Dr Rania Habib (Host): This is Flourish, a podcast brought to you by PRISMA Health. I'm your host, Dr. Rania Habib. Joining me today is Dr. Laurie Theriot, the Medical Director of Senior Care PACE Programs for PRISMA Health and the Chief of Geriatric Medicine for PRISMA Health Upstate. She is here to discuss care for the aging family members.

Welcome Dr. Theriot and thank you for joining me today on Flourish.

 Laurie Theriot, MD: Thanks for having me.

Host: What options do families have when it comes to caring for an aging loved one?

 Laurie Theriot, MD: Caring for an aging loved one presents a unique challenge. It takes a multifaceted approach to do it successfully. It's important to take time to evaluate and develop resources, such as siblings, neighbors, possibly even church members who may be able to help you. There are agencies who provide in home caregiving as well as day centers.

Patients with dementia may qualify for respite vouchers from the Appalachian Council on Aging. Medicaid eligible older adults may qualify for community based long term care resources. Within PRISMA Health, we have home health resources, home based palliative care, as well as our PRISMA Health Senior Care Program, which is an all inclusive care of the elderly program, which is designed to holistically meet medical and psychosocial needs of the older adult.

Host: Wow. You have tons of options. If an elderly loved one wants to remain at home, what can we do to help keep them safe?

 Laurie Theriot, MD: It's important to utilize technology when trying to keep a loved one in the home as long as possible. Mobile phones, as well as life alerts, are good devices for older adults who are able to utilize these. If wandering is part of a dementia syndrome, bed alarms, movement alarms, as well as door alarms, can help with awareness of their activity, as well as cameras. And, these are really good because you can also have apps to where your phone can notify you to help with monitoring the situation. It's also good if you have someone who is able to stay with them at night, once the home is secure. It's important that if we have an older adult that we're worried about, you can register them with Operation Safe Outcomes, which is available in Greenville County and a free program offered by the Greenville County Sheriff's Office.

And it allows the police and emergency personnel to be aware that this is a vulnerable adult should an emergency situation develop.

Host: That's a fantastic program.

 Laurie Theriot, MD: It really is. We have some great resources in Greenville County, as well as other parts of the upstate, and then through our PACE program, we're able to utilize our adult health center to provide social activity and safety, as well as therapy services, while the caregiver is at work.

We're able to utilize home health resources when it's appropriate as well. I can't emphasize enough that it is not okay to lock an older adult within their home with no way to escape in the case of an emergency. The legal and safety consequences of this can be quite dire.

Host: Absolutely. Now you did mention the PACE program. What is the PACE program and who qualifies for it?

 Laurie Theriot, MD: The PACE program, PACE stands for the Program of All Inclusive Care of the Elderly, and our PRISMA Health PACE model is named Senior Care. It services individuals 55 and older who meet nursing home level of care with the purpose of allowing them to reside in the community for as long as possible. PACE is covered by Medicaid, but if an older adult meets criteria to reside in a nursing home and chooses to receive the PACE benefit, there is a self pay option as well.

PACE covers all medical care. Think routine visits, specialty visits, emergency room, as well as hospitalizations. And we also provide transportation, and this will also cover medications and any equipment you may need, such as hospital beds, wheelchairs, walkers, oxygen, and the like. So really anything that you need to optimize your health and wellness, PACE would provide that for you. We also have a day center with activities and while at the day center, you would have meals provided as well as therapy and medical services as clinically indicated. It allows our team to provide the care needed through kind of a unique capitated payment model.

Host: Wow, that's fantastic. It sounds like a really all inclusive program.

 Laurie Theriot, MD: It really is. It's an amazing resource we have for the community.

Host: What is the difference between the Senior Care PACE program and adult daycare centers?

 Laurie Theriot, MD: A non PACE adult daycare center provides socialization and activities, mental stimulation, usually provides meals, whatever you would need to get through the day as an older adult. They would generally provide services, for a range of functional levels and a variety of expense. Adult day programs that are non PACE would not have the medical care and extra therapy services, even if those are clinically needed. Whereas, the day center that's a part of our PACE model would have all of the benefits of an adult day program, the socialization, the activities, the mental stimulation, as well as the meals, but then you would have access to medical care and therapy, even if that would involve breathing treatments, IV fluids, we can give IV antibiotics, we can do wound care, so really any medical service that you may need, could be provided here at the PACE Center, as adult to a non PACE day center.

Host: Wow. Your center is really all inclusive. I love the fact that you're providing the medical care on top of all the cognitive care that they need throughout the day. It's fantastic.

 Laurie Theriot, MD: It really helps us be a lot more holistic and comprehensive in the care of an older adult.

Host: I could not agree more. It's a very unique program. I wish all hospital centers had it.

 Laurie Theriot, MD: And it's so hard to get the community aware of it, because it's definitely an underutilized resource right now.

Host: Well, hopefully this podcast will get the word out because it sounds fantastic. We've discussed home care. When is residential care the best option?

 Laurie Theriot, MD: When the caregiver can no longer meet the needs of the older adult without sacrificing their own mental and physical well being, it's really time to consider a residential care option. This is definitely a difficult decision, but it should never be viewed as a failure of the caregiver. It's an acknowledgement that this is difficult and it takes a tremendous amount of resources to be successful.

