Caring For Your Senior Through Occupational Therapy

What if we told you there's a therapy that helps elderly patients regain their self-care, strength, balance, and coordination for daily activities? Welcome Danielle Hopkins, an occupational therapist at both McLaren Hospital and Wellbridge of Grand Blanc, who joins us to shed light on the crucial differences between occupational therapy and physical therapy, as well as her experiences working with stroke patients and using adaptive techniques.

Discover what it's like to work as an occupational therapist in various settings, such as hospitals and skilled care centers, and the challenges faced when treating patients with cognitive issues or dementia. Learn how music and art therapies can aid memory care, and the realities of inpatient therapy duration in skilled care centers, often cut short by insurance companies. Danielle also shares how therapy can continue beyond inpatient care through home care and outpatient therapy, providing comprehensive care for patients throughout their journey.

Transcript

Speaker 1: You're listening to Advice from Your Advocates, a show where we provide elder law advice to professionals who work with the elderly and their families. 

Speaker 2: Welcome back to Advice from Your Advocates. I'm Bob Mannor. I'm a certified elder law attorney in Michigan And this podcast has been going on for a little over a year. We've had some great topics I'm really excited about. Today We have Danielle Hopkins. She's an occupational therapist at Both McLean Hospital and Wellbridge of Grand Blanc, which is a skilled care facility. Welcome, Danielle. 

Speaker 2: Hi So occupational therapist. Now I'll share it with you. My wife is an occupational therapist when I met her, we met on a had never met before, which was kind of a random meeting, and she described herself as an occupational therapist And my first instinct was that she helps people get jobs. Now, is that the case? Do you help people get jobs? 

Speaker 1: No, unfortunately, no. So if you're unemployed, you're out of luck with me. 

Speaker 2: Well, it's funny, though, because my wife worked with children, you know, especially with children, and many times that was people would say, okay, so you're getting these young children's jobs. So the same thing probably applies to you where they say, okay, so you have these very elderly people that had had a stroke and severe dementia, are you trying to find them jobs? Do you ever get that? 

Speaker 1: Yeah, most of my patients actually. If you walk in and you tell them you're an occupational therapist, they just say, oh, i don't need a job, yeah, i'm retired. 

Speaker 2: I'm retired now. That's great. 

Speaker 1: I'll just stick with sometimes therapy. 

Speaker 2: Yeah, there you go. I like that. So tell us what is occupational therapy, give us the understanding of what it is that occupational therapists do. 

Speaker 1: So I like to kind of describe it as anything that occupies your time. So I always tell my patients that I could pretty much argue anything for my therapy sessions, as long as it's something meaningful to you and it's something you do, you know, in your everyday life. So, basic though, care for occupational therapy in the hospital or the nursing home setting is a lot of self-care. So things like getting dressed, bathing, getting to the bathroom, you know, moving around. But we also focus on other things like strength, balance, you know those coordination, all those types of things. 

Speaker 2: So as opposed to, say, physical therapy, where we're maybe making sure that certain muscle groups or certain you know things are stronger, or we're helping get back some of our strength, so that's what we do, so that's what we do, and that's what we do, so that's what we do. 

Speaker 1: So we have a lot of physical therapy that's more focused on making sure that you can do the things you need to do during your daily life. 

Speaker 2: Yep, yep, function-based. So after you get those muscle groups stronger, how are we going to apply that in our day-to-day? And that must be pretty interesting because I imagine a lot of the folks that you work with would be able to regain the strength and go back to doing things the way they did them before. My imagination is that you're having to help people adjust to the changes in their life that they're going to experience and how to still do those daily activities in a different way than they've done before. 

Speaker 1: Yeah, I mean, if we can, we'll do it the same way. Great. But a lot of times, you know, if there's medical precautions or whatnot, then we have to adapt to use equipment. You know, try different techniques, things like that. 

Speaker 2: So you know you have an interesting perspective because you're an occupational therapist in the hospital setting. And so tell me, is there a typical patient that you're dealing with specifically in the hospital setting? Is it going to be mostly older folks, Is it going to be mostly certain conditions or diseases, Or are you dealing with the whole gammon of ages and other things? 

Speaker 1: So for the most part, I mean, I would say, like our youngest patients usually are around, like you know, 30s, We have any pediatrics but then we go all the way up the spectrum. You know, in people in their 90s I would say definitely a variety of diagnoses as well. So McLean Flint is actually like a stroke, a specific stroke center hospital. So we do get a lot of those like neurological cases, but for the most part, you know, we still see cardiac cases, pulmonology. You know joints, you know So hip, you know someone who had hip surgery or fell and broke their hip and all that kind of stuff. So the age, ranges. 

Speaker 2: Is there going to be a I don't know if this is the proper word, but a typical Patient? Are most of them going to be in the older ages? or really, on any given day, you might be seeing anybody of any age. 

