End of Year Traditions and Discharge Planning with Dr. Marsha Neville, Ph.D.

Summary:

This Carelab episode focuses on discharge planning and the critical role occupational therapists (OTs) play in ensuring a smooth transition from hospital to home. Dr. Marsha Neville, an experienced OT and neuroscientist, joins hosts Emilia Bourland and Dr. Brandy Archie to discuss the complexities of discharge planning, including addressing the patient’s environment, socialization, medication management, and other factors that contribute to a successful recovery. The episode also highlights Dr. Neville’s personal experiences as a patient and offers actionable insights for caregivers and healthcare providers.

Key Takeaways:

• Discharge Planning Starts Early: Effective discharge planning begins at hospital admission and requires active collaboration between patients, caregivers, and healthcare teams.
• Critical Factors for Safe Discharge: Successful discharge involves addressing environmental accessibility, socialization, medication management, and cognitive stimulation.
• OT’s Role in Discharge: Occupational therapists are uniquely positioned to assess patient needs, develop tailored plans, and educate patients and caregivers for long-term success.
• Importance of Advocacy: Patients and caregivers must advocate for clear communication, practical solutions, and appropriate resources to navigate post-hospital care effectively.
• Personal Experiences Provide Insight: Dr. Neville shares her own challenges as a patient, emphasizing the need for patient-centered approaches and thoughtful planning to avoid readmissions and enhance recovery. 

Transcript:

Dr. Brandy Archie
Welcome to Care Lab.

Emilia Bourland
Welcome to Care Lab! Yay! It's Care Lab Day!

Dr. Brandy Archie
We're so excited to be together. And guess what? We have an all OT Care Lab episode today.

Emilia Bourland
Oof, can I say, I probably shouldn't say this, because we have a lot of really wonderful guests, but I love all OT episodes. Because we can just soapbox.

Dr. Brandy Archie
I could just soapbox and nerd out.

Emilia Bourland
the whole time. So we do have a really, really wonderful guest with us today. I am a little bit biased because this person is not only has been an OT for 45 years with a rehab focus. She has a PhD in neuroscience. She's been a professor of occupational therapy for 20 plus years, which is where I come in because she was actually one of my professors and someone that I consider to be a very
important mentor in my life in many ways. She's also had a couple of knee replacements, a couple of back surgeries, an Achilles repair, a bunch of stuff. So she's been through it all. She knows a lot of stuff. Welcome Dr. Marcia Neville.

Dr. Brandy Archie
Thanks for coming on.

Marsha Neville
Well, thank you for having me.

Emilia Bourland
Absolutely, okay. So we're gonna start with an icebreaker, which I just started, but I realized I don't have the icebreaker. Brandy, it's you.

Dr. Brandy Archie
You

burger is not too hard. is this is a softball for you okay. All right so it is the end of the year and everybody usually has some kind of tradition small or big that they like to do in December. Tell us what your traditions are. What's your favorite thing to do in December?

Emilia Bourland
Okay.

Dr. Brandy Archie
You got to start, Marsha, because you're our guest. I forgot to tell you that you're on the hot seat first. Boom. Go.

Emilia Bourland
yeah, you go first. Yeah.

huh.

Marsha Neville
December traditions. Wow. Well, first of all, I must say I am a procrastinator when it comes to Christmas gifts. So I don't do a whole lot of Christmas shopping until very late in December. And the first part of December, I just sit there and think about what should I be getting people? And then

Emilia Bourland
And this is your favorite thing in December?

Dr. Brandy Archie
Ruminating, procrastinating, and then rushing.

Emilia Bourland
It's just ruminating and procrastinating, yes.

Marsha Neville
Yeah, it's ruminating and procrastinating. And of course then putting up the Christmas tree the day before. The other thing is because I have been in academia for so many years, there is that rhythm of the academic year. So, you know, it's final exams, it's crying students, it's closing out the end of the year. It's not a good time.

Emilia Bourland
Hahaha

Dr. Brandy Archie
That's funny.

Dr. Brandy Archie
Mm.

Marsha Neville
Bye.

Dr. Brandy Archie
And it's a reason for the procrastination. You got stressed out students to deal with.

Emilia Bourland
Mm-hmm.

Marsha Neville
Yeah. Yes.

Emilia Bourland
So what you're saying is that the holidays can be a stressful time for lots of people for a variety of reasons. And sometimes that makes them not always the most enjoyable.

Marsha Neville
Very nice stuff.

Marsha Neville
Mm-hmm. Yeah. But I always love when finally school's out and the holiday actually begins and the family's all together. And we have a pretty goofy family. So we have traditions of all the kids get peanut &Ms despite the fact that they're now 40 plus years old.

Emilia Bourland
That's fair.

Emilia Bourland
Yeah.

Marsha Neville
Hmm.

Dr. Brandy Archie
That's cool. That's why traditions are awesome because they carry on. That's the point. They carry on.

Marsha Neville
Yes.

Mm-hmm. Yeah.

