Summary
In this episode of Care Lab, Emilia Bourland and Brandy Archie delve into the intricacies of rehabilitation, discussing its various forms, the importance of patient participation, effective communication with rehab teams, and the significance of setting realistic goals. They emphasize the need for patients and caregivers to advocate for themselves, understand the rehab process, and prioritize their concerns to achieve the best outcomes in therapy.
Key Questions Answered
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What’s the difference between inpatient rehab and skilled nursing facility rehab?
Inpatient rehab requires tolerating about three hours of therapy per day and offers more intensive therapy over a shorter stay, while skilled nursing provides lighter, slower-paced therapy with typically longer stays. -
Why are “participation” and “progress” so important in rehab?
They are central to continued insurance coverage and better recovery outcomes—actively participating helps demonstrate progress, which supports medical necessity for ongoing therapy. -
How can caregivers and patients best communicate with the rehab team?
By directly engaging therapists, attending care meetings, sharing phone numbers, and offering detailed home and lifestyle information that shapes realistic goals and discharge planning. -
How do personal goals and worries influence therapy?
Sharing what matters most—such as caring for pets, returning to work, or managing bathroom setups—helps therapists design meaningful sessions, increase motivation, and set relevant goals. -
What information about home life should be shared with therapists?
Details about the physical environment (narrow doorways, low toilets, lack of grab bars), routines, responsibilities, and preferred activities enable therapists to tailor therapy and advocate for appropriate length of stay and equipment.
Transcript
Emilia Bourland, OTR, ECHM
Hey, welcome to this episode of Care Lab. Today, we're pulling back the curtain on rehab, how it really works, where it can fall short, and what you can do to get the care you actually need. From confusing systems to hidden strengths in good therapy, we'll break down what matters most and give you practical tools to advocate for yourself or your loved ones. Let's lift the veil and get real about rehab.
Brandy Archie
I'm excited to talk about this because usually people are entering into this without having any prior knowledge and just like anything else in the world, it has a system to it and it has like ways that it works and when you understand it a little bit better, you can maximize it more and use it to your benefit and everybody should be trying to help you do that anyway, but there are some key things that we can be advocates for.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
as patients or caregivers. And so we want to just like bring to light what those are coming from an insider's perspective because we know how the ins and outs of the thing works. So my question to you is, is that? Let's start at the very beginning actually. When we say rehab, what are we actually? Very good place to start. Exactly. ABC. So.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
That's a very good place to start. When you sing or when you read, you begin with ABC. Okay. Yeah.
Brandy Archie
That's so funny because I do love musicals and especially those ones. So that's good. But the beginning I'm talking about is not from Sound of Music. It is for rehab. What does rehab mean? We're using a very generic word that can mean a lot of different things. So maybe can we talk about what that means?
Emilia Bourland, OTR, ECHM
Yeah, that's a great question. so kind of generally speaking, you're right. When we talk about rehab, we're talking about like rehabilitation for at least you and I are talking about rehabilitation for a physical or cognitive injury or illness or something like that, something that has happened to someone where they had lost some of their abilities and now we are working to get those abilities back,
And rehabilitation can take place in a lot of different settings, right? We can do rehabilitation in home health. We can do rehabilitation in acute care. I think that what we are really specifically talking about today, although that's not to say that you can't take some of these lessons to any of those scenarios where you are working with a therapist to get rehabilitation services, I think we're really kind of focused in on inpatient
Brandy Archie
you
Emilia Bourland, OTR, ECHM
rehabilitation settings, which can either be usually like a skilled nursing facility where people often receive inpatient rehabilitation services or inpatient acute rehab, which is also inpatient, but the rehabilitation tends to be much more intense. People are a little bit less sick sometimes in those or a little bit less medically complex, and maybe they're going to rehab a little bit faster in those scenarios. They can handle more.
So is that a good place to start or do you think we should talk a little bit? Did I miss anything there?
