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We cover topics on physical and mental healing, health, happiness, growing wealth and living wise in a world that often sabotages you.
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Welcome back to Healthy, Happy, Wise, Wealthy. I am so excited for our guests today.
We have Comprehensive Home Health Solutions
in Reno, Nevada area and Dr. Sandra Weitz
and Carrie Ingerman are joining us today. They are
a mother, daughter daughter combo. That's easy for me to
say. So I have
been working with them for a little while now and just adore
them and so appreciate the insights that you both have
in terms of like helping people as they age.
So I know you help people with home health and then
medical or non medical either way. But could you guys just
introduce yourself brief briefly for us and tell us a little bit about
your background? Go ahead,
I'll go first. I'm Carrie. I
have a long history of being
interested in patient advocacy which
started really from my own experience with the healthcare system
as I'm sure my mom will go into detail.
She is a physician and one of the reasons that I am where I am
today in terms of my abilities and
not having significant consequences from my medical history
is because she was able to advocate for me. And so one
of the things that led me to
senior care and advocacy is my own experience.
I went to Northwestern University and studied
learning and organizational change and am very
interested in helping people
navigate the healthcare system. And I'll let
my mom introduce herself and then we can share. Share about
how we started our agency and how we got into
really helping people live well at home. Yeah, I love that because I didn't,
I don't think I knew that the patient advocacy piece came because
your mom was such a good advocate, but I can see that happening. So
Dr. Weitz, do you want me to call you Dr. Weitz?
You can call me Sandy. I answer to
everything. Hey you. Right.
Yeah, including hey you
in any case. So I am a double board
certified pain management specialist. I did a
surgery internship, anesthesia residency, pain management
fellowship, all at UCSF in San Francisco and stayed
on faculty there for five years running the pain service.
I moved to Baton Rouge, Louisiana with kids. Carrie's dad,
he is actually the silent member of Comprehensive Home Health
Solutions, but a very active member. I actually
met him the first day in medical school. He was the guy sitting behind me
41 years ago,
basically moved to Baton Rouge, started my
own practice, grew it to 11 docs and 11
mid levels and ultimately
ended up retiring in 2016 after
number one having taken care of Carrie and her
multiple medical issues and then ultimately in 2016
taking care of my mother in law who was dying of metastatic breast
cancer and my elderly father in law. My husband
is an only child. Very long story
short, we were traveling the world, minding our business,
had moved to Northern Nevada
and really enjoying
just living and dealing with our three kids. When Carrie said,
you know what? I originally wanted to be a disability rights
attorney, but you talked me out of doing that. And
then we can talk about why. What does one do when
they don't become a disability rights attorney? You go to work for
Goldman Sachs as an investment banker for four years in New York City.
Did you do that? I don't think I knew that. I did, in fact do
that. And after three and a half years,
I realized that I wanted to get back to helping people.
And around that time, we
had close family friends diagnosed with terminal illnesses, one with
ALS, one with Parkinson's. And it was
kind of that moment where I understood how
challenging and navigating end of life care is. And when I say
end of life care, I'm not talking about terminal care. I'm talking
about when you're diagnosed with multiple
chronic diseases and your quality of life or
your ability to navigate life becomes more challenged,
how do you have the supports? And so
that is really where Comprehensive Home Health Solutions was born,
was really trying to provide coordinated care in the home to help
people have the best quality of life, to provide supports for their friends
and family, caring for them. And for some crazy reason,
my mom and dad agreed to go on this journey with me.
And so we started the licensing process
about two and a half years ago, and we started providing caregiving
services in the home two years ago. I as
of about two days ago. So it's been quite the journey.
And now we are ACHC accredited and
credentialed with Medicare for Home Health, and we also offer
patient advocacy. So really trying to, again, provide that coordinated
care in the home. I love that. But Mary, I want
to clarify a couple of things because I think Carrie and I come at this
from a slightly different perspective. Perspective, even though we're mother and
daughter and there's usually not a lot of daylight, number
one, while many of the folks that we take care
of are indeed seniors, there are plenty
of people. Illness and
disability does not affect only old
people. You can become disabled. You
can get diagnosed with some significant
illness pretty much at any age, including Carrie
at eighteen. All right. And so the
idea that we do senior care, a large portion
of what we do is senior care, because as we get older, we're
more likely to have illnesses, we're more likely to
need support. But it is not limited
in any way, shape or form to only old people.
Number One. And number two, I want to be really
clear in the explanation of home
care versus home health because I think a lot of
people don't understand the difference between those two things. When
Carrie says that we have been providing home care for the
past two years, that is really the non medical side.
And what I mean by that is activities of daily living, getting dressed,
getting showering, bathing, toileting,
meal prep, going to doctor's appointments, all the things that allow
you to live your life that you may not be able to do
independently and you may not necessarily have the family
or social support to enable you to do that. That's
really what home care is. On the other hand, home
health is the medical army. Skilled
nursing, PT physical therapy, occupational
therapy, speech therapy, really skilled
services. And for home health you need a physician
order and it's covered by insurance. Whereas on the
home care side, that is something that anybody who
understands that they have a need or a family member has a need can
arrange for, even without a physician being involved.
Yeah. And I think that as a
doctor, I will tell you that doing both home care and
home health has been probably the most humbling
experience. And the reason for that is that when we
see patients in a clinic setting,
it's very sterile, right? We see you for 10 minutes, 15 minutes,
we tell you a bunch of stuff. And even if you're able to tell us
back what you heard us say, you may or
may not actually comprehend that you may not remember it
by the time you get home. And so then
sometime later you come back either to see us in the office or you end
up in the hospital, whatever it is. And I'm sure
your listeners will acknowledge that they've heard
physicians or healthcare providers say, oh, that patient is
non compliant. And it's not until you do home care and home
health that you realize that most people actually really want to do the
right thing and they really do want to be taken care of and
have the best care possible, but they don't have
the resources, they don't have the social support. And
so once you get out into the world, it's a very different
environment than when you're sitting in a clinic. And the other thing is
that do themselves a disservice because they
frequently want to put their best face forward and they
tell us they're doing stuff or they understand stuff when they don't. All you have,
all you have to do is think about, you know, maybe your
mom who, or a friend of yours who
gets dressed to the nines, puts on their makeup and
going to the doctor looks totally put together and
yet you see them on another day and they haven't gotten out of their
pajamas, but they don't want that.
