Latest / Healthy Happy Wise Wealthy / Navigating Aging with Compassion: Home Health, Independence, and Family Conversations for the Holidays

Transcript

Navigating Aging with Compassion: Home Health, Independence, and Family Conversations for the Holidays · Healthy Happy Wise Wealthy

0:00
Welcome back to Healthy, Happy, Wise, Wealthy. I am so excited for our guests today.
0:05
We have Comprehensive Home Health Solutions
0:09
in Reno, Nevada area and Dr. Sandra Weitz
0:13
and Carrie Ingerman are joining us today. They are
0:16
a mother, daughter daughter combo. That's easy for me to
0:20
say. So I have
0:24
been working with them for a little while now and just adore
0:28
them and so appreciate the insights that you both have
0:31
in terms of like helping people as they age.
0:35
So I know you help people with home health and then
0:39
medical or non medical either way. But could you guys just
0:43
introduce yourself brief briefly for us and tell us a little bit about
0:46
your background? Go ahead,
0:51
I'll go first. I'm Carrie. I
0:55
have a long history of being
0:58
interested in patient advocacy which
1:02
started really from my own experience with the healthcare system
1:05
as I'm sure my mom will go into detail.
1:09
She is a physician and one of the reasons that I am where I am
1:13
today in terms of my abilities and
1:17
not having significant consequences from my medical history
1:21
is because she was able to advocate for me. And so one
1:25
of the things that led me to
1:29
senior care and advocacy is my own experience.
1:33
I went to Northwestern University and studied
1:37
learning and organizational change and am very
1:41
interested in helping people
1:45
navigate the healthcare system. And I'll let
1:49
my mom introduce herself and then we can share. Share about
1:53
how we started our agency and how we got into
1:57
really helping people live well at home. Yeah, I love that because I didn't,
2:01
I don't think I knew that the patient advocacy piece came because
2:04
your mom was such a good advocate, but I can see that happening. So
2:09
Dr. Weitz, do you want me to call you Dr. Weitz?
2:13
You can call me Sandy. I answer to
2:16
everything. Hey you. Right.
2:20
Yeah, including hey you
2:23
in any case. So I am a double board
2:27
certified pain management specialist. I did a
2:31
surgery internship, anesthesia residency, pain management
2:34
fellowship, all at UCSF in San Francisco and stayed
2:38
on faculty there for five years running the pain service.
2:42
I moved to Baton Rouge, Louisiana with kids. Carrie's dad,
2:46
he is actually the silent member of Comprehensive Home Health
2:50
Solutions, but a very active member. I actually
2:53
met him the first day in medical school. He was the guy sitting behind me
2:56
41 years ago,
3:00
basically moved to Baton Rouge, started my
3:04
own practice, grew it to 11 docs and 11
3:08
mid levels and ultimately
3:11
ended up retiring in 2016 after
3:15
number one having taken care of Carrie and her
3:19
multiple medical issues and then ultimately in 2016
3:23
taking care of my mother in law who was dying of metastatic breast
3:27
cancer and my elderly father in law. My husband
3:30
is an only child. Very long story
3:34
short, we were traveling the world, minding our business,
3:38
had moved to Northern Nevada
3:42
and really enjoying
3:45
just living and dealing with our three kids. When Carrie said,
3:49
you know what? I originally wanted to be a disability rights
3:53
attorney, but you talked me out of doing that. And
3:56
then we can talk about why. What does one do when
4:00
they don't become a disability rights attorney? You go to work for
4:04
Goldman Sachs as an investment banker for four years in New York City.
4:08
Did you do that? I don't think I knew that. I did, in fact do
4:11
that. And after three and a half years,
4:15
I realized that I wanted to get back to helping people.
4:20
And around that time, we
4:24
had close family friends diagnosed with terminal illnesses, one with
4:28
ALS, one with Parkinson's. And it was
4:32
kind of that moment where I understood how
4:35
challenging and navigating end of life care is. And when I say
4:39
end of life care, I'm not talking about terminal care. I'm talking
4:43
about when you're diagnosed with multiple
4:47
chronic diseases and your quality of life or
4:50
your ability to navigate life becomes more challenged,
4:55
how do you have the supports? And so
4:58
that is really where Comprehensive Home Health Solutions was born,
5:03
was really trying to provide coordinated care in the home to help
5:06
people have the best quality of life, to provide supports for their friends
5:10
and family, caring for them. And for some crazy reason,
5:14
my mom and dad agreed to go on this journey with me.
5:18
And so we started the licensing process
5:22
about two and a half years ago, and we started providing caregiving
5:25
services in the home two years ago. I as
5:29
of about two days ago. So it's been quite the journey.
5:33
And now we are ACHC accredited and
5:38
credentialed with Medicare for Home Health, and we also offer
5:41
patient advocacy. So really trying to, again, provide that coordinated
5:45
care in the home. I love that. But Mary, I want
5:49
to clarify a couple of things because I think Carrie and I come at this
5:53
from a slightly different perspective. Perspective, even though we're mother and
5:56
daughter and there's usually not a lot of daylight, number
6:00
one, while many of the folks that we take care
6:04
of are indeed seniors, there are plenty
6:08
of people. Illness and
6:11
disability does not affect only old
6:15
people. You can become disabled. You
6:19
can get diagnosed with some significant
6:22
illness pretty much at any age, including Carrie
6:26
at eighteen. All right. And so the
6:30
idea that we do senior care, a large portion
6:34
of what we do is senior care, because as we get older, we're
6:38
more likely to have illnesses, we're more likely to
6:41
need support. But it is not limited
6:45
in any way, shape or form to only old people.
6:49
Number One. And number two, I want to be really
6:53
clear in the explanation of home
6:57
care versus home health because I think a lot of
7:01
people don't understand the difference between those two things. When
7:04
Carrie says that we have been providing home care for the
7:08
past two years, that is really the non medical side.
7:12
And what I mean by that is activities of daily living, getting dressed,
7:16
getting showering, bathing, toileting,
7:21
meal prep, going to doctor's appointments, all the things that allow
7:25
you to live your life that you may not be able to do
7:28
independently and you may not necessarily have the family
7:32
or social support to enable you to do that. That's
7:36
really what home care is. On the other hand, home
7:39
health is the medical army. Skilled
7:43
nursing, PT physical therapy, occupational
7:46
therapy, speech therapy, really skilled
7:50
services. And for home health you need a physician
7:54
order and it's covered by insurance. Whereas on the
7:58
home care side, that is something that anybody who
8:01
understands that they have a need or a family member has a need can
8:04
arrange for, even without a physician being involved.
8:09
Yeah. And I think that as a
8:13
doctor, I will tell you that doing both home care and
8:16
home health has been probably the most humbling
8:20
experience. And the reason for that is that when we
8:24
see patients in a clinic setting,
8:28
it's very sterile, right? We see you for 10 minutes, 15 minutes,
8:32
we tell you a bunch of stuff. And even if you're able to tell us
8:36
back what you heard us say, you may or
8:39
may not actually comprehend that you may not remember it
8:43
by the time you get home. And so then
8:47
sometime later you come back either to see us in the office or you end
8:51
up in the hospital, whatever it is. And I'm sure
8:55
your listeners will acknowledge that they've heard
8:58
physicians or healthcare providers say, oh, that patient is
9:02
non compliant. And it's not until you do home care and home
9:05
health that you realize that most people actually really want to do the
9:09
right thing and they really do want to be taken care of and
9:13
have the best care possible, but they don't have
9:17
the resources, they don't have the social support. And
9:20
so once you get out into the world, it's a very different
9:24
environment than when you're sitting in a clinic. And the other thing is
9:28
that do themselves a disservice because they
9:31
frequently want to put their best face forward and they
9:35
tell us they're doing stuff or they understand stuff when they don't. All you have,
9:39
all you have to do is think about, you know, maybe your
9:43
mom who, or a friend of yours who
9:47
gets dressed to the nines, puts on their makeup and
9:50
going to the doctor looks totally put together and
9:54
yet you see them on another day and they haven't gotten out of their
9:58
pajamas, but they don't want that.
