Terry Cassidy, Occupational Therapist and owner of Health Partners specializes in the evaluation and support for older drivers.  The week of December 7 is Older Driver's Awareness week and an ideal time to learn more about safe and comfortable drivers to take into their senior years.  To see more about the week's activities visit

https://www.aota.org/Conference-Events/Older-Driver-Safety-Awareness-Week.aspx

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

 

Transcript:

 

This is Studio 809.

 

Cynthia Margiotta:

Hello everyone. This is Area Agency on Aging, Aging with Altitude Podcast. Welcome to all of you. This is where we provide answers, assistance, and advocacy for our elders. Thank you for joining us today. Our topic today is Older Driver Safety Awareness Week that’s coming up in a couple of days, yes?

 

Terri Cassidy:

Starting December 7th.

 

Cynthia Margiotta:

So let’s get that in our heads. I’m your host, Cynthia Margiotta. I’m a geriatric social worker and a volunteer with the Pikes Peak Area Council of Governments Area Agency on Aging. That’s a mouthful. And CEO of a program called PEARLS Program of Colorado. With me today is Terri Cassidy. Thank you for being here today, Terri. Thank you. She’s got all these wonderful letters after her name so I’m gonna just tell you what they are. The first one is OTD. What is that?

 

Terri Cassidy:

Doctorate in Occupational Therapy.

 

Cynthia Margiotta:

And then the second one is OTR/L.

 

Terri Cassidy:

And that’s just licensed and registered occupational therapist in the state of Colorado.

 

Cynthia Margiotta:

There’s no “just.”

 

Terri Cassidy:

No just.

Cynthia Margiotta:

No just. And the third one is CDRS.

 

Terri Cassidy:

Certified Driver Rehabilitation Specialist.

 

Cynthia Margiotta:

And that’s a mouthful girlfriend. I like the letters. OK, she’s here to talk to us today about Older Driver Safety Awareness Week. Terri has her doctorate in occupational therapy and is a certified driver rehab specialist, as she mentioned. As the owner of Health Promotion Partners, she empowers people to take positive action toward their health and well-being. She and her team provide driver evaluations and home evaluations to help older adults stay independent and connected with our community. Wonderful, wonderful. So let’s get started with some of the questions. I have a million of them. What is Older Driver Safety Awareness Week?

 

Terri Cassidy:

Yes. Well, thank you, Cynthia. I’m excited to be able to be here and talk about this topic. Older Driver Safety Awareness Week has such a long title, partially because it’s trying to explain what it is. It was started through the American Occupational Therapy Association really to have a set time to raise awareness to this topic. Just safety of older drivers really in a way that’s non-threatening. That’s really just about a topic that people don’t like to talk about, maybe. So trying to bring some attention from different sectors. So starting with AOTA, but there’s a lot going on even statewide with the Colorado Department of Transportation, nationally with AARP and other partners to promote this week. It’s always the first full week of December so this year is December 7th through the 11th to encourage people to think about and talk about older driver safety.

 

Cynthia Margiotta:

That’s a very important thing. There’s so many out there and it would be helpful, yes?

 

Terri Cassidy:

Yes.

 

Cynthia Margiotta:

So what do you do as a driver rehab specialist?

Terri Cassidy:

So in my role as a driver rehab specialist, I do driving evaluations and driver training. As an occupational therapist is really the background that I bring to this driving perspective. So particular to older drivers, I might see somebody when there is some concern or question either by the family, sometimes by the physician, sometimes by the client themselves. Am I still doing well with driving? Is this still something I should be doing? And so we do see clients and we do an evaluation here in the clinic and then also out on the road to give people feedback about maybe how age related changes are or are not affecting their driving. For some people that’s just giving them a really good baseline of this is what’s going on now so that if there’s concerns in the future, they could come back.

 

Cynthia Margiotta:

And this office is so easy to get to. You’re just off of Filmore and on Beacon which is not far from I-25 in Colorado Springs.

 

Terri Cassidy:

Yes. I’m glad that you were able to get here today.

 

Cynthia Margiotta:

Yeah, me too.

 

Terri Cassidy:

Something I like a lot about this space is our, we have a very accessible parking lot so it’s a good place for a driving program.

 

Cynthia Margiotta:

I even parked in it. Not so straight in the line.

 

Terri Cassidy:

Oh I didn’t look at your car.

 

 

Cynthia Margiotta:

Don’t look, don’t look, don’t look. I backed into a parking spot. What are some trends related to older drivers?

 

Terri Cassidy:

Well, I would say just for starters that when we’re talking for me, talking about driving evaluations, or even in general, for older driver safety. To me it’s not so much about age. I’m really looking at function overall. So for anybody that we’re talking about driving with, I don’t see that you know, a certain age means yes or no in terms of driving or anything like that. Like we’re really looking at physical skills, visual skills, cognitive skills is what makes up a lot of that. And older drivers tend to be more safe drivers. They tend to have less risky driving behaviors, tend to drive less at night, less overall miles. However, the data does show that over the age of 75, the fatality rate for individuals over 75 increases quite a bit compared to drivers of any other age. Except new drivers kind of mirrors that. So the concern becomes, you know, are there just changes that are happening that are affecting ability to drive and there is also an issue of frailty adding to the increased fatality rates. So somebody who’s 80 who’s involved in a crash is more likely to have more injuries, potentially life threatening injuries than a 40 year old person involved in that same crash. So there’s a couple of factors going on there, but I think overall older drivers have good driving habits, safe driving habits. We just want to find ways to keep them safe.

 

Cynthia Margiotta:

That makes a lot of sense to me. How do we, you know, what’s the biggest barrier to having discussions with folks about older drivers? Those barriers that, you know, I’m fearful of losing my driver’s license. She’s going to take my driver’s license away.

 

Terri Cassidy:

You said it. I mean that’s basically. You know, it’s a type of topic, and like I said in the beginning, people don’t always like to talk about this subject. Once you bring it up, so when I’m out talking to people, it doesn’t matter the population of people I’m talking to, everybody has a personal story about a relative, a family member, a friend where driving was iffy or where that person successfully decided on their own to stop driving. It’s a type of thing that everybody can relate to, but it’s touchy. Because, I think the biggest reason that it goes so far into our own identity and our independence of being able to drive. So if your child comes to you and says, “I have some concerns, dad, about your driving.” I think it can be hard to not take, get defensive around that discussion. So I would say the barrier is almost this stigma around removing driving, or stopping driving and really, what I would love to see is that our focus, or our value is on being engaged in the community, continuing to do things that are important to you. If you’re the driver or the passenger, it’s ok. You know, how can we just keep people involved in what they’re doing. But sometimes we get really stuck on the who’s in the driver’s seat.

 

Cynthia Margiotta:

Yes, yes. I have known multiple women who haven’t driven in 20 or 30 years because the husband, or even sometimes the wife, has to be the driver. You take their driver’s license away and it’s almost, and I can’t, you know, it’s for people, I guess for women to understand because it’s generally men who are very sensitive about losing their driver’s license. The closest I can think of to coming to that is you take away a woman’s home, her ability to care for her home. Because the generation we’re talking about, you know, women’s homes were their jobs. And you take that away from them, maybe they would understand a little better about their husband’s feeling about losing their driver’s license. Am I off?

 

Terri Cassidy:

Yeah, I appreciate that because I think it does go back to the person’s role. And so, you know, in your example, talking about the husband as the primary driver, that’s his role. And when we’re talking about changing that it’s a big deal. So yeah, no, that’s a good analogy of taking, shifting, or changing that person’s role there.

 

Cynthia Margiotta:

We don’t like losing our roles.

 

Terri Cassidy:

It’s true. It’s true and I think any ways we can help redefine our roles as we age, but hold on to, kind of figure out what the most important piece of that is, but on the surface it’s a discussion people tend to shy away from.

 

Cynthia Margiotta:

Yeah. Oh yeah. What are some good ways to make sure you’re a safe driver?

 

Terri Cassidy:

So, yes. There’s a great quote. I think it’s a Dave Barry quote that says, “Everybody feels they’re an above average driver.” Something along those lines. Everybody thinks they’re a safe driver. It’s just kind of our mentality. But things change in our bodies as we age and so sometimes it’s worth having those things checked up. In terms of being a safe driver, it’s not just important for your own self-perception. I felt safe during that drive, but doing kind of just routine medical visits. That’s going to affect your safety as a driver. Vision is a huge one, so getting an eye exam, talking to your eye doc about driving. Certainly, just medical routines, typical health examinations, things like that. There are some self-assessments of driving that are available online. I know both triple A and the AARP have those on their websites that people could fine. They’re just asking you questions about your driving. I feel like when it comes to family members, a good question is do you feel comfortable having your children in the car with your loved one. You know, so I think sometimes if you’re the older adult who’s interested in being like, how am I doing? How’s my driving going? Asking people who have driven with you. Just being, opening up to that feedback a little bit of do you feel comfortable driving. Usually, it comes the other way. Usually comes after the fact where people are saying, they’re finding out about it for another reason.

 

Cynthia Margiotta:

So what you’re saying really, I guess I can equate that to people who have not had glasses. And they get their very first pair of glasses. And they look out the car window. I’ve heard this story from lots of people. And they say oh my gosh. I can see the leaves on the trees.

 

Terri Cassidy:

Right. I’ve had that experience, yes.

 

Cynthia Margiotta:

Right. It’s a shock because an older driver thinks they’re being safe, being careful, but maybe they’re driving, maybe they’re weaving a little bit. Or they aren’t using their blinker in time. You know, a hundred things, right. So that’s what I can equate it to that might help listeners to hear gee yeah, I remember when I first got glasses.

 

Terri Cassidy:

Yeah, and that idea of oftentimes things change slowly so we don’t notice the change. Vision is a great example of that. Of your vision, and something we see a lot is trouble with contrast. So a lot of people maybe their night vision isn’t as good anymore, but they don’t notice it because they’ve just gotten used to it slowly over time. And that’s where I do feel an outside, objective opinion or evaluation can be really helpful.

 

Cynthia Margiotta:

Yes, that way we can’t blame the kids. We can’t blame the doctor. We can blame that lovely lady, Terri.

 

Terri Cassidy:

Yes! Absolutely.

 

Cynthia Margiotta:

It’s all her fault. OK. So driving concerns about an older family member have long been considered a family issue. Shouldn’t this topic just be addressed by family members?

 

Terri Cassidy:

Yeah, and that kind of gets back to the barriers question and I feel like that has in the past been a big, just part of our culture of, in a different time. Let’s say where people say “Oh, Mr. So and So is not safe behind the wheel. We know what his car looks like and we just try to avoid it” for example.

 

Cynthia Margiotta:

Yes, yes. I remember that person.

 

Terri Cassidy:

But our world has changed and sped up and there’s, there’s too many cars on the road to keep track of which ones to stay away from. And I think that, you know the research that’s been done in terms of focus groups, talking to older adults about who do you, who would you want to bring up problems with driving, or concerns that could potentially could affect your driving. The answer has tended to be spouse. Although for a certain percentage the answer is definitely not spouse, so that’s kind of a tricky one. The other person that ranks high is the doctor. So a lot of individuals feel like my doctor will tell me if I’m not safe enough to drive.

 

Cynthia Margiotta:

Whoa, yeah. Wait a minute.

 

Terri Cassidy:

It doesn’t necessarily happen that way.

 

Cynthia Margiotta:

Yeah.

 

Terri Cassidy:

But I think that’s a perception of, you know, they’re looking at my health. They’re going to look at these decisions with me. And that’s where, you know, a lot of my education is to the medical community. Say hey people are looking to you for making these decisions, here’s some suggestions on some ways that we can do this together.

 

Cynthia Margiotta:

How could a doctor do that? I don’t understand how they could. Seriously I don’t because I’m thinking of my doctor visits, um, my doctor doesn’t ask about my vision, doesn’t ask about my reflexes and maybe that’s down the road a little bit. Maybe they will, you know, but I have been with many, many people over the years in their doctor’s visits and I can’t recollect a single one doing an eye exam or even checking those kinds of questions.

 

Terri Cassidy:

Yeah, it’s really interesting because I think of like from my sphere of being in the medical world, we think of somebody’s had a stroke. It should be their doctor that talks to them about, finding out if they’re safe to drive before they go back to driving. So maybe the medical professional in the sense of an acute injury or illness, so this person had a fall, had an injury. But when you say it like you’re saying it, it does seem like a big leap to ask the doctors to then be talking about driving. And so I think there’s potential there. Like I think there’s definitely room for that discussion. And I have, even in town, spoken with some of the doctor’s offices who’ve said “oh, yeah, maybe that’s something we should add to our general questions.” You know with the Medicare health, the physical, yearly physical there’s questions about just about everything else. You know, in terms of emotional state, and alcohol use and all of these different things, but there isn’t something specific to driving. So I think it would be really interesting. There has been some research around primary care physicians and how they could be, just tapping in and asking some of these questions and mostly what they came down to was that it was too much to ask a doctor’s office to perform a screening or some kind of test related to driving. They really found though, just having the physician’s office ask the question: “How’s driving going for you?” Like just even that would be a huge improvement over what we have going on right now. And I love the idea of normalizing that conversation so that you’re asked that every year. And so you’re not defensive when somebody asks you. It’s just an honest conversation of I’ve started to notice that sometimes I think I’m pressing the break and I’m actually pressing the gas. And that can relate back to sensation and that could be something the doctor could help you manage.

 

Cynthia Margiotta:

Right, so it would lead into so much more information for the doctor. So what kind of solutions are there for someone who has an injury and is having trouble with driving?

 

Terri Cassidy:

So I mentioned some medical diagnosis. So I mentioned a stroke and for example there are a variety of things that a driving rehab specialist can do with a client to help them get back to driving after something like a stroke. Some of that is going to be in an OT clinic so that might be part of outpatient therapy before somebody comes to see me. Really focusing on reaction time and multitasking and some of these pieces, these higher judgement pieces that we use all the time when we drive and we don’t really think about it. To me the other answer that though has to do with adaptive equipment. So for example, if someone’s had a stroke, and they, let’s say they can’t use the left side of their body. They can still do gas and break with their right foot, but they usually would have done their turn signal with their left hand. So there’s some equipment we can put in the vehicle to make it safer for that person to steer with one hand, to access their turn signal and to keep their attention on the road through that whole time. Or another example would be somebody who has an amputation. We do training for use with hand controls, so you don’t need to use your feet at all for accessing gas and break and steering. So there are some really great ways to keep people driving safely even after there have been some injury or illness changes.

 

Cynthia Margiotta:

Yeah. Wonderful. And are those expensive? Are those expensive adaptive types of equipment?

 

Terri Cassidy:

You know, expensive is a good question because it’s all relative. So for someone to get equipment, you know, hand controls can be about $2000. There’s also training involved with that. Evaluation involved with that. That could be another thousand dollars. To me, when you’re looking at that amount versus not driving, you know, so I think the expensive part is hard to answer. It depends on everybody’s particular situation. Driving a vehicle, owning a vehicle is expensive. Paying for insurance is expensive, you know. So it’s...

Older adults have continued to receive much needed services and many new ones during COVID19, with the help of Area Agencies on Aging.  These agencies were started in the late 1960's as part of the Older Americans Act.  Over the years, thanks to advocacy, more funding has come available to add services like counseling, vision support and much more to a program that originally focused on food and transportation.  During COVID19, even more support has been provided by these agencies and their community partners.  Mr. Jody Barker, Director of the Pikes Peak Area Agency on Aging shares many of the ways this region stepped up.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.  

 

Transcript:

Cynthia: This is Aging with Altitude, welcome to all. This podcast is brought to you by the Pikes Peak Area Council of Government's Agency on Aging. We strive to provide answers, assistance, and advocacy for our elders. Thank you for joining us today. Our topic today is COVID-19 Now. I am your host, Cynthia Margiotta, a geriatric social worker and volunteer with the Pikes Peak Area Council of Government's Area Agency on Aging. With me today is Jody Barker.  

Jody Barker: Thank you, Cynthia.  

Cynthia: Thank you for coming. A little bit about Jody... Jody is the director of the Pikes Peak Area Agency on Aging, which serves three counties: El Paso County, Park County, and Teller County in Colorado. He has served in many roles in his twenty-two-plus years in senior service organizations in Colorado. Among those roles have been editor of the Life After 50 newspaper, the director of operations for a home care agency, Central Colorado Regional Director of the Alzheimer's Association, and director of the Colorado Springs Senior Center. Jody's greatest joy is matching services with seniors and their families or enabling staff and services to do so. Jody has served on various boards and commissions over the years and currently is on the Colorado Commission on Aging, appointed by Governor Hickenlooper. I'm impressed!  

Jody Barker: Thank you, Cynthia.  

Cynthia: Well, thank you, Jody! I have known you through several of those organizations, all are so great.  

Q: So, let's get started with our first question about COVID if you don't mind? Jody, how are you at the Area Agency on Aging? How are you still meeting the needs of our community?  

Jody Barker:  

A: Well thank you, Cynthia, it is a pleasure to be with you today. When the governor's order began in early March, we knew that we would have to continue operating even if we had to close our doors. March 17th, St Patrick's Day, as a matter of fact, we packed up what we needed to serve our community. That included telephones and paperwork and our computers and we began to work remotely. So, even a sense March, even with our doors closed to the physical building, we are still 100% operational. We have even added services that I'd like to share with you later. The exciting thing is that our staff has taken this as a really exciting challenge. We continue to answer all phone calls, we're reaching out to our clients, we're reaching out to past clients, we are reaching out to our community to continue to serve them every day.  

