Elder Care Insights with Bryan Adler

In this episode, I spoke with Bryan Adler, an elder care attorney from the Rothkoff Law Group. My curiosity about elder care law grew when I began working as a death doula, and I was eager to learn more from Bryan.

Bryan shared that their firm, the Rothkoff Law Group, is committed to educating the public about issues related to the elderly and the professionals who assist them. When someone reaches out to them, whether it's a family member or the individual themselves, they often have concerns about a loved one's health or aging-related conditions. They may receive a diagnosis and be unsure of how to proceed. In such cases, the firm's team conducts a phone consultation to understand the situation and determine how they can be of assistance.

During these consultations, Bryan and his team delve into the clinical aspects of the situation, including diagnoses and the family's worries. They work on creating a comprehensive plan focused on ensuring the best possible care while also addressing financial concerns. Bryan emphasized that their team consists of non-lawyer professionals, including social workers who develop care plans, occupational therapists who handle home safety modifications, physical therapists who assess balance and mobility, death doulas to help with end of life planning, and a public benefits team that explores funding options through Medicare, Medicaid, and other government programs.

Their approach is team-based, and clients often stay with them for years, building strong relationships that extend beyond crisis management.

We also discussed the Elder Care Symposium, an educational event hosted by the Rothkoff Law Group. This year's theme is "Death is Part of Life," reflecting the crucial role of addressing end-of-life issues. The symposium, taking place on October 19th, offers both in-person and live streaming options for attendees. You can find more information in the show notes at https://rothkoffsymposium.com/.

The symposium, which began in 2018, aims to bring national discussions on elder care to the forefront and promote innovation in the field. Past topics have included Alzheimer's drugs and unique approaches to dementia care. This year, the focus is on death and dying, emphasizing that acknowledging and embracing this aspect of life is vital for elder care advocates. The hybrid format of the event allows for networking and flexibility in attending sessions, making it a valuable resource f

Chapters

• 2:37 About Bryan
• 6:58 Caring for the elderly in the US
• 11:43 Three levels of elder care
• 15:07 What elder care law does for clients
• 23:30 Caregivers being able to return to previous roles such as spouse or child
• 29:40 Technology in caregiving
• 40:12 Elder Care Symposium
• 43:10 Next weeks guest

Transcript

[00:00:00] Bryan: We're end of life care planners. No one's coming to us in their 40s and healthy to plan for the rest of their life. They're coming to us in their 70s and 80s to plan for the remainder of their life. We got to face it. Let's see if we can't face the best way we can. 

[00:00:11] Jill: Welcome back to seeing death clearly.

[00:00:13] I'm your host, Jill McClennen, a death doula and end of life coach here on my show. I have conversations with guests that explore the topics of death. dying, grief, and life itself. My goal is to create a space where you can challenge the ideas you might already have about these subjects. I want to encourage you to open your mind and consider perspectives beyond what you may currently believe to be true.

[00:00:36] In this episode, my guest is Bryan Adler, who's an elder care attorney at a local law firm I recently started collaborating with. To be honest, I didn't know much about elder care law until I started working as a death doula. I was really looking forward to my conversation with Brian to learn more about it.

[00:00:54] During our discussion, Bryan shares some valuable insights about elder care law. He mentioned that he works at Rothkopf Law Group, a firm dedicated to educating the public on various topics. One of the educational events they organize is the Elder Care Symposium, which this year's theme they chose is, Death is a Part of Life.

[00:01:14] Bryan and I discussed this year's symposium, which will take place on October 19th in a hybrid format. You could find more information about the symposium by clicking on the link provided in the show notes. Thank you for joining us for this conversation. Welcome to the podcast, Bryan. Super excited to talk to you.

[00:01:31] I know we've met a couple of times in person, but it's always nice to get to know people a little bit better, especially now that we're actually working together. 

[00:01:39] Bryan: I'm very excited about that. The last time we met, we were just having drinks and we were talking about it. So it's great that you're part of the team now.

[00:01:44] Jill:Yeah, I'm really excited to be part of the team. I think at Roscoff, you have a really wonderful team of people. So it's nice to be kind of included in that. Now it's kind of a little weird for me coming from food service. I never thought I'd work in a law office. At like any capacity was not on my radar for sure.

[00:02:01] Bryan: Some of our  best team members have no legal background. They joined us some out of college, some from other jobs in customer service. They just wanted to see what it was about. They've never worked in a law firm before and they're doing great. The elder law is the easy part. You can teach anyone the laws and how to manipulate it, how to bend it, how to take advantage of it to your client's benefit, but you can't teach them that compassion, that connection with families. A lot of people just want to go in and do their job and be out. And a lot of lawyers just want to work behind a computer. But if you really can connect with families, that's our part. 

[00:02:29] Jill: Let's kind of start from the beginning, like where you're from, where you grew up, any background as to who you are as a person.

[00:02:37] Bryan: Well, I grew up in Harrisburg, Pennsylvania. I went to Penn state and ended up in Philadelphia. I didn't go to law school straight away. I took several years off and I sold software for six months. I sold gym memberships for two months, but ultimately all through college, I was a personal trainer. So I started a little personal training company and I did personal training for several years and I was convinced it would be my career.

[00:03:00] My clients to this day. I still really, really deep relationships with one woman's like my, I call my Philly mom. She always took care of me. Like even when I was struggling, whatever I was struggling with, she was always there for me. Another family, two summers ago, I was in their oldest daughter's wedding as a groomsman.

[00:03:15] These relationships stayed forever. And that's what I loved about it. I'm passionate about fitness because it's important to me, but it was those relationships with the clients that got me through my days is I was working 14 hours a day. It was crazy. And I remember I was in the gym probably five o'clock in the morning and I saw this trainer.

