Occupational Therapists Enable Independent Living For Seniors Through Wellness Design Interventions

If your health is exemplary, if you have no physical or mobility challenges, if completing tasks you’ve always handled with ease is still easy, and if no one in your life suffers from any of these difficulties, you may never cross paths with an occupational therapist. And you’d probably be the exception, rather than the rule.

According to the U.S. Bureau of Labor Statistics’ Occupational Outlook Handbook, OT jobs are expected to increase 16% by the end of the decade. A rapidly-aging population has much to do with that, especially the millions of seniors who want to continue living independently in their own homes. (The Covid-19 pandemic has likely increased this number too, as seniors in nursing homes have been especially hard hit by the virus.) Occupational therapists are the healthcare field’s wellness design facilitators.

Keeping Low Income Seniors Safer at Home

Enter CAPABLE, (short for Community Aging in Place – Advancing Better Living for Elders), a program created at the Johns Hopkins School of Nursing and profiled recently in Forbes.com, that brings an OT with a nurse and handyman to low income seniors’ homes to make them safer and more functional. The program has been praised by both the current Secretary of Health and Human Services, Alex Azar, and the Democratic candidate for president, Joe Biden.

Here’s what Biden said about it in a recent speech, streamed live on Facebook in July: “There’s a pilot program now in 27 cities and 16 states where a nurse, an occupational therapist and a handyman come to the home that’s caring for an aging family member… They walk through the house… and install handrails in the rights spots in the house and bathroom, or they fix the door that’s stuck so she doesn’t trip when she tries to open it. It initially found that about $3,000 in program costs yielded more than $20,000 in savings to the government, from hospitalizations and other reasons.”

According to its creator, Sarah L. Szanton, a nursing professor and director of the school’s Center for Innovative Care in Aging, Azar has been encouraging about the program’s expansion, and a key HHS committee voted in favor of having Medicare scale it further to test continued cost-effectiveness.

Occupational Therapy and Wellness Design for Seniors

Scott Trudeau, practice manager for the American Occupational Therapy Association, became aware of CAPABLE when it was in the research stage and promising early results were being shared, he recalls. Since then, the organization has consulted and partnered with study leaders to provide their specialized expertise. “In addition,” Trudeau notes, “we have advocated with Congress, CMS [Centers for Medicare & Medicaid Services] and HHS to support codifying important occupational therapy interventions in policy and regulations.” Interventions, a term for professional involvement by an OT, are only effective when there are established mechanisms for reimbursement and payment, he observes.

AOTA has also been involved in educating its members on CAPABLE so that they can be part of its successful implementation and expansion, and in providing direct advice to the leadership team.

The CAPABLE intervention provides for a range of modifications to the home to make it safer and easier for clients to perform the activities they have set as a priority, Trudeau explains. “Key improvements like installing grab bars in bathrooms, or a railing to make it safer to navigate stairs have been widely reported. Very specific needs related to the individual home – changing out steps for a ramp, for instance – are also included. It is not one size fits all, but rather highly tailored to the needs of the individual within their home environment.” The visiting OT recommends improvements that let the senior perform the task safely and successfully and then the handyman implements them. That could be walking a dog for one client, with help from a new entryway ramp, or being able to continue baking for another, with the addition of cabinet accessories that help someone in a walker reach her rolling pins and baking sheets more easily. All CAPABLE clients set their own functional task priorities, giving the program more power to positively impact individual lives.

“This is really a key turning point in our appreciation that health care costs can be impacted by interventions that don’t necessarily fit into the traditional medical model,” Trudeau points out. “Programs like this are why I became an occupational therapist,” he shares.

You may not need occupational therapy for age or disability any time soon, and your income may be too high to qualify for reimbursement under a government program, but the ability to continue living productively and independently at home for decades to come is one an occupational therapist can help you or someone you love achieve.

