The demand to stay in your home is growing because Baby Boomers are more independent as a generation.  They demand more independence, they demand to stay at home.  So Home health services have been growing like crazy over the last 15 years.  Tom and Greg Pang discuss options for seniors.

Greg Pang, President & CEO
Community Home Health & Hospice
www.chhh.org

has served with Community since September 2005. A native of Washington State, he has almost 30 years’ experience providing compassionate, community-based care. Greg’s prior experience included home health and hospice services provided by Good Samaritan Home Health & Hospice in Puyallup, WA and Group Health Cooperative in Seattle, WA

Greg earned a bachelor’s degree in speech communication and a master’s degree in health administration at the University of Washington (Seattle, WA). Certified as a home/hospice care executive, Greg is published in professional journals and has presented at national, state and local conferences. He is passionate about providing community-based services to the growing elderly population so they may “age in place” and remain in their homes as long as possible.

Greg serves on the board of the Home Care Association of Washington.

Show Transcript
Welcome to it's just wallpaper, a podcast dedicated to providing solutions for seniors and families dealing with life changing health and living conditions. Your host Tom Deutsch is a graduate of Columbia University School of Public Health and administrative medicine. Tom brings 43 years of executive experience working for the care and well being of senior citizens with credentials and licenses as a nursing home administrator, life insurance agent with a long term care endorsement, professional guardian and court appointed guardian ad litem in over 1500 cases. Tom brings a lifetime of knowledge to help you and your family make the best decisions you can. And now from our studio in Coeur d'Alene, Idaho, here is Tom Deutsch.

Welcome to it's just wallpaper. My name is Ed Bejarana. And I am the producer of the program. In this episode, Tom and I will revisit the information we've covered so far, and get a personal take from Tom, on how these episodes should help seniors make life focused decisions. Good afternoon, Tom. Thank you for joining me today on this special episode.

Well, it's uh, as always, it's great to be with you. As you know, I retired a couple of years ago, and have been trying to find a forum to share information and my life experiences to help our seniors and their families. It is gratifying to receive the support that has been forthcoming from our guests that had been willing to share their expertise and enable me to continue this work

well in the program. So far, at least from my vantage point, has been just going great. Tom, for the listeners who may not have been listening since we went live on October 1. Can you share a little bit about the name? It's just wallpaper?

Absolutely. As our listeners know, and for new listeners for many years, I work behind the desk of multiple health care facilities. I personally witnessed potential patients and their families make placement decisions based upon decorative items such as wallpaper, rather than what really mattered. Can the appropriate care be delivered? Perhaps another way of saying it would be the decision was made based upon who had the best mousetrap and example. At one point in my career, my wife and I owned and operated four adult family homes. A son and daughter toured our home as they struggled with the placement decision for their mother. In the end, they selected another facility. As I knew the family, I asked them, Why did they choose another home instead of the one that we ran? They told me that they like to shower better. Our main shower was a prefab unit and my competitors was tiled.

Tom, we went live with two episodes with Kerry Espinosa, the first entitled Medicare Part A, B, C and D. And the second one titled Medicaid Advantage plans and Medicare supplement plans explained with Medicare open enrollment season that started on October 15. I'd say those episodes were timed perfect. What were the big takeaways for the listeners? And what feedback have you received from those who have listened?

And I think the major the major takeaway is that the consumer has to make very important decisions that will affect their health care delivery. As a Medicare consumer today during open enrollment, my mailbox is flooded with advertisements, television is filled with commercials and my phone is ringing. You need to ask questions and not be influenced by a sales pitch that perhaps you don't really understand. I had a friend call me and told me that he was going to switch to an advantage plan because they had dental. He told me his wife had had a root canal the previous year, and they had to pay for it out of pocket. I told them the first call the plan and asked whether root canals were a covered expense. The plan he was looking at may only have covered perhaps annual exams and routine cleaning.

