0:05

Start having the

0:05

conversation about what are your

0:08

wishes, so some stranger doesn't

0:08

make it for you. And yes, we all

0:13

want to age in place in our own

0:13

homes. But wouldn't it be nice

0:18

if you found a place that looks

0:18

nice? No way off could be 5, 10,

0:23

20 years off, just in case you

0:23

have the peace of mind knowing

0:26

I've made a decision. This is

0:26

where I'd want to be here if I

0:29

need it. I can look without a

0:29

deposit. And I don't have to

0:33

worry. And that's gives peace of

0:33

mind only to the person who

0:37

would end up there but also the

0:37

family.

0:42

Welcome to Now

0:42

or Never Long-Term Care Strategy

0:45

making. themselves. with Kosta

0:45

Yepifantsev a podcast for all

0:47

those seeking answers and

0:47

solutions in the long term care

0:51

space. This podcast is designed

0:51

to create resources, start

0:55

conversations and bring

0:55

awareness to the industry that

0:58

will inevitably impact all

0:58

Americans. Here's your host

1:02

Kosta Yepifantsev.

1:04

Hey, y'all,

1:04

it's Kosta. Today I'm here with

1:06

my guest Bill Cohen, caregiver

1:06

support group leader, educator

1:11

and speaker in Alzheimer's

1:11

Association volunteer and

1:14

advocate, certified senior

1:14

advisor and the owner of Cohen

1:18

caregiving support consultants,

1:18

LLC. Today we're talking about

1:22

your step by step guide to

1:22

creating a successful care plan.

1:26

Bill, your journey as a

1:26

caregiver for your mother has

1:29

led you to become a certified

1:29

senior advisor and caregiving

1:33

support consultant. Could you

1:33

briefly share with our listeners

1:37

what led you to this path and

1:37

how your experience shaped the

1:41

advice you give to others?

1:42

great honor to be

1:42

here today. Your cost is low

1:45

compared to our conversation.

1:45

Absolutely. So as I like to say,

1:48

if you were told me about 1819

1:48

years ago, what was going to

1:52

transpire? And I'd be sitting

1:52

here talking to you today I'd

1:55

say no way crazy. Just an

1:55

incredible scenario. To make a

2:01

very long story short, my mom

2:01

used to live in Biloxi,

2:05

Mississippi, and NACA, they're

2:05

going winnowing the deer living

2:08

in Portland, Oregon. But she was

2:08

showing some signs that cause

2:14

concern, agitation, paranoia,

2:14

not take care of the house, I'll

2:19

take care of the finances. And

2:19

we wondered, okay, she's taken

2:22

care of my late stepfather. He

2:22

was on hospice on and off. Was

2:26

she just getting older,

2:26

stressed, tired? What have you.

2:32

And unfortunately, we didn't get

2:32

a chance to find out if he

2:35

passed away or went to do care

2:35

community if she would bounce

2:38

back. What happened on the Gulf

2:38

Coast in New Orleans in August

2:42

2005. Katrina, Katrina, exactly.

2:42

The house they have lived in for

2:49

almost 30 years, was completely

2:49

swept away in the storm surge.

2:54

She had safely evacuated, but

2:54

she came back fully expecting to

2:58

see that house still there

2:58

because it had survived many

3:02

other storms. Needless to say,

3:02

the trauma is seeing her house

3:06

gone. And everything in it.

3:06

Accelerated exacerbated.

3:12

Whatever was coming on with her

3:12

later, it became obvious who has

3:16

Alzheimer's. I go into the long

3:16

term caregiving mode. Do cross

3:21

country travel by holding down a

3:21

full time job, start attending a

3:25

support group. Start talking to

3:25

a care community of Southwest

3:29

Portland. And like I said making

3:29

the trips first she was with

3:33

other family in North Carolina

3:33

than Delray Beach and move her

3:37

out to Oregon. In 2008. She was

3:37

less than a year as we expected

3:43

in the assisted living side of

3:43

the wonderful nonprofit faith

3:47

based community. And then she

3:47

was four years in memory care.

3:52

Okay, he passed away from

3:52

Alzheimer's 10 years ago at the

3:56

age of 83.

3:58

Did you did

3:58

you have a care plan in place

4:01

when all of this was happening?

4:03

Oh, no, no, no, no,

4:03

no. Okay, what was in place what

4:07

was starting to happen was I had

4:07

taken to a doctor, we did get

4:12

her on some of the medications

4:12

that were available, and treat

4:16

her for like, anxiety and that

4:16

type of we had talked about

4:22

maybe then moving into a care

4:22

community. We had got me on some

4:28

of the financial documents

4:28

later, I became POA, Advanced

4:32

Directive, things like that, but

4:32

I'm not much different than

4:34

anybody else. It sometimes it

4:34

takes in event, not a hurricane,

4:39

but something that puts things

4:39

into action. Unfortunately, too

4:44

many of us too many people react

4:44

in a crisis rather than being

4:48

proactive and planning like we

4:48

would all prefer. And of course,

4:54

if you react in a crisis crisis,

4:54

you have fewer options. You're

4:58

acting emotionally and distress,

4:58

not the optimal situation.

5:03

So, Bill, so

5:03

much of your advocacy and work

5:07

is centered around the

5:07

importance of having a care plan

5:09

in place, especially for those

5:09

dealing with dementia or

5:12

Alzheimer's. Can you break down

5:12

for our listeners, the first

5:17

step they should take when

5:17

creating such a plan?

5:20

First thing is, no

5:20

matter what age you should have

5:24

your legal documents in place,

5:24

you should have your Will you

5:27

should have your power of

5:27

attorney trusts if applicable,

5:29

your Advanced Directive later in

5:29

life that the pulsed that

5:33

physician's orders. The other

5:33

things are, if you have any

5:37

concerns, or you're thinking

5:37

ahead, have those conversations.