Brandy Archie
I think it's a good place to start. The thing that I would want to like lean a little heavier into is these days a lot of skilled nursing facilities just market themselves as rehab. And we use all these different words around it. And I just want to just take one moment to explain the difference between inpatient rehab and a little bit more depth in what you did already. So if somebody leaves the hospital and goes to a nursing facility, a skilled nursing facility, they might call it rehab.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
and they are living there and they are not getting three hours of therapy a day, but they're getting some therapy every day of the week, that's probably a skilled nursing facility. And most of the time those lengths of stays are right around 21 days. But the other one which you alluded to, which is inpatient rehab, you have to be able to tolerate three hours of therapy per day and you get that five or six days in a week.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
and they're often connected with hospitals or you're a floor within the hospital or they're a standalone hospital. They also have a length of stay, which is a little bit more variable, but around a couple of weeks to four or five weeks, depending on what the insurance will cover. But that level of therapy is significantly more intense and you're going to get more, you're going to get more out of it because you're getting more frequency and
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
those clinicians are used to pushing people a fair bit harder. And that's kind of the point. That's the point. You can't handle that much because we're really sick. We've got wounds. We're having a lot of other issues. We're not sleeping well. Then we're going to go to a skilled nursing facility where we can take our rehab a little bit slower. But if your person can tolerate it, we should be trying to get them into inpatient rehab if we can, because it is going to push them further faster.
Emilia Bourland, OTR, ECHM
Mm-hmm. And I think that's the difference can be confusing. I think that's one of the reasons that we want to talk about how to get the most out of rehab kind of wherever you are today, because let's say you do have a loved one or you are in a skilled nursing facility, you're receiving rehabilitation services there, but you're not able to tolerate three hours a day. That doesn't mean that you can't do well. That doesn't mean that you can't make progress. That doesn't mean that you can't reach your goals.
but there are things for you to know about how these systems work that are going to help you get the most out of your stay and to maximize, you really do need more therapy, to maximize your length of stay as much as possible to get as much therapy as you need because there's rules and regulations around all this and it's complicated and the therapists know all the rules, but you don't necessarily know all the
So it's helpful for you to know some of the rules that we're all having to follow here.
Brandy Archie
Yeah. So, okay. So then let's keep going and let's talk a little bit about participation because that's kind of where we started it. We're talking about like, can I tolerate three hours therapy or not? And so wherever situation that we're at, participation is really key and making progress is like a thing that gets talked about in your weekly progress meetings, literally that's what they're called. So can you talk a little bit about like why that's important and how that can be maximized?
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Yes. like participation and progress are two things. You can think of it like these two big P's and they are almost universal in the rehabilitation world, almost no matter where you're receiving services. In order to continue receiving therapy services, you have to one, participate and two, make progress. And of course, if you're listening to this, you probably realize that these two things go hand in hand, right? Like you're not going to make a lot of progress.
Brandy Archie
Okay.
Emilia Bourland, OTR, ECHM
if you're not participating. So, but if you are participating well to the highest capacity that you can participate in, then it's highly likely that you will see that progress. And why that matters is because insurance will not continue to pay for a person to be in a rehab facility if they are not participating and if they are not making progress because it costs a lot of money.
Brandy Archie
you know, participate.
Emilia Bourland, OTR, ECHM
for people to be in rehab, like a lot. And so basically if it's a situation where someone is like choosing not to participate, they're unable to participate. Sorry, I shouldn't say unable. There can be circumstances where like you're really sick. You have to miss a day of therapy. That happens in skilled nursing sometimes, right? Like things happen where maybe you can't do therapy that day. That's understandable. But
If you are not pushing yourself to participate when you can participate and that becomes an issue, then insurance isn't going to continue to pay for it basically. And of course, if you're not participating, then you're not going to make progress. Progress doesn't always have to be huge, by the way. We can make little incremental bits of progress. We don't have to go from being wheelchair bound to being walking.
in a few days in order to measure progress. A good therapist is going to write achievable goals. And we'll talk more about like your participation in that goal setting process here a little bit, and how important that is. But a good therapist is going to write goals that you can achieve to continue to demonstrate that progress. So as long as you keep putting in the work, this is really the takeaway here. If you can put in the work, put in the work.
Brandy Archie
Okay.
Emilia Bourland, OTR, ECHM
And if you do that, you're going to make progress. And that helps the therapist to document for the insurance company, basically making a case that, this person needs to continue to be here because they're working hard and they're still making progress towards their goals and they haven't met those goals yet. So we have a reason to keep this person here and keep working with them. So if you take away almost nothing else from this,
participation and progress, unless there is some reason that you really can't do the work, you know, and your therapist will help be a guide for this too, right? Like if you're too sick, your therapist can help guide you through that. But if you can do the work, get enough and doing the work, even when you don't want to, because it is hard, it is work, it can suck, but we have to have that participation to make that progress so that you can get
to the highest possible level that you can get back to and meet all your goals.
