From Denial to Prepared: A Family Roadmap for Aging & Care Decisions with Annalee Kruger

Steadfast Care Planning host Kelly Augspurger sits down with Annalee Kruger—caregiving strategist, author, and elder planning educator—for a candid conversation on the “what-whens” of aging. They break down early red flags, why families get blindsided, and how proactive planning can protect relationships, finances, and care options before a crisis hits. 

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Come back next time for more helpful guidance! 

Transcript

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Kelly Augspurger [00:00:02]:
Hi, everyone. Welcome to Steadfast Care Planning, where we plan for care to live well. I'm Kelly Augspurger, long-term care insurance specialist and your guide. With me today is Annalee Kruger, author of "The Invisible Patient: The Emotional, Financial, and Physical Toll on Family Caregivers". She's also the creator of Elder Planning Specialist Certification Program, creator of Aging Strategy Coaching Academy, and a national speaker on aging, caregiving, dementia, family dynamics, mediation, and end of life. Annalee, I'm tired just thinking about all those things you do.

Annalee Kruger [00:00:38]:
I'm tired doing it.

Kelly Augspurger [00:00:39]:
Oh, my goodness, it's a lot. But because you're doing all these things and you have created all of these things, it means you have a lot of experience and expertise. So I'm really excited that you're here to talk about...really what we're going to talk about is how to prepare for caregiving and extended care. That's the gist of the conversation. So can we jump right in?

Annalee Kruger [00:00:57]:
We absolutely can.

Kelly Augspurger [00:00:58]:
Perfect. So, let's talk about what planning for the "what whens" of aging, as you call it. Not the "what ifs", but the "what whens". We know that none of us get more mobile, more able-bodied, more cognizant and more independent as we age and that we have to face some realistic expectations that we'll probably need care. So what are some indications that you or your loved one is failing at home, Annalee?

Annalee Kruger [00:01:24]:
The red flags are weight loss, memory confusion, or memory issues, or more confusion where they probably aren't taking their medications properly, they're missing their doctor's appointments, they're wandering out of their house, they're showing up to doctor's appointments when they don't have doctor's appointments, hospitalizations and ER visits, falls. When you go to visit, if they're full of bruises, that's probably an indication that they're falling. And they may not remember, or they're not telling you, or worse or just as bad, someone is the caregiver there and they are hurting your loved one. And that's where the bruises might be coming from. Scams...but that's not necessarily fair because these scammers are so good that you and I can get scammed. In fact, I'm dealing with a scam issue right now. So our vulnerable adults are definitely at risk of getting scammed because they're such a trusting generation.

Annalee Kruger [00:02:19]:
So those are some indications. If their clothes don't fit, if they're driving, and when you come to visit, there's like four dings in the car and dents, that's probably a good sign that they're getting into fender benders. And then from a financial perspective and bill pay perspective and mail management perspective, if they have stacks of mail, they're probably not managing their finances very well. And so that means that they might not be getting their car insurance paid, or any other bills properly taken care of. A lot of times I've worked with families because the adult kids can only visit so many times throughout the year.

Annalee Kruger [00:02:57]:
Because of work and family and multiple aging loved ones that they're blended families that they're trying to kind of oversee as much as they can remotely. But then when they come to see their parents in person and they're like, "Oh, my gosh, Annalee, there were 4 months of bills stacked up, and dad got an eviction notice, and he didn't know what to do with it. And when I opened up the refrigerator, it was full of rotten food. It smelled so bad because the food and the milk, everything was rotten. He lost all this weight, and he's been eating frozen food because he doesn't know how to use the microwave anymore." So those are all real life examples of when things are clearly not going well at home.

Kelly Augspurger [00:03:34]:
And there's a lot to consider there, right? There's a lot of indications, a lot of red flags to look at financially, but even physically and what do they own? Can they keep up with these tasks on a regular basis? It's a lot for a fully functioning adult to do everything that we need to do throughout the day to take care of ourselves and take care of the things that we have and the people or the pets that we're responsible for. So add on, okay, we are now maybe in our 80s or in our 90s, and we are slowing down. It's a lot harder. It's definitely a lot harder to do.

Kelly Augspurger [00:04:07]:
So, okay, if we have those red flags, we have these indications, maybe it's time for some assistance, it's time for some home care, or it's time to consider maybe assisted livings. Talk through what's the landscape of senior care? Talk about care levels, waiting lists, quality of care. What do we need to consider?

Annalee Kruger [00:04:25]:
Yeah, when we do aging planning, because that's what we do is, I call it aging planning, but it's actually mostly crisis planning, because when families realize things aren't going well, then they're like, "Oh, my gosh, Annalee, it's time that we need to figure out what to do with mom and dad now." So what is the landscape of senior care? Now just keep in mind this is an educational podcast, but it's going to scare the bejeezies out of you because I'm going to tell you like it is. In the real world, what's happening in our senior care, care is expensive. A lot of our clients and our clients are the whole family. So when I ask mom and dad, "What are your goals as you age?" It's always the same two things: "I want to age in place at home and I don't want to be a burden on my kids," except that the adult kids who have already reached out to me to be like, "Oh my gosh, I don't know what to do with mom and dad.

