Aging in Place - Growing Older at Home

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>> Good evening and thank you so much by the way for watching PBS Fort Wayne.

Our show is LIFE Ahead.

We're on every Wednesday night at Seven Thirty and this show, by the way will air three more times here through the weekend in case you want to share it with someone else.

>> Now tonight's topic is Aging in Place and How to Stay Home Longer and we have two experts in the field that will not only answer my questions but hopefully your questions as well.

You see the phone number at the bottom of the screen (969) 27 twenty which you'll see periodically here in the next half hour.

>> And that's because we want you to call with any questions that you might have now we're going to take a legal look and a care specialist look in fact our guests this evening no stranger to you if you want your LIFE Ahead regularly, let me introduce you reintroduce you rather to Jessica Thorson there on the air and Jessica Elder law turning always good to have you on and you always get a lot of phone calls.

>> You must people must have confidence in her.

>> I do.

I hope so.

I hope so.

It's great to be back.

Thank you.

And you brought with a roof force again.

>> You've been with us before.

Yes, yes.

Yes.

So nice to see you again.

It's great to be here.

Ruth is a and a geriatric care specialist so she could zero in on specifics for you while Jessica could handle any legal questions that you might have pertaining to our topic.

>> Again, aging in place or how to keep you home longer.

OK, big question and obviously very timely I think finding ways that people can stay home longer as they age has become a hot topic, right, Jessica?

>> Oh, for sure.

For sure.

And what we're also seeing is that we're seeing not only do people want to stay home longer but they may have family that spread across the the country and so they're not always sure how to make this work for their family because they may not be living just a couple miles down the road from their parents or their loved one.

So trying to figure out ways to make this work and keep people safe is is something that we are seeing on a very regular basis these days.

>> I think that in Roof country if you agree with me in what Jessica said, I mean people are more transient now.

I mean the the next generation down who maybe in years past would be the ones responsible for caring for their parents or grandparents and now they may live in California or Texas or somewhere else.

>> So they need to know there's somebody here that's helping to guide them.

Yes.

Oh absolutely.

I see it all the time as well.

>> Absolutely.

Adult children living out of state or just even south Indiana and just need that help for parents who are still here in the Fort Wayne area.

>> What are the most common things Roof since you work with this every day and have for many years what are the most common reasons people want to stay at home longer or what needs can be met in home?

>> Sure.

Oh, I think all of us want to be able to age in place and live in our homes.

The comfort of that the memories shared in that home you know, hold them there.

>> What's important to to know is is it safe to be home and that's where those phone calls come in from the adult children or other loved ones seeing is an assessment available to make that you know, to determine what those needs are and there are assessments available for that and they're very holistic.

>> It can be everything from social support background to the medical team in place financially.

Are they stable to live at home even home assessment you know, or their needs that can be put in place durable medical equipment or whatnot to keep them?

>> You know, a lot of different reasons.

Yes, somebody might need some help and staying at home again ,don't forget to give us a call here and we'll try to answer your questions as well.

>> Jessica, as an elder law attorney, do people come to you to begin with and say my mom needs some help?

>> What can be done and what do you do as an attorney?

You guide them sometimes they come to us first because maybe we've had a relationship with them in the past where we talked about estate planning documents or maybe we've talked about asset preservation planning.

So a lot of times they will start by going back to their elder law attorney or just estate planning attorney because they that's kind of who they know and who they feel is a resource and so a lot of times that is how our first phone call comes in to put in.

And so we talk about a lot of different options we talk about has somebody been evaluated first by a doctor if that's necessary.

A lot of times that phone call has to do with they just seem to be forgetting some things are placing objects in strange spots or they're wandering and so my first concern is always do we have the right medical treatment going on and so are we getting proper nutrition, proper sleep.

So some of those things it's could be a very simple fix or it could be more in depth and they may need a neurological exam by either a psychiatrist or a neurologist.

And so we talk a lot about just kind of that first foremost let's make sure medically we are stable and then we can kind of figure out some long term plans.

>> OK, here we go.

Ruth building on this and you ask people or your staff assesses people all the time what do you look for ?

>> How does that all begin?

I mean do you work with the person directly?

Absolutely.

>> Their family or with their doctor?

Normally it starts with the family calling in and just having that dialog of what their concerns and observations might be of their loved one and then the assessment is done in the home with the person it is OK?

>> Yep, because I me personally I want to talk face to face to that person because I want to see cognitive lead to are they are they oriented you know are they showing any memory issues and I'm just kind of get a feel for what they're able to do.

We want to know are they able to take care of themselves still basic dressing bathing.

>> Yeah.

Eating or you know, medication management.

It can be those simple activities of daily living that we're looking at.

And then I mentioned finances.

