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Summary:
In this episode of the CareLab podcast, hosts Emilia Bourland and Brandy Archie engage in a lively discussion, focusing on debunking myths surrounding physical therapy (PT) and occupational therapy (OT). They explore the differences and similarities between these two fields, emphasizing the unique roles each plays in patient care. They also touch on the significance of speech therapy and its often misunderstood scope.
Key Takeaways:
- PT vs. OT: Physical therapy focuses primarily on mobility and functional movement, while occupational therapy emphasizes helping individuals regain independence in their daily activities.
- Overlap: While PT and OT may seem similar, they approach patient care from different angles and have distinct goals.
- Personalization in OT: Occupational therapy tailors treatment to the specific needs of each individual, unlike the more standardized approach often seen in physical therapy.
- Collaboration: PT, OT, and speech therapy often work together to achieve the best outcomes for patients.
- Misconceptions about Speech Therapy: Speech therapy is not only about helping people speak; it also addresses cognitive functions, memory, problem-solving, and, in some regions, swallowing issues.
Transcript:
Emilia Bourland
Hi, welcome to Care Lab.
Brandy Archie
Welcome to CareLabs CareLab Day. I'm so excited to have a chat. It's just me and you today.
Emilia Bourland
It's just me and you. It's been a long time since it's been just a Brandy and Amelia episode. So I'm kind of excited about this.
Brandy Archie
Me too, we get to be on our soapbox for longer.
Emilia Bourland
Exactly. Basically, we can just, you know, we can, I can just talk more. And we all know that I like that. So can I show you something real fast first though? That was, okay, first I have to set it up a little bit. So I'm in my closet again today. We're back in the closet. Listen, improvements. I'm working on it. But I was, I was trying to figure out my lighting. Cause you know, lighting is like really important if you're going to have a good
Brandy Archie
Okay, sure.
Brandy Archie
Okay.
With a better background though.
Emilia Bourland
for folks who might be watching this on YouTube. Of course, as you can see here, it's not great because I am like blindingly white, but you know, so put on some sunglasses or whatever if you're watching this. This is the best I could do though. But in the process of doing that, hold on a second. I had an idea for our Halloween episode.
Brandy Archie
Hahaha
Brandy Archie
scary stories.
So she then turned the lights and now it's like so shadowy and if you want to see you should follow us on YouTube.
Emilia Bourland
It's, listen, this is CareLab, the Blair Witch Project Edition.
Brandy Archie
Do you want to know something else weird I have never been to a haunted house and My husband has tricked me into agreeing that I will go this year after 40 years of life of not having gone very intentionally So I don't watch scary movies. I haven't seen the Blair Witch project. I don't go to haunted houses. My imagination is too vivid
Emilia Bourland
What?
Emilia Bourland
I hit.
Brandy Archie
And so I will close my eyes and go try to go to sleep and I will have, I already have nightmares all the time about regular life stuff. I don't need additional imagery or what's that movie called? Inception? I don't need, I don't need more of that.
Emilia Bourland
Yeah, so I mean, I actually, I went when I was like younger, you know, when I was a lot younger, like in my teens and in my 20s. And I would watch scary movies back then too. But I'll be honest with you, I never actually, I never enjoyed it. Cause same thing, my imagination is just like way too powerful. And it definitely was back then. Like literally after I saw Blair Witch Project, I was convinced that my house was haunted.
for like, until I moved out and went to college, basically. It was, I was so intensely afraid just going even into like my dark house the night that I saw it. I, yeah, same thing. It's actually, not. Yeah. Yeah.
Brandy Archie
See, I don't need these problems. I just already know I don't need these problems. But now he tricked me and said, okay, you got to say yes to what I'm about to say and made me shake on it. And I trusted him.
Emilia Bourland
Why did you do that?
Brandy Archie
I don't know. I tried to trust my husband, but then he was like, we're going to a haunted house this year. was like, no.
Emilia Bourland
my gosh. What I will say is though, like, certainly as I've gotten older, that stuff doesn't freak me out nearly as much anymore, because I just realize how it, I can, I think it's easier to tamp down your imagination as you get older, right? Has that been your experience or no?
Brandy Archie
Mm
Brandy Archie
I don't maybe I haven't tested it. I just was like no this isn't go well with my brain So I was like no you could just stay over there So I don't know that I've really tested out like will I see the fakery in the haunted house and then turn my brain off and be like this is Very clearly not real. I know it's not real. I don't feel like it's real and not Incept me. I don't know if that's gonna happen one can hope
Emilia Bourland
I'll keep my fingers crossed for you. mean, I think here's what I would say, like, know it's fake no matter what. It's not that, it's the way that they like build up the emotional anticipation of things. Even though you know something is gonna jump out at you, that almost makes it worse, right? That you know something is gonna happen. And then they're really good at just doing it. Even though you know it's coming, they're so good at figuring out how to do it.
Brandy Archie
Thank you.
