Choosing a Career in Caregiving with Tzivya (Tee) Murrin

Why would a person choose a career in caregiving? In this episode, our guest is Tzivya (Tee) Murrin, Founder of Sensible Senior Planning. She has over a decade of professional and volunteer experience in caregiving, starting in a pediatric nursing home to eventually working with dementia patients. Now, she helps families navigate the Medicaid process and leads a helpful Facebook group called "Medicaid Senior Planning and Support." We discuss Tee's journey as a caregiver and some of the moments of joy, heartache, surprises, and everything else along the way.

Transcript

SPEAKER_00 0:00

Why would a person choose a career in caregiving? What draws them to it and how does it impact them in the long run? Welcome to the In-Between Years, where life doesn't come with a manual, but we've got the mic. I'm your host, Holly Westerveld. And our guest today is Sivia Murrin, who goes by T. She's the founder of Sensible Senior Planning and has over a decade of professional experience and volunteer experience in caregiving. She started in a pediatric nursing home and worked all the way up to working with dementia patients. Tia spent her career walking alongside seniors and families in all of their hardest moments. And she now works with families to navigate the Medicaid process with clarity and with confidence. She also leads a very helpful Facebook group that I definitely encourage you to check out. You can search on Facebook for Medicaid Senior Planning and Support Group. So check that out and join that. You can certainly follow up with more information. But today we're going to talk about T's journey as a caregiver and some of the moments of joy and heartache and surprises and everything else that she found along the way. So, T, I thank you so much for joining us today and for sharing your story. Yes, thank you for having me, Holly. Absolutely. So as we start here, can you maybe just start by giving us an idea of what led you to the time that you spent in caregiving and your journey to be a professional caregiver?

SPEAKER_01 1:25

Yeah. So I think starting from a younger age, I've always, you know, had always wanted to assist those that couldn't advocate for themselves to help advocate for themselves. And I think that was something that from a young age that I struggled with not having resources when I need others to advocate for me. And that was something that I wanted to, you know, put out and help others. And the healthcare field was something that I felt like that was an opportunity for me to be able to help advocate for those that were less fortunate than I am, because I was, you know, physically healthy and able to care for myself. So I was like, hey, maybe, you know, that's the way I can help others and advocate for others that need care. As a teenager, I did have in my on 1920, I did have two very good friends who actually did get cancer. They were at end stage cancer, fairly close to each other. And I was one of theirs the primary caregiver. The other one, I was, you know, spent months in hospitals with her. So they both unfortunately did pass away. But that for me was really the jumpstart in finding how much, you know, how good it really felt for me and the expertise that I recognized and the talent that I recognized that I had in helping those that were ill and, you know, weren't able to care for themselves. So, like you mentioned, I worked in a pediatric facility and then went on to work with geriatric because, you know, I saw that there's was definitely a disconnect in a lot of caregivers and providers and healthcare professionals and working with seniors as to the focus and quality of life of the senior, as opposed to all just being clinical or business-minded. So really wanted to tap into that. And that's how I got into working with geriatrics.

SPEAKER_00 3:18

Yeah. Oh, wow. And such a journey and those two friends, I mean, that's got to be incredibly difficult to see your friends go through that journey and things. So definitely sympathies to you for that. But such a good thing, you know, that they had a friend by their side just to support them, you know, through that journey. I mean, I think it's so important for caregivers, the role that they play in helping people through that is just tremendous. So you've seen and helped a lot of families that have been along this journey. I know, you know, you were a caregiver, but you also worked with a lot of families, counseled families, all kinds of things. You know, what do you think that families are missing? Like, where do you see them struggle and what should they be, you know, what should they be doing about that?

