Carole Hirsch is a board-certified patient advocate and owner of Prepare to Care – Emergency Companions. Carol has her MBA in Emergency Planning and has spent 24 years of advocating for Seniors.
Transcript:
Frank Samson: Welcome to the Aging Boomers. I'm your host, Frank Samson. On our show, we discuss so many of the issues facing boomers, and their parents, and we know of course is an aging population, which I'm smack in the middle of and I want to thank everybody for all their support. Our listeners are growing each and every day, picked up by radio shows all over the country now, as well as our podcast. I want to remind everybody that today's show is sponsored by Senior Care Authority, a senior placement and elder care consulting organization that has a national network of professionally trained and experienced local advisors to assist families. They'll work with you in determining the right path for you or your loved one and discuss various longterm care options, whether it's in home care, assisted living, possibly memory care, or nursing, or if you just need an advocate to get advice from, you can contact a Senior Care Authority advisor for your loved one and you could do so by calling 888-809-1231 or you could go directly to the website at www.seniorcareauthority.com and our listeners are growing and growing as I mentioned, and they mainly are because of our wonderful guests.
Frank Samson: Just a wealth of information and we have another one today. We have with us, Carole Hirsch, Carole's a board certified patient advocate and owner of Prepare to Care Emergency Companions. We are going to learn more about that. Carole has her MBA in emergency planning and has spent 24 years of advocating for seniors. Carole, thank you so much for joining us on the show today. Really appreciate it.
Carole Hirsch: Thank you so much. I hope I'm going to be helpful to your audience.
Frank Samson: Yeah, well I think so. We were just talking a few minutes before we went on the air here and I learned a lot from you already, so I'm really excited to hear more. So tell us a bit more just, there's so many different specializations growing in our industry, especially with boomers aging and just the needs out there and you seem to have targeted in on a certain niche. So tell us more kind of what you do, what your organization does, how you got into this. I'd love to know more.
Carole Hirsch: So I got into this because I was actually care taking for my family and found that there were gaps in services that were of concern for me and I figured they were concern for other people and in particular, we have a fear of talking about end of life care. And so some people get more care than what they asked for and some people don't get the care that they're asking for. So I wanted people to be able to have those conversations ahead of time so that people had a more quality of life, end of life care. And then I also found that people were going to the hospital alone and that that is just not a safe or a dignified way to be in a situation. And so I started my business called Prepare to Care, Emergency Companions and I really want to talk about the general issues associated to this to why I started the business because they're issues that everybody faces.
Frank Samson: So give some examples of, you were saying that people, I know I saw something that you wrote that people should never have to go to the hospital alone. And boy I agree with you there and I know you happen to be based in southern Florida and there's others that do some similar work as you. We'll talk about that later. You know, different parts of the country. But I have to think probably in your market, there's a lot of people that maybe have retired there. Maybe the children aren't around, maybe they still live in other parts of the country and they may be alone, they may not have family down there. So that seems to be an area that you accompany that particular person, if they do have to go into the hospital. Is that correct?
Carole Hirsch: Yes. I mean even when children want to be involved in their parents' care. They may not have a clue as to what medications they're taking and what they're for. They may not have thought about what their medical history is and they may not be prepared to actually answer the questions that the doctors are asking or the nurses are asking them in the emergency room. So the whole goal is being prepared for that, it makes when somebody does go to the hospital, a much more likely that they'll have a positive outcome or something untoward would happen.
Frank Samson: Carole, give us an example maybe, a scenario, like how did that family get in touch with you? How did you get that referral? If it's an emergency, how would you have known about it if they have to go into emergency and then kind of take us through some of the things you do.
Carole Hirsch: Okay. So what I will say is that in any emergency situation, if I'm called in, whether I had a background on this person or made a prearrangement, just the mere fact that somebody is not alone, they will have a better outcome because it's not somebody by themselves in a hospital when they don't feel well, will have additional issues that will affect the outcome. So if I were to know nothing about their care or their history, they're still going to have a better outcome because somebody is there with them and they're not going to feel alone. Generally speaking, the goal would be to make a prearrangement and to have a plan in place. So I work with both kinds of situations where somebody is a primary caretaker, they're care taking for somebody who has dementia or some other ability where they're dependent on somebody in order to survive.