Brandy Archie
Yeah.
Brandy Archie
Yeah.
Emilia Bourland
in a way where you're not expecting it right at that moment necessarily. And that's, it's the jump scare thing. As my son would say, like, it's the jump scare thing and that gets your heart pounding. But you know what? I think I've got my fingers crossed for you. You're going to be okay. I mean, you are going to be okay no matter what, but.
Brandy Archie
I'll be alive, but will my brain be okay? That's what we'll see.
Emilia Bourland
Hmm.
I wonder if you would still have nightmares if you didn't, if you stopped drinking caffeine.
Brandy Archie
Don't try to get me on your trip and you don't know if there's tea in here or coffee. Thank you very much.
Emilia Bourland
That's true. I also say that and I actually am having just like a teensy bit of caffeine this morning because it's Friday and I'm treating myself because I do love, I do love caffeine. But you know, it's just not good for my brain.
Brandy Archie
Mm -hmm. you know better, you do better, I guess.
Emilia Bourland
I guess so. guess, I mean, sometimes. If you have enough motivation.
Brandy Archie
That's the key. So what are we going to talk about today?
Emilia Bourland
I think we should do another Mythbusters episode.
Brandy Archie
I like it. Let's do it. If you didn't already hear our last Miss Busters was about this about aging in place.
Emilia Bourland
Okay.
Emilia Bourland
Mm -hmm. Yeah, it was good one. So definitely if you or someone you care about is thinking about aging in place, and I guess I don't really know anyone who doesn't fall into that category, it's definitely worth checking out because there are some really, really commonly held myths about that that we bust in that episode. So worth listening to for sure. So for today's myth, I thought that we would bust this idea
that PT and OT are basically the same thing.
Brandy Archie
Let's go. I'm ready to talk about this.
Emilia Bourland
Yes. Okay, I'm gonna let you take it away then.
Brandy Archie
Okay, How do I want to deal with this? First of all, they can't see didn't get the lead in they are not basically the same We do very different things however to the person who's experienced it and depending on the setting it might seem very similar So I'm gonna give people credit, right? So I think we'll talk about this a little bit later and get into the details or maybe we should just talk about now, but I'll give a general overview
Occupational therapy, our goal is to help people regain or maintain their independence, doing their everyday things, whatever that is. And whatever tools we have at our disposal in order to do that, we will do. So that might be rehabilitation, like trying to get the muscles to be stronger. It might be compensation by using adaptive equipment to accommodate the situation. It might be education because you have to change the way you do it and we teach you a new strategy to do it.
All of those things and more are encompassed in what our goal is. Physical therapy's goal is to make sure that you can perform your mobility as independently as possible. they also care about whether you can, like what good does walking do if you're not walking to go do a thing, right? So that's why they seem very overlapping, because you don't just, unless you're a cross country runner or a crazy track person or runner like you, you don't just get up and walk around for no reason.
Emilia Bourland
Right, yeah.
Brandy Archie
And so you need to be able to walk across the house to get to the bathroom. You need to be able to walk up and down the stairs to get to where you need to go. You need to be able to move your hands and arms in order to do the things you do in your everyday life. And so, because their goal is mobility and our goal is independence with ABLs, it overlaps for sure. But we're coming at it from two different angles and we're working on two different sets of skills.
Emilia Bourland
Okay, myth busted episode, episode, episode done. That was an excellent summation of that. Yeah, no, I don't honestly know that I have anything to add to that. I think that was a perfect summary of the difference. like, of course, physical therapists care about function, right? They don't just care about just how far your body moves and being able to get up and walk around to your point. But.
Brandy Archie
Hahaha!
Emilia Bourland
I think the difference, can also really see it in the name, right? Like occupational therapists, our end goal is ultimately that occupation, how you are occupying your time, whatever that is, whatever that task, activity, not just a job, yep, you do not have to be working to receive occupational therapy. Although we can help people get back to work if that is the goal that they have, whatever it is someone needs or wants to do.
Brandy Archie
Not just a job.
Brandy Archie
to have occupational therapy.
Emilia Bourland
Our goal is to help them achieve that and do what they want or need to do with all of the tools in the toolboxes. And if that sounds huge, it's because it is. It really is. That's also one of the things, by the way, that makes this job so much fun is there are, you know, really at the end of the day, we're problem solvers and we get handed these really complex problems and it's our job to figure out how all of these
Brandy Archie
Mm -hmm. It is. Yep.
Brandy Archie
Mm -hmm
Emilia Bourland
really different pieces fit together in order to get someone where they want to be. And that is so fun and rewarding and satisfying when you really, when all those pieces get put together and someone is suddenly able to do something that they never thought they would be able to do again. Like that is amazing.
Brandy Archie
Mm -hmm
Brandy Archie
That is, yeah, that's the winner right there.