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Okay, it was my icebreaker, so Amelia, favorite December activities.

Emilia Bourland
I know, I know. Ooh, you know, there are a lot of things that I really love. So ours, the Dallas Zoo every year does like a big, huge Christmas display. And by a big, huge Christmas display, I mean, the entire zoo is literally decorated with like hundreds of thousands of Christmas lights. And it is so cool. And they have places where you can go get

hot chocolate and you can make s'mores and it's honestly it's really really magical and that's one of my you know I'm same as you Brandy it's hard to always pick a favorite but that's one of my things that I really love to do with my family and my kids and everyone's excited for and especially if it's actually cold here in Dallas for us so you know it's kind of like crisp in the air it's that's absolutely one of my favorite things to do in December. Okay what about you?

Dr. Brandy Archie
Okay, I also, well, I have a young family, so we're always kind of trying to create the traditions that are gonna last until their 40s. And so the one, we have lots of things I like, and I don't like to pick favorites, but one thing that I really love is that we take our family pictures. Amelia, you were talking about this earlier about Christmas cards. We actually do it on Christmas Eve, and we send out New Year's Eve, New Year's cards. And so we take the time on

Emilia Bourland
Mm-hmm.

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Christmas Eve to go take pictures in the same place every year. And we do a little staycation at this hotel because we use their lobby for our pictures.

Emilia Bourland
Okay, so I have, first of all, think that's really cute and very fun, but I have a question for you. How do you turn that card around in time to actually get it out for New Year's?

Dr. Brandy Archie
So Christmas is one day, but celebrating New Year's, it's all of January. So it is not necessary, I don't feel the stress that I have to like get it there before it turns January the first. As long as it gets there in January, I'm fine with it.

Emilia Bourland
Okay, that's fair.

Emilia Bourland
Gotcha.

That's fair. I also like that it kind of spreads out the work of the holidays a little bit, because I think, like for me, getting Christmas cards out is actually one of the things that I really, really enjoy. And I love getting Christmas cards. But it is probably the most stressful thing about the holidays is like making sure that I get the card and the letter and all of that stuff kind of written out on time. So I like that idea of spreading that out a little bit.

Dr. Brandy Archie
Bring it out.

Mm-hmm.

Emilia Bourland
Okay, well, that was all wonderful. We should probably though talk about one of the things that Dr. Neville is an expert on though, what we've got her on here today, which is to talk about discharge planning, which has been a kind of a hot topic here on CareLab in the past. One of our most popular episodes actually, Brandy, was when you and I were talking about discharge planning. And I think that why no.

that Dr. Neville has some really incredible insight to offer into this as well. So take it away. No pressure.

Marsha Neville
Well, I am so glad to be here to talk about a topic that I really am so passionate about. And this came about as, because we all know that hospital stays have been shortened. And particularly in my area of expertise and interest is rehabilitation. So these are people who

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
probably oftentimes enter the hospital and are going home in an altered physical and cognitive state. And this can be as simple as hip replacements, knee replacements, or it could be as serious as somebody who's had a stroke or a brain injury. And these people go from the hospital to rehabilitation and

the expectation is they may stay two weeks and then they're gonna discharge home. Now, these are people who went into the hospital. It could be for an elective surgery or it could have been under an emergency such as a stroke or something. But they're going home and they're not gonna be the same oftentimes as they were prior to their admission to the hospital.

But then again, we as therapists all know when you interview them and you say, well, do you have any problems getting into your house? Well, no, that's no big deal. Or, you know, how do you prepare your meals? I don't have any problems with that. And the issue becomes that they're remembering where they were prior to admission. And these weren't problems, but the...

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
recognition and the admission that maybe things are changed and different is what poses the problem. And so as we talk about discharge planning, and I'm a true believer in discharge planning starts at admission. When that person comes to me and I see them in the hospital, the first thing I'm thinking about is what is their going home environment and build that

Dr. Brandy Archie
Yep.

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
going home environment afford them the quality of life in independence that they want, deserve and need. And so in saying all of this, the evidence certainly shows that readmission rates go up.

quite rapidly for people because of falls post discharge, medication errors post discharge. And let me talk a little bit about that. And please pipe in as you hear me speak. One of the issues with medication management is the person may have been managing their medication prior to admission, but now medications have changed.

Dr. Brandy Archie
Mm-hmm.

Emilia Bourland
you

Marsha Neville
Maybe the dosage has changed, the pills have changed, and is this client prepared to manage their medication now? So what we know causes readmissions post discharge are, first of all, they've been discharged to the wrong environment and that discharge fails. They have a medication error and have to readmit to the hospital.

Emilia Bourland
Thank

Emilia Bourland
Mm-hmm.

they kind of have to.

Marsha Neville
or they've had a fall. The other thing is a isolation issue that happens after discharge for people that don't have access to mobility in the community. so that being said, do you guys have anything to add to it or experience this?

