Rita Grandelis and Melissa Weiss Bressler – Senior Care Strategies and Medicare Insights

Rita Grandelis is a key member of Unicity Geriatric Care Management. Her personal and professional life is deeply intertwined with geriatric care, especially since her father was diagnosed with dementia nearly a decade ago.

 Melissa Weiss Bressler is the Director of Business Development for Unicity Healthcare. She has a Master's degree in social work and a long-standing passion for working with seniors. Her first job involved working with dementia patients, and she joined Unicity Healthcare because of its Senior Advisers component. 

Melissa and Rita from Unicity Geriatric Care Management share their expertise on client-centered care for seniors with dementia, emphasizing the importance of individualized care plans and cognitive stimulation. 

From managing benefits and insurance to coordinating post-acute care, the Unicity team navigates the complex landscape of elder caregiving with compassion and precision. Join us as we explore their personal experiences, the challenges in healthcare, and the invaluable impact of care managers in the lives of seniors and their families.

Connect with Rita Grandelis and Melissa Weiss Bressler:
Website: https://www.unicityhealthcare.com

Takeaways

1. Care management for seniors requires tailored care plans.

2. Care managers play a pivotal role in crisis situations.

3. Understanding long-term care insurance is crucial.

Timestamps

05:40 Offering continuing care for New Jersey residents.

06:44 Alleviating stress for long distance caregivers, blending worlds.

12:46 Customized approach essential in mental health care.

14:46 Effective communication: active listening and asking questions.

17:37 Responding to crisis situations, ideal scenario.

21:54 Uniti team went above and beyond during COVID.

24:25 Finding insurance-accepting psychiatrists can be challenging.

26:42 Provide support for overwhelmed adult children and families.

30:22 Care managers provide crucial emergency support for individuals.

32:52 Hospital fines for repeat high-risk patients.

37:46 Discuss with registries or agencies to optimize.

40:52 Constant communication with clients and their families.

43:40 Great team dedicated to seniors and advocacy.

45:15 Education seminars, coaching, and training for caregivers.

