Transcript
Speaker: Angela's father was being discharged from the hospital in 72 hours. And in those 72 hours, she spoke with a discharge planner, a social worker, a home health coordinator, someone from a rehab facility, a very friendly person from a senior living referral service who seemed to appear out of nowhere, and a cousin who knew a guy who was an elder law attorney, or was it and maybe an estate attorney? No one was quite sure what the difference was. So that's six professionals, six sets of advice. And later when I asked Angela what the hardest part was, she didn't say the medical decisions. She said, I couldn't figure out who all these people were, who they actually worked for, or who was in charge.
Speaker: It turned out the answers were it's learnable, not always you, and no one in that order. So today to go over all three. The complete roster of professionals in the aging world, what each one actually does, one question that instantly reveals whose side anyone is on, and how to make sure your family has a quarterback before the 72 hour clock ever starts.
Speaker: Stay with me. Welcome back to the Aging Parent Playbook. I am Dr. Barbara Sparacino, triple board certified psychiatrist in adult psychiatry, geriatric psychiatry, and addiction medicine, and I am the aging parent coach. And I'm back, rested, unpacked, and genuinely glad to be in this chair again. Thank you for every kind of message I receive. Follows away, my team showed me the highlights, and you are the reason I i continue to do this.
Speaker: So this is episode 70, and it's the episode I find myself teaching in fragments on almost every strategy call. So it's time it existed in one place. Now, who does what in the world of aging care?
Speaker: Let's go over the standard reminder that stories on the show are composites, details change and combine to predict privacy. And this is education, not legal, financial or medical advice for your specific situation.
Speaker: Today's episode will make your conversations with all of those professionals dramatically better. It does not replace any of them. Okay, so part one, the 72 hour problem.
Speaker: Now let's stay with Angela for a bit because her 72 hours is where most families first meet this cast of characters and it's the worst possible classroom right? A hospital discharge is a deadline. The hospital needs a bed, the insurance clock has been running, and the family is handed this enormous set of interlocking decisions where where he will go, who will care for him, who pays. Is going home even an option?
Speaker: At the exact moment they're most frightened and least informed. So into that vacuum walks a parade of well-meaning people with badges and titles and the family quite reasonably assumes they're all on the same team.
Speaker: They are not all on the same team. Most of them are good people doing honest jobs but every one of them works for someone. and who they work for shapes what they can do for you.
Speaker: The discharge planner works for the hospital system whose legitimate goal is a safe discharge on the hospital's timeline. The home health coordinator often represents a specific agency, the friendly senior living referral service and hold this thought because we're gonna go deep into it on next week is often is very often free to you because it's a paid commission by the facilities they recommend none of this makes anyone a villain and makes them players with positions and so a family that doesn't know the positions can't really read the field right so the goal of today is simple you're going to learn the roster now calmly at podcast speed so that if
Speaker: 72 hour clock ever starts for your family you already know who everyone is what to ask them and who's actually yours right so one fair question before the roster why does no one explain in this field to families and look this is there's not a conspiracy it's because the aging world is genuinely fragmented medical legal financial residential and social services grew up as separate industries with separate training separate payment systems and separate vocabularies and every professional inside it sees their own slice clearly and the whole field a little more timely. The discharge planner is not hiding the elder law attorney from you.
Speaker: Discharge planners simply do not know the law that it doesn't impact them. The attorney is not concealing home care economics. attorneys don't do staffing. Each one hands you a competent piece and the family is left assembling a puzzle where you know every piece came from a different box.
Speaker: So today we dump all the boxes on one table and we're going to figure this out. Now part two the medical bench. let's build a roster starting with the medical side so we have your primary care physician the home base for many families this is where everything routes through and the most underused sentence in aging care is a direct question to this person the primary care physician we're seeing changes can we get a full evaluation and what should we be planning for bring your list ask for the time time. A geriatrician is a physician who specializes in older adults the way a pediatrician specializes in kids. Not every aging parent needs one and there aren't nearly enough geriatricians but when the picture gets complicated many conditions, many medications, many specialties not talking to each other. A geriatrician's whole training is that
Speaker: is unraveling that exact tangle, right? The specialists you'll likely meet along the way are also neurology or a memory clinic for cognitive workups, cardiology, you know, and the rest is the bio dictates.