Speaker 1: Yeah, I mean most of the time, like right now, my caseload is like 65 and up, 70 and up Every now and again. You know I mean the people who are a lot younger. Usually, it's a you check in and you sign off kind of thing. The doctors just need that, you know Check. So usually like longer therapy is for older people in the house. 

Speaker 2: So she mentioned stroke, uh, situations. Why don't you walk us through because obviously that's something that my clients are dealing with a lot. You know we're gonna be helping them with trying to find Continuing care and paying for that care and things like that, and so walk us through what an occupational therapist would do For someone who's experienced a stroke. What typical things are you gonna be working on? 

Speaker 1: So this is a very tough question because everyone who's you know had a stroke is a little bit different. But, like we talked about in the beginning, a lot of that self-care, so things like getting dressed, getting to the bathroom, so a lot of times with a stroke you have to learn what's called a hemi technique. So one arm is weaker, one leg is weaker, so you put in that armor leg first. So we kind of educate on those things, like you said, kind of changing the way you do things. We work on the mobility piece. So you know walking. If you need new equipment like a walker cane, you know what have you. We'll work a lot on coordination. So oftentimes you have one arm that's weaker, so we'll work on that like grip strength, you know being able to manipulate your clothes better, your fasteners, things along those lines. 

Speaker 2: You know it's interesting. I think a lot of what you just said there isn't necessarily gonna be intuitive, you know. I think that when you mentioned about one side being weaker than the other side, i don't know that we would always come up with that on our own, necessarily without the assistance, to say, okay, this is gonna be a lot easier if you do it this way and you have those sort of tried and true techniques and Sort of researches to make their life a little easier. 

Speaker 1: You're very right, because sometimes after a stroke you know you have those cognitive maybe deficits or delay, so you might forget so there's all sorts of different things that It's good to have an extra set of eyes, to kind of outlook. 

Speaker 2: That's what they teach you in school is like you look back, you let them do it and you analyze how they're doing it And then you kind of figure out the best way of How can we do this so that they're most independent you've mentioned the cognitive issues, and that's true for a stroke and for, obviously, any form of dementia Alzheimer's or any form of dementia And so I imagine you also work with lots of folks that are experiencing some kind of cognitive issue or dementia, and how do you work in that situation? What is your typical efforts and work to help somebody that's going through that difficulty? 

Speaker 1: I would just say a lot of the times you have to be wherever they're at. 

Speaker 1: So you have to kind of get on their level. Sometimes patients don't always know where they are when they have dementia, so you are wherever they are. So you have to be kind of adaptable. Sometimes you might, like I always say to those sessions you can't really plan, because you might get there and they might not want to do that or, you know, not always. But that's, we kind of have to go into it with a little bit of an open mind that your patient might more so direct. You know your session a little bit, depending on severity and all those things, but also just you know the safety aspect and making sure that they're not putting themselves. 

Speaker 1: You know you're making sure they're moving right and not putting themselves at risk for falling and all those kind of things. 

Speaker 2: I don't know if you've heard about that. 

Speaker 2: We have this event we call Boot Camp, the elder advocacy Boot Camp, elder Advocacy and Law Boot Camp, and so one of the earlier. 

Speaker 2: This is gonna be our ninth year, i think, and one of the early years one of our speakers was an occupational therapist at Lincoln, out of Ohio, and she was telling this story and I thought was fascinating. 

Speaker 2: So you know she had seen the research about how when you have I think it's probably true for stroke victims too but certain types of dementia, they can see in the brain that certain parts on the connections aren't happening but in other parts those connections are still working. And so she mentioned, in particular as an occupational therapist, that music was something, that those connections were still there, and so she'd work with somebody that because of their memory issues where it was falling a lot, because they forget to use their walker, they forget that they needed that, but that was a requirement for their safety. And so one of the techniques that she used that I thought was fascinating would she put it to music and she would create this song to remind them and just every time they get up she would sing the song to remind them that they got to use the walker and she'd go. 

Speaker 2: I'm not gonna try to do the song or the song and not gonna torture you guys with that, but it's fascinating because the person that she was referring to could not ever remember that they had the physical limitation where if they don't use their walker they're very likely to fall and get injured again. And there those brain connections were not there anymore and they could not make that executive decision-making, but the music connections, the synopses and all of that were still there. So they put the instruction to music and then just repeated that you know how you get a song in your head you can't get rid of. Well, that was the goal, was to keep that song in her head and she was able then to remember to use her walker because we'd sing that song. It would remind her then to use her walker and it's an example of sort of innovative occupational therapy I'd say. 

