Care Management for Dementia and Alzheimer’s Patients

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7 Ways to Prevent Isolation in Aging Adults

Steve Lorberbaum: Well, good morning everybody. Thank you for joining us for What’s Your Plan. Today we’re very happy and lucky to have a special guest, Susy Murphy. She’s the owner of Debra Levy Eldercare Associates. They’re really like wedding planners for growing older. And we’re going to talk today about what care managers do and how you can work with one and, and how they can help make your lives easier as you plan for the future. So welcome, Susy. Why don’t you give us a little intro on you and Debra Levy Eldercare?

Susy Murphy: Sure. Nice to see you, Steve, and thanks for inviting me to be part of this program. So I’m Susie Elder Murphy, owner of Debra Levy Eldercare Associates. We’ll be celebrating our 32nd anniversary on November 1st this year, and we are a practice of aging life care managers. So our practice includes nurses, social workers, and gerontologists.

Susy Murphy: And we often help people when a crisis has happened. Somebody had a fall and you get the call from the hospital, your mom has dementia and she can’t go home again. But we also are increasingly seeing families and individuals calling us, wanting to proactively have a plan for the future, or have us get engaged to help a relative before a crisis happens. And one of our main programs that are growing in size is our Well Senior program. That is specifically for people who are currently well but anticipate either that they have a chronic condition that may get worse over time, or that they don’t have friends or family that they feel they can or want to rely on if they have a medical crisis, and they want to have a relationship with us in case something like that comes up for them in the future.

Steve Lorberbaum: So I talk to families all the time and they’ll say, “Well, why do I need a care manager? Why can’t I do this myself?” It’s a daughter or son, or son in law. And so what’s the thing that you bring to the table that maybe families don’t have the ability to do as easily?

Susy Murphy: So one of the reasons that we say we’re like wedding planners for growing older is that most people, when they go to plan their first, and for many, only wedding, they’re not really sure, which photographer should I use? Which venue is it going to be at? How much money is reasonable to spend on a dress? How do I find a reliable caterer? So all of the different details that go into having the wedding that’s right for you. It’s similar when there’s a crisis of aging.

Susy Murphy: We have a client right now who’s 79. Her husband is almost 10 years older. He has Parkinson’s, she’s very healthy. She does Pilates and yoga every day, and she’s had a number of health issues over the years but has been fairly healthy for the last few years until she fell twice in two weeks. The first time breaking her knee and the second time breaking a hip. And she was like, “Well, I can get over this. I got over cancer and all these other things.” And then she discovered, “Oh actually, hip surgery recovery really hurts and really takes time. And how come I just can’t power through it?” And I said, “Well, because it’s your first time breaking a hip like a 79-year-old.” And so even her past experience of recovering from surgery or illness as she has gotten older, the response time, the recovery time has changed.

Susy Murphy: And in Montgomery County and in DC where we primarily provide services, there are hundreds of home care companies, there are dozens of assisted livings, there are dozens of skilled nursing facilities, and knowing what’s going to work out the best for you is really very individual depending on your preferences, your needs, and also your budget. And so yes, you can go through the guide to retirement living and call all 43 assisted livings, or you might want to consult with an aging life care manager like us, where we’ve been in and out of those communities every week and know their strengths and weaknesses and whether or not it might be a good fit for you and your needs.

Steve Lorberbaum: Okay, so that’s a great point. So not every assisted living is the same. Each one is different. They have their own personalities, their own programs, the things they excel at, things maybe they’re not so good at, and that’s your area of expertise, you know those things and can help guide families to picking the right one.

Susy Murphy: That’s definitely one of them. And I would also say right now with COVID and with restrictions that many communities either are choosing to do or being required to do, depending on their licensure, many families are thinking long and hard about do I even want to move mom to a community where I may have limited access to her? So we’re really spending a lot of time trying to figure out what is going to work best for them. And certainly, some families are choosing to do what we call assisted living at home, and either having a family member living at home with them or renting them an apartment and putting services in place for the next six months, perhaps the next year, until we see how communities are able to respond to the limitations of the virus, and protect their residents while allowing family members to see their mom or their dad or their spouse.

