New Home Study Modules Now Available on the APTA Learning Center
Management of Falls and Fall Prevention in Older Adults
Tool Kit for the Prevention of Diabetic Foot Ulcers
Assistive Devices, Adaptive Equipment, Orthotics, and Wheeled Mobility for the Older Adult
Bariatric Obesity in the Older Adult
End of Life Ethics
Breast Cancer Related Lymphedema
Biopsychosocial and Environmental Aspects of Aging
Full details can be found at http://geriatricspt.org/?dd90jb
Please plan on joining us at the annual AGPT Member Meeting on January 24 from 630pm-8pm in the Marriott Marquis. The Board of Directors unanimously approved the new plan at their Board Meeting in October and we are excited to share it with you!
Embracing aging and empowering adults to move, engage, and live well
Building a community that advances the profession of physical therapy to optimize the experience of aging
Goal 1: AGPT provides education that enhances practice by producing value, empowering advocates, and promoting the use of evidence informed practice
Goal 2: AGPT attracts, engages, and mobilizes physical therapists, physical therapist assistants, and students serving aging adults
Goal 3: AGPT builds relationships to expand its influence and the reach of physical therapy
Purpose: To develop specific initiatives to implement an ongoing partnership with the NCOA
Objectives include: GOAL 3C2 of the AGPT 2019-2020 Strategic Plan
The AGPT BOD will appoint a task force by CSM 2019 led by Director of Publications & Partnerships, to implement and complete tasks in the NCOA partnership agreement by December 2020.
Time Frame: December 2018 to December 2020
Time Commitment: Monthly conference calls, travel to CSM 2019 and 2020 (not required), 5 hours per month working on strategies created by the TF to meet the above objectives
Please respond by December 17th, 2018 with your interest to participate to Jackie Osborne at [email protected]
Please include a brief statement including the following:
AGPT Director of Publications and Partnerships
On behalf of The Centers for Medicare & Medicaid Services (CMS) and the Quality Innovation Network National Coordinating Center, we are excited to share a new resource with you: a Change Package to prevent all cause harm in nursing homes:
A draft of the Locomotor Function Clinical Practice Guideline (CPG) is now available for review and public comment from December 1-21 at https://geriatricspt.org/?jusp8m
The goal of this Clinical Practice Guideline (CPG) is to delineate the relative efficacy of various interventions to improve walking speed and timed distance in individuals > 6 months following stroke, incomplete spinal cord injury, and traumatic brain injury. Please email all comments to [email protected]. Thank you for your consideration.
June 7-8, 2019
8 am – 4:40 pm both days
St. Catherine University
2004 Randolph Avenue
St Paul, MN 55105
This 2-day course will focus on the Physical Therapist Assistant’s (PTA) use of exercise as an advanced rehabilitation
intervention for the aging adult. Several common functional outcome measures will be actively performed by
participants or demonstrated by instructors. The physical stress theory regarding proper exercise intensity will be
presented. PTA’s will learn how to utilize this concept in exercise programs for aging adults, as indicated by the physical
therapy (PT) plan of care (POC), for aerobic conditioning, balance, gait and strength training. A variety of diagnoses
commonly treated in aging adults will be reviewed and discussed relative to the application of exercise principles,
treatment progression, and precautions. A discussion of barriers and motivation strategies to assist the aging adult in
achieving goals will be included. The course will include both lecture and hands-on practical lab activities
Spaces are limites so Register for this course early at http://geriatricspt.org/?35w774
This message was developed jointly by the ACAPT National Consortium of Clinical Educators (NCCE) and the APTE Clinical Education and Physical Therapist Assistant Educators Special Interest Groups (CESIG and PTAESIG).
Here is a summary of what we know so far:
These are the key points we learned in this conference call with APTA:
We have identified the relevant regulations and pasted them as an addendum to the bottom of this message.
We have known for a long time that Medicare does not consider students to be qualified practitioners. Many of you will remember that we dealt with a similar Medicare regulation in clinical education several years ago with Medicare B. Essentially, the Medicare B regulations allow the student to be in the room and involved, but the therapist is directing all care, is not engaged in anything else, and is present for the whole session. The presence of the student in the room does not make the service unbillable, nor does documentation by a student. We do not know whether this current discussion will land in a similar place, but we should be reassured that CMS understands the importance of training health professionals and is working with the professional associations.
Until we have more information, we recommend that clinics and CIs use their best judgment on how to involve students in patient care based on the language in the regulations. Documentation by students should indicate that a licensed physical therapist or assistant was present during all patient care.
We have set up a Discussion Board on the ACAPT website. It is not password protected, so please share the link. The purpose of the discussion board is to identify questions and concerns and to share comments and potential strategies. Participation can be anonymous if the individual chooses, but we do encourage individuals to identify themselves and/or their role to provide context. We will monitor the discussion board and consult with experts as necessary to resolve questions.