Book a call with Lee Berkowitz: www.welcomebackhomecare.com

Transcript

0:00

Was the COVID waiver. It was the COVID waiver, which was amazing. I could admit people from home. Yeah. It was fabulous. We actually were extremely busy during the pandemic from a home care and geriatric. In fact Wow. We may be one of the only companies that actually grew during the pandemic. Yeah. Welcome back to the Elder Care Insights podcast by Welcome Back Home Care. Today, we have a great company, Unicity Geriatric Care Management. We have Marissa Bressler, And we also have Rita Grandellis. It's a a great episode ahead of us, and we're gonna learn about geriatric care management, Ask a little bit of questions and get some insight on what geriatric care management is and learn a little bit about Unicity. So thank you both for coming on the podcast. What made you get into geriatric care management? How long have you been in this business for? I have always worked with seniors. I have my master's in social work. I started I am not a geriatric care manager. Am the director of business development for Unicity Healthcare. I have always had a passion for seniors. My first job was working with dementia. The reason why I came on to work with Uniti is because of the senior advisers component. What our geriatric care managers do is really remarkable So you you worked, in dementia. I've worked in Was this in New Jersey? That's Yeah. So Mhmm. Unicity Healthcare started in New Jersey in in 2010 with Gregory Bruhn, our owner. He had a partner. Now Greg is the sole owner of UnitiHealthcare. Greg, a lot of passion in this business. Yes. Great guy. Yes. And UnitiHealthcare has 2 components. It has UnitiHomecare and senior advisers in New Jersey. Great. Over the years, we had snowbirds that would come to Florida, and we realized why are we gonna lose these clients when they come to Florida? So Greg decided to open up Unicity senior advisers so that we can follow our clients to Florida so that we don't lose them. And he's always had this idea that he wanted to start in Florida, and last year, it actually his dream became a reality. We started last October. We just celebrated our 1 year anniversary last night. Mhmm. We had a great party together. Great party. Mhmm. Pamela Van Damme is our community liaison in Florida, and she really did a wonderful job. Met a lot of our partners that we really have been very supportive of us in getting this company started. Great. Great. Now, Rita, how long have you been in, the health care field? And longer than I'd like to admit. Yeah. And tell us tell us your, you know, once after that, tell us your why. Why did you decide to come into the health care field? Absolutely. So I've been working in the health Absolutely. So I've been working in the health care field now for 27 years. I'm a licensed clinical social worker. I'm also a certified dementia Practitioner and also a certified care manager. I got into working with health care initially through my family. Both, my mother is a nurse, And, 2 of my sisters are nurses, and I have a sister who's a nurse practitioner, so it's kind of ingrained in our family. And my mom being the nurse really cared for all of our relatives. So I kind of always had an affinity with working with older adults, and, that came to fruition after graduate school. I landed my 1st job at Hackensack University Medical Center, Jersey working with on the geriatric unit, and it it really just clicked. And I just have a passion for working with seniors And the aging, population, and it's also personally a passion of mine. My father is now 91 years old, and he was diagnosed with dementia almost 10 years ago. Mhmm. So we've been caring for him. So not only can I speak to a lot of the challenges our families are facing, I also deal with it myself self as a caregiver Mhmm? For a loved one who has dementia. So it's it's a little it's personal for me, and it's it's a passion both personally and professionally. Wow. God bless him, and and thanks for all that you do. Yeah. So let's give a shout out to the graduate school. Where where did you graduate from? I graduated I got my master's in social work from Adelphi university in Garden City, Long Island. Woo hoo, New York. Woo hoo. Great. Great. Yeah. Woo hoo, New York. A lot of New Yorkers out there. Correct. Definitely down here in South Florida. Yeah. The 6th borough. Yeah. And to piggyback just a little bit off what Melissa said, we we definitely are the company opened up, And our primary location is in Northern New Jersey, so we do have a lot of snowbirds and, that obviously are in New Jersey, New York area, and then come down here for the winter. So it's nice now to be able to follow them and have that continuity of care and have that consistency and the communication. It really just improves the quality of the health care and their quality of lives, so we're really enjoying being down here in South Florida. Definitely. Wow. I can see such a great value. So, for all all the Northeasterners in New Jersey and, do you do you do a little bit of work in New York as well? We do. We'll go over the border right into Rockland County in New York and, a little bit of Manhattan too, New York City. Great. Great. So just to specify, you do the the home home care in New Jersey, and that's Private duty home care? Yes. Correct. And, oh, and you do the geriatric care management here in South Florida? Correct. So the geriatric care management is in New York, New Jersey, and South, South Florida, Southern Palm Beach County, and Northern Broward County Great. Great. For now. Yeah. That's so great. And, I see such a value in following yeah. I'm sorry. In New Jersey, we cover Bergen County, Hudson County, Passaic County, Union County, Essex County, Morris County. So even if people are here in Florida Mhmm. For the season, and then they go back to New Jersey. We can actually follow them and continue helping them at home. Whether they use geriatric care management or not. We also have home care, which is a great and so if people come down here that are from that are part of our home care, we can actually connect them with home care agencies down in South Florida that we have developed partnerships with. Mhmm. Mhmm. Wow. Wonderful Yeah. Yeah. Like your company. Exactly. So need relationships with you. So this is, you're making it Kind of as seamless as possible to make sure that this, you know, traveling can be difficult, you know, wondering, you know, what's the next steps, you know, where's mom and dad going for the adult children? You know, it's companies like Unicity can very much help that process. It's true. We're trying to alleviate the stress, for long distance caregivers. Mhmm. It's either their their parents are down here or their aunt, their their loved ones in Florida and maybe the the families up in in the northeast or vice versa. We're seeing a little bit of a switch where it's the kids or, you know, nieces, nephews. The family's down here in South Florida, and perhaps the the the senior is in North North Jersey or New York or or the you know, where we are for for care management. So it's nice to