10:03
That is, that is an interesting thing, I imagine as a. Because it's
10:07
a completely different setting. So. And I know today
10:11
I wanted to have you guys on the week before Thanksgiving because there is
10:14
this going into, you know, aging. I know this can be for other
10:18
people. Maybe it's not aging, it's health related, but you're
10:22
going home for the holidays maybe, and you're going to see some relatives you haven't
10:25
seen in a while who might be aging. And I know you guys
10:29
give talks out in the community and you just gave one about
10:33
staying safe during the winter, but are there things
10:37
like when you go home and it's over holidays and you're seeing
10:41
a parent or a family member who is, you know,
10:45
getting up in years, are there things to look for? So
10:48
I, I think one of the biggest things to look out
10:52
for is changes in cognitive status.
10:56
And that's kind of the high, high level idea.
11:00
But when you talk to your parents on the phone
11:04
or your grandparents on the phone, you might talk to them for
11:07
five, 10, maybe even 30 minutes. Whether it's on
11:11
phone, by phone, or on FaceTime, you're getting
11:15
a very small snippet. And one of the things that I have found
11:19
is that people are really good at faking
11:23
how well off they are. And so
11:27
the opportunity to spend prolonged time with your
11:30
loved ones is a great opportunity to kind of assess
11:34
their cognitive status. So when you talk to them on
11:38
the phone, they may have a typical
11:41
conversation, but after 30 minutes, an hour,
11:45
you might notice that they are on a loop, that they
11:49
are having the same conversation with you that they had an
11:53
hour ago. You might notice that they are fixated
11:57
on different topics, whether that is,
12:00
oh, I need to do laundry, I need to do laundry. And even after you've
12:04
addressed laundry, they may still be fixated on that.
12:08
So that's something to look out for. You might notice
12:12
forgetfulness or confusion.
12:16
Another thing is, especially for people with cognitive
12:20
changes is change in routine can be really
12:23
disorienting. And having a lot of family in town
12:27
might be disorienting for them because they have
12:31
established a very specific routine. And so
12:35
if they become anxious, if they become confused,
12:39
those might be signs that they are
12:42
disoriented. And so by
12:45
spending more time with people, you'll be able to get a better
12:49
understanding of what their cognitive status is.
12:53
Yeah, so we probably should be checking in with relatives more than just on
12:57
holidays is also what I'm hearing, you know, and be
13:01
be or, you know, it might be neighbors or whoever
13:04
that might be. But if we, if we see something,
13:08
we're like, that's not great. What do you recommend doing?
13:13
Either one of you can. I mean, I think some of it
13:16
depends on how acute it is. All right, so
13:20
I want to come back to a couple of things that Carrie touched on.
13:24
When she talks about a loop,
13:28
you may not even recognize the loop. And whether you're home for the
13:32
holidays with them or you're just talking to them on the phone on a
13:35
regular basis, be aware of the conversation you're
13:39
having. If you constantly ask somebody questions that
13:43
really are yes, no questions or things that
13:47
can have a very simple answer, you may not
13:50
recognize how impaired that person is.
13:54
And so, because if the question is,
13:58
so, are you having a good day? Oh, yes, I am. I mean, I can
14:02
have a whole conversation with you and say nothing. Right?
14:07
Be aware of the conversation that you're having. The other thing
14:11
is that, you know, it's very hard when
14:14
you really haven't seen this person for three months or six months and
14:18
haven't had any in depth conversation to figure out what
14:22
is acute versus not acute. What I mean by
14:25
that is somebody may have a gradual
14:28
decline. And frequently those cognitive changes
14:32
are relatively gradual.
14:35
Sometimes, however, it can be a sign
14:39
of, let's say, a urinary tract infection. One of the most
14:42
common presentations of urinary tract infection in an older
14:46
person is, is actually change in mental status confusion.
14:52
So if you normally are talking to your loved one and they're
14:55
with the program and all of a sudden they're making no
14:59
sense to you, they need to go to the ER immediately. That
15:03
makes sense. Yeah, because, you know, they could be having a
15:06
urinary tract infection. They can have ischemia, meaning
15:10
inadequate blood flow either to their brain, to their heart. They could have a heart
15:14
attack, they could be having a stroke. And so, you know,
15:17
it becomes very hard for family members who don't see
15:21
their loved one on a regular basis to kind of ferret out
15:25
what's new, what's not new. And that's, where are their friends around?
15:29
Do they go to church? Who else are they interacting with? So that you can
15:33
get some other data points to really recognize
15:38
kind of what we're dealing with. That's number one. Number
15:41
two, anxiety and depression
15:45
are very frequent symptoms of
15:49
cognitive change. And one of
15:53
the things I've learned as a physician over the years Is that depression
15:57
and what people perceive as dementia or cognitive change can be two
16:00
sides of the same exact coin. I have historically
16:04
seen in my own practice, people where you thought they had cognitive
16:08
changes and you thought they're depressed, you treat their
16:11
depression, the cognitive changes get better.
16:14
Similarly, if you are aware that you have cognitive changes and
16:18
most people who have slow decline are
16:22
very well aware of it, they may not be articulating it to
16:26
you, but they know. Carrie will tell you about
16:30
her grandfather who would say to us, my brain is not
16:34
working my brain the way it used to be
16:38
until he finally passed away at 89. I mean, so, you know,
16:42
he had a long, wonderful life, but he was
16:45
aware probably a good 15 years.
16:50
I also see folks that we work with who are in their
16:53
70s, some in their late 60s, who can notice that,
16:57
that their short term memory might be affected.
17:01
And so it's not, to Sandy's point, it's not
17:05
necessarily that there is a drastic drop off in cognitive
17:09
function. Oftentimes when it is age related or
17:12
dementia related, it is a slower, gradual
17:16
decline. So to Sandy's point, just to echo that, if there
17:20
is an acute change that requires immediate attention,
17:24
yeah, that makes sense. But the other thing,
17:27
Mary, it's about teaching people to look for clues.
17:31
Okay? If you come to visit and it used to
17:35
be that the house was impeccable and now the house
17:39
is kind of not so clean anymore, or there's we've
17:43
all seen either on Instagram or
17:46
commercials on TV about children,
17:50
about adult children coming to their parents houses and throwing
17:53
out expired food and we all giggle. But the reality
17:57
is that if you find milk in mom's refrigerator
18:01
that's three months old, okay, and she's unaware
18:04
that she's got milk that's three months old, that's a good clue
18:08
for you that there's something going on here.
18:14
Go ahead. But I think the second piece, piece to your question, Mary, is also
18:17
about what do you do? And there are some
18:21
cognitive changes that are a normal part of
18:24
aging. And you do need to kind
18:28
of plan ahead and take precaution and put safety
18:32
measures in place, but there might not be a drastic
18:36
thing that needs to be done. So for example, if you
18:40
are visiting your parents, your grandparents, and you notice
18:44
that their pill bottles are still sitting in their
18:48
prescription packs, that might be an opportunity
18:52
to come up with a plan for how are we going to help you take
18:55
your medications routinely? Yeah. That being
18:59
said, if you come in and you notice that you smell gas
19:03
because they've forgotten to turn off the
19:06
stove, then that's obviously a more urgent, immediate
19:10
need for intervention. And so there's a broad
19:14
spectrum of things that you can see when someone is
19:17
experiencing cognitive changes. And part of it is
19:21
the planning ahead, coming up with a plan for, okay, how are we going
19:24
to manage your meds? How are we going to manage
19:28
if you start wandering, if you leave the house and go for a walk and
19:32
can't find your way back home? How are we going to manage if you
19:36
are leaving the stove on or turning on the water
19:39
in the shower and not turning it off? Things like that.