That is, that is an interesting thing, I imagine as a. Because it's
a completely different setting. So. And I know today
I wanted to have you guys on the week before Thanksgiving because there is
this going into, you know, aging. I know this can be for other
people. Maybe it's not aging, it's health related, but you're
going home for the holidays maybe, and you're going to see some relatives you haven't
seen in a while who might be aging. And I know you guys
give talks out in the community and you just gave one about
staying safe during the winter, but are there things
like when you go home and it's over holidays and you're seeing
a parent or a family member who is, you know,
getting up in years, are there things to look for? So
I, I think one of the biggest things to look out
for is changes in cognitive status.
And that's kind of the high, high level idea.
But when you talk to your parents on the phone
or your grandparents on the phone, you might talk to them for
five, 10, maybe even 30 minutes. Whether it's on
phone, by phone, or on FaceTime, you're getting
a very small snippet. And one of the things that I have found
is that people are really good at faking
how well off they are. And so
the opportunity to spend prolonged time with your
loved ones is a great opportunity to kind of assess
their cognitive status. So when you talk to them on
the phone, they may have a typical
conversation, but after 30 minutes, an hour,
you might notice that they are on a loop, that they
are having the same conversation with you that they had an
hour ago. You might notice that they are fixated
on different topics, whether that is,
oh, I need to do laundry, I need to do laundry. And even after you've
addressed laundry, they may still be fixated on that.
So that's something to look out for. You might notice
forgetfulness or confusion.
Another thing is, especially for people with cognitive
changes is change in routine can be really
disorienting. And having a lot of family in town
might be disorienting for them because they have
established a very specific routine. And so
if they become anxious, if they become confused,
those might be signs that they are
disoriented. And so by
spending more time with people, you'll be able to get a better
understanding of what their cognitive status is.
Yeah, so we probably should be checking in with relatives more than just on
holidays is also what I'm hearing, you know, and be
be or, you know, it might be neighbors or whoever
that might be. But if we, if we see something,
we're like, that's not great. What do you recommend doing?
Either one of you can. I mean, I think some of it
depends on how acute it is. All right, so
I want to come back to a couple of things that Carrie touched on.
When she talks about a loop,
you may not even recognize the loop. And whether you're home for the
holidays with them or you're just talking to them on the phone on a
regular basis, be aware of the conversation you're
having. If you constantly ask somebody questions that
really are yes, no questions or things that
can have a very simple answer, you may not
recognize how impaired that person is.
And so, because if the question is,
so, are you having a good day? Oh, yes, I am. I mean, I can
have a whole conversation with you and say nothing. Right?
Be aware of the conversation that you're having. The other thing
is that, you know, it's very hard when
you really haven't seen this person for three months or six months and
haven't had any in depth conversation to figure out what
is acute versus not acute. What I mean by
that is somebody may have a gradual
decline. And frequently those cognitive changes
are relatively gradual.
Sometimes, however, it can be a sign
of, let's say, a urinary tract infection. One of the most
common presentations of urinary tract infection in an older
person is, is actually change in mental status confusion.
So if you normally are talking to your loved one and they're
with the program and all of a sudden they're making no
sense to you, they need to go to the ER immediately. That
makes sense. Yeah, because, you know, they could be having a
urinary tract infection. They can have ischemia, meaning
inadequate blood flow either to their brain, to their heart. They could have a heart
attack, they could be having a stroke. And so, you know,
it becomes very hard for family members who don't see
their loved one on a regular basis to kind of ferret out
what's new, what's not new. And that's, where are their friends around?
Do they go to church? Who else are they interacting with? So that you can
get some other data points to really recognize
kind of what we're dealing with. That's number one. Number
two, anxiety and depression
are very frequent symptoms of
cognitive change. And one of
the things I've learned as a physician over the years Is that depression
and what people perceive as dementia or cognitive change can be two
sides of the same exact coin. I have historically
seen in my own practice, people where you thought they had cognitive
changes and you thought they're depressed, you treat their
depression, the cognitive changes get better.
Similarly, if you are aware that you have cognitive changes and
most people who have slow decline are
very well aware of it, they may not be articulating it to
you, but they know. Carrie will tell you about
her grandfather who would say to us, my brain is not
working my brain the way it used to be
until he finally passed away at 89. I mean, so, you know,
he had a long, wonderful life, but he was
aware probably a good 15 years.
I also see folks that we work with who are in their
70s, some in their late 60s, who can notice that,
that their short term memory might be affected.
And so it's not, to Sandy's point, it's not
necessarily that there is a drastic drop off in cognitive
function. Oftentimes when it is age related or
dementia related, it is a slower, gradual
decline. So to Sandy's point, just to echo that, if there
is an acute change that requires immediate attention,
yeah, that makes sense. But the other thing,
Mary, it's about teaching people to look for clues.
Okay? If you come to visit and it used to
be that the house was impeccable and now the house
is kind of not so clean anymore, or there's we've
all seen either on Instagram or
commercials on TV about children,
about adult children coming to their parents houses and throwing
out expired food and we all giggle. But the reality
is that if you find milk in mom's refrigerator
that's three months old, okay, and she's unaware
that she's got milk that's three months old, that's a good clue
for you that there's something going on here.
Go ahead. But I think the second piece, piece to your question, Mary, is also
about what do you do? And there are some
cognitive changes that are a normal part of
aging. And you do need to kind
of plan ahead and take precaution and put safety
measures in place, but there might not be a drastic
thing that needs to be done. So for example, if you
are visiting your parents, your grandparents, and you notice
that their pill bottles are still sitting in their
prescription packs, that might be an opportunity
to come up with a plan for how are we going to help you take
your medications routinely? Yeah. That being
said, if you come in and you notice that you smell gas
because they've forgotten to turn off the
stove, then that's obviously a more urgent, immediate
need for intervention. And so there's a broad
spectrum of things that you can see when someone is
experiencing cognitive changes. And part of it is
the planning ahead, coming up with a plan for, okay, how are we going
to manage your meds? How are we going to manage
if you start wandering, if you leave the house and go for a walk and
can't find your way back home? How are we going to manage if you
are leaving the stove on or turning on the water
in the shower and not turning it off? Things like that.
