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Now or Never: Long-Term Care Strategy is a podcast for all those seeking answers and solutions in the long-term care space. Too often we don’t fully understand the necessity of care until it’s too late. This podcast is designed to create solutions, start conversations and bring awareness to the industry that will inevitably impact all Americans.
Annalee Kruger: I always ask how
many of you are family
caregivers right out of the red
out of the gate? And you might
get like a few hands like, Oh
yeah, I'm here. But then as I
talked about what a caregiver
actually is, and then I asked
again, then like all these hands
like shoot up and you're like,
oh my gosh, I am doing all of
that. That's a caregiver. I just
thought I was helping.
Caroline Moore: Welcome to Now
or Never Long-Term Care Strategy
making. themselves. with Kosta
Yepifantsev a podcast for all
those seeking answers and
solutions in the long term care
space. This podcast is designed
to create resources, start
conversations and bring
awareness to the industry that
will inevitably impact all
Americans. Here's your host
Kosta Yepifantsev.
Kosta Yepifantsev: Hey ya'll
it's Kosta. Today, I'm here with
my guest, Annalee Krueger,
founder and president of care
riping, senior care advisor,
author of the invisible patient,
and working in a long term care
industry with seniors and
families for over 30 years. And
elite like so many of us your
introduction is senior
caregiving happened at home,
will you tell us about growing
up watching your parents care
for your grandparents and how
that shaped your career?
Annalee Kruger: Sure. So I'm 51.
And so back when I was growing
up in the 70s, we didn't have
all these different levels of
care for our grandparents. And
so if they weren't able to
manage at home on their own,
they did one of two things, they
either moved in with their kids,
because there wasn't any other
option other than a nursing
home. And nobody wanted to do
that. Right. So so our whole
family actually took care of our
grandparents. It wasn't just mom
and dad, it was like, as a
little girl, I'm helping bathe
my grandmother, I'm putting the
powder on her and I'm getting
her dressed and putting on her
sandals. And, you know, with my
grandfather, he he didn't need
hands on care, but he needed the
socialization, because he was
right. I'm a farm kid. So he was
riding horses with us, he's
feeding the cows, and he's on
the combine with us, you know,
so he just needed the activity
and the structure and the and
the companionship of family. So,
but I saw just how how hard it
was to meet their needs. Because
especially with my grandmother,
her she was very chronically
sick. And so it was just, you
know, it was just a lot of just
a lot of work to take care of
her. And then shortly after,
like a year after my grandmother
who, who needed the most care,
moved in my oldest sister went
missing. In college, she, she
became a missing person. And so
on the weekends, my dad and my
brother would drive to Nebraska
to try to find her. And so then
my mom and the rest of my
siblings would manage the farm
and take care of the
grandparents. So I saw that how,
how, like, life just unfolds
like life has its own agenda.
And we're constantly getting
thrown curveballs. And when
you're a family caregiver, that
that dedicates a lot of time and
energy. But it also all these
other things in life happen. And
you can't just like, Okay, well,
you're on your own Grandma, you
know. So I saw how just life
happens. And we're always thrown
curveballs. And we had a family
crisis. But we still, we still
honored our promise, we were one
of the families that made the
promise that we'll take care of
you. And we did, but it wasn't
always easy. So. So that's what
led me into working in social
work. And I knew when I was nine
years old, because this was all
kind of unfolding when I was
nine. And I was like, I just I
know that this is how I want to
help families because we can't
possibly be the only family that
this is happening to. And boy,
was I correct? Because now fast
forward, we're in the silver
tsunami.
Kosta Yepifantsev: Absolutely.
And I mean, one of the things
that I talk about often is how
we've shifted from this multi
generational family unit where
you took care of your parents
that your parents moved in with
you and a lot of cultures still
do that. But like, as you talk
to families, and you reference
back to your own experiences,
what what do you think has
changed in our society that's
prevented people from taking on
the responsibility like you and
your family did?
Annalee Kruger: A lot has
changed in our society. Number
one, it seems like in my
opinion, in my opinion, when I
first started out working in
long term care, I started out as
a social worker and admissions
coordinator. Then I moved up
into executive director roles
into CCRCs continuing care
retirement communities, but part
of that job when I was an
employee, so it was a job a part
of that job was always to do the
tours. The tours, were almost
always with the adult kids,
because mom or dad was in the
hospital so there's no way
they're coming. out to tour,
right? And then the hospital
will say, here's a list of
facilities go find one by noon
tomorrow because we're
discharging. Well, it just seems
like back in the 90s. When I was
starting out as a new social
worker, it just families lived
down the street from each other,
they lived in the same zip code,
or at least in the same time
zone, right. And so there was
that kind of family cohesiveness
and everybody just pitched in
just like farm kids, we all just
pitched in, because that was for
the greater good of the family,
right. But in time, by the time
I left corporate America and
started my own company, and 2011
families don't live near each
other. It's rare that even as a
family consultant, that we have
a family that the nuclear family
is all in the same state, like
same timezone. So I think what's
what's shifted is this, the
profile of the typical family,
you know, they have to move away
because they get married, or
they jobs, they have to follow
the job. Or maybe their family
dynamics were such that they're
like, I don't want to stay in my
hometown, or I don't want to
stay so close to mom and dad,
the relationships not great. So
between the economy and the
family relationships. And I say
that just because as a family
consultant, 92% of my clients
come to me in crisis, because
there's been some terrible thing
that has happened, or the family
is kind of woke up and realized,
Oh, dad is more demented than we
thought we need to probably do
something and yes, you're you
do. But also, there's just so
much, there's just so much
denial, you know, with with
families thinking that their
parents are doing better than
they are. And so when you layer
on all those kind of opinions or
perspectives, with adult
children, about their parents,
then there's those relationship
rifts as well. And it seems
like, in my opinion, when
families started moving away
from each other, if they didn't
invest the time, the effort, the
energy and the resources and
maintaining those relationships
with each other as siblings, and
with parents, then when there's
that medical crisis, Dad falls
and breaks his hip, or mom dies
unexpectedly, and she's the
caregiver to dad, then they have
to get reacquainted as siblings
and as a family. The other
contributing factor is employers
in my opinion, aren't as family,
the culture isn't as family
oriented as as it used to be,
like, when my dad was, was
working and taking and we were
all taken care of his dad, my
grandfather, his boss would say,
you know, take whatever time you
need, you know, family comes
first. You don't hear that
anymore. Oh, yeah. So and you
know, and your colleagues are
like, well, if you're going to
be gone for another two weeks,
because you have to fly to
Arizona, because Dad fell again,
you know, even colleagues are
saying, Look, you know, I I
can't keep carrying your weight
for you when you're gone. So
those are, those are some those
are, in my opinion, just the the
shift that I've seen, and then
just, you know, people,
employees only get two to four
weeks of vacation, and they're
certainly not going to spend
every PTO day checking in on
aging parents, and then you've
got blended families or you
know, dad lives in Tucson, but
mom lives in Fort Myers. And you
know, there's only so many
vacation days that you get.
