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When Planning Gets Personal - When Care Comes Home · The Tyler Show

• 0:05
  SPEAKER_02: Welcome to the Tyler Show.
• 0:06
  SPEAKER_02: I'm your host, Tyler Dahan, and we have in studio with us actually my neighbor, Kelly Peterson.
• 0:13
  SPEAKER_00: I'm so lucky.
• 0:16
  SPEAKER_02: I hope my wife is listening to this.
• 0:18
  SPEAKER_02: So, but it it's great to have you.
• 0:20
  SPEAKER_02: And thank you for taking time out of your day to come and talk to us.
• 0:22
  SPEAKER_02: And Kelly, you are a home healthcare nurse, and this really ties in well with what we've been talking about here around our topic and our theme, which is when planning becomes personal.
• 0:37
  SPEAKER_02: And one of the things that I've noticed in my 20-plus year career here in the financial services industry is that often people get really excited about the latest stock tip, uh, the the newest money manager, the asset class that's that's at 30% year to date, the income strategies that help them maintain their lifestyle through retirement.
• 1:01
  SPEAKER_02: But often they forget to talk about some of these very important aspects of life.
• 1:08
  SPEAKER_02: And it's it's not always an easy conversation.
• 1:10
  SPEAKER_02: And being a home healthcare nurse, we certainly thought it'd be great to have you come in and talk to us a little bit about what you see on a daily basis, things that we need to be aware of as a uh whether it's a caregiver, uh, whether it's somebody that's getting close to this time of of maybe needing home health care.
• 1:28
  SPEAKER_02: So we just certainly appreciate you coming in and and talking to us and giving us some of your expertise here today.
• 1:33
  SPEAKER_00: Yeah, well, thanks for coming over a few weeks ago and asking me to do this.
• 1:37
  SPEAKER_00: I appreciate it.
• 1:38
  SPEAKER_00: Because the truth is, honestly, a lot of people don't really have an idea of what their life could look like in a matter of moments if something goes wrong.
• 1:52
  SPEAKER_00: And most of the time people haven't planned for it or have even had a discussion with their family or their spouse about what it is that they want and what help they may need and all the things that go into just being able to care for each other in the home before having to maybe go somewhere else.
• 2:11
  SPEAKER_00: Yeah.
• 2:12
  SPEAKER_02: Yeah.
• 2:12
  SPEAKER_02: Well, before we get into all that, tell us a little bit about yourself.
• 2:17
  SPEAKER_02: Tell the audience a little bit about Kelly Peterson.
• 2:19
  SPEAKER_02: What makes Kelly Peterson tick?
• 2:21
  SPEAKER_00: Well, I've been doing, I've been a nurse now for about 16-ish years.
• 2:27
  SPEAKER_00: I've been doing home health for 11, almost 12.
• 2:30
  SPEAKER_00: And prior to home health, I was a travel nurse.
• 2:34
  SPEAKER_00: I got into nursing, um, honestly, I always said I would never be a nurse because I didn't want to do 12-hour shifts and miss kids' soccer games and baseball games and miss the things on the weekend.
• 2:47
  SPEAKER_00: Um, but travel nursing really allowed me to explore the country and get paid for it.
• 2:54
  SPEAKER_00: And when we decided to come back to Iowa and settle down, I had a lot of stress thinking about going back to the hospital and not making travel nurse pay.
• 3:05
  SPEAKER_00: So I didn't know what my options were.
• 3:08
  SPEAKER_00: And the great thing about nursing is there's so many options, so many different categories of nursing that you can do.
• 3:16
  SPEAKER_00: So I had a girlfriend actually that I went to school with, and she told me about home health and ended up landing a job.
• 3:23
  SPEAKER_00: And I've been with Unity Point at home now for almost 12 years.
• 3:27
  SPEAKER_02: Let's get into the details here.
• 3:28
  SPEAKER_02: So for somebody that is thinking, okay, home health care, how do people get enrolled in home health care?
• 3:38
  SPEAKER_02: I mean, is it a situation where they have to have a health event?
• 3:41
  SPEAKER_02: Is it a situation where maybe it's a doctor's recommended recommendation?
