Transforming Bathrooms for Independence with Occupational Therapist and Toilet Expert Maria Lindbergh

Summary

In this conversation, Janet Engel and Maria Lindberg, OTR/L, discuss the importance of home modifications, particularly in the bathroom, for older adults.

They explore the challenges faced by seniors in maintaining independence and safety at home, the innovative solutions provided by Toilet Talk, and the role of Jukebox Health in facilitating home modifications.

The discussion also touches on emerging technologies, advocacy for legislation supporting home modifications, and the significance of occupational therapy in this field.

Takeaways

Home modifications can significantly improve independence for older adults.

The bathroom poses the highest risk for falls among seniors.

Toilet height and accessibility are crucial for safety.

Bidets can enhance hygiene and dignity for older adults.

Emerging technologies can assist in monitoring the well-being of seniors.

Advocacy is essential for improving access to home modifications.

Occupational therapists play a vital role in home modification recommendations.

Community partnerships can help fund necessary home modifications.

Legislation is needed to support home modifications for all income levels.

Education and resources are key to empowering seniors to live safely at home.

Sound Bites

"Nobody's goal is to live in a nursing home."

"The number one room is the bathroom."

"Showers can make people feel very tired."

Chapters

00:00 Introduction to Toilet Talk and Home Modifications

01:22 The Journey of Home Modifications

03:21 The Birth of Toilet Talk

06:19 Common Bathroom Challenges for Older Adults

10:43 The Importance of Safe Bathroom Design

15:31 Recommendations for Bathroom Modifications

22:20 Emerging Technologies for Aging in Place

31:36 Jukebox Health: A New Approach to Home Modifications

36:01 Advocacy for Home Modification Legislation

Here's the link for OTs interested in joining Jukebox Health.
Here's the passive monitoring system I was talking about: Mimzy!

Transcript

Janet Engel (00:01.24)
Hello everyone and thank you for being with me today. I have, I'm sure as many of you on LinkedIn will recognize this beautiful face, Maria Lindberg. She is the founder of Toilet Talk. She is an occupational therapist. She's been doing home modifications for many years since 2017. And I'm very happy to have you on the show today, Maria.

Maria Lindbergh, MOT, OTR/L (00:29.003)
Thank you so much for having me, Janet. I feel like we have mutual appreciation. I told you I've been following you for a long time too. And so it's really nice to meet another OT who loves home mods as much as I do.

Janet Engel (00:43.318)
Yes, and I do want to start a conversation with Toilet Talk, but I also want to mention to our viewers and listeners that you are also the clinical director for Jukebox Health. And I'll just let you tell us about Jukebox Health. I know they've been around for a few years, so tell us how they've grown.

But let's go to the origins of how you started, which was a company that you started doing home modifications.

Maria Lindbergh, MOT, OTR/L (01:22.709)
Yes, yeah. Well, way back after I graduated school. Well, I mean, it wasn't that. It was 10 years ago. But when I graduated OT school, I knew I wanted to work with older adults. And I love the CCRCs, the community or the Continuum Community of Care, whatever. I can never remember what it stands for. But anyway, I loved working in nursing homes, assisted living, independent living.

Janet Engel (01:43.757)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (01:50.599)
And I would help people get better and they would be able to take care of themselves, go to the bathroom, get dressed, as independently as they could in the facility. But when they went back to their own homes, their homes weren't set up for them to be successful in taking care of themselves. And I saw a gap there where if we could change their home environment a little bit.

by maybe adding a grab bar in the bathroom or a toilet riser or something to help them get in and out of the home easier, then maybe that person could take care of themselves at home more independently and stay out of the facility. And Janet, I'm sure you've worked with clients before who've said that their goal is to go back home. Nobody's goal is to live in a nursing home or some other long-term care facility.

So I decided to create my home modifications business called Stay at Home Solutions. so I worked, I was a Medicare Part B provider. I would bill for OT services. And I was also the liaison between the client and the contractor with getting the equipment they needed in their home and then having the contractor make those whole modifications.

so that they could live safely and more independently at home.

Janet Engel (03:21.282)
Well, that's great that you started off that way and then COVID hit and then that's when you started Toilet Talk. So tell us about that venture.

Maria Lindbergh, MOT, OTR/L (03:34.027)
yes. Yeah. When COVID, when we went into lockdown, I had a seven month old baby. And I knew that for me and my family situation that it wouldn't, it would be too difficult to continue my home modifications business as it was. So I converted it. I love creating content. I love writing. I love making silly videos. And my favorite room at home is the bathroom.

