Latest / OT Potential Podcast | Occupational Therapy CEUs / #152 OT and Aging in Place with Dawn Heiderscheidt

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#152 OT and Aging in Place with Dawn Heiderscheidt · OT Potential Podcast | Occupational Therapy CEUs

0:00
SPEAKER_00: Healthcare has many challenges right now, but many of them stem back to one looming global reality.
0:07
SPEAKER_00: By 2050, the number of people on our planet over age 65 is projected to double.
0:15
SPEAKER_00: It is honestly hard to wrap your head around the financial impact, the caregiving demands, and just how profoundly this shift will alter society.
0:25
SPEAKER_00: Luckily, the latest systematic research is crystal clear.
0:28
SPEAKER_00: To truly support aging in place for this population, the best interventions that we know of are multidomain interventions that target the physical, cognitive, and social dimensions of healthy aging.
0:42
SPEAKER_00: Even better, we already have a health workforce where multidomain care is our absolute specialty, and that is occupational therapy.
0:51
SPEAKER_00: Unfortunately, though, we do not yet have the widespread turnkey business models to deliver this type of care at scale.
0:59
SPEAKER_00: Today, we are talking with Don Heiderscheid, an occupational therapist who is pioneering a career in business in the aging in place arena.
1:09
SPEAKER_00: We'll learn how she leverages her specialized OT skillset, makes the financials work, and provides much needed care to her community.
1:18
SPEAKER_00: We have a lot to cover today, so let's dive in.
1:24
SPEAKER_00: Welcome to the OT Potential Podcast.
1:27
SPEAKER_00: I'm your host, Sarah Lyon, OTRL, and I wanted to let you know that this podcast may qualify as continuing education for you.
1:35
SPEAKER_00: You are probably listening to this podcast on a free podcast platform.
1:39
SPEAKER_00: But to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform.
1:47
SPEAKER_00: You can go to OTpotential.com to learn more.
1:51
SPEAKER_00: Okay, here we go.
1:55
SPEAKER_00: As I mentioned at the top, joining us today is Don Heiderscheid, OTRL, ECHM, CAPS, and CHAMP.
2:04
SPEAKER_00: Driven by an unwavering commitment to helping individuals achieve independence and enhance their quality of life, Dawn courageously established her own company, Aurora Independence.
2:15
SPEAKER_00: To make her company a reality, Dawn has formed strategic partnerships with local non-medical home health companies, foundations, and nonprofits.
2:24
SPEAKER_00: She is the program admin lead for a capable program and also acts as a wellness and prevention specialist with UUH Outreach.
2:33
SPEAKER_00: Her visionary leadership has propelled Aurora Independence to the forefront of the industry, offering tailored solutions that foster independence and well-being.
2:42
SPEAKER_00: On a regular basis, she imparts her knowledge and expertise to aspiring professionals.
2:47
SPEAKER_00: Dawn serves as a national continuing education provider, equipping professionals with the skills to create accessible and safe living environments for individuals of all ages and abilities.
2:58
SPEAKER_00: So without further ado, we will patch Dawn into our live studio.
3:01
SPEAKER_00: Welcome to OT Potential.
3:03
SPEAKER_00: Don.
3:03
SPEAKER_00: It's so great to have you.
3:04
SPEAKER_02: Hi, I'm so happy to be here.
3:06
SPEAKER_02: Thank you for inviting me.
3:08
SPEAKER_00: I am so thankful that you are here.
3:11
SPEAKER_00: I was just thinking about how this is maybe the biggest problem, quote unquote problem that we've ever talked about on the podcast.
3:21
SPEAKER_00: The numbers are so startling that the number of older adults is on track to double.
3:28
SPEAKER_00: It's going to transform everything about our society.
3:33
SPEAKER_00: I feel like there are a lot of people seeing this like upcoming shift, but there are not many people working on solutions that really connect the dots for people.
3:46
SPEAKER_00: Like literally, when I look around the country, I'm just like, I think foremost of you probably, um, which is so awesome that you're tackling this.
3:58
SPEAKER_00: But why is it just you?
3:59
SPEAKER_00: I'm so curious to just talk about your journey, the solutions you found, and what the therapy community can uh do to help meet this need.
4:10
SPEAKER_00: So let's start with kind of your origin story.
4:14
SPEAKER_00: How did you see this need in your community around aging in place?
4:19
SPEAKER_00: And what was the step from seeing the need to wanting to start a business?
4:26
SPEAKER_02: Yeah.
4:26
SPEAKER_02: So I think I'm similar to a lot of people, because there are other OTs who are doing this in the country, maybe not the exact same way I am, but I think a lot of occupational therapists are thinking about it.
4:37
SPEAKER_02: Um, a lot of mine started with COVID.
4:39
SPEAKER_02: Surprise, surprise, that big thing that also changed our uh entire environment.
4:44
SPEAKER_02: I realized that we were really sending people home to homes that weren't ready to support them.
4:50
SPEAKER_02: And it was during a time in our country when there were a lot of people who did not want to go into medical facilities and the facilities kind of didn't want people there.
4:59
SPEAKER_02: And so it was sort of a perfect storm of hey, we have this great need, we have all of these barriers that are happening, the world's kind of flipped upside down.
5:08
SPEAKER_02: And I think a lot of us were realigning what matters.
5:11
SPEAKER_02: So putting all that kind of together, it kind of brought me to this business model that allows me to kind of figure out where and how to solve the misalignment between what scope is and what payment models are, but what people actually need.
5:26
SPEAKER_02: So, like I said, we were kind of sending people home to homes that weren't supporting them.
5:30
SPEAKER_02: We still kind of are, and we have a long history of that in I think our healthcare system.
5:35
SPEAKER_02: And it was really and hard to find someone's job to actually walk that house and see the house that the person is going to be returning to.
5:44
SPEAKER_02: We're very stuck in, we only have a few days left under this payment, you know, model.
5:48
SPEAKER_02: We have to get you out on Friday.
5:50
SPEAKER_02: But great, if we're sending somebody back to a house that isn't going to work for them, they're just going to be readmitted very soon.
5:57
SPEAKER_02: And I realize that there's kind of no one there to answer that random question.
6:01
SPEAKER_02: Like when you're online Googling, I mean, now maybe AI is answering some answers or answering some questions.
6:07
SPEAKER_02: But for the most part, like who is helping you figure out which one of the thousands of shower chairs on Amazon you should be purchasing?
6:13
SPEAKER_02: And so I kind of try to find the gaps in service and make that sort of the market that I can help.
6:21
SPEAKER_02: And so that's sort of wherever I started.
6:24
SPEAKER_00: I have so many questions about your business.
6:26
SPEAKER_00: I do want to say, I don't want to downplay how many uh OT professionals do work in aging and do serve over serve older adults, but I do think that your approach is so interesting and needed where you're really sitting in that gap of aging in place.
6:44
SPEAKER_00: I totally relate to being the therapist in the hospital, in the skilled nursing facility where I'm asking about the home and I'm hearing all these red flags.
6:54
SPEAKER_00: And there's only so much you can do in an acute care setting where you have 20 minutes and there's a billion questions.
7:03
SPEAKER_00: Um, we're just so limited.
7:05
SPEAKER_00: We can't really use our full skill set there.
7:08
SPEAKER_00: And we have we have unreliable reporters, right?
7:11
SPEAKER_02: How many times do we have clients that are like, I'm great?
7:13
SPEAKER_02: And you're like, um, well, your wife and your daughter are looking at me like that's not the truth.
7:18
SPEAKER_02: So maybe we should be asking.
7:20
SPEAKER_02: I will say this is kind of a funny story.
7:22
SPEAKER_02: I had asked with permission, of course, a client, can I just look at your street view of your home?
7:27
SPEAKER_02: And they were like, Yeah, sure.
7:28
SPEAKER_02: And I was like, No wonder you keep falling your staircase, getting into your house is horrible.
7:33
SPEAKER_02: And that was sort of the moment that it was like, we really aren't able in our current payment models to find that time to really look at that home in that way.
7:42
SPEAKER_02: And so that was really one of those first moments that I was like, I think we can solve this.
7:46
unknown: Yeah.
7:46
SPEAKER_02: I don't know how, but we're gonna do it.
7:49
SPEAKER_00: So walk me through your business model and what services you offer at Aurora Independence.
7:58
SPEAKER_02: Absolutely.
