Jean Wendland Porter

As a Physical Therapist for several years (and even several decades), I’ve participated in rehabilitating a lot of joints. Some shoulders, a few elbows, some hips, and lots and lots of knees.

Our job is to increase strength and range, increase mobility and function, and ultimately get our seniors (literally) back on their feet and back to their lives. Some of our patients aren’t even seniors. My youngest (and worst) patient was a 38-year-old knee-replacement patient who thought he’d be back on his feet and back to work by next Monday. Reality + disappointment resulted in some difficult discussions and severely delayed his rehabilitation.

A bunch of my peers have had their knees replaced recently, and I’ve been getting calls and texts asking for advice. I offer what I can, but ultimately my advice is “listen to your therapist and be realistic about how long this will take.” Now I’m one of them.

I went to my Joint Replacement class yesterday. I didn’t want to, but I went because it was required. The class was a diverse microcosm of ages, genders, and races. I knew what to expect, except I didn’t. The healthcare professionals who held the class offered kindergarten-level, step-by-step, low-and-slow explanations of what to anticipate. But the questions from the class blew me away.

“I don’t want to do the exercises on my bed. Can I do them on the floor?” (How will you get up?)

Are you the therapist who’ll stay at my house all day?” (Unreasonable expectations about how healthcare works are not limited to family members.)

“Why can’t I stay in bed for a month once I get home?” (Do you stay in bed all day now? Do you want to get better?)

“Once I get my hip replaced, I know I can’t cross my legs for a few days, but can I still do yoga?” (I can hear the new hip popping out of the socket right now.)

“I know I can’t eat before my surgery, but can I at least have breakfast?” (The education had a slide in all caps: DO NOT EAT THE DAY OF SURGERY.)

As therapists, nurses, CNAs and other providers who encounter patients and residents, we often gloss over important parts of our jobs by assuming our patients’ knowledge level. We often assume all our residents have the same experience base and same knowledge base, and we even assume that they know what we know.

I once had a 29-year-old resident who came to our SNF after an opiate overdose shut down his kidneys. We scheduled him for rehab and dialysis, and he kept asking why he couldn’t just drink a ton of water to get his kidneys working again. I explained that his kidneys didn’t work anymore and dialysis would keep him alive until they did. He said no one at the hospital or at our facility ever explained how important dialysis was. No one had told him his kidneys stopped working. I once had a hip replacement patient crying that no one told her that surgery would hurt.

No one told her that surgery would hurt.

I walked into the joint replacement class thinking that this was a waste of my time, but what I learned is that patient education is perhaps the most important thing we can do to encourage healing, promote good outcomes, and help people realize the benefits of their procedures. Thorough education not only provides better outcomes and increases patient satisfaction while decreasing provider liability, it decreases the load on the healthcare system and insurance by ensuring that repeat hospitalizations are less likely, and making the patient responsible for their own success.

Our job is not just to rehabilitate and send them home. Our job requires us to engage our patients and make them as independent and in control of their health as possible.

Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.