What Are the Levels of Care for Elderly? – The Caring Generation®

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The Caring Generation® – Episode 83 April 24, 2021. On this caregiver program, expert Pamela D Wilson offers insight into levels of care for elderly from various perspectives. Guest Ben Clincy a paramedic, writer, artist, fellow podcast host, and comedian with a caring heart for the elderly shares insights into his work as a first responder.

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What are the Levels of Care for Elderly?

0:00:04.0 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.

0:00:37:37 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, elder care consultant, and guardian of The Caring Generation. The Caring Generation focuses on the conversation of caring, giving us permission to talk about aging, the challenges of caregiving, and everything in between.  It’s no surprise that needing care or becoming a caregiver changes everything. The Caring Generation is here to guide you along the journey to let you know that you’re not alone.

0:1:06:19 Pamela D Wilson: You’re in exactly the right place to share stories, learn tips and resources to help you and your loved ones plan for what’s ahead. Invite your loved ones, family, and friends to listen to the show each week. This week we are talking about levels of care for elderly from a variety of perspectives. If you have heard the term levels of care for elderly, you may have heard this from a health professional. Levels of care for elderly is what I call a medical speak term.

01:40:69 Pamela D Wilson: Those who work in the aging and care industries use many terms and abbreviations when we talk about patients, clients, and other people. These terms might designate the type of assistance a client needs or may be acronyms for diagnoses and other medical terminology. The term levels of care for elderly can also apply to the cost ranges of care on a level or point basis provided in assisted living and care communities.

02:15:35 Pamela D Wilson: Family members might think of levels of care for elderly with the thought of the increasing amounts of care provided for parents and others related to tasks or time for managing health, providing support with physical abilities, and monitoring memory issues as they become worse. For example, the levels of care for elderly can quickly progress from caregivers helping occasionally or only on the weekend to all of a sudden becoming a 24/7 caregiver when mom or dad breaks a hip or has a heart attack.

02:57:65  Pamela D Wilson: The concept of levels of care is also related to medical and financial decision-making for aging parents. These decision-making levels range from being available to answer questions to moving into the role of an advisor for a parent to making all of the decisions for a parent who is unable from a mental or physical perspective to make decisions for him or herself. Levels of care for elderly can relate to claiming benefits for a long-term care insurance policy with qualifying care needs called activities of daily living—ADLS and instrumental activities of daily living—IADLS.

03:52:23 Pamela D Wilson: We will talk about all of these levels of care for elderly during this program to offer a broader understanding of the responsibilities that many caregivers accept. To add a little fun to a subject that tends to be on the serious side, the guest for this show is Ben Clincy, a full-time paramedic who shares his experiences about time-sensitive care situations. In addition to being a paramedic and attending medical school, he is a writer, artist, comedian, and creator of the popular comic strip EMScapades.

04:32:48 Pamela D Wilson: As a comedian, Ben has performed at clubs and a variety of venues for over 20 years. He is the host of EMScapades: Off Duty, a podcast that features men and women in various healthcare roles sharing their experiences. Because of his interest in humor and his love for the elderly, he appears calm in chaotic situations and uses humor to calm people who might be experiencing stressful healthcare situations.

05:02:69 Pamela D Wilson: Let’s begin our conversation about levels of care for elderly by talking about nature and trees. How many of you have seen a tree that was cut down, and you examined the rings inside the trunk of the tree? Trees are a fantastic plant species. The history of trees is discovered by examining the rings in the tree trunk that show years of drought, floods, insect attacks, lightning strikes, earthquakes, and other events.

05:38:82 Pamela D Wilson: Every year that a tree lives, the new growth of the tree trunk produces another interior tree ring. For humans, the rings that we see in a tree trunk are similar to the brain’s ability to collect and store experiences into our short and long-term memory. The way that humans store and retrieve information affects decision-making. According to research, the decisions that many of us make are shaped by our memories of past experiences. Even more interesting, the life experiences we have beginning in childhood set a foundation for learning, managing emotions, physical health, and other aspects that guide life experiences and decision-making.

6:31:42 Pamela D Wilson: This concept is relevant to levels of care for elderly because each person in a care situation proceeds through life with different backgrounds and different levels of experiences. For example, a child who experienced high levels of stress or trauma at an early age and learned to adapt may not have the same emotional reaction to a stressful incident as a child who grew up free of stress, trauma, or worry. We respond differently because of life experiences.

07:08:78 Pamela D Wilson: Life experiences impact how we look at and provide levels of care for elderly. Consider this as we age. Depending on how well we have taken care of our bodies and the level of interest we take in health education, we might have a preventative mindset that says I want to remain healthy and physically well. Or if you are like me and grew up with a chronically ill parent who you watched suffer because of one health issue after another, you might also decide to do whatever you can do to make sure that your body remains strong and healthy.

