Speaker 0 00:00:00 You have to keep calling. You have to keep pushing to have those conversations with your providers. Um, you have to be your own advocate. Like I said, there's so many specialists that you have to, um, keep making the phone calls. I know it gets daunting and having to make phone call after a phone call to a provider to get 'em, call you back, get, get them to call you back 'cause you are so busy. But you just have to keep, um, advocating for your loved one and for yourself.
Speaker 2 00:00:27 As our parents grow older, it can be difficult to guide them through their golden years, while still respecting their autonomy and fitting it into our already complex lives. Welcome to the Parent Projects Podcast, where our guests share practical wisdom to tackle the issues that impact adult children of aging parents. I'm Tony Sievers. Thanks for joining us today.
Speaker 3 00:00:51 You know, the, uh, fall protection is something that, that is a little bit foreign to us, I think, uh, for most of our life. It's not something you think about. We, we wear helmets. When we ride bicycles. We, uh, the, these are things when you're gonna go out there and you're gonna do some pretty outrageous activities. Maybe, maybe you're watching Red Bull and you're watching those guys do some pretty insane things. And then as life starts true, as, as life starts getting a little bit older, we start understanding that we move a little bit slower, things get a little bit more difficult. And it's not a stretch to understand that our parents as they get older, have more difficulty even doing the basic items and the basic things in life. Today we're gonna talk about, we've got, we're gonna talk about that fall prevention. We're gonna talk about ways to achieve lifelong independence and autonomy for our family members by looking at fall protection with Noel Graham. Noel, thanks for joining me. I really appreciate you. You are, uh, you're joining us, I think, from Wichita today. Is that right?
Speaker 0 00:01:53 Correct. Yes.
Speaker 3 00:01:54 Awesome. We're just outside, just outside the Wichita area. Right. Um, you know, I, I didn't do, I'm driving right into this, but I'm gonna give just that, that background in how you take a look at this. You are an occupational therapist there in that market. Yeah. You're a level one trauma center. Been there for quite some time, and it sounds like, if you will, you got a chip on your shoulder watching enough people come through level one trauma centers that you want to do something about it. Absolutely. Am I catching that? Absolutely.
Speaker 0 00:02:22 A hundred percent <laugh>.
Speaker 3 00:02:24 Tell, tell us about what that experience looks like for you as they come through, and why it is you got into focusing, helping people with their parent projects.
Speaker 0 00:02:32 Uh, just, it's just devastating. You know, we just have very independent active people that, you know, are out golfing, playing with their grandkids, driving the boat, farmers, um, just working class people that are just trying to enjoy their, the rest of their years and, and just active, sometimes I feel like they're more active. They're not going to the gym several times a week, um, but have, you know, sustain a fall or, you know, maybe they had one fall and then since then they've had a fear of falling and then they just get weaker and weaker because they're not as active. And it's just really sad to see the aftermath. Um, a lot of people just aren't able to be at home, or they have to go to rehab or skilled nursing facility for weeks to months, and sometimes they never get to go home. And it's just, you know, I feel like there's a lot of, um, easy things that family members can do to help help, uh, their families age in place, or stay at home. 'cause ultimately that's where we wanna, that's where we wanna stay. Everybody wants to be at home, and I think there's some easy things to do, uh, to keep that, to make that happen.
Speaker 3 00:03:33 Yeah. There. Uh, so in today's show, we're gonna talk of some prevention. Mm-hmm. And we're gonna talk a little bit of response when you have to kind of respond off of all of that. And I know as we, we were talking before coming on the air, there's a lot of of ways to do both of those. And some, some of these activities have a spot in, in both houses here. Right. Um, occupational therapy in general, uh, for those of us that aren't familiar with the occupational therapist, what, what does occupational therapy do?
Speaker 0 00:04:05 You know, there's, there's different fields of occupational therapy. There's some for the school setting and pediatrics, there's outpatient. But in terms of, um, aging in place and geriatric older people, um, we really try to keep people at home. Um, in the hospital, what we do is we evaluate their, their balance, their strength, their cognition, um, how they do getting up and around, and how they do their self-care. We really look at, not only do we look at walking, but how do they get to the bathroom? Can they bathe and dress themselves? Can they navigate their home? Do they need an assistive device like a cane or a walker or a wheelchair? What do they need to be able to do to go home? Do they need medical equipment or are they gonna need, uh, a rehab or a skilled nursing stay before they go home?
Speaker 0 00:04:47 Um, we just really, that, that's our big thing in, in an acute care level one trauma center, is can, can we, can we help people get home? Um, with that though, a lot of people after they go home, they have home health occupational therapists, which to me, that's kind of where the heart of occupational therapy is, even though I work in the hospital and I love it, but there's nothing like having eyes and ears in the home setting to kind of look at those barriers. Like picking up, throw rugs, clean, you know, kind of clearing another path or a, a better path for people to be able to navigate to prevent those falls. Lighting is very important. Can their new walker fit through their doorways and their bathrooms that they need a wheelchair? Can they get the wheelchairs through the bathroom? How are they navigating?
Speaker 0 00:05:27 How are they making their transition from? Yeah, they could walk a straight line in the hospital to the bathroom, but what if there's other barriers and, and like I mentioned the doorways. So, um, I feel like we're kind of a global thing. You know, physical therapists work on ambulation. You know, speech therapy works on cognition, but occupational therapy, we really look at the whole picture and kind of tooting our own horn a little bit. Um, but we're able to really look at people as a whole and, and interact with doctors and pharmacists and how are their medications doing? How are their vital signs, right? So we're just able to look at the whole picture in order to keep people home and independent.
Speaker 3 00:06:02 So one of the, um, one of the ways that we talk, we talk a lot on the shows about to help a family member, uh, understand what mom and dad or other loved ones able to do, is we talk, uh, activities of daily living. And when I hear you talk off of that, I'm, I'm hearing, I'm hearing ADLs, I'm hearing you talk about those activities of daily living, but maybe more importantly about how accurate, uh, someone maybe an assessment might be. You guys having those eyes on help you understand, okay, well they can toilet themselves in the cases that the toilet is lifted a little bit higher, it works off of this, or something that sits out that way they've got a clear path that works. Am I tracking and how that relates?
Speaker 0 00:06:42 A hundred percent. A hundred percent. And that's what's really cool about occupational therapists. We have a lot of tricks of our sleeves about adaptations or like having grabbed bars installed. Do they need a toilet riser? Um, do they need a shower chair? Just all those modifications that just because you didn't have 'em before, we can give 'em to you so you can stay there and stay at home.
