Dannelle speaks with occupational therapist, Emilia Bourland. In this episode, Emilia shares how we can reframe our approach to using mobility aides as tools of support and independence and how care partners should communicate needs and concerns for our own health and safety. Dannelle and Emilia discuss the importance of acknowledging our loved one’s fear of loss of independence and why support systems are essential to gaining the most effective tools and information as a caregiver.
“The way might not look like we think it should look or like it used to look, but when we open up our mind to the possibilities, when we stay open-minded as to how something can happen, it’s limitless.” – Emilia Bourland
- 03:31 Emilia’s three core values and how they connect to occupational therapy and caregiving
- 07:43 Educating people on caregiving by explaining the “how” and the “why”
- 10:07 How occupational therapists help with safety
- 13:21 An example of how an adaptation can help with transfers
- 18:46 Affordable places to buy durable medical equipment
- 21:24 How home health assessments can help improve accessibility
- 24:26 Paying for home health assessments with an occupational therapist
- 28:02 How to help loved ones adjust to integrating mobility aides
- 32:28 Examples of simple, inexpensive home modifications that will make life easier
- 37:02 Amelia’s passions outside of caregiving
Balancing safety with support for our care partner’s independence can be so challenging. Using mobility devices, adaptive equipment, and home modifications can help create a care environment that reduces risk of injury for both care partners, while also empowering more self-reliance in those we care for.
When we have the right information, we’re empowered to make better decisions. The disconnect between educational resources and the people who need them most is frustrating, but most importantly know that they exist, and may require a little digging to find what works. It may also be helpful to enlist a professional, or provide additional information like the Home Modification Information Network, which has been developed with support from the Administration for Community Living. On their site, you can find educational materials, programs, policies, funding, and more resources by state.
If the person we care for is in medical crisis or rehabilitation, that’s an optimal time to talk with an occupational therapist or other appropriate care specialist to do a home safety assessment.
Emilia talks about the difference our approach can make to help reframe how loved ones can understandably feel about using mobility aides. The default feeling is often that using a device like a walker or lift aid represents a taking away or loss of independence. When we’re having these conversations, taking time to first think about how we present choices and their benefits can be helpful – like, “I want to support you in doing what you can for yourself for as long as possible”. So, we’re addressing the fear and grief around loss of independence along with a potential help.
For those of us who provide educational support, training, or instruction, as care professionals, it’s important we’re clear about our role – which is not about trying to fix a single specific problem or situation, but rather asking ourselves, “What information can I share to help care partners make more informed decisions now and in future?” This is empowerment.
We need to take our physical strain and limitations seriously. Ask yourself, your support group, or consult with a professional about what kind of device aids, tools, or other assistance can help ease the strain of transfers or other daily caregiving activities.
Resources Mentioned in the Episode
- HESTIA (Home Evaluation System with a Triangulating Integrative Approach): The study Emilia mentions that she is a part of that is working to develop a home safety assessment for nonmedical professionals.
- Home Modification Occupational Therapy Alliance: The website Emilia mentions that you can use to find occupational therapists that specialize in home modification.
- Home Modification Information Network
- Administration for Community Living
About Emilia Bourland
Emilia Bourland, OTR, ECHM is the president and founder of Higher Standards Caregiver Training, as well as co-founder of The Purpose Project. She has been an occupational therapist for over 10 years, working in adult settings ranging from home health to the ICU, and everywhere in between. Emilia has worked as adjunct faculty at Texas Woman’s University, teaching masters level occupational therapy students both hands on clinical skills and advanced professional reasoning. She has taught safe handling and care skills to nurses, caregivers, and clients/patients since the start of her career as an occupational therapist, providing direct training to thousands of people, in addition to logging tens of thousands of hours in her own clinical practice. Emilia holds her master’s degree in occupational therapy from Texas Woman’s University and her Executive Certificate in Home Modification from the Leonard Davis School of Gerontology at the University of Southern California. She is nationally registered with the National Board of Certification of Occupational Therapists and is licensed as an occupational therapist in the state of Texas. Emilia has been academically published in “Topics In Stroke Rehabilitation,” and is the creator of “The Guide to Successful Aging” Planning Tool.
[00:00:06] Emilia: There’s always a way. That’s why I’m an occupational therapist. That’s why I do what I do. There’s always a way. The way might not look like we think it should look or like it used to look, but when we open up our mind to the possibilities, when we stay open-minded as to how something can happen, it’s limitless.
