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Patty's Place
When Parents Need Help: A Conversation with Senior Care Expert Debbie Miller
Okay, so our guest today here on Patty's Place is Debbie Miller, a certified senior advisor, an aging in place specialist and author of Doing the Right Thing Simple Solutions, essential Tips and Helpful Resources for Assisting Aging Loved Ones. So, debbie, I'd like to welcome you to Patty's Place. How are you today?
Speaker 2:aging loved ones. So, debbie, I'd like to welcome you to Patty's Place. How are you today? Thank you, I'm doing great and I appreciate being invited to come on your show. Thank, you.
Speaker 2:So I read your book. So what made you want to write this book? Well, it all started back in 1995, which sounds like eons ago but I was responsible personally, as an adult child, for the care of my parents, my in-laws and two sets of aunts and uncles who didn't have any children. And it was over a period of about two years and I had to do everything you know run to the grocery store, fill out Medicare forms, take them wherever they had to go with health issues, take them wherever they had to go with health issues.
Speaker 2:And once they had all passed away, I just kind of said you know what? I'll bet you there's going to be other baby boomers, adult children like me, who are not going to know what to do and don't have time to figure it out. So I'm going to write this book to help them, you know, educate and empower them to make better decisions for their loved one. And so over the years I was already in real estate, but I'd always wanted to be a social worker. So this was kind of a good fit and I've helped hundreds of adult children and their parents make the move to another facility or age in place safely. And the book is a compilation of not everything I've learned, but the basics to help you get started and learn things before it's too late.
Speaker 1:And it is very overwhelming as an adult child having to take. You know my mom had dementia and trying to figure it out and navigate. It's a lot. So what type of advice would you give someone who's struggling with a parent who maybe can no longer live alone?
Speaker 2:Well, I think there's a few things that you can do. The problem is, many people think, oh well, mom's doing fine, I'll worry about that when the time comes. Well, you need to do the research before it's too late, because once she falls or there's an emergency, you won't know who to call, you won't know what questions to ask and you don't know where to look. So do some homework beforehand and at least you'll be prepared, because a lot of times, let's say, she fell and now can no longer live in her own home. You have to find a place. Well, a lot of the better places have wait lists, and so waiting till the last minute is not good. And I realized that people say, oh well, mom's doing just great. Well, that's wonderful, but and so you need to at least research, because there are lots of options out there for her depending on what the issues are with her health Exactly.
Speaker 1:So what type of questions do you think someone should ask themselves to determine?
Speaker 2:if their loved one can stay at home or they may need additional care. Yeah, we refer to it as the ADLs activities of daily living. And when you visit, if you live far away, it's harder to ascertain what might be the problem. But if you visit her, can she cook for herself easily, can she get herself dressed, do housework, even simple things like changing the sheets on the mattress can become a challenge. So if you notice that she's having a bit of problems, or maybe she forgets something that she did or she can't find her car keys take note, find her car keys, take note. It helps to talk to her doctor and see what the doctor thinks, because they have testing they can do to ascertain where she is in the scheme of things. And the other thing I love is having an aging life care manager to come in. They will do an assessment of the situation, of her living situation, and make recommendations and help her get placed, if that's what has to happen or how to fix the home so that it can be lived in more safely.
Speaker 1:And how would somebody go about even finding an aging life care manager?
Speaker 2:They have a website. They're all all over the country, so, regardless of where you live, uh, you come on to the uh website and it is aging life care.
Speaker 1:Uh, let's see because I know aging life care association aginglifecareorg org okay, because I know that's partly too. I you know I have a lot of friends right now too. They're taking care of their, their, their parents, and it's so overwhelming to even know where to start to get your parents some help. So what would an aging life care manager? What would they do for somebody?
Speaker 2:Okay, well, when you come on their website, you can come up on their they have a section called what is Aging Life Care and come in there and find an aging life care expert. They have a lot of information that's a big help on their website so you can put in your zip code and they will give you a list of people. They can come in and do an evaluation. They can substitute for you.
Speaker 2:If you live far away, they can come in, make sure she takes her medicine, make sure she gets to the doctors things like that as well as help you if she has to be placed in some other facility, help you know what that facility should be and how to go about filling out the paperwork to get in. They do a myriad of things for the adult child. It's a wonderful resource and I've used them many times over the years to help not only with my situation, but also just recommending them to adult children that I work with, because they really it's like a substitute person to be there in your place and also they work with the adult child. You know they don't leave you out, but it's an encouraging situation. They help you with resources and lots of ways to deal with issues that come up.
