May 20, 2026 - Elder Care (Part 1)

[00:00:00] Speaker A: Proactivemd. [00:00:07] Speaker B: From ProactiveMD, this is healthcare Explained. I'm Jeremy Vandercnajfe. [00:00:11] Speaker A: And I'm Vinay Patel. Okay, Jeremy, so we're gonna be talking about specifically elder care, but the topic is broader than that. And you know, we ran into a, I ran into a statistic that stated 20% of adults are a caregiver either for an elderly family member or an adult with disabilities. And you aptly brought up that this is likely a hidden social determinant of health because people don't realize, adults with children, middle aged folks, don't realize how much of a burden it is physically, mentally, socially to be able to care for an elderly family member either full time or part time or for an adult with disabilities. So we wanted to take a two episodes to discuss this topic. It's important for people to understand, know about, plan for it, ask questions, become familiar with it before either the individual needs to retire and something, God forbid a health scare happens to them, or they find themselves taking care of an elderly family member without any previous exposure to the topic or guidance. So that's just our goal here for the next two episodes is one, Jeremy, you can share a personal story. I know you've been through it recently and I think it'd be important for you to share your lived experience going through this. And then two, talk to expert in the space that works in this area and has great advice for folks in episode two coming up here shortly. So let's kick things off, Jeremy, and why don't you share a little bit about your story and what your experience has been as a caregiver for an elderly family member. [00:02:05] Speaker B: Yeah, I think this is something where until you live it or you work in this particular area of healthcare, this was pretty invisible to me. I work with fully insured populations, self funded employers, you know, know less so with, with folks who are Medicare eligible. And I think we have this idea outside of the, the experts in, in health policy and economics that it's almost like when if you can just hold on to 65, then you can get on Medicare. The government foots most of your bills with low premiums, relatively low premiums, and you'll be able to live out your twilight years, you know, living off of whatever retirement savings you were able to have and not worry about healthcare. And the last few years have personally opened my eyes, you know, being a caregiver, one of the primary caregivers for my father as he, as he battled Alzheimer's and then ultimately physical disability as well. And so to kind of set the stage here, I think. My dad was a Dutch immigrant. He was born in a Dutch colony in Indonesia right after World War II. Grew up as a child in the Netherlands and then immigrated to the U.S. i think around age 8 or 9. You know, grew up in not a wealthy family, but you know, it was that post war boom of middle class being within reach. And it was very important to his parents that he go to college as his older brother had done. You know, my dad was not a great student in college and he lost his student deferment. This is during Vietnam. So he was drafted. So he ended up enlisting. Enlisting for three years in the army and serving his three years during Vietnam. He was lucky in that he wasn't sent, you know, in country to Vietnam itself, but you know, did, did serve his country as part of the Army Signal Corps at other bases around the world, which for him was a very important maturing experience. He, that was not the life he wanted to live. Right. He realized when I, I don't pay attention in school, when I don't study, these things happen. And the reason I bring that up is because for as long as I knew him, been a voracious devourer of books on all kinds of esoteric topics from philosophy to ancient Greek to art history, politics, fiction, nonfiction, biography. Just thousands of books in his collection. And he ended up getting a degree in construction science, did project management, built some, a couple of nuclear power plants as a project manager and. But he didn't want to do that either. He wanted to be a writer. So he ended up, you know, throughout my childhood and until he retired, he was a, he was a writer and editor. He did copywriting for publications for, you know, marketing firms for employers and, and he loved it. So he was a man of. For whom words were very important. Drilled into me from a very young age. The importance of being able to write clearly, communicate clearly. And, and I say that because the signs probably started as he was approaching his 70s in age. Some of those signs I think were there. And I think me and my brother, my mother had passed away in 2010. I think we were willfully ignoring some of those early signs of sometimes trouble following conversations, these kind of periodic out of character angry outbursts, a little bit becoming more withdrawn, you know, but I think we told ourselves, look man, 72, 73, right? He, he himself would joke about senior moments and this type of thing. And so I knew it was there and it was at the back of my mind. And I had, had talked to my family about it. And things like that, but it's just like, well, it's. It's not there yet. I don't need to do anything. And that kind of changed one day when he had asked me to. To come over and help set up. He had bought a new iPad. And, you know, it asked me to help him set up his iPad. And, you know, he said, make sure you put my banking apps on there. And so I did, and I got him, logged into his banking apps, and that's when I saw he was not paying bills. He was owed about $11,000 on a credit card, not because he didn't have the money, but because he wasn't paying his credit card bill. His natural gas and power were about to be shut off because he hadn't paid those. His water bill, his home insurance. He was about to lose. For me, it was a major slap in the face of, you can't ignore this anymore. Right? Like, it's not just a senior moment. This was a man who, if he was not 15 minutes early for anything, you might as well be late all of a sudden not being able to manage his finances. [00:06:54] Speaker A: