Jason Parker interviews Betty Herman about her work as a Geriatric Care Manager with Martha & Mary.
Betty Herman is outreach coordinator for Martha and Mary Home and Community Services. Martha & Mary has served the West Sound region for the last 124 years. This not-for-profit organization currently serves people from 4 weeks old to end of life with child care, early childhood education, senior housing, in-home services to help clients stay independent; and physical rehabilitation, long term care and memory care in a skilled nursing setting.
Betty, however has only served seniors for the last 35 years in all capacities from individual caregiver to Care Director. She joined Martha and Mary in December 2010. She speaks often on the topics of The Continuum of Care, From Full Independence to Last Breath, Fall Prevention and Senior Housing Options. She is not only doing outreach she is assisting in the newest area of Martha and Mary services, Geriatric Care Management.
To learn more please visit www.marthaandmary.org
Below is the full transcript:
Announcer: Welcome back, America, to Sound Retirement Radio where we bring you concepts, ideas and strategies designed to help you achieve clarity, confidence and freedom as you prepare for and transition through retirement.
Now, here is your host, Jason Parker.
Jason: America, welcome back to another round of Sound Retirement Radio. I’m so glad that you’re here with us. For those good people right here in Kitsap County, especially, and for the people driving down the street in Seattle this morning, welcome back. I’d like to get this day started right, and I believe one good way to do that is by renewing our minds. I’ve got a verse here for us from 1 Timothy 5:25: “In the same way, the good deeds of some people are obvious. And the good deeds done in secret will someday come to light.” Awesome. Then, I want to put a smile on your face. If you’re going to go see the grandkids, I want you to have something fun that you can share with them. What did the spider do on the computer? Made a website. Web. Oh, men.
We’re going to go right into this episode. It’s my good fortune today to have Better Herman in the program with us, that you’re listening to Episode 077. We’re going to be talking about the continuum of care, geriatric care managers, aging life care professionals. Before we get into the program, I want to tell you a little bit about Betty.
Betty Herman is outreach coordinator for Martha and Mary Home and Community Services. Martha and Mary has served the West Sound region for the last 125 years now, 2016. They are a not-for-profit organization currently serving people from 4 weeks old all the way to the end of life with child care, early childhood education, senior housing, in-home services to help clients stay independent, and physical rehabilitation, long-term care and memory care in a skilled nursing setting. Betty has a lot of expertise here.
Now, here’s the great thing about this program that we’re going to be talking about. This may be something you need to be thinking about for your own retirement, but maybe you have a parent or a friend or a loved one or an uncle or an aunt or somebody who’s getting ready or maybe they’re going through this right now. We’re going to fill your brain full of resources, things to think about. Betty, however, has only served seniors for the last 35 years in all … You have served seniors for the last 35 years in all capacities from individual caregiver to Care Director. She joined Martha and Mary in December 2010. She speaks often on the topics of Continuum of Care, From Full Independence to Last Breath, Fall Prevention and Senior Housing Options. She’s also doing some outreach in assisting in the newest areas of geriatric care management.
Boy, there is a lot to say there. Betty Herman, welcome to Sound Retirement Radio.
Betty: Thank you very much. I appreciate being here.
Jason: Oh, I appreciate having you. I had the good fortune recently to have one of your associates, Paula Rimmer on the program and we are talking about some of the work that she was doing to raise money and raise awareness for the good work that Martha and Mary is doing. It is terrific work. I know this firsthand because we have a family member that’s receiving pretty amazing care right now. we’re very grateful for that, so.
Betty: We’re honored to be able to serve your family and lots of other people in Kitsap County.
Jason: Yeah. I want to start talking about these two topics specifically, continuum of care and geriatric care management. Let’s start with that phrase, continuum of care, because it’s this new catchphrase people are … You’re hearing this more and more. It seems like it’s a very popular topic, Betty. When we use that phrase, what does that mean exactly?
Betty: Those really are stages of life and looking at your life from a healthcare perspective, but also a broader perspective in today’s conversation about what folks need to be able to support each of those stages of life. I like to talk about it in four phases and know that when you’re meeting with someone, there is infinite granularity and infinite uniqueness for your individual situation. The four stages that I talked about in a general way are full independence, needing some help, relocation options, and then end of life care.