5:43

Mom, Dad, what would you like to

5:43

have happen? Or if you're seeing

5:46

concern, talk to your other

5:46

family members, hey, we need to

5:49

talk. We need to have a

5:49

conversation about what's going

5:53

to happen because there's

5:53

concern about age dementia,

5:57

frailty, whatever, there's so

5:57

many steps that need to be

6:01

taken, and frequently and too

6:01

often are not being done. And

6:06

that includes the what ifs, we

6:06

all want to be aging in place

6:11

our own homes. That would be

6:11

nice. And actually most people

6:15

do. Right. And it used to be as

6:15

we know, that it was more multi

6:20

generational extended family

6:20

taking care of each other on our

6:24

own homes. That doesn't happen

6:24

as much. We're all spread out

6:27

all over the place. Yes, certain

6:27

cultures still maintain that.

6:31

Right. But Americans in general

6:31

do not. We're all over the

6:36

place.

6:36

And it? Well

6:36

it is it is actually really

6:38

interesting, because the current

6:38

statistics is that 84% of

6:43

Americans want to age in place.

6:43

And what that statistic fails to

6:47

mention is they age in place,

6:47

Intel, they can't. So there is a

6:53

period of time towards end of

6:53

life for about two years where

6:57

typically they are two to three

6:57

years where they typically have

6:59

to go to a facility once their

6:59

disability gets to a certain

7:03

degree. And and as you're

7:03

talking about these advanced

7:07

directives, these legal

7:07

documents that you have in

7:10

place, when you started this

7:10

process, and you're going to

7:16

your mom's doctor, for example,

7:16

you know, something as simple as

7:20

just getting a diagnosis or

7:20

getting information on her

7:23

diagnosis. Right, right. So

7:23

like, when you don't have those

7:28

legal documents in place? How do

7:28

you even begin to navigate

7:33

providing care for a loved one?

7:33

Because it seems like all doors

7:37

are closed until they're there?

7:37

Right, right. We

7:39

heard that and HIPAA

7:39

and so many of your finger. So,

7:42

and many family members will

7:42

say, Well, you're not getting

7:47

into my stuff, I'm fine. I will

7:47

make my own decisions. I'm going

7:52

to maintain my independence as

7:52

long as possible. And I'm sure

7:54

you've heard it, we all many of

7:54

us have industry or otherwise.

7:59

Oh, I'm going out of here, feet

7:59

first down need a plan. Right.

8:03

Right. So we do face that. But

8:03

what I tried to talk to families

8:09

about is start having the

8:09

conversation about what are your

8:15

wishes, so some stranger doesn't

8:15

make it for you? And yes, we all

8:20

want to age in place in our own

8:20

homes. But how about some what

8:26

ifs? What if you have a fall,

8:26

something like that, or some

8:31

other incident, and at least

8:31

temporarily, have to go into a

8:36

facility to convalesce to

8:36

rehabilitate, and then you can

8:40

probably come along, but we want

8:40

to have that plan in place. Or

8:44

once you do come the home, who

8:44

will come in to take care of

8:47

you. For the time being I living

8:47

1000s of miles away. I can't do

8:52

it. But let's have somebody on

8:52

hand ready to go in case that

8:56

happens. And on the same level.

8:56

And by the way, I do this not

9:00

just here in the Pacific

9:00

Northwest. I work I collaborate

9:03

with professionals all over the

9:03

country. We just talked about.

9:08

One of them is Jenny Kundera's

9:08

with Premier living solutions.

9:11

And while it's just that

9:11

example, a clever those people

9:15

all over it and I tell people,

9:15

okay, sure you're not ready to

9:18

go into independent living or

9:18

assisted living or memory care

9:23

or adult care home or

9:23

residential care facility. But

9:28

wouldn't it be nice if you found

9:28

a place that looks nice. Now,

9:32

way off could be 510 20 years

9:32

off just in case, just in case

9:36

you have the peace of mind

9:36

knowing I've made a decision.

9:39

This is where I'd want to be if

9:39

I need it. I can look put down a

9:43

deposit and I don't have to

9:43

worry. And that's gives peace of

9:47

mind only to the person who

9:47

would end up there but also the

9:50

family, especially the adult

9:50

soldier, if there aren't

9:54

right and

9:54

that's a great point. I want to

9:57

before we talk about the

9:57

referrals and sort of the net

10:00

work that you've been able to

10:00

build, I think listeners should

10:03

know that a lot of the services

10:03

and the majority of services

10:07

when it comes to long term care

10:07

are paid for by Medicaid, and

10:12

the financial documents that you

10:12

were talking about at the

10:16

beginning, that making sure that

10:16

you have those elements care

10:21

taken care of is because there's

10:21

a lot of services that you can't

10:25

either afford, or generally

10:25

access without having been

10:31

qualified for some Medicaid

10:31

program within your state. And

10:35

so you offer a support plan that

10:35

includes referrals to vetted

10:39

service providers and

10:39

professionals. How can our

10:42

listeners ensure they're

10:42

choosing the right service? The

10:47

right service providers for

10:47

their specific needs?

10:50

That's a great

10:50

question. And I want to go back

10:53

to when I was first started with

10:53

my mom, because back in the mid

10:56

2000s, how did you find

10:56

resources? One, you come from

11:02

the doctor I just mentioned, if

11:02

you get a diagnosis, but then

11:06

they say, well, basically keep

11:06

them safe, keep them out of

11:09

pain, that type of thing. And,

11:09

and it hasn't changed much. Good

11:14

luck. Right? Word, where do I go

11:14

from here? Where's the treatment

11:20

plan? Where's the care plan?