Kosta Yepifantsev: And it's
interesting that because
everything that you've said, has
come up in a lot of the episodes
that we've talked to people who
have acted as primary caregivers
who have since transitioned to
a, you know, whether it's
building their own company or
helping other families or
managing a support group online.
That's exactly what they talk
about. It's about putting their
life on hold. It's about moving
across the country. It's about
having to essentially change the
direction of their lives to be
closer to an assisted living
facility that their parents are
living in. And you know, it, it
always brings up in my mind how
many families aren't doing that.
And they have to rely on the
long term care system, which is,
generally compartmentalize. So,
you know, whether you're a
spouse or a family member,
child, whatever it might be, and
you're caring for an individual
day in and day out, you know,
burnout is obviously going to
happen and today's episode
revolves heavily around the
concept of compassion fatigue,
or the burnout that caregivers
experience due to the chronic
self sacrifice. How does this
normally manifest for caregivers
and what should we be on the
lookout for?
Annalee Kruger: Sure. So let's
let's back up a bit first, so
because I do a lot of speaking,
I just did one. I did three of
them yesterday, there were live
webinars, and there were total
for the day, probably 450
people. Oh, total webinars,
right. And so the converted into
podcasts, but anyway, I always
ask how many of you are family
care? givers right out of the
great out of the gate. And you
might get like a few hands like,
Oh yeah, I'm a kid. But then as
I talked about what a caregiver
actually is, and then I ask
again, then like all these hands
like shoot up, and they're like,
oh my gosh, I am doing all of
that. That's a caregiver. I just
thought I was helping. So, so
let's talk about what a family
caregiver is. And I'm sure that
your listeners will be like, oh,
gosh, that is me. And I need to
I need to figure out what a plan
looks like so that I don't get
burned out because it is
preventable. caregiver burnout
is preventable, if we have
enough supports in place if
we're educated about what the
disease is that our loved one
has. And we have an actual aging
plan, which is what we do at
care, right? We do aging
planning. So caregiving is tasks
that you do and time that you're
spending on your aging loved one
or the person that you're the
care recipient is not always
aging loved ones, because we do
special needs planning as well.
But it's tasks that you're
spending time unpaid doing. So
it could be you know, going to
go pick up the mail, because
mom's driveway is too steep, and
you don't want her to tumble
down, right? So it could be
going to pick up the mail, it
could be Well, mom needs
groceries, so I have to go to
the store. So I might as well
pick hers up, could be doing
laundry housekeeping, setting up
medications, coordinating
doctor's appointments and
therapy appointments, taking
time off work to drive them to
their doctor's appointments,
because you can't trust that mom
is going to relay the messages
back to you about what's what
transpired during that doctor's
appointment. It's calling
insurance companies, it's going
to the bank, it's paying bills,
it's talking to the financial
planner, it's talking to the
estate attorney, it's signing
documents, it's money, managing
their money, making sure that
their bills are getting paid to
all of those things. That sounds
like a full time job. And then
you got Oh, now mom needs help
in the bathroom and bathing and
dressing, grooming and not Mom's
got dementia. So if I'm not
there in the afternoon, she's
likely to wander out, you know,
so. So it's all of those things.
And we talk about or I talk
about the caregiver snowball. It
sounds like we as kids, we just
think we're all these heroes,
right? Like, we're like, yeah,
we got this we can sure we, we
can do this. And it starts out
feeling manageable. And then in
time, whatever happens, but in
time dementia progresses, Dad
has another fall, they move in
with you and you don't like
their cat. And you're like, oh
my gosh, what have we done? I'm
so not joking about that. Is
that a big relationship breaker?
Kosta Yepifantsev: Pets in
general, though,
Annalee Kruger: relationship
breaker and I have
Kosta Yepifantsev: I have had
certain individuals who are in
complete crisis. I mean, they
know they are living in unsafe
conditions. And we have a no
pets policy. Because a lot of
times it'll just end up the
caregiver will end up spending
more time taking care of the pet
than it is than the individual
at times, of course, and people
will forego the service. So they
remain in their environment
because of their pet. And it's I
mean, you know, I don't I don't
know every how they think I'm
not inside their minds. And you
know, maybe it's they consider
it like children, so I totally
get it. And cats cats are a big
one.