Speaker 3 00:07:02 Awesome. The, um, the, the occupational therapist, what, when you're, what's the fir like in a family? Do, do families tend to know what you are when they come into the er, they're working? Are they, is that something there? Do you spend some time having to explain this? Usually that Yes. That first big, yeah. Okay. That, that would make a lot of sense of sense.
Speaker 0 00:07:24 Yeah. A lot of people are like, oh, honey, I'm retired. I I don't have an occupation anymore. So that's always, I would love to change our title in that regard, but that's okay. I love what I do. Um, and usually when I, it's kind of, I always tell my students that I have them, you have to sell our service because we are a service that's, we're trying to help them. I think a lot of people, especially when I first started as a new grad, like, I've got all this knowledge to give you, well, let me, let me hear you. What, what do you need? What, what are your goals? What can I help you do? Um,
Speaker 3 00:07:52 So yeah, those, and those are, I guess you, you think of that the occupation going forward is autonomy. The occupation is independence, right? It is choosing what you want. Do you, you might be exchanging time for money while you're doing that, or you are exchanging Yeah. That time in your life here. So, awesome. I love how that connects down. You know, when, um, when we, uh, when we jump back from this, we're actually gonna run, we're gonna take our first break here. When we come back, we're gonna, we're gonna start diving into this preventative measures and things that you can do from the perspective that occupational therapist ways to make sure that your family member is main, is able to achieve lifelong independence and autonomy with a little bit of fall prevention. When we come back right after this on the Parent Projects podcast, stay tuned.
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Speaker 5 00:08:43 I always get the best parking spot.
Speaker 6 00:08:46 I think she needs a little more help.
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Speaker 4 00:08:54 A fashion statement out of anything.
Speaker 9 00:08:58 I will be fabulous.
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Speaker 3 00:09:38 And welcome back. This year or this year, <laugh>, I guess this week, uh, this year as well. We are talking achieving lifelong independence and autonomy for our loved ones. It's independence. It's the theme, uh, that we're going through over the course of the month of July. And, uh, and joining me this week, uh, is Noelle Graham, who is an occupational therapist. Level one trauma centers. Like this is Noelle. You catch us when our families, uh, when we, we end up in that, that first we and, uh, and, and we end up unfortunately working through those hospital systems and you, and you work hard. Occupational therapists like you work hard to help family members find that way to get along back at home to hold onto that autonomy as as much as possible. I appreciate being able to walk through off of that. Now, I'd really want to dive in here and, and get to a couple of these real proactive things that, you know, may, maybe, maybe families can do this before they end up in level one trauma. Maybe a family's, you know, doing this to be proactive after they've had that incident and they're trying to stay out of ending up in that, in that, um, position in the first, you know, off the top of your head, what are some of the most important things that we can be thinking about at a high level? And then let's get into some detail for them when we're looking to prevent, um, the falls and, and other things that lead us back into the hospital.
Speaker 0 00:11:00 Well, I think the first one are just home modifications, like I said, just installing grab bars. Um, well the first part would be to have an occupational and physical therapist come in and kind of look at that home setup and see what they recommend. But, uh, grab bars, shower chairs, non-skid bath mats, um, raise toilet seats. Do they need an assisted device? Um, all of those types of things as well as have their vision checked. That's a big one. Um, a lot of times, uh, macular generation, uh, cataracts can also obviously cause, cause issues with balance and way finding, um, medications is big. Polypharmacy is huge. I'm, I'm amazed every time I look at a patient's medical list. Um, and that's really important to have a really good pharmacist or a really good family practitioner. 'cause there's a cardiologist, there's a pulmonologist, there's a diabetic, um, physician, they're a nephrologist. There's all these, um, different disciplines that are need, they want to give the right medication. But sometimes you definitely, that's what pharmacists are so good about. Or a doctor, like a hospitalist before they go home can look at their meds and say, Hey, this is a contraindication of this. Or just really that follow-up is really important because, um, people are very sensitive medication. And so even just a small change in their dose can completely upset the apple cart, if you will. Um, and change the whole dynamic of how that person is doing and feeling.
Speaker 3 00:12:21 I feel like a lot of families that's really gonna resonate with them. And it's difficult because that can take, that can often take a couple of week, a week or so to really, sometimes some of that happens right away. Sometimes it takes a week or two of, of all those medications working within themself where you're taking a medication you might only take once a week. And it isn't until you hit that one that all of a sudden you're like, oh, the <laugh>. These things don't play nice in the sandbox. And as much as medical science has really, I mean pharmacologically, they're pretty good about it. One challenge seems to be that in, especially if your family's in a Medicare or Medicaid system, you, you, that that's managed by so many different people have their hands in a pot that oftentimes one just misses, you know, one might like provide that medication and, and it doesn't pick up that you're on this other medication until you have had some kind of a problem down there. Absolutely. Is that something you guys see pretty often? Or, or, or often enough? Clearly.
Speaker 0 00:13:18 Yeah. And a a long times it's really hard because it'll change two to four at the same time. And then it's like, okay, well we gotta take one, you know, one away at one time and then oh, let's change these. And it's just kind of a revolving door. That's why it's really important to have somebody skilled, whether it's a home health nurse, um, or like I said, a pharmacist or a a a sit down with the family doctor. Like these are what the meds are saying in a daily journal. If family members can say, Hey, we gave this med at this time, this was the, this was the outcome, this was the reaction. Um, and kind of do that over several days, um, to see if there's any trends or, or what's happening. The eyes on in the home is so important as you know. Yeah. Sometimes, you know, patients or family go to the doctor's office, you have 10 minutes with somebody, forget to write it all down. Or the, I've had family members that, you know, say, well, this isn't really what's happening. The patient, oh yeah, this is happening. But if you can see it in the home, that really is a true tell sign of what, what's really going on.
Speaker 3 00:14:12 Well, and and it is, it is that context. You're, uh, you say 10 minutes and that would be great, right? Nationally it's about six and a half minutes that you get with that doctor on average. And it is, and that is stating that you're also meeting with a doctor's office that's allowing and, and is already in, in line helping family members participate in that as well. Because there's honestly, look, falling, falling is embarrassing. Right? Right. Uh, uh, it's, there's, there's like two things. There's a lot more than this, but there are two universal things I see about that. Number one, when falling happens, you man, it's embarrassing. I don't care who you are. And number two, uh, it's probably embarrassing because when you see someone else fall, it kicks off humor in some way, shape or form, whether it's a banana peel or something else. It's just something you're like, oh my, I, there's this thing that happens. So trying to avoid that moment, I can see or, or talk to somebody about, uh, falls that you're making.
