Episode 39: The Five Pillars of Aging Successfully with Star Bradbury

Welcome to Caregiver Relief! I'm Diane Carbo, a registered nurse. Today's topic is the five pillars of successful aging. And I'm blessed to be joined by Star Bradbury, a former Florida licensed administrator and executive director for both assisted living and memory care facilities. Star brings a wealth of knowledge to this podcast.

With 18 years of experience at Oak Hammock, a nationally recognized life care community at the University of Florida, Star has a deep understanding of the complex choices families face in senior living. Her insider expertise is invaluable for anyone looking to choose the right community for a loved one, help parents age in place successfully, or find additional care when needed.

Star's realistic approach to aging well and making crucial decisions is not only refreshing, it's immediately applicable. She will guide you in asking the critical questions during times of need. As the founder of Senior Living Strategies and the author of Successfully Navigating Your Parent's Senior Years, Star regularly collaborates with individuals Families and professionals across the legal, medical, financial, and long term care and insurance sectors.

Her passion lies in helping families develop comprehensive, proactive plans for informed decision making. For both their parents well being and their own Star has lost both sets of parents, her in laws, a sister and many friends. She brings both compassion and professional experience to her guidance.

She is sought a sought after keynote speaker and workshop preventer for groups and conferences focused on aging successfully, whether for guiding loved ones, or you're a solo senior or professional and corporate groups. If you want more information, I suggest you visit her website, www.starbradbury.com, and her last name is spelled B-R-A-D-B-U-R-Y.

That's starbradbury.com. Star, I'm so excited to introduce you to my listeners. And we do have a lot in common. I've been a nurse for over 50 years. And at one time in my career, I was an assisted living director. And I also worked as a director of nursing in an assisted living for a very upscale assisted living outside of Philadelphia.

So I'm excited to welcome you and I'm excited to delve into this challenging topic.

Thank you, Diane. What a lovely introduction. I think even I'm impressed and I'm excited to forget until you hear what you've done, that you've actually done it all. But we do share a lot in common. And thank you for having me on your podcast.

You are also a wealth of information. It's great to quote unquote meet you. I'm glad also to promote your book successfully navigating your parents seniors years. I wrote it to help people make educated and informed decisions because I spent so much of my time talking with families who were not prepared.

When the discharge planner calls them up, as from the hospital and says your dad can't go home. Your mom can't go home. Who's at home to be with them. They'll need more help long term and I just saw so many families thrown into crisis and unprepared to even know what their options were.

And as I like to say, Diane, you just don't know what you don't know

We also have a public health crisis occurring right now in this country. We have more seniors than youth. So we have no one to provide care for our seniors. And we also have changes in Medicare reimbursement. And right now I'm seeing more unprepared family members because of unsafe discharges to home.

Our Medicare reimbursement system has cut the coverage for therapy so low that we went from 90 days of daily therapy to now the facilities make more money if they provide no or little care as far as therapy, so I'm seeing patients discharged after 1 or 2 weeks, and I'm dealing with more families and in crisis than ever before.

I'm excited for me to promote your book.

It's pretty hard for the average family, Diane, to be knowledgeable about Medicare and what it does or doesn't cover even before this change that you're talking about. It's complicated enough. And most people don't know how Medicare works, what it covers, what it doesn't cover.

You can appreciate this, when I share this story with you, how many times have families said to you? "Oh, Medicare covers assisted living". How many times have you heard that? Doesn't it cover a long term skilled nursing?

It is a terrible shock and believe me for the listeners out there, you do not want to discover when you're suddenly looking for assisted living or skilled nursing for your loved one that it is 99 percent private pay. The only thing that's going to help is if you have either one very deep pocket to long term care insurance that's going to cover some of those costs or some other mechanism that is going to help you pay for that long term care.

Well, one of the things I'm learning right now and seeing is for the first time ever Medicare has moved to a cost sharing platform, meaning we are more personally responsible for paying for the doctor recommended treatment services, medications, equipment or whatever. I'm going to share a story that I recently experienced.

I was helping one of my neighbors find a skilled facility and we did end up surprisingly in a life care community, which it's very hard to get into a life care community in their skilled setting. But this was basically new as far as they weren't filled up on their skills. We went in there and the family before us, we're sitting in the admissions office and we're waiting for a tour.

And the couple before us was a young woman and her mother, and they were looking for care for their grandmother which we didn't know at the time, all we heard was somebody scream and start sobbing. And I thought somebody had died and that wasn't it at all. They were just told that the Medicare advantage program that they had was going to cost them 250 dollars a day copay for them to get the recommended care in the facility.

And that meant that this 84 year old patient was with a stroke was it was cost prohibitive. And that's what our family caregivers are facing face day when you say we have a public health crisis I do think that in general, people are becoming more and more aware of this because every time I get my copy of the Sunday New York Times or reads an article in the Washington Post, it is story after story of families in tremendous financial stress and crisis trying to provide care.

Now, not everybody can quit their jobs to take care of their mom or dad, even though they might want to, they have their own responsibilities to themselves and their family, to provide a living for themselves. People can't just stop working and take care of mom or dad, especially if it's long distance, trying to add your mom or dad into your family may not even be feasible for many reasons.

