The Care Levels Every Family Needs Before There's a Crisis | Mary Ann Pickell Explains Senior Care — Full Episode Transcript

Hello and welcome back to another episode of LTCareNav's The Care Compass. I'm your host, Lindsay Friedman. And today we're here with Mary Ann Pickell of CarePatrol of the Lehigh Valley and Upper Bucks. And I'm so excited to have you here today, Mary Ann. Thank you.

Thank you for having me, Lindsay.

So as everybody knows, we bring on the providers who service LTCareNav, and I stand by every one of them, and I can tell you that Mary Ann is such a wonderful person, and I'm really excited to have this conversation with you. So we always start with the same three questions: tell us who you are, what you do, and why do you do it.

All right. So again, my name is Mary Ann Pickell and I am a Certified Senior Advisor as well as a Certified Dementia Practitioner. And the why that I do what I do is because growing up I had a lot of older adults around me and I really enjoyed their company, enjoyed caring for them, and again because my father was a World War II veteran and I really appreciated everything that he did for our country. And I honor our veterans in his memory.

I love that. And I'm sure you're doing such a beautiful job honoring his memory and his legacy. So today we're gonna talk a little bit about different levels of care and what families can expect along the continuum.

But to start, you and I know most families don't come in quite when they should, right? So tell us a little bit about where you're typically meeting families versus where they should possibly meet you a little earlier.

Yes, of course. Yes, ideally we would love if people would call us before having an urgent need, but typically that is kind of where we're meeting families — is usually something has occurred, a loved one's been hospitalized and they're kind of in a panic and not really understanding or knowing what to do. So at that point in time we do prefer to meet with families in person if it's possible. But of course, we do understand there's urgency at times, and that may not be ideal. We may have to do a Zoom call or do a phone call conversation.

But meeting with them and understanding more about their loved one and why they're calling us is where we basically get started. We want to talk with them and learn more about what is happening with their loved one, why they're calling us, and what it is that they're looking for.

Typically what I'm finding more and more is as people start the journey of caregiving, a lot of our family members are just not in the same area as their parents. They may be states away. Even if they're just streets away, it can be difficult because they're working. So we're right in that middle of that sandwich generation where they may have families and they're raising young children and then they have older adult parents.

So it can be challenging for them to balance all of that. And I do find that maybe a jump-off point is to bring in non-medical home care. So when we talk about that, I again think all of those terms can be a little confusing and overwhelming, and not understanding all of that can bring a lot of confusion and sometimes just hesitation to do anything because they don't understand, right?

So we talk about starting at that point of non-medical home care, it's kind of a little jump-off point and what that looks like and what they can do to help maybe maintain someone's independence in their home. And some of those things that they can do is, you know, helping somebody with their personal care, bathing, dressing, grooming, maybe even med reminders, or going to the grocery store and shopping for them and making meals.

Doing some light housekeeping and laundry can help keep somebody maybe in their home a little bit longer. Ultimately we do talk about all of the levels of care, because as you're starting, at some point it may just not be enough. So we want to go into that conversation so that they can understand all of the different care levels.

Can you talk a little bit about what the main levels of care are and what we're looking at between independent living, home care, assisted living, memory care, skilled nursing? What do those actually mean? And how do you know you qualify for each one? How do you help families assess that?

Sure. Yeah, absolutely. So we'll talk about the different levels of care first. Sometimes people will want to talk about senior living in an independent senior living. And that's a great place to start, in that maybe it's just getting harder to maintain a home and the property around the home. So an independent senior living facility can actually be a nice way to start off.

In that they have an apartment so they still have their own space, but it could include things such as transportation or meals. And then of course just a free lifestyle of not caring for a home or even appliances, right? The stove breaks and it's a simple call down to the front desk, hey, my stove's not working, and they come and they fix it. So that's a really nice place to start when you're starting to see that it's becoming challenging to maintain your home where you live currently.

Some other levels of care beyond that could be a continuing care retirement community. When you're looking at those types of options, it's a little bit more complicated in that many of those include an entrance fee. So you would pay an entrance fee — that could be a pretty substantial fee going in — but it's kind of like buying long-term insurance, if you would, because once you pay that entrance fee, you go through a financial application process, and that's showing the community that you are able to live there and be able to pay for a period of time.

Because many of those continuing care communities have a benevolent fund. So if you qualify going in, they would never ask you to leave.

Because their benevolent funds would keep you in place. But that needs a lot of explaining because of the entrance fees and what you still do pay monthly, but it does include the continuum. So you would initially move into an independent apartment, but then if you needed the next level of care, which we know as either personal care or assisted living, it's under that roof. So it's a simple move from one apartment to another area.

Or if you need rehab or long-term nursing care, that would also be in that continuum. So that could be something people can look at as an alternative to staying in their home, because once again it is maintenance-free living. You don't have to worry about cutting grass or shoveling snow or any maintenance of appliances.