Donna Applebaum, PT, DPT, MS
Carol Beckel, PT, PhD
CESIG Academic co-Chair
Jay Lamble, PT, DPT, MS, OCS, NCS
CESIG Clinical co-Chair
Kathrine A. Giffin, PTA, MS Ed
Addendum: These are the relevant regulations and the link to each:
42 CFR 482.56: Condition of Participation for Hospitals: Rehabilitation Services, which states that PT, OT, and SLP services must be provided by qualified therapists or assistants as defined in Part 484. It also mentions the provision of care and personnel qualifications must meet the requirements of 409.17. https://www.ecfr.gov/cgi-bin/text-idx?SID=701c600508ebd3d4596d82be385f4710&mc=true&node=se42.5.482_156&rgn=div8
42 CFR 484.115: Condition of Participation: Personnel Qualifications: Outlines the qualifications of therapists and assistants being referenced by 42 CFR 482.56 and 42 CFR 409.17. https://www.ecfr.gov/cgi-bin/text-idx?SID=5d0e26127b202b6434791c979c6f3269&mc=true&node=se42.5.484_1115&rgn=div8
42 CFR 409.17: Hospital Insurance Benefits: Inpatient Hospital Services and Inpatient Critical Access Hospital Services: Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services: States that PT, OT, and SLP services must be provided by therapists or assistants who meet the requirements specified in part 484. https://www.ecfr.gov/cgi-bin/text-idx?SID=701c600508ebd3d4596d82be385f4710&mc=true&node=se42.2.409_117&rgn=div8
Medicare payment system is in the midst of a paradigm shift—away from the fee-for-service payment structure, in which providers are rewarded solely by the volume of services provided, and toward a structure that holds providers accountable for patient outcomes and costs. Unfortunately, there are a number of myths about the new payment systems finalized for SNF (the PDPM) and for Home Health (the PDGM), shaping biases and working against the long-term success of these models.
Watch this FREE informative recorded webinar to learn more about the “Reality” of these models. The webinar is recorded via Adobe Connect, so you may need to download the Adobe Connect Application.
Thank you to the many AGPT members who submitted comments for the Request for Information: IMPACT ACT Research Study: Provider and health plan approaches to improve care for Medicare beneficiaries with social risk factors. APTA has submitted final comments and your contributions to the final document are evident. We thank you, our members, for your continued advocacy for our patients. Please see http://geriatricspt.org/?f85f3d
Do you work in IRF, LTCH or hospital settings? Do you take students? If so or are considering, please take a moment to read this
This week CMS held a conference call on the IRF Payment and Coverage Policies: FY 2019 Final Rule call. On that call, there was apparently a robust discussion related to the use of students in the IRF setting (and indirectly in the acute inpatient setting) that would potentially have a significant impact on all involved. In essence, it would relegate the student to an observer only. the representative from CMS on the call communicated several times that according to hospital conditions of participation that IRFs must meet, students do not have a role in providing therapy or therapy minutes to patients, even under direct supervision of the licensed therapist.
the CMS spokesperson cited Code 42 of Federal Regulations, specifically 482.56 regarding the provision of hospital based therapy services and indicated that all therapy must be provided by qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists.
The APTA has contacted CMS and request a meeting as soon as possible. Until then, it would be important to insure your documentation reflects the licensed therapists' involvement in documentation, and that the student serve only as a "second pair of hands". Any treatment provided by the student only should not be counted toward the 3 hr. rule.
It is encouraged to send specific scenarios and practice questions related to students to the [email protected]<mailto:[email protected]> address since multiple questions may prove helpful to speeding up their response.
APTA has issued a joint statement regarding use of students in hospitals - please see http://geriatricspt.org/?q9q6a5
On November 1, CMS began posting the first elements from the Quality Reporting Program. There are five elements that contain data, compared to the national average. Why should you care? In a PDPM world, therapists will need to push back on the notion that "less" therapy is the way to go. Therapy services are important to all of these quality metrics in order to support the SNF in meeting/exceeding expectations. Talk to your facilities and colleagues about how you contribute to the value of services delivered.
* Percent of residents developing new or worsening pressure injuries
* Percent of residents experiencing one or more falls with major injury
* Percent of residents who had a functional assessment on admission and the outcomes incorporated on the careplan and assessed at discharge
* Medicare spending per beneficiary
* Percent of successful return to home or community
A sixth measure regarding avoidable, 30 day hospital readmission was not reported as CMS is still trying to determine how to best present the data.