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Wellness Design Makes Surprise Appearance In Biden Campaign Speech

It’s rare that wellness design, the growing practice of creating built spaces that support the well-being of their occupants, shows up in presidential campaigns, but it made an appearance in a policy speech Democratic nominee Joseph R. Biden Jr. gave in late July and streamed on Facebook Live. Here’s how he tied it into his healthcare policy-focused talk:

“There’s a pilot program now in 27 cities and 16 states where a nurse, an occupational therapist and a handyman come to the home that’s caring for an aging family member. They might not be able to cure Mom’s Alzheimer’s, but they can make sure she doesn’t break her hip. So they walk through the house…  and they install handrails in the rights spots in the house and bathroom, or they fix the door that’s stuck so she doesn’t trip when she tries to open it. It initially found that about $3,000 in program costs yielded more than $20,000 in savings to the government, from hospitalizations and other reasons.”

Campaign Cameo Surprises Program Creator

The wellness design program Biden described is called CAPABLE, a descriptive acronym for Community Aging in Place – Advancing Better Living for Elders, developed at Johns Hopkins School of Nursing. It was the brainchild of Sarah L. Szanton, a nursing professor and director of the school’s Center for Innovative Care in Aging.

She did not know it would come up in Biden’s campaign, she says, or that he was aware of it. “It was a fun surprise,” she muses, suspecting that his staff shared it with him recently, rather than him remembering it from his days in the Obama administration when the program began. “People from other campaigns had reached out during the primaries but not Biden,” she recalls.

Affordable Wellness Design Program for Low Income Seniors

What makes it notable? “No other program addresses function from a prevention point of view, by addressing the person and their home environment,” Szanton shares. CAPABLE covers four environmental areas:

  •  Structural adaptations include widening doors for wheelchair access, adapting showers, installing non-slip flooring and installing grab bars;
  • Home repairs include fixing holes and broken lights, securing loose carpet and un-sticking the doors Biden mentioned to eliminate trip and fall hazards;
  • Assistive devices include raised toilet and shower seats and reachers to make accessing items easier;
  • Regular household items include fire extinguishers, night lights and desk lamps, sturdy nonslip rugs and mats.

These items cost anywhere from $5 to $500, a modest expense for adding safety and functionality to an older resident that can save thousands in healthcare costs related to hospital stays. “Currently, Medicaid pays for it in Massachusetts,” Szanton says. “Other than that, it has been either philanthropy or value-based payment insurers who believe they will achieve the savings we did.”  (They have, studies show.)

In cases where the client is a tenant, rather than a homeowner, the property owner has to give permission for the modifications. This hasn’t been a barrier, Szanton observes. “We haven’t had any landlords deny permission.” Some say they will perform the modifications themselves. Others allow the program’s handymen to do them.  (Those are selected by the program sites, she notes, with nonprofits like Civic Works participating.)

Health Policy Success Story

In a three-year test starting in 2012, CAPABLE enrolled 281 adults aged 65 and older who were eligible for Medicare and Medicaid, had difficulty performing daily living tasks and experienced related depression at their loss of functionality.  Reporting results in the prestigious Journal of the American Medical Association in 2019, Szanton and her colleagues wrote, “Participants in the CAPABLE group vs. those in the control group were more likely to report that the program made their life easier, helped them take care of themselves, and helped them gain confidence in managing daily challenges.” The JAMA study concluded: “Low-income community-dwelling older adults who received the CAPABLE intervention experienced substantial decrease in disability.”

Looking at the program’s impressive results, Szanton says, “In June 2019, the PTAC committee voted to recommend traditional Medicare should scale CAPABLE in a limited way to test continued cost-effectiveness.” PTAC is the Physician-Focused Payment Model Technical Advisory Committee within the Department of Health & Human Services’ planning and evaluation office.