Annalee Kruger: A big one only
because they climb on counters
and you know, anyway, so yeah,
pets can be a challenge. But But
anyway, so caregiving starts out
feeling manageable until it's
not until you're like, oh my
gosh, now I'm spending 10 hours
a week now I'm spending 20 hours
a week and now I'm spending, you
know, all this money out of
pocket. So for example, my care
right clients, I asked them, How
much money are you spending out
of pocket just because again,
families are darting across the
country every time mom falls. So
it's not like they're always
just right down the block from
mom. And so the typical my
typical family is spending
$15,000 In airfare alone the
year prior to engaging with us
on a comprehensive aging plan.
Because when dad lives in
Arizona and you live in New
York, and he falls again and you
get that crisis call airfares,
not $69 on a legion, it's like
$1,000 at a pop. And they tend
to you know, sometimes they tend
to get a one way ticket because
they're like, what, I don't know
how long I'm going to be gone
this time. You know, and then
spouses you know, their spouse
is like look, the first couple
three grand was when was one
thing but now it's like 1015
grand a year like this isn't
sustainable for us. So we talked
about the financial tool of
family caregiving as well. And
so that's why Unfortunately, by
the time families come to us to
talk about an aging plan, their
relationships are really burned
out at home because the spouse
is like you're not even
emotionally present for Are us
in your own family anymore. And
you're like, I love your
parents, but you got to figure
this stuff out. They're stressed
out because of their employers
and colleagues saying, Look, you
know, we got to have you here,
dude. Like, if you're not
selling and meeting your sales
quota, you're not going to have
a job. So there's all this like
other stressors in that trickle,
because of family caregiving and
family caregiving can derail
your your relationships, your
emotional well being your
physical well being your safety,
and your finances all across the
board. And so we want to, we
want to educate family
caregivers, that aging and
caregiving can be a positive
experience, when you have an
aging plan, you know, we, we
spend our whole life planning
for all these other things, you
know, oh, I want to go to this
college. So I need to do these
classes, get these grades, do
this type of volunteer work to
be able to get into this
college, oh, I want to do this
as a, as an occupation. This is
the type of college I need to go
to. And this is what I need to
do that this is the other
training and certificate. If you
want to go on vacations, people
spend 20 hours just planning the
vacation. But so why why
wouldn't we leave our most
dependent, vulnerable
population? Why would we be
willy nilly about that when they
are when they become so at the
mercy of health care workers and
family to take care of them.
That's That's why families fail,
and they fall through the
cracks. Because, you know, the
health care system will say, Oh,
you have Parkinson's, good luck
to you. And then that's that's
kind of it, you know, and that's
why that's why that's why curate
fills the gap, you know, to go I
working with a new fan, you
know, a new family. And, you
know, their mom had Parkinson's
for five years, she's had that
diagnosis for five years. And
when the daughter called me,
because she's like, had mumps
falling all the time. And she
was I'm just, I just can't do
this anymore. You know, I hurt
my back trying to pick her up
the last time and I said, Well,
you know, so I laid out what
Parkinson's really means. And
falls are a hallmark of that
disease. And it can be a
dementing illness. So I walked
her through well as your mom,
you know, I have a memory
impairment checklist. And she's
like, Yeah, she's doing all that
stuff. And five years of that
diagnosis in the family, you
know, family had no idea. So
shame on the healthcare industry
for allowing these families to
fall through the cracks. But
that's why we talk about with
the aging plan, we have to
educate our families that we're
working with, because they don't
know or they'll say, if dad's
dementia progresses, so that
tells me that no one's done
their homework, right. And so
that's why with our clients,
it's so much almost curriculum
based because they're coming to
us so naive and misinformed.
They'll say Medicare and
Medicaid in the same sentence as
if it's the same program.
They'll say, if dad's dementia
progresses, they'll say assisted
living and nursing home in the
same sentence as if it's the
same type of care, and it's not
at all. So we have to really
start at Ground Zero and just
really educate them about aging
and dementia and caregiving.
Kosta Yepifantsev: Well, and to
prevent that burnout, the best
solution, in your opinion, is to
have an aging plan, and to start
doing education and research. So
as we're talking, it's bringing
up a few things to mind, because
from the healthcare industry
perspective, they're not doing a
good job of educating
individuals. But more
importantly, when you're talking
about preparation, whether it's
college or a career, how many
people prepare for retirement,
and estate planners, and
retirement experts. I just had a
conversation last week with
somebody who's a very prominent
real estate planning in our
community. And he doesn't even
recognize the necessity for
having a conversation for long
term care nor preparing for it
and his rebuttal. And I want to
hear what you have to say about
this is that they don't need a
state planning, because they
have the financial means to be
able to afford long term care
and they'll be just fine.
I know. I was like, Oh, okay.
And his client base is getting
older and older. He may not be
he may not have you know, they
may be in their late 50s, early
60s. They're not quite there
where they need this, this this
hands on and wraparound
services. But when you talk to
people you say 92% of your
individuals come to you in
crisis, which means that they've
spent a substantial amount of
money and they've also reached
the end of their rope. They may
very well be at that burnout
stage. They are at that burnout
stage and when you see all of
the people that are supposed to
help helped them along the way,
sort of dropped the ball over
and over and over again. I mean,
how, specifically speaking to
estate planner and retirement
experts, I'm curious your
thoughts as to why they don't
have a more thoughtful
conversation about planning for
long term care.
Annalee Kruger: So that is that
is an entirely other podcasts
because I have a whole lot of
stuff I have to say about that.
But I'll just give you a
breakdown in a couple of things.
Okay. All right, so. So I truly
believe that if we want to be
successful in life for anything,
we have to put a plan together,
how you can't be willy nilly
about everything in life.