• 3:46
  SPEAKER_02: Is it a physical, like how how does how do people get referred to you and how do they get put into home health care?
• 3:54
  SPEAKER_00: Most of our admissions, most of them do come from the hospital.
• 3:58
  SPEAKER_00: Okay.
• 3:59
  SPEAKER_00: So it's whether someone fell at home and they ended up into the hospital, or even they could have gone to the ER and then they followed up with their primary doctor, and the primary doc said, you know what, I think you could benefit from home health for a little while.
• 4:13
  SPEAKER_00: So a lot of it is hospital referrals.
• 4:16
  SPEAKER_00: Um, we do get primary care referrals, and sometimes too, people say they went to the hospital, they were there for uh two or three weeks, and then they ended up going to a skilled facility, a skilled nursing facility to get stronger for five weeks that Medicare will pay for.
• 4:33
  SPEAKER_00: Well, at the end of that five weeks, if they're still needing a little bit of assistance, then we can also get those people from skilled nursing facilities that are coming back home.
• 4:42
  SPEAKER_02: Okay.
• 4:43
  SPEAKER_02: Yeah.
• 4:43
  SPEAKER_02: Okay.
• 4:44
  SPEAKER_02: So when you think about home health care, when people think about home health care, what are some of the biggest misconceptions that people have when they enter into home health care that you see as a as a nurse?
• 4:57
  SPEAKER_00: The most there are the biggest misconception that I see on a weekly basis is usually people anytime someone says home care, it just the wording itself can be misconstruing because they think home care, okay, well, I'm gonna have a nurse or I'm gonna have a bath aide come in and they're gonna see me for however long I need them to, whether that is six weeks or six years, I'm always gonna have someone here.
• 5:27
  SPEAKER_00: That's not the case, unfortunately.
• 5:29
  SPEAKER_00: So home care is short term.
• 5:32
  SPEAKER_00: And uh once we are done, once those patients meet those goals, then we discharge them.
• 5:38
  SPEAKER_00: So I think it's it's kind of confusing because they do think that we're there to help them in their home, not just medically, but a lot of people also think, okay, well, I need help making my bed, I need someone to help with my meals, I need someone to help me um go take me to a doctor appointment, um, those types of things.
• 6:00
  SPEAKER_00: Those are more homemaking services that home care does not provide.
• 6:04
  SPEAKER_00: So we end up referring those people to outside resources.
• 6:10
  SPEAKER_02: And that's one of the things I think, you know, be having people that I know that have gone through home health care.
• 6:15
  SPEAKER_02: I think that was one of the things that I think initially people are like, well, you're going, you're gonna you're gonna make sure that all my medication's uh where it's supposed to be, right?
• 6:23
  SPEAKER_02: And you're going to make sure that you're gonna help me get dressed and you're gonna be here to maybe do some laundry.
• 6:29
  SPEAKER_02: And I think that's one of the things like when people think about home health care, well, home health care is not necessarily coming in and and doing daily activities of daily living, correct?
• 6:40
  SPEAKER_02: I mean, it's it's you're going in there, you have you have a medical purpose that you're there for, and maybe there is some overlap, but they're not you're not taking them to their doctor's appointment.
• 6:50
  SPEAKER_00: No, we're not taking them to their doctor's appointments.
• 6:52
  SPEAKER_00: But when it comes to like activities of daily living, that's when we say, okay, if a nurse was the only person who was ordered to see this patient, and say on my admission that I notice, okay, this patient is really not stable walking with their walker, or they are having trouble getting in and out of bed, or they can't get in and out of the shower safely.
• 7:16
  SPEAKER_00: That's when I say, okay, well, I think you could benefit from physical therapy, some occupational therapy, and they will come in and assist you with teaching you how to safely do these activities of daily living.
• 7:31
  SPEAKER_00: And then physical therapy can give um, we give exercises to do that they can do on their own when physical therapy is not there, because PT's only there usually for two times a week.
• 7:43
  SPEAKER_00: So it's really up to the patients and the caregivers to continue the care that and education that we provide when we're not there.
• 7:53
  SPEAKER_02: Okay, gotcha, gotcha.