be able to blend both those worlds and for the families to know they have somebody, You know, boots on the ground when they can't they can't be there for their loved ones. So our goal is to obviously eliminate that stress and alleviate that stress that the caregivers do have. Mhmm. By Yeah. By providing care management services. And we also because we have New Jersey and Florida, sometimes what happened was someone's loved one 30 years ago moved down here, right, to retire. And now they're 90, and now they're not as independent, but the children still live in New Jersey. So we've had situations where they utilize us to really help facilitate the move to New Jersey. And it's like Rita said, like, they can start in Florida, and then we follow them in New Jersey. And we help the families. The the 2 states are very different in a lot of ways. Mhmm. We've we're learning. Regulations. Regulations. Yes. Oversight. Yes. Access to medical care completely Yes. Completely different. Mhmm. Agency for health care administration is one of the major regulating bodies here in South Florida. How does it work in New Jersey and New York? Who who's the main without getting into the weeds, who who's the main regulating body for, the New York area? In do you have to report to? Well, we report to we well, from a home care standpoint Sure. We are an accredited agency. Mhmm. We we are accredited by CAC. We're we're licensed through the state of New Jersey. Mhmm. So that, I guess, is the division the department of health. Human yeah. Yes. We are accredited with distinction from our home care in New Jersey. So it's CAC, which is a private accreditation company, in New Jersey. Great. So all the caregivers in New Jersey bonded, licensed, Background checks, all that good stuff on the references. There are certified home health aids in the state of New Jersey. New Jersey, I in order to work in a facility because we do have clients that are in skilled nursing facilities. You have to be a CNA. So we have CNAs. In order to work in the home, you have to be a certified home healthy. Mhmm. That is how it works in New Jersey. Yeah. Yeah. Actually, I think it's quite similar here in that aspect. So we have CNEs and certified home health aids. Okay. Great. And then for the geriatric, care management piece of the puzzle, my team and I, we are composed of either registered nurses We're social workers. We all have our certified dementia practitioner, accreditation as well. So all of us are very, very experienced in working with seniors, the older adult population, geriatrics, whatever term you wanna utilize. So we all, are licenses, by the state for for registered nursing or social work. Wow. That's great. Yeah. And, any nurse agents agencies or registries you're working with Probably is a is a good idea to work with someone who's, dementia certified or maybe does a little bit of training piece with dementia. We that that is a big component of our Unicity senior adviser business. That is you know, it's unfortunate, but dementia is the onset is hitting earlier and Earlier, our youngest client who's been with us now about 7 years, had early onset. She was diagnosed when she was 57 years old. Mhmm. So we're seeing dementia on the rise. The numbers are growing tremendously, and the age of the onset is happening younger and younger. So, the dementia education is a huge piece of the work we do. Lot of education and training for caregivers Mhmm. For families, For the client themself who has dementia because if they you know, if we get involved at the early onset, we can kind of help them for the disease Russian. Mhmm. And we love going out there and providing education Yeah. To a lot of our trusted partners. Yeah. Whether it's at senior centers, assisted living communities, we love getting out there, and our team loves to speak on, a lot of topics, including dementia to kind of educate and inform. Like, you're a home care agency? Yeah. Yeah. So if you had a client and your aide that is in the home is struggling, our geriatric care managers can actually come out and work with the caregiver to and the family. Sometimes there's no family, but the caregiver and the client to develop a dementia care plan for them. Our team has great ideas with different types of cognitive stimulating activities. A lot of work we do as care managers, as geriatric care managers, is really it it's client centered. It's really about that client and figuring out what what makes them tip. What do they like? What hobbies do they enjoy? How can we connect with them? For so somebody it could be music. Music is a great connector for for a lot of, a A lot of seniors, but especially seniors with dementia. It could be gardening. It could be we had 1 gentleman with trains, And that was his love. His hobby was train. Wow. So he moved into his assisted living community in the memory care unit, and the identifier for his room is we were able to get a big train, Mhmm. You know, sticker for his door, so he always knew how to to find his room. So it's really tapping into their interest, their likes, and connecting with them and doing some cognitive simulation, some therapies, some activities with them to really keep their brain active. As we say, you know, you gotta exercise both your body and brain. It's really Mhmm. For seniors to keep active. Yeah. And we have some good resources around here, but I believe that's one thing that makes Unicity very different than other care management companies is that you're out there. You're doing the education. You're doing the training. Every case is different. Correct? Every person is unique. Every family has a different dynamic. There's not one set approach that works for everybody. What works with 1 client, it may not duplicate over to the next client. So it's always really taking that complete biopsychosocial and really looking at the client as their own individual person, looking at their health needs, their mental health history, their emotional health, and and looking at all of that, their family support or lack thereof. So there's so many there's so many layers that you have to unpeel. It's I gotta say it's like peeling back an onion, you know, and you just hit trying to obtain layer after layer, to make sure we really have a good understanding of our client and being able to meet their needs short term and long term, and that's where creating a care plan It's very important. And the process actually begins really from the intake. So when somebody calls, They will get myself or Rita to do the intake or Pamela if they have her direct number in Florida. We have other people in New Jersey, but primarily, they'll come to myself or Rita. If it comes to me, I do an intake. Mhmm. I could go over the process. Lot of listening. Yes. We get a we get, like, the demographics because we really start to take off the first. I basically am the 1st level. I'm I'm taking off the 1st peel of of that that onion. Mhmm. Once I send my intake, the next step is it goes to Rita, who is the the clinical director of our senior advisers comp. Rita then really digs a little deeper and then decides, really, who will be