The line between essential and non-essential businesses during the COVID-19 pandemic is anything but clear-cut. Stores, restaurants and other business across the country are wrestling with the challenges of serving their customers while also adhering to social distancing guidelines. Likewise, consumers must choose between supporting local businesses or staying quarantined to reduce their risk of exposure to the virus.
The magnitude of those decisions is amplified when it comes to personal health and well-being, which is the reality for physical therapy patients and providers. Many patients depend on physical therapy and rehabilitation services to recover from surgery, treat an injury, or to maintain fitness during their later years. Others utilize it as an elective, beneficial service that can be put off during an ongoing health crisis.
That leaves physical therapy centers in a challenging middle ground: essential for some, non-essential for others. Still, their work is ongoing in an altered, limited capacity with no clear end in sight.
“Our caseload is probably reduced by a third and our new patient referrals have been reduced by more than half, because doctor’s offices aren’t open,” explained Mike Rymer, Director of Therapy at California Rehabilitation and Sports Therapy in Long Beach. “For someone who has chronic lower back pain or shoulder pain that they’re waiting to get surgery on, those patients aren’t able to go to the doctor, so they’re consequently not being referred to therapy.”
Rymer said that most of his medicare patients are no longer coming in for therapy, since they are among the most vulnerable patients to the threats of the coronavirus. It’s up to each individual patient to weigh their own personal risk against the benefits or treatment, but Rymer and his staff have taken additional measures to make therapy as safe as possible for all patients.
The facility is now open seven days a week instead of five, spreading patients out over a longer time period to avoid having more than 10 people in the office at any given time. They also screen every patient before they enter the facility, require all patients and staff to wear protective masks, and have increased the frequency of their already thorough cleaning regimen.
“The patients who are still here are real appreciative, because they’re in pain,” Rymer said. “That’s the reason most people come to therapy is because they have some sort of movement disorder that is painful for them. The CDC and the American Board of Physical Therapy have said that therapy is essential, and it keeps the patients we’re seeing out of unnecessary doctor’s visits. And for patients that have pain that’s bad enough, they aren’t making ER visits while their doctors are closed, so we’re saving that space for patients who truly need it.”
Telehealth services are also being offered to patients who can do exercises at home or are uncomfortable with coming into the facility. Through the use of an app called Physitrack, patients can receive one-on-one videoconferencing, and have access to instructional videos and descriptions of exercises to aid their recovery.
“It’s not as good as being here, but it’s a lot better than nothing,” Rymer said. “A lot of patients will come once per week and do their other visit via Telehealth, so they’re limiting their exposure by half.”
At the Center for Physical Therapy in East Long Beach, owner Kyle Baldwin has seen a 60 percent drop in business, mostly due to a decrease in Medicare and surgical patients. For the time being, his patients are self-selecting for treatment based on the severity of their need.
“Most of the cases we’re taking care of right now are really acute pain things where they can’t live in the pain they’re in,” Baldwin explained. “Or they’re post-surgical and they just can’t afford the time to be away.”
Fortunately, one opportunity has presented itself for Baldwin and his facility, through a partnership with Long Beach State Athletics. With college athletes across the country unable to visit their on-campus training room or see their team-affiliated athletic trainer, local facilities like Baldwin’s are places where athletes can still receive treatment and complete their rehab. Whether they’re a Long Beach native back home from college or a local Long Beach State athlete, Baldwin has seen around a dozen new patients from the college sports ranks.
“It’s been fun seeing these Long Beach kids coming home and trying to continue their rehab for their respective sports,” said Baldwin. “So we have picked up a few non-traditional referral type patients. It’s not substantial, but we’ll take anything, plus it adds to the fun and diversity of athletics within our office.”
Even still, Baldwin has had to limit his staff size due to the downturn in business, but he said he’s been proud of their flexibility during such a challenging time.
“We’re a referral-based business, but when there’s no referrals, the business isn’t going to be there,” he said. “Health care always comes back, but like most of us it’s a big question of when. As a healthcare provider I have to put the best interest of my patients and staff first, but as a business owner there’s economics involved in all this too.”
As elective medical procedures resume and referrals begin to roll in once again, business should return to normal for physical therapy facilities. The timeline for that is unpredictable, however, and in the short run it will be up to each individual patient to decide if and how they will pursue treatment.