There's some people who skate
through life doing that. And
that's cool. If it works out for
you, but usually does not. When
we're talking about because I
built a whole nother company, I
have care, right. But I also
have planned for life because of
the financial planning industry,
ignoring the needs of their
clients not addressing
caregiving and the impact of
caregiving on the financial
portfolio and assets under
management, not using that
collaborative approach and
referring them to attorneys to
make sure that they have their
living wills, power of attorney,
all that stuff buttoned up,
because all of those things
litigation and, you know,
premature hospitalizations all
affect the premature facility
placement all impacts negatively
the assets under management
portfolio, elder planning
attorneys, if they fall into
that same clump, you know, of
every I just can't believe that
an elder law attorney doesn't
see the value in proactive
planning. And here's because
when we say estate, estate
planning, we're talking to
living wills and power of
attorney and the HIPAA documents
are included in that, right.
We're not just talking to trust
and stuff like that. So just so
that your your listeners are
educated on what that means. So,
so when we're talking about a
family who doesn't have, let me
give you an example. Recently, I
worked with a family that I
talked to them about seven
months ago for their 30 minute
consult to see if they wanted to
work together to put a plan in
place. I said you're already in
crisis. They had their mom on
Zoom. She's in her 80s She
looked exhausted are ready.
She's been taking care of the
dad with dementia. He's
wandering, he's got his days and
nights mixed up all that kind of
stuff. And I'm like, we have to
safeguard your mom, because we
know that the primary caregiver
over age 60 has a 65% mortality
rate. Fast forward seven months,
it didn't want to engage in
services because it costs money.
There's like, pay now or pay
later. So they call him on a
Saturday morning at 7am. And
here's where this is important.
Because no one calls me at 7am
on a Saturday with good news. So
So what happened is the four
kids live in four different
states parents live in a totally
different state. And so the kids
are like, hey, you know, I tried
to get a hold of mom all week.
Have you gotten a hold of her?
No, no, no. So the closest
daughter lives the six hour
drive away. So she hops in the
car and drives and lo and
behold, she knocks on the door
of mom and dad's house. Dad
opens the door. He doesn't
recognize her because he's that
progressed with dementia. And
she's like, Oh, my gosh, what is
going on? So first of all, she's
hit with dad doesn't recognize
me, you know? Because she's
like, Oh, when did that start
happening? And she looks around
the places trash BM everywhere
all over the furniture. Mom is
dead on the kitchen floor. Oh,
God. The dad is too demented to
call 911. He doesn't know how to
use the phone. Mom was the
primary caregiver. She made sure
he ate properly had his meds was
bathed dressed groom toileted,
clean. mom's dead on the kitchen
floor for a period of time,
right? And so this daughter
who's like, first she gets hit
by dad not understood not
knowing who she is the place is
trashed. mom's dead on the
kitchen floor. So here's, here's
why estate planning is
important. Because then of
course, now they see the value
of working with us, right. But
now we're doing crisis planning,
which is different rates.
Because now it's also Saturday.
And so here's why estate
planning is important. So I'm
asking them and of course, this
is why I tried to get families
to plan ahead because then we
have the luxury of time and
emotions aren't so heavy. So now
we're working now in working
with this family. And I'm like,
Okay, what because dad obviously
can't stay home by himself. Does
he have a living will a power of
attorney and HIPAA documents?
No, I can't I don't know where
any of that stuff is. We've
never talked about this kind of
stuff. So obviously dad is not
decisional so now they have in
their state. The attorney quoted
on it was gonna be like 18,000
to get emergency guardianship.
Why? Because they didn't have
their estate documents in order.
And I'm like, Okay, who are your
parents financial planner? I
don't know. We've never met this
person. We've never Talk to
them. We don't know where their
accounts are because mom and dad
took care of all of that, or mom
took care of all of that. And so
as the daughter is in the house
and the you know, waiting for
the funeral home to the
mortician to come get mom and
all that kind of stuff, she's
looking around, and there's like
stacks of mail piled up, because
mom was so overwhelmed with
taking care of dad, she's
exhausted. There's only so much
energy that we have, it's a
finite amount when you're,
especially when you're at ease.
And so then the daughter's like,
Oh, my God, we had no idea that
she wasn't taking care of the
bills and wasn't taking care of
any of this type of stuff. So so
that's a long story of what a
typical crisis can be. But now
the family's got our crisis
rates that they're paying to put
to fix this problem. And now
they've got the teen $18,000
Emergency guardianship paperwork
to get done and the fee that
they're like, how are we
supposed to pay for that?
They've got the cost of the
funeral, because parents didn't
plan ahead with a funeral
either. So that, you know,
they're they're looking at 3540
grand, just like within within a
few days, right. And so that's
why it's so important.
Kosta Yepifantsev: But to solve
the problems of having so many
different siblings, and kids
living in so many different
states, and being confronted
with this with with the, with
aging, essentially, of your
parents. The best solution is to
create that aging plan. And but
more importantly, like, when
should they start creating when
their parents are 5060? When is
it when is it too early? When is
it too late? You know, when
should they? Okay?
Annalee Kruger: It's never too
early, in my opinion. And this
is why because every single
family needs an aging plan. I'm
50 years old, but when I was 40
I had because I'm also an
international speaker on all of
these types of topics. Right? So
I just made it through Shenzhen
and Beijing, China. God, I don't
know how I made it through but
I've managed Thank god. Yeah,
I'm I that that is on Anneliese
list of accomplishments and, and
but then I come back to
Sheboygan, Wisconsin because I
had built care right in in
Milwaukee. And I had a cluster
of clients in Sheboygan. So I
was just going to have a
Sheboygan week. Long story
short, I'm walking, I'm walking
up the street on the main street
in Sheboygan, I encounter this
little cute little older guy,
he's in his 80s. I can't help
myself, I just I love elderly
people. They're my people. So
I'm like, Hi, how are you? And I
know when you ask an elderly
person that you're gonna get a
whole laundry list of their
diagnoses and how constipated
they are. And I'm cool with
that, because I know my people.
