Vices of Mobility Devices: Damage Done By Misuse with Linda Mac Dougall M.A., HHP, CMT - Episode 91

This episode of the Caregiver Relief Podcast features host Diane Carbo and guest Linda MacDougall, a holistic healthcare practitioner and author ✍️. Together, they dive into the often-overlooked dangers of improperly used mobility devices and the systemic issues in senior care 👵👴.

Episode Outline:

Introduction of Linda MacDougall

• Diane introduces Linda MacDougall, a holistic healthcare practitioner, author, and massage therapist with decades of experience in senior care and with individuals with disabilities.
• Linda shares her passion for senior care, noting that seniors are often "left out in the dust" compared to children.

Linda's Personal Experience and Advocacy

• Linda recounts a personal experience where she was given ill-fitting crutches after breaking a bone in her foot, leading to falls and her having to crawl up and down stairs.
• This experience ignited her passion for mobility device education and advocacy.
• She mentions a legislative proposal she has written to address issues with mobility device regulation.

Systemic Failures in Healthcare

• The discussion highlights how doctors often fail to refer clients to occupational therapists (OTs), physical therapists (PTs), or assistive technology professionals (ATPs) for proper assessments.
• The co-hosts express concern that mobility devices are frequently not fitted correctly, leading to potential injury.
• They discuss the "ridiculousness" of over-correction in regulations, citing instances where seatbelts are removed from wheelchairs because they are considered a "restraint".
• Linda shares a shocking story about a woman whose prosthetic leg was almost taken away by a licensing agency under the guise of it being a "restrictive" device.

Misuse of Mobility Devices

• Linda and Diane explain that common mobility aids like walkers, canes, and crutches are often misused.
• Walkers that are too high can cause a person to hunch over, leading to neck and back issues.
• They describe the long-term consequences of improper use, such as strained muscles, poor posture, and increased risk of falls.
• Linda emphasizes that devices should be adjusted so the user can walk upright with slightly bent elbows, not leaning forward with their "butt in the wind".

Empowering Caregivers

• Caregivers are advised to consult with an OT, PT, or ATP to ensure devices are properly fitted.
• The importance of documentation is stressed; a professional's assessment and fitting must be in the client’s medical records to prevent licensing agencies from taking devices away later.
• Linda and Diane discuss the declining quality of care due to financial cuts and low reimbursement rates from Medicare, leading to rushed appointments and unsafe patient discharges.

Advocacy and Future of Healthcare

• Linda shares her legislative efforts to create a "supportive licensing" system that educates and helps caregivers and facilities, rather than just penalizing them.
• The conversation touches on the broader issues of government overreach in healthcare, the decline of private medical practices, and the negative impact on patient care and safety.
• They express fear for seniors due to the "mess" in the healthcare system and the "silver tsunami" of aging adults 🌊.

Key Takeaways for Caregivers:

• Recognize that pain in a loved one might be due to improperly fitted mobility equipment 🤕.
• Before purchasing a device, get a professional assessment and ensure it is documented 📝.
• Understand that a fall can be life-altering and that using assistive devices correctly is crucial for maintaining independence and safety 🛡️.

Don't miss this crucial conversation! 🎧 Listen to the full episode now to learn more about how you can advocate for better care and ensure the safety of your loved ones ❤️.

Podcast Episode Transcript

Diane: Welcome to the Caregiver Relief Podcast, where we explore real world solutions, expert insights and compassionate support for those caring with aging loved ones. I'm your host, Diane Carbo, rn.

Diane: Today's guest is the true powerhouse in the field of holistic aging and senior care. I'm thrilled to welcome Linda MacDougall, a holistic healthcare practitioner, author, educator, and massage therapist who brings decades of hands-on experience with seniors.

Individuals with disabilities and those navigating mental health challenges. Linda is the author of the award-winning book, the Spirit Method of Massage for Seniors Raising the Bar, A Primer for Massage Therapist and Caregivers, which is now regarded required reading for therapists with Massage Inc.

Her work bridges, physical care, emotional insight, and compassionate advocacy, all shaped by a remarkable journey that has taken her from direct care worker to federal advocate for Hawaii's developmentally disabled. That's a big word. As a baby boomer herself, Linda offers a unique perspective grounded in both personal experience and professional wisdom.

She's here today to share how massage therapy, mobility, education, and a whole person approach can transfer the way we support older adults and the caregivers who care for them. So whether you're a caregiver, a health professional, or simply passionate about aging well, this conversation will open your eyes to an often overlooked details that can make all the difference.

So let's dive in. Linda, thank you so much. It's such a pleasure to have you here. For those who may be new to your work, can you share a bit about your background and how you became so passionate about caregiving holistic health and elder care?

Linda: like you said, I have been decades with, the developmentally disabled in all sorts of roles, from caregiver all the way up to the federal advocacy for Hawaii.

That took me through most of my youth. And then as I began to age, I went into massage for seniors and holistic health and advocacy and all the rest that you mentioned, because everybody loves kids. They give kids just about anything they can, but seniors get left out in the dust.

Diane: they really do.

I agree with that. Yes.

Linda: And it's really sad. And my passion is about what's behind me, the mobility devices and what's going on with seniors in that arena. And it started to dawn on me when I was in Hawaii because I fell down some stairs, broke a bone in my foot, and ended up with being given crutches.