Right, right, right, right. So that's when it. That's when it hits you. So before we get deeper into the story and sort of the next chapter of what you're alluding to, I just have a couple of questions for you. Growing up, did you ever see your dad take care of his parents, or did you ever have to have your grandparents live with you guys? And was it, you know, a cultural thing to be near them and to take care of them? And did you ever see your dad go through caregiving? [00:07:22] Speaker B: I did. So his family lived on the west coast, so they had. When they had emigrated, they lived in California. And my brother, older brother, was born in California, and my mom is from Northern California, and that was where they're going to live their lives. And then in the mid-80s, they. He didn't have a. That job that he was working at at that time. Just didn't seem stable enough. And so he said, I think I need to look for another job. Found one on the East Coast. They wanted to have a second kid. That was me. So he moved to the east coast while I was in. His family was still there. But my grandfather had Parkinson's disease, and so I. I didn't know him well. He passed when I was five years old. But I do remember visiting my grandfather in the nursing home. And, you know, him having very limited mobility, late stage of the disease, difficulty speaking. And, you know, I know My dad's siblings did what they could to take care of him. But again, Parkinson's is one of those that in its later stages, especially back then when there were no treatments, is very difficult to do at home. And so, you know, it was. But I do know he had helped move my grandfather into the nursing home, which again. Right. It's that loss of independence is a huge. [00:08:40] Speaker A: That's right. That's right. [00:08:42] Speaker B: And, and so then later when I was in college, my grandmother got diagnosed with a slow growth brain tumor that ultimately resulted in her falling into a coma. But similar, I know it, it killed my dad that his life was on the east coast, but he would make trips out there, you know, to help move my grandmother into first assisted living and then, and then a nursing home. And you know, I, it, I, I sometimes have to have a gallows sense of humor. I, I joke that my, my grandfather, paternal grandfather had Parkinson's. My paternal grandmother had a brain tumor. My maternal grandfather had a stroke that u took his life. But my maternal grandmother lived to 102. So the odds are not in my favor. But depending on how the genetic lottery plays out, you know, maybe I'll have a healthy brain. [00:09:34] Speaker A: Healthy at 102. No. [00:09:36] Speaker B: No serious conditions other than being 102 and being done with it and losing her hearing. Yeah, she was, she was very sharp until the end. [00:09:48] Speaker A: And so what about planning? Had you guys, when your father retired, did you or your family have, discuss or do anything in terms of planning for what does retirement look like or if I have any health issues? Did that ever come up or did you guys do any planning? [00:10:04] Speaker B: We did. And that's a great question, vinay, because in 2015, my dad had a stroke. Thankfully, he made a pretty much full recovery from that. Um, at least for, you know, where it hit the right parietal lobe, he maintained his mobility. You know, his cognition came back. After my mother's passing. He had named my brother executor and, but more importantly, general power of attorney, healthcare power of attorney. But he didn't live in this state, so I was making all the decisions. He was on his way. At that time, he lived in Seattle. He was on his way. I was making all of the healthcare decisions for my dad. And with this realization that they didn't have to listen to me, they very easily could have just led me out of there saying, you don't have healthcare power of attorney. But thankfully, nobody did say that. Right. And so after that experience, a couple years later, he had an elder care attorney. They consulted on this. And he revised his. His documents to make sure there is an advance directive, a living will, that stated what type of care he would want towards the end. He updated his healthcare power of attorney and gave me that power should it be activated. And same with durable power of attorney. And I think that was incredibly important for what would happen a few years later, you know, when he was showing signs of dementia. And because I think, and I would definitely recommend to our listeners, having those conversations and not just having the conversations with your family, but having them legally documented, because when you're a family member going through that, you're asked these things, you have to be an advocate and not knowing if you don't know or your family doesn't know what you want to be done in those situations, it is a massive burden that you are placing on them as the next of kin or the caregiver or the person who the hospital then appoints to make those decisions or a court appoints to make those decisions. Because it is so deeply everything from do you want your organs donated? To do you want to be on life support? Do you want CPR at the end of life? And those are decisions that you might make today that might change ten years from now. Right. I mean, if I collapse in the hallway right now, as a father of two kids, young children, I absolutely want CPR done on me. If I'm in my twilight years and in my mid-80s, I really don't want broken ribs to have a poor quality of life for the remaining days or weeks of my life, assuming that such a resuscitation is helpful or successful. Right. So I think having that conversation regularly with your loved ones, with your children when they're old enough, with your spouse or your partner, with your parents, and prompting them to have the conversation with you is absolutely critical. Because as tough as these situations are, they are so much harder if you feel like you're shooting in the dark. [00:13:04] Speaker A: That's right, that's right, that's right. All right, Excellent. Wow, that's great. And on the financial side, clearly in this case, we've. What you've elucidated is that it's important that someone be aware, as every couple years, if