Expansion Possibilities

HHS Secretary Azar has been encouraging, Szanton notes, which could mean possible program expansion regardless of which candidate wins the election. What might that look like in terms of funding? Szanton sees four possibilities: “It could be paid for as a bundle of services by Medicare. It could be part of the Annual Wellness Visit (that already screens for how functional someone is. That visit could be at home and then could be a referral (if needed) to CAPABLE. Medicare Advantage programs could be given blanket approval to offer CAPABLE through their supplemental benefits activities. The [Medicare and Medicaid Dual Eligibility Special Needs Plans] could be encouraged to offer CAPABLE.”

Any of these approaches would be building on a record of success: “So far, all organizations who have tried CAPABLE have saved money and improved participant engagement.” While Biden cited 27 CAPABLE cities in his speech, Szanton reports that it’s now in 30 places, with expansion coming soon.  Existing organizations include the National Center for Healthy Housing, Trinity Health system in Michigan, SCAN health system in California and Colorado Visiting Nurse Association.

Best Possible Outcomes

What’s most valuable about CAPABLE isn’t the home improvements or healthcare savings, Szanton believes: “The real strength is addressing people’s own functional goals. Participants achieve them partly through environmental changes, but it is much more about building self-efficacy for what they actually want to do – to go out their front stairs, take a walk, stoop to feed their dog without pain, etc.”

Helping Mom enjoy the later years of her life while avoiding ending up in the hospital with a broken hip is the best possible outcome for her and her family. Lowering Medicare and Medicaid costs is a worthwhile outcome for the federal government, states and taxpayers.

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Feng Shui’s Potential Health Benefits

Maybe you’ve heard of feng shui, the ancient Chinese practice of harmonizing your home with nature. A quick Amazon search turns up 75 pages of English language books on the subject. Google holds 128 million feng shui results. Clearly, there’s strong interest in its potential to enhance your living space. Is there potential in this ancient practice to enhance your life and health too?

“My experience is that when people take action on making their homes and workspaces feel and look better to them, they have a sense of feeling stronger, happier and healthier,” says Ann Shippy, MD, a functional medicine doctor in Austin, Texas. “This could be through feng shui, ‘Marie Kondoing’, or other measures,” she adds. Is there any science behind the feelings? Possibly, Shippy says. “This isn’t generally covered in mainstream publications, but I have some theories based on my own professional observations and scientific readings on why feng shui works.”  

The Basics

First, what is feng shui (or Feng Shui, as some refer to it)? Not surprisingly, there’s a Feng Shui for Dummies book. In its first chapter, the authors share: “On the surface, Feng Shui is simply the interaction of humans and their environments. Taken a step further, Feng Shui allows you to strategically influence these interactions to achieve specific life improvements by positioning or designing your surroundings in harmony with principles of natural energy flow. As a result, you can achieve harmony with your surroundings.” The key words in that passage are positioning or designing your surroundings.

The practice includes guidance on room planning for those building a home, furniture placement, color choices, sounds, electronics, and inclusion of plants and other natural elements in your home. Its goal is to optimize those energy flows and harmony between your home, yourself, your family and guests. Shippy has some thoughts on whether the effect can also optimize your health.  

Stress Mitigation

“Creating an environmental sanctuary for the body to rest, relax and restore allows the limbic system to reset, as well as the parasympathetic and sympathetic nervous system to become balanced. Stress can cause the body to produce an excess amount of epinephrine (adrenaline), which then causes a  weakening of the immune system,” she explains. “The benefits of feeling safe and comfortable with a positive mindset about the environment may lower chronic stress, which can lead to better blood sugar balance, stronger immune system, lower depression and anxiety. Because stress can weaken the immune system, most design principles that minimize stress have a positive impact on the immune system. This is important because the impairment of the immune system can make people more vulnerable to various diseases, including, some scientists argue, cancer,” the physician notes.

Quantum Physics

In an article for NCBI, the National Center for Biotechnology Information, Christina L Ross explains quantum physics and its connection to human health: “Quantum physics teaches us there is no difference between energy and matter. All systems in the human being, from the atomic to the molecular level, are constantly in motion-creating resonance. This resonance is important to understanding how subtle energy directs and maintains health and wellness in the human being.”