I want to come back to a list of things that we can do for
that. But before we go back to that, I really want to talk
about from the medical perspective, the evaluation
of that person. Okay. Obviously,
if there's something acute, you're going to take them to the emergency room
or urgent care to make sure that we're not having a
stroke, a heart attack. You don't have a urinary tract infection.
More likely than not, to Carrie's point, it's gradual. How do you work up
that person? How does that physician figure
out whether you have dementia? I want to
come back and say that a lot of people have cognitive changes
for a myriad of reasons
ranging from. From age related to
drug interactions to,
you know, the chemotherapy fog
to vascular insufficiency. All right.
If you have high blood pressure, long term, you can end up
with what is called small vessel disease, where basically
part of your brain atrophies because it's not getting enough blood
flow to the brain. Interesting. I mean, I can give you a
laundry list of these. The point is, is that there are multiple
causes. So are you a diabetic? Do you have high blood
pressure? How well controlled are those things? Because those are things that are
going to predispose you to cognitive changes. There
is a whole metabolic workup that the physician can do.
There's obviously, or maybe not obviously,
MRI of your brain. Do you have a brain tumor? Do you
have just ischemic changes where you're not getting adequate
blood flow? Maybe you had a stroke and you didn't know it
because depending on which part of your brain has been affected,
you can have mini strokes, okay. And not
either. Either TIAs, transient ischemic attacks, or
even an actual stroke. But if it doesn't affect the part of a
part of your brain that has a significant function,
you may have a series of them before you have a large stroke without
ever knowing it. There's an
entire medical workup that can be done in order to sort
out, do you have cognitive changes? How significant are
they and what can we anticipate? Then the other thing that I
would strongly advocate for anybody who either they
themselves or have suspicion that their loved one has cognitive
changes and is to get neuropsych testing done. That's
usually done by a neuropsychologist. It's a battery of
tests that evaluate cognitive function.
Everything from simple stuff like who's the President of the
United states to remembering five
numbers that I tell you now, 20 minutes from now, there's a
whole battery of these. In the ideal world,
as soon as you become suspicious, you get that as a baseline
and then it can be repeated in order to evaluate
the progression of this over time.
Okay. Because most people do not fall
off the cliff abruptly. Most cases,
people, regardless of the medical issue, most
people have this progressive red
flag, red flag, red flag before we fall off the cliff.
And to Carrie's point about what can we do to keep you safe
at home and keep you functioning and as
independent as you can be understanding
what are the red flags, what's the progression, what's the trajectory of
this is fundamental to that. And that's the
neuropsych. That's what is helpful for that workup of this.
Yes. Okay. And so I think part of your question too,
Mary, is how do you get this worked up and
who do you go to? So you can go to the primary care provider,
ultimately you'll likely want to go see a neurologist
and then they will likely be the ones to refer the person
to, to have a neuropsych eval done.
Okay. That is really great information. I
appreciate it. So if someone is, is at home
and like they're listening and they might be one who are, you know, they're past
70, they're 80, whatever they are, and they're like,
are there things that, that they can think of to help themselves
with aging and for reaching out for help? Is it,
you know, or is it harder because it's kind
of the brain function? I mean, have you found that people can be good at,
at kind of self regulating that
piece of it and, and knowing when to ask for help? Or is that hard?
There are certainly those people who can either
themselves or with support. And so
they're coming back to things you can do simple stuff like
don't have throw rugs on the floor that you can easily trip over.
Okay. Make sure that
either your neighbor has a key to your house or you have a
lockbox so that God forbid something happens, the Fire department doesn't have to
break down your door. Make sure you have an up to date
medication list and that you know what medications you're taking
and that you are actively communicating with the physicians to
make sure you don't have any drug, drug interactions.
And, and so there are a number of these things I'm sure Carrie's going to
add to my list. But one of the things we see in,
particularly in couples who are older, one is frequently
covering for the other. I know you
mentioned that and I can see that happening. And so I
think that, you know, really it's about honest
communication between the, between the
partners. It's honest communication with
your family members about what your needs are,
how you anticipate your needs to be. Do you want to
stay in your home? Do you, you know, are you willing to have a caregiver?
Do you want to move in with a family member? What do we think? Depending
on what this progression is, what does that future look
like? Before I turn this over to Carrie to add to my list,
the one thing I really want everybody who listens to this to understand
is asking and accepting help, whether it's from your family
member, your friends, whether it's a caregiver,
putting scaffolding in place will actually help
you maintain your independence. People have this
perception that if they accept help that it
means they can't do it and they will lose their independence. It
is exactly the opposite of that. Okay, that's really good.
I feel like we should repeat that, you know, because it makes me wonder and
I can see, you know, because of course I have, I have relatives in this
age range. So I'm thinking of them as you're talking and, and one who
has Alzheimer's. So that is, that is a tough one for him for
sure. And he's aware of it, like you had mentioned before, but
it. Do you, I mean, I feel like maybe, maybe you guys tell me, you
think some, some fear, some shame, some fear of dying, fear of
losing your independence, shame that you're, it's,
there's a change going on. I mean, do you feel like that can hinder
them? Asking for help from family members or neighbors or putting things in
place to, to assist with helping
them stay healthy? I
absolutely think that's the case. I think accepting
change in your functional status is a huge
deal. I experienced that when I was 18 and was
needing help with showers after I had three back
surgeries. I don't want to turn this on my mom, but
she is a breast cancer survivor and had
to Lean on the family and my dad. Dad for
support when she was going through treatment. If you make it to your
70s and 80s and have never had to rely on
your community, your family, then you are
beyond lucky. Different people have
to. My camera wants to keep turning. It does,
doesn't it? Different people have
to ask for help at different points in their life,
and that's okay, but it is really hard,
especially the first time you have to ask for help. And so,
again, I do think that's a huge barrier. And I
think, just to echo Sandy's point,
accepting help allows for greater independence.
