Important Long-Term Care Conversations and Decisions with Cory Fosco

Our guest in this episode is Cory Fosco, author of the book "The Question of When." Cory spent decades in long-term care as a social worker and nursing home administrator. He wrote the book to help families find their way through difficult decisions; it's available at www.coryfosco.com. We start by talking about Cory's encounter with long-term care insurance coverage during his mom's brief stay at a skilled nursing facility. He shares some of the unexpected aspects of utilizing a policy, advice for family conversations about aging and long-term care, and how planning ahead ensures your loved one will receive proper care.

Transcript

SPEAKER_00 0:00

What if your family did everything right, bought the insurance, they made the plan, and still found it difficult to use that coverage when the moment finally came? 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 Westerveldt. My guest today is Corey Fosco, the author of the book The Question of When. Corey spent decades in long-term care and as a social worker and a nursing home administrator, and he wrote the book, not just to sell the book, but to help families find their way through the decisions that no one prepares you for. You can find that book at CoreyFosco.com. Today we're talking about something that just doesn't get said often enough, which is that planning ahead is not the same as planning all the way. And what happens to a family when they discover the difference at the worst possible time? So, Corey, I thank you so much for being here and sharing both your experience and your own family's story with us today.

SPEAKER_01 0:57

Thanks for having me. I'm really excited for today's conversation.

SPEAKER_00 1:00

Absolutely. Let's start with your caregiving story and your mom's situation and what led you to that.

SPEAKER_01 1:06

Yeah. And so just it stepping back, uh, it's been 34 years that I've been in this industry. And as you mentioned, social work, I did admissions and marketing. Now I'm on the technology side. And it's funny. I've had all this experience, all these years, friends and family calling me. And then it was around the COVID time frame when my mom needed to go into a skilled nursing facility for some rehabilitation. Of course, we knew that Medicare would cover that, and her her her stay extended a bit because of the situation of the world. And I also knew that she opened up a long-term care insurance policy back in the 90s when she was probably my age now. And I thought, oh wow, that's good. If she does need to stay longer, if we realize that she needs more care, that was going to cover it. So she allowed me to see the policy. And then I came to find out that there was this thing called a 90-day elimination period. And uh we're like, what does that mean? And so I come to find out that uh, you know, with this policy, and it's actually a really good policy. What what she has to do is before the policy kicked in, she had to pay privately for 90 days. And it does cover for her, it covers home care, assisted living. Like it's, like I said, a really good policy. However, she didn't plan for needing three months worth of funds for for care. And so thankfully, she didn't need to go into a skilled nursing facility or any type of residential setting. She is 80 years old now, she's active. She lives out in Arizona with my brother and sister-in-law, plays mahjong like 10 times a day, 10 times a week.

SPEAKER_00 2:47

Nice.

SPEAKER_01 2:48

But her, you know, as as she's getting older, we're starting to see she uses a walker now. While she's still driving, things are starting to slow down a bit for her.

SPEAKER_00 2:57

Yeah.

SPEAKER_01 2:58

And you introduced me to a policy a term I'd never heard of, uh a short-term care policy. So that could be an option for us with her. But again, all these years I've known about the different types of funding that are available for folks, and didn't realize that until my mom uh was in that situation.

SPEAKER_00 3:18

It's and I think that's really common. You know, somebody does all the work that she did all the right things. She got the insurance, you know, you think everything's covered, and then, oh, surprised, you know. And and if that's facility care, I mean, that couldn't be 10,000, 12,000 plus a month. That's not a small dollar amount for people to have to cover. So it's uh, you know, I think it's probably good that you found that when you did, so that, you know, if something does happen later, you have some ability, but that's that's a tough, tough thing.

SPEAKER_01 3:46

It really is. And that's part of my mission, is making sure people know that there are options available. And the earlier they they they talk about these things, the better they'll be prepared for uh the situation when it when it arises.