SPEAKER_01 4:02

Yeah, so I think one of the things is expectations. You know, I think that's really one of the key things that the key aspect that I always like to point out to families. You know, I get asked often is what facility should I put my loved one into? What home care agency should I hire? What has good, you know, stars, good ratings, good reviews. And what I'd always say is that you always want to keep your expectations very low because we're hiring businesses, right? And you want to keep the expectations low. And of course, and of course, with that, you also want to make sure that you can be an advocate for your loved one. So I think that's always one key that I always that, you know, I always say is that it's you need to make sure that you are really your number one advocate for the number one advocate for your loved one, whether it's a parent, whether it's a child, whether it's a sibling, when you're putting them into a nursing home, or you're they have to go into a facility and you know, you're admitting them into an assisted living facility or whatever it is, you want to make sure that you're finding out who is the social worker at the facility, who is the nurse manager at the facility, who is the administrator at the facility. And I always like to say facilities don't necessarily love it or love seeing me coming or love seeing my name calling because it's very important that in it, clients that I'm working that I work with, that I am advocating to the professionals on behalf of the family or behalf of the individuals at the facility. Unfortunately, you know, nurses, administrators, they're overseeing so many aspects that, you know, it is hard for every resident to get the care that they need and to get the personalized care that they need. That it's just so important that you are able to be an advocate for your loved one. And if you can, there are organizations or there are resources out there for others that can be an advocate. There's some that are, you know, there's some that are will cost money, can be minimal, or they'll be an advocate, patient advocate. And then there are other resources such as like a local ombudsman. If you have an issue with the facility and maybe you can't go down there and go check it out and you think that your loved one may be mistreated, you can contact a local ombudsman. So there's different, there are different resources and different avenues that can take to make sure that you are an advocate for your loved one. And I do hear a lot of times from families, no, well, it's so exhausting, it's so hard to be an advocate for a loved one. And it is, it is very hard. It can be a full-time plus job, you know, to be that one. And that's where I say to sometimes tap into the resources. Because if you do have those resources, either if you have some finances to hire someone that can help advocate, or if you have, you know, being able to call on the ombudsman to look at, or, you know, you ask the social worker, you want to have a once-a-week meeting to get an update. So you know every week you're having a meeting. You want to make sure that you're really using all of the resources that's out there. I think that's really that I'm gonna keep so when people ask me about like what facility should I put my loved one into, and usually I say the one that's gonna be the most convenient for you to go to. Because if you know, if you're gonna have to travel an hour, but that facility maybe is beautiful and gorgeous, you don't really know what the care is going to be, and you can have a difficult time advocating from afar. So I usually always say, you know, like the closest one you want to go to. But I think that circling back the key is expectations. You want to have very low expectations, systems in place, put communications in place that you're gonna need to be the best advocate for your loved ones.

SPEAKER_00 7:38

That's that is tremendous advice, and so true. I mean, I'm living I'm I personally am living that today. My husband just had to go to the assisted living and have one of those conferences today. So Mike can attest to that being excellent advice. And the thing about the closest one, also true, because you do have to, you know, sometimes drop things and run over there for a Friday morning conference. So that's good, that's great advice. I want to transition a little bit. You know, I know you spent some time working with dementia patients and families that were some supporting loved ones with dementia. And, you know, sometimes, especially with that disease or with something that happens suddenly, like a stroke or something. I know that many people have talked to me about, you know, I wish we would have talked about this, but it's too late. You know, that they can't answer, you know, what kind of care they want, or I wish we would have planned ahead. Do you have any thoughts or advice for people that maybe are listening now and have still the opportunity to discuss these things ahead? How should they do that and what should they talk about?

SPEAKER_01 8:38

Yeah, it's a good question. So they I used to run an Alzheimer support group. I was a facilitator for that. And I'm thinking of some of the questions that some of the those type conversations that would take place there. And I know one of the big things was, you know, definitely end-of-life care, right? So what type of burial does the individual want? Do they want DNR? Do they want to be resuscitated? Even conversations of when do you would you want me to start bringing hospice in? So if you have a loved one that, you know, you're for that may be heading towards there and you're able to have these conversations, is you know, at what point do you want me to bring hospice in? And of course, hospice, you have to medically qualify. But even with hospice, right, you can only be required, you only can be allowed to take certain medications. So you may not just be looking at just DNR and do you want to be resuscitated? But even from that standpoint. The other thing is, and this is the number one thing that I say, this really should be for anyone, even for caregivers themselves, even for myself, is getting power of attorney in place. So getting financial power of attorney in place and getting medical power of attorney in place can cause it can cost, I mean, at least it can be free because you can find some online, or you can hire an attorney to write one up if the assets are more complex. But getting power of attorney in place with a backup power of attorney as well, so that if the individual won't be able to appoint a power of attorney later on, you won't be able to make decisions for your loved one unless if you go for guardianship. And guardianship can cost thousands, if not tens of thousands of dollars, requires going to court, requires hiring an attorney, and can take months and months. So to avoid a lot of heartache, a lot of financial strain, I always say power of attorney is a conversation that you want to have. Like even like I say, even me being, you know, younger, I have that power of attorney in place. It's just so important.