Jason: You and I were talking before the interview. It would be great if you … There were just like a little retina scan or something you could take and it said, “Here’s where you’re at in this continuum of care,” but it’s really challenging to figure out where we’re at and what we should be doing. In fact, as our family has gone through this planning process recently having a loved one transition into a care situation, I think the biggest mistake we made was not to make, taking action, bigger action fast enough and soon enough. When people meet you for the first time, share with our listeners what that looks like when you walk into a house. What’s the first question that comes out at somebody’s mouth when you walk in?
Betty: Where do I start? We’re already in crisis. Where do we start? How do we manage this? How can I have life better right now, so that the caregiver can get enough sleep, so the crisis isn’t exacerbated? What can I do right now? Give me 24 hours of help and then we can put together a plan.
Jason: Ah, okay. Do you find that that’s a good starting point then? Maybe just a little respite before the actual planning starts, or is that always possible?
Betty: Utopia is you are monitoring yourself. You are asking about how do I know where I’m at in these stages. If you’re monitoring yourself, if your physician is monitoring you, if your family is monitoring you with some very specific things in mind, one would be whether or not you’re able to accomplish your activities of daily living all on your own. Can you cook for yourself? Can you transfer from one chair to another safely? Are you managing your medications? Are you taking care of your personal care? All of those things, once those are in place, then you’re okay. When those things start to slip, so when your grandmother has always been absolutely immaculate in her dress and all of a sudden there are food spots, something is going on, you need to look at that and say, “Do we need to get you some laundry help? Is it safe for you to still go downstairs and do your laundry? What’s going on, gram?”
Jason: I will never forget, I had some folks in my office, husband-wife. They have been married 50 plus years. He was like 85 years old at the time. His wife was so frustrated because he refused to stop getting up on the roof to clean the gutters. Betty, I’m sure you run into this all the time, but there’s something in all of us that says, “I can still do today what I did 20 years ago.” How do you get over that? It seems like it gets harder sometimes when people get older. They really hanker down into some of these old desires to be able to do what they used to be able to do. What do you recommend when you see that and people aren’t willing to stop getting up on the roof cleaning gutters?
Betty: Two things. One is we find creative ways to get help, to help that person be safe. Maybe it’s the son-in-law comes over and helps. Maybe it’s the church youth need a project: Can we come clean your roof? Can we come clean your gutters for you? It’s not really them giving up their definition of who they are as an independent, strong, healthy person who can still do this, but they’re helping another organization and the task gets done more safely.
Jason: A way to give back to the community, too, so they don’t necessarily feel like they’re needing help, that they’re maybe giving some assistance. Continuum of care, this is basically just saying, “Okay, there’s going to be different phases of life.” There is no specific test. Now, a minute ago you talked about having the doctor doing assessments every year. Doctors are, unless you’ve signed the documentation that gives doctors the right to share that information with somebody, maybe an adult child, that doctor may not have the legal ability to share that. we are talking before the show that that might be something that people want to think about as they start transitioning in into retirement, giving that HIPAA authorization to people that are in their lives that are going to be a part of that process.
Betty: Absolutely, and there are two documents that folks want to have in place for sure. There are actually four, but the two that are most important is the durable medical power of attorney that says someone else can make healthcare decisions for you under these circumstances and actually that these are your wishes. Once that’s in place, the doctor has the authority. Often, in one’s last will, there’s information, there’s a clause in there saying you can disperse that medical information. The other would be the financial power of attorney so that if, Jason, there is a person that you’ve been seeing for years and years and you say, “Mm, they’re not quite as sharp as they used to be,” or their wife is saying, “Mm, I’m real concerned about these checks that have been written.” If she has the durable power of financial attorney … Boy, did I screw that one up …
Jason: Welcome to the club. That’s all I do all day long.
Betty: … Then you can talk with them. You can strategize with them about how you want those funds set up, how you want them titled so that money will flow appropriately.
Jason: Okay. Folks, I want to just share this, too, because as an adviser, I specialize in working with folks that are retired and retiring. I’ve helped a lot of families through this process, but when I got into this position with our own family members, it’s like, man, I tell you, decision making is different when there’s emotions involved. When you’re removed from this situation, it becomes a much easier planning process because there’s no emotions. You’re thinking clearly. My call, one of my very first calls, was to Betty. She was one of the first people I reached out to. I said, “Betty, here’s where we’re at, what do we do?” That’s one of the reasons I wanted to bring her on to the program today because she’s fielding these types of calls all the time from families that are looking for some assistance.