Medicare is one of those very confusing parts of life. I know every Medicare insurance agent in America hosts seminars and Medicare. But I hear from so many agents that they struggle to get people to attend. Why do you think seniors are more open to listening to a podcast sharing information about Medicare?

Well, I think today the odd So, first answer is the COVID environment that we live in. The seminar type programming that we had for so many years is just not working. I believe the podcast presentation is by far safer, and then presented within a concentrated timeframe. The listener can take the information, play it again if necessary, and begin to formulate questions to make sure they are purchasing the product that works for them.

I'm going to jump around a little now. Episode Four was titled Are you ready? The importance of legal documents and your guest was attorney Rebecca Iman. She was also your guest on episode nine. When his elder Guardian Guardian ship necessary in Episode 10, you can't give it away senior financial considerations when planning for long term care. All three episodes were fascinating to me, and I'm I'm not up the retirement age. But what are the big takeaways you feel our listeners gained from these episodes?

Well, you know, the biggest takeaway is to get your planning in order. Again, look, and we both know I'm not an attorney and I can't give legal advice. But I have seen time after time, the emotional and financial toll taken by not having documents properly prepared. This should prevent questions as to who you want in charge of your decision making. This should prevent questions as to who you want charge for decision making. Should that be necessary? what your thoughts are on end of life decision making? How your real estate should be handled? And who should be in charge.

You have lots of experience helping seniors with long term care in your 40 years. What do you feel is the biggest failing of our health care system for seniors?

I would venture to say that there is too much misunderstanding as to what Medicare will pay for a long with a real lack of understanding the real cost of long term care.

Now episodes five and six were with nurse practitioner Mary Buckland and YouTube discussed how to recognize and monitor ongoing clinical warning indicators for seniors. What do you feel was the important takeaway for our listeners,

the major takeaway is stay involved with your parents care, and to be proactive and be a proactive good observer. Go to the physician appointments, monitor their medication, look for signs of poor hygiene and nutrition, do a home safety evaluation. Should there be a need for placement continue to stay involved and be a good historian, especially in today's dynamic healthcare delivery system.

I shared the story of my mom dying from complications brought on by Alzheimer's. Having watched my mom make the transition from a vibrant, well educated, strong woman to the frail woman with no memory of her past or the people around her. I know the warning signs to watch for a critical at least in my book. Right after nurse Mary Bucklin you had Dr. Steve mark, come on and talk about dementia testing and care. What do you feel was the big takeaway from those episodes,

as emphasized with nurse Mary Bucklin and Dr. Steven? stay involved, educate yourself. There are things that can be done to make life simpler and less complex. With the dementia patient. It is critical that family be there, understand the illness, seek professional guidance and make the very tough decisions. I know that my own parents had a better quality of life with my brother and I involved and providing oversight

so much of life for children of elder parents who struggle with health issues. It's juggling two priorities. On one hand, we have our work and family at home and then we have a parent or loved one who might need full time long term care. Your latest guest was Ed Stone who talked about long term care insurance. What was the ...

In the second of two episodes, Edward Stone gives further definition to the long-term care products and discusses future growth and costs.

Cost of Care Calculators:

Mutual of Omaha
Nationwide Insurance

Show Transcript

Welcome to it's just wallpaper, a podcast dedicated to providing solutions for seniors and families dealing with life changing health and living conditions. Your host Tom Deutsch is a graduate of Columbia University School of Public Health and administrative medicine. Tom brings 43 years of executive experience working for the care and well being of senior citizens with credentials and licenses as a nursing home administrator, life insurance agent with a long term care endorsement, professional guardian and court appointed guardian ad litem in over 1500 cases. Tom brings a lifetime of knowledge to help you and your family make the best decisions you can. And now from our studio in Coeur d'Alene, Idaho. Here's Tom.