Speaker: The family's job with specialists isn't medical expertise, it's coordination. It's keeping the medication list current, making sure each one knows what the others changed and taking notes. And yes, that job description is exactly why the quarterback question matters, which is what we're building towards.
Speaker: Now, geriatric psychiatry, my corner, it's where cognition, mood, behavior, and medication all intersect. When depression looks like dementia or dementia arrives with agitation or paranoia or the medication list itself, seems to be causing the fog that's the specialty that's a tangle my specialty entangles right and then we have physical and occupational therapy strength coordination and function you heard me saying the praises of the occupational therapists in the last week's episode about home safety yet that home evaluation remains one of the best kept secrets of the whole roster and home care where one word changes everything so listen closely home health
Speaker: is generally is skilled and clinical so it's nurses therapists typically short-term after often following a hospitalization and often covered by insurance when ordered by a physician home care is non-medical is help with daily living things such as bathing meals companionship driving this is usually hired privately and paid out of pockets it can range from hours to run round-the-clock care Families conflate these two constantly and the confusion costs real money and real planning time. Two different services, two different payment world, one nearly identical name.
Speaker: So now you know. And two more medical bench members before we move to the money side. And both again are chronically overlooked. So first, the pharmacists. Your parent's pharmacist sees the whole medication list across every prescriber and is trained specifically in interactions and will review the list with you for free. In an era of five specialists who don't talk to each other, the pharmacist is often the only professional besides you who sees everything and they are standing behind a counter not even 20 minutes from your house wondering why nobody ever asks.
Speaker: So use them. Second, and I want to handle this one with care, palliative care and hospice. Families flinch at both words and the flinch costs them dearly. So let me give you the literacy now, calmly, hopefully years before you may need it. Palliative care is specialized support focused on comfort, symptom relief, and quality of life for people with serious illness and here is the part almost nobody knows it can run alongside full active treatment accepting palliative care is not giving up it is adding a team whose entire job is that your parent feels as good as possible while everything else proceeds now hospice is a specific version of that care for the final stretch of life when the goals shift fully to comfort and the most common thing families say afterward is
Speaker: We wish we had called them sooner. You do not have to make any of these decisions today. You just have to fear the words so that if a doctor ever offers either one, your family, here's help. but Surrender.
Speaker: Now we have part three, the legal and financial bench. So now the money and paper side of the roster where the job titles fool almost everyone. So an elder law attorney versus an estate planning attorney. Here's the clean version. Estate planning is mostly about what happens to assets after death. So it's think wills, trusts, inheritance.
Speaker: Elder law is about protecting your parent and their resources while they're alive. So power is attorney done properly. Planning for long-term care costs. Benefits eligibility. Protecting a healthy spouse's spouse's finances while the other one needs care.
Speaker: And guardianship matters. if it comes to that. So there's an overlap and many attorneys do both, but if your project is the living years, ask specifically about elder law experience. Long time listeners already know my feelings about the documents themselves.
Speaker: Episode 66 is the deep dive if you missed it. So we have a financial advisor and CPA. So this is the long game bench. What does care actually cost in your area? How long do the resources you have last at each level of care? What's the tax smart order to draw things down? Does any long-term care insurance policy from 1997 still mean anything?
Speaker: The families that bring their advisor into the aging conversation early make calmer decisions for a decade. The ones who don't often discover the money questions and the care questions were always the same questions. Geriatric care manager also called an aging life care professional.
Speaker: I've called them the general contractor before and you know I'll stand by that because they assess the whole situation, build the care plan, know the like the local landscape, which agencies are actually good, which facilities to see and can serve as the professional quarterback liaison for families who are long distance. divided or simply underwater. They charge for their time, typically hourly, and for the right family, they're the best money on this entire list.
Speaker: Social workers and discharge planners, often the same training different employers, and by now you know why that sentence matters. A hospital discharge planner can be skilled, kind, and genuinely helpful, and their job is still a safe discharge on the hospital's timeline from the hospital's list of options. Take everything useful they offer. Just know the position they're playing.
Speaker: And senior living referral and placement services. The friendly folks from Angela's 72 hours. Most of the big national ones are free to families because the facilities pay them a commission when you move in. Sit with that business model for a second.