• 7:55
  SPEAKER_02: So one of the things that I I want to ask you is I remember, uh course, this was 20-some years ago when my grandparents started kind of aging out, and they would have been in their low 80s, mid-80s, and I remember my grandpa and grandma Dahan, who lived in Osceola, which is just 40 minutes here south of south of Des Moines, and they put in a ramp for my grandfather because he had a wheelchair and started doing some things around the house and and prepping for some of his uh future needs.
• 8:27
  SPEAKER_02: I and I and I've asked this to a couple of other guests is what so somebody that is maybe a potential future caregiver or somebody that might need in-home health care at some point in time in the future, what are some of the things that they can do to prep for that?
• 8:44
  SPEAKER_02: Whether that's something in their house, some uh maybe it even maybe even is even mentally prepared.
• 8:49
  SPEAKER_02: Like what are the some of the things that you you would suggest in for for somebody like that?
• 8:54
  SPEAKER_00: I would definitely say having a conversation, first off, having a conversation with the spouse and also having a conversation with the children or other family members who are involved in care and having things in order as in like a durable power of attorney.
• 9:14
  SPEAKER_00: Um, who's gonna make decisions if dad falls down the stairs and now maybe he's not able to swallow anymore?
• 9:24
  SPEAKER_00: Is he gonna get a peg tube?
• 9:26
  SPEAKER_00: Does he want a peg tube?
• 9:27
  SPEAKER_00: Like how what types of things um I guess at this point in time, what types of things could happen that we need to prepare for?
• 9:40
  SPEAKER_00: Um, who's gonna manage their medications?
• 9:43
  SPEAKER_00: Do we need to get talked to the pharmacy and talk about bubble packs?
• 9:47
  SPEAKER_00: There are electronic medication machines that will dispense meds at certain times.
• 9:53
  SPEAKER_00: If I have a mom or a grandma that cognitively doesn't really remember, did I take my meds this morning?
• 10:00
  SPEAKER_02: Sure.
• 10:00
  SPEAKER_00: That type of thing.
• 10:02
  SPEAKER_00: Um, but having the conversation, I think the biggest thing is having the conversation with family and friends because sometimes those conversations do talk about things that aren't happy.
• 10:14
  SPEAKER_00: And the last thing you want is to have those conversations during a stressful time.
• 10:20
  SPEAKER_00: So having a plan in place is the most important thing when stress is low.
• 10:26
  SPEAKER_02: Yeah, I I I 100% agree with that.
• 10:29
  SPEAKER_02: I mean, even when I've seen people dealing with estates or any type of money when when stress is high, anxiety is high, yeah, you kind of revert back to your your natural inclinations.
• 10:43
  SPEAKER_02: And sometimes those are good and sometimes sometimes they're not good.
• 10:47
  SPEAKER_00: You just never know who you're gonna be dealing with.
• 10:49
  SPEAKER_00: And and if you're not close to a family member, say you a lot of patients I've had, they have children who don't even live in the state.
• 10:58
  SPEAKER_01: Yeah.
• 10:58
  SPEAKER_00: So you do have some maybe um a child who lives in the state and then another child who lives somewhere else, and those two children don't get along.
• 11:07
  SPEAKER_00: So, but they've never had a conversation about okay, this is what mom wants if something were to happen.
• 11:15
  SPEAKER_00: And I know it because we've had the conversation.
• 11:17
  SPEAKER_00: It's in a legal document.
• 11:19
  SPEAKER_00: This is who's in charge, because that can cause a lot of conflict on top of the stress of having a health issue or a health concern.
• 11:27
  SPEAKER_02: Sure, sure.
• 11:28
  SPEAKER_02: So let's let's talk about like the the caregiving aspect.
• 11:32
  SPEAKER_02: So this might be a grandchild, it might be uh, as you mentioned, uh a child, uh, it might be even a parent.
• 11:40
  SPEAKER_02: Uh, it could even be maybe a niece or a nephew, or maybe just uh a neighbor.
• 11:45
  SPEAKER_02: So as a you know, home in home healthcare nurse, what are some of the things that these caregivers can do to help you when you're going in and doing your procedures and and doing your medical whatever's required for for you?
• 12:00
  SPEAKER_02: What are some of the things these caregivers can do to make make this easier?
