Renee Kinder

Two weeks ago, over her post-game Chick-fil-A, my 14-year-old put me in my place.

I was, because I thought being a good mother required so, upset over the overly aggressive basketball schedule her father had set forth.

Fifteen games and practices over a three-day period to be exact. Half of which included her playing on a varsity team.

She is an eighth-grader. Her varsity career started when she was in seventh.

After seeing her in one Saturday afternoon play with her middle school team, go directly to a freshman game, and then close out the evening playing varsity, I was exhausted. Other parents in the stands were asking me, “How does she do it? It really seems like too much.” 

The parental guilt sinks in.

Of course, no one is asking her father these questions. He’s over there on the bench adding to this chaos and scheduling way too many games, I decided. 

When we get home, we are going to have a talk. 

I had the fully scripted play-by-play in my head and when they made it to the kitchen, I let it roll.

“She’s way too young for this pressure.”

“Did she even eat today? She looks drained.”

And the ultimate line… because life for kids in 2022 is supposed to be enjoyable…

“If you keep this up it’s not going to be FUN anymore!”

At which point Kathryn looks up at me with an expression that was equal part disgust and disappointment.

“You really think I play basketball just for fun?” she demanded. 

Huh? I’ve got nothing. 

No response. Simply let her finish eating, cleaned this kitchen, and started the wash cycle again. 

Uniforms on cool for the long week ahead. 

It was clear to me at that moment that the fun was a small part of why she endured playing on her brother’s team as a child, missed other social events for practices, and stayed up late at night to complete schoolwork after games. It’s not about the fun of the game. It’s a deeply ingrained love for the game.

For most of you out there, in 2022, serving in the long-term care industry, I imagine you are thinking the same thing many days. 

We are not here because it is fun. Some days it is fair to say we are not here because it’s even slightly enjoyable.

We are here because we have no other way of existing without being here. The love for the game if you will supersede all the hardships, the low staffing numbers, the sick patients, and the increased regulations. 

We are in it now and we are in for the long haul. 

This will include caring for active patients and for patients with residual impairments after this is all behind us. 

Per a recently published report from the National Institutes of Health related to Post Acute Coronavirus (COVID-19) Syndrome there are delayed, or long-term complications of COVID-19 increasingly being recognized and are associated with increased morbidity. 

This report is worth the read and highlights the role of the interprofessional team in the evaluation and management of patients with post-acute COVID-19 syndrome.

Furthermore, there are helpful tips for caregivers to consider regarding the following body system.


  • Post COVID-19 patients with persistent/residual pulmonary symptoms after recovery should be seen by a pulmonologist as early as possible for evaluation and close follow-up. 
  • Patients with persistent symptoms may benefit from enrollment into a pulmonary rehabilitation program which is key for faster clinical recovery and vaccination against influenza and Streptococcus pneumoniae.
  • Pulmonary function tests (PFTs) and 6MWT should be considered if clinically indicated.
  • The role of steroids in post-acute COVID-19 is unknown, and data evaluating its effectiveness in post-COVID-19 patients is limited. A small study evaluating COVID-19 patients four weeks after discharge demonstrated rapid and significant improvement with early initiation of steroids. Further clinical trials are required to ascertain its benefit in COVID-19 patients.


  • Post COVID-19 patients with persistent cardiac symptoms after recovery should be followed closely by a cardiologist.
  • Cardiac function tests such as EKG, echocardiography must be considered to rule out arrhythmias, heart failure and ischemic heart disease.
  • Additionally, given the increased incidence of myocarditis in patients with COVID-19, an MRI of the heart can be considered to evaluate for myocardial fibrosis or scarring if clinically indicated.


  • Although COVID-19 is associated with a prothrombotic state, there is currently no consensus regarding the benefit of venous thromboembolism (VTE) prophylaxis in the outpatient setting. However, current CHEST guidelines recommend anticoagulation therapy for a minimum duration of three months in COVID-19 patients who develop proximal DVT or PE.


  • Patients should be screened for common psychological issues such as anxiety, depression, insomnia and PTSD and should be referred to behavioral health specialists if indicated.
  • Given the vast neurological symptoms associated with this syndrome, neurology evaluation should be considered early.
  • In addition to routine laboratory workup as described above, additional laboratory tests such as hemoglobin A1C (HbA1c), TSH, thiamine, folate, and Vitamin B12 must be checked to evaluate for other contributing metabolic conditions.
  • EEG and EMG be considered if there are concerns for seizures and paresthesias, respectively.

In closing, we are clearly not here for the fun. 

We are here, however, pushing through the exhaustion for the moments that challenge us to become better providers, understand and learn more about our patients, and force us to stand up for the industry that we all love. 

Press time everyone. There is too much at risk to play any other way. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]

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.