Steve Lorberbaum: Gotcha. So sounds like the Well Senior program’s a great introduction to what you all do. So what’s the sort of level of commitment if I just want to have you in my back pocket? That I want to know that somebody knows about me, and when I have a problem, I’m not starting at ground zero. So can you expand on that a little bit?

Susy Murphy: Sure. So our Well Senior program is run by our two staff gerontologists. So they both have masters in gerontology. And Brie, who’s the lead on that program, her master’s degree was a focus on aging in place. So for many of our seniors, they believe at this time, or they know they have the funds to be able to stay in their home wherever they are right now.

Susy Murphy: So when they engage us through the Well Senior program, Brie or Liz comes out and does an intake with them, we get copies of their medical power of attorney, we ensure that they have a financial power of attorney who can pay bills in case they’re incapacitated for any period of time. We also find out about their medications, their diagnoses, their physicians, and also their emergency contacts. So if they’re in the hospital, who do they want us to talk to and who do they not want us to talk to? And what are their wishes? Do they want a lot of supportive, aggressive care, or if they have a difficult diagnosis, are they more interested in palliative care?

Susy Murphy: Many of our good seniors also have issues that they want answers to when we go out and do that initial assessment. So for one couple, they have been debating about which type of bed to go. They knew they needed a new mattress and they weren’t really sure what would be best for them given the different health issues that we had they had, so we helped them with that research. That same couple, actually, the wife was a gourmet cook and I asked her, “So what’s your specialty?” And she said, “Everything.” Every day, full-on Julia Child gourmet food. And they said, “That’s what’s important to us, is always being able to eat well.”

Susy Murphy: But nine months later, she needed to have elective hip replacement surgery. So they called Brie to talk to her about it, and in addition, of course, to set up some home health and PT and other supports, they said, “We want gourmet meals delivered to our house for every day that the wife was not able to get up and cook on her own.” So that was part of the plan that we helped put them in place, connecting them to a resource so they could get those gourmet meals delivered every day. Because to them was what made life worth living.

Susy Murphy: After that initial intake, when we answer questions and help address concerns that they have, we go back to the office, we put all of their information into our secure database because we need to have all of that information accessible if and when they have an emergency. And then we check in with them quarterly by phone or email, depending on their preference. And then our only other requirement is that they allow us to meet with them in person once a year. Now, right now we’re doing that by Zoom. But we need to know, do you have a new diagnosis? Do you have any new medications? So if you do end up in the hospital, we know what your baseline is at that point in time. So that program has about tripled in size over the last six months of COVID, because a lot of people are thinking I want to be, “I want to be ready if something happens, whether it’s COVID or anything else. And I want to know who I can count on to be there for me.”

Susy Murphy: And I did put our website in the chat and it’s on that screen as well. And if you’d go to our website, you can see an interview with Betty, who was our original well senior, talking about what the program did for her and how it gave her and her mom and her daughter peace of mind. And actually her daughter is now enrolled as a well senior because she doesn’t have family and she saw how helpful it was for her mom to have us, as her mom did have four hospitalizations over the eight years that she was part of our program before she passed. And each time we were able to get her through the crisis, through rehab, and back to her home.

Steve Lorberbaum: Gotcha. All right, great. So as you know we work with families, we put aids in people’s homes to help care for them, provide assistance with activities of daily living. And we get questions a lot about coronavirus and how to plan and what to do around being sure that if one loved one gets sick, how are people going to care for each other? Is that something you have any information on?

