The invisible skillset of physical therapy in LTC
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Physical therapy input was viewed positively at the charity, reflected by the manager observing “it’s such a drawcard for lots of families, having such a proactive physio team” (Mgmt#5). However, in the for-profit organizations physical therapists were predominantly “limited to assessment and advice” (FAC#4), contributing to multidisciplinary resident assessments and care plans. A senior management participant observed that “the physios do more paperwork than they do time with the residents doing walking programs” (SM#4). This perhaps meant managers and other staff did not experience and understand what falls prevention skills physical therapists had. Instead, falls prevention practices were a set of discrete tasks completed by a nurse or caregiver, mainly focused on the physical environment. If residents were having recurrent falls, physical therapists were sought for advice on how to manage the environment rather than for therapeutic intervention, as one manager illustrated: “when the resident had a fall, usually the clinical team will send an email to [physio name], “Can you please review this transfer plan? Is there something else that we can do?”” (Mgmt#3). This then contributed to senior management participants’ expectations not being met and they questioned the value of physical therapy. One commented: “Whenever I … do any clinical reviews of [residents], their physio assessments and the physio input into their plan is nothing like what I think it could be or should be. So it comes down to telling them, ‘Yes, carry on with the walker’. Well the nurse could’ve figured that out. So I don’t see a great depth of investment. Or individual planning.” (SM#3). The clinical reasoning of physical therapists appeared to be invisible to managers but was evident when physical therapists described how demanding it was to challenge a participant “to their level”. Observations and ongoing clinical decisions needed to be made during each SUp class, “you need to make a quick assessment of who is safe to stand up and try standing on one leg” (FAC#4). This demonstrated how assessment and clinical reasoning skills are central to individualising SUp and supporting individual progress. However, if this skillset is not usually recognised within an organization, this may not be ‘seen’ by those who make the financial decisions.