Brandy Archie
That is a great definition, but also you left some wiggle room for like if you're too sick to participate. The definition of that and who decides that is variable. And so I'm going to give an example. If a therapist comes into see you and says, Hey, it's time for OT. Let's get up and brush teeth. And you say, I don't want to do that right now. Can you come back later? They could.
Emilia Bourland, OTR, ECHM
Mm.
Emilia Bourland, OTR, ECHM
Mmm.
Brandy Archie
Say, sure, I have room in my schedule to come back and see you and we'll plan for me coming at noon. Does that work? Great, we're good. There's no problem. They could also say, this is a mis-visit and they didn't participate. Because I don't have any room to come back and see you because I have more people to see than I have time for, technically.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Yeah, not because your therapist is trying to be a jerk, but they've got so many people on their schedule that if they come in and you're like, don't feel like it right now, they're going to move on. Yeah.
Brandy Archie
literally just have so many people on the ship.
Brandy Archie
They don't necessarily have the bandwidth to be able to accommodate that for you or everybody else too. And so if you can, instead of saying no, come back and say, I'm feeling nauseated. Can we just sit at the edge of the bed and do something? Great. I will help figure out something that we can do that will help move you, move us forward, show that you are participating. Because nobody feels great. You're in the hospital or in rehab, like, because something sucks, right? Like,
Emilia Bourland, OTR, ECHM
Mm-hmm, mm-hmm.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Yeah, understandable.
Brandy Archie
So we all understand that and we can work around it as long as you're willing to work with us. So even if it's happening at an inconvenient time for you or you feel like you would prefer to be sleeping or whatever would normally happen when you are in control of your time at home, you got to give a little bit of compromise and then just say, I'm feeling this kind of way, can we do something that can help me with that or that works alongside with that? And if it's going to be happy to oblige, just say yes first and then work it out.
Emilia Bourland, OTR, ECHM
Mm-hmm. I think that's a that's a really good point The the other thing that I'll follow up with there is sometimes there are legitimate medical reasons why someone cannot participate in therapy maybe There are certain labs that have come in really low. It's not safe to participate Maybe there's some other medical condition that has come up and it's not safe to participate it's actually part of your therapist job to know those things to
Brandy Archie
Hey.
Emilia Bourland, OTR, ECHM
read your records every day to understand what's going on with you medically so that they can also make the call to say like, hey, this person is genuinely too sick to participate today. They're not able to, it's not safe to. That's one of the things that makes a therapist really different from, for example, like a personal trainer, which sometimes I think can be confusing, like, okay, we're getting up, we're doing exercise. What's different between this and going to the gym? Well, your therapist has a huge extent of medical knowledge.
Brandy Archie
Mm-hmm.
Emilia Bourland, OTR, ECHM
that they should be applying on a daily basis to make sure that it's safe for you to continue with whatever rehab processes need to be done. So just know that like, you know, if you are really genuinely sick, it's not safe for you to participate. That's not something that, that also gets documented and that's not something that counts against you. But like Brandy said, if it's a situation where you're like, just don't feel good. The fact is that probably most people there don't feel good. It does suck.
Brandy Archie
Bye.
Brandy Archie
I don't feel good.
Emilia Bourland, OTR, ECHM
your therapist is not there to torture you. They want to help you through it. Just help communicate with them. Tell them what's up. Create an opportunity and an option. And you know what? Most of the time, a good therapist is going to leave you feeling better than you felt before they walked in, right? It's their job to do that. It's their job to take care of you. So just having that open communication, being open to
Brandy Archie
Right.
Emilia Bourland, OTR, ECHM
finding a way so that you can get that participation.
Brandy Archie
Exactly.
Emilia Bourland, OTR, ECHM
Okay, so something else kind of going along this communication thing that's really important is actually like talking with the rehab team. And this is important, obviously, if you are the person who is in rehab. But if you are a caregiver for someone who's in rehab, talking with the rehab team itself is very, very important. Can you talk a little bit more about that, Brandy?
