Caring for Mom and Dad Session 1 | Julie Smith | Caring Strategies

[00:00:00] Speaker A: You. [00:00:00] Speaker B: Hey, thanks so much for listening to this message. My name is Jason and I'm one of the ministers here at the Madison Church of Christ. It's our hope and prayer that the teaching you hear today will bless your life and draw you closer to God. If you're ever in the Madison area, we'd love for you to stop by and study the Bible with us on Sundays at 05:00 p.m. Or Wednesdays at 07:00 p.m. If you have questions about the Bible or want to know more about the Madison Church, you can find us online at Madison Church. Be sure to subscribe to this podcast as well as our Sermons Podcast Madison Church of Christ Sermons. Thanks again for stopping by. I hope this study is a blessing to you. [00:00:38] Speaker C: All right, we're excited to have. Yes, we are excited to have that up and running. That's great. But then we are also excited to have Julie Smith. Years ago, we did this and we had an organization come I really didn't know anything about called Caring Strategies. And a lady named Jenny House came and made a presentation and she just was such a great presenter. But she also, you could tell she had the sparkle in her eyes, the excitement about how to help people, and all the knowledge that she had gleaned over years and years. Well, when I talked to her to ask her to come back again this year, she said, oh, you don't want me. She said, you want this lady that works with me now. Her name is Julie Smith. She has the sparkle, she has the energy, she has the expertise. And so she is, I think, director of operations at Carriage Strategies. And Julie Smith is going to come and share with us a little bit about how to put together a plan. Really thankful to have her. Let's make her welcome. [00:01:45] Speaker A: All right. I picked the wrong one already. Okay, we got it down Pat. Can everybody hear me? I've got two microphones on. That means I'm really, really special, right? I've got two. So I'm Julie Smith. I am the director of operations at Caring Strategies. This is a great crowd on a beautiful Sunday afternoon. Thank you so much for having me. And Brandon and I were speaking before and know it's one of those situations. Unless you've been through a caregiving experience with a loved just. You don't know what you don't know, right? I'm curious. Raise your hands if you have been a caregiver for a loved one. All right, a lot of you. Okay. So if you haven't, you probably will at some point, right? And then I think Nancy Reagan was the one who said, if you've not been a caregiver, you probably will need a caregiver. I think that's who said that. But anyway, so it's a privilege to be here today. There is information in your handout about caring strategies, and we offer a free 15 minutes consultation with me. So if you guys want to talk to me one on one about a specific situation that you're going through with a loved one or a friend or neighbor, please feel free to call or email me, reach out to me, and I'll be happy to help. Okay, so we have a short amount of time today, and I'm a fast talker. And that sentence I slowed down tremendously. I guarantee you I'm going to talk a lot faster. So I have a lot I want to try to cover. And so I definitely want to take questions. But let's try to save questions if we have time at the end because we have a really great agenda today. So honor your father and mother by being prepared to care. That's just kind of what we're talking about today. And like Brandon and I were talking about, that day is going to come, right? When you get that phone call, when it could be the hospital calling, it could be a neighbor calling, right? So then you rush to the ER or to the hospital. Do you have the information you need for that person, whether it's an aging parent, an aging spouse, a sibling? Lots of different scenarios, right? You have no clue where their information is. You have no clue what medications they take. If they have any allergies. Those are big, important questions. Maybe you have siblings, but they aren't around to help and you're just really having to go through this experience on your own. Where do you start? How many of you, does this sound familiar? You've been through it. It can be really scary. The good news is you can start today. Did you mess me up? The good news, you can start today, right? That's why you're here. You're going to get education and you're going to start thinking about, if nothing else, just thinking about having a plan, right? Even if you leave here today and don't even have the conversation until a year from now, at least it's in your head, right? So what do you do? You have to start that conversation. If you have aging parents and you have concerns, especially if they don't live locally, you have to start that conversation now. Parents are reluctant, adult children are reluctant, but we have to begin that conversation with our parents. It's also important if you have siblings to begin that conversation with your siblings. How many of you have been through that before? Yeah, it's not fun, is it? It can really be scary. The whole idea of these conversations is to have a plan, right? No one makes a good decision