Exactly. And that is why I'm so passionate. That's why I wrote this book. Please have these conversations early with your parents when people say what's the right age to start talking to my parents about aging successfully. I like to put it that way. It has a positive spin because it is possible to age successfully.

You just mentioned your 82 year old friend who was a hospice nurse and loves to work. There's a lot of people out there aging successfully, tons of role models for all of us as we age. But guess what? It doesn't just happen. You have to have a plan. And I tell people the time to start talking to your parents is before they retire.

And you can't start out with the heavy questions first, right? You have to gently move into those tough conversations. Exactly. And the tough conversations are end of life planning, getting the legal paperwork in order and the other topics. Those are the last questions. The questions you want to start with is, Mom, Dad what are you thinking about for your retirement lifestyle?

You don't start out with, oh, my God, how are you going to pay for long term care? And what about that end of life plan? Nobody I just why coach like you and I are in the coaching business. You start out with a gentle questions first, lifestyle questions. Are you going to move?

Are you thinking about moving closer to me? Of course, you don't offer that unless you mean it and can and you want that or your brother move closer to another sibling and hopefully the siblings are talking to each other and making a plan together with their parents. Very gentle lifestyle questions to begin with.

Yes. Sometimes the most difficult one to start with that I see, most caregivers or family members are in denial until a crisis occurs. Yes, caregiving creeps up on us. It starts out intermittent and then all of a sudden a crisis occurs and they get maybe get a call from the emergency room.

Hey, your mom or dad's in the emergency room, they've fallen. Do you know what medications they're on? What insurance is? There's a whole slew of information on my list of things. Exactly. Exactly. And one of the things I encourage my clients to do is really start like cutting out newspaper as if there are any, right?

True. Look what this person's doing. What do you think you're going to do or that is a wonderful approach recommend coming from the approach of, hey, mom, I'm thinking of when I'm getting older, who's going to take over, I need to put a will in place or whatever.

What have you done? Exactly. Yeah, exactly. That's about yourself. I tell people, Hey, bring up. I read this article or my best friend is dealing with a really difficult crisis with her parents. And it suddenly made me think about what I would do if something happened to you and I want to be prepared. Can we sit down and have a conversation?

So I know what your wishes are. What if something did happen? I'd like to be prepared. I don't want to be guessing. But yes, if you make it about you, you know why? Because there's this parental instinct. Exactly. And it kicks in where you don't want your children anxious and you don't want them worried.

And so if you say, I'm the one that's worried. Can you please help me out? They're more inclined than you need help. Yes, somebody called it the H word. Don't use that word with your parents. Anything about you needing help, especially for those of you listeners out there who have what we all know to be resistant parents. I used to laugh Diane when I would do tours of the life care community. And inevitably there was some guy, I hate to say this, but almost always, it was a man who said, you're going to have to carry me out feet first. I'm never leaving. There's a wife almost in tears realizing that her husband is not open minded about making a change. A change in their living situation that could probably better meet their needs. Yeah, I'm a big fan of life care communities. Oh, me too. I absolutely am for the people that have the funds. Yes, that is absolutely the way to go. I have many different life care communities. And I think with the way the health care is going right now and everything going to a cost sharing plan, I agree here in order to get the best possible health care and we have limited use.

And so we're limited to who's going to be able to take care of us. It's going to get worse caregiver. I'm going to share a stat with you that I find shocking. When I started my first site, aginghomehealthcare.com I was shocked then as I was not new to the industry, but not new to learning about the statistics of the family caregiver.

50 percent of family caregivers became seriously ill or died before the person they were caring for. I know, that is a frightening statistic. And I have heard it. It's even worse now to bring up because you and I both know that when there's someone within a couple. Any couple, as I say, it could be whatever, whoever your life partner is, but one of them is not well and requiring care.

And the other one is the primary caregiver. They never even think about that. And I have to say, when I'm sitting down trying to help develop a plan to age successfully, what is your plan? Should the primary caregiver become ill? Or God forbid pass away first. Yes. And they almost sit there in shock because they've never really considered it.

They're so habitually used to caring for someone else. Yes. They haven't even thought about it. Almost always. Star, I will tell you 15 years later, that statistic is 63%. Oh, my gosh, Diane. And I will tell you with the changes in Medicare, family members provide over 650Million dollars a year in unpaid care.

That is just. That's astonishing. That's astonishing. I'm sure, that survey that came out about 2 years ago, it was ARP and the National Family Caregiver Alliance, I hope I have that right. And there's 53 million caregivers. Yes, in the United States, and many of them are long distance caregivers.

Yep. And we live in a world that's going to only increase because of the baby boomer pandemic. Yes, and as you said, less and less people to provide that care. And so it's it's a challenge. I want to tell your listeners that the longest chapter in my book is on life care communities, because I'm well aware, Diane, that the saying is, you've seen one life care community. You've seen one. There's no federal regulation. Exactly. Anything that says that they're the same or so I caution your listeners, even though, as you and I both said, big fans of a life care community you have to really do your homework.

And read your contracts thoroughly and ideally get somebody very knowledgeable to read that contract and help you understand what it is, or is not offering. And for those of you who might be saying what do they keep saying life care communities? Another term you might be more familiar with is continuing care retirement community in a nutshell that provides independent living.

