Most families don't think about home safety until after the first fall. Today, we're trying to beat that timeline. Welcome to the Sandwich Bread Podcast. I'm Tom Kaminsky, and I'm joined by occupational therapist Emelia Borland to talk about aging in place, practical home modifications, and planning for caregiving realities. We've included all resources discussed in today's episode in the show notes. Let's jump in.

Tom Kaminski (00:22)
Welcome everybody back to another episode of the Sandwich Bread podcast. I'm your host, Tom Kaminsky. I'm really excited to have on today's show Emilia Bourland. She is now newly Kansas City based occupational therapist. And that's the focus of today's dialogue. So

getting out in front of the aging process, outfitting a home or a preferred living space for aging safely for a parent or elder. So really excited for this conversation. Welcome Emilia.

Emilia Bourland (00:48)
Thanks so much for having me, I'm really excited to be here today.

Tom Kaminski (00:51)
Yeah.

Well, and Emilia had me on the CareLab podcast, to talk financial planning with a couple occupational therapists.

Emilia Bourland (01:00)
I know. So hopefully I was nice to you on Care Lab. So be nice to me here.

Tom Kaminski (01:04)
was rough.

I love it. We'll link to the episode All right. So let's start with Emilia. I'd like to learn about you, your credentials, your experience, and then we'll segue into the part of the episode that relates to outfitting the home and care, proactive care. So I see some letters beneath your name. I come from an industry of letters that is obsessed with letters and credentials.

Emilia Bourland (01:12)
Mm-hmm.

So many letters. Yeah.

Tom Kaminski (01:26)
So tell us about yours.

Emilia Bourland (01:28)
Yeah, thanks for asking. Yeah, so OTR basically just stands for Occupational Therapist Registered. It means I'm like nationally certified, which is something that pretty much all therapists have to do after they graduate from school and before they get licensed in the state that they are licensed to work in. ECHM stands for Executive Certificate of Home Modification. That's from USC's Leonard Davis School of Gerontology, and that's a big long program.

⁓ helping professionals from lots of different backgrounds actually prepare to help clients to ⁓ age in place at home. And there's a really great occupational therapy focus in that program as well. CFPS stands for Certified Fall Prevention Specialist, which basically means I have a bunch of experience and have taken a ton of coursework specifically around fall prevention because it's a huge passion of mine.

Tom Kaminski (02:19)
what I like about your educational experience is that you sort of started broad, like psychology, and then occupational therapy with your masters, and then as you've gotten additional credentialing, you've gotten more narrow with your focus, seemingly. Is that fair?

Emilia Bourland (02:33)
Yeah, in a way, I think so one of the things that really attracted me to being an occupational therapist is I am a person with really broad interests. I'm very curious. And being an occupational therapist is something that allows me to constantly be like stretching my knowledge base, flexing different muscles, because, you know, if you're working as a therapist in a variety of settings, you're seeing a huge number of


Yeah.

Emilia Bourland (02:57)
of things on a daily basis.

But absolutely, yes, there are definitely things that you develop passion for. One of the things that I'm really passionate for is doing home modifications and helping people to age.

where they want to age and the other is preventing falls because I cannot tell you the number of people that I have seen in hospitals and rehabs who did not need to be there. Yeah, super frustrating. And so that's one of the reasons that I've really dedicated a lot of like my own practice and my own like educational content that I create towards things like fall prevention and aging in place.

Tom Kaminski (03:18)
Yeah, that's frustrating.

these are the things that are way on me as I think about, you know, the aging process for my clients or my clients' parents. ⁓ And I just want to have...

Emilia Bourland (03:39)
Yeah. And falls have

huge financial impacts. mean, massive financial impacts. So we can't actually can't even think about financial planning if we're not also thinking about people's health and specifically things like fall prevention.

Tom Kaminski (03:43)
Yeah.

Yeah.

Yeah.

My job is to meet people like yourself and bring them into the fold at the appropriate time or provide a resource set to help help people do a little bit better job. I want to start high level with you, ⁓ occupational therapy. Could you start by clarifying what that means?

