(upbeat music) - And welcome back to our Family Health Matters.

I'm Shelley Irwin.

With me today, Merrin Bethel from Emmanuel Hospice.

Hello to you, Merrin.

Good you're here.

Attorney Shawn Eyestone, Eyestone Law Offices.

Shawn, thanks for what you do.

Sarah Sobel from the Area Agency on Aging of Western Michigan, appreciate you as well.

And Patrice Conrad on behalf of Priority Health.

Patrice, thanks for you as an RN.

Here we go, a tough topic.

An important topic to talk about November is of course Family Caregiving Awareness Month and family, probably a key word here.

So let's do some even deeper introductions.

Patrice, tell us how you are involved with caregiving.

- As an educator for many years, I have always wanted to offer support for those who are not only needing the care, but also providing the care for their loved ones.

- Merrin, tell us about your specialty with Emmanuel Hospice.

- I serve as a Bereavement Coordinator for Emmanuel Hospice, which is a faith-based nonprofit provider of person-centered and compassionate hospice care.

And we've been serving patients and families in West Michigan since 2013.

So I provide grief support services to our patients and families and the community at large.

- Sarah Sobel tell us about your good work.

- Yeah, as a Contract Administrator for the Area Agency on Aging, our goal and our mission of our agency is to keep older adults in their home.

But my job is specially focused on caregivers because we know if we're gonna keep those older adults in their homes, we also need to focus on their caregivers and I'm taking care of them emotionally and physically.

- Shawn Eyestone, your expertise please.

- I'm an Estate Planning and Elder Law Attorney.

And my role is to help families have plans in place that are actually gonna work both for the caregiver and for the recipient to make sure that the people have the resources and authority that they need to make financial decisions and healthcare decisions for their loved one.

- Shawn, how would you define a caregiver?

- Well, a caregiver is anyone who is providing care for, it could be a relative, family member, spouse, neighbor, friend.

Michigan requires caregivers to be over 18, to have the legal authority, to make the decisions that need to be made, but it really can be anybody that is there to help provide care.

And we're talking about family caregivers today.

So I'm talking about family and friends, but it could also be institutional caregivers as well in home care.

Any of those things.

- Sarah, any expansion on that?

- Well, I think that oftentimes caregivers have a hard time identifying themselves as caregivers, but maybe if you say, are you helping this person out with groceries or a meal or getting things?

And if you say it like that, oftentimes people realize, oh, maybe I am a caregiver for my neighbor or someone else.

Sometimes just caregivers have a hard time identifying themselves as caregivers.

- How do you use the term, Merrin?

- I agree with Shawn.

I think it's anyone who's providing care to someone that they love.

And just making a note that there's billions of dollars in unpaid caregiving provided every year in our country.

- And Patrice obviously equal time and then expand with the positives, and we'll start talking some challenges as well.

- Well, I would also define a caregiver as anyone who provides love support, whether it's physically, emotionally, mentally, to someone who is in need of that extra support, and Priority Health is also committed to providing support for not only the care given, but the caregivers as well.

There are certainly positives and that's something that is often thought about, but not as focused on.

And that is that you do get that time to have that special relationship with the person that is needing your care.

But there are also, it is a drain, particularly for the sandwich generation, for those who are caring for maybe aging parents or aging aunts, uncles, loved ones, and then caring for minor kids and making sure that they're aware they need to be, it can be really draining, especially if you are trying to help everybody and working and getting food on the table for multiple different people in multiple different directions can be very draining.

- Sarah, would you expand on that?

- Yeah, I think another disadvantage is oftentimes we can make these plans.

Thinking about caregiving two years ago of maybe we have these plans that our loved one, the daughter would come in and check on the parents every Tuesday, well then enter COVID and now daughter's in quarantine and can no longer come in and check in her parent.

So I think the real challenge right now is that we're making these plans and we're making these plans for caregiving.

If it is a family member caring for a loved one or having a paid caregiver, but not all things are able to happen the way that we planned because caregiving has really evolved in the last couple of years with the pandemic and just some difficulties there.

So I think a real challenge is just it's ever changing.

- Shawn, you provide a caregiver empowerment guide and let's go back to the talk about the family that it is involved with caregiving.