Shippy can see this having an impact: “Two of my favorite physicists,  Dean Radin and Konstantin Korotkov, have found ways to measure the minute changes in energy as it affects the body and the environment. Thus, it’s possible that the energy of a space can have positive effects on the inhabitants at a quantum physics level. This warrants further research.”

Placebo Effect

Placebos have gotten a bad rap over the years, but they can have a beneficial effect on human health, Shippy says. “We see the placebo effect at work in medicine on a daily basis. I think It applies to approaches like feng shui as well. An article published by Harvard Medical School provides that the human mind is a powerful healing tool and can help stimulate healing, and this explains why the placebo has been popular for millennia. As people implement feng shui , it can provide the inhabitants with a positive ‘placebo’ direction for the body to stimulate healing and improve a sense of well-being.”

Design Practice

Award-winning New York City-based interior designer Julie Schuster discovered feng shui while working on a show-house benefiting breast cancer research; the project’s founder was a breast cancer survivor Schuster found very inspiring, she recalls. “One of the designers working on the house was also a feng shui practitioner. I had never even heard the term before, but I was fascinated by the obvious link between creating beautiful spaces and positive energy spaces.” A few weeks after completing that project, Schuster received her own breast cancer diagnosis. “I committed to myself that once I defeated cancer, I would treat myself to pursuing feng shui studies.”

Wellness Design Connection

Schuster says feng shui is gaining popularity as people become more interested in the connections between their homes and their health. This is certainly a timely topic, as millions of Americans spend more hours indoors, helping to flatten the curve of the COVID-19 pandemic. “Wellness design includes technology integration, better food preservation, improved lighting design, living in place design and better, more nurturing energy in our homes.” She sees feng shui playing a role too, especially in creating that nurturing energy.

Other Connections – And Misconceptions

Schuster sees feng shui also being connected to sustainability for its strong support of biophilia, the practice of incorporating elements of nature in design for their nontoxic and healing properties. It connects to other disciplines too, she notes. “I am continuously astounded whenever I am reminded of a principle in feng shui that I learned in high school physics, or in Jewish principles, or even my interior design training,” Schuster declares. “So much of what I have learned is readily applicable to our lives today. Is not emotional health a scientifically proven benefit? Is not the essence of the nature of the movement of energy science?”

The most common misconception Schuster encounters about feng shui is “that it is a religion. Nothing could be further from the truth. In fact, I feel it works well with any type of religion.”

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Why You Might Want A Leak Detection System (With Six Plumber Tips For Choosing One)

Water damage ranks as the third leading cause of homeowner loss, according to the Insurance Information Institute, and the third most expensive, with an average $10,234 claim, based on the trade group’s latest figures.

An Ounce Of Prevention

If you’ve had water damage in your home, or in a rental property you own, you know how disruptive and stressful the clean-up and restoration process can be. If there were a way to detect a potential problem source before it caused damage, would you try it? Would your insurer provide a discount for doing so?

The answer to the first question is probably yes. If a small cost lets you identify leaking pipes or hoses and running faucets before they create a flood, there’d be little reason not to do so. A leak detection system can help you do this. Basic models without shut-off capability start at less than $100. Professional grade systems can cost $1500 or more, which is still lower than some single year deductibles.  There are many systems in the middle of the price range, depending on the capabilities you want and need.

The answer to the second question is, in most cases, no; very few insurance companies are offering premium reductions for implementing leak detection systems. “If insurance discounts become more widespread, and more people became aware of those benefits, then demand could increase,” observes Phil Georgiades, chief real estate agent at FedHome Loan Centers in San Diego. “This could be an especially attractive feature for investment properties where the owner or manager might not be around to notice a leak early on or shut off the water when necessary.” It’s also ideal for homeowners with ski cabins far from their primary residences; freezing pipes can create serious damage.