So it could be an alternative to staying in your home. If that's not something you're interested in and you're staying in your home a little bit longer, of course you could start, like I mentioned before, with non-medical home care to keep you in your home to support you, but then at some point it just may not be enough care. And that's when we can look into those other levels of care such as personal care or assisted living.

Because in that type of a setting, you still might be able to have either a studio or a one-bedroom apartment, so you could still have a nice amount of space, but there's always care at that level. So if somebody needs assistance with bathing, dressing, grooming, toileting, all of that is already in that facility. So you're not hiring people separately. They're already there to help you, to support you.

And then nursing care is the highest level of care. So when that happens, that means somebody is needing or requiring two people to help them out of bed every day or to help them with their personal care needs, or maybe they have more increased medical needs, such as intravenous medications. So those are really at a high level of care. So typically in that setting, it does feel more like a hospital setting, because there's generally usually someone else in the room with you. Sometimes you can get into like a studio to yourself, but typically there is somebody else in the room with you.

And I think that is what most people think of when they say, 'I don't wanna go to a nursing home,' when really what most people step up into is assisted living, and they've got this connotation of sterile environments in their head. Why do you think we still have such a stigma and a misunderstanding around what assisted living, independent living looks like, which they're beautiful? Like, this is my end goal. Like, this is what I'm gonna do. I'm already planning on this, right? Versus — I don't like taking care of the weeds in my yard today. Like, I'm looking forward never seeing a weed that I have to pick again.

I agree. Sign me up.

Right? I agree. I'm with you. I know the reason behind that is because a lot of the people that we're assisting now are in their eighties and they saw their parents go into nursing homes and what nursing homes looked like back then. We didn't have so-called assisted living facilities till the eighties, really. So, you know, that's why they're not used to that.

So if they've never spent any time visiting somebody in an assisted living and all they ever remember is visiting maybe their parents or grandparents when they were in a nursing home, that's what they recall. That's what they remember. Or maybe they themselves have spent some time in rehab. And again, that's a nursing home. It's just a particular section of the nursing home where they do rehab. Nobody really says, sign me up, I want to spend the rest of my days in a room with this other person that I don't know.

But that's the misconception. Once we go out and we show them what assisted living looks like, it does oftentimes bring them some peace of mind and understanding that, no, this could be really good. And ninety percent of the time, or maybe even higher, once they are there, I equate it to like going to college, right? It's like, I have to leave my comfy home and go spend time in this little room with a roommate. But once you are there and you understand the benefits of being there — you're getting your three meals and you didn't have to cook any of it, or you're getting somebody helping you with the things that are getting really challenging — they do tend to thrive, because they're getting socialization, med management, hydration. All of that creates such a different way of living, and you do tend to thrive in that setting.

Yeah, I said it as I said — I think they're lovely. And actually the meals thing is fantastic. I have a friend whose mother is in assisted living in Cleveland. And the restaurant at the assisted living is my friend's favorite restaurant in the entire city. Yeah, she's like — for her birthday, she was like, 'We're gonna go to my mom's place.' And I was like — and I went and I'm like, well, that was impressive.

Wow, that's great.

Yeah, I'm with you. I've raised three children and have cooked for the last thirty-some years, and if I don't have to cook another meal, I'd be just as happy to sit down and look at that menu and say, hey, I'll take that today. It always tastes better when somebody else is making it.

Right. Always. I don't know why, but. So now kind of back to the topics of care. So when you're seeing families and they're coming to you, do you help to assess the level of care that they need? And, you know, care is not consistent — what you need today is not what you need tomorrow. So what do you think families need to expect as they're looking at care today and care tomorrow?

Yeah, that's a great question. Yes, we often do meet someone in person, right? So if we really feel the need to put eyes on that individual, then we will do that and give an assessment of the situation so that we can help them and direct them to the right level of care. When we're working with communities — and we have a lot of wonderful communities around us — we will at least give our initial indication of where we feel someone would do best. At the end of the day, the community also will have to do an assessment because they're going to take responsibility for caring for that individual. But yes, our initial assessment, whether we're talking with families or we're meeting the individual in person, we will assess the situation and then help to give them direction as to which direction would be best for that individual.

And when a family is entering an assisted living at one level of care, how long can they realistically stay? And is there different regulations in different states? Is it community-based? When care starts to change, what does that look like for families and where they're placed?

Yeah, that's a great question too, because every state does do something differently. So where I am in the state of Pennsylvania, our personal care homes or assisted living communities, they are not paid by Medicaid at all. So someone living in an assisted living here, eventually if they either outlive their resources or they get to a level of care that we spoke about before, where they're two-person assist or needing a Hoyer lift, they may end up having to move into a nursing facility.