Brandy Archie
Yes, in so many episodes prior to this one, we've talked about how important it is for therapists to understand the context in which things are being done at home. regardless of what kind of rehab you're at, the goal is to get out of here, right? And so we want to make sure that you're prepared for that. And it's really hard to do if we don't have good communication and aren't able to talk to everybody who have that knowledge, especially if you're a person who's there can't really speak well for themselves.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
And so being connected with the rehab team is of vital importance actually, so that we can have the information that we need as therapists to try to help do the best things possible for your person, even though you maybe can't be there 100 % of the time. And so either leaving your phone number on the dry erase board in the room to say, call me for questions or stop being present virtually or in person for care planning meetings or.
looking at the schedule to see when therapy is happening and see if you have the capacity to be there can be really illuminating for the therapist and then also can help you relay those.
Nuanced things that are happening in y'all's daily life for that person So we know that the person needs to get dressed and use the bathroom and all the things but we don't always know if every Tuesday they go get their hair done or they like to go bowling or Yes, they need to use the bathroom, but it's actually a sunken bathroom Which is not normal and you got to step down to get in there or something like that, right? And so those details actually do matter a lot for function
And so if you can relate some of those to us, this can be really useful. What other things do think you would ask that?
Emilia Bourland, OTR, ECHM
I think that I would just add that having that real world information is so helpful to like that goal writing process that we had discussed earlier. So when someone comes in for therapy, the therapists do evaluations and they actually write, like we go and we write down goals, both long-term goals and short-term goals for that individual. The more we know about what your real life looks like,
or what your loved one's real life looks like, what their home looks like, what their daily routine looks like. Do you do your own hair or do you go and get it set once a week? These are all really important things to help make sure that the therapist is writing goals that are relevant to your actual life and that we're writing goals that are gonna be appropriate
for where you want to actually end up. If we don't have enough information, then there's a chance that we write kind of more generic goals. And that doesn't mean that you won't get better, that you won't make progress, but are you gonna... The goal of therapy is to get you back to your life. Like I've said before, it's the doctor's job to save your life. It's my job to give you your life back. So I need to know what that looks like, or I can't give that to you.
Brandy Archie
Mm-hmm.
for me.
Emilia Bourland, OTR, ECHM
And the more that you can just be real and honest about, you know, what your goals and priorities are, what things really look like, again, that helps with writing the right goals. It also helps with that participation and progress because you're a lot more motivated probably to show up if you know what you're showing up for. If you know why, if you know why I'm asking you to do these things, you're probably a lot more motivated. If you're a part of that
Brandy Archie
That's a good point.
Emilia Bourland, OTR, ECHM
process, if you're part of that goal writing, which really is how it should always be, then you're probably going to be a lot more motivated to say, yeah, I don't feel my best today, but you know what? I'm going to do what I can. And we're going to get one little bit further. So it's just a really powerful thing to do to talk about what that daily life really, really looks like. What about,
Brandy Archie
Bye.
Emilia Bourland, OTR, ECHM
Sometimes also, and this happens, I think, particularly in skilled nursing in my experience, sometimes a lot of the communication, the community or the facility, they'll try to have a direct communication channel. Oftentimes that direct communication channel is actually through nursing and not necessarily for a regular weekly communication. A lot of times that's through nursing or even sometimes administrators versus through the therapy team.
Brandy Archie
Thank you.
Emilia Bourland, OTR, ECHM
have always recommended to all my patients that they reach out to me and their other therapists directly if they really want the real story about what's going on. What do you think about that?
Brandy Archie
okay. So not just for the family to relate information to us as rehab professionals, but to get the real understanding of like how is the person doing. Yeah, I think that's actually really key and important because while nursing is doing a great job at their job, they're often set up to do things for people and make sure that they are well taken care of. And it's our job to make sure that people can be independent.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Yeah.
Brandy Archie
And so we might push you a little bit to like actually get up on your own without some help and do whatever is the next step up and what you need to do in order to be in order to get better. Right. So we don't challenge you. You're not necessarily getting better. And so we have this really honed in perspective on exactly what the person is capable of doing. Because that's what our got our whole job is.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
And so if you want to understand like how close are they to being ready to come home or being able to do XYZ task, then talking to the therapist is really like the way that you're going to get that in-depth knowledge because it's not, you can ask me, was he going to be able to get him down from the toilet on his own? And I'm going to say he can't walk to the toilet by himself, but if the toilet, if the shower, if the wheelchair is pushed up right there, he can transfer independently. as long as you would get him in the bathroom.
You can leave them be and like that's super specific. Whereas if you're getting that from nursing or administration, they're going to say something more like, well, the staff has been helping him get to the bathroom. And so that doesn't tell you a ton, right? Does that mean you need full help or is it what I said, which is really just need help getting in there and wasn't in there. can do it on his own. And that's a totally different mindset about like how much help you need to have set up ready for that person to come home. And so if you want that unique level or that.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
granular level of information so you can plan and prepare. You should definitely talk to a rehab team.