Annalee Kruger [00:05:08]:
But, what we're doing isn't safe, or sustainable. We need help." And so adult kids goals are, "I want my parents to be safe, happy, have the best quality of life and the best quality of care possible." So the only way to make sure those things happen is putting an actual plan in place. But when people say that they want to age in place at home, what they're not realizing, Kelly, is that it sounds good out loud. But the reality of it is this, these are the things you need to think about. Cost. So many families assume that Medicare is going to pay for all of this home care, or that if their parents are on Medicaid, that Medicaid is going to pay for all of this home care 24/7 and that is simply not the case.

Annalee Kruger [00:05:47]:
That is not how that works.

Annalee Kruger [00:05:49]:
Home care is an out of pocket expense unless you have long-term care insurance, or you're using VA benefits, or you have a reverse mortgage, or however else you've kind of orchestrated how you're going to pay for care. But the bulk of the people are paying, you know, $30K to $40K a month for one companion, 24/7. When people say they want to age in place at home, they're still upright, talking and making decisions and driving, or playing tennis, or whatever. They're like, "Oh yeah, I want to stay at home until I pass away." They're not fast forwarding in their brain about when the time comes that they actually need help with bathing, dressing, grooming, medication management, driving to doctor's appointments, wiping their bottoms, showering them, putting lotion on them. When you are that vulnerable and dependent...because like I always say, none of us get stronger, more able bodied, more mobile, more cognizant and more independent as we age.

Annalee Kruger [00:06:46]:
We have to know that going into it. So when you need 24/7 care, just one companion can be $30K - $40K per month depending on where you live.

Kelly Augspurger [00:06:56]:
Can we stop, Annalee? Did you hear that?

Annalee Kruger [00:07:01]:
Yes, they're all freaked out.

Kelly Augspurger [00:07:02]:
$30K to $40K per month. Most people are like, "No, that's not right." That's because it's 24/7. Yes, it's accurate. That really can be the case. Now if you need part time care, it's not going to be that expensive. But we're talking worst case catastrophic here. Like you really do need a lot of assistance all throughout the day.

Kelly Augspurger [00:07:22]:
I'm sorry, go ahead, proceed.

Annalee Kruger [00:07:23]:
No, no, that's good. Because that's when people say they want to age in place at home. That's where they're heading. That's what they're going to have to pay if they want to stay at home is whatever the fee is by the time they need 24/7 care. So we always look at worst case scenario and then backtrack from that.

Annalee Kruger [00:07:38]:
So say you only...so the other landscape of senior care and home care that families don't know because they're like, "Well maybe mom can just get by with two hours of home care a couple times a week." Well, home care companies can't staff that. So when we work with clients, we're helping them understand in your market, where you live in northern Wisconsin, or wherever it is, because we're virtual, I have clients literally in every single state. We help them understand that all of these home care companies have shift minimums. Like you might have to commit to a 4, 8, 10, 12 hour shift several times a week or 28 hours of care per week, otherwise they simply can't staff it.

Annalee Kruger [00:08:17]:
And I'm going to say why that is because so many families don't understand that they're like, "Well I shouldn't have to pay for an 8 hour shift if mom only needs 4." Well here's the landscape of senior care is we have a massive shortage of healthcare workers. I have 30% of my clients who are trying to age in place at home are on waiting lists of home care companies because where they live there's just not enough home care workers for the demand, the volume of people trying to stay at home. And when people think about just like in the Naples, Florida market as an example, they're like, "Well, why should I have to pay for an 8 hour shift?" Well, these caregivers, when the client lives in a kind of a higher end community, or town, caregivers are only making $13, $14, $15, $16 an hour. They don't live in Naples, Florida, they live an hour away. So if a caregiver is going to pick up a shift, they're not going to want to drive an hour for a 4 hour shift.

Kelly Augspurger [00:09:16]:
Exactly.

Annalee Kruger [00:09:17]:
That's why there's that disparity. And so I want to just talk about, if you have two aging parents, how expensive it can get very quickly. We'll just use my parents so that none of the listeners are like, "Hey, I think she's talking about me." This is typical. But just to help families understand, or listeners to understand how it can add up, I have clients that are paying $80,000 a month in home care. And this is why we'll just use my parents as an example. My dad is 6' 4". When he had a stroke, he's 6' 4" and 240 pounds.

Annalee Kruger [00:09:52]:
So he's not a small man.

Annalee Kruger [00:09:54]:
And so when he had his stroke, if he would not have had a full recovery, he would be what's called a two person assist. Because these companions, these non-medical companions, they're not football linebackers.

Kelly Augspurger [00:10:06]:
Right. Exactly.

Annalee Kruger [00:10:07]:
Yeah. The home care company comes out and says, "Oh yeah, we can take care of your dad and your mom, but we're gonna have to send two people for your dad because he's a tall guy." So that's two people. Because if dad has to have a bowel movement, or dad needs to take a shower, it's two people anytime he needs to move. So they have to send two people just for dad. My mom had mild cognitive impairment, which progressed very quickly, which it always does when there's a major physical injury like a fall. And so when she fell, she went and they lived here with me.

Annalee Kruger [00:10:40]:
And when she fell, or before she fell, she was perfectly able and content to sit and do word circle puzzles all day long. Literally all day long.