SPEAKER_00 10:33

Yeah. I I have one too personally, and I can attest to that. And you said something that was really important, and I want to reinforce your point because I it's something that my in-laws did that was really saved the whole thing, I think. So they, of course, had power of attorney on each other. And my mother-in-law has dementia. My father-in-law was her caregiver. But as happens a lot of times, he had a heart attack and passed away before her. And so luckily, they had the power of attorney draw-up where there were backups. My husband and I were both backups for for him on her power of attorney, which enabled us to step right in and take care of everything that we've needed to, because she wasn't in a place that we could have redone that had they not had it set up properly. So I just want to reinforce that point. Even if you've got it done, if you don't have that backup, because things happen. They really do. So yeah, it's a great, it's a great point. So I want to, you know, transition a little bit. Let's talk about the industry, the caregiving industry, the Medicaid industry, which I know you have really deep experience with. And there's been so many changes, you know, so many things happening around, you know, senior care, Medicaid, you know, caregiving, all of that. From your perspective, what are you seeing, positive or negative, that you think is going to impact people?

SPEAKER_01 11:49

Yeah. The one thing I think when it comes to caregiving, I think that social media definitely has had a positive impact because I think that there's, you know, and from what I've seen, there's different ways to connect with others that are caregiving. So from a support standpoint, but also in regards to holding healthcare professionals accountable. I think, you know, I've seen in different Facebook groups where a family will point out a concern that they have with their loved one that's at a facility, and a few other families will then go ahead and speak about similar concerns that they've had in the same facility. And that really helps to present where there would be either, you know, in this one particular situation recently that I'm aware of, it did get the embudsman involved and it did call for a state inspection at the facility. And there were some things that were then adjusted. So I think, you know, from a, again, from that standpoint, I think that there's definitely benefit in being able to rally and hold some healthcare professionals or providers accountable. And to that end, too, I will say, just as the years have been going on, the different experiences, I am finding that there's more and more healthcare providers and healthcare professionals that really are trying to, you know, work on putting the clients first. So of course it's a business as well. But there's been, just from my perspective, you know, I think that there's been staffing. There's been, you know, more staffing in place. There's been a lot of advocating. So that can be even, you know, a policy, the staffing ratio. So I think that there's been definitely an uptick in that positive. And also the Medicaid waiver program. So I think I've seen more and more that there are more facilities across the U.S. There's certain states that just don't have it, but in states where they do, that there's more facilities that are accepting residents into assisted living facilities with Medicaid. And assisted living facilities are less institutionalized, like more are providing higher level of care so that people can experience end-of-life care in an assisted living facility. And Medicaid, they a lot of these facilities are starting to accept Medicaid as well. So that's, you know, from the positive, I'm definitely seeing some changes. I think, you know, from the from any changes that are impacting negatively, I would just say I think really it's just changes, right? That's negative. It's just hard. Every time there's new rules or there's new procedures or there's new, it can be difficult. But from my perspective, even with, you know, with Medicaid, I think that there's a lot of changes. But I wouldn't necessarily say it's making it, you know, more difficult for individuals than it was, you know, three years ago. Other than that, I'm saying the one thing I think is staffing. I think that Medicaid case, I hear this because I work with Medicaid all over the US. Medicaid offices, many of them are experiencing staffing struggles. And that's just ultimately impacting Medicaid and being able to get actual guidance for the Medicaid application from the Medicaid office. So I think, you know, that's been a struggle. But then of course, that's where, you know, again, there's resources out there, either free resources for aging disability and resource center if you have a very straightforward Medicaid case, or there's Medicaid professionals like myself and attorneys. And, you know, I work closely as, you know, with like Krauss, where we can set up Medicaid compliant annuities. So the advantage of that is that it then has people looking elsewhere instead of the Medicaid office for guidance. And when you look elsewhere, you learn more about asset preservation, ways to preserve assets, even if you need to apply for Medicaid in a day or in five days, and you have no time, you have money. There's ways to preserve assets. So the positive spin to that is that yes, it it has people leaning elsewhere for guidance and they learn about ways to preserve assets.