Speaker: Free to you, paid by the supply side. which means the list you receive is drawn from who pays them, not from everyone who exists. And some placement people are wonderful and genuinely helpful, but whose interest shapes the list is not a real question. It's the question, the question you need to be asking. And next week I'm dedicating an entire episode to how that industry actually works, what a major invest newspaper investigation found inside, and what I believe families deserve instead. So remember, join that one, bring a friend.
Speaker: And one more section of the bench that families forget to staff because every position so far has been for your parent, the positions that exist for you. A therapist, when the grief, the guilt, or the old family wounds are doing real damage, that is that work looking backward and inward and is the right and it is the right tool for that job. A caregiver support group would to be free everywhere. It's online. at 9pm after everyone's parents are settled and it's full of people who never need the backstory explained because you know they're there and a coach which is my own position on this field so take the disclosure with the description coaching is the forward-looking structural work the plan the scripts the sequencing the decisions a therapist helps you carry the weight a coach helps you shrink the load
Speaker: Different tools, different jobs, and the strongest caregivers I know are not the ones who need me neither. They are the ones who staffed their own bench on purpose without waiting for permission. So part four, the one question and the quarterback.
Speaker: Now, so how do you keep a roster this size straight in real time in a hallway with a clock running? One question asked warmly of every professional you meet. How does your service get paid? And look, this is not because paid gets this means bad. Everyone on this list deserves to earn a living. And the ones you pay directly are often the most unambiguously yours.
Speaker: You ask because the answer instantly maps the field. Paid by the hospital. Helpful on the hospital's clock. Paid by the agency. Helpful from that agency's menu. Paid by facilities on commission. Helpful from the list of who pays.
Speaker: Paid by you directly with a fiduciary or a clear fee. This person's incentives point at you. You can love and use people at every category once you know which category you're in. And two follow-ups if you want the full picture.
Speaker: What is exactly your scope? And how do you coordinate with the others? Professionals worth having will answer all three easily. Anyone who gets slippery about the first one has answered it anyway. That's their answer.
Speaker: And let me show you the question working because tone is everything and the tone is warm, not prosecutorial. So the reserve referral service. This is so helpful. Thank you. Just so I understand how this works. How does your service get paid?
Speaker: And when the answer is the communities pay us when a family moves in, you smile and say, oh yeah, that makes sense. And simply hold the knowledge. This kind person is showing me the menu of who pays her. and there may be excellent options that are not on this menu.
Speaker: To the discharge planner, I know you are working on a timeline. Help me understand what the timeline is and what our actual options are, including ones beyond this list.
Speaker: You are not accusing anyone. You are asking for for the map and professionals respect families who ask for the map. The ones who bristle at the map question, you know, have also told you something. Now, the quarterback.
Speaker: Here's the uncomfortable truth. Angela discovered the system does not supply one. Every professional on that roster owns a position. Nobody owns the whole field. And the coordination job, tracking the big picture, holding the family's actual goals, sequencing the decisions, lands by default on one adult child.
Speaker: Unpaid, untrained, at 11 o'clock at night. Does that sound familiar? It should. it's all It's the mental load episode wearing a different coat. And so nobody's guessing, here is a quarterback's actual job description because you cannot assign a job no one has to find.
Speaker: The quarterback keeps the master picture, the current medication list, the bench roster, the documents, and they know where they live all one place so the family can see.
Speaker: The quarterback sequences, what decision has to happen before what and what can wait. The quarterback holds the goals, what dad actually said he wanted back when he could still say it. so that every professional and every professional's recommendations gets measured against his wishes, instead against the loudest voice in the room.
Speaker: And the quarterback runs a communication rhythm, the monthly family call, the shared document, the updates that keep the far siblings inside the circle. Notice what's not on the list.
Speaker: doing all the care personally. Quarterbacking is a coordination job, not martyrdom. And confusing the two is how the most devoted child in the family ends up the sickest. So make it explicit instead of accidental.
Speaker: Someone one must be the quarterback and there are exactly three honest options option one a family member takes it on purpose named out loud and the family meeting with the lanes language from episode 67 and with real support option two you hire the role most commonly a geriatric care manager and the family stays the decision maker while a professional runs coordination option three and this is my lane, so again, take it without disclosure.
Speaker: The family member keeps the role, but gets a coach. Someone who's walked hundreds of families through the field, who helps you build the plan, prep the conversations, and see around corners. oh you're the quarterback with a coordinator in your ear, instead of alone on the field.