Emilia Bourland
Yeah, sorry, Brandy's got questions. I'm gonna let Brandy go.

Dr. Brandy Archie
I got a question. So how would we know that they got discharged to the wrong environment? Like that's the reason. Like how is it, like from the data and the research that you're citing, that I noticed in your head, explain that a little bit more.

Marsha Neville
Next.

Marsha Neville
That's a really good question. So what they determine as discharge to the run situation is the person gets readmitted and has to discharge. Let's say the person went home to independent living and it was not working. They weren't able to take care of themselves. They were maybe even the family members deemed that this is not the appropriate discharge environment because the person

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
First of all, they don't have the support system in place with caregivers or whatever is needed to then sustain them in their home independently. And we all know the stubborn parents that we've had who said, I'm not going to assisted living. I can do that. Yeah, I can take care of myself. Well, that person ends up.

Dr. Brandy Archie
Mm-hmm. Take me out of this house feet first.

Emilia Bourland
Mm-hmm

Marsha Neville
Either getting readmitted to the hospital or the family is now looking for a higher level of care.

Dr. Brandy Archie
And so the data is letting us track them all the way through. Like they discharged to here, they came back and then we discharge them to this other place. Got it. Okay.

Marsha Neville
right

Marsha Neville
You're right. Yeah.

Emilia Bourland
Okay, so then I have a follow-up question for that then. And we can just kind of think, I think, take these things one thing at a time. So thinking about discharge environment. So there are multiple people involved in this discharge planning decision, right? There's the patient themselves, there's the family members or support system of that person. And then there's also the healthcare providers and the healthcare team that are involved. So what are the different things that...

Dr. Brandy Archie
Mm-hmm. Mm-hmm.

Emilia Bourland
each one of those players can do to help make it so we're not getting discharged into the wrong environments.

Dr. Brandy Archie
And before you add to that, I think we should add one more piece in that the insurance and the payment source is also being considered when it has to go for the discharge plan. So like. Yes.

Marsha Neville
You know

Emilia Bourland
Mmm. That's a great point.

Marsha Neville
Yes, yeah, it is multifaceted. And this is where I really feel like the care partners have to be part of this discharge planning team. And we have to be very honest with the care partners and they have to be honest with us about what level of care they're actually planning. know, the daughter, the wife, the son,

the father says, no, I'll do all the grocery shopping, I'll do the meal prep. But then when we look at it, this person's working full time and doing this on top of it. So it's like, is this sustainable for the period of time? then, part of it is a real honest discussion with care partners. And as we as therapists evaluate the client and say, well, they're gonna need somebody in their

for half day, four hours a day or something like that for self care, maybe for meal prep. And also if we deem that this person's gonna be socially isolated and this oftentimes happens when the person returns to their independent living home. Now, if they're in a retirement community where they have access to other social events and stuff, that can...

really play into their cognitive stimulation and socialization that they need to sustain their cognitive functioning. But if they're going home and isolating in their own home, then we have to educate the care partners that they have to have some level of socialization. That's critical in particularly the aging process, but we all want socialization. We all need people in our lives.

Emilia Bourland
Can I just, can I chime in and add something here, which is that in all of my years of practice, in all of the settings that I've practiced in, never ever has a discharge, like a, like a discharge template or a discharge program ever included.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
Yes.

Emilia Bourland
socialization as a factor in the discharge plan. It just hasn't. It's not part of how we do things in our health care system. But what you're saying is that that part is actually key to safe discharges. Can you talk more about that?

Marsha Neville
Yeah, we know that social isolation is detrimental to our cognitive functioning. And as we age, it becomes more important, but it's important across the lifespan. And so when people get into situations where they're not having access to socialization.

and people contact, then they're not getting the cognitive stimulation that they need to sustain mental functions. And that's where we'll see a decline in people's desire for independence and living in a productive way. But you talk about that. And one of the things that I can mention is that

In all of my passion for discharge planning, I developed discharge planning assessment tool. It has multiple areas of, it's basically a checklist across all these different areas of care partner commitment to caring, the environment and how accessible the environment's going to be. it's basically a yes, no. Is this a problem or isn't it? If it's a problem,

Emilia Bourland
It's basically that yes.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
need to address it. If it's not a problem, great. If the person never cooked a meal in their life and they have somebody who's going to continue to cook their meals, it's not a problem. But, and it does include things like access to socialization and access to community, access to prior interest areas, going to church if you have a faith base.

Dr. Brandy Archie
Right.

Marsha Neville
And all of those things are really critical for a successful discharge.

Emilia Bourland
you

Dr. Brandy Archie
So in your discharge planning assessment, who's the target person to complete it?

Marsha Neville
the occupational therapist. I really believe that we as OTs with our level of intimacy that we have with our clients affords us the opportunity. Now it's not done in isolation from nursing because there are certainly questions there about medication management, side effects of medication that I feel very strongly that our nursing community needs to reinforce.

Dr. Brandy Archie
Yeah.

