EPISODE 6 (PART 1) Why it is overwhelmingly important not to approach assisted living alone.

When hospitals discharge patients into assisted living without proper planning, the results can be devastating. In this episode, Jamie Callahan shares a real and tragic story that could have been avoided — and explains exactly how Team Senior steps in to protect patients and families during these crucial transitions.

If you’ve ever wondered when to start planning, or what can go wrong without advocacy, this episode provides clarity and urgency.

👉 Learn more or call Team Senior at (541) 295-8230

Transcript

Jamie Callahan: Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging society, grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia.

That's our area of expertise, and we are here to share our insight. And now the Team Senior podcast. Hi, this is Jamie. I am really excited to introduce our guest today. I'm gonna tell you a little bit about the organization that she works for because it is the same organization that I work for Team Senior.

We essentially help. Folks connect all the dots around aging in Southern Oregon. And Linda BI has been with the company for a little over a year now. So Linda, I'm gonna turn it over to you. Tell us a little bit about I'm yourself and why you're in this industry. 

Linda: I entered this industry back in 2014, actually 13.

2013. And, I wanted to do something more important than what my career had been up to that point. And so I was introduced to this world and loved it. And, immediately got my license to run a senior living community and then ended up running several and enjoyed it. But what I loved best about those days that I was running those companies was when I was, working directly with a family or a senior, that was the most rewarding part of it. So about a year ago, I was ready to do something like this and the opportunity fell in my lap where team senior said, Hey, why don't you join us? I'm thrilled to be here and I have just absolutely love what I do.

Jamie Callahan: This was a tremendous opportunity for all of us. Working with Linda is such a pleasure and she brings a lot of interesting and very valuable information to the table that we did not always have as a part of our team. Linda, like I said, has. Been with us for a year and we are super excited to take a deep dive into what she does for Team Senior and how she helps the community.

So we're just gonna get right into it. Can you maybe briefly explain just what a community liaison is for Team Senior? 

Linda: Absolutely. And it is about a liaison for Team Senior because there are similar jobs out there or positions out there that aren't. The same. What we do at Team Senior is again surround our knowledge and our experience to help seniors navigate a very complicated world for senior living and senior care.

There are so many options to be considered and it's nice to have a guide from the senior perspective. Families, don't have the answers and they're trying to help their families or their senior loved one with the right decisions. We, get very involved with the family and the senior and just.

Start to explore the options and what that senior would love to have happen for their life. And go from there. And unfortunately, sometimes a senior will end up in a hospital and it's a whole different and more complicated process, which we can get into another time. 

Jamie Callahan: Yeah, absolutely. And that's a great opportunity for me to just say that we really encourage families to get what we refer to as an a, b, C plan in place.

So a is you are still making all the decisions we're meeting with you where you're. Still highly capable of being in your own home and doing everything by yourself. We like to meet with families at that point in their life because it gives you the opportunity to make all the decisions around what would happen should you end up in the hospital.

The B plan is, we've done a b is you're in the hospital. And because we made decisions with you or helped you identify what options are available to you in that a part of the plan B, maybe you are in the hospital now, but because we had that meeting ahead of time, you were able to identify all of your wishes and we're now able to just help you honor them.

C is where we really never wanna be working with families, and the really unfortunate part is that, I'm gonna say probably 80% of the time, that is where we're working with families. So what. What that looks like is that you've had a stroke or a fall and now you're in the hospital and we never had an opportunity to help you get a game plan in place.

What are your wishes that we're going to help you honor? Now you are not making those decisions. Most of the time, like really most of the time the people that are making those decisions are your hospital discharge planner and sometimes your adult children if you have them. If you don't have an adult child that's gonna come alongside you and advocate for all the things that you want that hospital discharge planner is likely gonna be making the decisions for you.

And I can't say it enough times. Their motivation is rarely. What is absolutely best for you. Their motivation is that they are, mandated by Medicare guidelines to get you outta the hospital as fast as possible. So they're going to take essentially any opportunity to do that. 

Linda, tell us if you are working with someone alongside the discharge planner perhaps but the family is now in the hospital and they're getting discharged, what does that look like 

Linda: again?

It can be very complicated. Where. The liaison comes in is we meet with you and your family in the hospital and we figure out what what that future, what the care looks like, and what's gonna be best for you. And we do work alongside the the discharge planners. And we can. Slow their role if May, if you wanna say because once they know you're working with Team Senior, they know that we have, we're working on the plan.