So he's telling me all about his
health issues, and we get to the
intersection and we get the
little green light that says we
can go so we walk across, he's
still telling me about his heart
stents that he had put in six
months prior. All of a sudden he
yells watch out the next thing I
know I'm getting up off the
street. I at the time had a
yellow leather backpack as a
person, I carry way too much
crap with me. But it saved my
life because the school bus
driver was distracted by the
kids on the bus. And instead of
looking through the windshield
at the four corners stop, she
was looking up in that mirror
because there were kids fighting
and so she blew through the four
corners stop. She did not apply
the brakes until she saw my face
break the headlight of the
school bus. I have this team
feet and got up. I'm a farm kid.
I'm 510 Thank God that you know,
I'm not a frail little lily
flower
Kosta Yepifantsev: by a school
bus.
Annalee Kruger: Yeah, the the
bus, the headlight. That's what
all these scars are right here.
So anyway, this she was
distracted. And so my point in
saying, how, when is the time
the time is now because I
certainly did not wake up three
days after my 40th birthday on
May 3 of 2012. thinking, Hmm, I
think I'm gonna get hit by a
school bus and have my whole
business derailed. My health
derailed, and honestly, my
finances derailed because not
working for a year kind of
sucked. Yeah. And so So my point
is life, I've said this twice
now on this podcast, life has
its own agenda. We have to be
prepared, we have to get through
that layer of denial of
nothing's going to happen to me.
Nothing's going to happen to my
parents or our age. Our elderly
parents have to get through that
denial and say and stop saying,
Well, of course I'm going to die
at home. And we don't need to
talk about any of this kind of
stuff, because none of that's
going to happen to me. But yet
1000s of people had major
strokes last Thursday, and they
didn't wake up thinking, Oh, I'm
going to have a devastating
stroke that's going to land me
in a nursing home at 16 grand a
month. Now do that,
Kosta Yepifantsev: you know, so
as I'm doing this presentation,
and I do it often, and I do it
to a wide array of audiences and
it's primarily around have long
term care strategies and estate
planning to try and avoid having
to essentially divest all your
generational wealth to qualify
for Medicaid. And I don't ever
paint a rosy picture, I explain
the increase in demand as people
start to age, I try to lay out
as many statistics about people
who are retiring, you know, only
60 to 70% of them are going to
retire on Social Security income
alone. And, you know, I try to
make it as bleak as possible to
try to get people into action.
So I have a friend of mine, this
was in the same meeting where
the financial planner was
talking friend of mine, good
friend. He, you know, is very
fiscally responsible works for a
bank. He's in his late 30s,
early 40s. His dad's in his 60s.
And, and he's and I could tell
like, the blood is leaving his
face as he's taught as we're
talking. And he says, I'm going
to go and call my dad right now
and tell him that we need to
start working on these things.
And then within two hours, he
texts me and he says, Hey, I
talked to my dad. And they said,
they're going to self fund.
That's all he said. So after
this, after this episode is out,
I'm gonna send it to him so that
he so that he understands that
it's a lot more than just yeah,
sorry, son. I'm gonna sell fund
Have a nice day. Yeah. And yeah,
people don't understand until
it's too
Annalee Kruger: late. They don't
understand until it's too late.
And I just want to say to the
state attorney thing is like,
really kind of,
Kosta Yepifantsev: that's okay,
I know I hit a hot button. I'm
good with it.
Annalee Kruger: thorn in my
side. Right, because, because I
have spent, I've been in the
long term care space working
with families and seniors and
very sick, frail people for 30,
over 30 years, because I was a
candy striper in nursing homes.
I mean, I literally lived in
nursing homes for the bulk of my
life working, working in them
and volunteering in them. So I
have spent plenty of time in
nursing homes and ICU units to
know what quality of life means
to me. Now, that is such a
personal, like, when you think
about quality of life, what does
that really mean. And I had to
rethink it when COVID hit two
because I have like two pages of
an addendum in my health care
power of attorney documents
because in case I can't ever
communicate because I I've
worked with I work with dementia
patients, traumatic brain
injury, people, they can't
communicate, they went from day
one day being able to
communicate to you know, a
motorcycle accident with a
traumatic brain injury to and
not being able to communicate at
all. So like I have two pages of
an addendum of instructions for
my healthcare power of attorney
that I didn't have walked
through with my brother and my
sister because I don't have
kids, they're, they're my my
siblings or my decision makers.
But I don't want feedings, I
don't want a feeding tube, I
don't want to be poked and
prodded at all. And so when I
had my bus accident I carry
because I do crisis, I have like
my own trauma from my families
who choose not to plan ahead. So
I carry my Living Will my power
of attorney and my HIPAA
document because I travel a lot.
And God forbid something
happened to me, like I did not
wake up that morning thinking
I'm gonna get hit by a school
bus. But thank God, I carry
those documents with me, in my
bag, in my purse and in my car,
because I don't want to be one
of those people that ends up
with a feeding tube and a trach
and then relying on an $11 an
hour employee to suction me
because I can't suction myself
and then drown in my own saliva.
Yep. You talk about painting an
ugly picture? Oh, yeah, that's
real. That's,
Kosta Yepifantsev: and it's an
every single state all 50 and
the territories.
Annalee Kruger: And so for oh my
gosh, this attorney is like,
because here's the thing, if you
don't have these documents in
order, and God forbid, you know,
your dad has a stroke. And now
it's like, okay, who's going to
make sure the bills who's going
to take care of the financial
stuff, right, like, who's going
to make sure that the bills
still get paid, because that
generation doesn't do a lot of
auto pay, they still cut checks.
