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Welcome to The Sandwich Generation Survival Guide, where we explore the challenges and strategies of navigating life caught between work demands and supporting our loved ones while maintaining our own well-being. Join us in this dynamic podcast series as we uncover the complexities individuals face balancing multiple roles in the modern world. Our host, Candace Dellacona, shares personal experiences and professional insights to guide listeners through this complex journey.
Candace Dellacona (2): Welcome to the
Sandwich Generation Survival Guide.
I am your host, Candace Dellacona, and
I am so glad to welcome our guest today,
the founder of My MD Advisor , Dr.
Gerda Maissel.
Welcome, Dr.
Gerda.
Dr. Gerda Maissel:
Thank you.
It was great to be here.
Candace Dellacona (2):
Should I call you Gerda?
Should I call you Dr.
Maissel?
Dr. Gerda Maissel:
Gerda, please.
Candace Dellacona (2): Okay, you got it.
Well, for our listeners I would
love to fill them in a bit on your
background and explain a little bit
of who you are and how you got here,
how you came to find My MD Advisor.
So, you are a duly board
certified physician.
I understand that you're board certified
as a patient advocate as well as through
the board of physical medicine and rehab
Dr. Gerda Maissel:
That's right.
Candace Dellacona (2): And you came to
find My MD Advisor through a personal
experience of yours as an advocate.
Is that right?
Dr. Gerda Maissel:
Yeah.
It was the summer of 2020.
The pandemic had started and I
had been working as a president
of a medical group in Florida.
And I was up here working
remotely a little bit up here,
meaning I live in New York.
And my mom was lonely.
And I got a call from a friend,
whose friend's, aunt and uncle,
had been in a car accident.
They were driving over the GW Bridge in a
heavy rainstorm and drove into the bridge.
And he walked away and
she became a quadriplegic.
And my friend's friend said, Can you help?
Is there, Can you just talk to him?
To the uncle?
So, I talked to him.
And here was this wonderful grown
man on the phone trying not to cry.
And he said to me,
They're killing my wife.
And I thought, okay, well let me see.
I know a lot about spinal cord injury.
I know a lot about how the system works.
Perhaps I can help him.
And I got involved, and you know what?
He was right.
She was in a facility where they were
not treating her infections, and if
she had stayed there much longer,
she probably wouldn't have survived.
I helped get her out, and over time we
actually got her home where she had many
months of a much better quality of life.
And I realized that so many people
get lost in the system, so many people
struggle and they don't know where to turn
when the care is not what it should be.
By the fall of 2020, I decided to
get out of corporate America and
founded My MD Advisor in January 2021.
Candace Dellacona (2): Which is really
remarkable because you know for our
listeners if we think back about what was
going on in our society at the time, we
were in the midst of a global pandemic.
There was a tremendous amount of fear.
There were patients that were being
treated in facilities completely
alone without access to their
families and their advocates.
And here you were as a physician, and you
really saw the need for this role that
candidly didn't really exist before then,
or not in a way that was so formalized.
But your passion for helping
others began much before that.
I remember talking with you the first time
we met and you shared with me that you
had a family member who was in a situation
in a care facility and you felt that the
care he was receiving was really subpar.
Dr. Gerda Maissel:
Well, that was really my mother
because I was a child at the time,
so this goes way back to the 1960s.
My mother had had German measles
when my brother was born in 1958.
And back then when a child was born
with the effects of German measles, they
didn't even quite realize what it was.
And they always blamed the mother, right?
Oh, you know, there's a
child's not developing, right.
The mother must be doing something wrong.
Well, my mother was alone in the country.
My parents were immigrants,
but they figured out there was
something not right about the baby.
And eventually over the years, when my
younger brother came along, they decided
he couldn't stay at home, and so he was
placed in a facility to care for him.
But the care he got wasn't good.
This was back in the days where, they
had certain drugs that they were hitting
everybody with, and I remember going and
we'd find him just drooling in the corner.
And I think watching my mother advocate
for my brother to have him treated with
dignity and respect and not just be
drugged into submission had a huge impact
and was probably a big piece of why I
became a physician in the first place.