Annalee Kruger [00:10:50]:
She wasn't wandering, she wasn't doing any of that. But what is typical when they have a fall or a major catastrophe, whether psychological...example of psychological is for people who are snowbirders, or they're still trying to travel all over the country, but their loved one has mid stage or severe dementia and they just can't recalibrate that quickly when they change out of their environment it causes a catastrophic emotional reaction. And that's when families are like, "Oh my gosh, he's out of control. He's violent, he's aggressive." And then the next thing you know, your loved one's in a geri psych unit, because they just...they had a catastrophic reaction. You can't keep bouncing dementia patients across the country, but families don't understand dementia, so they do a lot of things that they just don't realize are really detrimental to their loved one.

Annalee Kruger [00:11:35]:
And so when we talk about my mom, when she fell, it progressed her mild cognitive impairment, that was her actual diagnosis, her dementia diagnosis, it progressed it literally overnight. So much to the point where she had her days and nights mixed up, she would start sundowning. She never sundowned ever, until she had that fall. And so at 3:00 every afternoon, right on the button, she would get so confused, so restless, a little tearful, and start wandering and be like, "Where do I go? What am I supposed to do?" And then she'd get her days and nights mixed up to the point where there were sometimes that she wouldn't sleep for 2 or 3 days, and then she was out for 4 days.

Annalee Kruger [00:12:12]:
So until we were able to get her medication adjusted, because all of this happened literally overnight. And that's the other thing families don't understand is with dementia, any trauma like that, then you have to emotionally wrap your head around like, "Oh, my gosh, is this our new baseline?"

Kelly Augspurger [00:12:29]:
Right.

Annalee Kruger [00:12:30]:
And so she would have needed to, if I would have been able to keep her here, I just couldn't because my dad had had a stroke. This all happened within two weeks of each other.

Annalee Kruger [00:12:38]:
My mom fell and my dad had a stroke. And this was right before, two weeks before the pandemic. So it's not like it was just...it was awful. I became kind of my own typical client. Like, "Oh, my gosh..." The difference is

Annalee Kruger [00:12:50]:
our family actually has an aging plan and we had everything buttoned up. It's just that because I do crisis management for a living, so I was certainly going to make sure my own family was buttoned up. But it gets really overwhelming really quickly. And so when mom fell and then dad had his stroke, they would have needed 4 people. If I could have kept them here at my house, my mom here at my house, they would have needed 4 caregivers.

Kelly Augspurger [00:13:12]:
Oh, my goodness.

Annalee Kruger [00:13:13]:
If mom is sundowning or she needs...she had a broken shoulder, so she needed help with bathing, dressing, grooming, everything. And so she would have needed 2 people. My dad needed 2 people. That's how it adds up very quickly and gets out of control.

Kelly Augspurger [00:13:26]:
Very few people in the United States, a small percentage, can actually afford to do that 24/7. And just with one caregiver. Let alone 4. So I'm assuming that that probably didn't last very long in your home and they ended up moving to some type of a community or facility.

Annalee Kruger [00:13:42]:
Yes. And so that's why we talk about why you have to be proactive. Everybody wants to age in place at home. But the reality of that actually happening, given the cost of care at home and the availability of workers, because what if you're like, "Yeah, sure mom," you make that promise, don't make the promise, "Sure mom, we'll never put you in a facility. We'll do everything that we can to keep you at home." And then when you realize it's not feasible, then you feel guilty and terrible because you can't follow through with the promise that you made. So never make that promise. But the challenge is, say you want to age in place at home and you're like, "Yep, we're going to do this come heck or high water."

Annalee Kruger [00:14:20]:
But then what are you going to do when that 12 hour shift Sally person doesn't show up for her shift because she went partying the night before and she's too hungover, so she called-in and canceled all of her appointments for the next 2 days. And so then who's going to take care of your loved one, or you if you're the care recipient listening to this, who's going to take care of you for that 12 hour shift if the caregiver company, companion care company can't fill the shift? Or you have been so adamant that you're like, "Nope, if Sally can't come, I don't want anybody to come." Well, that's fine, but who's going to get you to the bathroom? What if you had a doctor's appointment that day? Who's going to remind you to take your meds? That's when we start seeing people falling because if no one's there, they're going to have the same problems they did when someone wasn't there. They're going to fall, they're going to wander out, they might burn their house down because the stove is on fire. You're not going to get your meds. Like all of that happens. So we talk about, "Okay, well what's the plan if you can't stay at home?" We have to just kind of buck up because again, none of us get healthier and more able bodied and more mobile.

Annalee Kruger [00:15:20]:
As we age, we need to just be realistic that it's likely, very likely, that our loved ones are going to need to move into a care community. So these are the things that families need to think about for a care community. Most families don't plan ahead. That's why they're coming to us in crisis mode. Because they're like, "Oh my gosh, dad wandered out and mom's got a broken hip and she couldn't get there to..." All this disaster happens because families think that they have more time. Well, you do until you don't. And then what?

