The number of falls continue to rise in the aging population and some of these falls have serious consequences. Each year, millions of older adults experience a fall. And, according to the CDC, more than one out of every four older adults fall each year, but less than half tell their doctor about it. Seniors value maintaining their freedom of movement around their communities and are frequently adverse to many safety measures that we might want to put in place to prevent a fall. 

How can you build safety into a person’s life while maintaining their independence?

• Incorporate Exercise into the Daily Routine: Try adding just twenty minutes of progressive strengthening and balance activity into the daily routine. What classes are offered through the wellness and/or activities program? Consider adding a balance and strength class at least two to three times per week for your residents.

• Mind Medications: There are many medications that can impact a person’s risk for a fall. Make sure you are aware of what medications residents may be taking and how it could impact their balance. For example, sleeping pills and sedatives can cause dizziness, while hypertension medications can cause postural hypotension.

• Modify Environment: Look at ways to make the environment for seniors as safe as possible. Eliminate area rugs, reduce clutter, ensure clear paths to restroom, install grab bars, and ensure furniture will not topple over if used to hold on to. These modifications can be done in common areas, but more importantly, they should be done in the residents’ rooms.

• Use Proper Lighting: Falls commonly occur in the middle of the night when someone gets up to use the restroom and falls because it is dark, and they cannot see properly. An easy solution is to Illuminate the path to the restroom. This can be done with nightlights, toilet lights, or even motion sensor lights.

• Select Footwear: Proper footwear is essential in fall prevention. Shoes with a back on them, like tennis shoes, and shoes or socks with tread are recommended. Avoid shoes that you slip into, like clogs or slides, and make sure the shoe fits properly.

• Use Recommended Walker or Cane: Assistive devices can be great aids for balance and fall prevention, but it is important that the device is fitted for the user, as well as educating the user on proper form and technique.

• Soft Floors: While it is not always possible, carpeting is preferable as it is softer if a resident should experience a fall. Consider carpet in bedrooms, common areas, and living spaces.

• Offer a Tai Chi Class: If possible, consider offering a Tai Chi class two to three times per week. Tai Chi emphasizes weight shifting, postural alignment, and coordinated movements with synchronized breathing.

Functional Pathways’ Wellness Program and Skilled Therapy services has trained professionals and programs designed for helping Senior Living Communities reduce falls while maintaining seniors’ highest level of independence. Remember: it’s a balancing act!

On July 27, the CDC released new masking recommendations for fully vaccinated, “to maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.”  Determining if you live in an area of substantial or high transmission is found on a website provided by the CDC at CDC COVID Data Tracker.  The maps and charts on this site are current and will be updated daily at 8pm ET.

By clicking on your State and then your County, you will find where your County level of community transmission is currently, this will help to guide how you need to protect yourself and others.

Drilling down on the County page will also provide you with the percentage of County that is vaccinated, and case counts both current and historical.  Please remember to check Counties that you frequent as the recommendations will change.  Although I live in Knox County, TN and it is listed as “substantial risk,” the adjacent County I frequently visit is “high risk.”

We are still learning how long the COVID-19 vaccines can protect people. Discussions are ongoing about vaccine boosters. There has not been a decision made regarding these yet and hopefully this will be coming soon.  The CDC has made recommendations for immunocompromised stating, “Wearing a mask is most important if you have a weakened immune system, or if, because of your age, or an underlying medical condition, you are at increased risk for severe disease, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated. If this applies to you or your household, you might choose to wear a mask regardless of the level of transmission in your area.”

Seems this virus is not just going to go away, if we continue to have a certain percentage of the population that is not vaccinated, they will continue to be the host for the virus to mutate. There does not appear there is a way for science to stay ahead of the mutation, since we cannot create a vaccine for a virus that has not yet appeared. Herd immunity, or the point at which enough people in a population have developed antibodies to a disease, is estimated to kick in at about 65 percent to 70 percent with COVID-19.  My County currently sits at 45.9%.  We have a long way to go.

