Power of Attorneys Graham Law Offices P.A. Attorneys Boise Idaho

Susan Graham: Hello, this is Susan Graham, and welcome. I want to welcome you to the second program of a series of virtual lunches with me where we discuss estate planning. Today's topic is about living independently in your home. Can you live in your home forever or is it time for you to move? What kind of changes might need to be made in your home? And then, if you should move, where are you supposed to move too? What's the best place, and how are you actually going to accomplish that move? Today we have two guests, Deborah Hansen and Wil Hansen, they both are registered guardians and they have a business called Castle Rock Services Inc., which is a guardianship and case management company in Boise, Idaho.

You may want to have a paper and pencil available for you to take notes, but this workshop will also be transcribed. if you go to our website, www.graham-lawoffice.com, there will be more information on today's topic and about our guests. So now let's get to today's topic, and that is, how can you stay in your home or do you need help in relocating? So, would you, Debbie and Will, address the question - how would you know if an elderly person can continually stay safely in their home?

Deborah Hansen: Well, in order to stay safely in your home you need to assess the situation and what's going on a bit. Some of the things you need to consider are your ability to manage your medical care and take medications in a timely manner; the ability to prepare foods safely, one thing that you often look is can you do multiple tasks? Can you answer the doorbell while you're cooking the dinner and remember to go back to the dinner on the stove? Because sometimes memory difficulties make people less safe because they are unable to do multiple tasks. Some of the other things that affect your ability to stay in your home is your home itself. Are there lots of steps? Are you having fall problems or walking problems? Often times, case managers, such as I am-I'm a social worker and case manager-I can go to your home and give you ideas on what you can do to make your home more functional so that you can stay in your home. Or, if things are serious, sometimes we ask the doctors to get your Medicare coverage to cover an evaluation by an occupational therapist or a physical therapist to see if they can make your home more functional for bathing and getting up at night and just general living.

Deborah Hansen: An occupational therapist is actually the person that would go evaluate your bathroom and tell you where the best places for grab bars are, they would tell you if you needed to raise the toilet seat or not and what kind to get, they would-if you're using a walker or a wheel chair-they would talk to you about the best ones to have. The physical therapists train you on how to use the equipment but the occupational therapists have a lot to do with choosing the appropriate spots to make it work. So, if your door for your bathroom isn't wide enough for a wheel chair or a walker, an occupational therapist can tell you the change you need to make. They also can do an assessment as far as safety in the kitchen for cooking and help you come up with skills if your eyesight is limited. They have tools that you can get that can make it so that you can cook safely even with limited eyesight.

Susan Graham: When these assessments are done, then can you or someone like you come back into the home and help them implement these kinds of changes?

Deborah Hansen: Yes. Often what we do is start by the family or the person calls us and saying "We're having a few problems." Someone from Castle Rock goes into the home and we talk with that person or family about what's going on and what concerns they have. Then we may talk to you and your doctor about arranging for a special assessment by an occupational therapist, a physical therapist, if you're having swallowing difficulties sometimes we get a speech therapist involved-those kinds of people-and then we come back and we help you get everything set up so that you can stay there safely. Or, if you can't, we can help you talk about and discover which alternate living situation would best meet your needs and be enjoyable for you.

Susan Graham: When you make these recommendations and assessments, do you deal with the other things? Like, how you take care of the yard, how you keep the house clean, having somebody come in as a bath aid?

Deborah Hansen: Yes, often times, people can stay in their own home with just a little more help and so we can talk to you about agencies who are licensed and bonded and who can safely help you. We can arrange with you to for house keeping, grocery shopping, get to medical appointments, maybe offer bathing assistance or whatever other services you need. That's part of a case manager's job is to know all the resources and sort of give you options.

Susan Graham: Do you have a bench mark to determine when it's no longer safe for someone to stay in their home by themselves?

Wil Hansen: Well, there are various signs that start off gradually and sometimes those of us who are actually experiencing them may not notice them. Some things to look for may be "I'm having more trouble seeing things in my home because things seem to be darker than they used to be." Are you putting in brighter light bulbs, are you having trouble when you're driving down the road because you seem to not knowhow to get back home as easily, are you able to get help or not get help easily, are you aware of when you're having a problem? Sometimes, people don't know they're having a problem, and someone else says. "Oh, by the way, George, did you know that you left the door open when you went grocery shopping?" It's signs like that that are a little bit here and a little bit there that we all do occasionally but if it becomes a pattern then we need to start looking at maybe making some adjusts to our lifestyle.