Emilia Bourland (04:06)
Yes, you know, we hear the word occupation and we assume that has to do with paid employment. Occupational therapists actually define it much more broadly. The field of occupational therapy has been around since 1918, and it's really about how we're meaningfully occupying our time. an occupational therapist absolutely might be helping someone to regain the skills or make accommodations that they need in order to go back

to work, but we're also concerned with really whatever it is that people want, need, and have to do. And that can be everything from helping people to get dressed, bathe, feed themselves, to doing leisure activities. Even sleep is something that we work on. And then all the way up the ladder to really complex things like driving, going back to work.

Tom Kaminski (04:51)
Okay, when would somebody need an occupational therapist versus just general physical therapist, maybe help us are like, understand the differences.

Emilia Bourland (04:59)
Yeah, yeah. So the goal of occupational therapy, like I said, is to help you return to the activities that you want, need, or have to do, or return to those occupations. physical therapists care about those things as well, but occupational therapists kind of view that return a little bit more broad and holistic. So while we absolutely do things like physical rehabilitation, we are also able to draw from kind of other tools in a toolbox.

So we think about not just the aspects and the characteristics of the person and what's coming from the person to be able to help them do a thing that they want to do, but also what are the particular aspects of that activity itself? What can be changed or modified about that activity?

Tom Kaminski (05:36)
Okay.

Emilia Bourland (05:44)
How much does that impact your ability to be comfortable to be able to be productive throughout the day?

Tom Kaminski (05:50)
Awesome. So in the context of aging at home, let's talk a little bit about that.

Emilia Bourland (05:53)
Mm-hmm.

Tom Kaminski (05:54)
Let's talk a little bit about, at what age should you start to have this dialogue with your parents about outfitting the home appropriately for the aging process?

Emilia Bourland (06:02)
think that conversation doesn't just start with our parents and the older folks in our lives, but it really should start with us. know, when you're in your 30s, when you're in your 40s, because you want to be thinking about...

Tom Kaminski (06:09)
Okay. Okay.

Emilia Bourland (06:16)
And this is going to sound maybe kind of morbid, but that's not the goal here. Like, if something happened, how well could I exist in this place? Or if something happened to one of my parents or one of my loved ones and I needed to care for them, how could we live in this space?

If you've got parents in their 50s, hey, mom and dad, do you think that you're gonna stay in the home that you're in now or are you gonna downsize eventually? And they may not know the answer to that necessarily. But it's about knowing what people want and what people would want.

to happen. And there's really no time that is too early to begin understanding what people's desires are, not just as they age, but for the life that they want to live. And it's not about being old or being a certain number. It's about how do I want my life to look? How do I want to live it?

It

happens that as we age, our number of fall risks tend to increase and our likelihood of being injured during a fall increases as well.

Tom Kaminski (07:15)
Yeah, yeah. I mean, I feel injured and I don't fall, you know, I just feel general. non specific pain.

Emilia Bourland (07:22)
Have you

fallen recently? It hurts. So bad.

Tom Kaminski (07:24)
yeah. Yeah.

Everything hurts. Big picture. Everything hurts every joint. Okay, so maybe we need a consult right after this.

Emilia Bourland (07:28)
Every, yeah. Well, you might, you might want to look into that, Tom. I don't know.

Tom Kaminski (07:35)
No, so I think that's that is going back to your original comment.

⁓ A gentle question to ask your parents that is not combative or pushy is to say, Do you want to stay in this home or have you thought about moving elsewhere? it allows them enough space to just come in and say, we haven't thought about it or we actually do want to downsize at some point.

then you say, well, what does that look like?

Emilia Bourland (07:56)
Yeah, what do you want your retirement years to look like? Do you want to stay where you are Do you want to be somewhere walkable? Are you going to be comfortable driving? do you want to stay here so that you can host big Christmas parties and things like that?

Tom Kaminski (07:59)
Yeah.

Yeah.

Emilia Bourland (08:10)
having a regular conversation about what people want their lives to look like, I think is a helpful place to start. then, let's say someone says, no, we want to downsize, or yes, this is where we want to be.

Tom Kaminski (08:15)
Yeah.

Emilia Bourland (08:23)
So what are we looking for? We're looking for spaces that can work flexibly for us. Meaning there's

if let's say there was a situation where you had to, you couldn't go upstairs. Maybe this is a two story home or three story home because you all have basements and they're just stairs galore.

Tom Kaminski (08:36)
Okay.

Emilia Bourland (08:41)
But if I needed to live on the first floor, could I? And even if there's not a bathroom that's accessible down there now, is there a space that we could turn into an accessible bathroom, If that's what our plan is, are we then planning financially to be able to do that if and when we need to, right?