Marsha Neville
We've all had the experience of working and being in the client's room when the nurse comes in with the pills for the day or whatever, and they said, here's your pills. And they hand them that little white cup of water and they pop the pill and down it goes. And I am a strong advocate that when it's up to the client to start being trained in the hospital on their medications.

And so the client should be responsible for, and we can put it up on their whiteboards or things like that as to what time their meds are due so that we get them started and start educating them, but that they ask for their medications and they ask specifically for what pills they need. And that also we educate them on what these pills are doing, why they're needing to take them and

any side effects that those pills might have that they should be looking for. And that should start at the hospital level. So I always advocate for when I'm working with a client and the nurse comes in and gives the pills, I'll say, let's talk about what these pills are. It doesn't do the whole thing of getting the client responsible for the scheduling of it. But if that's something they're gonna be expected to do when they're discharged, then they should be doing it in the hospital.

Emilia Bourland
in

Dr. Brandy Archie
Uh-huh.

Dr. Brandy Archie
I think that's such a fair and important point, but it feels like there's so many barriers to making that actually happen. There's such regulation, rightfully, about you can't even bring your own Tylenol into the hospital. You're not supposed to take it, right? Because they need to know exactly everything that's going in, and places are understaffed, and they get around when they can get around. so have you seen any...

best practices or great examples of places where this has occurred or even small programs where maybe somebody's in like a discharge apartment style setup and then we've done it through there. Like, do you have any like actionable recommendations for like the OTs that are listening?

Marsha Neville
Yeah, and there's a lot written in the OT literature about medication management. So where I kind of expect nursing is to help me understand what these meds are, what the drug interactions are, but the daily activity and medication management is a daily activity becomes the OT. So I, as the OT then can start figuring out strategies for this person to understand. Maybe it's a med pack.

that they have in their home. And we have it pre-measured, pre-prescribed. Maybe it's setting up a schedule. And again, this might work with the client and the care partners. What is going to work in their home so that this person knows when they're supposed to take their meds and what meds they're taking at that time? So it's really kind of falls to the OT when it becomes the daily activity of taking the meds.

Emilia Bourland
So, thanks.

Emilia Bourland
And even expanding that into the hospital setting, think, because you're right, there are so many barriers in a hospital setting, Brandy, because of different regulations and things like that. But patients even getting more information about what their med schedule is, having that written down for them in the room so that at the very least, even if they can't control it, they know what it is, when it's coming and why it's coming.

Dr. Brandy Archie
Mm-hmm.

Emilia Bourland
so that they can one, get in the habit of knowing those things, but also do be able to advocate for themselves better in terms of their own medication management in the hospital. Just because the person doesn't have their meds to dole out to themselves doesn't mean that you're powerless over your medications in the hospital. At the end of the day, it's the patient who ultimately decides what care they do or do not receive, right? So empowering people with that information I think is something that

Marsha Neville
Thank

Emilia Bourland
that we can all do and you know, to Dr. Neville's point is something that falls on the OT shoulders to really help with in thinking about the now, but also that transition home.

Dr. Brandy Archie
So on the discharge tool, is the goal that it gets done when they first get admitted and then also done again before they leave and then use that as measurable data to show outcomes of what you've been working on? So yeah, tell us how you like to see it play out.

Marsha Neville
That's exactly it. And again, as I said before, discharge planning starts at admissions. So when I'm first working with this client, I'm getting all the care partner information and I'm working with those care partners because oftentimes they have to get things in place. They may be taking some leave in order to help out or.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
things like that. And we could talk about whether this is going to be a permanent condition such as a stroke or a brain injury or things like that, or is this simply a temporary, like a knee replacement or back surgeries? So, you you're starting, you know, early on talking to the family members and letting them know how much they're part of this team if they're going to be a cure partner in

this process. And then it's as we do our daily activities with the client when we're working on accessing for self care is going through the list of things about the bathrooms, about the kitchens, about the bedroom area and completing it as we go. It's not something where you just sit down and formally go, okay, is this a problem? Is this a problem? It's when we're doing the shower,

And we've got this beautiful setup in the hospital with the tub bench and the this and the that. This may not be the client's home. We all know. And so it's really talking to the client about, so tell me at home, what is your setup? And we, of course, because of our expertise can ascertain whether we are thinking there's going to be a problem with access that maybe things need to change or

Dr. Brandy Archie
Okay.

Marsha Neville
Maybe the equipment that they have or at home now isn't going to work. Or maybe they need new equipment or different equipment. So it's that kind of process. Now, as we go through, as I said, it's a yes, no, or not applicable at all. So if we deem things as a problem, and that's how it's addressed, will this be a problem? Then if we say yes, we continue to go back to that.

Emilia Bourland
you

you

Marsha Neville
And at discharge then, we hope to resolve a lot of those yeses to say, no, we've resolved that problem. It's not going to be a problem at discharge. But yes, then the hope is that this becomes predictive of a successful discharge.

because what we don't want is an unsuccessful discharge. And the other thing that they've shown in the literature is unsuccessful discharges leads to depression.