19:45
I want to come back to a list of things that we can do for
19:48
that. But before we go back to that, I really want to talk
19:51
about from the medical perspective, the evaluation
19:55
of that person. Okay. Obviously,
19:59
if there's something acute, you're going to take them to the emergency room
20:03
or urgent care to make sure that we're not having a
20:07
stroke, a heart attack. You don't have a urinary tract infection.
20:11
More likely than not, to Carrie's point, it's gradual. How do you work up
20:15
that person? How does that physician figure
20:18
out whether you have dementia? I want to
20:22
come back and say that a lot of people have cognitive changes
20:26
for a myriad of reasons
20:30
ranging from. From age related to
20:34
drug interactions to,
20:38
you know, the chemotherapy fog
20:41
to vascular insufficiency. All right.
20:45
If you have high blood pressure, long term, you can end up
20:49
with what is called small vessel disease, where basically
20:52
part of your brain atrophies because it's not getting enough blood
20:56
flow to the brain. Interesting. I mean, I can give you a
20:59
laundry list of these. The point is, is that there are multiple
21:03
causes. So are you a diabetic? Do you have high blood
21:07
pressure? How well controlled are those things? Because those are things that are
21:10
going to predispose you to cognitive changes. There
21:14
is a whole metabolic workup that the physician can do.
21:18
There's obviously, or maybe not obviously,
21:22
MRI of your brain. Do you have a brain tumor? Do you
21:26
have just ischemic changes where you're not getting adequate
21:29
blood flow? Maybe you had a stroke and you didn't know it
21:33
because depending on which part of your brain has been affected,
21:37
you can have mini strokes, okay. And not
21:41
either. Either TIAs, transient ischemic attacks, or
21:45
even an actual stroke. But if it doesn't affect the part of a
21:49
part of your brain that has a significant function,
21:52
you may have a series of them before you have a large stroke without
21:56
ever knowing it. There's an
22:00
entire medical workup that can be done in order to sort
22:03
out, do you have cognitive changes? How significant are
22:07
they and what can we anticipate? Then the other thing that I
22:11
would strongly advocate for anybody who either they
22:15
themselves or have suspicion that their loved one has cognitive
22:18
changes and is to get neuropsych testing done. That's
22:22
usually done by a neuropsychologist. It's a battery of
22:26
tests that evaluate cognitive function.
22:29
Everything from simple stuff like who's the President of the
22:33
United states to remembering five
22:37
numbers that I tell you now, 20 minutes from now, there's a
22:40
whole battery of these. In the ideal world,
22:44
as soon as you become suspicious, you get that as a baseline
22:48
and then it can be repeated in order to evaluate
22:52
the progression of this over time.
22:56
Okay. Because most people do not fall
22:59
off the cliff abruptly. Most cases,
23:03
people, regardless of the medical issue, most
23:07
people have this progressive red
23:11
flag, red flag, red flag before we fall off the cliff.
23:15
And to Carrie's point about what can we do to keep you safe
23:19
at home and keep you functioning and as
23:22
independent as you can be understanding
23:26
what are the red flags, what's the progression, what's the trajectory of
23:30
this is fundamental to that. And that's the
23:33
neuropsych. That's what is helpful for that workup of this.
23:37
Yes. Okay. And so I think part of your question too,
23:40
Mary, is how do you get this worked up and
23:44
who do you go to? So you can go to the primary care provider,
23:48
ultimately you'll likely want to go see a neurologist
23:52
and then they will likely be the ones to refer the person
23:56
to, to have a neuropsych eval done.
24:00
Okay. That is really great information. I
24:04
appreciate it. So if someone is, is at home
24:07
and like they're listening and they might be one who are, you know, they're past
24:10
70, they're 80, whatever they are, and they're like,
24:14
are there things that, that they can think of to help themselves
24:19
with aging and for reaching out for help? Is it,
24:23
you know, or is it harder because it's kind
24:27
of the brain function? I mean, have you found that people can be good at,
24:31
at kind of self regulating that
24:35
piece of it and, and knowing when to ask for help? Or is that hard?
24:39
There are certainly those people who can either
24:43
themselves or with support. And so
24:46
they're coming back to things you can do simple stuff like
24:50
don't have throw rugs on the floor that you can easily trip over.
24:54
Okay. Make sure that
24:59
either your neighbor has a key to your house or you have a
25:02
lockbox so that God forbid something happens, the Fire department doesn't have to
25:06
break down your door. Make sure you have an up to date
25:10
medication list and that you know what medications you're taking
25:14
and that you are actively communicating with the physicians to
25:17
make sure you don't have any drug, drug interactions.
25:21
And, and so there are a number of these things I'm sure Carrie's going to
25:25
add to my list. But one of the things we see in,
25:30
particularly in couples who are older, one is frequently
25:34
covering for the other. I know you
25:37
mentioned that and I can see that happening. And so I
25:41
think that, you know, really it's about honest
25:45
communication between the, between the
25:48
partners. It's honest communication with
25:52
your family members about what your needs are,
25:56
how you anticipate your needs to be. Do you want to
26:00
stay in your home? Do you, you know, are you willing to have a caregiver?
26:05
Do you want to move in with a family member? What do we think? Depending
26:08
on what this progression is, what does that future look
26:12
like? Before I turn this over to Carrie to add to my list,
26:16
the one thing I really want everybody who listens to this to understand
26:21
is asking and accepting help, whether it's from your family
26:24
member, your friends, whether it's a caregiver,
26:29
putting scaffolding in place will actually help
26:33
you maintain your independence. People have this
26:36
perception that if they accept help that it
26:40
means they can't do it and they will lose their independence. It
26:44
is exactly the opposite of that. Okay, that's really good.
26:48
I feel like we should repeat that, you know, because it makes me wonder and
26:51
I can see, you know, because of course I have, I have relatives in this
26:55
age range. So I'm thinking of them as you're talking and, and one who
26:58
has Alzheimer's. So that is, that is a tough one for him for
27:02
sure. And he's aware of it, like you had mentioned before, but
27:06
it. Do you, I mean, I feel like maybe, maybe you guys tell me, you
27:09
think some, some fear, some shame, some fear of dying, fear of
27:13
losing your independence, shame that you're, it's,
27:17
there's a change going on. I mean, do you feel like that can hinder
27:21
them? Asking for help from family members or neighbors or putting things in
27:24
place to, to assist with helping
27:28
them stay healthy? I
27:31
absolutely think that's the case. I think accepting
27:36
change in your functional status is a huge
27:39
deal. I experienced that when I was 18 and was
27:43
needing help with showers after I had three back
27:46
surgeries. I don't want to turn this on my mom, but
27:50
she is a breast cancer survivor and had
27:54
to Lean on the family and my dad. Dad for
27:58
support when she was going through treatment. If you make it to your
28:01
70s and 80s and have never had to rely on
28:05
your community, your family, then you are
28:08
beyond lucky. Different people have
28:12
to. My camera wants to keep turning. It does,
28:16
doesn't it? Different people have
28:19
to ask for help at different points in their life,
28:23
and that's okay, but it is really hard,
28:27
especially the first time you have to ask for help. And so,
28:31
again, I do think that's a huge barrier. And I
28:34
think, just to echo Sandy's point,
28:39
accepting help allows for greater independence.