That's the number one room when I worked with clients when they were in rehab. If their bathroom wasn't set up for them to be, you know, go to the use the toilet or get in and out of the shower, then the chance of that person living at home was severely like diminished. Like they were not going to be able to live at home or even have family members help them. So I decided to create a website. It's kind of like a

educational website, but I also sell bathroom safety equipment. And it's called toilet talk, like you mentioned. And so I talk about some certain modifications, certain equipment. As far as like modifications, like structural things to the bathroom, like I have a blog post and a video about like curbless showers or barrier free showers, zero step showers, all of those are the same.

interchangeable thing. I talk about different shower chairs, talk about assistive devices, and most importantly, I talk about toilet things. And so I actually created a free course on my Toilet Talk website, where the course is called Hard Time Wiping, Let's Talk a Booty It. Because that is something that when I worked with clients, when I worked with

clients that is such a hard if you are struggling to take care of yourself on the toilet. my gosh, you don't want to talk to your doctor about that. So where do you go? Like how do you find this information on the internet? And I had found through like when I was writing my blogs regularly, I found a lot of people were searching for like, like wiping specific things on my website, which was so interesting.

Janet Engel (05:58.094)
No.

Maria Lindbergh, MOT, OTR/L (05:59.297)
So that's why I made that course because it gives you some ideas, some techniques on how to clean yourself up easier after using the toilet. And it also talks about some changes you can make to the area around the toilet and also different tools that can be used to wipe yourself easier.

Janet Engel (06:19.342)
Well, that sounds like such great information because as a fellow occupational therapist, I know exactly what you're talking about in terms of patients having a very difficult time either after a hip fracture or let's say after a having back surgery that one of the restrictions is you can't twist or you can't bend and that's really going to impair your ability to do toileting tasks.

how important it is and then also how embarrassing it is when you have to ask for help. So what do you think, what are some of the most common bathroom related challenges that you see older adults having as they try to remain independent and age in place?

Maria Lindbergh, MOT, OTR/L (07:10.155)
Well, they kind of line up with the top two highest risk falls situations in your home. So the number one is when people step out of their shower, that is the highest fall risk that you could possibly have in your home. And there's a lot of reasons for that. So after people take showers, know, know, Janet, I'm preaching to the choir here, but for the people who

are not familiar so much. Showers can make people feel very tired. That's because the warm water opens our blood vessels and it just kind of makes us feel more sleepy. So after you're undressing, you're getting in the shower, you're washing your hair, your whole body, you're starting to feel more tired. Maybe you close your eyes and it makes you feel a little bit dizzy.

And so when people are stepping out of the shower, the shower floor is slippery. Maybe they're stepping onto slippery bathroom tile, who knows, but that is the place that people more likely fall. So that can be a challenging thing, making sure that you're set up for that. And then the second place people fall where I see a lot of challenges that the number two place at home that you fall is when you're getting on and off of the toilet.

Janet Engel (08:18.542)
Sorry.

Maria Lindbergh, MOT, OTR/L (08:33.057)
And so sometimes toilets, maybe they're too low for older adults who are taller. I don't have any evidence behind this, but it seems to me like people who are like five feet, four inches and taller benefit from a comfort height toilet as opposed to those who are shorter than that tend to benefit from just a regular like 15, 16 inch

high toilet where the bowl is off the ground. And of course it depends on, you know, people like if you have a shorter torso or longer legs or those kinds of things. But if you are having a harder time getting on and off the toilet, if it's, you know, if you have severe, you're talking about the back earlier. So back pain, hip, knee pain.

Janet Engel (09:11.182)
Mm-hmm. Mm-hmm.

Maria Lindbergh, MOT, OTR/L (09:24.961)
those things can really impact. there, I saw a huge stat a while ago is like 75 % of older adults have moderate orthopedic limitations. So that means that they're more than likely having some kind of issue with back, shoulders, hips, knees. And that's a lot, 75 % is a lot like of older adults in this country. So yeah, so those definitely are the top two things.

And then it's when people do start to struggle to clean up after they use the toilet, that can lead to people not taking, know, they're not able to thoroughly clean their sensitive skin down there. You know, that sensitive periurethral, perianal, you know, areas of the body. And that can lead to some major health issues. And in fact, I used to work in

acute care too in the hospital. And I did see people in ICU because they were septic because of issues that they had in around their genital areas due to not cleaning. So yeah, those are some big, big issues that I've seen. And Janet, I'm sure you've seen those as well.

Janet Engel (10:43.462)
Yes. And you know, I want to piggyback on what you said about transferring on and off the toilet. That's what I learned as an OT working in home health that that was when people had mobility issues, the toilet was the first place where you were going to see them struggle and where their fall risks really went up because now you're taking off clothes, you've got clothes around your ankles or clothes around your legs. Now you have to get those clothes back up.

you have nothing to hold on to because you're trying to get your clothes back on. So imagine how much your fall risk goes up there. And then I learned a few months ago that the primary determinant of health and independence as we age is leg strength. So that, when I heard that I said, well, that makes total sense why people.

Maria Lindbergh, MOT, OTR/L (11:33.633)
Big time.

Janet Engel (11:40.246)
suffer so much with toilet transfers and is because you're squatting you're doing an active squat now you have to get back up and if leg strength is suffering then you're not going to be able to squat and maintain your balance

So right there, and then range of motion issues at the knee. A lot of people, as we age, we have tight hip flexors, we have tight hamstrings, and so now your body isn't moving the way it's supposed to.