What We Know

• COVID-19 vaccines are safe and effective at preventing COVID-19, including severe illness and death.
• COVID-19 vaccines are effective against severe disease and death from variants of the virus that cause COVID-19 currently circulating in the United States, including the Delta variant.
• Infections happen in only a small proportion of people who are fully vaccinated, even with the Delta variant. When these infections occur among vaccinated people, they tend to be mild.
• If you are fully vaccinated and become infected with the Delta variant, you can spread the virus to others.
• People with weakened immune systems, including people who take immunosuppressive medications, may not be protected even if fully vaccinated.
• THE VACCINE IS CURRENTLY NOT AVAILABLE FOR CHIDREN UNDER AGE 12

Resources:

When You’ve Been Fully Vaccinated | CDC

CDC COVID Data Tracker

#getvaccinated

The Delta variant is more transmissible and more dangerous. Not enough Americans are getting vaccinated, even though there is enough vaccine for everyone. Currently, we stand at 56% vaccinated in the US, we are well on our way, but this is not enough to establish herd immunity. During several interviews recently, Dr. Fauci said he did not have a “good explanation” for why people will not get vaccinated. “It’s ideological rigidity,” he ventured. “I think there’s no reason not to get vaccinated. Vaccinations have nothing to do with politics. It is a public health issue. It does not matter who you are. The virus does not know whether you are a Democrat,  Republican, or an Independent, for sure. We know that. And yet there is that divide of people wanting to get vaccinated and not wanting to get vaccinated, which is really unfortunate because it’s losing lives.”  In fact, he also commented, “We probably would still have smallpox and polio in this country if we had the kind of false information that is being spread now.”

Per Dr. Theodore Strange, the interim chair of medicine at Staten Island University Hospital in New York, “The bottom line is that the vaccination program with any of the current vaccines available is the only way to break the cycle of spread by not allowing the virus to infect unvaccinated hosts and then mutate into variants such as Delta. These vaccines are safe and with a high degree of efficacy to prevent further morbidities and mortalities.”

Barriers to vaccination vary from fear of side effects, including long term effect, to not having full FDA approval.  The side effects from routine vaccines most always are within the first two weeks and certainly by first two months. For most of the public, who developed any side effect, it was local injection site pain, generalized malaise, and fever lasting 24-48 hours after vaccination. These are also signs your body is mounting a good immune response. It is true that the current available COVID vaccines have emergency use authorization from the FDA and do not have full approval yet. Dr. Paul Offit, Director of the Vaccine Education Center at the Children’s Hospital in Philadelphia and a member of the FDA’s Vaccines and Related Biological Products Advisory Committee stressed that the vaccines’ EUA status does not mean they are less safe. As a member of the FDA vaccine advisory committee, Offit said the vaccines are reviewed with the same level of scrutiny as they would to get full approval. It is only a matter of time until full FDA approval is given, there has not been enough time pass to determine how long the vaccines stay effective.

Although current guidelines do not recommend a booster for vaccine, there are current studies ongoing to make a final recommendation.  As recent as today, panels are meeting to determine whether there will be a booster needed for high-risk individuals with compromised immune systems. 

Throughout the course of this pandemic, the recommendations and guidance have been updated, this does not mean we have been provided wrong information, but as newer information is available, the guidance may change.  It is a NEW virus, and we continue to learn about it. The Delta variant is likely the first mutation. It is likely, as the virus continues to mutate, recommendations will change.

Due to Delta variant the increase in cases of COVID is rising in some areas. We may be seeing changes for masking recommendations again. The CDC recommendations continue to indicate if you are fully vaccinated it is OK to go without a mask. Dr. Fauci feels individually it is best to do your own “risk assessment” based on your environment. The example he provided: “A person who’s vaccinated who goes to an indoor event with 60,000 people in a state where the level of infection is relatively high, and the level of vaccination is relatively low. That means the chances of there being people in that 60,000-person audience who are infected and capable of transmitting it to someone else, even someone who was fully vaccinated, is more of a risk than if you were in a less crowded place in a state that had low level of infection and high level of vaccination. And that is the judgment call that I think you’re pointing to or suggesting, that each individual is going to have to evaluate their own relative risk.”

The CDC is hearing from other organizations regarding community safety as well, the National Nurses United (NNU) has reached out requesting reinstating stricter public actions. NNU sent a letter to the CDC stating, “NNU strongly urges the CDC to reinstate universal masking, irrespective of vaccination status, to help reduce the spread of the virus, especially from infected individuals who do not have any symptoms.”