Speaker 1:Do you happen to know is this service free or is there a charge?
Speaker 2:Well, when you first talk to them, they're not going to charge you because it may not be the right fit, and then they usually will have like a retainer fee or charge an hourly rate, but each one is different. When you come up on the website and find all the different ones, you're going to want to definitely talk to more than just one, because you're going to click with somebody, right?
Speaker 2:away personality-wise, and that's what you're looking for, because this person is going to be a part of your life care for a long time and they will tell you what they charge for different things, like they'll take your mom to the doctor or they'll make sure she gets her medication. It depends on how serious and how detailed the work is that they have to do, but they will explain to you. So it's a good idea to talk to two or three of them just to see you know who makes sense for you in your situation and also the care that they provide and how much it costs, Because a lot of times the adult child if they're close by, they can do some of the things, but if they need help, they're a great resource to help out.
Speaker 1:So what type of advice would you give someone if their parent isn't ready to accept the help? You know, because a lot of times you know my mom was very independent. She would be like I'm fine, I'm fine, I don't want anyone want anyone. You know she would have resisted someone coming in. So what? What can you do?
Speaker 2:because it's a hard battle oh yeah, it's one of the hardest parts of the whole process in my opinion. But, um, you have what I did once uh, I've done this more than once actually but I invite the person the life care manager ahead of time and I explain the situation about mom or dad or whatever the situation might be, give them a little bit of background and then have them come with you on a visit and just kind of introduce mom to them gently, because they're trained social workers and nurses. They know how to deal with people in dire situations, so they're used to this and they have a lot of different techniques to help you. And mom may not want it, but if you wait until it's too late, then it's too late, and I've never met a parent yet who thought, oh yeah, sure, let's have them come in and take over.
Speaker 1:no, it doesn't happen that way, trust me on that and you will know from experience right they. They tell you they're like I don't need your help. When did my adult child become my parent? You know they get. They get very upset. You know which I understand, which I understand as of today.
Speaker 2:Mom, I became your parent, exactly, exactly, but both my mother-in-law and my mother both said no, nobody's going to take care of me. You're not putting me into assisted living. Exactly, I know that feeling. I know that feeling. Yeah, one of the hardest parts is when the adult child becomes a parent to their parent, because it's a totally different mindset. Yes, it is.
Speaker 1:You're reminding mom, did you take your medicine Of?
Speaker 2:course I took my medicine. What's the matter with you. You don't think I can do that, oh yeah. And then you get over there and you found out that they haven't taken it in three days. So you know. Then you just have to put your foot down sometimes and just say you know, mom, this is what we're going to have to do, because I can't bear the thought of having something happen to you because we didn't take action.
Speaker 1:Exactly. So what should somebody look for when they're visiting, say, an assisted living community, because that's overwhelming too when you go into those places, community, because that's overwhelming too when you go into those places.
Speaker 2:I have oh yeah, I put down I I learned so much from this uh exercise. Um, as far as what to ask, and I I think I have like three or four pages in my book, but I want you to. When you go in, you make an appointment and a marketing person is most likely the first person you're going to meet up with and they're only going to tell you what they want you to know. What you need to know is what you don't know and how to find out.
Speaker 2:So what you want to find out? Well, what happens if mom falls and has to go into your rehab center for a while? What happens to dad? And do you have to pay rent or extra fees for both services? In other words, you're paying a monthly fee to live in the apartment as an independent, but then one of you has an issue and then you have to move into rehab for a while. It may be 20, 30 days, but how much extra does that cost? And then, if the other big one that I learned was, let's say, the facility has 20 beds in rehab, but you're the 21st person and they don't have a bed for you, when do you go?
Speaker 2:Well, then you want to find out. Well, where would you take my mom if she had to have rehab for a while and there's no bed available in the facility? Where will she go and how will you let me know about where she is? And do they have to have renter's insurance for the personal items in their apartment? Every state requires a resident bill of rights and it has to be posted somewhere obvious so that you can read it. But you want to also talk with other residents about how they live there. Do they like it and other things to do, or is it all just kind of sitting around watching TV all day? Do the residents socialize with one another? Are they happy? Does it smell funny when you walk in the door? You know there's nothing worse than a urine odor when you walk in.
Speaker 1:That's true.