Maria Lindbergh, MOT, OTR/L (12:06.442)
Yes.

Maria Lindbergh, MOT, OTR/L (12:18.303)
Yeah, absolutely. Absolutely. So finding that, that proper positioning, you know, trying to help that person like figure out what is the best toilet setup for you so that we can get your body and, you know, and, and I just wanted to say something quickly. I tell people, you know, especially working with older adults, it's like, we, you know, it is good, absolutely good to do your best with

Janet Engel (12:36.078)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (12:48.193)
maintaining activity and, you know, going for walks and exercising. you like exercising, like doing the best that you can to stay active. However, I do want to tell people, I think a lot of people can feel shame for, you know, they let their bodies go or, you know, they're not where they were like 10 or 20 years ago. And, I just want people to know, like, it's okay to be.

who you are and how you are and like however your body is because we can make changes to your home environment to make it easier for you to take care of yourself how you are. So I just wanted to put that out there in case anyone needs to hear that where it's because that that's a big deal and that definitely comes up with wiping issues as well. People they're like, I let myself go. I deserve this. I don't deserve help. None of those things are true.

Janet Engel (13:42.99)
you

Janet Engel (13:47.294)
Yeah, and especially when you think about our housing stock in the US, which 90 % of homes were built more than 20 years ago and homes, especially before the 1970s, they were built with 24 inch doorways, very narrow bathrooms. And so even if you are the healthiest person, most active older person there is, when you are in an environment that isn't

helping you be independent and actually hurting you because did you know that half to two thirds of all falls in older adults are due to home hazards? Yeah.

Maria Lindbergh, MOT, OTR/L (14:28.495)
my gosh, I that's such a huge number. That is such a huge number.

Janet Engel (14:32.832)
Yeah?

So, you know, that directly speaks to what you said that it's not the person that is 100 % responsible for, you know, not having strong legs or being overweight. But when you live in an environment, which most of us do, that aren't going to help you be independent. In fact, the environment is going to put you in a position where your fall risk.

is increase because now you have to navigate stairs. There isn't enough lighting. You have furniture in the way or in the bathroom. For example, the sink is in the way and the sink is too high for someone to use as leverage to push off. So there you go. You got the shower on one side and the sink on the other and your toilet is sandwich in between. So yes, I agree with you that it's

Maria Lindbergh, MOT, OTR/L (15:14.859)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (15:27.455)
Yeah.

Janet Engel (15:31.334)
not the person, it's the environment that needs to change. So going back to that, what are the recommendations that you have for the bathroom and especially for that toilet area?

Maria Lindbergh, MOT, OTR/L (15:37.415)
I'm giving you high fives. Yeah.

Maria Lindbergh, MOT, OTR/L (15:53.793)
my gosh, yeah, starting off with the toilet area. I like to think, so going back to that kind of that height thing that I was talking about, thinking about like, who is in your household? Who is using this particular toilet? Is this a bathroom that you are using on your own? Are you sharing it with like a spouse or children, grandparents, whoever's using that bathroom?

And I like to think about like, how can you make the bathroom work for the most amount of people in your home environment? Or how can you make your bathroom work for the person who needs the most help in the home environment? And so I like to think about height as a thing, not only like first ability.

you know, do I live with somebody who has like limited like strength? You know, that's a great example since we're talking about it. And also how tall is this person would, so I just want to give an example of my grandparents because this is such a good example. So my grandmother, she was like maybe four feet, 10 inches tall, like soaking wet. Like she's a little lady.

Janet Engel (17:12.142)
you

Maria Lindbergh, MOT, OTR/L (17:14.099)
And so she is somebody who, even though you would think, okay, she's a little lady, she's in her 90s, so her leg strength isn't, it's definitely not as much as it was when she was younger. But that still doesn't mean, people tend to think, let's make toilets taller so this person can get on the toilet and then hop down.

But for her, I actually walked in one day, I was in OT, and my mom and I were my grandparents caregivers in their home. And I walk into her bathroom, and lo and behold, there is a tall toilet. And it felt like a slap in the face because I was like, Mom, don't you know what I do for a living? Like, this is not a good toilet for her. Because when she sat on the tall, like, comfort high toilet, chair high toilet, ADA toilet, you know, all those are the same.

her feet dangled from the floor. And that is a huge safety concern because if, I mean, anyone you are welcome to try, if you're sitting on a chair or something, go ahead and lift your feet in the air or go sit on something like put some books or some pillows in your seat and let your legs dangle and then see how your balance is.

Janet Engel (18:24.621)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (18:31.933)
And you will notice that your balance is worse because your feet, when they're placed on the floor, they help you keep your balance better than if you don't have your feet there. So not great for someone who's already older and who's a higher fall risk anyway. So you really want to make sure that for toilet height, is it right for you and your family? Are you?