[00:00:51] Dannelle (Recorded): Hello and welcome to The Caregiving Soul. The Caregiving Soul podcast is a series of conversations about what it’s like to care for loved ones in need, and how we can better navigate the relationship, and the physical, emotional, and logistical complications we encounter as partners in care.
[00:00:29] I’m your host, Dannelle LeBlanc.
[00:00:56] [Music Ends]
[00:00:56] Today we’ll be speaking with Emilia Bourland. She’s the president and founder of Higher Standards Caregiver Training©, as well as co-founder of The Purpose Project. She has been an occupational therapist for over 10 years, working in adult settings ranging from home health to the ICU, and everywhere in between. Emilia has taught safe handling and care skills to nurses, caregivers, clients, and patients since the start of her career, providing direct training to thousands of people, in addition to thousands of hours dedicated in her own clinical practice.
[00:01:37] Today with Emilia we’ll discuss ways to reduce risk of physical strain or injury with help from mobility devices, adaptive equipment, and transfer techniques. Also, resources for home safety, home modifications, including low or no cost recommendations and support for more independent living.
[00:02:03] In this episode we talk a lot about empowerment from both care partners’ perspectives. To be clear what we mean when we talk about “empowerment”, it does not mean we suddenly know how to do everything, but that we can have greater confidence in hard decisions, and quality of care, when we’re armed with the right information and resources.
[00:02:29] Welcome to Emilia Bourland!
[00:02:35] [Music Ends]
[00:02:35] Dannelle: Emilia!
[00:02:37] Emilia: Hey Dannelle! What’s up?!
[00:02:40] Dannelle: How are you, my friend?
[00:02:42] Emilia: I’m fantastic. Any time I’m talking to you, it’s always a highlight of my day.
[00:02:47] Dannelle: You know I love you too. I love seeing your face. I love being in your company. You have such wonderful energy and I’m just excited. Thank you so much for being here.
[00:03:00] Emilia: It is absolutely my pleasure.
[00:03:02] Dannelle: Emilia, I am super excited for our listeners to have the opportunity to get to know you because when I first met you, and started learning about what you do, and how you really make an impact, make a difference, in the physical stress, along with your understanding of the emotional challenges of caregiving, it was just a unique way to approach caregiver support.
[00:03:31] To allow our listeners to get to know you a little bit, can you share with us what your three core values are and how they connect to your work and your caregiving experience?
[00:03:44] Emilia: That’s a really good question because as you know already everything that I do and every decision that I make is really driven by my values. I do a lot of value checks all the time to make sure that the decisions I’m making, in everything that I do, are in line with those. I’d say that my top three values are really truly education, respect, and empowerment. For me, that defines everything that I do.
[00:04:09] Back when I was working clinically, if I was working with a patient or client directly, or providing family caregiver training, sort of at point of service, one-on-one, I think that any valuable interaction where people can actually get something out of it starts from a place of respect. I can never approach anything as the end all be all, know it all, expert who’s going to tell someone else what to do. I don’t have the right to do that.
[00:04:35] I approach every interaction and relationship from a position of thinking about it as a respectful partnership, where I’m bringing something to the table in terms of my skills and knowledge, but the person that I am speaking with and working with is also bringing something to the table because no one knows them or their situation better than they do. Everything that I say to them has to respectful of their perspective, their situation, and what they’re really facing day to day, because there’s no way that I (not being them), there’s no way that I can possibly understand that. In order for someone to actually be able to get what they need out of the information that I’m trying to provide, I have to start with respect.
[00:05:18] Then education – that’s mostly what I do. Even when I was in clinical practice and I was in a hospital or rehab and seeing one person after another, the most important thing that I think I’ve ever done, always, in any interaction, is provide education, because, at the end of the day, I’m only there for a short period of time. The way that I really make an impact on people is through sharing valuable knowledge that they can actually apply to their situation, that they can use to go make their lives better. I think actually that people are smart. If you give them the right information, if you give them high quality information and high quality tools, they’ll be able to go and apply those things. I think that’s always the most important part of what I’ve done as an occupational therapist – is just helped to provide that quality information in a way that people, hopefully, can actually respond to and apply in a positive way.
[00:06:10] Empowerment is what we hope – I’ve got my fingers crossed here – is the natural by-product of both of those things. When you provide people with high quality information, when you interact with them in a respectful way, then the goal is to empower them to make good decisions that can protect them, that can protect the person they’re caring for, that can ensure that everyone has the highest quality of life possible. That’s really the goal – is to give people these tools and let them make the decisions that they need to make based on their personal situation, and empower them to live the best life possible.
