Your Step-by-Step Guide to Creating a Successful Care Plan with Bill Cohen

Join Kosta and his guest: Bill Cohen, caregiver support group leader, educator and speaker, an Alzheimer’s Association volunteer and advocate, Certified Senior Advisor, and the owner of Cohen Caregiving Support Consultants LLC.

Today we’re talking about your step-by-step guide to creating a successful care plan.

Find out more about Cohen Caregiving Support:
https://cohencaregivingsupport.com/

Find out more about Kosta Yepifantsev:
http://kostayepifantsev.com/

Transcript

Bill Cohen: 0:05

Start having the conversation about what are your wishes, so some stranger doesn't make it for you. And yes, we all want to age in place in our own homes. But wouldn't it be nice if you found a place that looks nice? No way off could be 5, 10, 20 years off, just in case you have the peace of mind knowing I've made a decision. This is where I'd want to be here if I need it. I can look without a deposit. And I don't have to worry. And that's gives peace of mind only to the person who would end up there but also the family.

Caroline Moore: 0:42

Welcome to Now or Never Long-Term Care Strategy making. themselves. with Kosta Yepifantsev a podcast for all those seeking answers and solutions in the long term care space. This podcast is designed to create resources, start conversations and bring awareness to the industry that will inevitably impact all Americans. Here's your host Kosta Yepifantsev.

Kosta Yepifantsev: 1:04

Hey, y'all, it's Kosta. Today I'm here with my guest Bill Cohen, caregiver support group leader, educator and speaker in Alzheimer's Association volunteer and advocate, certified senior advisor and the owner of Cohen caregiving support consultants, LLC. Today we're talking about your step by step guide to creating a successful care plan. Bill, your journey as a caregiver for your mother has led you to become a certified senior advisor and caregiving support consultant. Could you briefly share with our listeners what led you to this path and how your experience shaped the advice you give to others?

Bill Cohen: 1:42

great honor to be here today. Your cost is low compared to our conversation. Absolutely. So as I like to say, if you were told me about 1819 years ago, what was going to transpire? And I'd be sitting here talking to you today I'd say no way crazy. Just an incredible scenario. To make a very long story short, my mom used to live in Biloxi, Mississippi, and NACA, they're going winnowing the deer living in Portland, Oregon. But she was showing some signs that cause concern, agitation, paranoia, not take care of the house, I'll take care of the finances. And we wondered, okay, she's taken care of my late stepfather. He was on hospice on and off. Was she just getting older, stressed, tired? What have you. And unfortunately, we didn't get a chance to find out if he passed away or went to do care community if she would bounce back. What happened on the Gulf Coast in New Orleans in August 2005. Katrina, Katrina, exactly. The house they have lived in for almost 30 years, was completely swept away in the storm surge. She had safely evacuated, but she came back fully expecting to see that house still there because it had survived many other storms. Needless to say, the trauma is seeing her house gone. And everything in it. Accelerated exacerbated. Whatever was coming on with her later, it became obvious who has Alzheimer's. I go into the long term caregiving mode. Do cross country travel by holding down a full time job, start attending a support group. Start talking to a care community of Southwest Portland. And like I said making the trips first she was with other family in North Carolina than Delray Beach and move her out to Oregon. In 2008. She was less than a year as we expected in the assisted living side of the wonderful nonprofit faith based community. And then she was four years in memory care. Okay, he passed away from Alzheimer's 10 years ago at the age of 83.

Kosta Yepifantsev: 3:58

Did you did you have a care plan in place when all of this was happening?

Bill Cohen: 4:03

Oh, no, no, no, no, no. Okay, what was in place what was starting to happen was I had taken to a doctor, we did get her on some of the medications that were available, and treat her for like, anxiety and that type of we had talked about maybe then moving into a care community. We had got me on some of the financial documents later, I became POA, Advanced Directive, things like that, but I'm not much different than anybody else. It sometimes it takes in event, not a hurricane, but something that puts things into action. Unfortunately, too many of us too many people react in a crisis rather than being proactive and planning like we would all prefer. And of course, if you react in a crisis crisis, you have fewer options. You're acting emotionally and distress, not the optimal situation.