I didn't know any better at that time, so I went out like this because they gave me these big old crutches and they hadn't adjusted 'em for me. They hadn't even considered that I was a much smaller person than those crutches were meant for. And I fell. And I fell. And at the time, we were living in a three story apartment, little skinny thing.

Oh no. Oh no. I couldn't go up and down with the crutches, so I crawled up and down stairs.

Diane: Oh, God bless you. I did orthopedics as a young nurse, and to this day, when I see people walking with crutches, I always feel compelled to help them make sure it's fit right. Because it's neglected nowadays.

people don't know what they don't know and Exactly. The healthcare system has failed us in that way. It is just hurry up, get them in, get the product and get them out. Yes. And it real crutches alone need to be fitted properly for you.

Linda: Yes.

Diane: Yeah. They,

Linda: they can injure the lymph nodes and everything else underneath the arm.

Diane: Mm-hmm.

Linda: And they could injure me because I kept falling.

Diane: I'll tell you what I was told I needed crutches, a few years ago and I have a bad shoulder from falling off a horse. And there is no way in God's green earth I could use crutches. It's just not possible. And, I had to argue

to get another, an alternative suggestion. Can't make this stuff up. Oh, well, you've written an award-winning book, the Spirit Method of Massage for Seniors, and it's getting a lot of well-deserved attention. What inspired you to write it and what do you hope massage therapists and caregivers will take away from it?

Linda: when I began it, it was strictly for massage therapists, but as I was writing it and rewriting it and doing all that, it dawned on me that a lot of what I was putting in there had to do with holistic health and that the caregivers could really need that kind of information as well as these devices.

Diane: Yes,

Linda: and all of these devices practically are not being done properly these days. I'll give you a quick rundown. I have a legislative proposal that I've written, that's in with my local area agency on aging. But the whole problem starts with the doctors not looking at their clients in sending them to OTs, PTs, or ATPs for assessments.

Diane: Amen. I agree.

Linda: Starts there and because they don't document and send on

Diane: Yes.

Linda: If they ever go to a home.

Diane: Yep.

Linda: Then licensing comes in and takes things away. There's a case up in Washington that I heard of. It's not, didn't turn into a case because the woman could advocate for herself luckily, but they tried to take away her prosthetic leg.

Oh my

Diane: Lord.

Linda: Now this is all under the guise of safety equipment versus restrictive equipment. Oh. And everything's a restraint according to licensing. So you can't have much of anything if they can take it away from you. So if you

Diane: look that thinking with a prosthetic leg, because it isn't a restraint, it's actually giving her the ability to have independence.

Linda: Exactly. And luckily she was bright enough to eventually, after arguing with them for quite some time, she threatened them with calling the police and saying they were harassing her,

Diane: but that's the kind of thing that's

Linda: going on.

Diane: Yeah. And you know what, I really, I'm glad you're bringing this up because it's happening more than people realize. And, one of the points I wanna make here is. You have to reach out and ask for your doctor to, and demand nicely, but demand you wanted an evaluation by an OTPT or speech therapist, whatever it is that you're needing support for.

if they're going to give you ideas or support of some way for a prosthetic or assistive device, it's a challenge. They just give 'em to them and they don't. And the wrong sizes and the wrong fit. And with wheelchairs you need different things like, cushions and

Linda: Yes.

Diane: Don't realize that.

So let's talk about mobility devices. Something we see often see in homes and care settings, but rarely questions. What are some of the most common ways mobility aids, like walkers, canes, or wheelchairs are misused?

Linda: Oh god. first of all. If you're in a home, they've taken away your seatbelt.

Diane: Yep.

Linda: You will not see a seatbelt.

I don't think you will see a seatbelt if you do. Wonderful. Yeah. Because they think they're a restraint and Yes. Yet they can be used as a restraint. And the reason all that came into play was because we over restrained at one point in time, and so now it's swung the other direction to a fault. I have seen while working on one client, I have seen another client slide right out onto the floor.

Diane: Oh, I've seen it many times. Yes.

Linda: That's unnecessary. And it's, it can break bones, it can cause all sorts of talk about restrictive. What if she broke her hip?

Diane: Exactly. Or suffered a head injury from the fall.

Linda: Yeah.

Diane: Yeah. we have, we've gone the other way to the point of ridiculousness. Yes. I have to say, and I know people won't appreciate hearing this, but government involvement has gotta stop in some of this stuff.

There's, we've gotta, 'cause the people that are making these decisions are business people. They're not professionals all the time. And it's really causing harm to our healthcare system.

Linda: And especially to seniors who don't need anymore harm.

Diane: Exactly. Exactly. you're absolutely right about that.

And I see it all the time and it's making me crazy and it's getting worse. I don't know if you're aware of this, but Medicare has cut reimbursement for rehab, down so low that facilities get a higher level of reimbursement if they don't provide. So what we're seeing is, and this is frightening 'cause they say we have a hundred days of therapy covered, by rehab under Medicare guidelines, but their o the reimbursement is so low that people are getting discharged.

The first, in the first 20 days, and I'm witnessing the most unsafe discharges to home that I've ever seen. It used to be just with the Medicaid clients That's been going on for decades. I will tell you right now, decades it's been going on, but now it's the seniors and Medicare, and it's really frightening to me what's going on.

I can't tell you, the things that are missed all the time, and I don't know what we're gonna do because family members don't have the knowledge or the experience, and they don't even know what to ask. And when a family member is coming home. they're not even giving them home care properly.

