Challenges in Healthcare – The Caring Generation®

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The Caring Generation® – Episode 63 November 11, 2020. Challenges in healthcare exist for providing elder care services. Pamela D Wilson, senior care advisor, shares steps caregivers can take to achieve the best care. Guest Jim Berklan Executive Editor of McKnight’s Long-Term Care News talks about Healthcare Turnover: Why Employees Leave.

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Challenges in Healthcare


00:04 Announcer: Caregiving can sometimes feel like an impossible struggle, caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.

Why Hospitals and Nursing Homes Don’t Want Your Aging Parents


00:48 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, senior care advisor, and speaker consultant. I’m your host on The Caring Generation radio program, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves, and aging parents, all tied together with a little bit of humor and laughter essential to being a caregiver. The topic for this caregiving radio program is the challenges in healthcare, including why consulting a certified senior care advisor can be beneficial. I’ll share eight challenges that caregivers face and offer practical tips from my years as a certified senior care advisor and a care manager that all of you can use today. As you already know—no surprise here. Being a caregiver involves more than you think—especially as time passes. At first, you might help with those little things like grocery shopping, picking up prescriptions. Today you might be changing catheter bags and bathing an elderly parent or a spouse. Caregiving can become very personal when hands-on care is provided that can initially be uncomfortable for the caregiver and your elderly parent or a spouse. As a certified senior care advisor, I’ve been where you are. I know.

02:14 Pamela D. Wilson: When I started my first company, an in-home caregiving company, over 20 years ago, I remember the first time I bathed a client. Even though I had extensive training bathing, what I call test clients in a course, I was uncomfortable when my first real bathing assignment materialized. I worried about whether I was doing it right. I worried about how my client felt needing help with such a personal subject. My company, at the time, was hired by a married couple and their children to provide care for mom who had dementia. We were there two days a week, and bathing was one of the main projects. This happened because her husband felt uncomfortable, and he was worried about safety. He also thought that a female caregiver might be a little better suited for this task, and his wife might be more comfortable. Plus, at the same time, having a caregiver in the home gave him a little bit of time to himself. He was able to leave the house, go to the grocery store, run errands, maybe play a game of golf for a couple of hours.

03:19 Pamela D. Wilson: Years later, after bathing so many clients, I helped my own father bathe. He was embarrassed, he said, I remember this, he said, “A daughter should never have to help her father with something like this.” And by that time, though, all of my embarrassment was gone. Because I had a lot of experience bathing many clients, including male clients. I reassured my dad that it was okay to need a little bit of help. That simple example is how gaining experience as a caregiver builds your confidence over time. There may be things that you are scared to death to do today that can feel like one of the many challenges in healthcare, but you can, and you will learn to do these things successfully.

04:04 Pamela D. Wilson: If you have a loved one with Alzheimer’s or dementia, you know or will soon realize that bathing a person with memory loss is on that list of the more significant challenges in healthcare. As a senior care advisor and a care manager, I trained a lot of staff in care communities and my staff. I worked with my clients who had loved ones at home on ways to bathe their loved ones with and without memory loss. That type of personal care can take a lot of trial and error to figure out what works and what doesn’t work. This is where taking a course or getting help from a senior care advisor can decrease your learning curve. Another of the challenges in healthcare is the idea of hiring an in-home caregiver or having a loved one live in a care community. Both situations bring a whole list of complexities, which leads to the introduction of our guest for the health and wellness segment of this radio show.

04:56 Pamela D. Wilson: Jim Berklan will be joining us. He is executive editor of McKnight’s Long-Term Care, McKnight’s Assisted Living Magazine, and He’s a specialist in the field of senior housing and care. We will be talking about the challenges in healthcare-related to healthcare turnover. Why employees leave. Turnover in the health care industry, especially in-home care and community care, was difficult before COVID. Today, after COVID, it’s very different, and we’re going to have some interesting facts to share with you. A lot of caregivers, when I had my in-home care company, if they weren’t going to make it—they quit in the first 90 days. That leads us back to challenges in healthcare. Number one, being a caregiver, a family caregiver, covers a lot of ground. High-stress situations, challenging interpersonal relationships for you and the care receiver, others in your family, and outside providers.