Welcome to it's just wallpaper where my guests and I aim to provide our listeners with thoughtful information and resources to enable them to make the best decisions the first time. Today we are going to discuss Long Term Care Insurance. Joining me from his home in Vermont is Ed stone. This just don't work for Crump Life Insurance Services, where he's responsible for managing existing producer relationships, and building new relationships through referral and marketing initiatives prior to joining Crump insurance and spent 16 years managing the sale of long term care products, as regional sales director and regional sales vice president with two major insurance carriers. Prior to that he spent seven years as National Sales Manager for a national brokerage agency. Before I welcome Mr. Stone, I would like to give you a recap of where we were, when we last spoke with him, we had got a really good overview, which I would encourage you to visit of the insurance industry, and long term care insurance industry. And we also talked in depth about the cost of care. Ed gave us two or two to three different calculators that are available to us where you can get a good idea of cost of care in the community or your community. And we'll provide this on our website as part of our program. So having said that, welcome, again, Ed Stone.

Thank you, Tom, pleasure to be with you.

What I'd like to do is talk about the most common product that you see sold in the long term care market today,

for sure, there's really three different types of products that you find out in the marketplace. There's what we call traditional long term care. There's what we call linked benefits, or hybrid asset base. And you may hear one of those three terms. And then there are products that are annuity based long term care. The traditional Long Term Care is the product that started the whole industry that we were talking about in our last session. It's a product that is a pure health product, it has no other features to it, you use it strictly for you know, for the long term care services. It doesn't develop any equity in it or anything like that. There are ways to join policies together between couples etc. and paths, you know, unused benefits to each other when you when you pass away or something like that. The industry has has morphed into a second area called hybrid products. And these basically were designed based on a life insurance policy with long term care features. And these particular type of products. The major reason for it is the long term care, ability to use money to be used for long term care. The secondary reason is, with the ones I talked about a moment ago, a lot of people said, well, gee, what if I have this policy for 30 years and step off the curb? get hit by a bus, I wasted all my money. There's nothing you know, nothing back. So the insurance industry said okay, we're pretty certain from our research that if you live long enough, you'll die haha. Well, let's build it on a life insurance platform charged more money because theoretically, there's a death benefit if you never use it, or if you only use some of it. And also, if you wanted to cash it out, there's some money you can get back. So those are the two main ones. But what we're seeing now is really very interesting. Because there's always been a product in the insurance industry called an annuity. Some of the listeners may have an annuity. an annuity is basically a sum of money that sits in an account the insurance company grows tax deferred, which is great and grows and grows and then you can cash it out. You got to pay taxes on anything not given tax and legal bites here. Of course, you can you pay taxes on a new game, or you can even turn it into a lifetime income. Well, believe it or not the federal government actually wants you to do something about your long term care potential long term care needs, they are our friends. Because they pass something back in 2010, called the pension Protection Act pretty easy to remember pension Protection Act. And in that act, they said, money that goes into a long term care annuity, if it's used for long term care services, the money you put in, and any money that it grew to comes out income tax free, as long as you're using it for long term care. So this has opened up a whole new part of the market. Because the other two products you have to have never be able to pass underwriting gotta be healthy enough to pass underwriting. annuity products are pretty much in your sign the application, some of them may ask a few health questions or even a nursing home etc. So what we're finding is folks that can't get the traditional policies or the hybrid are now taking some what I call lazy money money that's sitting in a CD or under the mattress that they're going to use for long term care down the line. And they're leveraging it because they get more money for the long term care services than they would if they just paid dollar took dollar for dollar out of whatever it was in. In terms of what's being sold the most right now or purchase the most, it is a hybrid product. And that has to do with a number of factors, including the the mistakes we talked about last time on the old product that's kind of made people a little skittish about products where you know, that were underpriced and could have raised increases. Plus, a lot of people are saying, look, you know, I may never need this. So let me let me at least hedge my bet a little bit with some life insurance. If I don't ever use my long term care, annuities, though, I think they're going to be something that you're gonna see a lot more people looking at, because the money sitting there, and they'd like to leverage it and do do better on their taxes. long answer to a short question, but that's kind of where it is.