when you're in a crisis. And if you're at the ER in the middle of the night and there's all these questions being thrown at you and all of this crisis going on, nobody makes good decisions. And so we want to have a plan. Think about how you want to keep up with that information. Track that information, whether it's medical history, like I mentioned, medication and allergies. If your loved one doesn't live local, who's going to be the emergency contact? Local. But how are you going to keep up with that information? Does that make sense? Some families like using Google Docs. That's something that everybody can access from wherever. Continue the conversation, but also just be paying attention and observing as you continue the conversation because things will probably change. I will tell you, if you have never had a conversation with your aging parent about what their long term care plans are, don't expect to accomplish a lot with the first conversation because that's completely normal. It usually takes returning to the conversation and taking opportunities when things happen to have another conversation or taking opportunities when you see something on TV or a friend or a neighbor, you can open up the door for another conversation. But the whole idea is to have some sort of plan for when that day and that call comes, you have at least a little bit of idea of what your plan is going to be. So if you talk to any of these folks in the back, wonderful resources, they're going to tell you, if you don't have a plan, a plan will be forced upon you and it's probably not what you really want to do. Right? And so I love that. Procrastinate now, panic later. Right? That's pretty true. There are some misconceptions. I meet with families, talk to families every day on the phone, and these are some of the things I hear. I think parents have it under control. This is not something that is even on our radar and it's not a priority for us. Right. My parents don't want help, so I'll just sit back and wait for them to ask for help. Or my sister is doing all that. My sister's already handling all that. The chances of those things being true are as good as you win in the lottery. Right? That's just not true. You can't just hide yourself in a hole and ignore it, unfortunately. Right. So you got to be thinking about these things. Starting the conversation is probably the toughest. So I want to kind of give you some conversation starters for having the conversation with your parents. If you are an adult and you have an aging parent, there is nothing more awkward than the role reversal. Right. When all of a sudden you're having to parent your parent. I mean, there are lots of examples I could give of the type of conversations of how it can go south really quickly, where that aging adult can tell their child, what is the saying? I brought you into this world. I'll take you out. Who are you to tell me what to do? There are a lot of awkward family relationships sometimes where maybe there's estranged relationships. So having the conversation is tough, but the first thing you want to think about, it's not what you want, it's what they want. We at caring strategies, and all of us in the back of the room are advocates for aging adults. And when I meet with families, I always listen to all the opinions, all the different sides of the story. And then I always look at the aging adult and say, what do you want? What is your goal? Right. And that's where a lot of families get messed up in these first conversations is they kind of press their own agenda onto the aging adult. So it's so important when you begin that conversation to talk about what do they want? What are their wishes? What are their desires? What do they see in their head as their final years? Have they thought about it? What plans do they have in place? Some aging adults may say, well, my plan is to come live with you. Well, that would be good to know, wouldn't it? If that's their plan, you may be surprised to learn that this is something that they have already thought about, that they do have a plan, that they've already been on a tour at a senior community, that they've already put their legal documents in place, and they just didn't discuss it with you because they didn't want to scare you. Talking about that next stage of life, that sometimes happens, right? Maybe, but see what plans they already have in place, chances are they have in their mind some sort of idea of what they expect to happen. Obviously, starting the conversation is also about getting that necessary information that we talked about. It's so important to know the medications, the allergies, all that kind of stuff, and then misconceptions. Sometimes when I have a first conversation with an aging adult, they think that the only option out there is a nursing home. That if I leave my home, you're going to put me in a home, is what they say, right? You're going to put me in a home. And there's just a huge continuum of care out there now in 2023 with lots of options for aging adults in between being independent at home and in a skilled nursing, nursing home. But a lot of older adults don't know that because that's been their only experience, maybe with their own parent or grandparent is