11:20

Where are the resources? And I

11:23

found that sorely lacking? There

11:23

are directories? There's so much

11:27

more on the internet today? That

11:27

was not available back then.

11:31

However, as you asked more than

11:31

a rhetorical question, how do

11:35

you find good vetted people? So

11:35

I have since I started my

11:40

business is that get to know the

11:40

professionals in my area, and

11:48

when necessary, out of the area,

11:48

that they're going to do a good

11:52

job for him, they're going to be

11:52

giving that holistic approach.

11:56

That broad perspective, many of

11:56

them are certified senior

12:00

advisors like myself, and I know

12:00

that they are looking out for

12:05

our most vulnerable population.

12:06

How do you become a certified Senior Advisor? I'm just curious.

12:10

That's a great

12:10

question. There is the Society

12:13

of certified senior advisors in

12:13

Colorado. And their course can I

12:19

believe they can do it in

12:19

person. Again, I took it online,

12:22

I did it a few weeks, and then

12:22

took a very long exam and

12:28

covered everything, a lot of

12:28

things I already knew, but

12:31

Medicare health insurance, long

12:31

term care, dementia, just about

12:37

every topic that would be

12:37

appropriate or suitable to know

12:42

about aging, and taking care of

12:42

our aging population. And yeah,

12:47

there's a fee. But yeah, it was

12:47

worth it.

12:49

As you're

12:49

looking for providers to join

12:53

this network or directory that

12:53

you're building. I know, you

12:57

said that you're looking for

12:57

kind of a holistic approach. Are

13:00

there key elements or tenants

13:00

that you want to see, when

13:05

you're looking at those

13:05

providers as they provide

13:08

services?

13:09

That is something

13:09

that certified senior advisors

13:12

do instead of looking at things

13:12

as a single transaction? Okay,

13:17

I'm going to take care of this

13:17

part of it, say, a care agency.

13:22

And for Mrs. Jones, okay, and

13:22

Mr. Smith is next. Next, instead

13:27

of thinking, who else does that

13:27

person need to talk to? Who else

13:31

does my client need to take care

13:31

of their care? Once I'm through

13:36

with them? Are you gonna leave

13:36

them hanging? No, we don't want

13:39

that we want to do the whole

13:39

job. So I look for people, and

13:43

not necessarily certified senior

13:43

advisors, but have that mindset.

13:47

Okay, I'm gonna go above and

13:47

beyond and make sure that even

13:51

though this is not my specialty,

13:51

or my jurisdiction, shall we

13:55

say, I'm going to make sure that

13:55

they're taken care of, and I'm

13:58

going to connect them with an

13:58

elder law attorney or a housing

14:02

adviser or whatever, whoever

14:02

they need. I'll give an example

14:05

of one client in particular just

14:05

pops in my head. It was somebody

14:11

who is here in Portland, but her

14:11

family was in Miami, South

14:15

Florida.

14:16

On the

14:16

complete opposite side of a

14:19

Exactly.

14:19

Coincidentally, I moved here

14:21

from Sarasota, Florida almost 40

14:21

years ago, so Yeah, can't go

14:25

much farther apart. And her, her

14:25

mom was had dementia, and it was

14:31

evolving her grandmother and her

14:31

siblings, and we got zoom calls

14:36

and everything else, but they

14:36

needed various resources,

14:39

including some of the ones we

14:39

just mentioned. And I

14:42

immediately contacted a

14:42

certified Senior Advisor with

14:45

one of the well known national

14:45

housing advisors, and I said, I

14:51

need this I need this. I need

14:51

that and probably they'll become

14:55

a client of yours because they

14:55

will need housing at some point.

14:58

And that got everything right

14:58

get back on track, they get have

15:02

the resources they needed. And

15:02

it gave them peace of mind,

15:05

especially the daughter here in

15:05

Portland 3000 miles away, or

15:10

whatever it is.

15:10

And I mean,

15:10

you're acting as a conduit. And

15:13

I think as as you're talking,

15:13

it's, it's important to note

15:16

that the long term care space,

15:16

the services that you would

15:21

receive or need to receive as

15:21

you age, are extremely complex,

15:26

they're multifaceted. They're

15:26

compartmentalized, and what

15:28

you're trying to do is you're

15:28

trying to bring them all

15:31

together into one network. A lot

15:31

of people don't realize that

15:34

housing is extremely important

15:34

because they think that they're

15:37

going to live in their own home

15:37

the entire time. But as we were

15:41

talking earlier, there's a

15:41

component between living in your

15:44

own home and not being able to

15:44

have your needs met because of

15:47

your disability progressing, but

15:47

also not wanting to live in a

15:51

facility. Well, if you are in

15:51

this quagmire, where you're on a

15:58

fixed income, and you don't have

15:58

enough savings to be able to

16:00

afford to move to a retirement

16:00

community, for example, because

16:06

those houses cost $700,000 A

16:06

year. I'm sorry, $700,000. In

16:13

general, what are your options?

16:13

So I think it's great that

16:17

you're that you've built out

16:17

this, this directory in this

16:20

network so that you can provide

16:20

people with actual solutions

16:23

that are really, really

16:23

complicated.

16:27

Exactly. I like to

16:27

call the my 18. There you go. So

16:31

it just so happens that my three

16:31

favorite local housing advisors,

16:36

their names all start with a

16:36

just a coincidence, but it's a

16:41

neat little package.