Cynthia: It's amazing how much you're doing and I can't wait to talk about that. As the emergency orders have changed we are seeing changing guidelines. As of today which is June 3rd, 2020, in case you're listening to this a little bit further down the road, we are at the Safer at Home stage or in the Vast Great Outdoors.  

Q: What does that mean?  

Jody Barker:  

A: There's a lot of interesting thoughts around the changes in the orders that have been provided by Governor Polis. Originally, as you know, we were in a Stay-at-Home order. It was necessary for all involved to really flatten that curve. This way, we could really understand more about the disease and how it was affecting our community. Of course, because covid affects upper respiratory issues, it has been very challenging for older adults, especially those with underlying health conditions. The Stay-at-Home order was crucial, to begin with. As those in leadership, especially those in the healthcare field, began to understand more about the disease in early May they changed the order to Safer-at-Home. This allowed us to have a little more movement, like maybe going to the grocery stores or getting out and about to pick up a restaurant order instead of sitting in a restaurant to eat. That was was crucial.  

Now, with this most recent phase, The Vast Great Outdoors, it simply is an encouragement for people who are able to enjoy the outdoors. Here we are now, on the very front end of summer and this week has been more like summer than June! It feels more like July and August kind of weather. It is very hot! The great thing about this new phase is that it is an encouragement to people who are able to get out and go to their local parks with appropriate social distancing or maybe go for a walk in their neighborhood. There was concern earlier on about even just stepping outside your home. Now, people are encouraged to open those windows and get some fresh air and to lessen the social isolation that was so important early on. Now, we want to encourage people who can, to get out there. There are actually a couple of exciting changes with our providers who are helping to promote the new orders that we will touch on.  

Cynthia: It is so important to get some fresh air and to get a little exercise, even if it's just walking around the block to take take the dog for a walk. I mean, I have a neighbor who takes his wheelchair and he goes and walks his dog. I think it's important to do that!  

Jody Barker: Even in my neighborhood here in town when we are able to get out for a walk, we see so many people out walking their dogs or going to the park. It is people of all ages, you know? So it's really exciting to see people moving about! It's an interesting change from the last two months but when we think about what it truly means for older adults, it's crucial. This is because the older Americans Act, which is a major source of our funding to the AAA, was written in 1965 to reduce social isolation. That is the primary directive around our funding and our programming. Imagine what that's had to look like in the last two months with the Stay-at-Home and even the Safer-at-Home safer orders in place. People we have served in a variety of areas, whether that's senior center programs, transportation to doctor visits, transportations to church or classes at the Senior Center, lunches at the Senior Center, all of those had to change on a dime. All of that was intended to help protect the safety, health, and well-being of older adults, as well as the rest of the community. But, it's probably been most difficult on our older population because someone who lives at home, to begin with, and maybe looks forward to that three to five days lunchtime with their friends at the Senior Center, suddenly are being asked to stay at home. That can be extremely challenging to their health and mental well-being.  

Cynthia: Yeah, absolutely! We could talk about that for hours, gotta get out gotta be involved as much as a person is able.  

Jody Barker: Exactly! An interesting comment came to me a few weeks ago from one of our volunteers who said she was talking with some neighbors. One of her neighbors, who is an older adult, said, "you know, I feel useless because I'm used to volunteering and now, I'm not allowed to. I feel useless." And so, one of the things that our advisory committee is working on is actually not only volunteering for seniors but involving those seniors in that volunteer project. This is to give people a purpose and to give people activities and things to look forward to. I know what will touch on it here in a little bit, but there's so much going on to not just serve the seniors but incorporate the seniors into the process. We're all working on this together.  

Cynthia: In a sense, that's serving them.  

Jody Barker: Absolutely!  

Cynthia: You know you've known me for a while and I'm a big advocate of volunteerism. I think it's a very important part of being part of the community. I think, you know, if you can when you retire don't go sit on a chair! It drives me crazy! If you can, go out and volunteer. If you can't go anywhere, find a way to volunteer from home. People can write notes or they can make phone calls. I can talk about it for hours...  

Jody Barker: I think what we have to remember is that there are opportunities for outreach, not just to our older population but for those older adults to participate in that process. Maybe there's an assisted living or retirement community or a skilled nursing facility in your neighborhood. Call those places and say "I'd like to write someone a letter." You have no idea how much of a positive impact that person can make.  

Because maybe you live at home but you might have three or four rooms to move about in. But someone right now, during this time, who lives in assisted living or a skilled nursing facility is being asked to stay in their room. Their meals are delivered to them, their activities are brought to them in the hallway, and they are being asked not to leave their room due to social distancing.  

So even just taking the time to write a note to an older adult who lives in a community near you could make a world of difference. You don't have to ask permission, you don't have to be part of a larger group, to do that. You can pick up the phone, you can write that letter on your own, and it will be such a positive impact on the staff and on the residents.  

Cynthia: Just the thought of me being in a room for a month... I'm an extrovert and I would have no hair because I pulled it all out. I absolutely think those are wonderful things we can do. I mean, we can even write a note to our neighbor. It doesn't have to be an official volunteer program.  

Q: So tell me, what are some of the service delivery changes and supports that have been implemented that you have found interesting or effective or both?  

Jody Barker:  

A: That's a great question! As you might imagine, as we started hearing more about this virus and as it began to grow, even at the end of February, before we closed our physical building, before the Stay-at-Home orders came from the governor, some of our providers were already beginning to make plans and make changes to their service delivery. For example, one service provider who many of you will know is Silver Key Senior Services. They are the primary meal site provider for El Paso County. So, when you think of meal sites, you're thinking of Colorado Springs Senior Center, Fountain Valley Senior Center, and the Mountain Mennonite Church in Palmer Lake. Those places receive meals from Silver Key Senior Service's kitchens. They're hot and fresh meals that get delivered to people who come into a congregate site. These people meet up with their friends. They might come early for a class or stay late for a concert. That is their time to get together. As you might imagine, as soon as that Stay-at-Home order came into place in mid-March, that service had to stop.  

So, what did Silver Key do? Silver Key immediately implemented appropriate social distancing. They increased their home-delivered meals. They increased their pantry of delivered meals instead of people coming in via transportation on a Silver Key bus, going to the pantry to do their own shopping, and then get back on the bus to go home. Silver Key tried to reduce that contact in their pantry. The pantry is big until you start putting 15 people with shopping carts in there. You know, it can get very crowded. It is shoulder to shoulder sometimes. To avoid this, what they started doing is packing up those pantry boxes and delivering those to their regular pantry clients.  

That was one thing that they did, another thing that they did is they converted those congregate meal sites into what are called grab and go sites. For example, every Monday at the Colorado Springs Senior Center, the Silver Key Senior Services blue meal truck shows up. Instead of daily pickup, they prepare multiple meals and flash freeze them. This way, clients have all five meals for the week. Clients also have the opportunity to pick up fresh produce, dairy products, and things like that depending on what silver Key has on hand or what has been donated.  

The Senior Center, normally provides classes such as educational classes, moving for better balance, tai chi, and more. Those are the kind of programs that we fund with the Older Americans Act and Older Colorado Act dollars that we administer. For obvious reasons, they had to close as they were not allowed to do congregate-type programs like those physical classes. So what they did was they started making calls of reassurance. The YMCA and the Colorado Springs Senior Center host over 16,000 members who are over 60 years of age. So, staff and volunteers began picking up the phone and calling in to check on their constituents. In addition to this, they created what they call a phone buddy program. Silver Key would invite someone to the program and have that person tell a little bit about themselves. They would then collect a little bit of information from an older adult who is interested. They then paired volunteers with participating older adults. So, think of it almost like a pen pal program, but by phone. The Senior Center has begun to host those pairings of phone buddies. Instead of Senior Center staff making those calls out daily, weekly, twice a week, those phone buddies can now be a lifeline to one another. All they have to do is pick up the phone to check in with each other, talk about common interests, and that kind of thing.  

Silver Key is also providing some meals to people who do not have access to the Senior Center to pick up their own meals. They're delivering those meals on a case-by-case basis. The Fountain Valley Senior Center, as you know, is one of those congregate meal sites. They have now become and one of the Silver Key grab and go sites. Under the front of the building, they have set up a drive-through system. People line up in their cars and they can pick up the meal, they can pick up information, they can check-in and see how they're doing. One of the exciting things that I heard about, as it relates to Fountain Valley Senior Center, was that the city of Fountain did not layoff their staff, but sent a great many of them home to work remotely. This is because they did not have the same functions during that early stay-at-home process. Someone from the city government contacted the Fountain Valley Senior Center director, Jolene Hausman, and said what can we do? How can we help at this time? And they began with 20 city employees making those calls of reassurance. These employees were making over 100 calls a day. At first, it was only going to be a couple of weeks. Now, it is becoming an ongoing project because the seniors love it and staff from the city love it. Now, Jolene is talking about when things slow down, she would like to have a barbecue so the city employees can meet their phone buddy. The Senior Center is actually been talking about putting on something when it's safe to do so. So that those phone buddies can meet one another.  

It's just been really neat to see those programs, even some of the smaller programs like Teller County Senior Coalition, based out of Woodland Park. This group has provided fresh fruits, vegetables, and even restaurant meals to their clients. This way clients are getting choices and variety, not just the same box of food every week. There is just a lot of neat things going on.  

Unfortunately, some of our providers were limited. Providers who were contracted with us to provide certain services like transportation, suddenly found themselves not allowed to provide their service. So, they reached out in other ways like helping with telehealth or counseling services to make sure that people's needs are being met.  

The irony in all of this is that it's changing almost daily, and definitely weekly, as our providers determine what needs must be met. Providers are determining what the outreach needs to look like as they plan for the future. Right now, we don't know what congregate programs are going to look like for the next few months or the long term. However, I would encourage people to take a look at the Colorado Springs Senior Center website at epymcappymca.org.  

On the website, they can find the Colorado Springs Senior Center. They have already begun art classes using the online zoom system. So, zoom, if you're not familiar, is really more of a teleconferencing system where you can log in and see each other if you have a smartphone or a computer at home. Using the camera on your computer or smartphone, you can see one another and you can see your teacher. They began art classes using that online platform last week and they had something like 16 or 20 people from all over join that class. So, they are going to be doing a variety of both free and fee-based classes as they begin to look at what serving the community needs to look like with these new circumstances.  

Cynthia:  

Q: These are some mighty changes, yes?  

Jody Barker:  

A: Yes! These changes are distinctly different than what we traditionally thought of about senior services. I'm really excited that so many of our providers are looking at how they can continue to serve the needs of our community in a new way.  

We have about half a dozen services that we provide directly out of our offices by our staff. These services include family caregiver support services. We are also going to be doing our own support groups via zoom and by electronic media. The exciting thing about this is that it means we can provide services to those who are caring for older adult family members, spouse, or parent. Instead of just the caregiver coming to a support group, he or she can invite family members from across the nation to join the caregiver in that support group. We now have the electronic technology in place to be able to do that. So, real silver linings are coming out of the challenges that we've faced due to COVID-19.  

Cynthia: Yeah! You know national support groups would be an asset ongoing.  

Jody Barker: Absolutely!  

Cynthia:  

Q: I like that idea! Will there be issue-specific support groups, or will they be more generalized?  

Jody Barker:  

A: I believe they're going to start somewhat general to begin with, but there is discussion around some more specific topics. So, if someone has a specific challenge or need in a certain area that person will be able to sign up for that specific support group. To expand on that, you know the Colorado Chapter of the Alzheimer's Association is also doing something very similar. It may be nationwide, but they're beginning to do a lot more online support groups for that very reason. Again, it's one of those silver linings that has come out of the changes that we are having to make as we do our best to meet the needs of our constituents. Even though we can't be...

The resilient second-halfer through wisdom and personal stories is prepared and empowered for the second half of life.  Tom Rasmussen, Income Protection Specialist with Clear Solutions, shares his proven insights about how to thrive through life happenings.  This two part podcast explores first what makes a good life and second how to financially build resiliency.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

 

Transcript:

You're listening to Studio 809. This is what community sounds like. 

 

Cynthia Margiotta:  

This is Aging with Altitude, welcome to all! Brought to you by the Pikes Peak Area Council of Governments Area Agency on Aging. We strive to provide answers, assistance, and advocacy to our elders. Thank you for joining us today. Our topic today is Life Happens. What is your plan? I'm your host, Cynthia Margiotta, a geriatric social worker and volunteer with Pikes Peak Area Council of Governments Area Agency on Aging. With me today is Tom Rasmussen, Rasmussen, Rasmussen, I will never get your name right. He is an income protection specialist with Clear Solutions Insurance Services. Tom is an income protection and longevity health planning specialist advising on life, disability, extended care, and health care planning. Tom has helped thousands of people with income protection planning across the country. He was a national broker to hundreds of agents across the country, and as a received top awards for management and production. He's published articles for industry magazines and local papers as well been interviewed on radio several times now a podcast regarding senior issues and the importance of planning. He's a member of the nonprofit Long Term Care Forum Panel of Colorado, advising state legislators and industry experts on long term care planning issues in the state of Colorado. He holds the designation of CLTC, which classifies him as a certified long term care specialist. Tom is currently doing educational workshops and seminars on income protection throughout Colorado. He's the co-host of the streaming TV show New Horizons, Living Life to the Fullest, which illustrates how resilient and empowering the second half of life can be. Tom contributed to Kevin Gussman's Amazon bestseller Retire with Freedom and Confidence, and released his own book called Are you Protecting your Greatest Asset in December of 2018? You've done a lot, haven't you? 

 

Tom Rasmussen: 

Well, I like to keep busy. 

 

 

Cynthia Margiotta: 

Yes! 

 

Tom Rasmussen: 

Don't we all? 

 

Cynthia Margiotta: 

Don't we all? Yes. So let's get started with some of our questions. First off, what is meant by "second halfers"? 

 

Tom Rasmussen: 

Well, that's a great question, and appreciate you allow me to be on the show here. So, "second halfers"...you know, there's a term that has been used for a number of years called seniors. And I've never liked that labeling, because it identifies that certain segment of society as being maybe has no value. I mean, that, you know, we're in a society that let's face it, our particular culture doesn't really cherish seniors. And I decided to coin a new phrase of " second halfers", because it doesn't identify somebody by what you would consider their age. And so, if I said senior to somebody, what age do you define that by? Sixty-five or older would generally be the response? If I say "second halfer"? You mean 45, 48? Sure, why not? It just it's a way to break down this the perceptions of society that you know, seniors are not ready to put out to pasture. 

 

Cynthia Margiotta:  

Alright, I like your term, by the way, I think it's a really useful thing. I think we should switch it up a little, huh? You did something like that. So what is resiliency? 

 

Tom Rasmussen: 

Resiliency is an interesting word because when I do workshops, I always ask the audience, are they resilient? And it's interesting, the puzzled look you get from people. And so I have to go a little bit further and I ask, have you ever made it through a challenge, whatever that challenge may be? Oh, yeah, yeah, for sure I have. Well, the dictionary defines resiliency as recovering strength and I always have to point out that resiliency is achieved by pushing through a challenging situation. So, resiliency is something that we probably have all experienced in our lives. But I don't know if we have identify it as such, when we actually achieve it. 

 

Cynthia Margiotta: 

Yeah, well, it's hard to be resilient. I think that that's a good term to use. I don't think that's used very often in our society. 

 

Tom Rasmussen: 

Well, for resiliency was easy than everybody be doing it.  

 

Cynthia Margiotta: 

I mean, it's not used that word, you know, either you did it or you didn't do it. Not that you became more resilient in and learned from it. 

 

Tom Rasmussen: 

Well, it's words are powerful. And I tried to take a very strong look at the words I use to identify either meanings beyond what people perceive certain things to be, or change the perception of what people think, like seniors to "second halfers". 

 

Cynthia Margiotta: 

So, what is empowerment?  

 

Tom Rasmussen: 

Well, I use those two words together, because sometimes people identify them as being the same thing. And they're really not, you know, where I stated the dictionary basically defines resiliency as recovering strength. Empowerment is defined as to give power to. So even though they're not the same thing, they're very much connected. Because when somebody pushes through a challenging situation, and is resilient, by doing so they empower themselves. And so that's where the connection comes from. And so that's why I like to use those two words. Because it really came about when I was writing my book, it dawned on me after I was about three quarters away of writing it that after thirty some odd years of doing what I do, nobody actually looked at putting a planning strategy together as empowerment. And I had to ask myself, and other people as well, why do we not think of that as empowerment? And so we had to define what was empowerment? Well, empowerment is anything that gives you the ability to be resilient. And so empowerment, on one hand, can come from resiliency or you can empower yourself to provide you more resiliency. 

 

Cynthia Margiotta: 

So they are wrapped up in each other very strongly. And they, like a circle, they come and they go. The circle can go clockwise, as well as counterclockwise. 

 

Tom Rasmussen: 

I mean, from the standpoint of putting together strategies that help what I call "life happens events", what's more empowering, to have a funding plan in place to help you push through those "life happens events", like a disability, an extended care situation, and unexpected death. You know, that should be a more prideful ability to say, look what I did, then to push it away, don't talk about it, and then not have it at all, and then have those things come into your life. And then is that the thing that could have created the resiliency to get through that? And because of that you didn't you achieve resiliency? 

 

Cynthia Margiotta: 

Hey, smart to be prepared? 