[00:06:45] Dannelle: You know what, there is so much fantastic about what you just said. First of all, Emilia, I’m so glad that you emphasize respect and how it’s tied to empowerment because that approach helps us as caregivers to feel like, “Okay, I do know what I’m doing. I just need some additional information to help me along the way”. It also helps us when we’re looking for educational resources for ourselves to look for that standard of the type of help and support that is going to empower us, and not necessarily just solve an immediate problem for us, because we know our loved one better than anyone else. And I think that’s a big reason why the educational programs that you do are so effective.
[00:07:43] Emilia: Yeah, I think that, just for example, if you were to take one of my courses, say on transfer training, really high-quality education is not just about teaching someone how to do that transfer, saying, “Do this, do this, do this”, because in the real world, things don’t always look like a perfect transfer scenario.
[00:08:06] Dannelle: Right.
[00:08:06] Emilia: While you’ll see me do demonstrations of what a transfer should look like, and how to set it up, and things like that, the real educational part of it is not just me telling you what do, but why it is you should be applying these concepts. If you know why I’m asking you do something, or I’m making a recommendation, then that helps you to apply that knowledge in the best way possible, regardless of the situation. I think that that’s really the difference between providing real educational content that actually helps people to continuously make good decisions versus just giving them a one and done demonstration of, “Do it like this, do it like this, do it like this”.
[00:08:49] Caring for someone is not paint by numbers, unfortunately, it would be easier if it was. What we really need to do is try to provide information that talks about the why, in a way that’s not overly technical, that is accessible to people no matter who they are, that explains things in a way that actually makes sense in the real world, so that they can take that information and run with it and not just be like, “Okay, but my situation doesn’t look like what she’s got in the video”. Cause most situations won’t look exactly like what you see in someone else’s video.
[00:09:25] Dannelle: That is hugely important for any of us who are providing educational support, or training, or instruction, as care professionals, or healthcare workers, for any of us who are providing that type of service for family members, that we ask ourselves a question, “How can I help this family caregiver continuously make good decisions?” If we ask ourselves that question then that will set the framework for how we deliver the program and ensure that we’re focused on that empowerment that you’re talking about. I love that.
[00:10:07] Emilia, we as family caregivers, we’re juggling so many different aspects of our loved ones’ health and safety. I would like our listeners to understand more about how your work as an occupational therapist helps prevent injury and support greater independence through mobility aids, for example.
[00:10:30] Emilia: As an occupational therapist, it’s really my job to think about the whole big picture of what is happening in a situation. It’s my job to help people do the things that they want to do, that they need to do, and that they have to do, regardless of the circumstances. Understanding that I’m not just looking at the physical characteristics of the people that are in front of me, I’m also thinking about the environment that that activity has to take place in, and also the demands of that activity itself. Because I’m thinking about that whole picture it actually gives me a lot of tools in my tool box to help people make things happen that they need to make happen, because sometimes we can’t change all of the physical characteristics about a person, right?
[00:11:09] We can’t change, necessarily, their cognitive characteristics, or their sensory characteristics, or whatever they are. Sometimes we can, though, make small adaptations in the environment. We can rethink the way that something is being performed. Certainly, a part of that is bringing in different mobility devices, or different adaptive equipment and aids, so that we can help support safe movement, and safe care, that allows people to perform that care in a way that is gonna prevent injury or illness in the person they’re caring for. But course, it’s also going to physically protect that caregiver themselves.
[00:11:50] I think just recognizing that being a caregiver is not just emotionally draining, and mentally draining, and exhausting – it can also be physically really challenging, and demanding, and exhausting. It’s important to think about ways that we can protect all of those aspects of the person and not just one. And so, certainly mobility devices, and adaptive equipment, go a long way towards making care possible, in a way that’s going to help protect everyone physically.
[00:12:20] I myself, I’m like 5’5”, I’m like a buck 20. I’m not a big person, but I can move bigger people, and I don’t know how many transfers I’ve done, like tens of thousands, honestly, over the course of my career. The reason that I can do that is because the most powerful part of me, just like the most powerful part of a caregiver, is my brain. It’s not my body. It’s my brain. And that’s the same for any caregiver that is out there.
[00:12:47] It’s about how do I think about this situation? What are the tools that I have available in order to help make this happen? And then of course also understanding where is my actual physical boundary? When do I need assistance either from a device or from another person? And knowing where that boundary is, because no matter how big and strong you are, there is a physical limit to what you can actually endure. And it’s important to know where that limit is so that you can get the assistance that you need.