16:42

Let's talk

16:42

about some pitfalls. What are

16:45

the what are some common

16:45

mistakes or oversights you've

16:49

noticed individuals or families

16:49

make when crafting their care

16:53

plans? And how can these be

16:53

avoided?

16:56

So I think,

16:56

sometimes the priorities are

16:59

wrong, or they are putting

16:59

things off shoving things under

17:04

the rug, so to speak, because,

17:04

again, the family members in

17:07

question her saying, No, I don't

17:07

want you to involve I'm not

17:11

moving, although so forth. I

17:11

think it's how you frame things.

17:16

Instead of, Oh, I'm gonna come

17:16

in, I'm gonna take over and you

17:20

know, you're gonna like it

17:20

better, you're gonna have to

17:22

deal with it, that's not going

17:22

to work very well. He's like to

17:27

say that I don't think he's

17:27

listening. The only thing that

17:30

my brother, a musician played

17:30

better than mom was his

17:34

keyboards, or bed better than

17:34

his keyboards was mom, you know,

17:38

kind of manipulate the long

17:38

story, little co Tbit dependency

17:42

going on there. But I was able

17:42

to manipulate mom a bit. But in

17:48

her best interest for her

17:48

welfare. For instance, before

17:52

the store, she, her papers, were

17:52

sitting on the table to file her

17:56

taxes, which she used to be

17:56

really good at. She would get

18:00

them all together, and she would

18:00

bring them to the CPA, just to

18:02

make sure everything was in

18:02

order. But they were not moving.

18:05

They were just sitting there on

18:05

the table and said, Hey, bomb me

18:09

to come down there and and help

18:09

you with a tax. Oh, I love that.

18:13

And basically, she was saying,

18:13

I'm glad I thought of it.

18:16

Exactly. So I just framed it so

18:16

that she could be on board, she

18:21

could do say, Well, I'm not

18:21

being imposed on, he's not

18:24

coming in and taking over or

18:24

taking charge. Fortunately, we

18:28

had a very close relationship

18:28

and, and she trusted me. So that

18:31

was good. But I think it again,

18:31

it's how you frame it, how you

18:35

talk to your family members have

18:35

the conversation. It may take a

18:41

team meeting first, together

18:41

without the parents or parent,

18:46

and then possibly talk to you it

18:46

may have to be some kind of an

18:50

intervention or say, Hey, we're

18:50

really concerned. Bah, bah, so

18:54

forth. And here's some things we

18:54

think that might be in your best

18:58

interest because we don't want

18:58

to see you end up getting sick

19:02

and or injured, etc. and safety

19:02

in the home might be is a big

19:07

one. If you're gonna stay in

19:07

your home. I mean, what's what's

19:10

job one besides the legal stuff,

19:10

safety?

19:13

Yeah, right.

19:13

And there's includes financial.

19:16

Yeah, exactly. And making sure

19:16

that you have the funds to be

19:20

able to pay for it long term.

19:20

Something as simple as you know,

19:24

we've spent and we've talked

19:24

about this on the show before

19:27

when we're talking to like home

19:27

modification experts. So many

19:31

homes were built as that

19:31

colonial two story you know,

19:35

type of house in the 90s and

19:35

2000s. And so believe it or not,

19:43

there are a lot of people who

19:43

didn't who don't live in a ranch

19:46

style house right. And something

19:46

is as significant or simple

19:51

maybe as a stairlift can really

19:51

help people stay in their home.

19:57

Coincidentally,

19:57

we're right across the street

19:59

from the and it didn't exist, we

19:59

moved into our house and mom

20:02

hadn't started her journey. Yet,

20:02

who wasn't evident, is a care

20:06

community, besides having

20:06

skilled rehab, and this is

20:10

letting our independent living

20:10

in place, Aging in Place

20:14

cottages, most of them are one

20:14

level. But there are a few

20:18

second level, but they have a

20:18

small elevator for those who

20:23

either now or will need a

20:23

wheelchair or otherwise who are

20:26

just amazing, using a walker. So

20:26

it was a lot of forethought

20:30

there. And it's a wonderful

20:30

community. And a community of

20:33

course, it's not just buildings,

20:33

it's the people. And they're

20:36

great. They're great.

20:37

I love lot helping male when you're building and connecting with the

20:39

support network. How should

20:42

caregivers incorporate this into

20:42

their care plan? And why is it

20:46

so important

20:48

to build support

20:48

into the care plan?

20:52

Yeah, when you're when you're building and connecting with support network,

20:55

I think I sometimes

20:55

like to use an example it was

20:58

our exam, it was our experience,

20:58

that right after the hurricane,

21:02

we were collaborative, we were

21:02

all had to get my mother and

21:05

stepfather back on track get it

21:05

because they had lost virtually

21:09

everything. And then it became

21:09

kind of tag team collaborative,

21:14

sequential, to take turns taking

21:14

care of them before before she

21:19

came out here. She's separated

21:19

from my stepfather in the

21:22

interim, and then it became more

21:22

solitary, me the prime, the

21:27

primary guy handling everything,

21:27

with a little help from my

21:31

family at a distance and one amp

21:31

moved out here to help take care

21:35

of her. So and family is how you

21:35

define or design it. Right.

21:44

You've heard of the savvy

21:44

caregiver classes through Emory

21:47

University, that was an evidence

21:47

based program, they talk about

21:50

this. And it can be not just

21:50

your family, it can be your

21:53

neighbors, it could be your

21:53

friends, ex co workers, your

21:57

charitable organization, like a

21:57

church or lions or Elks, things

22:03

like that. So there's a lot of

22:03

ways you can gain support. And

22:06

sometimes I think the biggest

22:06

problem is people are afraid to

22:08

ask, they're so proud, or they

22:08

want to be a burden, or they

22:11

want to be independent. So ask

22:11

for and gain support where you

22:16

can get it. I was fortunate, as

22:16

opposed to some other families,

22:22

where my aunts had a lot of

22:22

opinions. And I certainly

22:29

listened. But they knew what my

22:29

name was on the power of

22:33

attorney, I had the final fate,

22:33

but they also knew that I have

22:36

mom's best interests at heart.

