A Message from Dr. Carole Lewis

I, like many of you, have been feeling disconnected, so I reached out the GTCCSs ( Geriatric Trained and Certified Clinical Specialists) in hopes to begin an exchange of thoughts, feelings and ideas. My hope was to get some real sharing going on not only to be better informed about what is going on across the country but to help us share and support each other.

Dear Therapists,

Usually I start messages by asking “How are you?” But these days, I would prefer to begin with good wishes. So, I hope you and yours are well, and knowing you, you are most likely not only surviving, but continuing to grow and progress during these challenging times.

Besides wishing you well, I am writing to connect and see how you are doing. All of you have worked so hard in geriatrics, and I am wondering how the pandemic and sheltering in place requirements are affecting you? I am deeply worried about our clients/ patients as well as our profession.

“Remember that every challenge — every adversity — contains within it the seeds of opportunity and growth.”
― Roy T. Bennett

Personally, I’ve been working on some online courses for Great Seminars  and seeing patients directly and via telehealth. There is a part of me that wants to brainstorm with other like-minded people, like you, to see what opportunities we can find to make a difference in our profession and in the lives of others.

I know what we do makes a difference, but I fear we may get pushed aside in the immediate aftermath of this crisis. I watch very little TV, but when I turn it on, I can’t bear to see how extensive the drug commercials have become and with that I get concerned that people may forget the importance of PT and OT as an effective and safe way to stay healthy and improve in function. The one thing we had going for us was that we were out there, and now … not as much.

So, what can we do? Do you have concerns? Ideas? Is there something I can personally offer to help you during this time?

Please feel free to write to me. I would love to hear from you. If I get enough response, I may organize a casual zoom group to share thoughts and ideas. I have already posted two amazing letters from an OT working with COVID patients in SNF and a PT doing the same in Acute Care. Both letters are eye-opening and heartfelt. They also follow this letter.

I wish you all the best. Know that I am thinking of you.

Stay healthy!

Editor-in-Chief, Topics in Geriatric Rehabilitation
President of Great Seminars and Books and Great Seminars Online
Practicing Physical Therapist
Adjunct Professor, George Washington University
Department of Geriatrics, College of Medicine

Each has given me permission to share their letters.

I received this powerful message from an OT who lives in another state and is working on the frontline of the covid19 pandemic.

Good morning Carole!

Your email warmed my heart. The thought of you always encourages me, and hearing from you is a breath of fresh air. I do have a few thoughts, and I hope they can help in your brainstorming.

Where am I personally/professionally: The two are intertwined at this time. My work has become me, full time. My family has been so supportive as I continue to acknowledge that they have taken a back seat and are doing so much to support me mentally and physically. As you know, Mardi Gras did not serve Louisiana well this year. It put us in the hot seat with COVID-19. I will give you a very personal account of happenings, but ask they stay between us as the media has a way of putting a negative spin on the most valiant acts of service within nursing homes at this time.  Of the many facilities we contract therapy into, only 2 have a significant number of cases. Those 2 that have tested all residents.

The SNF where I am assigned has been proactive from the beginning. In March, to help lower the risk of cross contamination, the facility assigned “usual” staff to work in only one home. They closed the doors to non-essential visitors/vendors, families of residents, etc., and began strict handwashing protocols/temp checks/masking before mandated by State government or CMS. In spite of these efforts, COVID came in. We began with a positive patient and a positive CNA; then more patients began having fever. A small isolation hall was established for anyone going to dialysis or out to hospital, as their risk for exposure was higher. We tried to carry on with “therapy as usual,” providing activity, exercise, and occupation for a home full of elderly individuals deprived of “normal activity” and a reduction in socialization.

I literally had daily emotional breakdowns, from anxiety and bad news that came too often. I would hold my breath, even masked with 2 masks, every time I would be close enough to breathe on a patient. I did not want my toilet training to possibly kill someone I loved so dearly, always in fear I may have been exposed and not knowing if I was shedding virus. It is like the grim reaper was walking down our halls, randomly pointing out individuals. We began to lose people. COVID tore through our hospice patients (I am crying just typing; we are in desperate need of closure when this is over).