Kelly Augspurger [00:15:47]:
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Annalee Kruger [00:16:13]:
Things that families need to think about from a senior care community perspective is waiting lists. Some of the really good ones have a 3, 5, 7 year waiting list, or for continuing care retirement communities, the CCRC care model that have independent living all the way down to memory care, skilled nursing, and rehab. Those have hefty community entrance fees, hundreds of thousands of dollars, or millions of dollars, right?

Kelly Augspurger [00:16:38]:
Huge.

Annalee Kruger [00:16:38]:
And then you still have to pay your monthly room and board for whatever unit you move into. And then you still have to pay for most of them a level of care on top of that. So you have for assisted living as an example, you have your room and board rate. But then if you need care and help with medication management and doctor's appointments and ADL's, Activities of Daily Living, those ranges for level of care can be anywhere from like $800 a month to $5, $6, $7,000 a month. And then if your loved one is like such a high fall risk, or a wander risk and you're trying to keep them in assisted living and the facility says, "Sure, we're happy to keep Martha in assisted living, but then that means you have to hire private duty companions so that she doesn't wander out or so that she doesn't fall." So then that's another cost on top of that. And private duty companions are, it depends on where you live, but it's anywhere from $25 to I've got clients paying $65 an hour.

Annalee Kruger [00:17:30]:
So again, with those shift minimums you can see how expensive care is. So you have to plan ahead. Because most of these care facilities, they don't contract with Medicaid. Some of you might be listening like, "Well, no big deal, we'll just put mom on Medicaid." No, because we have a shortage of Medicaid and only nursing homes contract with Medicaid. There's very few assisted living facilities that contract with Medicaid.

Kelly Augspurger [00:17:56]:
That's right.

Annalee Kruger [00:17:57]:
So waiting lists, what levels of care do they offer? What if dad needs memory care, mom needs assistance, assisted living. But where you live, they don't offer those types of care. And so then you've got mom in one facility in one town, dad in a different facility in a different town, and then they don't get to see each other. Or some of those care community models, the CCRC care community model that has all the different levels of care. Some of them, their business model is that you had to have moved in at the independent living level of care. You can't just move in assisted living, or move in memory care. Because their business model is you had to have had enough mindset to be like, "Oh, we need to move before we get sick."

Kelly Augspurger [00:18:33]:
Absolutely. And I think very few people know that, Annalee. Some people that have not even heard of CCRCs are like, "Oh, yeah, that could be. We'll consider that later." Well, yeah, you need to go in at an independent level. You're not going to go in where you already need the assistance and need the care. It's not what you think.

Annalee Kruger [00:18:47]:
It's not what you think. And families don't realize that you have to financially qualify to get into these different care communities. You have to physically qualify. So you have to be healthy enough to move into whatever level of care. You have to cognitively qualify. You have to pass the memory exam to be able to get into...Yeah, that's right.

Annalee Kruger [00:19:07]:
That's why they have these pre-admission assessments and you have to fill out a financial application. They're not going to admit your loved one, or you, if you don't have enough money to be able to private pay for whatever their requirement is. And all of these different care communities have a different equation. And that's why we help families understand what that looks like. Because then we can say, "Okay, well, if you have to have 5 years of private pay to qualify to get into this care community because you live in a limited area where you don't have a lot of care options, but this care community requires a 5 year private pay, then we had the conversation as we're putting this plan together." Okay, well then what is going to be your aging in place at home care budget so you don't break the bank and now you can't financially qualify to get into these different care communities? Or what if you live in an area where they have what's called partial, what we call partial or standalone facilities where they only provide independent living, or it's an only independent living. Well then what about when your loved one needs care, you have to bring care in. So we got to kind of begin with the end in mind, otherwise all you're doing is moving your loved one.

Annalee Kruger [00:20:10]:
"Okay, well, I guess we didn't understand this care model. So now that mom needs memory care, now we have to go find a memory care, see which ones have an open bed, which ones haven't been cited for abuse and neglect." And then disrupt mom again, pay probably another small entrance fee into a different care facility. I don't know, families just, they don't know all of this. And how would you, because it's such a complicated, overwhelming, and there's so many nuances to this, what we call aging planning, you wouldn't know unless you work with a professional and do it right the first time.

Kelly Augspurger [00:20:43]:
That's it. Or you've personally already been through it yourself and you've come in contact with some of these difficulties, you find out, "Okay, there are a lot more things to consider here than I had ever imagined." And so having an advocate and having a professional to guide you through it and hopefully planning in advance that, I mean, we can't say that enough on today's episode. The more that you're able to plan in advance, the better off everyone is going to be.

Annalee Kruger [00:21:09]:
When we say plan though, because we're all very good about throwing out that word. And people are like, "Oh, I do, I have a plan. I have my living will. I have long-term care insurance and a power of attorney." Okay, that's great. But when we're saying a plan, when I say a plan, that means...So when someone's like, "Oh, you know, we don't need to work with you because we already have a plan in place." I'm like, "Okay, do tell."