a nursing home. And so a lot of misconceptions in their head maybe about what long term care planning looks like. So a couple of conversation starters. This first one is a great one, right? I went to a workshop at church about long term care planning, and it made me wonder what your thoughts are about your care. It's a great conversation starter. I read an article, I met with my financial advisor. So there are a lot of ways we can start the conversation. And like I said, don't expect to get a lot out of that first conversation, but at least it gets the conversation started. So you want to keep in mind why your parents are resistant to talking. Probably one of the biggest fears. I've read lots of articles and seen lots of studies over the last 15 years. The number one fear of an aging adult is the loss of what? Independence. There you go. So whether some people say it's taking away the car keys, it's leaving my home, it's having a caregiver in my home, a stranger take care of me, all of those things are true. But all of that comes down to loss of independence. So that's probably the driver behind any resistance that you have with an aging parent that doesn't want to have the conversation. They have that fear. They also have this hope in their head that it's all going to work out or like the last one here, that they're just going to drop dead, why do we need to have a plan? I'm just going to drop dead, right? I'll tell you, I have a 97 year old grandmother that prays every day that she just drops dead because she is just done. And like, why is this lingering on forever? My grandfather passed away when he was 64. She is 97 now. She'll joke and say, it's been so long, he probably thinks I went the other way. So this is a conversation I have with her all the time because literally every conversation I have with her, she says, I pray the Lord takes me tonigHt. And I say, I pray that, too. I pray that, too. But there's these fears about running out of money, the fear of longevity, which is, fortunately, we're not to that place yet with my 97 year old grandmother. Right. But there is a real fear of living too long to where you run out of the money and the resources to be able to have the care you need. It's a real fear. And then the fear of losing control, losing their lifestyle, losing that independence. So just know when you approach that conversation, this is what's going on in their head. The moment you mention, let's talk about long term planning. Right. All of this rushes to the surface. Put yourself in their shoes. Would you not feel the same way? Absolutely. So now let's keep in mind why you and your siblings may be resistant to talking. I kind of alluded to this earlier. Maybe adult child doesn't want to talk about the mortality of losing their parents. They don't want to think about it. I'm going to have to move back over here. I can't send that lot being right in my eyes. So sometimes it's the adult child that doesn't want to talk about it. They may have a fear of angering a sibling. I love that the description is angering that controlling atop personality sibling. Do we all know who that is? We all know who that is. Do you all think I'm that person in my family? Yes. I have a brother. He has no chance. There's a fear of just, again, avoiding the unpleasant topic. Right. But how about the fear of angering a parent and maybe taking a risk of messing up that relationships or even the inheritance? We have some, I would say more shy adult children who, they don't even want to bring it up because they're just going to do what Mama and Daddy says and I'm not going to rock the boat. Right. Whatever they say goes regardless. Right. So those are some of the issues going on between the siblings, some obstacles and some ideas to handle them. Definitely think about, if you're going to have this conversation, think about where you're going to do it. You're not going to do it in a crowded restaurant where there's lots of noise, like you're not going to go to Buffalo Wild Wings, where there's three, four games going on and there's really loud music and there's probably kids. Keep in mind, there may be sensitivities for hearing loss, vision loss, if there's dementia, sensitivity to that. So you don't want to pick a place real noisy, but pick a place that is going to be comfortable for everyone involved. They definitely don't want to feel like they're being ganged up on, like an intervention. You don't want to do that. Right. It might even be better to have the first conversation with the sibling or the adult child that they're closest to without everybody there, just that closest sibling. Let them know that you're trying to have a plan so that you want to meet their wishes. The goal of this conversation is for you to meet your goals. I want to help make that happen. I have that conversation every day with our clients. They get immediately defensive, and I say, look, I'm on your side. I want to help you meet your goals. So let's talk about what that looks like. And again, I've already mentioned this, but listen and try not to push your agenda. It really is about them. There are some exceptions to that. If there's a cognitive decline, if there is a diagnosis of Alzheimer's, and you know