Your Care Quarterback: Life Care Planning with Ryan Callahan — Full Episode Transcript

The earlier you can plan and get those resources in place, the better off you are down the line. And so some of these programs that would be available to you earlier on in life, like long-term care insurance, are not available whenever you're crisis planning. It can become very costly and very stressful very quickly.

When caregiving feels overwhelming and the system feels impossible to navigate, this is your guide. Here, you'll learn ways to navigate long-term care planning, find real support for caregiving, and prepare for the road ahead. I'm your host, Lindsay Friedman, and now you're not in this alone. Let's get started. Welcome back to the Caregivers Compass. I'm your host, Lindsay Friedman. Today, we welcome Ryan Callahan. Ryan is the founder of Callahan Care Solutions, a nurse-led care planning firm dedicated to helping families navigate complex health and long-term care decisions with clarity and confidence. With a background in hospice, long-term care, and as a former Texas Medicaid hearing officer, Ryan saw how overwhelming it can be for families to coordinate medical needs, finances, and benefits. He started his firm to bridge that gap. Today, he helps families understand their loved ones' medical picture and strategically align all available options from Medicare and Medicaid to VA benefits and private resources so they can protect both health and legacies. Ryan's also a value partner at LT Care Now. Welcome, Ryan.

Thank you, Lindsay, for the warm welcome. Great to start off this Friday with a smile. I appreciate it.

Well, thank you. I'm so glad you're here. And I absolutely love what you're doing. But I don't think most people know what that means, because I've talked to people in the industry talking about a life care plan, and they're like, what is that? So let's start by, what's a life care plan?

Great question. And actually, that's probably been one of our bigger sticking points with education for our families. And I'll dig into a little bit of my background in order to kind of pull the picture together. As you indicated, I'm a registered nurse.

I've spent most of my career helping families navigate long-term care. I worked in assisted livings, nursing homes. You indicated hospice care for over a decade. One of the things I saw so often is the planning that goes into preparing for a loved one or spouse or even ourselves moving through the long-term care spectrum — there's not a lot of support, and there's a lot of resources that are involved. There's a lot of complex decisions that are involved. And so whether it was at the bedside or from the legal capacity of navigating benefits for families, I saw the struggle, both financially and psychosocially, for families just trying to navigate that spectrum.

So what we tried to do was put together kind of a roadmap or foundation for these families to feel like, one, they had a plan for when unexpected events occurred, and also that they felt like they had a support system as they navigated this complex pathway for their loved one. And so we came up with what we call a life care plan, where as a nurse, I'm able to look at complex disease processes like Alzheimer's, dementia, heart disease, and plan out for families what that disease progression looks like both now and in the future, and how that factors both financially and in regards to benefits down the line.

And so what we do is really try to look at the holistic picture for a family — what their wants and goals are for their loved one — but also bring in all those other resources that they typically were having to navigate themselves. Where we have a financial advisor that comes in and looks at the finances from an in-depth perspective — maybe that's tax projections, maybe that's looking at 401(k)s and IRAs. Then we also coordinate with benefit advisors to look at complex policies like Medicaid or long-term care insurance or Medicare, and how all of those things factor into just the natural aging process. And so our goal, one, is to give families a very solid roadmap to kind of move through these changing seasons. But also what we try to do is actually concierge that process and take away some of the burden for these families that are already navigating stressful times.

I think when you talk about the complexities and the amount of people that are needed — it's not that when people think of long-term care, their first thought is, I need help doing these things, I need care, who's gonna give me the care? And then maybe they start to think of how I'm gonna pay for it. But again, there's so many people that you need to help make this happen. So when they come to you, is that something that's sort of included, like you really kind of pull together every resource they need and sort of manage it — you're like the quarterback?

You know, it's funny you ask it that way, because it was kind of the foundational piece. And I know this sounds a bit cliché. In all my time in hospice, the thing that was the most frustrating was that hospice is the highest reimbursing level of Medicare, and typically both the patient and the family get a significant level of support. The patient gets nursing and caregiving and all the things that are important to promote quality of life. But the caregivers also get support psychosocially, foundationally, helping navigate resources. But it was disheartening to me, in all my time in hospitals, that families had to wait until kind of the last stage in order to get this layer of support.