Are you all a taller family over five feet, four inches? Are you a shorter family under five feet, four inches? And basically going from there. So my grandmother, she benefited the most from just a regular toilet height so her feet could be on the floor. And then something that could help her in addition to standing up if she was having a hard time with leg strength are

There's so many different products like this, but a place to push with her hands. And so one of my favorite low cost options is a toilet safety frame, or they're also called Versa frames, like depending on where you are in the country. So something that's basically just arm rests for the toilet that do not make your toilet seat taller, but those arm rests are right next to you on either side. And when you push down next to your side,

Janet Engel (19:42.862)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (19:52.629)
you're actually strongest there, you that proximal stability that OTs learn in school. It's easier for people to push down. For some people though, like luckily, and I think this is why occupational therapists, like this is why we should be, you know, the leaders in HOMADs is because there's other things that can affect people who have different neurological conditions. Like if they're...

Janet Engel (19:58.786)
Maria Lindbergh, MOT, OTR/L (20:19.271)
if they've had a traumatic brain injury, for instance, or spinal cord or something like that, where maybe it'd be more beneficial for them to pull or, you know, pull on something, there's all kinds of different grab bars for that. So I would say at home, if it's just you, you don't want to use a occupational therapist or ask an occupational therapist to talk with you about your bathroom around the toilet.

I also recommend I created a free grab bar guide on toilet talk dot me and it helps you customize your grab bar placement next to the toilet. So then you can go through that walkthrough and kind of determine for you and your family like would what type of grab bar would work best in our situation. And then of course if you do need that extra help then.

Contact get a referral from your primary care provider and reach out to an occupational therapist to help them Specialize it even more if you're having a really hard time deciding if a grab where should we put a grab bar? What type what's going to work best for me and my family in this situation?

Janet Engel (21:20.332)
Thank you.

Janet Engel (21:28.843)
Yeah, that's such great advice because it is so specific to a person because of different factors. Their height, their strength, if they have paralysis on one side, let's say from a stroke or a traumatic brain injury. All of those factors play a role in how that person is going to function.

I was going to ask you about equipment that you recommend and you brought it up on your own. And I wanted to say one of my least favorite pieces of durable medical equipment is the raised toilet seat, where it's just the toilet seat that goes on the lid because it's like five inches tall. And for most women, that toilet seat is way too high.

Maria Lindbergh, MOT, OTR/L (22:08.159)
Yes. Yes.

Janet Engel (22:20.384)
you're going to be dangling, unless you're about 5'8", your feet are not going to be touching the floor. And then now you have a different problem.

Maria Lindbergh, MOT, OTR/L (22:20.789)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (22:33.375)
Yes. Now you, I, Janet, we are soul sisters because I don't like them. They're hard to clean. They stain. They, they retain smells. They're not comfortable because yeah, the other, mean, my grandmother like sitting on a, on a tall toilet for her, also hurt the back of her legs. Like, you know, it's not conducive to, you know, quickly using the bathroom and,

Janet Engel (22:37.94)
Yeah.

Maria Lindbergh, MOT, OTR/L (23:01.163)
being comfortable, but also there's so many, there's toilet risers where they don't secure to the toilet, like they don't bolt on. And that's another safety issue too, because then you have people falling off the toilet with the toilet riser and not meaning to laugh at that, but it's just shocking where it's like, here's this thing that's supposed to make it

Janet Engel (23:24.174)
.

Maria Lindbergh, MOT, OTR/L (23:30.407)
easier for you to get on and off the toilet. It's actually more risky.

Janet Engel (23:35.604)
Mm-hmm. Yes, I agree with you. I totally agree with you. So I wanted to ask you, what are some emerging technologies or innovative products that you've come across that you think are great for aging in place and maintaining independence?

Maria Lindbergh, MOT, OTR/L (23:37.473)
you

hahahaha

Maria Lindbergh, MOT, OTR/L (23:59.527)
my gosh, when it comes across, this is very, I mean, the first one that comes to mind is very, it's kind of off the wall. It's not like 100 % bathroom related, but it is really cool. And I hope I remember the name of the product while I'm talking to you. But there are technologies that are coming out there that are, they are a type of passive monitoring.

where, my gosh, I cannot believe, I'll send it to you later and then if you can share it in your show notes or on LinkedIn later or something like that. But basically where it's a box that a person would have in their home. They could choose to put it whatever rooms, like maybe they get two or three boxes and one's in the bedroom, one's in the living room, places where they spend a lot of time.

Janet Engel (24:36.567)
Yeah, we can do that.

Maria Lindbergh, MOT, OTR/L (24:57.779)
And so if you have like an older adult or family member who wants to live at home, what this box does is it tracks the client. It picks up their patterns like when they normally wake up in the morning and eat and, you know, their kind of activities. And it does it based off thermal. Like it can sense that person's body heat. It's it can do it visually.

