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When Planning Gets Personal – Starting the Conversation · The Tyler Show

• 0:05
  SPEAKER_00: Welcome to the Tyler Show.
• 0:07
  SPEAKER_00: I'm your host, Tyler Dahan, and we have here in studio a representative from ARP, Paige Jans.
• 0:13
  SPEAKER_00: Thanks for joining us here today.
• 0:15
  SPEAKER_00: It's great to have you.
• 0:16
  SPEAKER_01: Thanks for having me.
• 0:17
  SPEAKER_01: Good to be here.
• 0:18
  SPEAKER_00: Yeah.
• 0:18
  SPEAKER_00: Well, Paige, you have a really interesting background.
• 0:22
  SPEAKER_00: We wanted to bring you in here and kind of give us a little knowledge on your experiences, especially in the caregiving space.
• 0:29
  SPEAKER_00: Yep.
• 0:30
  SPEAKER_00: But before we get into that, I just want to know a little bit about tell tell the audience a little bit about Paige.
• 0:37
  SPEAKER_00: Like what makes Paige tick?
• 0:39
  SPEAKER_01: Oh, there's lots of things that make Page tick.
• 0:42
  SPEAKER_01: Um, well, I'm a native Iowan, so I'm an Iowa girl, and it's great to be in my home state.
• 0:47
  SPEAKER_01: I moved around for a little bit and then I saw the light and came back.
• 0:50
  SPEAKER_01: Um, spent some time in Milwaukee, which was great.
• 0:53
  SPEAKER_01: Terreho, Indiana.
• 0:55
  SPEAKER_01: It was okay.
• 0:56
  SPEAKER_01: Nothing against Terrehoe, Indiana, but it wasn't my cup of tea.
• 0:59
  SPEAKER_01: Uh, so came back to Des Moines.
• 1:01
  SPEAKER_01: Um, all my family's here, which it's great to see them.
• 1:04
  SPEAKER_01: I see them at least multiple times every week.
• 1:06
  SPEAKER_01: So I feel very fortunate to be able to do that.
• 1:09
  SPEAKER_01: Um, gosh, what else makes me tick?
• 1:12
  SPEAKER_01: Obviously, the topic we're going to talk about today makes me tick, but that's not my entire personality for sure.
• 1:17
  SPEAKER_01: Love to read.
• 1:18
  SPEAKER_01: Um, I used to take dance as a kid, and I've started taking it again as an adult, which is fun.
• 1:23
  SPEAKER_01: It's me and a bunch of 50-year-old suburban moms hitting the adult ballet circuit.
• 1:28
  SPEAKER_01: Um, what else?
• 1:30
  SPEAKER_01: Gosh, I love to watch my favorite TV shows.
• 1:33
  SPEAKER_01: West Wing.
• 1:33
  SPEAKER_00: West Wing.
• 1:34
  SPEAKER_00: West Wing.
• 1:35
  SPEAKER_00: That's kind of an old, old show.
• 1:37
  SPEAKER_01: I mean, for me, it's I know, you know, but I just finished my sixth rewatch of it, I think.
• 1:42
  SPEAKER_01: And I did the math.
• 1:43
  SPEAKER_01: It's a lot of hours.
• 1:45
  SPEAKER_01: It's a lot of hours.
• 1:46
  SPEAKER_00: Well, it's great to have you in in studio here today.
• 1:49
  SPEAKER_00: So, one of the things I want to talk about, at least start with uh, and when we were talking uh before we we had a little pre-meeting, you had mentioned your experiences as a nursing home administrator.
• 2:04
  SPEAKER_01: Yeah.
• 2:04
  SPEAKER_00: And I think that's really interesting.
• 2:06
  SPEAKER_00: So I think one of the things is as people are thinking about nursing homes or um home health care, what would you say is one of the biggest misconceptions that people have when they're thinking about nursing homes and home health care, community health care, all that, all that stuff.
• 2:23
  SPEAKER_01: Yeah, it can be a lot to digest.
• 2:24
  SPEAKER_01: Um, and for context for folks listening, my role today, I'm the state advocacy manager for AARP Iowa.
• 2:31
  SPEAKER_01: But prior to that, um, I served as a long-term care administrator, um, licensed in federally and state.
• 2:39
  SPEAKER_01: That's one thing.
• 2:40
  SPEAKER_01: It's the only healthcare administration role that you have to have a license to do.
• 2:43
  SPEAKER_01: You could run a hospital and not be licensed to do it, but you can't run a skilled nursing and not have a license.
• 2:48
  SPEAKER_01: So federal and state level.
• 2:49
  SPEAKER_01: Um, and then after that, spent some time in primary care and outpatient.
• 2:52
  SPEAKER_01: So my background's really in healthcare administration and have shifted into kind of the policy world today with AARP.
• 2:59
  SPEAKER_01: Um, but it has informed a lot of what I do today.
• 3:02
  SPEAKER_01: And I think you're spot on that most people just don't understand what skilled nursing and nursing home care really looks like.
• 3:09
  SPEAKER_01: The nursing home care that people probably think of in their mind is maybe a little bit more of the 1990s version or pre-1990s version of long-term care prior to some of the most significant reform that happened.
• 3:21
  SPEAKER_01: Um, but I would say one of the biggest misconceptions that people have is that it's their only option for care.
• 3:27
  SPEAKER_01: Um there will always be a place and space for nursing homes in our continuum of care across the country.
• 3:36
  SPEAKER_01: Um, but it doesn't have to be the only option for long-term care.
• 3:40
  SPEAKER_01: Um, I know my grandparents would tell you there's no way they will ever go to a nursing home.
• 3:45
  SPEAKER_01: And I think that's the sentiment of a lot of people.
• 3:48
  SPEAKER_00: That was a setup of my grandparents though.
• 3:50
  SPEAKER_00: That they were never gonna go into a nursing home.