And so your question kind of centers on all of these different resources that are important. A lot of times when we encounter families initially, it's stressed by something financial. For whatever reason in Western society, we think about finance first. But so many times our education to our families is: in order to figure out what you're gonna do financially, you first have to know where health and life are taking me. We've seen so many times where a family's encountering health challenges and somebody in their financial sphere — whether it's their financial advisor or an elder law attorney — has made decisions with their assets or resources that don't take into consideration where health is going with these loved ones, and it affects them in a negative way. And so first and foremost, our education to families is, hey, we have to know where health and life are taking you. Then we can start to navigate all these other factors that are involved.

And so again, back to the like — so you sort of kind of step in for somebody, right? And because it is the whole thing with the overwhelmingness, you kind of manage that for everybody so they don't have to think about it so much or start to worry through things. You can kind of take that.

Exactly. And it's funny you mentioned quarterback, because we had a client that came on very recently and they're like, you're going to be my dad's quarterback. And so to kind of dive into that: my background in hospice care — and I think you and I have actually talked about this personally before — one question I always ask families was, what did they value the most, and what did they regret the most? And the answer always revolved around time — whether it was they valued time with their loved ones, doing the things they enjoyed, being together. And the regret was always around focusing on, how are we going to do this? How are we going to pay for it? The stress that goes into navigating these things.

And so our goal, aside from just giving them that plan, is to give them their time back and help navigate some of these resources and pull in the appropriate parties. Because a lot of families don't even know where to start or who to coordinate with at what time. And that's how we actually come into contact with a lot of families — them taking that first step, trying to figure out, okay, where do I even start and who's involved in this?

Yeah, and it is a big process that people don't realize they're getting into. Now, the other thing that you do that I think is really different and is a new term is that life plan, right? And you started to touch on it. But when we talk about a life plan, I like it because most people are like, I'm not going to need long-term care, right? We're talking about all the options in life. What is the right time to come to you? Like, is it earlier? Because I'm sure you're like the rest of the industry right now — it's crisis, right?

Many times, many times, yeah. It's such a tough question to answer because, due to my background, I primarily was kind of in geriatric care. And so I'd seen a lot of the crisis planning — or, hey, mom was just diagnosed with Alzheimer's or dementia, or mom's aging and we're trying to figure out what the next step is. But ironically, through this process, we've come into contact with a lot of partners that are actually planning earlier on. We have one potential partner that we're working with that is looking at individuals in the 30 or 40 year old range that are planning in a different way.

Because the cost of long-term care is so expensive, the earlier you can plan and get those resources in place, the better off you are down the line. And so some of these programs that would be available to you earlier on in life, like long-term care insurance, are not available whenever you're crisis planning. And so we often get that exact question that's, hey, when is the right time? Is it too early to engage? When should we really start thinking about this? And I don't think that there's a time that is too early, because even those folks that have resources available to pay for long-term care, or the policies available to help supplement it, it can become very costly and very stressful very quickly. And so the earlier you can plan, the better.

So when a family comes and they are creating this plan with you, what do they actually get? Like, what does the end result look like? And are you available to help them execute on this plan? Because most people get a plan and, you know, the hardest part is executing on it. Are you there and, like, help them walk through it?

Yeah, so another great question. We kind of prided ourselves on being a family company. When I talk to clients, I let them know, hey, you're gonna get me through this process. I'm gonna be your concierge. What we've tried to do is pull in enough resources — like having Medicaid planning services, like having financial advisors. We also have a dementia care educator that meets with families to talk about what it looks like from a psychosocial side. She's amazing.

You know, it's funny when you're looking at things from a business perspective, even in healthcare, a lot of times it's: what is success in your eyes with these families? For us, it's them feeling like they were supported through this process. And so that really involves us being as hands-on with families as possible and making sure that they feel truly like they have an advocate walking them through this process. Now, while we do pull in some other entities like the benefit consultant and the financial advisor, we really try to be present and help concierge that process and then provide re-education every time that we go through a different individual and say, this is why they're advising to do this. This is how it factors into the overall plan. And this is when you would execute it when you need it.

This is such a huge service, because I do think a lot of people, even if they get put on the right path, everything's so fragmented, it's hard to pull it together, right? You're having people of all different parts. Like, we really have to understand the whole picture. And that's fantastic that you do that. So now say we have the whole picture figured out, you have all of these things, and we started to execute on this. Are you able to stay with families? Can you support going forward?