And then eventually I guess all
things come full circle and I
ended up helping other families.
Advocate for the needs
of their loved ones.
Candace Dellacona (2): Yeah, it's really
a remarkable story of coming full circle.
And I think one of the things that we
connected on is relating to our clients
and how we can help them advocate and
find systems that are within their
family or within their community so
that as they age and they become more
vulnerable, they have others that can
help advocate for them, perhaps when
they can't advocate for themselves.
And through that topic and that discussion
that we had, we talked about the
concept of something called solo aging.
Do you want to talk a little
bit about what solo aging is?
Dr. Gerda Maissel:
Sure.
Solo aging is when a person is, and
they're usually living alone and I'll come
back to why it's not always, but they're
usually living alone and they're, in their
world they don't have the traditional
supports provided by family and what that
by that what I mean is, family typically
takes you to the doctor's appointment.
Family typically shows up when
you're ill and takes care of you.
But these days there is a huge growing
population of people who are solo agers.
And I do include in the solo
ager definition people that are
living with a spouse or a partner
who can't take care of them.
For example, if your spouse has
dementia and you're the caretaker,
in many ways you have become a solo
ager if you don't have family nearby.
Candace Dellacona (2): In my
practice and in yours, I think
we've seen a trend of increased
solo agers for a number of reasons.
One of the things that you and I
have spoken about is the fact that, I
think there was a cultural revolution
where the quote unquote traditional
family requirements of being married
and having children fell by the
wayside in the sixties and seventies.
And I think that people were provided
an opportunity for choice and some
folks decided that they did not
want to pair up and perhaps they
did not want to have children.
And so we're seeing a trend in solo
agers for that reason, and also because
the traditional family unit of staying
together at least geographically
close by is not as common in the U.
S.
as it perhaps is in other cultures.
Is that right?
Dr. Gerda Maissel:
That's 100 percent right.
It really started in the fifties with
our societal emphasis becoming more
about the nuclear family than about
the extended family, and then we've
become a geographically mobile society
as people move for education or work
opportunities or for whatever reason.
So families don't physically
live as close together.
And then you combine that with the
fact that boomers are aging, and
we have this big population bump.
You simply have more people over 65 now.
They call it the silver tsunami.
More people over 65, and then within
that, more of those people don't have
children, or have children at a distance.
And we also see gray divorce.
So, gray divorce is when people
get divorced over age 65.
In past generations, that was not
considered an acceptable thing to do.
If you made it into your 50s and
60s, you stayed with your partner.
And now the stigma has come
off and people are making
decisions to split later in life.
Candace Dellacona (2): Really,
where MD Advisor comes in is
where you have the solo agers.
Who are in their apartments, say
in New York City, or in their
homes in the suburbs of New York,
elsewhere in the country, and
they have no relatives close by.
And so they are trying to think about
what's next and so as a physician or
through your work as your MD Advisor,
what are you hearing from the solo agers
themselves, or from the distant family
members about what they're afraid of and,
what they're trying to think about as
they move forward in their aging process?
Dr. Gerda Maissel:
I think there's a couple of key fears.
One is there's a stigma and
I just want to call that out.
I think people are almost embarrassed
to find themselves in a situation where
they don't have close family nearby.
And it takes a bit of support
and encouragement for people to
realize that it's not their fault.
And it's very, very common.
But I think the boomer generation
grew up with negative stereotypes
about the spinster aunt, in the
rocking chair up in the attic.
And, that's just not the
reality for today's solo agers.
When I first heard about solo
agers, the term was elder
orphan, which is just awful.
And so I have, I've
switched now to solo agers.
So what they, but what people experience
is that we know, and I'm speaking from
the medical point of view, that people
have a 23 percent higher chance, I'm
sorry, 23 percent increase in all
cause mortality if you're a solo ager.
You don't have to know that
statistic to feel vulnerable.
So people who are solo agers are
aware that they have vulnerability
around their medical care.
And they have other fears, like many
people, especially women, are afraid
they're going to run out of money.