Kosta Yepifantsev: 5:03

So, Bill, so much of your advocacy and work is centered around the importance of having a care plan in place, especially for those dealing with dementia or Alzheimer's. Can you break down for our listeners, the first step they should take when creating such a plan?

Bill Cohen: 5:20

First thing is, no matter what age you should have your legal documents in place, you should have your Will you should have your power of attorney trusts if applicable, your Advanced Directive later in life that the pulsed that physician's orders. The other things are, if you have any concerns, or you're thinking ahead, have those conversations. Mom, Dad, what would you like to have happen? Or if you're seeing concern, talk to your other family members, hey, we need to talk. We need to have a conversation about what's going to happen because there's concern about age dementia, frailty, whatever, there's so many steps that need to be taken, and frequently and too often are not being done. And that includes the what ifs, we all want to be aging in place our own homes. That would be nice. And actually most people do. Right. And it used to be as we know, that it was more multi generational extended family taking care of each other on our own homes. That doesn't happen as much. We're all spread out all over the place. Yes, certain cultures still maintain that. Right. But Americans in general do not. We're all over the place.

Kosta Yepifantsev: 6:36

And it? Well it is it is actually really interesting, because the current statistics is that 84% of Americans want to age in place. And what that statistic fails to mention is they age in place, Intel, they can't. So there is a period of time towards end of life for about two years where typically they are two to three years where they typically have to go to a facility once their disability gets to a certain degree. And and as you're talking about these advanced directives, these legal documents that you have in place, when you started this process, and you're going to your mom's doctor, for example, you know, something as simple as just getting a diagnosis or getting information on her diagnosis. Right, right. So like, when you don't have those legal documents in place? How do you even begin to navigate providing care for a loved one? Because it seems like all doors are closed until they're there? Right, right. We

Bill Cohen: 7:39

heard that and HIPAA and so many of your finger. So, and many family members will say, Well, you're not getting into my stuff, I'm fine. I will make my own decisions. I'm going to maintain my independence as long as possible. And I'm sure you've heard it, we all many of us have industry or otherwise. Oh, I'm going out of here, feet first down need a plan. Right. Right. So we do face that. But what I tried to talk to families about is start having the conversation about what are your wishes, so some stranger doesn't make it for you? And yes, we all want to age in place in our own homes. But how about some what ifs? What if you have a fall, something like that, or some other incident, and at least temporarily, have to go into a facility to convalesce to rehabilitate, and then you can probably come along, but we want to have that plan in place. Or once you do come the home, who will come in to take care of you. For the time being I living 1000s of miles away. I can't do it. But let's have somebody on hand ready to go in case that happens. And on the same level. And by the way, I do this not just here in the Pacific Northwest. I work I collaborate with professionals all over the country. We just talked about. One of them is Jenny Kundera's with Premier living solutions. And while it's just that example, a clever those people all over it and I tell people, okay, sure you're not ready to go into independent living or assisted living or memory care or adult care home or residential care facility. But wouldn't it be nice if you found a place that looks nice. Now, way off could be 510 20 years off just in case, just in case you have the peace of mind knowing I've made a decision. This is where I'd want to be if I need it. I can look put down a deposit and I don't have to worry. And that's gives peace of mind only to the person who would end up there but also the family, especially the adult soldier, if there aren't

Kosta Yepifantsev: 9:54

right and that's a great point. I want to before we talk about the referrals and sort of the net work that you've been able to build, I think listeners should know that a lot of the services and the majority of services when it comes to long term care are paid for by Medicaid, and the financial documents that you were talking about at the beginning, that making sure that you have those elements care taken care of is because there's a lot of services that you can't either afford, or generally access without having been qualified for some Medicaid program within your state. And so you offer a support plan that includes referrals to vetted service providers and professionals. How can our listeners ensure they're choosing the right service? The right service providers for their specific needs?