Speaker 2:Yes. Is there a staff person available to coordinate home health care visits from a nurse, a physical therapist or whatever, if needed? What is the procedure that they use to respond to a resident's medical emergency? If there's an evacuation required, like California with the fires or Florida with flooding, what is their evacuation plan and is it something that you think is realistic? And how many people do they have on staff to help with that? And what are the training requirements for staff? Are they really capable people on staff? Do they have to pass a criminal background check? What training is provided for the staff on elder abuse and neglect? What is the policy for reporting suspected abuse? Do they allow hospice care? Some communities you know they can take you in and have assisted living facilities, but then if they have memory care for a dementia, do they?
Speaker 2:have that or do you have to move again? For example, a life care community with a life plan community is you walk in as an independent and as long as you can walk in by yourself, they will take care of you through all phases of your life, regardless, until you pass away and you know you're only in one apartment and then when you need to have memory care, you'll move to another floor and then when you need hospice, you'll move to yet another floor so that they keep you. It's quiet for you when you're there. You don't need to be involved in all the hustle bustle of the independent people. Is there a staff person available to coordinate home health care visits from a nurse, a physical therapist? You want to check the residency agreement before you move in. That's very important. You want to know what plan they have available. How much does it cost? Are there varying levels of plans? Some places will have plan A, plan B, plan C, and it depends on how much you pay as to how much you get as far as services. There's so many other different things, but those are just a few. But can you go in and spend the night? Or can you take your grandchildren in to spend the night and, if they can, how much does that cost?
Speaker 2:And what's the reason that a resident might be told to move out of a community? Is it because the community itself doesn't have the care that is needed? For example, if they're in assisted living but the community does not provide dementia or Alzheimer's care, that means they have to move. And will that staff help them find a facility that is agreeable and amenable to your parents or your loved ones to care for them?
Speaker 2:Or I had one woman she was so difficult to work with. We got her in and all she did was call me. She said, well, they're just yelling at me all the time. So I talked to the staff and they said, well, all she does is cause trouble, so we can't keep her, because the other people, they have a right to a quiet environment. So she had to move out and she didn't like that. But that was the way it was, and there's a lot of different things that you have to think about, but the marketing people are not necessarily going to ask you, they're not going to tell you and you need to know what to ask.
Speaker 1:Definitely, because it is overwhelming, because when you, especially you know sometimes when you go to those places you don't have a choice and so you feel overwhelmed about the whole thing anyway. Oh yeah, you know. So if you have a resource like your book to kind of prepare, that's helpful too to kind of prepare.
Speaker 2:That's helpful too. So you mentioned Remember too, lisa, the ones that are for-profit. I call them facilities. They have what I call a heads-in-the-bed mentality, whereas faith-based or church-based, religious-based groups are not quite as aggressive about that. But those marketing people have to fill the empty spaces and as people pass away they have an empty bed. So it's a heads-in-the-bed mentality and they like to put pressure. They'll come back and I mean I've had clients be told oh well, we'll pay this and this and this for you and you can come in right now, and otherwise they would have been told oh well, it's going to be at least a year before we can get you in. So as soon as you balk at it, they're going to come after you.
Speaker 2:So be careful about the aggressive tactics that some communities use to get your loved one in their facility. It's just you need to be careful about that and look at more than one facility before you make a decision and find out. I like to tell people move in to move up. In other words, they might not have the exact floor plan that you're looking for initially, but they may have something a little smaller. That's not quite perfect, but it's available sooner and that's important. You need to get the care provided as quickly as possible and then, once you're inside, on the inside track, so to speak, oh wow, well, we put you on the list ahead of everybody on the outside. So you stand a better chance of getting in if you move in to move up and you get the one you really want.
Speaker 1:So those are all very good, because it is a very overwhelming situation Very much so.
Speaker 2:And you've got a job, you've got kids and you don't even know what to look for. You don't even know if there are any places near you and if your parent doesn't live close by. Do you keep them in a facility where they live now or do you move them in with you for a while until you look for something? There's a lot of choices and they can't be made and quickly. You have to take your time and have time to evaluate.
Speaker 1:Oh, definitely, and you know if the if your parent is still living alone or if they've moved in with you. You mentioned about creating a safe space in a person's home. Yes, like you suggested, like maybe improving lighting through the interior, exterior of the home. What are some other ways? You know? Like I know, with my mom. She lived with me for a short time before we, before she went into mammary care. Like for her situation, we had to take all the knobs off the stove, you know, and different things like that.
Speaker 2:I remember hearing that I listened to your podcast on that subject and, yeah, you don't know what can go wrong. But one thing that's very important, or two things actually, that I would like to stress. There are a number of things to do, but one is to make sure, if they live in a single-family home, make sure the exterior house number is easily readable from the street, because when the ambulance comes, even though they're using GPS, that light on the house number is a big help to them to act quickly and it just makes a big difference.