there's any kind of risk to an elderly family member. And that could be in the form of at least just an alert like, hey, you know, you're overdue by 60 days or 30 days, something that's just a far enough trigger where it's not something that would pose to be an infringement on, you know, personal freedoms for that family member, but at least that there is a safety net that says there's something else going on. You're, you know, someone else should be alerted if it's been more than a month since you've paid your heating bill or whatever the threshold is. But I think that on the financial side, there should be some also conversation and also some safety nets put in place. [00:13:59] Speaker B: And the time to have those conversations is when you are lucid, when you're not going through a crisis, when there's not a diagnosis. Because the person my dad was at the end is a very different man than he was that I knew all my life up to that point. And so the things that he would say that he wanted when he was ill were not the things he said he wanted when we discussed this type of thing. And that's a very difficult position to be in as a caregiver. You know, my dad had always been, you know, take away my keys when I'm no longer safe to drive, take away my keys. Well, guess what? Try having that conversation with a 75 year old with Alzheimer's who is cognizant on some level of the gravity of what they're going through, and, and in absolute and utter denial of it at the same time. So making those plans with your family earlier is important. And to your point, the finances, I consider it so lucky that he did buy an iPad that he didn't need, that he didn't know how to use and wouldn't learn how to use, because that gave me the opportunity to do this thing which was getting him signed into his accounts and recognizing that conversation I had at that particular moment was, I think you've gotten behind on some of your bills. I know the banking apps can be difficult and they make them difficult. So, hey, I can help you. Just get these set up on autopay, right? At the same time I'm adding myself to accounts, I'm giving myself access to his password manager because I knew this is only the beginning of what is going to be a very, very difficult time. So after I did that and got his payments made so that he didn't lose his house and he, you know, didn't have power shut off and have somebody come and repossess the car, even though that might have made some things a little bit easier, I said, dad, I, I think, you know, it's been a couple years since you had a checkup with your neurologist after that stroke you had. I think you should make an appointment. Okay, that's fine. What do I Do. I said, just call your doctor, your PCP, and they'll take care of you. Just say, I think I need a. A checkup with the neurologist and I will take you to that appointment and it's going to be fine. But the next day, I was going out of town, so I was out of town for work for five days. And every day I was like, did you make that appointment yet? What was I supposed to do? Just call, call them. I can call for you. No, no, I've got it, I've got it. And on the fifth day, as I was coming in and returning home, he sent me an odd text that said, well, I. I went ahead and wrote down my MyChart and I brought it to them and gave it to the doctor. I'm like, your MyChart? Like they have access to your MyChart. What would you be writing down out of your patient portal? But I will say, just as an aside, that I was very frustrated at his PCP for a couple reasons. One is, this should have been a very obvious sign that you've got a patient that you've. You've seen for 30 years. [00:17:07] Speaker A: Oh, wow. [00:17:08] Speaker B: And that has a history of stroke and things like that. He's walking in and handing you a handwritten medical chart, and you're not calling his emergency contact to say this is going on. And second, because of what happened next, which was I immediately when I got that text, I called his pcp. And yes, it was a Friday. I didn't hear back from them that afternoon. I didn't hear back from them Saturday, Sunday. I didn't hear back from them Monday. I heard back from them six weeks later. I'm not going to wait six weeks. I work for primary care. So I texted one of the doctors we work with and I said, can you see him on Monday? And he said, absolutely. So I brought him in. I had already prepared the doctor with, here's the symptoms that I'm seeing and what's going on. So they did a slums, they did a cognitive test, which my dad failed with flying colors. And he got scheduled for an mri. They pulled some lab work. MRI was the next day, went in, had that, and of course I get pinged that his results are in and, you know, two pages of radiologist notes. But I do know enough to recognize, even as a non clinician, what it means when they say signs are consistent with Alzheimer's disease. And so the next few months were very difficult. My dad had very clear signs of dementia. He would confuse day and Night. Constantly calling me in the middle of the night, hey, why aren't we going to lunch today? I'm like, dad, it's 2 o' clock in the morning. Okay, so when are you coming and calling back repeatedly and getting into these spirals? And he, you know, I won't dwell on this side, but for a long time, he blamed me. I was the person who brought him to the doctor. And when he heard the word dementia, that was it. Right? The neurologist he saw used the word, which I. I wish so much. Why did you use this word of how long have you been experiencing these hallucinations, Hans? And to him, the fact that people are coming up through the toilet and breaking into his house are not hallucinations, because that is his reality. That is his lived, experienced reality. And so our relationship was very strained. And I would say I was having to manage his finances, managing his healthcare, taking him to and from appointments, and regularly getting these angry text messages, these hurtful text messages. And I finally said, dad, what I'm doing as a caregiver, just, we need to reset. Because I know it feels like I'm making you do things, and I don't want to do that anymore. So I just want you to know I am here to help you