[00:03:30] He was high 50 at the time. And this might be pushing 65. Now he was gray and bleary eyed. I was looking, I was like, man, I don't know if I can do this one 35 or 50. And the economy kind of started to shift around that time. So I figured I'll go ride this out in law school. I thought my father's a litigator.

[00:03:47] I thought I'd go into litigation or entertainment law. And I hated it all. I hated litigation. It was you just saying, okay, I'm going to sue you for half a million bucks. I'm gonna say, I don't owe you anything. Then we settle on 250, 000 bucks and you're pissed and I'm pissed. And the lawyers go off and make the beach house payments.

[00:04:01] I was just so unfulfilling. So I kind of fell ass backwards into estate planning and a client asked me a Medicaid question. And I was just, I had this little tiny practice, right? I had law schools of my own. I was still doing personal training. I had a lawyer, a personal training lawyer. I changed my car, like from a suit to track clothes, suit to track clothes.

[00:04:19] And this client asked me a Medicaid question. I don't even know what Medicaid is. I wanted to find the answer. And I read more about what Elder Law was. And I kind of serendipitously found an Elder Law attorney. That's an estate planning experience. So I joined the small firm in Bucks County and cut my teeth to meet another guy.

[00:04:34] But all along the way, I kept missing those relationships. Estate planning is paper pushing. You do some documents, you don't see your clients again. In my opinion, traditional elder law is not paper pushing. You're doing good work, but it's very transactional. Clients hire you to get a guardianship or you get on Medicaid or move to a nursing home.

[00:04:48] And I, I just missed the relationships both with professionals and with the clients. So I, I met Jerry Rothkopf and I saw who he was dealing with. And I said to him, I think I want to leave my practice and start one like yours. I want this care coordination. I want these annual relationships with clients.

[00:05:02] I want to be more of a resource than just a hired gun. I don't want to be hired to do tasks. I want to be hired to be a solution. Like we're gonna have problems. We know what they are today. We'll fix them this way. Whatever comes up tomorrow, we'll fix them that way. And he said, join me instead. Why start your own practice?

[00:05:17] I've already got this thing going. So I joined him about 10 years ago. 

[00:05:19] Jill: Because I was wondering about that. I wouldn't say that elder law is glamorous. A lot of times when I've met people that are lawyers, it is partially the money and the power and like all the stuff that goes with it. And elder law isn't exactly the glamour side of law.

[00:05:36] Bryan: And so when I tell people what I do it, they think everyone's like, Oh, you sue nursing homes. I'm like, Nope. We help people get care. We help navigate. No one knows we exist until they need us. We're like the best kept secret, but I really, I don't love the law. My father's a litigator. He loves getting up there and debating the law and arguing his point and winning or losing.

[00:05:52] He loves winning, but you know, it's a win or lose. I have no interest in that. I don't want to argue to debate the finer points of trust planning. I just want to know this trust works for this purpose and actually get my client a good result. I have no interest in debating. I want to be more of a counselor and advisor.

[00:06:05] Jill: Yeah, I didn't know elder law existed until I became a death doula and I started working in this realm. And now of course I've been meeting other elder care attorneys along the way, but I really didn't know that that was something that was out there because you're right, I hadn't needed it yet. And now that I know about it. It is important. And I like the way you guys do it. 

[00:06:27] Bryan: First off, it's shocking to me that more people don't do it like we do. And it's shocking to me how little people understand about aging in the United States. I mean, it's still, to this day, it just staggers me how completely misunderstood long term care is, health care is, how, how it really is shocking.

[00:06:42] Jill: We don't like to think about aging. We don't like to think about death. We don't like to think about getting old and dying ourselves. And so what do we do with our friends and family? We just kind of push them off onto somebody else. It's somebody else's problem. I'm not going to deal with it. 

[00:06:58] Bryan: It's unfortunate cultural thing. And look at the way our older nursing homes, what do they kind of look like a warehouse? Yeah. You know, I'm not casting a dispersion, but I was listening to a podcast or a speech. I forget who it was. Some aging expert, a true expert, not like some self made expert. It was like a geriatrician or a PhD in something.

[00:07:16] He was like, we just bungled it. The United States, we failed miserably at long term care. We could have pioneered this, but we really just created a warehouse model that we're just now. Trying to dig out of.

[00:07:26] Jill: And we don't have enough care in this country. You know, that was one of the things, the baby boomer generation, there's a lot of them and they're all starting to age and they're going to need a lot of care and we don't have facilities, we don't have caregivers. 

[00:07:41] Bryan: That's the problem. Everyone sits here and says, well, I'll get long term care insurance and I'll save all my money and I'll play to pay for care. Great. Cause almost no one has the kind of resources for it, but it's not just. Dollar resources, not just financial resources. It's also human capital and we don't have it.

[00:07:56] We don't have enough caregivers for everyone to stay home. We don't have enough money for everyone to stay home. So it's all these resources are the amount of free, uncompensated caregiving by family members. It's like bigger than the extent of Medicare and Medicaid combined annually. the, the theoretical value of it.

[00:08:12] We need more and more family caregivers because there isn't the professional caregiving available. 

[00:08:17] Jill: I think about, it's hard enough when you need to take care of somebody full time, but what about when you're working still and you still need an income? And there's a lot of people like me that they call it the sandwich generation because I still have young children.

[00:08:30] I mean, my children still need a lot of care. And my mother also is a baby boomer. She had me when she was older. I had my kids when I was older. So I might potentially need to care for a child and a parent at the same time, which I want to like knock on wood. So far, I'm okay. But. 

[00:08:50] Bryan: You're absolutely right.

[00:08:51] To your point, you're seeing baby boomers, the disease, dementia, multiple sclerosis, Parkinson's, name it. They're setting on earlier and earlier. I remember when I first got into elder law, my clients were universally over 75, 80 years old. I have clients with Alzheimer's in their fifties. I have clients with Parkinson's and MS in their fifties.