22:36

So you'll work out very well.

22:40

But of course, there are

22:40

situations where and these are

22:42

the other caregiving types,

22:42

where people are at a distance,

22:46

or they're providing unsolicited

22:46

advice, and it may be

22:51

misinformed advice on how to

22:51

handle things. And that's not in

22:57

your loved one's best interest.

22:57

Because they really don't know

23:00

or they're really not doing that

23:00

there are ways of handling that.

23:04

When you were

23:04

building this this care plan in

23:06

this network of close friends

23:06

and family members, was it just

23:13

family? Or did you have to like

23:13

reach out to a neighbor or

23:19

someone that may not be either

23:19

extended or directly related to

23:23

you.

23:24

I can give a lot of

23:24

other examples because I've seen

23:26

with like clients and in my

23:26

support groups, but since this

23:29

is personal with me, I will

23:29

mention a couple of things. One

23:32

was when she did have to go into

23:32

memory care, across the street

23:37

in his care community. What we

23:37

did was put mom into the adult

23:42

day program on site for a few

23:42

hours. And with the help with

23:48

friends cluding a truck, etc.

23:48

Most of his stuff ended up in my

23:52

garage again, kept happening.

23:52

And then what little she had

23:57

that could go into her memory

23:57

care space, moved it into the

24:01

care facility. And of course I

24:01

took good care of them. Governor

24:05

bought them pizza and beer

24:05

afterwards. And I like the

24:07

traditional move thing, right?

24:07

Yeah. But we and then move took

24:13

mom into the memory Karen took

24:13

around a little chore. Isn't

24:17

this nice? Sheila again. Okay,

24:17

great. This looks nice. I'll add

24:21

on to that. What happened was my

24:21

wife and I made went to lunch. I

24:26

thought, oh, that went

24:26

surprisingly well, except we

24:28

made a mistake. We went back and

24:28

she saw me and said How dare you

24:33

move me without my permission.

24:33

She wasn't quite ready to grasp

24:38

that. But she had watched it.

24:38

And unfortunately, she did get

24:41

out of memory care a couple

24:41

times because she was still a

24:43

little smarter than the average

24:43

bear. Another one that I love to

24:49

talk about and I just put posted

24:49

on this on social media was

24:54

sometimes you just have to ask

24:54

there's so many different things

24:58

that we deal with But and this

24:58

is a kind of a light hearted

25:03

version of it the last couple of

25:03

days. Mom's in on hospice before

25:08

she passed away, happens to be a

25:08

norovirus quarantine. Oh, the

25:13

only people that were in the

25:13

building besides their staff and

25:17

the residents were my aunt and

25:17

I. And the care was exceptional.

25:22

As I like to say the coffee was

25:22

institutional. I get on social

25:28

media. And it said, because

25:28

somebody, please bring me a

25:31

mocha. I love it. Two different

25:31

friends from two different

25:35

coffee stands Dutch Bros and

25:35

Starbucks. little plug here, and

25:40

ended up showed up at the front

25:40

desk with the coffee for me. And

25:45

I am forever indebted. I just

25:45

thanked them again this week,

25:48

because sometimes they don't

25:48

know what to do, how you can

25:52

need help. And sometimes you

25:52

just need to ask. And that's

25:56

part of that support plan.

25:56

Because emotionally or

25:59

otherwise, those same people

25:59

were supporting me, they knew

26:03

what I was going through.

26:04

You know, it

26:04

takes a village and we talk

26:07

about this in almost every

26:07

single episode. But caregiving

26:11

is one of the most demanding

26:11

roles a person will experience

26:15

in their life. And your opinion,

26:15

how can a care plan incorporate

26:20

strategies for caregivers to

26:20

practice self care and avoid

26:24

burnout?

26:26

Yeah, huge issue. Of

26:26

course, then there's the flip

26:30

side, for the health care

26:30

workers and therapists and, and

26:33

like what I do is the compassion

26:33

fatigue. They're very closely

26:39

related, but a different focus

26:39

different person. And I

26:42

certainly was feeling the

26:42

burnout side, because here I am

26:46

dealing with all these issues,

26:46

including mom's care, and I'm

26:50

holding down a full time job.

26:50

And I had a narcissistic

26:54

micromanager boss. So you can

26:54

imagine where my stress level my

27:00

blood pressure was sharing that

27:00

time period. So some that what

27:05

the first thing I did, and I

27:05

think I alluded to this earlier,

27:08

after the storm was contacted

27:08

the Alzheimer's Association

27:12

found a support group. It was

27:12

the word as many back then in

27:16

the mid 2000s. Then that we have

27:16

now but I found one that was in

27:20

the evening, during the week. So

27:20

I could attend because I was

27:24

working. And I always say is

27:24

that if that had not been a good

27:29

experience, where I got the

27:29

support, and it was

27:33

confidential, it was saved.

27:33

Great tips, great advice, great

27:37

people, some who had already

27:37

lost their loved ones, and were

27:41

still coming to help others

27:41

through the journey. I again,

27:45

wouldn't be sitting here today,

27:45

I probably would have walked

27:47

away upset after mom died and

27:47

said, I'm done. Yeah, I'm burned

27:51

out. I'm exhausted and lightened

27:51

so much later. Yeah. And six

27:56

months later, it became the

27:56

facilitator. And that's the

27:58

fifth. I'm still facilitating

27:58

that same group 18 years later.