the primary manager for that case. Mhmm. And Rita could go into this a little bit more, but each client has 2 care managers. That is our goal. So there's always somebody. Sometimes somebody may need a nurse as their primary and a social worker as their secondary. But it really it all begins on that very initial that initial phone call. And sometimes families called in or, a fam a family member may call a friend, a a guardian, a power of attorney, whoever it may be, And they'll call thinking it's for one thing, and by the time you end the conversation, it's 5 different other reasons why now we realize we could have, you know, geriatric Care management services for for their loved one. So it is active listening, being able to ask probing questions, which elicit a little bit more information, which sometimes people are hesitant to share, but it's it's a skill. Yes. It's active listening and making sure you're asking the right questions in a nonthreatening way. Yeah. And at what point do you, go into the living room and get to see the environment? Is that something that's, part of the, process? Yeah. So after the intake process And they they sign our service agreement. I make the primary phone call to the contact for the client, and we set up the 1st visit. So whether that's at their home Mhmm. Or an independent living, assisted living, a memory care, absolutely going to see that client in their home environment. So there's a lot more to discover once we see the home environment. Absolutely. Maybe a home safety assessment test. Home safety. They could be a quarter. You know, how people present when they go into a doctor's office or the hospital or subacute rehab, and what they tell people It's one thing, but seeing them in their home really reveals a lot. Mhmm. So, yes, doing a home safety assessment, making sure the house is Safe for them to reside. Are there tripping hazards? Is the stairs stable? Do they need a chairlift? If they're coming home from a hospital or a a rehab Do we need to change the layout of the home? Maybe now we need a hospital bed, and it needs to be on the 1st floor of the home. So we're always We're always thinking and planning, and it's a very fluid process when you're a care manager. But, yes, you're you're assessing and looking at everything, whether it's In their home environments or in a senior living community. And, Lee, there's times that we will actually I mean, our goal is even for that initial call, sometimes we get a family member calling from out of state for care management. But a perfect example is the other day, we got a call from, a psychologist that is seeing a client, and the family's been who lives out of state has been trying to get this client to sign on for our geriatric care management. Acceptance is Right. A big part of Yes. This process. Pamela, who is our, community liaison, went to her home in the community, met her face to face, literally did the initial call in person, obviously. So our goal is to get in front of the client as soon as we can. That's the ideal, is to get there, do the initial inter for lack of a better term, interview, and then we pass it on to Rita, and then they go and do their initial assessment. An ideal situation. A lot of times, we get a call when it's a crisis situation. So sometimes that home assessment may not be the first thing we're doing if they're in the hospital and our focus is getting the the medical care that they need, getting them into, To, post acute care. But, yes, the ideal patient would be 1 the ideal client, excuse me, would be one that isn't in crisis, we can kind of come in and and start that process, do the whole, home safety assessment, get their complete medical information, get their past medical history information. But a lot of times, We get the call when it's a family in crisis. Yeah. There's nothing perfect in this business. And every case is uniquely different. So you touched on a few different things. Tell us, about postacute care. What what what for for the people listening, what what does that entail? Sure. So a lot of, family members don't really understand, once the loved one is discharged from the hospital, it's not just the only option to go home. You can go into what we call a subacute or skilled nursing facility Mhmm. Which is is a a nursing center that can provide, inpatient care. It's not At the same level as being in a medical center or the hospital. Mhmm. But they can get their meals, medications, nursing care, physical therapy, occupational therapy, speech therapy, wound care, whatever their need may be, in an inpatient setting covered under Medicare. Yeah. Sometimes managed care as well. Sometimes, a patient then from there even needs to then they can't go home for whatever reason. It may not be appropriate. So then we may look at transition then to an assisted living Mhmm. If we need. Currently, we actually just work with a client who is at Delray Medical Center, and he had a lot of complex medical needs. So he Currently is what? He's at, an LTAC, which that stands for a long term acute care hospital. Mhmm. So he still required a level of care, but not requiring him to be in the hospital, but was too clinically complex to be in the subacute. So he's at the LTACH for right now. So, a lot of these options are covered through your health insurance, and a lot of family members don't know that. So Medicare does cover the LTACH and for the skilled nursing if medically appropriate, and you you meet the criteria. And so that's based on a doctor's recommendation or the discharge planner Or the family or is it is it all all of It could be a combination of any of it. Sometimes it's the care manager that's making the recommendation. Sometimes it could be the case manager at the hospital. Sometimes it is the physician. It could be anyone. You don't particularly need to have a physician's order per se. You can make the referral to the LTAC of the subacute skilled nursing facility without a physician order, but the doctor obviously does have the the the to write the discharge order to legally discharge them from the hospital. Yeah. So I could be wrong, but I think if the client's in the hospital for 2 to 3 days. Then at that point, they can either be recommended to a rehab facility, and that's covered through Medicare, so nothing out of pocket. Your Medicare will Correct. So you you very good point. You do and this is a confusing point for a lot of seniors and their families. Medicare requires a 3 night inpatient acute hospital stay for you to utilize your subacute or skilled nursing facility. So you do need to have that 3 over the 3 midnights. We call them in the field. Right? 