Speaker: Different families, different right answers. The only wrong answer is the default. Nobody until the 72 hour clock decides for you. One more practical layer.
Speaker: You do not hire this bench all at once. Trying to would be overwhelming and unnecessary. The bench gets staffed in stages that match where your family actually is.
Speaker: In the noticing stage, the little things adding up stage, you need exactly two positions filled, a primary care physician who is taking the changes seriously and the legal documents done, which may mean one engagement with an elder law attorney.
Speaker: That's it. That stage is also the cheapest and the calmest time to do both. So that is the whole thesis of this episode. The complex and and the complexity stage. but There's multiple conditions, multiple helpers, a long distance family or siblings who cannot agree. That's when the geriatric care manager and possibly the geriatrician earn their seats.
Speaker: And when the financial advisor conversation stops being optional. and in transition stages ah hospitalization a move a new diagnosis that is when the bench you already built gets used rather than assembled at gunpoint that for the stage you're in with one eye on the stage that's coming that's the entire art of it part five the 72 hours replayed before your assignment let me replay angela's 72 hours the way they go for a family that did today's homework a year earlier Because the contrast is the whole argument.
Speaker: So the call comes, dad is being discharged Thursday. The prepared daughter opens the family shared document where the bench roster already lives. She calls the elder law attorney's office. No, she doesn't need to because a durable power of attorney and healthcare proxy were signed two years ago and the hospital already has copies on file. So every conversation with the care team includes her.
Speaker: legally from get-go. She meets the discharge planner and asks warmly for the map, the timeline, the full range of options, what insurance covers, and for how long.
Speaker: She knows the difference between home care and home health. So when the planner says he qualifies for home health, she knows that this is that this is a short-term skills kind, and she's already pricing the non-medical home care that will need to follow it using the agency her geriatric care manager vetted last spring.
Speaker: The friendly referral service that calls, she thanks them and mentions the family already has a care manager and the call ends in 90 seconds. No hard feelings.
Speaker: Her brother, owns the financial lane, pulls the numbers that afternoon, what rehab costs after day 20, what the long-term care policy actually covered, how many months of home care, the savings support.
Speaker: By Wednesday night, the family holds a 20-minute phone call, three agenda items, care manager presenting, and makes a calm, informed decision that dad himself, per the documented conversations from two years ago, would have chosen.
Speaker: Same hospital, same 72 hours, same loving family. The difference is not luck, money, or medical knowledge. The difference is that every question got answered before it was urgent. And that is the entire philosophy of this show compressed into one story and it's available to your family.
Speaker: starting with 10 minutes of homework tonight. So this week's assignment is the bench audit. Take 10 minutes and write your parents actual roster as it exists today, primary care physician, any specialists, attorney, and which kind, financial advisor, any care already in the home, which kinds, is it home health or home care? Then answer two questions in writing, which positions are empty,
Speaker: And who is a quarterback right now on purpose or by default? And for most families, this takes 10 minutes and produces one uncomfortable, extremely useful sentence. Bring that sentence to your next family conversation or bring it to me because here's the news. I promise I'm back and my strategy call spots are open. Again, if your bench audit produced that uncomfortable sentence, if the quarterback is you by default and it's costing you sleep,
Speaker: Time, energy, comment the word call on any of my posts and let's spend 30 minutes looking at your family's feel together. You'll leave with clarity and for the written companion to today's episode, the full bench roster with the three questions, comment system, and it's yours. Here's what I want you to remember from today.
Speaker: Every professional in your parents' world works for someone and knowing who is not cynicism, It's literacy. Ask how the service gets paid, fill the empty positions before the clock starts, and name your quarterback on purpose.
Speaker: And it today felt like a lot of names and positions. Let it settle into the simple version. Two documents, one doctor who's paying attention, one question about who pays, boom and one named quarterback.
Speaker: A family with those five things is more prepared than 90% of the families who walk into that 72 hours. You can have all five within a month and most within a week.
Speaker: Next week, the free senior placement industry, how it really works, what the um investigation found, and why I built my practice on the opposite model. You won't want to miss it. I'm Dr. Barbara Sparacino. This is the Aging Parent Playbook. New episodes each week. I'll see you next week.
Speaker: Thank you and take care of yourself.