28:42
That's one of the things I love about the disability community, and
28:46
one of the reasons that I ended up down this path to begin
28:50
with, was when you look at the
28:54
disability community and the social model of disability,
28:58
it's really that your environment is what
29:02
makes you disabled. It's not that you yourself
29:05
are disabled or not able to do something. And by
29:09
providing a person with the necessary supports,
29:12
whether that's a curb on the
29:16
side of a street, to be able to get on and off the
29:19
sidewalk, to using assistive
29:22
spoons or forks, if you have tremors, to be able
29:26
to feed yourself. These are all just assistive
29:30
devices or technology or supports to
29:33
enable someone to live independently. And
29:37
so accepting help is really one of the first things you can
29:41
do to live more independently.
29:45
I love that. And so I know you guys have. Provide a
29:48
lot of just education and stuff for people. So if
29:52
someone comes to you, whether it's someone who feels like they're losing, you know,
29:56
some help for themselves or a family member comes on behalf, and. And
29:59
they reach out to you and say, we need some help.
30:04
How does. How do you. How do you guys help? Like, what are some of
30:07
the first things? Let's say it's not medical, but they need some. How do you
30:11
evaluate that? And, like, what kind of things can
30:15
a company like yours do? I mean, you're in Reno in this area. So
30:18
what? But other. There's other areas of the country,
30:22
obviously. So, I mean, what are. What are some of the things
30:25
that they can get help with that would be, you know, help them stay in
30:29
their home and, you know, stay healthy.
30:33
So I'll take this because I. I spend most of my days doing this.
30:37
I think part of it is having an initial conversation
30:41
where someone who has more experience dealing
30:45
with aging or different diseases that
30:48
might impact your ability to navigate your
30:52
activities of daily living, they can help guide you in
30:56
a conversation of what can you do? What do you need a little
30:59
bit of support with how can we improve the quality of your
31:03
life? How can we improve your ability to do things
31:07
independently? And really that starts with a
31:10
conversation. I think the folks who work in
31:14
healthcare in senior care obviously
31:18
encounter these kind of
31:21
situations more regularly and so they bring a wealth of
31:24
knowledge and experience and are a
31:28
great way to explore what options exist.
31:33
I think if a person is looking for a
31:36
caregiving agency to actually step in and help
31:40
with activities of daily living, making sure
31:44
that the philosophy of the agency and the approach to
31:47
care is aligned with your personal values.
31:52
I like to think that we take a really
31:56
coordinated approach. My mom has spent her
32:00
entire career thinking about the biopsychosocial
32:03
model of health and we really try to do that here and
32:07
I know other agencies across the country really do that.
32:11
So really aligning values and philosophy I think is the
32:15
second step. Once you've had the conversation of what kinds of
32:18
supports could I benefit from or what tools can I
32:22
utilize to live well and independently at home?
32:26
Yeah, that's great. I think Mary, I want to echo what
32:30
Carrie said but maybe put a finer point on
32:34
really starts with that conversation. And
32:38
obviously if somebody calls us, we have a conversation
32:42
with them. We do a free in home consult to evaluate what their
32:46
needs are. Because most people are
32:49
overwhelmed by the time you realize that you need
32:53
help or your or your family member needs help. It's
32:57
kind of like the old game of hot potato. I'm managing, I'm managing, I'm
33:00
managing. And then as soon as I realize that I'm in over my head,
33:04
I need to do something right this minute. Right? Yeah. And
33:08
so I remember you saying that when you came in, it's just like by the
33:11
time we realize we need help, it becomes urgent. It becomes urgent
33:15
part one, but part two. And we also talked about this, the three
33:19
of us and that is there's so much
33:22
emotion when it's your parents or your
33:26
a loved one, you're afraid they're going to die, you don't know how to handle
33:29
it. Then there's, you know, in my case, I have three children.
33:33
You know, when my father, when my in laws were ill, My husband's an only
33:37
child. So they're the bucks stop with him. Right. When you have
33:41
multiple siblings and everybody has
33:45
an opinion and there's this, you know, it can be very
33:49
hard to navigate. And so one of the things that talking to a company like
33:53
us and to your point, there are people like
33:56
us all over the country, it's not limited to just Reno.
34:02
We are that independent
34:05
you know, ear to basically help you
34:09
ferret out in an unemotional way.
34:13
Here's where we are. Here are what the options are and how
34:16
do I navigate this? And you know, one of the problems in
34:20
today's healthcare
34:24
world is that people have multiple doctors. There is now a
34:28
doctor for, you know, the nail on your third finger and
34:32
there's another doctor for the nail on your fourth finger of the opposite hand.
34:36
Okay. Most two doctors don't talk to one another and each one is
34:39
giving you a list of meds. And, and so if you're the person
34:43
who is overwhelmed by this, sometimes
34:47
just having people around and this is in part where the
34:51
patient advocacy piece comes. How do I get my doctor to talk to
34:54
me? How do I get this doctor to communicate with that doctor? How do I
34:58
get my insurance company to approve this? What does it mean
35:01
to be on a Medicare Advantage plan or
35:05
an HMO if you're not of Medicare age as
35:09
compared to a, a plan where I can go to anybody?
35:13
How does the whole system work and how do we coordinate it?
35:17
And that's, I mean that's overwhelming at any age. Right. So if
35:21
you feel like you're somehow your mental faculties are, are
35:25
starting to slip a little bit. I can, you immediately have to be overwhelmed. There's
35:29
no way you couldn't be, you know, with that. So
35:32
I can, I can definitely see that. So the patient advocacy
35:36
does come into play with dealing with the medical system.
35:40
You know, come into play with the financial
35:44
system. It can come into play with understanding your
35:47
explanation of benefits. You get a bill from the hospital
35:51
and it says that they charged $40,000 and the insurance
35:55
only paid 2,000. And you can't understand what that is
35:58
about or how much do I actually owe. And
36:02
it's every aspect, you know, health is not
36:06
just about going to the doctor or a drug. Yeah. It's
36:09
your overall well being and it affects every aspect of
36:13
your life. Yeah, man, that's a lot. It
36:17
is a lot. So I know you guys
36:21
just gave a talk. Maybe it was, was it just you, Sandy, or both of
36:24
you about staying safe over the winter? So like what are
36:28
some things that you can do to avoid falls and those kind of things that
36:31
you guys gave that talk about? I'm kind of pivoting a little bit. But
36:35
so it was actually Alex and I. So there are
36:39
a couple of big things. Obviously one
36:43
of the issues is regardless of where you
36:47
live, you don't, you can live in Atlanta
36:50
or Baton Rouge, Louisiana, where it usually does not snow,
36:54
but it can be 35, 40 degrees in
36:58
the morning. And with the humidity, the ground is slick
37:02
and so you can come out and slip and fall. All right? If you
37:05
are unaware of how slick it can be, regardless
37:09
of whether there's snow and ice. So wearing good quality shoes,
37:13
making sure that the traction on your, the tread on your shoes
37:17
is up to par. If you are like my husband who wears his
37:20
hokas until they're threadbare, that is a losing proposition.
37:26
God's honest truth. Making
37:30
sure that the lighting is adequate. You know, if you're going
37:33
out at dusk, if you're going out in the dark, turn the lights on around
37:37
your house. Take a flashlight, wear a headlight,
37:41
try and make ways not to fall inside your
37:45
house. Make sure, as I talked about, that you don't have throw rugs, that you
37:48
have a night light and that you turn the night light
37:52
on before you go to bed or have a light under your bed that's
37:56
a motion detector. So that because especially
38:00
as it's dark in the morning and it's dark by 5:00 clock at night,
38:05
you may think, oh, I'm not going to turn the lights on. Turn the lights
38:08
on. You need to be able to see where you're going. All right?