Are they paying their bills on time or do we have a stack of mail unopened on the table?

Do they need assistance with that?

>> So there's those little queues along the way, you know?

Right.

Do you talk with like their doctor or the family or how does their home health care visit or requirement began the family first and foremost.

OK, we can pull medical records from doctors if needed so on on the the care management level.

Yes.

So for home care coming in they're going to have a list of tasks that are developed with the client in the family.

OK as to what to do for that individual it can be as simple as housekeeping or making sure that the meals you know, good meals, healthy meals or Aaron running and it can be as hands on is actually bathing that person and making sure you know that their hygiene is kept up, that they're, you know, clean and odor free and there could be many different things and it could be a case where maybe it's not just a matter of getting older, maybe you've had a major surgery of some sort or some sort of an illness that's keeping you home bound or hospital bound for a number of months.

And if you prefer to stay home, there might be a way to meet your needs to help take care of you during those months while you're in recovery .

>> Does that happen with clients very often, Jessica?

For sure.

There are a lot of times where a major stroke is is something that they are progressing and they are they truly are progressing and they and they will get better.

>> Yeah, but it could take a significant amount of time and they need that support during that time and they don't want to necessarily rehab in a facility anymore.

They want to rehab at home.

So it's figuring out what can we have at home to support that is that family is that cleaning?

Is that home health care?

Is that you know, a physical therapy at home?

It's a whole number of things and services that that may be beneficial.

It just really always starts with what is going on physically and mentally with that person.

>> I know, Jessica, that you always endorse as an attorney to make sure people always get a name and document and sign legally a power of attorney in a health care representative.

>> Would you work with one of those positions at all?

Yes.

So it will kind of depend on the situation and so generally speaking a durable power of attorney or appointment of a health care representative, the person that you have nominated in those documents is not going to take effect until you cannot make these decisions for themselves or your kind of direct them to do this on your behalf depending on the circumstances.

So really as an attorney most attorneys are going to want to know whether or not that person is truly incapacitated before just taking the word of the person that is the attorney.

In fact, they want to kind of do their own assessment to make sure that they're not going against that person's wishes.

>> Got it.

OK, and we do have a call coming in.

I knew he would because this is a big topic.

Rick is called in and he said how often do you see disagreement among siblings on how the care should be provided for their parents and you know who has the final say?

>> Is this a legal question, Jessica?

It's probably a little bit of both.

>> OK, yeah.

Yeah.

And Rick, thank you so much for watching.

Thank you, Rick, for calling our at least.

Yeah.

Tell your question on the air.

And so generally what I say is if there is disagree and we got to try to work together but at the end of the day if you have a power of attorney document the person that is designated in those documents is who is going to have the final say.

>> I see all the more reason to plan ahead and do these documents so that the person in control of your decision making is the person you designated and not falling to this disagreement or left up to chance.

>> It doesn't surprise me Rick's question that there might be disagreement among the siblings especially again if like you mentioned people you know, the family members siblings live in many different places so they're communicating by phone or Facebook or or whatever way and maybe if they're living in Texas and they're calling you in here in Indiana, they can't see what's going on and maybe they say, well, I don't think you're doing the right thing.

>> You know, the person here says, you know, I am and whatever the other sibling in New York says, you know, I think you should do this.

>> Do you how do you handle that when you have a family?

>> And I want to add to what Jessica was saying to and I think it's important to make the distinction when there's a power of attorney that power of attorney comes to play if the loved one is no longer able to make their own decisions.

>> Right.

And I think that's that's a line that always needs to be explained a little more to families to sidestep the if it was my parent, the doctor would be telling me or we would have that determine if we have a little dementia started or confusion then we would know.

But the doctor really is the one to make that ultimate decision that the person is no longer able to safely take care of themselves in that way in the power of attorney or health care rep would kick in.

>> I am a firm believer in honoring the wishes of the elder of my client of the moms and dads and the grandmas and grandpas.

So if I have got adult children calling me and they are in conflict, it is generally because someone is trying to control their parents where they shouldn't be controlling their parents and I want to honor what the parents want.

What is it that what are their wishes?

You know what if they are incapacitated, what were the wishes before they became incapacitated?

And I feel it's very strong to honor that.

>> Does it produce produce conflict?

It does.

But I think when you know your loved ones wishes ahead of time and you know you are honoring those the conflict less that that makes sure I'm going to respect your wishes and what you want, whether it's something that I would personally do or not is kind of irrelevant because I'm honoring your wishes and I know that's what you want to also think it's a good philosophy.

>> So I guess keep that in mind as well.

Jessica, she talked about, you know, making making things or making people aware make the family aware beforehand of your needs and your wishes is always a good thing.

>> What kind of legal documents should be in place to help somebody stay in their home longer?