28:02

I mean, so

28:02

many people go to that stage of

28:06

burnout, because the experience

28:06

itself can be so traumatic. You

28:10

know, exactly. You're losing

28:12

your loved one.

28:12

Yeah, absolutely. And then on

28:14

top of that you're losing, you

28:14

may be losing your own ill

28:17

because you're neglecting it, or

28:17

rental and physically.

28:20

Well, so. And

28:20

you said, you know, as Katrina

28:23

happened, it exacerbated her

28:23

disease because the stress of

28:27

losing her home and everything,

28:27

you know, made things so much

28:30

worse, progressed at so much

28:30

quicker. And so when your

28:33

caregiving for somebody, and

28:33

you're losing your loved one,

28:36

that is also increased stress,

28:36

you know,

28:39

yep. And besides

28:39

that, I found a very good

28:43

counselor to talk about my

28:43

issues besides how I was

28:48

handling everything with mom,

28:48

and with my family, and trying

28:54

to get away from the

28:54

narcissistic boss tried to get

28:57

out of that job. Did you Good

28:57

God, it was a good job. No, I

29:00

actually retired from it six

29:00

years ago, or actually, the one

29:03

good thing that happened was

29:03

that that boss retired a few

29:06

months after mom passed away, so

29:06

great. So overall, my stress

29:11

level did come down to a nice

29:11

level. Last couple of years was

29:15

tolerable. But the counseling,

29:15

but also, it gets it in in self

29:22

care means different things to

29:22

different people. And besides

29:26

getting away from my desk, and

29:26

walking around the building, and

29:30

clearing my head and getting a

29:30

little fresh air and getting

29:33

some exercise. They started

29:33

having chair massages there at

29:38

work, and I took advantage of

29:38

during my break or basis, and

29:43

then I found a local massage

29:43

therapist and started going into

29:47

that person. What I realized was

29:47

one, two things one, and we've

29:54

heard a variation of this self

29:54

care is not selfish. I started

29:58

to say it's vital And that

29:58

getting the massage, it was not

30:04

a luxury, it was a necessity is

30:04

something I really needed. And I

30:08

still do it to this day.

30:11

So let's

30:11

summarize because I think one of

30:13

the main points as we're talking

30:13

is how you need to approach a

30:19

care plan from an emotional

30:19

aspect, not just from the

30:23

perspective of the client, I'm

30:23

sorry, of the person receiving

30:27

care, but also from the person

30:27

that's actually going to be in

30:31

charge or providing the care.

30:31

And I think that that emotional

30:35

component stretches, probably

30:35

close to the top of the list,

30:40

right, under the legal

30:40

documents, of course, how should

30:44

a care plan address the

30:44

emotional needs of both people?

30:51

I guess the best, I

30:51

mean, you're summing it up real

30:53

there. But as far as the detail,

30:53

and there are so many different

30:57

components involved. And that's

30:57

what I like to do with my

31:00

clients, not just take care of

31:00

one thing. But do you have all

31:05

the legal documents in place, so

31:05

you do have peace of mind that

31:08

you can advocate for not just

31:08

your loved one, but also for

31:11

yourself? Absolutely an

31:11

advocate, whether it's at the

31:14

doctor or at the care facility

31:14

or with a homecare agency? those

31:19

aspects? i The we move forward

31:19

to okay, what other is are there

31:28

any ongoing issues besides

31:28

dementia that need to be taken

31:32

care of? Should we be looking at

31:32

some of the housing and maybe

31:36

they may be rural, there may be

31:36

very few options. Right? Most of

31:41

the places the case anywhere

31:41

from the independent living to

31:45

the care, adult care homes are

31:45

mostly centered around popular

31:50

large population centers and

31:50

gone to rural America, their

31:55

options are much fewer. And

31:55

that's and that's sad. So that

32:02

we add to somebody's stress,

32:02

what do I do? Do I give up my

32:06

job? And how do I deal with

32:06

that? How do I pay for it? How

32:11

do I take care of mom and dad or

32:11

other family members? That's not

32:17

going to bankrupt me? Yeah.

32:17

Right. I mean, I was fortunate

32:22

that mom has certain amount of

32:22

income, certain amount of

32:25

assets, but then that got spent

32:25

down and she went on Medicaid. I

32:30

was fortunate that the local

32:30

caseworkers said, Okay, I hear

32:34

your situation, you're going to

32:34

be setting up a trust, keep her

32:39

eligible, move her we'll take

32:39

care of the paperwork later,

32:42

which shocked me because I've

32:42

always heard that applying for

32:45

Medicaid was a horse or show it

32:45

right. So yes, it was a perfect

32:51

storm that I had to take care

32:51

Medicaid and move mom and a

32:54

memory care. But fortunately, my

32:54

relief was probably obvious to

33:00

those around me that it could

33:00

have been a lot worse. So that's

33:03

where all that getting support.

33:03

Taking care of myself mentally

33:09

and physically was so important.

33:09

And I preach this so much to

33:13

people and in to not have a care

33:13

plan. And that includes a Plan A

33:18

B, See, look at all the what ifs

33:18

great point and and have that

33:23

care team in place. recently had

33:23

a and it's still ongoing. It's a

33:30

can't get into too many details.