I had a recent discharge where a patient was sent home with a wheelchair and they didn't do a home evaluation. They're cutting corners. She had 17 steps to go into her bedroom and upstairs to get into her accessible bathroom. She had no bed downstairs, no access to the toilet downstairs.

They didn't order her a commode. They didn't, they ordered a PT to come and see her when she definitely needed a nurse, 'cause she had new seizures diagnosed. A urinary tract infection that they sent her home with. They didn't, it wasn't fully resolved and they told, and she falls within the third, 31st 30 minutes of being home.[00:13:00]

And, of course I wasn't there. 'cause if I was, I would've sent her right back to the hospital. But her husband, he says, how am I gonna get her into the bathroom? And, luckily this is sad. A student nurse, my, my roommate's daughter helped her. And the, he actually, she says, you need to go out and buy a commode chair.

And he did. And of course he found the cheapest one he could, which, it was challenging, but, and we couldn't even get her to the bath. We couldn't walk her to the bathroom and there was no bed. They had this bean bag type of, kidney shaped, wicker. Chair and she was in that chair and it swiveled and everything.

We couldn't get her into bed. And she spent days in that because the facility wouldn't order a bed. Said she was independent upon discharge. And this was just a few months ago. Yeah. And

Linda: that's

Diane: And this is, really happening. Yeah. you talk about, the phrase devices of mobility devices.

Yes. Can you explain what you mean by that and how these well-intentioned tools can actually cause harm if used improperly?

Linda: we talked about the lady who scooted out onto the floor on her hips, because of no seatbelt, but any of the ones where you're walking with them. Yeah. Whether they're canes,

Crutches or walkers all have to be adjusted properly for you. Yes, I see it. Look, I live in a big 55 plus senior community, okay?

Diane: Mm-hmm.

Linda: And I see butts in the wind because they're leaning over the walker. Yes. Instead of standing up. Yeah. They're meant to support your frame, standing up fully, not bending over.

As I say, you don't need to grip 'em, it's a matter of life or death if you stand up properly.

Diane: Exactly. Yep.

Linda: If you stand up, I used to watch my mother-in-law before I knew too much about this, and she was a little tiny thing, and she would go down the ramp that was supposed to help her.

Changing the walker, and I'm just waiting for her to do in those dives. Oh, yes, yes. so you have to have it so it fits you so that you can walk upright properly, not with your butt in the wind.

Diane: Yes.

Linda: You're supposed to walk with the walker part in part out, but not with a, but in the wind and not with your shoulders up in your ears.

I've seen that.

Diane: Yes.

Linda: I've seen so many people that could have used upright walkers, but in my entire two decades or more, I have seen two upright walkers. That whole time. And one of them was homemade by the husband.

Diane: Oh Lord. yes. You know what, that's the other thing. I think reimbursement, or payment now everybody has to buy their own.

It's not covered. Very little is covered by Medicare right now as far as they don't

Linda: know how to buy. No. And

Diane: they don't know how to buy. They're not, and they go in and they wanna, when they purchase something, they just purchase the cheapest because, they're trying to just get through. They don't think of the future and they don't think about all the things.

Andhow do you address that? and, like I, it's my goal to educate people on this stuff, on, on how to get properly fitted and use it properly. 'cause there is physical damage that can result from Oh,

Linda: yeah. Being a massage therapist. That's what I deal with. I walked into one. Young lady got me to her father, who was in one of the local homes and he was having all sorts of neck and back issues.

as soon as I walked in and saw what he had, I went, oh yeah, of course. Yeah. Because he had, again, a walker that was way too high. So all his shoulders, everything, and he was forward as well. So he was just a reckon. He told me I had angel hands because I worked on some of that stuff.

Diane: Bless. Oh, you know,

Linda: I just looked, took one look at him and I said, you need to get, I showed him how to do it, Uhhuh, and I said, now you need to get some of the maintenance people from your home here to lower it to a proper.

And I showed him how to do that.

Diane: Uhhuh,

Linda: I worked on him twice. That was it. And he was fine.

Diane: Oh. I'm 72. I am a, I did a lot of rehab nursing in my early years. So my whole body, because we, in those days, we lifted a patient. We didn't have a lot of mechanical assistance. I was in the Flintstone days, but they, I did rehab and we didn't use the Hoyer lift very often, and we did fireman lifts and we did.

So my whole back and my thoracic and my back hurt. And then from other injuries, when I think, how am I gonna use some of this equipment, when I'm older? Because I'm sure I'll need it, but so what are some of the long-term consequences caregivers and users should be aware of?

Linda: Oh my goodness.

Okay. if you're incorrectly in a walker, say Uhhuh, and let's say it's too high. First of all, you're going to get all this neck. You're gonna get the arms, you're going to get even the wrists. Yes. So you're gonna get that whole area and the upper back all messed up because you're doing like this.

Yes. And that's not where your body ought to be. Your body ought to be like this.

Diane: Yes.

Linda: Okay. And the other thing is when people go down too far, and then you're looking at a neck that becomes a U.

Diane: Yep.

Linda: Because the eyes try to level.

Diane: Yeah. Try it. Yes, yes, yes.

Linda: And so you get this, I had one poor lady in my brain, I called her turtleneck because.

She would always go around like this. And she was such a sweet lady, but I knew she was killing herself with that.

