I’ve worked in the nursing home setting as a PTA for the past six years. The average age group I provide therapy for is around 75 years of age and older. However, sometimes we receive outliners that do not fit the norm. “Sue”, for confidentiality reasons, was an atypical patient; she was 58 years of age. Sue was admitted to the nursing facility for an overall general decline. The biggest culprit for her admittance to the nursing facility was end stage kidney disease. End stage kidney disease sounds bad, but it is manageable through dialysis. Although dialysis helps extend the life of the kidneys, it takes a toll on the physical and mental well-being of the patients. A typical dialysis patient takes treatment three times a week for four to six hours a day.
My first therapy session with Sue was short. She wasn’t able to roll over and wouldn’t allow me to exercise or get her out of bed. Toward the end of the first week the only thing she would let me do was assistive exercises bedside on her back. Every day was the same conversation with Sue; “I’m so tired, I feel sick, what’s the point.” By the end of week two Sue had made little to no progress with therapy, while spending about twenty hours a day in bed. At this time it was up to me to give Sue an ultimatum. She could remain in the condition she is in or take therapy seriously.
Sue knew I was motivated to help her, but she wasn’t motivated to help herself. She had the mentality that this was the end of the line for her since she was in a nursing home. But, she wasn’t looking at what she had outside of the nursing home such as a loving family, her dog, and a house. These are the things that ultimately changed Sue’s attitude and motivated her. I made a deal with Sue. I informed her that she would have the possibility of going back home with her family and dog if she did what I asked of her.
First thing every morning I would go to Sue’s room and remind her of how many days we had left until her projected go home date. As the weeks went on Sue’s attitude became more positive and she became stronger and more independent with therapy. Sue went from week one of dependence with everything, to week twelve of ambulation to and from therapy with an independent exercise program. By week fourteen arrangements were made with Sue’s family and she was discharged home.
Sue had the ability from day one, but lacked the self motivation because of her negative attitude. Former college football champion coach Lou Holtz once said, “Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.” As therapists we build knowledge through school, our experiences, and fellow employees. But, the knowledge we acquire is useless if we can’t motivate, educate, and encourage our patients to reach their potential.