Annalee Kruger [00:21:29]:
What does that...what is that plan? So that's where it comes up, "Well, we have a financial advisor, we have an estate attorney and we have our long-term care insurance." Okay, so that's great. But that's not an actual aging plan. So who's going to take care of you? Where are you going to live? What Is your aging in place at home care budget? What are the safety triggers that you can all agree on? That when mom has these 5 things happen, that yes, that's when we're going to, we're all going to agree that yes, care needs to be brought in. Who's going to pay for that? How much money does mom have? Who's the decision maker? But every day that you haven't selected different care communities, proactively toured them like crazy, like a lot, like not just a one and done tour, every day that you're not on the waiting list of different care communities, and yes, you're going to have to pay the waiting list deposit, but I'm telling you, it's money well spent because then if or when it's determined that you can't stay at home, then at least you're on the waiting list of 3 or 4 different care communities, it increases your probability that at least you might be able to get into one of them, that you've already got some comfort level because you've done 8, 10, 12 tours. Now here's where families also get into like reality smacks them right across the face because they're like, "Well, mom lives in Tucson, Arizona, but the 4 kids live in 4 different states." Because that's our typical family profile.

Annalee Kruger [00:22:49]:
That's why I went virtual way back in 2011, because that's kind of already the market of families or the profile of families back then. That's why I went virtual way back in 2011 when I first started my company. So then what happens is mom lives in Tucson, Arizona, say she has Parkinson's disease, which can also be a dementing illness. So the 4 kids live in 4 different states and they're like, "Oh, mom's doing okay." Well, she is until she isn't. And what families don't understand is as an example with Parkinson's, we call it a fall disease. They're going to fall. That's a hallmark of that disease. And so then when the daughters or the family starts getting all these calls like, "Oh, your mom fell, she's in the ER and she gave us your phone number."

Annalee Kruger [00:23:30]:
Well, what if she can't at some point express that? And then they've got Jane Doe here in the ER if she loses capacity. So that's when we start seeing the adult kids start to get worried and so then they start taking shifts and turns like, "Okay, will you go down these two weeks? You go down these two weeks?" So that that's how these families end up in that caregiver snowball. They get so overwhelmed because that's not sustainable. You can't just keep missing work and missing important meetings, or time away from your own family because you don't have a plan in place and you're just band-aiding it. Let's sit down and put an actual plan in place so that it's sustainable and safe.

Kelly Augspurger [00:24:05]:
Those are key. Sustainable and safe. I mean in doing that, talking to your family, getting together with a professional, documenting these things and updating, too. Because maybe the plan is going to shift and change five years later after you originally put it in place. And that's okay. Sometimes things change, but you want to document those and be ready for when the time comes of care actually being needed. Annalee, this is so good.

Kelly Augspurger [00:24:30]:
I want to just shift a little bit to what are some common mistakes that people make when it comes to their aging family member? I'm sure that there's quite a few. What do you tend to see the most often?

Annalee Kruger [00:24:41]:
That's a 77,000 hour podcast.

Kelly Augspurger [00:24:42]:
Yes, I know, and we cannot, we don't have the time for it. But let's just highlight some of the main big mistakes that you see.

Annalee Kruger [00:24:49]:
A few key things that I see literally every single day. And I have for the last almost 40 years of, 30 some years of working with families, simple things like denial. Denial is a great place to be until you can't be there anymore. "It never occurred to me that mom would get sick," or "It never occurred to me that she would fall," or "I didn't realize that dementia meant that he's going to get worse," or "I didn't realize that Parkinson's meant that he could get dementia and he would start falling a lot and start choking." So mistakes I see people making is denial. They think things are going way better than they are. Well, they are until they aren't.

Annalee Kruger [00:25:23]:
And then when you go to do your visit in person and realize there's 4 months of stacked up mail, your mom's lost 30 pounds and dad doesn't recognize who you are. That's a problem. So not having their documents in order because again, that's why I started my company in the first place, families are like, "I have no idea what mom and dad have in order. I don't know if they have a living will, a power of attorney. I've never met their financial advisor. I don't know if they have long-term care insurance.

Annalee Kruger [00:25:47]:
I don't know if they have their funeral taken care of. Where are their accounts and passwords." And I live in Florida. Every day, banks are telling me, they're like, "We have adult kids coming in with this stack of mail. And they're like, 'Apparently mom has an account here. She wandered away, and now she's in geri psych. Geriatric psych units because they're trying to figure out our medications because of her dementia behaviors. But we have bills to pay.'"

Annalee Kruger [00:26:09]:
And the banks are like, "I can't help you because you aren't listed on the account. You don't have the bank's financial power of attorney documents in order." So these are all some examples. And then families not working as a team. 85% of my week is spent doing family mediation, because by the time families come to me, they simply are not getting along. Everybody has a different idea of quality of life. Everyone has a different idea of dementia. I mean, I literally talk to about seriously about 15 to 20 families a day, and it is the same problem all the time.

Annalee Kruger [00:26:39]:
"I saw the writing on the wall, and I tried to get my siblings to understand and get on board. And let's get ahead of this before the dementia gets worse. Or before dad, who's the caregiver, has a stroke because he's trying to figure out how to manage mom's care." So 85% of my week is spent doing family mediation because they don't get along. Everybody has a different idea of how the inheritance should be spent. If we have blended families, that's always another layer.

Kelly Augspurger [00:27:05]:
Oh, I could see that.