Okay. And you have to come while you can still live independently to pass the required health care assessment. Yes. But should your health change over time, they provide assisted living, memory care and skilled nursing usually for a reduced cost. Why? Because typically you are paying an entry fee. Exactly.

You own your property, it's not real estate, you pay an entry fee. Think of it as a one time lump sum, long term care insurance. That's what I tell people. And I love that because I have a book about all the alternatives to long term care insurance. And for those out there that have purchased long term care insurance, I want to share with people if you have not purchased a plan that has a cost of living rider on it.

I can't tell you star how many people I've come across over the years that they're so excited that they think that everything's going to be covered because they have long term care insurance and then they learn that little inflation writer box. Yes. Yes. It's very expensive. What people are finding is if they bought their plan 20, 30 years ago.

It doesn't even come close to covering anything right now market. No we were 250 dollars a day. Yes, at the community that I worked at the life care community. If you call them up today and said, how much is skilled nursing? And again, for your listeners many life care communities provide excellent care. They tend to be more expensive, and they may or may not be able to accept somebody from the community. Why? Because their obligation or to their contract holders, the people who already live there in independent living and that contract promises that they'll get access to care, to higher levels of care when they need it, so they can't fill up their beds from the community, but they may or may not be able to accept somebody, but it's over 14, 000 a month Diane. Oh I'm well aware of it. Yeah, just like you said it. I thought that was high until I started checking now for a private room. Let's say that's for a private room. It could be a little less for semi private, but many of these upscale communities, they don't even have semi private rooms anymore.

They're all exactly. And the thing is people look at I'm an advocate for life care communities or continuing care retirement communities as well because. One of the things you do is you get to know everybody in the community, get to know the professionals and even better than that, the professionals that are there get to know you.

They know your little quirks. And when you show up at the wellness clinic or the sick clinic, they know you and that is valuable. that's priceless. It is priceless. And the other thing that I like, and this goes for even a standalone retirement community, not a life care community and even assisted living, people used to say, but I promised mom or dad, I would never move them to any other community. But what I saw in my 25 years in the senior living industry, that many people who fought tooth and nail did not want to go anywhere, moved into a community. And guess what? They made friends. They suddenly had peers their age with similar shared memories.

They had a supportive community emotionally. They weren't isolated. So when I tell families, before you put your foot down or before you're so sure that it's going to be miserable, go visit some of these communities and you will see some of them are wonderful, lovely, nice staff.

The better ones hold on to their staff. So there's not as much turnover and they can start a whole new life. I've seen people come back to life because they're not isolated and lonely. Exactly. I have seen curmudgeons, male curmudgeons, especially. I have seen them. Some of them get girlfriends.

Totally. And you know what, if you have a good staff, they encourage, they really nudge and I have seen even the grumpiest curmudgeon come out of his shell and start sharing, especially if they've been were a veteran or whatever. As they get older, they have so much knowledge and information to share and they have life experiences and they can find similar people with other experiences, or they just find a comradery in their life experience.

And things to do, exactly. Many communities have hopefully truly stimulating activity program. Now, where I work and some of your listeners may want to know this. There's a acronym called a UBRC. Instead of a CCRC or a university based retirement community. And if your parents have to happen to be a lifelong learners and love intellectual stimulation, then look for a community that's connected to a university.

And again, it may or may not be a life care community. It just could be what I like to call a full service retirement community near a university. Full service means that it's not just 55 and up. Okay. Full service means there's a dining, there's maintenance, there's housekeeping, there's security, there's a wellness center. They may not have other levels of care. But they might. There's one where I live that is full service, not life care, not licensed. That's a specific license. Correct. It's not just I think I'll call myself a life care. They have to be licensed as a life care community in the state.

But even full service retirement communities that have no entry fee their rental, but they have this supportive environment as people age, they may not offer skilled nursing. The one that I'm talking about has memory care and assisted, but it's rental. So you don't have to pay a big entry fee. So I want your listeners to know that, like I said, you don't know what you don't know.

Be prepared when you have conversations with your parents, if they say, next time we come visit you, let's all go together and visit blah, blah, blah community near you or next to your sibling so that you have several years to look at the options and develop a plan. And like you said, Diane, some of these communities have wait lists.

You can't just decide I'm moving in. You got to get a wait list. And if you might be on for the really popular communities, there could be a 2 to 3 year or longer way. Exactly. Exactly. Star in your book, you address how adult children can start preparing now for a time when their senior family members need extra help.

Can you tell us more about that? You said earlier that, often children are in denial. Yes. And they think their parents are going to be fabulous forever. And I refer to this as a simple way to look at this is to ask yourself this question. Are your parents in the go years, the slow go years or the no go years. Oh, I love that. I talk about that because it's such an immediate representation of the phases that if your parents or any of us live long enough, we'll probably eventually get to, but there's no rule that says you can't go from go to, go years to no go if you had a major stroke or a major diagnosis that was a whammy that you weren't expecting and that happens all the time.