Emilia Bourland, OTR, ECHM
Yeah. And of course, that's not a knock on nursing at all. we, love nursing. We love nurses. They are, they are vital, important, and we depend on them all the time, but we have different scopes of practice. Right? So if you talk to the nurse who is often the primary point of contact, if you talk to the nurse, you're going to get primarily nursing information. But if you need to know that information about how well this person is progressing,
Brandy Archie
No.
Brandy Archie
Yeah.
Emilia Bourland, OTR, ECHM
how far they're likely to get in terms of their independence before they get home, what you need to learn as a caregiver in order to take care of them when they get home. And even so far as like, what kind of thoughts do you need to have about modifying your house or modifying their house? What equipment do you need to be considering? The people to talk to are the rehab professionals there. So just making sure that you have an open line of communication with them.
You know, know the number to the rehab department. It's really as simple as that. You don't need to get everyone's personal cell phone number. to be clear, I never give my personal cell phone number out when I'm treating patients, but you can call the rehab department and it's easy for patients to get a hold of me that way. And I'm always like delighted. I've never met a therapist that was not delighted at having a involved caregiver who wanted to know what's up.
Brandy Archie
Yeah.
Emilia Bourland, OTR, ECHM
who wanted to have a great plan and who just wanted to have their finger on the pulse of, okay, what's going on? What should I expect? What do I do next? Because that makes everyone more successful in this.
Brandy Archie
Totally. Totally.
So.
Brandy Archie
and having that line of communication that, and the reason, I think the reason that therapists are delighted to have you reaching out is because we know you're invested one and that we're not bothering you. Cause sometimes I'm, I really want to talk to the person they live with. So I can ask these really particular questions. I'm not actually getting answers from the person on. And so we have this open line of communication, which means you then get to tell the therapy team about what your real life is like.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
And so we started talking about this a little bit about goal writing. And the one thing that we also didn't bring up there is that goal writing is actually really important for how long the stay is and what the reimbursement is like, right? Because if we write generic goals and we're like, okay, well, he can go to the toilet here, can get in the bed here. But we're not writing goals that are like, they need to be able to walk around the other side of the bed because their side of the bed is over there by the wall and in sidestep.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
to get through this small space without a walker to get in the bed, that's a very different goal, right? I can say like, okay, we're independent with getting in the hospital bed on the right side, but we need to be independent getting on the left side and doing these tasks in order to do it. And so that might actually be what we need to do to stay like, we need just a couple more days to get this down so we can go safely. So can you talk a little bit more about how important it is to talk to the therapy people?
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
the therapy team about what your real daily life is like.
Emilia Bourland, OTR, ECHM
Yeah, really all comes down to if you want... So there's two things. One, if you want your outcome to be as close as possible to your previous daily life, we have to know what that looks like. And two, from the point that you made about being able to continue therapy, and essentially that means that therapy has to be reimbursed for it, we need to have really clear and specific goals.
And so the more specifically that we know what you need to do, how your environment is set up, what your daily life is like, the more specific we can make those goals, the more clearly we can document both like incremental progress as well as why someone might not be ready to go home yet. So a great example might be, well, this person is transferring independently
with the grab bars in the bathroom in their rehab facility. But at home, but the rehab facility has a 48 inch doorway. It's got two sets of grab bars. There's nothing impeding the area around the toilet. So you could roll up in their wheelchair or you could walk up with a walker. But at home, you have
an older house with a very narrow doorway. There are no grab bars mounted. You don't have the space to, yeah, you have a lower toilet. Maybe there's not space to access that area easily with the equipment that you need. And so that is actually a completely different situation. So you might be independent with a toilet transfer using a grab bar in the facility, but that does not mean that you will be independent doing your toileting at home.
Brandy Archie
A lower toilet.
Emilia Bourland, OTR, ECHM
in the way that you need to do it. And so that changes the goal, right? And that can change how long you need to reach a goal because it's a lot easier for most people to be independent in toileting in a perfect situation where they have access to a grab bar and all the equipment can get in. Most people's lives are not that, most people's bathrooms are not set up like that. Your life doesn't look like that.
it can reasonably be expected to take longer in order for you to be independent with a more challenging transfer in a more challenging environment. in order to be independent, we have to be not just physically or cognitively capable of doing something, we also have to be safe doing it, right? And so there are other layers on top of that there. So again, just that being specific, communicating with your therapist.