Annalee Kruger [00:27:06]:
Another layer of complication. Because a lot of times these seniors, the moms and the dads got married late in life, and so the kids have never really even met. They don't even have each other's phone numbers.

Kelly Augspurger [00:27:17]:
Oh, my gosh.

Annalee Kruger [00:27:18]:
Because Bethel and Marvin got married in their 80s, and the kids are like, "Okay, well, great. At least dad and mom aren't...my dad and your mom aren't going to be alone as they age," but they don't have relationships with each other. And so then when Marvin gets dementia and his dementia progresses to the point where the kids are like, "Oh, wow, now we're really concerned." Ethel's kids are going to be like, "Look, we don't want our mom taking care of your dad because he's bigger than her, and he's going to fall down, and then she's going to fall down, too." And so you can see how complicated, like how is money set up? Like, "Well, my mom's the one that came into marriage with all this money and now your dad needs dementia care.

Annalee Kruger [00:27:53]:
And who's going to pay for that?" So you can see, that's why I look like this.

Kelly Augspurger [00:27:59]:
You, you are beautiful. If you're listening to this, you look very well put together. You are the energizer bunny. Annalee, I don't know how you have all the energy to do all this and especially mediation. I mean, that emotionally has to take a toll, right? Day in and day out...

Annalee Kruger [00:28:16]:
It totally does. But you know what's so cool about it is because, like I say, I join in families journeys wherever they live. So wherever they live in the world, because as long as they have Internet, I can help them. And wherever they are in their care, decision journey. And it's so cool, there's nothing better. Well, except for ice cream. But there's nothing better than seeing a family who just could not see eye-to-eye and are at each other's throats.

Annalee Kruger [00:28:41]:
For weeks or months or decades. Then when dad has that stroke, then they're like, they didn't get along in the first place. And now they have to make care decisions and they have no idea. "Well, what does dad have for money? Who's the power of attorney?" They have nothing. Everything is chaotic, a mess. But it's so cool to see families really start coming together because now they're starting to realize, "Hey, you know what? This is going to be so much easier on everybody if we can just put the past behind us, focus on the here and the now. Dad needs care.

Annalee Kruger [00:29:12]:
Mom needs care. Let's figure this out together." And it's really cool to see families stop wasting hate energy and anger and angst energy, because it's not productive. And so I have really perfected how to get these families to work more as a team. But it's because I've worked with over 20K families, so it's...I got this pretty much down pat.

Kelly Augspurger [00:29:35]:
Yeah.

Annalee Kruger [00:29:36]:
And so it's just really cool to see families coming together. And then they'll come back and say, "Annalee, my brother and I got in this big fight at Christmas..." Someone said something stupid. And then that just tore the family relationships up. And so they've lost 30 years, 3 decades, their kids don't know each other.

Kelly Augspurger [00:29:53]:
Sad.

Annalee Kruger [00:29:53]:
It really hurts, these relationships. And then when mom or dad have a stroke or dad dies suddenly and he's a caregiver to mom with Alzheimer's, then they're like, "Oh, crud. What do we do?" Because they have no idea what the care options are, how much it's going to cost. There's nothing in place.

Kelly Augspurger [00:30:09]:
Right. So you're really able to.

Annalee Kruger [00:30:10]:
I know this is a super uplifting podcast.

Kelly Augspurger [00:30:13]:
But you know what I mean? This is real life, right?

Annalee Kruger [00:30:15]:
It is real life.

Kelly Augspurger [00:30:17]:
I've said it plenty of times. But extended care really can tear families apart.

Annalee Kruger [00:30:21]:
Oh, it does.

Kelly Augspurger [00:30:22]:
If you do not have communication and a plan and you're on the same team and on the same page, it really can. And so we want to minimize those consequences as much as possible. How do we do that? We plan, we talk to our families. We coordinate these things, we have these grown up conversations that can be uncomfortable, but they need to be had. The Steadfast Care Planning podcast is sponsored by AMADA Senior Care. AMADA provides complimentary consultation with a senior care advisor to find the right care from in-home caregiving to community care, as well as long-term care insurance claim advocacy and unique support partnerships for financial advisors to address family transitions and generational retention. To learn more, visit www.SteadfastWithAmada.com.

Kelly Augspurger [00:31:15]:
Give us some tips like, you've done this thousands of times. What are some realistic tips for how people can have these conversations with their family about extended care?

Annalee Kruger [00:31:24]:
Yeah, so because I come from a mediator and social worker head, it takes an actual professional that has this background to lead family meetings. I can't always undo what other people have tried to do in a helping way. So ground rules, if you're going to try to facilitate your own family meeting, and just know that when I first started in the early 90s as a social worker and mediator working with families, helping them understand all of this aging and caregiving stuff, families seemed to get along better back then because they lived near each other and they were still, at that time, getting together after church for lunch, or they just worked together as a team because they were local to each other. So there was a little bit more awareness of what is actually going on at mom and dad's house. Because they would go over there.

Kelly Augspurger [00:32:15]:
Yeah.

Annalee Kruger [00:32:16]:
As families. But then as families started moving away from each other, if they didn't invest the time, effort, energy, and honestly money, to maintain relationships with each other, it's easy to drift apart. Airfare is expensive, you have to take time off work. And I'm that person that does that in my family because it's important to me that our family stays a solid unit through the end of time. And so I'm the one that's like, "Hey, you know what? I'm going to be flying up, let's get together." But if there's not someone like that in each family, then that's when these relationships really start to wither away.