Betty, how does the continuum of care relate to retirement concerns?
Betty: Each stage of your life is financed by different parts of your whole financial picture. When you’re working, it may be financed by your paychecks. As you’re getting ready for retirement, you may want to put other things in place such as burial policies, insurance policies that cover the expenses of final burial or cremation. Then you want to work with a financial planner to get things in order so that the money flows in the best way for taxes for you, taxes for your estate, and any legacy gifts that you might want to give. You may choose to donate to a particular cause and there are a variety of vehicles for doing that with more and less tax implications to your estate and/or to the agency that you’re giving the gift to.
Jason: One of the things I’ll say here is it’s so important that people establish relationships when they’re young enough and healthy enough to be able to enter into those relationships. Unfortunately, I’ve met people that come into my office and they want my help but I can tell by having a conversation with them that they don’t have the capacity to enter into a relationship. Unfortunately, that creates a huge amount of liability for me. I can’t enter into relationships with people that have already started to have capacity issues … Incapacity issues maybe is the better way of saying it. I really encourage people, find those trusted advisors, the people that you can bring into your life that you plan on having a long-term relationship with, that you know can be there.
I actually have a story. A couple, they initially hired me to do just some fee-based planning and we put together a financial plan for them. Several years later he ended up having a stroke and the wife came in. She said, “Jason, my husband used to manage all these money for us. He just can’t do this anymore. I don’t know what I’m doing. We need you to take over.” We had the relationship established and it was easy for me to come into that role because I understood what the game plan was. I helped create that plan. Yeah, that’s really a good point there.
In terms of funding, we were talking before the show, too, about where you add the most value. Is it the people that have run out of money or is it the people that have millions in the bank and nothing to worry about? Who do you find you can give the most assistance to from a financial standpoint?
Betty: The folks that are in the upper middle income where, if they need services that are only privately paid, they have the financial capacity versus the mental capacity that you were talking about. The financial capacity to fund those things, either short or long-term. Medicare, Medicaid, supplemental insurance, talking about those kinds of things with a financial planner, with me, can be of help because then you can structure your life so that if you do need to use the government-funded Medicaid program, you’ve spent your money for that five-year look back period in a way that makes you qualified when you need those funds.
Jason: Yeah, I think that’s important to understand for people that Medicaid … Medicare is a program people pay into their whole life, but Medicaid is state and federally-funded welfare that’s available for folks once they have depleted all their assets and their health has deteriorated, essentially.
Jason: There’s very specific rules. Some people say, “Well, just put me on a sailboat. I’ll give all my money to my kids and you won’t see me again, and you won’t see me again.” That’s probably not really what’s going to happen and Medicaid says before you qualify, if you’ve made any gifts in the last 5 years, you may not qualify for coverage for a period of time as a result of those gifts. Like you were saying, there’s this look back period that Medicaid can come back and say, “Sorry, we’re not going to pay the bill for X period of time.” When it comes to Medicaid, Betty, do you find that people have as many options available to them through Medicaid as they do through private pay or having an insurance policy to help cover some of these expenses?
Betty: Absolutely not, and I’m not a Medicaid specialist but I know that when there are folks that I try to find care for, not everyone takes Medicaid. Some facilities, some assisted living places will take it but you have to do private pay for two years. That private pay can be as much as $5,000 a month. Once you’re in that, I don’t have two years of private pay available to me. Then the selection of residence for Medicaid is very limited.
Jason: Is very limited, yeah. Just a quick a story that popped into my head as you’re sharing that. A friend of mine, his mom needed to go into an assisted living facility and they had one of those provisions. They said, “If you can private pay for two years and a bed is eligible for Medicaid after you spent in all of your assets, we’ll let your mom stay here.” Well, they paid for the two years. They spent all of the money and, guess what, there’s no Medicaid eligible bed at the time,” so what he thought he was doing was going to be able to keep his mom in this one really nice facility because he thought if you private paid for two years, she’d be able to stay, and then the clause was “If there is a Medicaid bed available,” and there wasn’t. They ended up having to move her. There’s all these little nuances that can trip people up. That particular person have a lot of experience in long-term care. It was a learning experience that he shared with me. He said, “Next time I was in that, I’ll make sure I had something in writing that said they would be able to stay after the two years.”