[00:13:18] Dannelle: Yes, knowing what our boundaries are. I would love to hear an example of how a small adaptation that you recommended for one of the family caregivers that you work with made a difference in the physical stress, helped them to avoid injury and to continue doing transfers?
[00:13:41] Emilia: Here’s a great example – this is something that I’ve trained people in really commonly, but I’m thinking of a very specific mom and her son that I worked with. This son had, unfortunately, had an accident that caused him to have a pretty high level spinal cord injury. His mother was providing all of the care for him and had for some time. Just a little bit of information about spinal cord injuries, for anyone who might not be familiar, it’s an injury to the spinal cord that can happen in many different ways, shapes, and forms.
[00:14:12] What happens often is that below the level of that injury in someone’s spinal cord, that person may not be able to move. They may not be able to have very much sensation. And of course, there are different gradients of that, but this particular gentlemen, unfortunately, had a relatively high level injury and he had no movement, and no sensation below that. What this mother had been doing, and she was a teeny tiny little woman – never doubt the power that a tiny person can generate, if they need to – but she was doing a total assistance transfer for everything that he needed to do.
[00:14:48] Dannelle: Emilia, when you say “total assistance”, can you define what that means?
[00:14:54] Emilia: Yeah, absolutely. Her son was completely dependent during the transfer. She was lifting 100% of his weight and performing all aspects of that transfer on her own, which is a lot, it’s a lot for anyone. It doesn’t matter if you are a professional licensed therapist, or a family caregiver, doing a total assistance transfer, or a fully dependent transfer, multiple times a day, you’re going to get hurt. You will get hurt eventually doing that. Of course, then when you get hurt, there’s also a question – does the person that you’re caring for get hurt at the same time? This is not something that we want to happen. We want to avoid this at all costs.
[00:15:33] What I did is I trained her in using a really simple piece of equipment called a sliding board. Anyone who might be watching this can probably see one sitting on the couch, actually, in the background behind me. If you’re not watching I’ll kind of describe it for you. A sliding board is literally a fancy piece of wood that is designed to help people transfer by them sliding themselves, or you sliding them along it. So basically I taught her how to use the sliding board to make it so she wasn’t really doing a lot of lifting during those transfers. What the sliding board allows people to accomplish is that you are not lifting, you’re not responsible for that weight. The weight of the person is always supported. Instead they’re just sliding along the board.
[00:16:16] It can also help people to actually participate more sometimes. You know, a lot of times we think people cannot participate when in fact they can, and in this particular situation, actually, the son was able to contribute and participate in that transfer using the sliding board. It literally took weight off of her shoulders. One – just because the weight of her son was being transported by the board versus by her own body, and second – because he was actually able participate in it more himself. That’s not just good for her, that’s good for her son too, to have some sense of agency, to have some sense of control over his own body, to realize that maybe things are possible that no one thought was possible.
[00:17:01] And actually, this doesn’t have anything necessarily to do with the transfer caregiver training, but in that same session he took his own shoes off and put them on for the first time in about two years. That’s one of my favorite memories from working clinically as an occupational therapist. That’s not because he couldn’t it before. I am not magic, but as an occupational therapist, it’s my job to show people what’s possible. When you show them what’s possible, this whole world opens up.
[00:17:30] Dannelle: Wow. You not only empowered her as her son’s caregiver, but empowered him as well. That is amazing. That’s what happens when we approach caregiver support and education from a place of respect and empowerment.
[00:17:50] I hope that for anyone who is listening, who doesn’t necessarily have a professional in their orbit right now, who provides that type of support or training, that the truth is still true. There are ways to, there are possibilities to, make things better and to be empowered for yourself and for the loved one you care for.
[00:18:17] Emilia: There’s always a way. That’s why I’m an occupational therapist. That’s why I do what I do. There’s always a way. The way might not look like we think it should look or like it used to look, but when we open up our mind to the possibilities, when we stay open-minded as to how something can happen, it’s limitless.
[00:18:38] Dannelle: That’s why it’s our brain that is our most important muscle.
[00:18:42] Emilia: That’s right.
[00:18:43] Dannelle: ‘Cause it’s about that mind shift.
[00:18:46] Emilia: I’m going take a little step back there and just make sure people understand, do not go to Home Depot and just pick up a piece of wood, and use it as a sliding board. That will not work very well. They are actually pieces of equipment, that are specifically made for this, and they have different weight ratings well.
[00:19:05] If you’re someone where maybe the therapist you’re working with has recommended a sliding board for you, then you want to make sure that you are purchasing a sliding board that is rated for the weight of the person that you’re providing care for. That’s an important safety thing to know about them. It is a piece of wood but it’s a special piece of wood that’s actually designed to do this. So, we want to make sure that we’re using it safely.
