Rehab Journey to Israel

A Connecticut facility takes residents on the trip of a lifetime.

Eleven octogenarians and nonagenarians traveled together on a 10-day journey to Israel organized by The Jewish Home, a 360 bed skilled nursing facility in Fairfield, Conn. The courageous crew made up of nursing home residents and caregiver buddies journeyed half way around the world with wheelchairs, walkers and other assistance to experience an adventure of a lifetime.

Spiritual, financial and physical preparations began 12 months before departure. Each resident was assigned a caregiver-buddy and weekly meetings were scheduled to prepare for the trip and to establish the social bonding necessary to spend 24 hours a day with each other for this 10-day experience. Preparing for the specific needs of each individual resident was certainly a team effort.

Travel criteria included ambulating 150 feet with or without an assistive device; negotiating four 6-inch steps using one handrail with the assistance of one caregiver; and the ability to perform activities of daily living with supervision. There were additional psychological and medical criteria including a history of non-aggressive, non-combative conduct; and non-use of supplemental oxygen or urinary catheterizations. The seniors needed to have substantial cognitive abilities. An Israeli organization secured wheelchairs, walkers, and other durable medical equipment for use by the seniors.

Challenges related to the physical environment of the airplane were anticipated. Walking through narrow aisles with a rolling walker and unexpected turbulence would test the seniors' ambulation and toileting abilities. The seniors would need to manage all hygiene activities in the airplane's small bathroom space behind the spring loaded door. They would need to be fitted with compression stockings and practice standing and walking activities every hour as a precautionary means to prevent deep vein thrombosis while in flight. 

We designed a combined strength and aerobic fitness training program for the travellers. Training began 10 weeks prior to the expedition and was carried out with the assistance of the rehab aides who received skilled training from The Jewish Home's physical therapists. The fitness program was supervised by Sue Nagy, PTA, also a trip caregiver-buddy. The seniors were already known to the rehabilitative therapy department and through screening assessments, a generalized fitness program was developed.

Gait training, stair climbing negotiation, seated and standing therapeutic exercises, and aerobic activities including upper and lower body ergometer machines were part of the program. The participants were divided into two groups and met twice weekly for one-hour exercise classes. When Group 1 performed gait and stair climbing activities including upper and lower body ergometer machines, Group 2 performed strength training exercises. The following day the groups switched their exercise focus to the activities they did not perform from the previous session.

Each week, both groups received opportunities to perform in a strength exercise class and functional and aerobic activities. Half way through the fitness program, the ambulation activities transitioned to outdoor surfaces on uneven terrain to increase each participant's demand for neuromuscular control and cardiovascular responses.

What are the ADA laws in Israel, if any? According to Dr. Liebermann, program director of the physical therapy department at Tel Aviv University, ". . . bylaws require appropriate adjustments of public buildings and transportation to serve the needs of elderly; however, we are back behind the United States and Europe."

In Israel, tours, attractions and hotel concerns centered on bathrooms and the availability of adaptive modifications for the seniors. According to Nagy, "Some of the attractions we toured presented limitations for wheelchair accessibility. Where a curb-cut was absent, the caregiver-buddy system used teamwork to lift and bump the seniors in their wheelchairs to get across the street. Other obstacles were unpaved sidewalks."

The seniors required more assistance in the bathrooms as some of the hotels did not have grab bars or raised toilet seats or the step over tub was too high to manage.

With intense preparation and a positive attitude, the journey was a huge success. These residents and caregiver-buddies took on a challenge that many others believed was too risky or ambitious. Travelers reported that the trip was marvelous, fabulous, liberating, a privilege and provided them with a new found sense of freedom. Some were at a loss for words as they cannot describe how deeply this trip touched their lives.

"The Jewish Home's exceptional rehab staff allows the opportunity to provide a high level of care and contributes to the organization's mission of enabling seniors to achieve the highest quality of life attainable," said Andrew H. Banoff, president and CEO.

Stephanie Coffey is director of rehabilitation services at The Jewish Home, Fairfield, CT. To learn more, call 203-365-6400 or visit www.jhe.org.  


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