 

Tom Rasmussen: 

Well, we'd like to think so. Yeah, I wish everybody would take that a little more seriously.  

 

Cynthia Margiotta: 

So they definitely relate to each other. Absolutely. Yes. So what does this have to do with the second half of life then? 

 

Tom Rasmussen: 

Well, with having thirty-plus years, working with, you know, the "second halfers" that I have, there's things that we have to understand that as we go through our seasoned years, so to speak. Then, can we better position ourselves back to the preparedness and planning to be able to be more empowered to get every moment to its fullest capacity? You know, that's that's how it relates. I mean, there's several different things that I always attribute to when I give workshops and seminars and regards to how do you achieve empowerment and resiliency. And there's four things that I always talk about. So it's decluttering, telling your story, doing the paperwork, and have a funding plan. 

 

Cynthia Margiotta: 

Is that are part two? Is that the question for our part two? I don't want to ask that yet. So don't let don't get there yet. Oh, good. What are some of the things one can do to bring about resiliency, and empowerment to the second half of their lives? 

 

Tom Rasmussen: 

Well, like I mentioned decluttering, let's talk about that. So decluttering is a very interesting thing because who we as maybe a human nature, we like to keep things, collect things, gather things, for whatever reason. And I don't know about you, but through my life when I've had either four situations or by design, or I decluttered my life, it was very freeing. I use an expression many times that, do we own things or do things own us, you know, the more things we have, it takes a lot more of our time to maintain those things, whether it's time or financially contributed to the maintaining those things. So decluttering is one of those things that as we go into our second half of life, the more we declutter, it's two things, it's less for us to worry about as we get closer to our end result, which let's face it, we're all gonna pass away someday. And it doesn't leave that burden to our loved ones, to figure out what the heck they do with all your stuff. And a lot of times, we have this assumption that they want our stuff. And if we don't have that dialogue, we don't know if they want it or not. And so I've always said this, the decluttering can take away from the experience of embracing the whole passing of a loved one, because they can't fully be in that embracing of that passing and that cycle of life because they're stressed out about what to do with the stuff. 

 

Cynthia Margiotta: 

Stuff is a pain in the back! 

 

Tom Rasmussen: 

And declutter, it's part physical, material. But it's also emotional. 

Cynthia Margiotta: 

Okay. Okay. 

 

Tom Rasmussen: 

Have we decluttered the emotional regrets that we might have, because of relationships because of things that were said one way or the other? You know, that's part of decluttering, too. 

 

Cynthia Margiotta: 

It's important to do that maybe, for our mental health. You make me think, Tom, 

 

Tom Rasmussen: 

I've always said that. If we know, the two certainties in life, that we're going to age and we're going to pass away someday. Then, if we can, as mentally as we can think through this, especially as we come being in our second half of life, as opposed to doing how do we define a good life lived? Is that how much stuff we have? Or how many moments and impactful events that we had with other people as well as to ourselves? 

 

Cynthia Margiotta: 

For me, I'd say it'd be the people. Think of how many people have been positively affected by my life? 

 

Tom Rasmussen: 

Well, if we don't actually ask that question of ourselves, how do we ever know what that means to us personally, before we can go forward, and have that good life left. 

 

Cynthia Margiotta:  

Right. Good questions. You're throwing questions back at me, Tom. I'm supposed to be interviewing you! 

 

Tom Rasmussen: 

Yeah. Okay.  

 

Cynthia Margiotta: 

So how does telling your story bring about empowerment?  

 

Tom Rasmussen: 

Well, I've found that we're not capturing our life stories, as much as we probably should. And I'll give them my own personal story with that. My mother did a lot of genealogy had many different records, and she had boxes and boxes of photographs when she passed. Well, I inherited those. But what I didn't realize is none of those photographs had any information on them. So I had no idea who these people were. And so it got me to think that if we're able to pass on the wisdom that we have learned in our second half a life, how can we pass that on, if we don't record it in some nature, whether it's written, whether it's video, whether it's just, you know, audio? If we don't tell our story, it's lost when we're gone. And even to our own children, because our own children only know us from the time that birth was given to them going forward. They've really don't know who we were prior to that unless we had those conversations. If they don't know it, how can they pass it on to our grandkids and great grandkids? 

 

Cynthia Margiotta: 

Right. Information is important to share within families. Yeah, my mother had, I ended up with all her photos, and everything had initials, which is better than you got, I will say. But, you know, one of those many pictures was marked CJ. And it was lots of pictures of CJ. Who's CJ? Well, CJ was my mother, Claudia Jones. 

 

Tom Rasmussen: 

Oh! 

 

Cynthia Margiotta: 

When she married my father, she became Claudia Cleaver. So who was CJ? So those pictures, you know? It took a little, I guess, hard guesswork to figure out that those younger pictures have that 10-to 15-year-old were actually my mom. 

 

 

 

Tom Rasmussen: 

You know, it's not only telling our story so we don't lose ourselves once we're gone, and that can be passed on to generations and generations. But there's a real important thing that has to be, I'd say it has to be earned. I don't know if everybody agrees with that. It's called wisdom. Are we passing wisdom on to our generations that will precede us? Because if we can help them understand, as they get to a point where they can learn, maybe they don't have to go through those failures and mistakes to learn that wisdom. If we can pass it on, prior to them having to learn that on their own. 

 

Cynthia Margiotta: 

But, the young people don't want to hear mom and dad's wisdoms. 

 

Tom Rasmussen: 

You know, it's funny. Maybe you had the same scenario that I did. But I've heard this from people and I and I have actually experienced this. It's amazing how smart my parents became the older that I got. 

 

Cynthia Margiotta: 

Right? Yeah, my mom suddenly got a brain. And I was like, wow, who knew? 

 

Tom Rasmussen: 

You know, they couldn't turn on the TV but boy, we can't mistake wisdom for, I guess, intellect. You know, there's a lot of smart people that I've met through my life, but I wouldn't say that we're really wise. So there's a difference between intellect and wisdom, wisdom is learned. And life will continue to give us these lessons to learn the you know, and if we don't, we'll repeat them. But the only way that we gain wisdom is acknowledging how we get past that lesson, resiliency. Empowerment comes from the knowledge of understanding of I shouldn't do that again. 

 

Cynthia Margiotta: 

Learn from my past mistakes. What is that saying? You know, something about doing it over and over again? 

 

 

Tom Rasmussen: 

Einstein said the definition of insanity is doing the same thing over and over again, expecting a different result. 

 

Cynthia Margiotta: 

There you go. That's the exact saying! It was Einstein, huh? Yeah, he should be my hero. So how does doing the paperwork bring about empowerment? 

 

Tom Rasmussen: 

Well, that kind of goes back to the decluttering. If we've decluttered the things in our lives and we've told our story, then we have the documents in place to help our loved ones know what to do with our passing. Or, if we just become incapacitated or incompetent. You know, they have to step in and take over our lives. How do they know what to do? Do they know who to contact, you know, so advanced directives, a will, or a trust, who is my insurance agent, my banker, my attorney? If we don't put this in some form of writing, whoever is supposed to fill in for us can go to and have those contacts, as well as have the authorization through, you know, the proper forms, to be able to make those decisions like the power of attorneys and, and those kinds of things. Then again, we're putting that burden and that stress on our loved ones when it wasn't necessary because we didn't want to get around to that.  

 

Cynthia Margiotta: 

I think it's so important to do that. Get those papers in order, have them all, you know, somewhere. Tell the people that are involved in those papers where they are and how to get to them. You want your power of attorney to know what's going on, what your expectations are, what your needs are, what your wishes are. And if you don't do that, they're lost. 

 

Tom Rasmussen: 

Even getting down to the details of who you want to step in for your financial matters, that might not be the same person you want to step in for your health issues. You might want to separate those two.  

 

 

 

Cynthia Margiotta: 

I think that's brilliant, separate them. In most cases, it's very important. When I became my mother's medical power of attorney was very good. I did not want her financial powers of attorney. And so my sister kept those and she was in charge of the money. And I was in charge or, no offense, but in charge of the body. And I think it worked out well for us in our family. But what if you only have one kid, you know? 

 

Tom Rasmussen: 

There are other ways to have, you know, people that can fill in those roles, like fiduciaries. You know, there's there's different ways that you can have people fulfill those roles.  I hate to say it, but I've seen situations where the individual who had the purse strings was also making the medical recommendations. And because they knew if they spent money on the medical, that they would reduce their inheritance. So that played a role in their decision making. 

 

Cynthia Margiotta: 

Right? And that's where some of the problems start, right? You know, between the two people. Then when you're only at one, okay, so you have you just shared the one if one person's in charge of both. If you have two people, you can sometimes have the problem. It's sort of the opposite where the medical wants to do one thing like, oh, let's say mom needs a new hip, we got to get her a new hip, we've got to pay for that. Let's do that. And then the financial power of attorney says, "no, I don't want to spend that money". 

 

Tom Rasmussen: 

That's not what that's about. It's putting...

Talking about death doesn't make it happen, yet so many of us are afraid that this will be the case.  Join MSW, Kent Mathews, as he discusses the differences in palliative care, hospice, what Medicare may pay for and how families can ask for help.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country. We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado. The Pikes Peak Area Agency on Aging is the producer. Learn more at Pikes Peak Area Agency on Aging.

Transcript:

You’re listening to studio 809. This is what community sounds like.

Hi, this is Dave Gardner. I just want to make sure you know that during these unusual times peakradar.com/virtual brings local arts and entertainment right into your home. From local music to gallery tours to classes in dance, yoga, writing, and more. Our community is still creative and invites you to join in at peakradar.com/virtual

 

Michaela Nichols:

Hello and thank you for listening to Aging with Altitude, a podcast series elevating the issues that matter. This series is produced by the Pikes Peak Area Council of Governments Area Agency on Aging. Today’s episode is about end of life issues. My name is Michaels Nichols and I’m here with Kent Mathews. Kent is a care manager in the Family Caregiver Support Center at the Pikes Peak Area Agency on Aging. He has over 27 years of experience as a social worker and has worked in hospice care as well. End of life issues can often be hard to talk about. Many people hope that they will be able to make their own decisions or that a loved one will be able to make their own decisions toward the end of their life, but in many cases they lose that ability so being unprepared can put loved ones in uncomfortable positions. So can you talk a little bit about what barriers individuals experience when beginning to make end of life plans?

 

Kent Mathews:

The most common barrier I hear coming from caregivers when I was doing hospice work coming from even hospice patients was when it comes to like the advanced directives, they would say well I’ll execute them. I’ll fill them out when I need them not knowing that they probably wouldn’t be able to execute them when they needed them because they would be like in a physical state where they were unresponsive, couldn’t speak or something like that where they wouldn’t be able to even begin to fill out those documents. So I think that’s one barrier. Another one is we don’t like to think about our end of life. We don’t like to think about our deaths, and we live in a very death aversive society. Generations ago when we were still a very rural society and weren’t as urbanized as we are now, and still a lot of people living on the farms or out in nature and what not, we were still very much in touch with the cycle of creation. Earth, life, death. All of that. And now, we’re really, really removed from that. And so that’s a huge barrier as well. I think another barrier that comes to mind is, people don’t have an easy place to go to get good information about what’s really going on with their physical condition. I recently ran across a statistic that said that if asked to do a treatment and a doctor knew that the treatment wouldn’t do any good for you, 40% of doctors still said they would recommend the treatment, which is in my estimation is just rather appalling that they would even do that. So a lot of times people rely on their doctors to give them that information to tell them what’s really going on, but most doctors aren’t equipped to do that. They don’t have the skills to do that. They may have the knowledge, but they don’t know how to communicate that in a way that is comfortable for them and therefore makes their patients comfortable. Everybody’s kind of walking around in the dark. You know, the medicines that we take, a lot of the medicines for chronic illnesses cover up the symptoms which then creates the illusion that I’m not as sick as I really am, which is another barrier. Why would I want to execute that because I feel fine? I may be taking 8 to 15 different medications, but I’m not going to die so why would I want to execute those things. So those are some of the barriers that I’ve been encountering in my career.

 

Michaela Nichols:

In the confusion around what end of life care is, can you talk about the differences between nonmedical and medical decisions that they need to think about?

 

Kent Mathews:

So I get phone calls from caregivers and they’re wanting to know where they can go to hire a nurse. And then talking with them on the phone, they’re looking for somebody to come out to the house to help mom or dad or a family member with like maybe bathing or dressing, and maybe making sure that they are taking their medications. You really don’t need a nurse to do that. In the home care industry, there are different levels of skill that a home care worker has. In Colorado when they required home care agencies to be licensed, they established a two-tier system. There is a class A and a class B license. The class B license is the nonmedical. The class A license is the medical or what’s often called the skilled. The two differences between those two licenses, there’s a number of them, but the major difference is the A license, or the skilled license, is that home care agency has what is known in the healthcare world as skilled positions, so you have the nurse. An RN, an LPN,  maybe a NP. You also have skilled positions like the therapist, the occupational therapist, the speech therapist, the physical therapist or what’s called the OT/STs. Those are all skilled positions. CNA’s are considered a skilled, semi-skilled position. And the class A’s have CNAs. The class B’s have what are called personal care workers and homemaker companions. When you’re looking at home care agencies, and you’re looking for what kind of care, if you’re needing somebody to come out and help mom or dad with maybe some light housekeeping or some bathing and dressing kind of a thing, you don’t need a nurse to do that. You don’t even need a CNA. You could use like maybe a homemaker companion who could do the light housekeeping, the light meal preparation. If you wanted them to help with bathing and dressing, you’d have to have like a personal care worker because that person then can legally touch your family member and provide that hands on, physical care. And going back through all those levels, the least amount that you’re going to pay per hour is a homemaker companion. In the Colorado Springs area, that’s probably running $18/$19 an hour right now. Then the next higher level would be like a personal care worker. That’s going to run in the low $20 per hour. Then you’re going to CNAs. That’s going to run in the mid to upper 20’s. And then when you get to like a registered nurse, you’re looking at $30 or more per hour kind of a thing. So to pay, you can choose between somebody that has the same skills a personal care worker who you could pay maybe around middle 20’s or so or an RN, you’re paying 30 or higher. You’re saving money to go with a personal care worker. And so that’s some of the difference between medical and nonmedical.

 

Michaela Nichols:

What are some misconceptions around these different types of decisions that people have to make?

 

Kent Mathews:

I’ll go into like, because I did 15 years of hospice social work. Some misconceptions, one of the huge misconceptions about hospice care is you have to be bed-bound. Now there is nothing in the rules or regs by Medicare which licenses and oversees the hospices. There’s nothing in the Medicare rules and regs that say you have to be bed-bound. But most people have that misconception that if my family member is up and walking around and able to do stuff, then they’re not sick enough to be on hospice care. And in reality, what qualifies a person for hospice care is not what they’re doing or not doing. It’s do they meet the specific medical criteria for a specific condition or disease to qualify. And oftentimes people can meet those conditions and still qualify for hospice care, but be able to do a lot of taking care of themselves. I had hospice patients in my career that were going on two-week cruises and going on vacations to Disney Land and Disney World or Las Vegas or travelling eight or nine hours across country to go visit family members for 7 or 5-8 days and they were the ones doing the driving, but they were still on hospice care. So it’s not qualifying for hospice care is not about what you can or cannot do. It’s about do you meet the medical criteria. Another misconception is people think that their doctor has to say that they’re ready for hospice care. I teach a concept called hospice 101 and basically after listening to a caregiver tell me what’s going on with their family member physically, what kind of chronic illnesses they have, often times I will say so have you thought about hospice care and they will say my doctor hasn’t said that dad’s ready for it. Most doctors, unless they have done time as a hospice medical director, do not know all of the specific medical criteria that go into qualifying a person for hospice care. And doctors like all of the social workers, healthcare professionals, even people on the street, we all have our misconceptions, misunderstandings about hospice care. So if doctors have those misunderstandings and misconceptions, they may not be willing to recommend somebody for hospice care. Years ago when I was in Arizona, I was working for a hospice who also had a homecare and the hospice was having difficulty getting people from their homecare over to the hospice side for a lot of different reasons. Some of them for the misconceptions we’ve talked about. I remember this one daughter was taking care of mom. First time I went out to visit her as the home care social worker, mom was living in her own apartment and mom had cancer. We talked about everything, and mom said I’m not ready for hospice care. I’m still doing treatment. I said that’s ok. And then, oh I don’t know, maybe three, four months later I was asked to go back out again as home health and this time mom had moved into daughter’s house. Daughter greeted me at the door and when we were walking down the hall we walked by mom’s room and mom was laying in bed. Her bed was elevated at a 45 degree angle and mom’s jaw was relaxed so it was dropped. Her mouth was open, her eyes were rolled back in her head and she was doing what we call chain breathing, so really rapid and in succession. So when I sat down with the daughter I said I think your mom is starting to enter what we call in hospice the active dying process. So before I could stop her, daughter picked up the phone and called the oncologist and the oncologist was screaming at the daughter and demanded who told her that mom was dying and she said well I have a hospice social worker in here and he said put him on the phone. I held the phone about two feet away from my ear and I heard the oncologist perfectly because he was yelling that loud into the phone and he was accusing me of practicing medicine. He was saying how did I know she was dying. Only doctors knew that kind of stuff. And he said if she stops her treatment now she is going to die because she needs to finish her chemo treatments in order to stay alive and all of that kind of stuff. I hung up the phone and had a conversation with the daughter. We figured out a way to go to another doctor to get an order, which then allowed our hospice to send out one of the hospice nurses to do the evaluation. Long story short, mom died the next day. We got her into hospice care that night. She died the next day. Sometimes, all of us have our misconceptions and this oncologist evidently had his own misconceptions about what hospice was. I’m not even going to speculate what those were, but that happened over 20 years ago and I still have a vivid memory of it. So when it comes to this whole end of life issue, because we have a lot of barriers, we also, and because we’re not talking about it anymore. It’s not an easy conversation. When I talk to caregivers, sometimes they talk about well, you know. I’m thinking dad’s really sicker than he really is and then they begin to apologize because they think that by talking about death, and that’s another misconception. If you talk about death, it’s going to happen. We can talk about death all we want, but that doesn’t mean it’s going to happen. But that’s how deep our fears go as human beings when it comes to death and dying is we believe that when we invite it in, it’s going to kill us.