Speaker 0 00:15:07 Yeah. And not only that though, we have, you know, I ask all my patients, have you had, how many falls have you had in the past year? It's not even have you <laugh>. It's just how about how, how about how many have you had if you, if you've had any at all? And a lot of times they don't wanna tell you because they know. Yeah. Oh, they, if somebody knows that they're falling at home, that that's gonna kick up a red flag. They don't look at it as like, oh, well maybe I could get some help. Let's find out what's causing me to fall. It's, I don't wanna tell anybody 'cause I don't wanna lose my autonomy. But if they are, if they know that they have a healthcare provider and or a family member that's kind of saying, no, we wanna address these things so we can help you stay independent. Um, just more of a, I don't know, just kind of a support system versus I feel like they sometimes try to hide it, and I understand it a hundred percent, but if we can come at it like, let, help us help you stay at home, type of a positive interaction, um, usually goes better. Mm-hmm.
Speaker 3 00:15:59 We, we've referred, or I've referred to that previously as a push and culture just in your family, in your parents to see you're there to push in for them to try to achieve that, that independence, that autonomy. You want to do that. Right. It takes some prep and this may or may not be the best time for your, your family might not, may or may not be able to do it at the moment. They've had a, a level one trauma incident, you're trying to get back on the horse. If you hadn't had conversations before, I think you bring up a really great point. Don't get frustrated if, if they're hiding on where that is, don't make that the argument or the point of where it is. Just know what you want is an a third party someplace they're not comfortable and having that discussion on there. So find out how to have that conversation on their terms. Right. Exactly. And where they go on their turf, right. In their area where they're in terms, they wanna throw 'em out, they can throw 'em outta the house. Right. Right, right. But
Speaker 3 00:16:51 This person, you know, Hey ma, how about how about if we have, uh, you know, Joan come and come out to the house and walk through it with you and find out ways that she can keep you in that house longer and safer. So that, or find out where there might be something that she's seen it's tripped up other people, or it's made problems for other people. I gotta tell you, there are things, Noelle, where, you know, my family, my mom's going to listen to you more than she's gonna listen to me. Right. It's, uh, it's just gonna be difficult. And that those are, I I think it's a blessing of what you guys do. Um, so you, that talks a little bit about those kind of the prescription stuff, and I think we'll get into some reactive stuff as, as well as the proactive.
Speaker 3 00:17:32 So, but, but let's go, let's talk proactive on prescriptions maybe. Okay. Um, anything out there we can be thinking about proactively, uh, specifically for managing of medications? I think you said journaling, by the way, that was not a paid plug. Everyone knowing that what's, what's coming in in August with the new parent projects app, <laugh>, our web app is the ability to see those things and to track those medications. And I did not set her up for that. He did not. But other than kind of journal you talk, maybe journaling that and so that we can go back and, you know, see that ahead of time. Anything else proactively around medications we could be thinking about?
Speaker 0 00:18:09 Um, definitely at a regular check of vital signs. I see a lot of drugs that <inaudible> or feeling lightheadedness or affect your balance. But vital signs are, especially orthostatic hypertension. I see that a lot when people go from a laying down to a sitting to a standing position. A lot of, a lot of medications, um, can affect that, that, that blood pressure. Um, the other thing you have to be very careful about is diuretics. Because what that does for people that have congestive heart failure or kind of any kind of edema at all, you, they, it helps you flush out those fluids, but it also dehydrates you. Mm. Um, so that's very, very concerning as well. So, like I said, get, get yourself a really good pharmacist anytime. You know, don't just have your prescriptions filled. <laugh> have a conversation with the, with the pharmacist.
Speaker 0 00:18:59 Every pharmacy I've ever been to, you can call. I, I even my dad's a pharmacist, but sometimes if I, he's not available, I call the pharmacist. And they're, they're very, very willing to answer all of your questions. They're very proactive and they'll go to bat for you and call the physician and say, Hey, you know, this is what the, the family's seeing. Can I try this instead? So, um, I, that's one of the things that I would recommend for sure. Also, I would have family members go with their, with their loved ones to their doctors too. Like I said, you know, it having two sets of ears and, and eyes and kind of communication is really key. Um, a lot of people don't think of things at the same time, or like I said, they don't necessarily wanna provide that information for concern of not being able to stay at home. But it really has to be a team effort. Um, and I think that, like I said, more people involved in the process is gonna be really beneficial.
Speaker 3 00:19:48 Yeah. I I I, another part that I'd state is when, or that would stress too, when we participate, when we start participating with a family member, an older family member in those medical appointments, I, if the early ones, remember it's about you're, you're building, you're building a rapport here. Exactly. And a trust to be able to hold onto their autonomy. So it's a, it's a time to, one of the best things I, I, I recommend to people is to listen at that point in time and just understand what their perspective on it and what it is that they're, how they're couching, what's going on at home. If you have that visibility, you know, wow, this is really quite a show that's going on back at the house and they're choosing to put it forward in this particular way that might tell you you don't have the right doctor relationship for them.
Speaker 3 00:20:34 Right. It might, it might tell you that it's, they don't, it might tell you that there's a cognitive inability, it might tell you that they just don't trust. And you, you can start to pick those things up a lot easier if you take up less of the time trying to communicate into that gap. Absolutely. And spend more of the time just listening to where they're going and how they would explain that. Right. And then potentially, you know, reminding, as you pointed out, they're not, when, when, when my grandparents were, were younger and when they were using medicine from that side, my grandfather used to talk with me a lot about this. My grandmother did too, actually. That they would, they knew their doctors, they knew their kids. They knew where that, like, they would spend a significant part of their appointment time talking about that stuff like you doing, where is it at? And they built that rapport and it used to be kind of part of what it was. And the reason my grandparents would talk about that is 'cause they were complaining that that doesn't exist anymore. That's right. Like, doctors don't care. They don't care to understand that and they don't work through that. Truthfully. Probably a part of really just the payer model of how much time they have and where they have to go. But, um, yeah, that was that expectation. They may have that expectation and we might have to be helping them with that.
Speaker 0 00:21:47 Right. I think one thing for sure, now I try to empower my patients is you have to keep calling. You have to keep pushing to have those conversations with your providers. Um, you have to be your own advocate. Like I said, there's so many specialists that you have to, um, keep making the phone calls. I know it gets daunting. And having to make phone call after a phone call to a provider to get 'em, call you back, get, get them to call you back. 'cause you are so busy. But you just have to keep, um, advocating for your loved one and for yourself and, and really build like that support system. Like we were talking about, nurses, pharmacists, doctors, therapists, um, chaplains, whoever, whoever needs to be involved to get the whole picture. Because, you know, I kind of think I'm not, I'm not very far off from meeting the services myself and, and, and my parents as well.