Susan Graham: If someone still says, "Ok, I'm having these difficulties but I insist I want to stay in my home," is it possible to make arrangements so that someone can continue to do that without going into an institutional setting?

Wil Hansen: Certainly, and that was what Debbie was talking about earlier. The assessment process is very important because what that does is it helps to identify those types of areas that you are having a problem with and also what you can do to mitigate those issues. Lots of times, with the help of O.T.'s and physical therapists, and making some changes in your home, you'd be fine just to stay where you are as long as you had somebody look in on you once in awhile, or have someone kind of touch basis with you to see if there are any concerns.

Susan Graham: If you needed to hire someone to come in and help with some of these smaller things, like bathing or some of the other care giving responsibilities that happen, what does that cost for someone?

Deborah Hansen: The rates in Boise are about $18 to $23 an hour for a caregiver to come in and most agencies have a two-hour minimum. And that's probably what you're going to need to pay to get a licensed provider in there that's dependable and trustworthy and that you can count on.

Susan Graham: If there's no family in the area, or no friends that look in on someone regularly, what kind of arrangements can be made so that the family who's sitting in Chicago feels comfortable that Mom and Dad here in Boise are still doing ok in their home?

Deborah Hansen: Well, at Castle Rock, Wil and I, we enjoy working with families who are out of state. We take care of many people's loved ones, and what we do is we can take people to doctors, we can check on them, we can let the family know what's going on, what the concerns are, we can help the loved one just sort of figure out ways to be more safe and secure. And if it is time that they can no longer live at home, we can help the family find a place that match, as best as possible, the person's values, medical needs, personal needs, and it's affordable and within their budget.

Susan Graham: What you're talking about is that if it turns out that they can't stay in their home, you can actually help them figure out what is the best location for them to consider here in Boise, or in this valley.

Deborah Hansen: Yes, yes. And it goes all the way, the spectrum starts at like certified family homes and it can go to assisted living or retirement centers or nursing care. But, we always do the least restrictive amount of care possible to meet someone's needs and to make it where people can have as much freedom and independence as possible.

Deborah Hansen: A certified family home is a regular home in a regular suburban neighborhood, typically, who there's a family that may be a middle aged woman, or it may be a couple, or it may be a family with children, who have gone through the process with the state and are now licensed to take care of up to usually three elderly or disabled people.

Susan Graham: And is there a range of costs that would be normal for such a family home?

Deborah Hansen: The cost for privately paying for the care ranges from two thousand dollars to the really deluxe which would be a maximum of four thousand a month. Some are covered by the state Medicaid program.

Susan Graham: I someone ends up going to one of these facilities, are there a series of steps that you can help them with to figure out how to move from their existing home into this new location for them?

Deborah Hansen: We're used to moving people from their homes and so, like often times what we do is we work to hire the movers and to get everything in place, and our clients often say that the move happened like magic. I think one of the things we do is meet with the person who is moving and we put stick-ums on things to have those items moved, then we have them placed in the proper place in the home before they get moved in and we also have people go back to their homes numerous times to make sure there's nothing we've missed so they take all the little things that they continue to want. When they're sure they're done, we often times arrange for an estate sale person to come in and complete the job. We work with families on that whole process.

Susan Graham: If they decide what items they want to take to their new location and what items they want to give to the family and then what to sell, will you make the arrangements to ship those items to the different family members for them?

Susan Graham: Whey they are in their new location, do you actually physically help hang the pictures?

Deborah Hansen: We do everything from hang the pictures to make the bed, we choose the color combinations. A lot of times people need new bedding and a few new things and we can get-we can take them shopping or we can shop for them, we'll do whatever makes the process work smoothly for them.

Wil Hansen: Ideally, what we'd like to do is be involved with the person prior to the move and long enough so that we build some relationship and then we can take the people to those places where they think they might want to live. Or, in the past a lot of times people have driven by places and said, "Well, someday I'd like to live there." It's not easy to figure out where you want to go sometimes because you're not familiar with the resources, so we talk to them and decide, as part the assessment process, some of the issues that concern them, and then we can narrow down the options. "Today we can go visit this facility or that facility or a home," or whatever and the person can go tour the site and then decide what they would like to do. Once they decide on their new home, they make a decision so they can start planning how they want to arrange their rooms or what they want furnishing and things can go there because they'll know what size and what kind of things they can bring with them. We try to recreate the same environment as much as possible as what they've left. Unfortunately, a lot of times, it's downscaled. That's the downside of getting older, sometimes in moving as you move into smaller and smaller spaces but you can take those valuable things and those things you cherish and love with you for the most part wherever you go.