 

Michaela Nichols:

That’s a really powerful story. And it shows that people rely on their doctors as well and they’re not always the specialist in end of life issues.

 

Kent Mathews:

Right.

 

Michaela Nichols:

So I guess, along the line of medical care, and you were talking about hospice care. Can you talk a little bit about the different between palliative care and hospice care?

 

Kent Mathews:

1. So I’m going to try to give as good of a verbal picture about this as possible. The picture is, draw a circle about the size of a quarter and then draw another circle that’s about the size of a small plastic lid on a container. And that small circle, the size of a quarter, needs to be inside that larger circle. And so you’ve got a small circle inside a big circle. So palliative care is the big circle. Hospice care is the small circle. So with that said, all hospice care is palliative care, but not all palliative care is hospice care. And there’s differences. The biggest difference between palliative care and hospice care is on palliative care you can continue treatment for whatever your hospice diagnosis may be. So let’s say it’s chronic obstructive pulmonary disease or COPD which means your lungs aren’t working well and it’s difficult to breath and it’s going to lead to your death. And so, if you’re on palliative care any treatment that you were doing for the COPD you can continue. On hospice care, any treatment that was “to cure the COPD” you can’t do. I think a better example than COPD would be like cancer. So on palliative care you can continue to get your oncology, your radiation for the cancer. When you’re on hospice care you cannot do the oncology. You cannot do the radiation. You have to stop those. So that’s the biggest difference. Another difference between palliative care and hospice care is the support level. When people are in hospice care the support they get is really well defined because Medicare pays for the hospice care and Medicare says that hospice care is provided by a team, and the team consists of a registered nurse, a CNA, a social worker, a chaplain and a volunteer. Medicare says in those policies that the only person that the hospice patient has to see is the nurse and the nurse has to visit them at least once every two weeks. Most people when they’re on hospice care take the full team. The nurse, the CNA, the social worker, the chaplain, and they even ask for a volunteer. On palliative care, it’s not as well regulated because I’ve had conversations with professionals in the community who are involved with the palliative care programs and the palliative care program is struggling to figure out a way to properly bill Medicare. Under hospice care there is very specific billing codes you use. Under palliative care there’s not. So you can get reimbursed by Medicare for palliative care, but it’s not easy to do as a provider. The other is because it’s not regulated by Medicare like hospice care is, you can have a palliative care program where it consists of a registered nurse or a nurse practitioner going out and visiting the patient once every three or four weeks to check on things like their pain level or their medications and maybe make some adjustments in the medications or what not, but that’s it. Nursing visit once every three or four weeks kind of a thing. There are some palliative care programs where they will allow a CNA to go out to help with maybe some of the physical care. I know of maybe one, possibly two palliative care programs in our community where they offer the full team. A nurse, a CNA, they’ll maybe pull the social worker from maybe the hospice side kind of a thing. A chaplain would be from the hospice side kind of a thing. No volunteer, but those four people to go out and support the person while they’re on palliative care. To be really honest, those programs that are doing that are really losing money off of the palliative care because Medicare doesn’t reimburse well for palliative care. I’ve had conversations with professionals in the community that have said, I have said until Medicare decides to license and regulate and oversee palliative care like they do hospice care, palliative care is not ever really going to catch on and take off because hospice care was suffering from the same thing back in the early 70’s and what not when hospice care came over. All of the organizations that were doing hospice care were non-profits and the professionals were volunteering their time or if it was a very organized non-profit they’d raise the money so they could at least pay the nurses and maybe the doctors, but the rest of the team were volunteers. And it wasn’t until Medicare came up with the hospice Medicare benefit which is under Medicare Part A, that hospice really began to take off and flourish. My point is, the same is going to happen with palliative care. It’s going to struggle, but when Medicare decides to regulate it and license it like they have hospice care, it’s going to take off. But those are some of the major differences. You can be on palliative care, but not on hospice care. You can be on hospice care, but that also means you’re getting palliative care and there’s restrictions either way. The other similarities between hospice and palliative care is it’s provided wherever you are at. So if you’re in a home, if you’re in a care facility, assisted living or nursing facility, palliative care can go there. Hospice care can go there. When I was doing hospice work in Arizona, I had one patient who the hospice care started. He was living under a bridge and then the other hospice patient that I remember, he was living in three large cardboard boxes in the middle of the dry riverbed of the Salt River. But hospice care, that’s another misconception. People often think that hospice care is a place. It’s not. It’s a type of care and hospice care will go wherever you are at.

 

Michaela Nichols:

End of life issues are so hard to talk about and America has a fear of talking about death. How would you recommend someone going about talking about it for themselves, talking to their children or loved ones or for a child talking to their parent about what they want?

 

Kent Mathews:

So I’ll start with the easy one first. So an adult child talking to their parent about what they want. The adult child needs to be thinking about what they know mom and dad have said to them. So why is the adult child coming over to take care of them? It’s because mom and dad want to stay in their home for as long as possible. OK, What mom and dad don’t understand is that they have to put some certain things into place to absolutely guarantee that. So a good starting point would be to say, dad I know that you really want to stay in the house and I’ve been coming over to help you stay in the house, but to really guarantee that you stay here until you die, which is what you told me, we

Go vote!  Shelly Roehrs, President with the Pikes Peak Region League of Women Voters reminds us the deadline to postmark a ballot is coming.  If you mail it in, it must be postmarked 8-10 days before November 3.  Yet, ballots can be dropped off at drop-box locations anytime up to 7:00 PM on voting day and of course you can vote in person.   Find drop-box locations at govotecolorado.gov.

The League has been an active, non-partisan voice encouraging voter engagement and understanding of issues since 1937.  Visit 411.org to review summaries submitted by candidates and issue sponsors.

Visit the local League at lwvppr.org for more information.  Additional ballot issues are discussed at the League podcast at lwvppr.org.

 

Transcript:

Cynthia: Hello everyone, this is Cynthia Margiotta with the Area Council of Government's Area Agency on Aging, volunteering some time to do an interview with Shelley Roerhrs. She is with the League of Women Voters of the Pikes Peak region and their mission is to empower voters and defending democracy, thank you. The League of Women Voters has fought since 1920 to improve our systems of government and impact public policy through citizen education and advocacy. The League is a nonpartisan and grassroots organization. The League of Women Voters from the Pikes Peak area region has been active since 1937. Members actively promote voter and civic education by registering voters in high schools and nationalization ceremonies, attend city and council government meetings, present the pros and cons of the issues of our elections, and much more. The League of Women Voters has two separate and distinct roles: better service and citizen education and action advocacy.  

What this means to you guys who are listening, is the league's mission is to inform voters about the issues and candidates on our ballots. Candidates and issue organizations fill out information provided to them in an online voter guide and voters can visit vote411.org for this convenient information. The League also encourages active participation, whether it's in the office of an elected representative, City Council meetings, writing a letter to the editor, or at rallies. The program also empowers voters by emphasizing the power of the voter and promotes voting in every election: presidential, gubernatorial, municipal, primaries, and special elections.  

Wow, you guys do a lot!  

Shelley Roerhrs: We do, we do. We keep pretty busy, especially in a presidential year.  

Cynthia: I bet you do! Now, it's like every commercial out there is about elections.  

Shelley Roerhrs: It is, it is. We try to strive like you mentioned the presidential, gubernatorial, and municipal, we want you to vote in every election. We don't care who you vote for, we are a very nonpartisan group. But again, it doesn't matter who you vote for! For us, as long as you vote in every election, that includes your primaries, municipal elections, and special elections as well.  

Cynthia: Yes, I agree with you it's important to vote. We are leaving ourselves out of the discussion if we don't vote.  

Shelley Roerhrs: Yes, ma’am.  

Cynthia: Let's get to our first question!  

Q: We are a mail-in-ballot state. Is there a lot of voter fraud in a mail-in-ballot state? Will my vote be counted?  

Shelley Roerhrs: So, yes, 100%! Mail-in-ballots are safe. The unique thing about Colorado is that we've been a mail-in-ballot state for quite a while. They are pretty much the grade A of how other states basically relate to and say "this is what we want to do in compared to Colorado." So, you know, there are no issues with mailing in your ballot, as long as you mail it in on time. We'll get to kind of some dates later on as far as when you're supposed to mail it in. But yes, mailing your ballot or you know, what's even more convenient is if you don't want to Mail it in, the El Paso County has all of those drop boxes. So, they are located all over the city and the county. Just go to one of those drop boxes and drop off your ballot if you don't feel like mailing it in. Again, so another convenient way the drop-off box.  

Cynthia:  

Q: Where do the drop-off boxes tend to be?  

Shelley Roerhrs: I think like there sixty-something boxes across the county. I know there's one on that, of course, the El Paso County Clerk and Recorder on Garden of the Gods typically have them. DMV places typically have them. Community centers, like your Municipal Court, have them. City locations, anywhere a lot of people congregate, that is a government facility, are typically where they're going to have one of those drop boxes. I know there's one down at the courthouse downtown as well.  

Cynthia: Yes, that's typically where we drop ours off.  

Q: Do you have a calendar of important upcoming dates? 

Shelley Roerhrs: Well, I want to go back to when you said is there a lot of voter fraud. I want to solve voter fraud because you see a lot of that coming from our leaders who say mail-in ballots are not safe. I think just a couple weeks ago there was a time when our president was actually telling people to vote twice. That's actually not a good thing, right? We don't encourage that. It's actually a felony in some states to vote twice. So from a voter fraud perspective, this is from Chuck Broerman, we have our own podcast called "Making Democracy Work" and we interviewed Chuck Broerman for this specific reason regarding voter fraud. Because, honestly, my dad thinks that mail-in-ballots are rot with fraud. Now, he comes from a state that does not have mail-in-ballots, so we try to educate him. Again, one of those things that the League of Women Voters does is try to educate voters. In my case, I'm trying to educate my father as a voter. Your mail-in-ballot, if you do choose to mail it in, is safe. It is not going to be manipulated. It will count. The great thing, again M. Broerman, the Clark County Recorder you know? They have specifically designed our ballots so they have a special barcode on special weighted paper that they know exactly when they come in. That might be a fraudulent ballot and the number of fraudulent ballots that actually come in is very, very minuscule. I think it's a matter of the ones, that he said that came in, and someone voted twice. And again, it was very small. So the thought that we need to spend money on trying to fight voter fraud is, I think, somewhat comical actually. You know, if some people think that there's voter fraud out there I would encourage them to actually talk to their Clerk and Recorder. The Clerk and Recorder is the person who deals with your voter registration in your elections. They know exactly what is going on. Just don't believe everything that you see on T.V. or look at in the paper. It's not necessarily the truth. But your last question was; will your vote be counted? I think yes, as long as you vote. That's the most important thing, right? The most important thing is that you vote and yes, it will be counted.  

Cynthia: They have a specific weight, you know? I don't know how anyone would mimic that so well.  

Shelley Roerhrs: There are some smart people out there, but again, I think that they're doing things in other ways to manipulate our elections rather than this voter fraud that we're focusing on. I think, for your listeners, yes drop it off if you feel that the mail-in- ballot is rot with fraud. Mail it in or go ahead and drop it off in one of those drop boxes knowing that that goes directly to the Clerk and Recorder's office. There's no in-between man and the post office is not in there. But, again, mail-in-ballots are safe. Here's the thing, the military people didn't have a choice, right? Overseas, people don't have the choice to mail it in. You know, they have to mail-it-in.  

Cynthia: Right!  

Shelley Roerhrs: Your other question was about important upcoming dates. I'll just kind of move into your other question! Military and overseas voters, they have already started mailing those ballots. So they are arriving in the next couple of days if you haven't already received them. So, those specifically were already mailed in. Our ballots, for everybody else, will be mailed out on October 9th.  

Cynthia: Okay, good!  

Shelley Roerhrs: So that's when we should be looking for them in the mail.  

Cynthia: That gives us plenty of time to do our individual research to see, you know, who do we want to vote for? I like that you guys are nonpartisan, that's an important part of who you are because you're not trying to convince people to vote one way or the other.  

Shelley Roerhrs: For candidates, I will say that. I'm going to preface that a little bit because we are going to get into some ballot issues, right? We do not specifically tell you who to vote for, especially candidates as a League of Women Voters. You know, that's not our job. There are certain ballot issues that we do take a stance on, just because it goes with our advocacy. Whether that's the park's air quality or the water, right? Those are big, important issues of the league and for us. We do kind of take and give you. There is one proposition, 113, which is a state ballot issue. The national popular vote is coming up. And, again, we will get into those ballot issues. That is one where we would like you to vote yes, right? We don't want the same issue to happen again with the Electoral College. You know, we want every vote to count and that is exactly how every vote counts, is the national popular vote.  

So, that is one thing but another date that is going to be important for your listeners. In the state of Colorado, two notices come out. One is a state notice that the state puts out, and it's on state issues. Those come out around the same time as our local ballot issues, which are local to El Paso County and the city and certain things. The state does a blue book, and we have a tabor notice for the local stuff. So, there are specific things, you know, those are coming out probably in the next few weeks that you'll see that. I know from vote 411, for your listeners, the League of Women Voters does vote for 411.org for candidates and any other issues pros and cons. You can go to vote411.org and get any information on the candidates. Now, the candidates have to fill it out and if you see that a candidate did not fill out the League of Women Voters nonpartisan vote 411 information, that tells you a lot about that candidate. They don't even want to take the time to give you the information.  

This is a national thing so it's not like just Colorado. This is a really good thing for candidates and issues, right? If you got an issue like Amendment B and Amendment C, we got a lot of stuff on the ballot this year. They try to shove it all in one year so it kind of is a lot. It really is. Well, the presidential year is obviously the biggest turn out here, right? The most turn out, it's I think it's like over 70% turn out, in a presidential year. So, it's got a lot on the ballot.  

Cynthia: So, if we could get it to 95%, that would be great! 

Q: When do I need to mail it back?  

Shelley Roerhrs: So, if you're going to be mailing it, you want to mail it at least seven days in advance. They're actually even recommending 8 to 10 days, right? I would even say you want to get it in the mail 8 to 10 days in advance of November 3rd. It cannot be postmarked November 3rd and have it count here in the state of Colorado. They actually have to receive it by Election Day for it to count. In other states, as long as it's postmarked it counts. In this state, you have to mail it in and it has to be received by November 3rd.  

Cynthia:  

Q: So eight to ten business days?  

Shelley Roerhrs: Correct! Or, drop it off the day of. Remember, at those drop-off centers, you can drop it off the day of the election, just like you're voting on Election Day. Drop it off that day. If you mail it, it is 8 to 10 days in advance. If you drop it off, you can go the day of.  

Cynthia: That would be good!  

Q: Do they have lines at those things?  

Shelley Roerhrs: Typically, you might have one or two cars in front of you. Usually, they have people out there making sure that things go pretty smooth.  

Cynthia:  

Q: What do I do with it? Where do I take it?  

Shelley Roerhrs: Again, those drop-off centers. I will tell you two places in Colorado Springs. You can visit govotecolorado.gov or the El Paso County Clerk and Recorder Ofice website. They have a list of the drop-off boxes there.  

Cynthia: Good.  

Shelley Roerhrs: If you have questions, call them. Their website has, literally, locations for ballot drop boxes and voter services centers. I forgot to mention one thing, they have these things called voter service centers here. El Paso County has them on Garden of the Gods, there are voter registration office. Then, they have these voter registration offices that are all kind of on steroids, just little pockets of accounting where you can go as well. So those are kind of, you know, all over. I would recommend going to the clerk and recorders office to kind of find exactly which one is closest to you.  

 

Cynthia:  

Q: Yeah, and if I'm not registered, how do I get registered? What do you do to be registered?  

Shelley Roerhrs: If you're not registered, you can do it online or you can go in-person. With COVID, you know, online is best, as long as you have a driver's license or ID. Go to votecolorado.gov, just go on there and it literally says "click register to vote." OK?  

Cynthia:  

Q: It's that easy?  

Shelley Roerhrs: It is that easy. Now, if you have a problem because sometimes it doesn't accept your driver's license or whatever, then you do have to go in-person. Again it's a really simple registration here in Colorado. So you can go on the day of the election on November 3rd.  

My son did it, he turned 17 this spring so he was not 18 when the primaries came up. In the state of Colorado, if you are 17, you can register to vote and vote in a primary if you'll be 18 before the general election. So we went the day of. he registered that day, and he voted in the primary. Now, of course, he's voting in the general election as well because he turned 18. So, for that instance, you know, again, Colorado makes it so easy to vote. 

 I find it hard to believe sometimes when people have an excuse not to vote, right? There's something else that I forgot to mention, in the state of Colorado, if you are a convicted felon, as long as you have served your time or you're out on probation, you are good to go. You can go and register to vote as well.  