3 midnights in the hospital. Unfortunately, a lot of times, It's getting confusing. Patients can be in the hospital, but be at an observation level of care and not really technically be admitted to the hospital under their Medicare benefits, so that a little confusing. To be admitted, not in the ER or Correct. You need to have the actual 3 night admission to the hospital to utilize those benefits under there. Yeah. And some people are actually still confused because during the pandemic, they waived that. That was the COVID waiver. It was the COVID waiver, which was amazing I can admit people from home. Yeah. It was fabulous. We actually were extremely busy during the pandemic from a home care and geriatric. In fact Wow. We may be one of the only companies that actually grew during the pandemic Yeah. Yeah. Because we were able to we had We were well prepared, and we were able to provide PPE for our care man for our caregivers in the home care point when nobody else could. Greg and the management team at Uniti was very forward thinking. You know, we got ahead of it with, getting access to PPE. So a lot of other geriatric care managers who are solo practitioners couldn't access any of that. We could in Unicity. So we were going in in full PPE, still seeing our all our home clients, and, actually, families loved it. I mean, it was really such a need and a a necessity. During COVID, a lot of seniors couldn't even do they don't use computers or have smartphones. So now how are you accessing your health care? They don't know how to do telehealth, so we were jumping in and managing telehealth, doing food shopping, Just anything and everything to help our families and our seniors. God, at the beginning of the pandemic, do you remember you couldn't even get an Instacart order? Yeah. Families couldn't even put an order through ShopRite. I was online at, like, 7 in the morning every morning waiting to get into the supermarket to do shopping for our seniors. So We really actually learned a lot from COVID. I think it made us stronger as a company, and, really, it just Expanded our competencies and our knowledge base about how to help our seniors more who really were homebound and socially isolated and withdrawn. Our care managers really are boots on the ground. I mean, they do things that many other care managers do not do. I've never seen them really shy away from any situation whether it be hoarding, whether it be very complex psych. I mean, Rita really knows we've had a lot of, gerry psych recently. And I get close back. Cases. That goes back to the increase in dementia, and it's a lot of, unfortunately, the the the symptoms and behaviors of dementia mimic psychiatric conditions. So Mhmm. It's really understanding the disease, understanding the behaviors, Making sure they're on the right medications, connecting them with the right physicians, like a neuros a neurologist, a geriatric psychiatrist, really, for those assessments and And evaluations because if we can manage a lot of the behaviors, it sets the caregivers up for success, whether it be a professional agency or the family member. It just makes the process easier to to care for the senior. Yes. So you have some professional Psychiatric, physicians that you refer to. Is this covered through Medicare, the psych evaluations? And, I think there's something involved with Medicare where Yes. If there's a if there's a Again, sometimes finding a psychiatrist that takes insurance is just challenging in general because of the majority of psychologists or psychiatrists really are private pay. But We there are, several geriatric psychiatrist practice here in South South Florida, same in North Jersey, That will accept Medicare, and it is covered by your health insurance. Absolutely. Yeah. And, ideally, if we can do the visits in person, that's beneficial. But if not, then we work with the health care provider, the psychiatrist, the neurologist to do the telehealth, and if for some reason we can't get our client to the office. Sometimes we have 1 client here in South Florida whose behaviors are she agitates easily, and it's not easy for us to get her out of the home. So everything is really home based. So her psychiatry visits are telehealth based. Okay. Yeah. And there's also, communities or facilities that people can enter themselves into When, you know, they start to get to that point where the they feel like the water is over their head and they can't breathe anymore when they say, you know what? I just can't live with myself anymore or, you know, that's the point where I would say, it's time for to call Unicity. You know, they can really help you with this. Yeah. It's it's a lot for families. Listen. It's difficult for all of us watching our loved ones age, but then add in a lot of clinical medical issues, Ed in dementia, Ed in psychiatric illnesses. It's a lot for family members to manage, and it's very emotional for them. So bringing in a professional like a geriatric care manager can help alleviate that stress for the family members. And, yes, we can recommend, you know, seeing the neurologist, seeing a geriatric psychiatrist. Sometimes we do need an inpatient psychiatric admission possibly for really close supervision of medication. We can recommend maybe the move to an assisted living or memory care where maybe it's better suited for their needs. So there's so many avenues and so many resources That are available for seniors, but a lot of times their families don't know, and that's where we come into play to educate them. I always say to the families that our care managers can do the hard stuff, and this will allow you to be the child, be the niece, be the loved one, be able to visit your loved one and just have it be warm. And not have it be stressful just to be the daughter and let someone else do the hard stuff. Yeah. And they don't have to the family, the adult children, they don't have to fly down, you know, to just be overwhelmed and not know what the next step is. You'll walk them through the process and tell them every recommendation. So let's go in into that a little bit more. So when you you mentioned and I wanna Also talking go back to the hospital. But so when you talked about, you know, we'll we'll get the the person to move, You know, out of their home. It's not like at that point, the children have to call a real estate agent or call a senior move manager. Unicity and care management companies have these types of connections where you say, you know what? We have a great company that's gonna, you know, help you move. They're senior specialists. They're gonna also pack up all this stuff, and you don't have to, you know, quit your day job or you don't have to, you know, call out of work because Everybody's busy. You know? We're working 40 hours, 50, 60 hour work weeks. And that's a great point, and that's what we say to families. Listen. We all get it. We're working. We have children. We have grandchildren. You're You're taking care of your own family and then trying to take care of a long distance loved one. It's very complex, and that's where we come into to play as geriatric care managers, but also, you're right, Like, trusted professionals that we work with, like you with with your home care company or a senior move company, a real estate agent. DME company. A DME company. Mhmm. Durable medical equipment. Correct. Durable medical equipment will help you get anything you need for the house. You need the shower chair. You need the raised toilet the you need the specialty hospital bed. One call, we can do it. We'll get that we'll get that all ordered and