Brandy Archie
Mmm, yeah.
Emilia Bourland, OTR, ECHM
so that we can write the right goals, so we can work on the right things. These are all things that help you or your loved one to get both the outcome that you want, but also to get as much time as you possibly can in order to achieve those goals. Because if we're going to ask insurance for more time, that means we're asking them for more money. And if you're listening, you probably are aware that insurance companies are not in the business.
They're in the business of making money. They're not really in the business of healthcare. They're in the business of making more money. So they're not motivated to give out more money or more time unless we can make a really strong case, which is what we want to do. When we see people who need more and we know can go further if they just get that, we want to do everything that we can to help do that. Because that's why we do this job. That's what we're passionate about.
Brandy Archie
I'm giving out more money. Yes.
Brandy Archie
Yeah.
Emilia Bourland, OTR, ECHM
Help us by being, help your rehab team by being open, talking about your daily life, getting specific about things, having that open line of communication. It'll also just be a more positive experience for you too, because you'll know why you're doing what you're doing and you'll probably have a good working relationship with your therapy team, which makes a huge difference.
Brandy Archie
Totally.
Emilia Bourland, OTR, ECHM
I think this kind of, we may have covered a bit of this already, but I just want to maybe ask you to talk a little bit more about, so a lot of times people, like you'll walk into the room, right? You know, say, hey, I'm your therapist. What do you want to work on today? And what's the most common response that you get, would you say, Brandy?
Brandy Archie
whatever you want to do is fine.
Emilia Bourland, OTR, ECHM
That's right. whatever. You're the expert. You're the professional. Whatever you want to do. Of course, your therapist is the expert on therapy, but they're not the expert on you. So talk a little bit more about that, Brandy.
Brandy Archie
Mm-hmm.
Brandy Archie
Yeah, we're not coming to ask them because they don't know what to do. We're coming to ask them because I want to know what is most important to you. Because maybe we have five things that need to be worked on, depending on what the study is, what's going on. And so I want to do the thing that's most important for you, either right now, because like I need to go to the bathroom and that's like urgent, let's do that. Or in general.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
Hey, I am not having any problems with having somebody help me get dressed, but I really do want to be independent with showering, you know, and then get some help. I don't know that unless you tell me that, right? And so otherwise I'm just picking from the things that I know you need to work on and then we're just doing them. And that's just not as engaged. And when you're more engaged in what you're doing, then you see more purpose in it and you're going to do better at it. And you're to work harder at it because it's not easy. If it were easy, you wouldn't be there. You'd be at home doing it.
So we want to really understand you and know what you need and want short term and long term. So either right now what's happening with your body and how you're feeling right now when I'm in your room. And also like what are the things that you spend the most time doing at home that you want to make sure that we can do right away when we get there. Because there might be the occasion that we don't achieve all of your goals before you go home.
And that's okay because you'll continue to get therapy there. I want to make sure we have the most important ones for you so that we're great at those and then we keep working on the other ones with, you know, therapy and home health or an outpatient or whatever study needs to be had. So I think that's, while I think the motivation besides saying whatever is easy for you is usually friendly and nice, that's not helping you get the most out of therapy because we really want to work on the things that are most useful for you.
Emilia Bourland, OTR, ECHM
Mm-hmm. think that was a good point too. And your therapist isn't asking because they are out of ideas and they don't know. They really are asking because they want to know what your priorities are. I do think it can be really overwhelming and challenging, especially in settings where maybe you're pretty sick. You've been through a lot. You have a serious injury. Like, what do I want to do? Well, I want to get the heck out of here and, you know.
I want to go home. I want to live my life. Right. And so it can be hard to kind of pare down from that into, well, what do I want to do right now? So I think a helpful question. So this is a helpful question for me when I'm working with patients to help people kind of dig down into what the most important goals might be for them right now. And I think if you're listening to this and you either maybe you are a patient somewhere right now, or you are caring for someone who is in this situation.
A good question to ask yourself could be, what am I most worried about being able to do when I leave here or when I get home? And if we can kind of, because there are definitely things that you're more worried about than others. And when we can talk about those things that you're worried about, and it doesn't matter, if you're worried about it, it is important.
Brandy Archie
Mm-hmm.
