Keeping Older Adults Safe & Independent At Home

Daniel Elliot
Daniel Elliot

An Occupational Therapist talks about keeping older adults safe & independent.

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Podcast Transcript

January 26, 2023


Note: This transcript was computer generated and might contain errors. People can also change the text after it was created.

I'm an occupational therapist actually. So I started off in private practice, home care, just going to patients homes, whether where they were living, where they were doing most of their activities and doing therapy there, so it's considered outpatient.

Daniel Elliot:  I'm basically realized that I could work with somebody for 15 20 sessions and then they'd contact me three months later and say Hey like I'm not doing my home exercises anymore. I'm not doing my activities like Let's do therapy again and unfortunately as much as I'd like to, like you can't really do therapy for an entire year with somebody because of insurance and all of that. So I wanted to think of a way to kind of have a more lasting impression on the care plans that I was doing with people. And one way I thought that that could be done was by addressing the environment. So you can get somebody as far as you can physically and functionally to a certain point. And then you really want to start to look at the environment and creating an environment that works for that person and where they're currently at. So just dove right into the home safety and home modification Space started doing private consulting for families that wanted to like remodel a bathroom or like make a couple changes or install. Some grab bars and

Daniel Elliot:  Then met the founders at Jukebox Health who basically said, Hey Dan, we love what you're doing on a small scale like just on Long Island and in my community. But we are scaling this thing nationally, because we really believe that housing and home safety is an issue, especially for our older adults. So I joined as the 15 member at the time, a couple years ago and now I lead clinical partnerships. So I have this Unique opportunity as a clinician to also speak with other healthcare organizations that want to implement home safety and home modifications into their care plan. So like whether that's a hospital or a therapy company or home care agency or really anybody who's, you know, working with older adults. So that's kind of my journey and what I do at jukebox out so,

Katie Wilkinson: Yeah, that's awesome. And what it like what a cool transition for you, from like your local business, which I don't know if you're still running that but to be able to scale this with jukebox and, I'm wondering if you can explain What can you tell us what an occupational therapist does.

Daniel Elliot:  Yeah.

What is occupational therapy and how is it different from physical therapy?

Daniel Elliot:  Yeah, us sot. We get that a lot. A lot of people ask even like other healthcare clinicians. Sometimes ask. I think the the best way to explain is actually In Colette like how we collaborate with physical therapists so OTS what we're focused on is is function and what's called activities of daily living. So at its core like dressing, feeding, bathing, all the stuff you need to be able to do as independently as possible to like

Daniel Elliot:  Start your day and like, do things that you want to do. So the OT is gonna work on those skills if you've had a fall and you went to the hospital and you become very weak and, you know, you can't dress yourself or can't get the to the bathroom safely. The OT is gonna work on those skills with you in the context of your environment. Whereas PT what they're gonna do that person has a fall and is really weak. They're gonna do exercises, Walking endurance training so they really work well together because the hope is PT gets you really strong and get to you Having more endurance and then OT is gonna get you using that endurance and strength to get back to doing the activities that you want to do.I think one of the issues with occupational therapy is people now link occupation with Job. There is a occupational therapy where you look at somebody's ergonomics when they're sitting it for cetera, but when OT was sort of formed as a profession in


Daniel Elliot:  1917 at that time. At that period of time and occupation. Only meant something that you do during your day. So occupational therapy was born out of this therapy to help people to be able to do the things that they want to do during their day. So, there's that, I always, that's a really long explanation. I never go into that detail with people when they ask but it's an interesting. It's an interesting story for sure.

Katie Wilkinson: I think that's interesting. I I, you know, cheated and I do know what occupational therapy is but I do also associate the word occupate like occupational with my job, and I think about it in the ways of like workplace hazards. So I think that's, um, useful.

Daniel Elliot: Yeah.

Katie Wilkinson: I guess I'm wondering what are some of the reasons like What are some of the most common things that lead someone to you? I understand your role with jukebox is different but as an OT, what are some of the common things that lead someone to you?