for sure that they're not capable of making their own decisions, that situation, and only that situation is where you are pushing more of your agenda. Otherwise, it doesn't matter what you want. It's what they want. And trying to help meet that goal in the safest way possible, in the financially appropriate way possible, and all of those things, and then just keep talking. It may take months, it may take years. Just keep the conversation going. It's real important to do that. Got to keep on track here with my time. So how do you start the conversation with your siblings? Let's say the parents are off base. You're not going to even go there yet. But definitely let's talk about this conversation with your siblings so that at least you and your siblings could develop a plan. Even if mom and Dad don't even know what's going on, maybe you and your siblings can at least have a plan for when you get that call or for when that day comes. So one of the things that we often tell our clients is define the roles as caregivers. And we call our families siblings, neighbors. All of the people involved, we call them care partners, right? Instead of caregivers. Now it just makes sense to call it a partner because there's so many people that are partnering in that care. So think about those roles for the family. Think about the roles maybe for local neighbors and friends, and you can go ahead and divide up these duties. Even if you haven't had a conversation in detail with your parents, you and your siblings, or you and the care partners involved can still go ahead and talk about. Let's think about how we might divide this up, and you might can even implement some of this already, right? So if you have local adult children, maybe they're the ones that's handling the local stuff, like doctors appointments, the medications, the household chores and meals, sometimes bathing and dressing. But I'll tell you, that's one of the toughest areas to get involved in personal care with your aging parent, because that's super awkward. And most aging parents do not want you involved with that. Transportation for the local person, and then maybe coordinating caregivers to help with some of these things, especially the personal care. That's one of the things we often advise our families. Look, adult son, you don't want to bathe your mama. Let's talk about the resources out there for you to hire somebody to do that so that it keeps that relationship and that integrity between you and your mama as mother and son, not as caregiver. So that's some of the things the local person can. You know, here in Huntsville, I get calls every day from people that live all over the world, and they have aging parents here in Huntsville. So what can they do long distance? There's a lot is the answer. There's a lot. You can handle billing, the financial stuff. You can do most of that from a distance. You can coordinate some of the caregivers and care partners that you're hiring to be in the home, help with family communications. I talked to a lot of engineers who love them, a spreadsheet and love to have, like I said, maybe it's a Google Doc or a Google sheet, and they coordinate communication. There's all sorts of fun apps and different things you can use for caregivers dealing with insurance. Man, I don't want to do that. I would love to pass that off to a sibling that lives out of state. And then those periodic check ins, whether it's by phone or in person, those are so important online orders. I mean, there's so much you can do online now, right? Groceries, personal care supplies, clothing, anything that they need. And you can do that from a distance, the periodic check ins. And it's really key, though, for this particular situation, because the adult child here in the mix every day, they need a break, don't they? Even if all they're doing is running over to mom and Dad's house a couple of days a week to make sure that their meds are right and to make sure they've had a good meal and maybe clean out the refrigerator. You're not even doing a whole lot right then why do you need a break right that's some of the conversations I've heard. But do you all know what respite means? It means break, right? An occasional break for the caregiver. It's so important that that person who lives out of state is coming in and giving the local person a break, even if what they're doing doesn't seem too difficult, or even if what they're doing doesn't seem that much of a burden. It is, right? It is. It's an emotional burden as well as a physical burden. So respite visits and those check ins are so important. You know what I also have learned, y'all tell me if you've ever dealt with this. The child that lives the farthest away is the golden child that can't do anything wrong. Y'All ever seen that? Yeah, but the one who's there every day, it's always something, right? I don't know why that is. So now that you have somewhat of a plan, when you visit, observe, make notes, keep an eye out of what's changing. If you are not the one that's local and you're only visiting every two or three months, I guarantee you there are changes and you will notice them. And it could be small things at first to big things. When you're at places like today or when you're