Tom Kaminski (09:00)
Yeah.

Emilia Bourland (09:01)
is there a way to reasonably make it able to accommodate people with a wide variety of mobility requirements within a cost that I'm comfortable with? And so I think those are good

Tom Kaminski (09:12)
Yeah.

Emilia Bourland (09:13)
basic questions to just be thinking about at any age.

Tom Kaminski (09:17)
The way our house is laid out, the one I live in, there's no practical way to put a bedroom on the ground floor or a full bath. It's just not in the cards. Um,

Emilia Bourland (09:24)
Mm-hmm.

Tom Kaminski (09:25)
So that is something to be proactive about. I, I'm hearing like step one, Where do you, how do you want to age? Then step two is look at the home you live in and start thinking practically about what is needed to be safe when you age.

let me ask you, I often thought, well, are stairs good or bad?

Emilia Bourland (09:42)
That's a really interesting question. So what I would say is that stairs aren't necessarily good or bad as long as we have in our own capacity the ability to go up and down those stairs and the stairs are safely built.

And if we fall down stairs, you're going to hit a lot more things on the way down and you're going to fall a lot farther than if you have what we call like a ground level fall where you're falling to a flat surface. That doesn't make stairs good or evil. It's just something to understand in terms of whether or not going up and down stairs keeps

Tom Kaminski (10:15)
Got it.

Emilia Bourland (10:23)
you healthier,

in terms of flexibility though, like in terms of thinking about what we want to have in order to age in place, is a ranch style home generally going to be more flexible than a place with a lot of stairs?

Generally, yes.

Tom Kaminski (10:41)
in real quick here. So you offered a couple good things step one how to start the conversation step two is outfit the home

What other like major hazards jump out to you that something you would want to counter or protect against?

Emilia Bourland (10:54)
Well, like you said, it really does depend on the individual and kind of what circumstances they are facing. a home modification recommendation for someone with dementia really differently than I'm gonna do who has a visual impairment or who has a mobility impairment or something like that.

you want to think about the rooms that you or the person that you love are going to use the most. these are generally, you know, our living spaces that we're in all the time, our bedrooms, our bathrooms, our kitchens.

obviously lots of falls do occur in the bathroom. Why? Because there's water involved, there can be soap involved, so things are

Tom Kaminski (11:28)
Yep.

Emilia Bourland (11:33)
if healthcare actually will teach you anything, if things are gonna go wrong, it's probably gonna go wrong when someone is naked. So, you you just wanna consider that for sure.

Tom Kaminski (11:41)
We have the title of the episode. Oh man,

I love it. So yeah, just thinking about where you're going to spend your time. Like that would be the other operative piece of advice.

Emilia Bourland (11:52)
It's also just about general accessibility.

thinking about if I had a walker, if I had a wheelchair, could I reasonably navigate from the sidewalk to the house, from the garage to the house?

Tom Kaminski (12:04)
Sure.

Emilia Bourland (12:05)
it takes very very little to make something difficult to navigate with a walker or a wheelchair. So it's definitely something to consider.

Tom Kaminski (12:13)
Yeah.

Emilia Bourland (12:14)
⁓

Tom Kaminski (12:14)
we've been talking about, you know, aging in the home more from like a physical aging process, but let's talk maybe about dementia, Alzheimer's. Are there different considerations?

Emilia Bourland (12:25)
So there are different considerations when someone has a cognitive impairment or dementia for aging in place.

⁓ But there are some big things to keep in mind.

So I think one of the things to be thinking about when someone is diagnosed with dementia, obviously many families want to keep someone in their home or with them for as long as possible. I do think as the process kind of continues, it is important to ask yourself the question, will there be a caregiver available who is going to be able to provide 24-hour support and supervision?

in this very demanding condition at some point because almost no matter what there is no there is no substitute for supervision when it comes to safety and when we're dealing with really complex cognitive impairments or like degenerative cognitive conditions like dementia it's at a certain point someone is going to need 24-hour supervision and assistance and understandably

Tom Kaminski (13:03)
Yeah.

Yeah.

Emilia Bourland (13:25)
Many families are not able to provide that. like loving spouses or children or individuals, it's just a very big task. how are we going to actually manage that task? Because it is monumental.