- Surely, we have a guide that has resources and tools that families can use to have the conversations ahead of time, or have a plan in place, whether it's in writing or verbal, but just have everybody on the same page.

And a lot of what happens is people get into caregiving and then they get television, and they're just giving and giving and giving and giving.

And they don't realize that they're beyond the standard of care that they're able to provide.

And then they start running themselves down.

So having those markers in writing saying, when I get to this point, if it's toileting, if I don't want my daughter toileting me, or if it's some other thing where I can't get out of bed or we wanna bring somebody else in and having a plan for the other family members to rotate in whether it's once a week or once a month, just something there to give some respite to the caregiver and to have some structure.

So other people are holding you accountable to that plan.

So if you only said, you're gonna provide a certain level of care and you're beyond that, have somebody there to hold you to that.

So you're doing more than you said you would.

- And I trust in a perfect world these conversations should be had in our perfect world?

- Yeah, they should be had early and often.

Every year or every time the family is getting together, talking about health and it not only helps the person who you think you're gonna give care for, but it expands out beyond that because other family members, maybe a daughter-in-law is gonna be caring for her mother and she'll get some information from that or other family members so that it raises everybody's awareness just by having the one family, having the conversation.

- Merrin, I wanna go into your expertise when it comes to hospice, how can we care for someone who has a terminal diagnosis in the dying process, obviously using your services, but also caring for the caregiver?

- Sure, so for us, our patient's goals are our goals.

So we begin with the line, how do you want to live as a starting point for how to make every moment matters?

So I think respecting our loved one's wishes in terms of how they've chosen to die or how they've chosen to be cared for, I think is one of the best ways to honor the dignity and autonomy of every person in our life.

And I agree with Shawn that it's never too early to learn about hospice care or end of life care to know before you need asking early and often for support.

And especially as a caregiver, he's so right when we're in the middle of that, that's our reality.

And so many people we hear so often I wish I would have called sooner, and having that whole additional layer of support on top of the providers that are already in your life is just invaluable.

And so many people report to us that they just feel such a robust sense of support asking for that help earlier, rather than later, especially because we know that hospice it's just a last hour service, but something that could be provided to allow people to live their most golden years on their own terms.

- Heads are nodding.

Patrice, follow-up on that.

And then I'd like you to delve a little bit into you as an RN, knowing the physical stress on that caregiver.

- Absolutely.

I would also just like to add my comments about early is good.

One of the things that can happen as we all know as the disease progresses, the person who is ill may have some mental changes that happen.

And so now we're not really talking to mom anymore.

Now we're talking to mom in a different way, or dad may say something that I want this, or I want that because dad's mentation has changed, or mental status has changed, that may not really be what he wanted.

So have those conversations while people can really be themselves and be in their best or relative best place to have those conversations.

I just like to reiterate that as well.

Certainly, the caregiver needs care.

I've heard for years, I've been a nurse for over 40 years.

You can't draw from an empty well.

You wanna give, I wanna give to my kids.

I wanna give to my aging parents, I wanna give to my beloved aunt and uncle, I wanna give, but if I keep giving and I don't do anything to help myself, there's gonna come a time when something could happen to me and now nobody gets care for me.

So not only am I stressing myself out and potentially emptying myself on, I may be leaving others where if I'm the primary caregiver and I get sick because I've drained myself down to nothing.

Now we have to redo the entire plan.

So it's not selfish.

It's actually selfless to take care of yourself.

It's actually important.

Some questions to ask yourself, am I getting enough sleep?

Am I hydrated?

Am I eating nutritionally?

It's not always gonna be possible to do that, but am I doing that?

How am I feeling?

And then by all means, ask for help.

- Sarah, would you expand?

And I know that the agency has many opportunities for reach out and ask.

- Yeah, so one thing that we do is that we provide a virtual caregiver support group for caregivers.

That's something that we've been doing during this time.

So that's one way that caregivers can meet other caregivers.

Talk to them.

It's led by a licensed therapist who is able just to go through some questions.

Lot of caregivers will glean support from other caregivers as well, maybe bits of wisdom or things that they've tried that have worked for them.

