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Archive for category: Original Posts

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Keep the Faith… in Insurance? I Think Not.

I think as a society we have lost faith in insurers.  I don’t know many people who still believe that an insurer, any insurer, will be forthcoming with benefits or reimbursement at the time of claim.  I see many people, before claiming, actually weighing the pros and cons between the monies they should be entitled to and possible insurer delay, deny, mistreatment, and likely future rate increases.

 My parents have some epic insurance examples in the world of travel.  Once, the place at which they were booked to stay went bankrupt.  They requested reimbursement through their travel insurance.  Surprise!  It does not cover bankruptcy, only if the place became unsafe for occupancy.  So my mom said to them “it is unsafe for her to vacation at a place that is bankrupt”. In another instance, extensive flooding caused the vacation destination to cancel the trip.  So, they again turned to cancellation insurance.  Surprise!  Their trip cancellation insurance did not cover trips being cancelled.  What?

I work in the world of insurance and I can tell you that there are still a wonderful number of insurers that really try to make the application and claims process as painless as possible.  After all, most of the people I see are in enough pain already and plenty of insurers get that.  Then, there are the ones that don’t.  Those are the insurers that have been jaded through poor training, company culture, talk at the water-cooler, or the one too many surveillance videos that caught someone being fraudulent.  I often wonder if some insurers are trained to make the process of claiming so difficult so that people eventually just give up and move on.

My solution to the perils of insurance is for people to start shopping for insurance based on feedback from people who have claimed, and not just on who offers the cheapest price.  Like most things, you will get what you pay for and cheaping out on insurance can result in crappy treatment at the time of claim.   And what happens when people are treated crappy?  They turn to the legal profession, and guess what?  This costs the insurers more.  In all insurance, especially auto, insurers need to exercise good faith, respect, understanding and compassion and this will go a long way in creating a more sustainable product.    
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Howdy Partner!

I believe in all those wonderful phrases that encourage risk taking and that try to convince people that fear drives personal growth and development.  I took a major risk two years ago when I decided to return to school for my MBA.  Having little formal business training beyond an entrepreneurial father and my own school of hard knocks, and even less faith in my math abilities, I knew that this challenge would be the intellectual stimulation I needed to take my brain to the next level.  And it has – time and time again.  I now think differently and approach problems with more strategy and big picture thinking than ever before.  I can also calculate bond returns, but I will save that as a party trick.

Fast forward to last Friday, and I embarked on major risk # 2.  With my new-found business thinking, and general desire to do more with my business than my abilities as one person allows, I joined forces with a colleague to forge a new journey.  Exciting, fun, a bit scary, but a great decision.  Entwistle Power Occupational Therapy was born!

People are mammals.  We need each other.  It has been well studied that people with reduced social outlets, a lack of love, or even animals and babies not nurtured at birth, do not fare as well as mammals that receive love, socialization, and affection.  I believe that while studies highlight the challenges of business partnership, people need to treat this like a marriage.  It needs to be entered into with respect, trust, and an absolute faith in the skills of the other person.  There will be ups and downs, challenges and successes, but in the end, two will be better than one.  I believe this to be true in business also.

 In the words of Garth Brooks: “don’t stand along the shorelines and say you’re satisfied.  Choose to chance the rapids, and dare to dance the tides”.   I agree Garth, I agree.
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Occupation Is: Managing a Household

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
 
Let’s just assume that we have done all the important stuff.  We have slept, are out of bed, groomed, dressed, fed, are done being productive, and did some fun stuff in between.  Eventually, like it or not, we need to tackle the not-fun stuff.
 
The interesting thing about “not-fun stuff” is that everyone defines this so differently.  Each of us has our own unique interests, abilities, and standards when it comes to groceries, laundry, cleaning and managing our yard and property.  Personally, I loathe grocery shopping (and anything that is meal preparation) and would rather cut the lawn then use a vacuum.  My kids do their own laundry as of age 10 because it has a wonderful built in consequence.  No laundry = no clothes to wear and I don’t need to say a thing.  Besides, I don’t think asking them to start doing this at 16 will go as well.  With six of us in our house, and two animals, the meal responsibilities, cleaning, and shopping tasks are time consuming.  However, all off these things are another layer in my lasagna of “occupations”. 
 