Susan Graham: What happens when there's a crisis? We've been talking about people being assertive and on the ball about their life care, but when the crisis occurs, someone has a stroke, someone falls down, they have a heart attack, and you get a call from a family member, how can you help them deal with this crisis?

Wil Hansen: Most of the time when emergencies happen, everyone is really stressed out, a lot of people don't handle emergencies well simply because it's so close to home. It's a very subjective thing. We have the advantage, of being objective and being an outside person who can step into the situation and provide the logical, rational thinking processes that are required for making those emergency decisions and then we work with the family in a sensitive way to provide the support and advocacy they need because they know that they can rely on us to take care of it. They can relax a little until they catch their breath and realize that everything isn't so out of control and it's no longer an emergency by then because we've already taken care of their loved ones.

Susan Graham: If someone call from out of the area because their folks are in a crisis here in town, can you and your company step in and help with doctor visits, with where to place them for housing, and to check up on them?

Wil Hansen: That's correct, Susan. We're available 24/7, which translates into we get calls in the middle of the night when someone has had a fall or something has happened to them. We work on a daily basis and make arrangements for doctor visits on a schedule basis. We always try to do those things and be present for those types of events because we need to be on top of it and then we can report to the family because we are actually the family's eyes and ears and voice for their loved ones.

Susan Graham: I know that you deal with the elderly, but you also help disabled family members that also need care. What kind of assistance could you help in a family where they have a disabled child, a child who's autistic or someone who's a Down-Syndrome individual? I have many clients who now are in their eighties that have dependent disabled children who are in their sixties. The parents are concerned that when the parents' die, those children will not be appropriately cared for.

Deborah Hansen: You know that's something that we're getting more involved with all the time and I actually have worked with the developmentally disabled and the mentally ill clientele in my past as a social worker. We often have family call us and we sit down with them we can talk to them about the options. Sometimes guardianship is necessary because the adult is not able to make decisions for themselves and they need someone to do that-that's a legal process-so we do act as guardians, but we also work with them to develop a concrete plan and then we can keep that plan in place as they're not able too. Recently we had gentlemen who took a fall and needed to go to a nursing home to rehab from hip surgery. He had a home, he had a wife who was really confused, and a daughter who was blind and developmentally disabled and she was quite old herself. We were able to help the whole family get the services they needed and then get the adult son, who lived out of state, involved, help him get everything taken care of to the point that, down the road, they didn't need our services anymore. But we did the case management for a long time to, actually, they all sort of needed placement together but where they could see each other but they all had different needs so they needed to be in different levels of care at the same facility. We facilitated that whole thing so that they could still have a relationship, still see each other, and the parents' wishes were carried out but they weren't able to. None of them were able to take care of themselves and each other anymore. We covered all the bases for them and the son was most grateful.

Susan Graham: I'm sure they were all thrilled with that, especially to be able to stay together.

Susan Graham: When the son is out of town, in this circumstance or other circumstances, when there's a loved one that's in a facility, do you do other things for them to lighten up their life so they're not just basically warehoused in a facility?

Deborah Hansen: Yes. We attend care conferences, we help people celebrate holidays. Part of keeping people oriented is if you celebrate the holidays and keep a calendar of events and sort of make sure their birthdays are all remembered and those kinds of nice things, too. So, like we ladies that have always bought their clothes at Macy's, and they still want to buy their clothes there. Some of them we can take to Macy's and help them get the clothes. Some of them we just buy the clothes for them and they tell us their favorite colors and what they like and we come up with clothes and we let them put them on and we take the ones that don't fit back. We do those kinds of things. The families can give us direction about what they want that way and we'll talk to them about it and we'll talk to them about the cost involved and sort of say, "Hey, is this something you want us to do or not? Do you want to have a neighbor come and see this person because they really want to do this kind of activity?" So, we can make things really personal. So, not only are we there 24/7 at the emergency room, calling the family saying, "Your loved one has a broken hip and these are the options what do you think?" We're also there saying, "We just visited your mom and she really wants to go to church on a regular basis and she remembers her hymns, can we figure out something to help you get her back at church on a regular basis?" We do all sorts of things like that.