>> So we counsel people all the time elder law attorneys, counsel all attorney, her clients all the time about what type of documents to have in place and really to spell out your wishes whether that's in writing or to have an in-depth conversation.

But I think you do need to start with a durable power of attorney.

Durable power of attorney is one where you're giving the authority for somebody to handle your financial transactions and a lot of times people will jump instantly to banking transactions and things of that nature.

But really it's a whole lot of other things.

It could be making a claim under the homeowner's insurance or canceling a car insurance or canceling the telephone or maybe dealing with paying daily or monthly bill some of that but also handling maybe your email or your taxes and things of that nature really, truly all of that kind of mundane adult stuff that we all have to do on a daily basis can Ruth, you said one of the things that can assist people if they're at home you said if they're not really able to handle their mail and it stacks up and there may be bills or finally notices or things can a home health care worker handle that or do they just kind of supervise it, supervise that so some health care workers will supervise and help them open the mail.

They can help sort out the junk to the bills, the bills and you have to have a designated person to pay those bills right now and that's not going to be up to the home health care aide that's a little outside of your scope.

>> But OK. All right.

Now what about other things that can be handled at home?

>> What kind of training do home health care workers have prepared?

>> There's numerous services and training so some come already with the background as a certified nursing assistant and have worked in a nursing home or hospital setting and have had the formal training.

Others are coming in more as a companion that just want to help people.

But each agency has their own sort of in services whether it's dementia care, infection control practices, proper ways to do housekeeping.

>> So there's been services that are given that are part of the state regulations actually to provide those so they could on training.

>> So then I guess what I'm curious about if if I felt like I needed home health care that I didn't want to go to assisted living or and couldn't maybe stay in the hospital, they don't let you do that very long.

>> But I needed a little extra help in one way or another if I were to apply or ask for a home health care do I say I need to specify I need help with taking my meds, I need help with my house cleaning or I need somebody to run errands for me.

>> What do I do?

Sure, sure.

Two different scenarios here if you're in the hospital OK, you fractured your hip, you're in the hospital or whatever the case may be and you want to come home, you're going to qualify for a Medicare covered home care which is going to be more of your skilled care where you have a nurse, you have the therapies that come in the home plus the home health aide and that is the Medicare covered benefit.

>> If it is so those workers would be medically prepared.

I mean the training for that.

Correct.

Correct.

If it is someone that you're not in the hospital, you know you need help so you don't want that companion.

You want that help then the agency when they come in we'll sit down and you will do an actual checklist of what you need done very specific to the housekeeping, the errands, the medication reminders to bathing, dressing that it's so it's very specific and they have a checklist.

>> So yes, you're able to really voice what you need help with.

I say OK, well that's always good to know and you should probably know what you need or tell your family members and then they can meet with the home health care agency or workers and specify more clearly.

Let's talk a little bit about funding if you will, Jessica.

Are there government programs, Medicaid, Medicare, health insurance how does one pay for home health care?

>> So it'll kind of depend on the stage that you're in when it comes to seeking the care so as Ruth mentioned, there are oftentimes a Medicare benefit that will pay for some services.

It just depends on what has caused you to need the home health care.

>> What do you mean by what's caused you?

So if it is a if it's a stroke or a hip replacement that has some rehab so if it's related to a particular injury or event, Medicare is more likely to cover that than if you are just kind of having a steady decline and some general assistance.

That's when we see more things like private hey, maybe a long term care insurance has a benefit that includes home health care.

But a lot of times we are talking about Medicaid or VA benefits and so there are programs under both that can help pay for home health care.

>> OK, VA benefits doesn't come up very often.

Ruth with clients.

>> It does.

It does and honestly that's when I refer to Jessica or an elder law attorney who specializes because the VA benefits.

>> It's very complicated, very complicated.

>> They really are and there's qualifications that need met and you know, so I do refer them to an elder law attorney who can specialize in and help them kind of navigate that system.

>> Yeah, OK. That makes good sense.

>> Anything to add to that, Jessica?

So generally speaking I will try to get somebody as soon as possible to an elder law attorney when they start thinking that they're needing a little bit more help at home.

Sure.

I really do advise that you go talk to somebody about your assets, your income and your health because then we can come up with a kind of a good care plan for you and who is going to help fund that plan.

>> OK, we always start with care because I think the care piece is the most important.

Not only do I want to make sure you're staying home longer, I just want to make sure you're getting a care that you desire first and foremost I recognize that sometimes the financial piece of it will prohibit or maybe shift that.

But let's start with what you really want and then work from there.

And so the sooner you get to an elder law attorney the sooner you can kind of talk through what your options are and how to fund it.

Is the VA an option is Medicaid?

