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Archive for category: Original Posts

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10 Tips to “Just Do It” in 2014!

I just received my Costco Online catalogue.  I was not surprised to see that the first 10 pages were dedicated to fitness equipment, health products, and weight loss supplements.  Why?  Because it is January – the time when many people make new commitments for the year.  According to Web Pro News, weight loss is the most common resolution people make, but ironically this is also the one goal most will fail to achieve.

Weight loss as a goal makes sense – excessive weight is unhealthy and can make even regular tasks like walking, using stairs, and completing home tasks challenging.  I remember when I was pregnant with my twins.  I gained 50 pounds – all out front much like older men that seem to carry their excessive weight in their bellies.  Towards the end of my pregnancy I remember feeling the extra weight when I tried to hike, carry my kids, or just get out of a chair or car.  After I had my twins and essentially lost 40 pounds of baby and “stuff” in 8 minutes, I got up from the delivery table and said to my husband “I feel so svelte!  Look, I can bend, twist, turn, I can breathe!” He laughed because I am sure my flabby baby belly still made me look like I was carrying something.  Anyway, the point was – over 9 months of accumulating weight my body had adapted and I had forgotten what it was like to be thin again, including how much harder things are when you are carrying weight in places where weight does not belong.

Fortunately for me, I have always been athletic and have good genes (my goal is to always weigh less than my dad – I gave up on weighing less than my mom in Grade 7).  But I also have a strong work ethic and even stronger willpower.  Many years ago I committed to karate with the goal of getting my black belt by 35.  Then, I picked up an Oxygen Magazine and committed to getting my body fat percentage to a level of elite athleticism.  This required me to start “eating clean” and as such I no longer consume (99% of the time) refined sugar, white grains or carbs, or red meat.  I only drink tea and water.  Boring, I know.  But the point is, I took 8 years to get to the point I am at and the small adjustments I made along the way have resulted in my success.  Weight loss, or any resolution, is not going to happen overnight.  Here are 10 tips to remember:

  1. First, keep track of what you are eating and how you spend your time.  Do this for a week. Then, analyze.  Where are the problems?  You know what they are, you just need them on paper to really impact you into “seeing” them.
  2. Pick ONE thing (the easiest one) to change.  And don’t get rid of it, just focus on reducing it.  Maybe try to stop eating sooner before bed, or change from heavy carbs at night to some fruit, from regular pop to diet, white to whole wheat, 2% to skim, from Wendy’s to Subway.  The goal is not abstinence, but improvement.
  3. Once you have reduced that ONE thing, pick another and proceed that way until you have addressed many of your identified problem areas.  If you can tackle ONE thing per month, by the end of the year you will have made 12 healthy improvements – excellent!
  4. Remember that less is still good, even if less does not mean NONE.  You can get to NONE, but cold turkey is not usually successful (but in the place of ham – much better J).
  5. Don’t think that the problem is lack of exercise.  That is part of it, but weight management is 70% diet.  If you commit to a new fitness program, without adjusting your poor diet habits, your success will be limited.
  6. If exercise is not your thing, fake it until you make it.  Try those activities that are exercise hidden as fun.  Go for walk with a friend, grab a Wii Fit, try Zumba, join a dance class.  Make small goals such as “I want to walk around the block without stopping” then when you can do that, make it two blocks.  I did this in University as a project for my Behavior Modification class.  I started walking my dog for 20 minutes a day, and gradually, over four months, was up to 2 hours.  This became my new “normal” and I did this with my dogs until they became too old to manage that amount of exercise.
  7. Remember it takes 3 weeks to 4 months to create a new habit.  Give yourself a month to “try it” and if at the end of the month you are still struggling, pivot your change to something less difficult.  Throw a calendar on the fridge, X out the days, circle your target (21 days, 30 days etc).
  8. Tell people your plans.  Facebook, Twitter, your journal, your best friend.  Write it down.
  9. Don’t get caught up in gimmicks.  They are just that.  If there was a fast and easy way to lose weight we would all be thin.  There isn’t – it requires dedication and persistence.
  10. Just Do It!  Nike is right – nothing beats just gettin’ er done!  Your mind will play tricks on you the entire time.  I laugh at my mind now.  When it is a Cross Fit day for me, my mind will invariably tell me I should do something else instead.  I smile, say “haha mind, good try” and get on my fitness clothes.  The real trick to going from “I want to” to “I am” is attaching a physical component.  You have FIVE seconds to turn a thought into action.  Think it, move towards it, and DO IT!