And it also keeps track of the audio so it can pick up sounds. And I love that it's not something it only records or it keeps up to like 10 minutes of information, like where you could actually like see. So it's not something that's like linked to the internet so that people, hackers can hack in and look at your family member. It's not like that.

It's somehow I can't remember. can't explain all the technology to it, but it has some really cool features like that where it can start to notice and detect behavioral disturbances. So for instance, when you have a family member who maybe they have a urinary tract infection and you know, sadly for older adults, urinary tract infections can make people not sleep as well or

they have hallucinations or delusions or they have these things where they're cognitively, like their mind is not working how it usually does and they're making like unsafe choices. Well, that passive monitoring thing, it's able to pick up and notify a family member or caregiver or whoever you determine to contact.

Janet Engel (26:49.516)
Mm-hmm. That there was something, mm-hmm, a reason to.

Maria Lindbergh, MOT, OTR/L (26:53.865)
Yeah, and they will say there's something going on.

Janet Engel (26:57.91)
Yeah, yeah. that brings me to bidets, is I love bidets for that reason. And I remember when I was still working as an occupational therapist and there was a patient that told me I got a bidet and I'm attaching it to the toilet. I thought, wow, that is such a great aging in place technology to keep people healthy.

Maria Lindbergh, MOT, OTR/L (26:59.261)
Exactly. Yeah.

Janet Engel (27:26.028)
with what you just said, preventing urinary tract infections. Then they also help with hygiene for the person themselves that has either range of motion issues, has restrictions or has pain, whatever it is, that bidet is gonna help you clean yourself. And if you have a caregiver, it's gonna make the job of the caregiver so much easier and just allow for dignity.

to for that person to maintain dignity because now you don't have someone all up in your business. So that the bidet with that other technology that you mentioned would be great because both of them are going to help.

Maria Lindbergh, MOT, OTR/L (28:01.565)
Yeah, exactly.

Janet Engel (28:13.09)
keep a person healthy and then monitor any changes. And as we age, especially for women, we're at a higher risk for UTIs because of our anatomy. But something I learned recently that as women go through menopause, estrogen levels, they decrease and a decrease estrogen levels is

Maria Lindbergh, MOT, OTR/L (28:24.875)
Mm-hmm.

Janet Engel (28:40.904)
is automatically correlated with UTIs. So you can have UTIs form. I didn't know that either until like two months ago that yes, so your estrogen levels dropping will put you at risk for a UTI. And so another treatment for UTIs in

Maria Lindbergh, MOT, OTR/L (28:47.199)
I didn't know that.

Maria Lindbergh, MOT, OTR/L (28:54.174)
No!

Janet Engel (29:09.974)
menopausal and postmenopausal women is having an estrogen, a vaginal cream, estrogen vaginal cream, and your risk of UTIs goes down. So now that made me think, well, maybe that's why we saw so many more women having UTIs. It wasn't just their anatomy, but it's what's happening to us hormonally as we age.

Maria Lindbergh, MOT, OTR/L (29:19.211)
home.

Maria Lindbergh, MOT, OTR/L (29:24.705)
close my mind.

Maria Lindbergh, MOT, OTR/L (29:39.147)
That is wild. I didn't know that at all. And it just, also makes me think like, well, first of all, I want to say yes, absolutely love bidets. Bidets are a no brainer for me. I mean, especially ones that you're, the price ranges are just getting better and better and better. Like having one with all the bells and whistles for $300. Like that's such a great investment. Yeah. Obviously it could be

Janet Engel (30:00.075)
and

Maria Lindbergh, MOT, OTR/L (30:08.511)
way more expensive for some than others. But there are cheaper versions of bidets, but the mid-price ones will get you more of the accessibility features that as OTs we really love. But yeah, just having, it makes me think like, my gosh, if you have this vaginal cream, how is that client, if you have a client who has arthritis,

How are they applying that? How are they, because is it a vaginal? I know I'm just like thinking like really deep, like how would we help those clients be able to, it's like a health management like IADL, like getting them to be able to use the medicine or use it as prescribed or applied as prescribed.

Janet Engel (31:03.886)
I've never used it, but I would think it has an applicator and it would be similar to inserting a tampon, except it'd be medication that goes in that area. maybe perhaps as a, I don't know, but maybe we're getting too far into the weeds.

Maria Lindbergh, MOT, OTR/L (31:24.897)
Yeah, sorry, I just that's how my mind works. I'm like, yeah, how would that work? Next on on the next episode we will know just kidding

Janet Engel (31:34.51)
But that is a great topic and a very necessary conversation. Maria, tell us about your work with Jukebox Health.

Maria Lindbergh, MOT, OTR/L (31:37.818)
Yeah, it is. It is.

Yeah, back to home mods. Anyway.