Emilia Bourland
Hmm.

Dr. Brandy Archie
Mm.

Marsha Neville
and anxiety and we don't want that to happen for our clients.

Emilia Bourland
So we've hit on three things here that are really important for discharge. One is making sure that we're planning for the environment that someone has and making modifications as need to be made before someone goes home. Making sure that someone has the appropriate social support, both in terms of actual hands-on or like supervisory care that might need to be provided for that person, but also

for like socialization that has to do with leisure and just being around other people and quality of life because that impacts cognition and function as well. And then the third thing was medication management being super, super important to ensure a safe discharge. Are there other things that the discharge tool covers?

Marsha Neville
Lidic.

Marsha Neville
I'm thinking really hard. sleep.

Emilia Bourland
Mmm.

Marsha Neville
Sleep hygiene. so, you know, the whole sleep routine that's so interrupted with hospital stays and then changes in medication. And so the whole idea of sleep hygiene and exercise.

Dr. Brandy Archie
Yes.

Emilia Bourland
Okay, let's talk a little bit more about that sleep hygiene and exercise. Like how and how do those things go together?

Marsha Neville
Yeah, because if we exercise we have better sleep hygiene. So I could talk forever and this will be another podcast that we'll talk about with exercise cognition and our brain-body connection. But as we exercise, and I don't mean exercise in going to the gym or

you can get actually what the literature says is exercise should be mixed with a cognitive press. So I think one of the funniest studies I ever read was where they had a group of people who just did an aerobic class and then they had another group that didn't do anything but daily activity and then they had another group that participated in a dance class and of course

Emilia Bourland
Mm.

Marsha Neville
the dance class did the best. the summation is that as we exercise and we have a cognitive press with it, the stimulation that we're getting with our blood flow and our heart rate and all that great stuff that happens with endorphins when we exercise, then is mixed with things like a release of neurotransmitters in our brain.

that because of the cognitive press of following directions and doing this and doing that. But we all know when we're also doing exercise and doing something like a dance class or something, we're also getting social and

Emilia Bourland
Socialization!

Dr. Brandy Archie
Socialization, yep.

Emilia Bourland
And it's fun!

Dr. Brandy Archie
It's a trifecta and it's fun. Yeah.

Marsha Neville
Yeah,

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
And of course we have emotional feelings about all of this that we have to think about that need for exercise, not for the sake of, well, it is for also the sake of gaining more mobility, but it's also for working on our brains so that we can have more initiation, more motivation, more initiative to then follow through on some of the exercises or

the things that the PT is going to make us do in order to get better or somebody else is going to make us do to get better. Does that make sense?

Emilia Bourland
100%, yeah.

Dr. Brandy Archie
Totally.

Marsha Neville
Yeah, so it does go into that and does the person have access to their therapies? Do they have access to the things that they're gonna need to continue with their rehab process? But then also, again, as therapists, while the person's in the hospital, we need to be looking at, what is your home environment for doing exercise?

Dr. Brandy Archie
Yeah.

Marsha Neville
they need to walk so much, do they have access? And we might need to help them map out within their house or maybe getting outside and how they can walk safely in their community. So we need to reinforce the home exercise program in the hospital and have them initiating, okay, this is my time schedule. This is when I'm gonna do my exercises.

Dr. Brandy Archie
And also sounds like, you know, not necessarily giving them a form type of home exercise program. Let's, if we're talking about all these things, then we should eventually come to a plan that says like, I'm going to go to swim class every Thursday and I'm going to do, walking around my neighborhood on Mondays. And I'm going to do walking around my kitchen island for the first two weeks or whatever that plan is, but it should not necessarily, not that the exercises that are rote are bad.

Marsha Neville
I'm

Marsha Neville
Yes.

Dr. Brandy Archie
that it could be much more enhanced if it has a cognitive action with it, it has socialization with it, and if you can like make it fun.

Marsha Neville
Mm-hmm. Yeah, and that's why I'm a real strong proponent of things like Tai Chi, because Tai Chi brings in that whole visualization. Now, you don't have to be trained in Tai Chi, but you can do that with your client as they're doing their arm motion exercises, or they're doing their leg exercises. You can come up with some mantras of, you know,

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
I can run fast, I can run fast, I can run faster, or I have power, I have power, I have control. You know, there's lots of things and the evidence is really, really strong in these areas for how this can build not only our body strength, but our brain strength.

Dr. Brandy Archie
connected. Before we get out of

Marsha Neville
And if I could plug another podcast, Dr. Suzuki, who's a neuroscientist, has some wonderful podcasts on brain body health.

Emilia Bourland
Awesome.

Dr. Brandy Archie
Yeah.

Okay, I really want to change the topic a small bit because you didn't have to tell us this, but you did in your bio about all the ways you have been a patient. And so I am assuming because you've been OT for 45 years, those things happened after you were a clinician, after you're an OT. And so I'd love to hear your experiences, especially about getting MRSA and PEs and those kinds of things that happened in hospital that we know how we're supposed to try to prevent and like just from the flip side of it.