Emilia Bourland
It is the it's the best and then like the physical physical therapist it is really more like focusing on that physical side of things right like so so you can also think about it as those differences just being Evident in in the name as well
Brandy Archie
And then we both like spread our wings within that foundational purpose, right? So like while mobility is the first idea that they're looking at as physical therapists, if you have a lot of pain, you are not gonna get up and move even though your joints do technically move. So then they might work on pain management strategy. And so like, there's all these other things that build on top of that, that you might see a therapist for that particular niche, but we're still coming from a different foundation.
Emilia Bourland
Mm
Brandy Archie
a different framework, I should say. And so I have a good concrete example. So if somebody has a total knee replacement, way we would address it is very different. And so in physical therapy, a total knee replacement, every knee is a knee, right? We have protocols because we know what's best practice and how we should do things.
Emilia Bourland
Okay.
Brandy Archie
Every doctor has their own kind of like way they want the person to rehabilitate the physical therapist is gonna follow through with that and make sure you follow through that help motivate you to do things but it's essentially the same thing for each person because you want to get the same outcome for each person right because a knee is a knee essentially right whereas an occupational therapy Your job your what you do every day
is very different than what Mrs. Smith over here does every day. And even though both of your knees are replaced on the same day, you might be the same weight, same height and all that, same doctrine, everything. What you're trying to get back to is different than what she's trying to get back to. You really care about wearing socks and your running shoes. She's gonna wear sandals. So I'm gonna work on how are gonna get to your feet even though you can't bend your knee. With her, that's not even a goal so we're not gonna deal with that. She's got a bunch of stairs, you got no stairs. So we're going to...
have to figure out a way to accommodate on the first floor until you're ready to go up and down the stairs. So like the treatment plans look very different per person in occupational therapy in this example. And whereas the treatment plans and physical therapy might look much closer to being the same because there's lots of protocols to keep the wheels rolling. And because their goal is mobility and our goal is independence with their everyday activities.
But we need to work together in order to do that because if your knee never gets better, that's really not optimal for your outcomes, even though we're accommodating for them right now.
Emilia Bourland
Yeah, and I think that's a really good point. I'm glad that you said that because it is really important to point out like one of these professions is not better than the other. One is not more valuable than the other, right? Like I, as an occupational therapist, I really value the time that I spend working with PTs and I value what they are helping patients and clients with, right? And I think it goes the other way too. If a PTC is an occupational therapy need,
Brandy Archie
Right.
Emilia Bourland
then they are delighted to have an occupational therapist involved, know, putting in that side of the equation and working together, I think that we produce really, really like wonderful, powerful outcomes. I should also, and I know we're not talking about speech necessarily here today too, but I don't want to leave speech therapists out because they're so like wonderful and amazing too. And also, you know, are an important part of the equation to really achieve.
Brandy Archie
was just thinking, I was like, we gotta bring Speeches in.
Emilia Bourland
you know, the kinds of like big positive outcomes that we want to try to achieve, you know, particularly when someone has a life -changing injury or a life -changing illness or something like that. And so that's why you'll see all three of these professions altogether, you know, when you are in like an inpatient rehab situation.
Brandy Archie
Mm -hmm. Mm -hmm. And let's bust another myth while we're at it Speech speech therapists. I mean listen if we're already on the top blue might as well do it these therapists Something I'm like, and then you have speech at three o 'clock. I'm like, don't need to eat I know how to talk beach is not only for knowing how to talk because speech language pathologists and While yes, they might work on you getting your words back if you have aphasia after a stroke and that is part of what they do But they're also really concerned about your cognition
Emilia Bourland
Ooh! We are on a roll!
Brandy Archie
and way you think and your memory, the way you problem solve, the way you plan, because all of that is also very well related to your ability to be independent, right? This is the reason why if you have dementia or some other thing going on with your brain, you need supervision and you need help with doing tasks. And so in many cases, they're to you do similar to occupational therapy, either restore and help you get some of those skills back or help you compensate and find ways to accommodate.
for this change in cognition so that you can still be as independent as possible.
Emilia Bourland
Yeah, and depending on where you are in the country, because kind of scope practices can actually vary depending on the licensing and where you are in the country. So depending on where you are, the speech therapist may also be working on swallowing and swallowing safety and swallowing strategies, which is crazy, crazy important. You know, in some parts of the country, that's still something that occupational therapy does. But in many parts of the country, it's it's now handled by speech therapy. So that's also a really, really important part of the picture that speech therapy brings to the team.
Brandy Archie
Mm
Brandy Archie
Mm -hmm.
Brandy Archie
Because listen, everybody wants to eat. So if you're having trouble swallowing, you can't eat anything because we're not about to have you choking in the hospital. So you need speech for that.
Emilia Bourland
yeah.
Emilia Bourland
Yes, indeed.
Brandy Archie
I do think there's a reason why a lot of people try to equate OTMPT because it sometimes looks the same or it looks very similar in certain levels of care. So it might be worthwhile for us to talk about like what happens in the different levels of care as far as rehab goes and what it looks like.
