Transcript
Making Home a Safe Place with Dawn Rushbrook
Melanie:
Welcome to the Family Carers Podcast, where we help mums, dads, aunts, uncles, daughters, sons, friends, anyone caring for a family member or loved one feel supported in their role and connected to their community. This week, we're joined by Dawn Rushbrook. She's an occupational therapist and business owner at Independently You. Independently You was created in November 2022 when Dawn decided that it was time to take a step into independent practice as an Occupational Therapist. She'd been working for almost five years as a Senior Practitioner Occupational Therapist as part of a community-based team for the local authority in Adult Social Care. In this episode, we'll learn about the key areas of the home that you should focus on when assessing and improving safety for your loved ones, Practical tips or modifications that can be made to reduce the risk of falls and accidents in the home. How you can create a more comfortable and accessible living environment that supports the independence and well-being of the person that you care for. So if you're a family carer and feel that your home may need some adaptations to keep your loved ones safe, but you aren't sure where to start, this episode's for you.
I'm Melanie Cohen. Stay with us.
Hi, Dawn.
Dawn:
Hi, Melanie.
Melanie:
How are you today?
Dawn:
I'm very good. Thank you.
Melanie:
Good. I'm very well. Thank you. It's lovely to have you here. Thank you for asking me. So for anybody who doesn't know you, or for perhaps anybody who doesn't know what occupational therapy is, could you give us a quick introduction to yourself?
Dawn:
Absolutely. So I qualified as an occupational therapist from Bournemouth University back in 2020 No, 2012. Wow. Seems so recent. And went into community teams, visiting people in their own homes. In a nutshell, what occupational therapy is, is a profession that helps people to do the things they want or need to do. things that are meaningful to them, things that are important to them. It can be something like getting in and out of bed. It could be something getting dressed, or it could be a hobby, or it could be feeding yourself. There is such a broad range of occupations that could be a podcast in its own right. But often as people get older, whether it's naturally through aging or whether it's because of a long-term condition or a trauma, they find that they are not able to engage with things and this impacts on their mental health and their sense of well-being. Occupational therapy tries to work with people and find solutions to make those things easier.
Melanie:
So it's really interesting, so thank you for that overview first of all. But is that directly relating to equipment? Because I think that's what we all feel occupational therapy is, and I think we're probably wrong.
Dawn:
There is an element of the truth in there. Obviously, some of what I do as an occupational therapist is about looking at equipment, whether that be grab rails, whether that be raised toilet seats, whether it be specialist seating. We also look at the environment. So it's about adaptations, whether they be small or large to the home environment, could be something as simple as getting a different toilet so it's a comfort height toilet that makes it easier to transfer on and off so you don't need grab rails because no one wants their home to look clinical. You still want it to be your home. We also look at graded activities so say for example you want to bake a cake Sometimes you can't bake the whole cake anymore. So sometimes it's about going out and buying a cake and just decorating it. You're still making the cake or it's about getting someone else to help you. It's about looking at how we do those occupations, breaking it down into tasks and then looking at those component parts to see what we can change or alter to make it so that someone can do that again.
Melanie:
OK, thank you for that overview. It's really helpful. I think the term occupation can be misleading.
Dawn:
It really, really is. Lots of people think it's solely related to jobs. Yes. And it's not. But there has been many, many discussions in the occupational therapy community over the years about what else we could be called and no one has yet come up with that definitive answer. I like the term professional problem solver. I think it's very much what we do. We go in, we work with people, we look at the situation, we're the experts on those adaptations, the equipment, the things we can do, and the customers we work with are the experts on their situation. that teamwork can come up with some really, really lovely results sometimes.
Melanie:
Yeah, really good way of reframing it, thank you. I think that will be helpful for people. So maybe we can start by talking about key areas of the home that people should focus on when assessing and improving safety for their loved ones. Okay. So where do you find, in your experience, what are the key areas of the home that often it can be beneficial to have those adaptations?
Dawn:
When I go on an assessment, obviously you walk up the path. Actually, maybe we should start with that.
Melanie:
We start outside. Talk us through the journey.