Yes, adult children need to realize that, when people say, what's the biggest mistake you think adult children make and you're going to laugh when you hear this, because you're going to resonate with you when adult children assume their parents are going to stay exactly as they are in the go years, but my father golfs 4 times a week. My mom is out playing tennis and having lunch with their friends. They travel all the time. They're in great health. That is wonderful. But when you're in your 80s, things can change and they can change very quickly, and it's foolish not to assume that you shouldn't develop a plan for the slow go or no go years.

I love that perspective. I've never heard that before. I obviously saw it in your book, but I have to tell you that is really gets to the point of what we're trying to teach our family caregivers. Have a plan for those have a plan and as you said, it could be temporary and then somebody recovers and then something else happens.

And now it's even a little bit longer and then maybe even requiring full time, long term care. And I do think that sitting down. And starting these gentle conversations and leading up to some of the tougher questions. Lifestyle questions first and then you're going to ease it into if something did happen,

where would you want to be living? And then the next question is gosh, have you thought about how you might pay for long term care? Then you bring it back to yourself. I was shocked to find out that the average cost of assisted living, which, by the way, Medicare doesn't pay for. Yes, and is always out 99 percent out of your pocket.

We won't get into possible, alternatives to that, but these are the questions to start with so that you can be prepared. You may take offense to what I'm going to say but please be patient to explain what I want to say. Okay. Assisted living is one of the most dangerous of the medical delivery systems. I want to hear 'cause I know how knowledgeable you are. Yeah. Here's the thing. So assisted living is based on a social model, not a medical model. Okay. So the basis is a person should be able to express their needs.

So when you're going into assisted living, family members think everything's going to be taken care of. And they seem to get lax in their follow up with things when in fact they have, it's like they're in a senior living community, but you as a family member, a primary caregiver still need to be actively involved in health care.

Part of it. Absolutely. And that's a piece that is dramatically overlooked by family members, they get to o complacent and the other thing is memory care. I have a hard time with memory care and assisted living. And here's why in a social model, you are supposed to be able to express your needs and concerns and direct your care. A person with dementia does not have that ability and what I am seeing right now, I recently had a call from a lady. God bless her. She's 88 years old. Her husband's 94. He's in an assisted living in Florida. And she calls me up and she was having issues with the facility. They only have two aides on for a facility, a unit of 30 people.

Oh my God. There's lots of falls happening. There's lots of things going on there. She goes in every day. Her husband's not getting fed and she's paying big bucks and she's a cost guarantees care. Exactly, and she often finds him in his own urine every morning because if he sleeps in, nobody checks him.

Nobody watches him or observes him and she took on the ability because she wanted an alarm put on his bed because of his fall, but she wanted an alarm to go off so that they could, and the facility was fighting her. They did not want an alarm. And one of the things I'm seeing is because there aren't any regulations on a social model people aren't getting the quality of care that they would if they were in a nursing home. At least they're not monitored and they're not held accountable for that. I do know that the assisted living world industry is fighting increased regulation. They're saying we have enough regulation. I agree with you.

They do not. Yes. It's going to make costs go up. They'll use any excuse to raise the cost and for your listeners out there, both you and I have questions to ask when touring assisted living and of course, one of the first one is what is your staffing ratio? Exactly. One of the things when I ran assisted living, that would just drive me absolutely crazy is this is that the corporation wanted to lower the staff at night.

Yeah, and I would fight that I would come up with every reason I could to why we couldn't do that. Not to mention patient care. Yes. Because I was always pushing back on that. For the reasons you mentioned, you can't have 2 people caring for 30 some odd patients in the night because there's always some crisis or emergency that might require both of the aids. Yes. And I always told people if you found an assisted living that actually had an R. N. on the 3rd shift, the midnight shift or the 11 to 7, or whatever they do, that was a good sign because they don't have to and they usually don't to cut back on exactly.

Hey, I'm grateful. That's great. Don't we go and look at my website or Diane's for lists of questions to ask. And of course, I have them in the book because there's so many questions that will educate you about whether or not this is a facility you should even consider. Exactly, and one of the things is happening with the Medicare reimbursement.

I hate to bring that up, but what people don't understand is because the reimbursement is so low for the skilled care right now, facilities are closing at an unusually high rate. At a time when we need more nursing homes, or at least well staffed nursing homes, they're closing and the patients that were once in nursing homes are now in assisted living and the patients didn't live this long before.

No, and we're going to see more private pay out of necessity because we have hospitals closing, we have nursing homes closing. I know. And I get so anxious and worried, Diane, when I look ahead to the world that us baby boomers are aging up into because between COVID that caused both good and bad because of many other types of jobs had to pay more.

Yes. Let me ask you if you had a choice between getting paid $20 an hour at a fast food or working in a nursing home as a CNA making less than 20 an hour. Exactly. It doesn't work. Yes, maybe you do or don't have benefits. What would you do? And after COVID, many people left health care many people, and even nurses were completely and doctors.

And so now we're facing a world with an increased need for care in a world where we don't pay enough to those people who are working day after day, taking care of our elders. And until we recognize their worth and pay what's deserved, we are just not going to be able to staff any of these facilities.

And we have to come up with a completely different model. I don't know what it is. One of the things I'm seeing is, staff will leave just for 10 cents more an hour. I know, and one of the things I also less aggravation. Yeah, CNAs and home health aides are treated so badly by their organizations, the majority of them.