Speaker 0 00:22:32 And so how do I wanna be treated as an individual when this happens to me? Um, we kind of talked about even autonomous and independent your whole life. What does that mean? Wanna look for me? How do I wanna be t treated? And you're not gonna get there. What I, for lack of better term, buy-in, but it's their life. You have to find out, you know? That's right. You, you may be able to make all these suggestions, but at the end of the day, my, my first part of my conversation is what do you want? How do you want the rest of your life? What do you want, want it to look like? And there may need to be some modifications and some changes, but I wanna get that as close to that picture as I can. And, and having somebody talk to you about that versus, you're not doing this, you're not doing this. Why aren't you doing this? You can't do that, mom. You can't do that. Help me help you to stay at home. What can I do? What, what's important to you? Maybe we can kind of, you know, give and take on some things. Um, yeah. Just to make sure that they're, that they're, I mean, it's their life. How can we help them? Well,
Speaker 3 00:23:24 You, that also opens a conversation to be realistic with yourself and with your family member. First of all, your, your parents don't want to, A lot of reasons why they don't talk to us about stuff is 'cause they don't want to trouble us. They know we're busy. They know we have a lot that's going on, right? Mm-hmm. <affirmative>. And so being honest, sometimes I've just thrown up and say, well, I, this is how much time I have to do this. It seems like you need this and this and this to be autonomous. I don't have the time to be able to push in and do that. Let's see if we can find somebody else. You, you don't want to do that. Or you can't do that. You don't want to vacuum the house or clean the house. It it, that's not how you wanna spend that time.
Speaker 3 00:24:00 I don't have the time to work off and do that. It would make sense. We're gonna find somebody to do that. It's their responsibility, but it's your responsibility on behalf a clean house. Right. And have a safe house. Right. That's not my responsibility. It's your responsibility from that. Right. So, so how do I help you to be an autonomous? You have to be able to exercise that responsibility. How, what can I do? Like, let's go find someone who can help you do that, who does wanna do that and doesn't mind doing that for you. And, uh, and then you can start working through these other realistic things. That seems to be that, uh, as I watch all of these industries, you know, more than 70 industries of people that touch a family, uh, and that's just what we found so far. That touch of family going through this, they all come into their piece.
Speaker 3 00:24:44 The best of what they have to offer comes one, mom and dad don't wanna do that thing anymore or can't do that thing anymore. And oftentimes the way that we approach it is, it's, it's when we don't want to do it mm-hmm. <affirmative>. And it's honestly not our obligation off of that. Right. So when we throw that back up and we let mom and dad kind of pull those people through, it gets easier. I love the use though of, of third parties to come in and to help communicate. That makes a lot of sense. Whether it be that the, the, um, occupational therapist or it be a pharmacist that's able to, to look at all the scripts, uh, and walk through something like that. Let's, um, let's talk about home order. Mm-hmm. <affirmative> setting, setting a home in good order. Right. Of, of what that would look like. Um, you know, one story I shared with you before, and I'll briefly throw it down, was an ear, an early client move management who told me she had, you know, a good two to four hours of good energy every, every day. That's what she had. Right. And she didn't wanna spend it vacuuming her house. And so where that discussion led off of that was, could have been someone to come in and do that, but for her it was like, uh, do you need this much house?
Speaker 0 00:25:58 Right. Right.
Speaker 3 00:25:59 And, and she was like, do you want this much? Well, maybe I don't want that. And that is literally what she said. Right. Maybe I don't want that. Maybe I don't need all this 'cause I don't wanna clean all of that. I don't wanna take care of all of that. And that drove into that next conversation. Mm-hmm. <affirmative>, what are the things that you would re make a recommendation for of preventatively putting a home in good order as they're getting older?
Speaker 0 00:26:22 Well, like I said, just having an occupational or physical therapist come out and evaluate that. But the big thing is just removal of clutter. You know, we talked about that, um, that generation where there wasn't a lot of extra and just all the mementos through the year that you, from your kids and your grandkids, it all just kind of starts to pile up. But like you said, that two hours of energy to us, it's like, well, just let's clean it up. Take it room by room. But if somebody, like you said, only has two hours of energy, that that becomes very difficult along with the kind of the nostalgia of, okay, well let's take a picture of this and then maybe not keep it, um, clearing those pathways. Because a lot of times when people are older, they start to use assisted devices like walkers and wheelchairs.
Speaker 0 00:27:02 They might not fit through those doorways anymore. What home modifications can we do, um, to gain them more access? Or like you said, do they need to move to a smaller apartment or a smaller place? Um, picking up throw rugs for sure. Um, I know that's a lot of times, um, one of the hardest things to convince people to do, but as we age, we, we lose that elevation or leg or leg weakness to where in our balance and our vision, we're not gonna see all of that or even have that appropriate reception in our extremities to know that that's there. And that could easily cause a trip. Um, as well as, um, pets are a big thing too. I've, I don't know how many people I've said, oh, I tripped over my cat or my dog. And, um, that's a really tough conversation to have that maybe we have somebody that comes and takes 'em for a walk.
Speaker 0 00:27:45 And you know, when you are getting up and around, there's different things. You know, there are a lot of dog walkers or, or vets that, or people that can come out and help you with that. Um, I have had a lot of patients say, uh, you know, I'm, are I ask 'em, are you responsible for the cooking and cleaning and laundry? Uh, yeah, but I haven't done it in six months. You know, so that, that's also a concern for safety and cleanliness and hygiene as well. Um, but, and like I said, all those home modifications, bathrooms are a big place for falls too, where we can definitely keep people safe. Lighting is a huge thing. You know, if, if there's not good lighting, that's a really easy thing to, to fix a couple extra light bulbs or a couple other installations or, you know, uh, lamps to be put in so that there's good lighting.
Speaker 3 00:28:27 Yeah. And that's an inter lighting's a really interesting one because it looked, it looked a lot different than what I thought good lighting was. Mm-hmm. <affirmative>, my, um, you know, in my first parent project it was, it, uh, the skylights everywhere. It was gorgeous. It was, there was, there was plenty of light off of all that. That wasn't actually the type of lighting that, that they needed. They needed lamps on countertops, kind of task lighting. Right. That sat over the top of something. And, and that was, um, and that was our quick, honestly, that like, <laugh> made a huge approach up front. Right. And it was one way that we could, we could recognize where things were going was, oh, we just, we're gonna set lamps. We're gonna set lamps into some areas. Add that into it if you, until we determined, okay, well what needs to be installed?