Dawn:
I walk you through the occupational therapy assessment journey. So usually when I arrive, I look at the access to the property. Is it level access? Is it wide enough for mobility aids? Are there steps? What are the doors made of? What are the handles like? When you get in, is there a conservatory, so is there a change in level? Do you have to go up another step to get into the house proper, to be in the hallway? Once you're in, the key areas for falls are generally bathrooms and kitchens. Also living areas. So a little fact that I found is apparently that the NHS states that falls cost them about 2.3 billion pounds per year. Wow. That's a huge amount. 74% of those falls happen in the home.
Melanie:
Yeah. And I guess, I'm guessing, that with the right equipment and adaptations, the reduction in falls would be huge.
Dawn:
Absolutely. We're never going to completely remove that. Falls, unfortunately, will always happen. It's looking at the home and looking at how the home is used, looking at the person that's using the home, and understanding where those key areas of risk are. Is it that the areas are cluttered, so you can't walk through? Are you going to trip over furniture? What have you got? Rugs, mats. furniture, if the leg of a chair or a caster is out or the coffee table, it's the simplest things that you will have walked past a hundred times. You will have done it so many times and on that one occasion, it's just that one time. It's also about looking at the lighting, so is the area you're moving in, particularly as we're going into the winter months, Is it well lit? Can you see where you're putting your feet? What is on your feet? Are you barefoot? Are you going to slip? Are you wearing slippers? And if so, do they fit you? Are they worn? Are they open at the back? Are they going to slip off? Another part of that, I was talking to someone last week at a community event, and we were talking about pants. A knicker elastic is a good thing. And if you've lost weight, as often happens with long-term conditions, your clothes might not fit as well, and it could be them slipping down that leads you to lurch forward, and then you're out of your centre of balance, and it turns into a fall. It's multifactorial obviously and I can't cover it all in.
Melanie:
And in fact I thought you were just going to answer that with a simple, well you can add grab rails or replace a bath with a shower but clearly it's the small things that are obviously making a really big difference.
Dawn:
Absolutely. Another thing is seating. So if you're in a chair that's too low for you, To get out of that chair, what you often see is people rocking backwards and forwards to build up momentum. And then with one almighty shove, they will haul themselves forwards. And what happens is they literally throw themselves out of the chair, take a massive compensatory step forwards, and you are halfway to a fall. So it's about making sure that the seating is suitable. Is it the right height? Is it supportive enough? If it's a sofa, you've only got one arm, so you're going to swing up on it and you're going to come up out of that centre of balance. So it's all about understanding where those risks are.
Melanie:
So you said that when you go to a client's house to carry out an assessment, that's where you start. How do people, I mean, how do people access an occupational therapist?
Dawn:
That's a really good question. So you've got your statutory service, you've got your social services. If you have involvement with the NHS after a fall, OTs may come out and assess your home.
Melanie:
So be referred by the GP or by the hospital?
Dawn:
You can be referred. And there's also a little army of guys like me that are independent occupational therapists. We can be found by going on the Royal College of Occupational Therapy website, RCOT for short, and they have a section that says find a therapist. I am seeing quite an increase in people going into independent practice because of the frustrations and the demands of working in the public sector. I'm one of them.
Melanie:
So talk to our listeners about the benefit of, because presumably then, if you want to go with an independent occupational therapist, there's clearly going to be a cost associated with that, whereas if you go with the NHS, then it's free. Talk to us about some of the differences. What's the benefits of going? What might be the appeal for people of searching out you or somebody like you and going independent?
Dawn:
I am blessed in that I do not have a huge waiting list because I choose not to. I take on the work as and when I have capacity to do it. It's very, very important to me personally that I give the kind of service that I would be happy to receive. I was in the situation less than three years ago where my mother was at home being cared for by my father with my support. And I understand the frustrations of trying to access services. And I know the system. I've worked in the system. I was part of the system at the time. And I felt incredibly frustrated at the level of service that my parents did not receive. So as a result of that, I have gone independent. And I make sure that my assessments, when I go out, take at least two hours. And I am not framed by any legislation. such as the Care Act, which is what social services have to abide by because they're a statutory service. I look at what's important to the people that I'm working with. For some people, it's not important to be able to get themselves out of bed. Yeah. So we don't look at that. For some people, it's really important to be able to hold a pen again so they can do the crossword in the morning like they used to. Yeah. It's those little things that are the big things. Yeah. And those are the kind of things that I'm blessed to be able to look at as an independent occupational therapist.