Bill Cohen: 10:50

That's a great question. And I want to go back to when I was first started with my mom, because back in the mid 2000s, how did you find resources? One, you come from the doctor I just mentioned, if you get a diagnosis, but then they say, well, basically keep them safe, keep them out of pain, that type of thing. And, and it hasn't changed much. Good luck. Right? Word, where do I go from here? Where's the treatment plan? Where's the care plan? Where are the resources? And I found that sorely lacking? There are directories? There's so much more on the internet today? That was not available back then. However, as you asked more than a rhetorical question, how do you find good vetted people? So I have since I started my business is that get to know the professionals in my area, and when necessary, out of the area, that they're going to do a good job for him, they're going to be giving that holistic approach. That broad perspective, many of them are certified senior advisors like myself, and I know that they are looking out for our most vulnerable population.

Kosta Yepifantsev: 12:06

How do you become a certified Senior Advisor? I'm just curious.

Bill Cohen: 12:10

That's a great question. There is the Society of certified senior advisors in Colorado. And their course can I believe they can do it in person. Again, I took it online, I did it a few weeks, and then took a very long exam and covered everything, a lot of things I already knew, but Medicare health insurance, long term care, dementia, just about every topic that would be appropriate or suitable to know about aging, and taking care of our aging population. And yeah, there's a fee. But yeah, it was worth it.

Kosta Yepifantsev: 12:49

As you're looking for providers to join this network or directory that you're building. I know, you said that you're looking for kind of a holistic approach. Are there key elements or tenants that you want to see, when you're looking at those providers as they provide services?

Bill Cohen: 13:09

That is something that certified senior advisors do instead of looking at things as a single transaction? Okay, I'm going to take care of this part of it, say, a care agency. And for Mrs. Jones, okay, and Mr. Smith is next. Next, instead of thinking, who else does that person need to talk to? Who else does my client need to take care of their care? Once I'm through with them? Are you gonna leave them hanging? No, we don't want that we want to do the whole job. So I look for people, and not necessarily certified senior advisors, but have that mindset. Okay, I'm gonna go above and beyond and make sure that even though this is not my specialty, or my jurisdiction, shall we say, I'm going to make sure that they're taken care of, and I'm going to connect them with an elder law attorney or a housing adviser or whatever, whoever they need. I'll give an example of one client in particular just pops in my head. It was somebody who is here in Portland, but her family was in Miami, South Florida.

Kosta Yepifantsev: 14:16

On the complete opposite side of a

Bill Cohen: 14:19

Exactly. Coincidentally, I moved here from Sarasota, Florida almost 40 years ago, so Yeah, can't go much farther apart. And her, her mom was had dementia, and it was evolving her grandmother and her siblings, and we got zoom calls and everything else, but they needed various resources, including some of the ones we just mentioned. And I immediately contacted a certified Senior Advisor with one of the well known national housing advisors, and I said, I need this I need this. I need that and probably they'll become a client of yours because they will need housing at some point. And that got everything right get back on track, they get have the resources they needed. And it gave them peace of mind, especially the daughter here in Portland 3000 miles away, or whatever it is.

Kosta Yepifantsev: 15:10

And I mean, you're acting as a conduit. And I think as as you're talking, it's, it's important to note that the long term care space, the services that you would receive or need to receive as you age, are extremely complex, they're multifaceted. They're compartmentalized, and what you're trying to do is you're trying to bring them all together into one network. A lot of people don't realize that housing is extremely important because they think that they're going to live in their own home the entire time. But as we were talking earlier, there's a component between living in your own home and not being able to have your needs met because of your disability progressing, but also not wanting to live in a facility. Well, if you are in this quagmire, where you're on a fixed income, and you don't have enough savings to be able to afford to move to a retirement community, for example, because those houses cost $700,000 A year. I'm sorry, $700,000. In general, what are your options? So I think it's great that you're that you've built out this, this directory in this network so that you can provide people with actual solutions that are really, really complicated.