And so it's not like you can be
in Ohio and dad and mom in
California and like manage their
unless you happen to have their
checkbook, you know, you got to
like shift everything online and
stuff, you know, so. So my point
is that too many times because I
work with families in crisis,
and they most of them don't have
any of this stuff in place. And
so they're like, Well, how am I
supposed to do the financial,
the financial power of attorney,
when I don't have any idea who
the financial planner is, I
don't know who the attorney is,
I don't know where their
accounts I don't have any of
their passwords. I don't know
what they have for long term
care insurance, if they have
insurance and all if they have
multiple properties, because a
lot of my clients have multiple
properties across the country.
They're like I have no idea
where these properties are. If
they're for landlords, they have
no idea who to contact for
property management. You know,
so if you if you want your kids,
I don't know, the audience here.
But if if you want your kids to
be successful as a power of
attorney, you have to give them
the information they need to be
successful. Same thing from a
healthcare perspective, if
you've named a health care power
of attorney, you have to sit
them down and say, these are
what my wishes are, this is what
I feel strongly about. Like,
that's why I have a two page
addendum of instructions,
specifically for my power of
attorney. And we go over this
twice a year, because I travel a
lot. And that way, and I'm doing
them a favor. And they know that
because the worst thing families
do, like families make tons of
mistakes, because they don't
know what they don't know. And
so the worst thing to do is not
have documented at all in place
number to have them in place,
but then never tell your family
that you have them and what your
wishes are and not giving them a
copy of the power of attorney
because otherwise they're they
have to have it in their
fingertips because they're going
to have to produce it.
Kosta Yepifantsev: Let's say
that a family did all the right
things. They got all the they
have the aging plan in place.
They have a they have they've
saved for retirement, they have
you know, the income to be able
to support themselves and long
term care. Let's say they even
got long term care insurance.
Okay, which is only 7% of the of
the US population,
Annalee Kruger: that would be a
unicorn.
Kosta Yepifantsev: Yeah,
exactly. Right. Let's say they
got it all. At the end of the
day, though, and I'd love to
hear your thoughts on this. I
mean, obviously, there is a
there is a level of morality
attached to this question. But
I'm just curious, how do you set
the correct boundaries. So
caregiving is a full time job,
whether you have a plan or not,
you're still going to be
engaged, let's just say it's a
part time job, it's 20 hours a
week, that's still 20 hours a
week, most people in America
have to work 40, even 60 hours a
week, you also have a family
that you have to attend to? How
do you set those boundaries in
caregiving without feeling
guilty?
Annalee Kruger: That's a loaded
question. So when we work with
our clients, you know, because
we were facilitating the family
meeting and say, what's working?
Well, what's not working well,
in our clients, the whole
family, right? So everybody gets
a everybody gets a say, because
it's affecting everybody in one
way or another. Even the brother
who's not involved, it's still
affecting him in a one in one
way or another, because it's
going to affect the whole
family. So so when we look at
when we work with our clients,
we're like, Well, what do you
want to take off your caregiver
plate? Because I find out from
each person who's doing what,
like, what is your role? who's
doing what, how much time are
you spending, because families
aren't talking about this. And
so then the siblings are like,
Oh, daughter, Sally, you're
always over exaggerating how
much time mom takes well, so you
know what, Fine, keep a time
tracker, keep a log. And that
way, you can say, Well, I had to
take four days off work this
month, because mom had four
doctor's appointments and that.
And so so we need to look at,
okay, if there's funds there, if
there's resources there to pay
for outside help, we need to
take off the most pressing
difficult, frustrating
resentment causing tasks. So
care coordination is an example
because you have to make all
these calls to doctor's
appointments and the VA during
normal business hours. Well, if
you work a nine to five job,
which there really isn't
anything like that anymore, it's
like a 12 hour job. No, can't
just step away for two hours
because you're on hold with the
VA for an hour and a half trying
to get a hold of somebody. Or if
you have to, you know, the
doctor change mom's prescription
and you have to be on the hold
was CVS for an hour, you just
can't do that. So and keep your
job and keep your sanity and
keep your relationships. And so
that's why we're like what do
you want to take off your
caregiver plate because then we
can do your care coordination,
because we're virtual. So we do
virtual care coordination for
families all across the country.
Because that way, you need to
think about how do you want to
spend your energy because that
is a finite asset that we have.
How do you want to spend your
time and how you want that
relationship to be these last
years with your elderly parents?
Would you rather be resentful
and angry because you have to
take another day off work or
miss another vacation? Or have
your husband on your budget
because he's like, Oh, we can't
travel to Rome because your dad
is having surgery you know? So
so we outsource that we're like
okay, you've got money to pay
for this is this is how much is
going to be a homecare companion
in your area is going to cost
this much a Geriatric Care
Manager, you know, our advocacy
services to be the project
manager basically so that you
can just be the son and the
daughter but yeah, it's gonna
cost money. So
Kosta Yepifantsev: when it comes
to self care, though, you know
at As we're as we're pivoting
through this conversation, I
want to hear more about kind of
what you think self care means
to a caregiver. And more
importantly, maybe some
actionable tips that caregivers
can incorporate into their
routine to ensure that they're
taking care of their own needs.
Annalee Kruger: I actually asked
because we can't be so audacious
to assume that we think that we
all know what self care is for
someone else. That's That's an
assumption. I know what self
care is for me. And so self care
for me is I want time alone. I
need to recharge, it's reading.
It's listening to music. It's
listening to podcasts. So I
asked each person, what does
self care mean to you? Because I
do a caregiver burnout
assessment with my clients, and
they are all in the severe
burden range. So I'm like,
because they're coming to me and
Christ, how
Kosta Yepifantsev: many clients?
How many clients do you see
annually? Oh,
Annalee Kruger: so we usually
have about 125 clients per month
on different services that we
offer amazing across the
country, and then a whole bunch
in the UK, because they can't
just, you know, hop on a plane
every time dad falls?