[00:19:29] Dannelle: Where can we find the sliding board?
[00:19:32] Emilia: Without having to order it through a professional or something like that, they’re super easy to find. The one that I have that I use for training here I got off Amazon. You can actually find a ton of durable medical equipment on Amazon for much cheaper prices than you would get them through your standard medical supply, or certainly through ordering them through the hospital or rehab or something like that.
[00:19:56] As I say that though, it really is important to make sure that you are ordering the correct piece of equipment though. So, I really recommend, don’t just go on Amazon or go to some durable medical equipment supply place and start ordering whatever you think might work. I have seen a lot of people get into bad situations because they ordered something that maybe their aunt Susie told them to order or that they saw and they thought would be great, and unfortunately, can cause the situation to be a lot worse. So, you do want to have some professional guidance in what you order, in order to make sure that it is actually an appropriate fit for you and your situation.
[00:20:34] Equipment is only as safe as we make it. I say that like a thousand times a week, because it’s true. So, you want to make sure you’re getting the right piece of equipment. But as I said, honestly, Amazon is a great place get that kind stuff. I am not an Amazon salesperson, just full disclosure. I get nothing from Amazon or any medical equipment supplier. It’s just an easy way for a lot of caregivers to do it, but you can also get a lot of durable medical equipment, not necessarily sliding boards, you can buy a lot of it at target, you can get it at Walmart, you can get it at your local drug store. There are lots of places that sell this kind of equipment for relatively inexpensive prices. Again, the most important thing is that you are making sure to get the equipment that is right for you and it is worthwhile to talk to a professional about that.
[00:21:22] Dannelle: Absolutely good to know. Emilia, many homes aren’t built with accessibility in mind because no matter how much we use our brains, we do need to make adjustments to our home environment in many cases. And many homes aren’t built with that accessibility. What kind of home assessments can help accommodate mobility aids, minimize safety risks? How do we do that? How do we start out finding the right, or making the right, home assessments?
[00:21:56] Emilia: I’ll be honest with you – I think it’s actually really challenging to do an effective home assessment, as a layman. That’s not because the mindset isn’t there. It’s just because there are a lot of little things that go into making a home assessment effective, not just from looking at the right things, but then understanding what to do with that information once you see it, that really do make it worthwhile to work with a professional. The most effective person to do a home safety assessment is an occupational therapist, and I don’t just say that from my opinion. There’s actually a large amount of research demonstrating that home modifications and home safety assessments that are led by occupational therapists are by far the most effective. Not just in terms of preventing falls and injuries, but also in terms of actually having people use the recommendations that are provided to them.
[00:22:54] An example of an assessment that I have commonly used is something called the SAFER-HOME. Again, that is something that’s meant to be used by professionals. And actually, this is really exciting, I’m participating in a research study developing a tool that can be used by nonmedical professionals, specifically for home safety assessments and home access assessments. I’m a participant on that study, it’s through several different universities around the country, and they’ve been developing this tool for several years now. I was actually able to go out and use it a couple of years ago to do home safety assessments.
[00:23:34] And one of the goals of that assessment is to create something that people who are not healthcare professionals will be able to use to go and do effective home assessments and that will actually help to generate the right recommendations for them based on the input of clinical professionals like myself. I have no idea what the timeframe is on that y’all, I’m sorry. I have no idea, but they’ve been working on it for a while. It’s pretty cool. And so, things like that are coming to make it more accessible for people, because I realize that it’s really easy for me to say, “You need a professional, you need a professional, you need a professional”, but it’s not always that easy to actually access a professional. There are folks who are out there working on ways to solve this problem, specifically in terms of assessments that are available to the general public.
[00:24:23] Dannelle: Something for us to watch. Let’s say we want to hire a professional, an occupational therapist specifically, is that something that is normally covered through home health services or what does that look like when it comes to typical private pay insurance benefits versus Medicare, Medicaid, or a supplemental program? What does that look like?
[00:24:50] Emilia: It is complicated. Honestly the most accurate answer is that it can be very complicated. I’ll try to answer that in a slightly more helpful way though. If you have insurance benefits that cover home health, then one of the easiest things to do is to make sure and request an occupational therapist come out and be part of your home health process. That’s one of the most traditional ways that people would typically access a therapist coming out to their home to actually do a safety assessment.