05:53 Pamela D. Wilson: Time management. How on earth do caregivers get it all done? Sometimes I think we don’t even know. Challenges in healthcare result from situations that are continually changing. As a certified senior care advisor and a care manager, I became extremely resourceful because of the number and complexity of situations where I helped caregivers and aging adults. Other challenges in healthcare crossover into the areas of financial planning and managing money—how do you pay for care costs? Then there’s the legal component of being that medical and financial power of attorney, or even a guardian. Sifting through what needs to be done and organizing everything takes a lot of effort and a lot of perseverance.

06:34 Pamela D. Wilson: Doing all of this alone can feel very isolating and have you wondering if you’re doing the right things. Caregivers experience stress, and they also say that they have a moral obligation and a duty to care for aging parents or a spouse. So all of this work, it’s not really a choice. It’s a responsibility. How can caregivers face all of the challenges in healthcare and make sure that their health isn’t compromised? That’s the magic question. Number two of the challenges in healthcare that I faced as a senior care advisor and a care manager that family caregivers also face, is that people who are involved in care situations also experience high levels of stress and emotional ups and downs. This includes the caregiver, an aging parent, spouse, staff who work in care communities, medical clinics, in-home caregivers. Everybody is stressed. How do we all hold it together without breaking down? There are actions that caregivers can take that accumulate to keep us emotionally together. This includes things like meditation, keeping a journal, getting more sleep, exercise, and eating right. But how do caregivers respond to challenges in healthcare that crop up unexpectedly and require immediate attention?

07:52 Pamela D. Wilson: The way that we react and respond to stressful situations guides the response that we will receive from other people. If you blow up, it’s likely that the other person will feel attacked and do the same. Stress and agitation are contagious. If you remain calm, others will probably do the same. More on the challenges in healthcare and sharing my experiences as a senior care advisor and a care manager will be in the second half of this program.

08:23 Pamela D. Wilson: Up next, we’re going to have Jim Berklan, Executive Editor at McKnight’s Long-Term Care, McKnight’s Assisted Living Magazine, and, talk to us about healthcare turnover. Why employees leave? What are all of you seeing with the in-home caregivers that are coming to your home? What are you seeing in care communities? Jim is going to give us some insight on that. Follow me on Facebook at PamelaDWilsoncaregivingexpert, where you can join my online caregiver support group. It’s called the Caregiving Trap. This is Pamela D. Wilson on The Caring Generation radio show, live on the BBM Global Network Channel 100 and TuneIn Radio. Stay with me. We’ll be right back.


11:23 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host on The Caring Generation radio show for caregivers live from the BBM Global Network, Channel 100, and TuneIn Radio. Jim Berklan is with us. Jim, welcome.

11:36 Jim Berklan: Thank you very much, Pamela. Thrilled to be here again.

11:39 Pamela D. Wilson: Thank you. So let’s talk about staffing in care communities and nursing homes. It seems to be a challenge. What are some of the issues that are resulting in high turnover?

11:50 Jim Berklan: Well, as you may very well know, this is a continual problem as we’re going to discuss. During COVID it’s that much worse. But really, the problems start right up front with pay. These are not huge paying jobs, and as it’s been said for many times, many years that people earning $9, $10 an hour or whatever, they can go do this in fast food or some other lesser detail, and they’re not going to be dealing with some of these elderly issues or some of the uncomfortable issues if you will. So pay is certain. The duty, as we said. Taking care of many sick, elderly people or needy people, and there’s a big load quite a bit when they do that. And now there are hazards, they could be exposed to COVID, and then not only that but they have to go home and be safe. So, in other words, they work. But then they have to go home and be safe so that they can come back to work and be safe, there’s that implied pressure on them.

12:45 Jim Berklan: Turnover within these industries. They’re being poached by other industries. We’ve heard tales that some of these aides are being lured away if you will, to be screeners or temperature takers, say at hospitals or other places, workplaces, outside of long-term care, and they can get better pay there. They might be going to less hazardous places. There’s also burnout, as I mentioned. If they’re taking care of 10, 12, if they’re working overnight, they may have more people that they have to take care of, and sometimes there’s not the flexibility that they need. Because they’re an awful lot of single mothers who have child care needs, and so this is just an accumulative pressure point that is just really constant. It’s tough to manage.

13:30 Pamela D. Wilson: Is there a turnover rate and a cost to these care communities for all of these employees that keep coming and going?