7:58
SPEAKER_02: So ultimately, what we are trying to do is help those individuals who are kind of falling through the cracks for various different reasons, whether it be emotional buy-in, right?
8:08
SPEAKER_02: Because they kind of have to admit that they need the help, or maybe it's the payment model.
8:12
SPEAKER_02: Um, so what we try to do is we have a wheel of services, we kind of do it all, which sounds really amazing, but also very confusing.
8:21
SPEAKER_02: So we do partner with some of the local nonprofits who do have some federal funding who are trying to help do home repairs.
8:28
SPEAKER_02: Thankfully, a lot of them have started to recognize that it's great if you, you know, have this house that you want to live in, but if the roof is going to be caving in or there's no studs where there needs to be a grab bar, we need some guidance.
8:41
SPEAKER_02: We want to make sure that we're making that safe and affordable home for you to age in place.
8:46
SPEAKER_02: So I was lucky enough.
8:47
SPEAKER_02: I live in a urban environment, which I do think makes a big difference on why I am semi-successful in this area.
8:53
SPEAKER_02: Um, and there are several nonprofits who have learned the value of having an OT part of the process to help guide that federal money or those grants that they've received, because it's not always a lot of money.
9:04
SPEAKER_02: So they want to make sure that what they're installing is actually effective for the person in front of them, not just a random grab bar that they put up per some standard.
9:13
SPEAKER_02: So that is one section of our business.
9:15
SPEAKER_02: The other section of it is helping those who are more on the insurance side or the private pay side.
9:21
SPEAKER_02: And so the key here, everyone always wants to ask how how do you build Medicare for this?
9:25
SPEAKER_02: And I will tell you that is longer than what this podcast can ever talk about.
9:29
SPEAKER_02: Um, but I will say that understanding sort of medical necessity and starting to learn about what insurances actually cover helps you figure out how to fill the gaps of what they don't cover because they don't cover a lot.
9:43
SPEAKER_02: And when it comes to home modifications, you know, we kind of get confused sometimes about what that means and who's actually going to pay for it and things like that.
9:53
SPEAKER_02: So we kind of start to help people navigate that confusion.
9:57
SPEAKER_02: So sometimes we're just answering questions to clients, and that's part of that home modification process.
10:02
SPEAKER_02: It's education, a lot of it.
10:04
SPEAKER_02: So yeah, we're trying to ultimately just like bridge that gap between the clinical need, the budget that they have, whether that's the payer source or their own money, and how they really want that home to look and feel and function for them.
10:16
SPEAKER_02: Because I'm ultimately trying to break that idea that a home modification or home renovation is all you can do, right?
10:23
SPEAKER_02: That it doesn't have to be a full gut job.
10:25
SPEAKER_02: It usually can be somewhere in between that.
10:27
SPEAKER_02: That yes, we have to spend some money, but we don't have to like go bankrupt for it.
10:32
SPEAKER_02: And so that's kind of where we live in services.
10:34
SPEAKER_02: So I'm sure there's questions with that, and I'm sure we'll answer more.
10:38
SPEAKER_00: Uh, I have a billion questions.
10:40
SPEAKER_01: Yes, please ask away.
10:43
SPEAKER_00: I want to know about uh the mix of people you see like are most people in the nonprofit, are most private pay.
10:53
SPEAKER_00: And how do the people in those buckets find you?
10:58
unknown: Yeah.
11:00
SPEAKER_02: No, I think that's a great question to start with, and there's a lot to answer.
11:03
SPEAKER_02: Um, so when I first started, I will say my most reliable source was the nonprofit partnership.
11:08
SPEAKER_02: So each one doesn't send me like a ton, but all three together that we are currently partnered with send me enough, if that makes sense.
11:15
SPEAKER_02: So that was sort of where it started.
11:18
SPEAKER_02: And I won't lie, with the political state where it is and funding being reduced and our federal budgets changing and even the state budget, we didn't have one in Pennsylvania for almost like a year and a half.
11:28
SPEAKER_02: It was a year and a half late.
11:29
SPEAKER_02: So we didn't get a lot of funding that we had before.
11:32
SPEAKER_02: So in Pennsylvania, we have something called the whole home repair, such an amazing program.
11:37
SPEAKER_02: Pennsylvania cut it.
11:38
SPEAKER_02: And so that was the funds that a lot of my nonprofit partners uh had received.
11:44
SPEAKER_02: The good news is we knew that they would have it for two, three years.
11:47
SPEAKER_02: And so once we saw kind of all of this coming together, um, I've been shifting over more into the private pace market.
11:54
SPEAKER_02: So I will tell people I am set up and ready to accept Medicare, but I do not market to the Medicare clients.
12:00
SPEAKER_02: And that is because people who want to use Medicare really can't get the same level of service that we provide.
12:06
SPEAKER_02: So, because Medicare just doesn't cover everything that we do.
12:09
SPEAKER_02: So I will say it is shifting from the grant spaces and those partnerships into more of the private pay services.
12:17
SPEAKER_02: And um, being as small as we are, we always kind of get to shift and budget that.
12:21
SPEAKER_02: So we'll try something for a few months.
12:23
SPEAKER_02: If it's not working, me and my team will shift to a different way, whether that's the cost or how someone accesses us or how we're providing the service.
12:30
SPEAKER_02: Um, being small but mighty allows us to kind of adapt for what the market is telling us.
12:35
SPEAKER_02: So it's a lie, a lot of business.
12:39
SPEAKER_00: So your core offering is for private pay clients who I assume find you through your websites.
12:50
SPEAKER_02: That and AI searches.
12:52
SPEAKER_02: So um, I will say like the hardest part of being a business owner is you have to be a jack of all trades or or Jill of all trades.
12:58
SPEAKER_02: And I am a master of none.
13:00
SPEAKER_02: Um, I will say a lot of our clients are finding us online.
13:04
SPEAKER_02: So making sure that I have the right service offerings out there.
13:08
SPEAKER_02: Um, but a lot of it comes from networking.
13:10
SPEAKER_02: So it's a lot of business to business networking that I spend because I can't be everywhere and everywhere that those clients are.
13:16
SPEAKER_02: But the case managers, financial advisors, um, all of those different individuals are seeing those clients.
13:22
SPEAKER_02: So it's creating that business-to-business sort of connection, which has been, I think, our most reliable form of referrals.
13:30
SPEAKER_00: And then is it what's some overall trends and the common pain points that make people reach out to you?
13:39
SPEAKER_00: Is it a health event?
13:41
SPEAKER_00: Is it that they're looking to remodel and they want advice?
13:46
SPEAKER_00: What are like those moments that make people take this step?
13:50
SPEAKER_02: Yeah.
13:51
SPEAKER_02: I mean, I would say it's a mix of all of them, but the one that I think we see the most are probably the individuals who are already like primed and prepped to know that their situation is going to be changing.
14:01
SPEAKER_02: So this is individuals with a progressive condition.
14:04
SPEAKER_02: Most of them have already been diagnosed.
14:06
SPEAKER_02: They sort of had an idea of what to expect, and now they're slowly starting to see the changes.
14:12
SPEAKER_02: So they're slightly already educated, um, but they're looking for more support and guidance.
14:17
SPEAKER_02: And they want to make sure that they're preserving their dollars because they know what the progression of their condition might be.
14:23
SPEAKER_02: So that tends to be the people that I am seeing the most.
14:26
SPEAKER_02: And how much of that's because of marketing, and how much of that's because those people need it.
14:30
SPEAKER_02: Sometimes unclear.
14:31
SPEAKER_02: Cause I'm obviously connecting and marketing with the people who are working with that individual or those types of individuals.
14:38
SPEAKER_00: I literally have someone in the comments who is like, I joined this webinar because I'm concerned about my parents.
14:45
SPEAKER_00: And then she synced up right away that her parents actually live in Philly close to you.
14:50
SPEAKER_00: Oh, um, which worked out well.
14:59
SPEAKER_00: Is do you feel like the client, the older adult, is typically the primary payer?
15:07
SPEAKER_00: Or how often does a child caregiver come in and are you working with this group of people supporting the older adult?
15:19
SPEAKER_00: What does that look like?
15:20
SPEAKER_02: Yeah, I'd say it's 50-50.
15:22
SPEAKER_02: Um, so I have been in the situations where it is the older adult or the piece person living with a disability that is like, hey, come in.