Yeah. So actually out of necessity, we had so many families that fell in that exact situation, Lindsay, where our goal was to give them the roadmap, make them feel comfortable, kind of give them the autonomy to start moving forward and making decisions. But even when things do tend to occur, oftentimes it's unexpected. We all also have our own life challenges, and a lot of times we're caregiving and doing the best we can for somebody else at the same time. We've had a lot of families that circle back months down the line and say, hey, this was so valuable to me. Y'all were so helpful in navigating these things. This has now come up with mom or dad or spouse. Is there any way you can step back in?

And so we ended up kind of creating a monthly service for families that wanted ongoing support or just needed help navigating additional resources, where we can continue to be hands-on with them. And actually, we were just talking yesterday — even through our processes, as hands-on as we are with families, as much as we feel like we get to know them and they get to know us, being on for a longer period of time, we really feel that connection and that level of support. Back to my time of being a nurse in the field, helping families hands-on — that was one of the things that I found most rewarding about being a healthcare provider, was that you felt like you were really part of that family unit. And so being able to offer ongoing support has allowed us to do the same capacity as an advocate.

And that sounds like, in this sense, like you're going way beyond just a life care planner, right? Caregivers' needs — family caregivers are stressed out. It is a hard job, right? It almost sounds like you're there to kind of support them as well, in a capacity to help them make wise decisions, to take the burden off. Because sometimes just making a lot of decisions is super stressful as a caregiver. Is that kind of where you're finding yourself?

Exactly. And then sometimes you just want somebody to bounce thoughts off of, or to offer reassurance, or even to be devil's advocate and say, hey, I know that you're thinking this way. I know this is kind of where you're leaning, but this is another option that may be valuable. Sometimes we're just evaluating different layers of support to get a little bit more specific. We've had families that are saying, you know, they have a loved one and it's, hey, we know we need this. We know we need additional support. We know we're going to have trouble paying for it, but we have no idea what our options are.

And so when we're able to present them, hey, you have option A, B, or C — this is why we feel like each one is valuable in its own right — we give them those options, but then whatever they choose, we support them through that process. And as I was kind of alluding to, you really just want to feel like you're not alone. Our mantra is to make families feel like they're not alone in this caregiving journey, because oftentimes you do. And I know she's going to be mad that I'm using this cliché, but I use it with our clients all the time. Jazz is my wife. We have two young kiddos. When we were getting ready to have our kids, we had nine months of runway to get ready, and we had everybody coming forward — hey, do we need the meal train? Do you need help? We'll take off work. And then even between her and I, we were deciding, how are we going to pay for care for these young kiddos?

But a lot of times when it's our loved ones that we're now becoming the caregiver for — our aging loved ones — one, we don't have that runway. And two, the layer of support that was there previously, a lot of times is not, because everybody else has their own burdens as well. And so we want to be that layer of support for our family.

I think it's interesting that you used that one, because I think it's a really good reminder for adult children who are becoming caregivers. Think back to that time, right? The reason you had all that support probably is because of parents and that generation, so we should remember that as we go forward. But it's a different level of stress. You're right — there's less people to step up and help as an adult child with an aging parent.

Yeah, it's ironic. We just met with a family a couple of days ago that were grandparents and very involved grandparents, loving and involved in their relationships with their children. But they were able to offer that level of support for their children, caring for their grandchildren. But now here they were with a loved one that needed a layer of support and they had become the caregiver for their spouse. But their children are not able to offer that same level of caregiving support, because they have young kids and they have a career and they're not available in the same capacity that they had been available for them. And so it was kind of a nice connection point when I brought up that analogy to use in that particular situation.

Yeah, I'm sure there were also some light bulbs going off. So my guess is you really deal with some complex family situations. Do you kind of deal with that with a life plan and kind of navigate some of the tricky things that happen in families to try to smooth that out and make the journey a little easier, like interfamily dynamics?

100%. I mean, we've seen some complex cases, some complex family dynamics, some urgent changes that needed to be attended to. But again, the goal is, one, to make sure the loved one of the person that comes into contact with us is safe — they have the care that they need in order to maintain their safety and quality of life — but also that the caregiver's psychosocial and physical needs are also being met.

And that's why — so we're located in Austin, Texas, but we have clients all over the US. One of the things that we've done is kind of build up our resources so that no matter where a family is, we have somebody that we can connect them with to kind of meet whatever scenario that they're encountering. And so we really try to act as fast as possible to, one, promote safety and quality of life, but also meet them psychosocially to support any stress level they encounter.