13:39 Jim Berklan: There is undoubtedly big costs on that, and we’ll talk first about direct care aide. That is the most prolific. Your certified nursing aide may be doing 95% of the direct care, and that’s where the highest turnover is. Harvard researcher David Grabowski just recently quoted as high as 129%. Now there’s other places that the average is 51%. You might say, “Oh, that’s great.” Well, think about turning over half of your staff every year or, in the 129% case, more than once. Now, there are flip sides to that. When you’re looking for these facilities, some of them do very, very well, and they don’t have as much turnover, but they are huge numbers, huge cost. We surveyed at McKnights, “Have you thought about leaving your job in the last three months?” Well, in 2019, 37% of this, and these were nurse managers, said “yes.” This year, as COVID took grip, it was up to 44%. Now, they said they had considered, they’re very dedicated, but it just goes to show about that pressure. Agency costs have gone way up. The use of agency nurses has risen from 36% to 63%.

14:54 Jim Berklan: So the agency nurse is the expense that any manager doesn’t want because they cost that much more than staff nurses, and you also don’t get that personal care because they’re really hired guns coming in and not knowing the routines. So nobody wants to turn over, nobody wants the retention problems on that. But yes. That’s a big problem—no doubt about it.

15:18 Pamela D. Wilson: So we talked a little bit about the reasons that employees leave. But let’s talk about the reasons employers make employees leave. So what is it? Is it training? Is it benefits? What are employers not doing to help these people staying?

15:35 Jim Berklan: Well, it is interesting. Well, some of them are basic things. Of course, again, decent pay levels. They do want some flexibility for child care. The job satisfaction surveys that we put through last year, the number one need was training. They do want training. They want ladders for climbing; they want a little bit better paid time off. But when we divide that a little bit more this year, it went through salary and then more staff. So, in other words, to spread the work a little bit better. They wanted better insurance or benefits. So all of these things come into play because you have to remember with COVID this year too, a lot of these people don’t have enough paid time off.  Although we’ve seen a lot of flexibility with that as well.

16:18 Jim Berklan: Interestingly, though, a lot of people say they don’t quit a job. They quit a boss. For our manager survey this year, that number was down about 3% or 4% as the top reason.  Last year it was maybe about 6%. So they know what they’re getting into, and this is a very dedicated crew, but they do need—and we’re going to talk a little bit, I think about the millennials coming up. I know, that’s a different generation, and we’ll talk about what pushes their buttons. But really the workers need to have the flexibility and to be heard, and that’ll help an awful lot.

16:55 Pamela D. Wilson: You had mentioned the statistics of 129% and 51%. So a lot of people coming and going, there has to be a cost to that. Do these communities not say, “Oh my gosh, we’re churning at $100,000 a year, why don’t we put $100,000 back into trying to keep these people?”

17:15 Jim Berklan: Well, they do. But unfortunately, by the nature of these jobs, these are entry-level jobs, and I’m talking about the aides, I guess primarily, on your managerial spots, they are much more circumspect, I guess I would say. But with these younger workers and the aides jobs, they do what they can, and they’ll have to train them up. However, if this aide worker gets offered another dollar an hour down the street, they can go. I don’t know. I think they’re in a tough spot is what it comes down to—because there’s only so much… This is the vast majority of the workforce. That it’s a constant churn, just by the nature of the economy period, as I told you earlier, that they’re being lured away by other industries. So the smart employers do offer great training. Keeping in touch with their employees, pathways for, like I say what matters to rise at their jobs. That type of thing. But it’s just incredibly taxing work. It’s very hands-on. There’s no way you can farm it out to the data processors or whatever. So that’s just something that they’re always going to be up against as your caregiving audience who may be listening at home, they know too.

18:35 Pamela D. Wilson: Well, and that makes me think when I’m older, and I need these caregivers, what a struggle it’s going to be for me to even—if I wanted to have somebody come into the home or I go into a care community. I’m going to be concerned about having a different caregiver every week, or just all these challenges. So hopefully, [chuckle] we always say hopefully, something in the industry will start to solve this. Listeners, we are going to continue our conversation with Jim Berklan, he is Executive Editor of McKnight’s Long-Term Care, McKnight’s Assisted Living Magazine, and after this break.