Diane: I have seen that as well in the nursing homes, many times. Lots of it. Yes. Yes. and it is really unfortunate. Again, it comes down to, people not knowing what they don't know, the families and the facilities.

not providing the support with, professional staff that can actually do something because it takes away out of the funds and it's all financially based. if you can't get money for an evaluation, you're not, they're not gonna do it. and that's what we're at right now,

Linda: and a lot of it is also the licensing coming in and taking away what you do have. And so let me go back to that because you have to talk to your doctor. You have to get them to document what is wrong and why you, why they're sending you to A-P-T-A-T-P or ot. Okay? And then that person that you get sent to needs to fit you, and train you on whatever device it is.

And they need to document so that it's all in your medical records. 'cause if you then go to a retirement home, whatever you wanna call it, yes. Then it's in your medical records. And it is, they can't take it away because the doctor has said so. Okay? And the PT or OT or whomever has said so, and document it.

If you don't have documents, you don't get anything, they'll take 'em away.

Diane: Oh my, I, that's

Linda: all documentation.

Diane: Oh my, I, you know what, I've seen that, but I didn't know that it was a major issue. Now I do. Oh my. It's probably worse now than ever before.

Linda: Yeah. And it's gonna probably gonna get worse.

Diane: It's gonna get worse.

Linda: Yeah. Yeah. So you really need as a family to know to do that.

Diane: Yes. how can caregivers recognize when a mobility device isn't properly fitted or being used correctly? And are there visible signs or behavioral clues that we can look for?

Linda: Well, like I said, let me see if I can stand up and do anything.

I don't know if I can do it this way, but we'll see.

Diane: So I'll explain to you.

Linda: Okay. You need to,

Diane: this is audio anyway, explain what you're doing as you're doing it. A

Linda: chain needs to be right here, and so there's a walker. you just need to be able to hold onto it. So the elbows are very lightly bent, but not very bent.

Diane: So you have your hands at your side.

Linda: Yes.

Diane: and you're saying that the walker should be located where you, Where your na your elbow is slightly bent?

Linda: Yeah, just slightly bent.

Diane: Okay.

Linda: You'll see people with higher ones with their table, like I said.

Diane: Yes. And then

Linda: they're not walking properly.

You walk inside the walker just a little bit and outside just a little bit as you step. Okay. So you're not walking totally outside, which a lot of. Tailwinds do.

Diane: I love that terminology. Oh, that's funny.

Linda: it's just so sad. think of the pain in that lower back. Yeah.

Diane: I just think about my neck and my back, so I'm like, oh my God, that looks painful to me.

Yes. And it's, yes. Posture and ergonomics play such a critical role in comfort, in safety. Yes. Can you speak to how posture is affected by mobility devices and why that matters? Because people don't understand that if it looks uncomfortable, it probably is.

Linda: Exactly. And you're, you get people like me in there that are then called in to work on these people, and it's like Groundhog Day because they have the wrong equipment.

Diane: Yeah.

Linda: So you're having their back in and help them live with what they have when what they have isn't right, and it's continuing the problem. People don't realize that when you bend forward like this, and you see a lot of old people like this.

Diane: Yes, yes.

Linda: These muscles are tightened

Diane: in your shoulders and back.

Linda: Back muscles are stretched. So the backwards, weak, this is strong.

Diane: Yes. So when you're bending forward, you're actually stretching your back muscles. Yes. And your neck muscles are, I can't imagine holding my heavy head up. They're tightened

Linda: because usually they're like this.

Diane: Okay. Yes. They're forward with it.

Yes. And I see so many, even commercials where the little old lady exactly is walking and she's got all bent down and she's got her arms up to her beyond, where her shoulder level should be trying to walk. And, it's just pathetic. And I think, oh my gosh, they need to make her stand straight.

I always tell everybody they have to be like a little soldier, stand straight. Let's work around you, your body. Oh, so what should caregivers know before purchasing device, and who should they consult to make sure it's the right fit and set up for their loved one?

Linda: Again, it's an OTPT or a TP and you're gonna find that these people aren't all the same.

They don't all know the same thing, so you're gonna have to look around for the one that knows and actually works with the equipment. An A TP is more likely to, it's an assistive technology professional,

Diane: uhhuh,

Linda: but like in this county, we only have one. And I couldn't tell you who that is right now. I met one of the people that worked with him one time, so I know he exists, but I dunno who he is or where he is.

Diane: I just had a conversation with, and there's a whole new field of certified, durable medical equipment specialist and assistive device specialists. And, there's not many of them and it's, yeah, we desperately need them.

Linda: Yeah,

Diane: we

Linda: desperately do. And the PTs are usually your. The more common people that do this type of thing, but not all of them know.

I went into one of my local homes and it was a lady that I didn't know, but I, every once in a while will have a big mouth and say something I maybe shouldn't. But I watched her and she was almost okay, but not quite. She was still, the elbows were still too bent and that thing was, the walker was a bit too high.

Mm-hmm. So I asked her about that. I said, do you realize that this is not, hey, not doing well and for you? And she goes. No. I said, what? What? You need it a little bit lower? Not much. You're pretty good. Yep. You need it just a little bit lower. And I said, do you have an OT or a pt? She goes, oh, I get both of them coming to my room.