• 3:52
  SPEAKER_01: Nobody wants, nobody wants to.
• 3:53
  SPEAKER_01: And that was something I was acutely aware of as a nursing home administrator.
• 3:57
  SPEAKER_01: Pretty much all of the people that lived in my community didn't want to be there.
• 4:01
  SPEAKER_01: And so that presents a really unique challenge.
• 4:03
  SPEAKER_01: But I think the other misconception people have about nursing homes is that they're all the same.
• 4:09
  SPEAKER_01: They are not, um there are different structures of long-term care facilities.
• 4:13
  SPEAKER_01: Um, but even more importantly, they're licensed and regulated differently at the federal and state level.
• 4:19
  SPEAKER_01: So what's permissible in Iowa may not be the same thing in New Mexico, Arkansas, wherever across the state, across the country, pardon me, um, they're not all the same.
• 4:30
  SPEAKER_01: Similar, perhaps, but not all the same.
• 4:32
  SPEAKER_01: So federally, um, the centers for Medicare and Medicaid services are the licensed or the accrediting body and the uh survey body that make sure they're performing well for skilled nursing facilities that are licensed.
• 4:47
  SPEAKER_01: Um, there are unlicensed skilled nursing facilities, but those aren't regulated federally.
• 4:52
  SPEAKER_01: Some states have different regulations surrounding what qualifies as an assisted living level of care, memory care level of care.
• 4:59
  SPEAKER_01: And so it's really important for people to understand their state specifically.
• 5:05
  SPEAKER_01: We could talk about generalities or even about what's true in Iowa or Michigan, but that could be super confusing for somebody who lives in a different state.
• 5:13
  SPEAKER_01: So it's really important to understand what your level of care is in your state.
• 5:18
  SPEAKER_00: So that that that's kind of interesting because a lot of times uh individuals they'll move to be closer to family.
• 5:24
  SPEAKER_01: Yep, definitely.
• 5:25
  SPEAKER_00: So uh you you you might spent your whole entire life living in Iowa, yep.
• 5:29
  SPEAKER_00: And then you decide you want to move to Florida or Texas to be with your your grandkids, and you're gonna have potentially different regulation.
• 5:39
  SPEAKER_00: It might look different there.
• 5:40
  SPEAKER_00: So that's why the state level is is very, very important for individuals to really realize what's what what are the rules.
• 5:47
  SPEAKER_01: Yeah, yeah.
• 5:48
  SPEAKER_01: And you know, I I will say I wouldn't expect an individual to go out and read the state code on assisted living regulations.
• 5:57
  SPEAKER_01: I I don't know that I would recommend that for anyone.
• 5:59
  SPEAKER_01: It's dry, and reading state code is not exactly the easiest thing to do.
• 6:04
  SPEAKER_01: It does take a little bit of skill to learn how to do that.
• 6:07
  SPEAKER_01: Um, but reaching out to organizations um that support nursing homes across the state.
• 6:14
  SPEAKER_01: So, for example, in Iowa and across the nation, there's an entity called Leading Age, and they are um an association that helps nonprofit nursing homes operate.
• 6:24
  SPEAKER_01: And so they often have a really great pulse on what regulations are in each state.
• 6:29
  SPEAKER_01: Um so people can do some research in that sense, um, but also reaching out to people like the area agencies on aging in the state, they can also help really uh ascertain and help people understand what uh each level of care look like looks like.
• 6:44
  SPEAKER_01: Um, because that's I think that's the hardest part is finding which level of care is really appropriate for you and making sure that you make that right choice from the get-go.
• 6:53
  SPEAKER_00: Okay.
• 6:54
  SPEAKER_00: And I think that leads into the second question that I have here is that, you know, for people that are thinking about this, and of course it's not exactly the topic that people are like, hey, I really want to talk about long.
• 7:07
  SPEAKER_00: I want to sign up for but for people that are thinking about this or families that are thinking about this, because this really is a family decision.
• 7:14
  SPEAKER_00: What is kind of the the first thing that they they should really be thinking about?
• 7:17
  SPEAKER_00: Like what so, like what is the first thing that the high level, what do we really need to get our our heads around on this?
• 7:23
  SPEAKER_01: Yeah, I think you're absolutely right that the first thing has to be a conversation, and that is the hardest.
• 7:29
  SPEAKER_01: I know, hardest part.
• 7:31
  SPEAKER_01: Um, nobody wants to have the conversation about what do I really want the next X number of years to look like, right?
• 7:40
  SPEAKER_01: I I think that truly once you get that going, you're off to the races.
• 7:46
  SPEAKER_01: You you can start making decisions.
• 7:48
  SPEAKER_01: It's just entering into that conversation.
• 7:50
  SPEAKER_01: And so figuring out how to approach that, I think is often the hardest piece for people.
• 7:55
  SPEAKER_01: Um, some people need it to be a more formal sit down, right?
• 7:59
  SPEAKER_01: Where you invite a parent or a grandparent to let's sit down and have a conversation and kind of lay it out like a business meeting, right?
• 8:06
  SPEAKER_01: Yeah.
• 8:06
  SPEAKER_01: Um, kind of taking out some of that personal element sometimes is helpful and making it a little bit more transactional.
• 8:12
  SPEAKER_01: And that might feel a little cold.
• 8:14
  SPEAKER_01: Um, but for some people that works.
• 8:16
  SPEAKER_01: For others, you need it to be a little bit more sentimental and ooey-gooey and warm and fuzzies.
• 8:22
  SPEAKER_01: Um, and so really helping adult children specifically understand what that conversational tone needs to look like.
• 8:28
  SPEAKER_01: And only you are going to know that, right?
• 8:30
  SPEAKER_01: And I think that's a really important thing to flag in all of our conversation today.