The above data is available for each SNF on Nursing Home Compare. To view, go to the website<https://www.medicare.gov/nursinghomecompare/search.html?> at https://www.medicare.gov/nursinghomecompare/search.html? (or past the link into your browser), choose a facility and then delve into the "Quality of Resident Care" tab. At the bottom of the screen, expand the sections on short-stay and long-stay to view all Quality Measures including this latest set. Remember that the data in most cases is more than nine months to a year old (observations between 2016 and 2017).
Online Registration is now open for the 2019 CEEAA Course Series at http://ceeaa.geriatricspt.org
We are pleased to announce the dates and locations for the 2019 Certified Exercise Expert for the Aging Adult Course Series. As always, we encourage you to register sooner rather than later as courses are capped at 65-70 registrants. Please note than if you cannot attend all three courses in the same location, the course administrators will need to pre-approve your request prior to registering.
Rocky Mountain University of Health Professions
122 East 1700 South
Provo, UT 84606
March 30-31, 2019
June 1-2, 2019
August 3-4, 2019
South Central Pennsylvania
Lebanon Valley College
101 N College Avenue
Annville, PA 17003
July 20-21, 2019
September 14-15, 2019
November 2-3, 2019
Fort Worth, TX
University of North Texas Health Science Center
3500 Camp Bowie Blvd
Fort Worth, TX 76107
March 9-10, 2019
April 13-14, 2019
May 18-19, 2019
St. Louis Park, MN
Methodist Hospital Auditorium
6500 Excelsior Blvd.
St. Louis Park, MN 55426
October 5-6, 2019
April 25-26, 2020
May 30-31, 2020
Also watch for details for our first Advanced Certified Exercise Expert for the Aging Adult Course for CEEAA Graduates April 6-7, 2019 in Madison, WI and Advances in Exercise for the Older Adult: A 2 Day Lab/Lecture PTA Focus Course specifically designed for the PTA who works with aging adults June 7-8, 2019 in St Paul, MN. Registration details will be posted soon!
Please listen to this audio file form the AGPT Director of Publications and Partnerships Jackie Osborne, PT, DPT
The Oncology Section is sharing a recent article from their Journal with all AGPT members. "A New Perspective! Behavioral Change Strategies to Improve Physical Activity After Cancer Treatment" can be accessed at:
A new CDC publication, “The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk,” has been published in the American Journal of Preventive Medicine. This report is the first to show that evidence-based fall prevention interventions delivered by U.S. healthcare providers have the ability to prevent thousands of falls, thereby improving the health and well-being of older Americans. In addition, these interventions could substantially lower healthcare costs currently estimated at $50 billion annually.
Using a two-step process, the authors calculated the population-level impact of 7 evidence-based interventions on reducing falls and lowering direct medical costs. In step one, they used the prevalence of seven fall risk factors among American’s age 65 and older to calculate the number of older adults who would be eligible for and willing to reduce their risk by adopting an evidence-based fall prevention intervention. The interventions included 1) Tai Chi exercise program, (2) Otago Exercise Program, (3) medication management, (4) vitamin D supplementation, (5) expedited first eye cataract surgery, (6) single-vision distance lenses for outdoor activities, and (7) home modifications led by occupational therapist. In step two, the authors estimated the expected number of falls that would occur if the intervention had not been implemented and the medical costs of these falls. Lastly, the direct medical costs averted were calculated based on the known effectiveness of the intervention.
The study found that implementing single interventions could prevent between 9,563 and 45,164 medically treated falls and avert between $94 and $442 million in direct medical costs annually.
Preventing falls can benefit older adults significantly by improving their health, independence, and quality of life. Healthcare providers are in a unique position to educate and empower their older patients on how to reduce fall risk. The CDC’s Stopping Elderly Accidents, Deaths, and Injuries initiative (STEADI) includes resources and tools to help members of the healthcare team (e.g., physicians, nurses, pharmacists, and physical therapists) integrate fall prevention into their clinical practice.
To order your electronic copy, please see:
On July 31, 2018 CMS finalized three 2019 Medicare payment rules for the Skilled Nursing Facility PPS, Inpatient Rehabilitation Facility PPS, and Inpatient Psychiatric Facility PPS. Individually and collectively, the final rules issued today put patients over paperwork, ease provider burden, and make significant strides in modernizing Medicare
The global population is currently undergoing the greatest demographic shift in the history of humankind. A direct consequence of this “longevity miracle” – if left unchecked – will be an explosion in the incidence of chronic diseases afflicting older people. In the absence of systematic and system-wide interventions, this tsunami of need is poised to engulf health and social care systems throughout the world. Osteoporosis, falls and the fragility fractures that follow will be at the vanguard of this battle which is set to rage between quantity and quality of life.