One thing also that I would like to mention is the need for respite.

As Patrice mentioned, too, that caregivers need to take care of themselves, but can they find a time that somebody else can stay with their loved one a couple of hours a week for them to get out and go for a walk or do something that reenergizes them.

If that's meeting a friend for lunch, kind of a standing appointment, or go out and go to a therapy session for yourself, but is there something that the caregiver can really do to set time apart to be an individual themselves and not just a caregiver?

- Thank you for that.

Most caregivers are unaware of government programs.

I want turn to you, Shawn, as part of your empowerment guide, you do talk finances.

Tell me more.

- We do, a lot of people get involved with the caregiving and they spend and spend, and they don't really talk to anybody about what benefits are out there.

There's veterans' benefits.

There's Medicare benefits.

There's Medicaid benefits.

The area agency and aging has programs that they can use.

There's all of these resources, hospice resources that people can use.

So they don't have to impoverish themselves.

And just having the conversations with as many people as you can and getting as much information as you can will help get you there.

If somebody looks like they're gonna have to go into nursing home, I think it's always best to meet with an elder law attorney and go over the finances, talk about it with your financial advisor, what can you afford to do?

What can you do with your assets to qualify for benefits sooner?

There's a lot of things that people can do that they don't.

And we hear the same thing.

People waited too long, or a hundred thousand dollars into the spending on nursing home care in-home care before they even try to apply for benefits.

So again, start early and make sure that there's a plan in place.

If you're gonna have paid caregivers, you've got to make sure that those agreements meet the requirements so that you don't get excluded from benefits down the road.

Same with gifts.

If you're giving away your assets, you got to make sure you do that in the right way, or you might not be able to get benefits down the road too.

I mean, those are just some of the mistakes that people do.

Just not knowing what's out there.

- Thank you for that.

Merrin more on your Emmanuel Hospice.

I know there's programming opportunities within your good services.

- Yeah, so as the holidays are approaching, we know anyone who's experienced a loss will relate to the fact that the holidays are difficult, whether it's the first holiday after loss, or it's just kind of triggering those memories.

The holidays are so full of senses.

We expect to eat certain things, hear certain music, see certain people and expectations are high.

And then if we add grief and loss or illness, right, prolonged illness, caring for a loved one on top of that.

And then we have the pandemic as an added layer as well.

It's just a very stressful and chaotic time.

So we just like to offer as robust support to our community as we can through a grief support group programming, as well as support for caregivers as well.

So we have several events through November and December offering those services.

- Great, obviously we'll get your contact information before we are finished back to the topic.

We have to reinforce it of stress and obviously catching it early or maintaining it.

Patrice stress can lead to chronic problems to expand.

- Absolutely, it can contribute to hypertension.

It can contribute to heart disease.

It can increase the probabilities or the severity of diabetes and blood sugars.

And it can also contribute to anxiety and depression.

So it's really, really important for not only the person being cared for, but equally, or if not more so for the caregiver to make sure that they take care of themselves.

And we do offer some programs for caregivers.

We have a care management.

If they wanna talk to someone, they have a behavioral health care manager.

We also have an digital program that's an app that we offer free to all of our different lines of business, which can help with anxiety, depression, stress, that kind of thing as well.

- Yes, Sarah, are agencies such as yours located throughout USFA say if I have a loved one in a different state, could you here locally help me with that?

- Yeah, so all agencies, the Older American Act Funding is required that there is an agency that funnels that money through for every part of the nation.

So the Elder Care Finder, you can look into that.

Otherwise we can help you, the Area Agency on Aging, put in a zip code to find what is the local entity that funds and does the Older American Act program.

With the Older American Act program, there is funding for caregivers for support in there that's mandated.

So all places that provide the Older American Act will have some sort of caregiver assistance program as well.

- Yes, Shawn, back to your empowerment guide, I'm looking through the list.

You spend some time talking about falls and this problem that could happen to a caregiver and again, treble in the neighborhood.

Talk to me about why this is included.

- Sure, a lot of people don't really have a plan in place for if somebody falls, even though people as they age, fall, quite often, if it's an elderly caregiver and an elderly person getting care, it's difficult to get that person back up on their feet.

