Out of Touch
By: Sandali Handagama
Tags: Covid 19, New York City, Healthcare, Physical Therapy

As the pandemic rages on, New York’s Physical & Occupational Therapists are struggling to reach their patients

Abbey Rosen, 60, a pediatric occupational therapist, spent almost four decades holding toddlers in her arms; her cheeks touching theirs, her hands guiding them through activities, her body keeping them warm and safe.

But now she has to look at them through a screen.

On March 15th, New York officials announced all schools, restaurants and bars in the city will shut down in an effort to control the spread of the virus. Rosen frantically drafted a letter to the parents of her small clients, reassuring them she had a plan to get through the pandemic. Five days later, Governor Andrew Cuomo declared all non-essential businesses in the city must shut down, and advised New Yorkers to stay at home.

Occupational and physical therapy are classified as essential businesses. So, Rosen went out and bought gallons of bleach and supplies to clean her two Kids Thrive practices in Midtown and Uptown Manhattan. But the very next day, she had to face reality. No one was coming.

The virus was allegedly spreading through close proximity and touch. On March 3rd, parents brought 17 children to Rosen’s practices, but in the week following the first lockdown announcement, only 5 showed up. Rosen had to shut down her offices and lay off her office assistant, but stopping work entirely was not an option. She had 6 part-time therapists on her payroll. The monthly rent for her two practices in the city came to $13,000.

“There’s no way I’m making the rent,” said Rosen. “This is devastating.”

Before the COVID-19 pandemic, physical and occupational therapy made up a $34.5 billion growth industry in the United States. There are over 15,000 licensed occupational therapists, like Rosen, and close to 25,000 physical therapists operating in the state of New York. Therapists of both professions treat movement dysfunction, helping patients to successfully carry out their day-to-day activities. They provide care through skilled manual techniques or therapeutic exercise, and are crucial to the process of recovery from injury.

A few weeks ago, physical therapist Susan Servetnick was making 5–6 house calls a day: most of her patients are over the age of 70, and she, along with the 4 therapists on her team, frequently left her Manhattan practice to visit patients in their own homes. Servetnick would help her elderly patients by guiding their movement, correcting for fault, and making sure they didn’t lose their balance. On March 17th, she closed her practice. Servetnick’s 90-year-old patient called to ask why she wasn’t coming to see him anymore.

“But I couldn’t,” said Servetnick. “I had to explain to him that I’d be putting him in danger.”

Seeing colleagues from around the state make a similar transition, Servetnick and Rosen realized quickly that in order to reach their patients, they would have to go virtual. But both were skeptical about how they were going to offer a meaningful experience without physical contact: Rosen lamented about not being able to hold her children in her arms, and instead having to glue her eyes to a screen to ensure her instructions were being followed. In addition to offering virtual sessions, Servetnick started making instructional videos so her her patients can to continue exercising.

“Physical therapy is a service industry based on touch,” said Iris Kimberg, 65, MS, PT OTR, a physical and occupational therapist and private healthcare business consultant based in New York. “For therapists, their hands are their most important equipment.”

Kimberg is busy helping practices transition from in-person consultations to virtual healthcare platforms like Telehealth and the rapidly evolving Zoom. Although some physical therapists already offered Telehealth as part of their services, Kimberg was doubtful they had considered a reality in which it would become the primary method of delivering care.

There are also unique risks involved in using an online platform to provide healthcare.

“You can’t reach across the screen if something happens to your patient,” said Kimberg. “What if they lose their balance during exercise or choke on a toy?”

Rosen wasn’t sure how she was going to hold the attention of a two-year-old through a screen but felt it was better than not seeing her patients at all, and seeing their progress lost altogether. But something had to change: for therapy to be a success, the children’s parents had to be involved. Before the pandemic, parents often left their children in her care to be picked up afterwards, or waited in the other room. But now, at home, parents had to be fully involved in the therapy, physically playing Rosen’s role, to minimize the risk of injury, and to ensure a productive session.

Rosen began reaching out to her patients and mobilized her team of therapists. She saw 16 patients in the second week following the shutdown order; the same number she used to see in a day.

“I had some great sessions today,” said Rosen. “I wish my business wasn’t going to shit. Yet, I’m lucky.”

Although there are risks involved, Kimberg agreed that having a bird’s eye view of a patient’s environment can have its advantages. Therapists can sometimes see where and how their patients sit; they can spot bad chairs, or unsupportive pillows.

Henry Louis Gates Jr, a professor at Harvard University, is one of Servetnick’s virtual patients. During their first session, Gates lay on his bed while his wife held up the iPad and Servetnick instructed.

“It worked like a charm,” said Gates. “She would say, flex your hips more gently or whatever it was. She was actually watching what I was doing very carefully. I plan to do a session once a week.”

But not all therapists have been quick to embrace virtual platforms.

Physical therapist Julie Zapata, 43, kept her Manhattan practice open. But remaining open had its own challenges. During the week of Governor Cuomo’s announcement, many of her patients called to cancel their sessions. In the following week, only 25% of her usual appointments were booked.

“I never pressured anyone to come,” said Zapata. “It’s my responsibility to keep them safe.”

Due to costs and social distancing guidelines, Zapata had to significantly reduce her staff and run her clinic alone. She saw only one patient at a time. She emailed her detailed cleaning procedure — including the laundry service she used along and a list of cleaning products — to her patients. She provided masks and gloves to her incoming patients, and maintained her distance.

Unlike Servetnick and Rosen, who accept cash payments from their patients, Zapata accepts insurance. But virtual care is not always covered by insurance, which made the switch to online services a unique challenge for her. For instance, her Medicare patients would not receive coverage for telehealth sessions, and a therapist received a $12 compensation for a 5–10 minute video or phone call up to 3 times a week.

As the situation in the city worsens, Zapata is careful to discourage high-risk patients or their relatives from coming to her practice, and hopes to slowly make the switch to virtual care.

“I’m going to try with a patient this week,” said Zapata.

While Zapata has kept her practice open, some therapists initially shut them down completely, and indefinitely.

Cameron Gomez, an orthopaedic manual physical therapist and acupuncturist, opened his own practice in Midtown Manhattan in June of 2019. He saw between 12 to 16 patients in a day, and to get the new clinic off the ground, Gomez worked up to 12 hours a day. But after the work day on March 16th, he felt a social responsibility to close his clinic.

Gomez couldn’t do acupuncture, which involves needling patients, through a screen. Having previously worked as an on-site therapist with the New York City Ballet and the School of American Ballet, most of his patients were dancers and athletes. So his work involved the careful manipulation of joints and soft tissue to manage pain or injury.

“Telehealth and telemedicine are not really applicable for that kind of treatment,” said Gomez.

He conducted some virtual sessions with a patient that had just undergone surgery and needed rehabilitative therapy, and he has begun slowly offering online sessions. Without a stream of revenue from his clinic, Gomez is covering the rent for his practice with his savings, and is confident he can sustain keeping it closed for at least a couple of months.

The virus has successfully turned something as innocuous as a therapist’s touch into a thing of danger and uncertainty. No longer able to use their hands without putting them in harm’s way, physical and occupational therapists are busy reshaping their businesses, and another booming industry has been upended.

But as essential healthcare workers, physical therapists are still needed on the frontlines. As he asked the city’s businesses to close its doors, Governor Cuomo also sent out letters to physical therapists asking how they can contribute their services to the city in its time of need.

“Some are waiting to go to the frontlines,” said Kimberg. “After a week in bed on a ventilator, patients will have to be rehabilitated. That will become a need.”