So they will, back off a little bit and let us, proceed with that. It's not a place you wanna be because we're working quickly, but team senior works 

Jamie Callahan: very fast and in your best interest. I think that's what's really important to note here. Yes. Thank 

Linda: you. Yeah 

Jamie Callahan: and the fascinating thing too is that the hospital has visibility and access to the things that are traditional.

Through the healthcare system, right? Yes. So what team Senior has access to is a little bit different. Let's say for example, that you're getting discharged and you need a hospital bed, but oh my goodness, your insurance isn't going to cover it. That is really no big deal to us. We have the resources to get you a hospital bed likely donated from a huge number of places that we could reach into and help facilitate whatever those needs look like.

Getting discharged from the hospital is only a part of, you know how we help families though? Sometimes you've gone to rehab and you're now discharging from skilled, but what does it look like when we're working with someone in their living room? 

Linda: I think that's a pretty good place to start versus the hospital.

So now we can take our time to investigate, evaluate the different options, whether it is stay in your home with care and. Or it's a community where you would like to have some social activities and your food cooked for you and your housekeeping and all of the things that you try and keep up in a home you don't wanna do anymore.

And then there's always. The adult foster home, which is a sweet opportunity for someone to feel like they're in a home with five other people and a much better one-on-one care scenario. So these are all the things that we can talk about when you're still at home and make a plan. 

Jamie Callahan: Yeah, and really recognizing too, so some ways that the community liaisons are really valuable is just helping you to understand the different kinds of care that are available to you.

Sometimes it is staying in your home. But when we look at assisted living, there are so many different types and I don't feel like the broader population or community is really aware of how and why these different types of care exists. So for example, if you are still really capable, you could move into independent living where you're just getting a little bit of assistance.

Maybe you're getting some housekeeping, your electricity is paid for and you're getting three square meals a day. But if you require a higher acuity of care, say you are bedbound or you have wounds that need dressed on a regular basis, or you are a Hoyer lift or you are a brittle diabetic. Those situations sometimes make it very hard for us to find a suitable assisted living community.

So in that scenario, we would pivot and look at an adult foster home. They bring so much value to the long-term care, a spectrum, because it's never greater than a one to five resident to caregiver ratio. So in assisted living, you might have a caregiver that's responsible for 15 different people. So if you end up on the floor it could take them.

Five, 10 minutes to get to you in an adult foster home, which is in a residential setting, if you end up on the floor your caregiver is just down the hallway all the time because it's, again, you're in a residential setting and they only have five people to take care of. I feel too, in foster homes, they really get to know their patients.

So if you have a special kind of like hot chocolate that you love, then they're gonna know that and they're gonna bring that to you. Getting that kind of personalized service in an assisted living is sometimes hard to meet. So Linda I know that, many families are concerned with, implementing a strategy to move folks into long-term care.

And some of that boils down to protecting finances, 

Linda: right? That is a huge consideration. How do you help families with. 

Jamie Callahan: That. 

Linda: Yes, we take a pretty deep dive into the financial assets and situation that each family has, and there is help for that. So I think it's a bit shocking when families hear about the cost of some of these communities to get the around the clock care.

But there are. Ways to help a family navigate through that. So the one thing that's wonderful about Oregon is that they have a long-term care, medicaid program. And your liaison or team senior in general can help you navigate getting those resources. Or if you're a veteran, there are some, there are ways to apply for certain types of programs that will help.

Pay for a community cost. 

Jamie Callahan: Yeah. In Oregon, we're so fortunate in the state of Oregon because we are one of three states in the entire country that offers long-term care Medicaid. And what that means is that if you need to move into assisted living or an adult foster home or something like that Medicaid will actually be the pay source for you if you do not have the resources to pay it yourself.

Sometimes when we're meeting with families and they're worried that they only have $40,000 and this community is gonna cost $8,000 a month, what's gonna happen to mom when they run out of money? The simple answer is that if mom legitimately requires care, we're going to put in an application for Medicaid, and then Medicaid is going to pick up the balance of whatever is due on a monthly basis.

And mom does not have to move. All of her care needs are going to stay exactly the same. And she gets to remain in that assisted living community indefinitely, so long as they can continue to provide the care. We are very fortunate to live in Oregon and have a program like that. Linda, when you're meeting with families and you're having a conversation about, when they should consider transitioning into assisted living, what are the key things that you encourage them to consider?

Linda: The things to consider, number one is finances. So if you're using in-home care and the needs of your loved one becomes more complicated and they need more and more care. Hours at some point there's a tipping point where it actually costs the same or less to move into a community that provides all the services around the clock.

Something to consider too is your senior safe at home and what, because their abilities are gonna change over time. And maybe in the beginning they have a bathtub shower and it seems to be fine. But then, six months down the road it's now a real safety issue for them to access their showers.