And another common fear is they don't,
and they don't want to be a burden.
Nobody wants, you might have some
distant nephew somewhere who might
help you, or maybe even it's a kid,
but your kid's got a busy life,
and you don't want to be a burden.
You want to be a person with dignity
who can take care of themselves.
Candace Dellacona (2): You
just said a lot, right?
Let's break it down a little bit.
We're talking about this generation
of our silver tsunami as I think
the New York Times perhaps coined.
Which is this huge group of
the population that is aging.
And the group of population is the
offspring of what you know, the generation
known as the greatest generation, right?
So you have these people who are self
sufficient, proud people that have never
asked for help and now they're in a
position where at the end of their lives,
after never having to ask for help.
They're in a position to ask
for help and often of people
that don't have the traditional
obligation to help Is that right?
Dr. Gerda Maissel:
All true.
Absolutely.
Candace Dellacona (2): More.
Yeah.
When you think about the stigma and
how difficult it is to ask for that
assistance you even get into the weeds in
thinking about the people that literally
don't have anyone to ask for the help.
There are people that certainly there's
family estrangement and there are
people that live more solitary lives
and they perhaps don't have the same
number of ties that others may have.
I think that's combined with the fact.
As we've talked about on this podcast
before, it's the cost of care, even
companion care is really expensive.
So you get into really thinking about
running out of money and the fear of that.
I think there was a, there's a term called
bad lady syndrome which to me feels a
little sexist and I'm sure to you too,
Gerda, but it's this feeling because we
as women tend to outlive our counterparts.
And we're worried about
simultaneously running out of our
money at the end of our lives.
And so, you really have answered the
call of all of that, which is being
there as a professional who's not just
a daughter, but a trained physician
to advocate with My MD Advisor.
So can you talk a little bit about,
perhaps an example of someone that you've
been able to help in such a way where they
didn't have the family highest connection
to our expertise to advocate for them?
Dr. Gerda Maissel:
Oh sure.
I have several clients who are solo agers.
One of my earlier solo ager clients,
wonderful wonderful lady, who was
facing an operation and was hospitalized
and was told she needed an operation,
but she wasn't going to be able
to have it for like four months.
And so she had a specific focus problem
at that time, which is she wanted me
to help her get her surgery sooner.
But as I started getting involved with
her, there were other medical issues
going on and a bit of misunderstanding
as to why the surgery was so delayed.
And then she had a couple of really
negative interactions with her surgeon.
And we worked through a lot of those
pieces so that ultimately when she
had surgery, it was successful.
I have another client who's a
current client who's a solo ager
in an apartment in Manhattan.
And she never had children.
And she does have a sister,
but they're estranged.
And her closest friend just passed away
and she, in her late 70s, is having a
number of medical conditions and she
was feeling really overwhelmed by them.
And I she hired me, I got involved.
And we've been peeling them back one at a
time, one at a time, because when you feel
overwhelmed, everything seems important.
And some of the issues, she's
like, okay, we're going to wait.
I got, we're going to not deal
with that one to the summer.
Okay, we're going to deal with this one
now, because this is more important.
She found herself being what
I call dismissed by doctors.
She had a weird condition.
She went to see the specialist and he was
like, Hey, I don't know what caused it.
Don't worry about it.
And this was a condition that caused her
a disability that went on for months.
And if it comes back, it
could be life threatening.
And so I'm helping her
find another physician.
And we're going to bring the information
that physician needs to know to help her
have a better understanding of how to
prevent her condition from coming back.
Candace Dellacona (2): So in, in all of
that, you're talking about someone that
is in need of a quarterback to advocate
for her and coordinate information that
would essentially assist her in finding
a path to restore her health and also
ensuring that the physician who's treating
her is actually listening to her so that
her condition can be properly treated.
I mean, it's really sort of a sad state
of affairs when you have doctors that
are in a position where they dismiss a
patient's concern or perhaps discount
those concerns as not being material
to what their diagnosis may be.
You coming in as a physician is even
better in some ways than a family member.