07:45:79 Pamela D Wilson: Individuals with interest in health or a family experience of sickness or death are more likely to seek education that includes learning about the importance of establishing and maintaining social connections proven to improve health and well-being. Routine medical care—annual check-ups, preventative screenings, immunizations all have the potential to identify health issues in the early stages so that an individual can make a choice to stop the condition from advancing.

08:24:34 Pamela D Wilson: According to a Kaiser Family Foundation study, 41% of Americans are depressed and isolated. The availability of telehealth visits for mental health and common medical conditions is a result of the pandemic. Even still, research confirms that many caregivers, many consumers have delayed medical care or treatments due to the pandemic.

08:51:54 Pamela D Wilson: The results of these delays in seeking care will have long-term effects that remain to be seen. If you want to avoid levels of care for elderly in your later years, be attentive today to your health. Individuals with a proactive attitude toward health may experience a change in health represented by a diagnosis of a chronic disease like high blood pressure.

09:17:41 Pamela D Wilson: They may realize that having high blood pressure has the potential to move them up to a level of care where taking daily medications, the possibility of being diagnosed with related health conditions, or accepting physical ailments can make it difficult to do activities that they’ve always done. The difference with these individuals is that they recognize the choice of accepting the changes or taking action to reverse or stop the condition from advancing.

09:52:63 Pamela D Wilson: Many adults simply accept a health diagnosis, walk away with the prescription and ask no questions. Gaining insights into choosing responses and behaviors is a skill that can be learned at any age that has a long-term effect on levels of care for elderly—our grandparents, our parents, and ourselves, who will eventually be elderly. As I mentioned previously, decisions are shaped by memories of past experiences.

10:29:63 Pamela D Wilson: How do we navigate health or care decisions when we have had no prior experience making a similar decision? It’s the idea of asking, “how do we know or learn what we don’t know and what questions we should be asking?” We will continue this conversation after a short break. If you are interested in learning how to avoid increasing levels of care for elderly or planning for future care needs—you can talk with me. It’s never too early to begin conversations.

11:05:49 Pamela D Wilson: Waiting is like a time bomb– doing nothing out of fear or because you don’t know what to do and waiting to act usually results in fewer and more limited options. Visit my website www.PamelaDWilson.com, click on the how I help button, then Family Caregiver Support, next Elder Care Consultant, and we can discuss a caring or caregiving action plan. We’re off to a break. This is Pamela D Wilson, caregiving expert, elder care consultant, and speaker. Stay with me; I’ll be right back.

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12:12:48 Pamela D Wilson: This is Pamela D Wilson on The Caring Generation program for caregivers and adults. Whether you are twenty or 100 years old, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. Visit my website PamelaDWilson.com to check out my caregiver library, videos, podcasts, and transcripts from The Caring Generation, online eldercare courses, my book The Caregiving Trap, and information for how I support caregivers, groups, and corporations.

12:47:85 Pamela D Wilson:  We’re back to answer the question, “how do we know or learn what we don’t know and what questions we should be asking about health and levels of care for elderly?” When we are children, our parents guide us. We attend grade school, then high school, where we learn basic skills. Some individuals choose to go to college. But where in all of this formal education do we learn what to do to have a healthy body and mind?

0:13:23:96 Pamela D Wilson: Most of us learn from trial and error or seeking education on our own. No matter your age, taking an interest in health and well-being is a positive step to minimize levels of care for elderly parents, family members, and you when older by the knowledge you acquire and the wisdom you gain. Let’s return to defining levels of care for elderly. An older person who needs help with small tasks around the house like housekeeping, meal preparation, errands, but who can take care of their physical needs is relatively independent and considered low-need or to be at a low level of care for elderly.

0:14:14:23 Pamela D Wilson: This is probably the stage we find most of our parents in when we begin helping out. Even though at this point we may not consider ourselves to be a caregiver. This independent level changes when physical difficulties like standing for long periods of time, walking distances, poor balance that might result in a fall become common concerns. This increase in needing help moves up the levels of care for elderly to an assistive level of care. At an assisted level of care, physical challenges, bathing, or showering safely may pose a greater risk for accidents.

0:15:00:13 Pamela D Wilson: Standing from a chair or getting out of bed may be more physically challenging. Other daily activities like cleaning house, cooking, or the physical exertion of driving to the store, walking through the grocery shopping areas, returning home, and putting groceries away may be exhausting for a parent. As I mentioned before, when physical concerns and weakness are first identified, everyone has a choice to make—regardless of age.

