with the feeding objective. The teamsters have nothing on the aides.

[caregiver222]

The importance of three separate snack periods cannot be emphasized. If you don't do this it won't happen. A "snack period" includes a beverage and a snack. A snall segmant of banana, perhaps two inches long, provides an excellent snack. The ability to peel the bananna provided a means to observe muscle coorination. Providing three extra snacks, plus three meals, develops the muscles necsesary to maintain swallowing. That little bolus of banana going down is medically helpful in regaining the ability to swallow. When a beverage is offered, and refused, the aide is instructed to offer another beverage of a DIFFERENT flavor.If that is refused to return fifteen minutes later with a third beverage of a third flavor. This is the definition of "encouraging liquids". Another good swallow-developing snack is a slab of butter on a 1/4 segment of graham cracker.

[Tressa999]

I'm thinking of posting notice in Whole Foods, perhaps Craig's List, college bulletin boards.  I dunno. I'd love to find out how Caregiver222 finds the right people.

[Tressa999]

So you're getting 24 hrs of the caretakers you train for less than the price of two hours of therapist.  Sounds like a good deal.  I'll be trying to find similarly bright, caring, trainable helpers when my husband is discharged from rehab, but I'll only be be able to afford a few hrs a day, rather than 24 hrs, so I imagine I'll have to pay more than $10/hr.

[lahinva]

We are going to be looking for the same type of people for a few hours a day also.  How do you go about finding these people.  We would like to have my dad home in the next couple of weeks.  He is so miserable in the Long Term Care Facility.

[caregiver222]

I have to add, I pay them by the day (a flat $240 per day) and they generally get a two hour (paid) break per day. Their Phd.'s were not in the health care field.

[caregiver222]

I get very good people for ten dollars per hour, plus a ten dollar a day meal allowance. Both of them have Phd.'s from European countries.

[Tressa999]

How much do you typically pay these surrogate therapists?

[caregiver222]

Most of the therapy is not rocket ship science. I have hired bright people and taught them the drills so they could provide therapy for someone who could not afford the standard rehab rates. Here-abouts the rehab therapists charge $125-$200 and hour. Ouch. Plus they like to bill in four hour increments. I like to take bright enthusiastic people and teach them what do do. You shoiuld ask permission and videotape the therapy while it is taking place. Then the videotape can be used to train an aide to do the same thing. I am not diminishing the value of a trained therapist, but the fact is, they are often unaffordable.

[dewald55]

You may want to check with you State's Department of Rehabilitative Services...I do not know if it is because I am on the state retirement system, but my fee right now is free and at one time was reduced....