with whatever you think you need help with and whether that's. You just want to be driven to the doctor. If it's just making sure that your bills are paid, you just tell me and I'm not going to make you do anything. And he said, I appreciate that. And that got us back on the right foot, which I'm thankful for, because right around Labor Day or so of 2024, I got a call in the middle of the night. He was. He couldn't get up. He was sitting. He couldn't get up. And it was probably about one or two in the morning. So I said, don't worry about it. I'll. I will come right over. Threw on some clothes. You know, we only lived about 20 minutes apart, so I. I got over there and he was stuck. And I. I tried to lift him, but at that time, he outweighed me by about 30, 40 pounds. And he was actually stuck in the hall bathroom in the powder room, and there's no room to get a walker in there. And I. I tried, and his legs wouldn't move. He felt like just, my legs have fallen asleep. So I did call ems and we were able to get him up, but, yeah, he couldn't walk. [00:20:59] Speaker A: Okay. All right, so let's pause there. We've gotten through another section of the story clearly and of course still very visceral for you reliving what's gone, gone on with your dad and how you had to care for him just a short two years ago. But a couple things you mentioned that I wanted to just highlight, discuss for our audience. One is that, and correct me if I'm wrong here, you didn't need to go see a specialist to get the diagnosis. There's a couple of things you can do with your primary care provider that can help to at least bring forth forward the risk, the how severe, not severity, but just the broad strokes of where you're headed to in terms of mental function, capacity, faculties. And I think it's really, I think that's a, a great point to make to our listeners that ask you, you know, when you get to 65, when you get to 60, somewhere around that age, you can ask for a mental faculty test. Like you mentioned, it's a simple, sometimes it's a few word, you know, it's, there's different tests you can do, but they're really simple. It's not like you're taking an exam and it's, you know, hundreds of questions. It's probably about five to seven questions that can help assess your mental faculties to determine if you should go get further evaluation to determine if you should go see a specialist. And your history, your history is so important. You mentioned that your dad had a relationship with his primary care doctor for 30 years. That's a, that's a great resource of information. Folks that, myself included, probably have seen several primary care doctors in my adult life and I probably haven't seen one for more than three or five years. And so that information is actually important. Establishing care with someone as you get older for a longer period of time. So they have that, they can see [00:22:52] Speaker B: that pattern of what they know your baseline, they can see the personality changes. It's tough in today's fee for service world where you see your PCP for five to seven minutes a year to really be able to assess that. But just one of the reasons why Medicare has made the Medicare annual wellness visit and provided particular kickers and payments to physicians to take that time to be able to appropriately diagnose these types of conditions and to encourage them to take the time for this fairly vulnerable class of patients for whom five minutes might not be enough, might not be enough to recite the medication list they're they're on, let alone assess everything from their physical, mental and spiritual wellbeing. [00:23:36] Speaker A: Yeah, yeah, that's right. And I, I think this is a great opportunity to talk about the difference between fee for service and, and looking at. If the, if a direct primary care provider is an option for you, again, longer times to see the provider, the relationship's different. You can ping them whenever you want. It's just different. And you have to, you can assess and evaluate if that's an option. Additionally, making sure you understand that there is a care team as you get older. Asking your pharmacy or your pharmacist about the medications that you take because the medication lists grow as you get older. And checking for interactions and medications that you can and can't take with drugs that you're on. Just checking, asking questions, questions about the medicines that you take to understand them more. There's probably also, you know, PT and ot, a nurse, so on, so forth. There's an entire care team that you can depend on. It doesn't just have to be the doctor that you can get information on. Share, share information from these different resources with your doctor so that they, that he or she understands or is aware of them, but to rely on the broader team as well. That's taking care of an individual. [00:24:41] Speaker B: That's an excellent point. And there are so many conditions that can actually cause dementia like symptoms in older adults as well. The medications that they take, urinary tract infections, can cause everything from hallucinations to personality changes. And so all those aspects. Right. Having some, somebody or a, a team that's able to look holistically at your health can also help rule out some of those things if they do start seeing behavioral changes. Going through the medication list. And we found, even at that time, we found some drug interactions. And you hope at that point. I was hoping against hope. Right. He came back positive for a uti. And I was just thinking, this is it. We just, we get him on the antibiotic and, or the sulfa, whatever it was, and that's, that's gonna solve it. And, and it didn't. Or hey, this, this drug interacts with that drug and he's taking both of them. This is it. And for some people, it can be that simple. It's a drug interaction or, or an infection. Unfortunately, that wasn't the case with my dad. But, you know, you keep hoping like there's a way out of this, there's going to be an easy answer because the alternative is the reality. And that is a very difficult decline as you lose more and more of the person that you love and it becomes harder and harder for them to be able to take care of