15:28
SPEAKER_02: I have questions.
15:29
SPEAKER_02: A good portion of it really is the caregivers who are some people live states away and they're like, listen, we've been getting in fights.
15:36
SPEAKER_02: We need someone else to tell mom and dad like what we see.
15:38
SPEAKER_02: And I and I make sure that I let them know, like, I'm gonna tell them what I see.
15:42
SPEAKER_02: I'm not gonna say pass along anything.
15:44
SPEAKER_02: So I'm not getting in the middle of the fights, but I absolutely encourage every decision maker or person who may have opinion to be present on the day of the evaluation.
15:53
SPEAKER_02: So I have been there before where there's six people in the house, and I'm like, okay, we're gonna talk through all of it.
15:58
SPEAKER_02: Um because ultimately I I am, I can be the mediator for families that are really struggling on what step to take first.
16:04
SPEAKER_02: Why are we taking it?
16:05
SPEAKER_02: You know, things like that.
16:06
SPEAKER_02: So it ends up being about 50-50 of the actual end user calling me or family members and loved ones.
16:13
SPEAKER_02: And then I let them figure out the financial side.
16:16
SPEAKER_02: I just say, here's my prices.
16:17
SPEAKER_02: Here's it, yes.
16:19
SPEAKER_02: You guys figure that out.
16:22
SPEAKER_00: I can see how valuable your service is.
16:27
SPEAKER_00: I can already see all the dynamics that you're helping with, like working with to support that older adult.
16:39
SPEAKER_00: Um, I'm going to say a question out loud that I want to come back to in the future.
16:44
SPEAKER_00: Uh, people are asking about the emotional buy-in.
16:47
SPEAKER_00: Help me remember to ask that when we talk about interventions.
16:50
SPEAKER_00: Um I will do my best.
16:52
SPEAKER_00: Because before we get to that, I just want to zoom out to the state of aging in place overall.
16:57
SPEAKER_00: Like, as we mentioned at the top, there is a lot of attention to this.
17:02
SPEAKER_00: Like, it's just one of those phrases you hear all the time.
17:05
SPEAKER_00: But even though you're you hear it, you're like, what is that?
17:09
SPEAKER_00: Who do I go to in my community?
17:11
SPEAKER_00: Like, I can't name the person in my town that I go to to talk about aging in place.
17:16
SPEAKER_00: What have you learned about the state of aging in place and OT's role in it?
17:23
SPEAKER_02: Yeah.
17:23
SPEAKER_02: I I think this is such an important question because that's exactly the problem, right?
17:27
SPEAKER_02: It's like, who do you call when you don't already have a doctor involved or you're not already engaged with a contractor and you don't know, you don't even know where to start.
17:35
SPEAKER_02: And that has helped me realize that what happens in this aging in place market is that we're all incredibly siloed.
17:43
SPEAKER_02: So construction is doing what construction is doing, design is doing what design is doing, healthcare is doing what healthcare is doing.
17:49
SPEAKER_02: And there are very few people, there are people, but very few people are actually being able to bridge that gap.
17:56
SPEAKER_02: And honestly, we struggle with it all the time as well.
17:59
SPEAKER_02: And so all of us in the aging in place spaces are doing what we think is best, but we're not always addressing the entire problem that exists.
18:09
SPEAKER_02: And so the best way to explain this is that an OT is really seeing the function, the person, the house, the environment, the occupation, right?
18:16
SPEAKER_02: So our PEOP model, right?
18:18
SPEAKER_02: But the contractor is seeing a code.
18:20
SPEAKER_02: Maybe the architects and designers are as well, because there are accessibility codes that do exist in the world.
18:26
SPEAKER_02: And some are very, very helpful for residential spaces and some are not so helpful at all.
18:31
SPEAKER_02: Most of those codes are made for uh public spaces and federal buildings.
18:36
SPEAKER_02: So, you know, contractors, architects, they're kind of living more in that world.
18:40
SPEAKER_02: I'm not saying entirely, but more.
18:43
SPEAKER_02: But a discharge planner is really seeing a date.
18:45
SPEAKER_02: They're looking at what their higher-ups are saying.
18:47
SPEAKER_02: They're hearing about the bed numbers left, they're trying to figure out how many admissions are coming in.
18:51
SPEAKER_02: So they're looking at like, how do we get this person out quickly?
18:54
SPEAKER_02: Families are often seeing panic because they're like, oh my God, mom's coming home on Friday.
18:59
SPEAKER_02: She's been in for three whole weeks and it's Wednesday.
19:02
SPEAKER_02: How are we supposed to get this house ready?
19:04
SPEAKER_02: Because unfortunately, no one's probably spoken with them about that part of discharge.
19:09
SPEAKER_02: Um, and then nobody's job, or like, I'm sorry, let me go back to the landlord, the HOA, the homeowner, they're looking at permission.
19:18
SPEAKER_02: What can be done?
19:19
SPEAKER_02: What do we have money for?
19:20
SPEAKER_02: What am I supposed to do myself?
19:22
SPEAKER_02: Which then kind of leaves it as like nobody's really paying attention to where that individual lands, right?
19:28
SPEAKER_02: That final end user.
19:30
SPEAKER_02: And so it's really that interconnectedness is one of the hardest things to bring together.
19:37
SPEAKER_02: And I think as OTs, we are uniquely qualified for this because this is literally where we exist, right?
19:44
SPEAKER_02: We have our nine domains.
19:45
SPEAKER_02: We're looking at everything.
19:47
SPEAKER_02: And again, it feels like that Jill of all trades, master of none, but because of the way that we employ so much psychosocial background and human development and all of that, it really is kind of where we thrive.
20:02
SPEAKER_02: We don't have to learn how to do this because this is what our degree is in.
20:05
SPEAKER_02: And most of us kind of do it naturally.
20:08
SPEAKER_02: So that's kind of what I've learned about aging a place.
20:10
SPEAKER_02: And maybe I'm biased because of my degree, but I do think that OTs we really can be the glue between all of those other professions who are absolutely needed and should be thriving in their skill set, but they're all trying to do what they don't need to be doing.
20:26
SPEAKER_02: Like I don't need a contractor to try and assess balance.
20:28
SPEAKER_02: I don't need a DME provider to be telling someone that their bathroom is unsafe.
20:33
SPEAKER_02: You don't have that background, you don't have that knowledge.
20:36
SPEAKER_02: Let us do that because you're still gonna get to install your grab bar.
20:39
SPEAKER_02: You're still gonna get to do your bathroom, right?
20:41
SPEAKER_02: Just let us tell you what needs to be done.
20:44
SPEAKER_02: So that is where I am with what I have learned about the aging in place market.
20:49
SPEAKER_02: And I see a lot of people entering it to try and make money off of it because it is a place to make money.
20:55
SPEAKER_02: But that, in my opinion, is not what should ethically be happening because ultimately, if you don't address the whole problem, we create a problem somewhere else.
21:03
SPEAKER_02: So if we don't make that home safe, well, the healthcare market is going to be the one that ends up picking up the bill with the false, because that's a$30 billion a year bill that hits the healthcare marketplace every year when we're talking about ER visits and all of that.
21:20
SPEAKER_02: So great, we got a new bathroom installed, but if it's not the right one and that person's still falling, then we didn't really solve the problem.
21:27
SPEAKER_02: So I'm sure that brought up a lot more.
21:45
SPEAKER_00: And our scope of practices in our state really afford us to do that.
21:51
SPEAKER_00: And I think if you ask most healthcare workers, if they're if you're like, who is the aging in place person on your team?
21:57
SPEAKER_00: They would say it is the OT.
22:00
SPEAKER_00: Not only is our skill set like looking at the interconnectedness of domains, it's also in relationship building and behavior management, like change happens at the speed of trust.
22:13
SPEAKER_00: Like that is one of the skill sets for sure.
22:17
SPEAKER_02: And I think the other profession that we go really well with is care managers, because while the OTs can start that like, you know, glue, I think the care managers help implement it all as well.
22:28
SPEAKER_02: So I just want to put that out there.
22:30
SPEAKER_02: But I just think OTs and care managers, while we may in the aging in place markets seem like we're actually competition, when it's worked well together, it's perfection.
22:40
SPEAKER_00: Great.
22:42
SPEAKER_00: It's a great fit for so many reasons.