• 12:05
  SPEAKER_00: The best thing is just knowing who they are taking care of.
• 12:10
  SPEAKER_00: Um if I come in and I say, okay, well, your your blood pressure today is 104 over 68, is that normal for you to have a lower blood pressure?
• 12:22
  SPEAKER_00: I can't tell you how many times people have been like, I don't know.
• 12:26
  SPEAKER_00: Well, it's really helpful for any medical professional to know what is your baseline, what is normal for you.
• 12:32
  SPEAKER_01: Sure.
• 12:33
  SPEAKER_00: Um, so the caregiver knowing what's normal.
• 12:36
  SPEAKER_00: Um is the patient that I'm talking to not remembering uh what they had for breakfast, is that normal for them?
• 12:47
  SPEAKER_00: Um is there any changes since the last time we saw this patient?
• 12:51
  SPEAKER_00: Was there a fall?
• 12:52
  SPEAKER_00: Did they have a doctor appointment?
• 12:54
  SPEAKER_00: If they did, were there any changes to medications?
• 12:58
  SPEAKER_00: We all need to know all of that stuff because if there's changes to medications, then I can educate on, okay, well, maybe this med was added, so you might want to look out for these side effects.
• 13:11
  SPEAKER_02: Sure.
• 13:11
  SPEAKER_02: Yeah.
• 13:12
  SPEAKER_00: So it's just pretty much giving us an update between visits, knowing what the patient's baseline medical health is, and um just keeping us updated in between visits.
• 13:26
  SPEAKER_02: And just just like that kind of piqued a question is how often are those visits?
• 13:32
  SPEAKER_02: Are they are they weekly, monthly?
• 13:34
  SPEAKER_02: Good.
• 13:35
  SPEAKER_02: How long can you go out and still be in quote unquote the program?
• 13:41
  SPEAKER_00: Right.
• 13:42
  SPEAKER_00: So actually we've had patients.
• 13:44
  SPEAKER_00: I actually have a patient right now that I've seen for like six years because um everyone's needs are different.
• 13:51
  SPEAKER_00: So anytime we go in and sign someone up with home care, they we always sign them up for eight weeks.
• 14:00
  SPEAKER_00: Um the I would say the insurance allows for eight weeks.
• 14:03
  SPEAKER_00: Whether we see them the whole eight weeks or not depends on are they meeting their goals?
• 14:09
  SPEAKER_00: Do they have any more needs that we're not addressing?
• 14:12
  SPEAKER_00: Um, if we can teach and educate, you know, did someone have a wound?
• 14:17
  SPEAKER_00: If they did, if it's healed within three weeks and they don't need anything else, then okay, great, let's discharge and you're doing well.
• 14:26
  SPEAKER_00: Um, at the end of those eight weeks, then we reassess does this patient still have skilled needs, skilled need being something that um is more complex, more education.
• 14:40
  SPEAKER_00: Is it a complicated wound that insurance will say, yes, we agree this patient does need more home care.
• 14:48
  SPEAKER_00: So if they do, then we sign them up for more time.
• 14:53
  SPEAKER_00: But every eight weeks we reassess if we have someone with us.
• 14:58
  SPEAKER_00: Um, some people just need to be seen once a month for a catheter change.
• 15:03
  SPEAKER_00: Some patients are three times a week because they have a wound that has to be addressed.
• 15:07
  SPEAKER_00: Some people are once a week because it's maybe just like a pick line with some labs that need to be sent in.
• 15:15
  SPEAKER_00: Okay.
• 15:16
  SPEAKER_00: So everyone's a little bit different.
• 15:18
  SPEAKER_00: Um, some people are every two weeks for a catheter change.
• 15:22
  SPEAKER_00: So you just every patient's different.
• 15:24
  SPEAKER_02: All over the board.
• 15:25
  SPEAKER_00: All over the board.
• 15:26
  SPEAKER_02: So if you are a caregiver and you're working with a caregiver and they just have questions on anything regarding home health care or resources, anything like that, where would you direct them to?
• 15:38
  SPEAKER_02: Like if there's any, is there any public resources that you're aware of?
