Subscribe
Share
Share
Embed
The Senior Hub Podcast is a resource hub for planning and caring well for your aging parents and loved ones. This podcast tackles everything from data, to key terms, to personal stories, to sacred moments, to tricky family dynamics.
Join hosts Daniel Alexander and Rebecca Hill as they engage their guests, and each other, on this most important topic. We are all learning about this topic as we get older. Let's do it together.
Find us at www.theseniorhub.com
Hello, and welcome to the Senior Hub podcast. I'm Daniel Alexander, the founding director of Senior Hub, and I'll be your host for today's conversation. Our hope is that each time we do this, by the time we're done, you'll feel a little more equipped and maybe even a little more hopeful for whatever's ahead. Rebecca, thank you for joining us again today.
Speaker 2:Hi there.
Speaker 1:Without further ado, let's dive in. Margaret is 78 years old. We're following her story. She fell. She made it into the hospital, had surgery, went through rehab, and the family has now worked through insurance and all these costs associated.
Speaker 1:But now comes the moment that everyone has been working towards. It's time for her to leave rehab. Before we dive in, though, I wanna give our listeners a quick road map of where we're going next. In these next three episodes, our plan is to tackle the scenarios of where she could go. The first scenario that we're gonna talk about today is moving back home.
Speaker 1:Second, we'll talk about moving into a senior living community and all the different options there. And then our third episode after this is moving in with family and how to think about that and the dynamics that can occur there. So today, we're gonna talk about Margaret coming home. So, Rebecca, let's start with this first question. Are we finished with all the chaos and the crazy and the hard stuff when Margaret leaves rehab?
Speaker 2:Not at all. In fact, it's a new starting point. So while you have all of this relief that the, stay at the hospital and rehab is complete, the work is by no means done, and it actually requires a new level of attention and some criteria for what we need to think about in terms of support. So Margaret has had this full system of support at rehab, both clinical and, you know, meals are being taken care of, she's not transferring in and out of a bed or out of a chair without assistance and support. So we need to understand where Margaret is in her ability to do those things.
Speaker 2:And then we're going to need to, insert and possibly replicate some of those rehab supports.
Speaker 1:Great. All right. So this is the next phase. This is not the, okay, we're finished and we can move on with our different lives. This is the next phase of making sure she has what she needs.
Speaker 1:Okay. That's right. Along the way, our listeners are gonna pick up that this is your wheelhouse. You've spent twenty four years in this space. Is that correct?
Speaker 2:Yes. Staffing homes and communities. So I really do know this well, and I'll try to rein in all the knowledge.
Speaker 1:Okay. Well, don't rein it all in. This is what we're here for. But I'm gonna go ahead and and call out vocabulary that you're using that many of our listeners may not have. So the first vocab word is the word transfer.
Speaker 1:Will you go ahead and and flesh that out for us?
Speaker 2:Sure. So, the term transfer means the ability to move from one place to another. So Margaret's ability to stand up, pivot, you know, grab hold of a piece of durable medical equipment, which is another vocab word, meaning a walker, a rollator, or, you know, her ability to transfer in and out of a shower, how she does that, and the level of supports that are required for for that to be a successful transfer is something we're considering.
Speaker 1:Got it. So when you say we're considering, this is an actual data point that rehab or people in the home care industry look at.
Speaker 2:You got it. And you should, upon leaving the rehab, be able to, talk through those data points with your discharging nurse. So how many feet can Margaret walk? How many people does it take to transfer her into a chair or a wheelchair? Can she stand, pivot, transfer?
Speaker 2:Can she bear at least 50% of her own weight?
Speaker 1:Okay. You're getting into lots of little data points that that Mhmm. Sounds like you all look at. That's very helpful. Alright.
Speaker 1:So let's come back to her home. Margaret left, let's say, five weeks ago, and now she's returning home. What does she need to be thinking about? Maybe give us the the high level buckets first. What are all the different pieces of support or different Mhmm.
Speaker 1:Items that we need to think about as we go?
Speaker 2:First and out front is the home safety piece. So what what of her home is now a barrier to entry or a trip fall hazard, we certainly don't want her to, you know, replicate this experience again simply because we didn't consider the rug in the bathroom or the rug in the dining room or, you know, not having the proper grab bars in place. So, you know, you can just kind of, eye level, see where things are out of place or maybe not secure and make those things secure. That's one easy kind of step that families can take as they walk through the home and they just notice that, you know, things are not secure, you can stabilize them. The other piece is, clinical supports, home health, you know, she's Margaret's been receiving med management, maybe even wound management.