at events where there's vendors, make note of the resources that are available, even if it's something you think, oh, well, we don't need that now. Make note of that. Write that down. I had a family call me that said four years ago, they were given caring Strategy's phone number while they were touring and assisted living, and they finally called. Four years. They kept our number because they knew eventually they would need that sort of support. So when we think about having a plan, we got just a few minutes we want to think about what do we do with that plan. It's about putting together care options. Right. So what are the options? I'm not going to go into a lot of specifics because every single family situation is unique. Right. So the care option that you choose for your family is going to be totally unique and personalized compared to your neighbor, your best friend, the people that you seek advice from at church. It's going to be different. So it's really easy to get wrapped up into what everybody's telling you you should do. Oh, well, this is what I did with my mama. This is what we did with my dad. It's really easy to get wrapped up into that and start feeling pressure, pressure on yourself. That you could have done things differently or you could have done something better. Every family is unique, and it's about a personalized plan and care option for that situation. It's based on money. It's based on availability of family to be a care partner locally. It's based on their ability to take care of themselves. It's based on cognition. Right. So, before I move on, I just wanted to say it's okay to take advice from your friends and your neighbors and even loved ones, but know that every situation is unique. Don't feel pressure, guilt, or any of that if you feel like you could have done something different, because every situation is so unique. So, as we talk to families about what next when it comes to a plan of care, we have to look at, are there any deficits right now in their ability to care for their needs? Right. Take care of themselves. We all have these activities of daily living that we all do. Many of us, hopefully, did these things today, right? So, these are the things that we all do every day to take care of ourselves independently. So, when you start seeing a deficit in your aging loved one, that's when you know that there is a gap that needs to be filled. What does that look like? Does it look like hiring a person to come into the home to help? Does it look like assisted living? What does it look like? Does it look like coming to move in with you? So, think about these activities of daily living as you're making those visits and you're observing, are there deficits? And you're noticing they no longer? Or maybe they're struggling with some of these areas more. And then the other thing that a lot of times, people forget about, we all focus on this, but sometimes we forget about all these other things that have to happen to remain independent in your home. And so, managing medication is probably one of the most challenging topics that we discuss with families. And probably one of the primary reasons someone will either hire help into the home or someone would actually leave their home is because of medication management. It has to be done right. Too many mistakes could really cause a crisis. But things like laundry, meals, even shopping, paying bills, housekeeping, transportation, using a telephone. Why is that important? Call for help. There you go. Or being willing to wear a pendant and knowing how to operate it to call for help. Right. We had a client that the loved one, lived alone here in Huntsville, had advanced Alzheimer's. Son. Again, you don't know what you don't know. Son thought he was doing the best he could do. He couldn't afford to have mom in a memory care, so he locked her in every day so that she wouldn't get out. In his mind, that was the best solution to keep her safe. But we know better, right? Some of us know better. He didn't know better. At least he thought what he did was fine. But looking at all of these things, looking for deficits, looking for gaps, that's one of the first things we do as a care manager, is to see well what needs to happen, and then we start putting together a plan, right? Don't forget about cognition. I could talk about dementia, Alzheimer's, cognition, for hours. I really could. Lots of education that's available, and this is probably one of the more common things that we see with aging adults, is a change in cognition. Now, when I say change in cognition, I don't mean Alzheimer's disease. I just mean a change in cognition, right. For whatever reason, maybe it's a stroke, maybe it's a medication that's causing this change. But there are a lot of changes that we often see. Maybe they're not able to remember appointments, or maybe they're not able to have good judgment, and that affects their safety. That's a big deal. Are they isolated? Have they gotten lost? How many of you see reports of seniors who go missing? We have a new law in the state of Alabama. It's called the Silver Alert. It's like the Amber Alert, but it's for aging adults who, for whatever reason, go missing. Do you know that almost always, they're