SPEAKER_00 3:59

Absolutely. And I mean, and speaking of that, you know, in your book, I know you do write tons of great advice about you know how to find a facility and how to have the conversations, all of that. There was there was one specific conversation in your book that really almost every family needs to have, and none of them actually do that. Um, I'm gonna actually read uh the little excerpt from it because I think a lot of people that are listening are avoiding it and and they're avoiding it because they don't know how to start. Yeah. And so the the passage, it just really struck me because we talk about it so much on this podcast. Um, it says there's a conversation that most families need to have, and very few actually do, at least not until the absence of it forces something worse. It's the conversation about what's happening, what's coming, and what the people who love your aging parent, spouse, or family member are going to do about it. It's the conversation that requires sitting down with the people you love most, saying things that are hard to say. The conversation you've been avoiding is almost certainly less devastating than the one you'll be forced to have if you keep avoiding it. I think that's that just struck me so much that's such great advice. Because it's not about the paperwork and the logistics and all the things we think about. It's about sitting down with mom and your siblings and whatever and saying those things that are hard to say. So it you've got a lot of expertise on this, obviously. You know, what makes that so hard that and what makes families work so hard to avoid it?

SPEAKER_01 5:24

Yeah. You know what I think is the common theme is families think having the conversation is really what's going to cause the pain, right? So uh, and it's not, it's the silence that causes the pain. There's there's guilt behind it, there's all the promises that people think they've made to one another. And and quite frankly, the earlier I talk a lot about the 72-hour decision. And what that really means is oftentimes while people are struggling to get through the day as a caregiver with somebody at home, something might happen. A fall might happen, or the the a disease that they might have, a progressive disease, might require them to go into a hospital, which then require might require them to go into a skilled nursing facility. And typically, hospitals are for throughput and they're not going to stay there a long time. And what happens then is they need to make this very quick decision in 72 hours. And and I have a friend who's actually in a skilled nursing facility right now and needs to go home with home care. And they were told yesterday they made needed to make the decision yesterday. And they haven't had the time to have that conversation, right? And and so I I I think why people avoid it is because A, it's a very personal conversation, and B, it's they're they're afraid that that it's gonna cause pain for the the person on the other end. And what I like to suggest to people is starting small, have that small conversation that that might even be if you're not safe at home anymore, where might you want to go? And what is important to you? Is it that you want to be close to me? Is it what is it that you want to be amongst friends, or is it that you want to, you know, make sure they have a garden? And so if the smaller you start and you just can then build upon that conversation, it's not gonna cause the pain. You're actually gonna learn a lot about finding options, and it isn't necessarily even home or facility or community. There are options in between. And so you can just start small and have those conversations along the way and make and remove that pain and remove that what do I do now conversation.

SPEAKER_00 7:36

Yeah, and and I I love how you framed it of you can have many small conversations versus the one, you know, emergency crisis conversation, which is so much easier. I I think you said something really important there that I want to make sure people catch too, you know, about what's important to the person that's gonna be receiving the care. And in like you mentioned a garden, you know, and if if that's important, when you have the conversation ahead, you actually have time to maybe find a place that has a garden or or have a place of choice versus when you're in that crisis situation and you've got 72 hours, you're taking kind of what you can get. I I know you talk a little bit about that as well. You want to maybe expand on uh how that goes?

SPEAKER_01 8:16

Yeah, maybe I can use an example of my in-laws who uh last October moved into a retirement community. So it's a community that for for those who don't know, it's a continuing care retirement community. So they have independent living, assisted living, they've got memory care, and they've got skilled nursing. They started to realize, and and what they first made was a lifestyle decision. They they they said, okay, we can't really take care of this house anymore. Uh we need to start looking for options. And there's a community that is uh that a lot of their friends live in. And so again, what was important to them was to be amongst friends, was to be closer to family, uh, but also to just leave behind the the doing the lawn and doing the laundry and cooking the meals. And what I've seen in them is actually a lot of coming out of their shell and doing just doing different things because they were in charge of making those decisions. Not everybody has either the finances to do that or even the conversation to know that that's happening. And so what what what really you need to look for is taking a step back and individualizing the person's situation, right? Because not everybody has memory loss, not everybody has a diagnosis of Alzheimer's dementia. There are progressive diseases, COPD, CHF, maybe Parkinson's, or any other kind of situation that may not be tomorrow. You need to go into what everybody calls a nursing home. And so it's just starting to pay attention to those signals that are starting to happen. Maybe somebody is repeating themselves over and over. There's missing medications, they are uh missing their way on the way home from uh, you know, a grocery store. All those things come into play. And so at the end of the day, what you need to do is just make sure you have what I like to call the foundation, just understanding what might or might not be available to the person.