Oh. And I went, oh God. And neither one of them have said anything,

and no they hadn't. And I'm just going, so that's what I mean by not everybody knows the same things. Oh. So well,

Diane: and the other thing we have to address is that many of, the physical therapists may not be doing the actual hands-on. They may be just a, it's the physical therapy aide who may not have the experience or the physical therapists.

I'll tell you right now, physical therapists are coming outta school and they're, 'cause I just have a dear friend whose husband graduated and he's not allowed, he's given 15 minutes and he has to get in and get out and, he feel he's leaving the profession because he's not able to provide the care and, in a way that is, meets his standards or what the qualities of care that he was supposed to be providing.

Linda: And that's a whole nother thing that's happening. I'm on LinkedIn and. I am connected with a lot of doctors who are upset about this. I'm connected with physical therapists that are upset about this. Nurses, you name it. They're all looking for ways to get back to private practice, and I hope they do because this is insane.

Giving 15 minutes to somebody to do something like that.

Diane: I will tell you right now, the Medicare is moving to a cost sharing platform and, the ma the Medicare Advantage programs, are already there and it's frightening. perfect example. I had, I was touring a family, showing them this rehab facility.

And, the couple before us, I heard them crying, literally sobbing. And I thought, oh, somebody's died, and we'll be patient. it turns out, no, that wasn't the fact at all. The fact was their 84-year-old grandma or mom had a stroke and she had a Medicare advantage plan. And in the copay for that plan to be in therapy in a rehab center was $250 a day.

Who in the hell has that kind of money? people aren't able to afford it. Linda, it's very frightening to me. I'm hearing all this. I just had, somebody say that they have ms, he was in the hospital, he was in a rehab hospital. They sent him home after. 10 days because the hospital used his rehab benefits.

And I don't know how they did this. I don't know, because he was in acute care for a spinal cord injury. Anyway, they sent him home and he was in rehab and he di they didn't even tell her when he came home. He had a wound on his heels from being in bed too long while he was in rehab and he's a diabetic.

And I'm like, how does. But rehab, it used to be we get them up, you get them moving, you get 'em undressed in their clothes, they go to therapy. in the morning, they come home back at, to the rooms at, for lunch. They all take a nap for an hour. So then they're back at it again for rehab.

That, and even in skilled facilities, it was, they had something every, morning and afternoon and now they're le, I can't believe it, but they're leaving them in bed for days. That just shocks me. It just, how do you improve, how do you get better if you can't, and I guess I hear this and I just think, oh my God, what's happening?

I never in my life as a rehab nurse would, I think anybody would remain in bed. Sundays were their favorite days, and I get it, it was mine too, because patients in rehab got to sleep in for a little bit. We didn't force them to go, it was their day of rest, and that was their business company, when they had company and could enjoy their days a little bit.

So I'm really, disappointed, afraid, and, disgusted with our government run healthcare because it's just gone down the toilet and it's, we have the illusion of healthcare, but it's the responsibility of us as private citizens to pay for that care that's being recommended. And it's sad.

Linda: Yep. it's real sad.

Diane: Yeah. And I know you know about this 'cause you're into, legislation and advocacy and Linda, I wanna make sure we touch on those legislative efforts because you've been advocating for changes in how elder care and body work are regulated. can you share more about the work you're doing and why it's so urgently needed?

Linda: I talked about the doctors being owned by the insurance companies and everything trickles down from that. My legislation, it actually addresses the bottom layer, which is the licensing coming in and being able to take things away. And basically it goes through what the problem is and then talks about why can't we have a supportive licensing that helps educate.

It that's what I had when I ran my group homes.

Diane: Okay.

Linda: I had, the first lady that went through came by with a bloody ax is what I usually say because she was just there to kill. Yeah. And I was brand new hired and I had never had to deal with licensing before. And it was just a, it was a freak show because I was just, I was really in, just scared.

Diane: Yeah.

Linda: And she ended up having a nervous breakdown about a month later. So apparently this was more her than any, than licensing at the time. Yeah. But after that I got a, what turned out to be a dear friend of mine over time, she just died last year and she and her team were there to support and to help me grow.

'cause they knew I was new. They knew, they were gonna find stuff. And they did, of course. and so they helped me until I was one of the best homes in the county.

Diane: Oh, that's impressive. That's good. I was

Linda: there for 11 years and they were there for much of that time.

Diane: Wow.

Linda: And it was just, it so different than it is today when they're coming through and just ripping everybody and taking away, I I had a friend of mine in a local home here that was all upset because she said licensing came in and I had this client and a recliner, and they made me get her up.

Now she needed to be in a recliner because she's in a wheelchair all day and she needs to get off of her tail end.

Diane: Yes, yes, yes.

Linda: But then they took, they, they got all upset and had her go back in the wheelchair. Because, she couldn't get herself out of that chair. okay. She can't. But there were people around, like my friend, it wasn't like she was just being left there.

Diane: it's very frustrating. 'cause I've seen here's the other end of the spectrum where I have patients that have in nursing homes, residents in nursing homes that have developed, bed sores, pressure stores. Yeah. Huge ones. And they shouldn't be getting up in a chair. Yeah. Be because they can't, they need to be put in a recliner on their side and turned or whatever, and they don't do it.

But, you know what makes me crazy is these facilities, because licensing comes and they want them out of their beds and in their chairs, they're putting people that should never be in a chair because of their wound. Yep. It's here for hours and it just defeats the healing process and everything, that they're accomplishing.