• 15:42
  SPEAKER_02: Um anybody locally, like any community organizations or anything like that that can that can help a caregiver out as far as anything around home health care, what what type of resources would you would you push people to?
• 15:56
  SPEAKER_00: I that's the hardest part.
• 15:58
  SPEAKER_00: And I think as a healthcare professional is one of the most frustrating things because a lot of times if we have a patient who maybe needs some homemaking services, um, their spouse is the caregiver 24-7, but they need someone to come in and watch this patient so they can go get groceries and have some respite time for themselves.
• 16:25
  SPEAKER_00: A lot of that stuff is private pay, which is frustrating because as a healthcare professional, I think to myself, okay, if I was taking care of someone and I need to take care of myself too in order to take care of them, I would think insurance would pay for that, but that's not always the case.
• 16:45
  SPEAKER_00: So we usually call in the social worker, and the social worker is the one who will provide a list of community resources.
• 16:53
  SPEAKER_00: Um they can get them signed up for um some elderly waivers that might help financially.
• 17:00
  SPEAKER_00: Um they can give them a list of private pay agencies that can come into the home and assist.
• 17:06
  SPEAKER_00: Okay.
• 17:06
  SPEAKER_00: So usually we call in the social worker to help with that aspect of things.
• 17:11
  SPEAKER_02: So one of the things that we've been doing here, and and people have heard me on the podcast talk a lot about as far as like, you know, med, you know, knowing what the baseline medical uh numbers are, your blood pressure and all that.
• 17:21
  SPEAKER_02: We have these things called in case of emergency booklets that uh, you know, basically talk about, hey, you know, when when were your flu shots, your vaccinations, that that was the first, you know, right there.
• 17:31
  SPEAKER_02: So I, you know, I think that's one of the things that we we try to provide for people is like, hey, write these things down because you know you never know when somebody's gonna slip and fall.
• 17:40
  SPEAKER_02: I mean, I I could I could slip and fall down the stairs tonight and may need home healthcare services uh, you know, tomorrow if if that's the case.
• 17:48
  SPEAKER_02: And so I'm I'm not quite sure Stacy knows what my blood pressure baseline is.
• 17:53
  SPEAKER_00: But if you know it, that's great.
• 17:55
  SPEAKER_00: Yeah.
• 17:55
  SPEAKER_00: I mean, the and I think that's also the thing that's uh kind of enlightening or eye-opening for myself is just how many patients themselves don't know what their normal heart rate is, their normal blood pressure, what is typical for them when they go to the doctor's office.
• 18:13
  SPEAKER_01: Yeah.
• 18:13
  SPEAKER_00: You would be surprised at how many people have no clue what it is.
• 18:17
  SPEAKER_00: And that can be frustrating.
• 18:19
  SPEAKER_02: Yeah, yeah.
• 18:20
  SPEAKER_02: Yeah.
• 18:20
  SPEAKER_02: And that's one of the things we try to do here.
• 18:21
  SPEAKER_02: And we have a another thing too, is a is a 27-point care caregiving document list that is is also available.
• 18:28
  SPEAKER_02: So I'll I'm gonna show these up if you're if you're on Apple Podcasts or Spotify, you can you can kind of see right there that though those are the those are the documents that we have here at Salmons.
• 18:36
  SPEAKER_02: And so if you're interested in that and you're a financial professional, you can reach out to your local uh whole salmon's or Midland wholesaler and they can get you in contact with some of that stuff.
• 18:45
  SPEAKER_02: But I I I've I've shared that this this helps with the communication because you're writing this down and you're sharing it with your spouse or child or grandchild or whoever happens to be.
• 18:54
  SPEAKER_02: And yeah, I think that's been the overall theme that we've heard from a lot of the people that have come on the show is that communication, communication, communication is is really, really important.
• 19:04
  SPEAKER_02: So um, Kelly, as we've wrapped up our time here, we've we've been talking for about 20, 25 minutes.
• 19:10
  SPEAKER_02: So is there anything else for the audience that comes to mind that you would like them to know about home health care, anything that they should be aware of that maybe I didn't ask or that just comes to top of mind that you might want to share with them?
• 19:24
  SPEAKER_00: So for home health care, I think it's not just people who have an actual procedure that needs to be done, whether it's wound care or labs or anything like that.