19:07 Pamela D. Wilson: The podcast of this radio show for caregivers, including show transcripts that you can read for all of The Caring Generation shows, are on my website at You can click on the media tab, scroll down to The Caring Generation radio show. All the shows are there. You can also add a podcast app to the cellphone of your elderly parents and loved ones, invite them to listen every week. Let me start these caregiving conversations for you. This is Pamela D. Wilson on The Caring Generation, live on the BBM Global Network Channel 100 and TuneIn Radio. Check out my website,, for my caregiving blog, and for other helpful information, my Caregiving Library, a lot of help for caregivers and aging adults. Stay with me. We’ll be right back.


21:13 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host for The Caring Generation radio show on the BBM Global Network Channel 100 and TuneIn Radio. We’re back to continue our conversation with Jim Berklan. So Jim, can you talk about what companies are doing? Do they just accept this high turnover as part of business?

21:35 Jim Berklan: Well, to some degree, yes, that’s a qualified answer. They don’t accept it. But they recognize it as somewhat of a cost of doing business because they’ve been in it for years. It’s just really tough to do. As I mentioned, though, in some markets, if they’re the employer of choice, they don’t have as many problems. So, they’re in a tough spot. And some of the things they have done, especially during COVID, they bring in chaplains for counseling, for example. They have employee assistance programs. They’re increasing the telehealth. They may give psych access a little bit for the stress and the strain. They’ve had hero pay. You may have heard this term where they increased payment by $2 an hour, perhaps. Obviously, rates may vary if they’re in COVID wings or if they’re doing this wartime duty, as they say. There are things for early pay— the industry’s kind of come up with it.

22:30 Jim Berklan: There’s a firm called OnShift, they have OnShift wallet where employees can take the wages they’ve earned already. In other words, they don’t have to wait till the end of, say, like a two-week pay period, and I guess that’s been very successful. Firms have paid out $40 million “early,” although it’s been earned. There’s been a revised sick leave and PTO for young mothers, especially if they need daycare. They’ve increased communication. I’ve seen newsletters come in daily. My mom is in the system, and I get an email daily from where she’s staying. They have meals at work. Not just pizza parties, but sometimes they’ve done that. They’ve been more flexible with their scheduling. So there are a number of ways. They’re really fighting for how to get the people taken care of because as the call-offs have increased—and they’ve increased by 50% over the last year—where do you go to get somebody? As I said earlier, you can’t punch something in a computer and say, “Okay, my patients are taken care of.”

23:35 Pamela D. Wilson: So a lot of these employees who have worked in care communities, I’m one of them, we’ve been around for a while. We’re getting older. Do the younger workforce, the millennials, do they have a different sense of priorities about work and what they want out of this type of work?

23:50 Jim Berklan: Well, they do, and it’s not all bad. And first of all, I was a little bit surprised when I heard this, but it makes sense. Seventy eight percent of the workforce in nursing homes are millennials right now if you think about that. And not only that, but Gen Z is going to be 75% by 2030. Again, my friends at OnShift who have done that research. And so this is something you can’t just say, “Oh, we’re going to do without millennials,” right? Well, what we found is millennials, they’re very interested in personal development. They want a collaborative work culture. Flexible schedules—they’re very into work-life balance. You notice I haven’t mentioned pay yet. Of course, everybody wants the dollar, but these sort of softer things, very, very important. And they want real-time feedback. If you’re doing annual reviews, that’s way too slow. That’s not going to handle it for them.

24:40 Jim Berklan: And they want to “make the world a better place.” You have to go through social media, of course. If you have long applications, 60% don’t even finish the application if it’s too long. And you need to talk to them and text them. Now that I say that, this has disappeared. Where it used to be two years ago—are you even going to let people have their phones— and can you let them text on a job? I think there’s been a surrender there, and I don’t mean that in a bad way. This is just how you get to these workers. But because of those virtues, I’ll say, from the first wanting personal development and collaborative culture, they’re into what you want to do as a provider. So, it’s not all bad. So certainly all this tech and mobile communication, they want to make a positive impact. So this is where you’re going to get to them. And again, they’re who we have to take care of us, our parents, our aunts, uncles, anybody going into these places.

25:41 Pamela D. Wilson: So COVID started—gosh almost we’re heading on a year here—at a nursing home in the State of Washington. Because employees were working at multiple locations. Is that the way of the future for communities, the staff? Just have people working in the same company but going from place to place?