driving a car? Almost always, they're still driving. So think about driving Fender benders. Do other drivers honk at them? Now, to be honest, we could all probably say we might have that issue. But anyway, cognition is something that a lot of families don't like to talk about. Why do you think that is? What did you say? Yeah, it goes back to independence. It's probably the scariest coNversation, don't you think, for the person who's experiencing it, they probably know something's not right. So that's scary. Scary to even go down that road and talk about. I might be having an issue with memory. I can't even get to my watch. What time is it? Okay. I got a little time. Okay. All right. Does anybody have any questions specifically that I can help with? As long as you feel like one parent is still capable of possibly the other fits in this, then they're able to sort of maintain and live alone. Yeah, it just depends. You definitely are setting up a situation that is screaming for respite care when you have a spouse caring for another. That is overwhelming, even if it doesn't look like it is. What we often see are aging adults in their eighty s or ninety s, they care for each other. You have one that doesn't drive and you have the other one that does. But the one that can drive can't bathe themselves and so the other one bathes them and it's like they pick up for each other where the other one has deficits. We see that all the time and that comes with years of marriage. So it just depends in a lot of situations. The healthy, quote unquote healthy spouse can care for a spouse with challenges for a really long time. But the biggest risk for caregiver burnout is spousal caregiving. It's detrimental. It could lead to abuse. You have to have respite. You have to have some way for that primary person to have a break. Whether it's every day having caregivers in the home or once a week having a day off, you have to have that. It's like a ticking time bomb to those who try to hire outside help to come in as such. Yeah, that's very common. I don't know if you could hear her question is, what if you try to hire outside help and they don't want them there? It's a really common problem. Challenge. They don't like strangers in the home. They don't like new people coming in all the time. All I can say is you just have to try it and try to. If you can get them to agree to two weeks, usually it takes about two weeks. If you're hiring an agency for the agency to make a good match, they're almost never going to make a good match in any less time than two weeks. Would you agree with that, Tracy? Yeah. Sometimes they might make a great match right off the bat, but especially if you know the person is reluctant. If you could get them to commit, let's just give it two weeks and see. And they might be pleasantly surprised if they get a good match. I got five minutes. He said. [00:34:10] Speaker C: Along the same line, what if you're trying to help your parents with laundrying something, they don't want you to do it. [00:34:18] Speaker A: Offer to pay for someone to come. [00:34:20] Speaker C: Do it, but it needs to be done. [00:34:21] Speaker A: Yeah. Say, well, if you don't want me to do it, would you let me pay for someone to come do it? Find out, is it the issue of having someone in the home because they know you, don't touch my stuff. Don't touch my stuff. [00:34:36] Speaker C: Yeah, I don't want to do it. Don't touch my stuff. [00:34:39] Speaker A: Yeah, I mean, none of this is easy, right? None of it is easy. A lot of it is a bunch of trial and error, and especially when you're taking care of someone with dementia symptoms. What works today may not work tomorrow, so it really sets up a number of challenges. But, I mean, you can call me. We can talk about it a little bit further. Real quickly. I've got just a couple of minutes. Just a few resources that I listed here. Senior centers have a lot of great resources. Our local area agency on aging is called TARCOG. They have a number of resources. The Alzheimer's Association, Family Caregiver alliance, and then Alabama Lifespan Respite. I guarantee you none of you have heard of that. Well, I should say raise your hand if you've heard of Alabama Lifespan respite. Good. Okay. You don't count because you're one of us. Alabama Lifespan Respite is a state agency. It covers the entire state of Alabama. But we're really fortunate that they're located here in Huntsville, and they provide respite resources, grants, and just so much education for family caregivers. So if you've paid to have someone come into the home to help with respite, they will give you a stopping to pay you back just because they know that's important. So that's really a great resource here in Huntsville. I think the last one is just my information. My information is in the program today. Please save it. It could be four years from now, but you please reach out to me if you have a question, if you want to continue some of these conversations that we've had today. It's really hard to just give a blanket answer when every situation and every family is unique. And so that's what we do. We try to get into those specifics so that we can help your situation. Thank you for having me, Brandon. Thank you.