Speaker 3 00:29:11 Do you need under counter lighting? Do you need, what would that look like to be there long term? And every situation, every family situation's different for how long, you know, and what modifications really to, to make to a house you can, so you could, you could add lamps in order to provide that at that side. Or if you know, this is the Alamo and it's a place where you think they're, you, you really, they wanna write it out mm-hmm. <affirmative> that might make sense to, to invest in some of that, that lighting that looks a little bit different there. Or softer lighting. Right. Um, the different colors.
Speaker 0 00:29:41 Sure. Motion lights are really important too. I've had a lot of patients say good things about that, especially at night. You know, if I get up in the middle of the night, I'm disoriented. I can't see where I'm going. So you throw a couple years to that and that makes it that much more difficult. And then you throw a balance issues, um, that becomes a, a real big thing. We have a lot of people that fall at night, so even having those motion textures when a detection, when you get up that cues the lights to come on and you auto that way, you're not reaching for the lamp or, you know, you don't, you can't get to the switch fast enough because it's across the room, you know? Right. That way, that motion detect, so you're getting up or you're entering the bathroom and it comes right on and you got your light. So that's also something,
Speaker 3 00:30:20 And, and they do, they do make, I've seen lots of great products on, on the marketplace for like underbed lighting so that when they step down, that light comes on and it lights up that general area there, uh, you know, top just really, I have a note here of a couple of those, those big ones working from that. Um, you're talking about pets. I know, uh, like pets that they, where they're maybe litter boxes for cats or something mm-hmm. Are in smaller bathrooms, but that bathroom now there's, in the way off of that bathroom become a trip hazard, particularly at night when they're trying to work through it. Uh, we see light in that lighting in particular over stared areas where they come back in the back, the back stair. We pay attention to the front of the house and we look at accessibility off of that. But think through when they're gonna go out the back and if they're gonna check something out at night or how do they do those basic tasks? How do they take garbage out? Right.
Speaker 0 00:31:13 What's
Speaker 3 00:31:14 That route look like during the day? What does that route look like at nighttime? And are those all safe places railings on, on, uh, steps. Right. Things like that. I'm, I'm imagining are all the stuff that you guys like to hear and see happening at home?
Speaker 0 00:31:28 Absolutely. Yes. <laugh>
Speaker 3 00:31:30 Is there, um, you know, I, I know we've had a checklist in the past that had been done, I believe it was University of Colorado, uh, that had provided that. And I know the at, I know the resource, it's an older resource, but it is, uh,
[email protected]. Do you guys have a, is are there handouts or is there a good guide that you can think through that's out there for walking through the house yet? Or have you run across something that you like to use at all?
Speaker 0 00:31:53 Um, I was actually looking on the C d C website. There's a lot. I mean, you can Google fall prevention and there's just tons of strategy. I think there's really not any bad <laugh> information. If you, if you know what I will, I mean, even if another website had three different ones than the, the, the previous one. Knowledge is power. Yeah. And mind. So, um, absolutely. I, I know for sure C D C a lot of medical journals have that, um, that information
Speaker 3 00:32:20 And, and those are, um, you know, those are just walking as, as I've seen 'em before. Like, you're just making your way through the house, spend one of the trips. I know a lot of us, it's, it's probably the holiday time. Mm-hmm. <affirmative> when you're out there visiting, maybe you did the 4th of July, maybe you've got another trip that's coming up in the fall. Um, you, we tend to see a lot of 'em between the week before Thanksgiving through New Year's is a time where people get back there and they're like, oh my gosh, if you are prepping for that trip, this is something you want to be prepared to do. Right. <laugh>, right. As you're, uh, yeah. Yeah. As, as you were looking at people and talking through, know what those ADLs are, the activities of daily living, uh, so that you know what you're looking for and how to communicate that effectively to the occupational therapist, to the, you know, two of their doctors on that side. And then do a walkthrough off of that. Um, in prepping on home modifications, uh, let's talk about what, what do we put? Bathrooms? Bathrooms are, man, they seem to be the room of trouble. Mm-hmm. <affirmative>, what, what are you aware of out there? What, what's the type of stuff we're talking about?
Speaker 0 00:33:24 Um, for sure non-skid bath mats, put those down or non-skid grippers. Um, even if bathrooms had those grippers, you know, the stickers they had 10 years ago, I guarantee you they're not working. <laugh>. Um, also I do recommend sometimes people wear the non-skid booties that you usually wear home from the hospital. You can wear those when you're in the shower to give you a little extra, a little extra traction. Okay. Grab bars for sure. If you don't have something to hold on steady, um, when you get up or, or sit down on a, hopefully you have a shower chair. Um, I think that, you know, anything to give you a little extra balance. Shower chairs are amazing because a lot of people can't tolerate standing very long. A lot of people in that warm, hot, moist environment tend to get dizzy, especially if you have medications that are already causing you to be dizzy.
Speaker 0 00:34:09 Um, another thing I really think is underutilized are the tub transfer bench. They're actually shower chairs, but they come out over the edge of the tub. So instead of having to step over the tub, you sit down on the end of the tub bench and then you swing your legs in kind of like getting in and out of a car. But it eliminates that whole extra balance of having to pass like off the ground in a wet slippery environment to get in and out. So I really recommend those for people that have issues with their balance. Um, another thing, a handheld shower. That way if you are sitting down on a shower chair, you're not standing up and sitting down. If you have to adjust the, however you have to adjust the knobs, those are really nice as well. Um, and also you can control where the water goes instead of having that stream of water coming down and going all over the bathtub.
Speaker 0 00:34:55 And maybe on the outside of the shower you, you declare, you know, you kind of, uh, clarify the narrative of where the water goes. Um, and in the toilet for sure, the toilet risers are really good. A lot of people, those older homes, um, are very low toilets. And if you're trying to get up and down off of that toilet and you make a, you know, you kind of fall back, there's a lot of times that people can fall either getting up or down and then add a grab bar next to it as well. There are tons of toilet risers out there on the market. My favorite or the commodes that actually sit over the toilet. Um, if you think of a bedside commode, you just take the hat out and put the commode over the top of it. 'cause you can adjust the height and it has rails on both sides. And I still wouldn't hesitate to put a grab bar right by the toilet as well. Yeah. So, um, those are the more safer things that I would say. As well as proper lighting, obviously <laugh>
Speaker 3 00:35:45 No, that, that is a, that's a wonderful list as it walks through and, and especially from a preventative side. Mm-hmm. <affirmative> pretty quick and easy. Most of these seem to be assistive devices that you can add into a bathroom in a moment. We're, we're gonna take a break here and, uh, and when we do come back from the break, we're gonna talk through that next step and that's gonna be, uh, if you're looking into modifications those more serious things, you might be making more in a response as opposed to proactive against that. We are working and talking about achieving lifelong independence and autonomy with some fall prevention with Noelle Graham. Stay tuned. We'll be right back right after this message to the Parent Projects podcast.