[00:25:21] Now, sometimes if someone is being discharged home from rehab, then you may also be able to get an occupational therapist out to do a home safety assessment at that time. When I was a brand-new therapist, a long time ago, that was actually pretty common. It’s gotten harder and harder to get occupational therapists, and physical therapists as well, out into the home before someone is discharged home from rehab, for various reasons, over the last several years. But if you request it, it’s much more likely that it’s going to happen than if you don’t ask.
[00:25:54] In healthcare you must advocate for yourself, not because the healthcare providers around you do not care, quite the contrary, we care deeply. It’s just that there are so many demands being placed on your providers that they might not be thinking of everything. We’re people, we’re humans, we miss things too. It’s really important that if you have a need, if you have a desire, that you ask for it. That’s the best way to ensure you’re actually getting that opportunity to have someone come out to your house.
[00:26:23] Certainly, there are lots of circumstances though, where people really need to have someone come and do an assessment and they are maybe not under the care of an occupational therapist currently, or they’re not in that system. Life goes on after discharge. People still have needs after discharge. If you need someone to come and if you’re looking specifically for an occupational therapist to come out to your house who specifically works in home modifications, then there is actually a website that has a national registry of occupational therapists, and you can search for one in your area. Where you can find that resource is Home Modification Occupational Therapy Alliance. The website is hmota.net. You can go and you can literally hit a button that says “find an OT and search in your area”. So, that’s a really great way to do that as well.
[00:27:16] Dannelle: That’s really important for us, particularly if there’s some type of medical crisis, or our loved one is in rehabilitation. There’s so much that we’re managing already, but one of the things that we can do ourselves a favor, and do our loved one a favor, to make things easier moving forward – if we ask about getting an occupational therapist to do a home safety assessment. And especially if we are taking on responsibility – I’m willing to take on that responsibility, and this is what I need in order to do that, and then you develop your checklist, including a home safety assessment. That’s really great.
[00:28:02] A lot of times it can be challenging to accept or to integrate the use of mobility aids, not just for our loved one, but for ourselves as well. As caregivers what do you see that works to help someone better adjust to integrating mobility aides?
[00:28:25] Emilia: You have just described 99.9% of people by the way. [Laughs]
[00:28:30] Dannelle: I’m saying that with my own experience in mind. What helps?
[00:28:35] Emilia: It really goes back to those core values again. You have to start from a place of respect and a place of partnership with the person that you are trying to recommend use that aid. I always come from a point of view where it’s my job to provide the information and the education, after that I can’t control what someone does or does not do. It’s up to them to make that decision. Obviously, I want them to make the decision that’s going to be safest for them. There are two really specific things that I try to do.
[00:29:02] One is that I try to help the person to understand how using a device is not about taking away their independence, or making them more dependent, or making them feel more dependent. The use of a device is always to actually help increase independence, and increase safety, so that something worse doesn’t happen. It’s not about taking away. It’s actually about adding to independence and quality of life. It’s really important to kind of frame that conversation within the specific things that the person in front of you values and finds meaningful. I can’t go and talk about why I would use the device, or what I find meaningful about it, or what I think is important. It has to be about what that person thinks is important, where they would be using it, how it would help them to engage in the occupations that they want to engage in.
[00:30:01] When you can take the perspective of the person and say, “This isn’t about making you feel disabled. This is not about making you feel less capable. This is about providing you with options and ways to keep yourself safe – and actually going back to the other value – empowering you to continue to do what you want to do”. That’s a much more effective way to get people to actually use the devices that are being recommended. And, I have a pretty high success rate overall of getting some uptake of those recommendations, not a hundred percent. People are going to do what they want to do. That’s okay, I’ve gotta respect that. That’s not my call, it’s their call at the end of the day, but when you approach it from respect it goes a lot better.
[00:30:44] Dannelle: Yes! This is huge y’all – how we approach these conversations, because so much of these conversations are like, everybody’s frustrated. When we’re in that place of frustration, that’s a sign. Okay, step back and think about what is important? These are some things that we can do to help increase your independence and mobility. Let’s think about how we can do that together.
[00:31:12] Emilia: One of the things that is so important is this idea of control. As I think you have pointed out a lot, caregiving relationship is a partnership. The person who is being cared for often feels like they are losing control over their lives. They literally may not have control over their own body or their own bodily functions anymore. If you put yourself in that position, it makes a lot of sense. If you’re already losing control over your own physical autonomy, you don’t want someone telling you what you have to do. Heck no, don’t tell me what I have to do because I am an autonomous adult.