SPEAKER_00 15:33

So, so talk a little bit more about preserving assets. Because I think there's a big thought out there that you have to spend all of your money down, and then when you have nothing left, that's when you apply for Medicaid and can get some help. But that's not entirely true, right? So, so talk about that and how somebody might have some alternatives. Yeah.

SPEAKER_01 15:54

And this was actually the reason why I got into Medicaid planning is because from a facility standpoint, we don't really share that. We don't really, when I was working in a facility, I was a, you know, a social service coordinator, and then I got my administrator's license and I was an administrator. We don't really share that or educate ourselves in because our perspective is we want to collect as much private pay funds because we get paid more. And yes, that can also lead to a nicer building, right? Or nicer. So we're using the money. A lot of times it is going back into the residents, but essentially we don't want to educate ourselves or advocate for the residents financially. Right. Over the years, I knew there have to be more. So I kind of found out that there's a lot more that can be done to preserve assets and not to just collect private pay funds from seniors. So one of the most common strategies, and I work with attorneys all over the US, and then in certain states, I work with seniors as well, is we use Medicaid compliant annuities. And Medicaid compliant annuities can be used in different ways depending on the scenario for each individual. Essentially, it's one of the most common ways where we can preserve assets. When I'm working with spousal cases, we often can preserve 100% of the assets. And when I'm working with single cases, it usually comes up to we can preserve at least 50%. Sometimes there's scenarios where you can preserve more in certain states. Sometimes, even with single cases, in certain states, you can preserve 100% using different strategies, and other times not. So there's definitely if someone has assets, there's ways to preserve it. That if either way you're going into a facility that accepts Medicaid, you want to look into those options. Now, what I do say to individuals, if you if you're going into a facility, you can go into an independent living facility or in a state where Medicaid doesn't cover assisted living, you can go into an assisted living facility paying privately. It might not be the good time to actually preserve the assets because rather use that for better better quality of life in an assisted living facility. But if either way, you know, and that's the part that we want to make sure again that we're advocating, really what is best? Is asset preservation is that best for you? Or is it best to private pay in a private pay type facility? So, but the one thing is that you just you always want to reach out to a professional in your area to kind of determine that and make sure that they're advocating for you. Or of course, like I say, I work in all states, you can always reach out to me free consultations, but you know, to make sure that you know which route and are you a good candidate for crisis Medicaid planning.

SPEAKER_00 18:27

That's that's great advice. And I think so many more people need to understand that there are options. So reaching out to professionals like yourself, to elder law attorneys, to people that are connected to this industry and can help, it can really make a tremendous difference. And yeah, like you said, sometimes spinning it down is right. If you can go to that beautiful assisted living that's right next door to your kids' house and, you know, live out there as long as you can, that's probably right for you. If they don't take Medicaid, then that's okay. You know, you can go to the Medicaid facility when the time is right for you to do that. So it's great advice. So as we kind of come closer at the end of time here, you know, tell me what is one thing that you think people should know about this journey of caregiving and, you know, the elderly.

SPEAKER_01 19:12

Yeah, I think the one thing is again is resources. Don't give up on finding resources. It's very difficult, it's stressful, it takes a huge emotional toll, it can take a huge physical and financial toll. But reach out and learn about resources. Take a few days to, you know, if you're new to the journey, take a few days to write a list, create a list while doing some research about all the different resources and see which one you find would benefit and would help you. Different financial resources, financial guidance, different clinical advocacy, you know, medical, just which learn about all of the resources and give yourself those few days to really learn about it. And then you can dive into each of them because we don't want to get burnt out just putting all energy diving into one, two, three, or four resources. And then those resources really aren't the ones that are for you. And then it's like there's no help. There's hundreds of thousands of different resources and organizations for seniors. So it's really important to dive into them and learn more about them and spend some time researching them.

SPEAKER_00 20:13

Yeah. Great, great advice, great advice. And we'll wrap it up there with you. I thank you so much for joining us today, T, for sharing all of those wonderful insights. You gave so much helpful advice to people that are facing this journey. Everybody, please remember to look on Facebook at Medicaid Senior Planning and Support Group. Join the group. There is lots of conversation on there, some great advice that T gives to everyone. You can certainly connect with her there as well or through Sensible Senior Planning online. She's more than happy to help. And like she said, free consultations if you have questions. And with that, everyone, please look for the next episode of the In Between Years coming your way next month. We thank you so much for listening and have a good day.