Emilia Bourland
Mm.
Emilia Bourland
Okay, all right, yeah, that's another good one, honestly, because it really can vary depending on what level of care someone is at. Like the therapy that you're receiving in the ICU or in acute care is gonna look, know, really even between those two places can look really different. But the therapy that you're gonna receive in inpatient rehab is different than what you're gonna receive in the hospital.
the therapy that you're going to receive in inpatient rehab is gonna look different than what you're necessarily gonna see in like skilled nursing, certainly in an LTAC, which is long -term acute care, and in home health as well. And there's an outpatient and there's all these levels and layers of places where people can get therapy services, really from any of these disciplines. And it's good to know
what they are and kind of how they work and function so that you can advocate for yourself to get what is the best level of care for you or for the person that you're caring for.
Brandy Archie
Mm -hmm.
Brandy Archie
Yes. So let's start at the lowest level of care or your first level of care and let's start at ICU and acute.
Emilia Bourland
Okay. Yeah. Okay. Let's do it.
Brandy Archie
I've, okay, so I feel like this is one of the areas in which people don't see the differences between PT and OT as much, but there's a good reason for that. And that's if you're in the ICU or in acute care, your level of ability is very restricted, right? In ICU care, you might, you are tied up to tubes, oxygen, all kinds of lines running to you and you're laying in the bed pretty much. And PT and OT's,
Emilia Bourland
Yeah.
Brandy Archie
goal is the same. We're still trying to help you with your mobility and your independence. But if you can't sit up, then you can't do, you can't take a step and you can't even brush your teeth. Right? And so a lot of times we'll work together to get you to the point where you can just sit up and we might come in together to help manage those lines and you might not be able to help us very much. And so we need two people to help you get to sitting up at the edge of the bed or even just sitting up in long sitting, when the bed is still fully supporting you.
Emilia Bourland
Mm
Brandy Archie
And then, but we know that these are the building blocks to get to the goals that we're trying to help you achieve. And so while you might not see the difference or your family as they come in might not see the differences between what we're doing, we are always coming at it from a couple of two different angles.
Emilia Bourland
Yeah, so let me give an example to kind of go along with that as you did earlier. So again, in ICU particularly, it might look like we're doing almost the exactly same thing, right? We're coming in, a lot of the times, this is a person who's got a lot of different lines, tubes, drains coming out of them, all of that has to be managed. Maybe they are on a vent, maybe they're on continuous renal replacement therapy, something like that. So all of these things have to be managed. And a lot of times,
Brandy Archie
Mm
Emilia Bourland
this person is not able to get up to even sitting on the edge of the bed on their own. Or if they can, it has to be really carefully managed situation, right? So we don't accidentally do something. will, little side note here, there is so much research, really great research on the benefits of early mobilization in ICU. That's one of the reasons that you see it more and more and more often and why you see therapy getting involved.
Brandy Archie
Mm
Brandy Archie
Mm -hmm.
Brandy Archie
Yes.
Emilia Bourland
really, really early in the process now, as opposed to it used to be, you know, back in the day, you had to wait till a lot of this other stuff was done. But we know, you know, based on research, the people's outcomes are better if we mobilize them earlier. But so it might look like we're doing the exact same thing, essentially coming in, getting this person up to sitting edge bed. But, you know, maybe the goal for that, for the physical therapist coming in in doing that is to
Brandy Archie
Okay.
Emilia Bourland
help you increase your upright sitting tolerance or strength so that when you're ready, you can progress to standing, right? Of course, the occupational therapist cares about that too, but maybe our goal when we're coming in and doing that same session, just getting you up to sitting on the edge of the bed is so that you are gonna be able to sit up and eventually be able to feed yourself again, right? So, and of course we're thinking about both disciplines are thinking about
Brandy Archie
Mm -hmm.
Emilia Bourland
of different goals all at the same time. And again, that's one of the things that makes doing either one of these jobs like so first, you know, complicated and harder to do than it looks like, but also really so interesting and rewarding. But we're thinking about what the long -term vision is for this patient in front of us and what they and their family are gonna need or want, you know, right from the beginning. And we're thinking about it in those kind of slightly different ways.
Brandy Archie
Mm -hmm.
Brandy Archie
Exactly. And then once you've progressed and you've been able to sit up at the edge of the bed, we got some of these lines out, your body is not as sick, you move to acute care. Or maybe you start in acute care because you had a outpatient surgery or something. There's also tons of research about how important it is to be mobilized after surgery, which is why every time I've ever treated somebody with a hip or knee and I come in on day zero and say, hey, it's time to get up. They're like, what the?
Emilia Bourland
-huh.
Brandy Archie
heck is going on here. I just had surgery like an hour ago. I'm like, yes, I know, but you got to get moving.
Emilia Bourland
Yeah. I just woke up. I just woke up. Can you come back later? No.