That's one of the things I love about the disability community, and
one of the reasons that I ended up down this path to begin
with, was when you look at the
disability community and the social model of disability,
it's really that your environment is what
makes you disabled. It's not that you yourself
are disabled or not able to do something. And by
providing a person with the necessary supports,
whether that's a curb on the
side of a street, to be able to get on and off the
sidewalk, to using assistive
spoons or forks, if you have tremors, to be able
to feed yourself. These are all just assistive
devices or technology or supports to
enable someone to live independently. And
so accepting help is really one of the first things you can
do to live more independently.
I love that. And so I know you guys have. Provide a
lot of just education and stuff for people. So if
someone comes to you, whether it's someone who feels like they're losing, you know,
some help for themselves or a family member comes on behalf, and. And
they reach out to you and say, we need some help.
How does. How do you. How do you guys help? Like, what are some of
the first things? Let's say it's not medical, but they need some. How do you
evaluate that? And, like, what kind of things can
a company like yours do? I mean, you're in Reno in this area. So
what? But other. There's other areas of the country,
obviously. So, I mean, what are. What are some of the things
that they can get help with that would be, you know, help them stay in
their home and, you know, stay healthy.
So I'll take this because I. I spend most of my days doing this.
I think part of it is having an initial conversation
where someone who has more experience dealing
with aging or different diseases that
might impact your ability to navigate your
activities of daily living, they can help guide you in
a conversation of what can you do? What do you need a little
bit of support with how can we improve the quality of your
life? How can we improve your ability to do things
independently? And really that starts with a
conversation. I think the folks who work in
healthcare in senior care obviously
encounter these kind of
situations more regularly and so they bring a wealth of
knowledge and experience and are a
great way to explore what options exist.
I think if a person is looking for a
caregiving agency to actually step in and help
with activities of daily living, making sure
that the philosophy of the agency and the approach to
care is aligned with your personal values.
I like to think that we take a really
coordinated approach. My mom has spent her
entire career thinking about the biopsychosocial
model of health and we really try to do that here and
I know other agencies across the country really do that.
So really aligning values and philosophy I think is the
second step. Once you've had the conversation of what kinds of
supports could I benefit from or what tools can I
utilize to live well and independently at home?
Yeah, that's great. I think Mary, I want to echo what
Carrie said but maybe put a finer point on
really starts with that conversation. And
obviously if somebody calls us, we have a conversation
with them. We do a free in home consult to evaluate what their
needs are. Because most people are
overwhelmed by the time you realize that you need
help or your or your family member needs help. It's
kind of like the old game of hot potato. I'm managing, I'm managing, I'm
managing. And then as soon as I realize that I'm in over my head,
I need to do something right this minute. Right? Yeah. And
so I remember you saying that when you came in, it's just like by the
time we realize we need help, it becomes urgent. It becomes urgent
part one, but part two. And we also talked about this, the three
of us and that is there's so much
emotion when it's your parents or your
a loved one, you're afraid they're going to die, you don't know how to handle
it. Then there's, you know, in my case, I have three children.
You know, when my father, when my in laws were ill, My husband's an only
child. So they're the bucks stop with him. Right. When you have
multiple siblings and everybody has
an opinion and there's this, you know, it can be very
hard to navigate. And so one of the things that talking to a company like
us and to your point, there are people like
us all over the country, it's not limited to just Reno.
We are that independent
you know, ear to basically help you
ferret out in an unemotional way.
Here's where we are. Here are what the options are and how
do I navigate this? And you know, one of the problems in
today's healthcare
world is that people have multiple doctors. There is now a
doctor for, you know, the nail on your third finger and
there's another doctor for the nail on your fourth finger of the opposite hand.
Okay. Most two doctors don't talk to one another and each one is
giving you a list of meds. And, and so if you're the person
who is overwhelmed by this, sometimes
just having people around and this is in part where the
patient advocacy piece comes. How do I get my doctor to talk to
me? How do I get this doctor to communicate with that doctor? How do I
get my insurance company to approve this? What does it mean
to be on a Medicare Advantage plan or
an HMO if you're not of Medicare age as
compared to a, a plan where I can go to anybody?
How does the whole system work and how do we coordinate it?
And that's, I mean that's overwhelming at any age. Right. So if
you feel like you're somehow your mental faculties are, are
starting to slip a little bit. I can, you immediately have to be overwhelmed. There's
no way you couldn't be, you know, with that. So
I can, I can definitely see that. So the patient advocacy
does come into play with dealing with the medical system.
You know, come into play with the financial
system. It can come into play with understanding your
explanation of benefits. You get a bill from the hospital
and it says that they charged $40,000 and the insurance
only paid 2,000. And you can't understand what that is
about or how much do I actually owe. And
it's every aspect, you know, health is not
just about going to the doctor or a drug. Yeah. It's
your overall well being and it affects every aspect of
your life. Yeah, man, that's a lot. It
is a lot. So I know you guys
just gave a talk. Maybe it was, was it just you, Sandy, or both of
you about staying safe over the winter? So like what are
some things that you can do to avoid falls and those kind of things that
you guys gave that talk about? I'm kind of pivoting a little bit. But
so it was actually Alex and I. So there are
a couple of big things. Obviously one
of the issues is regardless of where you
live, you don't, you can live in Atlanta
or Baton Rouge, Louisiana, where it usually does not snow,
but it can be 35, 40 degrees in
the morning. And with the humidity, the ground is slick
and so you can come out and slip and fall. All right? If you
are unaware of how slick it can be, regardless
of whether there's snow and ice. So wearing good quality shoes,
making sure that the traction on your, the tread on your shoes
is up to par. If you are like my husband who wears his
hokas until they're threadbare, that is a losing proposition.
God's honest truth. Making
sure that the lighting is adequate. You know, if you're going
out at dusk, if you're going out in the dark, turn the lights on around
your house. Take a flashlight, wear a headlight,
try and make ways not to fall inside your
house. Make sure, as I talked about, that you don't have throw rugs, that you
have a night light and that you turn the night light
on before you go to bed or have a light under your bed that's
a motion detector. So that because especially
as it's dark in the morning and it's dark by 5:00 clock at night,
you may think, oh, I'm not going to turn the lights on. Turn the lights
on. You need to be able to see where you're going. All right?