Speaker 2:So she's going to need people like that to come into the home to continue those services and those are Medicare reimbursable. She will need meals, she might need transport, she might need someone to help her to dress and undress daily or help with toileting, or maybe she's a little more unsteady in the morning and unsteady at night, she might need those hands on helps in, you know, at weaker times of day. So those are the things we're considering.
Speaker 1:Okay. Lots of pieces there, and let's let's go ahead and flesh some of them out. Wanna start back with the home safety piece as well, and and then we can move forward. Stairs, lighting, like are all these things things that they should be thinking about even while she's in rehab? Are these things that you should do beforehand or wait till she gets home or give me a little bit more and
Speaker 2:then Yeah. So family can, you know, again, kind of survey what things need to be changed. I also wanna encourage listeners that, again, before she leaves rehab, you're going to have physical therapy and occupational therapy assessments. You can utilize your occupational therapist before you leave the rehab to say, mom has a two level home and I need to know, can she go up and down stairs or what would you recommend? And in fact, occupational therapists can make orders for adjustments to the home.
Speaker 2:So if mom needs, a stair lift, for example, to get up to the 2nd Floor, you can have those ordered and installed. Use your occupational therapist to help you, understand what modifications are going to be necessary before she comes home. But we are considering things like the bathroom, which is the most dangerous room in the house, you know, because as you're getting in and out of the shower and you are wet, there's more potential for, you know, slip fall. We are considering pathways, loose rugs. We are considering how she's getting in and out of chairs and in and out of the bed.
Speaker 2:All of those things are considerations. You should, you know, tap the occupational therapist for their knowledge about what Margaret is able to do now. Now, the good news is as well that she's likely going to continue with those therapies outside of the rehab, So you have another layer of opportunity and eyes on support to make those adjustments.
Speaker 1:Okay. Before I go to those therapies, I'm I'm just really curious if you had to pick one safety thing that you would say to any family as they're caring for an aging parent they should be considering. What what would you say everybody should do?
Speaker 2:Rugs.
Speaker 1:Okay.
Speaker 2:I mean, number one
Speaker 1:Really?
Speaker 2:People love their beautiful rugs. I mean, you as a as a woman who loves home decor, I will spend good money on rugs. But at a certain age, they really do become more of a hazard than than a help, and although aesthetically beautiful, they've got to go.
Speaker 1:Okay. That's super helpful. Good to know. And maybe let's all save a little money and not do all of that as we go, but to each his own. All right.
Speaker 1:Go back to the therapies. PT, OT, and I've heard the ST as well. Can you talk us through what those mean, who does what, and how do you know when it is too much and when do you need it?
Speaker 2:Okay. So PT, OT, and speech are, sorry, physical therapy, occupational therapy, speech therapy, it's so ingrained. These are disciplines in the therapy realm. So these are doctor ordered therapies based on your diagnosable condition and they do continue outside of a rehab setting. So physical therapy equals strengthening help.
Speaker 2:These are doctorate level educated strengthening specialists. Occupational therapy is transfer supports. Again, doctorate level transfer understanding about the, body mechanics related to how to get in and out of a chair or in and out of a car or in and out of a shower. And then speech is really, both related to, cognitive abilities and actually the formation of words. So, you know, speech therapy can be utilized for both, you know, cognitive function as well as actual, formation of words typically provided after a stroke or some sort of neurological, deficit Okay.
Speaker 2:Is declared.
Speaker 1:So Margaret's story is she she broke her hip, so she probably wouldn't need speech therapy unless she hit her head or something else.
Speaker 2:That's right.
Speaker 1:Okay. Alright. So can you can you give give me a picture of how often these things happen? Mhmm. And it's probably it depends.
Speaker 1:But
Speaker 2:So, again, each, each bucket is a discipline. So, Margaret's likely going to have physical therapy and occupational therapy. Those can happen as many as two to three times per week.
Speaker 1:Okay.
Speaker 2:You can have outpatient rehab that you drive to, or you can have physical therapy and occupational therapy that comes to the home.
Speaker 1:So when do you decide whether you go outpatient or
Speaker 2:Yeah. In There's lots of criteria around that. But basically, are able to get to and from the therapy gym, or do you need those supports provided to you at home? Typically, older you are, the more deficits you have, doctors will then order the in home PT, OT.