0:15:31:95 Pamela D Wilson: Assuming that this is just the way it is when aches and pains begin or to seek a doctor’s advice to ask what can one do to reverse the physical concerns can help you avoid becoming a contributor for advancing levels of care. What do you think happens in most of these situations? Due to lack of prior experience with this issue—whatever it is—the brain doesn’t immediately start making suggestions like “go see the doctor, ask for physical therapy exercises, ask how to reverse the condition, ask about the consequences of doing nothing.”

0:16:19:14 Pamela D Wilson: As a result, most people do nothing. The condition may be bothersome, but it’s not “bad enough to see a doctor.” Hint: when a health issue first begins is the perfect time to see the doctor. Early identification of health concerns offers the best opportunity to reverse or stop the condition from getting worse. Waiting and doing nothing can result in needing higher levels of care for elderly or you that over time have a personal and financial cost when help from family members or money to bring care into the home is needed.

0:17:05:33 Pamela D Wilson: Advancing levels of care for elderly, in many cases, can be avoided, maintained, or improved if you take action. We’re back to talk more about assisted levels of care for elderly that family can provide in the home or care provided by staff in a care community meets assisted living levels of care. Assisted levels of care for elderly living in care communities involve providing support with daily living activities that include physical care like bathing, dressing, transfers, escort services to dining areas, medication management, meals, and socialization. Adult children provide assisted living levels of care for elderly parents in their homes.

0:18:02:58 Pamela D Wilson: The difference between community care and care provided by adult children in the homes of aging parents is the provision of medical-type care plus love. Assisted living communities are not medical care providers. They may have nurses on staff to supervise medication management and supervise and train the care staff.  Medical family-care type care activities like managing insulin, special diets, wound care, physically lifting to assist a parent to stand or transfer, taking daily blood pressures, using a feeding tube, monitoring pulse oxygen, ostomy care, changing catheter bags, or taking temperatures and tanking INR readings to manage coumadin dosages, are levels of care provided in the home for elderly provided by spouses or adult children.

0:19:05:07 Pamela D Wilson: Most of these medical-type activities were previously offered in nursing homes, also called skilled nursing, or you might know them by the name rehabilitation communities. Today, family members are expected by nursing homes to accept these responsibilities. However, many caregivers cite fear or concern about making mistakes or unintentionally harming an elderly loved one. Many of the medical tasks that adult children or spouses perform are tasks that nursing home care staff still perform.

0:19:43:67s Pamela D Wilson: When we add a diagnosis of memory loss from dementia, Alzheimer’s, a brain injury, Parkinson’s, or other neurological disorders, the stress level and time-related to level of care for elderly grow by leaps and bounds. When we consider levels of care for elderly, the care is not only the tasks and physical care but the emotional stress of the person receiving care and the emotional stress of the caregiver.

0:20:21:02 Pamela D Wilson: As more care is needed, stress levels related to decision-making, the time devoted to care, quality of the relationship between spouses, parents, and adult children, family support, and other aspects increase. When aging parents or a spouse is diagnosed with memory loss or a disease that affects cognitive abilities, reversing health declines is no longer possible. However—it is possible to manage and maintain health concerns for a period of time until other health conditions begin to cause complications.

0:21:04:14 Pamela D Wilson: Maintaining the health of elderly parents at any stage is possible when a care plan is developed, agreed upon by the caregiver and care receiver, and implemented. For more information on creating a care plans to manage the health of aging parents and learning about what can happen in care situations so that you can make good decisions, check out my online course for family caregivers: Stay at Home: Taking Care of Elderly Parents at Home and Beyond. It’s on my website at pameladwilson.com.

0:21:42:22 Pamela D Wilson: When aging parents, a spouse, or a parent caring for a disabled child approach assisted levels of care or nursing home levels of care for elderly, It is essential to have planning conversations about the future. Just as talking about care situations rarely happens before becoming a caregiver or needing care because there is no memory of past caregiving situations in the brain. The practicalities of discussing a future that may have limited care options can be challenging.

0:22:318:65 Pamela D Wilson:  Many of us may outlive our income or the money we saved to pay for care during retirement. For some becoming disabled in mid-life or having a chronically ill spouse may derail life plans. If you are an aging parent with a disabled child who may outlive you, discussing and creating a care plan before you need care or run out of money is a conversation not to be delayed. Discussing levels of care for elderly can be positive and less emotionally stressful conversation when one is healthy, when one continues to seek health education, and participates in preventative care.