[00:09:11] So you have people getting sicker earlier. You have their children having their own children later. So now that window is a lot narrower and there's a, there's a hard cost to that. It's not just the exhaustion. You have limited time to devote to your children and your parents, but these people leave the workforce, they spend their own money on their parents.

[00:09:30] So it puts them in a much more tenuous financial position, a much more tenuous energetic position. So now they're not as great a parent. They're not as financially secure. It creates greater stress. And you have this spot, this death spiral where it just gets worse and worse and worse. And we don't seem to have any real resources to address that.

[00:09:45] I mean, we're trying, but universally we don't have this, the approach like they take in Europe or even in China, to a certain extent, they're rethinking care models, what we need to rethink is how we provide care to not just the actual institution. Yeah. 

[00:09:58] Jill: Yeah. And it's a huge, I don't know, problem, I guess, to tackle.

[00:10:03] We're certainly not going to solve it in a one hour zoom call, but at least talking about it, hopefully bringing awareness to it. And eventually, I mean, we're going to have to do something because what else are we going to do? I even read an article that they were saying how many elders are becoming homeless and ending up in homeless shelters and homeless shelters are not equipped to help somebody get out of bed, they don't have four year lifts or caregivers.

[00:10:29] Bryan: We have people with psychiatric problems that wind up in prison. You have seniors that should be in long term care facilities winding up in homeless shelters. It's just this misunderstanding of how to address the problem. I have a client, she's in assisted living.

[00:10:42] She's in memory care. That's an important distinction. And she somehow slipped out of the door and she was in the main lobby. Nighttime and she got her hands on a butter knife and the night security night watch person was there and she just started like sort of stabbing it. She's dementia. She's stabbing him.

[00:10:58] He calls the police, which is outrageous to begin with. This person has dementia. Why would you be calling the police? You need to be calling your care team. Calls the police. Now I don't have the 911 calls. I'm not sure what was relayed, but the police come. She starts stabbing at him at the cop. The cop tackles her and breaks her shoulder.

[00:11:12] Now there's a failure on multiple levels. I don't want to cast an aspersion on the police officer because I think my guess is they weren't informed. They just said resident stabbing people with a knife and they immediately think that they're in danger because it wasn't communicated clearly. But that's just like a perfect articulation of just this fundamental misunderstanding of how to handle it.

[00:11:31] Jill: Yeah, because what's the difference? I think I know the difference, but I'm sure a lot of people don't know the difference between somebody being in a memory care unit versus a traditional kind of facility would be. 

[00:11:43] Bryan: So you kind of have three levels of care. There's some, there's more nuances. I'm overgeneralizing, but you have care in the home, which is of course, your home health aid, maybe skilled services with a nurse to help with daily living activities, lighthouse, keeping personal care, things like that, or higher level skilled care needed.

[00:11:59] The residential care options tend to fall into three categories. While you have independent living, that's more just senior friendly apartment or houses. There are rarely care services provided. Care is really provided in either assisted living or nursing homes. And inside assisted living, you have the memory care option.

[00:12:16] So assisted living or personal care is for the physical support. You might need help with your personal care, like bathing, toileting, getting dressed, getting to and from meals, making meals, things like that. Memory care is a similar concept. They help you with all of that, but it's number one, it's a secured facility.

[00:12:33] So the resident can't wander out of the front door to a dangerous location, but that doesn't mean they don't have freedom of movement. All of them at this point, I'd be shocked if there were any that didn't. Freedom of indoor outdoor. Just the outdoor area is secure indoor. They're often designed with no dead ends.

[00:12:47] So you can kind of continue to walk around and around. The architecture is specific. You'll rarely see mirrors because mirrors for someone with dementia can be very startling. If they don't recognize himself, it's strange in the room. The rooms are often identical. Whereas in traditional assisted living, you might have a studio or one bedroom, even a two bedroom and you have a studio, you all of a sudden walk into a two bedroom.

[00:13:06] It can be very agitating, can be very, it can be scary. So everything is sort of constructed and architected specifically in the caregivers are specially trained. So, and it's important to understand though, having dementia doesn't mean you need memory care. You can have dementia and live in traditional assisted living.

[00:13:20] It's if you need that additional level of security, additional level of support.

[00:13:22] Jill: And dementia is kind of like an umbrella term that Alzheimer's falls underneath and there's other types? 

[00:13:32] Bryan: I think there's 80 plus types of dementia. Don't quote me on that. Smarter people know that for sure. But Alzheimer's is like, if you were to pile up all the other it's just like super weighted towards Alzheimer's.

[00:13:42] But you have vascular dementia that's often caused by ischemic events like strokes. You have frontal temporal dementia. You've got Lewy body dementia, Casey Kasem had. There's all different types of dementias that are out there, but Alzheimer's is the one that is most obviously most known, but I think it's also the most prevalent.

[00:13:59] Jill: Yeah, it's very interesting, because I know growing up, my grandma would just call people senile, like as they got older, and she was old, but she would be like, I'm going to go visit the old people. They're senile. To me, it just meant they were forgetful. It's such a weird word to know that I think about it.

[00:14:14] Bryan: Dr. Sabat, he's a professor at Georgetown. He does a lot of research. He was talking about the origin of the word demented. And dementia, just a little bit of thought makes you realize D meaning removed and mentally removed, demented. But also the pejorative phrase demented, like you think about this, you think like the house on haunted hill, you think like this crazed doctor who's doing all kinds of weird, he's demented.

[00:14:38] So to say like you have dementia, you're demented. It really is pejorative. We call it now cognitive impairment. They're softer words. But it's like anything else. It doesn't matter what you call it. Eventually it becomes pejorative and then you have to move on. Like it used to be the Department of Public Welfare, but then that became, Oh, you're on welfare.