And so even before we're thinking about the modifications, we need to be really asking and honest with ourselves about our own capabilities, our boundaries. Are we gonna need help in the home? If this isn't gonna be possible, how are we going to pay for this person to go into a community?

Tom Kaminski (13:38)
Okay.

Yeah.

Emilia Bourland (13:58)
where they can get that kind of care that maybe we're not able to provide at home. There's not a right or a wrong here. There's so much guilt around caring for our loved ones, around caring for people with dementia. It is one of the hardest jobs that anyone could ever do.

Tom Kaminski (14:04)
Yeah.

I appreciate

all of that. So much there. guess the first thing, you know, and that's a segue into the kind of the next section of our conversation, but paying for care, right?

Emilia Bourland (14:26)
Yeah.

Tom Kaminski (14:27)
what I try to do for my clients is you kind of take the statistical average of long-term care needs, which is published studies every year,

Emilia Bourland (14:27)
Mm-hmm.

Tom Kaminski (14:36)
And you assess the cost for about two years before passing for basically light to moderate care, because that is the statistical average. However, you extrapolate that out into a dementia need where you, you are going to transition into 24 hour care and $35 an hour around the clock for an in-home health aid is I, I off the top of head, it's in the 200,000s per year.

Emilia Bourland (15:03)
It's astronomical. Yeah, it's out of reach for the vast majority of people to do it in that way.

Tom Kaminski (15:05)
Yeah.

better to just not push it aside, better to have the conversation and do planning as you're suggesting. To understand the costs, understand the different options at your disposal, very emotional, very difficult to kind of navigate this because you want the very best for your parents or the elders That's a painful decision to make, but it is out of reach for the vast majority of families, 24 hour care for a year.

Emilia Bourland (15:24)
course.

Tom Kaminski (15:31)
Even for people of decent means, it's just totally out of reach. So with that, maybe let's transition into the strategies for paying for renovations, paying for care. How do you help your clients, how do you help them navigate the insurance system, long-term care policies? Maybe you can share a little bit about your experience going through that.

Emilia Bourland (15:31)
Mm-hmm.

Mm-hmm.

Long-term care policies don't generally pay for skilled services. So occupational therapy is considered like a skilled service provider. ⁓ Basically that means that we're helping with medical needs, same as like nursing or doctors or things like that. A lot of times long-term care, though, many policies will pay for in-home care.

for a certain number of hours up to a certain benefit. It really just depends on the policy. knowing what that policy does and doesn't cover helps you to understand what those options are. When it comes to things like insurance and paying for home modifications,

Most insurance doesn't necessarily pay for home modifications directly.

Tom Kaminski (16:32)
Yeah.

Emilia Bourland (16:33)
There have been lots of studies done showing that an average modification costing around $1,200 is all a lot of people need in order to have a huge outcome change. And in my experience doing home modifications, most of the people that I work with are not millionaires who can afford to do, or a lot of folks

Tom Kaminski (16:40)
Yeah.

Yeah.

Emilia Bourland (16:56)
don't necessarily have money to go and do all of these big modifications. But when we can change the environment using a piece of equipment or by rearranging things or, know, by changing the technique that we're doing something with, like that's the real value of having an occupational therapist come in your home and help you with it. Because if you have a contractor over and there are fabulous contractors over there that

Tom Kaminski (17:07)
Yeah, railing or carpeting.

Emilia Bourland (17:21)
that work in home modifications that do beautiful work. But their job is to do construction. My job as an occupational therapist is to help you do the thing that you need to do in the way that makes the most sense for you, both in your situation, which includes your financial situation. So if taking out your shower, taking out your tub shower,

and putting in a new roll-in or walk-in shower is not in the cards for you, that's fine. We have equipment we can solve that problem with, and that costs about 45 bucks. So it doesn't necessarily have to be this huge investment. We can think about it in ways that really maximize effectiveness and lower costs, and that's the benefit of having an occupational therapist kind of at the forefront of that process.

Tom Kaminski (17:52)
Yeah.

And in terms of paying for these costs, know, financial planners like myself generally love HSA plans. We pitch them whenever appropriate to our clients as a really powerful tax saving

vehicles for building a substantial sum of money that's used for qualified medical expenses.

not tax advice specifically to your situation, but engage your tax professional and say, hey, we're thinking about doing these specific things for our health. Do they qualify as a medical expense against our AGI for a possible itemized deduction?