• 8:35
  SPEAKER_01: This is such a uniquely personal decision that anything you or I say today might not be the case for somebody else, right?
• 8:43
  SPEAKER_01: That it what works for you is what's gonna work for you, and that might not be true for what works for Tyler in your family.
• 8:50
  SPEAKER_01: Um so I think the first step is just deciding to have the conversation and not waiting too long.
• 8:57
  SPEAKER_01: Um, I have encountered so many individuals when they came into the nursing home that I was um operating in Indiana, they're like, man, we should have had this conversation decades ago.
• 9:09
  SPEAKER_01: And my answer was, yeah, you probably should have.
• 9:12
  SPEAKER_01: But here we are.
• 9:13
  SPEAKER_01: What are we gonna do?
• 9:14
  SPEAKER_01: Um, how are we gonna deal with the uh the cards that we've been dealt now?
• 9:18
  SPEAKER_01: Um, but so often we've got people that say, Man, I wish I would have talked about this so much earlier.
• 9:24
  SPEAKER_01: So, in a continuum of care, right?
• 9:27
  SPEAKER_01: And I think that's a a term that gets thrown around a lot.
• 9:29
  SPEAKER_01: There's independent living, assisted living, memory care, skilled nursing.
• 9:34
  SPEAKER_01: Those are all very different levels of care and levels of need.
• 9:37
  SPEAKER_01: Um, but we had lots of individuals in the independent living level of care in our retirement community that said, wow, I wish I would have moved here sooner.
• 9:46
  SPEAKER_01: I wish I would have, I wish I would have sold my house and decided to to move to this community because it's so much easier.
• 9:53
  SPEAKER_01: There's I don't have yard work to do.
• 9:55
  SPEAKER_01: I don't have to take my garbage out.
• 9:57
  SPEAKER_01: I don't have to shovel snow.
• 9:59
  SPEAKER_01: I mean, you name it, the household chores stack up.
• 10:01
  SPEAKER_00: Yeah, they do.
• 10:02
  SPEAKER_00: Yeah.
• 10:02
  SPEAKER_01: That's true for you and I today.
• 10:04
  SPEAKER_01: I just replaced an air conditioner.
• 10:06
  SPEAKER_01: That's fun.
• 10:07
  SPEAKER_01: You know, like, but you don't have to do that in a in a community setting.
• 10:11
  SPEAKER_01: And so there are real perks to that.
• 10:13
  SPEAKER_01: Um, and we would have individuals in their 70s, 80s just moving into an independent living facility, and they're like, oh my gosh, I should have done this when I was 67.
• 10:22
  SPEAKER_02: Yeah.
• 10:23
  SPEAKER_01: Right.
• 10:23
  SPEAKER_01: Um, and that might not be true for everybody, right?
• 10:26
  SPEAKER_01: I my grandpa, he's still my grandpa and grandma still live on their farm in rural Iowa.
• 10:31
  SPEAKER_01: He still farms and he's turning, I think, 82, 83.
• 10:36
  SPEAKER_01: And that's not uncommon, right?
• 10:38
  SPEAKER_01: We we know, you know, in the Midwest in particular, Midwest farmers never quit.
• 10:42
  SPEAKER_00: Oh, they never do.
• 10:43
  SPEAKER_01: They really don't.
• 10:44
  SPEAKER_01: They really, really don't.
• 10:46
  SPEAKER_01: And that has its own can of worms.
• 10:48
  SPEAKER_01: And but that's true across the country, right?
• 10:50
  SPEAKER_01: We're seeing more and more people age in place because they want to, right?
• 10:54
  SPEAKER_01: It's their home.
• 10:55
  SPEAKER_01: Um, but for some people, that decision to move into a facility is one they wish they would have made years ago.
• 11:00
  SPEAKER_00: So one thing that comes up quite a bit when we're talking about this whole topic of continuum of care, right?
• 11:08
  SPEAKER_00: Like a nursing home and all that.
• 11:10
  SPEAKER_00: A lot of times people will think, okay, well, how much is it gonna this is gonna cost me?
• 11:13
  SPEAKER_00: And it and it can be very expensive.
• 11:15
  SPEAKER_00: Yep.
• 11:15
  SPEAKER_00: So it without getting into great details here, walk us through just kind of what you see, how people pay for this, um, what people can expect, um, and then how do how do they plan for that?
• 11:29
  SPEAKER_01: Mm-hmm.
• 11:30
  SPEAKER_01: Yeah, the numbers and sense behind this all is really hard for people to grasp.
• 11:36
  SPEAKER_01: Um, there are so many different ways that long-term care can be paid for and is being paid for.
• 11:41
  SPEAKER_01: Um, across the country, though, Medicaid is still the largest payer.
• 11:46
  SPEAKER_01: Um, and that is across the board.
• 11:49
  SPEAKER_01: Um and that's a product of a lot of things.
• 11:52
  SPEAKER_01: We won't dive into why Medicaid is the largest payer.
• 11:56
  SPEAKER_01: Um, but more and more people are spending down their assets and relying upon Medicaid to pay for long-term care.
• 12:02
  SPEAKER_01: The caveat to that though is that not every long-term care facility, whether that be assisted living, uh, medic uh memory care or skilled nursing, not all of them accept Medicaid as a payer source.
• 12:14
  SPEAKER_02: Okay.
• 12:15
  SPEAKER_01: Um, so not every facility is required to accept Medicaid.
• 12:19
  SPEAKER_01: And that's an important thing to flag for people as they're looking at facilities that they're considering.
• 12:25
  SPEAKER_01: If you or your family member are are likely going to need to rely upon Medicaid and spend down those assets, it it does benefit you to look for a facility that does accept Medicaid.
• 12:37
  SPEAKER_01: So you're not having to move multiple times.
• 12:39
  SPEAKER_00: Makes sense.
• 12:40
  SPEAKER_00: Right.