[00:14:54] So now it's the Department of Human Services. It used to be mental retardation. Now it's developmentally disabled. It's just because how these words develop. So they're constantly changing the vernacular. And now I'm waiting for them to say, well, cognitive impairment, we're onto something else. It's true.

[00:15:07] Jill: Eventually people just start using it. In a way that's meant to insult people and then we just change along the way. Yeah. That's fascinating. And so as an elder care lawyer, you help people find the facilities that they need. Do you typically work with the person that needs the care? Is it more of the families?

[00:15:26] Like how does that actually work? 

[00:15:28] Bryan: So that's a really good question. So, well, yes, I would say we as a team at Roscoff Law Group, we do that. That's not really my role. Maybe I'll walk through the process instead of just more generalities. Somebody. Whether it's an adult child, family member, loved one, or the individual, call us and say, my, fill in the blank, mom, dad, sister, brother, husband, wife, has some sort of health, long term health condition, age related condition.

[00:15:51] It could be, I've already articulated this, Parkinson's and MS are ones I run to pretty, pretty clearly because they're widely known, or cognitive impairment. I say, look, we got this diagnosis, we don't know what to do. How do we make sure that my mom gets the care she needs? How do I make sure my dad has the resources he needs to maintain his quality of life?

[00:16:07] How do we make sure we can advocate legally? So they call the office, they talk to our team. We have trained staff members who do a phone consult. What's going on? How can we be helpful? How can we be useful for you? And if they're appropriate, if we can assist them, they'll schedule a consultation with either me or Jerry.

[00:16:23] Jerry runs Jersey. I run PA. And we spend a couple hours. I want to learn as much as I can. What's going on really? What are the clinical issues? What are the diagnoses that how are they presenting themselves? And what is the family worried about? Let me put a plan together and overarching. It's how to get the best care possible, figure out how to pay for it, outgoing broke.

[00:16:39] So inside of that is our team of non lawyer professionals. We have six social workers that develop the care plan and they coordinate. All the care that's needed. No hands on care, but they'll say, okay, you need this. Now you might need that later and you might need this other thing in the future. Here's how we're going to get it.

[00:16:56] It could be D. M. A. It could be hands on care that we have to coordinate could be transitioning to care community. We have an O. T. Who does home safety modifications. We have P. T. That's starting in the fall. Who does balance and gate assessment so we can track their independence. And then we have our public benefits team that accesses Medicare, Medicaid, VA, other government benefits to pay for care, all overseen by Jerry and me and our legal team that are putting the plan in place. So it's a team based approach, and most of our families work with us for years. And after the crisis is managed, they'll talk to me.

[00:17:28] They'll talk to Jerry far less frequently than our benefits coordinators or our care coordinators because they develop that bond that really builds relationship and that's what they rely on for for advocacy. Yeah. 

[00:17:38] Jill: And  now you have death doulas too. So look at that. 

[00:17:40] Bryan: And I got to tell you, so Chelsea Duckers, she was the driving force behind all of this.

[00:17:44] She approached Jerry and me, and we're big on education. We try to educate people in the community. We teach CE credits to all manner of professionals. We seek a lot of education ourselves and we encourage our team. So Chelsea came to us one day and said, I want to be a death doula. Go do it. And she was super excited about it.

[00:17:59] And she brought you to us. She introduced us and she said, listen, Jill's amazing. If you don't, someone else will. And that's what I was like, okay, let's do this. 

[00:18:08] Jill: Yeah. I was excited because when I started going to the networking groups and like talking to people in person after I left my job, I was still working for the first, you know, year and a half, two years.

[00:18:19] And then eventually it was like, I can't do both. I don't have the time to go out and talk to people and do what I need to do. And I met Laura first, Laura works at Rothkoff. And she was the only person at this networking event that was like, Oh, you're a death doula. I've actually heard of that. Everybody else was like, wait, you do what?

[00:18:35] And I was like, Oh man, this is going to be hard. 

[00:18:38] Bryan: The word doula  has been co opted by so many industries. It's becoming bastardized. Yeah. And I feel like doula is to, historically doula, of course it's a birth doula, but it's sort of to usher you into or out of life. Now you have a kind of business doula and I've got a sports tool.

[00:18:53] I'm just, it's so co opted and frustrating, but please continue. 

[00:18:57] Jill: Yeah, no, you're right though. It is funny, but that's why sometimes I'll say to people that I'm an end of life coach, because I feel like people understand coaches better than they may understand doulas. And it's basically the same thing. I'm coaching you through the end of life, but.

[00:19:13] It is difficult because most people have not heard of Death Rulers, but it has changed even in the year and a half now since I met Laura and she was the only person in many, many people that I was talking to at that point that had heard of them. Now, a lot of people say, Oh, well, I heard about it in the news or a podcast or something.

[00:19:31] So it is exciting. I think it's going to be. Used a lot more as we move forward because people are going to start to understand the benefits because we can't keep Avoiding it. We can't keep pretending that we're not gonna die that our parents aren't gonna die that we're not gonna need care and Help along the way because that's the thing too.

[00:19:52] I'm thinking okay hiring a lawyer is expensive I do have all my paperwork my husband and I got ours done Many years ago, actually, because of Terry Shiavo, that case, before we even got married, I was like, Oh, no, no, no, no, this will not happen to me. Like you were the only person I trust. And so we got our paperwork done, even before we got married.

[00:20:12] And we've updated it over the years. But there's a lot of people I think that probably are listening and going, Oh, I don't know, lawyers expensive, getting them involved is expensive. But you know, what's going to be really expensive if you don't have these things in place, and if you're not prepared and actually a friend of mine, I did send them to Rothkoff.

[00:20:29] And the thing that they said was they were very expensive, but they were totally worth the money because now it's going to actually save us money in the long run, because we didn't know all of these things. And I was like, see, amazing. 