• 19:37
  SPEAKER_00: A lot of times, too, a lot of our job as a nurse with home care, physical therapy, occupational therapy, a 90% of our job is education.
• 19:49
  SPEAKER_00: And even if someone gets a new diagnosis and they're just not really sure, for example, it could be diabetes.
• 19:57
  SPEAKER_00: Someone gets a new diagnosis of diabetes.
• 20:00
  SPEAKER_00: And if they're at home and they're their spouse and they're just having a really hard time figuring out what is working for them or how to give insulin or what should my numbers be, it's okay to go to your primary doctor and say, hey, you know, I'm really not understanding the um insulin dosages.
• 20:21
  SPEAKER_00: I don't understand what type of diet I should be on.
• 20:24
  SPEAKER_00: Can I get home health for a little while to have some education?
• 20:28
  SPEAKER_00: So it's okay to go to your primary and ask them for home health if you're needing more education regarding something that's going on.
• 20:36
  SPEAKER_02: That's interesting.
• 20:37
  SPEAKER_02: So, you know, if you have a new diagnosis and you're struggling with it, you can go back to the primary doctor and say, Hey, I need somebody to come in and kind of walk me through this.
• 20:45
  SPEAKER_02: Home health care can come in and kind of do that.
• 20:47
  SPEAKER_02: Right.
• 20:48
  SPEAKER_00: We need some more support and some more education.
• 20:50
  SPEAKER_00: And absolutely, yeah, we can come in and do that.
• 20:53
  SPEAKER_02: One last question that kind of popped in my head because we talked about entering the healthcare, you know, home healthcare system.
• 20:58
  SPEAKER_02: And for somebody, how do how do people exit?
• 21:02
  SPEAKER_02: So, what what what's typically the procedures?
• 21:04
  SPEAKER_02: And I'm sure like some of it might be going to hospice, some of it might be to assisted living, some of it might be where you just don't need the healthcare anymore and you're done.
• 21:12
  SPEAKER_02: You you'd mentioned that eight-week cycle, but just kind of can you just walk through like what's that exit process look like?
• 21:19
  SPEAKER_00: As long as what they were ordered for, if someone comes in with again, diabetes, if the order for home health is for diabetes education, as long as we are documenting and showing that prog progression of okay, we taught about uh when to check your blood sugars, and then that's all logged.
• 21:40
  SPEAKER_00: And the next visit we'll talk about um diet.
• 21:44
  SPEAKER_00: It's getting giving the education, checking off our goals, making sure the patient understands.
• 21:52
  SPEAKER_00: And as long as all of our goals have been met, all of the education has been given, they are healthy and stable enough that they can make their own decisions, they can call the doctor, they know what red flags to look out for.
• 22:06
  SPEAKER_00: That would prompt them to call the doctor's office.
• 22:10
  SPEAKER_00: Okay, so they don't end up back in the hospital.
• 22:12
  SPEAKER_00: So those would be more of the exit strategies, making sure that all the education's given, they know what to keep an eye out for, and they're good with um discharge, and we go ahead and discharge them.
• 22:23
  SPEAKER_02: Awesome.
• 22:24
  SPEAKER_02: Awesome.
• 22:24
  SPEAKER_02: Well, Kelly, I certainly appreciate you coming in and sharing with us a little bit about uh what you do every single day and sharing your expertise.
• 22:32
  SPEAKER_02: And it, you know, I I think again, this is this all goes back to you know communication.
• 22:37
  SPEAKER_02: It goes back to having these conversations that aren't always exciting to have, right?
• 22:42
  SPEAKER_02: But are but are critical.
• 22:43
  SPEAKER_02: And and uh we just appreciate you uh taking your time to come in and and s and speak with us here today.
• 22:48
  SPEAKER_00: Well, thanks for having me.
• 22:49
  SPEAKER_00: I appreciate it.
• 22:50
  SPEAKER_02: Yeah.
• 22:51
  SPEAKER_02: So for the audience, we certainly appreciate your support here for the Salmons Institutional Group.
• 22:57
  SPEAKER_02: For the Tyler Show, I'm Tyler Dehan.
• 23:00
  SPEAKER_02: Until next time.