Episode 51: Are You an Occupational Therapist or Healthcare Provider Looking for a Career Change?

Catia "Cat" Garell, MA, OTR, SCEM, ECHM  co-owner of Thrive for Life, talks about how she started a successful home modification business 10 years ago. In 2019, she joined the faculty at USC Davis Leonard School of Gerontology, as an instructor for the "How To Get It Done" Module #2 course of the Executive Certificate in Home Modification (ECHM). Cat and her business partner Damian Sempio, OTR ECHM also started another program called: "Home Mods Mentor," with a focus on mentoring future occupational therapists and professionals in the  home modification business arena. Please listen to learn more about Cat's business journey and the future of home modifications as the Baby Boomer generation continues to grow.

Thrive for Life
Home Mods Mentor Program

Transcript

Janet: 0:44

Hello everyone and thank you for being with us today. My guest is Cat Garrell. She is an occupational therapist in the state of Hawaii and she is also an instructor for the executive certificate Home modification program out of University of Southern California, Davis School of Gerontology. And. Also owns her own business as a home modification specialist, and she is going to educate us today and tell us how OTs and other professionals can do the same thing that she's been doing for several years. Cat thank you for being with

Cat Garell: 1:29

us today. Oh, thanks for having me. Happy to be here and answer questions and help support other o.

Janet: 1:37

Great. And I want you to start telling us a little bit about your company, thrive for Life, and how you started that. And I believe that you were probably one of the very first OTs that got into home modifications because you started your company in 2011. So tell us how that came to

Cat Garell: 2:02

be. Yeah. I had been practicing occupational therapy for about 10 years at that point. Did a good chunk of time in pediatrics in the schools birth to three, and then moved on to skilled nursing, traditional adults home health, and even with the time I spent in pediatrics. And then the same issue would happen from the pediatric hospitals to. Skilled nursing facilities and rehab facilities. Just watching the discharge process fail our patients. Where as occupational therapists we're really good at doing our comprehensive assessment. Even measuring the home and seeing, okay, these are all the things you need to do to make the home accessible and safe and improve your independence. But then the follow through is lacking and I noticed the follow through was lacking. When I started working in home health and I would get patients who had just discharged home and months later or even weeks later, they just weren't able to get the recommendations that were made. They know what they need to get done, but they just weren't able to do it. And at that time I had actually read an article about emerging areas of practice for occupational therapy. And it was talking about home modifications and I was, I just was really interested in merging this frustration that I was noticing of families not able to do what the recommendations that we were asking them to do and how if we were able to create some kind of. Comprehensive approach, a consulting firm. Thrive For Life was born out of the frustration of the disconnect and the idea of, could we follow our recommendations from start to finish? And I say we, because it's myself and Damien Sano, who's another occupational therapist, my business partner we. To OT school together and at USC and kept in touch through the years and decided in 2011 we don't have to quit our day jobs. At that time we were working in the skilled nursing facility setting, But could we be a consultant to these families or even the health plans and funding sources and help? Find funding sources, find contractors, talk to the landlords, educate family members who are pushing back against the recommendations. And don't discharge until the recommendations are completed, or at least figure out a plan to revisit that case every six months or so and make sure the. Is aware that their home setting is extremely unsafe and they're at risk for falls, yet they are not able to do X, Y, and Z for these reasons. And started the business slowly and over time. the hospitals, different therapists we've worked with started to understand, if we refer to you, it's actually another therapist, not a vendor or a durable medical equipment company. We can help grab the relay race, the baton and follow those cases from start to finish. And so slowly we built up a business and we're able to. Take the leap and quit our day jobs. I'm making this sound easy. It was a lot of hard work. But we did find referral sources through private pay, through some equipment needs and through Medicaid the waiver program. That's

Janet: 5:40

a lot of great information cuz I know that there. OTs and other healthcare professionals, like physical therapists and social workers that are trying to get into home modifications, but don't know exactly how to navigate it. Since it's such a fragmented coalition of professionals that you need in order to actually make a home modification happen, and especially if that's right, you want it to be paid for.