[00:20:45] Bryan:So Jill, we talked about resources and it's not just money, there's money, there's time, there's energy. And my father always taught me from the time I can remember, be the best at what you do and hire people for the rest. You don't want to know how to sort of fix plumbing, sort of do electrical, sort of landscape and sort of be a lawyer. Go be the best lawyer and hire a plumber.

[00:21:07] Go be the best lawyer and hire an electrician. And I look at this and that's why I have no objection to hiring professionals. And in our practice, I see this. I see families come in and they're going to ascribe one, usually one of those resources to what we're doing for them. We have families that hire us.

[00:21:22] This is unusual. Most of our families are very blue collar, very middle class. House some money. We're not talking millionaires, but occasionally we have families come as the kids pay our fee because look, I just don't have the energy or the time to deal with this. We'll have families come to us and say we need to protect resources.

[00:21:40] It's the money motivation, but whatever motivates them. The other two are always sort of there. But now I see, particularly with the baby boom generation coming up, they were accustomed to hiring help. There was a lot less bootstrapping it. It was, I'm going to do these things. I need help with the rest of this.

[00:21:55] They're much more open to looking for the assistance when it's not just money. When we talk about traditional elder law, it focused very heavily on nursing homes, meaning get mom in the nursing home, develop an asset protection plan and save money to get mom on Medicaid. Which means mom has this much, she's 10, you pay me 2 and I'll save the other 8.

[00:22:17] Well, now all of a sudden people are drooling because we're saving all the money. That's how you justify your value. It was just unfulfilling with care coordination, with health insurance advocacy, benefits planning. Well, now, yeah, we might be able to protect some money, but they have a whole bunch of long term care insurance policy.

[00:22:31] They don't care. But they need help making sure they're advocated for. They know there's going to be a problem. How do they untangle all this? So they're looking at the time and the resource value as well. 

[00:22:39] Jill: Yeah, it's true because money is one of them, but especially the older I've gotten, the more I realized that my time is more valuable than anything else.

[00:22:49] My time with my loved ones, hanging out with my kids, like all this stuff. And really, that's, I think, partially why I went into doing a different career that I could work from home, because I was working in kitchens and I was You were in food services. 

[00:23:02] Bryan: You were never home. Well, you're home at all the wrong hours.

[00:23:04] Exactly. 

[00:23:05] Jill: Exactly. And then you're exhausted and you're cranky and like all the other stuff. And so Now it's great. I get to work from home and spend time with my children. And that's actually why I have the, the headphones. It's more to drown them out because they're living life in the background and I'll hear something and my brain will go over there.

[00:23:23] So I wear the headphones. So I can't hear them. And I'm like, whatever, they're fine. They're safe. If they're not, I will definitely know. They'll squeal. 

[00:23:30] Bryan:. Yes. I said to a family yesterday, I met with the adult. Children. Well, adult child. There was only one child. He was here playing for his mom in Jersey and wants to move her closer.

[00:23:41] And it was one crisis after another. It was hospitalization crisis, crisis, crisis. And we talked at one point. I was like, look, let us help you out. Go back to being her son and let us worry about all of this. And he was like, you know what? That's what could that, that, at that moment, that's what I was like, I need that.

[00:23:57] That's when I want to work with Brian and his team. I do want to go back to just hanging out with mom. I don't want to have to be fighting with the nursing home or the assisted living or arguing with insurance. I would take, I just want to go back to being a kid. 

[00:24:06] Jill: That's a great point that when we have to be somebody's caregiver, we stop being just the child or even in some cases, siblings, you know, sometimes people have to take care of their siblings.

[00:24:17] You end up having to become a whole different role. And that's sometimes people will be like, I don't know, what's the point in having a death goal? Well, part of the point is kind of similar to what you're saying. Allow me to come in and advocate and be the person that can help so that you can just be.

[00:24:35] The child or the spouse and go through the dying process with your loved one, not worrying about all the things that you have to worry about when you're a full time caregiver. I can take some of that pressure off. Not that I'm going to be a caregiver, but I'm going to help you navigate it. Maybe I'm a little weird, but.

[00:24:53] To me, there's not many times in life when you're going to be as intimate with somebody as when they're dying. And if it's somebody that you love, right, if it's somebody that you love, you want to be fully present for it. And yes, it might be a little scary sometimes, and it's going to be sad, but it's also going to be beautiful.

[00:25:08] I had some really amazing experiences with my grandmother as she was dying. Once I calmed down, once hospice came in and was like, Oh no, no, no, all this is normal. She doesn't know who you are. It's fine. She's talking to people. It's fine. All of it's fine. And I was like, Oh, okay, good. And then once I could relax, then we had these really amazing conversations and times when we would be up at three in the morning sitting together.

[00:25:32] And again, she was talking to people that I did not see, but it was. Really interesting. I enjoyed it. It was a beautiful experience. I wouldn't trade it for anything, but also at the beginning I was really freaked out because I thought it was going to be like movies. Grandma was going to go home. She was going to be on hospice.

[00:25:49] She was going to sleep and like that was not that's and she's got all sleep and never woke up.

[00:25:52] Bryan: Yeah. Yeah. These caregivers, there's a lot of reports of the studies reflect that it's this double edged, that double edged sword is the wrong, wrong word to use. Maybe there's a bittersweetness to this, this family.

[00:26:04] Devotees, adult children who really devote a lot of time to kids. They report extraordinary stress, burnout, fatigue, anxiety, sometimes doesn't dissipate. It's there. It's baked in now. It's almost post traumatic, but they also report on the flip side of that. They're much closer with their parent. They feel more empowered.

[00:26:22] They feel like they're taking control of things. They're not just watching things happen. They're really in control. They're talking to the doctors. They're managing their parents care. They're not relying on somebody else who is invested, but not familial invested. And they report this great connection.