Emilia Bourland
Mm-hmm.

Emilia Bourland
right?

Dr. Brandy Archie
as a person in the hospital bed instead of helping them, like what, I guess a specific question would be like, what problems did you see that occurred in your care and what solutions did you either see in action or now know are good solutions because you've experienced it from both angles.

Marsha Neville
I think one of the things, I guess we've talked about the medication management. I went home on medications, as I'm leaving the hospital, literally as I'm leaving the hospital, they're handing me prescriptions for things I'm supposed to start taking when I get home.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
And first of all, I was stressed going home. I live alone. I had periodic care partners that helped out. it was really, there was in one of the instances I had where I started reading my discharge papers about three days after discharge to realize how many things I had done wrong.

Dr. Brandy Archie
huh.

Emilia Bourland
And can I just like, I would just want to butt in here and say, and you are, you've been an occupational therapist for decades. You have taught for decades and you're a neuroscientist and you are struggling with this. So like if you of all people are struggling with this, how messed up is it for folks who don't have any of that background or experience?

Dr. Brandy Archie
Right.

Marsha Neville
That's why I have, and as I went through each one of my procedures, I became more more cognizant of where the deficits were in our discharge planning. And so that's one of the big ones. The other things were, is I did have complications and thank God I...

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
As a therapist knew things were going right. So when I got the MRSA, which was after my first back surgery, then I went in and I had all the nasty signs of MRSA, including the fever. And they gave me the PA and the PA said, well, yeah, it looks like you might have an infection here. Let me put you on an antibiotic.

Dr. Brandy Archie
Mmm.

Marsha Neville
And I said, no, I think it's more than an infection. I'm vomiting and I'm, or I was dry heaving and I have a fever. And she was pretty insistent. And I said, I need to talk to my surgeon now. Well, he's in surgery. That's okay. I'm going to wait. And I waited and he came out of surgery and he looked at it. He says, have you eaten today? Because we've got to go back in and open you up.

Dr. Brandy Archie
Mm.

Marsha Neville
But I had to be a very, very strong advocate in that case. And then I did. I had a pick line for six months. I got C. diff three times. It was not a pleasant experience that people have to go through with these kinds of things. So.

Emilia Bourland
Mm-hmm.

Marsha Neville
And then I got the pulmonary embolisms and that I was discharged home after my second back surgery because the first one actually failed. And a few years later, I had to go back and have a three level fusion done. And it was a three hour surgery on the table with a posterior lateral fusion. And I was home maybe three days from the hospital and my spirometer was going down.

Emilia Bourland
Hmm. Which no one would know that that was a problem.

Marsha Neville
and I called.

Dr. Brandy Archie
You were actually doing.

Marsha Neville
Yes, I was actually...

Dr. Brandy Archie
because you were actually doing it so then you noticed it was going down.

Emilia Bourland
You're actually, yeah, which by the way, that's not supposed to happen, folks. If you're using a spirometer and it starts to go down, that's the opposite.

Marsha Neville
and for people.

Dr. Brandy Archie
And back that up, a spirometer is a thing you breathe into that they drop on your table. You have one, show the people.

Marsha Neville
Yes.

Emilia Bourland
actually, hold on. I have one. I can't let me go. I have one to show. Yeah. Give me just a second.

Marsha Neville
Yes. Yes, I was doing my spirometer and it went down and I called my doctor and he said, get to the hospital right now. And sure enough, it was pulmonary embolisms and I had to go on Coumadin and then be discharged on Coumadin. again, all of these things are

you know, we have the benefit of understanding what's happening, but could I have been better prepared? That could very well be the case. And of course, a lot of times those are in your discharge things.

Dr. Brandy Archie
to know to look for those things.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
But again, it took me three days to read one of my discharge. And I think that was after my knee replacements that I finally read what it said.

Dr. Brandy Archie
You

Marsha Neville
Yeah

Dr. Brandy Archie
Okay, so make sure you describe it well for the people who are listening.

Marsha Neville
Yep.

Emilia Bourland
Okay, so the spirometer is a thing that you use to exercise your lungs, exercise your diaphragm, which is the muscle that controls your breathing, especially after a surgery. And it's really important because it helps you to be able to breathe deeply, cough, clear out your lungs, prevents pneumonia and other things like that. So it's important exercise to do. So what you do is you put water on your mouth.

And then you suck in, you don't actually blow out, you suck in. Hold on, I gotta...

Dr. Brandy Archie
Sounds like you need a couple of tries.

Emilia Bourland
Apparently, yeah, apparently I should be doing this more on my own. But basically, it's showing you the volume of air that you are bringing into your lungs. So we want that to go up over time as you get stronger, not down over time. That would be an indication that your lungs are not getting better. Anyway, spirometers.