Obviously, especially make sure you have a
clear path around your house. People seem to have obstacle courses
where there's an ottoman in the way and there's a, and there's a coffee table
and there's some, and there's a dog to trip on. So that's
fall prevention. One of the other things that we talked about in this talk
is this is the height of fall cold and flu season.
This is not a political statement, but vaccines, particularly as you
age, are super important because our immune systems are not what
they were. And the consequence of getting a viral
illness is much greater, particularly if you have significant
underlying diseases like asthma or COPD or
underlying heart disease. So flu FLU
VACCINE UPDATED Covid BOOSTER There is
now a new vaccine in the past couple of years for
rsv, otherwise known as respiratory syncytial virus. Used to
be a virus that everybody thought only kids got, but
turns out old people, actually young people, actually anybody
can get it and you can get a vaccine for, for it, and that will
make a huge difference. And then the other one is
Prevnar, which is the pneumonia shot. It's particularly important
if you're, if you're going to go visit your family members
or they're coming to visit you because they're either you or
they are bringing a bunch of bugs that you're not used to seeing
and you're in close quarters, all right? And if you
have, you know, young kids around you, whether they're your nieces and
nephews or their grandchildren, children are petri dishes.
And so they are bringing home from school whatever they were
exposed to, but you haven't seen that bug in a long time.
And so the likelihood of you getting sick is that much greater. So
trying to prevent that. The other thing that we talked about
was the tendency to eat too
many sweets, actually, the tendency just to eat too much
this time of year, Whether it's Halloween tomorrow, whether it's
Thanksgiving or Christmas, if you're a diabetic,
obviously things that are high in sugar or you're a pre diabetic
can tip you over the edge. But even things like
Thanksgiving dinner, which tends to be high in salt, if you
already have high blood pressure, if you have heart disease, if you have
congestive heart failure, can take somebody who's well controlled
and tip them over the edge. The other thing to. To that
point is Thanksgiving night is the.
The most significant night in terms of people having heart attacks of the
entire year. Oh, and that's. That's. I don't think I've ever heard
that. That is until I heard you say that. Yeah. And so it
has to do in part with the tryptophan and the turkey, but it also has
to do with the amount that you eat and the. And the amount of salt.
So again, something to be aware. And then the last thing
we talk about in terms of hazards of fall is really seasonal
affective disorder, otherwise known as sad.
And that is really the depression that comes when it's
cold and it's dark. And if you think about it, when it's
cold and it's dark, there are many days that you don't want to get out
of the bed or you don't want to go to the store, you don't want
to go to a movie, or you don't want to go see your friends because
it's cold and it's dark, and I might as well just stay home.
Socialization is super important, all right?
Making sure you don't isolate yourself. And then the last thing I will say about
that, and I'm sure Carrie will have an opinion because Carrie had a happy light
for a long time. But the
last thing I'll say about seasonal affective disorder is the need for
routine. All right? And at the
beginning of this, about disrupting
people's routines. Well, in the winter, you tend to Disrupt your
routine because again, you don't feel like doing stuff. And so if
you normally get up, get dressed, put on your clothes and
go for a walk in the neighborhood, even if you just walk around your house,
you need to do that same routine. And
basically whatever your daily routine is, that's what has to stay because
that is what helps you maintain your sleep cycle.
It's what helps you in terms of your cognitive function
and overall helps with the depression. Okay, Carrie, what did I miss?
No, I love it. Covered it all.
Happy light. That's.
Right. Yeah, I feel like that, you know, the seasonal affective disorder,
that's, that's some real stuff. Especially in, in states where
that, those Grace. I know I lived in Wisconsin for a while and I think
those gray skies lasted for six months. Like there's certain, there's certain
things that, that aren't helpful at all in any
age. So, so tell me this. I mean when
you're, I know you work with families all the time where they're, you're working with
the kids trying to help an aging parent.
So I'm curious for someone like, I mean my, my
mom and her husband do their best to stay very healthy and
do all kinds of things, but you know, everyone gets older. So
what is. And we have multiple kids in our family, to your point.
So for someone like that, where like kids aren't necessarily nearby,
there's multiple kids. What are the things that you recommend for
families? What, what do the. Primarily the children,
but you know, anyone who's stepping up to help, what
do we need to do? And I think you
mentioned a few things like you know, kind of making sure the list for,
for medications there and making sure everyone has a key to the house and
people are checking in. Maybe. But are there some other things that you've noticed
that would be helpful? So I
think it really depends and I know that isn't a helpful
answer. I think one of the first things, especially
if you're early on in your parents
evolving status, is to have a conversation and
figure out who is going to be able to step up in which ways.
We have a number of families where there are
multiple kids involved. And so if one person is really good
at finance, maybe that person is going to take over the
parents finances. Maybe one person loves to talk to their parents
on the phone. So maybe that person is the one calling every day to
check in or every other day. So figuring out who,
who has which strengths and which way that they are going to best
support mom and dad I think is one
and then two is starting to talk to your parents
and talk about the quality of life that they want to live.
If they are having to give up their license
because they're no longer safe to drive, if they are
not socializing as much because they have mobility
impairments, what are the things that you,
as the kids can do to help facilitate them
having independence? Again, it comes back to that idea of
having the necessary supports in place to help them
live independently or as independently as possible.
So again, it comes back to that initial conversation
and figuring out who's going to do what to step up.
And then if you are coming from out of town, I think that's a great
opportunity to start interviewing different community
partners. Whether it's a home care agency that can provide
caregiving services, whether there are
day centers where your parents could go to spend
a day and have socialization activities. I
think those are some things that you can do during your visit.