You sound like the biggest bang for the buck kind of in this field. You're supporting both parts of it, right? You're getting prepared for the care, but that support of the caregiver is so important, right? I mean, structurally you're keeping them in place longer. So that's great.

Yeah. And Lindsay, so many families are already navigating stressful financial situations. And again, I know it sounds repetitive, but even families that have what feel like plentiful assets in order to pay for whatever long-term care they may experience, it can deplete very quickly just because of the cost of all of these different resources — whether it's assisted living, nursing home care, caregivers, in-home support, equipment. All of those things can add up pretty quickly.

And I think that's where we'll start to see a shift, where all of a sudden you're going to get more people than you can handle, is when we have enough light bulbs that go off to realize that you have to pay for care, that it's out of pocket till you get to Medicaid. Can you help with the planning for the out of pocket and to the Medicaid? Is that part of what you're doing?

Yeah, great question. So that's actually the biggest factor. And, you know, I don't want to feel like I'm biased because I spent time working for Medicaid, but it's such a valuable component of paying for long-term care. And a lot of families don't even understand at what part of the process Medicaid comes in to be a payer source, and whether it would pay for skilled nursing or assisted living.

And so what we try to do is show them, hey, based on the assets that are available to you or your loved one — maybe you have Social Security income, a 401(k) that's been funded — how long will these assets last before you need to utilize a benefit like Medicaid, and where would that come in? And I'll give you a very brief example. So if you had a loved one who was recently diagnosed with dementia or Alzheimer's, maybe they were living at home independently. They had enough Social Security income to pay for maybe just their apartment and whatever their cost of living was for the month — electricity and food and things like that. But then you identify, hey, my loved one, they're really not safe in this environment anymore. We need to be looking at either supplemental care or moving them to an environment that's more supportive.

What we try to do is, one, figure out, okay, are there programs that the loved one can qualify for? For example, individuals who have Medicare — I believe it's both A and B — can qualify for a program that provides in-home support and in-home caregivers if they have a cognitive diagnosis. And so the first thing we try to look at is, out of what benefits they currently have, how can we get support funded in their current environment? Well, if that's not an option, or if moving to the next stage — like an assisted living or memory care — is going to be more beneficial to the individual, then we start looking at, okay, there's a fixed amount of Social Security income. The room and board for an assisted living is gonna be X amount. Can we appropriately fund that environment with the loved one's income, or are family members gonna have to step in and provide additional resources? Or are we looking at the potential for Medicaid to be utilized to pay for long-term care?

And so in the United States, most assisted livings — now, it does vary from state to state and area to area — are private pay. And so Medicaid typically will not pay for the room and board at an assisted living. Now, that does vary, and there are some that will accept room and board from Medicaid. But as far as skilled nursing care, which is the highest level of care as far as care facilities are concerned, you can get Medicaid to pay for room and board at a skilled nursing home. And so what we try to do is break down all the family's assets and resources and help provide them those options that might be best available for their loved one.

Yeah. And so in Ohio, there could be a spend down to get to assisted living. And I think that's something really beautiful that Ohio does, at least having that option. And you're right, not many places, not a lot have that. And that's amazing — you can, state by state, if I come to you from Ohio, you can understand all that and help me with all that.

100%. Yeah, one of our national Medicaid planning partners, they have knowledge based on every single state. They've been an amazing resource. Eldercare Resource Planning is who we typically work with nationally, and they've been amazing with our clients. It's such a valued piece of the puzzle, and we really work together synergistically. And that's the point, is that all of these parties are talking to one another and working together as a collective team to help promote these families' quality of life.

That's amazing. And I could — we're gonna have to do another one, 'cause I've got like 22 more questions, but we're getting out of time. It's like a good spot to end, because I can be like, and Ryan is your quarterback. And I don't even like sports or care about them at all, but I still like that. So we'll do this again. But I will tell everyone, like, I know Ryan personally, and he is amazing. And if you really are in a sticky situation and you need some comprehensive analysis and a life care plan, reach out to them, and we will put the link below and we will see you again next time.

Thank you, Lindsay.

All right, that's a wrap for today. Until next time, remember, you're not alone. Take things one step at a time, stay centered, and trust your compass. See you next time on the Caregiver's Compass.