Rethinking Elders' Rehabilitation: Set Your Own Goals

06/10/2010 11:01 am ET | Updated Nov 17, 2011

My father had a stroke last year. Fortunately, everything went right in those critical early hours: He was immediately taken by ambulance to a stroke center and received tPA, which greatly improves prognosis in ischemic stroke victims if administered within a three-hour window.

While he was lucky, he still faced a challenging road to recovery--a road that started, of all places, at the dishwasher. After living at my house for several weeks, my father wanted to return to his house to live on his own.

"Okay," said the visiting occupational therapist, opening the dishwasher door. "Unload the dishes."

My father had not yet regained the fine motor skills to put away dishes. And before he could live on his own--safely--at home, he needed to remaster daily activities such as unloading the dishwasher, putting clothing in drawers and closets, and showering. And there was one daily activity that he aimed to return to above all others: to take his yellow lab for a walk.

For many over age 65, rehabilitation from illness or injury will one day become a fact of life. Each year, more than one-third of adults 65 and older suffer from a fall, which is the leading cause of injury among elders in the U.S., according to the CDC. And each year, about 795,000 people experience a stroke; nearly three-quarters of those stroke victims are over the age of 65, and most will need rehabilitative care.

When people think of physical rehabilitation, they often think of imposing steel machinery, brightly colored bands and balls, and the hustle and bustle of an outpatient rehab facility. They don't think of the dishwasher or the family dog. But physical and occupational therapy at home can be, and often is, a vital part of the overall rehabilitation puzzle.

An Integrated Plan

For elders who've been discharged from the hospital following injury or illness, there are three main options for rehabilitative care: inpatient, outpatient and in-home. Inpatient rehab--which takes place in the hospital, rehab unit of a hospital, rehab facility or skilled nursing facility--is for those with the most demanding medical issues. The patient is assigned a room and stays overnight, receiving other medical and nursing care along with a wide range of rehab services.

With outpatient rehab--which takes place in a facility, an outpatient center of a hospital, or an office with equipment--the patient will visit on a regular basis, receiving intensive physical therapy one to three times per week. The goal is to fine-tune remaining physical deficits and return, as closely as possible, to the previous level of function.

For those who do not need or qualify for inpatient rehab yet find it difficult or debilitating to travel to outpatient treatment, or for those who simply would prefer to recover in their own environment, in-home rehab can be a good solution. In addition, many health insurance plans, including Medicare, place a cap on the number of outpatient rehab visits, so it's good to know you have other options.

In the home, the patient and physical and occupational therapists work around the existing challenges of daily life, such as climbing stairs, showering, navigating the furniture in the living room, unloading the dishwasher. At Visiting Nurse Service of New York, physical and occupational therapists work with what's there, using day-to-day activities to improve balance, flexibility, coordination, stamina and strength.

As an added benefit of in-home rehab, visiting adult children, friends or other informal caregivers can learn and reinforce the exercise program.

When considering or comparing in-home and outpatient rehab, here are a couple important things to remember:

  • Traveling to an outpatient facility takes a lot of energy and mental organization, especially in the early days and weeks of recovering from illness or injury.
  • At the end of the day, you still need to go home--so make sure your rehab helps you transition to your home environment safely and independently.

Setting Goals

When my father began his rehabilitation, he said again and again that he wanted to be able to take his yellow lab on a walk. The therapists listened to his goal and worked toward it, giving the therapy a personal focus and a tangible objective. They also saw how my dad longed to be back in his own place, less dependent on his children for the everyday activities of life.

With my dad's own personal recovery goals as a starting point, he and the therapists worked together as a true team, creating an exercise program that he could easily link to those goals. I saw a real difference in his motivation level once he was doing his exercises at home, rather than prescribed exercises in the hospital. I'd never seen my dad so motivated to clean up the table after dinner.

For many whom I've encountered during their care with VNSNY, the essential human desire to walk proves to be a great motivator. For Walter, who suffered severe wound complications from diabetes, the first step was the hardest. "After that, the more he walked, the more he wanted to walk," recalls VNSNY physical therapist, Gunay Ardali. "On a scale of 1 to 10, he said it was 40." But Walter had his eye on his goal: being able to walk outside, around the block. That goal--because it was his--helped him put up with the pain.

When it comes to rehabilitation, everyone could benefit from the simple words of Dorothy, a 79-year-old stroke survivor who held fast to her goal of walking the streets of her beloved Bronx neighborhood. "You've got to keep on keeping on," she says.


The road to recovery can be a daunting one, but there are many places to go for information. Here are a few:

  • Post-Stroke Rehabilitation