Speaker 1:And how about costs? Are those different? I assume it would be more costly for them to come to you versus you go to them?
Speaker 2:Actually, there's no difference in cost to the consumer because, again, this is a Medicare Part B reimbursable therapy.
Speaker 1:Great. Okay. So this goes back to the insurance conversation
Speaker 2:That's right.
Speaker 1:As it's connected to the incident. You had a different word for it.
Speaker 2:Event.
Speaker 1:The event Mhmm. That is all still one ongoing event and recovery period. Yes. Okay. Great.
Speaker 1:Alright. So those are the therapies that can that can come. How do you know when therapy is done or it's over or you've had enough?
Speaker 2:Well, you don't necessarily get to determine. Some of this is based on your your goals and your ability to continue progressing towards goals or making gains in your strengthening. If the therapist has determined that there's really not much more to be gained from the therapy, they're going to, call the work complete. Okay. Now you can opt in and privately pay for physical therapy and occupational therapy services.
Speaker 2:You know, there are groups that provide just kind of a concierge level, you know, therapy support, and you can opt into that. But if it's going to be Medicare reimbursed, it needs to be doctor ordered, and it needs to have some attainable goals around it.
Speaker 1:Okay. Wonderful. Alright. Let's switch gears away from Margaret's actual kind of body health to what else she's doing on a daily basis Mhmm. And how she needs any support for that.
Speaker 1:Can you talk to us about how to get her ready or how to make sure she has what she needs as far as either medicine or food or any of those kind of things?
Speaker 2:Sure, sure. So I'm calling those activities for daily living.
Speaker 1:Okay.
Speaker 2:So we all have things that we do independently for ourselves each day, like feed ourselves, dress ourselves, help ourselves get up and about throughout the home. If Margaret is struggling with any of those things, it may be time to consider supports. So, in terms of medications, you can, opt through the pharmacy to have blister packed meds where date and time are stamped on your medicines so that it's clear if a medicine has been taken or not. That's an easy request of any pharmacy that you're fulfilling your meds through.
Speaker 1:Okay, terminology alert, blister packed meds. What in the world does that mean?
Speaker 2:It just means like a sheet of meds in a day and time stamped sheet that you can push out through a foil package. There's also something called, pillow packed meds, which are they look as the term suggests like a small pillow, and they are plastic wrapped, and they too have date and time stamped on them about when they're to be delivered. And it's a very common delivery system now.
Speaker 1:Wow. Okay. That's news to me. But you are saying that this is one step towards becoming, you know, healthy as far as your medicine intake, prior to having somebody help you with it. Like if they mail it and Margaret can do that on her own, then it's time stamped or date stamped, etcetera.
Speaker 1:Mhmm. What if she can't do that on her own?
Speaker 2:Well, then she's gonna need some home care support very likely.
Speaker 1:Okay.
Speaker 2:And those are companions all the way up to certified nurses aids who help you with things like medicine management, meals, showering help, a term we call ambulation, which simply means how you move through your through your home, primarily walking.
Speaker 1:Alright. Let me come back to the home care thing because I don't wanna miss Okay. Any of these other activities for daily life. Can you talk us through any of those? We'll come back to the medicine and getting support for that.
Speaker 1:Mhmm. What else is there that we need to be thinking about and making sure that is done correctly when she comes home? Mhmm.
Speaker 2:So we covered the medicines. Hydration, you don't think it's a big deal, but it is a tremendously big deal, for elders. So and and that's another, like, top tier reason people are hospitalized is dehydration. And certainly after a hospital event, Margaret is not going to have the energy to track how much water she's taken in in the day. So hydration support, med management, meals, what is she eating?
Speaker 2:The physician may qualify that she might have to make some adjustments to what she's eating in terms of sodium or cholesterol or, you know, modifications to make sure that she's healing or just even increasing her intake of protein. Those are things that are gonna have to be monitored and delivered. Also, you know, she may need transportation to and from follow-up appointments. Those, you know, that's a very real felt need, and if family aren't available to do it, you're gonna need somebody to do that. And then just the basic showering.
Speaker 2:We always guide people that you need to be showering at least three to four times per week and, you know, changing clothes, making sure things are clean in the home, towels, you know, your clothing, making sure, your surfaces are clean so that you're not getting sick from some sort of viral infection.