They really are. They are, they're all, it's really sad and they should be elevating them and lifting them up and giving them a pathway to get their nursing degrees. Exactly. You complete X number of years with us. Exactly. Part of your, and I do think. That many organizations realize, what we're doing isn't working.

I've been listening to some podcasts where there are a lot of people saying we really need to change this model. We can't warehouse our seniors. And I don't know whether we're going to go back to smaller mom and pop organizations that can handle and do it well, maybe 4 or 5 seniors or some sort of multi generational supportive environment.

I think we have to think out of the box in both in terms of making care, which is, what a challenge affordable and high quality. Yes. When you talk about multigenerational, I worked at Dock Terrace in, it's a Quaker community in outside of Philadelphia, and I love the multigenerational approach.

I do too. There was just so many good things about it that they had it set up so that the daycare can be seen by the students. Yay! And in the seniors, if they wanted to go in, they could as a re to read a book or whatever, and they also had community members that volunteered to pass water and nourishment and they also had people that would sit vigil when a person was dying. I love that because there are so many times when I would call a pastor or a priest up and say, Hey, can you sit with this person because we're so busy and she's actively dying or he's actively dying. And I'm a recovering Catholic.

And one of the things that offended me when my husband calls himself recovering Catholic. Yeah. One of the things that offended me is a priest one time told me she's all caught up on her. Sacraments, and that's just, that wasn't Wow, you were hoping to hear. No. So I really have a serious issue with that.

And that's why I love the multi generational approach. Let's hope we can inspire people to think outside the box. I'm going to read this quote that I love and in the beginning of every section of my book, I have a quote and this is one of them. The power of community to create health is far greater than any physician facility or hospital.

And we all know that what keeps us healthy is connection to community. And one of the first questions that I asked people when they say, I'm not moving anywhere. I'm aging in place, I'm staying in my home. The first question I asked, because I am a fan of community living. But let's say somebody says, no, it's just not going to work for me for many reasons and good reasons.

The first question I say is how strong is your support system? You can age in place well, if you have a very strong support system. Do you have a family in the same town ready, willing, able, capable? That's a lot. There's a lot of boxes to check. Able, capable, willing, to help you when you need it to support you and so you're not isolated.

COVID taught us Diane that being isolated and lonely kills people. Yes. It doesn't matter if you're in your big, beautiful home. When I did assessments, when I was running assisted living and you're required to do an assessment, I would go into these big, beautiful homes and find somebody very sad and lonely.

Yes. And that's when I realized money doesn't protect you from being sad, isolated, and lonely. Oh, absolutely. Community, Connection, Friends. One of the things that I have done is I've created a concept of care team partners and a care team partner group. And that's what I'm promoting. I'm actually in the middle of rewriting a book, and I want to start with the faith based communities on how you as a community can step up to the plate and start helping the seniors in your community with a care team partner group. And I think that's important because we have too many seniors that are isolated and alone or the family caregivers feel that they are a failure if they ask for help and that's far from true. Here's my own personal story. My parents divorced when I was in high school and remarried, and my stepfather, who I adored, wonderful man, I was very lucky in that, became the primary caregiver for my mom.

Also, we hadn't predicted that, really, we thought that he had more health problems, but one never knows. Yes. He became so focused on caregiving for her that he ignored his own health and I know you've seen that over and over again. Yes, he ignored symptoms that were very serious. She passes away and within a few years and I moved him closer to me but within a few years. He finally said, if you talk to the doctor, let's go to the doctor together. He had advanced cancer. He had just been pushing these symptoms away. And for those of you that are caregivers, as Diane said, I'd like to remind caregivers, if you're not here, you're being no help to your loved one.

You have to take care of yourself and your own health. I recently got the experts section on my website and I just this last weekend, I got a post from a spousal caregiver and she writes me and she says, I wonder if you can help me. She says, I have three adult children all in their late thirties.

And she says, they're really giving me a hard time about the care I'm providing for their dad. I don't know if it's obviously I'm assuming that they're their children and she's not a stepmother. And she said to me, I'm tired and angry and I'm providing him the basic care. What should I do?

And my first response with for her was, oh, my Lord, spousal caregivers have the hardest time of all caregivers because the family members, everybody around the family thinks it's just there. The spouse's responsibility of providing that care. When I told her she needed to have a family meeting and sit down with those adult children and tell them like it is, and here's another thing that many caregivers find offensive, but I always tell them, you need to look at your family caregiving as a job Oh, that's horrible. Come on, in a job, you get breaks, vacation, people to relieve you. Yes. And I say the same thing. Yes. And I really take issue with the fact that people think somebody should be responsible for somebody 24 7. It's just not possible. And speaking of which for your listeners

who are looking for a possible affordable alternative for a break or respite or regular breaks. If you are caring for someone with dementia, as opposed to medical complicated issues, look into adult daycare. Exactly Alzheimer's daycare. Yes, hard to find. I'm sad. It's sad to say that when I started doing research, they're few and far between, but there are licensed adult daycare.

Some a little more medical where they can address more medical, but many of them are daycare. Very inexpensive. There is some help for for paying usually for those, but they're nothing like the cost of home care and you can you go for 3 days a week, 3 mornings a week, sometimes they even help with transportation so that the caregiver can get some break some time off.