Just the stress of it.

Somebody is laying down, are you gonna call the fire department?

Are you gonna call a neighbor?

What's the pecking order for who's gonna come and help?

And it gets back to the self care.

If you're a hundred pound woman and you're picking up a 250 pound man or trying to do that, it is not gonna go very well.

You're gonna strain your back.

You could have all sorts of injuries and you could end up on the ground right with them.

So having that, just a simple plan, if I follow this is what's gonna happen, I'm gonna call these people.

So you've planned through it.

The steps in advance that this is what's gonna happen.

So you're not scrambling.

They go, should I call this person?

Should I call this person?

Is it serious enough?

So just having that planning in place.

- Preparation again.

Merrin, talk to me about where holistic care falls into play into your services.

- Sure, so as Patrice was hinting at the physical stress can absolutely result in emotional and mental stress and vice versa.

So for us, holistic care is something that we're really passionate about and providing to our patients and really anybody that's in the unit of care, which just means anyone that the patient calls family.

So that could be family of blood or family by choice.

And for example, in addition to the expert medical care that we provide, we have a variety of complimentary services, including massage therapy, massage therapy, acupuncture, pet visitors, essential oils, virtual reality, to just care for the whole person.

So those are some ideas that you can employ in your own life as well just looking after that mind, body and spirit, because we know that especially as we are under stress, those things are all interrelated, so.

- Yes, Sarah, do you have specific programs safe for veterans or other niches?

- A lot of the veterans programs are through themselves.

We fund a lot of the same services such as Adult Day is funded through Older American Act and the Kent County Senior Millage, but then veterans also can get assistance for our program like Adult Day.

So for the veterans, I would just encourage you to contact your caseworker or the veterans administration to figure out what programs are provided for you.

- Yes, and Patrice, back to that word of family.

What if a child, well, an adult child is across the country from the caregiver.

How is that best handled in these times?

- Well, I think Sarah alluded to the fact that you can go into your local area on aging.

I would certainly want to contact someone in the area and have eyes and ears available.

So if, for example, my loved one was in California.

I might see who a neighbor is.

Could you check on aunt Cialli a couple of times a day?

I know that even in my family, we had a neighbor who my uncle would turn the light on and off at different times.

And if he didn't turn the light on or off, the neighbor knew they had to come over and make sure that my uncle was okay.

So there's all kinds of different things you can do with local people that isn't a big demand on them, but can be of great comfort to the caregiver to know that at least someone is checking on them and making sure they're okay.

- Yes, and this topic also included in your report, Shawn, where most extended families are willing to help, but are unable to.

And again, mom may not want to ask for help.

How do you handle that?

- We try to foster that communication.

When we do the planning, when you're naming somebody to make decisions, when you're not able to, who's gonna be the backup?

How are they gonna communicate with one another?

What does that line of communication look like?

And having them go through, when should they ask for help?

So when they're not in the middle of it, it's easier to say I'll ask for help if I'm not getting enough sleep or if I'm not getting out once a week.

So having those parameters in place, and then having the family call and check in and have an agreement amongst them, how it's gonna happen.

Like she said, go and talk to the neighbors, and make sure they're able to check in on them and the community is gonna help care for the community members usually.

- What do you add to that, Sarah?

- No, I just think that's a really good suggestion of making sure that people are in place around talking about it.

This is also where we go back to pre-planning, sit down.

You might not know that mom has a really good relationship with someone at church that when you're making a caregiving plan, she wants that person involved.

So again, talk to them, talk often, talk frequently.

I think that if you're hearing anything from all of us, I think that's one thing we are agreeing on is just making sure these caregiving plans are put in place early.

So I do really agree with all of that and making sure that you're on board to see who people are caring for.

- Merrin, another piece of advice in your niche is to include anticipatory grief in conversation.

Tell me about this.

- Yeah, so if you're a caregiver for someone who you're expecting an impending loss, so you know that they don't have many years left or much time left, we do experience grief even before someone passes away.

I think this is especially true if caring for family members with dementia or any kind of cognitive deficit or memory loss, because we experienced loss each time they have declines in cognition or their personality starts to change as the disease progresses.