Bill Cohen: 16:27

Exactly. I like to call the my 18. There you go. So it just so happens that my three favorite local housing advisors, their names all start with a just a coincidence, but it's a neat little package.

Kosta Yepifantsev: 16:42

Let's talk about some pitfalls. What are the what are some common mistakes or oversights you've noticed individuals or families make when crafting their care plans? And how can these be avoided?

Bill Cohen: 16:56

So I think, sometimes the priorities are wrong, or they are putting things off shoving things under the rug, so to speak, because, again, the family members in question her saying, No, I don't want you to involve I'm not moving, although so forth. I think it's how you frame things. Instead of, Oh, I'm gonna come in, I'm gonna take over and you know, you're gonna like it better, you're gonna have to deal with it, that's not going to work very well. He's like to say that I don't think he's listening. The only thing that my brother, a musician played better than mom was his keyboards, or bed better than his keyboards was mom, you know, kind of manipulate the long story, little co Tbit dependency going on there. But I was able to manipulate mom a bit. But in her best interest for her welfare. For instance, before the store, she, her papers, were sitting on the table to file her taxes, which she used to be really good at. She would get them all together, and she would bring them to the CPA, just to make sure everything was in order. But they were not moving. They were just sitting there on the table and said, Hey, bomb me to come down there and and help you with a tax. Oh, I love that. And basically, she was saying, I'm glad I thought of it. Exactly. So I just framed it so that she could be on board, she could do say, Well, I'm not being imposed on, he's not coming in and taking over or taking charge. Fortunately, we had a very close relationship and, and she trusted me. So that was good. But I think it again, it's how you frame it, how you talk to your family members have the conversation. It may take a team meeting first, together without the parents or parent, and then possibly talk to you it may have to be some kind of an intervention or say, Hey, we're really concerned. Bah, bah, so forth. And here's some things we think that might be in your best interest because we don't want to see you end up getting sick and or injured, etc. and safety in the home might be is a big one. If you're gonna stay in your home. I mean, what's what's job one besides the legal stuff, safety?

Kosta Yepifantsev: 19:13

Yeah, right. And there's includes financial. Yeah, exactly. And making sure that you have the funds to be able to pay for it long term. Something as simple as you know, we've spent and we've talked about this on the show before when we're talking to like home modification experts. So many homes were built as that colonial two story you know, type of house in the 90s and 2000s. And so believe it or not, there are a lot of people who didn't who don't live in a ranch style house right. And something is as significant or simple maybe as a stairlift can really help people stay in their home.

Bill Cohen: 19:57

Coincidentally, we're right across the street from the and it didn't exist, we moved into our house and mom hadn't started her journey. Yet, who wasn't evident, is a care community, besides having skilled rehab, and this is letting our independent living in place, Aging in Place cottages, most of them are one level. But there are a few second level, but they have a small elevator for those who either now or will need a wheelchair or otherwise who are just amazing, using a walker. So it was a lot of forethought there. And it's a wonderful community. And a community of course, it's not just buildings, it's the people. And they're great. They're great.

Kosta Yepifantsev: 20:37

I love lot helping male when you're building and connecting with the support network. How should caregivers incorporate this into their care plan? And why is it so important

Bill Cohen: 20:48

to build support into the care plan?

