How to do it...Rehabilitation

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1 While people of all ages love to take a dip, bear in mind that your aquatics program best serves residents who stand to benefit most, says Karen Banks, vice president of business development for EnduraCare therapy provider. Appropriate candidates include those with conditions such as soft tissue limitation, decreased strength or stability, weight bearing difficulty, chronic pain, balance impairments, edema, altered gait, decreased positional sense and de-conditioned status or endurance limitations.

2 Similarly, the pool and space around it must be used appropriately, and this means ensuring your patients are getting the two most important benefits of water therapy: buoyancy and resistance, Banks says.
“Keep in mind that Medicare requires a rented pool to have a dedicated section by means of physical barrier like a lane line,” adds Lynn Davis, MPT, aquatics director for Fox Rehabilitation. This also applies to different areas of the pool. “The entire shallow end might be perfect exclusively for an exercise group, while one lap lane may lend itself to use for therapy reasons so that a patient may benefit from both shallow and deep water training.”

3 You're dealing with mostly frail or vulnerable residents, so safety and training are paramount. This includes equipment.

“Facilities must ensure that the most modern, scientifically proven aquatic therapy approaches are being consistently used,” notes Anson Flake, president and cofounder, HydroWorx, Inc. In turn, it will pay dividends in “more satisfied clients, empowered physical therapists and wellness experts, and revenue-generating innovation.”

Other key safety considerations, according to Davis: maintaining water quality; multiple means of entering and exiting the pool, including steps, railings, ladders and mechanical lifts; gradual shallow-to-deep gradation; and gritty (versus slick) bottoms.

4 Water temperature is often one of the most overlooked elements in aquatic therapy. Davis advises water temps from 86 to 92 degrees Fahrenheit (88 is ideal, she says) as a guideline for skilled therapeutic activity.
Avoid over-heating your residents in aerobic workouts with slightly lower water temps, adds Banks.

5 There are two schools of thought when it comes to gadgets and gizmos. There are the purists, like Davis, who calls herself “a simple kind of gal. I prefer to use the density of the water and speed of movement to achieve resistance, not fancy or expensive equipment,” she says. She also embraces pilates and simple things like beach balls and pool noodles.

Others firmly hold that aerobic therapy equipment such as specially designed treadmills also do play an important role.

“Today's physical therapists can tap into technological advantages not available to their predecessors, including underwater treadmills that can quickly and easily drop into an existing swimming or therapy pool,” says Flake.

In any event, Davis advises: “Don't offer what you don't have or expect to get.”

6 How your water therapist uses the time with residents is as important as what she or he does, according to Davis. For example, Medicare requires skilled therapy to be conducted in a pool setting on a one-to-one basis if the aquatic billing code of “97113” is used.

Unassisted free swims are unbillable as skilled therapy, and if two or more patients share the services of a single therapist for any overlapping time, then the group charge must be employed, she adds. And to ensure a more reliable revenue stream, favor class session sign-ups over drop-in rates.

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