Annalee Kruger [00:32:49]:
And then again when you get that crisis call, then you kind of have to get reacquainted as siblings and then figure out what to do. So, ground rules, if you're going to start trying to do your own family meetings, ground rules: no talking over each other, no swearing. Like we're in kindergarten, right? These are the kindergarten rules. No talking over each other, no interrupting, no swearing, no yelling. If you start to feel like you're emotionally out of control, you need to take what we call it as a mediator, a caucus. You need to take a break, take a 15, 20 minute break. Because that's about how long it takes for your amygdala, your emotional center in your brain to resettle and readjust.

Annalee Kruger [00:33:27]:
It takes 15, 20 minutes. You need to take a break if it gets too emotional. But just know that the reality of a family being able to actually have their own family meeting is nearly impossible. Because you can't expect a family who doesn't understand dementia and what that really means, or thinks that assisted living and nursing homes are the same level of care, or they think that Medicare and Medicaid are the same program, or they think that Medicare or Medicaid is going to pay for all of this care. You can't expect a family who doesn't understand any of this stuff. You can't expect a family to have their own family meeting to then try to figure out what are we going to do? And that's where families make a ton of mistakes. And they're like, "Well, Annalee, we move..." Because then they call me to kind of try to undo what they did.

Annalee Kruger [00:34:13]:
They're like, "Well, Annalee, you know, we tried to figure all this out on our own. So we just put dad, mom, and independent living. And now the facility is telling us that they both need memory care and we don't know what that means and how do we do that?" So you can't expect a family to productively and effectively facilitate their own family meetings because about the only time they do that is when they're really scared and finally have realized maybe things aren't going well at home. So emotions are high.

Annalee Kruger [00:34:43]:
Which never helps with a family trying to have their own family meeting. That's why there's value in working with someone who actually does family mediation and actually has all of this long-term care, dementia, senior care, family caregiving, and professional experience it brings to the table. It's a beautiful package that we offer for our families. It's a one-stop shop working with a professional.

Kelly Augspurger [00:35:04]:
I cannot emphasize this enough. It really makes all the difference. And what is that outcome going to be? Like you just said, if you end up moving your parents to independent living and then you get a call shortly after, "Oh, that is not the right fit." We want to minimize the moves as much as possible, especially when there are cognitive issues going on because that just complicates things, makes them more difficult if they now have to move to somewhere else with new people, new caregivers. It's much more complex and difficult.

Annalee Kruger [00:35:33]:
Oh, completely, yes. So one thing I wanted to share because in case some of your audience are the Ethels and the Marvins, the moms and the dads, these are things that you can do to help your kids. Number one, don't shy away from these conversations. If your kids notice some concerns, be open to listening to them because the kids are the ones that get the brunt of having to pick up the pieces because parents don't have their own plan in place. So a lot of times the kids will say, "You know, Annalee, we tried to have these conversations with mom and dad, but they gave us so much pushback that we quit trying." They come to us in like hopelessness and despair because they're like, "Well, we tried to have these conversations, but we didn't know the magic words to get mom and dad to be on board, so we just figured we'd have to wait until crisis because we tried to do proactive, but mom and dad weren't open to hearing anything that we had to say." So moms and dads be open to if your kids come to you with concerns, be open to that because they love you and they want what's best for you.

Kelly Augspurger [00:36:33]:
And that's the key. Right? We're not doing this just to be nosy, or just to be a pain. This is really out of love.

Annalee Kruger [00:36:39]:
Believe me, as an adult, we don't like having to do that either. We don't want to have to step into that role of like, "Okay, well, this is what's going on. And since you wouldn't listen to me the first 5 years I tried to bring this together..." I've had families tell me that they've tried for like 9 years to get mom and dad to get their accounts and passwords together, get their living will, or power of attorney. They're like, "It took me 9 years to get this done." This is what your kids are going through.

Annalee Kruger [00:37:01]:
So if you're the mom and the dad, be open to what your kids are sharing with you because it comes from a good place. Like a good place in their heart. Number two, be the one to instigate or initiate these conversations and say, "Hey kids, I want what's best for you and I want what's best for us as a family. I don't want my aging or caregiving needs to be the wedge in our family because we get along. And so I want to have some conversations about the "what whens" of aging. I need to be thinking about where am I going to live, who's going to take care of me, what is this going to cost? And I want your input. I want you to be a part of this process." So be the one to take the initiative.

Annalee Kruger [00:37:38]:
A few weeks ago I had a son and because they come to me so overwhelmed and emotionally spent and frustrated and angry and resentful, they're like, "I told my dad that it is irresponsible..." Just like this, "I told my dad..." because this is how they come to me, "I told my dad that it was simply irresponsible of him if he did not cooperate with us with working with you to put this plan in place."

Kelly Augspurger [00:38:01]:
Oh boy.

Annalee Kruger [00:38:02]:
And so ways that you can think about this, too, is look at their background. If your parent is a business owner, you have a business succession plan. So an aging plan is an aging plan.