Daniel Elliot:  I think most some of the most common ones are. Well, I'll break it up. There's there's preventative and then there's more reactive cases that will work with. So reactive case might be, I'll go back to the same example. Somebody had a fall, they go to the hospital and they're getting discharged in, you know, a week or two weeks. And they realize my home is not set up safely or I fell because, you know, this rug was in the way in the bathroom is too slippery. And now I'm going back to the same environment and they're really concerned about falling and going back to the hospital. So that reactive situation is when they reach out to us and say, Hey, I want to make a change so that this doesn't happen again. And then on the other side is, are more preventative cases where maybe somebody went to the doctor and they just gotten diagnosed with Parkinson. They don't have a lot of symptoms, they're not falling, but they're just, they just want to plan for the future.

Daniel Elliot:  Or maybe it's just somebody who's recently retired and thinking about redoing some things in their home anyway and want to plan for the future as well. We don't get as many of those as we'd like to. I don't, I just don't think people are at the point where they're like, so so preventative but yeah, those are probably the two biggest cases where someone will reach out to us.

Katie Wilkinson: Awesome. Yeah, that's helpful. And you've touched on a couple of them already but I'm hoping you can tell us like what are some of the what causes older adults to fall? Like What are what are some risk factors for falling?

Daniel Elliot: Hmm. Yeah. So Everybody's different of course which is why it's important to have a clinician kind of investigate that I think it can be intrinsic which is you know maybe you have a condition that's impacting your balance, maybe it's impacting your vision so you can't see as well and you're tripping over things.

Daniel Elliot:  And it could also be extrinsic. So you could be living in an environment, that's not conducive to like your current status, right? Or It's just unsafe, you have, you know, a throw rug that's really slippery on the floor or you have a really high tub to step into or there's clutter in the bedroom. Those are all like extrinsic or environmental factors that that can lead to a fall. And there's, you know, not to like not to scare your listeners, but there's probably 800 other things you could think of in the environment that could potentially be dangerous and then also it's seasonal as well. Right. I think, you know, if you think in the winter especially on the East Coast as it gets, I see snowy, cold or whatever. You know, you're outdoor areas, really important as well but unfortunately, could could cause a fall too. Yeah, those are, those are the major ones. And then again, every person is different if you know they Parkinson's or arthritis or pedestro like

Daniel Elliot:  You're always looking at what specifically is going on with that person and how that could potentially lead to a fall and how to avoid it.

Katie Wilkinson: Yeah. And and after someone falls like why, why are false such a serious hazard for older adults.

Daniel Elliot:  Unfortunately, they often lead to a lot of decline in function, so One aspect is, Somebody has a fall, they go to the hospital, maybe they have a stay or, you know, unfortunately. But what can happen too, is they fracture their hip to go through surgery and all of that. There's a lot of research out there that just shows that they're at a higher risk for falling. Again, they're at a high risk for like for declining and function as well. So that one fall that could happen out of the blue and for, you know, just a minor thing in the home causing you to trip can lead to you know, years of decline that you otherwise might not have had and then

Daniel Elliot:  Even if, you know, if you have like a great, if you have great therapy and address everything, but you've had that fall like there's a, there's a likelihood that you're gonna have a fear of falling moving forward as well, which also impacts your life. So the idea is to prevent the fall so that it doesn't have these effects on your life moving forward.


How to reduce the fear of falling in older adults

Katie Wilkinson: You just read my mind, maybe, but this fear of falling. I read a stat somewhere. And I don't know if it's true or not but that older adults fear falling more than they do robbery or…

Daniel Elliot: Here.

Katie Wilkinson: financial stress or other health problems. And regardless of that, that's true or not. I guess the question is like, how can Older adults and or US as caregivers help reduce this risk. Sorry, this fear of falling

Daniel Elliot:  Yeah, I mean that sounds about right? Yeah, I think. In for, for older adults in their mind. they know they already know like what a fall could lead to, I think like I think back like 10 years ago used to see like the help I can't get up stuff which I absolutely hate not a big fan of that but I think it's sort of pushed these thoughts into older adults minds that have fall can lead to a lot of bad things. Clip this out of the short clip: And the reality is he can I think There's, I'll mention another study they did at a Helsinki university. They found that

Daniel Elliot:  Older adults, fear going to a nursing home more than they fear death. And I think it's that imagery of having a fall being in the hospital, your family being upset, you know, then going to a nursing home being in a wheelchair, just like watching TV for the rest of your life, right? Like that image is so scary for older adults and really anybody right? But [11:52] ways to reduce fear falling.