22:44
SPEAKER_00: I'm going to just say one more.
22:45
SPEAKER_00: I'm trying to build to get sane barriers, but I have to say one more great fit.
22:49
SPEAKER_00: Like one of the other reasons I see what you're saying working so well is to your point, like there are sharks out there in the aging in place.
22:59
SPEAKER_00: And when I'm getting ready for a course on tech adoption and for consumer-facing health tech, 75% gets abandoned because it wasn't the right fit.
23:10
SPEAKER_00: When a clinician's involved, it goes way down to like 15%.
23:14
SPEAKER_00: And I think part of the reason is we're so good at being like, you don't need that.
23:17
SPEAKER_00: Like, let's do the easier thing.
23:19
SPEAKER_00: Yeah.
23:19
SPEAKER_02: And there are similar studies with home modifications that say the same thing.
23:23
SPEAKER_00: Oh, yes.
23:24
SPEAKER_00: Such a good fit.
23:25
SPEAKER_02: Even a shower chair.
23:26
SPEAKER_02: Yep.
23:26
SPEAKER_02: Yep.
23:27
SPEAKER_00: Yep.
23:27
SPEAKER_00: Such a good fit.
23:29
SPEAKER_00: But I want to say the barrier that you've alluded to, which is Medicare reimbursement, really limits what we can do currently.
23:40
SPEAKER_00: Can you speak to the barriers that an OT in a traditional setting, um, probably taking uh focus on Medicare, what barriers are they hitting in really meeting the needs of clients?
23:53
SPEAKER_02: Yeah, absolutely.
23:54
SPEAKER_02: So I think that what Medicare usually covers really well, and without any question, when we documented it, well, because we all know that documentation is part of it, is that they pay for the clinical reasoning.
24:05
SPEAKER_02: So that is the one good thing about Medicare, that they they recognize that we have a certain set of skill as rehab professionals, so not just OTs in general, but they really don't always cover the intervention that that clinical reasoning would need to help implement it, if that makes sense.
24:22
SPEAKER_02: So I know in like a home assessment standpoint, they're not paying for a comprehensive report.
24:29
SPEAKER_02: They're probably not paying for someone to help the family figure out which grab bar to put in, but they may cover exactly like the assessment of where the grab bar should go, how to size it for a person, which again kind of brings us to some of these like over-the-counter benefits that exist in Medicare Advantage plans.
24:48
SPEAKER_02: A lot of people are excited because they're like, well, I switched over to Medicare Advantage because it covers a home modification.
24:54
SPEAKER_02: And it's like, well, it really doesn't.
24:56
SPEAKER_02: It may give you a grab bar, but it doesn't tell you how to and where to install it.
25:02
SPEAKER_02: And so, unless you have a plan of care, unless you have a doctor and it's medically necessary, then like great, you just ordered a grab bar from your over-the-counter benefits, but now it just sits on your couch because what are we doing with said grab bar?
25:15
SPEAKER_02: So that can be really difficult.
25:17
SPEAKER_02: And I think that a lot of clinicians may miss that part.
25:21
SPEAKER_02: Um, so they're like, hey, put this grab bar here, do that.
25:23
SPEAKER_02: This is the size.
25:24
SPEAKER_02: Great.
25:24
SPEAKER_02: Medicare Advantage may have covered it, or maybe they bought it themselves.
25:27
SPEAKER_02: But it's like, again, who's installing it?
25:30
SPEAKER_02: What if the handy person comes out and says, I love that you want to put that grab bar there, but there's no stud.
25:35
SPEAKER_02: Where else do you want that grab bar?
25:37
SPEAKER_02: Or more than likely, a handy person's just gonna put it in the next place that makes structural sense, which is not where the person needs it.
25:43
SPEAKER_02: So those can be a lot of the barriers with Medicare.
25:48
SPEAKER_02: Do we want to get into Medicaid at all?
25:52
SPEAKER_00: Because that's a beast.
25:54
SPEAKER_00: Just say some of them really quick.
25:57
SPEAKER_02: Okay, so with Medicaid, I think the hardest part that I find in Pennsylvania, each state is different.
26:01
SPEAKER_02: Usually they do want proof that a person needs something, but that doesn't always mean that the person who can provide the proof.
26:07
SPEAKER_02: So take my company, for example, we are not a network with Medicaids.
26:11
SPEAKER_02: And even though we are what they want to make sure that the money they're spending is going where it should, I'm not a network.
26:18
SPEAKER_02: They've rejected me in certain areas because they have enough OTs, in which case they really don't have somebody who's actually providing them the actual modification guidance that they're looking for.
26:28
SPEAKER_02: So it can be a difficulty of we need proof, but we're not gonna necessarily pay for the proof, but we will pay for the modification when it's a Medicaid.
26:36
SPEAKER_02: So that's the hard part there.
26:37
SPEAKER_02: So everywhere has a gap.
26:41
SPEAKER_02: Yeah, it's a lot.
26:43
SPEAKER_02: And every state's different.
26:44
SPEAKER_02: So this is I can only speak to Pennsylvania.
26:47
SPEAKER_00: Uh you really have to be good in this business of at, I assume, getting into the details and understanding what's covered, what's not covered, where's the gap, where can you meet it?
27:00
SPEAKER_00: Yep.
27:00
SPEAKER_02: And being okay with being wrong, like it a lot of what I say when I help a client go to figure out a funding source is I tell them a lot, I've never done this before, but I'm happy to work with you.
27:11
SPEAKER_02: And so letting peak clients know too when you don't know the answer because it changes.
27:18
SPEAKER_00: So we know you're working with different kinds of clients, and some of them may have different uh stipulations based on where their funding may come from.
27:29
SPEAKER_00: But I want to, as best we can, get specific and hear about what uh just like your home assessment entails, let's just say in your ideal world, let's just say with your private pay clients.
27:43
SPEAKER_02: Yeah, absolutely.
27:44
SPEAKER_02: So this may ruffle some feathers.
27:47
SPEAKER_02: I don't actually use anything official in my private pay client situation.
27:51
SPEAKER_02: So my grant funds, we have a very specific system.
27:54
SPEAKER_02: I have, you know, assessments that have been tried and true, they're valid, you know, all that kind of stuff.
27:59
SPEAKER_02: But when it comes to my private pay clients, I don't do a lot of that.
28:03
SPEAKER_02: Um, mostly because what I find is a lot of those act a lot more like a checklist than they actually do a conversation.
28:10
SPEAKER_02: So I end up doing an occupational profile, like that tried and true thing that we started in school.
28:17
SPEAKER_02: And I ask a lot of questions.
28:18
SPEAKER_02: A lot of open-ended questions will tell me a lot more than a questionnaire or an assessment ever could, because it allows me to kind of dig deep.
28:26
SPEAKER_02: It allows the client to guide the conversation.
28:28
SPEAKER_02: So we sort of go with that.
28:31
SPEAKER_02: Um, so what I find is like sometimes as a checklist, they kind of tell you that there is no grab bar, but my personal conversation, that occupational profile, really helps us figure out like how a person is actually functioning and what their perception of that function is.
28:48
SPEAKER_02: So yeah, I don't do anything like crazy, crazy official unless the payer source is going to require, in which case we have a whole process for that.
28:57
SPEAKER_02: But my private pay people, they've already seen the value.
28:59
SPEAKER_02: They just want someone to come out and make them feel heard and seen.
29:02
SPEAKER_02: And I want to make sure that they're gonna adhere to what I recommend.
29:05
SPEAKER_02: So I kind of need to understand where they are.
29:09
SPEAKER_00: So uh you ask these open-ended questions.
29:15
SPEAKER_00: Could you give some examples of what they are?
29:18
SPEAKER_00: And when you go in for the home assessment, are you like sitting at the beginning and talking and then you go on a tour and do the things?
29:26
SPEAKER_00: What's like the structure of your time look like?
29:29
SPEAKER_02: Yeah.
29:29
SPEAKER_02: So usually by the time we've come out there, they've already participated in a phone call.
29:33
SPEAKER_02: So we kind of have an idea of what motivated them to call us.
29:37
SPEAKER_02: So whether it be the loved one from across the country who's like, I'm just really worried about my mom and I have to know that she's okay at night, or maybe it's the older adult that's like, listen, I'm having a hard time getting out to pickleball and I don't want to miss my pickleball session.
29:50
SPEAKER_02: And I'm like, okay.