0:23:04:56 Pamela D Wilson: In situations where chronic disease has already advanced, talking about health and healthcare wishes can create a plan for the unexpected to avoid making decisions in crises. The next concept of levels of care for elderly relates to the stages that a spouse, parent, grandparent, or another aging family member experiences. These stages of care that advance or progress as chronic diseases become more severe equate to making healthcare and financial decisions.

0:23:41:38 Pamela D Wilson: In my Caring for Aging Parents Blog, there is an article called The Four Stages of Caregiving For Elderly Parents and another called Helping Elderly Parents Make Decisions. Both of these articles add insights into all of the decisions that caregivers and aging adults are faced with when decisions must be made about health. If your parent or your family lacks experience in managing health and levels of care for elderly, it can be easy to make uninformed decisions about medical care.

0:24:17:95 Pamela D Wilson: Rather than making rushed decisions or feeling pressured—as long as a time-sensitive decision is not necessary—take the time to learn more about the pros and cons of the decisions you’re about to make. Know the benefits of seeing medical specialists and request referrals when appropriate. When caring for aging parents, making a plan for what you know might happen and becoming aware of the things you don’t expect to happen will help you manage stress levels and achieve better care for aging parents.

0:24:56:26 Pamela D Wilson: Up next, let’s lighten the mood with guest Ben Clincy a fellow podcaster and a full-time paramedic who shares his experiences with emergency care situations, interactions with other healthcare professionals and clients, and his love of the elderly.  Join me every Wednesday for The Caring Generation. The show is not limited by time zone or location—caregivers worldwide listen. Install the podcast app on Apple, Google, Spreaker, and other sites on the cellphone of grandma, grandpa, mom, dad, brothers, sisters, friends, or colleagues. Encourage them to listen each week. I’m Pamela Wilson stay with me on The Caring Generation. I’ll be right back.

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0:26:15:52 Pamela D Wilson: This is Pamela D. Wilson, caregiving expert, speaker, and elder care consultant on The Caring Generation. If you are looking for hope, help, or support for an aging or caregiving challenge, I can help. Visit my website PamelaDWilson.com, click on How I Help tab, next the drop-down for Family Caregiver Support, and then the tab for Elder Care Consultant, where you can learn more about the support I offer for family caregiving situations.

0:26:42:11 Pamela D Wilson: Get ready to meet Ben Clincy, writer, artist, comedian, the creator of the popular comic strip EMScapades and podcast host, in addition to being the calm, cool, and collected paramedic who puts people in stressful situations at ease with his kind demeanor and a little bit of humor.

0:27:06:62 Pamela D Wilson: Ben, hey, thanks for joining us on your day off today.

0:27:09:77 Ben Clincy: Yes, thank you for having me on my day off today. (laughter)

0:27:13:63 Pamela D Wilson: So can you share the difference for our listeners between an EMT and a paramedic, and how long have you been doing this?

0:27:18:93 Ben Clincy: Okay, I’ve been an EMS for I think just over ten years now this year, and the difference between an EMT and a paramedic is—I think in the quickest and easiest way to describe it is—one is able to do invasive. So I always say EMTs are kind of responsible for everything outside of the body, and paramedics can do things inside the body. So say if we were working a cardiac arrest, EMT would do compressions outside of the body, we (paramedics) would push drugs into the body or put a tube into the person.

0:27:51:76 Ben Clincy: You know, so we are—it’s just the—it’s the next step to be able to do more invasive medicine is what a paramedic is—but without EMTs, we can’t do our job. We need EMTs as much as anything. They each have their part to play, and I was an EMT first. Most of us are EMTs first, and then we go on to be paramedics. So that’s the way that goes.

0:28:16:18 Pamela D Wilson: Well, an interesting thing about you that our listeners may not know is that you are also a comedian, so when we talk today about everything you do, we’re going to throw a little comedy in here. So, the first question on that is what information should family or care staff at communities tell you when you show up, and sometimes maybe do they give you too much or not enough information?

0:28:36:08 Ben Clincy: It’s the too much, okay, so it’s the too much or not enough situation sometimes when it needs to be the exact opposite. Like if I have a simple injury, a wrist, an ankle, something like that. And then I get a list of things. What they’re allergic to, their daughter is a Senator. They had a bowel movement at 3 o’clock. I get all this stuff, and I really just need to know how they did this injury and what you’ve done for this injury. Have you given them any pain relief? Is it bandaged? What do I need to do?

0:29:11:97 Ben Clincy: And then I’ll go there for somebody who is altered or unconscious. And I’ll say, “so when did this come about?” and they say, “they were normal this morning.” And I’m like, “did they take any medications?” They say, “yeah, I got their list around here somewhere.” And it’s no fault to—I don’t know if maybe it’s the pressure or the stress of the situation. I have no idea what factors are involved, I’ll also say that, and I’ll also tell you right now I am presently in college to become a nurse, so I’m going to learn the other side of this very soon and maybe find out how wrong I am in some of my assumptions in my comedy.