[00:26:36] You know, you look at a parent child relationship. I'm my kid's dad. And yeah, like we're buddies and pals, but I tell them what to do and they do it. I help them take showers. I help them go to the sports and we make meals and I parent, they don't know me as a person as much as I know them as a person.

[00:26:52] They don't want to. They want me to be dad. They do. They want to see me be fearless and they want to see me be there and they want to see me be energetic. They don't care about the rest because they're kids. But when you have that, when you start to age, you have that relationship and you can see. We're just people.

[00:27:05] I'm scared of things and I'm anxious about things and I'm tired. And when you see that you can really connect with them because you're really people now. And there's all these like life experiences that you've never understood or known about that you're going to be able to connect when you're in that vulnerable stage.

[00:27:19] I would want to encourage everyone to do what they can to get to know their parents or grandparents like that. The value of that can't be overstated. 

[00:27:25] Jill: Yeah, I agree. It's unfortunate that Our culture does not encourage it and doesn't support it more. There will be people that actually can't do it. But again, if you can't, you're really kind of stuck between like, what did they say?

[00:27:38] Rocking a hard place. If you can't afford caregiving, whether it's in the home or to send your parents somewhere, then you also probably can't afford to not work to do it. And so what do we do? 

[00:27:51] Bryan: I mean, you look at this way when my kids were in daycare. So I have a seven year old and nine year old daughters.

[00:27:56] Daycare was give or take $16,000 a year each, a year. Nursing homes are $15k, a month. Assisted living is $8,000 a month. So what you look at here is the overwhelming population. And don't get me wrong. I'm as big a believer in individual responsibility as anybody else. I believe you have to be responsible for yourself.

[00:28:15] You should be responsible financially. You should do your best to live within your means, but you look across the board. No one, no one can save the kind of money needed to pay for nursing home care for that long. It's just a little sliver of the population. So even though you need to be financially responsible, it doesn't work like that anymore.

[00:28:33] It's too expensive. And I, I don't know if you and I've talked about this, but my Big passion. My whole side hustle is age tech and big proponent research, studying all the technology technological developments to support successful aging, whether it be simple things like social engagement, which is kind of like yesterday, all the way up to robotic caregiving, which three, four years ago, I would stand on a stage in front of a hundred people and talk about age tech and say, we're 50 years away.

[00:29:00] I would say we're five to 10. I think it's accelerated so fast that technology can really change everyone's life. It's going to totally revolutionize care. 

[00:29:08] Jill:  I think you're right that it's going to be faster than we all thought. Being somebody that comes from an industry that is typically In food service, we don't get paid a lot, right?

[00:29:20] We do a lot of work and we don't get paid a lot. One of the fears that we've talked about in our industry is robots coming in and taking jobs in fast food restaurants. I mean, making the food to taking the food out and whatever else, but I can see how also in healthcare, it's especially caring for elders.

[00:29:40] Bryan: I want the humans removed from caregiving. And hear me when I say this, I'm not misspeaking. If you can, and I'm talking personal care, I'm talking the hands on getting dressed, bathing, toileting, getting him out of bed. I want the human removed from that. And I'm not saying I want the human removed from the life cycle, the continuum.

[00:29:57] I want the hands on care provided by technology. So that human, that's where you're going to get the value. Having somebody, if you're in a nursery and you've got one nurse to 10 or 15 or 20 or 30 residents, and they have to. Get up, get dressed, brush hair, brush teeth, get changed, get to life. Boom, boom, boom, move on.

[00:30:13] You can't have valuable social and personal connection, but if you have that same time frame, you still have only 10 or 15 minutes, but you have a technological innovation that's helping with the nonsense. And I'm saying nonsense, meaning getting dressed, the basic stuff. How you doing, Jill? How you feeling today?

[00:30:30] Did you see your favorite sports team one last night? Did you watch the game? Some sort of social interaction is so much more valuable psychologically, so much more valuable physically. Then is the actual taking on a shirt, taking off a shirt, put on a new one.

[00:30:41] Jill: And it'll be better for the caregivers because the burnout, I didn't do it professionally, but I know getting my grandmother in and out of the shower took two people and she's wasn't big, but because of the fact that when they're not able to hold their own weight and there's a whole thing that goes into it. It was so hard to do.

[00:31:02] Bryan: You can’t maintain good body mechanics. So you're going to hurt yourself. There's Boston Dynamics came out with a robot called Atlas. I would encourage you to look at this thing on the video of him on her. It's supposed to personify robots. It look at it on YouTube. We instinctively know I pick up this bottle.

[00:31:18] I don't crush it. Robots had a problem with that instinct. They didn't know how to pick up an egg in one hand. And a hammer in the other. Atlas does. He understands how to maneuver, how to hold things gently, how to throw things, move things appropriately, get it where it needs to go. This thing's going to revolve.

[00:31:34] It was Boston Dynamics. I remember watching it. I got chills. Like the first time I watched the space shuttle launch. This is a technological revolution. This thing's going to change the world.

[00:31:42] Jill: I will definitely check it out because I am fascinated by all of those things. And there's parts of AI and robots and all that, that I guess I would hesitate on fully embracing yet.

[00:31:54] But at the same time, it's like any other tool. If you can use any tool for negative, you can use any tool to hurt people. But ideally, we're going to use these tools to help a lot more people. 

[00:32:05] Bryan: I mean, AI worries me for a bunch of all the reasons that have been articulated, but you're absolutely right. I mean, look at Facebook.

[00:32:11] Everyone's on Facebook, but I think the overwhelming assessment is it's actually been worse for society and better. You know, it has some good things like you can alert family and friends, I think, but it makes psychologically, it's torment. It torments a teenager's Instagram, TikTok is all these problems with it.

[00:32:26] So there's some good, some bad, but you look at other technology like the iPhone, airbags, seatbelts, GPS, all these things are technological innovations that made life easier. So I really do believe the hardware side of things. Is going to be it will be revolutionary. It's the software side that tends to make people go crazy.