Emilia Bourland, OTR, ECHM
It doesn't have to be something that like fits into a certain box or category. What matters is that it's important to you. And I guarantee that if it's something that you're worried about, it's something that we want to work on and we're going to have a way better session that's going to be much more helpful to you. I'll give an example. So I was working in rehab one day and I walked in to see a gentleman and you know, hi, I'm a miliary occupational therapist today.
Brandy Archie
Right!
Emilia Bourland, OTR, ECHM
What would you like to work on today? I don't know, you're the expert. you want to do is fine. Okay, well what are you most worried about being able to do when you get home? He was most worried about how he was actually going to feed his dog.
Brandy Archie
Mmm.
Emilia Bourland, OTR, ECHM
Okay, we can work with that. Is that a direct like activity of daily living? Not necessarily, but there are a ton of things and skills that go into having to feed your dog that are still super applicable to all of the goals that we're working on for those activities of daily living and everything else. And most importantly, like that's a genuine concern that this person had.
How can I expect this gentleman to do other things with me and work on anything else if I haven't met his most basic worry and concern, which is how is he gonna feed his dog? And so that turned into a really, really helpful session where we talked a bunch about environmental modifications for the home, different types of equipment that he could use for different types of things. We ended up solving lots and lots of.
Brandy Archie
Mm-hmm.
Emilia Bourland, OTR, ECHM
problems in addition to doing a lot of great physical work. And at the end of it, like he felt much more confident that by the time he left, he was going to be able to take care of his dog. And that was important to him. So like, that's, that's a good session. You know, when you feel like you had a worry in some way alleviated, now you have a plan for that. Not that we can solve every problem in one session. Of course we can't, but
Brandy Archie
Emilia Bourland, OTR, ECHM
Thinking about the thing that you're most worried about it. Don't be concerned about whether or not someone else is gonna think that's a valid issue. If you're worried about it, bring it up and it's a great place to start.
Brandy Archie
Yeah, totally. And that is his responsibility, right? It's not unlike me saying like, oh, I'm worried about being able to change my kid's diaper now that I have this kid's ass on my hand, right? Every ADL or daily living task doesn't always have to deal with you as a person, your person, like bathing and dressing. There are higher level tasks like going back to work or walking your dog or taking your kid to school or picking up your grandkids. All of those are useful and valuable.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Yeah.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Brandy Archie
And if those are the ones you care about more than like dressing and bathing and you're willing to get help with those things so that you can do those things that you want to do, that's also fine too. and so, but we don't know that unless you talk to us about it. So, no ask is really too small. If it has something to do with your life, you should tell your therapist.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Emilia Bourland, OTR, ECHM
Mm-hmm. And I say like for therapists who might be listening, that's one of the best questions I ever learned to ask. What are you worried about today? What are you most worried about? Definitely good, especially if you're a new therapist who listening, that's a great one to have in your back pocket.
Brandy Archie
Mm-hmm.
Brandy Archie
I totally agree. I usually ask a similar question, is especially in rehab. It's like, if we went home today right now, what would be the most challenging for you to deal with? What are you most concerned about? Is this another way of saying, what are you worried about? And that really illuminates what's on their mind and then also what we need to work on that day. But then it leads into all the other goals that you might be having because I started with the thing that's most important to you.
Emilia Bourland, OTR, ECHM
Mm. Yeah.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Mm-hmm. Okay, Brandy, anything else to add here? I feel like we did a pretty good job, hopefully.
Brandy Archie
I think we did a great job. And I hope that people just understand that the system is not set up to make you feel outside of it. And the goal is to help you. you are the center of it, is what I'm trying to say. I know a lot of times when we are in a facility, especially, it feels like we're on somebody else's turf, which is fair, you're not in your own home, but it's really for you. And as long as you remember to keep that at the center, and we are trying to keep you at the center.
Emilia Bourland, OTR, ECHM
Mm-hmm.
Yeah.
Brandy Archie
then gives you a little bit more agency to feel like you can speak up and say what's important to you because that's really what the goal is.
Emilia Bourland, OTR, ECHM
Yep, absolutely. Well, if you made it to the end of this episode, then please take a second to share, like, subscribe. Most importantly, leave a comment, leave a review. These are the best ways to help other people find this content that is hopefully helpful to lots of folks out there. Until next time, we'll see you right back here on Care Lab. Bye.
Brandy Archie
Bye everybody.
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