All the best in 2014 and may all your resolutions, goals, wishes (or whatever you call them) become your reality this year.

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Funding Sources for Children Living With Disability

Raising children is an expensive feat. But raising children with special needs can be even more expensive, especially because of the increasing need for private therapies due to the long waitlists and scarce availability of government funded programs. So where can parents turn for financial support to help pay for costs related to therapy, assistive devices, and activities? The following is a list of private and public funding sources that are available for children with special needs living in Ontario:

Private Charities

Ability Gives
Contributes to life changing experiences in children with disabilities by helping their families obtain much-needed medical devices & mobility aids.
www.abilitygives.org

The Children’s Wish Foundation of Canada
A national non-profit organization dedicated to fulfilling a favourite wish for children diagnosed with life-threatening illnesses.
www.childrenswish.ca

Kids Life Line
This service is offered through A Children’s Voice Foundation, and offers a one time fulfillment, of a necessary product or service that will enhance a child’s quality of life and is not otherwise provided by healthcare plans, levels of government or other organizations.
www.acvf.ca/index.php/our-programs/kids-life-line

Deeds & Dreams
Deeds & Dreams is a charity where 90% of all funds go directly toward delivering a child’s special dream.
www.deedsanddreams.com

Give A Miracle A Chance (G.A.M.E)
This charity supports children living withCerebral Palsy. The charity supports children with independent therapies and treatments and provides life management counselling, therapy programs and other support services to enable children to become more independent in their lives and in the community.
www.giveamiracleachance.com

The Easter Seal Society, Ontario
Easter Seals Ontario provides programs and services to children and youth with physical disabilities across Ontario to help them achieve greater independence, accessibility and integration
www.easterseals.org

The Golden Griddle Children’s Charities
Grants wishes to children with disabilities and illnesses. The most popular wish that is granted is a trip to Florida.
www.goldengriddleinc.com

Jennifer Ashleigh Foundation
Assists seriously ill children and their families with special treatment needs, medical expenses, and financial assistance in times of need.
www.jenash.org

Make A Wish Foundation of Canada
Along with the national office, seven independent regional chapters grant magical wishes to children in need from coast-to-coast.
www.makeawish.ca

Ontario Federation for Cerebral Palsy
Provides a wide range of services, resources and programs for individuals with CP and their families as well as professional organizations. These services can range from funding for equipment, education and recreation to housing and life planning.
www.ofcp.ca

Ontario March of Dimes Home and Vehicle Modification Program
Ontario March of Dimes’ Home & Vehicle Modification® Program provides funding for basic home and/or vehicle modifications. The program is intended to assist permanent Ontario residents with a substantial impairment expected to last one year or more
www.marchofdimes.ca

President’s Choice Children’s Charity
Supports children with disabilities by providing financial grants for essential specialized equipment and essential therapies.
www.presidentschoice.ca

Sunshine Dreams For Kids
The Sunshine Foundation is a charity that provides individual dreams to children with severe physical disabilities as well as life-threatening illnesses.
www.sunshine.ca

Government Services and Programs

Assistive Devices Program
Provides support and funding and access to personalized assistive devices to residents of Ontario.
www.health.gov.on.ca

Special Services at Home
The Special Services at Home program helps families who are caring for a child with a developmental or physical disability.
www.children.gov.on.ca

Assistance for Children with Severe Disabilities
Helps parents with some of the extra costs of caring for a child who has a severe disability.
http://www.children.gov.on.ca/htdocs/English/topics/specialneeds/disabilities/index.aspx

Disability Tax Credit
A non-refundable tax credit that a person with a disability can claim to reduce the amount of income tax he or she has to pay in a year. This amount includes a supplement for people less than 18 years of age at the end of the year.
www.cra-arc.gc.ca/disability

Homeowner Residential Rehabilitation Assistance Program
This fund offers financial assistance to low-income homeowners for mandatory home repairs that will preserve the quality of affordable housing. The program helps people who live in substandard dwellings and cannot afford to pay for necessary repairs to their home.
www.cmhc-schl.gc.ca