In a truly heroic call between our Administrator and DON, all residents were packed up with a few days of clothes and 3 personal items. All closets and other personal belongings were moved to the cleared out dining room to be thoroughly sterilized. EVERY resident was then tested. A hall was locked down and residents were re-roomed based upon test results. We were half positive. That was a hard day for every staff member, as well as for all families that needed to be notified. That was a Saturday. On Monday, we re-organized our caseloads and got back to our modified version of work.

I was not ok; I prayed and felt like I was not where I needed to be. I began talking to my bosses and to the heads of the nursing home. I reminded them that this is a respiratory virus, and being bed bound will increase risk of things going bad. They decided to allow therapy to begin on the COVID hall, but we had to be fully committed and NOT return to the other side of the home until this whole thing is over. Soooooo, for the past two weeks, a PTA and I have transitioned to full time corona therapists. My anxiety is so much better, which is odd since I know I am working with ONLY positive people. It wasn’t the virus that scared me, it was all of the unknowns.

I feel we have adequate PPE to protect ourselves and those we are treating. I love being able to provide them with activity and engagement. Our hospitalizations have slowed, and we have not had any more deaths. Our first group of 9 asymptomatic patients have tested negative, and await one more negative result before they head to the other side of the fire doors, into our step down unit. We have a team of therapists on the other side that eagerly await their transition.

Don’t get me wrong, it still sucks. However, I am a hardcore optimistic, so this little ray of sunshine has renewed my spirit. I wear a mask all of the time, and watch people in public look at me as if I am part of this radical anti-corona come back movement. I believe in things slowly opening, but in my mind I accept their inappropriate judgement and know that I am protecting THEM because I know how I just spent my day. So, as of now, I am an exhausted, never been more fulfilled, geriatric, COVID treating therapist. I still could not love my job any more than I do. I work with heroes who are taking so much pride in loving and protecting our GREATEST GENERATION. Nursing homes always bear the burden of the good paying for the bad. It will be that way again. The good that we are doing will go undocumented, but I believe God sees it all. 

Our profession: I feel the biggest supporter of therapy, in these times, lie with the Corona survivors. While media highlights doctors and nurses (and they should be recognized), I have heard on NUMEROUS occasions the recovered persons themselves state, “I still have a lot of rehab to get me back to where I was before.” They mention PT and OT. Is there any way to harness what we mean to these people, and let that message be a reminder that we are here, we have not stopped, and we will continue to be on the frontlines to maximize quality of life?

I love you so much. Thank you for your thoughts and your email. 

Name witheld

This compelling email comes from a PT working in Acute Care in a faraway state.

Dr. Lewis,

Thanks for your email and sorry for the delayed response.  After I read it, I wanted to take some time and reflect, and time just got away from me.  I agree, this has been a crazy and scary time for our patients and our profession.  I have been extremely fortunate that my job was not affected and have been able to go to work and do what I love to do each day.  I have a number of friends across the country and spectrum, from acute to outpatient to SNF who have been “furloughed” or laid off. 

It is terrifying how quickly many of us became “non-essential” and quite frankly it makes no sense.  Not only do we have our “normal” patients that still need us but there will definitely be a post-covid surge as well.  From the acute care side of things, this situation has been quite the eye opener.  At the onset of the pandemic, a few of us really had to advocate (to charge nurses, the higher ups, even our immediate director), that yes, we are absolutely essential and we need to get into these covid and isolation rooms. 

The “keepers of the PPE” would have no problem giving PPE to a doctor who steps into the room for 10 seconds and doesn’t lay a hand on the patient, but we had to fight for it.  Thankfully our role became much more apparent as the disease progressed here.  I have spent a fair amount of time in the non-ICU covid unit and it has been surreal. I am truly scared for these patients on all levels.  Physically they are extremely weak and many of them cognitively compromised as well. Months of rehab are needed for some of them, but sadly most won’t be able to get the continued PT/OT they need when they leave the acute care environment as none of our SNFs or IRFs will take a positive patient, home care has been picky, and a number of these patients have either come from Mexico and/or are uninsured. 

The emotional toll that all patients have taken, covid or not, has been huge due to hospital visitor restrictions as well as just general fear.  The fear has also affected our geriatric community in general as many are significantly less active, or getting sick and they are too afraid to go out.  I had one lady a few weeks ago who had a stroke and waited 5 days to come to the hospital because she was too afraid she would get the virus. 