Daniel Elliot:  As a family, I think family support is huge and caregiver. Support is huge as well for talking research. There's even research out there that shows carryover support has such better outcomes for people. That's a huge one. And when they're taking action and taking steps to get the right people in place to help address that fear of falling, that's something that's really powerful. And then those, you know, the experts, the clinicians, the doctors all doing their part to put somebody's ease at mind and address each thing that might be causing them to have that fear of falling. So for us, For example, if somebody, you know, we've had people who are petrified to go back into the bathroom because that's where they had their fall and by changing the environment, and then walking them through their new space, you can actually you can get somebody to have less of a fear falling. so,

Katie Wilkinson: Yeah, that's helpful. Thanks for sharing that study and you guys that jukebox do, you know, fall, risk assessments. And can you tell us a bit more about like, risk assessment tools? Are there different options? Is there a best one? Etc.

Types of risk assessment tools to reduce fall risk for older adults

Daniel Elliot:  Yeah. So the one we point to a lot is called steady and that's that's an initiative developed by the CDC. It's a, it's essentially a tool that allows you it provides a home safety checklist or a screen, it provides a fall risk assessment as well and then it gives you different resources and essentially options to choose from to help address those things. So anybody can do those those screens and then you go down the line and it get and it says, Hey, you should talk to Jared to care manager or you should talk to a physical therapist and get this assessment. So it's a really great way for a caregiver.

Daniel Elliot:  Or, you know, the client themselves to kind of self-assess or self-screen and then make decisions one of those things. [END SHORT CLIP] That's a decision making tool. So after you take the first couple screens is addressing home safety. And like, that's where we certainly advocate for us to be involved. and then, in terms of, when we do that full home assessment, not just the screen we've taken Different evidence-based, protocols assessments, and kind of combined, all of that to make sure that we're addressing every possible hazard in the home.

Katie Wilkinson: And how often would you say it's helpful to be doing a screening and or a full assessment.

Daniel Elliot: How often for like one person in?

Katie Wilkinson:  Yeah, I mean, as I'm, I guess, I'm specifically thinking about older adults whose health might be changing, you know, more quickly, how frequently should they, or their caregiver be doing an assessment?

Daniel Elliot:  I would say probably at least twice a year. And also acting on it too, right? So that first screen, if you find that there's something, you know, potentially wrong like diving into that, getting a set getting an assessment done by a clinician. They'll probably address most of the things and then, six months later, and a year later, if you notice anything changing, that screen is a great way to recognize that. So,


Katie Wilkinson: Cool. That's a good benchmark.

Daniel Elliot:  Yeah.

Katie Wilkinson: I'm wondering what's the role that someone like you an occupational? Therapist plays in the home modifications process like I don't know, a lot about the in between, you know, you get an assessment done, You should make these changes that we're, we're to someone like you come in to support in that process.

Daniel Elliot:  Yeah, I think that's been one of the biggest challenges is kind of combining the the clinical side of it to the home services side or the actual installation of it. It's not very often. That healthcare workers are talking to contractors. So it's a really unique You know, connection that has to be made. The ot's role is to essentially go into the home, develop rapport with the family, talk to them about their goals, where they want to live, how they want to live medical history, all of those things, and then go room by room, keeping all of those things in mind and using clinical decision-making to say, Okay, what are the hazards in the home? And what home modification equipment or products, am I going to recommend to help address this? So they're keeping all those things in mind, they're creating a report and then that report is what

Daniel Elliot:  Should be shared with the contractor installer. So for there are lots of, you know, there's a lot of home modification consultants, including us something that we do is that report also includes recommendations for installation. So, For example, if we're recommending a grab bar, be placed next to a toilet or in a shower, we're gonna recommend the size of that, grab bar, the color if they have any like vision impairments and also the placement as well. So that once the installer is ready to install, he knows kind of exactly where it's going to go, and why and can do his, or her thing in installing it properly and securely. So I think that's where the OT plays the role of the clinical decision making and what needs to be changed, and then the installers, the one who is taking that information and actually executing on it.