26:00 Jim Berklan: Well, yes, unfortunately. It’s probably going to stay that way just because you have a lot of your contract workers, and whether some of them may be therapy or social or whatever, these multiple site workers are not going to go away. That’s the word I have and that we’ve got. They have trimmed a little bit during the crisis, especially early on. In other words, I’ve heard of confining workers. You’re just going to stay here and maybe wear more hats, but that’s probably not practical for continuing on. Now, thankfully, the PPE, personal protective equipment, and some of the safety measures have—the equipment has come back into play so that they will be safer moving from site to site. But it’s just going to be that way, and that’s because probably a lot of these places are smaller, and there are multiples or maybe regional firms, and that they need them to rotate around. So again, the danger—you’re right.  Was these asymptomatic unknown workers spreading the virus. I think there’s going to be a lot more testing. The new normal is not going to be just going carefree in the future.

27:10 Pamela D. Wilson: So paint me a picture of the future. What does this industry look like in three years, in five years? What are we going to see?

27:18 Jim Berklan: Okay, well, some very good things are happening being in the year here. A new payment system, which we have talked about previously on a visit, that is paying for higher needs patients, and it looked like the Federal Government had gotten it right. They’d actually been a little bit more generous. So things are going towards a value-based reimbursement sign that’s good. So when we can get back to that, it’s looking like that will be good. About three years from now, maybe the census will be getting back up to full rates. They’re hoping by summer because census drives everything. Remember, folks; nursing homes are long-term care, Medicare, Medicaid reimbursed by the government. Those are fixed rate. That’s why some of these staffing problems exist too. You don’t just have extra buckets of money. But you’re going to have younger employees. You’re going to have continued reimbursement struggles. But you will have this age wave, so that hopefully, by doing things on massive scales, these providers will be able to do a little bit better. And again, but nothing happens until COVID is taken care of, and that’s not going to happen really, probably for a couple of years, even with a virus around the corner.

28:26 Pamela D. Wilson: Oh, that is a shame. Jim, thank you so much for joining us and for the work that you do. I want to follow up with you after the show and just find out where all this research is, where people can find it. Listeners invite your friends and family to join us every Wednesday evening for these conversations about caregiving, aging, health care, family relationships, and everything in between. I’m Pamela D. Wilson, your host on The Caring Generation live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.


31:14 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert and senior advisor. I’m your host on The Caring Generation radio program for caregivers and aging adults live from the BBM Global Network, Channel 100, and TuneIn Radio. The Caring Generation focuses on the conversation of caring, giving us permission to talk about aging, the challenges of caregiving, health, the patient experience, family relationships, and everything in between. Helpful articles are on my website at So let’s return to talking about my experience as a senior care advisor and a care manager related to the subject of the challenges in healthcare. In the first segment, we talked about caregiving, requiring a wide variety of skills and the role of caregiving being highly stressful and emotional. So the third idea for challenges in healthcare that follow are challenging customers and people management. Anybody who expects a lot of him or herself is probably expecting a lot from other people. That thought process can be good and bad, depending on the situation.

32:16 Pamela D. Wilson: As a business owner and a senior care advisor, in both of my in-home care businesses and my care management business, I had high expectations for my employees like most companies do. We had goals. Customer satisfaction was very high on our list. Challenges in healthcare occur for family caregivers because they have gaps. So in my businesses, my staff and I created goals. We had plans. In the normal day of being a caregiver, a lot of caregivers don’t realize that they should be creating goals and plans and gaining agreement from family members and elderly parents, and outside care providers. That’s where expectations and what we want from situations can fall apart. The reality of that hard work, the setting goals, the planning, implementing—it’s very important for family caregivers also.

33:07 Pamela D. Wilson: In training my care staff and creating my online caregiver training program, I share a lot of practical experiences as a senior care advisor and a care manager. For many people, family caregivers, professional caregivers, when our expectations aren’t met, we get disappointed. And a tendency can exist to give up at the first time from bumps in the road until we learn how to bounce back—until we learn how to become more resilient. So here’s an example, a home care agency tells you, “Oh, our caregivers are professional, we’ll take care of everything that you don’t want to do, and they’re experienced.” So what do you get? They send you a caregiver who has no experience caring for a person with memory loss. The caregiver can’t cook. The caregiver wants to be told what to do, and you have this expectation of getting some sense of relief out of this caregiving situation, and now it feels like your hopes are dashed. Your expectations, it’s never going to happen, you’re discouraged. You’re thinking, “Why would I want to try this again?” Don’t give up. Please don’t give up. Keep trying.