Maria Lindbergh, MOT, OTR/L (31:57.463)
yes, yes. So Jukebox Health, we help. It's essentially, Jukebox Health is the bigger version of what My Home Mods business was originally, where we have occupational therapists go into people's homes. They evaluate the home and make home modification recommendations. And then we have a team of client care coordinators.

who reach out to general contractors and handy people, handy men and women, to go to the home, make those home modifications. And in some cases, we are able to send the OTs back out to the home to make sure the home mods are done correctly, but also to provide any additional ADL education, training, caregiver training, whatever else is needed for that client so they can be safe in.

independent with their ADLs in their home environment.

Janet Engel (32:56.704)
Well that sounds wonderful and I know originally they were in the northeast and had plans to expand to several states so what does that look like today?

Maria Lindbergh, MOT, OTR/L (33:04.289)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (33:10.709)
Yes, we are still, so we focus on building partnerships with different organizations who are interested in funding the home modifications. Because Janet, I've no doubt you've had this experience where you, we know the benefit and we know people want to live at home, but the biggest barrier is finances. And asking people to pay a thousand dollars out of pocket

is too much for most people. That makes sense. Like my family, there is no way they could afford and do that without help. And so we partner with different organizations, with different Medicaid or managed care organizations that are Medicaid in different states, Medicaid waiver programs, long-term insurance providers.

Medicare Advantage plans, we work with those types of organizations so that they will refer their members and then they usually give some kind of benefit for the members. So maybe they will pay, you know, in some cases it could be as high as $5,000. Like here's $5,000 to complete the home mods that the OTs are recommending. In some cases it's $500.

In some cases, could be, you know, they will pay whatever amount just because it's so much cheaper than having somebody live in a nursing home. So, you know, for instance, I'm sure you know this number, where the average, like a semi-private room in a long-term care facility, on average annually, that's $100,000 a year. And so if you have a state Medicaid,

waiver program looking at, you know, for us to remodel this bathroom and, you know, put a ramp in or whatever the case is, if we have to pay, you know, $20,000, for instance, that would save us so much more money than paying for this person to live in a facility where we know we're going to be spending at least $100,000 a year on this person. So there are,

Maria Lindbergh, MOT, OTR/L (35:34.906)
governmental and like private organizations who are realizing like this is a huge deal where we need to throw whatever tools we can to help people live at home because that's the only cost effective way. I mean, but also like on the human side of it, that's just where everyone is so much more happy. And that's where they want to be any anyway.

Janet Engel (36:01.248)
Yeah, prevention is key, just like prevention in medicine, preventing that heart attack is key. So is preventing that fall. And I've had in my CAPS courses, I've had several employees from UnitedHealth take CAPS because UnitedHealth has started a program for paying for home modifications or including technology in the

Maria Lindbergh, MOT, OTR/L (36:10.175)
yeah.

Maria Lindbergh, MOT, OTR/L (36:21.536)
Nice.

Janet Engel (36:29.614)
beneficiaries home or in the members home and I think that's wonderful. Tell me in your role do you find that more organizations other than Medicaid because Medicaid has always had different

kind of grants available for home modification, but what about all those people that don't qualify for Medicaid, that have Medicare or some other Medicare replacement program? What do you see happening in that area?

Maria Lindbergh, MOT, OTR/L (37:09.299)
It seems like the Medicare Advantage plans, are starting to jump on that same bandwagon as United, where it's like, we need to start trying to provide some supports for our clients. And unfortunately, Medicare Part B, which we fall under,

It's still the same where I mean, I have no doubt the federal government is like, this is a problem. Or I know for a fact they do because they just, CMS had a Zoom meeting about it in July where they were like, we need more home and community-based services, which home modifications falls under because this is a huge deal.

Janet Engel (37:51.374)
I'm.

Maria Lindbergh, MOT, OTR/L (37:54.591)
But for Medicare Part B, we are, as occupational therapists, we can go out and provide the OT services. The OT services are covered. And in a lot of cases, people do have a supplemental Medicare co-insurance where it covers the cost of the copay for the OT services. However, Medicare does not cover the actual home modifications.

And so that's where the problem comes in, where it's like, okay, we can come in and do the OT part and that's covered. But now, you know, here, this is what this is the cost of the home modifications that the OT is recommending. Not that, you know, OTs like you and I, like we're very aware of like the cost side of it. Right. So if I can get away with like this person, if, they had a tub transfer bench to get in and out of their shower safely and

you know, to me at the time of evaluation, it looks like they could do that safely, not a problem. Then I'm going to recommend that because that's a lower cost solution. But the issue comes when it's like, ooh, actually, you know, you really would benefit from like a barrier free shower. Like you, you are total assist, you know, for getting in and out, which means, you know, this person needs all of the help from caregivers to get in and out of the shower. And

So this kind of solution would be better, but that could be like a $15,000 remodel. And that's where the issue comes in for those people who are unable to afford it. So I'm actually like doing an internal webinar for OT network, but there's a lot of things like as OTs, but as like, you know, individual, just people in the world who are like, I want home mods covered, or I want to take advantage of, you know, those kinds of things.