So we again can assess that, the communities do assess that. And they're constantly meeting with the family. So that's not a situation that's going to sneak up on them. When they're living in a community, they do regular assessments. It might be thirty, sixty, ninety days, but they're constantly talking with the families about the things that they're seeing, because we don't age in reverse. You know, it would be lovely if we were heading backwards and maybe now instead of being sixty-one, I could be thirty-one. But it doesn't happen that way.

So we just know that things are going to progress. We're going to get older and maybe our physical body's going to start to fail, or maybe we're going to start having issues with dementia. But at least being in a community and always being around others — again, that socialization, the good med management, nutrition and hydration adds so much to someone's life, and then just always being monitored for what care will come down the road as well.

And you just mentioned the dementia part. And I always feel like that is one of the hardest things for a family member to care for, especially when you are dealing with dementia. What does that look like in assisted living versus memory care, and what stages do you have to start to look at between is assisted living right or memory care correct?

Yeah, so dementia is such a unique fingerprint to every individual and how their dementia will progress. So when we start to see the early stages where maybe someone's having issues with their short-term memory, that's generally the time that we start to get calls, because now maybe mom took the car out and she can't find her way back home, or she's not taking her meds regularly, or we notice a dramatic drop in weight because she's not remembering to eat on a regular basis. So that's kind of the time when we get those calls of needing some assistance.

Now, sometimes people will try to maintain their individual loved one at home during that early phase, maybe by again bringing in non-medical home care to help out for a few hours each day — maybe make sure that mom got up in the morning and had a good breakfast and took her medications, maybe she needs somebody to help bathe her. So that's kind of like a jump-off point. But when someone is at risk for exit seeking or wandering, that's when we become very concerned.

Again, we go back to that driving issue. If we're noticing that there's things in the car or, you know, your loved one's taking drives and they're not finding their way back — it's time, if you haven't already been assessed by a doctor, you really need to have your loved one assessed and at least get a baseline understanding of what may be going on. Sometimes dementia kind of appears when there's other things happening. Maybe they're having medications that are causing some of these issues. UTIs can cause issues as well. So it's important to have your loved one assessed.

Have a basic understanding of what might be going on and understanding the stages of which they are in with dementia, because yes, it can be very challenging to care for someone that has dementia and it really is unique to them. So understanding where they are in their journey and then understanding what may need to come down the road for their care by talking with a senior advisor would be a good idea.

And after you have these conversations, when families are hearing assisted living and memory care, what is the main difference between assisted living and an actual memory-care facility or community?

So I do have many people that will go into assisted living or a personal care home when they have dementia in the early stages, because they really probably at that point just need some structure in their day. So maybe going in and having someone remind you that it's time for breakfast, time for taking your medications, maybe cueing you to make sure that you're getting dressed, using the toilet — things like that can really help someone in those early stages that they may not need to go into a secure memory care at that point.

The line in the sand, I guess you want to say, is when we talk about wandering or exit seeking, because in our personal care homes or assisted living, the doors to the front door are not generally locked. Right? Because we are thinking that those individuals living there are autonomous. They can make good decisions for themselves, that I can go out for a walk and I know how to find my way back.

When you start noticing that that person is not able to do that or understand safety awareness, or perhaps it's starting to become apparent that they're losing words and they are not able to have discussion when it's mealtime with the other individuals that are in the community, it may be time for them to be in the memory care, because there's just a lot more hands-on care at that time and cueing and helping them with the things that maybe they're forgetting to do themselves. But again, I wanna say and I can't state this any stronger: if somebody is exit seeking or wandering, they do need to be in a secure setting for their safety.

Absolutely. So, seeing that we're hitting our time, and this has been a great conversation and probably super helpful for families to really understand — what would be your final words to families who are starting this journey about understanding their levels of care or the right time to talk to a senior care advisor?

Yeah. I definitely would encourage anyone, whether it's the children or the older adult themselves, to speak with an advisor before you need them. To get a plan in place is always a better place to come from. When you're making decisions because you're under duress or stress, it's difficult to make those decisions. And I will say, as a senior advisor who's been doing this for many years now, we can help in that quick fashion. We are able and equipped to do that. But it doesn't feel good to be in that scenario.

So I would advise anyone, whether again it's the older adult themselves, the children that are starting to become concerned — it's a good time now to get a plan in place. What does it look like today and what does it look like when things start to change? And we are there to hold your hand through that entire time. We don't just help make that plan or put that plan in place, we help to carry through any time that you need us to help you.

No, that is amazing. And I can say that you and all of your fellow CarePatrol owners really do such a beautiful job. And so can you tell people where to find you?

Yes. So we're CarePatrol of the Lehigh Valley and Upper Bucks, and you are able to find us online, but you can also call us at 610-509-0445 and we'd be happy to speak with you about any type of care that you are interested in learning more about.

And we will put your information below. Thank you so much for being with us today.

Thank you for having me, Lindsay. I really enjoyed speaking with you.

And we will see everybody next time.