One insurer that is not only offering a discount for leak detection, but providing its policyholders with smart home kits that includes that capability, is the Palo Alto-based Hippo. “Every state has a different set of regulations; where allowed, the discount usually falls somewhere between 5% and 11%,” shares senior director of underwriting Mike Gulla. “Hippo began offering its smart home program in 2017, and has increased the activation rates of its smart home kits to more than 70%,” Gulla notes. The company hasn’t had enough time to prove the influence of the program, he says, but has seen that policyholders who activated their kits are more likely to renew their policies. Will the potential for increased retention and reduced claims encourage other insurers to offer leak detection capabilities? It will be interesting to see. 

Plumber’s Perspective

There are numerous systems you can consider, depending on the size and location of your property. Which one is right for yours? Roger Wakefield, LEED AP, owner of Richardson-based Texas Green Plumbing, and host of the popular All About Plumbing channel on YouTube, shares his experience with these systems, and advice you can use.

Jamie Gold: When it comes to smart home leak detection systems, what do homeowners need to consider in selecting one?

Roger Wakefield: They need to figure out where the device is going to be installed and which one is best for that location. Does it require electrical service, water line access, or Wi-Fi? What if the power goes out; will it still work? Is a plumber required to install it, or is this something they can do themselves? Is there a monthly subscription; if so, what plans are available? Does this unit cover all the water piping, including irrigation and the pool? Is there an app or a portal for the customers to check their system? There are many different systems, bells and whistles. All these things need to be considered in order to get the right unit. 

Gold: Are there any hidden costs, risks or problems involved? If so, what are they?

Wakefield: Some systems must have power and a Wi-Fi system or they will not operate. These will not work outside, or underground at all. That makes them a bad choice for most Southern states where the meters are out by the curb, or the valve box is in the front yard. Only cellular systems will work out at the meter, because the Wi-Fi signal isn’t good that far out.

Gold: Are there certain “must have” features? If so, what are they?

Wakefield: We have to have a reliable cellular system that is capable of operating on a battery. The other “must have” is notification of a leak in less than one hour. A leak can cause serious damage if it’s not caught quickly.

Gold: Which new products on the market are you aware of, but haven’t used yet? What makes you want to try those, if anything?

Wakefield: I have checked into many different brands. There aren’t many that use cellular and are battery-powered. The only one that I’ve found that has worked here is the MeterDog. I like the LeakSmart system also, but I can’t put it underground. That makes it tough in our area. 

Gold: Which are the easiest, most user-friendly to install and operate?

Wakefield: Any that don’t have to be installed by a professional plumber and have the requirements that people need make the most sense. Some have a sensor that detect any movement in the water meter, and just attach to it. That’s the easiest. Some have to have a plumber install the system. I love the water shut-off possibilities, so that makes them a great option. 

Gold: What would you like to add on this topic?

Wakefield: The most important features for homeowners are reliability and ease of use. Think when purchasing, “Is this system the right one for my house?” Many times, it is the simple, reliable system that is needed to solve most water loss event issues. At the end of the day, we need to know if we have a leak under our house causing foundation problems.

The conversation has been edited and condensed for clarity.

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How Your Home Can Help With Your Resolution To Exercise

Gyms across the country fill up with enthusiastic resolution keepers in January. Running paths, yoga studios and cycling routes lose their standard claim to serenity with seasonal crowds. Exercising is one of the four most popular health-related New Year’s resolutions, (smoking, eating healthier and self-care are the other three – to be addressed in the series’ other  installments). Dedicated fitness enthusiasts know that things will mostly return to normal in a few weeks. They’re sadly correct.

Why exercise resolutions are so hard to keep

“The temptation to jump into an aggressive new exercise program to fulfill a New Year’s resolution can lead to aches and pains as the body adapts to the new stresses put on it – and  leads some people to stop altogether,” observes Yale Medicine orthopedic surgeon and chief of sports medicine, Dr. Michael Medvecky, MD. While the athletes he works with as head physician for the Connecticut Sun WNBA and New England Black Wolves lacrosse teams train on a professional level, the average adult tends to work out when their schedules and motivation allow. 