So look in your area for adult daycare. Again, more oriented for cognitive impairment than medical, but see what's available. Star, I'm going to take that one step further. For the entrepreneurial caregivers out there, one of the things that is desperately needed is nighttime care for patients with dementia.

The sundowning that occurs, and there's one facility I know of in New York and nowhere else in the country if I'm aware of any place in the country, I think employers should look at this as an option to for their employees that have want to keep employed and provide an environment that is conducive for somebody with dementia or anybody really that has issues with wanting to sleep and their family member doesn't sleep.

This is a really it's a nugget, a golden nugget of information for anybody out there who wants to do something new and different that is needed in the industry. That is a really great idea and the need is tremendous because one of the things I saw at the life care community I worked at is that if a spouse got to the point where they were wandering or not sleeping, their caregiver is completely exhausted because they're up all night in a life care community, the spouse with dementia could transition to memory care, the memory care neighborhood, their spouse could stay in independent living, get the sleep they needed and spend as much time during the days they wanted to with their dementia partner take them places, do things even back up to the apartment for lunch, but at night they could get some sleep and their loved one could be in the memory care unit that was secure, obviously. And safe. And so I love that. Just another advantage and people don't often we know because we've been doing this for 25, 30 years or longer.

I think you said you were a nurse for 50 years, 50 years. Yeah. So we see the future a little differently for our clients and families and loved ones and for ourselves. Yes. I like to call myself a realistic optimist. I love that. I love that. I thought that would resonate with you. I'm pretty realistic. If you asked me what my plan is, I have, and I also think. In my book, I talk about the two principles that I want people to apply and I think it's very helpful. I apply it to myself. Principle number 1. Whenever I make any sort of decision about my plan, personally, to age successfully, I ask myself this question first. How can I maximize and prolong my independence for the longest possible time? And I already know that I will likely not be aging in place. I already have a community picked out that I will likely move to for all the reasons we discussed.

Yes, that support connection, even if you lose your spouse. You're not alone in the big house. You've been in for 40 years. You're completely overwhelmed by imagining moving out. It's just become too much. I've seen a lot of that and make a decision soon enough. And then the other principle that I call it just in time senior planning, which means it's a waste of time Diane to make a plan that's 10 years out. Yes, so I tell people don't overwhelm yourself with thinking. What am I going to do? My husband just got diagnosed with dementia and you start churning mentally and wasting time and being anxious just plan in 3 to 5 year increments and make that plan flexible and resilient. Already know you're going to have to be thinking about a plan A and B as things progress. When you're trying to make a resilient, flexible plan. I'm going to respectfully disagree with you. And this is the average home if a person wants to age in place for a youthful body, you're the light switches are too high, the doorknobs are all round. So I tell families to, if you're going to make changes in your home and many don't, when you make changes to your home, contact an aging in place specialist and let them help you determine what is best for the aging body.

No, I agree with you. A toilet, a bathroom that you can, that with a little lip to, shower to step in. The door handles you can change over time. There are things you can do. Most of the time, it's the family caregivers that see what their parents went through. They think, ah, this is what I need to do.

Because otherwise, I agree with what you're saying. Absolutely. That is a very practical approach. And when it comes to don't wait, because how many times have you had people say, oh, my God, I need hip surgery and my bathroom. Is not going to accommodate me, or I haven't made the changes I need to age in place.

So you are right. If you think your plan is to age in place, remember, keep that plan resilient may not be exactly how it goes down, but do the things you need to ahead of time, even if it's years beyond 5 years. Where I'm coming from is more like, care and where I'm going to live. I agree wholeheartedly with that.

Yes. Plant a seed. Star, can you tell me some warning signs that an elderly parent requires additional support? What are things that a family caregiver or a family member should look for? The first thing is, when you visit them, and it's almost impossible to do long distance, but even if you are visiting two or three times a year, you want to really make sure that you're observing your parent and their actual environment.

If you see post it notes everywhere, you're probably going to confirm what you already have become aware of through your phone conversations that they're starting to have memory issues and they're trying to remind themselves through this post it note system. I've gone in and there's post it notes about everything.

Yes. Also, if your parents used to be very social, and suddenly they're becoming less and less social, your mom isn't going out and having lunch with friends. She's stopped going to her social groups. And she's not really becoming forthcoming about why. You're just sensing this. If you see pills, this is a really big one.

If they're taking a lot of medications, pay attention to how well are they managing taking those medications on their own? Is it becoming overwhelming? Do you see pills on the floor? Do you see their pill dispensers? Depends if they're using old fashioned little pop up weekly pill dispensers that can become overwhelming if someone's taking a lot of medications or there's any cognitive impairment.

If your parents, let's say your parents used to be super neat, your mom is a sharp dresser and so is your dad. Now you're seeing them put the same clothes on or the clothes are stained or they're not as fresh. Or maybe they're not showering the way they should. Or you're getting notices that bills aren't getting paid.

Or they're holding on to furniture every time they get up because they're not steady. These are all warning signs, red flags, and they're major ones. There's lots of little ones, but I threw out a lot of information. Yes, the things to look for when, your parents need more help. And that's great information.