0:29:49:35 Ben Clincy: But still, it is definitely—you would figure a call like that, a higher acuity call, they would have all of their information ready and be ready to bombard us with it and get that person out the door as quick as possible. But those kinds of calls tend to be a little—we have to pull it out of people. And I don’t know if it’s a fear that they’re going to get blamed for something or we think they’ve done something wrong. It’s not my assumption. I need to get this person to the hospital. I need to know everything you know quickly. And that’s really all it is.

0:30:20:43 Pamela D Wilson: Well, and I can share, it makes sense, and I can share a little quick insight on that. So, people at assisted living communities they’re necessarily like medically trained. So they have no idea with what you need, and right now, with the pandemic and everything, they can’t even keep staff. So half of these people—they may have shown up for their shift at 8 o’clock and have never seen this person before.

0:30:40:23 Ben Clincy: That is true. I can appreciate that. I completely understand that too. (laughter)

0:30:45:10 Pamela D Wilson: Do, do you guys get to pick which calls you go on?

0:30:47:82 Ben Clincy: Well, on neither side. So I’m presently in a private service which—you would have your 911 service typically. And private service does 911. We are mutual aid for our county. As paramedics, no—at least not in my experience and not that I could ever think. We are—calls are taken. We are dispatched to that call. We don’t get to pick, choose— “oh, this one sounds interesting. Oh, maybe this one. I could go for an easy one. Let’s do this one.” No, nothing like that. And as a private service, we kind of do really everything.  So I can take a patient in for altered mental status and bring them back three hours later with their prescription for their diagnosed UTI. Like I can be almost completely with that person through the whole care process. It’s very interesting.

0:31:42:59 Pamela D Wilson: And can you talk about that? Because when I was a care manager, so I had a client who was a bariatric client. I actually had to hire a service like yours and get four people to carry him out of the house. And then they stayed with us at the doctor appointment, and they took him back. So how do people who would have that need—how do they know to call a private service. Or can you give us some recommendations about that?

0:32:02:47 Ben Clincy: So typically, as I understand it, they—it’s kind of a lot of times up to the facility that they’re in. And the facilities that they’re in can be contracted to certain people. Like, we have a facility that uses a particular private service only. And then we have other facilities that they’ll just call whoever and if nobody’s available they’ll call the first one that is. Or a lot of times, through, say, dialysis clinics or any type of continuous care, a lot of people get to know people who are also in long-term care situations who say, “O my God, I ride with so and so. You should ride with them they’re great. They’re always on time.”

0:32:46:21 Ben Clincy: We definitely see a lot of the same people from a lot of the same places. And eventually, you’ll find out how small that world really is. And it’s something as simple as “we’re going to this new care facility, and I’m like, wow I’ve never been here before,” and then you walk in the door and there’s, “the RN is like hey guys” Because she left the other place and came to this place and said you have to use them.

0:33:07:43 Ben Clincy: So it’s really interesting on the private side of ambulance services. On 911, you’d never get to see all that. You go, and you do the call. You drop them off at the hospital. Very rarely do you know what even happened to that patient—whatever became of. So private service offers me a little more, I guess, and while I’m in nursing school it’s kind of neat too. Because I’m getting to see full cases and I’m getting to meet people in the field. And I’ll probably wind up doing my clinical rotation at these places very soon so.

0:33:38:36 Pamela D Wilson: So then do you also get to know the staff at the emergency rooms? If you show up there a lot. Because my experience is sometimes emergency rooms don’t want to accept the elderly because there’s all these penalties for having them being readmitted. Do you have relationships with people at emergency rooms where you can kind of say, “Hey, you know this really is serious?”

0:33:55:46 Ben Clincy: You do build a rapport over time. I know all the nurses and the doctors at the ERs that I routinely go to. You can be a strong patient advocate, but unfortunately, I feel in first responders, our voices aren’t as loud as they could be or maybe even should be considering how much we see or how much we know. A lot of times, there’s a doctor assigned to you know an in-house doctor assigned to that place, and a lot of times they’ll call the referral into the ER.

0:34:27:44 Ben Clincy: So it helps when they know, when the care facilities know the ER docs and they communicate. But I have spoken up here recently to do everything I could to say that this person probably should be admitted and evaluated because I don’t think that their living environment is particularly safe or you know, I don’t think it’s a great environment for them. And then they take my words and then as I said I’m taking them back two hours later to that very same house.

