Respiratory therapy improves quality of life for Detroit-area skilled nursing residents

Among the healthcare heroes in the Detroit area throughout the pandemic are respiratory therapists, who supported COVID-19 patients, as well as other patients who need ventilatory support from respiratory illnesses or accidents. What was once a quiet, albeit essential, role within the hospital and skilled nursing facility fields is now widely recognized as one of the key components to acute and long term care.

Debora Merrill, who’s been a respiratory therapist for decades, is well prepared to do whatever is necessary to support skilled nursing facility residents in Detroit who require respiratory therapy support to get the best possible care. Debora is the regional respiratory therapist for SKLD’s Metropolitan Detroit-area skilled nursing facilities and has been in the industry for 35 years. She says she fell into her life-long career by accident. 

Debora says, “I wanted to be a nurse, but at the time so did everyone else. It was during a time when nursing was a primary career choice for women. Because of that it was difficult to get into the nursing program. I had already completed all my core classes and when I met with my counselor she recommended I try respiratory therapy. I looked into it and realized it was exactly what I wanted to do.”

Debora started out in pediatric care and then moved to adult care. She says, “I worked with chronic ventilated adults in the ‘90’s. That was my introduction into skilled nursing, and I stayed with it.”

What is respiratory therapy?

Just like Debora’s career, respiratory therapists’ work spans the lifecycle of patients from newborn through hospice care, supporting patients with breathing and airway problems. 

For hospital and skilled nursing facility patients, this typically includes providing pulmonary rehabilitation and educating patients and families about lung disease, asthma, pneumonia or Chronic Obstructive Pulmonary Disorder (COPD) so they can maximize their quality of life. Respiratory therapists also manage ventilators and artificial airway devices for patients who can't breathe normally on their own.

Respiratory therapists improve quality of life for skilled nursing residents 

Helping to improve the quality of life is a major role of a respiratory therapist. Debora says, “I love when I see improvements or can help residents get back to breathing on their own. It doesn’t happen in all cases or conditions, but it’s wonderful when a resident can get back to normal existence without a trach, which enables them to get back to eating and talking.” 

There is a great deal of collaboration between the nursing staff and the respiratory therapist. “I move between the facilities so working with the staff and having open communication is beneficial to help the residents keep improving. I rely on the nurses' expertise and information they give me, and I direct what’s going to happen if they have a trach,” says Debora.

In order to determine how to help improve a resident’s quality of life, the staff begins with an assessment. Debora says, “It’s important to see where the resident’s condition is currently and what predisposes them to having a trach. Sometimes it’s the course of illness or they needed ventilatory help. We continue the healing from the process they began in the hospital to work within their limitations.”

Helping the resident progress is truly a team effort. “We work with the family if they are involved. We also work with the speech therapist, physical therapist and occupational therapist. Our work all melds together to help the resident thrive. I typically cover 4 buildings plus the Monroe and Adrian buildings if needed. When I’m not in the buildings the nursing staff or Director’s of Nursing can reach out to me if they need my assistance. ”

With a resident who is alert, the staff works together to get him or her comfortable with the idea of having a tube. Debora says, “Speech works with the valves to communicate and one of the first steps in this process is getting the resident to talk. Everyone wants to communicate; it’s part of the human experience.”

She continues, “If they are unable to speak, for instance if they had a stroke or something debilitating, we work with them to make the quality of life better. We make sure that the family understands the steps and course.”

Respiratory recovery is a process

One of the first actions Debora takes when she sees a resident is to check the trach tube. She says, “If they have one already, I make sure the trach tube is appropriate for their condition. I try to assess whether they do oral and nasal breathing.”

Other assessments include vocalization and airflow. Debora says, “We like to use cuffless tubes in our environment because it gives residents an opportunity with more airway space to breathe around the tube. I also review what happened at the hospital and carry out the process to give an opportunity to improve and get better from either the disease process or incident that caused the trach tube.”

Recovery can be a slow and steady process. Debora says, “When people get pneumonia, it takes the elderly population a while to recuperate. We work with them to make sure they are getting what they need to get stronger. Working with speech and occupational therapy together with respiratory therapy helps to build endurance and get back to normal faster.”

Respiratory therapy awareness 

Respiratory therapy can help residents in a number of different ways.  “Respiratory therapy helps people understand their lung conditions. We can explain to them how to breathe and pace breathing so they don’t get out of breath. We also help teach what to do during panic situations as well as how to take medications like nebulizer treatments. Essentially, we teach ways of breathing to improve or expand the lungs better.”

Debora continues, “It’s important to know how respiratory therapy helps because it can help a resident manage their condition. Understanding the limitations enables the residents to know how to improve and make life better.”

A goal of respiratory therapy month is to promote awareness of the conditions that require respiratory care and what can be done. Debora says, “There are programs in the community for those who have chronic lung conditions like chronic obstructive pulmonary disease (COPD) to educate them on how to have a normal lifestyle. It’s a wonderful field and very necessary, especially in long-term care. So many conditions are impacted by the need for respiratory care services.”

Debora shares, “When I am able to help a resident get back to normal and remove a trach tube, I feel I’ve made an impact. It’s a great feeling to know you’ve done something to improve a resident’s life. It doesn’t always happen, but when you can, it really feels like an accomplishment. We have been successful decannulating, or removing a tube. It uplifts both the staff and residents when that happens.”

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