Brandy Archie
No, I'm like, literally that's why I came in because you just woke up. So it's time to get moving. Let's go. And so even though that feels very overwhelming, that is the goal and the research shows it. And that's we push that so hard. Even if you're getting up is like out of the bed and one step forward and one step back and sit back on the bed, that is still really important to do. So in acute care, it might look very similar again, because we're depending on the level of care and how
Emilia Bourland
Let's do this.
Brandy Archie
close we are to that ICU level. But then we're also going to be working towards the next level of goals, right? So we want to, as an OT, we want to be eating, feeding ourselves, brushing our teeth, using a bathroom and managing that. PT might be working on getting to the bathroom. And you see how those two things are tied. I can't really work on you being able to wipe yourself and manage your clothes if you can't walk to the bathroom, right? And so together we might walk to the bathroom, use the bathroom.
Emilia Bourland
Mm
Brandy Archie
And you might do the same thing in PT. might walk to the bathroom with the PT and use the bathroom. But we're reporting out on and focusing in on the part that is in our scope as more than the other. even though it's exact same task, but you got to do these basic tasks before you could do other stuff.
Emilia Bourland
Exactly. So again, kind of digging into that example, and I think that's a great one. The physical therapist is thinking about how far does this person have to go in their own home to get to and from the bathroom from where they're going to be most of the time during the day? Are they doing it safely? there any barriers that they're going to have to get past in order to get there? And how do they manage those things? Whereas the occupational therapist is going to be thinking about, what is
First, once we get to the bathroom, let's figure out how are you going to wipe yourself? If you can't do that on your own right now, how can we work towards that? And what are some things that I might recommend to help you be independent more quickly? We'll also talk about things like what's the layout of your bathroom like? How are we going to manage the environment that you're in safely? are there any, this is something that I have done a lot in my work in acute care is talking about
Brandy Archie
Mm -hmm.
Emilia Bourland
You know, how can we even from the point of care in the hospital, think about modifying that environment to make it more safe in a really simple way so that you're actually going to be able to do these things? Because guess what? Almost no one's bathroom and bedroom looks like the hospital room and bathroom that they're in right now. So what is this really going to look like? Do we need to make any changes? What plans do we have to make? And how can we plan for all of that?
Brandy Archie
Mm -hmm.
Brandy Archie
Basically, right.
Emilia Bourland
and ensure that when you go home from the hospital, you're going to have a safe and successful discharge. I think that that is one of the differences between getting therapy in acute care versus like inpatient rehab or other levels of care where you're gonna be seen for longer is obviously in acute care, the goal is certainly to achieve the highest level of independence possible in that setting. But the other goal is
Brandy Archie
Mm -hmm. Mm -hmm.
Emilia Bourland
to make sure that you're safe to go home or to go to the next level of care. So you might be discharged from the hospital and discharged from therapy in the hospital before you have reached your full potential. In fact, that's often the way it goes, But you, just because you haven't reached your full potential doesn't mean you're not safe or ready to go home. You know, from either a medical standpoint or from the standpoint of therapy, like, okay, this isn't perfect, but
Brandy Archie
Mm -hmm.
Brandy Archie
Mostly what happens.
Emilia Bourland
you are to a place where you can do this safely enough or you can do this safely enough with assistance. And then, you know, the deal is, well, let's then you can go home from the hospital, but let's still continue on with either another level of therapy. Maybe this is going to be an inpatient or maybe this is going to be an outpatient setting. But then that next level of therapy to take over to keep you getting your gains to get
back exactly as close as possible to where you want to be.
Brandy Archie
That's such a good point because sometimes people are like, I'm not ready to go home because I can't do X, Y or Z. And you're like, well, that's true. You can't do those things yet, but you are safe to go home. Here's how you're going to accommodate at home. And you're going to keep going with your rehab, which is why we have so many levels. That's why therapists work at all the levels of care. And so if you're in acute care and you're safe to go home, you might go there, get home health. If you're not safe to go home, you might go to inpatient rehab or to a skilled nursing facility.
And so at inpatient rehab, you are able to tolerate three hours of therapy a day. And it's a high intensity, short -ish amount of time being there, usually around two weeks or less, in order to make the most gains as quick as possible. And if you go to skilled nursing, it's because you're not maybe able to tolerate that high level of rehabilitation, or maybe there's like not a big rehab need, but a big nursing need in that you're on antibiotic.
that has to be run through a line and can't do it at home or some other kind of medical condition that's not acute enough to be in the hospital but you can't manage it at home and so you might go to still nursing. So maybe you want to talk about like what happens in inpatient rehab which is one of my favorite places.
Emilia Bourland
Yeah, yeah. So as you said, inpatient rehab is an intensive level of therapy. The rule is, and I know you said this already, but I want to kind of highlight this. You have to be able to tolerate three hours of therapy a day because you have to receive three hours of therapy a day. So this is
Brandy Archie
You can't be like, I could do three hours of therapy, I don't want to do it today. Let's do it tomorrow. No, you have to do it every day.