Melanie:
So to me, that sounds like quality of life rather than functionality. Absolutely. I mean, it can be both, but you are able to focus on the quality of life rather than the kind of basic needs.
Dawn:
Yes. It's the flip side of statutory services in that I look at wants, not needs. I also consider risk, obviously, and I consider future needs. But the process is very much driven by the customer in front of me. And I work with them. I can't fix everything, but sometimes just making things a little bit better and just giving that hope is the real value to the assessment.
Melanie:
Yeah. So my experience with your service was that one of our customers, our home care customers, was in hospital. She was fit for discharge, but she needed an occupational therapy assessment before she was able to go home so the correct equipment could be put in place so she could be discharged home safely. Now the wait that she was going to have to have for that was over a week and she was so desperate to get home that she then contacted you, you came out the same day or the next day, you did an assessment and then between us we managed to put everything in place in the home that was needed and then we were able to take over her care at home and she was able to be home within 48 hours. So for me that was a revelation because I didn't realise that there was a private occupational therapy service that could enable people, should they wish to pay for it, to be able to be discharged home much more quickly. and I think that's the frustration we see for a lot of our customers is because of the limitations and you know the NHS are really doing their best with a very limited resource but because of that you're often waiting and costing the NHS more money because you're in hospital for longer but it is just the system isn't it and that's where we're at at the moment. But for that customer, it meant that she could get home really quickly, which was brilliant. And since then, I've learned more about what you do and seen more. And it's really important for other people to understand that there are services out there available. And it may be that they just tap into what you can offer as and when they need it for those specifics like coming home from hospital. Absolutely. So maybe just talk our listeners through what that might look like. So if they're in hospital, like that customer that we were supporting, if they're in hospital, they're fit for discharge, they're medically fit for discharge, but their needs have changed and their home's going to need some additional equipment. and they are going to be waiting a while, what steps would they take and what might that look like if they were to contact you?
Dawn:
Okay, so we'll take it from the point that they found me on the RCOT website, they've given me a ring, sometimes I come back to them, I'm out there doing my thing, it's not immediate, I can't always do within 48 hours just to manage expectations. We'll have a chat about the situation just so I can get an overview and look at what needs to be done. From that, I like to go and meet people rather than just go straight to their home and have a look. So I'll go and meet the customer, we'll have a bit of a chat and then I will go on from there with the family member or whoever's available and go and have a look at that home environment and get an understanding of where I feel the risks are. what we can do to maximize independence and minimize risks. And from there, I will produce a report and recommendations. Obviously, if there's any equipment to be bought that has to come from the family, I can buy it, but I'm not funding it. That's one of the key differences. Obviously, social services and the NHS can provide equipment on loan. I'm not in a situation to do that. So people have to buy their own equipment. But the plus side of that is that I have an entire world of equipment suppliers out there, whereas the NHS and social services have to provide a cost-effective service because of the sheer volume of people they deal with. So it's not always the best fit. It's always safe and it's always appropriate, but sometimes there's something that works a little bit better that's more expensive.
Melanie:
They don't have access to. that they can't.
Dawn:
It would just take too long to do that, which is really challenging for my colleagues in those services. I used to be one and I understand it thoroughly, but for someone that is in a situation where they are stuck either in a temporary placement or a rehab bed or in hospital I'm very well placed to go in and look at that and just hopefully facilitate that journey home. People recover so much better in their own environment.
Melanie:
Yeah, sure. And I assume then that you can do a kind of an acute plan to get somebody just home with the bare minimum that they need to be safe. Once they're home, you could then follow up and go into all of those real quality pieces that you were talking about earlier to help them to be as independent and the things that really matter to them.
Dawn:
Absolutely, I've got a few customers at the moment that are in permanent residential but have deconditioned and their mobility and their transfers aren't great and I've done exercise programs with them so I go in and work through the exercises with them. I literally do the exercises with them because you feel silly when you're sat there by yourself doing the exercises and it's good for me as well. Just to work on those important things, sometimes it's bed-based exercises, sometimes we progress from the bed-based exercises to chair-based exercises and in one case we've progressed from chair-based exercises to walking around with a rollator. Amazing. Which is, it's just beautiful, it's such a reward and so lovely for the lady I'm working with to look her carers in the eye. to be able to stand up and to just meet their gaze on a level, and for people to say, oh, I didn't realise you were this tall. It's really, really lovely. So that's a part of the job I really quite enjoy, is looking at those long-term goals. It doesn't stop when you get home. It's about making sure you don't go back in hospital.