Incontinence Supplies Grant
This program is for children and youth between the ages of 3 to 18 years with chronic disabilities that result in irreversible incontinence or retention problems lasting longer than six months and requiring the use of incontinence supplies. The grant is a contribution to the cost of supplies.
www.easterseals.org

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Top 10 Ways to Survive Dread-ember

It was an effective exercise in venting and I feel much better.  I wrote my blog on “Dread-ember” listing all the reasons I strongly dislike this month and the holiday season in general.  Then, I read it over, accepted my grievances, realized I was being grumpy (albeit honest) and admitted that I don’t want to bring other people down who legitimately love this season.

However, I will equate my problems this month with one word – STRESS.  December is, legitimately, the most stressful month of the year.  Shopping and presents, food preparation, cards, socializing, crowds, different schedules and routines, decorations, spending, pressure to buy the right thing for the right person – and not forgetting anyone.

Instead of harping on all the reasons I struggle this time of year, I am going to be productive and offer some practical suggestions for people that also have issues getting through to January.  Here are Julie’s TOP 10 TIPS based on my own experiences as a busy mom, but also as an occupational therapist who often helps people to break down tasks into more manageable, and less stressful chunks:

 

  1. PLANNING – this is everything.  Often the stress of shopping is not the shopping per se, but rather the planning beforehand.  Who do I need to buy for? What will I get them?  When do I need to deliver it or mail it so it is received on time? Spending endless hours in the mall looking for the “right gift” works for some, but for others some planning ahead of time can really reduce the stress of the season.
  2. ORGANIZATION – plan it, buy it, store it, and then cross it off your list.  Make separate lists – cards to send, presents to buy, food to coordinate, functions to attend, decorating to do – then set it and forget it.  Pull out one list a week, tackle it, and then discard.  Repeat.
  3. START EARLY – don’t be a dude and end up in the mall on the 24th.  If you do, say hi to my husband.  Seriously though, starting early can really reduce the pressure to get it all done in time.  Personally, last year I was done my shopping September 9, and this year I bought my first present in February and was done in August.  Soon, I will use Boxing Day to shop for the next Christmas.  But being done early lets me focus on other things in December, and allows me to avoid the crowds and chaos on the roads and in the malls.
  4. GIVE BACK – nothing says Christmas more than charity.  Think of those less fortunate, donate your time, no-longer used items, or money to those that are less fortunate.  Get your kids involved with this by sponsoring a family, sorting through toys they no longer need, or having them come with you when you drop off donations.  Have a social gathering and in lieu of a hostess gift, ask for items for the local food bank.
  5. GET OUTSIDE – I agree with this completely.  Cold schmold.  Put on some layers and get some fresh air.  Snow is beautiful, the air is crisp, and getting outside will really assist with de-stressing and avoiding seasonal affective disorders.  If it is windy, hit the trails to escape the wind chill.  If you are alone, listen to some tunes.  Last winter I would always hike with my snow pants on so that if the mood struck, I was freely able to stop for some snow angels (which I do).
  6. MAKE A BUDGET AND STICK TO IT – this world of abundance does not mean we need to live that way.  What can you afford?  Make a list within your budget, total it, and stick to it.  Financial strain is stressful anyway, let alone this time of year when there are high expectations to buy the right gift, that “wow” item, and to think of so many people.  Simplify – draw names, play a gift giving game, or just consider “togetherness” and a pleasant meal as your gift to each other.  Consider giving people photos you have taken in the year that you can print in larger sizes for minimal cost, or do what we do and make a DVD of the kids from the year set to their favorite music for the grandparents.  This year, we realized we have a bunch of Visa points and will be clearing these off to save our bank account.
  7. MAKE IT PRACTICAL.  Sometimes the practical gifts are the best.  Kid’s activities are expensive and some money towards the hockey skates, dance outfit, or Karate uniform would be appreciated by most parents.  Or, everyone needs haircuts, and Mom’s love Starbucks or Tim’s, getting their nails done, a massage, or maybe even a housecleaning service as a treat.
  8. LAUGH.  Never underestimate the value of a good laugh.  Time with friends, or a good movie can do wonders for the psyche during this hectic time.  My favorite holiday movies are Christmas Vacation and Elf, and of course the timeless A Christmas Story.  Grab some eggnog or a warm tea, curl up with a blanket and laugh for a while…
  9. SIMPLIFY – try buying things online.  They come to your door!  Shopping online provides a practical way to compare prices, avoid the crowds, save some travel and search time, and to look around without being bothered.  Toys, books, games – these are all great online gifts.
  10. DELEGATE – can anyone help you?  Perhaps provide a list of items to your spouse that they can grab on their lunch break maybe for the teachers, bus driver, or the table gifts or stocking stuffers.  Do you have a parent that can hit the mall with a list for you?  Can the kids help you with stuff envelopes and mailing these?  You don’t need to tackle the stress of Christmas alone. 