29:51
SPEAKER_02: So generally I come out and I sort of like reiterate what that conversation was.
29:56
SPEAKER_02: So we start that intake on that initial phone call, if that makes sense.
30:00
SPEAKER_02: So by the time we get out there, I kind of sit down and I ask them some of those questions.
30:05
SPEAKER_02: So, what's been more difficult for you?
30:07
SPEAKER_02: What motivated you to call me?
30:09
SPEAKER_02: Tell me more about what like your best day looks like and your worst day looks like.
30:14
SPEAKER_02: And then I kind of feed off and riff off of whatever they send me.
30:18
SPEAKER_02: Um, and then through that conversation, I kind of get an idea.
30:22
SPEAKER_02: Okay, I think that your outside is probably one of the places you want to address, or I'm hearing a lot of concerns about the bathroom.
30:29
SPEAKER_02: And I'll just ask for them to kind of clarify what I'm what I'm hearing.
30:35
SPEAKER_02: So it's a lot of like teach back, listening.
30:38
SPEAKER_02: It's that, it's that positive affirmations.
30:40
SPEAKER_02: I tend to give people credit for what they've already tried.
30:42
SPEAKER_02: So if they're like, oh, I already have a grab barb, I'm like, I love that.
30:46
SPEAKER_02: Fantastic.
30:47
SPEAKER_02: Tell me why you picked it there.
30:48
SPEAKER_02: Why, why didn't you put more?
30:50
SPEAKER_02: That kind of stuff.
30:51
SPEAKER_02: So those are sort of how my conversations go.
30:55
SPEAKER_02: And every family's different.
30:56
SPEAKER_02: So sometimes I come in and they have a laundry list of things that they already want answers on.
31:01
SPEAKER_02: And so we just start there and it'll kind of depend because again, private pay, it's their dollars, it's their money, it's their goals.
31:07
SPEAKER_02: So I'm just doing my best to match what their expectation is.
31:10
SPEAKER_02: So I don't know if that answered it fully.
31:11
SPEAKER_02: Yeah.
31:13
SPEAKER_00: Are you?
31:13
SPEAKER_00: I'm thinking about like, I can really wrap my mind around the conversation part because I think that's just what I did in other settings when you're very similar.
31:23
SPEAKER_00: Yeah.
31:23
SPEAKER_00: And looking at the space, are you like measuring, taking pictures?
31:28
SPEAKER_00: Like what's like all the time.
31:30
SPEAKER_00: Going to are you having them do the thing?
31:32
SPEAKER_00: What does that what does that part look like?
31:35
SPEAKER_00: That's the part I can't quite see in my yeah, mind's eye.
31:39
SPEAKER_02: I am lucky enough that I have a lot of construction knowledge.
31:42
SPEAKER_02: So I mine my assessment when I run it looks very much like a conversation because I'm already looking at stuff while they're in the middle of talking.
31:48
SPEAKER_02: I'm probably knocking on walls, I'm hearing where studs are and feeling, you know, that kind of stuff.
31:53
SPEAKER_02: So I'm just like naturally looking at.
31:54
SPEAKER_02: But yes, there's always measurements, there's always going to be photos.
31:57
SPEAKER_02: Um, very often I will ask a client to actually do the task in front of us.
32:02
SPEAKER_02: So again, if the shower or the toilet is the issue, I do ask them if they can.
32:06
SPEAKER_02: Sometimes clients aren't comfortable doing that, in which case I just kind of do my best.
32:10
SPEAKER_02: I'm looking at all of the construction pieces of this, because again, I know just enough to be dangerous, but not enough to actually solve their problems all the time.
32:19
SPEAKER_02: So I'm looking at like, what is the tile texture looking like?
32:23
SPEAKER_02: What is the contrast like?
32:24
SPEAKER_02: Is there enough lighting in this room?
32:26
SPEAKER_02: I do have an app on my phone that will actually check like the lumens in a room just to kind of give me an idea.
32:33
SPEAKER_02: And um, a lot of people, believe it or not, will take a rug away before they'll change the lighting in their house, even though lighting is probably one of their bigger issues.
32:43
SPEAKER_02: So having an app with actual numbers can be really helpful to show people like, here, this is the number range I'm looking for.
32:51
SPEAKER_02: Look how low this particular space is.
32:53
SPEAKER_02: So it kind of depends on the client, but I'm taking measurements of their body, their hips, their their, you know, leg bones, all of that in comparison to the areas of the home that I'm actually in.
33:04
SPEAKER_02: Hard to give a good example without somebody right in front of me because they're not ever going to be the same, but it's very similar in that.
33:10
SPEAKER_02: So door widths, step heights, um, all of that is going into my mind's eye or something that I'm assessing.
33:18
SPEAKER_00: I really want to get the intervention.
33:21
SPEAKER_00: I really want to get to the intervention part, but I want to ask one more assessment related.
33:26
SPEAKER_00: When you do need to use a standardized assessment, um, either for insurance or for someone who's just starting out, sometimes it's nice to have a standardized assessment to help remind you of the things.
33:36
SPEAKER_00: Yep.
33:37
SPEAKER_00: Um, what are some standardized assessments you've used in the past?
33:41
SPEAKER_02: Yeah, absolutely.
33:41
SPEAKER_02: So I think my favorite one actually is the FES International.
33:45
SPEAKER_02: So that's the fall efficacy scale.
33:47
SPEAKER_02: Again, I think that one's really great because it kind of helps me see where the client is perceiving themselves and often opens up another conversation because I think any OT who's probably provided that, you ask the question, you're looking for just a number and the client will give you a whole paragraph, right?
34:02
SPEAKER_02: And so you're kind of like bringing them back to it.
34:04
SPEAKER_02: But all of that information is so incredibly helpful.
34:07
SPEAKER_02: Um, when I am looking to kind of show like this is the number of things wrong with the house, and look how we improved it, um, I'm usually, usually, usually using the HSSAT.
34:18
SPEAKER_02: That is just one of the more uh available ones, doesn't cost any dollars, and it makes it really affordable for my grant funds and especially those payer sources that don't pay a lot.
34:30
SPEAKER_02: It's really important to find things that are affordable.
34:33
SPEAKER_02: There are a lot of really great assessments out there.
34:36
SPEAKER_02: Um, I know that my partners have a really hard time with the dollars, and they would rather spend the dollars on the intervention than on an assessment if they can.
34:45
SPEAKER_02: So those are my two favorites.
34:47
SPEAKER_00: Those are very helpful.
34:48
SPEAKER_00: I'll make sure we have those in our assessment search.
34:51
SPEAKER_00: In terms of intervention, then I think I can kind of see the asset the home assessment part as you describe it.
35:02
SPEAKER_00: What does intervention look like just kind of typically for you?
35:06
unknown: Yeah.
35:07
SPEAKER_00: We make this two parts.
35:08
SPEAKER_00: And what if are there any trends for what feels like the most high impact for people, things you tend towards that just really seem to make a difference for people?
35:17
SPEAKER_02: Yeah, absolutely.
35:19
SPEAKER_02: So I think that in the long run, when I'm helping someone implement any of the things that we found in their home, it's it's not just about a product or an end result, it's really about the order and the importance of it.
35:31
SPEAKER_02: So when we go out, I'm probably gonna find 60 to 70 things wrong.
35:35
SPEAKER_02: And I'm putting that in quotations so that people don't realize it's like you recognize it's not wrong, wrong, but it's like things that we could address, things that we could fix.
35:43
SPEAKER_02: That is extremely overwhelming for people to be like, oh my gosh, I had no idea my house had this many things wrong.
35:50
SPEAKER_02: You can really get them.
35:51
SPEAKER_02: So, so what I try to make sure people know is that okay, there are things that should be done now.
35:56
SPEAKER_02: There are things that should be done in three months, and there are things that can be done in five years.
36:01
SPEAKER_02: And I probably am talking myself out of business when I do this because I try to give them as much information on that first visit as possible because I recognize what caregiving is.
36:10
SPEAKER_02: I have been a caregiver myself, and I recognize that there's just it's really hard to go back to something when you feel like you've kind of already solved that problem.
36:19
SPEAKER_02: And so I tend to give a handwritten report for those people who actually would like it.
36:24
SPEAKER_02: Um, and it's color-coded in like a traffic light sort of system so that they know like red is we got to get this stuff going now.