By 2010, the global incidence of one of the most common and debilitating fragility fractures, hip fracture, was estimated to be 2.7 million cases per year. Conservative projections suggest that this will increase to 4.5 million cases per year by 2050. While all countries will be impacted, in absolute terms, Asia will bear the brunt of this growing burden of disease, with around half of hip fractures occurring in this region by the middle of the century. And the associated costs are staggering: in Europe in 2010, osteoporosis cost Euro 37 billion, while in the United States estimates for fracture costs for 2020 are US$22 billion.
If our health and social care systems are to withstand this assault, a robust strategy must be devised, and an army of health professionals amassed to deliver it. This strategy must transform how we currently treat and rehabilitate people who have sustained fragility fractures, in combination with preventing as many fractures from occurring as possible. The latter can be achieved in part by ensuring that health systems always respond to the first fracture to prevent second and subsequent fractures. In short, let the first fracture be the last.
A major step towards making this aspiration a reality has occurred today with publication of a Global Call to Action to improve the care of people with fragility fractures. Endorsed by 81 leading organizations from around the world, covering the fields of medicine and nursing for older people, orthopaedic surgery, osteoporosis and metabolic bone disease, physiotherapy, rehabilitation medicine and rheumatology, the case for transformation of the following aspects of care has been made:
The Call to Action was conceived at an annual congress of the Fragility Fracture Network (FFN), when six leading organisations came together to determine how they could most effectively collaborate to improve fracture care globally. Lead author of the publication, Professor Karsten E. Dreinhöfer said “Fragility fractures can devastate the quality of life of people who suffer them and are pushing our already overstretched health systems to breaking point”. Dreinhöfer added “As the first of the baby boomers are now into their seventies, we must take control of this problem immediately before it is too late”.
The Global Call to Action illustrates that for the first time, all the leading organisations in the world have recognized the need for collaboration on an entirely new scale. “The Academy of Geriatric Physical Therapy has a long history of promoting bone health to improve population health and we are proud to be among the charter group of global endorsers. The publication of this CtA along with the unprecedented level of consensus shared by societies across the world provides an opportunity to drive widespread implementation of best practice in the United States and globally,” Dr. Greg Hartley, President of the Academy of Geriatric Physical Therapy.
The Global Call to Action proposes specific priorities for people with fragility fractures and their advocacy organisations, individual health workers, healthcare professional organisations, governmental organisations and nations as such, insurers, health systems and healthcare practices, and the life sciences industry. The World Health Organisation (WHO) has declared the years 2020-2030 to be the “Decade of Healthy Aging” and later this year the United Nations (UN) will hold its Third High-level Meeting on Non-Communicable Diseases. The authors highlight the opportunity for WHO and UN to consider the recommendations made in the Global Call to Action as an enabler for their global initiatives.
Read more at http://fragilityfracturenetwork.org/cta/
Fragility Fracture Network Central Office
c/o MCI Schweiz AG
Kate Mangione, PT, PhD, FAPTA
Member, Physio Special Interest Group
The Cognitive and Mental Health SIG would like to share with you a youtube video link that speaks to how we can all clinically assess and address feelings of job burnout. It speaks to physicians, but we can change the script ourselves from MDs to physical therapists, physical therapist assistants, students, residents, and physical therapy doctors.
The video is < 5.5 minutes long and describes a straight-forward 3-step process to clinicially assessing job burnout and real action steps to correct it. It is hoped you think it is worth your time and worth sharing/discussing with your colleagues in team conferences and in local chapter meetings. We always love to hear from you! Please keep sending your comments on content and project development ideas to Lise McCarthy, CMHSIG Chair at [email protected]. Last, if you like and appreciate the content posted on the CMHSIG webpage so far, please do sign up to be a member at https://geriatricspt.org/special-interest-groups/ as this is the only way to really let the Board of Directors and the CMHSIG leadership know we are on the right track in developing content that supports and represents your needs.
The video can be accessed at:
The Residency/Fellowship SIG proundly supports geriatric residencies and is excited to announce the recipients of scholarships to assist with offsetting costs associated with geriatric residency work. Congratulations to the following Academy members: Sarah Evans/University of Minnesota; Lashia Hicks/Brooks IHL Geriatric Residency; Ashley Kinsey/Durham VA Medical Center; Matthew Mucha/Louis Stokes Cleveland VA and Alexandra Piersanti/Creighton University.
The Academy of Geriatric Physical Therapy is pleased to announce Management of Falls and Fall Prevention in Older Adults written by Mariana Wingood, DPT, PT, GCS, CEEAA and edited by Barbara Billek-Sawhney, PT, EdD, DPT, GCS is now available in the APTA Learning Center.
Falls are major concern for older adults! Physical therapists play a key role in fall prevention, as well as treating falls and fall related injuries. With evidence-based practice the functional mobility and quality of life of older adults may be improved, while decreasing the national fall related statistics. This information will provide clinicians with the appropriate multi-factorial assessment and interventions to set their patient up for success!