But the biggest thing I think we need to realize is that not everyone enjoys this time of year.  For some, it will bring terrible or sad memories, guilt, pressure, stress, financial hardship, anxiety, and loneliness.  Respect that not everyone can manage this season as they would like, and if that means you are missing a card, an email, present or phone call from someone you expected to hear from, let it go.  We all have different capacities to manage stress, and the holiday season is no exception.

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International Day of the Disabled Person

I love the saying that we are all “temporarily able bodied”.  How true.  Each one of us, at any time, are one situation, condition, virus, bacteria, accident, or even random event away from becoming disabled physically, emotionally, behaviorally or cognitively.  Or, really, many of us are already disabled – visibly or invisibly, and I truly believe the saying: “be kind to all you meet as everyone is fighting a hard battle” – Plato.

This definition of disability from Wikipedia speaks to how all-encompassing the word really is:

Disability is the consequence of an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person’s lifetime.

Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.

The last sentence is especially true.  A disability is an interaction of the person and their environment.  This is why I love being an Occupational Therapist.  While I do enjoy helping people to function better through therapy that improves physical, cognitive, behavioral or emotional abilities, I also take pride in tackling the environmental aspects of functional problems.  If we can’t change the person, we can try to change the environment in which they live, and the spaces in which they need to function.  This “holistic” view of disability is, in my opinion, one of the key facets of Occupational Therapy.

I wanted to celebrate this important day by listing some of my most favorite quotes about disability:

“The only disability in life is a bad attitude” – Scott Hamilton

“I choose to not place “DIS” in my ability” – Robert M. Hensel

“Just because a man lacks the use of his eyes doesn’t mean he lacks vision” – Stevie Wonder

“One’s dignity may be assaulted, vandalized and cruelly mocked, but cannot be taken away unless surrendered” – Michael J Fox

“We know that equality of individual ability never has existed and never will, but we do insist that equality of opportunity still must be sought” – Franklin D Roosevelt

“I am only one, but still I am one.  I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do” – Helen Keller

So, consider that we are all vulnerable and only temporarily able bodied.  We need to celebrate humanity – in all’s its forms, including the form that is “disability”.

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“I Am Celebrating: Life”

I recently spent a week at Disney.  My daughter actually won the vacation through a draw with Air Transat, but I can tell you the price was not even the best part of our trip.

As it says when you enter the park, Disney is truly the “happiest place on earth”.  Disney does everything right.  The staff have a culture of fun, positivity, aliveness, and humor.  The grounds are spectacularly groomed and maintained.  They attend to all the little details in everything they do.  Right now, the castle is covered in icicles for the Christmas celebrations.  They even make waiting in line fun.  Disney is even up to date with technology and are piloting a wristband program to get you into your hotel rooms and the parks, charge items to your account, and let you get fast passes for rides.  The My Disney Experience app lets you know the wait times for all the rides and attractions at each park, allows you to book fast passes, meal reservations, park maps, and even plan your entire vacation.  Disney has an underground world where trucks deliver goods, staff come and go, animators and characters work away.  You can spend days in Disney and never see a delivery person or anyone out of character that is not a visiting guest.  They have even mastered the transportation system – from airport to hotel, to and from the parks, and even between attractions.  We never waited more than 15 minutes to get anywhere.  Disney employs 66,000 people – all there with a vested interested in creating a magical vacation experience.