38:12
Obviously, especially make sure you have a
38:16
clear path around your house. People seem to have obstacle courses
38:20
where there's an ottoman in the way and there's a, and there's a coffee table
38:24
and there's some, and there's a dog to trip on. So that's
38:28
fall prevention. One of the other things that we talked about in this talk
38:31
is this is the height of fall cold and flu season.
38:38
This is not a political statement, but vaccines, particularly as you
38:42
age, are super important because our immune systems are not what
38:45
they were. And the consequence of getting a viral
38:49
illness is much greater, particularly if you have significant
38:52
underlying diseases like asthma or COPD or
38:56
underlying heart disease. So flu FLU
39:00
VACCINE UPDATED Covid BOOSTER There is
39:03
now a new vaccine in the past couple of years for
39:07
rsv, otherwise known as respiratory syncytial virus. Used to
39:10
be a virus that everybody thought only kids got, but
39:14
turns out old people, actually young people, actually anybody
39:18
can get it and you can get a vaccine for, for it, and that will
39:22
make a huge difference. And then the other one is
39:25
Prevnar, which is the pneumonia shot. It's particularly important
39:29
if you're, if you're going to go visit your family members
39:33
or they're coming to visit you because they're either you or
39:37
they are bringing a bunch of bugs that you're not used to seeing
39:41
and you're in close quarters, all right? And if you
39:44
have, you know, young kids around you, whether they're your nieces and
39:48
nephews or their grandchildren, children are petri dishes.
39:52
And so they are bringing home from school whatever they were
39:56
exposed to, but you haven't seen that bug in a long time.
39:59
And so the likelihood of you getting sick is that much greater. So
40:04
trying to prevent that. The other thing that we talked about
40:07
was the tendency to eat too
40:11
many sweets, actually, the tendency just to eat too much
40:15
this time of year, Whether it's Halloween tomorrow, whether it's
40:18
Thanksgiving or Christmas, if you're a diabetic,
40:22
obviously things that are high in sugar or you're a pre diabetic
40:26
can tip you over the edge. But even things like
40:30
Thanksgiving dinner, which tends to be high in salt, if you
40:34
already have high blood pressure, if you have heart disease, if you have
40:37
congestive heart failure, can take somebody who's well controlled
40:41
and tip them over the edge. The other thing to. To that
40:45
point is Thanksgiving night is the.
40:49
The most significant night in terms of people having heart attacks of the
40:53
entire year. Oh, and that's. That's. I don't think I've ever heard
40:57
that. That is until I heard you say that. Yeah. And so it
41:00
has to do in part with the tryptophan and the turkey, but it also has
41:04
to do with the amount that you eat and the. And the amount of salt.
41:07
So again, something to be aware. And then the last thing
41:10
we talk about in terms of hazards of fall is really seasonal
41:14
affective disorder, otherwise known as sad.
41:18
And that is really the depression that comes when it's
41:22
cold and it's dark. And if you think about it, when it's
41:26
cold and it's dark, there are many days that you don't want to get out
41:29
of the bed or you don't want to go to the store, you don't want
41:32
to go to a movie, or you don't want to go see your friends because
41:34
it's cold and it's dark, and I might as well just stay home.
41:37
Socialization is super important, all right?
41:41
Making sure you don't isolate yourself. And then the last thing I will say about
41:45
that, and I'm sure Carrie will have an opinion because Carrie had a happy light
41:48
for a long time. But the
41:52
last thing I'll say about seasonal affective disorder is the need for
41:55
routine. All right? And at the
41:59
beginning of this, about disrupting
42:03
people's routines. Well, in the winter, you tend to Disrupt your
42:06
routine because again, you don't feel like doing stuff. And so if
42:10
you normally get up, get dressed, put on your clothes and
42:13
go for a walk in the neighborhood, even if you just walk around your house,
42:17
you need to do that same routine. And
42:21
basically whatever your daily routine is, that's what has to stay because
42:24
that is what helps you maintain your sleep cycle.
42:28
It's what helps you in terms of your cognitive function
42:32
and overall helps with the depression. Okay, Carrie, what did I miss?
42:36
No, I love it. Covered it all.
42:40
Happy light. That's.
42:44
Right. Yeah, I feel like that, you know, the seasonal affective disorder,
42:48
that's, that's some real stuff. Especially in, in states where
42:51
that, those Grace. I know I lived in Wisconsin for a while and I think
42:54
those gray skies lasted for six months. Like there's certain, there's certain
42:58
things that, that aren't helpful at all in any
43:02
age. So, so tell me this. I mean when
43:05
you're, I know you work with families all the time where they're, you're working with
43:09
the kids trying to help an aging parent.
43:12
So I'm curious for someone like, I mean my, my
43:16
mom and her husband do their best to stay very healthy and
43:20
do all kinds of things, but you know, everyone gets older. So
43:24
what is. And we have multiple kids in our family, to your point.
43:28
So for someone like that, where like kids aren't necessarily nearby,
43:31
there's multiple kids. What are the things that you recommend for
43:35
families? What, what do the. Primarily the children,
43:39
but you know, anyone who's stepping up to help, what
43:42
do we need to do? And I think you
43:46
mentioned a few things like you know, kind of making sure the list for,
43:50
for medications there and making sure everyone has a key to the house and
43:55
people are checking in. Maybe. But are there some other things that you've noticed
43:58
that would be helpful? So I
44:02
think it really depends and I know that isn't a helpful
44:06
answer. I think one of the first things, especially
44:10
if you're early on in your parents
44:14
evolving status, is to have a conversation and
44:18
figure out who is going to be able to step up in which ways.
44:24
We have a number of families where there are
44:27
multiple kids involved. And so if one person is really good
44:31
at finance, maybe that person is going to take over the
44:35
parents finances. Maybe one person loves to talk to their parents
44:38
on the phone. So maybe that person is the one calling every day to
44:42
check in or every other day. So figuring out who,
44:46
who has which strengths and which way that they are going to best
44:50
support mom and dad I think is one
44:53
and then two is starting to talk to your parents
44:57
and talk about the quality of life that they want to live.
45:01
If they are having to give up their license
45:05
because they're no longer safe to drive, if they are
45:08
not socializing as much because they have mobility
45:11
impairments, what are the things that you,
45:15
as the kids can do to help facilitate them
45:19
having independence? Again, it comes back to that idea of
45:23
having the necessary supports in place to help them
45:26
live independently or as independently as possible.
45:30
So again, it comes back to that initial conversation
45:34
and figuring out who's going to do what to step up.
45:38
And then if you are coming from out of town, I think that's a great
45:42
opportunity to start interviewing different community
45:46
partners. Whether it's a home care agency that can provide
45:49
caregiving services, whether there are
45:54
day centers where your parents could go to spend
45:58
a day and have socialization activities. I
46:02
think those are some things that you can do during your visit.
46:05
But ultimately it depends on what your
46:09
family, what the kids are able to provide
46:13
and what the priorities are for the parents. I'm sure
46:16
Sandy also has thoughts to add. I
46:20
think that in the old days
46:24
people didn't want to talk about death and dying or loss of
46:27
function or acknowledge that we get
46:32
illnesses or. I remember even as a kid that,
46:35
you know, the C word, cancer was something that was very hush hush and
46:39
nobody talked about. Right. I think that the world
46:43
has changed. And I think that having these conversations
46:46
early and often before we get to the
46:50
point of it's a problem, because once it's
46:54
a problem, then everybody has emotion about it. If you can
46:58
discuss it before, like now, before it's even an
47:01
issue. All right? Your chance of having
47:05
that unemotional. So, mom, what, what, what?
47:09
What would you like to have done? I think it's also the
47:12
reason to encourage everybody, not only your parents.