Speaker 2:And then I've worked with a lot of hoarders and accumulators over the years, and I find that if a fireman cannot get in to the house through a window or the door because there's so much trash and stuff blocking the way, that's going to be a problem, because they need to be able to get in and they're carrying a backpack of health supplies on their back and they have to get in, and they're using an axe or whatever. So make sure that the areas there's a clear path to move around inside the property, and if you have to put the magazines up and away, then so do it. Or have one room set aside for stuff that your loved one doesn't want to part with at all, because it's just the most wonderful thing they've ever had, even though they don't remember where they got it or what's in it. Just be sure it's safe and you can.
Speaker 2:The well-lit entrance, though, and getting rid of a throw rug. Make sure the path that they have to walk, because if they're on a walker or a cane, it's helpful to have the hallways wide enough to be able to walk, because if they're on a walker or a cane, it's helpful to have the hallways wide enough to be able to walk next to them instead of behind them. But the way houses were constructed back in the day, a lot of hallways are not wide enough and bathrooms are not large enough to accommodate either a wheelchair or even a walker. So there's different things that you can do, but the safety is important.
Speaker 1:Oh, definitely Like that was our always our biggest concern. We just wanted to make sure she was safe, right.
Speaker 2:And that, to me, is paramount. Yeah, so, and remember one other thing. One other thing, lisa. I'll just mention it quickly. A lot of people are saying, well, medicare will pay for me to have this tub, a walk-in tub. Just be aware, first of all, before you do it, you need to find out how far away the fire department is, because when the paramedics come, time is of the essence. And if that tub takes seven minutes to fill and seven minutes to drain, that could be the difference between life and death, because they cannot get her out of the tub until the water's drained. People don't think about that.
Speaker 1:But that's a big concern.
Speaker 2:That's a big concern, I think, and you know it's wonderful to be able to take a bath, but if you're going to and if you have a care provider with her helping her bathe, they can't lift her out. She's too heavy. So the paramedics, when they get there, or the fire guys get there, they have to be able to get her out quickly, and every minute counts, and so if the fire department is further away than how long it's going to take for the water to drain, you really need to rethink that.
Speaker 1:Yeah, I didn't even think about that. And then too, if you do those walk-in tubs, those are very expensive too.
Speaker 2:Well, and they say oh, Medicare will pay.
Speaker 2:Well, these guys are making money hand over fist and I don't mean to speak disparagingly of them, because I've remodeled a lot of bathrooms myself over the years. But you want to just be careful because sometimes they will forget or not tell you that there's supposed to be a barrier, a waterproof barrier, behind the wall and behind the tiles that they put in. And if you don't have that, then you can have mold grow easily and just things like that that you don't know about construction. That can make all the difference in the world. And those tubs it's wonderful to see them in the picture, you know, and relaxing and taking a bath, but if they have a heart attack while they're in the tub, it's going to be extremely difficult to get them out in time to be able to get them to emergency care.
Speaker 1:And that's the most important If you have to call the paramedics, you want to make sure they can help them as soon as possible. Exactly.
Speaker 2:Exactly, exactly. And it takes time for the tub to drain and people think, oh, I can just get in and out like a regular tub, but you can't. That door is locked and it won't unlock until the water is drained out.
Speaker 1:Oh, ok, see, I did not know that. Yeah, an adult child should obtain from their parents. I know it's a long list. I'm lucky in the sense that before my mom got sick, my mom and dad had done the wills and the powers of attorneys, and all that at a time, and even now my dad always makes sure I know where everything is.
Speaker 2:Oh, that's wonderful.
Speaker 1:Yeah, so how would an adult child even go about trying to talk to their parent about this, getting information that you need, Because sometimes you don't know you need the information, until you're standing in the hospital and you're like I don't know where this is you know, right, and that's that's very important.