Emilia Bourland
That's exactly right. You have to do it every day or, you know, basically you're, you're, or you won't qualify to continue to stay there. Those are just kind of how the rules are laid out. So this whole three hours a day thing, it's really not optional. And that can be split out either between the three disciplines, meaning it could be,
Brandy Archie
Mm -hmm.
Emilia Bourland
occupational therapy, physical therapy, and speech therapy, each seeing you for an hour a day. A lot of times that's how that works out. Or it could be just two, sometimes people don't always need speech therapy, right? But they almost always needs physical therapy and occupational therapy if they're gonna be in inpatient rehab. And so then maybe that time will be split between, you know, an hour and a half of occupational therapy and an hour and a half of physical therapy. And sometimes it works out a little bit differently, just,
depending on the individual person's needs. Maybe they need a little bit more physical therapy one day, maybe they need a little bit more occupational therapy one day, but you are gonna get three hours of therapy and you gotta tolerate three hours of therapy in order to be in inpatient rehab.
Brandy Archie
Three hours of therapy. Yes.
Brandy Archie
Yep. And so there, I feel like you see a bigger difference between what all the different disciplines are doing, mostly because your body can do more, right? And so this is why it's actually really important to have multiple disciplines working on the things because even though you're one person, there are so many building blocks to the things that you need to be able to do. And we need to be able to focus in on them specifically and not just blend it all together.
So you're still gonna be working on mobility in the best way possible, which we've been talking about walking, but it also includes wheelchair mobility. And so if you're gonna be a wheelchair user, you need to be able to push the wheelchair or drive the power wheelchair, whatever it is, the device you're gonna use. And then we also need to be able to get in and out of that and how do we manage dressing and bathing with all that. And so that's the stuff that you're working on inpatient rehab and trying really hard to set the scene up so that what you're doing inpatient rehab immediately translates to what you're
Emilia Bourland
Mm -hmm.
Brandy Archie
what you will need to do at home and really try hard to make the environment seem or meet the demands for what you'll need to do at home so that you can discharge home safely.
Emilia Bourland
And of course, the goals are gonna vary depending on the individual who is being treated, right? As you said earlier, Brandy, everyone's life is different. No two people are the same. And so goals aren't gonna be the same for everyone. Of course, in inpatient rehab, we do still want to make sure that people's basic activities of daily living, that they're able to perform those as independently as possible. So we're still thinking about bathing, toileting, dressing, grooming, eating.
Sleep is also an area of occupation that we can help address. So we want to make sure that all of those things are as safe and independent as possible. But we can also work on kind of higher level skills, things like planning for things like grocery shopping, household management, cooking, making the bed, doing laundry, balancing a checkbook.
Brandy Archie
Mm -hmm.
Brandy Archie
Mm -hmm.
Money management.
Emilia Bourland
Right? Like we can work on, on all of these. No.
Brandy Archie
Does anybody balance a checkbook anymore?
But if that's your occupation, we'll work on it.
Emilia Bourland
Yeah, no, I'm probably some people do
Brandy Archie
Heheheheh!
Emilia Bourland
I think my mom balances a checkbook.
Brandy Archie
Just saying. -hmm. Keep going. Check how to log into your online baking and make sure that this stuff is right.
Emilia Bourland
whatever it is
Yeah, right. Yeah, exactly. But yeah, think anything that you want or need to do, right, as you kind of meet the basic levels, then we can work on these higher and more complex levels and skills. And again, same for physical therapy. You know, you're gonna see people working on stairs more. You're gonna see people working on more advanced levels of mobility. You're gonna see people working on things like car transfers, which are really tough transfers.
Brandy Archie
Yeah.
Brandy Archie
Okay.
Emilia Bourland
And PT and OT might work together on some of those things as well. So that's kind what you're going to see in inpatient rehab.
Brandy Archie
And similarly in skilled nursing, you're going to be working on the same level of skills. It just might be that you're doing it at a slower pace because you can't tolerate the three hours of therapy a day for whatever reason. Mostly it's a medical reason and your body is just too fatigued to be able to handle it because your body is fighting whatever other things going on. And so you're still going to be working on those same goals and they're to set a plan of care for you for the amount of time that you need to see each clinician, each therapist.
And the stays in skilled nursing are usually a little bit longer and closer to like 28 days to give you time to build up what you need in order to go home or decide that you need to be in a facility somewhere where you have more 24 hour assistance if we're not able to get out of the skilled nursing facility in those 28 days that Medicare usually allows for. So yeah.
Emilia Bourland
You wanted... Go ahead.