delivered and set up for you. Yeah. We have a resource guide that we developed as a company that we use internally of our trusted partners, people that we have worked with that we trust. So we're not opening up the yellow pages and saying, okay. We'll send it to a. We set we utilize people that we know will get the job done. We don't wanna bring any more stress to the families. Yeah. So if it's a hoarder, a home organizer, a clean out company, to make the house safe and livable. Home care companies. You're correct. Durable medical equipment, assisted living communities Elder care attorneys. Elder care attorneys, financial advisers, insurance specialists, obviously, because right now is open enrollment with Medicare. Mhmm. If you needed to make a change with your health insurance, we even have handymen that could come in and hang a TV if needed. Yeah. Yeah. I'm sure that there's a pump up plumber. Companies. You know, when somebody household. Yes. You're you you can do it all. So if somebody says no one hairdresser. We've we have fostered animals as well. We have fostered and then also got, cats dogs adopted for our clients as well. So they're pretty much just in anything and everything that we haven't touched on. I've even heard of, which is a a growing industry, a, geriatric dentist Yes. Yes. To you, do the cleanings because Correct. It's the little things that we forget about. Right? And it's not Necessarily the caregiver's responsibility to say, oh, you need your cleaning. It's been 6 months. Those things may be overlooked, but if you have care management, You probably have a, you know, 6 months, a year checking in twice a year because We look into all of that, and we make sure they see their doctors on a regular basis. If it's annual physicals. They're getting their vaccines, the flu vaccine, COVID, pneumonia, shingles, making sure they keep up on their routine health appointments. A lot of what we do is To prevent crises from happening if we possibly can. So, yes, compliance with their medic their medical treatment plan, going to see their making sure that they're taking the appropriate medication, doing medication management, all of that, yes, to help keep our seniors And another thing that I love that our care managers can be for some people is really being that emergency contact. When someone's in a facility or living alone and they need to go to the emergency room. They don't usually send a staff member from a skilled nursing facility or an AL to go sit in the emergency Durham. I mean, I know personally when my grandparents lived in South Florida and my parents were in New Jersey, I can't even tell you how many times my grandmother called and said, you gotta get on a plane. We're going to the emergency room. By the time we got down here, they were already home. Mhmm. So we can really be that emergency contact for people. If they need that. My mother just went to the emergency room. Can you go? Let us know if we need to come. There's hurricanes here. Some people don't have people to help them come up with a plan. We can help find someone if they're I don't know. If they are panicked, a safe place, whether it be respite or whatever we need to do. Sometimes it's nice to, call a nurse registry or an agency and see, hey. You know, the hurricane's coming up. Can we have a live in for a couple days? You know? We wanna Sure. Try to go ahead and and make sure that, you know, these folks have their, groceries. They have all of their batteries. They're ready to go, and just to have somebody there. Correct. The pandemic. Panicked. Correct. A lot of seniors, are living alone, solo seniors as I like to refer to them, and it is comfort in knowing they have a companion or a caregiver with them or that they can call a care manager in a time of crisis. Mhmm. Sometimes we can even prevent an ER visit. Sometimes They don't need to go to the ER. We can assess the situation. The nurses can assess the situation in the home. Sometimes we can use a great service such as, like, dispatch health and have the mobile urgent care Come to them Mhmm. And not have to sit in the ER. I mean, it really depends on the situation. Every everything is a case by case basis, but there's so many services now, Back to your point too, Lee, about, like, in home dental, in home podiatry visits. There's really so many services that the senior can access in their home now. It it's it's it's nice to see. We also can help, with readmission rates to the hospitals. We know that subacutes hospitals. It's that 30 day readmission. Right? They get dinged for lack of a better term. On Medicare. Called it when we worked when I worked in a skilled from Medicare. Mhmm. So if someone goes back to the hospital within 30 days with the same diagnosis, they get a fine, whether it be the subacute or the hospital, or the even, I believe, like, an acute rehab, probably. So We can come in and really, like Rita just said, alleviate those callbacks because most people, no matter how much confusion is, they seem to remember 911. Right? There's those frequent callers that the, after a while, like, even the ambulance services know, oh my god. You know, I have to go pick her up again off the floor. The goal is having us in there to really help, prevent as much as possible. Yeah. Rehospital Rehab admissions and Yeah. Because if you're making sure they make those doctor appointments that are necessary post hospital stay. Reconciling the medications is the biggest issue post the hospital stay, post the rehab stay. The senior, you know, went into the hospital with one list of medications, and now they've been through several health care communities, and their medications are all maybe different different dosing. So really, medication reconciliation post post acute or subacute care is the key, As well as making sure they are compliant with seeing their doctors and follow-up, which a lot of times they're so confused and Right. Overwhelmed just being home that the those pieces of the pencil puzzle. They're re they're they're discharged with skilled care, right, that Medicare covers. Yeah. And when care managers are there and skilled care is giving an hour twice a week of a shower, Our care managers are also that's when they call the private home care agencies because we see the whole picture. Mhmm. We know, wait a minute. Their PT's over. They're gonna pull out that caregiver. That's when our care managers often call in private duty home care agencies to then step in when Medicare no longer is gonna provide them with the services. Yeah. And we pick up where Medicare leaves off with private duty and Exactly. A lot of times, you know, people don't know where to look. People, a lot of times, don't know that it's Well, people also yeah. That is true. And a lot of times, Especially children who are now dealing with aging parents don't realize that Medicare does not cover the cost of long term care being at home Mhmm. Or in a facility. So once you Kinda clarify that you they have to realize you have to access the private sector Mhmm. For either home care services, geriatric care management services. They're all private pay Mhmm. Which