Emilia Bourland (18:35)
Yep, that's awesome advice.

Tom Kaminski (18:37)
So I would, I'm going to revise the steps. I'm going to say now step one is have the conversation with your parents or elders. Just have an open dialogue about what their hope is to age. Step two, rather than actually going around the home, considering renovations needed, step two would be engage a professional for a consultation. If you know which home you're going to stay in, have a professional in for a simple low flat cost to

Emilia Bourland (18:47)
Mm-hmm.

Tom Kaminski (19:01)
observe, assess your home for aging, So that would be step two. Step three develop the budget and then you start to know if you can actually afford the modifications needed for your aging plan. This will obviously change over time. And then the fourth step would be

actually paying in a most cost-effective, tax-sufficient way for all these modifications. Is that fair? A four-step process?

Emilia Bourland (19:24)
I think that's super fair. And again, I just wanna reiterate the value of having an occupational. This is literally what we are trained to do. There aren't actually other professionals that are trained to do environmental modification in the way that we are and thinking about what's going on here now and then projecting out into the future. So you will absolutely...

not only have a better outcome, but it will save you money working with an occupational therapist right up front.

Tom Kaminski (19:48)
Yeah.

I love that. in my profession, my profession is find a specialist with expertise in your specific need, not an occupational therapist, but an occupational therapist that specializes in modifications to the home. mean, so it's take take that skill that very important knowledge skill, but then look for the specialist, you know.

Emilia Bourland (19:58)
Mm-hmm.

Tom Kaminski (20:10)
look into their background, try to get references and other client experiences is always helpful as well. Do have places you would point people to to find an occupational therapist that specializes in this type of consult?

Emilia Bourland (20:16)
Absolutely.

Yeah, My co-host, ⁓ Brandy Archie, her company is Ask Sammy, and they can help provide virtual occupational therapy assessments. There's also a great company called Rosarium Health. they also do occupational therapy assessments first,

Tom Kaminski (20:27)
Yes.

Emilia Bourland (20:39)
and they can help with things like what benefits there might be available to you in your health plan to pay for the assessment and then pay for any modifications as well. So those are two great companies.

Tom Kaminski (20:49)
Very cool.

Emilia Bourland (20:51)
Another great resource that you can try to find someone who is ECHM certified just like I am is you can go to USC's website. It's the Leonard Davis School of Gerontology and you can just basically Google like executive certificate of home modification. Everyone who's ever graduated from that program is listed there. And so that's a great way to find folks who may be local to you who have.

Tom Kaminski (21:11)
Cool.

Wonderful. Awesome. Really good resources. Obviously we'll include those in the show notes,

So I'll close with what are you working on? I saw an interesting business venture you appeared to have launched.

Emilia Bourland (21:22)
That's right.

Tom Kaminski (21:30)
So you want to share with us a little bit about Luma Link, I believe?

Emilia Bourland (21:33)
Yeah, yeah. So, Loomalink is basically a ⁓ connecting service where we help people to find the things that they need based on the problems that they have. Right now, we're really doing that through communities that focus on senior living. but basically sometimes you know what you need, but you don't know how to get it.

or you know what your problem is, but you don't know what the solution is, right? And so Lumalink is basically this very simple voice concierge that people can call up and they can get access to things to help them age in place, support services that'll come right to them to their.

Tom Kaminski (22:00)
yeah.

Emilia Bourland (22:11)
to them there in their community and can help link them to things that are already available within that community itself. So really excited about what we're doing at Loomalink. I also just published that book, What Do I Do When? An Occupational Therapist's to Daily Challenges of Dementia Care. but if that's something you're struggling with, please, please check that out. There is a

Tom Kaminski (22:21)
Yeah.

Yeah.

Emilia Bourland (22:31)
of just very practical like, you know, paint by numbers, like XYZ, here are some things that you can do in these situations.

Tom Kaminski (22:38)
Good. Love it. So you've started a business, written a book, and then you got to do CE. So that's your life.

Emilia Bourland (22:44)
Yeah. At some point I have to feed my children too.

Tom Kaminski (22:49)
Yeah.

Emilia, thank you so much for coming on today. This is this has been an amazing episode in my view, great content

simple and actionable because that gets done.

Emilia Bourland (22:59)
Thank you so much for having me enjoyed it. And I'm so, I'm very honored to be

bye.