Now, is there inflation protection built into these policies?

They're not built in, but you purchased them as an add on rider. And we tell people, you know, if you're under 70, you probably want to look at an inflation rider. Because the average claim age today and remember what the definition of average is, of course, half half and a half. The average claim age today is about 83. So if I was 60, I got probably 2025 years before I might incur a claim. Now the thousand dollars I have today, I'll get a check for 1025 years, but what's it going to buy? So we really encourage younger people to consider inflating the policy just keeps inflating, inflating, inflating till you go on claim and then it actually continues to inflate after you are on claim. But that's more

Yeah. But at this point, that's an add on to the policy.

It is an extra cost. I think it's an option on the car, you got white walls you got paid for.

Right. A...

In the first of two episodes, long-term care specialist Edward Stone gives us a history of long-term care insurance, relative costs of the product, and current costs of care.

Cost of Care Calculators:

Mutual of Omaha
Nationwide Insurance

Show Transcript

Miranda Hamilton  0:00  
Welcome to it's just wallpaper, a podcast dedicated to providing solutions for seniors and families dealing with life changing health and living conditions. Your host Tom Deutsch is a graduate of Columbia University School of Public Health and administrative medicine. Tom brings 43 years of executive experience working for the care and well being of senior citizens with credentials and licenses as a nursing home administrator, life insurance agent with a long term care endorsement, professional guardian and court appointed guardian ad litem in over 1500 cases. Tom brings a lifetime of knowledge to help you and your family make the best decisions you can. And now from our studio in Coeur d'Alene, Idaho. Here's Tom.

Tom Deutsch  0:42  
Welcome to which just wallpaper where my guests and I aim to provide our listeners with thoughtful information and resources to enable them to make the best decisions the first time. Today we are going to discuss Long Term Care Insurance. Joining me from his home in Vermont is Ed stone. This just don't works for Crump Life Insurance Services, which is where he is responsible for managing existing producer relationships, and building new relationships through referral and marketing initiatives. Prior to joining Crump insurance, Ed spent 16 years managing the sale of long term care products as regional sales director and regional sales Vice President for two major insurance carriers. Prior to that he spent seven years as a national sales manager for a national brokerage general agency. Well welcome Ed stone.

Ed Stone  1:45  
Hey, Tom, thank you. Good to be with you. Thank you,

Tom Deutsch  1:48  
well, before getting into the insurance product themselves, I believe would help to get an overall history of the long term care industry. When Long Term Care Insurance took off, how many companies were in the market compared to today?

Ed Stone  2:04  
Well, at the height of the long term care insurance industry, we probably had about, oh, maybe 100 or so carriers out there, marketing, long term care insurance, varying degrees of success or varying degrees of size of their companies, about 100 or so at the height of it maybe 1015 years ago,

Tom Deutsch  2:25  
can you give us a little bit of history about how this whole long term care insurance industry started?

Ed Stone  2:31  
Sure, sure. Back in the probably the early 70s, you had products called nursing home policies. Some of them were called home health care policies. And these were put out as just a flat, per diem reimbursement type of product, need to go to a nursing home, will give you up to $50 a day, as long as you're in the nursing home, as long as you know, whatever amount of policy benefits you had purchased. Same thing on homecare, if you need people to come into your home, we'll reimburse you for $50 a day. Those types of policies were pretty broad in terms of how you can get them and the definitions within them. But I'm going to say in the early 70s, they started to get a little more sophisticated as different forms of, of care. In the long term care industry service industry started to evolve, where you had assisted living facilities, starting up home care, adult daycare, things like that. So the insurance companies looking at the demographics of the baby boom generation. And you know, at that point in time, the greatest generation getting into their 70s, they started marketing products that were what we call comprehensive that would cover you from the home to the nursing nursing facility. So it became much more of a structured industry. And they started to put in things such as how you would trigger the benefits. They were very specific and how you would trigger benefits when you were trying to collect on your policy where before was just kind of open ended here. You show us that you're going to nursing home, and we're going to send you the 50 bucks a day, that type of thing. So it's just like a lot of the insurance industry became more sophisticated as the need evolved for services. That'd be the easiest way to explain it. Tom,

Tom Deutsch  4:26  
in an earlier question. You said when things started out, there were about 100 companies in the business. Where are we today? And why?

