Randi Goldberg is a senior Resource Specialist with Archer law offices. She comes to us from the BW NICE Mercer chapter. She shared a lot with us about how to navigate the health care field for seniors.
Randi made us see that there's a lot more to it than we realized.
Part hand-holder, part social worker, and always client advocate, Randi understands the unique needs of seniors and the sometimes tricky family dynamics involved.
Most importantly, she taught us how important it is to have a plan before there is a crisis.
You can reach Randi at:
Randi Goldberg (she / Her)
Senior Resource Specialist
Archer Brogan, LLP
P: 609-842-9200
F: 908-315-5140
www.archerbrogan.com
Learn more about BW NICE and our mission to help end domestic violence HERE
Check us out on Social Media:
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Sign up to be a member HERE
Randi Goldberg is a senior Resource Specialist with Archer law offices. She comes to us from the BW NICE Mercer chapter. She shared a lot with us about how to navigate the health care field for seniors.
Randi made us see that there's a lot more to it than we realized.
Part hand-holder, part social worker, and always client advocate, Randi understands the unique needs of seniors and the sometimes tricky family dynamics involved.
Most importantly, she taught us how important it is to have a plan before there is a crisis.
You can reach Randi at:
Randi Goldberg (she / Her)
Senior Resource Specialist
Archer Brogan, LLP
P: 609-842-9200
F: 908-315-5140
www.archerbrogan.com
Learn more about BW NICE and our mission to help end domestic violence HERE
Check us out on Social Media:
Facebook
LinkedIn
Instagram
Twitter
Sign up to be a member HERE
Hello, everyone and welcome back to the BW nice voice podcast. I am Debbie Weiss and I'm here with my co hosts Lynne Thompson, and our wonderful guest for today, Lynne. Hello, and why don't you tell everyone who we're sitting here with? We'd love to today, our guest is Randy Goldberg. She's a senior Resource Specialist with Archer law offices. She comes to us from BW nice Mercer chapter. And she's going to talk to us today about how to navigate the health care field for seniors. And just from our pre interview talk, we know there's a lot more to it than we realize. So. Welcome, Randy. We're happy to have you. Thank you so much for having me. And thank you for allowing me to be part of BW nice. We live? We sure do. So Randy, why don't we start with a little bit of background on you and how you even got into this field in the first place. So I've been in senior healthcare, as I say, I only admit to 15 years, wink wink. But I've been in it for for so much more than that. It was my experiences in retail management. So knowing anything about seniors healthcare, I had no clue until someone invited me to make an application. And the rest was history, I have worked in a skilled nursing facility, also known as a nursing home short term and long term nursing home, assisted living as a regional director for home care services. And all of that information allows me to work for Archer law office in this role, so you know, the inner workings you've been through the different places and you know, the issues that seniors face, I not only know the issues that everyone else that the public sees, I also see the behind the scenes. So I know what to look for, what to ask who to ask, what answers are valid, what are not, that helps my clients that helps us find the best suited housing situation for our clients. It's not just, I've come up with this wonderful term, and it is based on a nurse that I first met almost 20 years ago, chandeliers are beautiful, but chandeliers will not take care of your family. They like that. So it's true. It was based around a nurse who was a nurse's nurse, she held her hand, she cried with you. She helped celebrate deaths and anniversaries and families and she and she's still working at the same place. 25 years later, she's still there. That's what we all want, right for ourselves and our loved ones. That's it. He wants someone who is not just going to run in and run out. But the questions, you know, even though this is probably just jumping right into it, but I think of my own personal experience with my dad, who had a stroke when he was 45. So he and he lived for 30 years. So I moved him from place to place to place with money being an issue and all of that, and especially when money's an issue. You know, you can't go into the Cadillac of assisted livings or nursing homes, right? And your options are fewer. And, you know, how do you determine? You don't know what happens as the loved one you don't know what's going on when you're not there. And it's scary. It is scary. And yet, you know, some of Wands go every day. And then you'll find out that because you're there, your loved one will probably get what you would think is the best care. The true answer is regardless of your payer factor, you should get the same level of care, the same care status. What I've heard so many times is when you place the loved one they deteriorate, that shouldn't be the case. And so I act as an advocate. There are also lots of other resources, lots of other people, the government for example, the Division of Aging offers what's called an ombudsman. There they are to support and