They're undoing all their work because they're trying to make these people that are, I call them government bureaucrats, but, and they are, but, and so many of them have no knowledge of healthcare. They don't have any nursing background or they're not doctor background or therapy background. one lady that was making decisions was in real estate before she got this.

I'm thinking, oh my. And that's the kind of people that are coming in from the licensing agencies, boards to, a approve a facility and there. it can't be black and white, but it is, it's black and white. It's black and white.

Linda: Pretty much. Yeah. there may be a few people here and there that do it better than that, but

Diane: yes,

Linda: I see so much black and white and have seen it for a long time that it's just sad.

Diane: there also, there's this big movement now where nurse, I'm sure you're seeing this too, 'cause you're out there, nurses aren't, and staff are not allowed to pick up somebody off the floor.

Linda: Oh, I haven't seen that.

Diane: oh my god. There's some states here that the absurdity of it, they have to literally call EMT to come and pick a patient up off the floor.

I think Wisconsin or Illinois, one of the one of those states is huge. You can't, and it's a big movement. They don't want nurses and staff to hurt themselves. hello. What's the dignity in letting a person stay on the floor? And here's another issue I had. They use these bed alarms and stuff for people that are falling, getting up and falling out of bed.

And, as the old rehab nurse in me, we used to have low, low beds for people or even put the mattress on a floor with a bound, like a little gate around it to keep a patient safe because, so they wouldn't fall 'cause they were rolling and agitated and stuff. And I, made a comment to a facility. I said, as a care manager, I said, this guy needs a low bed.

And they said, we can't have a low bed. Well, what do you, why can't you have a low bed? His chances of hurting himself and harming himself are significantly decreased because if he rolls out of the bed, it's just a short six or 12 inches and he's got the mat there that's going to make it comfortable. And they, I, it literally was a challenge.

They refused to do it. So what's he do? He gets out of bed and he falls and he ends up with a head injury in the hospital. there's no common sense. and it's very frustrating to me as an old seasoned health worker, worker. Oh,

Linda: it's great. I'll tell you a story that's similar to that, but opposite of that.

Diane: Okay.

Linda: One of the local facilities many years ago, this was quite a while ago now, I was doing my vices of mobility devices talk and Uhhuh, show and tell thing. and at the end I was getting a lot of questions. So I was standing around talking to different people and this small diminutive lady comes up and says, when you're done, will you go up to my room?

I want you to see something. I said, yeah, sure. So I went and here is this tiny woman, she's got a pedestal bed. Oh, that woman could barely get purchased. Her little butt get purchased on the bed.

Diane: Yep.

Linda: her butt was in the air. Her head was almost on the floor. And here she was trying to get purchase on the bed.

Yeah. And then when she got a tiny bit of purchase, she threw her legs over onto the bed.

Diane: Oh my Lord. Oh. And then

Linda: she clawed her way into the middle of the bed and I was going, who didn't see this? this shouldn't have never been allowed in, or they should have taken the pedestal away. Something she could have easily done exactly what your person did and hit their head.

Yes,

Diane: yes, yes. And

Linda: broken a neck. God knows what you know.

Diane: I have had two situations with people in their homes. I'm a little old lady, so I can call them little old ladies. and they're having fall issues and balance issues, and they have the pedestal beds.

And I walk in and that's the first thing I say is, you gotta get the bed out and get a reasonable bed in here. This is impossible. And I cannot tell you how the families and the female that wanted that bed wants that bed. And it doesn't make it. It's

Linda: no,

Diane: both of them ended in bad ways,

Linda: of course,

Diane: because, they let vanity or their whatever reason to have this big, beautiful bed.

I get it. But I told them, just let me saw off the legs

Linda: exactly. I have two mattresses and they're on the floor.

Diane: Uhhuh. Yeah.

Linda: They have, I don't have a bed as such with all the paraphernalia. It is simply two mattresses on the floor. Yeah. That way I have to force myself to get up, which keeps my legs going.

Yes. As both walking, the dogs doing all that. Yeah,

Diane: exactly. Yeah, exactly. people don't realize, falls are the number one independence robber of seniors and a fall can keep them from ever returning home again, ever. And people don't realize this because the modern home is made for a young body, not an aging body.

And unless you've made changes as you've aged to accommodate the aging body, you're not gonna be able to return home. With the serious. I was literally walking a dog a few years ago, and this dog is a challenge to walk. she does whirly gigs as I'm walking her. She was a sweetie, but, I'm walking her and we're in a neighborhood where the houses are a little far apart and she's on the end of a cul-de-sac.

And there's nobody, all the other neighbors have, their vacation homes, they're not there all the time. So I'm walking the dog and I see this lady on the floor, driveway, and I said to her, what are you doing down there? She goes, I fell. I said. You did. I said, how long have you been sitting there?

And she goes, oh, about an hour. I went, oh god almighty. She didn't have a life alert on, she had just had, this is what scares me. She had one total knee done. She's had her hips done and she says, I can't get up because my, I have bad knees and I need my other surgery. And I went, oh my Lord. And I said to her, where's your walker?

Do you have anything? She didn't have anything. To help and support her. And, I was really concerned. So of course I got her up, then I got her in the house. I had to take care of the dog, which was a challenge 'cause she was a puppy. She just wanted to jump all over. And I'm like, please don't change.