[00:32:42] Jill: I try to remind myself that if it wasn't one thing, it would be something else like in the past. Yes. Now I have more access to things that maybe make me feel bad. That's where you try your best, I guess, as a parent to teach your children. To work with technology, like I can't make it go away. 

[00:33:02] Bryan: I agree with you.

[00:33:03] Like my daughters spend time on the ride and I worry about what they're looking at. I watch it. She was mostly just garbage, like actual, just total nonsense. And it's like so enthralled with, but I, I really do worry about that. I hate with a passion, Twitter, Instagram. Facebook, but I'm on it. You know, I just sit there, I scroll through it.

[00:33:22] I follow people that are of my interest. Like I don't follow celebrities. I don't follow the friends. I do love LinkedIn. LinkedIn is so, it's so pristine. Maybe I've just cultivated like people I follow, but I just, I go to LinkedIn, it's like, there's no negativity. It's super positive. Great stuff is posted.

[00:33:38] Jill: I have tried over the last few years to cultivate all of my social medias to be what I want them to be, which is essentially a place to connect and find the people. But then there's a problem with that too, is that like find the people that are like me, that think like me, that have similar interests, but then you end up in an echo chamber if you're not.

[00:33:57] And so I try to find that balance. Of making sure that I still know what's going on in the world, that I still talk to people that aren't like me, but also connecting with people all over the world that are like me. In the past, if we disagreed with people that we went to church with or school or whatever else, you still had all these other things that you could connect on.

[00:34:17] Yeah. Where with social media, I do find it difficult sometimes. It's very tribal. 

[00:34:22] Bryan: It's very tribal. Everything. You look at a lot of these things. Even the title of some of these publications, like I have to, there's a website called Media Matters and it rates news outlets. On to where their biases and sometimes I'll read an article and I'm like, I go on, I want to check out their bias because I want to know why.

[00:34:40] And sometimes it's wildly biased. I try to stay right in the middle. And it's fascinating because you see things where it's like the real truth and it's ultra conservative or, or like it's the center, right. And it's super duper liberal. Like you just can't trust them what they're, how they describe themselves anymore.

[00:34:55] You got to do a lot of research yourself. Yes. 

[00:34:57] Jill: And it's hard because everybody thinks they have the truth. And honestly, I don't know. And maybe again, I don't know if you're into like astrological signs, but I'm a Libra and we are very balanced. I mean, we're the scales. So I definitely am at that point now, especially the older I've gotten that I'm like, honestly, I don't believe anything fully to be true.

[00:35:21] Because I feel like there's so much that our human brains can't comprehend. There's so much that in a hundred years, they're going to look back and be like, what the hell was wrong with those people? Why did they believe those things? But at this point, we just don't know yet. We don't know better. We maybe even can't understand yet.

[00:35:37] Bryan: We used to do bloodletting and use leeches. Actually, we're using leeches again, but you know, look, we used to do bloodletting, you know, George Washington had wooden teeth.

[00:35:46] Jill: Well, I think it's also okay to say that we don't know anything for sure. I don't know. Some people, I guess that makes them scared and anxious.

[00:35:54] It's like even end of life. When I talk to people at the end of life, I'm like, what are you most worried about? And some people, they just are so worried that they don't know what's going to happen after they die. It's just that unknown really freaks them out. 

[00:36:07] Bryan: My biggest fear is heights. like crippling, crippling fear fights.

[00:36:10] There are other things. I don't like snakes. Death is just not on that list. Like it just, I don't know what it is. I just doesn't bother me. And I think that it's because I'm elbow deep in it daily during COVID the peak of it, the first six months. I mean, in our office, it's not unusual for a client or two to pass in any given week.

[00:36:27] We were having 10, 15, 20, 25 a week. I remember that hit me really hard because it was so unexpected. But when a client passes away, I say to the family, No, there's a blessing here too. It's a tragedy, but it's also a blessing. Your loved one, for the most part, is really suffering. Aging, it sucks. My wife's grandfather was 94 when he died.

[00:36:46] He used to say to us, I'm just going to suffer. My wife has died. My friends have died. I have nothing left. I just, I'm done. I'm ready to be done and there's nothing I can do. And there's a lot of truth behind that. It's a, it's a scary truth. Actually death doesn't scare me. It's that, that gap in between that pop used to talk about.

[00:37:01] That's what I fear. 

[00:37:02] Jill: Yeah, same for me. My husband and I joke around. We've known each other since I was like 21, and he was 18. So a good portion of our life, we've been together. And so I'm always like, all right, well, hopefully we'll just die within like a couple days of each other. 

[00:37:17] Bryan: You know, Oh my God, Jill, if my wife, my actually, I say heights, my actual biggest irrational fear.

[00:37:22] I can't even watch that movie, the television show with Jason Segel. It's on Apple TV. I forget. The central theme is his wife dies suddenly and he's stuck raising his daughter and he's got this whole psychological problem. I can't, I, half the first episode I was out. I can't, the thought of my wife, it's indescribable.

[00:37:39] I, that couldn't deal with it. So I always say to her, she got sick. I'm going with her. 

[00:37:43] Jill:  But you know, when you had children, if it happens soon, and unfortunately, as much as I like to think it's not going to be me, I don't know for sure. I mean, my husband's traveling right now. He's down in Miami.

[00:37:53] Something could happen. I can't. He's in Miami right now. Yes. I know, right? It sucks. It's like 200 degrees. Yeah, I know. He would not be in Miami right now. Yeah. If he had a choice, he would not be there. But if something did happen to him now, I couldn't abandon my children. It would be hard enough on them losing one parent, but yet I really don't want to live the rest of my life a really long time without him.

[00:38:17] But I don't also have a choice. And I know, like, when my grandfather died, he was probably, 61. My grandmother was probably 59. At that time, it seemed really old. I was really little. Now I'm like, oh, 59 is not that far away from how old I am now. And she lived to be 94. For many years, she lived without him.