Kosta Yepifantsev: Is it fair to
assess that you have a fraction
of the need, in terms of I mean,
you're seeing without looking
roughly about 1500 people a
year, 1500 families a year. And
think of how many people are out
there that don't even access
your services? And they don't
know about it? They don't know
about it? Are there other? Are
there other companies like
yourself with across the
country,
Annalee Kruger: companies that
do bits and pieces that we do
have what we do because there's
companies that do Geriatric Care
Management, you know, but
they're not. They're not doing
aging planning. They're still
it's still crisis mode. So when
we'll talk about and then
there's the, then there's these
companies that do placement, you
know, so they just work off of
commission, you know, they only
refer people to where they get
the kickback. And I that's a
whole nother thing. I'm not
gonna go into that. But there's
no planning, there's no Grab and
Go binder. There's no patient
advocacy is just a transaction.
It's a one and done. And if your
parent runs out of money, and
they're in that facility that
they got placed at by the
placement company, you're on
your own. And or if that, are
you, you chose one of the
companies that the placement
company referred to you. And
then you find out oh, my gosh,
mom's been abused or neglected.
They've, they're not doing
anything for her. There's no,
there's no support there. It's a
transaction, it's a one and
done. Or they'll move you or
parent into a different facility
so they can get yet another
kickback. Because that's how
that all works. It's not client
focused. It's kickback focused.
So anyway, I got off on a little
tight.
Kosta Yepifantsev: I think I
took you down a rabbit hole.
Buttons for me.
Annalee Kruger: Okay, so asked
me that question again.
Kosta Yepifantsev: Well, I just
I just love to hear your
perspective on self care. I know
that you said it's different for
everybody else. But I mean, just
I guess some some simple things
that that caregivers can strive
for, to say, Okay, I'm at least
some caring for myself and a
general standpoint.
Annalee Kruger: So in general,
what seems to be across the
board. What people are looking
for, and what they're craving is
stuff that they haven't had for
weeks or months. They want time
alone, they want, they want
their care recipient to say
thank you. They want to be able
to read a book without being
called Honey, I needed to go the
bathroom, they just want to be
able to read a chapter or read a
book, they want to be able to
unplug from their phone from dad
calling at two in the morning,
because he's added toilet paper
they want they want that
boundary and they want to be
able to schedule a vacation and
actually have confidence that
they're going to be able to go
on that vacation. They want to
go get their hair done because
they haven't been able to get
their hair colored for weeks or
months. They want to go to the
salon to get their nails done.
They, they they want their
spouse to say Hey, honey, I've
got you, I've got you. I've got
instead of you're not performing
your spousal obligations because
you don't have energy or you're
not present or you're always
looking at the camera to make
sure your dad didn't fall when
you should be spending time with
us. I mean, those are the common
themes of families that say I
just I just want some time alone
or I want somewhere that they
think you or say you know this
is noble that you're doing this
but but there's a fine line
between being a caregiver and
getting burned out to when
you're when you can tell that
you're emotionally stressed out
or when your head hits the
pillow and you should be
sleeping, and you're like, oh my
gosh, did I did dad take his
meds tonight, you know, when you
have that kind of angst and
anxiousness about you, that's
you're heading in the wrong
direction of being a healthy
caregiver. When when caregiving
has derailed your physical
health, and you're gaining
weight, you're not sleeping, or
you want to sleep all the time,
or you've got blood pressure
issues, or your diabetes is out
of control. So when it's
derailing your emotional health,
your physical health, your
finances, because a lot of us
caregivers are shelling out a
lot of money in airfare or gas
checking in on parents or Yeah,
Kosta Yepifantsev: coming not
to, not to mention the unpaid
caregiving thing that's been a
Annalee Kruger: gap of that, you
know, and families will say, you
know, I took early retirement,
not thinking that how how much
of this care is going to cost
because again, families are
coming to us that care, right?
thinking, Oh, Medicare is gonna
pay for everything. Or they
think that their parent can stay
home 24/7 until they die on
Medicaid, and I'm like, Medicaid
doesn't cover that, you know,
Kosta Yepifantsev: you know, so
there's so much education that
needs to be making
Annalee Kruger: bad decisions
off of wrong information. And
that's why when we do aging
planning, it's a process because
we have to educate them so they
can make smart decisions. And
that plan is that's great. If
mom and dad want to age in place
at home, here's what that's
going to look like. And here's
how much that's going to
potentially cost. But what's the
plan if aging at home doesn't
work out? Or it's not feasible
or safe? We have to do that care
matrix to so that you understand
what care options are available
to you based on what you can
afford? How long are there
waiting lists? What are their
State Surveys, like? We teach
our clients how to tour these
different care communities we
teach our clients, what are the
differences in levels of care,
independent living, assisted
living memory care, secured
memory care versus alarmed
memory care, families don't know
that there's two different kinds
they don't under they don't know
what home health is compared to
companion care. So it's really
you know, we have to educate
them and teach them how to do
those tours of those different
care communities proactively to
get yourself on the waiting list
so that if or when things change
at home, you're not now at the
11th hour trying to find
communities that you can move
into. That's why I started care
right in the first place is
because families weren't
planning ahead at all. So we
gotta get everything buttoned up
if you want to have the best
aging and caregiving journey
possible.
Kosta Yepifantsev: Emily, I want
to talk about your book, The
Invisible patient, where you
talk about the emotional,
physical and financial toll
experienced by family
caregivers. How does this book
help empower both caregivers and
their loved ones?
Annalee Kruger: Yeah, so it's
actually so when you asked about
demand, because there aren't
other companies doing what I'm
doing. Like I said, there's
companies doing bits and pieces.