Speaker 1:Gotcha. I will not call out my teenagers in case they're listening to this podcast on that conversation. Okay. So there's lots of pieces. That sounds doable for those of us that don't have ambulatory issues, as you said, but that sounds almost overwhelming, all the different pieces you have to track for somebody on her own, especially like like Margaret.
Speaker 1:So let's go back into the home care conversation and talk us through, since this is where you've been working for your career, talk us through the options of getting her help inside her home.
Speaker 2:Yeah. There's just a plethora of options, and particularly here in the triangle because we have so we have such a robust health care system, the options are really limitless. But I think we wanna linger on how do you find support. Yeah. And really the three ways that you do that are a lot of people go online looking for, registries of people who provide home care or companion care as it's called.
Speaker 2:That is essentially a private duty hire, but you and you do assume risk in that hire. So the second and third ways are an agency hire, which is where I lived for twenty four years. You know, an agency hire means that you are hiring somebody that has been pre vetted, is insured, is overseen by a nurse, as per North Carolina licensure, and they are then handed a plan of care that's been written by a clinician, which is a very safe and structured way to hire a home care aide. The last way is, and a lot of people do this because it's just easy and convenient and cost effective, is hiring a neighbor, friend, or student to come alongside and deliver home care. While it is probably the most cost effective, you are still assuming some risk.
Speaker 2:So online hire and private duty hire, you know, friend, neighbor, student are the most risky but can be really the most cost effective and the most consistent.
Speaker 1:Okay. Yeah. Can you give me a little bit more on the pros and cons then? I'm hearing three different three different main buckets. I'm sure there's scenarios for each of them, but maybe a little bit of pro and con.
Speaker 2:For sure. So, we'll tackle this in in two buckets. So the private duty hire that you are finding either online or through a friend, neighbor, student, you are assuming all risk in terms of if something goes wrong, really, you are liable for any of the, potential pitfalls. So if somebody gets, for example, if somebody gets hurt on your property, your homeowner's insurance can be sued to make up the cost of their lost income, wages, and then any kind of medical support that they might require. If you hire an agency, you are likely getting all of that insurance coverage to include workman's comp and there's umbrella insurances that come along with, you know, delivering home care via underneath a licensure and those umbrella, insurance policies.
Speaker 2:So the agency assumes all risk. In a private duty hire scenario, you assume all risk. But in a private duty hire, you might really get the say about who's coming when, what skill level you require, what job, what duties they perform. You know, agencies are more regulated about what types of tasks they'll perform and they typically are working with large numbers of care providers, and they're rotating through who comes to your door.
Speaker 1:Okay, so with an agency, you often don't get the same person Right. Week by week or it's just
Speaker 2:Day by day.
Speaker 1:Often up to them. Okay.
Speaker 2:That's right.
Speaker 1:Alright. So where should we go with that? I'm I'm wondering if you could talk us through the types of things that they most often do with Margaret or, like, what's the upside of really engaging some of these agencies?
Speaker 2:Yeah, so things people would ask for my care providers to do, cook is the number one answer. Wow, amen. I know, right? I mean, we are nothing if not creatures moving aided by what we're eating. So what we eat is very specific and you might want very specific food to be cooked.
Speaker 2:So, I mean, depending on where you're from, your origin, you might want a specific type of Indian food or Asian food. So you know, you can ask for those things. People also ask for certain kinds of exercise follow ups. So, you know, when physical therapy and the intensity of the rehab physical therapy has ended, you may want mom walking, you know, down the street a couple of times per day. You, may have a pet in the home that needs cared for.
Speaker 2:So there are, you know, there are agencies and people who will also do pet care in addition to your person care needs.
Speaker 1:So that makes it sound like most things are on the table. I mean, within bounds, of course, but
Speaker 2:They really are. I mean, the only things that, agencies will not do is most agencies will not do medicine oversight because of the licensure that they hold. Okay. Most agencies will not do, yard work, which is something that independent solo agers have to consider. There are groups for that though.
Speaker 2:And then we often got, requests to transport somewhere. So, you know, say Margaret wants to get out and meet with friends for lunch, you know, as part of her social morale, component of healing and health and getting back to normal, those are important things. Sure. And so, yeah, almost everything is on the table.