Wil Hansen: We work very hard at honoring the values and the lifestyle choices that people have made throughout their lives so that, whatever point that we interact with them, we try to, as much as possible, recreate the same interests and give them the same choices and options and have them participate in the same activities that they would have done had they been doing it on their own. We had one gentlemen, he was in a nursing home, and he really liked Thai food a lot. So once a month we would go to this Thai restaurant and have Thai food, even though he was not nutritionally on that diet. It was also at the point where his quality of life was much more important than sitting there and eating nursing home food every day of the month. He enjoyed that, he got to know one of the waitresses there, and he had been in Thailand so he spoke Thai. They had a really good time that way and it was something that he looked forward to all the time.

Susan Graham: When you get contacted by a family do you go through a series of steps to find out what papers they have so that you know who you should be talking with?

Wil Hansen: Well, Susan, one of the things that you well know we work with you in your legal capacity and we work with other attorneys, bank trust departments, and other fiduciaries, to make sure that whatever values and whatever financial estate issues might be there that we all work together and any legal capacities that are required we are aware of them so that, we are guardians of the person primarily, so we usually don't step into that other arena very much, but we are aware of it so that we know what to do in case those kinds of issues come up. Many times, family will call and say, "Uncle George has a Last Will and Testament, and I'm in it. I want his furniture, and I know he's going to move out of the house next week, can I have that table?" We know what is involved so that the person and his estate are protected, his interests are protected. The elderly person also feels secure and other family members all feel secure that the property and the things that they value are being looked out for, and taken care of.

Susan Graham: I know you can be appointed by the court to handle affairs for someone as the guardian, the one who makes the medical and housing decisions for someone. If that is not necessary because there is another family member who is serving in that role, can you deal just with that Court appointed family member on the health or financial issues?

Wil Hansen: That's correct. We try to work with the people with whatever is in place already as much as possible because they are already comfortable with that, they're familiar with that and they know what the dynamics of those issues are. Debbie might have some other experiences to share.

Deborah Hansen: When we meet a person, one of the questions we always ask is, do you have a durable power of attorney for health care, so someone to make your health care decisions. We always ask about living wills and if they've got that. We also check out, if they have their financial, they're working with an attorney, or a trust department or some fiduciary. We always work to make sure there is no problem with the financial decisions. We don't take care of finances and we actually always send our bills to a third party for review to make sure that someone else is overseeing the services we are offering and then they're aware of what we're doing and how much it is costing. We build a team, and the team is made up of the people in the person's life that they've had in the past. Some of us are new, such as when we are hired to do case management or, sometimes we are appointed durable power of attorney for health care. People will ask us to be their durable power of attorney for health care because they have no one and they want someone that will carry out their wishes no matter what. We also act as durable power of attorney for health care and we work with attorneys to get that done.

Wil Hansen: Recently, I had a call from a gentlemen who had done a durable power of attorney for health care appointing us as his agent, and he was in the I.C.U. about to be incubated. It was because he appointed us that I was called and I was there to advocate for him and work with him while he was in the hospital. I was able to communicate with him as he could make gestures. I became the temporary guardian for a period of time. Now we're going back to court to remove that guardianship. This gentleman is moving back home next and his life is going back in place. He didn't have any family in the area or any one that was able to step in and be there for him at the time he needed it the most.

Susan Graham: That is fabulous. We are almost out of time so let me wrap this up. One of the things that Debbie has created is a checklist of some options for visiting people, could you describe that?

Deborah Hansen: What I did is I made a little list of things that you might want to do when you visit your loved one if they're in assisted living or a nursing home because sometimes after you've done all the move in tasks it's hard to know how to proceed. I made up ideas and suggestions that you might want to consider when you visit your loved one, and it will be on Susan's website.

Susan Graham: Thanks. Well, what we covered today is housing. Staying independent as long as you can, and if you can't be independently living in your home, what are the good options to look at and who can help you out? I greatly appreciate that Debbie and Wil were able to participate in this today.

Susan Graham: You're welcome, and if you'd like to visit with Debbie or Wil further about your own family circumstances, I encourage you to call them, their phone number is 208-433-3920. If you do mention that you saw their information on this website there is charge for that first meeting with them. There will be additional materials about the Castle Rock Services on our website as well as the list of things to consider doing when you visit people in an assisted living or nursing home facility-that will be on our website. Our website is http://www.graham-lawoffice.com/ and thank you very much for participating with this, I appreciate that, goodbye.

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THE GRAHAM LAW OFFICE, P.A.

Boise, Idaho