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Speaker 3 00:36:56 Welcome back. This week we're talking about achieving lifelong independence and autonomy with fall prevention with Noelle Graham and Noelle, thanks again for joining us. She's occupational therapist, so if you're just joining us at this end of it, we've, we've up till now, we've really heard that background. What occupational therapy does with this. We've talked about some great tools and ideas of prevention, uh, but you are in a level one trauma center, and when, uh, when people have come into you, you know, now you've gotta prep to get them back. You're making some assessments. The way I'd like to really kick this off and, and to dive into this, this kind of, as we turn the corner to start landing the plane here, is could you, could you talk us through what's gonna be happening? What's the assessment that's being done by occupational therapy and by the hospitals when we're looking to get a discharge, we're looking to go home. What types of things are you looking towards so that we can be prepared for those things back at the house set up to do that, to note that we're gonna come home into a safe environment.
Speaker 0 00:37:54 So, um, definitely just seeing if people can get in and out of the hospital bed, walk to the bathroom, be able to, to bathe and dress them, bathe and dress themselves, toilet themselves, all of that that goes into it. The biggest one is cognition. Are they, are they thinking clearly? Have they had, because they've had a fall, do they have a head injury? Do they have a lot orthopedic fractures? Have they broken a, an arm or a leg? Have they, um, lost part of their vision? Um, have they had any motor deficits, one side weaker than the other? Um, looking at that balance, just even determine if home is, um, a possibility. A lot of times, unfortunately, we, and fortunately we recommend rehab or a skilled nursing facility so that they can recover from those injuries. Um, also looking at their medications, their vital signs are, are, um, also closely washed when they're getting up and moving around to make sure they can even tolerate going home.
Speaker 0 00:38:45 You know, we've had people that can, they're on the borderline, they can kind of do those things, but, you know, I think after you have one fall, your, your fall risk exponentially grows for the next couple of months. Just because you've been in the hospital, you've been less active, you've been sick, you've been on a thousand different medications, you know, you're, we're dealing with pain and then nobody sleeps in the hospital. Like, is it gonna be a safe transition to go home or do we need to, I always kind of take a pit stop so that you can go home just a, a short stay to make sure you can get your mobility, mobility and balance and your safety, um, before you go home. Because sometimes we have people that go home too soon and then they're revolving door, they're right back in the hospital. I just tell people, if you can give it just a week or two to get your strength back and get your safety back, and we can keep you at home, you don't have to come back and see us.
Speaker 3 00:39:30 Yeah. I, I love, I would imagine that also helps to get a little deeper assessment of what they're able to truly independently do and maybe what needs to be augmented, uh, with either family, loved ones or professional help to be able to push in to really help get them there. Does that, is that, am I track? Yeah, absolutely. Uh, so the thinking that clearly the independent function off of those, we talk, uh, the skilled nursing facilities in the rehabs in terms, if you haven't heard the term before, sometimes I'll refer as a s sniff is is one, right? Uh, so if you, if you hear them working through those, that that's what that is. These are skilled nursing facilities. They're there to help get you back on. Generally they're there to, to get you set back up, to get back out into some other place. Right. These are are transitional.
Speaker 0 00:40:18 Sure. So a rehab facility usually is a shorter stay. Um, it's more of our higher functioning folks that usually can get better in seven to 10 days. Two weeks is kind of not usually the, the deal. Skilled nursing, they can be there for two weeks to to to a month. Um, sometimes unfortunately they have to trans transition onto long-term care. A lot of times I tell people, just see how it goes. A skilled nursing facility. See what function your parent or, or you as a, as a patient get back. And then I have a lot of people that just say, I can't go home. I need to go to assisted living. I can't do this anymore. You know, so a lot of people do have that insight of what they do or don't need. But sometimes with, with, I'd say it takes a village with all those, all those people we, practitioners we were talking about, if we can get that buy-in from the patient to say, Hey, we've got a village that can help you decide what, what's gonna be best for you. Maybe you do need to go to assisted living. Maybe you would benefit from the socialization of being there. Or, Hey, you wanna go home, let's see if we can make it happen. Let's have a 14 day to a 30 day stay at a school nursing facility. Let's see what you can do and then if you can go home, let's make it happen. So there's different options for sure.
Speaker 3 00:41:25 Well, and it sounds like a, a good, there's a lot of pressure. Well, there's a financial pressure and there's, there's a lot of pressures just to keep kind of everything moving that when you're under the gun of, of that trauma center and you're trying to get through the trauma center here, now all of a sudden, you know, you've gotta solve the whole world right there. And if, if this, if this hits you from out of the blue, that it, it is not a thing and it is not an expectation on you to have it all figured out at that point in time. Take that time to take that breath, utilize those rehab facilities and that opportunity or the skilled nursing facilities is a chance to really catch your breath, talk to people and let that outside impact push into you, uh, and help family, you know, help help you and the family develop what your course of action is.
Speaker 0 00:42:09 Right. Well, and because healthcare has become so expensive, there is that pressure for doctors to get patients out the door as fast as possible. They may be physically ready, but that doesn't mean they're ready to go. I shouldn't say medically ready. Ready. They're stable, but they don't have the mobility or the independence or the cognition to go home. So, you know, a lot of people refuse to go to a home, you know, to skilled nursing facility or rehab. But again, that education to, you know, in order to keep you autonomous, that that has to kind of happen. But I think a lot of times, um, parents, you know, or family members think, well, they're gonna be here for a week. Not necessarily. I mean, it's nothing for a, a doctor to come and say, okay, we're gonna send you home. And then the case managers and the family are kind of struggling to say, oh, well what's next?
Speaker 0 00:42:51 Right. Right. Really use those case managers in the hospital because they deal with the insurance. They know what facilities they'll tell you kind of a wink, wink, Hey, here, here are two or three best choose from them. But they're the liaison between you and the facilities. They're so helpful. Um, and they work with the doctor and then the patients and the family, like I said, with insurance to kind of bridge that gap so that you're, you know, I think when family members have families, uh, members that go into the hospital, you have to be prepared, like you said, the next step, step quickly. 'cause it happens way too quickly.