Cat Garell: 6:11

Through other funding sources. So tell us

Janet: 6:17

how you started with the E C H M program

Cat Garell: 6:23

at USC Davis? Yeah, the usc the executive certificate in home modifications course at the University of Southern California's the Leonard Davis School of Gerontology. In 2011, actually, when Damien and I were really thinking we wanna do something in home modifications we reached out, we took the E C H M course at u usc. and it was really helpful. It really gave me a foundation, gave us a foundation to feel confident to go out in the field and try and. Via home modification consultant. I wanna try and do a research study I wanted to look at how does home modifications improve the quality of life, not only of our clients, but Of our caregivers. We know that improves the quality of life of our clients, but what we don't see, is a lot of data showing this direct impact that if we do a home modification and we do some pre-imposed testing of the quality of life of the caregiver, it improves. And what are the impacts of that for maybe lawmakers or different types. approaches. if we can get a caregiver to return back to work because their loved one is independent and safe at home, or improved independence and safety, then that's remarkable. And then about six. Later they asked me to join them on a conference presentation in San Francisco at the Aging in America Conference. So I co-presented with them. And then 2019 they said would you like to teach one of the courses? The How to Get It Done Series for the E C H M and I said, yes, I would absolutely enjoy doing that. it's great for professionals who are still doing their day jobs. I'm really enjoying it because it's majority of the course is with occupational therapists. I'd say about if there's. Students in the class, about 25 are OTs. And then the other five are contractors or interior designers. There's some physical therapists and I love really being The students cheerleaders, oftentimes they're practicing OTs who have been in the field like much like I was about 10 years or five years. And they're looking to change or adjust and become a consultant. as OTs I believe that we should be at the forefront of the home modification consulting. Field because we are uniquely trained, as to be able to make these recommendations that are medically necessary and appropriate and support, independence and safety. And so oftentimes what I'm doing in the class as far as yes, I'm giving a lot of the details of how to draw to scale and how to work with a contractor and talk about permits and things like that, but also just sort of that cheerleader for OTs who. Already OTs and practicing and been out in the field. you're ready to do it, you're ready to become a home modification consultant. And oftentimes, I've just giving them that reassurance that you're on your way and ready to go, if that makes sense. Yeah. I

Janet: 9:38

really enjoyed the ECHM course could because it goes in depth into all of the different areas that are very valuable. How do you perform an assessment what assessments are out there that exist to do a home safety evaluation and what's best for that particular client. And then also how to work with the general contractors and other disciplines. And then there was your cho, which was great

Cat Garell: 10:09

about how to actually draw. A home

Janet: 10:13

modification draw, a floor plan to scale, and then the funding sources, it really is very in

Cat Garell: 10:21

depth. Now,

Janet: 10:23

how would you say the E C H M certification and the coursework is different from the CAPS certification?

Cat Garell: 10:37

I think that us occupational therapists are really good at we go out and get as much training as possible and as many letters behind our names. As possible. There's a lot through the last decade there's so many different certifications that have popped up. Whatever reassures you as a practicing occupational therapist that you are ready. I believe is enough. I am still that cheerleader that your OT license and your OT degree coupled with your experience in home health and skilled nursing and doing some of the hard work that we do in the hospital. We'll give you that experience, that unique experience that contractors, architects, interior designers, they don't have that training. Couple that with the ECHM course Pretty intensive. Classes that you're self-guided, but you're going through that's a really good foundation. The CAP certification, the certified aging in place certification I really appreciate that they identify in the curriculum the value of an occupational therapist and identify that for contractors who are taking the CAPS certification, that there are other members on the team. And those should be in some cases, occupational therapists. I think the N A H B, the National Association of Home Builders has done a really good job in marketing the CAPS designation. So a lot of consumers recognize it and are reassured that okay, the person I'm working with is caps certified. And it's a two to four day training versus the years of being an OT and versus the months of the ECH M course. I would like new grads who are interested in home mods to get a little bit more experience in the field home, do home health, actually work in the hospital, see people when they're at their worst and when they're gonna be transferred home and really get an idea and skilled nursing and rehab settings, what they would look like before they go home. I'm really using a lot of that experience when I'm making my recommendation and or just that backing that I know I'm making the right recommendation. I'm not missing anything. There's a lot of nuance in being an occupational therapist. once you're at five years, 10 years, you're really know your stuff. And now it's just really reassuring you that you've done the training to go out and make recommendations and then of course, go out and keep doing some more. Certifications or get more education in the field.

Janet: 13:26

and piggybacking on what you said about new grads, I would like to see programs include

Cat Garell: 13:35

home modification in

Janet: 13:37

their curriculum because it's such an integral part of ot and that was what led me to work in home health was my professor saying Home health is the

Cat Garell: 13:51

perfect path

Janet: 13:53

for an OT because you get to see people in their natural environment and you have the opportunity. Not

Cat Garell: 14:01

only

Janet: 14:03

rehabilitate the person, but also change the environment and change how they perform the task. That's right. So that's right. I think home modifications is, A big part of what we do as an occupational therapist, so it should be

Cat Garell: 14:27

in the curriculum. Agreed. Yeah, absolutely. it's a disservice at this point to ignore it and let new grad OTs figure it out. I think why. Empower them now to give them as much knowledge as they can have as a base, and then give them that, that leg up when they're out in the field. Oh yeah, I learned this in my in school this is now in practice. Okay. This is feeling even more confident to go out and maybe have a mentor at that point, or the other OTs on their team presumably don't have to bring them up to speed.