Imagine you are in a car accident and spend a few weeks in hospital.  Your spouse, friend, mother, brother, someone, has to swoop in and help with your children, pets or house.  Eventually you come home and find that things have not been done to your standards, if done at all, and it will be months before you will have the ability to get back to these tasks independently.  The look of your home and property is stressful for you, the meals are different, and you are home all day to notice.  Or maybe you weren’t in a car accident, but have a progressive illness or medical condition that renders you to be no longer able to complete heavier tasks, but you try diligently to manage the smaller tasks within your abilities but this too is now declining.   Perhaps you have sustained a brain injury and your memory is lacking for when things were last accomplished, or when you try to go to the store you end up missing half of the items on your list, if you even take one.  Or worse, the store is an overwhelming place for you considering the visual and auditory stressors from any busy shopping environment.  Maybe mood is the problem:  depression and anxiety can be significant barriers to getting things done, but yet the more things are not done, the more depressed and anxious you become. The cycle continues.
 
Managing a household and all the tasks included in this, is very much an occupation.  It is a separate set of demands from personal care, earning an income, or managing our productive time.  Occupational therapists routinely help clients to return to the occupation that is managing a home.  There are multiple strategies that can be used for people with brain injuries, chronic pain, or social phobias to return successfully to grocery shopping.  There are also multiple aids available that makes light and heavy cleaning easier.  We often need to help people break down tasks into smaller chunks, or educate people on pacing as a means to get things accomplished.  Education on proper body mechanics is also very useful at reducing strain on recovering shoulders, necks and backs for things like lifting, carrying, reaching, and bending.  Outdoor tasks are more difficult to resume, simply because they are heavier, but many of the same principles apply.  If behavior, mood or avoidance are the problem, we have strategies and tools to help with that also.  We believe that most functional problems have a solution. 
 
Occupations are therefore all the things included in managing your home.  These tasks can be heavy, time consuming, and “not-fun”, but they are a necessary part of living.  If you are struggling to get these things done, or know someone else who is, occupational therapy can help.
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Occupation Is: Managing Your Finances

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

It is no secret that there are physical, mental and emotional consequences of stress.  Access to money is a basic human need as food, shelter, and emotional security are all impacted by our ability to provide for ourselves and our family.  As such, the stress created from a lack of money, or drastic and sudden loss of income, is significant.  In the economic crisis of 2008, there was mounting evidence that financial issues were causing a whole host of associated health problems including a rise in reports of headaches, backaches, ulcers, increased blood pressure, depression and anxiety (http://www.frbsf.org/community-development/files/choi.pdf).   Therefore, it is no secret that financial security is a determinant of health.

I can say that 100% of my clients suffer from financial problems after their traumatic event.  How could you not?  If you think your income is “insured” against illness or disability, check again.  If you are fortunate you have private disability or health coverage.  Or, you might have a good short or long term disability plan at work and in that case, you might get 80% of your income covered at the time of claim.  However, this usually only lasts for two years before the “test” changes and most people find their income loss benefits end.  In the world of auto insurance, without other coverage, the maximum income replacement is $400 / week, regardless of what you made before (unless you “bought up” which no one does).  And just think – three years ago the Financial Services Commission of Ontario wanted to lower this to $300 / week to put more money back in the pockets of insurers.  Could you live on $1200 / month?  I digress…

So, you are in an accident, suffer an illness or can no longer work.  How will you manage?  How will you be able to afford the medications you are now required to take (these aren’t covered 100% either folks), the equipment you need (the government might fund 75% for some items, but when a prosthetic limb is $60,000 that is still a lot out of pocket), the treatment you require (even with extended benefits, $350 in PT won’t get you very far), and your regular expenses that won’t dwindle unless you make major lifestyle changes?  The answer is stress, worry, concern, sleepless nights, borrowing, illegal activity, and brutal attempts to unsafely return to work because you “have to”.

Believe it or not, managing your finances is what we call another “occupation”.  Working with an occupational therapist, a disabled person can create a new budget around the change in income, get support to make decisions about spending, and gain access to other potential sources of financial support.  Perhaps you qualify for the Disability Tax Credit, or the Registered Disability Savings Plan?  Maybe you need to apply for the Ontario Disability Support Program, or can access funding for devices through the Assistive Devices Program?  Perhaps your home modifications qualify for the new Tax Credit, or you can apply to the March of Dimes under their Home and Vehicle Modification Program?  Maybe without other coverage the local Community Care Access Center can provide you with home care, treatment or equipment?  Can your medications be covered by Trillium?  Are you maximizing the coverage available to you under auto insurance policy or work benefits?  Is there a local food bank, or disabled transportation program? These are all things we look at.

Then of course, there is the process of returning to work.  What if you cannot manage the demands of your previous job or this is no longer available to you based on a long absence?  Perhaps the jobs you are trained for no longer match your abilities?  Occupational therapists can help with identifying previous job demands, outlining new job interests, and comparing these to the abilities you have.  We can set up structured work programs, gradual re-entry plans, and connect you with people and programs in the community that help people get back into the work force.