Annalee Kruger [00:38:14]:
It's like, "Okay, when we need care, how's it going to happen? Where we're going to live? Who's going to pay for it?" And so think about how to leverage these conversations because that's always the question that comes comes up. They're like, "Annalee, you're speaking to the choir sister, but how do I get mom and dad on board?" This is how, "Mom and dad, is it important for you to have a say in what happens to you as you age?" Who is going to say no to that?

Kelly Augspurger [00:38:35]:
Of course, yeah.

Annalee Kruger [00:38:36]:
"Is it important for you to have as much independence and dignity as possible as you age?" Who's going to say no to that? "Is it important for you to stay in your house as you age?" Most people are going to say yes to that. But then, you live in a 3 story house. The washer and dryer is in the basement, your main bathroom, big bathroom is upstairs. You have nothing on the main floor that's going to help you as you age. So we need to do something to the house. And so again, the lesson for the mom and the dads listening to this, if you want to age in place at home and your house is not senior safe, you need to be tackling that now for sure because you can't have a stroke and then all of a sudden be like, "Oh, I guess we need a big bathroom now and a walk in shower and the washer and dryer moved up," and think that that's going to happen tomorrow.

Kelly Augspurger [00:39:23]:
Not going to happen. Right.

Annalee Kruger [00:39:25]:
So again, everything boils down to planning ahead.

Kelly Augspurger [00:39:28]:
And I think that's our final takeaway, Annalee, is we need to plan ahead. You need to have these tough conversations. You're not going to necessarily love doing it, but the outcome is going to be worth it. So Annalee, where can people find more information about you and how you help people?

Annalee Kruger [00:39:45]:
So people can find me on LinkedIn if they want to. It's Annalee Kruger. It's simple. Annalee Kruger on LinkedIn you can also go directly to my website at: www.CareRightInc.com there's a free webinar on the home page that you can listen to, or watch. Then there's also a "Contact Us" where you can actually schedule your own 30 minute consult. So my schedule, as you can imagine, the demand for what I do, it fills up fast. So if this message hits home for you, you will want to go to the CareRightInc.com website and get scheduled as soon as possible.

Annalee Kruger [00:40:21]:
If you realize because this is the other mistake families make and it ties into the denial part, they'll be on the 30 minute consult with me crying and sobbing about how their dad's care needs has derailed their marriage, their own life, their career, their finances, or they took early retirement because dad had a stroke, and they didn't want to retire. They love their job, but they didn't know about an aging plan. So I've had families just be absolutely almost hysterical on these calls and then not decide to move forward with putting a plan in place. So be ready if you've got the notion that things are not going well. And if I did any good at all on this podcast at sending the message that things are going to change quickly and get out of control very quickly. And if you don't have a plan, your parent is to going going to end up in whatever care facility has an open bed. A World Health Organization study found that 64% of direct care workers in nursing homes admitted to abusing and neglecting the residents under their care. So I am not joking when I say if you want the best outcomes, you have to plan ahead for that. If you're already in crisis, then don't be in denial. Crisis, it's only going to get worse.

Annalee Kruger [00:41:34]:
You can only brush problem problems under the rug for so long and then it's going to bubble up and then you're really going to have a mess on your hands. So go to the website, go to the CareRightInc.com website, reach out to me on LinkedIn at Annalee Kruger. You can Google me, I am all over the Internet in a good way. You can always track me down. And the work, Kelly, that you do is equally critically important because you do the insurance piece.

Kelly Augspurger [00:41:59]:
It all ties together. Yeah.

Annalee Kruger [00:42:01]:
And the other thing is, because everybody thinks Medicare or Medicaid or some other source is magically going to pay for care, it doesn't occur to them to get long-term care insurance. So the cool thing is, and you see this, too, is while it's too late for mom and dad to get coverage for long-term care insurance, the kids on my zoom calls are like, "Oh, now that we know that it could cost $70K, $80K a month for two caregivers for mom and dad, or now that we know that nursing home care is $18K in the Massachusetts area, in Rhode Island for one parent, $16K, $17K, $18K a month for one parent." Maybe it's time that you as adult kids start getting your affairs in order, get your long-term care insurance. And Kelly, you work with families literally all across the country so you can help them no matter where they live, too.

Kelly Augspurger [00:42:47]:
That's right. Just like you, Annalee, we are virtual and we work nationwide and I know we have spent so much time together today. Really appreciate the wisdom and the nuggets that you shared with us, Annalee. I hope this motivates people to take action and not wait because the stakes are too high. The quality of lives for you as a caregiver and your family member who needs the care.

Kelly Augspurger [00:43:09]:
It's at stake. We need to take action and do something and don't wait until it's a crisis because the options are going to be fewer, it's going to be harder, more complex. Make it better on everybody. And yes, that's right, it's more expensive if you wait. There's definitely that component, too. So Annalee, thank you so much for this afternoon.

Kelly Augspurger [00:43:30]:
Taking some time with me. Really appreciate it. Everybody, reach out to Annalee. You need to talk to her, take her up on that 30 minute consult, get your plan in place. Thanks, Annalee. Have a great day.

Annalee Kruger [00:43:44]:
Thanks, Kelly.