And I appreciate you sharing that with Star because so many families take it for granted that, like you said, that their family member is going to stay the same. And one day, they're just going to go to sleep and die. And it just doesn't happen that way. I've been thinking about writing a book that says, check here if you want to die in your sleep.

I'll be the first to read it. I went all the clues. We would all do it. But the statistics on. Dying in your sleep, number one. Dying at home, number two. Even though that's what we want, the statistics show that often people die in a medical hospital setting, that is not what they want. Yes. And you have physicians who are throwing all kinds of options at you that really are not viable but people are afraid people are scared and I had a client who said I was so surprised my wife and I talked about this for years and years about when in their living wills what they would or would not accept and he was shocked at his wife was in a medical crisis completely changed her mind accepted being intubated and he, he just couldn't believe it. I've seen it. It was a terrible situation. Then families are really faced with making the decision. I have seen late people that are in their late 90s put on a ventilator. Terrible. And they're in long term care on a ventilator, and now the family has to make a decision.

Do they want to continue that or, and that's a hard thing to do is to take somebody off a ventilator. I've had to do it. Yes. Oh, and it's so challenging, very challenging. Yes. Even knowing that's what he wanted. Yes. Even knowing it's still very difficult decision. So for our aging population that may be listening to this, really think through your decisions at the end of life about what, I can't tell anybody what's right for them.

Exactly. The consequences of asking your family to make those decisions rather than yourself are tough. Exactly. Even for a healthcare professional, such as myself, many struggle with that decision. They really do. Star, in your book, you address the needs of the family caregiver, which family caregivers are my primary focus, because without them, everything starts to fall apart.

What are some ways family caregivers can protect their own mental, physical and social needs? The first thing that I want to tell any of our young listeners, when I say young, I'm talking about Gen Z, Gen X who are many of them in that sandwich generation, they still you know, so many women have waited to have children later.

Yes, they find themselves moms of younger children or even middle school or even high school kids still need you even more and older parents. And so I caution families as they develop a plan please be honest with your parents. If you know that you cannot be the primary caregiver because of your existing responsibilities, don't agree to a plan that's doomed to fail.

Exactly. And I've also talked to so many young people who are not close to their parents. They have a very difficult time mentally dealing with perhaps a parent who's unwell mentally or abusive or was abusive. Your parents don't automatically deserve your love and attention. However, having said that, and this is pretty heavy duty conversation, having said that I have seen many people for themselves, be compassionate to a parent that would normally one would say why are you even helping them after your history with them that again a very individual situation. Yes, but we live with our choices. Don't we? Oh one of the hottest topics on my site is the family caregivers who are caring for a narcissist and up until the end of their parents life, and even beyond, I have so many caregivers that reluctantly, I call them reluctant caregivers.

That's such a good word. Yeah, they provide the care and they're still trying to get that love and attention from their parent. I know. And it's very sad because I'm on quite a few forums and I can't tell you how many times those, the reluctant caregiver becomes angry and resentful and it just is not conducive to providing good care, but they feel that they have to continue on because of guilt difficult.

Difficult. Oh, absolutely. And guilt is the most difficult negative emotion that we have and it's an unproductive emotion and it negates all the good we do so you got to get rid of the guilt and when you make decisions based on emotions, and not logic, you have a problem because decisions made with emotions are generally poor decisions when there's no logic involved.

And I know people make promises and they're going to do all these things. And then there, a time comes when they realize, oh crap, I can't do this. I can't do this. And I want to say to your caregiver struggling with that kind of a decision that you will not do not forfeit your mental health or your physical health caregiver.

Exactly. Some of you say, but I have no choice. So I recognize that's advice that may fall on deafness, not easy to say, but not easy to carry through. And if you are for whatever your circumstances are required to be a caregiver, please do everything you can to find some balance in your life.

Again, adult daycare programs, faith based programs who might offer some sort of respite care. In some communities, and I love this, you can bank volunteer hours. And I'd like to see that happen more and more with your care team partners, where you can volunteer and bank those hours for when you might need it. With no money exchange, banking volunteer hours to withdraw those hours for yourself should you need it. But we need to, we're going to have to respond to this as a community. Yes, nationally to help our families struggling with this, because it's becoming unaffordable. You can't find staff anyway. Caregivers anyway paid. And what did you say 650Million dollars yes, in unpaid care. Star, at the beginning of the year, I created a petition because it's an election year.

And on my site in 2016, I'm moving my site from one platform to another and one of the things I came across was I was so excited because Hillary Clinton was going to help the family caregiver. She ran on that platform and it gave hope to so many family caregivers. And nothing happened and in 2020, it wasn't even discussed.

So I thought I'm going to create a petition so that we, as a group of family caregivers, I thought, Oh, hell there's 53 million of us out there. We should be able to create momentum in this and I don't want to tax credits for caregivers. I don't want that. I want affordable respite care. I want health care when they need it.

I proposed all this stuff. I could not get momentum on that, and it made it why, because they're also exhausted. Yes don't add one more thing and I that's what I've come to see. Yes, if you're working a full time job, trying to raise kids, provide care for an aging parent in your home or a long distance, you are so stressed out.

You read that study that I referred to earlier. Exactly. You study the number of caregivers that are so stressed out emotionally, financially. And it goes back to what you and I are saying, we need to come up with some other approach nationally, we do. Yeah, we can't government is going to solve this issue.