Kosta Yepifantsev: 20:52

Yeah, when you're when you're building and connecting with support network,

Bill Cohen: 20:55

I think I sometimes like to use an example it was our exam, it was our experience, that right after the hurricane, we were collaborative, we were all had to get my mother and stepfather back on track get it because they had lost virtually everything. And then it became kind of tag team collaborative, sequential, to take turns taking care of them before before she came out here. She's separated from my stepfather in the interim, and then it became more solitary, me the prime, the primary guy handling everything, with a little help from my family at a distance and one amp moved out here to help take care of her. So and family is how you define or design it. Right. You've heard of the savvy caregiver classes through Emory University, that was an evidence based program, they talk about this. And it can be not just your family, it can be your neighbors, it could be your friends, ex co workers, your charitable organization, like a church or lions or Elks, things like that. So there's a lot of ways you can gain support. And sometimes I think the biggest problem is people are afraid to ask, they're so proud, or they want to be a burden, or they want to be independent. So ask for and gain support where you can get it. I was fortunate, as opposed to some other families, where my aunts had a lot of opinions. And I certainly listened. But they knew what my name was on the power of attorney, I had the final fate, but they also knew that I have mom's best interests at heart. So you'll work out very well. But of course, there are situations where and these are the other caregiving types, where people are at a distance, or they're providing unsolicited advice, and it may be misinformed advice on how to handle things. And that's not in your loved one's best interest. Because they really don't know or they're really not doing that there are ways of handling that.

Kosta Yepifantsev: 23:04

When you were building this this care plan in this network of close friends and family members, was it just family? Or did you have to like reach out to a neighbor or someone that may not be either extended or directly related to you.

Bill Cohen: 23:24

I can give a lot of other examples because I've seen with like clients and in my support groups, but since this is personal with me, I will mention a couple of things. One was when she did have to go into memory care, across the street in his care community. What we did was put mom into the adult day program on site for a few hours. And with the help with friends cluding a truck, etc. Most of his stuff ended up in my garage again, kept happening. And then what little she had that could go into her memory care space, moved it into the care facility. And of course I took good care of them. Governor bought them pizza and beer afterwards. And I like the traditional move thing, right? Yeah. But we and then move took mom into the memory Karen took around a little chore. Isn't this nice? Sheila again. Okay, great. This looks nice. I'll add on to that. What happened was my wife and I made went to lunch. I thought, oh, that went surprisingly well, except we made a mistake. We went back and she saw me and said How dare you move me without my permission. She wasn't quite ready to grasp that. But she had watched it. And unfortunately, she did get out of memory care a couple times because she was still a little smarter than the average bear. Another one that I love to talk about and I just put posted on this on social media was sometimes you just have to ask there's so many different things that we deal with But and this is a kind of a light hearted version of it the last couple of days. Mom's in on hospice before she passed away, happens to be a norovirus quarantine. Oh, the only people that were in the building besides their staff and the residents were my aunt and I. And the care was exceptional. As I like to say the coffee was institutional. I get on social media. And it said, because somebody, please bring me a mocha. I love it. Two different friends from two different coffee stands Dutch Bros and Starbucks. little plug here, and ended up showed up at the front desk with the coffee for me. And I am forever indebted. I just thanked them again this week, because sometimes they don't know what to do, how you can need help. And sometimes you just need to ask. And that's part of that support plan. Because emotionally or otherwise, those same people were supporting me, they knew what I was going through.

Kosta Yepifantsev: 26:04

You know, it takes a village and we talk about this in almost every single episode. But caregiving is one of the most demanding roles a person will experience in their life. And your opinion, how can a care plan incorporate strategies for caregivers to practice self care and avoid burnout?

Bill Cohen: 26:26

Yeah, huge issue. Of course, then there's the flip side, for the health care workers and therapists and, and like what I do is the compassion fatigue. They're very closely related, but a different focus different person. And I certainly was feeling the burnout side, because here I am dealing with all these issues, including mom's care, and I'm holding down a full time job. And I had a narcissistic micromanager boss. So you can imagine where my stress level my blood pressure was sharing that time period. So some that what the first thing I did, and I think I alluded to this earlier, after the storm was contacted the Alzheimer's Association found a support group. It was the word as many back then in the mid 2000s. Then that we have now but I found one that was in the evening, during the week. So I could attend because I was working. And I always say is that if that had not been a good experience, where I got the support, and it was confidential, it was saved. Great tips, great advice, great people, some who had already lost their loved ones, and were still coming to help others through the journey. I again, wouldn't be sitting here today, I probably would have walked away upset after mom died and said, I'm done. Yeah, I'm burned out. I'm exhausted and lightened so much later. Yeah. And six months later, it became the facilitator. And that's the fifth. I'm still facilitating that same group 18 years later.