It is a definitely a scary time for all of us, and knowing that there isn’t going to be a magic switch where everything goes back to normal adds to the concern.  So, to answer your question as to what we should do – I honestly don’t know.  Personally I just keep on advocating and questioning “policies” that don’t seem to be in the best interest of patients.  I think as a profession there needs to be a continued push to figure out how to safely treat these patients outside the acute setting.  I hope as the post covid surge progresses, our role in this area becomes much more apparent.  Additionally, our “regular” patients need to feel safe returning to their outpatient clinics and such.  So basically, I suppose it just comes down to advocacy, but how to actually carry that out is the challenge. 

Thank you for the email and the thoughts it provoke.  I hope that you and your family are safe and healthy as well!!

Text from a PT working in an SNF

Right now I am working harder than I have for a long time.  I am expected to treat and still do all the DOR stuff.  

It is very discouraging and hurtful to read what the media has been saying about nursing homes. The coverage has been so unfair that it makes me feel physically ill sometimes. I heard that a senator from Florida claimed that she got covid-19 from walking into the lobby of a SNF. She had a mask and gloves on and didn’t touch anything, so she probably got it from grocery shopping or being in crowded areas. But she blames it on nursing homes instead of any of her other outings because nursing homes and older people have become scapegoats for the fear and frustration everyone is feeling about the pandemic. 

Contracting COVID19 while working in a SNF and maintaining a positive outlook

Hello!  Thank you for sharing the heartfelt letters from other OTs/PTs working with Covid positive patients.  It is uplifting to hear stories that are similar to my own, in the struggle and pride that continue to push us forward.  Here is my story.

I am writing this from my home, as I recover from Covid 19.  I work full time in a SNF that focuses on post acute rehab with a few LTC and hospice beds as well.  We were Covid-free until early May when one patient presented from the hospital as positive, despite the screening procedures in place.  The next two weeks resulted in our facility designating a “Red Zone” for Covid positive patients only, dedicated staff, full PPE, and strict laundry/trash and dining procedures.  I was the PT to spend all day on that unit, providing broader therapy services, as OT/ST had temporarily put care on hold to limit exposure.  I also provided care in a Nurse Tech role, allowing me to monitor the functional status of patients who were not currently on case load.  

Adrenaline and love for my patients and work were my driving forces!  I accepted the challenge, modifying my assessment and treatment strategies to fit with more confined mobility and new respiratory limitations.  I provided socialization whenever I could to these patients who were isolated to their rooms, now only seeing 3-4 staff members per day.  Then came a positive test result for me.  My sinus symptoms I had attributed to allergies and N95 mask-wearing, were the initial symptoms of the coronavirus.  
Thankfully, my symptoms are mild and with increased rest I am able to carry out my daily activities and get into a few “projects” while home.  My family was all tested yesterday, with only my teenage daughter currently showing symptoms.  Again, so thankful, they are healthy with low risk for any complications, should they also contract the virus.  Developing antibodies seems like a benefit at this point.  

This story will continue as I will return to working with Covid positive patients once cleared.  While home, I will be taking several courses regarding rehab considerations for patients with Covid 19.  My facility will need to provide transitional care to those who have recovered from the virus, yet have not recovered their PLOF.  With a dedicated Covid unit, we may also be able to serve as a resource for those patients who are still positive and stable enough to transfer to post acute rehab.  I look forward to facing the continued challenges with all of the tools and benefits that therapy can provide.  