It's fantastic as a solo ager, but I
really do think that, someone like you,
Gerda, is an incredible resource to a
family that does have advocates within
its circle from a medical perspective.
Dr. Gerda Maissel:
Yeah I help, I've often, I've helped
physicians because even when you're a
physician recently had an injury but
she was a pathologist and she doesn't
know her way around the rehabilitation
system and she was feeling like
she was getting jerked around and
she didn't quite know who to trust.
And I helped her understand how the
system worked and then we went through,
there's a lot of data online when she
had to pick a rehabilitation facility.
And I helped her go through that
because even though it's out
there, you gotta go through a lot
of clicks to look at the data.
And when the care manager in the
hospital said to her, Oh, I applied
to a few extra rehabs for you just in
case I said, no, no, no, no, no, no.
And we looked and the ones
she'd applied to were awful.
And they said, you refuse those.
And what I call Joe's sub basement
rehab took her right away.
I'm like, no, you didn't request that one.
You're not going to Joe's.
And she held out a few more hours and
then one of the ones that she wanted did
take her and, it worked out just fine.
Candace Dellacona (2): Yeah,
which is remarkable that you point
out, that is a physician, right?
Someone who is trained the same way that
you were and a medical doctor herself.
But this world of rehab and discharge
and Medicare are really difficult worlds
to be in all the while, especially if
you're a solo ager, you're alone and
trying to process that information.
Dr. Gerda Maissel:
Yeah, well, now that I think
about it, that physician is
a solo ager, as it happens.
She lost her husband.
Yeah, it's whether you're on your
own or whether you have family.
I'm thinking of a client where there
were three very involved children.
But mom, at the time that I was hired,
had probably a dozen different doctors,
and she was on nearly 30 medications.
And she wasn't feeling very good.
And the kids were running
around constantly.
And fortunately was able to get
involved, bring the temperature
down, help them focus.
Help them understand more of mom's wishes
because sometimes the adult children
can, in their attempt to be helpful,
can say this is what you should do, mom.
And created some space for mom
to say what mattered to her.
And now things are many times better.
And when something doesn't go well,
we have a whole system in place.
And when she's in the hospital.
It's much, much calmer than it
was before, and the children, the
involved children are suffering
much less than they suffered before.
And when I say suffered, they didn't
feel like they were, they didn't think
of themselves as suffering, but they
were taking enormous amounts of time out
of work and a lot of angst and a lot of
worry that was able to just calm down.
Candace Dellacona (2): I think also,
you bring up an important point with
the family dynamics and everyone
plays a role within a family unit.
The role has been likely been played
for decades, so it's really hard
to step outside of that role when
there is an acute sort of scary issue
that everyone is dealing with and
doing the absolute best they can.
But, I would imagine most would
admit not their best selves.
So having a voice of reason come in like
you, just order, organize and set a plan
in place and find a role for everyone and
take some of the weight of caretaking,
the advocating off of the family members
and you as a professional taking that
on to be the quarterback for a family.
So your role really can straddle
between whether the family has a lot
of family members who are ready to
step in and advocate and for those
who don't, but as far as solo agers
go, what were the top, I would say
conditions that you think, as a solo
ager, should really trigger your thought
about your long term plan as you age.
Are there particular conditions
that you should say, you know
what, for my mother, my father, my
neighbor, who I'm thinking about?
These are the issues that I can see
becoming problematic as a solo ager.
Dr. Gerda Maissel:
It's a great question.
We could spend an entire podcast on that
one, but I'll point out one particular
thing that many people aren't aware of.
That I think is important and
it's easy to correct, whether it's
yourself or whether it's a parent.
Which is, there is a very strong link
between hearing loss and dementia.
And when solo agers think about their
future, one of the most terrifying
things is, what if I get dementia?
And I can't run my life.
I can't make my decisions.
Who's going to make sure
that my values are respected?
So people are often very frightened,
for good reason, about getting dementia.
And correcting hearing loss is
a very, very good way to reduce
your chances of having dementia.
And one of the things that
people also don't realize about
hearing loss is that if you wait
too long, you can't correct it.