• 12:40
  SPEAKER_01: And so that can be a challenge and something that requires some foresight and advanced planning.
• 12:44
  SPEAKER_01: Um, and sometimes you don't know that you're gonna rely upon Medicaid, and sometimes that's dependent on how long you're going to be in a facility, and you don't have an exact prediction of that.
• 12:54
  SPEAKER_01: Um, so Medicaid is the largest payer from a short-term, long-term care perspective.
• 13:00
  SPEAKER_01: Um, another thing to consider is that long-term care sometimes means short-term rehabilitation and moving back home.
• 13:06
  SPEAKER_02: Yep.
• 13:06
  SPEAKER_01: Um, so a lot of those uh stays are covered under Medicare.
• 13:11
  SPEAKER_01: Um, and note the difference, Medicare and Medicaid, right?
• 13:14
  SPEAKER_01: Um, but under some short-term stays, Medicare is going to be the payer source for that.
• 13:20
  SPEAKER_01: Those are individuals who, let's say um, Grandma Betty fell and broke her hip, right?
• 13:25
  SPEAKER_01: And she's in the hospital recovering from that, but she can't go home yet.
• 13:29
  SPEAKER_01: So Medicare is gonna cover a short-term stay at a skilled nursing to get her back on her feet and hopefully get her back home.
• 13:36
  SPEAKER_01: However, if at some point Grandma Betty isn't progressing and can't go back home, there is a cut point where Medicare says, okay, the short-term stay has ended.
• 13:45
  SPEAKER_01: Now you've got to decide how you're gonna pay long-term to stay here.
• 13:48
  SPEAKER_01: Um, and so that can shift, right?
• 13:50
  SPEAKER_01: So then we get into does Grandma Betty ultimately need to go on Medicaid at that point?
• 13:55
  SPEAKER_02: Yep.
• 13:56
  SPEAKER_01: Or does she have traditional long-term care insurance, which we are seeing a decrease in?
• 14:02
  SPEAKER_01: Traditional long-term care insurance was most popular in the 90s and 2000s.
• 14:06
  SPEAKER_00: Those I I actually have a traditional long-term care insurance policy.
• 14:10
  SPEAKER_01: Yeah, and there are still a lot of people that have it, but they were previously more popular than they are today.
• 14:15
  SPEAKER_01: Yeah.
• 14:15
  SPEAKER_01: So we're not seeing quite as many younger individuals purchasing them today.
• 14:19
  SPEAKER_01: What we are seeing more, though, are a hybrid long-term care insurance and life insurance policy.
• 14:24
  SPEAKER_01: Um, that kind of combo.
• 14:26
  SPEAKER_01: And so there are still uh folks who are gonna rely upon that.
• 14:30
  SPEAKER_01: And then kind of the the third option here is true private pay.
• 14:34
  SPEAKER_01: So you're paying from your own self-funding, self-funding, whether that's retirement savings, um, investments that you've made.
• 14:40
  SPEAKER_01: Um, and for a lot of people, that there is a mix of payer sources.
• 14:44
  SPEAKER_01: So for a period of time, you might be covered by Medicare, and then you're gonna rely upon your insurance policy, and then maybe those terms expire, whatever it may be.
• 14:54
  SPEAKER_01: And then, okay, I do have some funds set aside, or I'm gonna liquidate my assets, I'm gonna sell my home.
• 14:59
  SPEAKER_01: A lot of people, that is kind of that turning point of I'm not gonna go back home.
• 15:03
  SPEAKER_01: So I'm gonna sell that asset, right?
• 15:05
  SPEAKER_01: And that money is gonna be what helps fund me for another however many years.
• 15:09
  SPEAKER_02: Sure.
• 15:10
  SPEAKER_01: And what it costs to receive care varies greatly state to state as well.
• 15:15
  SPEAKER_01: Um, and so it's hard to give an exact estimate.
• 15:18
  SPEAKER_01: Um, but what we do know is that institutionalized care, so this setting that we're talking about, is far more expensive than receiving care in the home.
• 15:27
  SPEAKER_01: Um, and so something that we really advocate for at AARP is what can we do to make home and community-based services the first line of defense?
• 15:36
  SPEAKER_01: Um, because that's A, less expensive for the state, especially if it's for Medicaid purposes.
• 15:42
  SPEAKER_01: Um, but it's also less expensive for the individual.
• 15:44
  SPEAKER_01: Um, the real challenge here though is that we don't quite have the workforce to supply that demand for individuals wanting care in the home.
• 15:53
  SPEAKER_01: Um, and so that increases price, right?
• 15:55
  SPEAKER_01: Your your typical supply and demand, right?
• 15:58
  SPEAKER_01: Um, and so that I I would love to see everybody be able to receive care in their home for as long as they can.
• 16:04
  SPEAKER_01: Um, and there will be a point where people just can't receive their care in their home and they need a more institutionalized setting.
• 16:11
  SPEAKER_01: But for a lot of people, that might not be the case.
• 16:13
  SPEAKER_00: Yeah.
• 16:13
  SPEAKER_00: So let's talk a little bit about the trends.
• 16:16
  SPEAKER_00: So we we we talked a little bit, uh, we kind of we kind of got got there, but what what do you see in this space in the United States now?
• 16:22
  SPEAKER_00: What what are the trend lines?
• 16:24
  SPEAKER_00: What are the trend lines saying in this space right now in the United States?
• 16:26
  SPEAKER_01: Yeah, well, I want to talk a little bit about unpaid family caregivers.
• 16:30
  SPEAKER_01: That's one of the biggest trends that we focus on at AARP, and one of the things that I think a lot of people can resonate with across the country.
• 16:37
  SPEAKER_01: Um, every few years, AARP does a report called Valuing the Invaluable.
• 16:42
  SPEAKER_01: Um, and it is astronomical, the number of family caregivers that are working hard to care for loved ones across the country.