Speaker 3 00:43:21 It it sure does. It should. And, and that is not, look, we have just completely set aside the emotional, uh, pressure that comes that you have a loved one. You have a parent or a loved one that just ended up in the hospital Right. From something happening. And, and it's very natural. It's very normal to have guilt and have fear and all that come running over the top of you. Right. And, and just, you know, you making sure that you give yourself that space to let that, you know, wash over you for a second, figure out where you're at Right. And then be able to get your witts. 'cause this is a time when your family can use that from you. Absolutely. Yeah. Um, when, when families are, okay, so families are gonna set up kind of that long term. Let's say they're, they're gonna make a, we call it the Alamo, maybe the, they're gonna make an Alamo run at it. They're gonna harden the home and they're gonna, they're gonna decide this is where we're gonna come back to. Uh, yeah, I mean, you walk through and, uh, using some of the c d C tools and others to, to walk through the house, maybe start get that checklist and walking through stuff. What are some of your favorite home modifications for occupational therapists you guys have heard of? Or if you know that's where you're gonna be and that investment's gonna happen happen, um, that, that you guys really like to see that you think might be effective?
Speaker 0 00:44:35 Um, definitely adaptive equipment for ADLs. Those activities of living long handled scrub brushes, sock aids, they help you put socks on reachers, long handled scrub brushes. Um, those are so important. I know a lot of times people are like, let's just faster if I do it myself. But if you think about the, all the balance and the cognition and the range of motion and strength that it takes to ab absolutely do those things for yourself. Yeah. Yeah. You know, you're empowering that person not only to to stay their independence, you're also making the workload easier for you. But that's kind of a, that's therapy in itself, being able to do those things for yourself.
Speaker 3 00:45:08 So, so lemme let, let, let me break in on you off of that. Yeah. You hit like three of them that are great little assistive tools from that. Right. Can you break a couple of those down really quickly? That work to helping somebody? Most of these may be around dressing themself or bathing themself, um, right. And or toileting themself. But these three key things that really <laugh> by the way for independence are probably what we all hold in our brain. Right? Right out of the gun of this means independence to me that I can do these things myself. Can you hit a couple of those top ones?
Speaker 0 00:45:36 Yeah. So the reacher is just kind of, you see people picking trash up on the side of the road. It's just kind of a gadget that you squeeze and that way you can pick things up off the floor. That's important. 'cause you know, as our, as our balance gets, gets worse as you lean forward, that can just throw your whole balance off. So that's really cool to pick things up off the floor. But it also helps you to put pants on if you don't have that range of motion to bend over and thread your leg through. You use the reacher as kind of an extension of your arm. Uh, the socket, it's kind of a, a gadget that's, it's a tube and then it has two kind of, um, strings on it. You basically just put your sock on it. You throw those strings out by your foot.
Speaker 0 00:46:10 You put your foot in, you pull it up. It's magic. My patients love 'em. Yeah. Um, long handled scrub brush obviously. So you can wash your legs and your feet lap. Oh, I use that for my back. Well, did you know you can use that to wash your legs and your feet? Um, which is really important for people that have decreased sensation Diabetics as well. You need to make sure that area is nice and clean and, and dry. Um, that's another thing you can use the reacher for. You could put a towel in the reacher, and that way you can make sure your skin is nice and dry with that. Um, and then the longhand shoe horn, a lot of my patients, I just say, just wear elastic shoe laces or slip-on shoes. That way you don't have to bend over and tie them. Um, there are just so many different, um, uh, pieces of equipment you can use. Another thing you talked about, toileting or toilet aids, we actually, they kind of, look, they're different devices you can use, but I kind of describe one as like, they're like kitchen tongs that are curved. And so you can use, um, uh, toilet paper, those wipes to use that so you can get yourself cleaned to prevent UTIs, urinary tract infections, um, and those types of things as well. So we have a lot of gadgets.
Speaker 3 00:47:14 A lot of gadgets, and we are on the cusp of an amazing time in technology where we're seeing more and more of these things start to hit the market. Obviously, you know, with an increasing aged population, you know, from that, that the next six years, us shooting from that 45, 40 8 million up to over 90 million people in that social security Medicare, Medicaid type, age range mm-hmm. <affirmative>, we're gonna, I think we're gonna start seeing more of those products hit the marketplace. And it's also, especially that boomer, baby boomer generation that has very much driven product developments like it has been. They have, they have expected. It is, this is not even like, you know, the sns the, the rehab community. This is not what it looked like living communities. This is not what it looked like from a grandmother, right. Originally, or great grandma like it is. There's some, one of them that we, we were taking a look at was set up like a cruise ship. They build their entire floor plan like a cruise ship. They had a Lido deck, right? <laugh>. They've got the, it was amazing. It was perfect. I'm
Speaker 0 00:48:20 Gonna go ahead and put on the waiting list for that one.
Speaker 3 00:48:22 Oh, lemme tell you. It was awesome that said, look, you wanna get really crazy out. There are people who did that. I, I remember reading a story of a woman who found that was what she did. She decided to cruise and they set up and she would disembark or embark, but she found she could do that. Um, for, uh, actually it was, it was Lester cost for her to work that way. And, and all those tools were a part of what that was. There is so much that is gonna come at us when you are talking about this huge mass of people who control so much of the spending in America. And then, you know, they have a lot of spending control. I I think we're gonna see some neat products come on the marketplace for sure. Um, so, uh, grab bars. This is one, it's a, it's a great time also to put out, look, if you are like me, there isn't anything that I won't build.
Speaker 3 00:49:12 I can't work, I'll work off of something. The military taught me a lot against that. But this is one I'm, I'm gonna throw out. This is one you don't install on your own. This is not a home improvement project. I don't care if you buy it someplace on your own rock on crouton, you can save a little bit of cash from that standpoint, but I'm telling you, let a professional do an installation. This is better than your 85 inch television that you don't want to see break or fall off the wall. This is your 85 year old mom that you do not wanna see break <laugh> if she falls off the wall. So, um, well
Speaker 0 00:49:47 That's what I always tell people. It's like, uh, I know it's expensive, but it's a lot cheaper than a hospital stay or paying $7,000 a month for, for a nursing, uh, center. So, um, it's that, you know, you kind of have to pick and choose what you can do budget-wise. But, um, a lot of people, you know, um, uh, you can always utilize community resources, you know, the arthritis centers. Um, I know a lot of churches have retired people that may be certified in construction. Maybe they're retired from that. There are different ways that you can get somebody that is knowledgeable and knows how to install them. They have grab bars that look like towel racks. A lot of people, I don't wanna look like I'm old. They don't, they're towel racks. They're really reinforced. And why not? I mean that's, it's pathetic, but it, it does its job because, you know, I when you grab, when you exit a bathroom or a a shower, that's what you think, I'm just gonna hold onto this and it comes right out of the wall. Well, if you can have one that does double, why not?