Cynthia: Oh!  

Shelley Roerhrs: I know, isn't that amazing? So, again, if you served your time, whether you're a convicted felon or not, you should not lose that right to vote. It is one of the fundamental things that we have. So, again, Colorado, if you know someone who is disenfranchised because they think "gosh I'm a convicted felon, I don't have that right anymore," they do in the state of Colorado! Some other states do as well. Here, go and register, I recommend it!  

Cynthia:  

Q: What if they are still in prison? Can they vote then?  

Shelley Roerhrs: Oh no, so if they had been convicted and they are in prison, I do not believe so. If they are awaiting trial, and not convicted, 100%! If they are still kind of in limbo, not yet, they can't. Again, if you're out and you served your time, go and register.  

Cynthia: Good!  

Shelley Roerhrs: One of the things is updating your information. It is not just about registering to vote, because a lot of people that we come across have already registered, right? You're like, "gosh, what is the league doing if everyone is already registered?" It's also important to update your information because there are a lot of inactive voters. That's what they are called, "inactive voters." You might not get a ballot, right? So, if you think "I may have moved since the last time I voted" ...if the last time you voted was in the presidential year in 2016, or if something is happened, right? You know, there are a lot of military around here and a lot of people moving in. So we also encourage you to go to govotecolorado.gov because you can update your information right there as well. It's really convenient to get your ballot.  

Cynthia: Yes, get that corrected. 

Q: If you don't have a driver's license, what can you use as an ID to register?  

Shelley Roerhrs: That's a very good question and I'm going to have to refer to the Clerk and County Recorder's Office. Typically, you're going to need a passport, you're going to need a military ID, or some other type of state-issued ID is what they require. You know you don't have to have a driver's license because the state will give you an I.D for free, right? In those instances, my first instinct is to say your passport, your free ID, or birth certificate. If you need to prove your identity, like to get a driver's license. they would take any of those types of things. But, I'm going to refer to the Clerk and County Recorder's Office, just to kind of confirm. It will say on there, govotecolorado.gov, exactly what you need. For online registration, you actually have to put in your driver's license or state ID number, it does not let you put in your passport. So, if you have something other than that, you have to go to the office.  

Cynthia: Some people, when they're no longer driving, they just let it expire.  

Shelley Roerhrs: Correct.  

Cynthia: They don't need, in their opinion, they don't need another form of identification.” I'm eighty, so I don't drive anymore,” kind of thing. So that would be helpful, thank you.  

Shelley Roerhrs: I still think they need some form of ID, though. At some point, right? Usually, you know for any type of Medicare or Medicaid, don't they need an ID?  

Cynthia: I think so, but some people just let it go and they just show their expired license. If their doctor says "no more driving" they may not drive anymore but they still have that.  

Q: So, what do I do if I don't receive that ballot?  

Shelley Roerhrs: So go to govotecolorado.gov, or check with our El Paso County Clerk and Recorder. Their phone number, I'm going to give you that real quick, just because there are a lot of questions that we refer to them. That number is 719-575-8683 to vote. Again, 719-575-8683. You can go update your information with them. Again, go to govotecolorado.gov and you can update your information there. If you don't receive your ballot, I would 100% either go to the El Paso County Clerk and Recorders Office or call them and find out why.  

Cynthia: Very good.  

Q: So, voting during COVID this year, what do the listeners here need to be careful of when voting during COVID?  

Shelley Roerhrs: Well, I think the main thing is, if you do go and vote in person, you want to wear the mask and take all those protocols. But, you know, if you don't have to go and vote in-person, and you want to just drop off your ballot, that's probably the best thing to do. Because of COVID, the only thing I can say is just don't not vote. It is so easy to vote, even in the current situation. We have it much, much better than some states. I come from South Carolina and I think their representatives just allowed, so there if you want to vote in-person or get a mail-in-ballot, you have to have an excuse. You...

PART 2:  The Pikes Peak Elder Abuse Coalition has been working to keep vulnerable adults safe for 15 years and that work continues during COVID19 times.  Dayton Romero, Chair of the Coalition and Director of Senior Assistance Programs with Silver Key, discusses the extenuating circumstances and challenges being faced during COVID19.  Fraud abounds with specific COVID scams and abuse is heightened as people lack support and have more stressors.  Learn how the Coalition is meeting the needs.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

 

Transcript:

You’re listening to Studio 809. This is what community sounds like.

 

Cynthia Margiotta:

This is Aging with Altitude. Welcome to all. Brought to you by the Pikes Peak Area Council of Governments Area Agency on Aging. We strive to provide answers assistance and advocacy to our elders. Please know that our guest today and I are sitting about 10 feet apart and we are practicing the social distance protocol, and I hope you are too. We are in the middle of the COVID-19 pandemic and one of the issues is elder abuse and how it’s increasing. My guest today is Dayton Romero. He works for Silver Key, has been there since 2015. He’s responsible for overseeing the administration and operations of several programs there at Silver Key. These programs include case management, guardianship, behavioral health, food pantry, and commodity food programs. and the Silver Key’s different lines of services. We have been talking about abuse in the home, also called mistreatment. There are several kinds that people deal with and so we are going to continue that discussion here. My name is Cynthia Margiotta. I’m a geriatric social worker and a volunteer with the Pikes Peak Area Council of Governments Area Agency on Aging, so let’s get started with our next question. When there’s financial exploitation, in particular, it’s done by an insider. That’s someone they know. A family member, relative, a loved one, a caregiver, someone. With the loss of income for many people, are families turning to their parents now for money?

 

Dayton Romero:

We have yet to anecdotally hear about those situations. I can say regardless of COVID, we see that too often already where there is a codependence among an adult child or another who’s actually living in the home with that senior who owns the home really kind of depending on that person too…

 

Cynthia Margiotta:

Support them.

 

Dayton Romero:

Support them. Yep, and you know it also could be, again, the codependence as well. We’ve seen it kind of one sided. One person moving in and really relying on the support of that person all the way to the point where an individual really reaches that level where they need a higher level of support. And I mean that in care support. Whether it be in need of assisted living or skilled nursing, we’ve seen kind of challenge decision making where people, if mom moves to a nursing home, what does that mean for me? And so it really compromises the health and safety of mom. Those are difficult situations to see, hear of, and be in for a lot of people. It’s prevalent. It happens, especially whenever we are talking about low-income families. With that, I think it’s important for adult children or the caregivers, relatives, whoever is in those homes and are in that position of financially exploiting. A lot of times there is self-justification in financial exploitation especially in those in-home arrangements of I’m going to the grocery store. I’m picking up all of these things and so I can pay myself this or buy me a little of that sort of thing. So that self-justification could really put everyone in a bad position, in a compromised position. I think it’s important that the caregiver have resources as well, so they are able to be preventative in being in those situations. I get in some it’s going to happen. There’s good intentions and bad intentions, but those especially we call, I forget who coined the term, but the accidental caregiver who started off by making runs to the grocery store for the person as a favor. Then really kind of find themselves a little bit deeper in helping medications, cleaning up the home, and then really being at the home, to the point of handling the debit card, run to the bank. And in those situations, I think it’s really important that they have the tools. The caregivers as well as the senior have the tools to really recognize where are those boundaries so they are able to kind of protect themselves and really refrain from being in that sort of position. I understand it’s a complex thing to navigate whenever you’re talking about anyone’s livelihood and safety, and even means of shelter. They’re complex situations, but we see it all too often where there’s and over dependence on the senior and they may be making, again, $1200 a month and they’re sharing that between two people. And it’s again, making sure both people have the resources so that they do have options. There’s options for seniors in terms of resources. There’s options for others in our community which we’re fortunate to have that can also provide supports for those individuals so those individuals who are so dependent, if they are given those resources maybe they are less likely to be so dependent on their mom, dad, or senior.

 

Cynthia Margiotta:

Right. So how can a senior decipher for themselves what is appropriate and what is not appropriate in the accidental care giver situation?

 

Dayton Romero:

Yeah so, I think it’s, there’s a combination so really whenever it comes to financial exploitation, sending debit cards with people really puts an individual at risk. It’s just essentially handing people money. And although again, starts with good intentions, there’s some self-justification of you know I could buy me this and that tends to escalate the more it happens, that cognitive dissonance going on. I think just keeping apprised of what are those protection measures of yourself, so not giving your debit card to people. Also being aware of what is your level of support needed. How dependent are you on that person to get around even because that could also be, I don’t want to exaggerate, but it can be weaponized. If you depend on a person as a means of transportation and getting out and getting around and that is your sole resource. That person has leverage or a way of keeping you socially isolated away from others or again, self-justifying in terms of I’m driving you everywhere and this sort of thing. So these are pieces to just kind of be aware of. Making sure where is your level of dependence and when is it a good idea to kind of get another party involved. I think checking signals with others around you is important as well. Really bouncing your circumstance and what’s going on with people who care about you and other supports around you to really kind of get a third lens to the situation. It’s so easy to get tunnel vision whenever you’re living it, breathing it, doing it. To get someone else’s take on what’s going on could be helpful and also a means of making sure those pathways, those other resources may be available for you as well.

Cynthia Margiotta:

So using the example you just brought up, let’s say child “Jane” is living with mom, and mom is depending on Jane to give her a ride everywhere and Jane says to mom, well I can’t give you a ride unless you pay to have my car fixed. That’s not mom’s total job. Maybe contributing some gas would be appropriate, but not paying for the transmission, right?

 

Dayton Romero:

Right, that’s exactly right.

 

Cynthia Margiotta:

That’s a good example. Yeah, yeah.

 

Dayton Romero:

And again, to that social isolation piece and relying on people for transportation and being connected in general. It’s very important to have a secondary resource. That dependence. Once you have all your eggs in one basket, it really makes for a tough situation and so really making sure that everyone has in terms of preventable measures, everyone has resources. Making sure should an arrangement naturally happen, then resources are very critical to have in that arrangement so that both parties whether it be respite for the caregiver to get away to do their thing, do some self-care, or even for the other person who’s being cared for, for them to have, you know…

 

Cynthia Margiotta:

Friends.

 

Dayton Romero:

Friends that could come pick them up, or even a delivery system through the grocery store or what have you. Just knowing how to navigate those pieces that help you maintain your independence is very critical because in situations where it becomes so dependent there are those situations where people can basically take you away from your support network and really kind of isolate you to the point where they’re the only person you’re talking with. That really could shape your world too, in terms of manipulation. Even in terms of financial exploitation, checking for signals and should you be accompanied your caregiver and you’re going to the bank and caregiver is talking for you, running the show with the bank teller, that’s a red flag. Luckily, we have some great financial institutions in our community who are on the lookout for those sort of things. In fact, we had our bank safe initiative through AARP here in Colorado Springs. We were a pilot, a pilot state. Colorado was for bank safe AARP where we were training. There was an initiative for training front line bank staff on how to recognize any signs of financial exploitation that could happen. So we’re fortunate to have that in place. As far as the senior checking in for themselves, if they do notice that caregiver is accompanying them more and more to the bank and speaking on their behalf more and more. Those are times to really advocate for oneself and if that person does not have any sort of financial power of attorney or any of these other pieces, they should have no dealings with your financials unless you have given that permission.

 

Cynthia Margiotta:

Right. My bank took that bank safe program and I’ve talked with them about that on numerous occasions. It’s a great program, helps them to be more aware. This is our bank tellers, that’s not their focus, that kind of situation. So for them to be more aware of those possibilities is great. It’s broadening their horizons as well as helping our seniors in our community so power to that program. I didn’t realize it was through AARP. Yay AARP. So to change the subject a little, one of the things that’s happening now is the scammers. The phone scammers. So stranger scammers are preying on the isolation and loneliness of older adults even more now. Can you share some tips to prevent these scams?

 

Dayton Romero:

Yes, absolutely. Again, you see there just within that line, social isolation is such a big risk factor for situations like this of being taken advantage of and so on. We’re at a point in light of the situation while we’re all at home, and staying in the home for long periods of time, a phone call would be nice. Hearing someone, talking to someone, but with that, that is being taken advantage of by scammers. Sometimes it may be by like a robocall. Some scammers are using illegal robocalls to pitch everything from coronavirus treatments to work at home schemes. The recording might say that pressing a number will let you speak to a live operator or remove you from their call list, but it might lead to more robocalls. There’s a lot of kind of clever scams going on right now, unfortunately. It’s really protecting yourself like fact checking information. If a scammer calls in, I always encourage skepticism and asking more questions and trusting your instinct. If there are those pieces where someone is pushy about selling you something regarding the coronavirus, or even the stimulus check that’s going on, is another sort of arrangement that could easily be taken advantage of. Someone could call and claim that they are the government and they need you bank account information so they could deposit your check. That is not happening right now. The government is not reaching out and telling you these things or asking these things. Really just being aware and connected to information and also just the normal practices around not clicking on sources you don’t know. Also, you know, being aware in terms of, I think another one that I’d heard of was around vaccinations, and there is no vaccination. And so those scammers that get you to buy products that aren’t proven to treat or prevent the coronavirus, sometimes online or over the phone. The overall awareness of there being no FDA authorized home test kits or coronavirus vaccinations is very essential. I would encourage people to do their homework when it comes to the coronavirus. Although watching the news too much could be a little detrimental in some cases so I would generally suggest that people keep apprised through experts like the Centers for Disease Control and the World Health Organization. They have some excellent information posted online. They’re continuously updating their information and data and keeping up with the continuous changes. Lastly, I think donations. I think doing homework on donations. There may be outreach around, you know, this country is very poor. They can’t afford test kits, so we need your money in order to make that happen. I’m sure that may be the case and I’m sure that’s happening somewhere, but really doing your homework in those initiatives that are outreaching to you and asking for your bank account information for that stuff because, yeah. Knowing who you are donating to, not letting anyone rush you into making a donation and know that if someone wants donations in cash, by gift card or by wiring money. Those are some indicators that it may be a scam.

 

Cynthia Margiotta: 19:00

Yes, I think that I have been contacted and I hope it’s because I’m interested in geriatrics and not because of my age, but I think, oh maybe 10 or 15 times being told that my social security is going to be cut off, my bank is closing and I need to transfer it to another bank, they’re going to come and arrest me. I mean it’s almost weekly so I choose to believe it’s because I’m involved in those geriatric things and they think I must be over 65. I’m going to believe that for a few more years. So you’re right. We need to stay away. Anybody asking for any personal information at all, it should be the biggest red flag I ever saw. And wave your little white flag and say well I’ll call my financial institution. I’ll call my mortgage company. Thank you for the call, goodbye. End of it.

 

Dayton Romero:

That’s exactly right. And also bouncing situations, not only is relying on your support networks applicable for the financial exploitation and prevention of that, and also even caregiver neglect and these other pieces, but also for vulnerability for scams. So relying on your support network and say you know, calling up your friend, have you guys received this same phone call. I received a phone call that’s asking for my bank account information so they could get that stimulus check that everyone is talking about in my bank account. Did you guys ever receive anything like this and really kind of having that dialogue because again, these scammers. They have scripts. They are very manipulative and are very intentional on who they’re targeting. Protecting yourself by being aware, staying connected, doing your homework, and leaning on your support networks are good examples of just protecting yourself.

 

Cynthia Margiotta:

Right, right. So there is no preventative. There’s no way to cure it.

 

Dayton Romero:

As of now, no.

 

Cynthia Margiotta:

OK, everybody hear that? There’s not a cure. There are protections. You know, I’ve got my little, my homemade mask on that I made. Little protections, but there is no cure.

 

Dayton Romero:

Right. And again, I am not a health expert so I would suggest that everyone looks and uses the valuable resources that the Centers for Disease Control and Prevention and the World Health Organization put out. They speak on things from coping and dealing with stress as a result of everything going on. They have some excellent resources for that. They also have some excellent resources in terms of keeping you up to date on what’s going on whether that be a vaccination or other safety precautions that they are recommending like the social distancing, like the masks, like the hand washing and these other pieces are critical to kind of keeping everyone safe. Those are the two go-to’s for me at least. I tend to share that information among my staff and some clients as well who are looking to get some information. I would just google World Heath Organization or CDC. They have made it very accessible, and readable too. A lot of the information I’ve seen is not medical jargon or these complex research articles or anything like this. It’s plain, simple writing on keeping us informed on what’s going on. Easy to understand so that we all can respond appropriately and put some different measures in place that we need to for our own safety and others around us.

 

Cynthia Margiotta:

I’ve been getting CDC newsletter for years. I actually love it. It is in English. We can understand it rather than big ole jargon stuff, so thank you. My last question would be how can we protect our parents or grandparents when they’re ones that are the most vulnerable? The coronavirus, they are saying they are very vulnerable. I know that young people are as well into the grocery store, young people are not wearing the mask as frequently gives me heart failure to be honest with you. I sort of look at them and say, “don’t you care about anybody besides what’s going on?” I stay out of it. So how can we as young people protect our parents and grandparents?

 

Dayton Romero:

I think we can assist in many ways. Primarily by developing safe communication pathways so keeping connected, checking in with our parents or our grandparents, great-grandparents. Those phone calls, as simple as it may sound, are valuable. They’re a big deal and in an event like this, it’s essential that, especially our seniors are connected. Whether it be a five-minute phone call or an hour phone call where you find out 50 minutes in, oh, you don’t have food. And so from there, facilitating those sort of arrangements whether you’re going to pick up groceries for them or arranging for a delivery of food over there, signing mom up for a program like Calls of Reassurance. Really just ensuring that mom, dad, grandma, grandpa have those resources and if they need some support in navigating those resources, being there, being available to help facilitate that is really, really helpful. And we’re talking about information as well. You know, some may not be as savvy as others in terms of jumping on google and typing in WHO and doing these things, navigating these websites. So even just simple, communicating what’s going on as well. You’re a trusted person, ideally and if you’re really well intentioned and wanting to support, making sure that they’re getting accurate and concise...