themselves. And selfishly, you know, that means that's more and more that you as a caregiver are going to need to be able to take care of them. And I am blessed that I was able to spend those last few months with my dad and become closer to him. But it is difficult, you know, working a full time job and my lovely wife was able to go and, you know, my dad would be spiraling. It's the, they're not here yet. They need to be here. Why aren't they here? And her just be able to say, I'm just going to go take your dad to lunch. Right, let's just go take him to lunch and, and spend time. Because that's so important for them. Even if they don't show the appreciation, it is important for them and it's important for you as well. Knowing the moments that's as difficult as they can be, are going to be fewer and fewer that you can, you can spend with your loved one. And so ambulance came and took him to the hospital. They did a CT scan. I'm sitting here in the ER, logged into his MyChart, get the ping, you know, before they even come tell us it's stroke, which was not surprising with the loss of mobility. [00:27:18] Speaker A: Yeah, yeah. [00:27:20] Speaker B: But unlike the first time he had a stroke, where, yes, he had a change in cognition, yes, he had some difficulty with mobility. He was a wonderful patient. He had a good sense of humor, got along really well with the nurses, the underlying disease. So you have two things. I'm not a neurologist. Maybe they're related. I've heard some things where TIAs can result in Alzheimer's. You know, transient ischemic attacks, mini strokes, related, unrelated. What you have is somebody with a cognitive disability coupled with a physical disability. And that is when you talk about donut holes. That's the big donut hole. Because there is not a healthcare facility, at least for us, that was equipped for that. So the hospital, of course they try to put him in pt. This is a man who has advanced dementia. He doesn't understand why they want to, you know, do things that hurt. He's. He can walk just fine. And you try to explain. Dad, we're just going to get you some practice walking. I don't need to get out of bed. I know how to walk. I've been doing it for 75 years. Right, so he's not a compliant patient through no fault of his own. However, especially with Alzheimer's, it's until you hit the last stage where you Become non verbal. What people are seeing is somebody who is able to articulate thoughts, who is able to answer basic questions, but with a personality that, let's be honest, a lot of the time is just garbage depending on how Alzheimer's affects you. So he's mean to the nurses, he's mean to the doctors and they want him out of there. And so once he was stabilized, they said, well, he's stable, we need to get him out of here. And I remember the case manager at the hospital, the social worker just said, here's a list of facilities. And it's just a printout, it's like six pages of stuff. Pick one. Well, it's not that simple, right? They recommended rehab hospitals. There were only two dedicated rehab hospitals. Neither of them wanted him. They didn't want him because, well, the notes say he's not going to be compliant with pt. That's correct. Because he, he can't. So I, I had a memory care facility that was wonderful come in and they assessed him and they said we could absolutely deal with the Alzheimer's, his personality, we are so well equipped for that. But he requires two person assist and we are not authorized to operate like that. You know, they need to have some mobility. So memory care was out. We found him then a rehab facility that kept him for a month. The second that they could discharge him, they wrote the discharge letter for Medicare. And this is what's key, I think, to talk and pause for a second around Medicare. And what they cover, they don't cover the room, they don't cover room and board. What they cover specifically is the therapy, the medical intervention. And that's honestly the cheap part of all of this. So we were paying about 400, $500 a day for this rehab facility. Medicare covered the physical therapy and PT and OT that he wasn't compliant with. So we got this discharge letter and it was kind of this thing of like, you know that song Closing Time? You don't have to go home, but you can't stay here. And so first it was the hospital, he needs to go. We're not going to tell you where to go. And obviously he can't be discharged to home because he can't move, he can't take care of himself, but just get him out of here, right? And then this rehab facility had this same, this same attitude. Well, he was mean to our nurses. So as soon as we could, the 30 days were up, we signed this letter. They said you can appeal. And the wonderful social worker there walked me through the appeals process. And luckily I speak medical. And so I spoke to the adjudicator and explained the different therapies that hadn't been tried, that they admitted hadn't been tried, which gave me one more week. So Medicare accepted the appeal which gave him one more week for us to find a place for him. This is the challenge. You have somebody who doesn't want to be in a healthcare facility at all, who can't move, which means they can't be in memory care, they can't be discharged to home. And no doctor or facility would allow a home discharge because it basically constitute elder abuse, even if he did have a home that was set up for it, including our own home. But he needed two person assist, he needed two nurses. And so Medicare won't pay for a full time home health aide, not for long term care. So your options at that point then as we start talking about skilled nursing is self pay or Medicaid. And Medicaid is difficult to be able to qualify for. So essentially in order to be have Medicaid accept you as a patient for long term care as a, as a, elder care is you need to show financial need for at least five years. So if you are somebody who has built up as my dad and my mother had a very comfortable nest egg through years of working their jobs, that is actually working against you. The fact that you have assets in retirement work against you. You don't qualify for Medicaid unless you can show a five year track record of these have dwindled