Janet: 15:05

Yeah, I couldn't agree with you more. And this is a perfect lead in to my next question, which is about your mentorship program. So tell us about that.

Cat Garell: 15:18

Yeah, so during the pandemic just thinking about other ways that I can support. OTs who are in the field of home mods and have taken the courses, the U C H M, and they're still reaching out or with questions. I love questions. I love helping other OTs become successful. And the more complex cases the better. And so over the pandemic. Damian and I decided what if we created a mentorship program for OTs, basically who are interested in a home modification consulting approach or business, but they're struggling to get started or keep momentum with referral sources. So basically how can we help OTs avoid the mistakes that, that we made when we were starting our. And providing them the support and guidance that I wish I had to achieve the goals of becoming having a self sustaining business. Yeah we did make a lot of mistakes. We did spin our wheels at the beginning and that's part of the journey. You're gonna make a lot of mistakes, but if there's a way that we can help other OTs guide them two hats you're wearing. So there's the clinical hat and you're getting all of that good information by taking courses, and you are an OT and you're practicing, but the business side of it is tough. So what insurance are you gonna have? How do you set up your your payment strategy, payment plans? How do you deal with liability and getting clients and keeping clients and determine which programs you wanna approach. How do you talk to a case manager who is under a home modification program? But their program is already established where the families get their own contractor bids. And so they've basically written out an occupational therapist from the program. How do you get an OT into already established programs into your state? We did that over time here in Hawaii, slowly. And so how can we mentor other OTs? In doing basically what we did here in a sense and becoming more successful at a faster pace. the home modification mentorship program it's intensive guidance. It's a six month program where you'd be working. With me and really landing your first paying customer. But we also have a curriculum where you would click through and there's a portal and platform you've got homework and tasks even if you don't have a business entity or a business bank account or marketing materials yet, Let's see if we can guide you in having a successful business. And what's

Janet: 18:15

the first step in someone who's interested in the mentor program?

Cat Garell: 18:21

If you go to our website, thrive for Life dot com. And you go to the home mod tab. At the bottom there's a Home Mods mentor and you can sign up to be interviewed and then we can go from there and see if it's a good fit to join the program. I also wanna go over. Case studies with students with OTs. I do have really complex, interesting case studies that I think are invaluable for people who are out in the field and starting to come across ca difficult cases. And I wanna share that with other OTs how do you present modification example. To funding sources where it's very expensive, but it's the right thing to do. how do you do that? How do you show okay, small, medium and large scale solutions and then talk through what's medically appropriate and reassure a funding source that, this is the right thing to do. How do you talk to landlord? And guide them through approving a modification that's gonna change their home for a tenant. But maybe the tenant is gonna have to put it back the way it was when they move out. How do you navigate that? And that's something that we can help navigate for our consumers. But I'd love to share that with other OTs so that they're not scrambling when they come across. New cases for them in their business. Let me see if I can help them, help guide them and behind the scenes if they come across any difficult cases.

Janet: 20:10

Yeah, that would be very valuable. And I will put the URL of this website, the Home Mods Mentor program and the show notes. That's great. And so my last question. With the growing number of baby boomers becoming older every year until about 2035, how do you see the area of home modifications growing and changing

Cat Garell: 20:45

over time? Oh, that's a good one. My, hope is that there become more occupational therapists who have home modification consulting businesses established, ready to go, sort of turnkey, ready for the silver tsunami because. Unfortunately, the well elderly population. I just don't see an a, Big change happening with the well elderly, meaning prevention. I've done a lot of outreach in my community and even amongst my family and and you talk about prevention and things you can do to prevent falls in your home. And I just don't see the, that elderly doing those recommendations. I see them saying I'm not old, and they just see themselves as healthy. And they don't need to do the, from my perspective, the glaring modifications that are just, look, you're just staring at that the home and saying, gosh, they really need to remove X, Y, and Z for their safety. So I see just what I've seen over the last 10 years of running my business. I try and do prevention, education. Nothing happens. The injury happens after the fall and then I get an urgent phone call either from the hospital or from the caregiver saying, we need a ramp. We can't access the shower. Can you come tomorrow? I think that's just gonna become amplified over the next decade and yeah, we can keep trying to get people to change before the fall. Absolutely. I think medi medicine needs to their primary care providers. Do more fall balance testing, identify the risk. And really if our medical system would pay for the modifications we might see things happen before the fall. But my guess is my hunch, it's gonna continue to be that reactionary crisis mode after the fall. Can you get a ramp in now? And if. Have a a group of competent OTs who are confident and ready to go and we get that phone call from a hospital or from a family member and react professionally like we always do. It's gonna be, become streamlined approach to after the fall care, I think hospitals will hopefully have. Set OT, home mod businesses out in the community that they much like they call a durable medical equipment company to deliver a hospital bed and a wheelchair to the house. When somebody discharges, why can't they also call an OT home modification consultant and get things moving? I know that there's also home. Care. it can be a blended approach, okay? Instead, they apply to home healthcare agencies, but there's still this lack in the home health. I could be wrong. No, I agree with you. Because

