With home therapist’s help, 81-year-old ‘not helpless after all’
(Ad) Late one night, Rose Kovach got up to go to the bathroom. Or, at least, she tried to get up. But unlike the night before, and the night before that, on this night she couldn’t get out of bed.
“I didn’t have any feeling in my legs, so I just flopped back down, and I called an ambulance,” Kovach said.
She ended up in the hospital for a week, with no clear diagnosis to explain her sudden lack of mobility.
“I have a very bad nervous condition, and that is what could have caused it, but there was nothing physically wrong — I just couldn’t make my legs go,” she said. “You have no idea how frightening it is when you have legs and you cannot use them.”
After the hospital, Kovach moved to a rehabilitation facility for about a month and painstakingly relearned to walk and use her muscles — but she wanted to go home.
“I was lying on the bed, and I said, ‘I have to walk tomorrow, I have to practice this over and over,’” she said, “and with my heel I was able to bend my foot and press it straight down, and just that small victory made me very happy. Then, with an aide’s help, I very slowly made my way to the door and back to the bed. After a while I was walking back and forth.”
But walking isn’t enough to allow for independent living. At 81 years old, Kovach is alone much of the time. Cooking, cleaning, laundry — that’s all up to her.
Enter Stephen Souza, an occupational therapist with Hartford HealthCare at Home. He goes into patients’ houses along with a team of clinicians, including a nurse, a physical therapist, and an OT assistant. He meets patients wherever they are in their journey and helps them become completely
independent again. He’s been in occupational therapy for more than 20 years.
“When I go in, I look at their home and social situation,” Souza said. “We do the best we can to keep that person in their home. They don’t want to go back to the hospital or end up in a nursing home.”
Home occupational therapists have a variety of tools to help them help patients, but first they must assess what the patient needs and how can they accomplish daily tasks on their own.
“I enjoy assessing the home environment and making recommendations, be it bathroom equipment like grab bars, or something as small as reversing the walker attachments to make it fit within the home,” Souza said.
Souza’s suggestions and advocacy proved to be instrumental to Kovach’s independence. He gave her tools to get down the stairs to do laundry by having a chair lift, a walker on the top floor, and another walker waiting at the bottom of the stairs after she got off the lift.
“It’s much slower than you’d think,” Kovach said. “You start the washing and you want to sit down, but at least you’ve done it. That feels very good. You just say to yourself, ‘I’m not helpless after all.’”
With Souza’s help, Kovach learned to improvise. He offered a walker tray or walker basket to help her carry food, but she decided she didn’t want any extra gear, so he worked with what she had.
“When I had to get Meals on Wheels, I couldn’t carry the bags, and he went out onto my porch and found a basket I had out there,” Kovach said. “He suggested we put the basket on top of my walker, and we gave it a try. I never would have thought of it on my own, and then I was able to take the bags and put them in the basket and walk them to the kitchen by myself. But one time the bags fell to the floor, so I just kicked them into the dining room and got them in that way.”
Getting around problems in the home is just one piece of the occupational therapy puzzle. Souza also worked with Kovach on strength and stability, reteaching her muscles to respond to her brain’s directives.
“Typically there is exercise, strengthening, and balance — all related to the functional tasks we need to do. We also assess their vitals every visit,” Souza said. “We come up with a specific frequency and time, of how long we think that individual will need before they reach their goals.”
“I had to relearn how to go down the stairs, how to wash clothes, and they made me do all these things repeatedly, over and over and over,” Kovach said, “but they always had me practice what I asked to practice.”
The point, Souza said, is to personalize the therapy to each person’s needs and requests. Someone who is recovering from a hip fracture will have different needs from someone with chronic obstructive pulmonary disease (COPD), but they all have the same goal: to continue to live on their own.
“Usually I sit with the patient and just talk,” he added. “That conversation then directs what I had planned to do with them. Sometimes if an individual says, ‘I wanted to make this meal, but I didn’t have the strength to put this into the oven,’ then that may be something we work on during that visit.”
Souza also personalizes his cognitive care, tailoring his approach to meet each patient where they are mentally.
“I had a deep fear of falling. I’ve fallen before, and I have very weak bones,” Kovach said. “Stephen would come in handy when I was afraid of falling. He gives you an awful lot of confidence in yourself, he really does.”
After two months of at-home care, Kovach was discharged as a patient. She currently lives happily and 100 percent on her own terms.
“It’s a wonderful feeling to do something you could never do,” she said. “Your legs are getting stronger, your mind is getting stronger. It makes you feel like — this is life. This is real life. I’m living my own life here at home.”
This is just one example of Hartford HealthCare St. Vincent’s Medical Center bringing more specialists and providers to the community. Tune into Hartford HealthCare St. Vincent’s Medical Center’s Facebook Live discussion, where you can ask your questions, on Thursday, Dec. 15, at noon. For more information, visit hartfordhealthcareathome.org or call 1.800 HOMECARE.