0:35:03:82 Pamela D Wilson: And you know why, right? You know the rules about elderly people sometimes being admitted for pneumonia or something else? If they come back within 30 days, the hospital is penalized, so they don’t want to admit them. So that may be some insight that you didn’t know.

0:35:17:24 Ben Clincy: And like I said, that’s the part I’m going to learn. I wonder which is going to make me, if I’m going to go “yeah, I think I’ll do part-time nursing and full-time paramedicine or if I go you know what I’ll do full-time nursing and part-time paramedicine. I’m wondering which side is going to win out in the “I can accept this kind of thing.” (laughter)

0:35:39:24 Pamela D Wilson: Yes, you may be the nurse on the other end saying, “EMS guys, I don’t think we want this person.”

0:35:43:59 Ben Clincy: Right, and I’ll be like, “Nah, that’s not for me.” I always have treated the elderly with my—with the same respect as I would a grandparent. Particularly my grandparents. Both my grandmas. My grandpas were dead before I was born. But I offer my full first name, which is Benjamin. I am very respectful to them, and It’s neat. I just become such a compassionate person almost to a fault because sometimes I —these calls linger with me. So maybe part of me wants to get in there and maybe try and enact some things as I know the other side of things. Maybe that’s deep down inside kind of why I want to do nursing. I definitely can see a lot more of my caregiver side and a lot more of my passionate side and compassionate side.

0:36:32:44 Pamela D Wilson:  What funny stories might you have that you could share about working with the elderly?

0:36:36:91 Ben Clincy: Just the other day, I had an elderly person who had sunglasses. I don’t know why. Like I said, I don’t know. I did not take this person in. This was a 911 call that brought her in. I was taking her back from the hospital to her nursing home. And she had on sunglasses, and I said, “love your shades, love your sunglasses.” “Oh, thank you.” They were real pretty, and she was super flirty and “ hey you, come here, what’s your name, she’s like, who are your parents?” And there’s no way we know each other I’m from a totally different state. So she’s just being super flirty and super sweet.

0:37:12:23 Ben Clincy: The more she flirts, the more I compliment her hair and her sunglasses, and we’re just going back and forth, just having fun with it. And then finally she said, “I want you to have my sunglasses. I said, “I can’t take them they’re too pretty. And I don’t look good with them. They are made for you. They look better on you.” And so she just smiles. As I’m giving my turnover to the LPN on scene, I feel something kind of messing with my backside. (laughter) And I turn around real quick, and she’s trying to shove her glasses in my back pocket. But she was sweet as can be.

0:31:30:00 Pamela D Wilson: You know, sometimes I find that the older people, they’re, I don’t know. People call them honey and sweetie, and people don’t treat them like people, and so when somebody like you jokes with them or treats them like they’re a human being, they actually appreciate that.

0:38:01:52 Ben Clincy: I can definitely say at the time I see that. I know in the very short limited time that I have with them, I make it count. I’ve had dementia patients. I had a dementia patient who we took for regular dialysis appointments years and years ago. She couldn’t remember her daughter’s name. But I asked her questions about what she used to do when she was younger. She used to make clothing for dolls. She used to work in a doll shop. You know, and I got to know her. But like I said, we could have the same conversation every time I saw her, but I never treated it like it was something that I already knew. I always enjoyed watching her tell it. And pretty soon, everybody who picked her up was named Ben.

0:38:43:37 Pamela D Wilson: Well, and I thank you so much for sharing your stories, and I’m actually glad that you are pursuing nursing school because I think like you said, you’ll get to see both sides and then you can choose which side you want to be on.

0:38:52:60 Ben Clincy: Yes, there’s three semesters left to go, so hopefully, by 2022, I’ll be out there, and well, thank you for having me on here.

0:39:06:23 Pamela D Wilson: It’s time for a break. Up next, wisdom from Henry David Thoreau to add a perspective into the levels of care for elderly and how we can all look at life a little differently Check out all of The Caring Generation podcasts and the show transcripts on my website at PamelaDWilson.com and listen all of your favorite podcast apps: Apple, Google, Spreaker, Podcast Addict, Pandora, Amazon Music, Stitcher, Spotify, I Heart Radio, Podchaser, Jio Saavn, Vurbl, and More.

0:39:43:53 Pamela D Wilson: Add the podcast app for the Caring Generation show on the cellphone of elderly parents, in-laws, family members, friends, and people at work. Helpful information about caregiving and aging is on my website and in my book The Caregiving Trap: Solutions for Life’s Unexpected Changes, available on my website at PamelaDWilson.com. I’m Pamela D Wilson on The Caring Generation Stay with me. I’ll be right back.