Disney is amazingly accessible.  There is no shortage of scooters and wheelchairs, all the buses have ramps or lifts and tie downs, and many of the rides accommodate people either on a mobility device, or through an easy transfer.  All the rides and attractions are clearly marked to indicate how they can be enjoyed by people with different disabilities, and everything on video includes closed captioning.  Even when I went to Disney as a young child with my grandfather who had polio, I remember marveling at how well he could get around the park in a scooter, and how accommodating the staff were in helping him on and off rides, letting us go to the front because the lines were not accessible, or stopping the ride altogether so he could experience it.  And that was 30 years ago – long before it became culturally and socially unacceptable for people with disabilities to have to miss out because of their condition.

When you enter Disney there are free buttons you can put on to tell the world why you are there.  You can get a “It’s My First Visit” button or the “I am Celebrating” button that you can then write “birthday” or “anniversary” or “wedding”.  These are common and you see people all over the park advertising the reason for their vacation.  However, hands down the best button I saw in my week was on a man at Magic Kingdom.  His button said “I am Celebrating:  LIFE”.  Wow.  What a message.

That button hit home with me.  How often between going about our day, dealing with the kids, working, exercise, driving, eating, worrying, thinking, being angry, upset or stressed do we really “Celebrate Life”? It should not take a vacation for us to celebrate the one thing that we all have every day – regardless of everything else – our life.  In whatever form, easy or hard, young or old, able bodied or not, if we awake in the morning then we too have the ability to appreciate all that it is to be alive.  I am going to remember that button, the man that was wearing it, and of course an amazing vacation at a wonderful place.  Then, as much as I can, when I can, I am going to make a more conscious effort to ensure I celebrate my life and will try to help those around me to also celebrate theirs.

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When Children Can’t Communicate Pain

A few years back my daughter (age five at the time) seemed a bit “off” when she came home from school.  She was withdrawn, tired, and “didn’t want to talk about it”.  She is my kid that struggles to communicate her needs, especially when she is upset, so I tried to give her some time and control over when she would be comfortable talking about it.  Eventually, I went over to her and in stroking her hair realized this had blood in it.  I pulled her bangs aside and noticed a bump, large bruise, and blood on her head, in her hair, and around her temple.  When I asked her what happened, she burst into tears.  Through some coaxing, I got her to tell me that she had fallen on the playground, hit her head, and was so embarrassed about this she didn’t want to tell anyone.  Her teacher picked up on the fact that something was wrong and sent her to talk to the principal.  To the principal she reported nausea, a headache, and was visibly upset, but wouldn’t tell the principal what happened, and the bump and blood on her head and hair was not noticed.  After I got her to calm down, and did some basic mommy first aid, I explained to her the importance of telling adults about these things in case they are serious and need immediate attention. 

The ability to communicate pain and discomfort is invaluable – it not only allows a person to express how they are feeling in order to receive medical attention, but also can help them to obtain medication or treatment to make the pain more manageable.  However, many children (and some adults for that matter) are unable to express their pain due to a difficulty with communication, or a developmental or intellectual disability.  This can make it very difficult for health practitioners and family members to decipher their level of pain following an injury, medical procedure, or with illness.

For children that cannot verbally communicate pain, there are other methods that can help.  For example, the Non-communicating Children’s Pain Checklist (NCCPC-R) was designed for children who are unable to speak due to a cognitive disability.  The NCCPC-R can be completed by a caregiver within the child’s home environment, and measures observations of the child’s vocalizations, social interactions, facial expressions, activity level, appearance of body and limbs, physiological signs, eating, and sleeping.  In addition to the home-based version, a postoperative version of the NCCPC-R also exists.

Interestingly, studies have shown that the expression of pain by children with Autism Spectrum Disorder is not significantly different from typically developing children or even from children with intellectual disabilities. However, what does seem to be different is the length of the behavioral reactions of children with Autism, after the source of pain has been removed. This information may be surprising to some, as it is often thought that children with Autism are insensitive or have a high tolerance to pain.  Therefore, caregivers and healthcare professionals need to be aware that although a child with Autism (or any developmental disability for that matter) may be unable to verbally communicate their level of pain, we cannot assume that they are not in pain.  We need to be able to look beyond verbal communication.  One method, using observation, is the FLACC scale (Face, Legs, Activity, Cry, Consolability).  With this, pain in children and adults who are unable to communicate are observed through are range of symptoms that are scored from 0 to 2.