So, depending on the needs of the older adult, you may consider a residential home, an assisted living, or skilled nursing facility for long term care, or what we generally think of as a nursing home.

Host: How do we bring up that conversation with our loved one about residential care? What is the best strategy for that transition?

 Laurie Theriot, MD: So these are tough conversations and ideally would happen in a longitudinal manner. Getting the input from the older adult, before the decisions need to be made, is going to be beneficial. For example, I'm asking, what would you want if you can't live at home anymore?

Or if you could no longer walk, how could we possibly take care of you? This gives you an idea of what they want, should they cognitively or functionally decline in the future. It also allows you to deliver this potentially difficult news in a more gradual manner. And knowing what your loved one wants, it doesn't mean you've promised to deliver, but at least you know what their goals are, and it allows you to be in a position to possibly meet them.

Host: It's almost like coming up with a care plan ahead of time before the cognitive decline, if that's, you know, the issue they have going on, so that everybody involved knows the long term plan.

 Laurie Theriot, MD: Absolutely.

Host: No, I love that. I think that's fantastic. How do I know if a residential facility is good? Are there red flags that we should look for?

 Laurie Theriot, MD: Depending on the residential facility you're considering, there's going to be different information available. If you're looking at skilled nursing facilities, or what we would traditionally refer to as a nursing home, these are universally evaluated by CMS on nursinghomecompare.gov. This is a good place to start your investigation.

You can see staffing and past health survey results, but it's important that you visit the facility and see for yourself. And really look at who is currently living there. Are they out and active? Do they seem to be having fun? Do they remind you of your loved one as far as their functional abilities and cognition?

Always a good idea to ask for a copy of their activities calendar and see if it's something that you think your loved one would enjoy from a day to day life. When it comes to nursing facilities, on this website, there would be an abuse report, which I would consider a pretty big red flag, and they're usually active and lively unless it's a scheduled quiet time or nap time.

So, an unusually quiet place might be a red flag. I would also pay attention to cleanliness and interactions with the residents and staff. Do the staff seem to know the residents by name, and do the residents seem genuinely happy when the staff engage with them? Residential care facilities and assisted living facilities will have less information available online, but you can look at sites such as assistedliving.org and search for facilities by state. These are compiled reviews and star ratings from patients and their family members. Also, ask around, talk to your friends, coworkers, church members, talk to your community about their experiences with these facilities. And I can't stress this enough, go to these facilities and tour them and really just get a feel for them to see if it's somewhere that you think your loved one would be a good fit.

Host: That's fantastic information. Now, besides the websites, we know that everyone's resource is Google and the internet. What are your thoughts about using those reviews to make that decision? Do you think it's helpful? Not helpful?

 Laurie Theriot, MD: I think we all use Google to make our decisions, and I don't have any strong feelings against that, except that we just need to stay cognizant of who goes on Google to write reviews, and it's normally unhappy people. The rest of us quietly are pleased with our services. So although it may give you an idea of how someone's perception of the facility is, I wouldn't use that to hang your hat on.

Host: That makes a lot of sense. So definitely go to those websites if you have any information because I do think that is a very comprehensive way it sounds like. And then like you said, visit the actual facility. What advice do you have for people who are caring for more than one aging loved one?

 Laurie Theriot, MD: So the resources available would be the same, whether your strategy is to take care of one older adult or two, but the stress load will be higher, and if it's couple, then realizing that they are somewhat dependent on each other for their day to day existence. So for instance, if one gets sick, realize you will be planning for the situation of two people, not just the one who may be hospitalized, but also planning for the one kind of left behind, if you will, and trying to fill in. So definitely a more stressful situation.

Host: Definitely for sure. I want to thank you, Dr. Theriot , for joining me today for this discussion on caring for our aging loved ones. What final tips would you like to share with the audience?

 Laurie Theriot, MD: Taking care of an aging loved one is a noble pursuit. It's difficult but rewarding. It takes patience and resources, both emotional and financial. It's important as the caregiver, to not neglect your own health and emotional well being. The old adage, place your oxygen mask on first before helping others, really rings true.

If you sacrifice yourself to care for another, then it is a setup to fail. So keep your health as part of any decisions you're making for the loved one you're trying to care for. PRISMA Health is proud to have our Senior Care PACE program to complement your efforts and to give you and your loved one wraparound support and resources so you can care for your loved one in the community where you want them to be for as long as this is feasible.

Host: If someone wanted to refer a loved one to be a candidate for the Senior Care PACE program, how would they do that?

 Laurie Theriot, MD: Referrals to PACE are really easy. Here's where Google comes in handy. Um, you can Google PRISMA Health Senior Care PACE, and I think any permutation that's close to that will get you one of our phone numbers. You can self refer to PACE if you just want to learn more information. If it's something that you would like to discuss with your PRISMA Health provider, they can do internal referrals through our electronic medical record, and then we would follow up with you directly.

Host: That's perfect. Cause it does sound like a wonderful program. And as you said, it's underutilized. So hopefully this will get word out and you'll start to be able to apply this multidisciplinary approach to more patients in the future.

 Laurie Theriot, MD: Absolutely. We consider it an honor to be able to take care of them.

Host: Absolutely. And thank you so much for your time today.

 Laurie Theriot, MD: You as well.

Host: For more information and to listen to additional episodes of Flourish, please visit prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm your host, Dr. Rania Habib, wishing you well.