Occupation is managing your finances and making sure you can get by.  If this is impacted by a disability, Occupational Therapists’ treat that.
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Occupation Is: Doing Fun Stuff

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, what are your plans after work?  How do you like to spend your evenings?  What do you do for fun?  Given the choice, how do you spend free time?  While being productive is essential for the human psyche, so is being unproductive.  Well, sort of, because even a lack of productivity is productive.  Deep, I know.

Personally, I love a good funny movie, dinner with friends, time with nature, getting out with my kids, exercising, playing sports, reading, blogging, and going on vacation.  Those are my “fun”.  For others, this could be creative hobbies or outlets, museums, live theatre or music, antiquing, collecting, photography, being online, or a thousand other things that I don’t even know exist.

So what if I was injured, suffered from a mental health problem, have a medical issue, or brain injury?  Perhaps I would lack the ability to sit through a movie, or could no longer understand the nuances of humor.  Maybe my personality would change and my friends would have a hard time relating to the “new me”.  Or, I could no longer physically handle my nature walks, exercising or playing sports.  If my vision was impaired, I could not read anymore.  If I struggled with cognitive communication, or attention problems, putting together a blog article might also be off the table.  And vacations?  Those are incredibly difficult to plan and organize at the best of times.

Occupational therapists are very skilled at helping people resume the occupation of fun.  There are multiple ways we do this, as we recognize that our “fun” defines much of who we are, and why we work so hard in the first place.  For example, if I had to rehab myself from the problems above, I might start with suggesting sit-coms as these require less physical tolerances for sitting, and a shorter attention span.  I could view these with another person, and discuss the humor, sarcasm, and recall the best one liners.  Perhaps I would need education and support to understand how my personality changes are impacting my relationships, so I can try to make some changes.  If my physical abilities were limited, my OT could help me find new ways to enjoy nature (bird watching, photography as examples), and could help me discover new sports and forms of exercise within my abilities (yoga, Tai Chi, and many modified sports have become very popular for people with disabilities).  If I can’t read a standard book, maybe I could use an iPad or e-reader so I can change the font size, or switch to audio-books.  For my blogs, I could learn new ways to move from a blog idea to a full article, by breaking down the topic into paragraphs or chunks, or learning how to dictate if written communication is my challenge.  Vacations could take the form of day trips, short overnights, and eventually out of the country through the help of a travel agent that specializes in planning accessible vacations.  I would probably learn that in Canada my attendant can fly for free (with approved paperwork), and that many places (Disney included) are highly accessible.

So if a disability is stopping you from enjoying the occupation of fun, OT’s treat that.
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Occupation Is: Eating

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, we have slept, are out of bed, groomed and dressed.  Now what?  Typically we head to the kitchen to grab something to eat.  Admittedly, I am a terrible cook.  And on top of this I am leery of ready-made foods, and think the microwave is the root of all cancer.  So, let’s just say I struggle with everything that is meal preparation.  Many of my clients struggle with this also, but for much more legitimate reasons…

For most of us, breakfast is typically simple.  Cereal, toast, maybe eggs, pancakes, granola or fruit.  Lunch slightly more complicated, and dinner is an effort.  So what if you have a brain injury and have difficulty planning meals?  Or, you cannot drive, or can no longer access public transit so you have problems getting items at the store?  Maybe you are on a strict budget and can only get food from a food bank.  Perhaps you have food in the house, but your appetite is supressed from medication, depression, or some other physiological or mental illness.  The dishes might be too heavy to lift if you have upper extremity problems, or you have one hand you can’t use at all which makes cutting, peeling, and carrying heavy pots very difficult.  If you have a special diet, or cannot consume foods by mouth, meals take on another form – pureed, soft, smoothies, Ensure, or even through a feeding tube.  If the meal is made, perhaps you just can’t carry it to the table as you use a wheelchair, or cane, and the last time you tried the meal ended up on the floor.  If you have tremors, shakes or dizziness, walking carrying anything is a challenge.  Once you are at the table with your food, an upper extremity or visual problem might make it hard to get the food onto the fork, spoon, or into your mouth.  Chewing could be another problem if you have oral-motor difficulties.  Then you have to swallow and choking or aspiration are possible.