Kosta Yepifantsev: 28:02

I mean, so many people go to that stage of burnout, because the experience itself can be so traumatic. You know, exactly. You're losing

Bill Cohen: 28:12

your loved one. Yeah, absolutely. And then on top of that you're losing, you may be losing your own ill because you're neglecting it, or rental and physically.

Kosta Yepifantsev: 28:20

Well, so. And you said, you know, as Katrina happened, it exacerbated her disease because the stress of losing her home and everything, you know, made things so much worse, progressed at so much quicker. And so when your caregiving for somebody, and you're losing your loved one, that is also increased stress, you know,

Bill Cohen: 28:39

yep. And besides that, I found a very good counselor to talk about my issues besides how I was handling everything with mom, and with my family, and trying to get away from the narcissistic boss tried to get out of that job. Did you Good God, it was a good job. No, I actually retired from it six years ago, or actually, the one good thing that happened was that that boss retired a few months after mom passed away, so great. So overall, my stress level did come down to a nice level. Last couple of years was tolerable. But the counseling, but also, it gets it in in self care means different things to different people. And besides getting away from my desk, and walking around the building, and clearing my head and getting a little fresh air and getting some exercise. They started having chair massages there at work, and I took advantage of during my break or basis, and then I found a local massage therapist and started going into that person. What I realized was one, two things one, and we've heard a variation of this self care is not selfish. I started to say it's vital And that getting the massage, it was not a luxury, it was a necessity is something I really needed. And I still do it to this day.

Kosta Yepifantsev: 30:11

So let's summarize because I think one of the main points as we're talking is how you need to approach a care plan from an emotional aspect, not just from the perspective of the client, I'm sorry, of the person receiving care, but also from the person that's actually going to be in charge or providing the care. And I think that that emotional component stretches, probably close to the top of the list, right, under the legal documents, of course, how should a care plan address the emotional needs of both people?

Bill Cohen: 30:51

I guess the best, I mean, you're summing it up real there. But as far as the detail, and there are so many different components involved. And that's what I like to do with my clients, not just take care of one thing. But do you have all the legal documents in place, so you do have peace of mind that you can advocate for not just your loved one, but also for yourself? Absolutely an advocate, whether it's at the doctor or at the care facility or with a homecare agency? those aspects? i The we move forward to okay, what other is are there any ongoing issues besides dementia that need to be taken care of? Should we be looking at some of the housing and maybe they may be rural, there may be very few options. Right? Most of the places the case anywhere from the independent living to the care, adult care homes are mostly centered around popular large population centers and gone to rural America, their options are much fewer. And that's and that's sad. So that we add to somebody's stress, what do I do? Do I give up my job? And how do I deal with that? How do I pay for it? How do I take care of mom and dad or other family members? That's not going to bankrupt me? Yeah. Right. I mean, I was fortunate that mom has certain amount of income, certain amount of assets, but then that got spent down and she went on Medicaid. I was fortunate that the local caseworkers said, Okay, I hear your situation, you're going to be setting up a trust, keep her eligible, move her we'll take care of the paperwork later, which shocked me because I've always heard that applying for Medicaid was a horse or show it right. So yes, it was a perfect storm that I had to take care Medicaid and move mom and a memory care. But fortunately, my relief was probably obvious to those around me that it could have been a lot worse. So that's where all that getting support. Taking care of myself mentally and physically was so important. And I preach this so much to people and in to not have a care plan. And that includes a Plan A B, See, look at all the what ifs great point and and have that care team in place. recently had a and it's still ongoing. It's a can't get into too many details. It might become obvious to somebody who's listening, where I have a client who's I'll say out of the country. She's really originally from Portland. But her family her mother then stepped down the year here in Portland, and mom was stuck in memory care at this very large buy in independent living with very few assisted living very few memory care spaces. And because she wasn't getting any attention, and the care she needed from the family, from the care facility, from her physician, et cetera, something as simple as be 12 shots. Oh, wow. Yeah, she was stuck in memory care. And she shouldn't have done. She was imprisoned basically. And because this new client got a hold of me, and I was able to put together the care team and the care plan. She is now out of that facility in another place. And she's never gonna be completely happy. She's still kind of isolated, but she's not in a lockdown. Memory Care. She's in a place where she can walk the grounds and see the ducks and the koi fish, catfish and the the chickens and the beautiful flowers. We're in the Rose City here, so and views mountains. And so she's, she's a lot happier. And in like I said it's an ongoing story. But by putting together those meetings with the care team, we got her on the right track. And that's better not only for the mom, but the daughters.