34:11 Pamela D. Wilson: In my online caregiver education program, I teach caregivers how to create goals, how to hire and manage in-home caregivers. Hiring and managing in-home caregivers was part of my business as a senior care advisor and a care manager, and I had an in-home care business. So instead of learning by making mistakes, caregivers in my online education programs learn to prevent mistakes. Number four in challenges in healthcare as a senior care advisor and a care manager is time management. Family caregivers are facing the same issues juggling work and caregiving as professional caregivers. Let’s say that you had your day planned out. What happens? One unexpected thing after another that cause delay after delay. The day is over, and nothing on that list that you created that morning was finished. We all have those days. How can you recover? You can recover by taking a pause and regaining mental clarity and focus. But that does assume that you’ve made a little bit of a plan. Maybe you went so far as to create a schedule for the things that you wanted to accomplish every day and this week. But you always want to build in time for the unexpected. That’s what many times we don’t do—which is why things go off track.

35:24 Pamela D. Wilson: There’s something to be said about a routine. While that might seem super boring to you. It can actually have a lot of positive results. Your parents also might appreciate having a schedule of knowing when you’re going to visit or knowing when you’re going to call. By creating that schedule, you manage your elderly parent’s expectations, and you reduce a lot of frustration on your side. Part of that time management component, it can make life easier. You can also monitor your conversations. How are you talking to people? Do you speak in I and me instead of we? Watch your conversations for a couple of days. Do you view yourselves as kind of separate or outside of a situation, or do you feel like you’re working in and you’re part of that solution?

36:14 Pamela D. Wilson: People who talk in we terms are likely to be more collaborative, and also if you say, “We,” people are more willing to work with you than if it’s “me, me, me, me, me.” Or “I, I, I, I, I.” It’s always not all about us. It’s about us working with other people. When I was a senior care advisor, my main focus was really on my clients’ well-being and the idea of “we” want to work together to ensure that my client or mom and dad gets the best care. How do we do that? When health care providers disagree with you or they fail to follow through, you want to take that conversation back to focusing on your parents. How do we get my parent’s help? I realize this is frustrating for you. It’s frustrating for me. How do we work this out? Stay away from the “You.” Because when you start using “you,” conversations can go off-track to blaming other people. Making other people feel defensive, and when that happens, everybody in that situation, you, your elderly parents, you all lose because the focus is on what one person did or they didn’t do. It’s a dead end. Just don’t even go there.

37:31 Pamela D. Wilson: The manual of how to be a caregiver, how to plan and coordinate care is in my online caregiver course called Stay At Home: Taking Care of Elderly Parents at Home and Beyond, it’s available through corporations and groups, so talk to your companies about offering caregiver support programs. More help for caregivers is also in my book; it’s called The Caregiving Trap: Solutions for Life’s Unexpected Changes. Information about both of those is on my website at And if you are a caregiver, you can join my caregiving support group. It is on Facebook. It’s called The Caregiving Trap. You can go to my Facebook page. It’s Pamela D. Wilson, Caregiving Expert. Also, make it easy for your elderly parents to listen to the show. Many times it’s difficult to learn how to initiate conversations with elderly parents, or they think that you’re a child and you don’t know anything. Install your favorite podcast app on their cellphone, show them how to listen every week. Let me start these caregiving conversations for you. This is Pamela D. Wilson, caregiving speaker, consultant, and senior care advisor on The Caring Generation live from the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.


41:01 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, senior care advisor, and speaker consultant on The Caring Generation, live from the BBM Global Network Channel 100 and TuneIn Radio. If your company isn’t offering caregiver support programs, maybe it’s time to ask your human resources department to support working caregivers. Caregiver education and programs for corporations and groups, including on-site education, online webinars, video conferencing presentations, and creating a workplace where people matter, are on my website at We’re back to talk about challenges in healthcare with the number five idea that caregiving is a constantly changing situation. As a senior care advisor and care manager, I experienced this with my clients, and I still do. There are periods of what I call high activity. This means hospitalizations, nursing home stays for rehabilitation and returning back home. As a family caregiver, you experience this. The time that you devote during these high activity periods can be exhausting. The key to managing these situations goes back to our earlier discussion of goals and planning.