I do not know about you, but I’m not looking forward to a repeat of last year. I certainly hope that we can get a quick handle on this and stop the spread, we know what is required, and how devastating the outcome can get. The Public Health Emergency is still in effect.  It was renewed for another 90 days on 7/19/2021, predictions are that it will stay in effect throughout 2021. A PHE is not a partisan issue it is a public health issue in which we all have a responsibility.

Track your state’s progress to become fully vaccinated here: U.S. COVID-19 vaccine tracker: See your state’s progress – Mayo Clinic

RESOURCES:

5 things to know about the delta variant spreading around the U.S. (msn.com); Dr Kavita Patel 7/7/2021

Here’s How Well COVID-19 Vaccines Work Against the Delta Variant (healthline.com); Yasemin Nicola Sakay 7/16/21

Dr. Kavita Patel  7/7/2021

Fauci blames ‘ideological rigidity’ for political divide in vaccination debate: ‘I just don’t get it’ | Fox News; Peter Aitken 7/11/2021

Nurses urge CDC to reinstate universal masking to reduce the spread of Covid-19 and protect RNs, essential workers, and the public | National Nurses United; 7/13/2021

Occupational Therapy emerged as a profession in 1917 in the U.S when the National Society for Promotion of Occupational Therapy was created. This later evolved into the American Occupational Therapy Association (AOTA). This association was established with the belief in remedial properties of human occupation. This therapy played a vital role in the treatment of patients suffering with AIDS, polio, tuberculosis, and other illnesses. OT serves as a holistic approach to rehabilitation incorporating both psychiatric and physical dysfunction components. How ironic that 104 years later, the world would be thrown into a COVID-19 pandemic. The role of OT continues to be multi-dimensional as we face a world of social distancing and isolation.

As a member of the Occupational Therapy profession, you help individuals across the lifespan participate in the daily occupations which bring meaning and value to their lives.  Your holistic and customized approach offer the specialized support and services Occupational Therapy can provide. During the past year, you have served not only as a healthcare practitioner, but also as vital support to meet not only the physical needs of your clients, but also the tremendous psychosocial toll brought by the pandemic.

As we begin to celebrate OT month, it is the perfect time to promote our profession. With our society’s increased use of social media, digital communications, and the Internet, promoting Occupational Therapy has never been easier. Whether you are a social media junkie or a newbie, our top 10 ideas will give you the information you need to start promoting OT online this month (and throughout the year). Because we know you are busy, we have sorted the ideas by the estimated time commitment for each—from as little as five minutes to a couple of hours.

1. Share information about Occupational Therapy on social media sites and tag FP (5 minutes) 
2. Use the hashtags #OTMonth #FPStrong (5-10 minutes)
3. Answer questions on public Q&A sites (15 minutes)
4. Contact your legislators (15 minutes)
5. Start pinning on Pinterest (20 minutes) 
6. Take and share pictures of OT in action (time commitment varies) 
7. Write a blog post about OT (30 minutes) 
8. Relate a story about OT on Wakelet (45 minutes)
9. Record a podcast (1 hour)
10. Create a video (A couple of hours) 

Functional Pathways celebrates our Occupational Therapy practitioners as an essential part of the therapy team.  Your dedication, creativity, and commitment to patient care is unwavering despite the challenges you faced both professional and personally.  Celebrate your success and remember to document your experiences.  Years from now, your wisdom will be used to guide the new generation of Occupational Therapy clinicians.

Think of the new Wellness as a journey that embraces all the dimensions of health in synchrony.  These dimensions include physical, emotional, social, vocational, environmental, spiritual, and intellectual wellness. When all dimensional needs are met, a person can live life to their truest potential.

We may find ourselves or others to be in a different place with each dimension.  Some people may have mastered the physical fitness and staying active, but struggle making connections and having a sense of belonging.

How do we move along the Wellness journey? How do we help others move along the Wellness journey?