Ed Stone  4:36  
Well, there's been a contraction in over the last 10 years in the industry. We're probably down to a dozen 15 carriers who are significantly in the business of marketing long term care products to the American public. What went wrong was just kind of a perfect storm of mistakes that were made whenever a new insurance Our product is developed. The actuary, those are the guys with the visors that do all the pricing of products have to look at the different risk factors out there, and price their products based upon potential usage potential number of claims per thousand people how long those claims are going to be there, the long term care product was a brand new product that really hadn't been invented, for lack of a better word. So the actuaries would look at what they thought would be similar products, and start to use some of that data to do their formulas to come up with the pricing and the benefit structures. The underwriters, the people that would look at the look at the applications from the clients look at their medical histories, they were, they weren't really underwriting it in ways that we now know, in retrospect, they should have been. So they were making some assumptions also, from an underwriting standpoint, as to medical care, and how that would work. So there was a number of things that occurred over the last probably 1520 years, that started to manifest itself in claims that were much higher than the actuaries had predicted. That was one factor. Part of that was 30 years ago, 40 years ago, if you were diagnosed with cancer, the doctor would pretty much say, you know, Tom gets your affairs in order, you don't have long to go, right. But today is a cancer as an example, cancer diagnosis isn't an immediate death sentence. people survive cancer, but they can be chronically impaired. So several factors led him to the carriers, making horrendous pricing errors. And also starting to understand from the new data that maybe this wasn't the type of market they wanted to be in for the risks that was involved. Things such as what we call the insurance industry persistency.

Ed Stone  7:06  
Every time you price a product, no matter what it is, you assume, at the average time of a claim would occur, you're assuming that x percentage of people that bought the policies back then would not have the policies in force at the time in normal, normal time of claim or the curve. So not knowing that they looked at a lot of other products, similar type health products, and they assume the latch ratio. Well, what they didn't know till for about 25 years was when people put a long term care policy in force, they had a tendency not to let it go. And today, the average what we call lapse ratio for long term care policies is around one to 2%. In other words, about hundred people bought a policy, we're now projecting that 9899 of them will have the policy in force at the time that most normal claims occur. So this scared the jeevers, as I like to say, out of the actuaries, and then obviously then scared the bejeeber...

Attorney Rebecca Eyman discusses financial considerations when planning for long-term care.

Rebecca Eyman
Associate Attorney
[email protected]
(208) 765-3595 (office)
(208) 765-0515 (fax)
Coyle & Wytychak Elder Law
POB 1888, Coeur d' Alene, Idaho 83816
www.cwelp.com

Show Transcript

Welcome to it's just wallpaper, a podcast dedicated to providing solutions for seniors and families dealing with life changing health and living conditions. Your host Tom Deutsch is a graduate of Columbia University School of Public Health and administrative medicine. Tom brings 43 years of executive experience working for the care and well being of senior citizens with credentials and licenses as a nursing home administrator, life insurance agent with a long term care endorsement, professional guardian and court appointed guardian ad litem in over 1500 cases. Tom brings a lifetime of knowledge to help you and your family make the best decisions you can. And now from our studio in Coeur d'Alene, Idaho, here is Tom Deutsch.