• 16:51
  SPEAKER_01: Um, our most recent data says that we have over 59 million unpaid family caregivers across the United States, and they provide about 49.5 billion hours of care every year, which is equivalent to work done by about 23.8 million full-time workers or about 17% of the nation's full-time workers.
• 17:11
  SPEAKER_01: Their economic value estimated of caregiving is over 350 billion unpaid care hours.
• 17:19
  SPEAKER_01: Those numbers are insane.
• 17:21
  SPEAKER_01: Absolutely insane.
• 17:22
  SPEAKER_00: Huge number.
• 17:23
  SPEAKER_01: Huge number.
• 17:24
  SPEAKER_01: Um if family caregiving were counted as a formal sector of the workforce, it would rank among the largest and most valuable labor force in the domestic economy.
• 17:34
  SPEAKER_01: Everybody that I talk to on a weekly, daily basis has some sort of caregiving story.
• 17:40
  SPEAKER_01: Somebody that they have cared for personally, um, their spouse has cared for.
• 17:46
  SPEAKER_01: Um it touches everyone in some way, shape, or form.
• 17:49
  SPEAKER_00: And it's gonna touch some everybody at some point.
• 17:51
  SPEAKER_01: We're not getting any younger.
• 17:52
  unknown: Yeah.
• 17:53
  SPEAKER_01: We're not.
• 17:54
  SPEAKER_01: Um, and we are running into what's called the sandwich generation right now, where we have adults caring for kids who are in school, elementary school, middle school, but they're also caring for their adult parents.
• 18:06
  SPEAKER_01: And some of them, even their grandparents.
• 18:08
  SPEAKER_01: Um, I I am a caregiver for my grandma.
• 18:11
  SPEAKER_01: Um, I help her with her medicine, showers, taking her to doctor's appointments.
• 18:16
  SPEAKER_01: Um, and my dad and mom helped too.
• 18:19
  SPEAKER_01: Um, but it becomes a full-time job sometimes, right?
• 18:23
  SPEAKER_01: You're you're constantly wondering, oh gosh, am I gonna have time to go run over and do this?
• 18:27
  SPEAKER_01: And do I need to pick up her prescription here?
• 18:29
  SPEAKER_01: Um, and so the unpaid family caregiving trend is something that we are just really seeing explode right now.
• 18:36
  SPEAKER_01: And we are approaching a precipice, really, by 2034, I believe.
• 18:41
  SPEAKER_01: Um, the there is a topsy-turvy reality here that we're gonna have more 65-year-olds than we are 18 plus.
• 18:48
  SPEAKER_01: Like we don't have the population and the people to care for our older adults across the country.
• 18:55
  SPEAKER_01: And that's not just true here in Iowa, it's true across the nation too.
• 18:58
  SPEAKER_00: Yeah.
• 18:59
  SPEAKER_00: And I think that's also a a demographic trend that we're seeing across all the Western world, you know, in Western Europe.
• 19:06
  SPEAKER_00: And and I and I think of the caregiving story.
• 19:08
  SPEAKER_00: I think of my my mother, who, you know, when my grandmother was, you know, last couple of years of her life was spending a lot of time taking her to doctor's appointments.
• 19:17
  SPEAKER_00: Now, thankfully, my my mother was retired at that point.
• 19:20
  SPEAKER_00: So but if if if you're not retired and you have a job, I mean, how do you how do you manage that time schedule, right?
• 19:27
  SPEAKER_00: Because you still have employer demands.
• 19:29
  SPEAKER_01: Yep.
• 19:29
  SPEAKER_00: Still have employ you have still have demands at home, and then you have so it it it it it's difficult.
• 19:34
  SPEAKER_01: Well, and we're seeing a lot of individuals like you and I in the workforce leaving the workforce to to meet these care demands, right?
• 19:42
  SPEAKER_01: Um, and that in and of itself is a stress on the economy, right?
• 19:46
  SPEAKER_01: We are taking people out of their jobs and saying you need to go be a caregiver.
• 19:51
  SPEAKER_01: Um, and there are ways around that, right?
• 19:53
  SPEAKER_01: Some employers do provide um caregiving leave that allow you to kind of flex that time, and that's huge.
• 20:00
  SPEAKER_01: Um, but we're also seeing some older workers who have retired decide to come back to work in order to pay for care.
• 20:07
  SPEAKER_02: Yeah.
• 20:07
  SPEAKER_01: And that's a whole other challenge, right?
• 20:09
  SPEAKER_01: You know, we've all seen the stories of, you know, these 89-year-old people driving for Uber Eats.
• 20:16
  SPEAKER_02: Yeah.
• 20:17
  SPEAKER_01: And they're dropping off food.
• 20:18
  SPEAKER_01: And it's like, well, why?
• 20:19
  SPEAKER_01: It's like, well, I need the money.
• 20:20
  SPEAKER_02: Yeah.
• 20:21
  SPEAKER_01: It's like, gosh, can't we do something better?
• 20:23
  SPEAKER_01: Right?
• 20:24
  SPEAKER_01: Like, isn't there a better way?
• 20:26
  SPEAKER_01: Um, and so I think we're seeing just such an interesting shift in how people are approaching caregiving um and really trying to balance those demands.
• 20:35
  SPEAKER_01: And not to mention in rural communities, it's even harder.
• 20:38
  SPEAKER_00: Yeah.
• 20:39
  SPEAKER_00: No, I and yeah, yeah.
• 20:40
  SPEAKER_00: I mean, you you see that here in the state of Iowa.
• 20:42
  SPEAKER_01: Yeah.
• 20:43
  SPEAKER_01: How far are you driving for a doctor's appointment?
• 20:45
  SPEAKER_01: Right.
• 20:45
  SPEAKER_01: It could be a couple hours each way for some folks.