Speaker 1: Absolutely and even so, a memory care that I previously worked at, they had a specific like three, two, three times a week. It was music therapy, so they had someone coming in for an hour and she would do all sorts of different things. She had all these instruments and everything like that and sometimes you know or even there was another lady who was there who she was an artist and so you know the crafting activity. You know when you can bring, like you know they're different, those synapses too, but you can bring tie-back in things that are, you know, someone's used to, that really can also help. 

Speaker 2: You know I'm sure you've seen this. You know there's lots of videos of someone that cannot remember their name, cannot remember their spouse, cannot remember any of that, but they can sit down on the piano and play, you know, a concert level piece, And that's just amazing. So very interesting. Well, so talk to us a little bit about the differences between working as an occupational therapist in the hospital versus working in a skilled care setting. So just to remind everybody, if you listen to this podcast, we often talk about sort of the different levels of care. Often what happens is when somebody leaves the hospital, they'll go to an inpatient setting for some form of rehab, And so talk about the differences in your work in those two settings. 

Speaker 1: So for occupational therapy in the hospital, you're getting people fresh off of whatever happened. You know a lot, sometimes a lot more fresh. You know like they might have this, their big incision. They still have their staples in or what have you. Either they might be hooked up to IVs or you know a feeding tube. So you have to. You know travel with all those things. You have to teach them how to use all those things. More so and not always, but more so when you're in that. 

Speaker 1: You know subacute or nursing home, skilled care type of facility. You know some of those things might be healing a little bit better. People might be, you know, functioning better, depending on you know what exactly happened. They might already know like so I talked about adaptive equipment earlier. They might be like Oh yeah, somebody showed me that when I was in the hospital, so they might have some idea of those things. But you're still getting. You know when they come from the hospital to a skilled care facility, it's because they need help still, so it's just might be a slower rate of progress. I think a lot of times you know the people that you see in the hospital are, you know, a little quicker with their progressing. So that's oftentimes why you see it. You know skilled nursing homes, as you know older adult facilities. You don't see a lot of people under 60 there, yeah. 

Speaker 2: Talk a little bit about that the duration when you are, when somebody is going for inpatient therapy at a skilled care center what the duration is. I know probably there's both extremes that some people think, oh, i'm just going to be here for a couple of days And some people think, oh, i'm definitely going to be here for 100 days. So talk to us about the typical duration on something like that. 

Speaker 1: Yeah. So skilled care, i would say generally two to four weeks is like a good range of how often, you know, depending on what's exactly wrong with someone. But you know some of our people who've had a stroke, i mean who knows, they could be there for six, eight weeks, depending on. You know what insurance allows. We don't see really too many hundred days anymore, you know, just because of insurance cuts and all that business. But I would say that's like an average And you know that also varies based on someone's progress, how they're progressing. You know I could tell someone on their very first day, oh, you're going to be here three weeks, but then two days later it's like they popped up like a spring chicken and we changed our mind, you know. So it's always better to ask for more time than to not ask for enough and need more. 

Speaker 2: It's not good. So the listeners of the podcast will know that I have an opinion that I feel like it is cut short more than it should be by in Medicare and the insurance is And there's more and more where it's really the insurance companies making the decisions over Medicare. And I think in both cases that I am often disappointed that the skilled care, the physical therapy, occupational therapy, speech therapy is cut short. The inpatient portion of things is cut short, shorter than we like it, and it is part of what we do for our clients is to try to help that get extended through appeals, through making sure that we're encouraging the setting of high goals for the therapy and things like that. But tell us about that When that does, and because of insurance, because of Medicare, because of whatever is there a way that it can continue when it's no longer inpatient care, so when you're no longer at the skilled care place? 

Speaker 1: Yes, absolutely So. We often will recommend what we say, but a continuum of care. So, like you said, you start at the hospital, then maybe you go to a subacute rehab. Then usually when you leave a subacute rehab we'll recommend home care therapy. So people who come into the house they help get you acclimated, They can see your environment, all those kind of things and then kind of help you adapt there. For some of our higher functioning people, when they're leaving, we could recommend outpatient therapy. But usually therapy doesn't end when you're done at a continuing or when you're done at a skilled care facility And even say somebody is that's their home, They live at a nursing home And they go to the hospital and they come back and they're on Medicare Part A for a little while And then whatever insurance, who knows, you can still get therapy other ways, even if you're, like a resident of a long term care facility, your Medicare Part B. So I mean I'm biased because I'm an occupational therapist, so I think everyone always needs therapy. 

Speaker 2: But Well, exactly, and I 100% agree with you on that, and I, you know, i do feel like If someone has a serious stroke, boy, you know, having more therapy is always gonna be better. And whenever they say, you know, honestly, but it's a stroke, i I encourage the thing because, occasionally we'll have families. Uh, that will say, oh well, we want to bring dad home right away. 

