How To Get Your Loved One To Perform Their Home Health Exercises

I bet you thought having home health therapy come in would be all about your loved one. You could relax while the therapists do the training and exercising with them. Not quite. Home health therapists rely on patients and their caregivers to carry out the therapy instructions when they're not there. Home health is becoming more and more restricted, often times only allowing a therapist to come in to the home 3-4 times. The visits need to be as efficient as possible. Which means therapists will leave the patient with instructions to perform exercises, sometimes on a daily basis. Following those instructions exactly is very important. Firstly, those exercises are hand picked for that individiual based on their current level and their goals. Second, if those instructions are not followed, third party payers could decline payment for services, leaving the patient with a bill.

I see many reasons people don't comply with instructions, especially their prescribed home exercise program, or HEP. The main culprits are usually forgetfulness, hating exercise to begin with, finding the exercises boring, or fear of performing the exercises. Reasoning with the patient rarely works. They just end up resenting the activities. Over the years (22 as of this year!) I've learned a few tricks to help with compliance! ;)

EXERCISES? WHAT EXERCISES?

Forgetfulness is common among aging adults, especially those diagnosed with Dementia or Alzheimer's Disease. Heck, even I have to make a daily list of to-dos. The goal is to make exercising just another part of the day. Is there a way to easily fit the exercises into the morning routine, between coffee and Judge Judy? It takes 28 days to form a habit. If you can help your loved one remember for 28 days, hopefully they will begin remembering on their own. My favorite method of reminding patients is to tape up their written HEP (each therapist should supply a written HEP) next to their "spot" so they can see it and trigger their memory.

I HATE EXERCISE!

I'd say the number one reason I hear from patients about not doing their HEP is they hate to exercise. You explain the benefits, you beg, you nag until you're blue in the face, but they aren't budging. Positive reinforcement is much better than nagging or threatening. Sometimes verbal praise is enough. People just want acknowledgement of their efforts. Other times, the reward needs to be more tangible. Maybe coffee after exercise, or play cards after exercise. Is it a bribe? Maybe. But if it gets the job done, right? Another tactic is to be their workout buddy. Make it a bonding experience. "Suffer" together or maybe a little friendly competition or have them teach you the exercises! Pretend to do them wrong and they need to demonstrate for you. But sometimes, we just need to get down to WHY they hate to exercise. Do they find the exercises boring? Do the exercises cause pain?

THESE EXERCISES ARE BORING

Yep, I've had people tell me this before. It doesn't hurt my feelings, but I do want to know why the patient finds them boring. I worked with one gentleman who was once a professional soccer player. To him, the geriatric exercises were too easy and a waste of time. I had to explain to him the benefit of each exercise in improving his gait and reducing risk of falls. I also threw him a bone and gave him a couple of challenging exercises. Some people don't understand that therapeutic exercises prescribed by therapists are different than wellness exercises and have a very specific purpose. Another favorite of mine is to ask the patient what their goals are and tie them into the exercises to make them more meaningful to them. When I notice interest fading, it helps to mention the patient's goals as a reason to complete the exercises. And if the patient still won't do their exercises, sometimes you just have to meet them halfway! Like my former patient who hated exercise but loved to garden. So her HEP included performing ten squats to pull weeds.

I'M AFRAID OF EXERCISING

Look, getting old is a b****. Body parts hurt daily. Then some stranger comes into your home and turns your family against you by making you perform painful movements daily. It's really no fun. And that misnomer of us being a "Physical Torturist" is not true. We do not like inflicting pain. We do not always believe in "no pain no gain". As a matter of fact, us therapists want our patients to perform the exercises within their pain tolerance. Don't be disappointed if that means less reps than what is prescribed. Try to help your loved one by pointing out objective progress like, "Today you were able to do 5 reps and yesterday you could only do 3 reps". Hopefully, every day they will be able to tolerate more. If the patient's doctor says it's ok to take pain meds, try administering them 30 minutes prior to exercising. Falling is another fear for the older population. In this case, try beginning the exercises in sitting or lying down. If that can't be done, offer an assistive device, like a countertop or walker, for stability. You could provide assistance by placing your hands on the person's hips. But if falling is a fear factor, do not test the person's balance to hlep them get past their fear. This will only reinforce that fear.

Ultimately, you know your loved one better than the therapist. If you know of a motivating factor, share it with the therapist. Since I have so few visits to spend with my patients, I'm always appreciative of family members that call me with ideas. That way, I can plan ahead of their next visit. But please, on behalf of all home health therapists, do not give up helping your loved one do their HEP!