[00:31:45] We want to always make sure that people understand, as much as possible, that we’re trying to do things that allow them to have more control and that ultimately what happens to them is within their control. I think that’s an important thing for caregivers to think about too. I think both sides of the relationship might feel like they have no control over what is happening to them, or their lives, or their bodies. How can we work together using the resources, the tools, that we have available to give everyone back some feeling of control? That’s super important.
[00:32:22] Dannelle: Yes. Super important. Thank you so much for that insight. Doing home modifications can feel like something really big, something a lot of us put off, because it just feels like it’s just going to be too much, too invasive, take a lot of time, take a lot of money. What are one or two simple, inexpensive home modifications that we can do to make life easier?
[00:32:50] Emilia: I can think of 100 really simple, cheap, low-cost, or free things, honestly, that you can do to modify your own home, or environment, to make it safer. This is not a free one, but it’s a big one. A lot of times when people fall, they tend to fall out of their beds, or they’ll have difficulty getting in or out of bed. And one of the most important things to look at when you’re looking at that is the height of bed. Lots of people’s beds are either too high or too low. A lot of times what people think is, “Well, I have to buy a whole new bed if I want my bed to be the right height”. No, no, no. There are a lot really simple ways to do that.
[00:33:28] So, for example, if your bed is too high, which is what I see more commonly, we don’t want anyone having to like jump to the floor. Something that’s really easy to do if you have like a traditional bed that has a box spring and a mattress, they actually make low-profile box springs that are only a few inches thick instead of several inches thick. For many people replacing that, it’s generally very inexpensive to do. Just those few inches are the difference between having a significant fall risk and a really safe and easy way to get in and out of bed.
[00:33:59] If that’s still not low enough, they have these things called bunkie boards that are meant to replace your box spring and it’s just a thin board. Those are also very inexpensive. In a pinch, you can get a piece of plywood and you can put that down to replace your box spring. There are so many different ways that you can solve that really big problem, and that really big risk, super inexpensively.
[00:34:23] I think you’re right. A lot of times people think home modifications are going to be intrusive. They’re going to be expensive. Modification just means change. It doesn’t necessarily mean construction, although that’s certainly something that can be done. I have made recommendations for construction in the past. But almost no matter what, there’s always something that we can do to make the situation better, easier, safer, that just requires an open-mindedness to looking at the situation a little bit differently.
[00:34:49] Dannelle: Can you give us one more free, or inexpensive, home modification tip?
[00:34:55] Emilia: Yeah, this is something people talk about all time – your throw rugs. Oof. There also one of the hardest things for people to let go. But the fact is that in the vast majority of circumstances, rugs pretty much never make anything safer. They tend to only make it less safe. Even if you have a good, solid backing on the rug, for a lot of people who have mobility issues, even a very small, low profile rug can be a tripping hazard. If it’s not a rug that’s well secured, then it can slide, it can bunch, it can cause all kinds of problems.
[00:35:29] You can remove rugs for free. I know that’s not a popular one. No one wants do it because of the aesthetic value of the rugs and maybe the emotional meaning behind the rugs, but it is one of those things that can be really effective and it doesn’t cost anything at all.
[00:35:45] Dannelle: We might not necessarily like that answer, but we need to hear that answer. And something that just popped into head – I know it won’t necessarily work for everybody in every situation, and every rug, but sometimes you can put a rug on the wall. If it’s about the aesthetics for you, if it’s about the emotional attachment, you could put that rug on the wall.
[00:36:08] Emilia: You’re so spot on.
[00:36:09] Dannelle: Go to the craft store and get like a cheap frame, or not at all, you don’t even need a frame. If you’re me you don’t even need a frame, [Laughs] just a couple of tacks [Laughs]. Don’t do that y’all.
[00:36:22] Emilia: I actually have had people do that after getting that recommendation, and honestly it can be really beautiful, and sort of a other, kind of fun, side effect of that is if you have someone who is hard of hearing in the house, then that rug can help to dampen any echo, and that can actually make it easier for people who are hard of hearing to hear.
[00:36:43] Dannelle: There you go y’all. It’s a two for one today.
[00:36:45] Emilia: [Laughs]
[00:36:45] Dannelle: Two for one today on The Caregiving Soul with Emilia Bourland.
[00:36:50] Emilia: [Laughs] Sometimes the answer won’t be what you want it to be, and that just is what it is. You don’t have to do anything about it. It goes back to that control thing that we were talking about. It’s up to you what you want to do with it, but this is the information.
[00:37:02] Dannelle: Outside of caregiving, Emilia, what is something you are also passionate about?