a lot of people long term care insurance, which, you know, something to look at. Which we accept. Mhmm. That as a, long term Care, through, care management. Sometimes they have a rider for care management. Care advisory Mhmm. Care coordination benefits. So we We always ask our seniors and their families if they have long term care insurance because that's a key piece of of getting services covered, be it at home or in a a senior community. So, but really just for families understanding what Medicare covers and what it does not. Mhmm. Again, it's all about the education and being able to educate our Our families and our clients on what what services are available, and then directing them if they need to apply for Medicaid. Exactly. Okay. Yeah. So this is another piece of it. Medicaid. Say you're in your eighties or nineties, most likely, they bought their policies, their long term care policies in their fifties Mhmm. Right, when it was when you were able to afford it. So our and then they we we may ask them questions. They are clueless. Yeah. They could have an inflation rider where they thought they had$100 a day, but they have 3.50, $400 a day. We so often, our care managers will go in just to review their long term care policy because they don't even know what they have. Yeah. And then a lot of times with the client's consent, we become the HIPAA authorized representative, and we help kinda manage the benefits for them because, again, it's very overwhelming, and it's very tedious with the paperwork and submitting invoices and and being able to do all of that. I like to get the, insurance comp the long term care insurance company, whether it's John Hancock, Gemworth, MetLife. There's a bunch of different ones, and I get the rep on the phone. I'll wait for the 30 minutes first. You know? Sometimes it's 15. Sometimes it's 10. Sometimes they're very good. Sometimes it's 2 hours. Yeah. So I'll get them on the phone first, and then I'll conference him with the client and say, alright. We got them on the phone. Right. You know, let's see. What's your daily benefit? Is there a lifetime benefit? Is this an indemnity plan? You know, as the cap and, you know, how much are they gonna cover for the home health aid at home? How much would they cover going into an assisted living, community. The big piece of the puzzle too is the elimination period. Yeah. Yeah. Huge. Most seniors don't realize too that there's an elimination period in their long term care insurance, which can be 30 days, 60 days, 90. I've even seen it go up to 120 where they have to pay out of pocket. Yeah. So speak with the, nurse registries or the nurse agencies and see how can we best utilize that. You know, I've seen sometimes where one one day counts as 1 week, Or I've seen where, you know, we can work it out. You know, 1 hour counts as one day. Yeah. You know? So when we're talking about elimination period, we're talking about the the amount of days that you have to pay out of pocket until you meet that, timeline where you no longer or you are now eligible for the claim. Right. And, at that point, there's a waiver of premium oftentimes. Yep. So you no longer have to pay your, you know, your premium. Your premium, and that's for the lifetime. Paid for the year already. A lot of times, they'll issue that refund. They'll prorate the first These are the experts here. I I can see this. This is terrific. That, and I know this because it's my parents' plan, that if 1 of the spouses pass first, then this the the the surviving spouse does not even have an elimination period. Okay. That was a good gem worth pro that was a good gem worth. But just know when the gem is. Now going to have to look into that because I have someone that's, Trying to meet their 30 days and, you know, begrudgingly trying to do what we can do to make sure that She gets to that point, so that may be something I look into. I've I've never heard of that one. Also another thing, which our our geriatric care managers his VA benefits. Right, Rita? Yeah. They're very unutilized as well too. Yeah. The aid and attendance program. A lot of people again, it's education evaluation. Services are available to them. A lot of families and seniors really don't have a good understanding of what's available. Yes. So VA benefits an encyclopedia. That. Mhmm. Aid in attendance, a couple, things with the aid in attendance. You have to have served, boots on the ground wartime. Certain wars. Wars. There's a certain, financial component, which you can speak with Unicity, and And they'll refer you to other folks or they can maybe help the process themselves to see Yes. If there's a good candidate there. So, wow, we've really touched on a lot of different things. I wanna go and reverse a little bit and talk about during a crisis in the hospital, How does Unicity help the aging population? How do they help? How do you help, advocate for that family, and What's the communication like? So when there's an emergency, what's the communication like, and do you go To the hospital room? Absolutely. We'll be in the by the nursing station, you know, making sure Absolutely. We'll be in the emergency room if they get admitted to the hospital and they're on a medical unit ICU. We are there. We'll visit. We'll advocate for our client. We'll have communication with the nursing staff, communication with the physicians, physical therapy, occupational therapy. Ideally, we would love to be there when those, disciplines are are seeing our clients in the hospital so we can really Have a conversation with them, and we are in constant touch with our families or the next legal kin, whoever that may be. It could be a power of attorney. It could be a legal guardian. We are in constant communication updating them every step of the way, whether it's via text. We do an email report after every contact With our clients, we send an update, and a report to their next if kin, their family member, their guardian with report of what we did for the day. So we're in constant communication with our clients and families all the time, and we advocate for their their medical needs throughout the hospital stay, and then We, become a integral part of creating the discharge plan Mhmm. Making recommendations for care, post discharge from the hospital and any follow-up that they do need. And, also, once they go, you go to care plan meetings also in in the subacutes. Yeah. We tend to be part of the care plan meetings as well too. And just recently, I had it happen, that the family didn't know that they could appeal the discharge under the hospital. They felt that under That the discharge was happening too soon, and they didn't realize under Medicare that you have the option to file an appeal. Yeah. So I was able to do that. Saw that as well. Yep. So I was able to system, and he, won the appeal, and he was able to stay in the hospital. So a lot of times, it's just really being that patient's advocate and our clients and their families on on what resources they have. A a big difference if it's that, you know, 2nd midnight. You know? Why not do an appeal for the 3rd midnight? Or that typical