42:08 Pamela D. Wilson: What is the goal for your parent? Can your elderly parent return home to live independently if a hospitalization occurs? Will in-home caregivers or more time for you to care for elderly parents be needed? When you begin the planning at the start of a change—before things get worse—you’ll feel like you have more control over the situation. If you don’t plan, the hospitals and the nursing homes will do all of the planning for you, and the situation can feel like you have no control or say over what is happening. This is a point where caregivers might engage in magical versus practical thinking, where caregivers hope things turn out but don’t take any action to influence that situation, or you may not know what you should be doing. The minute that healthcare providers and others become involved is the time for caregivers to become more involved.

43:03 Pamela D. Wilson: The more cooks in the kitchen, the greater likelihood that details about the care of an elderly parent or a spouse may go off-track, or that information may not be communicated correctly. Care coordination, especially when loved ones are shifted from one place of care to another, like hospital to skilled nursing, to assisted living, to home, is an area where thoroughness and detailed communication is essential so that important details aren’t missed. As the caregiver, you should be driving this process and taking control instead of waiting for other people to step up and communicate with you.

43:38 Pamela D. Wilson: The goal is to stabilize that situation of high activity back into a routine that meets the care needs of an aging parent or a spouse. As I did with my clients, you’ll have periods of time where everything seems stable. It’s a blessing, alternating with these periods of high activity, especially as your elderly parents, health becomes more serious. At that point, you might feel like you’re on a Merry-Go-Round that never stops. Accepting that change will be constant is one of the challenges in healthcare that all caregivers experience. While we all want to maintain some sense of control, learning to be flexible will ease those emotional ups and downs that we can experience. Instead of responding to a situation with, “oh, oh my gosh, oh my gosh, what now” attitude, when you can pause for a second and change to a response of, “well, of course, we knew this was possible.” Instead of getting upset, let’s talk about what we can do next. Then you go back to planning, to list-making, to looking at all of the alternatives to identify the choices that you can make.

44:49 Pamela D. Wilson: That leads to the idea of challenges in healthcare and the idea of becoming resourceful. As a senior care advisor, I met a lot of people working in the senior care industry. I created my own resource list so that when a situation happened, and I wasn’t the person to solve that, I had a list of people who could help with all of these concerns for my clients. As a caregiver, you become resourceful as situations continue to change. Like many of my clients realize, there are times when consulting a senior care advisor or a care manager that has thousands of hours of experience like myself, or seeking out education before you make an important decision has a lot of value to you. You save time. You avoid frustration. Sometimes you can avoid having to redo something again because maybe you made a decision that wasn’t so right or didn’t quite work out.

45:46 Pamela D. Wilson: Let’s talk about challenge number seven, which is perseverance. Which relates to all of this. It’s the idea of not giving up and to keep going when things look like they are the bleakest. When we’re going down that path of caregiving, or really the path toward any goal, there can be a point where all these thoughts are bubbling up, “Oh, this is harder than I thought it would be. Why does it seem like I’m getting nowhere? I feel like I’m drowning. Everything I try doesn’t work out the way I expect. I can’t do this. What was I thinking? I’m uncomfortable, but I still don’t want to give up.”

46:21 Pamela D. Wilson: Cultivating that mindset of not giving up and pivoting, so changing a little bit if necessary, can help caregivers through challenging situations. Perseverance, flexibility, self-evaluation, and the willingness to change directions are valuable skills in all areas of life. What does this mean? It means saying, “I’m not going to give up.” It means thinking, “I will find a way to make this work.” As a senior care advisor and care manager, one of the discussions that I have with clients is that you always want to have a backup plan. You want to create a plan A, plan B, sometimes a plan C, because it’s impossible to predict what can happen.

47:02 Pamela D. Wilson: You want to be prepared for any situation that might arise. In challenging situations, think about the how. Wisdom comes from acknowledging that the skills we possess might not be enough to solve the problems that surround us. I don’t know if you remember Albert Einstein, but he had a saying that problems can’t be solved with the same mind and the same thinking that we used to create the problem. Part of making progress is continuing to persevere despite not seeing immediate results. This is why so many people quit right before they are about to succeed. When you become open-minded and flexible, it’s easier to see that there is no one right way to do anything. There are many right ways. Not the same thing will work for you as it will for somebody else. That’s the benefit of life-long learning and life-long education. Whether you are a caregiver, or in all areas of life, continually learning is beneficial, being open-minded is beneficial.