Welcome to Woods just wallpaper. It is our aim through these podcasts to provide our listeners with thoughtful information and resources to enable them to make the best decisions the first time. Today, the name of our podcast is you can't give it away. When someone finds themselves in a situation in which they require post hospital care, or can no longer live at home, or need help at home. The foremost question is often who is going to pay for it. During our previous podcasts, we've discussed major health care benefits programs. For a quick review. Medicare, as opposed to Medicaid is a federal program designed to meet skilled care needs. This is generally for a short period of time, although maximum benefits could go up to 100 days. Examples of skilled care could include rehabilitation following a stroke, fracture, administration of IV medication to feeding or intensive nursing, the care must be delivered at a skilled nursing facility. In essence, the general rule is that you are going to get better. Medicare is not a long term care solution. Another not federally funded program is private pay, where care is paid for personally or by family members. We will be talking about long term care insurance and what's covered in separate programming. This now brings us to Medicaid, which in many instances is state specific program, the Medicaid program can assist those who qualify with what is called custodial care. This type of care is needed by individuals who could no longer live independently. Besides institutionalized care, there may be some limited benefit for care in the home. I have met many people who operate under the assumption that they can simply give away their money or sign their property over to others, and the government will simply take care of them. Today, we're again joined by attorney Rebecca Iman, with the quarter lane law firm of coil and whitey check elder law. Although there are guidelines specifically states, I have asked Rebecca to give us a basic general outline of qualifications. My understanding is there are two factors needed to be eligible. One is actual need, and the other is financial. Although at best, there are variations. I've asked Rebecca to focus on a single individual that has a home and Social Security. So beginning if eligible, how does the State agency Rebecca, look at this person?

So that your introduction was absolutely right, Tom, the state is going to look at both the medical need and the financial need of the individual. And it's it's a little bit easier just to look at an unmarried person because I will say that married couples the analysis is more complicated, but the state is going to ask first, is there a medical need for this person to be in some sort of long term custodial care? And second, financially, do they need support to pay for it? So that's sort of the the two step analysis taken by the state.

Let's talk about a person that has a home and I know there are all kinds of ways to go but let's say they own their home. It's debt free. They have some money in the bank. Let's say they have $10,000. And they're single, and they need to go into a care facility. And they now have made application. What happens?

So this is a really, that sounds like a really common scenario that could that could describe any one of my many clients who have found themselves struggling to figure out how they're going to pay for nursing home. So let's say just hypothetically this person has a medical need can be shown because I'll tell you, that's not usually the factor. Usually, it's pretty clear that due to medical issues, long term care is needed. So then the state's going to look at income and assets. So let's focus on assets first, because that's what your question presented. So this person owns his own home, and he's got some money in the bank. So every state, I will back up and note that every state has its own interpretation of Medicaid, which is a federal program applied by the states. Some states stick to social security rules when it comes to financial need, and others have their own limits. But I'll just describe Idaho's financial analysis, which allows for exempt assets and non exempt assets. So certain items can just be taken off the table when it comes to countable assets, and the home is one of those. So if a person owns a home, but is moving into the nursing home, they don't have to sell it to pay for care, not necessarily some other exempt assets or vehicle. Even if they can't drive, some irrevocable funeral and burial pre payment plans and a variety of other assets, then everything else is going to be fair game, those are your non exempt assets, your bank accounts, your cash on hand, etc. So this person has $10,000 in non exempt assets, because his home is exempt. In the state of Idaho, he can have 2000. So that means he's 8000 too high, he needs to spend down $8,000, before he can go on Medicaid. And if he's paying for nursing home out of pocket, it won't take very long before he spent that

in again, we're only looking at the state of Idaho, because every state we know is different. The person is now the single person is now in the nursing home. What happens to the house at one point does the sale is this is a house is there a trigger for the sale of the house.

You know, it is at least in Idaho, there's this sort of as long as there's a vague intent to return to the home, even potentially, hypothetically, they won't force a sale of the home. One thing and I might be jumping ahead a little bit is that the state will ultimately lien the home for any amount they've paid out in care and will want to get paid back after the Medicaid recipient dies.