47:17
This applies to you, to me. To have
47:20
a living will to make, to go through the exercise of
47:24
thinking about what would I want. Okay. And understand
47:28
that if you have an advanced directive, if you have a living will, it is
47:32
really nothing more than a suggestion. All right? It
47:35
memorializes kind of what you're thinking, what you want.
47:39
It doesn't mean you can't change your mind. It doesn't mean that circumstances don't
47:43
change, but it at least provides a framework. That's number one. Number
47:47
two, you really need to decide to carry his point. Who's going to
47:50
do what? But more from the perspective of who's
47:54
going to be the durable power of attorney over
47:57
finance, who's going to be the durable power of attorney over
48:01
health care. If mom says it's dad
48:05
and dad says it's mom, if, God forbid, something impairs
48:09
both of them simultaneously, all right, then who's the
48:12
backup? And if it's not memorialized, you don't have,
48:16
there's no backup. And then it becomes the state. So again,
48:20
to have these conversations in advance and be
48:24
realistic, okay, if you are the kid who lives far away
48:28
and there's a kid who lives nearby, chances are it's the kid who lives
48:31
nearby that's going to go to the doctor more easily
48:35
than the kid who lives in Thailand. Right,
48:39
Right. And so when you're sorting out who's going to do what, think
48:43
about that. The only other thing, Carrie, that I would
48:47
come back and take issue with, it's not a kid who's
48:51
going to do the calling every day. Set up a schedule
48:54
where every kid calls every
48:58
other, like a rotation. If there are three of you,
49:02
each one of you takes two days a week.
49:06
It is one of the things that we see repeatedly
49:10
and, and I've seen in my medical practice is
49:15
that people get burnt out.
49:19
And, and I said something to you, Mary, and I've said it to Carrie
49:23
now a number of times that is very crass, and I will apologize for
49:26
an advance. And that is, you know, on
49:30
some level, many family members end up feeling,
49:34
okay, if you're going to die, can you just hurry up and die quickly? Because
49:38
we can all do anything for a day, a
49:42
week, a month. The thing that wears folks
49:45
down is chronic illness. And because
49:49
medicine has evolved so much, we've gotten so much
49:53
better in keeping people alive for a longer
49:57
period of time. The, the getting
50:01
sick and gradually declining is over a longer
50:04
period. Well, that kid who can put their life on hold for two
50:08
weeks to go take care of somebody may not be
50:12
able to do it for six months or a
50:15
year or. Or five years. There's no,
50:19
there's no guarantee the time frame in which this happens. And that's
50:22
where understanding what the contingency plan is going to
50:26
be is so important. And to come back to Carrie's point,
50:30
if you live out of town, going to look at the
50:33
various, whether it's the independent living, assisted
50:37
living places, whether it's figuring out who the community resources
50:41
are, whether it's interviewing companies like us,
50:44
talk is cheap. It does not hurt you to line up all
50:48
of this stuff, understand what's out there, because when
50:52
you are in an emergent situation, it is too late
50:56
to first be scrambling to try and Figure this out. You really want to
51:00
think about it preemptively. Yeah, I really
51:03
appreciate that advice. So, you know, the, the living will is one you
51:07
said, and that, that can go into, you know, what medical
51:11
decisions you want to have made is what I'm understanding. Yes,
51:15
yes. And then just making a, you know,
51:19
because how long it will take in this, in the state of
51:23
not being able to fully care for yourself is a, we don't know
51:27
that timeline. And I feel like that's another just thing that we
51:31
can think about both, you know, my age and,
51:35
you know, boomers can think about that's, you know, they're aging right
51:39
now. So I really like that. I really like that
51:43
idea. And so if you are like listening and you are,
51:46
you know, the boomer who's, you know, you feel fine right now, but you kind
51:50
of are going, maybe I should have some things in place.
51:54
But maybe it's the opposite way where your kids have no desire to talk
51:57
about this. What, what should you do
52:01
if you're the one where you're like, I, I feel like I should just maybe
52:05
have some plans and some things in place. And
52:08
what, what, what ideas would you have for them? If
52:12
you're independent enough, you can go out and
52:16
do this on your own. You do not need to involve your
52:19
kids. I mean, I would tell you that I know
52:24
personally multiple couples,
52:27
multiple individuals who have gone and ferreted out what their
52:31
options were and then said to their kids, this is the
52:35
plan. I think the caveat to that, Sandy,
52:38
is you want to make sure whoever is your durable power of
52:42
attorney, especially for health care, is someone
52:46
that is on board and obviously
52:49
agrees with your wishes. But I agree,
52:52
otherwise, if you are able to, you
52:56
can go out and evaluate all of your options on
53:00
your own. Yeah, I think, I think absolutely, Carrie, you
53:04
have to have their buy in. But the point is you don't need them to
53:06
take you or go with you. It's a two way street, all
53:10
right? And I think that a lot of the time
53:14
it, the kids don't are afraid to bring it up to the
53:17
parents because it makes the kids uncomfortable.
53:21
And so, you know, saying
53:25
out loud, you know, you and I talk about it all the time.
53:29
You know, saying out loud, hey, I know this time is
53:33
going to come. Here's what I'm thinking, here's what I would like,
53:36
here's what the plan should be, is, is a
53:40
two way street of a two way conversation. Right?
53:45
And so you, if you're up to it, you can do the
53:48
research on your own and then present it to your family
53:52
or you can say to your kids, you know, I, I realize
53:57
this is what's happening. I, I think the one thing
54:01
that Carrie said that bothers me a little
54:05
bit. You know, if your mobility is an issue,
54:09
then the $64,000 question in my mind is why
54:13
is your mobility an issue? Is there some underlying process
54:17
here that we can do something about? Hey
54:20
mom, have you been evaluated? Do you need a knee replacement? Do you
54:24
need to go to physical therapy? Is it a function of getting
54:28
you a trainer? Can you do sit and be fit? What are the options
54:32
to deal with your. All right. And I think
54:35
regardless of what medical condition or what the situation
54:39
is, you know, it really boils down to that Serenity Plan
54:43
at prayer rather meaning,
54:47
is this something I could do something about? If so, let's do something
54:51
about it. Is it something that I have no control over?
54:55
Okay, then let's acknowledge I have no control over it and let's put it in
54:58
a plan to compensate for the thing that I have no control over.
55:02
But I think regardless of what the underlying set of
55:06
issues is, the very first question that either you or your family
55:09
member should be asking you is, is there anything about the
55:13
situation that we can change? And
55:16
if so, what is that? And if not,
55:20
then okay, how do we problem solve given
55:24
the circumstances that we have? Yeah. Where it's a two way
55:27
conversation. That's, that's so brilliant. I actually like
55:31
the, the misspeak you did with the Serenity Plan. I
55:35
think, I think maybe you should write a book called A Serenity
55:38
Plan and reference that and because that's that, I mean that kind of
55:42
does boil down to that. Right. If there's, can we do something about this? Then
55:46
what can let's do it. And can we not do something about it? Then let's
55:49
have it in the plan for when that time comes. So, and
55:53
I do think it just, it really does boil down to that,
55:56
that we don't want to talk about. We don't want to talk
56:00
about death, we don't want to acknowledge death. We don't want to acknowledge that that's
56:04
a thing that's going to happen to us all at some point. We certainly don't
56:07
want to think about all that's involved in,
56:11
in it. So you know, this is, it is, you
56:14
know, part of life and so on your way.
56:18
I guess that's the, the Serenity Plan. But not that we, and we don't want
56:22
anyone to go before their time. So how do, how do we stay
56:25
healthy and comfortable and. And,
56:29
you know, as. As we age? And so
56:33
one of the things that I've said for a very long time to
56:37
pretty much every patient I've ever had, but including the ones
56:41
who have been dying, and that is
56:44
nobody controls how long
56:48
you live. The only thing that we control
56:52
is the quality of the life that you have while you
56:56
are living it. And the same thing is true
56:59
even of dying. Dying does not have to be a
57:03
terrible or a scary thing. You can have, you know,
57:07
a good quality death, as crazy as that may sound.