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0:40:35:62 Pamela D Wilson: This is Pamela D Wilson. You’re with me on The Caring Generation. If you’re in a caregiving situation where you are not sure what to do, and you want to plan for care needs for aging parents, a spouse, or yourself to avoid unexpected ups and downs—help is on my website, in my online articles, online caregiver courses, podcasts, videos, elder care and aging consultations, and the support that I offer to groups and corporations interested in supporting caregiving conversations.

0:41:07:02 Pamela D Wilson: As I was working on this program, I was thinking of ways to talk about levels of care for elderly by offering inspiration for everyone who may be getting a little older—that would be all of us. For people beginning to experience health concerns, or maybe anyone feeling just a little bit down. I found a little wisdom from 19th-century philosophy.  If you’re not familiar with Henry David Thoreau, he was an American essayist, poet, and practical philosopher known for having lived the doctrines of Transcendentalism and as recorded in his masterwork, Walden (1854), and for having been a vigorous advocate of civil liberties, as evidenced in the essay “Civil Disobedience” (1849).

 0:42:08:19 Pamela D Wilson: Let me begin with a quote from Thoreau. Many men go fishing all of their lives without knowing that it is not fish they are after.  What does that quote mean to you? When we think of everything involved in levels of care for elderly parents—or a spouse or grandparent or a friend, there is a lot of work involved. Not only task work, or physical hands-on care, or monitoring medical care, attending medical appointments, or conversations with insurance companies. That list goes on and on.

0:42:53:80 Pamela D Wilson: We, the caregivers, become so busy that the role and responsibilities of caregiving takes over life. If you are a caregiver, you know this to be true. There are probably days of providing levels of care for elderly parents that you don’t know if you are coming or going. Like the quote about fishing, is caregiving really what you’re after—or is it something else? Do caregivers seek appreciation from care receivers? Do caregivers want to be loved by the persons for whom we care? If you are a caregiver, what motivates you to keep going?

0:43:40:89 Pamela D Wilson: How many caregivers wake up in the morning trying to figure out what day of the week it is? I do this myself. Because caregivers never get a day off. Suddenly days, nights, weeks all become a blur. It’s an odd feeling, isn’t it to wake up and have to think for a moment and then say, oh yes, it’s Wednesday. The act of reorienting our minds to the day of the week puts us back on track for all of the things we have to accomplish that day. In talking about levels of care for elderly, we talked about the healthcare definitions of level of care for elderly, meaning how much help a person needs at home or in a care community.

0:44:28:27 Pamela D Wilson: In care communities, levels of care are often designated by care levels. For example, 1,2,3 levels or points. IF a person takes ten medications, that could be 10 points. Add a shower that could be another 5 points and so on. These points often equate to levels of care at a cost  $300 to $500 or more per level that are incremental as care needs increase. Care level one. Care level two. Care level three. We talked about the stages of health care needs and medical and financial decision-making that can add complexities to levels of care for elderly.

0:45:18:92 Pamela D Wilson: Last on my list for this show but certainly not the last consideration is to mention levels of care related to long-term care insurance policies that provide care for individuals in their homes, at day programs, assisted living communities, and nursing homes. These policies are privately paid—you buy them on your own. Hint:  the younger you are and the healthier you are, the more affordable the policies are. If you wait until you have health concerns, you may not qualify to receive a policy, or the premium may be sky high and unaffordable.

0:45:59:61 Pamela D Wilson: I’ve had my long-term care insurance policy for about twenty years now, and it’s one of the best things I did to make sure there will be a way for me to receive care when I’m older and need a little bit of help. The levels of care for elderly related to long-term care insurance policies relate to a memory loss diagnosis and needing some care and oversight for safety reasons or help with ADLS. Activities of daily living like bathing, managing continence, dressing, eating or feeding, transfers and mobility. In a sense, all of the activities that qualify one for a long-term care insurance policy are activities that an adult child helps parents with at home or services that the elderly receive in a care community.

0:46:58:15 Pamela D Wilson: I bring this up because I want to add a new perspective on the value of family caregivers that is rarely discussed. This value applies regardless of culture. Whether you are of a culture that your family believes that the youngest daughter or a particular family member gives up everything to be the caregiver for a parent. Or if you are from a more individualistic culture where you care for aging parents from a sense of duty or responsibility. But want your parents to remain as independent as possible.

0:47:35:50 Pamela D Wilson: The average cost of an in-home caregiver is $20 to $30 an hour, depending on where you live. One month in an assisted living community can range from $5,000 to $8,000. A nursing home upwards of $8,000 to $10,000 a month. A long-term care insurance policy pays for this type of care. However, If you have an adult child or a spouse dedicated to your care – be kind and thank them. These family caregivers are your FREE long-term care insurance policy.