• 20:48
  SPEAKER_01: And when are you getting into an appointment?
• 20:50
  SPEAKER_01: Um, where's your nearest pharmacy?
• 20:52
  SPEAKER_01: It, you know, not every town has a a true pharmacy.
• 20:56
  SPEAKER_00: So Yeah.
• 20:57
  SPEAKER_00: So ARP, you know, this is this is a this is a topic.
• 21:02
  SPEAKER_00: This is a subject that ARP has been really focusing on here the last couple of years.
• 21:06
  SPEAKER_00: And I just went out to your website, you know, you just type in ARP caregiving.
• 21:10
  SPEAKER_00: There's a lot of great information on that website.
• 21:13
  SPEAKER_00: Uh, just just highlight a little bit about some of the resources that you really find really helpful for people that who are maybe looking at this topic right now and are are trying to find some resources.
• 21:25
  SPEAKER_00: Just highlight some of the ones that you would say, hey, here's one or two or three that I would I would look at.
• 21:30
  SPEAKER_01: Yeah.
• 21:31
  SPEAKER_01: Well, you're absolutely right.
• 21:32
  SPEAKER_01: Our website is a wealth of knowledge, um, and you could spend a lot of time diving through all the things.
• 21:36
  SPEAKER_00: And it goes by state.
• 21:37
  SPEAKER_00: I it does.
• 21:38
  SPEAKER_00: You can go right down by state.
• 21:39
  SPEAKER_01: Yep, you can go by state, um, or you can go kind of more generic, a more broad reaching look at caregiving.
• 21:45
  SPEAKER_01: Um, so each state has a caregiving guide with maybe state specific resources.
• 21:49
  SPEAKER_01: Um, but we do have um a couple of resources that are really aimed at helping you have that initial conversation, which I think is huge.
• 21:56
  SPEAKER_01: Um, we have toolkits like financial preparedness.
• 22:00
  SPEAKER_01: Toolkits for what kind of financial conversations should you be having with your loved ones that can at least spark that conversation that you can then have with them and then even with their kind of financial advisors and professionals in their life.
• 22:12
  SPEAKER_01: We also have some toolkits surrounding, you know, end of life.
• 22:16
  SPEAKER_01: Like what are your wishes?
• 22:18
  SPEAKER_01: What do you want to be true for the last X number of years of your life?
• 22:21
  SPEAKER_01: Um, and I think they're called conversation cards or something similar to that.
• 22:25
  SPEAKER_01: Um, but really just sparking uh some of them are lighthearted and funny.
• 22:30
  SPEAKER_01: Like, what's one of your favorite memories from elementary school?
• 22:32
  SPEAKER_01: And I'm like, gosh, I'd have to dig deep to think about that one.
• 22:35
  SPEAKER_01: Um, but things like that.
• 22:37
  SPEAKER_01: Um, but we also have um, it's called, oh gosh, I think it's called prepare to care, or it might have a different name now.
• 22:43
  SPEAKER_01: We've done some rebranding over the last few years, um, but really focused less on the individual you're caring for and more on you as the caregiver.
• 22:51
  SPEAKER_01: Because being a caregiver is a it's a weight, it's a burden, um, it's a privilege as well.
• 22:57
  SPEAKER_01: Um, and so what can you do to make sure you're taking care of yourself as a caregiver?
• 23:01
  SPEAKER_01: So there's a lot of different things on there.
• 23:03
  SPEAKER_01: Um, it'll and we also have things that direct you to other resources too.
• 23:07
  SPEAKER_01: AARP is not the end-all be all on caregiving, but we certainly think we have a good grasp on it and we have a strong authority on it.
• 23:14
  SPEAKER_01: Um, but directing people to the area agencies on aging that are localized, those are funded through the Older Americans Act federally.
• 23:21
  SPEAKER_01: And every state has some form of an area agency on aging whose sole purpose is to help resource navigate and help people end up where they need to be and find the resources that they need that are specific to them in their state, their county, their city.
• 23:34
  SPEAKER_01: Um, but also our our partners within kind of the disease groups too, Alzheimer's Association, Parkinson's, you name it, they also have a lot of more specific caregiving things.
• 23:44
  SPEAKER_01: Okay.
• 23:45
  SPEAKER_01: Um, so caring for somebody with dementia might look very different than caring for somebody with ALS, Parkinson's.
• 23:50
  SPEAKER_01: Um, so recognizing those nuances, I think, is important too.
• 23:54
  SPEAKER_01: Um, but yeah, I would encourage people to check out the resources online, but also look at the events that are being offered in your state that AARP is hosting.
• 24:04
  SPEAKER_01: We do localized events and we have local um presentations that happen about caregiving sometimes, um, different caregiver resource events.
• 24:13
  SPEAKER_01: Okay.
• 24:13
  SPEAKER_01: Um, and that's across the country.
• 24:14
  SPEAKER_01: There's a lot of different things that happen, and every state's a little bit different.
• 24:18
  SPEAKER_00: So and I think you you mentioned the conversation starters.
• 24:22
  SPEAKER_00: Yeah.
• 24:22
  SPEAKER_00: That's that's the biggest thing.
• 24:23
  SPEAKER_00: It's it's I I've talked to a lot of people.
• 24:26
  SPEAKER_00: In fact, I had a conversation not too long ago with somebody that's that's my age, you know, and I'm in my uh almost mid-40s.
• 24:33
  SPEAKER_00: But it having conversation about, hey, I my in-laws are doing this and really not sure how to how to have these conversations.
• 24:41
  SPEAKER_00: So I think that kind of the communication thing is key.
• 24:45
  SPEAKER_00: But if you're a 30 or 40-year-old, you're somebody my age, and you're starting to think about this, or you're starting to see situations where this might be applicable, what would you say is the number one thing they should be thinking about, or what what's the number one thing they should do?