SPEAKER_00 10:18

I I think that's wonderful advice and and and understanding their their priorities is huge. You mentioned as you were talking about that and watching those signals, one thing that you mentioned in your book was like sitting at the the dinner table at the holiday and the and the siblings are kind of giving each other the side eye, you know, when they when they notice mom repeating herself or or whatever might be happening. Like everybody knows it, and we're nonverbally communicating it, but we're not actually talking about it.

SPEAKER_01 10:45

Right. Yeah, and and so I the the the story I I talk a lot about or have in my book is about Frank and Eleanor, who his his wife was was uh diagnosed with dementia, and he just started to cover for her and make excuses. And I like to say the worlds start getting smaller and smaller and smaller. And the thing that gets overlooked quite a bit is the caregiver health as well, the person who and the cost of that person who is overlooking their own health. But you know, what happened in that situation was she at 2 a.m. walked out of the house and was gone for 23 hours. So all those mini conversations that the the son and and two daughters were having with one another all came up to a head because they couldn't find her. And fortunately she was found, but then you know, Frank said, okay, I I can't do this anymore. And that real conversation that they were avoiding all along, but but having behind their back came out and they realized, okay, now we need to make a decision. And you know, Frank was uh talking about how he felt I'm giving up on my wife. And that's not giving up. What what I what I like to talk about too is that's an extension of him, it's an extension of the caregiving services that the person is providing. You're just making that uh that a much wider caregiver uh circle, right? And people don't think of that, they just think of this situation, of what's happening right now, but don't think about what might happen in the next day or two or week or two.

SPEAKER_00 12:16

Right, right, exactly. And and caregivers so much feel like they're failing if if they just can't do it all sometimes. And you do a great job of addressing how no, you know, asking for help, taking care of your own health as a caregiver is caring for the person that you love. It really is.

SPEAKER_01 12:31

That gets overlooked so much. And I've I've been listening to a lot of podcasts lately and and reading a lot of information about caregiver health and the costs of caregivers. And uh, I think we need to start paying attention to that just as much as paying attention to the person who needs the care. It gets overlooked so much, and I think that's where people fall into some challenges as well, is because the health of that caregiver starts to decline and they might need placement before the the the person that you're dealing with uh does. And that just changes the the you know the situation tremendously as well.

SPEAKER_00 13:09

Yeah, yeah, absolutely. And so many of them, so many caregivers even pass away before the one that they're caring for, just because of that neglect of of their own health, you know. I think especially in the cases where it's a spouse caring for another spouse because you know they're they're they're aging and and have their own issues as well. And so I agree with you, couldn't agree with you more that we really as a society need to do more for caregivers.

SPEAKER_01 13:32

I think the one thing I also want to stress is the the maybe the most difficult conversation isn't necessarily about do you want home care, do you want to move into a community? It's the finances. And I'm sure you deal with that all the time. And so right. And and so that nobody wants to talk about that. Why? That's a private conversation. You know, you were raised by your parents if you're if you're a child, and you never talked about money, you didn't talk about your mom and dad's personal finances, right? But again, starting small, talking about do you have a long-term care policy, insurance policy, because they might actually have one, but just don't know that it exists because they avoid having the financial conversation. And I think if you are aware that there's funding available, whether that's private pay funds or something like a long-term care insurance policy, the stress level of the caregiver, the children, the family, what have you, could also be eliminated about that conversation. So it's important to have that conversation while either A, the person you're caring for can still participate in that conversation and tell you, oh yeah, I've got one in the filing cabinet. And you need to call Holly on the phone and she'll give you all the information. That what often happens is they start rifling through the, you know, the files and all that and find it, either don't find it or find it, and and and all the stress that comes along with that. So I want people to have not just the where do you want to go or what do you want to do? It's the what kind of finances do you have? And if you don't, let's start learning about what other options are available to us as well.