advocate for those who cannot make their voice heard. So, money is a concern. Money is a concern, and depending on the generation, so the quiet generation who wants to give their kids all their money, doesn't mind living in a one room with no one else, they don't care. But my rule of thumb is money shouldn't make the difference of who you are and what care you get. I couldn't agree with you more. But how do you how do you make sure that something like that happens? So I can tell you a lot of experience. So we also need to keep in mind that this is a business. So I actually did some research, what it would cost to start a nursing home. And nursing home is the highest level of care, that means you have more nurses, you have more high qualified aides to provide care, you must provide food, therapies, social workers, that all costs money. So you need to pay your staff. There, we are a society that is highly regulated, you need to meet all those regulations. So it's very expensive, and most people don't have in. So in New Jersey, I'm in central New Jersey, anything from 12 to $14,000 a month. So then we come down to applying for Medicaid. Medicare covers very short term, immediate nursing care. But then after Medicare, which is government insurance, you got to Medicaid. And that's, you know, when it becomes extremely complicated. We have a team that knows every law, every aspect of filing Medicaid, if there's a family member who lives in the home, doesn't, it becomes complicated. But yes, you have to keep in mind. I'm sorry, can you hear that? I'm sorry? No, we didn't hear it. So you have to keep in mind that, you know, our whole industry. We need to pay and provide care. How does someone know when they should reach out to a law firm that has the specialty just to find someone like you? When you hear? Yes, so we've actually morphed into a crisis we do very well in crisis management. You know, if dad is coming out of a hospital, and the hospital says, oh, no, no, he can go home. And clearly he can't we advocate for them. If something is going wrong in a nursing home, we go in with our client, we help resolve or transfer them out. When do you start? Hopefully, before you see crisis, I was just talking to a client today, the holidays are coming. Now a lot of their adult children will go visit mom, and they haven't seen her in months at a time. And all of a sudden, something isn't the same. Whether it be that her crystal isn't as shiny. Her laundry is piled up because she can't make it down the basement steps. Any one of those things she forgot to turn the oven on, or she burnt the chicken or whatever those scenarios of simple things. When you take note of something like that. That's a perfect time. That's a good answer. Yeah. UPS plan. Yeah, having a plan. You don't have to execute it. And another family that I've been working with for a year, who are noticing changes keeps us in the loop. We've already looked at assisted living communities. But she's not ready to make the step yet. We also have to recognize that sometimes family members are not the best gauge of when to make a move and when not to because it's more emotional than clinical. And emotions take a huge step, a huge part of making that commitment to some really good advice in a really good point. And on the other hand, for example, when when I talk with our clients, I know those questions, they are not the common questions. They are not. You know, do you serve chicken three times a week questions. It's those in depth questions like, How many times do your clients go to the hospital? In an average six months? Are they rehospitalized? Oh, most people don't Think about that. That's a key factor as you age, that references the care that they're being provided. So and I can tell you that, as I continue to go through this, the emotions, the family dynamics are another huge part, legally, who has the ability to make the decisions versus family members who are going to criticize that person? Yeah. And as I go through each one of these steps, my mom right now, excuse me, is my best client, and my worst client. She'll take the information and not to what I say. And I'm like, Mom, you know, people pay me to do this, right. So yeah, there's I have siblings. And yeah, it's a whole dynamic. I've noticed, friends, friends, keep telling me the same thing over and over that one sibling steps up, or two. So it's never everybody, then that's part of the problem. They're not united, or they're just not ready to face it. Like you said, sometimes, they're not the best judge. Well, so I think we talked before we started that, in my role, I am not licensed as a social worker, I am not licensed as a nurse. But through the 15 plus years, I've learned their roles because I've worked so closely with them. A family always has a dynamic if you think of as we go into the holidays, this one always says a worrying too much. This one always has an opinion, this one stays as far away as possible. So I'm going to give you a good example. My mother was a, a huge working woman, a professional. And she learned from her mother. So my mother had her will power of attorney, health care proxy who can make healthcare decisions. She had all that in place. There are four girls in my family. So my mother had delegated, delegated, usually, and