33:30

It might become obvious to

33:33

somebody who's listening, where

33:33

I have a client who's I'll say

33:36

out of the country. She's really

33:36

originally from Portland. But

33:39

her family her mother then

33:39

stepped down the year here in

33:42

Portland, and mom was stuck in

33:42

memory care at this very large

33:46

buy in independent living with

33:46

very few assisted living very

33:51

few memory care spaces. And

33:51

because she wasn't getting any

33:55

attention, and the care she

33:55

needed from the family, from the

33:59

care facility, from her

33:59

physician, et cetera, something

34:03

as simple as be 12 shots. Oh,

34:03

wow. Yeah, she was stuck in

34:08

memory care. And she shouldn't

34:08

have done. She was imprisoned

34:11

basically. And because this new

34:11

client got a hold of me, and I

34:16

was able to put together the

34:16

care team and the care plan. She

34:20

is now out of that facility in

34:20

another place. And she's never

34:25

gonna be completely happy. She's

34:25

still kind of isolated, but

34:28

she's not in a lockdown. Memory

34:28

Care. She's in a place where she

34:31

can walk the grounds and see the

34:31

ducks and the koi fish, catfish

34:35

and the the chickens and the

34:35

beautiful flowers. We're in the

34:39

Rose City here, so and views

34:39

mountains. And so she's, she's a

34:44

lot happier. And in like I said

34:44

it's an ongoing story. But by

34:48

putting together those meetings

34:48

with the care team, we got her

34:52

on the right track. And that's

34:52

better not only for the mom, but

34:55

the daughters.

34:56

So before we

34:56

wrap up, I want to ask you kind

34:58

of a technical question. Do

34:58

Because I am really curious,

35:02

since you have this experience

35:02

with developing a directory and

35:05

a network to establish a

35:05

successful and a holistic care

35:09

plan. If you consider other

35:09

industries in the United States,

35:16

nothing is as complicated as the

35:16

long term care space. More

35:19

importantly, there aren't any

35:19

companies that are actually

35:23

vertically integrated. So like a

35:23

hospital doesn't offer Nursing

35:27

Home Services doesn't offer

35:27

health care doesn't offer home

35:30

health care, or all the other

35:30

components of long term care,

35:33

right? You know, you go to you

35:33

buy a car, you go to the

35:37

dealership, you buy the car from

35:37

the dealership, you get the car

35:40

service at the dealership, you

35:40

trade the car in at the

35:43

dealership to get a new car, you

35:43

get tired, you get it all done

35:47

at this one spot. Two questions,

35:47

one, from your journey of

35:55

developing this network, do you

35:55

ever get frustrated at how

35:59

different not only the services

35:59

are? But how different every

36:04

single state is in terms of

36:04

services and the providers in

36:08

each state? And then, and then

36:08

my second question is, do you

36:13

feel like it's getting better,

36:13

that access to services getting

36:17

better, that the integration of

36:17

services, creating somewhat of a

36:21

one stop shop for people able to

36:21

either age in place, live in the

36:26

community on in a adult care

36:26

home or be in a facility,

36:31

whether it's assisted living or

36:31

nursing home? Do you feel like

36:33

that's improving?

36:35

He was very

36:35

important to the short answer is

36:37

it's getting I think it's getting better. But we got a long, long way to go. Yeah. I

36:39

usually talk about my first

36:45

major industry, which is similar

36:45

was hospitality, primarily a

36:50

banquet manager work in some

36:50

very nice hotels. The problem is

36:54

that as in most cases, that's

36:54

what people want to be at a

36:56

hotel. They don't want to be in

36:56

assisted living, etc. Unless

37:00

they have to. But I think they

37:00

actually do even a better job,

37:05

because what do they have on the

37:05

property? Everything you could

37:07

possibly want, right? From

37:07

lodging, and the pool and the

37:13

food and the spa, and a

37:13

concierge and everything else

37:16

that's up on the property. But

37:16

yeah, there's so much disparity

37:22

across our industry, in terms of

37:22

consistency and service and

37:27

doing the right job, again,

37:27

holistically. For our, again,

37:33

our most vulnerable population.

37:33

I don't I did, you brought up a

37:38

very good point about different

37:38

states. I made like, one state,

37:43

I'm thinking not far from here,

37:43

that doesn't even allow the

37:46

placement specialist, the senior

37:46

housing advisors, so crazy

37:50

people were on their own. Yeah,

37:50

you got to do as I used to say,

37:53

back when I was first time with

37:53

mom is like, let your fingers do

37:57

the walking to the other pages

37:57

and good luck. And how do you

38:00

know who's good, right? So at

38:00

least you can if you have

38:03

professionals like that, that

38:03

have good training, and they've

38:07

got a good network, and they've

38:07

got a good heart. Those are the

38:10

people I work with, then you

38:10

know that your clients are going

38:14

to be taken care of whether it's

38:14

saying okay, refer work with so

38:19

and so they'll take good care of

38:19

you and find the right fit the

38:22

right place. As opposed to

38:22

somebody else who is just going

38:28

to be looking for the quick

38:28

buck. Yeah, where the place of

38:32

they always put people and where

38:32

their friends are. That's not

38:35

the people I work with.

38:37

Do you ever

38:37

find capacity issues? Meaning

38:40

like the, because good providers

38:40

usually fill up really quickly.

38:44

And as more and more people are

38:44

aging, there's less beds

38:48

available? For people that need

38:48

them. The supply just can't meet

38:54

the demand? I think

38:55

we have the biggest problem, of course, is Medicaid beds. We know that. That's

38:57

obvious. Yeah. It depends on the

39:02

place, there's usually other

39:02

options, it may be hard to find

39:05

a safe they're looking for, even

39:05

though there's many of them. The

39:08

adult care homes, not be hard to

39:08

find the right place fits their

39:13

specific needs. Like I'm talking

39:13

to somebody right now where

39:17

their loved one needs a catheter

39:17

three times a day, most care

39:22

homes aren't going to take care

39:22

of that needs to be a nurse on

39:24

staff all the time. So yeah,

39:24

that's a problem. And when we

39:29

need better solutions for those,

39:29

yeah, it's hard to take care of

39:34

every single person's needs. We

39:34

try to get as close as we can

39:39

find the best possible solution,

39:39

but that's where asking the

39:44

right questions and having a

39:44

network and people who know

39:49

their jobs are gonna have a big

39:49

heart not just to try, Okay, I

39:52

gotta take care of this as quick

39:52

as possible. Make my my sale and

39:56

move on. Again. I'm not going to

39:56

work with people. evaton Who's

39:59

going to take that initiative.