But ultimately it depends on what your
family, what the kids are able to provide
and what the priorities are for the parents. I'm sure
Sandy also has thoughts to add. I
think that in the old days
people didn't want to talk about death and dying or loss of
function or acknowledge that we get
illnesses or. I remember even as a kid that,
you know, the C word, cancer was something that was very hush hush and
nobody talked about. Right. I think that the world
has changed. And I think that having these conversations
early and often before we get to the
point of it's a problem, because once it's
a problem, then everybody has emotion about it. If you can
discuss it before, like now, before it's even an
issue. All right? Your chance of having
that unemotional. So, mom, what, what, what?
What would you like to have done? I think it's also the
reason to encourage everybody, not only your parents.
This applies to you, to me. To have
a living will to make, to go through the exercise of
thinking about what would I want. Okay. And understand
that if you have an advanced directive, if you have a living will, it is
really nothing more than a suggestion. All right? It
memorializes kind of what you're thinking, what you want.
It doesn't mean you can't change your mind. It doesn't mean that circumstances don't
change, but it at least provides a framework. That's number one. Number
two, you really need to decide to carry his point. Who's going to
do what? But more from the perspective of who's
going to be the durable power of attorney over
finance, who's going to be the durable power of attorney over
health care. If mom says it's dad
and dad says it's mom, if, God forbid, something impairs
both of them simultaneously, all right, then who's the
backup? And if it's not memorialized, you don't have,
there's no backup. And then it becomes the state. So again,
to have these conversations in advance and be
realistic, okay, if you are the kid who lives far away
and there's a kid who lives nearby, chances are it's the kid who lives
nearby that's going to go to the doctor more easily
than the kid who lives in Thailand. Right,
Right. And so when you're sorting out who's going to do what, think
about that. The only other thing, Carrie, that I would
come back and take issue with, it's not a kid who's
going to do the calling every day. Set up a schedule
where every kid calls every
other, like a rotation. If there are three of you,
each one of you takes two days a week.
It is one of the things that we see repeatedly
and, and I've seen in my medical practice is
that people get burnt out.
And, and I said something to you, Mary, and I've said it to Carrie
now a number of times that is very crass, and I will apologize for
an advance. And that is, you know, on
some level, many family members end up feeling,
okay, if you're going to die, can you just hurry up and die quickly? Because
we can all do anything for a day, a
week, a month. The thing that wears folks
down is chronic illness. And because
medicine has evolved so much, we've gotten so much
better in keeping people alive for a longer
period of time. The, the getting
sick and gradually declining is over a longer
period. Well, that kid who can put their life on hold for two
weeks to go take care of somebody may not be
able to do it for six months or a
year or. Or five years. There's no,
there's no guarantee the time frame in which this happens. And that's
where understanding what the contingency plan is going to
be is so important. And to come back to Carrie's point,
if you live out of town, going to look at the
various, whether it's the independent living, assisted
living places, whether it's figuring out who the community resources
are, whether it's interviewing companies like us,
talk is cheap. It does not hurt you to line up all
of this stuff, understand what's out there, because when
you are in an emergent situation, it is too late
to first be scrambling to try and Figure this out. You really want to
think about it preemptively. Yeah, I really
appreciate that advice. So, you know, the, the living will is one you
said, and that, that can go into, you know, what medical
decisions you want to have made is what I'm understanding. Yes,
yes. And then just making a, you know,
because how long it will take in this, in the state of
not being able to fully care for yourself is a, we don't know
that timeline. And I feel like that's another just thing that we
can think about both, you know, my age and,
you know, boomers can think about that's, you know, they're aging right
now. So I really like that. I really like that
idea. And so if you are like listening and you are,
you know, the boomer who's, you know, you feel fine right now, but you kind
of are going, maybe I should have some things in place.
But maybe it's the opposite way where your kids have no desire to talk
about this. What, what should you do
if you're the one where you're like, I, I feel like I should just maybe
have some plans and some things in place. And
what, what, what ideas would you have for them? If
you're independent enough, you can go out and
do this on your own. You do not need to involve your
kids. I mean, I would tell you that I know
personally multiple couples,
multiple individuals who have gone and ferreted out what their
options were and then said to their kids, this is the
plan. I think the caveat to that, Sandy,
is you want to make sure whoever is your durable power of
attorney, especially for health care, is someone
that is on board and obviously
agrees with your wishes. But I agree,
otherwise, if you are able to, you
can go out and evaluate all of your options on
your own. Yeah, I think, I think absolutely, Carrie, you
have to have their buy in. But the point is you don't need them to
take you or go with you. It's a two way street, all
right? And I think that a lot of the time
it, the kids don't are afraid to bring it up to the
parents because it makes the kids uncomfortable.
And so, you know, saying
out loud, you know, you and I talk about it all the time.
You know, saying out loud, hey, I know this time is
going to come. Here's what I'm thinking, here's what I would like,
here's what the plan should be, is, is a
two way street of a two way conversation. Right?
And so you, if you're up to it, you can do the
research on your own and then present it to your family
or you can say to your kids, you know, I, I realize
this is what's happening. I, I think the one thing
that Carrie said that bothers me a little
bit. You know, if your mobility is an issue,
then the $64,000 question in my mind is why
is your mobility an issue? Is there some underlying process
here that we can do something about? Hey
mom, have you been evaluated? Do you need a knee replacement? Do you
need to go to physical therapy? Is it a function of getting
you a trainer? Can you do sit and be fit? What are the options
to deal with your. All right. And I think
regardless of what medical condition or what the situation
is, you know, it really boils down to that Serenity Plan
at prayer rather meaning,
is this something I could do something about? If so, let's do something
about it. Is it something that I have no control over?
Okay, then let's acknowledge I have no control over it and let's put it in
a plan to compensate for the thing that I have no control over.
But I think regardless of what the underlying set of
issues is, the very first question that either you or your family
member should be asking you is, is there anything about the
situation that we can change? And
if so, what is that? And if not,
then okay, how do we problem solve given
the circumstances that we have? Yeah. Where it's a two way
conversation. That's, that's so brilliant. I actually like
the, the misspeak you did with the Serenity Plan. I
think, I think maybe you should write a book called A Serenity
Plan and reference that and because that's that, I mean that kind of
does boil down to that. Right. If there's, can we do something about this? Then
what can let's do it. And can we not do something about it? Then let's
have it in the plan for when that time comes. So, and
I do think it just, it really does boil down to that,
that we don't want to talk about. We don't want to talk
about death, we don't want to acknowledge death. We don't want to acknowledge that that's
a thing that's going to happen to us all at some point. We certainly don't
want to think about all that's involved in,
in it. So you know, this is, it is, you
know, part of life and so on your way.