statistics, my older sister, that is usually the oldest, commonly female, because females are more nurturing, to take the role of power of attorney. So she does make the decisions. But I have to say my sister is wise enough to ask for help. Doesn't know. So as my mother continues to age, each singer comes across certain diagnosis that are just extremely common to a certain age population. She's ahead of the game, she keeps a journal, so she knows how to manage that. I will tell you, there's other siblings, who are clearly not on the same page, not even on the same boat, not even in the boat club. So yeah, there's always differences. And if you go to a professional, you, you take the emotion, and we really, truly talk about who makes those decisions, who my client is, right, who I'm serving. So technically, I'm not allowed to share client privilege and information with someone who's not power of attorney. What happens in a situation where the family feels that their loved one needs to go into assisted living or something like that, and it's pretty clear, but you know, the person themselves is resistant. So I'm gonna say what I commonly say to a lot of clients, if you are considering this, and that senior is declining, whether it be cognitively or physically, financially, whatever there needs, who's gonna make the most appropriate decision? Are you going to allow that person to make the decisions? And hence if you're thinking about it now, what are we waiting for? Perfect example. My mom fell on Thursday, went to the hospital on Friday came home Friday, went to the hat for had another fall. Went to the hospital on Saturday and came home on Sunday. And my best advice to my sister was, and we waiting for the next book, because it's gonna happen. And she's declined each stab. So are we waiting for the final fall to come? And who are we letting make those decisions? Take their information into account, have a reasonable conversation. If they're alert and oriented, bring them into the console. You meet again, you don't know what you don't know. Family is dealing with emotion. Not all the other factors that need to be put in together. You know, I do hear this I have another friend who's a little old Sir. And he said, they didn't move until they didn't act on this until their their father fell. Most people are just sort of waiting for a sign. And that's your logic and your planning sounds much better than that. You know what, go for a consultation? How do you find an attorney? So do your research, and find the right attorney. So for example, I wouldn't find a commercial real estate attorney to draft my power of attorney. Right? You find a specialist for your medical condition, find a specialist for all your other needs, right. So an elder law attorney, versus in general, is going to give you more in depth knowledge of the laws that exist, what's appropriate, do not use the internet, they do not have the most accurate information for the state and your individual needs. Because everybody's an individual. So get information first, arm yourself with information. And then when you go for a consultation, you'll be able to answer a lot of questions, which may help you make a decision on how to help your family. Let me ask you a question ready? And I don't know if this is something you deal with. So I apologize in advance if it's not sure. So especially this time of year, it's you know, that Medicare enrollment time. And, you know, I saw myself actually looking for my husband last year, it is darn confusing, very confusing. And now, so I, when I say I got a guy in my phone, I do I know quite a few specialists. What happens is, and there has been lots of, so I got to go on, and I participate in a lot of websites. So it's called Medicare advocacy group, it's a national group, help support legislation advocates for every aspect of senior living that Medicare would be part of. So these plans that are out there may be less expensive. But you're not getting the same true Medicare benefit. Most of them are insurance based. So you have to follow insurance guidelines. Medicare, the traditional red, white and blue. You do you? It really so there are lots of people you need to know, Medicare Part C, which is those those insurance plans for D, which is prescription, you will be penalized if you don't take one. How many people know that you're going to be penalized and how long you're going to be penalized. And it's a financial penalty. So there is so much, there are quite a few people and I do have a few names to speak with. Who can really guide you through it. It's complicated. I mean, thank goodness, when I did it. I knew the right questions. Again, you don't know what you don't know. So I asked the right questions to the right people qualified their answers, and shows what I needed. Right? So Medicare is also based on your income, your premiums are based on your two previous year's income. I just went through this. And I could not believe how complicated I'm still trying to figure out if I have the best. No idea. You know, and that's it, you have no idea until you have to make a trade. You have to find out. So you've learned through this one plan that you may have what's good not, then you gotta go to the next and do the same thing. Yeah. But there's so many