57:11
It's all about how do we help you from
57:15
the moment that you're born until you ultimately die,
57:19
have the best quality of life, regardless of how long that life
57:23
is. That's so beautiful. I'm
57:27
definitely putting that out as a social media clip.
57:32
That part right there, that's actually part of the reason I'm doing this
57:36
podcast, is like, you know, the. The aspect of healthy living from
57:39
cradle to grave. And let's talk about all of it and not,
57:43
you know, get caught up in fear or, you know, anxiety
57:47
or any kind of stigma, shame, whatever that stigma
57:50
is. And, and then also about all the financial thing and how we
57:54
can live a big, beautiful, healthy relationship, healthy
57:58
body life, you know, with. Regardless of things that
58:02
go wrong. Like. And what I appreciate so much about both of you is you
58:05
both have live through stuff. You have a lot. I mean, probably even
58:09
before you live through your. Your medical challenges, you were. Had compassion, because
58:13
you have compassion. And just by listening to you, you know, you have a lot
58:16
of intelligence and wisdom. So it's very helpful to have
58:20
those two things paired together to talk through all these things. And I know you're
58:24
a huge benefit to all of your
58:27
clients for that, for sure. So
58:32
do you have any other kind of in. I know we've been going about an
58:34
hour, so just kind of any thoughts that you have about
58:38
anything else? We haven't talked about
58:41
staying healthy and happy over the holidays, over the winter,
58:45
things we can do, conversations we should have with
58:49
people of different generations. Anything. Anything
58:52
that you can think of along those lines. Everything
58:56
in moderation. That's. That's a good one.
59:00
Everything in moderation. Exercise.
59:03
Exercise. Because most people, not only do we overeat,
59:07
but we tend to do less because it's cold in the sweat, unless you like
59:11
to ski. Right? And so big bad combo.
59:16
The other thought that I'll put out there, that is
59:20
purely a medical thought that I
59:23
spoke about the other day in Hazards of Fall, and that
59:27
is Tylenol
59:31
hangs out in many over the counter
59:34
drugs. Whether you have a headache and you take Tylenol, whether
59:38
you have a cold and you take Dayquil or nyquil,
59:42
Tylenol hangs out in a bunch of over the counter things that you never
59:45
think about. Tylenol can be liver toxic,
59:49
okay? In moderation, less than 4 extra
59:53
strength Tylenol a day, you should be fine unless you have underlying
59:57
liver disease. But Tylenol is liver toxic.
1:00:00
So if you like to drink. And when
1:00:04
I said this the other day, my husband was like, you mean alcohol?
1:00:08
Yes, I mean alcohol.
1:00:12
I was like, what else? What else could I need? And his response,
1:00:16
well, you know, there's like water, there's seltzer, there's.
1:00:20
I'm like, no, I mean alcohol. So, so funny. I love that.
1:00:24
Drink alcohol, right? Alcohol
1:00:27
is also metabolized in the
1:00:31
liver and can be liver toxic. And just
1:00:35
as a news alert, one of the
1:00:38
first liver transplants I saw at UCSF back
1:00:42
in 1989 was a young guy
1:00:46
who had taken Tylenol and drank several
1:00:49
beers and basically needed a liver transplant. Oh,
1:00:53
that's horrifying. And so people drink too
1:00:57
much, they get a headache and they take Tylenol to deal with
1:01:01
their headache and you can kill your liver. So you are
1:01:05
going to drink. Do not take Tylenol, whatever
1:01:08
you do. That's the end of my. That's great
1:01:12
advice. That's super great advice. For
1:01:16
any age. For any advice for any age.
1:01:20
Yeah. 21. 21 and older maybe even
1:01:24
that made. Me remember I did have a specific question. So the durable power of
1:01:28
attorney, is that part of the living will? Yes. Is that included in
1:01:31
that? Okay, get that signed up at the same time. Okay,
1:01:36
I just had that specific question. So now we, now we know.
1:01:39
And there's general durable power of attorney, there's durable
1:01:43
power of attorney that it is specific for
1:01:47
finance, and then there's over health care and you. They don't all
1:01:51
have to be the same person. Okay, and did you
1:01:55
have an ideas on what you would want people to, to sign up for? I
1:01:58
know this is Medicare season too, so are that you would want them to sign
1:02:02
up for, not want them to sign up for. I know I did have someone
1:02:05
on the podcast who talked about all that too. But as doctors,
1:02:10
as a physician, we call Medicare Advantage
1:02:13
Medicare disadvantage. And so you have to understand
1:02:17
why the way in which Medicare Advantage works
1:02:21
is Medicare does not want to administer
1:02:26
Medicare to everybody. So they give private
1:02:29
insurance companies like United Healthcare, Aetna, Humana,
1:02:35
Blue Cross, a certain amount of money per life
1:02:39
to take care of Medicare patients, okay?
1:02:43
So when you sign up for Medicare Advantage, they.
1:02:47
There's often this. Come on. Because they're going to give you
1:02:50
vision and dental and prescription and a
1:02:54
lower premium. So let me start with. There is no such thing as
1:02:58
free lunch. If you are getting a
1:03:02
lower premium and you think you're getting all of these free things,
1:03:07
you should be thinking to yourself, why are they giving me all of these
1:03:10
free things? And Medicare won't give that to me.
1:03:14
It's usually because, number one, there is
1:03:18
a network which means that you have to go to only
1:03:22
a doctor within that network. Okay?
1:03:26
So if you live, for example, in Reno and you sign up
1:03:29
for locally here, for example,
1:03:33
Hometown Health, it's a closed network. So if you go visit
1:03:36
your child in California, in Southern California,
1:03:41
you can only go see a doctor if it's an absolute emergency because
1:03:44
they're not in network. The same way if you're not of Medicare
1:03:48
age and you get an hmo, okay? If you can only
1:03:52
go within your network, it's number one.
1:03:55
Number two, you typically need a prior
1:03:59
authorization and a referral to see any kind of
1:04:02
specialist or to get any kind of test,
1:04:06
okay? If you have plain Medicare, not Medicare
1:04:10
Advantage, you can go to any doctor in the entire United States who takes
1:04:13
Medicare without a referral. So it's what we call an
1:04:17
open network. And
1:04:20
you do not need a prior authorization or a referral. So
1:04:24
if you need an MRI of your knee, you can call up
1:04:28
the orthopedist, go see the orthopedist, the orthopedist can order the MRI
1:04:32
of your knee, and you can just have it done. If you have Medicare, if
1:04:35
you have Medicare Advantage, you're going to have to go to your PCP, who's going
1:04:39
to then refer, if he's willing or she's
1:04:43
willing, refer you to the orthopedist, who then has to jump through the
1:04:47
hoops of proving that you've had X, Y and Z treatment
1:04:50
before they'll approve the MRI of your knee. Why is that?