36:32
SPEAKER_02: But I'll even help people recognize like, but start with these three.
36:35
SPEAKER_02: Like all five of these are important, but these two or three are the ones that I want you done by the end of the season, right?
36:40
SPEAKER_02: And then do your next two by December.
36:43
SPEAKER_02: So we're giving timelines sometimes.
36:45
SPEAKER_02: In a perfect world, I would really love clients to actually like call me back once they've actually installed the items so we can talk about it, how it goes.
36:53
SPEAKER_02: A lot of clients do, not a lot of clients do as well.
36:56
SPEAKER_02: So I know that sounds contradictory, but I will sometimes get clients call me like a year and a half later.
37:01
SPEAKER_02: They're like, hey, so we we did like all half of that report, and uh, I think we need you because things have changed.
37:06
SPEAKER_02: I'm like, I emailed you, I called you, I did, I offered to swing by and you guys like ghosted me.
37:13
SPEAKER_02: But it's funny because that's caregiving, right?
37:15
SPEAKER_02: They were in the middle of everything, and so we're thinking of them, but they're not always calling us.
37:19
SPEAKER_02: So in a perfect world, I would have that like post-occupancy visit.
37:23
SPEAKER_02: Um, it doesn't always happen because there's a lot of factors that go into it.
37:27
SPEAKER_02: But yeah, that's kind of the main intervention piece is like what comes first, how do we get started with that?
37:34
SPEAKER_02: And then it might go from there.
37:36
SPEAKER_00: As we kind of alluded to earlier, like lots of times the main value of OT is um like simplifying down to the most, ideally, the kind of the easiest things to do that have the most high impact and getting those that like I like how you said, like giving them the order and picking out the top thing.
37:59
SPEAKER_00: What tends to be in those top red things?
38:02
SPEAKER_00: Is it lighting?
38:03
SPEAKER_00: Is it flooring?
38:04
SPEAKER_02: Oh, yeah.
38:05
SPEAKER_02: It's yeah, what thresholds?
38:07
SPEAKER_02: Yeah, it's usually thresholds, it's lighting, it's toilet heights, believe it or not.
38:11
SPEAKER_02: Tubs are sometimes up there too, but I I find the toilets is maybe it's the northeast area, but like we end up with like toilets that are 14 inches high sometimes.
38:19
SPEAKER_02: So I think that and lighting is the other big one because a lot of our homes are like a hundred years old over here, and so we don't have any overhead lighting in most of the homes here in Philadelphia.
38:29
SPEAKER_02: So a lot of times I'm trying to just like get at least one recessed light bulb somewhere in that room.
38:34
SPEAKER_02: So those tend to be the the three main ones, I think, in my area.
38:37
SPEAKER_02: And it is it is housing market specific.
38:40
SPEAKER_02: And we have a lot of like claw foot tubs.
38:42
SPEAKER_02: So sometimes those are a big trouble that just don't exist in other places.
38:45
SPEAKER_00: And thresholds is in like the bump in the doorway, correct.
38:50
SPEAKER_02: Yeah.
38:50
SPEAKER_02: So um that might be maybe the sliding glass door.
38:53
SPEAKER_02: It could be the fact that we have like marble steps that are never in line with the actual like flooring.
38:59
SPEAKER_02: It could be that this house had like an original beautiful door and then it's been replaced by some door from some hardware store somewhere.
39:06
SPEAKER_02: Um, and so trying to make sure that they're as level as possible.
39:09
SPEAKER_02: And if not, how can we fix it within a budget with a product that actually solves your problem?
39:17
SPEAKER_02: So it's it's a it's a balance of the of those things.
39:21
SPEAKER_00: If I had to guess, I would have uh guessed just getting into the house initially, like wishing everything was zero entry, but there's usually like the steps.
39:31
SPEAKER_00: Is that a common one for you?
39:33
SPEAKER_00: Yeah.
39:34
SPEAKER_02: Perfect world, it would be zero entry steps, but uh that does not exist in Philadelphia.
39:38
SPEAKER_02: We have those really old marble steps that usually have the divot from hundreds of years of people walking up the middle.
39:44
SPEAKER_02: Um, we have a lot of problems with like sidewalk codes.
39:47
SPEAKER_02: So there's only so many things that you can do for the outdoors because we have to leave enough and uh walkway space for the actual like public spaces.
39:57
SPEAKER_02: So, yes, entryways are always um very, very difficult and because there's only a few solutions, sometimes we just kind of acknowledge that that's hard and we don't have a solution that works for you, which is a really tough one to be in because you sometimes a vertical platform lift would make a lot of sense, but you physically can't put one in.
40:18
SPEAKER_02: So if a person can't get into their house, we are looking at alternative housing at that point.
40:22
SPEAKER_02: If they can't afford it, we are looking at potentially how to help them escape the home that they are probably now trapped in.
40:29
SPEAKER_02: And I feel really uncomfortable saying it, but um Philly comes with a very unique set of issues, and we have a lot of people who who really don't leave their homes often because those steps are a problem and they don't have the monies to fix it.
40:45
SPEAKER_02: It's a really tough one.
40:46
SPEAKER_02: I know.
40:47
SPEAKER_00: Yeah, I feel like um like anytime we get concrete on the podcast talking about uh solutions, like each situation is always so unique, and I'm always not like taken aback or just just like struck by the individual challenges that people face, which is why so often we're always talking about tailored solutions and um uh really that holistic approach.
41:14
SPEAKER_00: Yeah.
41:15
SPEAKER_00: I want to swing us to um technology, uh, thinking of like the smart home and curious if there's things that you see helping and trends there overall.
41:32
SPEAKER_00: I did include in our show notes a really great article about OTs helping with smart homes in Korea.
41:39
SPEAKER_00: Like they have a very awesome structured program that is just great to read through.
41:46
SPEAKER_00: Um, I feel like we're not there in the United States, but what are you seeing on the ground with like smart home technology?
41:52
SPEAKER_02: Yeah, I will say in the last couple of years, I've seen a lot more people more comfortable with adopting some smart home technology.
41:57
SPEAKER_02: So that's a plus.
41:59
SPEAKER_02: Um I will say that there's kind of two realms of technology that we're looking at.
42:02
SPEAKER_02: So there's technology that the older adult or the person with disabilities, or as the end user is the best way to say it, the person who lives in the home that they're controlling.
42:11
SPEAKER_02: And then there can be some technologies that the um other people use.
42:16
SPEAKER_02: Maybe it's to monitor the individual who's living in the home, or maybe it's so that they can have access to the home in a different type of way.
42:23
SPEAKER_02: I do think that some products that people use can fall into both.
42:26
SPEAKER_02: So I'm thinking about things like Alexa or Amazon Echo.
42:30
SPEAKER_02: I mean, there are ways to connect those smart technologies so that a loved one can use their phone to run it, which case they can look at the smart plugs.
42:39
SPEAKER_02: Can they make sure that all the lights are off?
42:40
SPEAKER_02: Because, you know, mom or dad has, you know, cognitive deficits and leaves the lights on, right?
42:44
SPEAKER_02: And so their phone is controlling the Alexa, which has the smart, you know, plugs in the house.
42:50
SPEAKER_02: But I am seeing a lot of people really like the ring, Alexa Echoes, those like home control or smart home uh controllers, and mostly because they have all that access that makes it really easy.
43:02
SPEAKER_02: We already have smartphones.
43:04
SPEAKER_02: A lot of older adults are moving towards smartphones, not all older adults, but I do think the younger generation of older adults, they have a smartphone already.
43:12
SPEAKER_02: So to open up an app and kind of use that makes sense for them.
43:16
SPEAKER_02: So I don't see a lot of people adapting those like high technology things or those like high level.
43:23
SPEAKER_02: Um, I don't even have a good example of it because it's really ends up being more of like the rings, the Alexa's, the smart plugs, um, trying to make sure that the home feels safe for the individual living there.
43:34
SPEAKER_02: So maybe not the answer people are looking for, but that is the trend of what I'm currently seeing in my area, the tried and true stuff.
43:41
SPEAKER_00: Yeah.
43:42
SPEAKER_00: In our um, like some nursing homes, uh, assisted living.
43:50
SPEAKER_00: I don't, I'm hesitant to use this word, but I'm just going to use it.
43:54
SPEAKER_00: There are technologies that to me feel very big, brother, where it is just watching the person.