Knock this lady over again. But yeah. and she had just lost her husband a few months before and She tells me, I went out there to rake leaves Oh lord. And she slipped on a. wet leaves and fell. and, seniors just, I know they don't realize how one fall can change their entire life and there's nothing wrong with having a life alert system or using a walker or if she's gonna rake leaves and she's got a bad knee, how about you pay someone to do it?

Or if you really feel compelled, take your phone with you. So if you do fall, you can tell, call somebody for help. or get a leaf blower.

Linda: I got

Diane: a leaf blower. there you go. There you go. it's really sad. I'm fiercely independent. I get it. I hate for anybody to have to do anything for me.

And I know there's a lot of seniors that are like that, but I know personally you have to have, it's a personal growth experience to accept health and accept that maybe I can't do everything I want to. My, my mind is willing, my spirit's willing, but this old body of me, mine is failing me and mine is with all my pain and stuff from all the years of.

I, I tell people I used to pick up men for a living 'cause I literally did. and it's just being silly. But, and I love when people react and they eyes what is she talking about? But, in those days we did pick people up and it's, and it was hard.

Big guys, I'm only five two and, but I'm strong. I've always been strong, because I had to be lifting patients. But when you're doing fireman lifts and helping people off the floor, it's a challenge. And, it's, that's the other thing I wanna, talk about empowering caregivers. They don't know what they don't know.

So what are some simple adjustments or actions that they can take to improve safety and mobility for their loved ones who use the system devices?

Linda: If you can keep a seatbelt, that's a really good thing for them to stay seated in their device. It's also really good to have postural support and wheelchair.

Okay. But what I find is that most of the wheelchairs are the wrong wheelchairs to support the support devices.

Diane: Yep. Yep.

Linda: when I ran my two group homes for United Cerebral Palsy, these were adults that could get anything they wanted from head to toe because they were disabled.

Diane: Yes.

Linda: Seniors get it taken away.

Diane: Yes, yes, yes. It

Linda: is just the opposite. It is totally insane. but yeah, you've got to get to the professionals, get somebody like the PTs to really look at your senior. And to get what is appropriate for that person support and get it documented so you don't have problems later on with licensing.

Diane: that's a good, good, I, good suggestion. I didn't realize that was such a serious concern. And I've been a nurse for 50 years, and I worked in long-term care. so that really is a surprise to me. I knew it was happening, but I didn't see it that much. And I'm sure with the seniors now, we're seeing it even more.

Linda: Oh, I see it everywhere. yeah. during the pandemic, I did podcasts from coast to coast and I surprised everybody and everybody went, oh yeah. I'm going, yeah. I'm the only one that seems to be talking about this. So it just became my passion because nobody else was in the space. And I'm going, how can they miss this?

Yes.

Diane: this is huge. A lot of things missed in, in healthcare, that's for sure. and it's really, frustrating, for me because I see it. And, I will tell you that doctors don't know what they're ordering when they order. People think, oh, the doctors say get a walker. And you're right. He doesn't follow through and say, get a PT eval to get it fitted.

Right. or whatever. Or the right type. 'cause there's so many different kinds of walkers, pull it later. Yes, yes. There's one with bra hand brakes. somebody from with dementia is not gonna know how to use a hand brake or, some have seats that you can sit on when you're tired, which I really like those.

But, there's so many different kinds. And if you've got shoulder issues like I do or wrist issues, there has to be adjustments made to that equipment to decrease your chances of pain and suffering.

Linda: And again, that sounds like a standup walker. Yeah.

Diane: So that

Linda: you're not putting any weight on the wrist.

Diane: Yep. Yep. See, and what I'm learning is our new PTs aren't getting the experience they should to learn these things. And it's unfortunate. It's a crazy

Linda: world out there. Really, really is. Yeah. And. I don't know if I'll be gone before it fixes itself or if, we will be gone

Diane: before it fixes itself.

One of the big things we're seeing is hospitals, community hospitals are closing not because of Medicaid, but because of Medicare reimbursement being so low and the government loopholes you have to, jump through to get anything paid. And nursing homes, this is frightening me because at a time when we have a silver tsunami coming our way.

We have nursing homes closing because the skilled facilities are the part of the nursing home that generated income for the facility to keep those on Medicaid, in providing care. But now that they've cut the Medicare reimbursements so low for therapies and people aren't getting that, it's not sustainable.

And we're seeing an unprecedented number of, nursing homes close. Especially if they had, because if they had a skilled unit and most of them did, 'cause that was the money making part of it, they're not going to exist anymore.

Linda: We have such a mess that needs to be cleaned up and restructured, and our doctors need to be in private practice again with insurance backing up.

They're not. Doctors?

Diane: No, no. The government policy makers have taken over the, the role of our, the doctor in the doctor patient relationship. And the other thing, I'm seeing is the government regulators are making these decisions and they don't realize the negative impact that it's had on our healthcare.

Or maybe

Linda: they don't care. I don't know what to do.

Diane: and here's the other thing I want you to know, I don't know if you're aware of this, but the accountable. a accountable care organization, they're moving to an a CO, that's what Medicare is. And it's literally to push the private solo practitioner out of business.

and it's happening now. they're making it so that they and you know what this is, this is universal healthcare. And if you look at England or Canada and see the delays in care or the inability to have a bed they have in Canada or in England right now, they have 30,000 people waiting for life saving.

