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Prakash Chandran (Host): Aging is a fact of life and affects all families. As adults, when imagining our parents as seniors; we may not fully understand the extent to which their aging will affect them and us. Even if they are in good health and independent now; long-term care may be needed eventually. I’m Prakash Chandran and in this episode of Magnolia Matters Healthcast Series, we’ll be talking about how to provide quality care for the elderly. Here with us to discuss is Marquetta Trice, Director of Home Health and Hospice at Magnolia Regional Health Center. Marquetta, thank you so much for educating us today.

Marquetta Trice (Guest): Thank you Prakash. I’m certainly happy to be here. 

Host: You know this is a very timely topic for me because my dad is 78 years old and like I said up at the top, he’s independent living right now; but I constantly am asking myself, should I have this conversation with him, because he’s not always going to be this healthy. So, I’m assuming I’m not alone in this. can you talk a little bit about the importance of planning ahead and having these discussions especially as children?

Marquetta: Absolutely. I think that it is vital to have the conversation especially when things are well because as the nation moves towards wellness, I think that’s important but it’s also important to have a well thought out plan in the event that long-term care is needed. 

Host: So, let’s talk a little bit about the plan that you are talking about. Let’s same I’m going to go see my dad this weekend and I want to have this conversation with him; what are some of the things that I should address?

Marquetta: I think that first and foremost, because this is going to be important to your dad; make sure that he has plans for anything of his personal, of his finances, but then also his medical status. Meaning, he may or may not have already had the conversation and decided that this is what I’d like to have. What I’m actually talking about is like an Advanced Directive or a Living Will for the medical care as to what he would like to happen to him in the event that he were to get sick. That’s really, really important. Power of attorney is also a conversation to be had. There’s a power of attorney over finances as well as a power of attorney over medical care. 

That would be a really good starting point. And then the what if questions I think would kind of take place because if he just has a bout of illness and would need other services maybe that the community may offer; how willing would he be to accept that so I think that would be the very starting point for having a conversation and it would be in the now. When things are good, I think it’s a perfect time to have those conversations. 

Host: Yeah, that is very good advice. And after going over those things that you were mentioning with him, there seems to be so many different forms of long-term care such as home, adult daycare facilities, nursing homes. Can you tell us a little bit about the benefits of each of them and when they might be the most appropriate?

Marquetta: Absolutely. Of course, if you were to ask your dad today, dad where would you like to have care? He’s going to say home. Definitely, because there’s no place like home. Absolutely. However, in intermittent or times when there may be just a sickness or an acute episode going on; there is a nursing service that is of course covered through Medicare, it’s called Home Health of course which is one of the services that we provide that is medical care in the home supervised by the doctor provided by nurses and other staff members to get the patient back to where they need to be. 

On the flip side of that, sometimes there are situations where there’s illness that is terminal or determined to be terminal; then there is another service in the home which is hospice and hospice immediately takes care of providing and improving the quality of life versus the quality and this important because the same team make up with the nurse and aide along with chaplaincy and social work is able to provide pain relief and comfort to patients along with providing tips and tools on how to grieve and how to express from both the patient and the family members. 

Moving outside the home, as an intermediate I would say position in assisted living. Oftentimes parents don’t want to be a burden on their children so they would elect to go into assisted living. This is provided where they are still able to maneuver and get around but just have supervision, just have assistance with things like meals and meds. And of course, this is at a cost to them. But it’s an opportunity for them to be independent however, to have supervision. 

Nursing home, I think would be a step that would take – it’s more like a long-term that this is the opportunity to go, 24 hours nursing supervision on meds, under doctor’s supervision, provided activities, there’s a whole activities of daily living including therapy. So, basically at this point; this is – of course it’s a long-term opportunity but it’s usually when there’s more medical care needed versus the independent living suite that I spoke about earlier. 

So, I think that every individual may have different thoughts as to what they’d like to see happen. But I think it’s important to discuss and make sure that mom or dad understand each option so that when it comes to that time; that they can kind of tell you what would work for them and what would not. I guess cardinal in this whole conversation Prakash, is that we have to hear from them what they would like and what they would not like. That’s vital as well. 

Host: I’m so glad that you said that and I’m also really glad that you broke down the different options because I know that when I speak with my parents about it, I have brought this up a couple of times; they just feel – they’re just like you know, not right now, we’re completely mobile, we’re moving around. But you know what, Marquetta they live on a top of a hill and it’s something that I’m concerned about and I don’t know that they can necessarily afford that in home help. So, for the people that are hesitant to leave, or their parents are hesitant to leave; how might you help them overcome the fears of leaving to get care outside of their home, a place where they have been for so long?