44:00
SPEAKER_00: Which all swings me way back to emotional buy-in.
44:03
SPEAKER_00: This feels like the time to uh talk about it.
44:06
SPEAKER_00: If it were me, I would want to have the device that I have control over or shared control over.
44:14
SPEAKER_00: Uh, tell me about emotional buy-in related to technology.
44:18
SPEAKER_02: Yeah, I think it takes a while for people to see that sometimes.
44:21
SPEAKER_02: And so this is where the clinician, we can sometimes offer a lot of education to people to say, like, because there is concerns about Big Brother.
44:29
SPEAKER_02: There is concerns about AI getting their information.
44:33
SPEAKER_02: I will say a lot of older adults are they're a little worried about what like Big Brother already knows about them.
44:38
SPEAKER_02: And so it is sometimes really helpful to help people understand like what an open system looks like, one connected to the internet, and that there's a lot of options of things that stay closed as well.
44:48
SPEAKER_02: So there are smart plugs that don't need to connect to that, like Amazon and Alexa.
44:53
SPEAKER_02: They can just be run by your phone.
44:55
SPEAKER_02: But then you just talk about the backside of that, which is you may have several apps on your phone.
45:00
SPEAKER_02: Whereas like an Amazon or an Echo or one of those Alexas, they have one app that controls many things.
45:06
SPEAKER_02: There are devices that don't require internet at all.
45:09
SPEAKER_02: They just require Bluetooth to your phone.
45:11
SPEAKER_02: You're just gonna have three or four different apps to run all of those.
45:13
SPEAKER_02: And so sometimes you can create that emotional buy-in that way where people feel more in control.
45:18
SPEAKER_02: Um, the question then becomes it's sort of the support.
45:22
SPEAKER_02: So when something goes wrong that you may have ordered from Amazon, who are you calling to fix it?
45:28
SPEAKER_02: And so that ends up being sometimes the problem.
45:30
SPEAKER_02: And so emotionally, people may not even want to start technology because they don't know what the support for that technology looks like.
45:38
SPEAKER_02: So I don't know if that answered that question, but I do think that emotional buy-in is part of it.
45:42
SPEAKER_02: And a lot of it is education and just reassurance and again, kind of understanding where that person is within that process of like, I'm thinking about it, I'm now actively looking at it, I'm now implementing it, and now I want to maintain it.
45:59
SPEAKER_00: So I highly recommend that uh article that I just mentioned out of uh South Korea because it does just have a nice list of what OTs do.
46:11
SPEAKER_00: Like it lists the 20 things that we do to help with that smart home process.
46:15
SPEAKER_00: So that is a nice read.
46:17
SPEAKER_00: I also, uh, while you're here, really wanted to bring up this article.
46:21
SPEAKER_00: It's called Community-Based Interventions to Support Aging in Place and Functional Independence in Older Adults, a systematic review of randomized control trials.
46:32
SPEAKER_00: This was published in 2026.
46:36
SPEAKER_00: I love this article because it looked at multiple kinds of community-based interventions.
46:42
SPEAKER_00: It actually had kind of six core domains: physical activity, cognitive and psychological support, health education and self-management, nutrition, social support and community engagement, and then rehab and supportive care were its own kind of domain.
47:00
SPEAKER_00: What it found overall was just the uh interventions that seemed to work the best were ones that were multidomain that hit uh more than one of these six options.
47:14
SPEAKER_00: They have a really great chart actually in there where you can just see like multidomain uh clearly had the most effectiveness across uh different areas for aging in place.
47:25
SPEAKER_00: It also talked about just like a hierarchy of outcomes.
47:30
SPEAKER_00: It talked about ADL and IADL performance as being like the main thing that we're going for, that that's supported by functional capacity proxies like gate speed, sit to stand, cognitive function, and then psychosocial enablers, uh, like self-efficacy mood and social participation.
47:49
SPEAKER_00: So hopefully in these interventions, we're kind of looking at all three, but our gold star is ADL and IADL.
47:57
SPEAKER_00: This is a really great read for anyone out there.
48:00
SPEAKER_00: It really showed me, like, oh, there are a lot of randomized controlled trials.
48:03
SPEAKER_00: There's a lot of things happening around the world.
48:05
SPEAKER_00: This was a very global study.
48:07
SPEAKER_00: It was out of Norway.
48:08
SPEAKER_00: Uh, we both got to look at this.
48:10
SPEAKER_00: I could keep talking about this research, but I'm just curious.
48:13
SPEAKER_00: This is like an article.
48:14
SPEAKER_00: Yes.
48:14
SPEAKER_00: What stood out to you in this article and how it relates to what you see on the ground?
48:21
SPEAKER_02: Yeah, I think um, I'm cracking up because one of the first things that stuck out to me the most was like just in the introduction and the way that it defined aging in place, which is, I don't think, the way that we define it here.
48:32
SPEAKER_02: And I had never really heard of it.
48:34
SPEAKER_02: So it defined it as I'm gonna read off of it really quick.
48:37
SPEAKER_02: Aging in place refers to the ability to live in one's home or community.
48:41
SPEAKER_02: I think that's where we stop.
48:43
SPEAKER_02: But they added on with access to health and social support.
48:47
SPEAKER_02: And I was like blown away by that because I had never really heard that defined in that way.
48:53
SPEAKER_02: Because yeah, you can live at your home, but if you don't have access to health and social supports, then what's the point?
48:58
SPEAKER_02: Which I think we've called quality of life, but I'm not sure I've ever heard it described that way.
49:02
SPEAKER_02: So that was one that like just stuck out to me.
49:06
SPEAKER_02: And it was like only from the introduction.
49:08
SPEAKER_02: So that was kind of hilarious.
49:09
SPEAKER_02: I think the other piece of this that I kind of uh kind of stuck on there was that it feels like no one is really getting reimbursed.
49:18
SPEAKER_02: And maybe this is just like my American point of view here that brought it was that no one's really getting reimbursed for that connective and often that implementation process that we're going through that, you know, again, I tried to build my business around.
49:32
SPEAKER_02: It's it, you know, we have the DME provider that is actually paying for the object, right?
49:37
SPEAKER_02: We have the insurance provider or a different payer source that may pay for like the evaluation portion, but no one is really paying a person or a group to make those things like agree and work together.
49:50
SPEAKER_02: So, like, how many times do we end up with shower chairs provided by some program that is actually in someone's closet because it wasn't actually what was there?
49:59
SPEAKER_02: So I feel like this study is sort of maybe purposely, maybe not.
50:03
SPEAKER_02: That's where my brain went with it.
50:04
SPEAKER_02: So I don't know.
50:05
SPEAKER_02: That's kind of where I was with this research article.
50:08
SPEAKER_02: Maybe I'm biased.
50:11
SPEAKER_00: Yeah, I was like our interventions are siloed because one, our specializations kind of tend to be siloed, and then our reimbursement is also siloed to your point.
50:25
SPEAKER_00: There's not enough people that connect the dots.
50:27
SPEAKER_00: And even though we are, I would say OT is the profession that is educated to connect the dots.
50:34
SPEAKER_00: It's in our scope of practice.
50:36
SPEAKER_00: We're often so limited by our reimbursement, we don't get to fully lean into that.
50:42
SPEAKER_00: Uh, we talk about value-based care a lot on the podcast.
50:45
SPEAKER_00: I do think there is a reality in the not distant future where we are reimbursed for keeping people healthy and helping them age in place.
50:58
SPEAKER_00: But even though that might just be a couple of years off for some of us, it's not a lived reality for most of us right now.
51:06
SPEAKER_00: Um, when it is that reality, we do have this evidence already.
51:10
SPEAKER_00: We already have the skill set.
51:12
SPEAKER_00: So, really, the barrier is a policy one, it's a reimbursement one.
51:16
SPEAKER_00: Um, that's a very common trend that we talk about.
51:19
SPEAKER_00: I have one big picture question I want to ask you, but I do have a question from the live comments that I'm going to sneak in first.
51:26
SPEAKER_00: Someone asked about uh threshold management.
51:30
SPEAKER_00: And I am also curious what are the options with thresholds?
51:33
SPEAKER_00: Uh depends on what can we do?
51:35
SPEAKER_02: Yeah, it depends on the house.
51:36
SPEAKER_02: I hate that.
51:37
SPEAKER_02: Very OT answer, right?