like, it's crazy, but you know, they they signed me up. We have a financial advisor, and he knows a lot about this. So I let him sign me up for United Healthcare, and it's good. And I chose Part D which is prescription but I just want to tell everybody, it has a hefty copay. And if you're like me, and you're not on more than one Med, you're never going to make the copay. So let's do all right, only a copay which is per prescription deductible. There's a huge deductible and they offer to deductibles, but they're very close in amounts. And if you're not on a lot of meds, that doesn't help. I mean, I literally will just pay for my deductible. Luckily, Part D is really cheap. It's like $9 a month. But it there's a lot to consider. I think it's just really good to know that resources like you exist, because obviously there's a huge need. Yeah, unfortunately they're scams in every industry. There are scams in this industry as well, which is I don't know, it's annoying. And I don't know that that's the best word. It's sinful, that there are so many scams in the senior world because seniors are so vulnerable. But yeah, there was. So again, finding the right person. So you need to work with. Let me ask you, what happens if somebody is ill and wants to stay in their home? It's a possibility. And ale is a very vague word. You're right. So so for example, there are homecare agencies. So let's follow let's take one person one scenario and follow that path. Dad lives at home, he fell. He went to the emergency room, there's a whole situation there. So when you're in the emergency room, and they're just diagnosing you, it's called observation. It's a different copay, under any plan Medicare or not. Now, if they did niche you, right, if you have three consecutive overnight stays in a qualified hospital, you can go to inpatient rehab, which are all the nursing home short term stays. If you go home, you must have a safe environment to go home to the social workers will recommend certain things they'll give you listen, say Go, go figure it out. Nursing homes are good, until they're not. homecare, there are probably about depending on what region 4040 to 45, some new, some corporate, some franchises some private, the average range of dollar per hour. So they'll send someone out to assess your home for safety. And assess you for what needs. The home care aides that come to your home, are not trained in many things. But yet, if they're through an agency they're trained with within the loss of what they need to be, they will not manage your medications. They can only assist you in certain things. And I usually say in a hospital, it's a crisis, they de escalate the crisis, and send you on to the next step. So if you feel you're still in crisis, you need to consider your options. Yes, you can go home. There are different levels of care, different hours, shifts money, it's all private pay Medicare, rarely, but will pay for home care. And it is only on a short term basis, few hours a day on a short term basis. Yeah, that was my question. It's really not an option. If you're not interested in private pay. It's not an option of whether you go home with home health care versus going into a facility. Right. So facilities are good for some people, not for others, and there's a lot of competition in those as well. For example, my mom went to rehab, she had fallen in January, she went to rehab. This time, she didn't go to rehab. I I agreed with that decision. But I always say I will not support her to stay in her home unless she is safe. When she is no longer safe in her own home. I'm going to advocate that she can't stay there. Remember, my uncle went through this. And he did not do well by himself at home. And there wasn't anything hugely wrong. He just was in mourning for his wife, and he didn't take good care of himself. He never had to cook for himself. There's all kinds of issues, right? And he deteriorated and we wanted him to go into assisted living and my cousin really pushed and he wasn't sure he wanted to but a doctor said you shouldn't live alone that used to that seems to be the turning point when the doctor says and he couldn't argue with that. And we we realized he wasn't even feeding himself enough. You know, like, that's a tissue I think that's kind of elation is in epidemic stages in COVID. Epidemic stages and what people don't realize as they fall further into the hole into the depression is IE, they don't sleep. They don't have hygiene. They're not medicating properly. They're not there are so many things which could lead to hospitalization, infections, many other diseases. So So having either having someone in the home to monitor what goes on, or going into assisted living, which assisted living when it first started, was this social environment with a little medical support, as opposed to a nursing home, which is a medical environment with the little social support. So if they're not a social person, at least they'll have oversight by nursing and by staff. Yeah, I did a whole presentation on senior isolation. And the rate of alcoholism, drug abuse and suicide in the senior population will be very prevalent. And I have to mention that this is the whole time my cousin would visit daily. He just couldn't handle the other 20 hours, you know, yeah. Yeah. It's it's