39:59

To go above and beyond, I'm

40:02

going to give a quick example of

40:02

one of my a team housing

40:05

advisors, I never, it was a

40:05

friend of the family, as

40:08

somebody who's a network here

40:08

locally, father is FTD going on

40:13

Medicaid, almost impossible to

40:13

find a bed, this one out of a

40:19

housing advisor happened to be

40:19

out in Central Oregon, on

40:22

vacation, had COVID. And she

40:22

didn't make and she doesn't get

40:27

paid for Medicaid, that she's

40:27

making phone calls to all these

40:31

places until she found one, just

40:31

outside of Portland. And that's

40:36

why I work with that person.

40:36

Because I notice she's gonna do

40:39

that for my clients, whether she

40:39

gets paid or not. Yeah. Which is

40:44

fantastic. And she's good.

40:44

That's a that's a big heart.

40:47

I just feel

40:47

like at this point, we need some

40:51

macro policy making. Because CMS

40:51

does a good job with Medicare

40:57

and taking care of individuals

40:57

over the age of 65. But there's

41:00

this component of long term care

41:00

that really needs a lot of

41:04

resources pulled together and

41:04

needs a concrete and solid

41:08

direction. You know, it needs

41:08

people to be able to make the

41:13

fundamental decisions and create

41:13

the foundation so that we're not

41:20

working. compartmentalized, it

41:20

can't be a state by state by

41:26

state by state by state, it has

41:26

to be a centralized policy of

41:32

how long term care should work.

41:35

And with that in

41:35

mind, we all know that one of

41:38

the big problems right now is

41:38

finding enough good staff, right

41:42

for whether it's in a care

41:42

facility care community or an

41:46

agency finding enough aides, and

41:46

we're not paying them enough for

41:50

what they do. And some places

41:50

are charging more and more and

41:54

not paying the that staff

41:54

enough. And finding good people

42:00

for that is really difficult.

42:00

And the problem is, is that it

42:06

will let's go back to the unpaid

42:06

caregivers, the families,

42:10

millions of them, and talking

42:10

about billions of dollars of

42:15

unpaid care. I mean, if they

42:15

weren't doing that, where would

42:18

we be? Our country needs to find

42:18

new and better sources, because

42:23

it is a growing national

42:23

problem. We shoving it out

42:27

there, we're talking about it

42:27

and more not enough. Where

42:32

whether it's through insurance

42:32

or government programs, some

42:35

other sources that is going to

42:35

fix this problem, because it's

42:39

not going away. It's going.

42:41

Absolutely.

42:41

So we always like to end the

42:44

show with a call to action. Will

42:44

you share three resources or

42:50

tools that could be helpful for

42:50

our listeners who are beginning

42:53

their journey and building a

42:53

care plan and how they can get

42:57

started today?

43:00

First, I think like,

43:00

well, one is, I guess that job

43:05

one is usually make sure the

43:05

legal documents are in place,

43:08

make sure you have the the

43:08

authority and the power to make

43:12

decisions when they can no

43:12

longer make them themselves.

43:16

Number two, make sure that they

43:16

are safe and getting good care.

43:23

And they are as happy as can be,

43:23

can be wherever they are. Even

43:28

before you may be bringing in

43:28

care or looking at other

43:31

housing. And third for yourself.

43:31

Combination go to a support

43:36

group highly recommended. There

43:36

are usually if not locally in

43:41

person, you can probably find a

43:41

virtual group somewhere in the

43:46

country. I have a group that I I

43:46

have been doing for about six

43:50

years, it's actually weekly.

43:50

Wow. And we it was in the care

43:56

community across the street.

43:56

During the pandemic we won vert,

43:59

wind virtual. But as things

43:59

reopened, I didn't want to cut

44:03

off the people that are joining

44:03

me from anywhere from

44:05

Massachusetts to Hawaii. So I'm

44:05

alternating each week, not

44:10

hybrid, but alternating each

44:10

week in person and virtually so

44:13

that those people can still join

44:13

us. And in my groups, some are

44:17

specialized by age or gender or

44:17

relationship or what have you. I

44:22

always say we take all ages, all

44:22

genders, all relationships, all

44:26

types of dementia and all

44:26

stages. We get all comers. So I

44:29

have people from their 30s to

44:29

their 80s and they all support

44:33

each other and it's really

44:33

gratifying and heartwarming.

44:36

Thank you for

44:36

joining us on this episode of

44:39

Now or Never Long-Term Care

44:39

Strategy with Kosta

44:43

Yepifantsev.If you enjoyed

44:43

listening and you wanna hear

44:46

more make sure you subscribe on

44:46

Apple podcast Spotify or

44:50

wherever you find your

44:50

Podcasts,leave us a review or

44:54

better yet share this episode

44:54

with a friend. Now or Never

44:58

Long-Term Care Strategy is a

44:58

Kosta Yepifantsev

45:01

production.Today’s episode was

45:01

written and produced by Morgan

45:05

Franklin. Want to find out more

45:05

about Kosta? Visit us at kostayepifantsev.com