Speaker 1:Wow, that sounds great. Can you talk to us about very practically how people should go online and find the right home agencies per se. Like, what do they type in? How do you how do they come across these
Speaker 2:rather quick? Keywords. Yeah. I think is what I'm hearing you ask. So, I mean, if you are looking for a licensed home care agency in Wake County, type in those words, licensed home care agency in Wake County.
Speaker 2:You will get the agency that has most recently Google boosted their ad. That means that you still have the responsibility to do some behind the scenes work and, like, look at their ratings and reviews. When you're engaging with their intake person or their care coordinator, ask them, can I have a referral or some, you know, can I have access to somebody who's currently using your services that can vet for the types of tasks I'm asking you to do?
Speaker 1:Gotcha. Okay. Well, that's very practical. Thank you. Let's go back to Margaret.
Speaker 1:If if I'm Margaret's son, I'm trying to figure out how long she's gonna need home care.
Speaker 2:Right.
Speaker 1:Can you help me with that? Are there benchmarks of time, like estimates or, like, how do I think about how long I need to do this?
Speaker 2:Yeah. So you are essentially replicating staff and supports that she's had in a hospital. Remember that you're hiring people as well. So you wanna think about how they're receiving work. Week by week is a good way to to approach.
Speaker 2:You know, if you staff a week at a time, Margaret may require twenty four hour care when she comes home because we don't know if her most unstable time is in the morning, evening, overnight, there's a discovery period, that's required. So you may have that twenty four hour support all the way up to day seven or day 10, but then you look back and you'll have more data points about where Margaret is in terms of if she's, steady and stable in the midday, maybe you can, take away some of that caregiving support in the middle of the day and you just use that overnight care, or maybe you just need, you know, bookend shifts in the morning and evening so that when she wakes, she has help, when she goes to bed, she has help. So there is a discovery period. I always guided people to load heavy on their support, both family and hired so that she could have as much, you know, support as needed to really get a good look back.
Speaker 1:Okay, that's great. And how long would somebody like Margaret who fell, went to hospital, had surgery, went to rehab for three weeks and came home, You think she may need support for a week or three months?
Speaker 2:I would say it's a good expectation to have supports in place for at least a month.
Speaker 1:Okay, Helpful. And I'm gonna put you on the spot here, but costs. Talk to me about private care, home care agencies. Like, can you ballpark general costs for this?
Speaker 2:So we're gonna talk about this in terms of per hour.
Speaker 1:Okay.
Speaker 2:Because that's how you'll be billed for Margaret's home care. So in the home care world, we talk about, you know, I wanna say this too, most agencies have a minimum, shift per session and, hours per week that they require. Most agencies require four hours of care per session and something like twelve to twenty hours per week. The cost per hour can range anywhere from 20 to $40 per hour.
Speaker 1:Okay. That's helpful. You don't need to go any further with that because I know everybody's different.
Speaker 2:Mhmm.
Speaker 1:But you're not saying it's $12 and it's also not a $150 an hour Correct. On the general home care bucket. It may be different with PTOT if it's you're doing private
Speaker 2:That's right.
Speaker 1:Those kind of things.
Speaker 2:And remember this as well, agencies are absorbing a lot of overhead to, meet those license criteria. So they're hiring nurses to do your plan of care. They're doing, you know, reviews of their staff. And so there's just a lot of cost, unseen cost that goes into an agency's pricing. That's why your private duty and your private hires are gonna be significantly less.
Speaker 1:Okay. Okay. But you've already walked us through the pros and cons as we go. The fact of the matter is I'm hearing you say consistently that we wanna support Margaret That's as right. Best as we can.
Speaker 1:It's much better support her fully and even with more hours than she may need or more people than she may need than to have her fall again.
Speaker 2:Absolutely.
Speaker 1:Okay. Alright. So the hope is, the prayer is that Margaret can go home and she can come healthy and do what she wants to if home is where she wants to be. At the same time, we recognize that doesn't always happen, though. So we're going to pause here for today, but just to tee up the next episode, we will need to get into the conversation about the senior living communities.
Speaker 1:So for those of you that have questions on that, tune in to the next episode. We look forward to working with you all as we go, but that's our conversation for today. Rebecca, thanks again for sharing your wisdom with us as always.
Speaker 2:And thank you, Daniel.
Speaker 1:Our hope is that you are all walking away a little more equipped maybe a little more hopeful than when we started. Wherever you are on this journey, call us at any point. We're here to help. Thanks for joining us, and we'll see you next time on the Senior Hub Podcast.