Susy Murphy: Yes, actually. We are rolling out this month, our custom coronavirus plan consults. So that will be something you can specifically sign up with and have a 90-minute meeting with one of our nurses or social workers. Be a 90-minute interview and we’ll address your three top concerns, provide a written report of all of our recommendations, as well as access to a special library that’s been created by a science writer that works with us on resources, both local and national on COVID. And that will be $400 for the 90-minute consult and written report. And we’ve had a lot of interest from people who live alone, as well as from people who are family caregivers and are concerned about if they got sick, who would be able to take care of their spouse or their adult parents?

Steve Lorberbaum: Gotcha. Okay. So one other thing we see is family members where maybe there’s one family member local, then another family member in another part of the country, and they’re trying to sort out how to help mom or dad. And maybe they don’t always have the same alignment of thoughts, and maybe parents have a completely different view. Can you help in that area? I don’t know if it’s being a referee or a therapist, but is that somewhere that that care managers have expertise?

Susy Murphy: Yes, that’s a role that we play pretty frequently, because we are an objective, outside person looking at the parents and looking at the situation. We know that in a family that has multiple children, each child was born into a different family. They all have different relationships with their parents and may see their abilities and challenges very differently. We just started working with a family where there are two adult children, and they feel very differently about what dad, what type of care he needs, and whether or not he has the capacity to make those decisions for himself.

Susy Murphy: So one of our social workers went in yesterday actually, and did an assessment targeted just to his ability to make decisions, and determined that he does have the ability to make decisions about his care. And now we’re going to monitor the care so that both children feel assured that there’s someone outside of the family who’s objective, who’s kind of giving it their seal of approval. He has the right amount of care, it’s not too much, it’s not too little, and his wishes are being followed. He does unfortunately have a stage four cancer diagnosis, and he has elected not to pursue treatment. And so he’s wanting more to have a palliative care approach to his care at end of life.

Steve Lorberbaum: Gotcha. Okay. So you mentioned briefly the cost for the COVID planning. Can you share with us generally the cost for these Well Senior program, and then the larger care management? How does that work and how do you get started with an initial assessment, and how do you bill that sort of stuff?

Susy Murphy: Sure. So to get started, people could email us through the email address, [email protected], or go on our website and they can make an appointment for an initial free consult with two of our staff. We bill for our time because that is … Our expertise is our product. So we bill very much like an attorney might. Our assessments and ongoing care management are billed at the rate of 160 an hour, and our consults, which we do by phone or video call, are billed at the rate of 175 an hour. Many people have long-term care insurance now, and one thing that we’re doing a lot of right now is reviewing long-term care insurance policies with people and helping them understand how to use them. So that would be something that would be more of a consult. If anybody on this calls as part of a village and identifies that before they schedule a consult with us, we give a special rate to members of the village. So instead of 175 an hour, our consults are 160 an hour if you’re a member of any one of the villages.

Susy Murphy: And the Well Senior program, we bill the same way. The 160 an hour. We don’t charge for the time that we spend checking in, but we do have an annual enrollment fee. So it’s $100 per person for our Well Senior program, and if you’re a part of a couple it’s 150 per year. And you pay that each year on your anniversary. So when you do your annual Well Senior visit. If you have long-term care insurance, depending on your policy it may cover your services. I talked to somebody yesterday and they have almost $1,300 a year to spend on our services. They had no idea. So our meeting yesterday, plus our initial assessment will all be more than covered by that benefit that they have. But if you don’t have long-term care insurance or services can be considered a tax-deductible medical expense. So if you’re engaging home care through assisting hands or another company, or paying for assisted living, any other long-term medical deductions, our expenses can just be added onto that and we can send you a statement at the end of the year for tax purposes.

Steve Lorberbaum: Thank you. So you mentioned at the very beginning that you’re an aging life care manager. Can you tell me a little bit about that organization and how that works in terms of overseeing or maybe credentialing or whatever it does?

Susy Murphy: Sure. So the Aging Life Care Association just celebrated its 36th anniversary. And this profession really got started with the greatest generation, which was the first generation to live through a lot of things that previous generations didn’t. Heart attacks, strokes, cancers. And they were living longer and going to state attorneys and getting their wills and powers of attorney, but then they were saying, “So where should I live? And who’s going to take care of me?” And the attorneys really didn’t have answers to those questions, so they started asking social workers to help them. And that’s really how the Aging Life Care Association and how our profession was born.