• 25:01
  SPEAKER_01: Yeah.
• 25:01
  SPEAKER_01: Well, I think you're spot on that the conversation is the most crucial.
• 25:04
  SPEAKER_01: And I think that's in your 30s and 40s, you still have a little bit of time in theory before you're going to become a family caregiver that's really involved.
• 25:13
  SPEAKER_01: Maybe you're already doing that for a grandparent, perhaps, um, but maybe not directly for a parent quite yet.
• 25:18
  SPEAKER_02: Yep.
• 25:18
  SPEAKER_01: Um, but starting to have those conversations with your parents, um, grandparents, whoever it may be, an aunt or uncle that you're expected to have some sort of family tie to for the long haul, really starting to ask them, you know, what role do you want me to play?
• 25:34
  SPEAKER_01: Because for some people, the answer might be we want you to be hands-off.
• 25:37
  SPEAKER_01: And that's okay.
• 25:37
  SPEAKER_01: If that's what the individual wants, then that's what the individual wants.
• 25:41
  SPEAKER_01: Um I think this is a really great opportunity for 30 and 40 somethings to start building that network of individuals who are in the same boat, right?
• 25:51
  SPEAKER_01: So having people over for dinner and just talking about what you're experiencing with caregiving.
• 25:56
  SPEAKER_01: Maybe the answer is nothing yet.
• 25:58
  SPEAKER_02: Yeah.
• 25:58
  SPEAKER_01: Um, but having that conversation with friends.
• 26:00
  SPEAKER_01: That way, when you do get into the real trenches of it, you've got people who are there to have your back, right?
• 26:07
  SPEAKER_01: And have that support network.
• 26:08
  SPEAKER_01: Um, my parents, um, some of their friends are caregiving for their parents as well.
• 26:13
  SPEAKER_01: So they got together and had dinner and just chatted about the things that were hard.
• 26:17
  SPEAKER_01: And I was there because I've become the resident expert in the family and they're farming me out to their friends now.
• 26:24
  SPEAKER_01: Um, but it was really cool to see a bunch of 50, 60 year olds connecting about their challenges because I think so often caregivers they do this out of sense of duty and obligation because it's your family, but that doesn't make it any less hard, right?
• 26:40
  SPEAKER_01: You you don't get to just shirk the responsibility.
• 26:43
  SPEAKER_01: Um, but it it it doesn't make it any easier.
• 26:46
  SPEAKER_01: And so finding people that you can talk with that about um is so important to uh preventing and alleviating kind of that caregiver burnout because it's real.
• 26:55
  SPEAKER_00: Yeah.
• 26:56
  SPEAKER_00: So let's let's flip that a little bit.
• 26:59
  SPEAKER_00: And let's say you're talking to a 60 or 70 year old about this topic.
• 27:04
  SPEAKER_01: Yeah.
• 27:04
  SPEAKER_00: What's the one thing you would tell them uh that they should be thinking about?
• 27:08
  SPEAKER_01: I would tell them to be honest with themselves about where are you at?
• 27:13
  SPEAKER_01: What can you do on your own today?
• 27:15
  SPEAKER_01: What can't you do on your own today?
• 27:17
  SPEAKER_01: And it's okay if that looks different from five years ago, a year ago, a month ago.
• 27:23
  SPEAKER_01: Things can change quickly.
• 27:24
  SPEAKER_01: Um, and it doesn't have to be some catastrophic event, right?
• 27:28
  SPEAKER_01: It just can be you're aging and there's things that I can't do.
• 27:31
  SPEAKER_01: I can't, you know, if you're 62 and you're like, gosh, I can't mow my lawn anymore, no one's gonna be like, well, what's your problem?
• 27:38
  SPEAKER_01: Right?
• 27:38
  SPEAKER_01: Maybe, maybe you can't.
• 27:40
  SPEAKER_00: It's funny that you mentioned that.
• 27:41
  SPEAKER_00: My dad just bought a ride in lawnmower and he he's 70, he'd be seven, he's 76, uh right in riding lawnmower.
• 27:48
  SPEAKER_01: And did he feel guilty?
• 27:49
  SPEAKER_00: No, I think he was fine with it.
• 27:51
  SPEAKER_00: The the funny thing was, is it looks exactly like the snapper in Forrest Gump.
• 27:56
  SPEAKER_00: So we had we had to give him a little bit of a little bit of a hard time about having this you know, red, uh what's not red, it's yellow, but it looks like he looks like Forrest Gump mowing the lawn now.
• 28:05
  SPEAKER_00: So we, you know, we had a little bit of a lighthearted moment, but that but when you said, you know, you can't mow your lawn anymore, I was like, well, that just actually happened in my own.
• 28:12
  SPEAKER_01: But it could be something that simple, right?
• 28:13
  SPEAKER_01: And we might not identify that as a big change, but for some people, it's huge, right?
• 28:18
  SPEAKER_01: Like you might really enjoy that.
• 28:19
  SPEAKER_01: My grandma loves mowing her lawn.
• 28:21
  SPEAKER_01: She has a riding mower, she hops out there, she loves it.
• 28:25
  SPEAKER_01: That's not my cup of tea, but for her, if she couldn't do that, I like I like I like mowing the lawn too.
• 28:30
  SPEAKER_00: It's such a Midwest thing, I think.
• 28:31
  SPEAKER_00: It's therapeutic.
• 28:32
  SPEAKER_01: Yeah.
• 28:34
  SPEAKER_01: Um, but it's little things like that, even doing laundry, folding laundry.
• 28:38
  SPEAKER_01: My grand, my other grandma, she has really bad arthritis.
• 28:41
  SPEAKER_01: She can't fold her laundry the same way that she used to be able to, and that really frustrates her.
• 28:44
  SPEAKER_01: So I would tell people, 60 and above, just be honest with yourself.