scary, and how fast they go downhill. That was really scary to me. Sure, sure. It's left unattended without support, even to have an aide come in and play card. Yeah. Cindy danger, right. And you know, he would fake it in front of us, we would go and visit him and he would be honest, best behavior, everything's fine. The lab started to notice the cognitive decline, because it's just me I call the TV, sometimes an idiot box. Sometimes it's just knowing that there's a voice in the house, right? Is company? Are they paying attention? No, do they watch whether it be soap operas or game shows, which is not intellectual content. So cognitive decline is huge. And by the time someone does go for further care, they're at the deterioration stages of not always up return to the status they were. So we find now in our industry, that people are more compromised, as they go into whatever care needs. Switching gears a little bit, Randy, maybe to give some helpful tips to our listeners, what are some of those legal documents that we all should have, whether we're a senior or not, so I just did a presentation yesterday, if you were any, any age, over the age of 18 years old, because that's considered a legal adult, you should have a power of attorney and a health care proxy. So the way that Archer law does these things are with future. So for example, the example they said is, for example, if you say you don't want to feeding tubes, you're thinking of technology right now. Technology in six to 10 to 20 years could be feeding through an IV, which is really non invasive. So really kind of guide the clients to who can make the best decisions. However, Attorney always designate someone who is willing to fill the role. And there are different types of power of attorney don't choose your loved one just because you love them to some because they're going to be good in the role. That's, that's a really important point. Because I've seen so many people because they are the oldest, they feel like they have to do it. And they're not up to it. And it doesn't help anybody. Right, because a power of attorney is when the person making power of attorney can no longer make their needs known, or is not in any capacity to do so. It can also be very limited. You know, if your mother lives in California, and the power of attorney is selling the house in New Jersey, take a look at what it entails. And that may be a viable option. But remember, most of us plan to get old but we don't plan to get sick. Got that right. So when you play it for all this, make a qualified decision and have a conversation. You can't just appoint someone and hope they'll kind of live up to it. Have a conversation. Let them go to the attorney with you. So you have a idea of what the role is. Because as you age, it could be a lot of responsibility. Some people are not willing to take on that responsibility when needed. I think if people hear anything today, they should hear that you shouldn't wait till you're ready. outright. You shouldn't wait till you're ready. You should try to plan ahead and not not be afraid to look at it before you're in crisis. That's really important today, for tomorrow. It's really good. So you know, let me say even though we're talking about a eldercare, I love the fact that you said anyone 18 or older. I, when my children turned 18 They got a health care proxy a POA. And people thought I was out of my mind. And you know, especially just thinking about when they go to college, when if something happens to them just because you're their parent, once they're over 18. That's it, you legally don't have that right, that ability without that documentation. So I think it's a good reminder, because I think that so many young adults, and parents of young adults would never even consider such a thing. And you're right College is one of the best examples, and I've seen it happen. I'll give you an example. My daughter and granddaughter live in Pennsylvania at the age of 13. They allow, yeah, they, they had to say to my daughter, you must sign this document, Your daughter must sign that document to allow us to discuss it with you. 13. Wow, that's crazy. That's crazy. Yeah. But being prepared. Because when you get to crisis, it just for some reason, seems that nobody's working as quick as you are. So if you plan for today, it could be good for tomorrow. Great advice. So is there anything else that you would like our listeners to know? have open lines of communication. on every level, don't there's always a dynamic amongst family members, but have communication and talk now and especially now that the holidays are coming? Have those communications over the dinner table. Don't make it taboo. Don't make it adversarial. Talk about it. Make sure everybody has ideas to share, not to criticize. Great advice. Yeah. Thank you. Randy, thank you so much for joining us today. You've shared such important great information to all our listeners. And we really, really appreciate you taking the time to join us. Absolutely. Ladies, thank you so much. It was great. We'll put your contact info and yes, please go to care adverse advocacy group and anything else that you want to send me we'll put in the show notes. Absolutely great. I will do so. Thank you. Great meeting you. You to really have a good one. You too.