One of the things that I always like to point out to people is that a lot of times when people are being discharged into skilled nursing, there's a confusion that people think that they are being discharged into a nursing home. And that is not what skilled nursing is. Skilled nursing is another level of skilled care that does provide rehabilitation. To your point, Brandy, it's not the same three hours a day because
If you're going into skilled nursing versus inpatient rehab, as you said, it's because usually for a medical reason, your body's just not able to tolerate that. And that's okay. That's why that level of therapy and that level of rehab exists is because not everyone can tolerate three hours a day, but that doesn't mean that people don't have potential to continue to heal, get better, be more independent, and ultimately return home, which is almost always the goal when folks are going into skilled nursing is
We still, those therapists, those nurses in skilled nursing, they still want people to go home as much as possible. It's just that, as you pointed out, that process can take a little bit longer. So, you know, I say that because I think even healthcare providers sometimes will get these two terms confused and they'll use nursing home interchangeably with skilled nursing. And that is really, really scary for people to hear.
right, because we have a lot of negative connotations with nursing homes. And so I just like to point out that those two things really are different things. And even I prefer the term like long -term care versus nursing home, just again, because we have this negative connotation as a society with nursing homes versus calling it what it is. I think a little bit more accurately, which is just long -term care. You're being provided with long -term care assistance.
Brandy Archie
Mm -hmm.
Brandy Archie
Now, to make that a little bit more complicated, you might be being discharged to a building that has a nursing home or a long -term care side of it. The skilled nursing, there are a lot of long -term care facilities that also have a skilled nursing wing. And so, but they are two different things. They run separately. They happen to be in the same building. Cause sometimes people do transition from skilled nursing to long -term care. And sometimes the people in long -term care need to...
Emilia Bourland
Yes.
Brandy Archie
have a level of nursing care after an acute incident before they go back to their long -term care so they can gain back as many skills as possible. So as muddy as that is, it is muddy, but the words do matter and what you're gonna receive those two places is different. And so it's not a pronouncement that you're never going home again, that's for sure. And even if somebody says that it is, that doesn't have to be true.
I think the other thing that's important for people to recognize is like, while we did talk about this, like a flow and a pathway and your medical professionals are going to refer you to the right level of care, you have agency in that too. And you can advocate for different things too. And so let's say your person, they're saying you're going to go to skilled nursing, but you're like, I think I really think they can handle inpatient rehab. Like that is a conversation that you can have, right? And then.
The decision could change depending on what happens the next day of rehab. Can I have an extra day here so that we can see if I can holler at the three hour therapy for real and go to that higher level of care so that I can, or higher level of therapy so that could get home sooner. Things can be, you have agency is what I'm trying to say. And while the, cause not everything is always black and white. A lot of times things are on the fence. And so it's important to know these levels of care so you can know how you can access them.
and how you can work through them. So whether it's inpatient rehab or skilled nursing level care, could do one. Those two are kind of on the same playing field as far as like timeline of where you're going. And then if you're able to get home, then the next level of care is home health, which is my actual favorite place to do OT because we're not making up stuff. I'm not trying to raise your house a little bit to meet the same height as your house, your bed at home. We're literally doing the thing in your house.
and helping you get to the independence level that we can best achieve and manage your environment the way we need to so you can be as independent as possible. So the therapist would come to your house. The key here is that you're classified as homebound, which means it's a challenge for you to get out of the house on a regular basis to go do things that you like to do. It doesn't mean that you can't go to doctor's appointments. It doesn't even mean that you can't go to church on Sunday.
Brandy Archie
or whatever day. It just means that on a regular basis getting in and out of the house is a significant effort. It might like require an additional person and so because of that we're going to send a therapist to your house so that you can get the highest quality of care as frequently as is needed without the barrier of having to get in and out.
Emilia Bourland
Now, of course, if you are not homebound, that doesn't mean that you can't get therapy services or that there's no therapy for you once you are back home. There's also outpatient therapy, right? So let's say you discharge from acute care or inpatient rehab or skilled nursing, wherever you were, and you go home and you don't qualify as homebound. You're doing pretty well, but you're not quite as advanced in some areas as you would like to be. don't feel like you've
quite met your maximum potential in certain areas, you can still have therapy. It just would need to be on an outpatient basis, which of course is an outpatient clinic, where then you would have to travel to that clinic. Whoa, what? What?
Brandy Archie
But there is also outpatient in the home to make this even a little bit more complicated. Because healthcare is complicated. So let's say you're not homebound, but you live in a city, which I'm guessing probably most people's cities, maybe not all the rural places have a practice or two that bills your insurance as outpatient. So you don't have to qualify to be homebound. But instead of you coming to the clinic, they provide you the service in your home.
Emilia Bourland
Mm -hmm.
Complicated. Yeah.
Brandy Archie
And so you can also look for a practice that does that and then we'll send somebody to the house, even though it's still outpatient therapy.
Emilia Bourland
I really think that for a lot of people that is actually an ideal option. And the reason is because it makes, at least from an occupational therapy perspective, it makes such a powerful difference knowing what someone's environment is like and being able to make recommendations for adjustments to that environment that it really, really substantially, I think, makes better outcomes when we can be with people in their homes.