Marsha Neville
Yeah, so, and again, we talk about this ferometer as being something that they give you for discharge. But again, if this person is being seen by an occupational therapist, that again is a daily activity.

Dr. Brandy Archie
Totally. I've written many goals for using your spirometer.

Marsha Neville
Yeah.

Yeah, so these are some of my own experiences. The other thing, of course, and I have consulted with a number of clients. In fact, I have a client right now I'm working with. Their father had a mild stroke. He's 96 years old. And the stroke affected his swallowing and his speech and has the facial weakness. A little bit about dragging his right foot, but

not sure that he wasn't doing that beforehand. He lives in an independent living community. There is no support in this community. It is truly independent living. He is a very social human being. And the family is realizing that he can't do his modified diet meal prep. The place that he eats at does not accommodate

Emilia Bourland
Yeah.

Marsha Neville
that kind of food prep. And that's really kind of his biggest problem right now is he needs a modified soft diet, mostly like pureed. If we think of things like mashed potatoes or sweet potatoes or, and there's so many things you can just put in a, in a bullet or a blender that will chicken pot pies do great for pureed diets and stuff like that. But there's nobody there to do that.

Emilia Bourland
Mmm.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
for them. So the family is very concerned about what they're going to do. And of course you can get home health in, you could possibly have an aide. Is there an agency that will do this kind of thing? So we're working on accessing what's available. The thing they're trying to avoid is transferring him to an assisted living facility where that help would be available.

Emilia Bourland
Mm.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
But we also have to be sensitive to the fact that the man is 96 years old and he has a social group where he lives. He does not have family or that that could come in on a daily basis of prep meals for him. Actually, his house is not set up, his apartment is not set up. It doesn't have anything but a coffee pot and a sink.

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Yeah.

Emilia Bourland
Cause he goes down for all his meals normally.

Marsha Neville
Yes. Yeah. Where a lot of our independent living will have a kitchen or a kitchenette. And this has no access for things like storing food in a refrigerator or, and, you know, the family's concerned because he wants to go down and eat with his friends.

Dr. Brandy Archie
Yeah.

Dr. Brandy Archie
or something.

Emilia Bourland
Mm-hmm. Mm-hmm.

Emilia Bourland
Yeah.

Dr. Brandy Archie
Yeah.

Marsha Neville
So we're working out what we can do with planning all of that. And again, these things need to be put into place before he goes home. And he has one more week.

Dr. Brandy Archie
I was just about to say, like...

He has one more week that he's in the rehab.

Marsha Neville
Yes, he's got one more week in rehab.

Dr. Brandy Archie
Okay, so you guys are working in advance. In my mind, he was at home struggling already.

Marsha Neville
no, no, no, he has not gone home yet, but we've chalked it off that we're not looking at assisted living for him, that there has to be some solutions. And we're talking about prep in advance and him. But again, he doesn't have access to warming his food. The kitchen will not work with them, which is kind of unfortunate.

Dr. Brandy Archie
Mm-hmm.

Dr. Brandy Archie
Yeah.

Marsha Neville
So I don't know.

Emilia Bourland
Like that's all I don't have anything out of the sand. Like what's up with that? You've got someone who's probably paying good money to live in your building. They want to stay in your building. They want to come down and eat with their friends. You can't pop some stuff in a blender. What's up with that?

Marsha Neville
Interplay? Yeah.

Dr. Brandy Archie
Yeah.

Marsha Neville
Yeah, or you can't warm up stuff or he could have a refrigerator with some prepped foods that he could then access.

Emilia Bourland
See, this is one of those examples. There are solutions to these problems. There are easy solutions to these problems. We have to be willing to be flexible enough to implement solutions for people. Because at that point, it's not this gentleman's problem that he can't get these things done. It's not him that's the problem. It's the environment not being supportive of his needs that becomes the problem.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
Yes.

Dr. Brandy Archie
supportive of him. Yep.

Emilia Bourland
I don't know what to say except like we have to be willing to make changes to find solutions to make things better or else what are we doing people? Come on.

Marsha Neville
Yes. And that's why I say it has to start at admission. Now, our hope is, and things are looking up with his speech therapy, that he is getting stronger. He's handling food much, much better. That maybe there's enough of a modified diet that he could be sustained in between when family can be there and things like that.

Dr. Brandy Archie
Exactly. Exactly.

Dr. Brandy Archie
Mm-hmm.

Marsha Neville
So we're kind of, that's one of the things we're really kind of on a wait and see kind of basis. Besides lining up things like he does need more help in the home and he needs somebody to help with some of the self care for safety. And so working out that whole process. Another case that,

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
Yeah.

Marsha Neville
I'd love to talk about is a client that I saw and this was post discharge. And she had, in fact, I don't even remember why she was in the hospital, but I was contacted by the family that said, could you come and help us? Mom is not doing well. Well, this is a woman again, lived in a retirement community and was discharged home. She's widowed.

Emilia Bourland
Mm.

Marsha Neville
and she still chooses to sleep on the far side of the bed because that's where she always slept.