I guess that's the, the Serenity Plan. But not that we, and we don't want
anyone to go before their time. So how do, how do we stay
healthy and comfortable and. And,
you know, as. As we age? And so
one of the things that I've said for a very long time to
pretty much every patient I've ever had, but including the ones
who have been dying, and that is
nobody controls how long
you live. The only thing that we control
is the quality of the life that you have while you
are living it. And the same thing is true
even of dying. Dying does not have to be a
terrible or a scary thing. You can have, you know,
a good quality death, as crazy as that may sound.
It's all about how do we help you from
the moment that you're born until you ultimately die,
have the best quality of life, regardless of how long that life
is. That's so beautiful. I'm
definitely putting that out as a social media clip.
That part right there, that's actually part of the reason I'm doing this
podcast, is like, you know, the. The aspect of healthy living from
cradle to grave. And let's talk about all of it and not,
you know, get caught up in fear or, you know, anxiety
or any kind of stigma, shame, whatever that stigma
is. And, and then also about all the financial thing and how we
can live a big, beautiful, healthy relationship, healthy
body life, you know, with. Regardless of things that
go wrong. Like. And what I appreciate so much about both of you is you
both have live through stuff. You have a lot. I mean, probably even
before you live through your. Your medical challenges, you were. Had compassion, because
you have compassion. And just by listening to you, you know, you have a lot
of intelligence and wisdom. So it's very helpful to have
those two things paired together to talk through all these things. And I know you're
a huge benefit to all of your
clients for that, for sure. So
do you have any other kind of in. I know we've been going about an
hour, so just kind of any thoughts that you have about
anything else? We haven't talked about
staying healthy and happy over the holidays, over the winter,
things we can do, conversations we should have with
people of different generations. Anything. Anything
that you can think of along those lines. Everything
in moderation. That's. That's a good one.
Everything in moderation. Exercise.
Exercise. Because most people, not only do we overeat,
but we tend to do less because it's cold in the sweat, unless you like
to ski. Right? And so big bad combo.
The other thought that I'll put out there, that is
purely a medical thought that I
spoke about the other day in Hazards of Fall, and that
is Tylenol
hangs out in many over the counter
drugs. Whether you have a headache and you take Tylenol, whether
you have a cold and you take Dayquil or nyquil,
Tylenol hangs out in a bunch of over the counter things that you never
think about. Tylenol can be liver toxic,
okay? In moderation, less than 4 extra
strength Tylenol a day, you should be fine unless you have underlying
liver disease. But Tylenol is liver toxic.
So if you like to drink. And when
I said this the other day, my husband was like, you mean alcohol?
Yes, I mean alcohol.
I was like, what else? What else could I need? And his response,
well, you know, there's like water, there's seltzer, there's.
I'm like, no, I mean alcohol. So, so funny. I love that.
Drink alcohol, right? Alcohol
is also metabolized in the
liver and can be liver toxic. And just
as a news alert, one of the
first liver transplants I saw at UCSF back
in 1989 was a young guy
who had taken Tylenol and drank several
beers and basically needed a liver transplant. Oh,
that's horrifying. And so people drink too
much, they get a headache and they take Tylenol to deal with
their headache and you can kill your liver. So you are
going to drink. Do not take Tylenol, whatever
you do. That's the end of my. That's great
advice. That's super great advice. For
any age. For any advice for any age.
Yeah. 21. 21 and older maybe even
that made. Me remember I did have a specific question. So the durable power of
attorney, is that part of the living will? Yes. Is that included in
that? Okay, get that signed up at the same time. Okay,
I just had that specific question. So now we, now we know.
And there's general durable power of attorney, there's durable
power of attorney that it is specific for
finance, and then there's over health care and you. They don't all
have to be the same person. Okay, and did you
have an ideas on what you would want people to, to sign up for? I
know this is Medicare season too, so are that you would want them to sign
up for, not want them to sign up for. I know I did have someone
on the podcast who talked about all that too. But as doctors,
as a physician, we call Medicare Advantage
Medicare disadvantage. And so you have to understand
why the way in which Medicare Advantage works
is Medicare does not want to administer
Medicare to everybody. So they give private
insurance companies like United Healthcare, Aetna, Humana,
Blue Cross, a certain amount of money per life
to take care of Medicare patients, okay?
So when you sign up for Medicare Advantage, they.
There's often this. Come on. Because they're going to give you
vision and dental and prescription and a
lower premium. So let me start with. There is no such thing as
free lunch. If you are getting a
lower premium and you think you're getting all of these free things,
you should be thinking to yourself, why are they giving me all of these
free things? And Medicare won't give that to me.
It's usually because, number one, there is
a network which means that you have to go to only
a doctor within that network. Okay?
So if you live, for example, in Reno and you sign up
for locally here, for example,
Hometown Health, it's a closed network. So if you go visit
your child in California, in Southern California,
you can only go see a doctor if it's an absolute emergency because
they're not in network. The same way if you're not of Medicare
age and you get an hmo, okay? If you can only
go within your network, it's number one.
Number two, you typically need a prior
authorization and a referral to see any kind of
specialist or to get any kind of test,
okay? If you have plain Medicare, not Medicare
Advantage, you can go to any doctor in the entire United States who takes
Medicare without a referral. So it's what we call an
open network. And
you do not need a prior authorization or a referral. So
if you need an MRI of your knee, you can call up
the orthopedist, go see the orthopedist, the orthopedist can order the MRI
of your knee, and you can just have it done. If you have Medicare, if
you have Medicare Advantage, you're going to have to go to your PCP, who's going
to then refer, if he's willing or she's
willing, refer you to the orthopedist, who then has to jump through the
hoops of proving that you've had X, Y and Z treatment
before they'll approve the MRI of your knee. Why is that?