SPEAKER_00 15:09

Right. Absolutely, absolutely. Because there are still a myriad of options, especially if you plan ahead and and can understand what what might be coming. So I I think that's wonderful advice. And and so many, so many good things you've shared. We're we're really coming up on our time here. But I do want I have one more question. Yeah, just given your depth of knowledge in this industry, I mean, tell me what kind of changes do you see in the industry as a whole or or even the world as a whole that could impact caregiving or elder issues in the future.

SPEAKER_01 15:38

Yeah, I I think the gap between affordability and funding, and I know I just talked a little bit about that, but for the next decade, that's just gonna get worse, right? The the care costs are climbing. I don't think we could talk too much about that. I would like to see that change. I I I don't know how that changes, but I think that is something that because more and more people are getting older and more people are needing uh to services that are available to them, and oftentimes people think Medicare is going to cover them. And as I talked about in the book, and I'm, you know, I know you talk about with with folks, Medicare covers short-term rehabilitation, but it does not cover long-term care. As you said, there are funding options available, but that gap is not going to shrink. The gap is just gonna continue to get bigger and bigger and bigger. And so I think we need to we need to really advocate to be aware of that and figure out ways to to make sure that that gap shrinks. The other thing that people in the industry know about, but but maybe not many folks do, is the shift that's happening is to what's called value-based care. Value-based care, the easiest way to describe that is in the old funding model that still exists, is a fee for service where I go into the doctor, I go into a skilled nursing person, I get a service, and that gets reimbursed in some form or fashion. And that's really uh funded with the quantity, is how is how operators get get paid for that. The shift to value-based care, which I love and I want to see keep going in in that way, is for quality outcomes. So what's starting to happen, and the government is saying, hey, we want everybody to be in a value-based care uh situation by 2030, is operators or practitioners are going to get reimbursed better and and larger for the outcomes, the quality outcomes that they provide. Listen, the nursing home industry gets a bad rap that I and you and others are trying to get rid of. There are a lot of amazing operators out there who are focused on quality. And now that the funding model is shifting to value-based care, those that are going out to consume that, the the worry about is this a good facility? There's a lot of publicly available information, is gonna get smaller and smaller because they're gonna really reward operators that are paying attention to quality. And so I love that. And I I I hope that we continue to go on in that in that way. And then it's just folks like me and you who are providing education, are providing podcasts, they're providing the certain the support that people need and the information that people need. And I just want more and more of that to be out there. Yeah. And people not to be feel like, not to feel like they're left, they're out there alone. There's a lot of support that's out there, and it's just knowing that it's there and and and getting the right information.

SPEAKER_00 18:29

Absolutely, absolutely. Couldn't agree with you more on those points. Um, just such such good information. You're you're a wealth of information. Um, I wish we had more time to even go further with the conversation, but I thank you so much for joining us today and for being so open about not only your personal situation, but just all of the knowledge you have on this topic. For anybody that wants to go deeper on some of the things that Corey talked about, I really encourage you to check out his book, The Question of When. It's practical, it's honest, it is a tremendous guide for families that are facing these decisions. Reminder, you can find it at Coreyfosco.com. Here's what I hope stays with you. Having a plan and having a plan that you can actually afford to use are two different things. And the difference can cost a family everything they were trying to protect. So look at those details now while it's still just paperwork and not a crisis. That's important. So pay attention to that. We'll be back soon with another conversation worth having. Until then, take care of yourself and each other.