Marching on, Betsy PT, GCS

Insights from a Hands on outpatient therapist

Hey Carole

Best of Health and Thanks for the email. To get to the heart of the matter, I feel I can best help my (our) patients with in-person visits. This allows me (us) to palpate, observe, inquire, validate, provide care, respond to emergent situations, provide feedback and further modify the care. In-person care allows better communication and interaction, both direct (straight forward) and indirect (body language and tone of voice). I realize that that what I have stated is obvious but sometimes impractical either due to the present COVID-19 situation or just geographic or transportation situations. Without getting on a “soap box” or writing an essay here’s a snapshot of my situation. I am a staff PT and work in a hospital based outpatient orthopedic PT clinic with a total of 7 PTs, 4PTAs and 2 CHTs (one OT one PT). The clinic was closed on 3-23-20 due to COVID-19; but allowed to see post op with social distancing including staggered scheduling, M-W-F only, temperature checks and masks for all people (patients, staff, vendors, building maintenance) in the clinic, and strict cleaning. This resulted in approximately 15-25 total visits per week with therapist sharing time off. Due to Indiana state law only MDs could do telehealth. During the second week of April the governor signed an executive order allowing other health care professionals to do telehealth; but as you know Medicare at that time did not cover this. Our clinic got set up with Doxy.me. I personally had 8 patients that due their need, my plan of care and their insurance  telehealth would be appropriate.Three people declined, two did not have a computer and three people did not return a call. The week of 4-20-20 the State of Indiana and our hospital guidelines allowed us to provide treatment to all patients as long as we followed all of our appropriate guidelines. In April and May PTs are working 10-20 hours a week and PTAs are working 5-10 hours a week. Presently PTs are working 15-25 hours a week and PTAs are working10-20 hours a week.  Our referrals are down (New Patient scheduling wait list is no longer 2 weeks but now a patient can be seen in 1-2 days).   Thoughts for improvement:  a)the provider of therapy care be able to demonstrate to the public how care (in clinic,in separate designated area, in home, telehealth) can be provided safely in any situation (virus, natural disasters, utility disasters, economic disasters); b) educate the governing and regulatory bodies (local, state, national) as well as the general public that therapy (PT,OT,Speech) is an essential function and can be provided safely and economically; c) (pet peeve of mine) though not cost effective, from day one of the shut down each therapist should make weekly phone contact with their patients for health care continuity as well as maintain a personal and caring connection. My Clinical Managers and Rehabilitation Department Director have all been very good at problem solving, providing direction, providing plans and providing support and supplies. I think it boils down to  my point b) such that all of us stakeholders need to provide education and statistics to convince others of why the therapy we provide is essential.

Wow This was long. Thanks for asking. I do plan to take more GREAT offerings but I will do it in person. I get so much more out of in person learning.

Stay Well

Blair Johnson GTCCS ’18 

I received this email after my live webinar. I think this heartfelt responses may help those of you dealing with Burnout and COVID


Thank YOU for taking the time to follow up with everything.  I really felt kind of bad for you and the participants with you this weekend.  While I was comfy at home in my air conditioning with a sweatshirt on, you were dying in the heat!  I sure appreciate you sticking with it.  This class did much more for me than help me review and learn new material, and meet my CEU requirements quickly. I think you gave me the jump-start  I needed to keep going after Covid.  I graduated from OSU in 1979. I’ve worked in acute care, home care, out patient clinics, big hospitals-and small community hospitals. What I’ve always loved though, is my work in Skilled Nursing.  So, I’ve been a Director of Rehab of a skilled Nursing facility for the past 25 years.  A lot has changed in skilled nursing in the last 25 years, so my job was constantly changing keeping me challenged and engaged.  That was until Covid-19 hit our building this past March.   We admitted a patient from a community hospital who insisted the patient’s cough was related to her COPD.  We sent the patient back to the hospital when she  became very ill and febrile, but Covid spreads quickly.  The patient tested positive and we sent 2/3 of my therapy staff, 4 aides and 2 Nurses  home due to exposure.  That night our department head team moved 42 patients into different rooms, setting up an isolation unit for all exposed patients. I had to set up my department in a lounge area as the facility used the Rehab space as a donning and doffing area.  We were one of the first facilities in our area affected and the media were not kind.  Despite heroic efforts by our medical and Nursing staff, we lost 14 people.   We are now admitting patients with Covid -19 to our isolation unit, but currently our residents are Covid free.  Unfortunately, our census has plummeted and I have laid off 3/4s of my department.  All new clients go into 14 day isolation in their rooms so most of our patients go straight from isolation to home. As you can imagine, our treatment models have changed a bit.   Before the class this weekend I was feeling pretty defeated.  My daughter in law keeps asking me when I’m going to retire so I can watch my grandchildren and she can go back to work.  I was starting to think that might be the best thing.  The class this weekend reminded me why I went into Geriatrics in the first place.  I’ve heard a lot about burnout over the years, and never thought I was at risk.  Yet, when you spoke of burnout this weekend I felt like you were talking directly to me.   Immediately after the class Sunday I went to my granddaughters first Birthday party.  It’s always a blast being with my grandkids and Sunday was really fun.  I realized though, that I still love what I do too much to give it up.  Maybe someday my granddaughter will decide to be a PT like her grandma.  Wouldn’t that be cool?  Thanks for keeping me focused and inspired.  I really enjoyed the class.   Ginny Krisanda