Speaker 3 00:50:40 Well, without a doubt, it, it is not, it is not. Grab bars, first of fault. Gotta happen in that. And I'm glad that the market has evolved into things that just aesthetically they look fantastic. They look, they, they look fantastic. 'cause it is not a matter of when it it is or or if, excuse me, it's a matter of when absolutely. You're, you're gonna grab it, somebody's gonna grab it and it's gonna be able to provide that assistance. And, and maybe over time we'll see that that's, that that's where the market just goes in general for these houses. So I
Speaker 0 00:51:10 Hope so.
Speaker 3 00:51:10 <laugh>, any, um, anything else, uh, that, that might come, uh, other modifications or other things to think about moving around the house, technologies that you're aware of that we should, um, that we could be on the lookout for
Speaker 0 00:51:22 Technology for sure and the Life Alert system, um, home buddy. You know, there's all sorts of different, um, names for different companies. Um, those have saved lives. Um, a lot of people don't wanna wear 'em or, oh, I had it in my drawer. Um, yeah, a lot of people say, well, I have my cell phone while I don't know how many times I leave the room and my cell phone is in my bedroom and I'm in the kitchen. But they usually come in either necklaces or bracelets. That way if somebody does fall, I will say the Apple watches are good. If you get the right series, they can detect a fall and alert. Um, e m s also, I've had a lot of patients have their family installed Alexa, but also the, the camera monitoring. Um, if you can get your family member agreeable to that, it is kind of an invasion of privacy.
Speaker 0 00:52:04 But again, it's jumping on that board. Well, you know, we wanna keep you at home, so it's nice just to have eyes and ears on, um, maybe what's happening from day to day. So yeah, like you said, you know a lot about the technology. There's a lot out there, but those are two, two major ones that I would really consider. Um, I have had a lot of patients say that different, uh, life alert systems, uh, they don't work or they cost too much. I'd really encourage people to, um, really investigate and do a lot of, um, research and just talking to different family members and look at the ratings to decide which one's best. Um, so
Speaker 3 00:52:40 That's great. Well, it has been, uh, it has been wonderful walking through that, you know, we have, we have gone over, over the course. I'm gonna try to do a recap to see how I kind of captured that. And, and we, we talked in the, the pro, there's a proactive and there's reactive opportunities for this, that those high wave tops is to think about, you know, upfront looking at just putting the home in good order and, and what it might take to, to keep those clean, clear areas. Looking for those things that maybe become a distraction or get in the way of gate. As, as gate seems to be one of the first things that start to really impact or send us into a trip and fall for that great lighting, whether it be a task lighting down in all the, the, the smaller areas.
Speaker 3 00:53:20 You know, our eyes don't necessarily work the same way with those high overhead canned lights, so well as we get older, as they did when we were younger. And we really love the aesthetic of all of that in and around areas of, of common use, maybe outside and around or wherever stairs are at or there's levels, level changes within the home, ensuring those are there. And the ability, uh, you pointed out of good lighting when we're getting out of bed or motion detection when we're walking down the hallway or something at night so we don't have to fumble or find our way to get out to, uh, to a light off of that side when that, when that little critter that that stir in the night wakes us. We talked on prescriptions, understanding what are the prescriptions that we have making use of, um, of the, uh, pharmacies and the pharmacists that sit out there to work through and to talk about where we, what we might expect to see mm-hmm.
Speaker 3 00:54:09 <affirmative> or where those things might click in and using some level of, of maybe a log against when it's come down or how they feel or something. Especially in the first few weeks of changing medication and walking through those, the use of third parties, physical therapies. We had touched, and we touched a little before the show too, but even, and you touched a little afterwards, strengthening and balance things that we can be doing to strengthen and our, and and balance. I think previously you've mentioned to me Tai Chi, other forms of, of active, um, stretching and just low impact type stuff, but they, they cause a level of thought and process. So that's great for memory off of that as well as just that motion is lotion kind of movement, uh, in our, in our life to get everybody going there. And then when we talked about in the responsiveness and those home modifications, making use of not being afraid of, uh, of, of having, having to go respond to everything at the moment while you're sitting in the moment at the hospital, um, making plans and, and giving yourself that opportunity to use either rehab communities or skilled nursing or some time immediately after to watch how those things are progressing and, and look at not just what are those activities of daily living and their ability to do it, but what's their ability to do those independently.
Speaker 3 00:55:25 And then finding ways to communicate to them how we pull other people in that help them do those things autonomously or independently. Whether we have the time to help 'em with that or we have to bring in another third party. How'd I do? How do, right. Perfect. <laugh> <laugh>, well you were perfect. You nailed that. That was phenomenal, phenomenal information for us. I think anybody that's might be experiencing this for the first time or setting themself, this is an episode I'm definitely gonna recommend for those family members that are getting ready to make maybe that trip where they've got an inkling of maybe we need to make this evaluation of something ahead of time and it probably doesn't hurt to have a list and to know a good occupational therapist that might be in your area. You can check us
[email protected] and you can look to see what occupational therapists might be available in your area and we've got some other resources if you're in a market that we're just still moving towards. Um, but, but have some of these folks online or, or an idea in the back of your head ahead of time we'll will help you be able to make those transitions. Well, any, uh, anything else for the audience before we go ahead and start to part ways today?
Speaker 0 00:56:31 Oh, thank you so much for having me, <laugh>.
Speaker 3 00:56:34 Noelle, it was really a pleasure. I appreciate you being on and sharing your time, talents, and treasures with us. Thanks so much. Thank
Speaker 0 00:56:40 You, <laugh>.
Speaker 2 00:56:45 Well, that's it for the team this week and thanks for joining us. If you've enjoyed the content, remember to subscribe and to share this episode on the app that you're using right now. Your reviews and your comments, they really help us expand our reach as well as our perspectives. So if you have time, also drop us a note. Let us know how we're doing for tips and tools to clarify your parent project, simplify communication with your stakeholders and verify the professionals that you choose. You can find us on YouTube, follow us on Instagram and Facebook. Thanks again for trusting us. Until our next episode, behold and be held.
Speaker 13 00:57:18 Thank you for listening to this Parent Projects podcast production. To access our show notes, resources or forums, join us on your favorite social media platform or go to parent projects.com. This show is for informational and educational purposes only. Before making any decisions consulted professional credential in your local area. This show is copyrighted by Family Media and Technology Group Incorporated and parent projects l l c. Written permissions must be granted before syndication or rebroadcast.