So while my daughter is capable of communicating verbally, emotional upset and embarrassment prevented her from taking the important step of telling an adult about what happened.  Through her behavior and presentation, her teacher, the principal and I were able to see that something was wrong, and eventually, when she was comfortable talking about it, I figured out what happened.  Thus, behavior, verbal or not, is a key indication of how a child is feeling.  It is important for parents and healthcare providers to be aware of the signs of pain in children, verbal or non-verbal, as their bodies can very well communicate their level of pain when they cannot do so through words.

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National Child Day

Written by Justine Huszczynski, Occupational Therapist

 

Today marks the date when Canada adopted the United Nations Convention on the Rights of the Child (UNCRC).  Simply put, the UNCRC is a treaty that outlines the basic human rights for children and youth.

                                             

Among other rights, the UNCRC outlines “survival and development rights” which are explained as “the basic rights to life, survival and development of one’s full potential”.  Looking into this a little deeper, Article 23 under the “survival and development rights” states:

 

“Children who have any kind of disability have the right to special care and support, as well as all the rights in the Convention, so that they can live full and independent lives.”

           

So, how is Canada ensuring that the rights of children with disabilities are being fulfilled?  Of course, we have public healthcare which provides children prompt access to medical attention.  But Article 23 goes beyond this.  It also includes the right to services – therapy services perhaps – that children with “any kind of disability” should be able to access such that they can become independent adults and experience a fulfilling life.

 

While Ontario offers plenty of publicly funded early intervention services for children with disabilities (based on the availability of twenty government-funded children’s treatment centres across the province), how are the outrageous waitlists for some of the most valuable services offered in these centres acceptable?  For example, last year the Toronto Star surveyed nine of the government-funded treatment centres and found average waitlist times ranging from one to FOUR years for a child to receive intensive behavioural intervention (IBI) therapy.

 

So how does this follow the guidelines of the UNCRC? Honestly, it doesn’t.  Simply having a service available to a child with a disability is not enough.  The service needs to be provided.  Long waitlists do not allow children to “live full and independent lives” but in fact can stifle a child’s development by denying access to programs that are most effective as “early intervention”.

 

Therefore, while we celebrate how far we have come to secure the rights of children, we need to look ahead and aim for a brighter future for those children that may need some extra support – sooner rather than later.  An example of striving for a brighter future comes from the parents of one of my clients who devoted their time to being their child’s advocate when “he didn’t have a voice”.  After this young client was denied services by one of the government-funded children’s treatment centres in Ontario, his parents scheduled a meeting with their local Member of Provincial Parliament (MPP) to advocate for their son’s dire need for early intervention services.  As a result of the advocacy skills of my client’s parents, the MPP ordered the treatment centre to complete a reassessment and the child was granted the early intervention services that he absolutely deserved and required.  During a conversation with the mother of this client, she stated, “It is my job to be make my child’s life better”.   This statement is heartwarming, and perhaps we should view it as a challenge.  A challenge for all of us – therapists, health professionals, teachers, citizens, governments– to truly make it our “job” to ensure children are given the best life possible.  So take the challenge and advocate for our children – ask more questions, get second opinions, research the available charitable funding, schedule meetings with your MPP, school board trustee, and don’t take no for an answer.  

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How is Ordering a Wheelchair the “Cost of Doing Business”?

The new wave in insurance denials (from assessors and adjusters) is that planning and communication time is “the cost of doing business”.  Huh?  Until you spend a day with me, at my desk, in my car, on my phone, and in my client visits, how do you know my “business”?  I can tell you that it goes like this:  for every hour I spend with a client, I spend an equal hour doing the follow-up that came from the visit in the first place.  And for CAT files, make that two hours.  What am I doing in that time?  I am calling vendors to source equipment, trying to get the best price, best client service, and the most appropriate devices.  I am researching practical and inexpensive solutions on the internet.  I am calling other team members to discuss functional issues, and to ensure collaborative but not duplicated service.  I am arranging attendant care as if they need attendant care, they often need someone to coordinate it.  I am trying to obtain funding approval from the insurer, or trying to save the client’s rehabilitation dollars by hooking them up with public services.  I am receiving calls from my client to tell me the cast came off, that the new medication is helping, and that they are trying to use the cognitive strategies we discussed.  I am reminding them of the things I am waiting on, or sourcing for them, or the calls that have not been returned.