So we experienced grief in that way too long before someone passes.

And some things that we can do is just to contemplate how we want to spend the remaining time to make the most of that, as well as what kind of legacy can we help our loved one create while they're still maybe their own decision-maker, connecting with others who understand through all of our agencies here, right?

And whether that be through support groups or other supportive programs.

And then something that I preach often is just a practice self compassion.

So whatever you're feeling on a given day, recognizing that it's natural and probably of course, there's great reason for you to feel the way that you're feeling and to just practice that acceptance and non-judgment towards yourself.

- Yeah, Patrice, what else would you like to share before we start our closing comments?

- I just wanna go back to again, getting that caretaker to take care of themselves before they have a stress induced problem.

And before they end up with so much resentment and frustration, that it just becomes a burden.

It isn't a burden all the time, but the more you don't give yourself a break, the more likely you are to just become overwhelmed and either not be able to care or have it be a chore.

So take advantage of those people who say not advantage, but I mean accept the help from people who say, "Hey, can I do something?"

"Yeah, could you come sit with me on my relative for an hour?

Just let me have some peace.

Can you run my kid to basketball practice or whatever?"

- Great, dow do we find out more about Priority Health.

- Priorityhealth.com is the best way to go.

There's a search bar, search for whatever you want.

Also, if you have Priority Health on the back of your card, there's an 800 number.

If you're not a person who likes to be online and you can talk directly to one of our customer service reps who will help you.

- Thank you for you.

Sarah, what do you leave us with?

- Again, look for resources.

Our website is aaawm.org.

Look for website of caregiver classes, get informed, start making a plan, see what you are comfortable at, what mom and dad are comfortable with.

What are they looking for?

Expectations as they age, and then try to create a plan of people around you that will help with that caregiving journey.

- All right, and again, all the information on your upcoming programs is on your website?

- Correct, AAAWM.

- Thank you very much.

Shawn Eyestone, tell me more about what you leave us with.

- Yeah, I think all of that is all good information.

The planning is important from a legal standpoint, we suggest that everybody take a look at their plan at least every three to five years or when there's a serious life event, birth, death, disability, illness, marriage, divorce, any of those things pull out the plan.

See if you still understand it, see if the people that you have named are still gonna be able to do the things that you want them to do.

And then have that caregiver discussion as an ongoing thing.

And we have resources as well on our website, which is eyestonelawoffices.com.

The guide that we alluded to, it's free to download.

I set up a special website, guide.eyestone.law, G-U-I-D-E-E-Y-E-S-T-O-N-E-L-A-W. And our phone numbers are available on the web to.

- Yes, and I see you do offer respite care resources for, there are adult daycare centers in our own backyard.

There is the Alzheimer's association.

We know the growing numbers there and other disease specific organizations, Shawn.

- Yeah, the area agency and aging has all of that information all in one spot.

So that's typically where we'll send people because they have all that information and they can find the resource that works best for them.

- That's why Sarah, so busy.

What do you leave as with Merrin Bethel on behalf of Emmanuel Hospice?

- Sure, I think that self-education is such a powerful tool.

Again, not being afraid to search online or pick up the phone and call on any of these organizations and just saying, "Hey, can you tell me more about this?

What do I need to know?

What can I be looking into?"

There's so many people who can help you.

There's just no shortage and things like hospice, there's lots of misconceptions out there.

Our passion is to help people and to provide that support and that respite there's so many options.

So just looking into things, don't be afraid to ask.

- What's one of the biggest misconceptions?

I think you alluded to it, but.

- Yeah, I guess that it is just a last hour service.

Whereas in reality, we routinely have people on service with us for years.

And people often discharged from our service due to improved prognosis as well because of that holistic care caregivers feeling a real sense of relief that having a whole additional layer of support there.

- Great, you all are in agreement to your heads are nodding.

I can only see that, lucky me.

Thank you.

Lucky you for caring for those who need the care.

So on behalf of, of course, this Family Health Matters, thank you all for your expertise.

Go get 'em and thanks for serving our community.

And as always, thank you for you for tuning into our Family Health Matters on Caregiving.

Enjoy your day.

These are available online wgvu.org.

Take care.

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