down to nothing. [00:32:34] Speaker A: That's right. [00:32:37] Speaker B: And so at that point then he needed to go into skilled nursing. We were able to find a wonderful facility, but it is a nursing home. It's a very medical feel. It's not a apartment feel, it's you're in a bed in a tiny room, people bring you your meals. And he did have therapy and he actually, as they began addressing and his provider, his PCP at the facility was addressing the dementia and the attitude and you know, working with Depakote and Klonopin to help help him cope better and also to help the nursing team and the therapist cope better with him. Fewer angry outbursts and things like that. He was actually able to regain, he was able to walk about 50ft, assisted with a walker. [00:33:26] Speaker A: Okay. [00:33:27] Speaker B: But as he became more mobile and able to use a wheelchair, his, his cognitive impairment was continuing to decline and so he became more non compliant. I think people talk about Alzheimer's and they talk about how their family member didn't recognize them. This was the Opposite. He saw his family members in every person he met. Every resident was his wife or me or my brother or his brother. And so he would try to follow them back to their rooms and as the staff would say, no, no, no, you can't do that. You can't go in there. You can't tell me, I can't talk to my brother. And so to add to it at that point then skilled nursing to, at this facility for a nice facility where it's not just 16 people in a room, right. With licensing violations, you know, the wazoo. It was $11,000 a month of self pay. Then the facility said, well your, your dad is mobile and he's disrupting other residents and he's going to have to leave unless you're willing to agree to have a full time caretaker, a third party service come in as a sitter 24 hours a day. Because again, day, night cycles mean nothing to him in his condition. That was another $20,000 a month. So when I had the meeting with his care team, I said, do you guys understand that this is not sustainable? This is the equivalent of buying a full time, like buying a new car every month for the rest of his life. Can any of you say right now that you're in a position to buy a new car every month? And well, no, we understand where you're coming from, but there's no source, there's no opportunity. I mean this was, you know, my. It's not about inheritance, it's the fact of. We had planned, we had a 10 year plan where he could stay in skilled nursing for 10 years. Now you triple the cost. We have just cut that down to three. And what happens after three years? [00:35:24] Speaker A: Yes, that's right. [00:35:25] Speaker B: Hopefully maybe get on Medicaid. Right? Yeah, that's right. Let's pause there for a second because I'm sure you've got some thoughts. [00:35:33] Speaker A: So. Yeah, no, I think that one. Let's break down what you just talked about in terms of options after the hospital because I think that it's important for everyone to understand. I think the way to think about it is, is what those facilities are. So you have rehab. Rehab is meant to rehabilitate you so that you can physically move again and continue to do your activities of daily living to the best of your ability. And that's what rehab is. It's short term. [00:36:00] Speaker B: Exactly right. [00:36:01] Speaker A: To get you. [00:36:02] Speaker B: It's transitional. [00:36:03] Speaker A: It's transitional. It's meant to get you back to some level of health so you can be back on your own two feet, whatever that means, it means different things for different folks, especially elderly folks. But that's what rehab is for. So that was one option. Rehab was one option. The second option you talked about was assisted living, which is a spectrum which someone helps to take care of you. If you are fully physically functional and you have some slight dementia like your father did in the beginning years, he could live in assisted living, someone could check in on him. He's basically independent other than someone being around, staff being around to help him if he needs something. And then you have that spectrum of when your cognitive decline, you have cognitive decline but you still have physical mobility, then you can move to memory care, which they can take your mental's condition and help treat that or help you cope with that and support that, but they can help you with when you have mental and physical disabilities, at least a facility you talk to. And that's important to note that that's, you think about a nursing home and that's what a nursing home is, but it's not for every patient. And you gotta figure out which ones, what types of care that they can provide or that they're allowed to provide. [00:37:15] Speaker B: Memory care, to your point Vinay, is designed to be apartment style living. The staff are all trained, they're social workers, they're nurses, they're medical assistants who are trained to work with people with dementia, memory issues, et cetera. So they know what to expect, they know how to calm a patient who's, who's maybe having a hallucination or you know, going through an cognitive episode. Now those are also self pay places, but because it's not full time nursing staff around the clock and you know, with a provider who's sitting there at the facility 24 hours a day, they tend to be less expensive and just a little bit more of an apartment community feel for the residents that are there. Right. They are residents, not patients. [00:38:03] Speaker A: That's right, that's right. [00:38:04] Speaker B: And, and specifically, you know, trained to deal with, with folks with issues like my dad had. [00:38:11] Speaker A: And so that was the second type of facility that you guys looked at and then explain what the difference is between those two and skilled nursing that he ended up going to, which was the right option for him, which is in the Medicare world covered. If you're coming out of a hospital for a certain amount of time and as you mentioned, covering the medical treatment or the medical therapy, but not the room and board, which you still have to pay. And then we'll talk a little bit about Medicare and Medicaid and why you mentioned