And in some other cases, your seniors get lonely. Social interactions are so important to keep them their brains agile and having a good time. Seniors slide backwards when there's no no one else in their life and they're just home alone. 

Jamie Callahan: Yeah, I actually wanna highlight that for a second.

So I went to a presentation a few years ago and there was a doctor there that was talking about the effects of loneliness, the impact that has on someone's life. And there was this entire analysis that was done around the health decline. That happens to a senior, or really anyone for that matter that has a social isolation and they compared it to smoking two packs of cigarettes every day being the equivalent of social isolation without having anybody to interact with in your life.

Wow. I thought that was really profound. Wow. The other thing to note that Linda was talking about is that, when we look at caregiving in the home. Everybody wants to stay at home for as long as they possibly can. And that's something that we definitely wanna cheer, lead, and support because I think that I too would feel that way.

I think the vast majority of the population feels that way, but there is a part where there is a piece or a point where that becomes cost prohibitive. Unless you are, say, a multi multimillionaire. Because when we look at caregiving 24 7, in today's day and age, you're probably looking at somewhere between 20 to $40,000 a month to have 24 7 caregiving in your home.

Whereas you could get 24 7 caregiving in an adult foster home for maybe six to $8,000 a month. So again, our job is to help you identify what your options are and then navigate how and when to a. Execute what is available to you based on both your care needs and what you can financially afford.

And then if you can't afford it, part of our job is to help you explore all of those financial resources that are going to be available to you. Let's talk a little bit about how you help folks get set up with necessary. Medical equipment wheelchairs ensuring that the transition from wherever they are living right now, maybe it is home many times it's a hospital.

We wanna make sure that when those seniors leave their current setting and go to their new setting, how do you make sure that they have everything in place? Great question. 

Linda: What's the hospital has determined or. Se team Senior has helped you determine the equipment that is needed either to stay in your home or operate in even in a assisted living community.

We are on it and helping you decide on how to get the, that equipment and making sure it's in your home or wherever you're going to go. It can be missed. Discharge planners are running at the, fast and a speed of light, and sometimes they forget to get those things on order. Or if insurance doesn't cover it, then we are out searching for that product to make sure you've got it when you when you get home or when you land in your community.

There are a lot of things to consider. Maybe it's a bedside commode or a hospital bed or a walker or a toilet lift. All the things that are gonna make your life and your safety much better. 

Jamie Callahan: So to emphasize some of what Linda is saying there, there are times when someone is discharging from the hospital and while everything has been.

Done in accordance to hospital procedure, the broader healthcare community isn't always moving at the same pace. So I'm gonna give you an example of something that happened in the last year that is the perfect example of why you want someone like team senior advocating for you in consideration of hospital discharges.

So this was a hospital, I'm not going to mention any names that was discharging a patient into assisted living. And we knew that patient required a hospital bed with bed rails so that they didn't fall out because they had a history of falling out of bed, and an order had already been submitted to the durable equipment provider to bring a hospital bed to the assisted living community because this patient would be showing up.

There from the hospital. So let's say it's a Tuesday afternoon. This patient discharges transportation is called in the form of say, ready ride or something like that. Patient is delivered to the assisted living community. But for some reason there was a may be a miscommunication or maybe just the durable equipment provider couldn't get there.

But the bottom line is that there was no hospital bed with bed rails for the patient when they arrived because the assisted living community was not comfortable sending this patient back to the hospital. And the hospital I'm sure would not have been very happy with the assisted living community either.

If the assisted living had sent the patient back to the hospital. This patient fell out of bed. They hit their head, they had a contusion. They did not survive this. It was an absolutely tragic incident. Next day, the hospital bed shows up. And again, this could have been avoided if team senior was involved in any kind of transition from hospital to literally anywhere.

And it was brought to our attention that the hospital bed either wasn't there or perhaps we were there to help welcome you to the assisted living when you arrived, because that is also a part of our role in the community. We would have made sure that everything was in place or we would have been the ones to send you back to the hospital.

So again, having an educated, necessary advocate in place when any transition is happening in your life is so critically important. So we're gonna intercept here for a minute and take a break and come back next week with the part two. There is so much information to share around all the things that we offer, but it's less about us and more about you.

We really want you to get the full picture of everything that we offer, and I just don't feel like we can do it here in one podcast. So you'll hear from us again in part two next week. Thank you for listening to the Team Senior podcast. We're here every week sharing new and relevant information.

Remember that we're just a phone call away. Team Senior can be reached at 541 295 8230. Again, 5 4 1 2 9 5 82 30. Until next time, this is Jamie Callahan.