PART 1:  The Pikes Peak Elder Abuse Coalition has been working to keep vulnerable adults safe for 15 years and that work continues during COVID19 times.  Dayton Romero, Chair of the Coalition and Director of Senior Assistance Programs with Silver Key, discusses the extenuating circumstances and challenges being faced during COVID19.  Fraud abounds with specific COVID scams and abuse is heightened as people lack support and have more stressors.  Learn how the Coalition is meeting the needs.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

Transcript: 

This is Aging with Altitude. Welcome to all. Brought to you by the Pikes Peak Area Council of Governments Area Agency on Aging. We strive to provide answers, assistance, and advocacy into our elders. Please know my guest today and I are sitting about 10 feet apart and practicing the social distance protocol for the coronavirus. I hope you are too.  

Thank you for joining us today. Our topic today is elder abuse and how it is increasing during the Coronavirus pandemic. Domestic violence goes up whenever families spend more time together, such as the holidays, long weekends and summer vacations. Seniors have it several ways, physical abuse, sexual abuse, psychological abuse, financial exploitation, and neglect are all forms of elder abuse. And it can occur in any family or any setting. We are here today to talk about two ways abuse occurs; one through trusted folks like family as there may be more time together, and then there are the more fun scammers.  

I am your host Cynthia Margiotta, geriatric social worker and volunteer with The Pikes Peak Area Council of Government Area Agency on Aging. With me today is Dayton Romero. Dayton is the co-chair of the senior abuse coalition and works at Silver Key here at Colorado Springs CO. Silver Key is a non-profit working with seniors doing many things to assist our elders. Dayton joined Silver Key in 2015 and serves as the director of senior assistance programs. He holds a BA in psychology with a minor in gerontology from the University of Colorado, Colorado Springs. Currently he is pursuing a masters degree In Public Health with a concentration in leadership and public practice at the University of Colorado Anschutz Medical Campus.  

He is responsible for overseeing the administration and operations of several programs at Silver Key; including case management, guardianship, behavioral health, food pantry and commodity food programs and Silver Key Silver Line. He also acts as Guardian to court appointed wards and develops partnerships in collaboration with community partners. Dayton has a strong technical knowledge and serves as Silver Key’s senior assistance database administrator and data analysist. Dayton also actively participates on other nonprofit boards of directors and serves as chair of both the Pikes Peak elder abuse coalition and the Colorado coalition for elder rights and abuse profession.  

Cynthia - Do you spend anytime at home? 

Dayton: I yeah, quite a bit of time and just some being very involved with the community. 

Cynthia – You are. you have a lot going on I'm very impressed. 

Q - So let's get started with our first question about family or persons and trusted physicians in our lives. I'm sure you've been getting some very distressing calls, showing just how intense psychological as well as physical mistreatment can get when people are kept 24 hours a day together within a reduced space. can you share some stories you have heard? With no names of course. 

A - Yeah Cynthia, I think in general that the climate is a little uncertain, it's uneasy. We're at a time where stress levels are high and if you compound that in an already strenuous arrangement whether it be a caregiver who's experiencing caregiver burnout, or in a situation where they have lost their job as a result of these sort of things. Those higher stressed positions really make for not so great environment and so it really is an uncertain time that's really kind of positioning people for uncertain circumstances. In terms of phone calls, I think primarily what we're seeing is individuals who are distressed by social isolation, and it's really ironic to me, (with) kind of the emphasis we're always putting out there of encouraging older adults or seniors to get out of their home, get involved, be active with the community and this totally just one 80 degree turn where we are having to self-isolate and in many cases stay home and kind of work around all the ways of getting out and getting exposed. And so social isolation really is a one of the higher risk factors for putting people at risk for mistreatment. Whether it be physical abuse, or financial exploitation, or scams, we really see those things coincide a lot of the time, so combating social isolation by keeping our clients connected has been our way of really doing our part to prevent those sort of things from happening. 

Q - Often physical abuse doesn't come from a stranger it comes from someone you know and trust. At this time physical abuse is increasing. Can you tell our listeners about the reasons? 

A – Again, I think it's really just the overall pressures and uncertainty of whether, you know the shelter in place I think causes some added pressure and keeping people in confined spaces as you mentioned and again you compound that with people like caregivers specifically where they really look to take care of these people and a lot of the time they rely on external resources (for) respite and getting out and really doing some self-care and those options may have some limitations now. And so again, that aspect of not really having alternative options or means of really getting away and distancing and really having some boundaries. It's a tough time to do that and so again the added stresses really adds to it. I pulled an article from the American Journal of Internal Medicine and it mentions how family members are the most common perpetrators of financial exploitation, and other forms of abuse. Which is then followed by friends and neighbors and then after that home care aides. And so really you see that trend in individuals who are those trusted entities, those trusted people in that older adults life and it's just really unfortunate to see where, (and) unfortunate to see those situations where people are just limited and really kind of feeling the pressures put on by this whole Covid situation that we're in right now.  

Cynthia- It's mortifying actually, I mean I've been a caregiver from my mother. She had dementia and to be able for me (to serve as a caregiver) I was able to get out, I continued working, I continued date night with my husband, I these little things that gave me breathing room from being a caregiver were so helpful to me. I truly advocate for that. But right now the movie theaters closed, you know you know the restaurants are closed, you can't go or do anything away and so I can see how it just becomes crazy scary for the person who's being abused.  

Q - Can victims of family abuse disregard the orders? Our governor has said we need to stay at home. Can they say I need to get away if they need to seek some kind of refuge? And then where can they go? 

A – Yeah, safety is always number one and I know it is a little bit of a dilemma considering Covid, and exposures, and limiting that, but whenever that safety risk is right there and you're living it on a daily basis, I really think there are that's why we have a central and critical providers and that is our law enforcement. That is our caseworkers through adult Protective Services, who are still on the front lines and seeing these circumstances in the community, to address them and prevent them. And so with that being said, safety is always number one, especially in physical abuse situations and any other mistreatments. We want to ensure that, you know, those paths to getting refuge and getting access to safety is there. And the means of doing that is getting connected with our law enforcement. And we as a silver key as a nonprofit that serves older adults, we have an accountability where we are mandated reporters and so we really have to be on the lookout, have a keen eye and be really observant within our interactions with people who are reaching out for support, to notice any sort of things out of the ordinary that may be indicators of any abuse going on. And also make sure that our staff here are equipped with the answers and the resources to give those victims if they are experiencing that abuse. So, Law Enforcement and Adult Protective Services are key entities in finding a pathway to safety. 

Q - So they can get away through contacting Adult Protective Services, they can call them, their phone numbers are readily available, they can also call Silver Key? 

A - I, yeah, I see us as really being a holistic support and we are seeing a lot of individuals who, interestingly enough, really kind of bypassing some of their emotional needs, but more so focused on, you know how are they gonna get their next meal? And so we're seeing a lot of food insecure, a lot of food insecurity come out, and so we you know our Silver Line is receiving near, I think in March received 3,700 phone calls, just from individuals in the community who are looking to get connected. Whether it be for Meals on Wheels, or getting commodities, grocery items or those sort of things. So we're having to be really nimble programmatically to able to address that level of need and being able to make sure that people are getting access to food. And while doing so, we’re being subtle in our efforts of gaining an idea of the additional supports that they’re in need (of) during that initial phone call. So if they need to get connected to a case manager they are able to very easily, and through that they are able to be assessed, their situation be assessed, and really kind of see how we could set that person up for success, especially in the midst of all of this. But even further beyond that, and also you know, what we've also taken into consideration is with all the modifications going on throughout programs, not only internally at Silver Key, but externally. It's really calling out a big risk factor, which is social isolation again. These studies out there on social isolation and it being a risk factor for people who become mistreated, there's a lot of evidence on it. And so, with that being said, a lot of our programs internally really focus on the social piece. So for example we have congregate meal sites, we have 14 different congregate meal sites (that are) kind of spread around the community where it encourages seniors to come out have a meal, grab a bite with their buddy, and with that it's an opportunity to get out and be connected. And in light of the current public health crisis, we've modified it where we're preparing those meals for the week, dropping off once, and they’re able to just go in and pick up, and there is no opportunity to sit around at a table and have that contact with their friends, family, neighbors, whoever.  And you know for our food pantry, we’re one of the largest food pantries in southern Colorado given the amount of people who come through our door. For a typical basis you would see our lobby for our food pantry just jam packed. It’s vibrant, people are talking, people are drinking coffee, and really just again using it as a way of just connecting with others and just fully enjoying the experience in the environment. But we've switched our program to a pick-up only model, where we're minimizing the amount of crowding in the lobby, and it's really just grab and go sort of thing, and so again we're minimizing that exposure, and (it’s) for everyone’s safety. But at the same time, we're effecting social isolation, where we’re essentially putting them in a position where they are socially isolated and so we're very cognizant of that I could say. In fact, we are really relying on volunteers right now, to help us a scale our existing Calls Of Reassurance program. And so, with our Calls Of Reassurance program, we're relying on volunteers to help us scale. We currently have outreach efforts going on to those clients, to our internal clients who are being effected. For example, for the pantry, we have near 2,500 people enrolled in that program. In our connections cafe we have upwards of thousands, upwards of 1,000 clients engaging in that program regularly, and so we're outreaching specifically to these individuals who are feeling the consequences of those modifications at the programs, and engaging, connecting. So we're checking in on that, seeing how they're doing, seeing if they need any additional supports right now, whether it be access to food or even transportation to their medical appointments, those sort of things. but we're also offering The Calls Of Reassurance program, which is done by mainly volunteers and they’re really checking in, having lighthearted conversations, one to three times a week. And they're also, a lot of the time, actually the basis of this program, the inception of it, was really targeted to prevent social isolation, especially among people who lack a social support system, and also our concern for their own well-being. So we've actually had people express that, you know if I were to fall, or if anything were to happen to me in my home, no one would know. And so they really look to us to be that check in with them, and we have protocols in place to respond appropriately in the situations where they're not answering their phone and that’s (not) kind of the ordinary to how they normally would respond to our calls. 

Q - Are you looking for some short-term volunteers that would help with those calls? 

A - Yes. Yes. Again, in order to scale, we're talking a good amount of clients, in fact our program steadily had near 30 people or so in it, and we've seen that increase by 100% just over this last week and a half. so a lot of people are seeing them value in it, and are really looking at it as a means of keeping connected, which is really essential in this, in this, again this uncertain time. 

Q - There's a lot of folks that aren't working so much right now, for lots of reasons some of which are extraverts, that are looking for things to do that might be useful. So is there a phone number where people can call to offer their time? 

A - Absolutely. We have a centralized call system here in Silver Key called the Silver Line and that is 719-884-2300. And it's really kind of the entry point to access any one of our services, whether you're a client and wanting to get connected to a program, or even a volunteer who is looking to give back or donate some of your time and talent, there's a really simple way of just getting into our system. 

Cynthia - And that program where they make friendly phone calls, again what is that called? 

Dayton- Silver Key Calls of Reassurance.  

Cynthia - I think that would be really good for some of us who feeI, I don't want to say totally isolated, but we have time on our hands and we would like to give back even if it's short term. 

Dayton - Absolutely  

Cynthia - So that would be helpful. 

Dayton - And within that program we’re privileged to have, we are a behavior health provider. And so we have behavioral health providers on staff who have been very helpful in making sure that those volunteers who are making those phone calls are equipped with the needed resources should any circumstances come up, whether it be any sort of expression on thoughts of suicide, suicidal ideations, or even mistreatment. So, how to really pick up on those things and have those resources at hand to be able to give that path to that person. And also the volunteers are versed on how to get that person connected back in (to) any of the internal programs at Silver Key as well. So they, they know how, if a person mentions that they haven't had food in two days and they can't get to the grocery store for another 3,  how does Silver Key, how does the volunteer, respond to that situation? And we have some pretty solid mechanisms in place to be able to respond appropriately and make sure that that person doesn't go hungry. 

Cynthia - Right so there's a lot of support within silver key for those volunteers who are trying to help others. I think that's essential. 

Dayton - Absolutely  

Cynthia - Food is important, it's one of those basic needs. I need it, you need it, we all need it.  

Q - So if a person is being mistreated, and that’s really the technical term for abuse, if they're being mistreated and they decide it's time to go, it’s “I'm outta here” kind of thing. What should they bring with them? 

A - It's a great question. They definitely will need their identification a lot of the time to navigate any governmental program, (and) proof of income, Social Security award letters is important. I would also recommend if any sort of advanced planning has been done, any key documents that have been put in place, to kind of keep copies of those with you. Of course, medicine lists, all those essentials that would be hard to produce without having to take a trip somewhere or have to wait seven business days to get it again. So really kind of just having that list of documents such as that handy would be really good. You’ve mentioned where can they go? With that in mind, our community has a program called the Emergency Shelter Network Program, and it was a foundational piece to the Pikes Peak Elder Abuse Coalition. And it is a means of finding or having shelter for abused or mistreated older adults to go to. You know, we have community partners, some skilled nursing facilities, some assisted living, who will take those individuals in. There is kind of a path to that,  in where some have gone through the emergency department, some are working directly with the caseworker, with an adult Protective Services caseworker and those are the two primary entry points to gain access to that program, and then be placed into one of those facilities as a means of shelter. We have a pretty unique program in and of itself here in our community, where we're the Pikes Peak Elder Abuse Coalition, and that subcommittee specifically, is involved with a national entity, and they help keep benchmarking and standards for that program, and also help out with the data tracking and these pieces, so that we were informed on the usage of that program in our community. So I think we're lucky here in Colorado Springs to have such an innovative program, and it really speaks to the collaborative nature of our community, especially when you have care facilities involved and willing to, you know, say they have a bed for an individual who has been, whether it be physically abused or these other pieces that really call for them to be removed from that environment. 

Q - Do you have a contact where they would call adult Protective Services, basically on themselves, in order to get hooked up with this possible space to stay temporarily? 

A - Yeah, so there there's some nuance involved in terms of navigating Medicaid long term care, Medicaid and these other pieces, but generally speaking, the emergency department or the Adult Protective Services caseworkers are the people in tune with the criteria

Aging with Altitude's host, Cynthia Margiotta, an older adult herself and BSW, shares her observations and insights during the age of COVID19.  She describes the chilling neighborhood drive, contemplates physical vs. social distancing, shares how friends with dementia can be supported and finally a multitude of ideas on how to stay busy, engaged and hopeful as we all find ourselves writing a new chapter in our lives.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

Transcript:

 

Episode Nine: COVID-19, A Personal Response 

SUMMARY 

Aging with Altitude’s host, Cynthia Margiotta, an older adult herself and BSW, shares her observations and insights during the age of COVID19.  She describes the chilling neighborhood drive, contemplates physical vs. social distancing, shares how friends with dementia can be supported and finally a multitude of ideas on how to stay busy, engaged and hopeful as we all find ourselves writing a new chapter in our lives. 

 

This is Studio 809, the Pikes Peak regions own podcast hub. 

 

Cynthia Margiotta:  

This is Aging with Altitude, welcome to all! Brought to you by the Pikes Peak Area Council of Government's Area Agency on Aging. We strive to provide answers, assistance, and advocacy to our elders. Thank you for joining us today.  

 

Our topic today is not so much about the Coronavirus as it is about us in the age of the Coronavirus. I am your host Cynthia Margiotta. I'm a geriatric social worker, and a volunteer with the Pikes Peak Area Council of Government's Area Agency on Aging. I am going to be interviewing me.I don't know how that will work. But we'll see.  

 

So our three topics today, actually four, are our drive around, I did a drive around. And then a little bit about physical distancing, as opposed to social distancing. Number three is activities for folks with dementia, and then a whole list of straight up activities. So if you can grab a pen and paper, and then when we get to that you can write down the ones that interest you and you had forgotten about them.  

 

The Drive Around 

 

So first off, the drive around. I went out into Colorado Springs and drove around a bit. What I got to see was very interesting. First off, during rush hour traffic, there was very little driving very few cars out there. I saw a lot of cops giving people tickets because they were speeding too much. But, you know, not a lot of people on the road. Then over at downtown Colorado Springs and Manitou I went over there as well. I saw a few people out, it was mostly the homeless people, and a few people that were actually on their way to or from work in their businesses.  

 

As far as the businesses were concerned, the ones that were open, were mostly the ones that had food that you could take out or drive up, like the Burger King, McDonald's, or the coffee shops. I grabbed some food from them, which was great. And then the restaurants, they had sort of car delivery situations, which helps them to stay alive. I am worried about the other businesses out there who can't do those things.  

Then there was the people who were in their businesses that the business was locked, the building they couldn't get into. And so they have to do it remotely. And then there were some folks inside their business. But what I've noticed is they're not having as many people come into the business, they're doing more of that remote work with them, either through the computer, or on the phone, or just talking to them about "let's set this up for later."  

 

Then there's the doctors offices, and they're conducting a lot of their appointments over the phone. They have this almost like zoom thing going on. I talked to one of the doctors the other day. And he's interviewing and talking with people over the phone. And you can see him. So that's kind of cool. 