Melanie:
Absolutely. And I know that we work also with occupational therapists when you've designed those programs. Our care team can then help to do the exercises with the customers on a day to day basis. And that's where the real gains are.
Dawn:
That's where the real gains are, doing it on a consistent basis. Obviously, where I work with quite a few people, I can't be there every day. It's not practical for me to do and it's not sustainable for the business. So having support from a care agency is absolutely vital to maximise the opportunity for positive outcomes.
Melanie:
And I think it's also really important that people know that that doesn't have to be a permanent thing. No. So it's a process of rehabilitation and understanding where you realistically want to get to and what the steps are going to be to get you there.
Dawn:
Absolutely. One of the tools I use when I'm working with people and we're at the start and we're like, OK, this is where we're at. I set something called SMART goals, which is smart, measurable, achievable, realistic and time measured. Yeah. So we say, OK, in six weeks you want to be able to transfer from bed with assistance of one. Yeah. And then we work towards that goal. We can look at long term goals as well. So maybe the long term goal is to be able to go to the shop again. Yeah. And it is my job. Sometimes what I'm asked for, I can't deliver. And it is my job to have those difficult conversations. I've had to tell people with memory loss that unfortunately they're not going to be able to walk again. We can look at standing and we go through the physiological benefits of being able to stand. But it is important for the therapeutic relationship that I'm honest and I cannot deliver some things as much as I wish I could because my business would be hugely successful if I could do things like that. But it's about that honesty.
Melanie:
And managing expectations. Absolutely. So people can feel like they're making progress but realistically. Yes. It has to be. Definitely. So how can our listeners, who are family carers, create more comfortable and accessible living environments that support the independence and well-being of the person they're caring for? So that's a big question. And I know that we've talked a little around some of the small things that are actually big things. But are there any kind of like your top three kind of that you see most frequently that make the biggest difference to comfort and accessibility around the home.
Dawn:
It's not quite comfort and accessibility, but it's a particular bugbear of mine that it's looking at risk and accidents and things like that. It's bathroom doors. So many bathroom doors open into the room. If your loved one, or even you, it happens to anyone, is heading for the door and you fall, you are behind the door and you cannot get that door open. It delays getting that care. Something as simple as having the door rehung where possible so it opens outwards. Really good, really good tip. It saved so much heartbreak. I almost died on that mountain with my own parents, but I am pleased to report that there is a swinging outwards door. As much as it was disliked at the time, the peace of mind it gives me without having a huge impact on day-to-day life. it's just so much safer for them. Yeah, really, really good tip. Another thing is, as you get older, your eyesight is not as good. So if you're in a room where you've got some really lovely, neutral, relaxing colours, it can be really, really hard to find the light switch. So maybe just painting a little frame around it doesn't have to cost a fortune. You can even get the little plastic frames that will go around, just to help orientation. Just little things like that that help reduce those risks. Obviously, I'm not a huge fan of rugs, I'm not a huge fan of mats. Slippery floors as well, not just in the bathroom but the kitchen, so spilling drinks, so something as simple as Instead of having to fill the kettle and walking with a heavy kettle that's potentially spilling water across the kitchen, look at buying a one-cup hot water dispenser that you can fill the reservoir. I think you can go up to about two or three litres on them. And then the person that you're taking care of can still go and make that drink, hopefully, but it just reduces those risks. And it's not a clinical piece of equipment. People with no disability, people that, you know, normal people, are using them. It's a regular piece of kit that is so helpful. That would definitely be number two. And with regards to it being comfortable, I think it's really important to maintain a sense of home. It's really very, very simple to make someone's home really clinical. and just highlight, hey, you're an old person. Hey, you're not as functional as you used to be. And no one, I've not met anyone yet that has introduced themselves as an old person because in our minds we're not. It's just our bodies that are getting older and we have to support them to keep going as safely as possible whilst respecting that inside that 84, 85 year old person's head is still someone that's, most people that I've spoken to are somewhere in their 30s. and that's a real challenge to keep people safe without making their home look like an equipment store.