1:04:54
It's because the arbitrage between what
1:04:58
Medicare pays to a Medicare Advantage plan
1:05:02
and what the Medicare Advantage plan pays to
1:05:05
take care of you is the profit that the Medicare
1:05:09
Advantage plan makes. And there is
1:05:12
no business in the entire United States that is in the business
1:05:16
of losing money. So whether it's Blue Cross, United,
1:05:21
Aetna, it doesn't matter who it is, okay? I promise
1:05:24
you that there is some bean counter who has figured out that
1:05:28
by denying or delaying
1:05:32
your Care that they can save money
1:05:36
relative to what Medicare gave them. And that is why we,
1:05:40
most physicians that you talk to, if not all, will tell you you should stick
1:05:44
with straight Medicare A and B. Medicare A covers
1:05:47
hospitalizations. Medicare B covers
1:05:51
physicians and outpatient treatment. And
1:05:55
basically people are always worried about, oh, you know, with
1:05:58
Medicare, I have no limit. The reality is, is that you have a
1:06:01
$250 deductible. All right? That's what the
1:06:05
Medicare deductible is. And then, yes, you are on the hook
1:06:09
for 20% of what Medicare
1:06:12
allows. So if the doctor charges $500, but
1:06:16
Medicare says that the allowable is 100, the most you
1:06:20
would be out of pocket after your deductible would be
1:06:23
$20. Okay. And so people are
1:06:27
petrified that if they had straight Medicare that they would be exposed to
1:06:30
an unlimited expense defense. That is not the case.
1:06:34
Okay. And you can get a supplement,
1:06:38
Medigap, that will cover that 20%.
1:06:42
So if you are somebody who has significant medical needs,
1:06:46
if you want to be able to go to whatever doctor you want to go
1:06:49
to, if you want to be able to travel, let's say you have kid, one
1:06:52
kid in Wisconsin and one kid in Iowa and one kid here.
1:06:56
And, and you know, maybe you are going to spend three
1:07:00
months in each place with somebody you. Medicare, plain
1:07:03
Medicare is the way to go. Yeah, you are. If you are
1:07:07
healthy and you're an underutilizer, then,
1:07:11
you know, Medicare Advantage may work for
1:07:14
you. The problem. And I'll come back to what we've
1:07:18
been talking about all along. None of us know when we're going to
1:07:22
fall off the cliff, right? I mean, I, I was
1:07:26
an absolutely healthy
1:07:29
61 year old who went for a routine mammogram,
1:07:32
yearly mammogram, had one a year before
1:07:36
that, absolutely nothing, and found to have
1:07:40
this breast mass. All right, no symptoms, non
1:07:44
palpable, minding my own business. You do not
1:07:48
know when you're going to fall off the cliff. So this idea of, you
1:07:51
know, well, I'm healthy, so maybe I don't need this. That
1:07:55
is truly a misconception.
1:07:59
Yeah, I appreciate all that. That's good
1:08:03
advice. Oh, so I appreciate
1:08:06
that so much. Carrie, what, what do you other thoughts do you have
1:08:10
for everyone, especially in this season?
1:08:15
I think that two things. One, I think the holidays are a wonderful
1:08:19
time to be with family. And I know that as I've gotten
1:08:22
older, I've come to realize that all of the stories that
1:08:26
I heard when I was a kid are stories that I have vague
1:08:29
memories of. And so just in terms of really having
1:08:33
an opportunity as an adult to spend time with family,
1:08:37
it's really important to ask your grandparents, ask your
1:08:40
parents to tell stories. It's really good for
1:08:44
them to be able to share those memories with you. But I think
1:08:48
it's also really fulfilling as the younger person to be able to
1:08:52
have an updated
1:08:55
recollection of those stories. So I think that's
1:08:59
really valuable, especially over the holidays and with family
1:09:02
traditions. And then the second thing I think
1:09:06
is relevant to the conversation we had earlier
1:09:10
about durable power of attorneys is something
1:09:13
called a polst. And a POLST is
1:09:17
a medical order. It stands for Provider Order for Life
1:09:20
Sustaining Treatment. And it is a valuable tool
1:09:24
for really every single person
1:09:28
to have because it is a medical order
1:09:31
outlining your wishes. And it is
1:09:35
typically used in emergency situations
1:09:39
when you have an advanced directive, they might be 20
1:09:43
pages long. And in an emergency, you want to get
1:09:46
care as quickly as possible. And so assuming
1:09:50
that you are unresponsive, emergency
1:09:54
response personnel will begin cpr. If that is not
1:09:58
something that you want, then having a POLST is really the only
1:10:01
thing to prevent you from an
1:10:05
attempt at resuscitation. And so I really
1:10:09
encourage everyone that we work with to have a pulse.
1:10:13
I gave a talk a few weeks ago. How do I
1:10:17
apologize for interrupting? How do you spell that? P O, L,
1:10:20
S T. P O, L. A polst..
1:10:24
P O, L, S T. I've never, I've never heard of that. Thank you for
1:10:28
sharing that. When I actually talked to a
1:10:31
mom who had kids in her 20 or kids in their
1:10:35
20s who attended a talk I gave
1:10:39
a few weeks ago. And as soon as the talk was over, she, she
1:10:42
thanked me and said, I'm calling my kids right now and telling them to get
1:10:46
a POLST because they lived out of state and did not have
1:10:50
family who lived near them. And so if they ended
1:10:54
up in the hospital, she wanted to make
1:10:58
sure that providers knew what they wanted, that they wanted
1:11:01
full treatment, that they wanted
1:11:06
everything that could be done. And that is the base assumption. And so if you
1:11:09
are someone who wants everything done,
1:11:13
then it's, it's still equally important. But
1:11:17
that is the base assumption. If you do not want to be
1:11:20
intubated, if you don't want to go to the icu, then
1:11:24
having a POLST will make sure that your
1:11:28
wishes are respected. And so that's why it's so important. And again,
1:11:31
it's not. Instead of an advanced directive or a living
1:11:35
well or a durable power of attorney, it's
1:11:39
a complement to those tools. All right.
1:11:43
And I just want to add one thing to that so that people
1:11:47
are crystal clear. An advance directive. Living
1:11:50
will is what you would like,
1:11:55
number one. Number two, it is usually a document that is
1:11:58
20, 30, 40 pages and it is almost always
1:12:02
buried in somebody's safe in a drawer,
1:12:06
nowhere than anybody can find. If 911
1:12:10
comes, they're not looking all over your house to
1:12:13
see if you have a living will, number one. Number two, follow up
1:12:17
back to to it's just your wishes. It
1:12:21
can say that you don't want this, that and the other thing. But if you're
1:12:25
unresponsive and there is not a POLST on
1:12:28
your refrigerator or easily accessible,
1:12:32
the EMS folks are still going to do a full court
1:12:36
press. A POLST is a signed medical
1:12:40
order by a physician. So it is a legally
1:12:43
binding medical order so that you can actually have
1:12:47
your wishes implemented again. It has to be someplace
1:12:51
that can be easily found. If it's in your draw, nobody's going to
1:12:55
look for it. Right?
1:12:58
Fascinating. All right.
1:13:02
Thank you guys so much for coming on and I'm wishing you a
1:13:06
very happy Thanksgiving and Merry Christmas
1:13:10
and happy holidays, all those things. Even though I will talk to you again, but
1:13:13
for right now.
1:13:18
And we hope you have a great holiday season with your family.
1:13:22
Yeah. Thank you. Well, appreciate you guys
1:13:26
coming on. And
1:13:27
comprehensivehomehealthsolutions.com is
1:13:31
your website. Any other ways you would like people
1:13:34
to reach you if they are needing services
1:13:39
or needing your wisdom or wanting you to talk or anything like that? Because
1:13:43
you give speeches, too, so.
1:13:47
Calling us up is probably the easiest way.
1:13:49
775-624-8939.
1:13:54
You can also find us on Facebook and LinkedIn. And
1:13:57
Carrie will tell you that both of us tend to be available
1:14:01
what seems to be 24 7. So call
1:14:05
us, send us an email, reach out to us on our contact page.
1:14:08
We'll get back to you with whatever answers you need. All right.
1:14:12
Thank you so much. Thank you. Did you
1:14:16
like that? You can watch more episodes here. Subscribe over here. We
1:14:20
actually have new episodes with awesome guests every Thursday,
1:14:24
so check back in. Is that all.