It's because the arbitrage between what
Medicare pays to a Medicare Advantage plan
and what the Medicare Advantage plan pays to
take care of you is the profit that the Medicare
Advantage plan makes. And there is
no business in the entire United States that is in the business
of losing money. So whether it's Blue Cross, United,
Aetna, it doesn't matter who it is, okay? I promise
you that there is some bean counter who has figured out that
by denying or delaying
your Care that they can save money
relative to what Medicare gave them. And that is why we,
most physicians that you talk to, if not all, will tell you you should stick
with straight Medicare A and B. Medicare A covers
hospitalizations. Medicare B covers
physicians and outpatient treatment. And
basically people are always worried about, oh, you know, with
Medicare, I have no limit. The reality is, is that you have a
$250 deductible. All right? That's what the
Medicare deductible is. And then, yes, you are on the hook
for 20% of what Medicare
allows. So if the doctor charges $500, but
Medicare says that the allowable is 100, the most you
would be out of pocket after your deductible would be
$20. Okay. And so people are
petrified that if they had straight Medicare that they would be exposed to
an unlimited expense defense. That is not the case.
Okay. And you can get a supplement,
Medigap, that will cover that 20%.
So if you are somebody who has significant medical needs,
if you want to be able to go to whatever doctor you want to go
to, if you want to be able to travel, let's say you have kid, one
kid in Wisconsin and one kid in Iowa and one kid here.
And, and you know, maybe you are going to spend three
months in each place with somebody you. Medicare, plain
Medicare is the way to go. Yeah, you are. If you are
healthy and you're an underutilizer, then,
you know, Medicare Advantage may work for
you. The problem. And I'll come back to what we've
been talking about all along. None of us know when we're going to
fall off the cliff, right? I mean, I, I was
an absolutely healthy
61 year old who went for a routine mammogram,
yearly mammogram, had one a year before
that, absolutely nothing, and found to have
this breast mass. All right, no symptoms, non
palpable, minding my own business. You do not
know when you're going to fall off the cliff. So this idea of, you
know, well, I'm healthy, so maybe I don't need this. That
is truly a misconception.
Yeah, I appreciate all that. That's good
advice. Oh, so I appreciate
that so much. Carrie, what, what do you other thoughts do you have
for everyone, especially in this season?
I think that two things. One, I think the holidays are a wonderful
time to be with family. And I know that as I've gotten
older, I've come to realize that all of the stories that
I heard when I was a kid are stories that I have vague
memories of. And so just in terms of really having
an opportunity as an adult to spend time with family,
it's really important to ask your grandparents, ask your
parents to tell stories. It's really good for
them to be able to share those memories with you. But I think
it's also really fulfilling as the younger person to be able to
have an updated
recollection of those stories. So I think that's
really valuable, especially over the holidays and with family
traditions. And then the second thing I think
is relevant to the conversation we had earlier
about durable power of attorneys is something
called a polst. And a POLST is
a medical order. It stands for Provider Order for Life
Sustaining Treatment. And it is a valuable tool
for really every single person
to have because it is a medical order
outlining your wishes. And it is
typically used in emergency situations
when you have an advanced directive, they might be 20
pages long. And in an emergency, you want to get
care as quickly as possible. And so assuming
that you are unresponsive, emergency
response personnel will begin cpr. If that is not
something that you want, then having a POLST is really the only
thing to prevent you from an
attempt at resuscitation. And so I really
encourage everyone that we work with to have a pulse.
I gave a talk a few weeks ago. How do I
apologize for interrupting? How do you spell that? P O, L,
S T. P O, L. A polst..
P O, L, S T. I've never, I've never heard of that. Thank you for
sharing that. When I actually talked to a
mom who had kids in her 20 or kids in their
20s who attended a talk I gave
a few weeks ago. And as soon as the talk was over, she, she
thanked me and said, I'm calling my kids right now and telling them to get
a POLST because they lived out of state and did not have
family who lived near them. And so if they ended
up in the hospital, she wanted to make
sure that providers knew what they wanted, that they wanted
full treatment, that they wanted
everything that could be done. And that is the base assumption. And so if you
are someone who wants everything done,
then it's, it's still equally important. But
that is the base assumption. If you do not want to be
intubated, if you don't want to go to the icu, then
having a POLST will make sure that your
wishes are respected. And so that's why it's so important. And again,
it's not. Instead of an advanced directive or a living
well or a durable power of attorney, it's
a complement to those tools. All right.
And I just want to add one thing to that so that people
are crystal clear. An advance directive. Living
will is what you would like,
number one. Number two, it is usually a document that is
20, 30, 40 pages and it is almost always
buried in somebody's safe in a drawer,
nowhere than anybody can find. If 911
comes, they're not looking all over your house to
see if you have a living will, number one. Number two, follow up
back to to it's just your wishes. It
can say that you don't want this, that and the other thing. But if you're
unresponsive and there is not a POLST on
your refrigerator or easily accessible,
the EMS folks are still going to do a full court
press. A POLST is a signed medical
order by a physician. So it is a legally
binding medical order so that you can actually have
your wishes implemented again. It has to be someplace
that can be easily found. If it's in your draw, nobody's going to
look for it. Right?
Fascinating. All right.
Thank you guys so much for coming on and I'm wishing you a
very happy Thanksgiving and Merry Christmas
and happy holidays, all those things. Even though I will talk to you again, but
for right now.
And we hope you have a great holiday season with your family.
Yeah. Thank you. Well, appreciate you guys
coming on. And
comprehensivehomehealthsolutions.com is
your website. Any other ways you would like people
to reach you if they are needing services
or needing your wisdom or wanting you to talk or anything like that? Because
you give speeches, too, so.
Calling us up is probably the easiest way.
775-624-8939.
You can also find us on Facebook and LinkedIn. And
Carrie will tell you that both of us tend to be available
what seems to be 24 7. So call
us, send us an email, reach out to us on our contact page.
We'll get back to you with whatever answers you need. All right.
Thank you so much. Thank you. Did you
like that? You can watch more episodes here. Subscribe over here. We
actually have new episodes with awesome guests every Thursday,
so check back in. Is that all.