Twenty-five years ago, Dr. Tim Fox, PT, DPT, GCS-Emeritus, CCI, founded the innovative concept of Geriatric House Calls™. Today, Paula Rizzo, an occupational therapist with FOX Rehabilitation, discusses the advantages of providing patient care in their homes. She emphasizes the benefits of making personalized environmental modifications, practicing essential daily activities in a real home setting, and involving caregivers in the treatment plan. This allows for a more holistic and effective approach to improving patient well-being, as it addresses their unique living conditions and fosters greater independence and safety.

Jim: Welcome to The FOX Five, the series that explores FOX Rehabilitation through an original list created by a FOX colleague. Today, I am joined by FOX occupational therapist, Paula Rizzo. Paula, welcome to The FOX Five.

Paula: Thank you so much, hello everyone!

Jim: What is your FOX Five today?

Paula: Five Things I Enjoy About Treating Patients in Their Homes.

Jim: Paula, what is number one on your FOX Five?

Paula: Number one is recommending environmental modifications. So, when you go in the homes [of patients], you see exactly how this person is living. You see their kitchen setup, you see their bathroom setup, and you really have the opportunity to make recommendations that will be safe for them. Maybe they're super cluttered and it's a matter of just helping them figure out what actually needs to be on the countertop and what can be put away, or whether it's all over the floor and you’re recommending they need more space to get their walker through. You really get an idea of how that works in their homes and being able to provide recommendations that will keep them safe.

Jim: And that cannot happen in an outpatient clinic? I mean, you could have dialogue about it, but when you're in the home, you see it with your own eyes.

Paula: Right, sometimes you don't know how these people are living in their homes.

Jim: Paula, what is number two on your FOX Five?

Paula: Number two is being able to practice ADL or IADL tasks. ADLs would be toileting, bathing, dressing, and IADL tasks like laundry or meal prep in their actual home environment. I've worked in a sub-acute facility, I worked in a hospital, and you can pretend to work on these things in those types of settings, but there's nothing better than going into their homes and using their actual kitchen and being able to see this is the pot that they have to be able to carry to get it to their stove, and you know, this is how far they need to be able to walk to get to their fridge and back—being able to work on those things in the actual context of their real home.

Jim: It makes sense. All those pots and pans are different sizes, beds are different sizes, toilets are different heights, so it makes the most sense to do it in their actual home, where they live.

Paula: It’s exactly what you learn about when you're in OT school. It's FOX. That's what we learn about, it's how to make it work in their actual living environment.

Jim: That brings us to number three on your FOX Five.

Paula: Number three is incorporating a patient’s actual chores into their treatment plan. As an OT, we walk into their house and you know we might notice that their sink is filled with dishes or I might see that the mailman just came outside and that they need to get their mail. Being able to see those things and actually have them do it as part of their treatment, gives them that feeling like, “I'm being productive, I'm contributing.” Sometimes they feel like those things kind of fall on a caregiver, and from our side of things, I'm looking at balance, their standing tolerance, and endurance, and they don't even realize that's part of their treatment session. We're able to help them feel productive as well.

Jim: That brings us to number four on your FOX Five, five things that Paula enjoys about treating patients in their homes.

Paula: Training caregivers and family members. Working with the patient is one thing, but when we go in their homes, we're able to meet their actual caregiver or we might see their son or daughter in the house and getting them on board with our treatment plan. Let’s say we're working on posture. I might say, whenever you see your mom kind of stooped and hunched over, cue her to stand up taller. If it's a caregiver, let's say that patient needs help with lower body dressing, but they have the ability to put on their shirt and their bra. Maybe tell the caregiver to tell them to do that portion of the dressing. You can help them right now with the lower body but try to coach them through that, let them think through it.

Jim: You just said the perfect word, “coach.” You're coaching people now, right?

Paula: Yeah, and even making them do their home exercise program, and getting the family on board to kind of say, “Hey, did you do your exercise program today?” That could be very helpful when we're not seeing them.

Jim: Yeah, I love this, because a lot of people may just assume that a clinician goes into someone's home, they do a treatment session, and they leave. You're doing a lot more than that. You're assessing the home, you're coaching, there's a lot going on here.

Paula: Right, just to get that carry over. That's huge.

Jim: That brings us to number five on your FOX Five.

Paula: Number five is seeing a patient's true reality, and what I mean by that is in our evaluation we might talk to that patient and kind of ask how they are doing with this, how they are doing with that, and they might say, “Oh yeah, I'm doing great, I'm fine with that,” but then when we walk into the patient's home or when we actually catch them in the act of doing their dishes at the sink, we might see that even though they said they had no problem, it's actually an issue because of XYZ safety-wise or maybe the setup of their kitchen isn't the best for them. We wouldn't know that unless we were actually in the house. It's great to see those things and be able to work on them.

Jim: Do you feel like you can do your job better because you can see everything that they do in their homes?

Paula: Definitely, yes it makes it a lot easier to make goals when you actually see how they are performing in their own environment.

Jim: Paula another excellent FOX Five. Thank you for all you do, because just hearing you go through your FOX Five, you do so much within a given week. It's more than one thing, and I hope people watching realize that.

Paula: Thank you.