Kosta Yepifantsev: 34:56

So before we wrap up, I want to ask you kind of a technical question. Do Because I am really curious, since you have this experience with developing a directory and a network to establish a successful and a holistic care plan. If you consider other industries in the United States, nothing is as complicated as the long term care space. More importantly, there aren't any companies that are actually vertically integrated. So like a hospital doesn't offer Nursing Home Services doesn't offer health care doesn't offer home health care, or all the other components of long term care, right? You know, you go to you buy a car, you go to the dealership, you buy the car from the dealership, you get the car service at the dealership, you trade the car in at the dealership to get a new car, you get tired, you get it all done at this one spot. Two questions, one, from your journey of developing this network, do you ever get frustrated at how different not only the services are? But how different every single state is in terms of services and the providers in each state? And then, and then my second question is, do you feel like it's getting better, that access to services getting better, that the integration of services, creating somewhat of a one stop shop for people able to either age in place, live in the community on in a adult care home or be in a facility, whether it's assisted living or nursing home? Do you feel like that's improving?

Bill Cohen: 36:35

He was very important to the short answer is it's getting I think it's getting better. But we got a long, long way to go. Yeah. I usually talk about my first major industry, which is similar was hospitality, primarily a banquet manager work in some very nice hotels. The problem is that as in most cases, that's what people want to be at a hotel. They don't want to be in assisted living, etc. Unless they have to. But I think they actually do even a better job, because what do they have on the property? Everything you could possibly want, right? From lodging, and the pool and the food and the spa, and a concierge and everything else that's up on the property. But yeah, there's so much disparity across our industry, in terms of consistency and service and doing the right job, again, holistically. For our, again, our most vulnerable population. I don't I did, you brought up a very good point about different states. I made like, one state, I'm thinking not far from here, that doesn't even allow the placement specialist, the senior housing advisors, so crazy people were on their own. Yeah, you got to do as I used to say, back when I was first time with mom is like, let your fingers do the walking to the other pages and good luck. And how do you know who's good, right? So at least you can if you have professionals like that, that have good training, and they've got a good network, and they've got a good heart. Those are the people I work with, then you know that your clients are going to be taken care of whether it's saying okay, refer work with so and so they'll take good care of you and find the right fit the right place. As opposed to somebody else who is just going to be looking for the quick buck. Yeah, where the place of they always put people and where their friends are. That's not the people I work with.