I want to transition into geriatric care management or manager because I think that is really an important service that you provide. There is a lot of family spread all over the country now. It’s just not realistic if we’re here in Washington and somebody else is out on the East Coast. That’s where my mom is. My mom is out on the East Coast. Now, fortunately, she’s healthy, but if something happens, I just can’t spend six months to a year out on the East Coast trying to figure everything out for her. Share with our listeners what a geriatric care manager does and how they usually get pulled into this type of planning.
Betty: Absolutely. Thanks for asking that question. A geriatric care manager is also known as an aging life care professional. In our case, our geriatric care manager is a licensed practical nurse and there is usually with the certified geriatric care manager, there is always some healthcare professional involved. They coordinate the big picture, the whole picture of what’s going on. They would look at your mom’s health, they would look at the finances available. They would look at her legal documents. They would coordinate all of that, her social needs. They would know their community, so if your mother needed to relocate out of her home, they would know which of the facilities that were available had the personality that had the best chance to meet her needs right off the bat. The transition can be very challenging. To get that right chemistry right away is important.
Jason: What’s the biggest mistake you see people making when it comes to geriatric care management or when you get called in? What would you say is the biggest stumbling block for most people?
Betty: Generally, it’s because the person needing care isn’t willing to give up their ego and say, “Yup, I really do need care.” Just as the man wants to stay on the roof, they don’t see the deficits that are there, or they don’t want to believe them or they discount them. Another area is when there’s family conflict about one sibling believes this about the situation, another sibling believes the other thing. The story I remember so vividly is when family members came in from out of town to be with a woman who was living in her daughter’s home and the daughter was saying to the siblings, “This is what mom is like. We need more care.” Mom pulled it together completely for the two days that the other siblings were in town …
Jason: Of course.
Betty: Therefore, the siblings were saying, “Mm, you’re overreacting. Mom isn’t that bad,” and that’s not the whole picture.
Jason: Yeah. One of the things I did, I think, that was wise was with my in-laws, I had them in several years ago and I recorded a conversation with them, and I specifically asked them about these long-term care type of situations. When is the right time for you to say, “I can’t live at home anymore”? I have a recording of them sharing with me what that looked like. Then I asked them, I said, “Well, what do you want to have happen at that point?” In their words, giving the authorization and the okay; that it’s okay to go to a facility. I’ll tell you, that just was so good and it relieves a lot of stress and guilt because you want to do what people want, you want them to receive a high quality of care and you’re worried that maybe that’s not what they want.
When you go back and you listen to the recording and as my father-in-law saying, “Look, if I get to the point where I can’t do this, this and this, then get me out of the house. Put me into a facility.” It’s so comforting to have those instructions you can actually go back and listen to that meeting beforehand. I would highly recommend, people out there that care about their children, their adult children, to do that for them, to record, say, “Hey, look, it’s okay if I need to go into a nursing home or assisted living care. I don’t want you to kill yourself trying to take care of me.” That’s an important consideration.
Betty, we only have a little bit of time and I know you have one thing that’s really important to share with us. What’s that piece that you wanted to bring to the table regarding geriatric care management?
Betty: That the geriatric care management will make a comprehensive assessment of what’s going on so you have the full picture. You can understand, they’re coming from an independent position, so has no vested interest, has no big brother that’s beating them up since they were kids, has no younger sister. It’s really an independent assessment.
Jason: That’s great. Betty, in 30 seconds, if people want to get in touch with you, what’s the best way to learn more about the work you’re doing?
Betty: My cell phone is 360-731-4402. Martha and Mary is 360-779-7500.
Jason: All right, very good. Well, I really appreciate the work you’re doing on our community. Thank you for taking time out of you day to be a guest on Sound Retirement Radio.
Betty: My pleasure. Thank you.
Announcer: Information and opinions expressed here are believed to be accurate and complete, for general information only and should not be construed as specific tax, legal, or financial advice for any individual, and does not constitute a solicitation for any securities or insurance products. Please consult with your financial professional before taking action on anything discussed on this program. Parker Financial, its representatives or its affiliates have no liability for investment decisions or other actions taken or made by you based on the information provided in this program. All insurance related discussions are subject to the claims paying ability of the company. Investing involves risks.
Jason Parker is the president of Parker Financial, an independent fee-based wealth management firm located at 9057 Washington Avenue, Northwest, Silverdale, Washington. For additional information, call 1800-514-5046 or visit us online at SoundRetirementPlanning.com.