Brandy Archie
Yes.
Emilia Bourland
Now, of course, that's partly dependent on what someone needs to be seen for, right? If I'm treating someone with a rotator cuff injury, it may be more important for me to have them come into a clinic where I have access to different tools and gadgets and machines and things like that in order to kind of get that shoulder back to where it needs to be so they can function where it needs to be. On the other hand, if someone is coming home and they are
Brandy Archie
on your stuff.
Emilia Bourland
their home and they have a new spinal cord injury, I would way rather be with that person in their house to be much, much more effective than have them come into a clinic because the skills that we really need to work on involve them interacting with their environment. And so why not be in the environment where they actually are, right?
Brandy Archie
Mm -hmm.
Brandy Archie
100 % true. And while that leads you through all the levels of care, and we took you from ICU all the way through the outpatient, it's not always a do each one of these steps in this order. And so you can actually access inpatient rehab or skilled nursing, home health, and outpatient without an acute hospital stay. And so...
Emilia Bourland
I don't know if that's, is that true now for skilled nursing? Has that changed?
Brandy Archie
Maybe not, let me not assume skilled nursing. That's not true. Not skilled nursing, but inpatient rehab, you could come from home and go to inpatient rehab. If your diagnosis qualifies, your insurance coverage and your doctor says it's necessary because there's been a change in status without having to have had an acute incident. I'm sorry, I shouldn't have included skilled nursing. That's not true for that. The same is true for home health. If you go to your doctor and say, listen, I'm having a harder time.
getting up and down the stairs and out of the house. I haven't fallen, but I'm fearful of falling or whatever. If your diagnosis qualifies and your doctor agrees, you can start home health without having to have gone into the hospital. That's like a great solution because we want to prevent you from having to go into the hospital in the first place. If you need additional rehab, you can do that. And of course, outpatient, can do, know, it's the easiest one to get into. You definitely don't need to have an acute stay to access outpatient. still need your
physician order or your primary care order. But yeah, you can start outpatient and you can do that, you know, as many times as is necessary through the year provided your insurance coverage.
Emilia Bourland
Yeah, and the only thing that I will add to that is that we would so much rather see you in a more preventative way in your home or in outpatient or even back in rehab if that's what needs to be done. We would rather see you in those places and fix the problems that you're seeing early on so that you can have a
Brandy Archie
Mm -hmm.
Emilia Bourland
So you can be more functional, you can be healthier, you can have a better quality of life. Those are all big things, right? But we can also prevent, hopefully, the thing that might send you to that acute care level, you know, in the first place. So lesson here being, if you feel like you're having a problem with your functioning in any way, talk to your health care provider about it. See if you can get, you know, some see if you can get some therapy for that early on.
So you can get someone into your house to help you address those issues, right? Because we can prevent so much with early intervention and save you so much time and heartache and really hard work, not to mention a boatload of money, right? So when we can intervene often and early, that really is the best way to get people not just where they want to be, but to keep people where they want to be as well.
Brandy Archie
100%. And I feel like we care lab that.
Emilia Bourland
We care lab the heck out of that. I'm gonna do a quick, I am gonna do a really, really quick summation here because it was kind of complex. So we've got just of the different levels of therapy. So there's acute care for people in the hospital. If you need inpatient therapy, there's inpatient rehab, which requires three hours a day and a shorter stay. There's skilled nursing.
Brandy Archie
haha
Emilia Bourland
Rehab as well, which is less than three hours a day and is usually a longer stay for people who are more medically complex from an outpatient level you can have outpatient therapy in a clinic you can have outpatient therapy in your home or there's also home health which is available for people who qualify as Homebound we didn't go super into LTACs, which is long -term acute care, but that's essentially For folks who are really sick and they can't handle
Brandy Archie
We didn't.
Emilia Bourland
They can't necessarily handle getting into like rehabilitation. They're pretty medically complex. And so essentially it is exactly what it says. It's long -term acute care and you can continue to receive therapy services there as well. But kind of that quick little summation for folks like these are the levels and kind of what they're there for and what you can expect.
Brandy Archie
Absolutely. And if you listened this far in the podcast, then you are now required to rate us and give us a review. Because one, we want your feedback because we want to be giving you the information that is beneficial to you. So please leave us a review. And two, we really do want to make sure that our information reaches the people who need to hear it. And the algorithm helps us out if we get more reviews and ratings. So if you want us to be shared around.
Emilia Bourland
You
Brandy Archie
a little bit automatically give us a like and a rating on all the platforms. So whatever you're listening to us on, you should be able to do one of those two things.
Emilia Bourland
Yeah, please do that. And don't forget to go ahead and subscribe so you get notified as soon as a new episode drops, which should be every Friday. And we'll see you next time right here on Care Lab. Bye.
Brandy Archie
Bye.
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