51:38
SPEAKER_02: But I'll go into more detail than just it depends.
51:41
SPEAKER_02: One thing, it depends where you are.
51:43
SPEAKER_02: Is it an entryway or is it a flooring in the home?
51:47
SPEAKER_02: You're looking at kind of what the edges of that threshold look like.
51:51
SPEAKER_02: So, for example, um, a lot of Philly homes don't have subfloors.
51:55
SPEAKER_02: So we have just the original hardwood floor.
51:57
SPEAKER_02: So a lot of families, when they upgrade, they just put the new floor on top of the original floor and they make the original floor the subfloor.
52:04
SPEAKER_02: So you walk around with a lot of like one-inch thresholds anyway.
52:08
SPEAKER_02: So then I'm looking at that threshold.
52:10
SPEAKER_02: Is it a straight edge or is it a rounded edge?
52:12
SPEAKER_02: Why is it rounded?
52:13
SPEAKER_02: Is it like something that can just be like ripped off, right?
52:16
SPEAKER_02: Is it just like an edging?
52:17
SPEAKER_02: And so then you might be looking at like rubber threshold mats.
52:20
SPEAKER_02: You may actually be looking at a carpenter who needs to come in and remove what's there and create something that is beveled.
52:26
SPEAKER_02: So a beveled edge kind of looks like a little ramp.
52:28
SPEAKER_02: Um, sometimes there is no good solution, and it's more about educating the client on how to step over it or add or offering like handheld support.
52:37
SPEAKER_02: So when they are on an uneven threshold, at least they're holding on to something.
52:41
SPEAKER_02: So that could be like the placement of a grab bar in a non-traditional space.
52:45
SPEAKER_02: I put all grab bars and doorways kind of all the time, if the doorway supports it.
52:49
SPEAKER_02: So this is where it kind of depends because it is that the best ideas only matter if the structure supports it.
52:56
SPEAKER_02: And so this is where OTs that are doing home safety assessments, I think it's really morally important for us to know enough construction that we can give an accurate recommendation.
53:06
SPEAKER_02: And I will say, like OTs that work with me, it can take three or four months to onboard fully because there's just so much construction knowledge that you kind of need to know because there's nothing worse than when we say just put a grab bar there.
53:18
SPEAKER_02: And then again, it's not structurally possible.
53:21
SPEAKER_02: Now we've just left our client out.
53:22
SPEAKER_02: And why do they guy us?
53:24
SPEAKER_02: You know what I mean?
53:25
SPEAKER_02: So I don't know if that's all of it, but those are some of the threshold management solutions that exist.
53:32
SPEAKER_00: It's always uh yeah, I love hearing the details, and when you get into anything, it gets so complicated.
53:38
SPEAKER_00: And that's just such a good jumping off point to like honestly, when I look at the aging in place problem, I want to say I feel a little discouraged because it's such a complex problem.
53:51
SPEAKER_00: Um, our housing is old, it's hard to maintain your housing as it, like it just straight maintain it, let alone like improve it for aging in place, acknowledging that there is some discouragement in this landscape.
54:05
SPEAKER_00: What gives you hope when you look out across the aging in place space?
54:10
SPEAKER_02: Yeah, so I actually took this question because I'm glad that you gave me this one beforehand, because I took it to my staff because I was like, let it just not be me.
54:18
SPEAKER_02: It'll also be the OTs that work with me.
54:20
SPEAKER_02: And I think that we all kind of agreed on it.
54:22
SPEAKER_02: And so I do think that there's a lot of hope.
54:24
SPEAKER_02: There is a lot of issues with silos.
54:25
SPEAKER_02: Yes, we can acknowledge that.
54:27
SPEAKER_02: But there is a generation of individuals who is doing a lot of caregiving right now, and they are learning the whole system before they even need it.
54:36
SPEAKER_02: So I truly think that we are gonna go through a really rough patch.
54:39
SPEAKER_02: I'm not even gonna lie about it.
54:40
SPEAKER_02: I think it's gonna be really, really hard.
54:43
SPEAKER_02: And I think the next generation's coming up, it's not gonna be that difficult because they're gonna be ready for it.
54:49
SPEAKER_02: So I don't know that the needs are ever gonna go away, but when we implement them, maybe come sooner, which is ultimately what we want to do, right?
54:56
SPEAKER_02: We want to do these interventions before someone needs it because decisions are made for you in crisis.
55:02
SPEAKER_02: But if you've already made the decisions, you can weather the crisis really well.
55:06
SPEAKER_02: And so I think that's really, really exciting.
55:08
SPEAKER_02: I do think that there are a lot of people asking the questions, and I didn't have that many people asking even three years ago.
55:16
SPEAKER_02: So I've been in business about six and a half, coming up on seven years, and even within the last couple of years, there's a lot more interest in it.
55:23
SPEAKER_02: Um, I wish it had been sooner, uh, just because we do have that generation coming, but it is being asked.
55:29
SPEAKER_02: So that is something to really look forward to.
55:31
SPEAKER_02: I do have some concerns about funding when it comes to federal sides, but at the same time, I do think there's a lot of other funding sources that are picking up the um the slack of what the federal government may have funded before.
55:45
SPEAKER_02: Are they as comprehensive?
55:46
SPEAKER_02: I don't know, but I think we're only limited by the buy-in of the people in our neighborhood.
55:51
SPEAKER_02: So I do think that there's a lot of really cool, innovative ways that we just have to be creative enough to see.
55:58
SPEAKER_02: Um, so yeah, I'm trying to think about it.
56:00
SPEAKER_02: There, there, those are probably the things that are bringing the most hope to me right now.
56:04
SPEAKER_02: And I think it's gonna be a societal change.
56:05
SPEAKER_02: I really do think it's gonna bring that.
56:07
SPEAKER_02: I do think we might have to hurt just a little bit beforehand.
56:12
SPEAKER_00: So I'm going to on all those, especially my last episode was on caregiving.
56:17
SPEAKER_00: One in six of us in the United States is a caregiver.
56:20
SPEAKER_00: And to think about that aging population, so many of them will have been caregivers in their life, will have hard-earned knowledge about aging.
56:29
SPEAKER_02: I mean, I've had a few families that like they hired me for their mom and dad, and then they're actually calling me because they're like, hey, we're redoing our bathroom.
56:36
SPEAKER_02: Can you just like make sure our plan's right?
56:37
SPEAKER_02: And I'm like, absolutely, let's get on a virtual call.
56:40
SPEAKER_02: So I've had a few of those.
56:41
SPEAKER_02: So I'm like, that's exciting.
56:44
SPEAKER_00: Oh, yeah, that's amazing.
56:45
SPEAKER_00: That's that trend.
56:46
SPEAKER_00: Give me the confidence you need.
56:49
SPEAKER_00: We have a minute left of this webinar.
56:52
SPEAKER_00: It's been so much fun.
56:53
SPEAKER_00: What's the takeaway you want to leave leave us on today?
56:57
SPEAKER_02: Yeah.
56:57
SPEAKER_02: So I want to say I think this is one of the biggest things is that aging is arguably one of the most predictable psychosocial processes that we have, and we have to stop designing it as if it's a surprise.
57:09
SPEAKER_02: And so I think that we're shifting towards that.
57:12
SPEAKER_02: But like it's gonna happen.
57:13
SPEAKER_02: We have a lot of documentation, we have a lot of years.
57:16
SPEAKER_02: So let's let's not pretend like we're surprised by it.
57:19
SPEAKER_02: So I think doing things before you before we need it is really the takeaway.
57:24
SPEAKER_02: Simple but easy.
57:26
SPEAKER_00: Don, this was so uh um helpful to hear from you.
57:29
SPEAKER_00: Congratulations on your business.
57:31
SPEAKER_00: Like, I look across the country and there's not that many Don's doing this work.
57:35
SPEAKER_00: I hope over the next years we just see more and more people really stepping into this gap, connecting the dots.
57:42
SPEAKER_00: And thank you so much for being a trailblazer and how to make that happen and then coming on and sharing.
57:47
SPEAKER_02: Thank you.
57:48
SPEAKER_02: I love to talk about it.
57:53
SPEAKER_00: Thank you for joining us on the OT Potential podcast.
57:56
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58:06
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58:13
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58:22
SPEAKER_00: Okay, I want to thank you for joining us today, and we'll see you next time.