So you think of all those people
who are going, uh, what'd you say?
What'd you say?
After they got their hearing aids, it's
because they waited too long and they lost
the neural ability to understand words.
And so all hearing aids do is it
turns into just this amplified noise.
Candace Dellacona (2): Yeah,
I mean, that's a great tip.
And, you forget that hearing and sound
and being able to engage with the people
around you is something that, really
adds to the beauty of one's life to
being able to participate in life to be
able to have conversations, certainly
those conversations and being able
to be involved in life can stave off.
Um, and when you think about the
strategies of what solo agers can
do in anticipation of this, because,
on the Sandwich Generation Survival
Guide, we want to talk about, okay, we
recognize that there's a problem, or we
recognize that this could be an issue
for someone that you know, or you love,
or even for yourself, if you're a solo
ager, but what are the strategies that
we can impart to our listeners when
trying to advocate for a solo ager,
or if you're a solo ager yourself.
Dr. Gerda Maissel:
So one of the key things is
deliberately building community.
And there's lots of different
ways to build community.
You don't have to suddenly become an
extrovert and be out there at parties,
but instead, friend of mine, who's a
solo ager, she calls it her circles
and she has her Bible study circle.
She has her swim aerobic circle.
She has her neighbor's
circle and she has these.
Sometimes overlapping circles
of friends, and she was very
deliberate about building circles.
Every time I go to visit her, she's making
chicken salad for somebody who's sick.
But what she tells me, because she's
now in her early 90s, is that she
has to intermittently assess who's in
her circles and look for other people
either to join a circle or she has to
go and look for other circles because
people move away, people get sick.
But when she needs something,
because she's, for 20 years, been so
deliberate about her circles, there's
inevitably somebody who will give her
a ride, who will help her, who, she
needs something done in her house.
Even if she's ill, people bring her food.
She has, by building her circles, created
a very deliberate support network.
For other people, It may be
something as simple as reciprocation.
I'll walk your dog if you give me a ride.
Or, I'll bring in your
mail if you do X for me.
What people need are often different
from each other and what people
can give are often different and
complementary and so some people feel
more comfortable with reciprocation.
Other people need to change where
they live in order to find people
that are in similar circumstances.
That's why adult communities, and
I'm not talking going to assisted
living, I mean, that's a strategy, too.
But when you're still independent, certain
adult communities that have independent
living can be a really nice way of meeting
other people in similar circumstances.
And some of those independent communities
have on site pharmacy and hairdressing
and they'll give you transportation so
they can, depending on what community
you choose, you can often replace some
of those traditional things provided by
society, or by your family you can replace
those things provided by your family with
a community that you choose to live in.
Candace Dellacona (2): Yeah, and so all
of these are strategies and, to your point
earlier with the stigma and the feeling
of discomfort and asking for help creating
these communities where there's maybe
reciprocity whether it's your neighbor
down the street or moving yourself
physically to a community in which
you pull the assistance that everyone
needs and make sure that your needs
are met that way thinking ahead is key.
I mean in my practice as an attorney
as an estate planning attorney, we
also put documents in place, and we,
ahead of time, sign documents called
advanced directives, in which I, as a
client, would appoint someone else to
make healthcare decisions for me, or
financial decisions for me, so I'm setting
the table and laying the groundwork of
building that community that you talk
about in a more official capacity.
But all of these strategies are things
that solo agers, and any ager should
really think about in this day and age.
Isn't that right?
Dr. Gerda Maissel:
Oh, absolutely.
And there are certain key documents
from my point of view that are
really important to put in place.
Candace Dellacona (2): And what are those?
Dr. Gerda Maissel:
Well, it includes making sure
that you have a healthcare proxy.
And it doesn't just mean, well,
hey, Joe, would you do this for me?
It means having conversations with that
person about your values, not so that they
decide for you, but so they can speak as
if they were you in certain circumstances
when you can't speak for yourself.
And also having somebody, whether
it's the same person or not, being
a financial power of attorney so
that your bills can still be paid.
