Keeping the Elderly Healthy and in Their Homes

Judy Kotler waits at the bus stop carrying a back pack, and two worn shoulder bags, over her slight, 5 foot 4 inch frame. She could be someone headed for the airport, or a white, slightly upscale bag lady, carrying her worldly processions. But she's off to visit her next client, her portable office in tow, just like any other working day. The shoulder bags containing manila folders, take a lot of wear traveling on Philadelphia buses, trolleys, and subway trains. Judy, a physical therapist, is part of the growing army of health care professionals, delivering care to patients in their homes.

Judy, a physical therapist for over 35 years, works for a racially integrated company. They treat mostly poor and middle class, minority patients, on Medicare, in their homes. "I graduated in 1971 and I've been practicing ever since. I've been treating people in their homes for about 6 years," says Judy.

With a frequent, easy smile, Judy talks about some of the successes and challenges of her job." I had this 60 yr old female patient, a stroke victim. She was house bound because she had to climb a steep flight of about 20 steps, outside her home. She wasn't walking and had trouble even getting out of bed. The first thing I did was get her a quad cane, and a wheel chair. With a lot of practice, I taught her to walk around the house and the outside steps. On the last day that I treated her, she was able to climb the outside steps, ending her confinement at home."

Sometimes the patients are uncooperative and unappreciative. An example was, a 70 yr .old guy who had arthritis and polio in one of his legs. "You don't know how to do the therapy. The other therapists were better than you," he said." "I arranged to have a brace manufacturer's representative, come to the house and personally fit him for a special leg brace. The brace man even walked this man down the steep13 outside steps, to test the brace. Shortly, he was able to walk the steps with some assistance. Another time, a patient asked if I could get him some Viagra. He couldn't even walk, he was all bent over, and all he could think of was Viagra."

About 10 years ago Judy went through a trying period, when she was laid off her city job at the Philadelphia Nursing Home. The city decided to privatize the physical therapy there, during a severe fiscal crisis in Philadelphia. "It was like a divorce. I had worked for the city since I graduated from the physical therapy school, at University of Pennsylvania, in 1971. The best option the city offered me, was to do some clerical work at a prison, completely unrelated to physical therapy." After a short time there, Judy was again laid off, in what appeared to be a tactic to remove her from the city payrolls, for good. "They gave me a poor performance evaluation. After the layoff, I still left the house every morning at 7:30 AM, because I didn't want anyone to know I wasn't working. I spent a lot of time at the library. When you don't have a job a lot of your identity is taken away." Six weeks later she returned to physical therapy in her present job.

A few years ago, at the company Christmas party, Judy received a citation from her company, for patient advocacy. "A physician who works with our company joked about how annoying I was, when I needed a signature from him, to order equipment for patients. I'll keep calling the appropriate people until I can get the patient the equipment they need. I spend at least 2 hours a week on the phone, placed on hold, listening to music, press 1, press 2, etc. You have to be persistent."

Sometimes Judy runs into her old clients. "The son of a former patient told me that his mother had recently died, but thanked me for making her life better, when she was alive. When she first started treatment, she slept on an old couch, which she couldn't even get off of, without the assistance of her sons. I got her a wheelchair, walker, a hospital bed, and even a commode. All of it paid for by Medicare. Before treatment, the only time she left the house, was on a stretcher to go to the hospital. After the hospital bed arrived, I had to train her to get off of the hospital bed, by herself. Then she was no longer couch bound."

In summing up her feelings about her work, Judy said, "I've never thought about doing anything else. If you know that this person's life is better than before, it makes everything worthwhile."