Where, everyone deserves that benefit. Like everyone, feel like everyone in the US deserves to be able to have home mods paid for or, know, stipend or some kind of help and assistance to get. But I'm a huge advocate for, or I'm a huge, I'm huge in advocacy. And advocacy like contacting the people who represent you at this local state level, federal level, you know, calling up.

Janet Engel (39:53.655)
Yeah.

Maria Lindbergh, MOT, OTR/L (40:16.603)
everybody and saying, asking, like, what are you doing, to help home modifications be covered? there is, I think it's still current and in this Congress, there's a bill in the house of representatives. There's one that was in the most recent Congress that concluded that didn't get pushed forward. but there's another one that's trying to get, I'm, probably going to butcher this, but I believe it's like.

Janet Engel (40:36.812)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (40:45.403)
something to do with, pulling out retirement funds. don't know. It's very similar to the other ones in there, but just finding different ways to creatively like.

Janet Engel (40:52.746)
Some kind of tax incentives that allows people to use their retirement funds without penalizing them for withdrawing early Mm-hmm. Yes, and I know that

Maria Lindbergh, MOT, OTR/L (41:02.355)
Yes. Yes. Yeah. So having different. Yeah.

Janet Engel (41:08.878)
Well, I was just going to say that the National Aging in Place Council is having a conference at the end of this week. It starts on Friday in Orlando, Florida. And the reason why I became a member of the National Aging in Place Council was because they are an organization that is trying to get legislation passed so that everyone has access to home modifications, especially people in the middle class.

Maria Lindbergh, MOT, OTR/L (41:10.68)
no you, go ahead.

Janet Engel (41:37.49)
demographic that don't qualify for grants or don't have the cash to pay for the home modifications. And unfortunately, Hurricane Milton, I mean, it's unfortunate that we're getting another hurricane because I live in Atlanta. So we experienced Helene even though we got lucky because it went around us. But now we have Hurricane Milton that may cancel that

Maria Lindbergh, MOT, OTR/L (41:55.115)
my gosh.

Janet Engel (42:06.158)
conference in Orlando, which I'm very upset about because I was supposed to travel there on Thursday and I was so looking forward to meeting my internet friends people I've been friends with for years, but I really don't know And I don't know if it's gonna happen now And it was gonna be the first conference that they've had so it was really going to be

Maria Lindbergh, MOT, OTR/L (42:23.709)
Yes!

Maria Lindbergh, MOT, OTR/L (42:30.269)
Aww, yeah.

Janet Engel (42:37.306)
You know a great way to get the conversation started and have people from all different professions Come together and talk about how we can enable more people to have home modifications to pay for them

Maria Lindbergh, MOT, OTR/L (42:47.478)
Yeah.

Janet Engel (42:56.488)
But yes, I totally agree with you. We need some legislation just like we have for energy efficient appliances and windows. We need the same thing for home modifications.

Maria Lindbergh, MOT, OTR/L (42:56.563)
Yes, that sounds great.

Maria Lindbergh, MOT, OTR/L (43:10.879)
Yeah, absolutely. And what a great organization to be a part of. Remind me, can anyone just join it? Or does it have to be like, like aging and perfect? Yeah.

Janet Engel (43:19.406)
Yeah, anyone can join even if you are not a business, just a lay person and you will be helping that movement grow.

Maria Lindbergh, MOT, OTR/L (43:38.561)
That is awesome. just any, I feel like for people, it's like, you know, just pick one thing. Like even there's so many different ways you can advocate and pick whatever's going to work easiest for you. If you like know your state house representative, then great. Then, you know, talk with them or join, join the national aging. I'm sorry. NAAC. Yes.

Janet Engel (44:02.88)
in place council. N-A-I-P-C. It's a mouthful.

Maria Lindbergh, MOT, OTR/L (44:08.897)
NAIPC, there we go. Yes. NAIPC also going in the show notes. them. Join them. Join any kind of effort that's already making. If you can donate time, that's great. If you can donate money, that's great. Whatever works best for you. Literally everything will help because these are, this is...

Janet Engel (44:13.537)
I'm

you

Maria Lindbergh, MOT, OTR/L (44:35.051)
We're talking about all of our family members and neighbors, our coworkers, eventually us. If it's not already you, like this is, it's a big deal for everyone.

Janet Engel (44:44.194)
Yeah, right. We're all aging in place. I want to ask you one more question, Maria, before we finish our conversation today. But I think Jukebox Health sounds like such a great place for OTs that are interested in doing home modifications but aren't ready yet to start.

Maria Lindbergh, MOT, OTR/L (44:48.447)
Yes, yes, yes, I'm like, I have a lot of work to do on my house actually.

Janet Engel (45:11.362)
their own business like you and I did, tell us what is that process like and where do OTs, where are they able to work and what different states with Jukebox Health?