 

 That's just my observations. You might have others. But I thought those of us that are staying home might be interested in hearing about that. So I think that's a good idea.  

 

Physical Distancing, Not Social Distancing 

 

Then, the second thing is talking about some of physical distancing. And there's a difference between physical distancing and socially distancing. We need to stay socially connected to people we love. How can we do that? Physical distancing, you know, there today, they were saying six, seven feet away from each other is important. I get that. I understand that. But the social distancing, we need to find ways to stay connected to people. So some of my list might be helpful, that some of these things you can do with your friends. But I just want to encourage you to think about the things that might work easily. For instance, talking on the phone with friends, using the computer to send out emails or perhaps connect with Skype and zoom. Both of those have free components so that we can use them. Then, you know, with your loved ones, we can't be close to them, so seeing them through the window even might have been helpful, I don't know. But that's important to stay socially connected and then stay physically apart.  

 

I noticed that when I went to some businesses of people I knew some of them had the masks on, they didn't want to see anybody, they didn't want to get close to anybody whereas others open their doors and said, I need a hug. And so we hugged. So there's differences in that.  

 

 

 

Activities for Individuals with Dementia  

 

The second thing I want to talk about is activities for dementia and working with dementia. Six out of ten people that have dementia, and this includes Alzheimers, they become wanders. So we need to find ways to keep them busy, keep them happy. What I say to people is just for a minute, you just want them happy for this minute. So finding things to do. So when I get to my list and share it with you, I want you to think about if you have a person with dementia, I want you to think about the possibility of simplifying those activities.  

 

What I mean by that, and I will use my own mom as an example. Let me explain. I grew up in a house with seven people and we would sit down at the dining room table and all seven of us would play Solitaire together. I know that sounds hard, but somebody would put an ace out on the middle of the table. And everybody who had a two with throw their two on there as fast as possible. First one got to put their two on there, got to keep it there. So, it was a little bit crazy. I'll be honest, I don't think I ever won, I'm not fast enough. But when my mom with her dementia came to live with us, she loved playing solitaire. So she would play Solitaire for hours, she loved her Solitaire. But as her dementia, or Alzheimer's, progressed it got harder and harder for her. So after a little while, we had to take away the aces, the kings, the queens, and the jacks because those didn't make sense to her anymore. She didn't understand what they were, they didn't have numbers attached. So we took them away and she played Solitaire with the two through 10. Simple, easy for her. Then, as things progressed some more, it was hard to understand the concept of the reds and the blacks and putting that together. So we took the black cards away. So she had the hearts in the diamonds. And she would play with those. After a while that even got confusing, so we took the diamonds away. Those diamonds were out of the picture. And she had her hearts, two through 10 she played. We call it Solitaire, what it really was is that she would take the little deck of cards, and she would hold them a one card at a time, until she got to the 10. When there were no more cards, she pick it up and start over again. That's what I call simplifying. Don't try and make them remember, don't try and make them do things that are out of their concept anymore. Make it easy, make it fun for them, that's what I think is important. You don't need to be distanced from them. They won't understand that.  

 

COVID Activities List  

 

So then I want to talk about some activities. I have a list here a mile long. A lot of these are things I've had for years and I've shared with older people, and younger people. Some of these are from a program out in Washington State. It's called PEARLS, program encouraging rewarding active lives for seniors. So I want to give a shout out to them as well.  

So I wrote them down and I have this list. So you might hear my papers. Oh, I forgot to mention, I am at home. So please excuse me if my dogs start barking. They might just do that. So here's my list. I hope you have paper and pencil to write down the ideas that I come up with that might help you and maybe new ideas. So here we go. Ready?  

• listen to music 
• buy household gadgets over the internet 
• lay out there in the sun on a warm day 
• laugh 
• think about past travels 

• organize those photos from those past trips 
• listen to others who are talking to you 
• read magazines or newspapers 
• pick up those old hobbies you haven't done in ages like stamp collecting or coin collecting or model building 
• spend an evening over the internet with friends 

• plan a day's activity for down the road when this is over 
• meet new people in internet land, like your sister's best friend for instance 
• remember some beautiful scenery 
• eat something you love 
• practice yoga or practice Tai Chi 

• ride your stationary bike 
• repair things around the house that you've been putting off forever 
• work on the car or on the bike 
• remembering the words and deeds of loving people 
• spend time with the people in the house 

• plan out which place and research where do you want to start volunteering when all of this is over 
• do you want to get time to have a quiet evening 
• go internet antique shopping 
• care for your household plants. My plants have never had so much attention in their lives, they're loving it.  
• doodle 

• share a favorite recipe with someone 
• start an avocado tree or any water routing house plant, I've started three and I'm hoping that all three of them take off and I'm going to give two away 
• Skype a friend or family member and visit over coffee on the Skype land or over a drink after five 
• sing a song loud and happy 
• arrange some flowers 

• rearrange a room in your house 
• practice your religion or practice spirituality 
• go on that diet you've been planning to either to gain weight or to lose weight 
• acknowledge your good points 
• find a bargain for something you were going to buy on the internet 

• paint 
• do something spontaneous 
• work on some textiles 
• embroidery, needlepoint, weaving knitting, macrame, I made a two-day macrame a three tier plant hanger the other day, it took me two days to make it but I feel like I accomplished something.  
• go to bed early 

• take a nap 
• drive someone to the grocery store 
• sing with a group on the zoom 
• play that instrument that you haven't taken out of the closet months 
• do some arts and crafts 

• make some cards for birthdays 

listen to those CDs 

• plan a party for when all this is over 
• cook 
• go for a hike 

• remember to physical distance 
• write poetry 
• write a book 
• write stories 
• write articles. 

•  So go out to dinner, well not really out but get some food and bring it in. 
• work on a project 
• discuss a book that you've read with someone 
•  do your gardening and beat them to the punch you can plant your little seeds in the house 
•  let's see... drink coffee and read the newspaper 

• kiss somebody in your house 

Elder fraud and abuse happens and is under-reported.  What can be done to help?  This podcast has two focuses first, learn about  the signs of abuse and strategies to avoid fraud and abuse.  Second, learn about the concept and practice of Elder Shelter.  Our guest is Colorado Springs Police Detective Chuck Szatkowski who is a member of the Colorado Springs Elder Abuse Coalition and the national Spring Alliance focused on creating elder shelter support.  Detective Chuck describes what mistreatment looks like so we can better know if a person is a victim and how to report it.  Detective Chuck also talks about the concept and services of Elder Shelter.  Colorado Springs has one of the best support systems in the nation to provide elder shelter to adults who have been victims of fraud and abuse.  This model is based on collaborations across organizations and for profit entities and is a member of Spring Alliance, a network of regional elder abuse shelters and similar service models.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

Transcript:

Elder fraud and abuse happens and is under-reported.  What can be done to help?  This podcast has two focuses first, learn about the signs of abuse and strategies to avoid fraud and abuse.  Second, learn about the concept and practice of Elder Shelter.  Our guest is Colorado Springs Police Detective Chuck Szatkowski who is a member of the Colorado Springs Elder Abuse Coalition and the national Spring Alliance focused on creating elder shelter support.  Detective Chuck describes what mistreatment looks like so we can better know if a person is a victim and how to report it.  Detective Chuck also talks about the concept and services of Elder Shelter.  Colorado Springs has one of the best support systems in the nation to provide elder shelter to adults who have been victims of fraud and abuse.  This model is based on collaborations across organizations and for-profit entities and is a member of Spring Alliance, a network of regional elder abuse shelters and similar service models. 

 

Cynthia Margiata with Detective Chuck Szatkowski, Springs Alliance and Elder Shelter 

Q – What is elder fraud and abuse? 

A – Mistreatment is Physical Abuse, Sexual Abuse, Caretake Neglect and financial exploitation. Nationally only 1 in 19 or 1 in 24 cases are ever reported. One of the national problems is that we have different definitions of what constitutes an at-risk or vulnerable adult and different definitions of what constitutes mistreatment or abuse. 

Cynthia – That makes it hard to work together 

Chuck – Right, no sort of national standard 

 

Q – What is the Elder Shelter Model? 

A – It’s a program in El Paso County where we have 9 skilled nursing facilities and 5 assisted living facilities so when we have a victim of mistreatment who requires either skilled or assisted living, when we arrest the perpetrator we have these facilities who have agreed that if the person is appropriate and they have a bed they will take the person in on an emergency basis and the adult protective services will work to expedite Medicaid funding to get the persons stay at the facility taken care of. We just recently joined the Springs alliance with a national association of 25 Elder Shelter programs across the united states. Every model is different based on the community and what we do is we help other communities try to set up elder shelter programs and they can look at the various models to see what works best for them. In El Paso County we are really fortunate that this has all been done on a handshake at this point. Christy Swanson from Sava Senior care has really been the guide to this, the go-getter that has kept this program going. But she has been doing this part time on the side of a full-time job as an administrator.  

Cynthia – Is she volunteering her time? 

Chuck – Her company has been very supportive. Which we really appreciate, but we are at the point now, last year we served 71, this year we have served 82. The program is large enough that we really need a full-time coordinator so we are looking at grant funding opportunities to have a ft coordinator and it looks like that coordinator will be housed in silver key senior services 

Cynthia – Nice. So, you are looking at space for them already 

Chuck – We are looking into a space, and a computer database so rather than calling around to see who has a bed. The participating communities can put in their availability – is there bed is it male or female so we can go down the list as we need a bed and find an appropriate placement for a person 

Cynthia – Are you taking applications? 

Chuck – We have to get the funding first. We are looking at applying in January 2020 for a GOCO grant.  

Cynthia – I hope you get it, we need it. 

 

Q – What are some signs of elder fraud or abuse? 

A – For the mistreatment part, the physical or sexual abuse, you would look for injuries that aren’t consistent with how they are being described, or an increase in emergency room or doctors’ visits. These are typically the signs you would see of physical abuse. For caretaker neglect you would see a decline in their physical wellbeing. Maybe they start to be dehydrated, malnourished, or you notice they used to be really clean and wear clothes properly, and now their appearance is changing. Those can all be signs of mistreatment, either physical or caretaker neglect.   Now it’s hard sometimes to see the difference between neglect or the disease process. The important thing is to work with law enforcement, and we will work with Adult Protective Services. To determine treatment, it may be just self-neglect, but adult protective services can help connect them with resources in the community. Our goal is least restrictive, we want to keep people in their home for as long as possible 

 

Q – What do we do in EPC that is different than other areas? 

A – In El Paso County we really have a long history of collaboration with our community partners. We work closely with Adult Protective Services; The Resource Exchange, which is our community center board which coordinates services for people with intellectual developmental disabilities; and the Area Agency on Aging, especially the Ombudsman Program.  In connection with Adult Protective Services we have a civil criminal investigator, paid for half by the police department and half by the Department of Human Services. She is a retired police officer. She has been to the social workers academy, so she is also social worker. She has access to both databases. The law says we have to notify Adult Protective Services within 24 hours of every report of mistreatment of an at-risk adult. We staff those calls every morning with Adult Protective Services to decide if it’s theirs, ours, or of both of ours.  If it’s both we coordinate closely with the assigned caseworker. We do share information freely between us. We do joint interviews not only with suspects and witnesses but also with victims. Primarily with victims so we don’t retraumatize them and so they don’t have to go over the same story over and over and relive the experience. And that’s unique, other jurisdictions don’t have that close collaboration with community partners 

Cynthia – I think that would help someone who is a victim to not have to talk about it many many times 

Chuck – That’s our goal. We’re victim centered. Sometimes it may not be in their best interest to pursue criminal charges, but we make that decision 

Cynthia – I like that term victim centered, thank you. 

 

Q – So, are older adults more susceptible to certain kinds of fraud then? 

A – There are a number of factors that make a person more susceptible as they get older. Some of that is that they become more dependent on other people as we become more frail. That results in isolation which makes it easier to exploit or mistreat someone and it’s not detected. A prior history of trauma, like domestic violence or something like that, also makes a person more susceptible to mistreatment.  Sometimes the economic factors can make it, but we see it occur across all income levels. We have it from the 700 social security check to the million-dollar home. The biggest problem is the isolation as we get older and aren’t as mobile and then we get isolated from the community and that creates an opportunity for people to mistreat and exploit us. 

Cynthia - I have seen a lot of that on the phone. Where people are calling on the phone and asking for money and lonely people seem to be more susceptible.  

Chuck – We seem to think about the phone scams as the mistreatment, but unfortunately 90% of offender oroffenders are spouses or family members.  The stranger crimes the fraud does occur over the telephone. The oldest of the old, the 80s seem to be the more trusting generation where things were done upon a handshake, so they trust when somebody calls them. But the government isn’t going to call you to tell you they are going to arrest you or that you owe taxes they aren’t going to ask you to go to Walmart to get gift cards to pay a bond because you missed jury duty. The key is if you don’t recognize the number don’t answer it. If its important they will leave a message. The federal government isn’t going to call you about your taxes, your Medicare. The sheriff’s office or the police department aren’t going to call you about an arrest warrant. The thing is to be cautious; you know the old story about if its too good to be true it is. We get the scams where the secret shopper or you won the lottery. Its illegal to participate in a foreign lottery number one, and how would you have won the lottery if you didn’t enter the lottery. A legitimate sweepstakes isn’t going to make you pay taxes or anything up front. They will take that out of your winnings.  

Cynthia – The one I got the other day was they were going to cancel my social security card 

Chuck – I’ve got over a dozen of those calls about my social security being compromised. The thing is its just a computer randomly dialing numbers. So, you say how do they know I’m older, well it’s just the luck of the draw you answer the phone and your older. The thing is if you answer the phone you get on a list that says this is a good phone number because it’s just a computer randomly dialing numbers. They sell that list to other scammers. And If you talk to them you go on another list, that I call the sucker list, and they sell that to other scammers too, because now people recognize that you are vulnerable. I remember when my grandfather would talk about during the great depression how the hobos would make a little symbol on the fence or back of a house where someone was willing to give them food and stuff.  And this is similar. This is organized crime that is doing this scam and its organized crime from outside the united states. So, it’s very difficult for us to investigate and almost impossible for us to prosecute.  

Cynthia – sounds horrible and very difficult for our seniors and sounds like our young people are having this problem too.  

Chuck – Yep. Some younger people are falling for it too. The thing is don’t answer the phone if you don’t know the number, get caller ID 

 

Q – How many cases have you dealt with in this area? 

A – In 2017 and 2018 my unit averaged 296 cases a year. My unit handles the physical assaults, the sexual assaults, the caretake neglect. The financial crimes go to the financial crimes’ unit. And we don’t have the stats on how many of those financial crimes because many of the times they are mislabeled. So, we aren’t sure if the victim’s elderly or how they are being targeted. So, we average close to 300 reports in my unit that we investigate a year.  

Cynthia - That’s a lot – painful.  

 

Q - So which ones would you say are the most common ones you deal with? 

A – The most common ones are intertwined, there is usually some sort of financial exploitation coupled with caretaker neglect. I have had people tell me they don’t want to spend their inheritance to take care of mom and dad. Its not their inheritance until mom or dad are gone. So those are the most common ones we see is the caretaker neglect coupled with the financial exploitation. We do, because we have a large number of skilled nursing facilities and assisted living facilities in this community, and we also have a very good program for our intellectual developmentally disabled citizens. So do get a lot of reports of incidents of what we call resident on resident assaults or participant or participant assault that we have to investigate. But usually does not result in criminal charges because the suspect doesn’t have the mental state capable of being charged with a crime knowingly or recklessly. But we do have to investigate those cases and establish whether they have the capability to understand right from wrong 

 

Q - How many convictions have there been?  

A – We don’t track convictions. When we make an arrest and file that with the DA office its pretty much out of our hands. We need probable cause to arrest the DA needs beyond a reasonable doubt which is a very high standard. We try to build our cases to beyond a reasonable doubt but many a times they will look at it and for various reasons they will decide it’s not prosecutable because they wont be able to reach their burden of proof to a jury. That why we don’t track our conviction rates.  

Cynthia - So is it sometimes also that maybe the victim doesn’t want to testify.  

Chuck – That’s a big problem, its just like in domestic violence, the victims recant they want the mistreatment to stop but they don’t want the offender to be punished and go to jail. So recanting is a big issue. We can prosecute those cases without their participation we try to build an evidence-based case like you do in a domestic violence case where you don’t have to rely on the victim’s testimony. But many times, when you get into the areas of exploitation the consent part is a big issue. Did they consent to this? You know, did they make poor choices and let people use their money the way it shouldn’t be and now they are in this position where they can’t afford their care. 

Cynthia – maybe writing a check to their daughter that is misused not for their care 

Chuck – Or undue influence. The daughter may say that if you don’t give me this money, you’re not going to see your grandkids or I’ll put you in a nursing home, that type of thing. Those undue influences do occur. The big challenge to prove in court.  

 

Q - What are some tips you can share to help an older adult prevent themselves from becoming a victim of abuse or fraud? 