Okay. So that that's a really, very important point, I want our listeners to know that if there is any possibility that the patient may return to the home, that the state is not going to force the sale of the home.

That's correct,

right. And However, if the state is paying for care, at a skilled nursing facility at an assisted living type situation where they're getting care, then the state ultimately is going to try to recover their out of pocket expense from that home,

right from the estate. So not not until after that person dies, but they'll hope to recoup that. So they can apply those funds towards someone else in need with the state put a lien on the house. Yes.

Effectively when the person goes in the facility.

Exactly. And although they can't recover against the lien until that person dies, they'll lean it to sort of hold their place in line so to speak. Okay, so, again, let's say this is our individual

is in the nursing home, and the individual has a will. And the will says I'm glad you're the attorney here, okay. The wheel says, I want to give this house to my son a...

Elder Law Attorney Rebecca Eyman will discuss the concept of elder guardianship and conservatorship considerations, the actual process, legal terms, costs, and on-going legal requirements.

Rebecca Eyman
Associate Attorney
[email protected]
(208) 765-3595 (office)
(208) 765-0515 (fax)
Coyle & Wytychak Elder Law
POB 1888, Coeur d' Alene, Idaho 83816
www.cwelp.com

Dr. Meharg discusses common testing methods for dementia with additional case specific inquiry to gauge the extent of the illness.

Steve Meharg, Ph.D., ABN
 945 11th Ave
 Longview, WA 98632
 360-414-8600 x130
 [email protected]
www.cfmal.com

Stephen S. Meharg, PhD, ABN, a neuro-psychologist defines dementia, discusses misconceptions and behaviors.

Steve Meharg, Ph.D., ABN
 945 11th Ave
 Longview, WA 98632
 360-414-8600 x130
 [email protected]
www.cfmal.com

In her second podcast Nurse Practitioner Mary Buckland discusses the risk of falls and prevention, proper nutrition, hygiene and weight loss, wandering and isolation. Nurse Buckland in addition offers meaningful suggestions to improve quality of life.

Senior Nurse Practitioner Mary Buckland
 My contact info is [email protected]

Show Transcript

Miranda Hamilton  0:00  
Welcome to it's just wallpaper, a podcast dedicated to providing solutions for seniors and families dealing with life changing health and living conditions. Your host Tom Deutsch is a graduate of Columbia University School of Public Health and administrative medicine. Tom brings 43 years of executive experience working for the care and well being of senior citizens with credentials and licenses as a nursing home administrator, life insurance agent with a long term care endorsement, professional guardian and court appointed guardian ad litem in over 1500 cases. Tom brings a lifetime of knowledge to help you and your family make the best decisions you can. And now from our studio in Coeur d'Alene, Idaho, here is Tom Deutsch

Tom Deutsch  0:42  
over the course of my career working in all venues of long term care. Time after time, I witnessed important decisions being made based upon impulse and non essential factors. Welcome to it's just wallpaper where my guests and I aim to provide our listeners with thoughtful information and resources to enable them to make the best decisions the first time when we visit our clinician or specialist as we age, it becomes increasingly more important that we be good historians of our health record, or can rely upon someone who is when I used to accompany my parents to physician appointments. I was amazed at what they told him and what they simply did not recall. Joining us today for a second podcast is nurse practitioner Mary Buckland. Mary Buckland is founder and president of mobile health care providers Northwest. She has extensive experience in internal medicine, family health care, urgent care, for ology hospice and palliative care. Mary, I want to thank you very much for coming back with us on this program.

Mary Buckland  2:04  
Thank you for having me.