[00:37:10] Emilia: We’ve talked about some of them already. I’m really passionate about my profession. I really believe strongly in advocating for occupational therapists. We’re often really misunderstood, partly because the name is confusing. You don’t have to have a job to see an occupational therapist. Also, because our scope of practice is really large, so it can be hard to describe. I believe that getting more people access to occupational therapists can really change a lot of lives and make the world a better place.
[00:37:37] I’m super passionate about home modifications and the way that, even very simple modifications, can change people’s lives and let them do the things that they need to do, and want to do, which is by the way why we all are here on this earth existing, is so we can do what we want, and what we need to. I’m really, really passionate about the power of environmental modification to do that for people. I also have a couple of kids who I really, really love. I’m pretty passionate about them. They’re fun. [Laughs]
[00:38:08] Dannelle: I’m so glad that I had the chance, we all had the chance, to learn from you today, Emilia. Thank you so much for being here.
[00:38:17] Emilia: Thank you so much for having me. You know I’m always delighted to talk to you in any capacity and always happy to share information and advocate, for people to get what they need. So, I really appreciate the opportunity.
[00:38:32] Dannelle (Recorded): Thank you for joining our conversation with Emilia Bourland.
[00:38:37] My father-in-law was a lanky 6’2 ex-pilot who had flown around the world, so his deteriorating mobility with Parkinsons seemed even more devastating. Meanwhile, I’m 5’4 on my tallest day, so you can imagine what kind of awkwardness ensued when I first started helping him out of bed, or in the bathroom, or pretty much anytime we needed to get from point A to point B.
[00:39:07] One of the things I came to dread was getting him in and out of my car, it was always literally a painful experience. Using a transfer belt or a transfer board didn’t occur to me because I didn’t know either one existed. And we had regular interactions with health care providers, in and out of the home, who saw the struggle. My best guess is that they didn’t want to interfere, but man my back would have been grateful for some help – and it was the kind of help that was easily accessible, I just didn’t know it existed until years later. So, this speaks to how awareness, well timed guidance and support from health care professionals can make a difference in some of the everyday challenges of caregiving.
[00:40:02] In my conversation with Emilia Bourland, I found the following thoughts to be most powerful:
[00:40:08] 1. Balancing safety with support for our care partner’s independence can be so challenging. Using mobility devices, adaptive equipment, and home modifications can help create a care environment that reduces risk of injury for both care partners, while also empowering more self-reliance in those we care for.
[00:40:37] 2. When we have the right information, we’re empowered to make better decisions. The disconnect between educational resources and the people who need them most is frustrating, but most importantly know that they exist, and may require a little digging to find what works. It may also be helpful to enlist a professional, or provide additional information like the Home Modification Information Network, which has been developed with support from the Administration for Community Living. On their site, you can find educational materials, programs, policies, funding, and more resources by state.
[00:41:27] 3. If the person we care for is in medical crisis or rehabilitation, that’s an optimal time to talk with an occupational therapist or other appropriate care specialist to do a home safety assessment.
[00:41:46] Consider how the following actions could help address your needs as a care partner or care partners you may support:
[00:41:55] 1. Emilia talks about the difference our approach can make to help reframe how loved ones can understandably feel about using mobility aides. The default feeling is often that using a device like a walker or lift aid represents a taking away or loss of independence. When we’re having these conversations, taking time to first think about how we present choices and their benefits can be helpful – like, “I want to support you in doing what you can for yourself for as long as possible”. So, we’re addressing the fear and grief around loss of independence along with a potential help.
[00:42:54] 2. For those of us who provide educational support, training, or instruction, as care professionals, it’s important we’re clear about our role – which is not about trying to fix a single specific problem or situation, but rather asking ourselves, “What information can I share to help care partners make more informed decisions now and in future?” This is empowerment.
[00:43:31] 3. We need to take our physical strain and limitations seriously. Ask yourself, your support group, or consult with a professional about what kind of device aids, tools, or other assistance can help ease the strain of transfers or other daily caregiving activities.
[00:43:57] For more information on Emilia, check out our show notes.
[00:44:03] Every episode of The Caregiving Soul has a page on empoweredus.org, where you can find the extended show notes – including tips and takeaways, transcripts, and relevant resource links.
[00:44:18] If you’d like to share your own tips related to this topic or connect with us, visit the Empowered Us Contact page or reach out to us on our social channels.
[00:44:30] The Caregiving Soul is an Empowered Us Original presented by Good Days, hosted by me, Dannelle LeBlanc. If you liked this episode, be sure to rate and subscribe to this show wherever you get your podcasts.
[00:44:48] And remember, the right care includes care for you.
[00:44:59] [Music Ends]
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