Friday 4: 42:13

30 discharge. Yeah. Exactly. Nobody always takes it, and then suddenly he's gotta get

out of the hospital on Friday at 4: 42:16

30. Anyone who's worked in. Health

care knows that. Then and that's We're lucky if it's 4: 42:20

30. It's usually 8. Yeah. Yeah. And that that's That's how That's a whole another podcast to talk about the times that seniors get discharged from the hospital. The confident home care companies that are prepared for that opportunity or turn that crisis into an opportunity. Uh-huh. That's how we get to meet our care managers. That's how we get to meet our discharge planners. We say, you know, give us your toughest cases, you know, and then Absolutely. Let us prove to you yourself. You know, what we can do. So, That's a great point. Usually, if you just prove one time. You become their trusted referral source. It's trust. It's all trust. Yes. Yes. So, please tell me, what is your best day ever at Working at Unicity. What what's the most, memorable day ever? Today. Oh my gosh. Wonderful. Great answer. This is such an honor today. That. To be with y'all. Actually, besides that, my my best day was probably my very first day in the field with Rita. That's a whole long story, but she Alright. Rolled up her sleeves, and she, like, got what she did, I was truly blown away. As a social worker myself, I was like, I would never do that. Like, she really helped this woman in a way that I was truly, truly amazed by. I talk about it all the time. Well, I think that's any the best day for For working at this company. Well, 1, working with the great people at Unicity. We really do have a great team starting with our leadership and our owner, Greg. But all of us are so passionate and dedicated to seniors and advocacy and working with our seniors. It's just nice to work with like minded people. But every day that we can actually be there for our seniors is a great day. But when we can see when someone takes our recommendations, they Take our advice, and we see the client thriving, and we've prevented a crisis, and we see they're living their best life. That's really what we want them to do. We want them to be as independent as possible and have the best quality of life. And so when we can give that to somebody, That's the best day, I think. And it's sad sometimes because we're with them right to the end. We've been with many of our clients when they pass. We're at funerals and wakes and speaking on behalf, and that's I say being a care manager is a blessing and a curse. Yes. Mhmm. But I it's one of the most wonderful jobs. Yeah. So is it Unicity senior advisers? It's Unicity HealthCare .com. Okay. Unicityhealthcare.com. Senior advisers.com. Unicity senior advisers.com. Uniti senior advisers.com. Uniti Then you could go to our website, I learned all about our services. You'll meet the team. And, again, we're in North Jersey and also here in South Florida. Yeah. So Main, takeaways, what makes Unicity different. You're out here in the community educating people. I'm sure that we'll do another, education based Seminar to the general public and talk about all these great things. Clearly, we still have a lot to talk about. Yes. So, there's so much, education there To, to to put out there. So you're doing that. You're doing these education seminars. You're meeting with the caregivers 1 on 1 To do a little bit of coaching, a little bit of training, talking about those specialized care plans. You know? What are some of the best strategies for this particular client? So You're boots on the ground. You're out there. So, we appreciate all that you do. It truly has been a pleasure, and you very much. Check check check out Unicity senior advisors. We're so proud of them, and we we truly believe in, the future of this company. Early. We appreciate it. Thank you. Thank you for tuning in. This is the Elder Care Insights podcast by Welcome Back Home Care. Look us up at www.welcomebackhomecare.com. Check us out on iTunes, Spotify, YouTube, And, the websites will will also broadcast. So please like the video. It's an honor, and, stay tuned and stay well.