Maria Lindbergh, MOT, OTR/L (45:25.459)
Yeah. So right now everyone, all of our OTs are 1099 contractors. So it's just like working PRN where you tell us what days and times are available. basically, and we have it that way because right now we don't have the referrals coming in. I know this doesn't sound the greatest, but the

the consistency of referrals is not enough for us to say, okay, now we have a part-time position, now we have a full-time position. So right now we are in New York, New Jersey, Massachusetts. We are also in Pennsylvania and Connecticut, but there's not a lot of action there right now. We're in Florida, Georgia, Illinois, and California. And we're hoping, you know, we're,

Janet Engel (45:56.77)
Mm-hmm.

Janet Engel (46:14.446)
Hmm.

Maria Lindbergh, MOT, OTR/L (46:19.231)
always in the background working on expanding to more places. Really the thing that takes the longest time for the referrals to come in is when we're working with new partnerships and they're trying to figure out on their end internally, how do we communicate to our policyholders or our members? How do we communicate this new benefit to them so they understand and it doesn't sound like off the wall or whatever the case is.

So we work in those states. I can share a web link with you if you wanted to, you know, put it in your show notes where we have.

Janet Engel (46:57.259)
Yeah, I think that'd be great because we have a lot of VOTEs that listen and I'm sure some of them would be interested in learning more.

Maria Lindbergh, MOT, OTR/L (47:07.103)
Yeah, it's really nice for, yeah, so we have a, I'll finish my first thought. like, know, my brain's like, So we have a newsletter that's monthly and it gives updates and it'll notify those OTs when job postings open. if you, know, like for example, I live in Kansas City, Missouri. As of right now, we don't have any partnerships in Missouri.

But if you're a fellow Missourian and you join the newsletter one day, we will have job postings here. And then you will be notified and we will welcome you with open arms. So the OT network is a lot of fun. I am starting to provide free CEUs, so at least quarterly webinars so we can have home-mod specific.

Janet Engel (47:43.138)
Mm-mm.

Maria Lindbergh, MOT, OTR/L (48:03.497)
CEUs as a benefit to OTs within our network. And it is the OTs who we work with, they are business owners. Like some of them have their own HomeMods businesses, which is great. Like I tell people all the time when I had my own business, like how great would it have been to partner up with Jukebox in addition to doing my own thing.

Janet Engel (48:24.416)
Mm-hmm.

Maria Lindbergh, MOT, OTR/L (48:25.599)
And then we have people who are just interested in home mods. have OTs who've worked for like 30 plus years and they're like, I just want to do something different. We have new grads. We have OTs who are like, I like home mods, but I can't leave my full-time job. And I just, you know, like having that extra income come in every once in a while. so yeah, we, we really, I like to make jukebox like a place where OTs feel valued and

Janet Engel (48:40.494)
Really nice.

Maria Lindbergh, MOT, OTR/L (48:55.391)
Because we are, like, are such an amazing profession and we love helping our people. Like, we are the only ones who do ADLs. It only makes sense for us to do home mods and, you know, work together and collaborate. yeah, I just, I love what we do. I hope OTs who are drawn to that would love to join us.

Janet Engel (49:20.466)
Yeah, and that's why we can have a conversation about the toilet for one hour or more. You didn't know, but my family, they always cringe whenever anyone mentions the bathroom because they're like, she's going to start talking. But there's so much to say.

Maria Lindbergh, MOT, OTR/L (49:27.113)
Yeah, exactly.

Maria Lindbergh, MOT, OTR/L (49:42.623)
Yeah. They're like, no. There is, there is so much. I had one of my OT friends and she's, she's more like, into peens and stuff like that. And she was like, is there really like a lot to talk about in the bathroom? And I was like, yes, there's so many. Yeah. I may not be making content anymore right now, but there's still so much to say about the bathroom. Like,

There's so much to cover, so many products, so many things that we can do. Yeah, so I feel you, like the bathroom is a fun place to be.

Janet Engel (50:21.374)
Yeah. Well, Maria, thank you for coming on. This was so much fun. It was such a great conversation. And I'm going to put your toilet talk URL on the show notes because if you haven't seen it, Maria makes them fun and funny, but gives you very valuable information at the same time. So I will provide.

Maria Lindbergh, MOT, OTR/L (50:39.871)
Hahaha

Maria Lindbergh, MOT, OTR/L (50:45.643)
Thank you so much for having me and sharing that.

Janet Engel (50:49.48)
Yeah, yeah, you're welcome. And thank you for coming in as a guest and and also for telling us about Jukebox sells because I think it's great that there's a company out there that is doing it on a bigger scale and hiring OTs.

Maria Lindbergh, MOT, OTR/L (51:07.507)
Yes, yeah. we, yeah, we want to continue to grow for sure and helping. Our, I mean, our mission is to empower everyone to live, safer, more independent lives at home. And it's, I feel like as a profession, we just fit in. We mesh in so well with that.

Janet Engel (51:27.298)
Thank you, Maria.

Maria Lindbergh, MOT, OTR/L (51:30.315)
Thank you, Janet.