Physiatry in Long-Term Care

Core Clinical Responsibilities

The American Heart Association recommends that physiatrists conduct comprehensive functional assessments as soon as possible after admission to long-term care, evaluating physical status, cognitive status, and functional capabilities 1, 2.
Assessment should include body composition, aerobic capacity, strength, flexibility, and balance, and results must be used to develop individualized care plans addressing physical, functional, emotional, cognitive, and social needs 1, 3.
When functional decline is identified during reassessments, physiatrists should update care plans, address safety issues, and initiate referrals to appropriate healthcare professionals 1, 2.
Residents with ongoing rehabilitation goals must have continued access to specialized rehabilitation services, including physiotherapy and occupational therapy 1, 2.

The American Geriatrics Society recommends that physiatrists recognize that infection often manifests as functional decline rather than fever in long-term care residents, and suspect infection when residents exhibit new or increasing confusion, incontinence, falling, deteriorating mobility, reduced food intake, or failure to cooperate with rehabilitation 4, 5, 6.
Infection is present in 77% of episodes of functional decline, and a single oral temperature ≥100°F (37.8°C) or repeated oral temperatures ≥99°F (37.2°C) indicate possible infection requiring evaluation 4, 5, 6.

The American Cancer Society recommends that physiatrists manage cancer patients in long-term care due to their expertise in identifying and treating functional loss, and integrate exercise across the entire cancer continuum to reduce symptom burden and increase independence 3, 8.
For advanced cancer patients in palliative settings, exercise interventions improve quality of life and reduce cancer-related fatigue, with benefits retained at 6 months 8.

The American Stroke Association recommends that physiatrists screen residents for cognitive concerns, mental health issues including depression, and psychosocial problems, and provide access to recreation therapy, leisure opportunities, and exercise programs 1, 2, 7.
Psychosocial and support needs should be reviewed regularly to minimize caregiver distress 9.

The American Heart Association recommends that families and caregivers be involved in decision-making and treatment planning as early as possible and throughout rehabilitation, and receive training on advocating for active participation in care planning and shared decision-making 1, 2, 9.
Physiatrists should maintain up-to-date information on community resources and provide assistance in obtaining needed services 9.
Patients and families should be provided with information and counseling on appointing alternate decision makers, developing advance directives, and palliative care options 1, 2.