Katie Wilkinson: Awesome. Yeah, I mean what an interesting like crossover of clinician talking to a contractor and…

Daniel Elliot:  Yeah.

Katie Wilkinson: such different worlds but so home You know, modifications or remodels. I imagine installing a grab bar is not extremely expensive, but I imagine installing a ramp or read like the cost. I imagine varies here and…

Daniel Elliot: Yeah.

Katie Wilkinson: Could could be expensive and. I don't know if you're able to, but can you share sort of a range of what someone might be expecting to spend on a remodel, or

Daniel Elliot:  Yeah.

Katie Wilkinson: Saying cost.

Average cost of home modifications to reduce fall risk

Daniel Elliot:  For sure. So That's a common, you know, people commonly think that, you know, the word home modification. It sounds like we're doing a ton of work and totally remodeling but that's not the case. You know, we also say sometimes like home safety adaptations, it sounds a little less intensive. I mean, the average. project price that we're seeing is between like 850 and 1,200 which actually happens to be less than the out-of-pocket costs for a fall for like coinsurance and stuff like that in some instances. so you know it's for some people that's a lot for some people, they can handle it and we you know, we'll work with everybody to to make sure that The job gets done, but I would say that's sort of the average and that project.

Daniel Elliot:  Between 850 and 1200 dollars, might be like a few grab bars. Replacing a toilet putting in motion, sensored lighting, a bed rail and maybe replacing like a door threshold. So like that threshold between a hallway and a bathroom, that's a tripping hazard. So, all of that can add up. And I think it's important to note too. The reason most of our projects are in that range because OTs are making really targeted recommendations. Like, they're not just going in and saying, Let's just redo all of this, right? They're going and saying, Here's exactly the things that are causing you an issue and exactly how to address it. So that that also in and of itself can drive costs down.

Katie Wilkinson: And I'm gonna leave us back really quick, but Like you've talked a little bit about prevent it like preventing this doing it in advance instead of,…

Daniel Elliot:  Sure.


Katie Wilkinson: you know, experiencing the cost of a fall and then also needing to make how modifications like Now this is you…

Daniel Elliot: Right.

Katie Wilkinson: doubled up, I'm not entirely sure. My question is but like, how far in advance or when might someone start addressing how to modify their home? So to avoid a fall you know I don't know if this is an age or symptoms. Someone might see in someone but how to You know, I don't think it's like our way in America to be preventative. So, you…

Daniel Elliot:  Yeah.

Katie Wilkinson: any tips from an OT on how to do that in this case.

Daniel Elliot:  Yeah. So you're asking like if there was like a like a benchmark or like a Place that maybe could apply to everybody.

Katie Wilkinson:  Yeah, which you know, maybe is ridiculous question because each of our situations is so nuanced. But

Daniel Elliot:  No. Yeah, I mean yeah that first starters. Yes. Absolutely. They've done research on like being the entire or a very large population and anybody over 70 is an increased risk for fall. So I think at that age and in America today that's starting to become retirement age for a lot of people. So I think around that time like 775 is when you should definitely be thinking about that. But let's say you're

Daniel Elliot:  You know, in your late 50s and 60s and you're moving or something like, Yeah, you're moving or unfortunately, you've been like diagnosed with some condition like That's, that's a good time to start thinking about the home environment. so that's, that's my best effort to kind of

Katie Wilkinson: Yeah, no I think that's helpful.

Daniel Elliot:  rot on it.

Katie Wilkinson: The eight I think the age markers good or a diagnosis but Yeah, I think it's it's not you know it's not in our way. I don't think to to be preventative and This question, I don't know if you know, we're not but back to cost of modification,…

Daniel Elliot:  Okay.

Katie Wilkinson: maybe do and modifications and remodels that are there any like programs or reimbursements like any? Anyways, people can save money. Out there beyond just like out-of-pocket costs.