“Depending on the last time they were involved in a regular exercise program, some people feel that they can jump back into exactly the level of activity they were doing in the past; however, they forget that level of activity was achieved over prolonged period of time,” notes Medvecky. “With a period of inactivity, their cardiorespiratory as well as musculoskeletal systems become deconditioned and need time to adapt to the new levels of stress.”  The pain and injury of getting back into working out too hard and fast can discourage people from continuing, robbing them of the benefits their bodies need.

Why busy adults really need to workout

“Ranking the most important health factors for executives and professionals, I would consider exercise at or near the top of the hierarchy.” Medvecky notes psychological stress relief, improved sleep, improved relationships, improved self-esteem and promotion of better nutritional habits among its many benefits. “Exercise helps decrease tension that can build during the workday when handling high-level clients and projects under deadline pressure,” he  explains, adding that for people with pre-existing or family-associated conditions, inactivity can increase their risk factors of getting ill. He also points out that modeling good workout habits for your children can help prevent obesity and its related health risks for them, as well as for you.

Recommended workout schedule

The sports medicine doctor recommends setting a goal of 30 minutes of moderate exercise daily, at the very least. That could be fast walking, riding a bike or even doing yard work, and can be broken into segments for the time-pressed. For example, you could do a 15-minute walk during lunch and a 15-minute bike ride after work.

If you’re ready for a more intensive workout, 75 minutes of vigorous aerobic activity a week would be a good alternative, he says. These would include fitness classes, recreational sports like volleyball, racquetball, etc. or running.

Medvecky also recommends resistance exercise – i.e., strength training all major muscle groups – twice a week.

How your home can help

Let’s face it, you know you need to exercise, but getting to the gym doesn’t always fit your schedule. That doesn’t mean you can’t get in a good workout. Your home can be an important ally in keeping this important resolution. “If possible, having a dedicated space or room where your equipment (hand weights, resistance bands, yoga mat, etc.) is easily accessible can facilitate more frequent exercise participation,” the sports doc advises.

“Fitting in short periods of exercise frequently throughout the day may be more feasible if the equipment is close at hand,” he suggests. This is especially true for those who work from home and stay-at-home parents, but even people who commute to an office can use a home fitness space to work out before work, after work and on the weekends. 

That space doesn’t need to be elaborate, but should give you room to move without bumping into anything large, hard or breakable, like a bed, table or glass door. If you’re doing high intensity interval training (HIIT) workouts involving high impact moves, it’s best to do it on flooring with a bit of give, like a floating wood, laminate or bamboo system, linoleum or cork, carpet or rubber. Bare tile or concrete can be punishing on your back, feet, ankles, knees and hips.

To deal with the soreness that often accompanies starting or increasing an exercise program, Medvecky suggests, “Saunas, warm showers or hot tubs, if available, help increase blood flow and can be beneficial in preparation for pre-exercise stretching.” If you don’t have access to a hot tub, a hand-held massaging showerhead can hit sore points and stand in for its jets.  

Of course, you’re going to need to power your workouts with proper nutrition. Food is fuel and your kitchen is your fueling station. The second article in this series includes tips on nutrition from The New Power Eating author, Dr. Susan Kleiner, and related wellness design tips for optimizing your prep space for cooking and convenience.

Bottom Line

Starting (or re-starting) your exercise program slowly and sensibly – plus arming yourself with the best possible home opportunities to support your workouts and recovery – can help your health, career and relationships in 2020.


Here are the publication dates for the complete series, with links to be added as they publish:

(Part 1) Quit Smoking – Monday, January 6

(Part 2) Eat Healthier — Monday, January 13

(Part 3) Get Exercise — Monday, January 20

(Part 4) Self-Care (Sleep Focus) — Monday, January 27

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