Marquetta: One thing I can tell you is this, you would have to actually have the conversation with them to kind of erase the myth because believe it or not, there are myths to things like nursing homes and all they probably would remember are the horrors that they may have heard. But the conversation just being able to provide information in regards to the activities and the services that will be provided that are like home. Of course it will not be home. There’s going to be a transition regardless because from going from the place that have known for many years. But I think if they are able to go in eyes wide open and understand that it’s going to be for the benefit of them; if there’s a safety issue or if there’s just concerns with them living alone for whatever reasons. I think having that discussion while they are still at home and then talking about what’s to become of their home, things like that. 

But here’s the thing. I think it’s very important because that’s like a scary thought for a parent. So I think to break the ice would be I want what you want, I think it’s important, we’re good now; but just what in the event of; kind of sort of breaks the ice and allows them to kind of speak to what they would like. Of course, there’s a chance that they are going to say absolutely not and that’s when the challenge comes in and you have to kind of be creative. But I would certainly suggest having the conversation before you get to that need basis. 

Host: Yeah, you know I think what I’m hearing from you is make sure to have that conversation early and often with the ones that you love. And if you’re listening to this and you are elderly; just to be a little bit open minded because there are a lot of myths out there around nursing homes and it isn’t what might be in your head just people and no activities going on and you are just siloed by yourself. I think things have come quite a long ways in 10, 20, 30 years. 

One of the things that I wanted to ask you about is when to make the transition. So, if we’re talking about not in home care; if they are leaving their home and they are independently healthy; do you have a rule of thumb that people can follow around okay, maybe when there’s a health incident, then we move outside of the house or maybe at a certain age? Can you talk to us a little bit about that?

Marquetta: I most certainly can. Actually, it’s going to be based upon every individual situation. But to pinpoint a little closer to that and bring it closer to home for each individual; there are times when there has to be thoughts and decisions made especially Medicare Medicaid recipients in regards to ownership of their homes, transfer of things like that. Those are things that Medicare.gov is definitely a good opportunity to take a look at because possessions, they definitely want to be able to have those conversations and make those accommodations in order to have plans in place for their place of living. 

But I guess at the same time, once that conversation is had; there’s not particularly a rule of thumb as to when or a certain age. I think it’s specific. To give an example, a fall with a broken hip is probably going include a surgery and hospital stay and most times case management within the hospital under the doctor’s request is going to look towards rehab, which would be a short-term stay in a nursing home where they receive physical therapy on a daily basis. And Medicare recipients of course will receive those for like 20 days. That will be short-term and so that’s going to be a what if. What if I fall and break an ankle because nine times out of ten, elderly are going to have to have some rehabilitation post-surgery. 

So, you may have a short-term situation like that or there may be a bigger situation for instance a stroke that leaves them unable to function where they may have to resort to nursing home stay. So, there’s not particularly a rule of thumb, however, I think it’s based individually. But I still think that it’s important and to answer those what if questions and to pose some what if questions to your parents, just to kind of see that – to make sure that they are pretty much understanding the way things go. I think that also is important as children for us and I’m an example of this as well, to get as much Medicare Medicaid information as possible so that I can answer those questions in regards to – that my mom may have in regards to what happens to my house, etc.

Host: I’m really glad that you mentioned that because when we hear about long-term care and these different options; we just think about how expensive it can be. So, it’s good to know that there are resources that we can look into to help facilitate some of this. Finally, if I wanted to learn more or my parents wanted to learn more about this; where can they go to just find out more about elderly care planning?

Marquetta: The wonderful thing of course, the internet, has outstanding resources. There are actually facilities that you may look up and Medicare.gov, particular facilities for instance Linwood, within your local area sometimes have a page that will kind of talk about the things that would lead to this and would offer printable resources like the Advanced Directives and things like that. 

Most importantly, if your parents ever have a stay within the hospital for any particular reason; and I always advocate this; if they have to go to rehab for short-term always ask for the social worker because she is their number one advocate for looking at things like working out even shot-term plans but also long-term plans for both the patient and the family. 

Host: Really good advice. So, look out for that social worker if something like that happens. 

Marquetta: Absolutely.

Host: Well Marquetta, thank you so much for this advice. It’s been extremely helpful for me especially in how I am going to speak with my dad this weekend. I just wanted to know for our audience members, is there anything else that you wanted to leave us with before we sign off here today?

Marquetta: Prakash, I just hope that there has been something that I’ve said to spark interest, to spark questions, to spark some conversation between parents and children in the what ifs and what we can do and how we get there to help with long-term care planning, even thoughts of that because it’s definitely a very important subject. 

Host: I couldn’t agree more. And like you said earlier, I think the most important thing is to start having the conversations soon and making sure that their voices are heard, if you are the child. And if you are in the elderly population; just being open minded to everything. So, Marquetta thank you so much. For the rest of you, for more information please visit www.mrhc.org. My guest today has been Marquetta Trice. I’m Prakash Chandran. Thank you so much for listening.