Speaker 2: Dad doesn't like it being there and even before insurance or anybody else cuts it off, they'll want to bring it home and my advice is always more is better, especially with stroke. A lot of things, obviously, but a stroke in particular, more, whatever more is about it. 

Speaker 1: Yeah, i'm like oh, if you kick, insurance gonna pay for it. Just take advantage of it. 

Speaker 2: Yeah, yeah, and even when it's when insurance says they're not going to pay for it. You know there's sometimes ways that we can, you know, try to get that extended or at least, like you say, get the outpatient. So for those that pay attention to the Medicare parts, and for some of you, this will probably not be particularly interesting, but the inpatient is going to be under Medicare part a And the outpatient is going to be met under Medicare part b. But those of you that have a, your insurance, it's really Medicare advantage program That's actually called Medicare part c and then incorporates both a and b. So that's going to be completely decided by the insurance company, and so the both the inpatient and outpatient would be Be decided by the insurance company. And of course, there's appeals in any of those situations about a part a, b or c. Um, talk to us a little bit about the process of a discharge, and you have experience, i think, in both And two at least two different settings discharge from the hospital and then discharge from inpatient skilled care. 

Speaker 1: Um. So I mean always our discharge. You know we want to strive for home Wherever that might be. You know they were, if someone was. You know a lot of our older adults We see they were living with their family before. So a daughter, son, um what have you? they might have the extra supervision, but still home. We want to get people as independent as possible and as good as they were before they came to us. So you know, i always try to strive for that. Then we have to factor in, you know, safety and all those extra things on whether or not that discharge plan is, you know, feasible. But that's always the goal. 

Speaker 2: Yeah, very good, and it's always obviously important to be optimistic and I, you know, i know certainly that you know you've experienced many a times where It was not reasonable or feasible to expect them to be able to recover to their old, previous, you know, level of functioning. And So talk to us a little bit This is kind of a tough question And um about the emotional challenges of dealing with that, the with the occupational therapist Stills, with with seniors and their families. That's beyond the physical challenges, because sometimes it's just Helping them sort of adapt and accept that there is going to be changes going forward And they may not be able to return to the previous level of functioning. 

Speaker 1: Yeah. So, um, you know, emotionally I mean, a lot of people Are older patients especially don't want to feel like they're burdening their family. Their family doesn't want them to feel like, you know, taking on too much or anything like that. So I think oftentimes it's like balancing that patient family. You know relationship, because there are a lot of emotions when you realize you might need more help than you used to And things are changing. 

Speaker 1: Like I always kind of try to get like driving as a good example, like sometimes you know, oh well, it's time that you stop driving. Like that's a hard thing to just stop doing. I mean, in america we're very independent people and you start driving when you're 16 and you do it your whole life. You know We all do and then you're 90 and you got to stop and that's not a fun thing to do. So, definitely, emotionally, i think a lot of people can get, you know, anxious or you know, depression, and oftentimes with strokes you see that as well. But the communication piece of people are having a difficult time communicating or understanding language, things like that. So I think that's always a good Thing to be aware of and that's why oftentimes you know we have social work involved In making sure that the whole person is looked at. Not that I don't, but you know, it's just another add-on to making sure that Everything is addressed. Even you know the emotional pieces. 

Speaker 2: Well, you know, i really appreciate you being here in, danielle, and it's good to hear that you're not trying to get our 90 year olds to get back into the workforce. So I think you have a great perspective of always really being eager to try to get, you know, folks back into the movement and the ability to complete the same tasks that they were able to before, and always having that perspective. So appreciate your time and anything else that you'd like to leave the listeners with any thoughts about occupational therapy and the importance of it. 

Speaker 1: OT is better than PT. 

Speaker 2: That's all I got to say That's great Love that. No, I'm just kidding. 

Speaker 2: Thank you for having me, if you're anything like my life, that occupational therapists and physical therapists tend to be both friends and rivals a little bit. They get a compare and contrast a little bit, but she's got lots of PT friends too. So, yeah, absolutely Thanks, danielle. And for our listeners, don't forget, we've got our annual boot camp and we usually do it every spring in 2023. 

Speaker 2: If you're listening to this, in early 2023, we actually are having that coming up soon. It's going to be on April 21st Friday We're offering continuing education credits five continuing education credits for social workers and case managers and such, and so if you haven't signed up, we encourage you to do so and hopefully we'll see you there. And if you like this podcast, you might want to look back at the rest of the episodes that we've done with some really interesting and great folks. And don't forget to subscribe to our channel. Whatever source that you're listening to this on, you can just hit the subscribe button and then you'll get access to the old podcasts that we've created and notice when we've put out a new one. So thanks everyone for listening and we'll see you next time. 

Speaker 1: Thanks for listening. To learn more, visit manorlawgroupcom.