We need to identify the benefits of each of our daily routines, be fully engaged in the present and appreciate the experience.  So, a walk around the neighborhood is not just about the physical exercise, but it also includes the benefits of breathing fresh air, the benefits of socializing with neighbors along the way, and appreciating the connection to nature that we identify in our path to help us shed stress and relax.

How do we help those we serve embrace this new Wellness mindset?

• Ask the person to identify the purpose of a routine or activity and find its’ Wellness benefits
• Help the person verbalize their feelings during and after an activity focusing on the positive
• Create opportunities for people to participate in activities where they can share a common goal
• Engage in new learning – this could be a new hobby that requires collaboration with others

Our Functional Pathways’ teams are embracing the opportunity to create a Wellness culture in the communities we serve every day.

During this holiday season, it is important we show our patients, caregivers, families, and co-workers that we care and extend a hand to combat loneliness.

Some useful tips include:

• Send a greeting card to your patients and others around you
• Plan “together” activities via virtual means, such as singing carols together
• Listen to faith-based televised programs
• Volunteer to help Activity Directors plan safe gatherings in your community
• Try learning a new skill with others via YouTube and discuss what you have learned with other participants
• Decorate patients’ rooms with holiday items and family photos
• Take time to listen to patients’ holiday stories and traditions
• Share with patients your own holiday stories and traditions
• Share holiday cookies with your patients
• Plan holiday activities at work to celebrate with your co-workers

This holiday season will be more challenging for many people, but more so for our patients that are required to isolate and may have limited contact with loved ones.  Our teams at Functional Pathways are ready to help combat loneliness and make new memories with our patients. 

Happy Holidays to All!

1. Conversion Factor Update
2. Evaluation and Management Code Changes
3. Therapy Assistants and Maintenance Therapy
4. Telehealth and Communication Technology-Based Services
5. Remote Physiologic Monitoring Services

As a therapy industry, we are extremely grateful that CMS has proposed to allow Physical Therapists and Occupational Therapists to utilize their professional judgment to delegate the performance of Medicare Part B maintenance therapy services to Physical Therapist Assistants (PTAs) and Occupational Therapy Assistants (OTAs).  During the PHE, this policy was enacted on an interim basis. Another positive is the proposed rate increase to therapy evaluation CPT codes:

Even though the increase rate in the evaluation codes is welcomed, the proposed cut on other therapy codes is shocking. And do not forget, in CY2022, therapy services provided by PTAs and OTAs will only be reimbursed at 85% of the Physician Fee Schedule. Yikes!

And if this is not enough, CMS is not proposing to permanently allow Physical and Occupational therapy services to be conducted via telehealth, even though they proposed the addition of other services to the permanent telehealth list. Residents in Skilled Nursing Facilities (SNFs) and Senior Living Communities, as well as Medicare Part B patients who would have gone to an outpatient therapy clinic for therapy services, are currently receiving medically necessary Physical, Occupational, and Speech Language Pathology services via telehealth due to the flexibility under the PHE.   

These rate changes are not all about the money folks; it is about access to care! Proposed cuts such as these are devastating without a PHE and proposing cuts, not to mention tying our hands without the permanent addition of telehealth, only increases the challenge of ensuring Medicare residents and patients receive medically necessary therapy care to improve or maintain functional abilities and quality of life.

Advocate for our Medicare Part B residents, patients, family members, and friends!  Please make your voices heard!

Functional Pathways is actively involved with The National Association in Support of Long-Term Care (NASL), a well-known and well respected advocacy group for therapy and other ancillary services. Our involvement allows us to be on the forefront of issues in the industry and to be a part of the solution. NASL has developed a link to help us contact our members of Congress urging them to oppose these proposed devastating cuts! 

1. Conversion Factor Update
2. Evaluation and Management Code Changes
3. Therapy Assistants and Maintenance Therapy
4. Telehealth and Communication Technology-Based Services
5. Remote Physiologic Monitoring Services

As a therapy industry, we are extremely grateful that CMS has proposed to allow Physical Therapists and Occupational Therapists to utilize their professional judgment to delegate the performance of Medicare Part B maintenance therapy services to Physical Therapist Assistants (PTAs) and Occupational Therapy Assistants (OTAs).  During the PHE, this policy was enacted on an interim basis. Another positive is the proposed rate increase to therapy evaluation CPT codes:

Even though the increase rate in the evaluation codes is welcomed, the proposed cut on other therapy codes is shocking. And do not forget, in CY2022, therapy services provided by PTAs and OTAs will only be reimbursed at 85% of the Physician Fee Schedule. Yikes!