Medicaid. [00:38:41] Speaker B: Exactly. So a skilled nursing facility has round the clock care. While it does have, you know, nursing assistants, it has full time nursing staff, RN staff around the clock. It has a provider on site around the clock. Even if they're not visiting with each patient. You, you do have a advanced practice registered nurse or a physician assistant or an MD who is there at the facility. And it's, it is much, it feels much more like a hospital type of environment, maybe a hospital with some common areas, you know, that are a little bit more accessible. But you are, those are designed really, the skilled nursing is. We have somebody who has an active medical problem so that it is about dispensing medications. It is certainly, you know, helping with the activities of daily living, like you mentioned, which include things like being able to feed yourself, being able to clothe yourself and bathe yourself. And if you can't complete those ADL's, the nursing staff can complete those ADL's for you. They can feed you, they can help you get, get dressed, brush your teeth, et cetera. But it is a different environment, right? You feel, as my dad did, very much like a patient and he felt like he was a prisoner. He kept referring to it as a jail. Even though he did have mobility, he could move around. And this was a wonderful facility. It had great staff. But it is, it doesn't feel like an apartment, it feels like a room in a medical facility. Because that is exactly what it is, right? [00:40:12] Speaker A: And more long term care. Like it can house someone for 30 days or house someone, as you mentioned, for years if they need the help and support and can financially support it. And so it's more than just rehab. Rehab is to get you back on your feet. And short term. A skilled nursing facility can be short term or long term, right outside of a hospital. Medicare can provide some coverage, but not all coverage. And that's when you started talking about, okay, well, what are the ways to pay for skilled nursing? It sounds like the right fit, fit for him, but how can we afford this? And it's important for everyone to know that Medicare doesn't pay for long term care. There's. All these types of facilities are known as long term care facilities. But Medicaid does, But Medicaid has those requirements. You need to meet asset requirements and income requirements for you to qualify for Medicaid. And that's how you get. The only way to get covered coverage, insurance coverage, if you will, healthcare coverage for long term care is through Medicaid. Or you can buy private insurance on your own when you're younger long term care insurance. That's a thing you can look into it, ask your financial advisors about that, so on and so forth and that's. And we'll talk about that when we talk about have the expert on to [00:41:20] Speaker B: talk about planning and long term care insurance is becoming more and more scarce. Right. Insurance exists because somebody feels like you as the buyer are making a gamble and them as the seller make making a gamble and the house should win. Right. Insurance companies across a risk pool are going to win. What we've seen though is because people are living longer, less healthy lives. You have more treatments available for people with neurological disorders or cancers or things like that. Long term care insurance is becoming less accessible and less affordable because all of a sudden the house might not win. If all of us, whether it's 30 years, 40 years, 50 years from now, are going to end up in a skilled nursing facility. There's, there's no gamble that an insurance company would want to take. So you know, even that aspect, and I'm sure the experts will talk to us next time is becoming less, less and less accessible for people to pay for. [00:42:19] Speaker A: Right? Right. And pay. The dollar signs that you just mentioned strike should strike everyone at your core in terms of how expensive it is to care for yourself or an elderly family member when you get to this point and God forbid if you should need these services. And that's what everyone should start thinking about preparing for because it's not at all inexpensive when it requires a lot of humans to help another human. And that's the important thing to sort of keep in mind and start thinking about planning for it. You also mentioned one other thing that is important, which is the caregiver emotional and mental stress. It's was something you were more than willing to do for your father because it's your responsibility. You cared for him, you loved him, so on so forth. But it's not like talking to him when you were going to college. It's now a new setup. And, and there's a couple things to remind, to remind folks about and folks that are already caregivers know this very to their core deeply. It's heartfelt that you're. Because you're not talking to the same person that you knew decades ago. The response you're going to get is much different. The challenges you have to face with these folks is much different. The reality that they're perceiving is much different than what they were used to. And so their response to you is going to be much more different. And, and I think you need to have one, a perspective on understanding that that's going to be happen to be prepared for it. Some kind of foundation, whether it's social or cultural or religious that you can lean back on because that's going to be important for you. And then three, having some kind of community, whether it's a community of caregivers that you can just talk about what your experience is and learn from tools that they've used and ideas, tips and tricks that they have. It's. You wouldn't, you won't know unless you talk about it. With folks that are going through the same thing that you're going through, it's really important to have just a variety of resources and tools to prepare yourself, because it's nothing. You've never experienced something like that before until you go through it. [00:44:19] Speaker B: Exactly. And, you know, there are groups like Alzheimer's association that have support groups for caregivers which can give practical tips and tricks, but also a place for people to share and kind of share that