Melanie:
Yeah, and I think it would be very easy to adapt somebody's home with all of the safety mechanisms that you have in a clinical environment. Absolutely. But I think that's another reason in my experience that we find that people don't do it and the risk of falls goes up. Absolutely. It's because they don't want to see that when they're walking around their old person's home.
Dawn:
Particularly on the outside because you don't want to highlight vulnerability. Yeah. But things like grab rails, I don't want grab rails in my home. And I recommend them, but there are other ways. You can look at wooden rails to add stability. There are increasingly more aesthetically pleasing things coming on the market. There is a real understanding that people don't want clinical things all the way around their home. And it's about that understanding and what else can we do? How can we look at why do we need that grab rail there? What's happening? and just trying to modify things a little bit so it's still home.
Melanie:
Okay, so we're going to put links in the show notes for the website that you talked about where people can actually access independent occupational therapists, also to your website so they can see what you do. And if there's anything... Let's edit that bit out.
Dawn:
Yeah, let's come back for that in a year.
Melanie:
Okay, so we're gonna put links in the show notes for the website that you talked about, so as people can find independent occupational therapists like yourself. And any other websites or resources that you feel are helpful for people will pop in there. So as they can start to have a look and see, just to explore the options, but it sounds like by working with you or somebody like you, you would be able to guide them and you'd be able to find a solution that
Dawn:
works for them. Absolutely. And sometimes it's just a case of dropping me an email or giving me a call and we'll have a chat. Yeah. I'm always happy to have a chat and just just try and get an understanding of the situation. I will. I'm not very precious with my knowledge. I will share it if I feel it can help.
Melanie:
Amazing. Brilliant. Well, so sadly, we're almost out of time. It's such an important topic. And I'd really like to thank you, Dawn, for coming and chatting to us today. My pleasure. And giving us a real insight into what occupational therapy is, and how people might be able to access the services that they need when they need them. I'm sure your tips will have helped a lot of our listeners. I hope so. And we haven't talked about, but I do think it's really relevant to mention that you were also a family carer. Yes. So around the time when you were launching or thinking or creating Independent EU, you also became a family carer for your father, who was caring for your mother. Correct. Who had been diagnosed with Parkinson's and Lewy body dementia. That's right. So you have first-hand experience of navigating the care system and the support services and how overwhelming that can feel even when we work within that sector. So acknowledging that a lot of our listeners who don't have any previous experience of the care sector and then need to access services You know, how difficult that can be for them.
Dawn:
It's hugely challenging. It's at a time in your life where you are going through so much emotionally. You are incredibly scared. I have a little card that I keep near my desk because obviously I've been practicing for a good few years now. And it's I can't remember where it came from, but essentially the quote is normal is an illusion. What is normal for the spider is chaos for the fly. Yeah. and it just helps me remember that those people that I'm meeting are going through what I went through or similar and it's It's so frustrating and you don't know what you don't know, but you just feel that you should be able to do more. There's so much care of guilt. It's a burden in its own way and you will continue to beat yourself up forever more in some ways for things you did or didn't do, but just be kind to yourself and try and give yourself that credit that you're doing all you can in the situation and that there are people that can help.
Melanie:
Yeah, really good tip. Really good tip. And I think reassuring for people to know that you have that first hand experience. Absolutely. So when they're reaching out to you, they don't need to really explain what they're feeling or what they're going through because you've been there yourself.
Dawn:
Absolutely. I've been through something similar. Every situation is unique, but I can empathize very much with how frightening it is to find yourself in a situation where you're looking after the people that looked after you when you were little. Yeah, absolutely.
Melanie:
Well, thank you again. Thank you for taking the time to come and speak to us. Thank you for sharing your insights. And we'll, as I've said before, we'll pop all the links in the show notes so people can access the resources that you've talked about and connect with you if that's what's going to be helpful for them. That would be lovely. So thank you again for joining us and thank you for listening to the Family Carer Podcast and a huge thank you to Dawn for joining us. You can sign up to our newsletter if you want to learn more about what's going on locally and we'll pop a link in the show notes so that you don't miss out. Alright folks, remember to subscribe and share this with anyone who you think needs to hear it. Thank you.