And if this is not enough, CMS is not proposing to permanently allow Physical and Occupational therapy services to be conducted via telehealth, even though they proposed the addition of other services to the permanent telehealth list. Residents in Skilled Nursing Facilities (SNFs) and Senior Living Communities, as well as Medicare Part B patients who would have gone to an outpatient therapy clinic for therapy services, are currently receiving medically necessary Physical, Occupational, and Speech Language Pathology services via telehealth due to the flexibility under the PHE.   

These rate changes are not all about the money folks; it is about access to care! Proposed cuts such as these are devastating without a PHE and proposing cuts, not to mention tying our hands without the permanent addition of telehealth, only increases the challenge of ensuring Medicare residents and patients receive medically necessary therapy care to improve or maintain functional abilities and quality of life.

Advocate for our Medicare Part B residents, patients, family members, and friends!  Please make your voices heard!

Functional Pathways is actively involved with The National Association in Support of Long-Term Care (NASL), a well-known and well respected advocacy group for therapy and other ancillary services. Our involvement allows us to be on the forefront of issues in the industry and to be a part of the solution. NASL has developed a link to help us contact our members of Congress urging them to oppose these proposed devastating cuts! 

She indicated that if a person wearing a mask was exposed to the virus, new studies indicated they could have a reduced severity of infection. This may attribute to some of the asymptomatic positive diagnoses we have seen.

If masking in public spaces will decrease severity of illness if exposed, we are still creating antibodies.  Understandably, asymptomatic persons often have less of a viral load, but will still exhibit an organized response of the immune system, this may be related to wearing a mask consistently.  If the overall outcome becomes increasing asymptomatic exposures, ultimately this may lead to increasing herd immunity.  Wow, think about this, with societal behavioral modifications, if we really embraced wearing masks at all times around others, we could in effect be promoting herd immunity.  With herd immunity, the virus naturally stops spreading because it has no one to spread it to.

We have seen this work in other countries who routinely wear facemasks for various reasons.  For example, in Japan, people had already been wearing facemasks.  An article found in SFGate.com from July 5, 2020  by Alyssa Pereira, states, “The existing prevalence of Japan’s mask use set the nation on a good trajectory for effectively battling the coronavirus from the outset. And thus far, Japan has been extremely successful at keeping case numbers down. In a nation of nearly 130 million people, less than 1,000 have died from COVID-19.”

Another example is South Korea, the article notes, “South Korea garnered early international praise for containing the coronavirus, mostly by way of ubiquitous mask use. Like in Japan, mask-wearing in South Korea was already common, giving the country a leg up in the fight against the virus. Cases have, for the most part, stayed extremely low.”

Face masks continue to be recommended for all, except when in your home environment.  When eating in public, you should observe social distancing rules to decrease potential spread.

One of my favorite statements is from Dr. Fauci, who repeats during recent interviews that, “you need to be humble enough and flexible enough to change things based on what the latest data and evidence are.”

Another topic that keeps coming up is the difference between quarantine and isolation, many people use the terms interchangeably.  Let’s review this now.  Quarantine refers to the period of time after you are exposed to the virus.  It is the time that you are watching for signs and symptoms of the illness and the current recommendation remains at 14 days.  It is known that up to 14 days after exposure a person may begin to exhibit symptoms.

Isolation on the other hand refers to the amount of time you isolate from others when you are symptomatic.  What is newly being reported is that evidence suggests you are most contagious for 7.7 days.  CDC recommendations have adjusted to recommend isolation for 10 days (down from 14 days) accommodating to this new information.  The recommendation of 10 days includes a bit of a buffer of two days for the known roughly eight days of contagious period.  Dr. Ghandi went on to explain that often times when you have people continue to test positive for longer periods of time, they are shedding the dead virus from nasal secretions.

To summarize, stay the course, wear a mask around anyone who is not immediate housemates, social distance when masking is not possible.  Stay Safe!