burden, share that feeling, that grief, because it is watching someone die in slow motion and there's no cure today. It's not reversible. It just gets worse. [00:44:46] Speaker A: Yes. [00:44:46] Speaker B: So those support groups are really important. Hospitals and a lot of nursing facilities will have chaplains, social workers that are also there, whose doors are always open for family members to come in. And the social workers at my dad's facilities, all of them were wonderful. And here at working for ProActive MD, I would call my patient advocate, I did that several times, and then he would actually call me and just say, I'm just checking in. How are you doing? Because it's something you have to carry when you show up to work. You can't be a wreck. And when I go home, I can't be a wreck to my kids or my wife. And so you carry that. And you can't be a wreck when you're in the room with the person you're caring for, because they don't need that. That's not going to help them. So finding an outlet where you can talk about these things, where you can share and let it off your chest, is very important. And nobody should ever feel like they have to go through it alone. And to our listeners, if any of you are going through that, I'm always here. Feel free to reach out on LinkedIn, email, whatever. I'll hop on the phone and just listen because it's tough. So my dad did pass in February of 2025, and he had suffered one or another series of strokes he lost the mobility he had regained and he just, he stopped being responsive, just sleeping all day, which made him easier. It made the caregiving easier. He wasn't fighting the nurses, but he wasn't there anymore. Luckily I knew because like we talked in the beginning, he made his wishes known. When he was lucid, he did not want to be resuscitated. So we had a DNR and he did not want life extension, life extending treatment if he were in a position like he was in, of permanent disability or a terminal illness. So I remember the phone call when the, the nurse practitioner called and said, you have a decision to make. And I'm sorry to say this, we can send them to the hospital for more testing and they will poke and prod them and they will take blood and they will do scans or you can move them into hospice care, which was at the facility. You know, it was a hospice agency that came and they were wonderful. They continue to send me letters and check in on me periodically, their chaplains, more than a year after his passing. But it's that palliative care is the last thing which Medicare does cover. And they're wonderful. And it was, I knew he would not want to be in that hospital inpatient room going to MRI after MRI to tell me what I already knew, which was that he was at the end of his life and it was his time to pass. But I do think, you know, understanding when hospice comes into play, which does require referral from, you know, a healthcare professional, from a provider, and there are certain metrics that you need to meet right. Criteria that Medicare will have. But hospice care is essentially covered at about 100% by Medicare, which meant that some of that palliative care, even though it didn't cover his room and board, you know, he, he got more attention in those last couple weeks of his life and I know that he was cared for in the end. I'm sorry to drop such a difficult topic here, but you know, Vinay, this is something that obviously I've sat down to write posts about it, but it's tough to condense it down in. I appreciate the opportunity to talk through that, to take that, yes, it's personal, but also that clinical lens, that healthcare expertise lens of being that healthcare insider, dealing with this as a caregiver and learning new things about it. I'm excited now that I've gotten that off my chest to hear from an expert in our next episode around long term care and elder care and what can families do to be able to prepare for this? This stage of life. [00:48:45] Speaker A: Yeah. Now, Jeremy, it is important for everyone to think about it. At some point in our lives, we're all going to be going through some form or fashion of either needing care or providing care or being in the room where someone is going to be making the decision for someone else. And so talking about it, I think, should not be taboo, should not feel like it's something that shouldn't be explained. No matter how heavy the topic is, we should be able to have this discourse, awareness and debate about it. I can't thank you enough for sharing something so personal with everyone who's listening to this. You know, clearly it's emotional still and it must have been difficult to try to, to go through and relive that. But I think it's that think about the amount of people that you've been able to help just by sharing your story and all the resources that we've talked about here. And so I'll leave our listeners with this is think about, you know, depending on where you are in life, think about what it, what your life will look like in 10, 20, 30, 40 years. You know, I, it just when you stop and think about that and you think about, you know, you're spending a weekend with your family in 40 years, that's going to look a lot different. And if you think about that and you think about what your life looks like then or in the future, you can start planning for it and you can start thinking about it and having those conversations and figuring things out before it, before it gets to the point where no one can figure out what you actually want. And that's super important. And what your family wants. Right. You think about not only you are going to be older 40 years, but everyone around you is going to be older 40 years. If you have parents, they're going to be older 40, 20, 30, 40 years. And that'll help hopefully trigger people to have these conversations and think about these things at the least. So, yeah, I think it's to your point. Excited for what we're about to learn in the second episode with the Expert and the conversations we're about to have have as well. [00:50:46] Speaker B: Well, Vinay, thanks so much as always. I'm Jeremy Vanderkanive. [00:50:50] Speaker A: And I'm Vinay Patel. [00:50:51] Speaker B: And we'll see you next time. Proactive m.