Kosta Yepifantsev: 38:37

Do you ever find capacity issues? Meaning like the, because good providers usually fill up really quickly. And as more and more people are aging, there's less beds available? For people that need them. The supply just can't meet the demand? I think

Bill Cohen: 38:55

we have the biggest problem, of course, is Medicaid beds. We know that. That's obvious. Yeah. It depends on the place, there's usually other options, it may be hard to find a safe they're looking for, even though there's many of them. The adult care homes, not be hard to find the right place fits their specific needs. Like I'm talking to somebody right now where their loved one needs a catheter three times a day, most care homes aren't going to take care of that needs to be a nurse on staff all the time. So yeah, that's a problem. And when we need better solutions for those, yeah, it's hard to take care of every single person's needs. We try to get as close as we can find the best possible solution, but that's where asking the right questions and having a network and people who know their jobs are gonna have a big heart not just to try, Okay, I gotta take care of this as quick as possible. Make my my sale and move on. Again. I'm not going to work with people. evaton Who's going to take that initiative. To go above and beyond, I'm going to give a quick example of one of my a team housing advisors, I never, it was a friend of the family, as somebody who's a network here locally, father is FTD going on Medicaid, almost impossible to find a bed, this one out of a housing advisor happened to be out in Central Oregon, on vacation, had COVID. And she didn't make and she doesn't get paid for Medicaid, that she's making phone calls to all these places until she found one, just outside of Portland. And that's why I work with that person. Because I notice she's gonna do that for my clients, whether she gets paid or not. Yeah. Which is fantastic. And she's good. That's a that's a big heart.

Kosta Yepifantsev: 40:47

I just feel like at this point, we need some macro policy making. Because CMS does a good job with Medicare and taking care of individuals over the age of 65. But there's this component of long term care that really needs a lot of resources pulled together and needs a concrete and solid direction. You know, it needs people to be able to make the fundamental decisions and create the foundation so that we're not working. compartmentalized, it can't be a state by state by state by state by state, it has to be a centralized policy of how long term care should work.

Bill Cohen: 41:35

And with that in mind, we all know that one of the big problems right now is finding enough good staff, right for whether it's in a care facility care community or an agency finding enough aides, and we're not paying them enough for what they do. And some places are charging more and more and not paying the that staff enough. And finding good people for that is really difficult. And the problem is, is that it will let's go back to the unpaid caregivers, the families, millions of them, and talking about billions of dollars of unpaid care. I mean, if they weren't doing that, where would we be? Our country needs to find new and better sources, because it is a growing national problem. We shoving it out there, we're talking about it and more not enough. Where whether it's through insurance or government programs, some other sources that is going to fix this problem, because it's not going away. It's going.

Kosta Yepifantsev: 42:41

Absolutely. So we always like to end the show with a call to action. Will you share three resources or tools that could be helpful for our listeners who are beginning their journey and building a care plan and how they can get started today?

Bill Cohen: 43:00

First, I think like, well, one is, I guess that job one is usually make sure the legal documents are in place, make sure you have the the authority and the power to make decisions when they can no longer make them themselves. Number two, make sure that they are safe and getting good care. And they are as happy as can be, can be wherever they are. Even before you may be bringing in care or looking at other housing. And third for yourself. Combination go to a support group highly recommended. There are usually if not locally in person, you can probably find a virtual group somewhere in the country. I have a group that I I have been doing for about six years, it's actually weekly. Wow. And we it was in the care community across the street. During the pandemic we won vert, wind virtual. But as things reopened, I didn't want to cut off the people that are joining me from anywhere from Massachusetts to Hawaii. So I'm alternating each week, not hybrid, but alternating each week in person and virtually so that those people can still join us. And in my groups, some are specialized by age or gender or relationship or what have you. I always say we take all ages, all genders, all relationships, all types of dementia and all stages. We get all comers. So I have people from their 30s to their 80s and they all support each other and it's really gratifying and heartwarming.

Caroline Moore: 44:36

Thank you for joining us on this episode of Now or Never Long-Term Care Strategy with Kosta Yepifantsev.If you enjoyed listening and you wanna hear more make sure you subscribe on Apple podcast Spotify or wherever you find your Podcasts,leave us a review or better yet share this episode with a friend. Now or Never Long-Term Care Strategy is a Kosta Yepifantsev production.Today’s episode was written and produced by Morgan Franklin. Want to find out more about Kosta? Visit us at kostayepifantsev.com