[00:38:36] Bryan: 40 years without him. And she spent more without him than she spent with him. 

[00:38:40] Jill: Yeah. And, you know, that entire time people would ask her, and I remember one guy that she knew, he wanted to marry her. She would like show me these love notes he would write her when she was in her 70s. It was adorable. And she was like, there's no way I'm ever getting married ever again. Your grandfather was it. And I'm done. 

[00:38:58] Bryan: Oh, I wouldn't. I don't know. I wouldn't. I mean, for a whole bunch of reasons, I wouldn't. Well, you heard what happened in Jersey over the weekend. There was a murder suicide. Really? Oh, God. Uh, don't quote me on the specifics, but my recollection is wife had long term cognitive impairment and husband ended it for both of them.

[00:39:12] Now that's tragedy. Yeah. But I understand. I get it. Yes. 

[00:39:16] Jill: Yeah. Me too. Yeah. I mean, I really, I can get how you could end up at that place where that would seem like the best option.

[00:39:22] Bryan: I look at my clients who are losing their cognitive capacity and I can go home at the day. These families living with it, frankly, I'm surprised they don't have it more often.

[00:39:31] It really, it is a horrible disease that robs you of literally everything. Your ability to eat, speak, see, hear, enjoy everything. And we just suffer with it. 

[00:39:42] Jill:  Yeah, it's really unfortunate. But let's switch gears really quickly. Yeah, let's take this a little bit. I know, right? Let's talk about the symposium here.

[00:39:50] The whole topic is death, but I am actually really I'm excited about the symposium. Like you said earlier, how Rothkoff is so big on education and just tell us a little bit about what the symposium is in general. And then this year's topic, I know Chelsea and I are really excited because it's all about death, our favorite topic. So tell us all about it. 

[00:40:12] Bryan: We started in 2018. Jerry had always had this dream of having an elder care symposium where we brought. Real national discussion issues to the foreground. It wasn't just like, Oh, Hey, what's the status of Medicare covering skilled home care. We really wanted to bring innovation. And our first year we brought Eloy van Haal.

[00:40:32] He was the architect of the dimension bills in the Netherlands. We brought in the United States twice. Once in the spring, once in the fall, PA, New Jersey, and we had a full day discussion. He did the keynote. We did a panel discussion with physicians on Alzheimer's drugs. And then we had professionals that talked about all manner of unique approaches to dementia care.

[00:40:51] And every year since we brought, try to bring heavy hitters. And last year we brought Karen Atkin. She's a geron technologist. She was on the team that developed leq. Which was a revolution at the time. She's in Israel. She's a fabulous, fabulous speaker. She's got such great knowledge. We've spent many of our last years focusing on dementia.

[00:41:07] This year, we're focusing on death and dying and how, again, death is a part of life. So we're going to have the entire day is dedicated to how to approach death in an appropriate manner, how to understand it and embrace it. And I remember we had two factions in our office. Half our team wanted it to be death.

[00:41:21] The other half said it's too morbid. And I remember I was shouting. I mean, like I was like red in the face if we pretend like death doesn't exist, we completely abdicated our role as elder care advocates. And one of our team members piped up and she said, everyone here says we're life care planners, but we are not.

[00:41:36] We're end of life care planners. No one's coming to us in their forties and healthy to plan for the rest of their life. They're coming to us in their seventies and eighties to plan for the remainder of their life. And that's what made the decision to do Death and Dying. We gotta face it. So let's see if we can't face it the best way we can.

[00:41:49] So it's October 19th. It's a Thursday in October. It's on our website. I encourage everyone to check it out. We're doing a hybrid this year. We have in person in Conshohocken. And then we're also going to be live streaming it. We'd like as many people as possible to enjoy it. The live is so much fun.

[00:42:06] There's a lot of people, a lot of networking, a lot of people will be there. The hybrid version also gives you this great opportunity to kind of check in and out. You can see what you want to see. If you can be there in person, it'll be great networking. If you're there virtually, you'll still be able to consume all this great content.

[00:42:19] And then we hope to make parts of it, snippets of it, available afterward for further consumption.

[00:42:24] Jill: And so I will definitely put a link. In the show notes. So if somebody wants to find it, but if somebody is not in New Jersey or Pennsylvania, they can still join, they would just do the virtual version. Okay. https://rothkoffsymposium.com/

[00:42:37] Yeah. Yeah, absolutely. You really do a good job educating people on things that, again, a lot of us don't understand. We don't always want to think about it or talk about it. And even if we're in the industry, there's still parts of things that we don't know. And. I'm really glad that you're talking about death.

[00:42:55] The more that we talk about it, the more we'll normalize it. And the more we'll take some of that fear and that anxiety away from people, because we are all going to face it one day, whether we like to think about it or not, we're going to face it.

[00:43:07] Bryan: Thanks for having me today. I really appreciate it. 

[00:43:10] Jill: Thank you. This was a pleasure. I really enjoyed it. Thank you for listening to this episode of Seeing Death Clearly. My guest next week is Nadia Kraus. Nadia originally comes from Germany. About a year ago, I had the privilege of being a guest on her podcast, where she shared a deeply touching story about her mother's final days.

[00:43:30] When podcast, Nadia was one of the first people who came to mind. I wanted her to share the same story with my listeners. Nadia's mother faced death without fear. She was well prepared for it thanks to the open conversations they had about death. Nadia joined my show to share that when we have these conversations about death, It doesn't have to be frightening or a traumatic experience.

[00:43:56] If you enjoyed this episode, please share it with a friend or family member who might find it interesting. Your support in spreading the podcast is greatly appreciated. Please consider subscribing on your favorite podcast platform and leaving a five star review. Your positive helps recommend the podcast to others.

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