Janet: 23:56

they're operating under certain parameters and making changes to the home is not their priority and they don't have the resources to do that

Cat Garell: 24:06

in home health. Right, right. So that's a whole, I could go, one more step then. So couldn't we also change the culture of home healthcare agencies where we don't turn a blinds eye as OT's in the home healthcare industry. We go out, we do an assessment. We know that they need to get these things done. Or even the the certified nurse, the CNAs that go out to the homes and do bathing services for the first month as respite or whatever. Sometimes that's added to their care plan and the shower is so unsafe and the way that they get in and out, but that we're still turning a blind eye. So what if there was something. Changed. It has to change. It just has to. But the home healthcare agencies what, if they were to. Reach out to or create their own programs, but really re respond to that need in the house. And I know that it's not realistic because there's no funding, but it's also, is it ethically correct that we just look away and don't stare at it. I think the doctor needs to be notified and why can't we advocate for. This grouping of people that are struggling in their homes and getting readmitted to the hospital because they've had a fall after the fall.

Janet: 25:26

I think if we had companies that could partner with skilled home health agencies, yes. Just like you have companies that offer technology for the home and they partner with the home health companies. Yeah. And as well as companies that sell different products that nurses need for wound care. Why couldn't we also have companies. Are created by OTs or other professionals that are qualified to do a home modification, and then the home health company reaches it out to them and puts them in contact. With the homeowner and then the OT that is in on the case can talk with the OT or other professional that is doing the home modification. That would be the perfect Yep. Solution. And then there's enough business

Cat Garell: 26:27

To go around for everyone. Right, and then the glaring issue is the funding source. And of course if our medical system was cleaned up a bit by then and there was actually funding available for the modifications they need. But right now it's so piecemealed we need to find non-profits and and different grants that can actually pay for the modifications that are recommended. That's something that I'm working on behind the scenes as well. Could we identify kind of wish list patients in your community that Yeah. We have a list of things that they need to get done to have their home be safe. We already have the scope of work and the contractor estimates, and could we put those all in a system? Now, if somebody were to write a grant or a legislator wanted to look at, Hey, this region has$30,000 in home modification need this is gonna reduce cost because the home mods X, Y, and Z are gonna prevent hospital readmissions in falls. Do we need to write grants for this or do we need to change? The tax code and get a tax right off for these tax credit for home modifications all of these things. But what we're doing sort of the home healthcare agency is doing is we're turning a blind eye to data. There's a lot of data. What if we were able to put all of that, those recommendations to combine them and identify and Remove all of the personal information and just identify, okay, this region we have 50 patients and this is their need. This is how much those modifications are. Write a grant and get them done, or change some of our health plan. It's a mess. Is the, another answer to your question, but it's tricky because there is no funding for home mods for people who are Medicare level or Medicare pays for the home modification assessment and the caregiver training, but it doesn't pay for the recommendations. Yeah, so it's a tricky one.

Janet: 28:45

I believe that the answer lies somewhere between education, where you educate. The well elderly or the younger baby boomers, just like people have been educated about having a healthy diet, right? most people know that if you have a H diet that's high in saturated fats and. You're consuming simple carbohydrates that you are going to be at high risk for diabetes and heart disease even if you're not currently overweight. So everyone should try to keep a healthy diet and exercise. Regularly, regardless of what you look like, right? So I think that we can apply the same thinking to home modifications that just because you currently are not at risk for a fall doesn't mean that it's not going to happen. And it's a good idea to. Invest in your home and make changes that are going to allow you to live in your home longer and make your home more comfortable and increase independence when you don't need these

Cat Garell: 30:07

changes.

Janet: 30:09

Right, right. The urgency. And then that coupled with tax credits or tax benefit. Where people can take advantage of that. Just like with energy.

Cat Garell: 30:22

in their home and receive

Janet: 30:25

a tax benefit or a tax credit,

Cat Garell: 30:28

then

Janet: 30:29

people would be much more likely to make these changes.

Cat Garell: 30:34

Yep. That's right.

Janet: 30:36

Cat, thank you so much for being on the show. Yeah. I'm going to include the URLs of your websites on the show notes so that people can learn about your company, and then also learn about the ECHM program and learn about your home mods mentorship program.

Cat Garell: 30:56

Wonderful. I'm available if anybody has any questions the more complex, the better. I do enjoy the more trickier nuanced cases, and I'm happy to help where I can. All right. Great. Thank you, Kat. Okay. Take care.