Occupational therapy treats all that.  We provide strategies and supports to enable shopping, and aids that might help get the groceries into the car, into the house, and into the cupboard, fridge or freezer.  Or to improve memory we can help to set up systems that enable people to shop efficiently and effectively, including meal planning, creation of lists, mapping out products in isles, and providing strategies on ways to prevent visual and auditory overload common to most stores.  When cooking, occupational therapists look at safety around appliances, provide strategies to reduce bending, standing, or reaching, or even aids to reduce bilateral (two-handed) tasks if necessary.  If there are dietary concerns, occupational therapy can provide aids and education, and can work with a speech therapist or dietitian to make people are able to manage nutritional needs.  If there are negative eating behaviors, we can treat that through cognitive and behavioral therapy, tracking, and helping people access other resources and programs.  For consuming food, there are several devices that we can use to address a visual-perceptual neglect, a dominant hand impairment, and train people how to eat with a prosthetic.  We can make customized utensils and splints to bridge the gap between a hand and mouth if the two can’t connect.

Spoken quite simply – occupation is everything that is eating: from planning what to eat, getting the food from the store to the house, preparing this safely, and making sure the food meets the mouth, or the stomach.  If these things are a challenge for you, occupational therapists treat that.  
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Occupation Is: Managing Toileting, Grooming, Showering and Dressing

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
 
Okay, so you are up, out of bed, heading to the bathroom.  “Occupation” is also the process of managing personal care tasks involved in toileting, grooming, showering or bathing, and dressing.
 
Assume you have reached the bathroom.  What happens if your back is too sore to bend you towards the sink, or the toilet is too low and you don’t have the lower extremity mobility or strength to crouch to that level?  Or, maybe you have lost bowel and bladder abilities and you are required to toilet differently?  What if when you look in the mirror your thoughts start racing to negative, derogatory or harmful comments about yourself?  You want to shower or take a bath, but you can’t stand that long, can’t get your cast wet, or have hypersensitivity to the water hitting your skin.  Maybe you can’t get to the bottom of the bathtub, or even if you sit to shower, can’t reach your shower head, lift your shampoo bottle, or lack the arm, hand and finger abilities to scrub your body or your hair.  If you are using a wheelchair or commode, maybe you can’t even get into the bathroom in the first place, or if you can, can’t get into the shower, under the sink, or can’t see yourself in the mirror.  Or, perhaps your depression limits your motivation to shower, or to brush your teeth or hair in the first place. 
 
Maybe you have managed to do your grooming, toileting and washing.  What if you can’t get dressed?  Perhaps you are on the main floor because you can’t do the stairs, but all your clothes are in your upper bedroom.  Or, your clothes are not clean because you lack the ability to do so.  Maybe you dresser is too high, or too low, or you can’t reach the shelves in your closet due to pain, limited strength or mobility.  Putting on a bra requires significant shoulder movements and putting on socks requires flexion and external rotation of the hips, or bending, and you can’t do any of that?
 
Occupation is all of that, and these things are addressed in occupational therapy.  If you can’t use the toilet, perhaps you need education, supplies or help to manage briefs, urinals, catherizations, bed pans, disimpaction, a colostomy, ileostomy, or suppositories.  Maybe you need a commode beside the bed because your bathroom is not accessible, or you don’t have a toilet on the level of the home you are required to sleep on due to limited mobility.  What if the commode you do have won’t fit over the toilet, or even through the bathroom door?  If you can get in the bathroom, but the toilet and sink are not usable for you, perhaps devices would help to correct this, or you need education on alternatives.  Perhaps your shower or bath needs some adjustments to help you transfer into / out, to sit to shower, or to reach the shower head.  Maybe the shampoo and soap bottles need to be changed or relocated.  A reacher may help you to access some of your clothing, or you need education and support to rearrange your things to promote your independence.  Education and equipment for dressing may help to reduce your need for assistance with dressing your upper and lower body.  No motivation to do these things in the first place?   Solutions can include cognitive, emotional and behavioral strategies and supports to change thinking patterns, reengage the psyche, and to restore normal routines. 
 
Spoken quite simply – occupation is going to the washroom, grooming, showering and dressing, and if these things are a challenge for you, occupational therapists treat that.  
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Occupation Is: Getting out of bed in the morning

In celebration of Occupational Therapy Month, I am spending October defining the word “occupation”. Why? Because, contrary to the traditional understanding of the word, occupational therapists define this differently. For us, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for this month, I will explore the journey of “occupation” complete from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