Susy Murphy: Back in the old days, 35, 36 years ago, we were called geriatric care managers. And some people still identify ourselves as such. We were the National Association for Professional Geriatric care managers, but in 2014 we rebranded. And I think Aging Life Care Association really fits what we do more than geriatric because many of us are people of various ages. We serve age one to 101, and everybody’s aging, and not everybody likes the term geriatric, likes to think of themselves as geriatric, and many of our clients aren’t geriatric.

Susy Murphy: What sets care managers aside from other professions is the fact that we’re interdisciplinary. So we’re looking at the spiritual, the social, the psychosocial, the financial, medical, local resources. But we also have a very strong code of ethics. And what’s most important is that we don’t have a financial relationship with any resource that we refer to. So while we do often work with you, Steve, and your caregivers, unfortunately, you’re never able to give me a plane ticket to Hawaii. And even if you did, we wouldn’t be able to accept it. So we’re very objective in the recommendations that we make.

Susy Murphy: I often say, “If you’re going to buy a car and you go to a Ford dealership, they’re going to find a Ford that fits your needs and your budget.” They’re never going to say to you, “Steve, I could see you in a Subaru. I just really feel like you should go next door and talk to that guy.” And the same thing happens when families are looking for an assisted living. They will be talking to a marketing person and that person will … Their job is to persuade you that there is the right fit for you or for your family member that you’re looking for. And we’re that objective person on the outside who can help affirm to you that that could be a good fit for you, or that it might not be the best and suggest other alternatives that could be a better fit, and why.

Steve Lorberbaum: Gotcha. Okay, great. So we have only about eight or nine more minutes. So I’d like to see if there’s anybody that has questions. I see some in the chat.

Patricia Dubroof: So one of the questions in the chat is, “Is there a way to prepay for care management so our children can use the services to care for us?”

Susy Murphy: Yes, absolutely. We have a number of people, more of our younger people, we have sort of a gaggle of young adults with autism spectrum challenges. And so they all pay a deposit and then we draw down as needed. But yes, we definitely can make a deposit and then draw down on it as needed.

Steve Lorberbaum: Okay. And I see one from Lynn that wanted to know … So assisting hands works with a variety of care managers. So we don’t only work with Debra Levy. We’re agnostic. We work with anyone that wants to work with us. We coordinate with a variety of care managers and family members, social workers, nurses. As it relates to another question about our testing when our aides clock in for a shift, they have to answer COVID screening questions, and if they answer the wrong answer, then they’re instructed not to go into the shift and call our nurse to be orally screened to make sure they’re not symptomatic and are capable of either going on to work or going home.

Steve Lorberbaum: We do provide testing for our aides on an as-needed or as-requested basis. There’s a lot of issues now around testing and the value of it, especially given the long timeframes for the return of the tests. So it’s something we monitor with the CDC website and with other public health officials to make sure we’re understanding what is the best way to ensure that caregivers are heading into homes, and not bringing COVID into a home. For us, all of our aides where can 95 masks, which are the substantial equivalent to the N95 hospital-grade masks. And so they’re supposed to wear those when they go on shift.

Steve Lorberbaum: One other one was, can aides give medication? So medicine technicians, which we have, are allowed to administer medications. Probably too long to answer here, and Lynn I could talk to you privately if you like. There’s a big stretch between what is a medicine reminder versus what is medicine administration? And so, we do both.

Steve Lorberbaum: Any other questions. So I have, I guess, one other question, Susy, for you. We oftentimes work with families and they don’t appear to have a primary care physician any longer because their doc retired, their doc who’s their age, and is now retired. Is that something where you can make recommendations for different kinds of doctors or specialists that people might need or go to based upon what you hear in an assessment?