• 28:49
  SPEAKER_01: And I think part of that is really navigating that kind of shame and guilt, right?
• 28:55
  SPEAKER_01: We feel like we should be able to do it.
• 28:57
  SPEAKER_01: We can pull ourselves up by the bootstraps and just get it done.
• 29:01
  SPEAKER_01: Um, but you don't have to all the time.
• 29:04
  SPEAKER_01: You can ask for help.
• 29:05
  SPEAKER_01: And hopefully there are people in your immediate family or your circle and your network that can help.
• 29:10
  SPEAKER_01: Um, but where my my heart really breaks is that there's a lot of people who don't have those connections to help them with the day-to-day things.
• 29:17
  SPEAKER_02: Yeah.
• 29:17
  SPEAKER_01: Um, and so how can we as a community kind of come together to help people that don't have some of those resources or connections?
• 29:25
  SPEAKER_01: I think that's that's huge.
• 29:26
  SPEAKER_01: So I think just being honest with yourself, and then on a more nitty-gritty piece, do you have all your paperwork lined up?
• 29:32
  SPEAKER_01: Do you have those important documents, your power of attorney, um all of those things that are really relevant towards end-of-life conversations?
• 29:43
  SPEAKER_01: Do you have a will?
• 29:44
  SPEAKER_01: You know, getting those ducks in a row, they're not fun to talk about, but they're really important.
• 29:51
  SPEAKER_01: And I tell people that even in your 20s and 30s, I have a power of attorney document.
• 29:56
  SPEAKER_01: Um, and I I don't anticipate uh end of life anytime soon.
• 30:00
  SPEAKER_01: Um, but it's important to have at any age, in any stage.
• 30:03
  SPEAKER_00: Yeah, yeah.
• 30:04
  SPEAKER_00: No, and I think that's that's one of the things we've done here at Salmons is, and as and you've heard us talk about this on this podcast, the in case of emergency booklets that we have that you know, passwords, medication, who's the banker, who's the where's the life insurance, all that's all those type of stuff is is critical because you just to your point, you you You never know.
• 30:23
  SPEAKER_00: You never know.
• 30:23
  SPEAKER_00: Nope.
• 30:24
  SPEAKER_00: You never know.
• 30:24
  SPEAKER_01: Nope.
• 30:25
  SPEAKER_00: So we covered uh a wide range of topics here in the last 30 minutes.
• 30:31
  SPEAKER_02: Yeah.
• 30:32
  SPEAKER_00: And uh, you know, we could really probably probably could go for another 30 minutes.
• 30:36
  SPEAKER_00: Well, probably.
• 30:37
  SPEAKER_00: I got about seven or eight, nine questions that I got in my head that I'd like to ask you.
• 30:41
  SPEAKER_00: However, uh, as we as we kind of finish out the show here, I want to ask you one one final question.
• 30:48
  SPEAKER_00: And again, just thanks, thanks for your time here today.
• 30:52
  SPEAKER_00: What would be the one thing you tell the audience?
• 30:55
  SPEAKER_00: I alright, in this whole entire space, what's the what's the one thing that you would say, really, we need we need to focus on this when we talk about this topic?
• 31:03
  SPEAKER_01: Yeah, I know that aging is not a glamorous topic to talk about.
• 31:07
  SPEAKER_01: And kudos to you for tuning in to a podcast about aging.
• 31:12
  SPEAKER_01: Um I know it's hard to talk about, but it's the universal truth, right?
• 31:17
  SPEAKER_01: We are all aging from the time that we are born, regardless of background, income, political beliefs, religious beliefs, every single one of us is aging.
• 31:28
  SPEAKER_01: And so I would just tell people and urge people include aging in your kind of worldview and in your perspective on things.
• 31:36
  SPEAKER_01: Um, but in start having those conversations, whether they're serious and really are timely and need to happen right now, or maybe they're a little bit more lighthearted and you can have them slowly as things progress down the road.
• 31:49
  SPEAKER_01: But just start talking.
• 31:50
  SPEAKER_01: That's all I would tell people is just start talking about aging in a way that's not eeor, right?
• 31:56
  SPEAKER_01: Like, oh, we're all aging, right?
• 31:58
  SPEAKER_01: Like, let's talk about aging as a privilege, right?
• 32:01
  SPEAKER_01: That we should all aspire to be able to age and age well.
• 32:04
  SPEAKER_01: Um, so I I'm very passionate about flipping that narrative a little bit that aging isn't a detriment.
• 32:10
  SPEAKER_01: It's um really quite a wonderful thing, and we we get to experience it.
• 32:14
  SPEAKER_00: Well, we it's been a pleasure to have you here in studio.
• 32:18
  SPEAKER_00: And thanks for thanks for sharing us with uh some of your wisdom and your experiences.
• 32:23
  SPEAKER_00: And I, you know, I believe that the audience got uh a lot of information here.
• 32:27
  SPEAKER_00: And and I think the biggest thing is just there's a lot of there's a lot of resources out there.
• 32:32
  SPEAKER_00: I mean, there's family resources, there's community resources, ARP has a lot of resources, uh salmon's institutional group has a lot of resources.
• 32:40
  SPEAKER_00: So um there there is information out there for this topic for people that are uh looking to to find you know what's my next step.
• 32:48
  SPEAKER_02: Yep.
• 32:48
  SPEAKER_00: And I think to your point, have your stuff in order and then just have the communication.
• 32:52
  SPEAKER_00: Just just talk about it.
• 32:53
  SPEAKER_01: Yep.
• 32:53
  SPEAKER_00: So thanks for coming on.
• 32:55
  SPEAKER_00: And Tyler, for all of you, thanks again for all of your support for the Salmons Institutional Group.
• 33:01
  SPEAKER_00: For the Tyler show, I'm Tyler Dehan.
• 33:03
  SPEAKER_00: Till next time.