How to save money on home modifications to reduce fall risk

Daniel Elliot:  Yeah, so I'll do my best and some of these things require like an additional expert and I'll give you an example. So there's certain deductions or write offs that you can make every year for like medical related expenses and home repairs related to that. So that's a situation where you can talk with your accountant on that. There's a fantastic organization called Rebuilding Together. They're, they're national, They have different national chapters, and they're all retired, contractors and handy. Men. And though actually do the labor piece of a modification project for free or install a ramp for free, you do have to make you have to meet certain financial criteria, but it doesn't include like your home and like, a couple assets like that. It's like, based on your your income at the time. And then in terms of the insurance landscape, some long-term care plans include a home modification.

Daniel Elliot:  Benefit. That's simply talking with your long-term care. Representative and they can walk you through that process. And then there's some really good funding state by state through through Medicaid, as well. So if somebody is on Medicaid, they can go through different programs that the state offers and actually get projects completely funded. That's something that we're starting in New York, and New Jersey to work with state, Medicaid programs, that cover quite a bit actually over 15,000 for home. Modifications. So that's like the insurance. Land that's like the coverage and funding landscape. Oh I guess the last thing too there's different you know conditions specific societies. So the MS Society the Parkinson's Disease Foundation. Those are always great organizations to be a part of if it's applicable to you because they'll always have really great resources for funding and grants.

Katie Wilkinson: That's awesome. And I didn't give you enough credit. You had a lot of resources available and we'll be sure to like tag them all. and in this post,

Daniel Elliot: Well, people ask all the time, of course. You know. So, and…

Katie Wilkinson: Yeah, I think I'm Yeah.

Daniel Elliot: so we were trying to help them.

Katie Wilkinson: That's I mean it's it's helpful. I think you know cost is a big concern for people and…

Daniel Elliot:  Yeah.

Katie Wilkinson: We like to ask everyone on the podcast. What is your number one tip for caregivers?

Daniel’s top tip for caregivers

Daniel Elliot: I would say. My number one tip. is that it takes a village and what I mean by that is It seems to me based on. Treating patients and in this home modification space that a lot of caregivers feel really overwhelmed and I guess my tip would be, like, would be that. There are a lot of professionals out there that are very eager to help out in all different spaces, like, whether that's care management or whether that's an OT, who's helping address the physical environment or for finances or anything else. So there's a lot of different resources out there and I think the tip would just be to understand, it takes a village and like, embrace those people who are, who are willing to help, and want to be trusted advisors, right? So, that'd be my tip.

[Caregiving] takes a village.Based on my experience as an occupational therapist and in the home modification space, I know that a lot of caregivers feel really overwhelmed. Embrace the people who are willing to help and who want to be trusted advisors.


Katie Wilkinson: Yeah, I love it. I think we hear a lot of similar things. Don't be afraid to ask for help. I haven't heard it takes a village…

Daniel Elliot:  Yeah.

Katie Wilkinson: but similar sentiments, like, you know, surround yourself with people, that, that can support you and that's part of what we're trying to just accomplish here is like, give people resources and and make it easier to,…

Daniel Elliot:  Yeah.

Katie Wilkinson: you know, find your village. And if people want to find You and or jukebox health, where can they go online?

Daniel Elliot:  So they can go on jukebox like the music box. Jukebox health calm. We have a lot of great blogs that we've written. There's even products on there. We just did a huge revamp of our website that has all these new photos of different home modification products that, that will offer and suggest. And then, of course, they can always reach out to me via phone email. I'm sure. You'll you'll post that in the description. And yeah, the, our main line too goes right to our client care team and their experts, in all things, modifications, and questions, that they might have as well. And I'm always available to chat with families as well. They have any questions.

Katie Wilkinson: Awesome. I really appreciate your time and sharing about, you know, OT and how people can start to think about preventing. falls and, and how to Look at their homes to be safe and we will tag you and jukebox and all the places and I won't post your phone number online. But I will put jukeboxes and…

Daniel Elliot: Okay.

Katie Wilkinson: yeah, people be able to find you that way.

Daniel Elliot:  Cool, thank you so much for having me. This is great.