Susy Murphy: Yes. We help connect people with practitioners. So whether it’s a primary care physician or a specialist such as a podiatrist or a cardiologist, we have a large database of doctors that we’ve worked with and we can sometimes bet recommendations you might have gotten from your neighbor or your best friend against what our experiences have been over the years because we track which clients work with which physicians around the area. And we also work with all of the home visiting practices that are in the area, and so we can talk to people about what the home visiting option might be for them.

Steve Lorberbaum: Gotcha. So if I wanted a doctor to come to my home, they all private pay? Do they take Medicare? Do they depend on it? Do you know?

Susy Murphy: It is really in the … It depends. Several of the practices take insurance and request no further payment beyond that. And some practices consider them more themselves more in the concierge physician department, and then they have typically a quarterly charge, usually around six or $700 a quarter, in addition to billing your insurance for their visits.

Steve Lorberbaum: And things like podiatrists. Do you have an array of people that might make house visits so that … Nowadays people need attention to their foot care, but they’re afraid to go to a doctor. Is that something you also have referral sources for?

Susy Murphy: Yeah. Podiatrists and dentists, and right now we’re really working with a lot of folks who’ve been cooped up for the last six months and making sure that they’ve gotten out to see their podiatrist or to see their dentist. If you needed to have a cavity filled back in March or April, you really need to get in there and get your mouth looked at now that there are practitioners who have reopened their offices and are taking precautions. So we’re looking always at the whole person, but especially looking at those teeth and toes that sometimes get overlooked by people. And we are also, unfortunately, getting more calls from families where mom or dad was home and reasonably healthy and has gone out to the hospital and been diagnosed with stage four cancers because people just had gotten any medical care of any kind whatsoever over the last six months. So they’ve been scheduled to see a doctor in say March or April, and postpone that visit and now have a more advanced disease process, unfortunately. So we’re really working with people right now to make sure that they’re getting medical attention, but staying safe while they do that.

Steve Lorberbaum: Okay. And so there’s a question more to, can Debra Levy higher health care aides?

Susy Murphy: No, we don’t hire healthcare aides. That’s why there are people like Steve and the other home care companies in the area. What we do is often we will work with families if they really want us to help screen the people, to match them to the situation. Because we do a lot of interviews, we have a sense of how to match clients with individual caregivers. We have what we call a Mary Poppins that we put together. What do you really want? Is somebody chatty? Is somebody quiet? Driver, not driver? And then do an initial screen to find the right caregiver. Just in the last month or so we had two pretty challenging family situations, and it took a good month to go through all of the interviewing to find just the perfect caregivers in these two situations. But in both situations, the families are really happy. We spoke with multiple agencies, we interviewed multiple caregivers to come up with the ones that the family was really happy with and that the client is really, really happy with.

Steve Lorberbaum: Great, okay. Well, I think we’re out of time. Is that right, Patricia?

Patricia Dubroof: Yes, sir. Time for a wrap-up.

Steve Lorberbaum: All right. Well again, thank you for joining us today. Hope you found it useful and informative. And if you have any questions, certainly you can give Susy a call, or email, or you can call Assisting Hands as well. And I think our number’s on a slide.

Steve Lorberbaum: Next up next month, we have someone coming to talk about assistive technologies. So again, that’s something Susy actually knows a great deal about as well, but we don’t want to monopolize all her time. So we’ve got Joan Green coming to speak to us. And so hopefully you’ll join us. Thanks for joining everyone.

Susy Murphy: She’s great, Steve. That should be a great program. And thanks again for inviting me.

Steve Lorberbaum: Excellent. All right. Thank you all. Have a great day.

If you would like to schedule an appointment to discuss your Alzheimer’s and Dementia care needs or to set up a free in-home evaluation with one of our nurses, call us today in MD at (301) 363-2580, or in VA at (703) 556-8983. We are located in Bethesda, MD, (301) 363-2580, and Reston, VA, (703) 556-8983.