A - Number one get your advance directives in place now – not only your financial powers of attorney but your medical powers of attorney, your living will. Make sure that people understand what your desires are so that when you get to the point you no longer have the capacity to make that decision. Be sure that when you create a power of attorney you don’t your rights to ask for an accounting of what’s going on with your funds. Be sure you have that accounting or someone who can ask the accounting because a family member can ask for an accounting too. You want to have some oversight because money does strange things to people. You may think its someone you can trust and then once they get access to the money, they start using it for their own benefit and not yours. As far as the way to avoid defrauds is don’t answer the phone if you don’t know the number. If somebody calls, don’t ask them for the number if they say they are from social security or the local sheriff’s office, hang up and find the number yourself and call to verify. Again, we’re not going to call you to tell you that your wanted. We are going to show up at your door. You get the grandma scams where they get the calls that this is some grandchild and they’ve been in a car accident or they’ve been arrested. My mother got that and first thing she did is hang up and call my brother to see where his son Justin was who was sitting right beside him in Cincinnati, he wasn’t in jail in Canada 

Cynthia - Good for her 

Chuck - Take a few seconds to breath, think it out. Don’t jump in and assume they are legitimate 

Cynthia - Smart move – your mom is a smart lady 

 

Q - When people are removed from their home with their family members. What happens from there? You mentioned that they might go to an assisted living or a nursing home, but what happens? 

A - First off, we don’t remove people from their homes. With consenting adults, you know it’s not like children, the law gives me the authority as a police officer to remove a child if I think it’s in an unsafe environment, I don’t have that with an adult. Adults are free to make choices. If there is a situation where they are dependent on their caretaker and we have arrested their caretaker and they need medical assistance, we will offer, and they have to consent, to go to one of our shelter facilities. A person can still deny it. We will work real closely with Adult Protective Services. Again, least restrictive is our goal. If its possible to keep them in their home and bring some in-home care in, then adult protective services will try to set them up. I want to emphasize that we don’t have the right to take away somebody’s civil rights as an adult. There is a process we have to go to through the probate court and it’s a lengthy process to protect people’s civil rights.  

 

Q – I found the online reporting form. It’s a 4 page form for reporting and I think it’s a great form and its very easy. I think I would have an easy time, so if people want to report I want them to see that. So, what’s the best number and site for reporting 

A – If you are a mandated reporter the law says you have to call law enforcement. But the best number here is 719 444-7000, which is the non-emergency reporting number to the police and fire dispatch. Give the call taker as much detail as you can about what you think is going on; what makes the person at-risk, are they elderly, disability, and as much information as possible about the perpetrator so we can do a check the welfare. But if you think someone is being physically abused or financially exploited, please provide those specific details. At a ‘check the welfare’ call an officer will go to the house, knock on the door, many times a victim won’t disclose what is going on. If the officer doesn’t know to ask about physical abuse or exploitation and they see the person and the person says they are well that is all that is going to happen. We are going to leave and we’re not going to get any in-depth investigation, so you need to leave as much detail as possible with the call taker. If its caretaker neglect you can call the Adult Protective Services intake line at 719-444-5755 and make a referral for self-neglect because self-neglect is not criminal so we can go out and check on somebody, but we don’t put resources in place. It’s important to understand too, that once Adult Protective Services gets...

Talking about death does not make it happen.  So what stops us from exploring the options for best living towards the end of life?  Kent Mathews with the Family Caregiver program with the Pikes Peak Area Agency on Aging (PPAAA) has supported hundreds of individuals and families over his years as an MSW, Chaplain and staff with the PPAAA.  He understands and knows the deep fear and loneliness that can come as people age and bodies change.  He shares his insight and professional knowledge in supportive ways that empowers the individual and the family to live the lives they want.

Aging with Altitude is recorded in the Pikes Peak region with a focus on topics of aging interest across the country.  We talk about both the everyday and novel needs and approaches to age with altitude whether you’re in Ft. Lauderdale, Florida or Leadville, Colorado.  The Pikes Peak Area Agency on Aging is the producer.  Learn more at Pikes Peak Area Agency on Aging.

Transcript:

Talking about death does not make it happen.  So, what stops us from exploring the options for best living towards the end of life?  Kent Mathews with the Family Caregiver program with the Pikes Peak Area Agency on Aging (PPAAA) has supported hundreds of individuals and families over his years as an MSW, Chaplain and staff with the PPAAA.  He understands and knows the deep fear and loneliness that can come as people age and bodies change.  He shares his insight and professional knowledge in supportive ways that empowers the individual and the family to live the lives they want. 

 

Michaela Nichols – I am here with Kent Mathews, Care Manager in the Family Caregiver Support Center at Pikes Peak AAA. He has over 27 years of experience as a social worker and has worked in hospice care as well 

Michaela - End of life issues can often be hard to talk about. Many people hope that they will be able to make their own decisions or that a loved one will be able to make their decision near the end of their life, but they lose that ability. So being unprepared can put loved ones in uncomfortable positions. 

Q – Kent, can you talk a little bit about what barriers individuals experience when beginning to make end of life plans? 

A – The most common barrier I hear coming from caregivers, but also when I was doing hospice work, coming even from hospice patients, when it comes to advance directives (is that) they would say, well I’ll execute them or I’ll fill them out when I need them. Not knowing that they probably wouldn’t be able to execute them when they needed them, because they would be in a physical state where they were unresponsive and couldn’t speak or they couldn’t even begin to fill out those documents. So, I think that’s one barrier. Another one is we don’t like to talk about or think about our end of life. We don’t like to think about our deaths. We live in a very death averse society. Generations ago, when we were still a very rural society and we weren’t as urbanized as we are now and still a lot of people living on farms and out in nature and what not we were still very in touch with the cycle of creation – birth, life, death, all of that. And now we are really, really, removed from that and that’s a huge barrier as well. I think another barrier that comes to mind is people don’t have an easy place to go to get good information about what’s really going on with their physical condition. I recently ran across a statistic that said if (a doctor is) asked to do a treatment and a doctor knew the treatment wouldn’t do any good, 40 percent of the doctors said they would still recommend the treatment. Which is, in my estimation, just rather appalling that they would even do that. A lot of the time people rely on their doctors to give them that information to tell them what’s really going on. But most doctors aren’t equipped to do that, they don’t have the skills to do that. They may have the knowledge, but they don’t know how to communicate them in a way that is comfortable for them and therefore makes their patients comfortable. So, everyone is kind of walking around in the dark. The medicines that we take, a lot of the medicines for chronic illnesses, cover up the symptoms which then creates the illusion that I am not as sick as I really am. Which is another barrier. Why would I want to execute that? Because I feel fine, I may be taking 8-15 different medications, but I am not going to die. So why would I want to execute those things? So those are some of the barriers I have been encountering in my career.  

Q - In the confusion around what end of life care is, can you talk about the differences between non-medical and medical decisions that they (caregivers and their family members) need to think about? 

A – I get phone calls from caregivers they’re wanting to know where they can go to hire a nurse. And then talking with them on the phone, they’re looking for someone to come out to the house to help mom or dad or a family member with like maybe bathing or dressing or maybe making sure they are taking their medications you really don’t need a nurse to do that. 

In the homecare industry there are different levels of skill that health care worker, a home care worker has. In CO when they require homecare agencies to be licensed, they established a two-tier system. There is a Class A and a Class B license. The Class B license is the nonmedical and the Class A license is the medical or what is often called the skilled. The two differences between these two licenses, there are a number of them, but two major differences. The A license, or the skilled license, is that home care agency has what is know in the health care world as skilled positions. So, you have a nurse, an RN or an LPN, maybe an NP. You also have skilled positions like the therapist, the occupational therapist the speech therapist, the speech therapist, the physical therapist, or what’s called the OTSTST’s. Those are all skilled positions. CNA‘s are considered a skilled, semi-skilled positions. And the class A’s have CNA’s. 

The class B’s have what are called personal care workers and homemaker companions.  So, when you’re looking at home care agencies and you’re looking for what kind of care; if you’re needing somebody to come out and help mom and dad with maybe some light housekeeping, or some bathing or dressing kind of thing. You don’t need a nurse to do that. You don’t even need a CNA, you can use like maybe a homemaker companion who could do the light housekeeping the light meal preparation. If you wanted them to help with bathing or dressing you would have to have a personal care worker because that person can legally touch your family member and provide that hands-on physical care. And going back through all those levels. The least amount that you are going to pay for per hour is a homemaker companion. In the Colorado Springs area that is probably running $18, $19 dollars an hour right now. The next higher level would be a personal care worker, that’s going to run in the low $20 dollars per hour. Then you’re going to a CAN, that’s going to run in the mid to upper $20’s. And when you get to a registered nurse you are looking at $30 or more per hour for that kind of thing. So, if you choose between somebody who has the same skills (you are needing) a personal care worker who you could pay like maybe around middle twenties or so, or an RN you are paying thirty or higher you are saving money to go with the personal care worker. That’s some of the difference between medical and non-medical. 

Q - What are some of the misconceptions around these different types of decisions that people will have to make? 

A – Some misconceptions, I’ll just start and go into it, because I did 15 years of hospice social work. One of the huge misconceptions about hospice care is that you have to be bedbound. Now there is nothing in the rules or regs by Medicare, which licenses and oversees the hospices, there is nothing in the Medicare rules and regs that says you have to be bedbound. But most people have the misconception that ‘if my family member is up and walking around and able to do stuff than they aren’t sick enough to be on hospice care’. And in reality, what qualifies a person for hospice care is not what they are doing or not doing. It is, do they meet the specific medical criteria for specific conditions or disease to qualify. Oftentimes people can meet those conditions and still qualify for hospice care but can still be able to do a lot of being able to take care of themselves. I have had hospice patience in my career that were going on two week cruises and going on vacation to Disney Land or Disney World or Las Vegas or traveling 8 or 9 hours across country to go visit family members for 7-5 days and they were the ones doing the driving. But they were still on hospice care. It’s not qualifying for hospice care, it’s not about what you can or cannot do, it’s do you meet the medical criteria. Another misconception is that people think their doctor has to say they are ready for hospice care. I teach a concept called Hospice 101; and basically, after listening to a caregiver tell me what’s going on with their family member physically, what kind of chronic illnesses they have, (that) kind of a thing, oftentimes I will say have you thought about hospice care. They will say “but the doctor hasn’t said dad is ready for it”. Most doctors, unless they have done time as a hospice medical director, do not know all of the specific medical criteria that go into qualifying a person for hospice care. And doctors, like all of us social workers, healthcare professionals, even people on the street, we all have our misconceptions (and) misunderstandings about hospice care. If doctors have those misunderstandings and misconceptions, they may not be willing to recommend someone for hospice care.  

I had, years ago when I was in AZ, I was working for a hospice who also had a homecare. The hospice was having difficulty getting people from their home care over to the hospice side. For a lot of difference reasons, some of them the misconceptions we have talked about. I remember this one, the daughter was taking care of mom. The first time I went out to visit her as the home care social worker, mom was living in her own apartment and mom had cancer and we talked about everything.  Mom said I’m not ready for hospice, I am still doing treatment I said that’s okay. And then maybe 3, 4 months later I was asked to go back out, again as home health, but this time mom had moved into daughters’ house.  Daughter greeted me at the door and when we were walking down the hall, we walked by moms’ room. mom was laying in bed. Her bed was elevated at a 45-degree angle, moms jaw was relaxed so it was dropped her mouth was open, her eyes were rolled back in her head and she was doing what we call chain breathing. Really rapid and in succession. So, when I sat down with the daughter, I said I think your mom is starting to enter what we call in hospice the active dying process. Before I could stop her, her daughter picked up the phone and called the oncologist. The oncologist was screaming at the daughter and demanded who told her mom was dying and she said a hospice social worker here, and he said put him on the phone. I held the phone about two feet away from my ear and I heard the oncologist perfectly because he was yelling that loudly into the phone. And he was accusing me of practicing medicine. He was saying that how did I know that she was dying only doctors knew that kind of stuff. He said if she stops her treatments now, she will die. Because she needs to finish her chemo treatments in order to stay alive and all of that kind of stuff. I hung up the phone. Had a conversation with the daughter. We figured out a way to go to another doctor to get an order which then allowed our hospice to send out one of the hospice nurses to do the evaluation. Long story short, mom died the next day.  

We got her into hospice care that night, she died the next day. Sometimes, all of us have our misconceptions and this oncologist evidently had his own misconceptions about what hospice was, I am not going to even speculate what those were. This happened twenty years ago, and I still have a vivid memory of it. So, when it comes to this whole, end of life issues, because we have a lot of barriers, we aren’t talking about it anymore. It’s not an easy conversation when I talk to caregivers sometimes, they you know talk about well, I’m thinking dad is really sicker than what he really is. Then they begin to apologize. Because they think that by talking about death and that’s another misconception that if you talk about death its going to happen. We can talk about death all we want but that doesn’t mean it’s going to happen. That’s how deep our fears go as human being when it comes to death and dying, we believe that when we invite it in its going to kill us.  

Michaela – That’s a really powerful story. And it shows that people rely on their doctors as well and they’re not always the specialist in end of life issues.  

Kent – Right  

Q – Along the line of medical care, you were talking about hospice care. Can you talk a little about the difference between palliative care and hospice care? 

A – I am going to try to give as good of a verbal picture as possible. The picture is, draw a circle about the size of a quarter and draw another circle that is about the size of a small plastic lid on a container. And that small circle needs to be inside that larger circle. So, you’ve got a small circle inside a big circle. So, palliative care is the big circle, hospice care is the small circle. So, if that’s said, all hospice care is palliative care, but not all palliative care is hospice care. There’s a difference. The biggest difference between palliative care and hospice care (is that) in palliative you can continue treatment for whatever your hospice diagnosis may be. So, let’s say its Chronic Obstructive Pulmonary disease or COPD, which means your lungs aren’t working well and its difficult to breath and its going to lead to your death. If you are on palliative care, any treatment you were doing for the COPD you can continue. On hospice care, any treatment that was “to cure” the COPD, you can’t do. I think a better example than COPD might be like cancer. On palliative care you can continue to get your oncology, your radiation (treatment) for the cancer. On hospice care you cannot do the oncology, you cannot do the radiation, you have to stop those. So that’s the biggest difference. Another difference between palliative care and hospice care is the support level. Hospice care, when people are in hospice care the support they get is really well defined because Medicare pays for the hospice care and Medicare says that hospice care is provided by a team and the team consists of a registered nurse, a CNA, a social worker, a chaplain and a volunteer. Medicare says in those policies that the only person that the hospice patient has to see is the nurse and the nurse has to visit them at least every two weeks. Most people while they are on hospice care take the full team; the nurse, the CNA, the social worker, the chaplain and they even ask for a volunteer. On palliative care its not as well regulated. I have had conversations with professionals in the community who are involved with palliative care programs and the palliative care program is struggling to figure out a way to properly bill Medicare. Under hospice care there are very specific billing codes you use. Under palliative care there is not. You can get reimbursed by Medicare for palliative care. But it’s not easy to do as a provider. The other is, because it’s not regulated by Medicare like hospice care is, you can have a palliative care program where it consists of a registered nurse or a nurse practitioner going out and visiting the patients once every three or four weeks to check on things like their pain level or their medications and maybe make some adjustments in the medications or whatnot. But that’s it, a nursing visit once every three- or four-weeks kind of a thing. There are some palliative care programs where they will allow a CNA to go out to help with maybe some of the physical care. I know of maybe one, possibly two palliative care programs in our community where they offer the full team. A nurse, CNA, maybe pull a social work from the hospice side a chaplain would be from the hospice side. No volunteer, but those 4 people. To be honest, they are really losing money from palliative care because Medicare doesn’t reimburse well for palliative care. I have had conversations with professionals in the community that they have said, and I basically said, until Medicare decides to regulate and oversee palliative care like they do hospice care, palliative care is not ever going to really catch on and take off. Hospice care was suffering from the same thing back in the early 70’s and whatnot. When hospice care came over, all of the organizations that were doing hospice care were nonprofits and the professionals were volunteering their time. Or, if it was a very organized nonprofit, they raised the money so they could pay at least the nurses, maybe the doctors, but the rest of the team were volunteers. And it wasn't until Medicare came up with the Hospice Medicare benefit, which is under Medicare Part A, that hospice really began to take off and flourish. My point is the same is going to happen with palliative care. It's going to struggle, but when Medicare decides to regulate it and license it like they have hospice care, it's going to take off. But those are some of the major differences. You can be on palliative care, but not on hospice care. You can be on hospice care, but that also means you're getting palliative care and there's restrictions either way.  The other thing, the other similarity or the other similarities, between hospice and palliative care is that it's provided wherever you are at. So, if you're at home, if you're a care facility, an assisted or nursing facility, palliative healthcare can go there. Hospice care can go there. When I was doing hospice work in Arizona, I had one patient who, when the Hospice care started, he was living under a bridge. And the other hospice patient that I remember, he was living in three large cardboard boxes in the middle of the dry riverbed of the Salt River. So, for hospice care, that’s another misconception, people often think their hospice care is a place. It's not, it's a type of care, and hospice care will go wherever you are at. 

Q - End of life issues are so hard to talk about. America has a fear of talking about it. How would you recommend someone going about talking about it for themselves, talking to their children, or loved ones or a child talking to their parents, about what they want? 

A. So, I'll start with the easier one first. So, it's an adult child talking to their parent about what they want. The adult child needs to be thinking about what they know mom and dad have said to them. So why is the adult child coming over to take care of them? It's because mom and dad want to stay in their home for as long as possible. Okay, what mom and dad don't understand is that they have to put some certain things into place to absolutely guarantee that. So, a good starting point would be to say “so dad, I know that you really want to stay in the house and I've been coming over to help you stay in the house, but to really guarantee that you stay here until you die, which is what you told me, we need to be talking about some things. Like powers of attorney, like a medical power of attorney, a financial power of attorney. Because yes,