And the last one that from a medical point
of view, and not everybody knows about,
but is an important form, is especially
if you have strong feelings about being
resuscitated is a POLST or a MOLST.
It's called different
things in different states.
It is a form that's like
bright orange or bright pink.
And it goes on your fridge.
And it covers you for what you might
or might not want if God forbid
you go down and you can't speak for
yourself and the EMTs come to your
home to take you to, to the hospital.
Because the EMTs the folks that show
up on the ambulance are obligated to
resuscitate you unless you have an
order, unless they have an order that
says, no, this isn't what I want.
And this medical order of
life sustaining treatment or
physician order of life sustaining
treatment, again, depends on state.
is right there and it's orders signed
by your doctor and it gives some
specifics like do not resuscitate, do
not intubate, don't give antibiotics.
There's different things you can put
on there if you have specific wishes
to not have certain things done to you.
Candace Dellacona (2): And this is a
great point and part of the framework of
what solo agers should really think about
putting into place before they get to the
point where they're in a position where
they can't make decisions independently.
And I want to make sure that the
listeners understand the distinction
between a health care proxy
and a MOLST form or POLST form.
So a health care proxy is a document
that an attorney can draft or you can
even sign in a hospital and you're
appointing a person and as you pointed
out Gerda, you are appointing a person
so that your words move through them.
And that's why the
conversation is so important.
Because it could be a layperson that
understands your ideas about living
and dying and the treatment you would
want or not want, your religious
beliefs, your spiritual beliefs,
and to make sure that they are
your voice with treating physician.
Whereas a MOLST or a POLST is a document
that you create with your physician.
And you get into the nitty gritty
about the type of care you would
want or not want specific to
whatever condition you have.
I think that's a really
important distinction to make.
And you should have both if you have
any sort of long term condition or
illness, and definitely speak with your
physician about whether or not getting
a MOLST in place or POLST in place is
something that you should institute now.
And so what would you say then, Gerda,
when it comes to people taking the
first step in finding someone like
you, would it be appropriate for them
to start now as these issues occur
to get the right people in place?
How would they go about contacting
someone like you and in what circumstance
do most people reach out to you?
Dr. Gerda Maissel:
So for the kind of work that I do, I am
unusual in the work that I do, so there's
not a lot of physician advocates yet.
There will be.
There are more.
I get calls, not quite weekly, but at
least monthly with doctors considering
doing this work, and I think you're
going to see a lot more of us.
People tend to hire me when
they're having a crisis.
You don't necessarily need an advocate
by your side when things are going fine.
We can help with all kinds of things,
but it's really when somebody is
feeling overwhelmed or really angry or
really frustrated or really worried.
It's an emotion I've found about
either themselves or their loved one.
I've had a few people who
have hired me proactively.
When they just want to make sure that they
understand everything about how the system
works and, any of that is fine with me.
But, people, when to hire a
professional, and it's not just
advocates, there are also geriatric
care managers who can be very helpful.
It depends on time and circumstance
and how much you need it
from your own point of view.
And it never hurts to ask the
questions, to talk to a few people.
And to see what they might offer to
decide if that's a service you might need.
Candace Dellacona (2): I think it's
really important too for someone who
knows they'll be in that position one
day to make contact with someone like
you, so that there is a level of comfort.
So perhaps even before the crisis
happens, they can go to Gerda, and
Gerda is going to be the person that
will advocate for them, and maybe
even the go to person for the family.
If they're not entirely a solo ager,
I can't tell you how helpful this
conversation has been for me, and I'm
sure for our listeners, and I know
sharing clients together, how helpful
you have been to other people, and I
think what we do here on the Sandwich
Generation Survival Guide is we inform
people about the resources and the
people that are in our orbit that can
make things like surviving the sandwich
generation or solo aging easier and
you are one of those people So I can't
thank you enough for joining us today
and we will have for our listeners all
of your contact information so people
know how to get in touch with you.
But I just wanted to say thank you so much
for all that you do for your clients your
patients and for their families because
I think and I know actually that people
are better off having you in the corner.
Dr. Gerda Maissel:
Thank you.
It's a real pleasure.