Do we maybe have some insurance we can tap into?

>> And so the sooner you get to somebody to talk to you about all of that, the better plan you have in place.

>> And you know, if somebody knows they're facing a major surgery, for example, good to make sure before you go in for surgery in case you Gurnett you're going to have some months, weeks or months or whatever to recuperate and you want to try to do it at home to check in before and see what you have to cover that right?

Yes, absolutely.

What about as needs change maybe someone as they are aging or if they have an ailment or the dementia or a chronic illness that is continuing to progress their needs might change.

How do you deal with that with home health care workers?

>> Do you start sending different ones in that specialized yet?

Well, your level of care changes so I I always tell people I can age you in place to your death if you can afford it because hospice you know we have palliative care, we have hospice care out there which is a wonderful life care that is also a Medicare benefit.

Sure.

You know but you you supplement the time that are in the home with home health care through like a private duty agency.

>> So financial you do have to be able to afford the round the clock care.

>> But as the needs increase you increase your hours.

>> What's the beauty is it's flexible so you start off with a minimum amount of hours and increase it.

>> You go and if there's a nursing need then we pull in nursing if you know if you need more therapy for strength and you can pull therapy and it can go out and then if you need it again it comes in or if you're if you've like you said a chronic illness or if you're just simply aging and your end of life then you pull in hospice care which brings a whole different layers of care into the home.

>> Who makes these decisions like you know, who makes the decision?

You know, I think Grandpa's getting much worse and I think just somebody checking on him three times a week and and making sure that he has his medications and little pillboxes isn't enough anymore .

>> Who makes them again?

I think the physician involved is a key for that as well because they're the ones that are going to be treating the person and being able to see the progression with the medical diagnosis and be able to say it's time for more care as well as well eyes in the home so the home the aides are going to know if that person is declining coming in.

They're going to be able to see that they're declining and then get with the family.

OK, and you're always in communication with the family and making game plans to keep going as an attorney, Jessica, do you work with at home health care agency or home health care workers at all in in terms of what they can do legally or direct them where to go?

>> How do you handle that generally not directly with the home health care aide but we are working with the the person that's been designated the health care representative or maybe the attorney in fact.

And so we're helping them kind of issue spot some things that they're seeing in the home to make sure that care is appropriate, that it's consistent.

And so we're we're really more working with the family member or the loved one that individual has appointed and hopefully we have had long conversations with the client to make sure that we know specifically what it is that they want so that we can help that attorney.

>> In fact, our health care representative further the wishes and make sure that they are honoring that person at the things the treatment that they really, truly want it.

Sure.

And so then they communicate with the home health care aide or whatever agency is in the home to continue that care right now we want to talk a little bit about money again, Jessica, and I'm going to direct this to you.

What are the requirements for Medicaid and VA in terms of assets or your income is a guideline at all or how can one where can one find that information?

>> Sure.

So I would refer to an elder law attorney because whether or not you go down the VA path or the Medicaid path will really depend on the care and kind of what your income is and what your assets are.

So there's a lot of factors to that.

So the sooner you get to an elder law attorney the sooner you're going to be able to try to figure out which road to go down if VA is better or if Medicaid is better because there are asset limits to both programs and they're very different depending on whether or not you're a single person or you're a married couple.

And so there's a lot of facts that affect the asset limit and so there are some general things that people see out in the community.

The home is generally exempt asset one vehicle is an exempt asset.

There are other things of that nature as well but it really kind of depends on are you married, are you single and what program were reapplying for .

So again the the sooner you get to somebody the better.

What I always advise people to do is truly come knowing what you own and how you own it assets, assets know what your list is.

I know that sounds kind of obvious but really truly it's very easy to forget things that you have.

You'll forget a life insurance policy.

You'll forget about that stock that somebody gifted you ten years ago or or maybe something split and you forget that you have these things.

It's easy to live life and kind of forget about that running list.

>> We always think of that in the future.

Yes.

I'll take care of that, you know, next month or or at the end of the year or something very quickly nearly at the end of the show, what kind of advice would you give to people that are looking at somebody in their family that's going to need some health care?

>> I think that they need to reach out whether it's to a home health care agency or speak with their doctor for a referral just to get a feel for what is available.

OK, have someone come into the home and do the assessment and have that professional opinion of what they see as the need and kind of get a collective goal together that makes such good advice again illegally with our elder law attorney Jessica Northen and Ruth Force always good information from you, Ruth and I want to thank you for being with us.

>> Thank you.

You make something new that you know now and next Wednesday night, by the way, I will have a LIFE Ahead again for you here every Wednesday we have different topics and different guests.

The first Wednesday of each month is always a legal show though.

Meanwhile I have a good night.

>> Stay healthy and stay safe .