I assume the routine for most of us is the same. Morning hits, we hear the alarm clock, snooze it a few times, and eventually swing our legs over the bed, stand, stretch and head to the washroom. Sounds easy, right? But what if it isn’t?
What if you have had a terrible sleep? Perhaps you live with chronic pain and cannot get comfortable in your bed. Or, you have an acute injury and are trying to sleep on broken ribs, while wearing a cast or sling, or with bruises, scrapes, or swollen body parts. Maybe you live with anxiety, depression, or have trouble controlling your thoughts when you try to drift off. You have restless legs, or are on medication that makes you sleep too much, or causes insomnia. You are worried about something, someone, or have a child, spouse, or family member in your home that might need you during the night. Tomorrow is a big day and you are excited or nervous. You have neighbors that are too loud, or are spending the night in a shelter because you have nowhere else to go. Really, obtaining a restful sleep is actually difficult.
Assuming you have slept, and recognize the alarm is going off, what if you can’t just “throw your legs over the bed, stand and stretch”. Then what? Do you have or need support or devices to make the transition from lying to sitting, from sitting to standing, to a walker, cane or onto a wheelchair or commode? Perhaps your depression or anxiety makes it extremely difficult to transition out of bed to face the day, or to start your morning routine. Maybe you need to stay in bed for an extra hour because the amount of sleep you got just won’t cut it for challenges that day will bring.
Occupation is all of that and as such, these things are addressed in occupational therapy. Why are you not sleeping? Can we assist you to obtain a better sleep surface? Can we educate you on how to obtain a restful sleep position by suggesting changes to how you are lying, or through the use of pillows or wedges? Can we help you to shut your mind off through progressive muscle relaxation, meditation, natural sleep remedies, or by assisting you to obtain medical assessment and intervention? Can we aid in reducing your stress such that you are more at ease when trying to fall asleep, or so you won’t wake as much during the night? If you are sleeping through your alarm, or can’t motivate yourself out of bed in the morning, perhaps we can provide you with cognitive and behavioral strategies to re-frame that process to enhance your success. If

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there are physical barriers to positioning in bed, sitting, transferring or standing, we can prescribe equipment, aids, tools and support to ensure this part of your morning routine is safe, to promote independence, or to assist your caregiver.

Spoken quite simply – occupation is getting out of bed in the morning, and if this is a challenge for you, occupational therapists treat that.

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I Always Called it Dumb-Ball

Football lovers beware, this post will offend you.

I have never liked football, in fact I have always called it dumb-ball. Why? Because I could not, and do not, understand the appeal of watching big dudes, many of them grossly out of shape, run into each other with their heads. I never saw this as sport, and recognize that in a three hour game, each player actually moves for about 6 minutes. How athletic (I mean pathetic).

Okay, okay, simmer down. I can see that some of them are sweating under those helmets, and to be honest I don’t even understand the game. I should not knock something I have not tried, take no interest in, and don’t get, but alas I will continue.I think the recent NFL player award of $765 million for those with brain injury resulting from football proves my point. According to one article, “under the settlement, individual awards would be capped at $5 million for men with Alzheimer’s disease; $4 million for those diagnosed after their deaths with a brain condition called chronic traumatic encephalopathy; and $3 million for players with dementia”. They indicate that there are 18,000 players affected (http://www.nfl.com/news/story/0ap1000000235494/article/nfl-explayers-agree-to-765m-settlement-in-concussions-suit).

Other articles talk about this as a “drop in the bucket” and an award very unlikely to have any impact on the NFL at all. I know that the economy lives on supply and demand, and it somewhat saddens me that there remains a “demand” for this type of sport via spectators that pay big bucks and derive pleasure from watching this idiocy.

I love this article from Grantland: What Would the End of Football Look Like? (http://www.grantland.com/story/_/id/7559458/cte-concussion-crisis-economic-look-end-football). In this, they speak of pending football lawsuits and that the end result is that “more and more modern parents will keep their kids out of playing football, and there tends to be a “contagion effect” with such decisions; once some parents have second thoughts, many others follow suit.

I can tell you that I work with people with brain injury, Alzheimer’s Disease, concussions and post-concussion syndrome. These are not easy injuries to live with, or to treat. Dizziness, visual disturbance, excessive fatigue, cognitive difficultly, physical and emotional challenges…not fun. Why as a parent would I sign my kids up for that, or the likelihood of that, when there are other sports like tennis, volleyball, swimming, baseball and golf that are more classy, often more athletic, and clearly more safe?

What is interesting is that a few years back I was at a conference on Spinal Cord Injury. At my table, there was a researcher from the US. He was talking about impact data being collected from sensors inside football helmets. He said they were astonished at the high velocity of impacts being measured, and said the numbers were so severe they “could not even release the data as the outcome would result in public outcry and a drastic change to the sport”. Well, we wouldn’t want an outcry, would we?

The bottom line is that society’s values are changing. Parents are going to be less and less interested in exposing their children to sports that are more likely to cause injury, and to have long-term disabling effects. Sorry dumb-ball, I think your days are numbered. Golf anyone?