Emilia Bourland
I would too. I don't think I could ever move to the middle of the bed. that's just, it would feel so wrong.

Marsha Neville
Yeah. Yeah. Well, she happened to have a very small room and to get to the far side of the bed where she liked to sleep, we had to move a stool. We had to move a quilt stand because I don't know how she was managing it before she went into the hospital and came home, but this was a fall waiting to happen.

Dr. Brandy Archie
Yeah.

Marsha Neville
So we went in and said, okay, she's going to sleep on that far side of the bed, which is, you know, when she gets up in the middle of the night, she has to get around all this furniture to then get to the bathroom. Not to mention that she weighed herself every morning, her entire married life so that she never changed a pound. And do you know where the scale sat?

in the middle of the bathroom floor.

Dr. Brandy Archie
Under the bed?

Emilia Bourland
So just the right place to trip over. I mean, I guess the good thing is if it's been there for however many decades, just automatically she's used to stepping over it. So she knows it's there.

Marsha Neville
You

Marsha Neville
Yes, and there were just a number of things. Her floor in her shower was not a safe floor. There were so many things that needed to be modified. Whether these would have totally been caught while she was in the hospital, it's hard to say.

But some of it definitely, and one of her biggest issues, and I witnessed this and it was the most.

Marsha Neville
sad thing I think I've witnessed is the daughter was her care partner and she was very conscientious in things. And so she was working on her mother's meds. Well, there was some change in the meds. was the dosage of the meds that changed, not the med itself, which is another thing that oftentimes happens.

and people have their old meds at home and the doses changed and there's lots of confusion. Well, the daughter, had, so they discharged her with those foil packs of pills.

Dr. Brandy Archie
Ugh, yes.

Marsha Neville
Yeah. So the daughter took the foil packs and undid them all and put them in her pill bottle. And the nurse came in, the home health nurse, and I have never heard somebody be so disrespectful to a patient's family with chastising her for altering the med packs. it was like, maybe that was an important thing to deal with.

Dr. Brandy Archie
Marsha Neville
But if that was true, then could you say it a different way? But then again, what difference did it make if the pills were in a pill pack or they were in the pill bottle? And the client was used to having it in her pill bottle.

Dr. Brandy Archie
Those pill packs are so hard to open. They're so hard to get the pills out of.

Marsha Neville
So it was just a very sad situation. She also did things like in her kitchen, there was not, and she did some meal prep and things. She made her own breakfast. And so there was lots of things that needed to change in her kitchen to make it accessible.

Emilia Bourland
Thank

Marsha Neville
Dr. Brandy Archie
I think I want to draw out the part that I think in both of these situations, a family caregiver reached out to you because they needed more direct help. And I think the lesson of this is like, wow, we would like for our healthcare system to work a certain way. It just doesn't. At this point, it doesn't mean we shouldn't try to work to change it. But for all the people who are dealing with life right now, you have to be an advocate. That's just the bottom line. You have to try to find the resources that you need.

Emilia Bourland
Mm-hmm.

Dr. Brandy Archie
get the help, wave the red flag and say, I need some helps, who can help me? And even if you're talking to the wrong person, likely they can help get you to the right person like you, Dr. Neville, so that you can get like specific and directed change at home so that we can make this thing work.

Emilia Bourland
And I think that's like one of our greatest missions here on CareLab is to help empower people with knowledge and information and resources so that you can be a more effective advocate for yourself and for whoever you're caring for when you need to be. Because guess what? It's like impossible to know everything, especially if you're not already immersed in this healthcare world. I mean, we just heard a story today from one of the most experienced, intelligent people you will ever meet, that they had a really hard time.

Dr. Brandy Archie
Yeah.

Emilia Bourland
with their own health care, right? Getting those needs met. you know, our goal here is to share as much information and experience and resources as we can to help make it easier for y'all. So. If that's something that's valuable to you and you made it all the way to the end of this episode, then please make sure that you are subscribing, liking the episode, leave us a comment if there's something that you want to hear about, a question that you have, something that you want to say and.

Dr. Brandy Archie
Mm-hmm.

Emilia Bourland
please, please leave us a review because that is absolutely one of the best ways to help get more people to know that CareLab is out there so that they can hear the resources that we're trying to share with you too. So thank you so much, Dr. Neville, for being here on CareLab. We definitely are gonna have you back again, because I think there are a crazy number of things that we can talk about, and you have more stories about...

Dr. Brandy Archie
Thank you.

Marsha Neville
Thank

Emilia Bourland
about all this stuff than anyone I know, and they're all so great. So thank you so much for being here. We really appreciate it.

Marsha Neville
Thank you for having me. I thoroughly enjoyed myself and thoroughly enjoyed educating people on how to deal with discharge planning.

Emilia Bourland
All right, y'all, we'll see you right back here next time on Care Lab. Bye.

Dr. Brandy Archie
Bye everybody.

Marsha Neville
Bye. 

 
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