Exactly. Sadly. And now you're telling me even worse news about Medicare, reducing therapy hours for those that need it. And we all know that without good physical therapy or occupational therapy after surgery, orthopedic or any kind of surgery or a fall that you reduced your chances of returning to full independent living. And we're seeing that more and more now with the changes in the Medicare reimbursement.

And it's really sad. So families are going to have to step up and do the work once done by professionals and it's and how are they going to do that? Number one, they're not trained. You're talking. I don't know. Oh, I know. You know what? I have this idyllic image of an intergenerational intentional community that is both designed architecturally and in initial planning that meets the needs of this multi generational and I know some people are thinking about this where you share the cost of care, yes, either volunteer banking plus maybe home care where there's communal activity areas where you share resources everybody doesn't need either on their own lawnmower, on a very practical level that you're sharing resources, both in terms of practical resources, time, resources. Perhaps in terms of healthy living and eating gardening that I mean I know that this is like a Shangri La image, but wouldn't it be wonderful if we had intergenerational where older people were helping with child care, not necessarily for their own children. And younger people might be helping look in on seniors.

We know that they can't work 3 hours a day, right? And senior, but where there's a supportive environment. One of the things that we're faced with is not having enough use. So the cost of living has forced people seniors to move towards communal living. And I laugh when I say that because I'm from the baby boomers and Lord knows, there was Woodstock and hippies and we're going back to .We might have to, yeah, we're going to be living in the closet of housing, on my TikTok video, my name is a senior living star, I got a lot of comments from people saying, who says we have to take care of our parents. My parents have done nothing to plan. Yeah, they're just assuming I'm going to take care of them and they haven't helped me at all. They don't even come and see the grandkids that were very upset and housing is expensive.

Yes, I may never even be able to own my own home and I said, I want you to know that there are a lot of baby boomers out there who are worried for you as a generation. We see the cost of childcare, we see the cost of owning a home. Yes. And what can we do to help you? I think it's going to be more intergenerational.

Maybe it's tiny houses, where the older couple have a tiny house and then the family has a smaller house and you're not living under the same roof, but right near each other. Like I said, we got to invent something to help people maintain, and when I say independence, even their Gen X or Gen Zers have their own home.

Yes I totally agree with what you're saying and I see people seniors having communal living where they share the cost of the housing, they share the staff, they share a ride, they make their appointments, for hairdressers, or there's also going to be a need for podiatrists and come to the house or visiting doctors to come to the house.

These are things that I've seen in Philadelphia. Come and see 10 older. Exactly. And then they, that those people share the cost. Yeah, I think we are going to reinvent things. And, many of your listeners may have not heard of this expression, but a naturally occurring retirement community, a NORC.

Yes, and a lot of organizations, including a national organization. Diane, have you heard of Uplift? Yes. Yes. So these are what we're talking about where these naturally occurring groups of older people are now organizing themselves into a community where they share some of these expenses and help with each other.

And so for those of you that are interested in that or want to try to organize your community, Google the uplift. Is it uplift? Yes, America, or I don't have that in front of me, but I'm sure I don't either intentional living or naturally occurring retirement communities and uplift. You'll see that states are, especially on the West Coast, starting to come to Florida, starting to come to the East Coast, organizing communities, organizing themselves to support each other in all of these daily living requirements.

Well, baby boomers broke the mold when we went through, we didn't have schools. We didn't have enough schools. We didn't have enough Educational programs, we didn't have enough of anything homes or anything as we move through life. So we're breaking the mold once again, and we are going to recreate how people age and how well they age.

Yes. Star, you have written such a valuable book for everyone that is aging or caring for another person. What do you hope readers take away from successfully navigating your parents senior years? That is a great question. And thank you, Diane. And I'm so glad you pointed out, even though it's navigating your parents senior years, I would say that 60 percent of the people who buy my book are aging themselves and they recognize that they want to make a plan for themselves and also with extended family, either of origin or by choice, as I like to say, I want people to take away the fact that they can develop a plan before a crisis that honestly optimistically looks at what their options might be and educate themselves. Go look at your options. Don't just live your life by default waiting for the crisis. You can choose by thinking and planning and educating yourself now and my book was written for that reason, to make a plan that will work for you, that it's resilient and flexible and work for your adult children. I love that. I always encourage my family caregivers be proactive, not reactive. That's a huge difference in your stress levels as well as taking care of your parents. Yes. And because I spent, 20 years in senior living. My book is different than many books out on the market because I have the insider expertise, having worked in assisted living memory, exactly life care. I really help you educate yourself and know what questions to ask. A lot of books are written to help care for your parents. This is before you're caring for your parents. This is to help you bring those conversations up and coach you on how to bring those conversations up early. Good information Star. I want to thank you for taking the time out of your very busy day to share your book and knowledge on a very timely and important topic.

Well, Diane, it is a pleasure because we're both passionate about the same thing. Yes. And we've had our life experience that is taught us and we really are committed to helping others. That's clear. Thank you. To my family caregivers out there, remember, you are the most important part of the caregiving equation without you, it all falls apart. So please learn to be gentle with yourself. Practice self care every day because you are worth it.