Tom Deutsch  2:06  
on previous program, we talked about core comorbid factors that should be considered in this COVID-19 atmosphere and the impact it can have on the elderly. We also emphasize the need to have a good story and present when visiting a physician. Mary also discussed the need for clear and concise state planning documents for power of attorney and Advanced Directive. In this previous broadcast, we also talked about medication management. And now I'd like to talk about falls and the dangers that they pose to our seniors. What are your concerns with falls

Mary Buckland  3:00  
Falls in seniors in and of themselves really increase the risk of mortality. Anytime somebody breaks a hip that can increase their mortality, even more. So the key to falls and reducing mortality is the key to is is the key to reducing or preventing falls in our community here in Vancouver worked very passionately on reducing fall risk in our seniors and before covid HIV we were constantly sharing information among many of the eldercare aspects of the conceit community to make sure we reduce those walls. A

Tom Deutsch  3:44  
lot of our seniors, great great a majority of our seniors are not living in facilities and are living at home or in retirement centers. So what services are out there that can analyze and look at potential risks for seniors in this environment?

Mary Buckland  4:02  
Very good question. Most physical therapy, home health physical therapy departments or programs will send us physical therapists out or an occupational therapist and they can look at the home and they can identify what areas or what things increase the seniors fall risk and they can work on making sure that the home environment is as safe as possible in reducing hazard of trips and slips and making sure that those obstacles are removed from the home to help reduce that risk.

Tom Deutsch  4:42  
So what would be some examples of what I'm thinking about or throw rugs that are in the house? Obviously I you know, possibly if there's a two story home to try to try to move somebody downstairs so the stairs are not In the way you're presented danger, if possible, obviously, that's not always the case. But people should take a good hard look at what's on the inside. To prevent that various serious fall, that could be a best Sentinel event. For the senior.

Mary Buckland  5:20  
Yes. throw rugs are a huge, huge factor in surfing. Everything that really needs to be remembered and many folks need to be reminded is the use of those mobility devices that help keep them on safer and upright such as walkers, canes. Sometimes people use wheelchairs, too, because they do not have good balance or their legs aren't strong enough to support them for periods of time. And certainly, analyzing somebody's care environment if if they can't traverse stairs safely, then trying to adapt to our environment where they can be an all in all on one level and reduce the risk of going up and down stairs is a very helpful intervention that can that can take place if possible.

Tom Deutsch  6:10  
You know, one of the things you mentioned earlier is that I don't think our listeners and perhaps they do but really understand the impact of a fall on a fractured hip and how that can really shorten life and have a dramatic impact on our seniors.

Mary Buckland  6:28  
Yes.  Anytime we have somebody that falls and breaks a bone or requires surgery, anesthesia, hospitalization, changing care environment, such as a skilled facility, anytime somebody that is a senior citizen lands in the hospital from a such an instance that in and of itself increases their risk of becoming delirious, it's very common for for seniors to become delirious when they're hospitalized. And anytime we put the senior in the hospital, we are on the medical side, bracing ourselves to be prepared for if that delirium still develops that in in somebody that when they become delirious in the hospital that in and of itself increases their mortality risk, the longer that is that persists. And that's not even factoring in if they've had surgery to repair a broken hip, for example, 

Tom Deutsch  7:27  
you know, I'm not here to scare our listeners. But even in my own mother, she had an nst she based delirium, which in fact, never cleared and impacted her for the rest of her life. So 

Mary Buckland  7:41  
yeah, that can happen. That certainly can happen. And I'm sorry that happened to her.

Tom Deutsch  7:48  
Let's talk about incontinence. And what you know, what possible steps we can do to mitigate incontinence are there things that are out there,

Mary Buckland  8:00  
incontinence can happen it's an unfortunate and frustrating thing that we have to deal with. Many times stress incontinence can sneak in more, so we see it more so and ladies. Some of that can be managed with main just mild incontinence pads to help for those times when when somebody sneezes or coughs or maybe they wait a little too long and their bladders too full. And there are certainly exercises that can take place that your that your urologist would recommend to try to increase the muscle strength within the pelvic floor. And certainly making sure that the prostate health is is factored in for gentlemen to make sure that they can evacuate their bladder and make sure the prostate isn't too large. Those are all things that we look at. There are medications that can also be considered depe...