Speaker 2:And just starting a conversation with your parent about you know what, what their future might be as far as housing and health care is important, and starting the conversation on you know, mom, where would I find your life insurance policy? Or do you have your will in a safe, or is it and you don't want to put it in a bank safe because the bank will freeze the safe and you can't access it. So you want to have it in a fireproof area in the home is the ideal place, unless she's in a facility, and then it would be in your home. But getting that information is tricky. But if you don't act combative, act like well you know, I'd really like to know have you made a will? Is it up to date? You know who is your attorney? And just check you know, casually, check with it, because a lot of times the parent doesn't even know how to begin the conversation and they want to tell you but they don't know how to start. So, and it might not be that you'll get everything in one conversation, you'll have to go back again. But start a master list and you want things like the death certificate and you need to have an original death certificate and you want to have a. You know if they have a birth certificate available. You want their driver's license, keys to the house and their social security number, the will, the original will and any codicils or a trust if they have their things in a trust who has power of attorney to act on their behalf while they're alive. You want insurance policies, as I said. You want also who should I contact for you, mom, if you get sick and you want to tell your friends. Wouldn't you want them to know too? So you get their emails or their phone numbers or whatever information you can glean and you add it to that list that you're collecting. You need to know who their doctors are. I mean, who should you call if there's a real emergency? The doctor won't necessarily know that she's fallen. I mean, the ambulance will take her to the hospital, but her doctor needs to know that she's there. And if they had a business boy, you have to know well who's the CPA for the business, who prepares the taxes, who does this, who does that? Do they have employees? And how do you tell the employees and what do you do with that? And any clergy or religious organizations that they're affiliated with if they're Catholic or Protestant or other and their friends their friends can help step in and help out with care, perhaps, and visiting after they come home from the hospital.
Speaker 2:If they were in the military, there's a procedure for being buried at Arlington National Cemetery. You need their Medicare and Medicaid numbers and identification cards. You need to know who their health insurance is with. If they own a property, you need to know what's the address and the tax record for the property. Is it tenant, occupied? You need to have the title. If they've paid off their automobile or whatever it might be, you need to know where the title is for that, because you're going to have to sell it and you want to make sure. If they have online accounts, you need to know the passwords and the PIN numbers, for example, if their bank account is online. Find out that information you want to know. Well, where do you keep your previous tax returns, mom? Is it in a safe or is it in whatever? And that will tell you an awful lot about how organized they are. Your parent is either going to be a planner or a procrastinator.
Speaker 1:That's very true, and you did a really good job outlining all this in your book. So I'm going to give you a plug for your book again, because people can get it right on Amazon and all those places. Yes, okay, so it's called Debbie Miller. Yes, okay, so it's called Debbie Miller. It's Doing the Right Thing Simple Solutions, essential Tips and Helpful Resources for Assisting Aging Loved Ones. And I like it because you have a lot of bullet lists and stuff so people can kind of check things off and go along. It makes it easier. It doesn't feel so overwhelming with it, it's true.
Speaker 2:You don't have time to think about this, oh gosh. And then they ask you, well, where's the yada yada? And you say, oh, I don't know, was I supposed to have that? And this is why I like to tell people to try to do this before it's too late, because there is no do over in dementia or death. No, they're they once that, and you know this from your mom. There is no do over. Once they're gone, they're gone and you cannot.
Speaker 2:Then it's going to take you hours to go through the house and if they have accumulated a lot of stuff you have to sort through that To find the important information. At least tell them, hey, show me where you keep it so that I know in case of emergency. We don't think an emergency is going to happen, mom, but you know it's good to know just in case. And if they're not organized, that will tell you. You know it'll be. Well, I think the life insurance policy is here. Well, is the life insurance beneficiary up to date, or is it 20 years old and they haven't updated it? How long has it been since their will was updated? If it's in a trust, it's a whole lot easier. But just ask and just say you know, mom, do you keep all your things all together? In other words, are you a planner or are you a procrastinator? Exactly, and that will help you. Well, you just be gentle, don't go in acting. All you know military and stand and salute and stuff. But just say you know military and stand and salute and stuff. But just say you know, mom.
Speaker 2:I was thinking the other day what would happen if we needed to access your records. For example, if you go to the hospital and you wind up too ill to speak for yourself, someone's going to be there. Who did you appoint to be there for you and where would they find that information? And you know your parents are not going to say that anything's going to happen to them. They don't believe that for one minute. But it's going to happen and you need to be prepared. So it's not like you're coming in and being the boss. You're just coming in and just saying you know, I'd really like to help in case of emergency, but I need to know where some of these things are case of emergency, but I need to know where some of these things are.
Speaker 1:Yes, definitely.
Speaker 2:Well, this has been very, very helpful today. Well, I'm glad it is a lot to understand. Lisa, I absolutely agree.
Speaker 1:So I appreciate you taking some time to talk with us here and again. This was very insightful, so definitely you should check out Debbie's book and thank you again for joining us on. Patty's Place. Thank you All right, bye-bye, bye.