Surgeries and care, and they are not, they wait like they're literally told, week to week if they can have a surgery or not. So the 50 years ago, I got my nursing license and I've worked all over the country and I can tell you I have taken care of Canadians and people from other countries because they could come here, get treated and go back home, before they were even going to have a diagnostic test done.

And now we are becoming that way. And Universal Healthcare is doing so badly because they have, the government policy makers have taken over the role of the doctor. So doctors aren't allowed to practice the way they are trained and they're not getting paid well. They just keep cutting them down. Doctors today make less.

Are reimbursed less than They were 20. Oh yeah. Ago, yeah. Yep. 20 years ago or 40 years ago. Even from, when they were starting out. And it's because they require more staff to handle all the government, who loopholes you have to, and regulations. You have to, go, you have to get things prior approval.

You, you get denied. You have to go to appeal. you have to, the doctor can't tell you what he can do because of that. So they really are, it's a big thing. For the first time ever, the American Medical Association is finally. I'm gonna say they're getting their, they got their balls. That's bad.

I know, but I don't care. They're finally taking the courage to stand up to the government and say, enough is enough. We can't do this anymore. It's good. A shortage of, doctors, a shortage of specialists. We have nurses leaving the field because they're expected to provide care that is not humanly possible.

The aides in the nursing homes are pushed to their limit, and yes, they are. And they are not given, they're not paid well. They are expected to provide care that, nursing homes are not, they are not, scheduling staff according to acuity levels. They're doing it based on minimum state requirements and it's just not enough help.

And it's really, it's really sad.

Linda: The whole system really needs a big overhaul and go back to the way it used to be.

Diane: I know, and you know what worries me is we keep hearing and, oh, we need to have free care. Free care. free care isn't free and when you provide free care, it's, you are not, getting quality care because nobody the reimbursement, everybody good.

Leaves to look into other things. And that's what we're having right now. We're having the universal healthcare countries have very few doctors and nurses. they're really stretched because it's not financially feasible and they're

Linda: recruiting from us.

Diane: Yes, yes, yes. and we have a shortage because, it just happened.

Obamacare brought us down. It when all the reimbursement came to the lower rates of reimbursement, to Medicare standards. 'cause I worked for one of the very first private review organizations in the country and I was shocked that, big companies, I would be looking, calling hospitals.

Say what? What are you doing? why is this patient in the hospital two days prior to surgery? in New York it was a big thing, 40, 50 years ago. 40 years ago for sure. they would actually put a patient in two days before surgery to do all the testing that is now outpatient testing because, they needed to assure that there was a bed for them.

now that's changed so much. we go in the day of, and, we used to have procedures. I'd love to know what the infection rates of some of these hospitals are now. 'cause when I did orthopedics, we used to shave the patient's hairy parts. if you had a shoulder or something or back or whatever, you had to have it cleaned.

And then we did absolutely, we did 10 minute Betadine scrubs before, and then we rinse it off and wrap the area in sterile towels. This is so crazy. And we did it twice. Once in the evening before surgery, in the morning of surgery before they went down. And when I had my shoulder surgery, the doctor just goes and puts a little iodine on my shoulder, wraps it, wipes it around a little bit, and then sends me on my way.

And I'm like, and I'm like, what happened? unbelievable. But yeah, we've got a mess that we're facing and it's a, I'm fearful for our seniors. So I would end up with talking about your consulting work. Linda, what's one misconception or surprise that caregivers often discover when they really start looking at how mobility aids are being used?

Linda: Oh, hopefully they're looking at just the pain that their loved one or charges in because of the improper usage. Because that's, all of this doesn't have to happen. Yes,

Diane: yes.

Linda: This is all preventable. And that's what kills me is people do not know what they don't know, like you said earlier. Yeah. And so they think what they see is normal and it is not normal.

I had. A person put together a couple of little tiny one minute videos to explain my services.

Diane: Mm-hmm.

Linda: And when she brought back the mobility device thing, I looked at her and I said, there's not one of these. That's right.

Diane: Oh.

Linda: And she goes, tell me what that looks like. And I did. She comes back, she goes, I can't find any

Diane: Uhhuh.

Yeah.

Linda: I believe it. So the picture, you see the people, you see how many of those are really the way they're supposed to be. And if you don't know and can't answer that, get your loved one to somebody who can't answer that.

Diane: it's funny because people think because we're old, that we hurt and complain about everything.

and we're discounted and dismissed. I was told, one time, when in my sixties. Women at my age, at 60 and beyond are invisible. And it's really sad because, that made me wanna be a glitter goddess, man, light and shining. Make sure you see me. but it's just really sad because it's very true.

we so much of the, and the residents in the nursing homes, they're not listened to. Nobody has the time to listen to 'em when they say I hurt or whatever. And then, like you said, the lymph nodes become damaged or something, and then all of a sudden it's like, oops, we did something wrong.

Linda: Maybe they don't even know it was them.

Diane: yeah. You're right. Just

Linda: the old person

Diane: falling apart. Yes, yes, yes. But we fall apart for a reason, guys. Yes, yes, yes. Linda, I'm so excited that we had this conversation, and I'm, I really wanna thank you profusely for sharing some knowledge. I learned things today that really are gonna help me in the future and, help my caregivers as well.

I really think, I did, I appreciate that. to my family, caregivers out there, I wanna tell you, you are the most important part of the caregiving equation. Without you, it all falls apart. So please practice self-care every day. Learn to be gentle with yourself because you are worth it.