0:48:20:67 Pamela D Wilson: At a minimum of 20 hours a week—and I know that many caregivers are committing more than 20 hours a week—the value of a caregiver to a care receiver ranges from $400 to $500 per week in addition to all of the personal sacrifices caregivers make that they rarely want to discuss with parents. Sacrifices about careers, marriages, family relationships, time not spent with children, lost income, and the caregiver’s health and well-being that declines as a result of all of the stress of caregiving. I’m not here to try to make anyone feel guilty.

0:49:03:84 Pamela D Wilson: Caregivers do this because they love. With these considerations in mind about the importance of valuing and appreciating caregivers, I have one more quote from Henry David Thoreau: None are so old as those who have outlived enthusiasm. Enthusiasm and an interest in life are what keeps all of us going mentally and physically. It keeps us motivated, and it can keep us healthy into our later years. How about thinking of ways to minimize levels of care for elderly parents by helping parents to embrace health and well-being and then thinking the same for ourselves?

0:49:52:53 Pamela D Wilson: Here are a few tips to add positive experiences to the brain to help with decision-making based on positive experiences we have. Because remember, we make decisions based on our past experiences. First, the brain loves and benefits from exercise, as does the body. Physical movement gets the heart pumping and oxygen circulating through the body and the brain. Exercise is a mental and physical break from work or routine activity or caregiving. While getting started with an exercise program may take a little persistence, I’m proof that going regularly to exercise helps decrease stress, and after you work out—you feel better, happier, and have way more energy.

0:50:44:94 Pamela D Wilson: The next tip for brain support is sleep. We talk about this one from time to time. The brain in deep sleep clears out all of the toxins and noxious thoughts, as I call them. Sleep clears out the weeds from our minds. Sleep is like housekeeping for the brain. The third brain support is meditation. Meditation, especially transcendental meditation, is another type of housecleaning for the mind. Meditation reduces stress, anxiety, improves overall health and problem-solving abilities—especially helpful if you are a caregiver. Number four for our brains is reading.

0:51:29:83 Pamela D Wilson: This one should be obvious. Can you believe that many individuals, after leaving high school or college, never pick up or read another book, a magazine, or any type of reading material for the rest of their lives? Since I’m a reader, I can’t imagine not reading and, most of all, not even continuing to learn. Number five for our brains is listening to music. This one is interesting for a couple of perspectives. Music brings about positive memories when we match songs to people or life events.

0:52:09:66 Pamela D Wilson: Then there is the focus part of music. When we put in our earbuds and tune out the rest of the world. Listening to music can increase our concentration and reduce stress levels. We can also tune everyone else out. Music can make us happy. Next, I want to talk about nature. Henry David Thoreau spent time in nature—2 years exactly living at Walden Pond that I believe was on the property of his friend Ralph Waldo Emerson—another philosopher you may have heard of. One more Thoreau quote: “I went to the woods because I wished to live deliberately, to front only the essential facts of life and see if I could not learn what it has to teach, and not when I came to die to discover that I had not lived.”

 0:56:09:69 Pamela D Wilson: When was the last time you took a walk outside in nature, in the woods, in the mountains, by the beach, in the city, through a park, or in a quiet neighborhood? This last tip for our brains is being out in nature. Time in nature can reduce anxiety, frustration, and perseverating—or the idea of getting stuck on issues, people, or events that aren’t good for our brains. We all have an amazing opportunity to learn and continue to learn about the levels of care for elderly parents. We can learn how to help our elders, children, and families, plus ourselves, to live healthier lives.

0:54:01:25 Pamela D Wilson: Start by adding enthusiasm into your life by supporting your brain: exercise, sleep, meditate, read, listen to music and spend time in nature. Caregiving is hard work. Being a care receiver is stressful. By answering the question what are the different levels of care for elderly, we can learn to minimize the likelihood that we will need care, or if we are in a position of needing care, we can take an interest and become enthusiastic about activities that will help us maintain or improve our health.

0:54:43:45 Pamela D Wilson: Listeners, caregivers, aging adults, everyone who is here listening – thank you for caring for others. Thank you for your kindness, compassion, and understanding. Together we make the world a happier, healthier, and better place. Thank you for joining me on The Caring Generation. Please Invite your family and friends to listen each week. I am Pamela D. Wilson, caregiving expert, advocate, and speaker. I look forward to being with you again soon. God bless you all. Sleep well tonight. Have a fabulous day tomorrow and a great week until we are here together again.

0:55:21:85 Announcer: Tune in each week for 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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©2021 Pamela D. Wilson All Rights Reserved

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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