So my, before my dying day, I
want to be able to reach these
millions of families all across
the world, because it's not just
the United States based issue.
It's people all across the
country are caring for elderly
parents, and they're getting
burned out because they don't
know what they're getting
themselves into. So I've
literally had 1000s of families
through the last many years say,
I just wished that there was
like a what to do with mom and
dad as they age kind of guide
book. So So I wrote one. And so
it's thicker than what I
expected or what I it's longer
than what I always is. And my
editor was like, we want it to
be 99 pages or less. I'm like
Fat chance of that. People need
to know, but I also wrote it in
like 40 Well, they edit it and
put it in like 14 point font
because I know my population,
you know, they're they're older.
So anyway, the it's called the
invisible patient because
usually when I'm working with
clients, I'm the first person
that they've dealt with it as
has actually asked, How are you
holding up because everyone's
always like, Oh, how's your dad?
Well, Dad's fine, but it's
killing me. Right? Yeah, like
caregiving is killing me. So the
invisible patient is jam packed
with scripts on how to
facilitate your own family
meeting, how to broach these
topics with your family, a
checklist on the your Grab and
Go binder. You know what we
have? It's a plug and play
solution. It's a grab and go
binder that has all the whole
checklist of what you should
have in place accounts,
passwords, state documents,
absolutely surance, all that
kind of stuff. But it's also
like how to tour care facilities
and like pages and checklists of
considerations. What if mom
needs one level of care and dad
needs another? What if mom's a
primary caregiver to dad and
he's got dementia and mom dies.
So it's a whole resource guide.
And it's meant to be read in one
of two ways, because it's all by
chapter. So for families that
are in crisis, they tend to flip
to the chapter that they need to
learn about Most, but other
people read it cover to cover.
So just so you know, there is
some redundancy in it because I
don't know the audience if
they're going to read cover to
cover or use it as a training
manual and just read chapter,
the chapters that they need to
know. Plus, I honestly wrote the
book literally from like
midnight till four o'clock in
the morning for weeks on end. So
I'm sure there's a lot of
redundancy in there.
Kosta Yepifantsev: So it's
sometimes it's important to
drive the point home, you know,
it
Annalee Kruger: really is. And
so my point in writing the book
was that way there are I can
offer solutions to families with
literally any budget and the
book is 20 bucks, if you don't
have $20, I can't help you, you
have to be able to invest in
your own outcomes. And the thing
is, the other thing is that,
like, there's agencies out there
that you can go to for
resources, but the reality is
that it just causes more
confusion, because you can go
and pick up brochures and
flyers, but then what are you
gonna do with it? And that's the
problem is there's, there's
information you can Google but
it's not going to be your
specific need.
Kosta Yepifantsev: And also, you
know, when you start talking to
an agency, you're automatically
going to be spending a lot of
money without even a plan or a
general understanding of what to
expect. I mean, there's no,
there's really no end in sight.
And obviously, money is not an
infinite property, right?
Eventually, it goes away. And,
you know, I'll be honest, most
of the private the private pay
clients, even in a community,
such as Cookeville, which is a
very small town in Tennessee,
with a population of about the
county, the entire county has
only 80,000 people, and it's
between Nashville and Knoxville,
most private pay rates are in
the $30 range now. And it's even
higher in Metro markets. Because
if you want a qualified staff
member that you can rely on,
you're gonna have to pay them
pretty well, you know, and, and
it's, it's fascinating to me.
How many people just don't know
what they don't know, don't know
what they don't know. It is
fascinating. I have I do have
three questions. And just real
quick questions. With with
relatively short answers you
cover or you can you can operate
within all 50 states, and you
can even operate
internationally. Right? And your
opinion, are there any states
that are actually doing a good
job? I'm just curious, because I
mean, you've been you have more
experience in this and in a much
more macro standpoint,
Annalee Kruger: I will say that
I was more proud of health care
and long term care before the
pandemic, pandemic shed the
light and that it when I got my
when I got my master's degree in
2008. My thesis was the changing
landscape of health care and
long term care about we have a
shortage coming of family
caregivers, because families are
smaller than they've ever been.
So less pool for family
caregiving and less pool for
professional caregivers, when I
and I don't want to totally bash
Florida but when I came from
Milwaukee, we have some pretty
decent care options in Milwaukee
for care facilities. But, but we
also have some bad ones there
too. But when I came to Florida,
I will admit that I feel like I
came to the Twilight Zone of
health care because I am. I've
never been so angry and
frustrated at care facilities
and health care agencies that
should care about their patients
and making sure that they are
providing quality, properly
trained staff,
Kosta Yepifantsev: we always
like to end the show with a call
to action. After 30 years in the
industry, what's your best
advice for listeners on how to
have a fulfilling and happy life
as a caregiver?
Annalee Kruger: Oh,
communication. I would say
communicate and I would say
communicate with your family and
say hey, we're having struggles
here we need we need to work as
a team. So I would because if
you communicate properly and
effectively then you can work as
a team as a family. But you have
to do it ahead of time you have
to do it before family
resentment happens and crisis
happens with families you have
to you have to start
communicating earlier so sooner
rather than later. And not shy
away from difficult
conversations about dementia or
being you know, admitting that
you're getting burned out as a
caregiver so that i That's why I
chose communication because it's
broad enough that it's going to
add value in every single area
of your life.
Caroline Moore: Thank you for
joining us on this episode of
Now or Never Long-Term Care
Strategy with Kosta
Yepifantsev.If you enjoyed
listening and you wanna hear
more make sure you subscribe on
Apple podcast Spotify or
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Long-Term Care Strategy is a
Kosta Yepifantsev
production.Today’s episode was
written and produced by Morgan
Franklin. Want to find out more
about Kosta? Visit us at
kostayepifantsev.com