Post Hospital Discharge Therapy - Our Experience & 2 Questions

LadyTexan

When DH was discharged from the psych hospital in June the doctor ordered physical therapy (PT), occupational therapy (OT), speech therapy (ST), a medical social worker (MSW) and nursing care. At the same time, I hired an in home caregiver for 4 hours a day, one day per week.

The home health agency (HHA) did not have a speech therapist until recently. The Speech Therapist is coming today for the evaluation. DH is tired of people coming into the home and does not want anymore therapy. DH is still verbal, although he has problems with word finding. He has no problems swallowing. My questions - 

1. what are the benefits of the speech therapy? 
2. what are the consequences of not getting the speech therapy?

DH has been discharged from PT because he has met his goals. The goals were improved balance and increased safety awareness.

Three weeks ago DH's OT was extended by three weeks. His OT evaluation is coming up. DH has significant apraxia. It is not speech apraxia. In my layman's terms, apraxia is his brain tells his body to move or do something, but his body does not do what his brain tells it to. For example, if I ask DH to step towards me, he might look at me blankly, then ask "am I doing it"? OR he may step forward. OR he may say "I don't understand what you are telling me". DH also doesn't realize where his body is in relation to other things, so sitting in chairs takes assistance from me. 

The social worker literally "phoned it in". She never actually met or talked to DH. We had one phone conversation where she agreed to refer me to a state agency. She gave me phone numbers for resources that I was mostly aware of. 

Nursing came by weekly to check DH's vitals, check on his overall health, ask about pain, ask about bowel movements, ask about falls, coach us on hydration, exercise, getting enough potassium, managing dry skin and eating enough fiber. 

I am grateful for the therapy. I have learned about:

1. cueing,
2. using a gait belt,
3. walking with DH on the steps, 
4. how to assist when DH falls and how to help him get up,
5. providing short directives, and 
6. much, much more.

One really helpful tip we implemented was using colored contrasting tape on our steps, to help DH differentiate one step from another. I alternated red and neon yellow using Duck brand tape which seems textured enough. I also used the neon yellow tape to mark a specific place on the safety bar in the bathroom for him to grab when he sits on the toilet. It has helped getting him to sit where he is supposed to (not hang his fanny over the side or too far forward).

DH did not like the therapy, but he tolerated it. The therapy helped us both. It was definitely an important learning opportunity for me.

Iris L.

Cognitive rehabilitation therapy falls under the domain of speech therapists.  This therapy is to help cognition after a brain injury.  Or it may be to help an early stage PWD find ways of functioning better.  Frankly, LT, since you are already so knowledgeable and detailed, you may know as much as or more than the therapist.  I had cognitive rehabilitation therapy for four months and I did not learn any techniques that I did not already know.  I went in under a diagnosis of cognitive impairment.

Iris

jfkoc

Wow...that is some really good information. I have never heard of the use of Duck tape.

Would you consider copying that part and posting it on all of the forums???

Jo C.

Even if it is only a one time assessment, it may well have value.  STs can assess re swallowing which is not a problem at this time, but ST can provide information if this should begin to become an issue.

A good ST can also provide communication assistance; sometimes a LO cannot use words, but  can use pictures to express needs, etc.  A ST can have such helpful items or can tell you where to find them.

Just good to have the assessment done and then if there is a problem in the future that needs a ST, you will have a baseline assessment from a specific date.

J.

aod326

Hi LT. By now the ST will no doubt have been for the evaluation. My thought is to just go with your gut. My DH had 25 sessions of ST, at which point the ST called me and said he was going backwards. We hadn't known at that time it was dementia, and had anticipated actual progress.

I don't think there are negative consequences if you didn't go forward with speech therapy, especially as he's not having swallowing issues. 

My DH, though, really enjoyed the sessions. He thought he was making huge progress and looked forward to them. Wouldn't do a lick of "homework" though! Not sure what your co-pay situation might be, but if it's OK, and he enjoys the interaction, I'd say go for it. If he's not interested, I'd leave it.

Good luck.

caberr

My DH was just released from PT but is still doing OT and SI.  He enjoys ST and likes the therapist.  She has worked with cards, shapes and helps him find ways to find his words.  It has given me tips on how to  talk with him.  Sometimes they just sit and talk.  He is home most days and the therapists coming to the house gives him something to look forward to. 

I have heard of the tape on the steps but have not done it yet.  I like the idea about the tape on the grab bar by the toilet.  

LadyTexan

We went through the Speech Therapy evaluation/assessment yesterday. I am glad we did so. 

DH is tired of having strangers (the therapists) coming into the home, so we declined moving forward with the speech therapy. The HHA stated we could change our minds and contact them if we want to proceed.  The end of the "event" for the HHA's purposes is August 19th. After that time, we will have to obtain another order from the doctor to continue any of the therapies.

@jfkoc I added a post called "Simple Solutions Using Duck Tape & a Rubber Band" to both the Spouse and Partner and Generic Caregiver Forums. I also added photos.

JDancer

Speech therapy can be very helpful. They evaluate swallowing, among other things. People with trouble swallowing can aspirate and develop pneumonia. There is something called "silent aspiration" that can go unnoticed. Just like physical therapy, speech therapy can offer techniques that will improve your LOs quality of life and keep the safe(r).

jfkoc

I saw the re-post---thanks