Sound like case management?  It is not, it is OT and those services are necessary for the provision of our therapy.  And believe me, calling to get quotes on devices is a lot cheaper than driving to the client each time to meet with a different vendor.  “Planning and communication time” actually saves money.

But what is concerning, and also comical, is that the people who are telling us what “is the cost of doing business” are getting paid the entire time.  The adjuster that denies planning time and spends 30 minutes on the phone arguing with us is getting paid.  We are not.  Or, the examination OT that got paid to review our plan and cut us off from a few treatment hours.  When was the last time that OT actually treated a client anyway?

I have had two epic conversations with adjusters that drive this point home.  In one case, the adjuster and I got off topic and started chatting about housing.  After 30 minutes he said “are you charging me for this phone call”?  I responded with “first of all, I don’t charge you, I charge my client, and no, I am not going to charge my client because you kept me on the phone for 30 minutes”.  I then said, “but you are getting paid to talk to me, right?”  He said “well I make less than you”.  My response was “not in the last 30 minutes”.  He laughed.  The other conversation was even more interesting.  An adjuster was going to arrange for an assessment to question our kilometer costs (which had been approved on the file for the last three years but she was covering the desk due to a vacation).  Again I spent 30 minutes on the phone explaining that this has never been challenged.  I did the math and she was disputing $4.80.  I asked her if she was seriously going to arrange for a $1500 assessment to question $4.80?  Apparently she was.  So I said “don’t worry about it then, I will eat the $4.80”.  I wonder if her employer knew that they paid her probably an hour of salary to save them $4.80.  Ridiculous.

But the biggest thing insurers and assessors need to remember is that the CLIENT has approved that time and those costs.  We are required to review our plans with those we are treating, and to get their signature and authorization.  We explain to people that often we spend significant time behind the scenes getting the job done.  They understand this and approve those expenses as “necessary” for their treatment.  Then, we demonstrate this to be the case as we remain in contact with them and are very proactive at helping them to function better – directly and indirectly.  Honestly, the nickel and diming is ultimately costing the industry more, and reducing the quality of care received by injured people.

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Keep the Faith… in Insurance? I Think Not.

I think as a society we have lost faith in insurers.  I don’t know many people who still believe that an insurer, any insurer, will be forthcoming with benefits or reimbursement at the time of claim.  I see many people, before claiming, actually weighing the pros and cons between the monies they should be entitled to and possible insurer delay, deny, mistreatment, and likely future rate increases.

My parents have some epic insurance examples in the world of travel.  Once, the place at which they were booked to stay went bankrupt.  They requested reimbursement through their travel insurance.  Surprise!  It does not cover bankruptcy, only if the place became unsafe for occupancy.  So my mom said to them “it is unsafe for her to vacation at a place that is bankrupt”. In another instance, extensive flooding caused the vacation destination to cancel the trip.  So, they again turned to cancellation insurance.  Surprise!  Their trip cancellation insurance did not cover trips being cancelled.  What?

I work in the world of insurance and I can tell you that there are still a wonderful number of insurers that really try to make the application and claims process as painless as possible.  After all, most of the people I see are in enough pain already and plenty of insurers get that.  Then, there are the ones that don’t.  Those are the insurers that have been jaded through poor training, company culture, talk at the water-cooler, or the one too many surveillance videos that caught someone being fraudulent.  I often wonder if some insurers are trained to make the process of claiming so difficult so that people eventually just give up and move on.

My solution to the perils of insurance is for people to start shopping for insurance based on feedback from people who have claimed, and not just on who offers the cheapest price.  Like most things, you will get what you pay for and cheaping out on insurance can result in crappy treatment at the time of claim.   And what happens when people are treated crappy?  They turn to the legal profession, and guess what?  This costs the insurers more.  In all insurance, especially auto, insurers need to exercise good faith, respect, understanding and compassion and this will go a long way in creating a more sustainable product.