48:04 Pamela D. Wilson: When we continue to be interested and curious and continue to seek out information, we can find the right answers. We can find the right people to help us succeed. More information about taking care of elderly parents and how I help caregivers as a senior care advisor is on my website at Follow me on Facebook at PamelaDWillsonCaregiving Expert, on Twitter  @CaregivingSpeak. This is Pamela D. Wilson, caregiving author, expert, and speaker consultant on The Caring Generation, live from the BBM Global Network Channel 100 and TuneIn Radio. Stay with me. We’ll be right back.


51:01 Pamela D. Wilson: This is Pamela D. Willson, caregiving expert, and senior care advisor. I’m your host on The Caring Generation radio program for caregivers and aging adults, live on the BBM Global Network Channel 100 and TuneIn Radio. Share The Caring Generation with your friends, family, co-workers, the companies where you work, your social groups at church, and everywhere. One in four people you know are caregivers looking for hope, help, and support that is here on The Caring Generation every Wednesday and on my website 24/7 at Next week, we’ll be talking about how to talk to aging parents when aging parents may have no recollection of conversations that they have with you. Dr. Aninda Acharya joins us from Washington University in St. Louis to talk about anosognosia. It’s a lack of insight into health concerns and safety by our care receivers. We’re back to swinging around to talk about the challenges in healthcare. As a certified senior care advisor and care manager, I continue to be amazed by caregivers who go on despite challenging situations because they feel they have a moral obligation and a duty to care for aging parents or spouses. When I was legally responsible for the care of my clients, I did the same.

52:16 Pamela D. Wilson: I was committed to making sure that my clients received the care they deserved. Today, I help caregivers, and aging adults take steps to receive care and support they need to keep going despite what can feel like insurmountable challenges. Challenges in healthcare exist, and they will continue to exist. Healthcare systems are complicated. They’re not easy to navigate. Individuals working within the system work within constraints, and they can’t always do the best for you either. It’s our responsibility as a caregiver to seek education about gaps that we find in our lives and in care systems. Whether that’s being a caregiver, learning about medical conditions, improving our people, or time management skills, nobody can do this but us.

53:00 Pamela D. Wilson: Challenges in healthcare can result in high levels of emotion. The way to protect yourself is not to take on the emotions of other people. The words and actions of others represent what’s in their minds, except that it’s not your responsibility or your job to change the beliefs of another person. Recognize that insults and criticism that come your way. They’re more about the other person than you. Negativity coming towards you, or negativity that you project on others comes from what’s up in your mind. What’s up in your brain. We have the ability and the control to respond positively to the challenges of healthcare and life situations. If we can just pause for a second, breathe for a second, and think about what we’re doing.

53:45 Pamela D. Wilson: My career as a certified senior care advisor and a certified guardian and care manager has been one of the greatest blessings in my life. Being here with you every Wednesday night is a blessing. Researching and finding guests who graciously give their time to visit with us every week, those people who share their knowledge, they’re amazing. That allows all of us to learn and to share our experiences. When we look at life, and we focus on the good, we create more good and less stress. What does that mean for caregivers? It means by recognizing that healthcare challenges exist and understanding how these can affect the care that an elderly parent or spouse receives. You can be proactive instead of reactive and planning for care. Don’t allow yourselves to be swept about by the waves in life. Create those waves of progress in your life. Don’t let not understanding the how stop you. Ask for the help, the education that you need from elderly parents, your family, and the workplace.

54:44 Pamela D. Wilson: Thank you to all the caregivers who continue to go to my website,, and complete that caregiver stress assessment. It’s on my website at You go to the Contact Me button and scroll down, and you can complete it. Sharing your stories there, and know that they’re confidential. They don’t go anywhere. It helps me create this radio show for you every week—it helps me create articles for my website and do a lot of the education that I do for caregivers. You are all amazing. Caregivers, know that you’re doing a fabulous job, and that I love all of you. Invite your elderly parents, your spouses, your friends, your family members, your workplaces, should join us here every Wednesday night on The Caring Generation radio show. Visit my website, for a lot of information and follow me on Facebook at Pamela D. Wilson Caregiving Expert. You can also follow me on Twitter @CaregivingSpeak. I’m Pamela D. Wilson, caregiving expert, senior care advisor, and speaker consultant. God bless all of you, sleep well tonight, have a fabulous day tomorrow, and a great week until we are here together again.


55:55 Announcer: Tune in each week with The Caring Generation with host Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D. Wilson’s The Caring Generation.

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About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

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