Carole Hirsch: So we make a prearranged plan so that if the caretaker, which you know that there's a huge stress on caretakers, ends up in the hospital, all the plans are set in place and we know what we're going to do, who are the people that are important, if there's going to be respite care set up, all of those things are already prearranged. And so that is one scenario where the service is just a really huge asset and a huge relief. The other way is that, if somebody has a DNR or somebody has strict advanced directives of their medications and their medical history, knowing who their primary care doctors are all helps in providing appropriate care and making sure that people have ... Did that answer your question?
Frank Samson: Yeah, no, that's great. So I know that the term DNR, advance healthcare directive. Listen, I know what it is. I would have to think that most people listening know what you meant. Discuss that. How does that DNR, explain what that is, or an advanced healthcare directive. Explain what that is generally and how that fits into this, what you are doing with that family and how you're prepared.
Carole Hirsch: Okay. This is actually one of the really important parts of why I started my business and that is that we can keep people alive. You can have a heart condition in which you know, every two months you're going back into the hospital and then you lie in bed for three days and it's called death by bed rest. And so people have to know when the out is, when they don't need to keep this process of going back and forth to the hospital. And when they can be able to tell their loved ones, "I'm okay, this is the right time for me. I've had a great life." So what we try to do is set up the overall category is called advanced directives and they include two things. They include who the person is that's going to be helping implement your decisions. And the second part is the actual choices, I don't know specifically what that's called, but the whole package is called advanced directives. Include end of life choices and they include the people who are going to implement it.
Carole Hirsch: A dnr is something very specific. A person can, a DNR specifically relates to when the heart stops and whether they want to be brought back to life or not. And a DNR is really important if somebody has a heart condition because chances are that the process of coming back from a heart stop, is that 99 percent of the time the person is going to come back more compromised because they will have lost oxygen going to the brain. They will have a significant deficit or a minor deficit, but they won't be 100 percent the same. And the process of having somebody pounding on their chest, which they call massaging, can sometimes break ribs. And so it's a very difficult process for somebody to have to go through if they're close to the end anyway. You know. So DNR is very important in that regard.
Frank Samson: And that stands for do not resuscitate.
Carole Hirsch: That stands for do not resuscitate. In Florida, it has to be on a yellow piece of paper, and it has to be signed by your doctor. Every state has different rules in end of life care. In Florida it's always got to be yellow and it has to be signed by your doctor and anything else isn't.
Frank Samson: You're right. So like in California, where I'm based, it's a post form and and it's on a hot pink piece of paper. And you're right, every state is a little different on that. Yeah.
Carole Hirsch: Well post is actually different. A post is a little different. It's a form of a DNR and the post is great because what post is, as opposed to advanced directives, post is something that is end of life care choices that your doctor signs, it's doctor's orders or physician's orders for end of life care. And that carries more weight than your advanced directives because advanced directives in general, are great, because you don't know what your future is exactly. Where a DNR, a do not resuscitate is very specific. It's just about your heart. And so as emergency responders come to a patient's home, they can hand them the do not resuscitate, and they know exactly what to do, but in end of life care, chances are, I mean, advanced directives, chances are they're still going to be taken to the hospital and they're still going to be going through whatever treatment. Unless somebody can come there like me and show them this is not what the person wants. This person's very clear about their end of life choices.
Frank Samson: Yeah. So if you bring on, let's say you have a family that wants to work with you and you're meeting with them for the first time. What are the types of things that you would ... information that you'd want to gather? So you are prepared, should that day come up where that particular senior, let's say, is rushed to the hospital over a particular situation, you're contacted, you're there with ... Tell our listeners if they were to use a service like yours, what type of information would you require?
Carole Hirsch: So, as a patient advocate, I make sure that my clients understand that all I do or all I am is a conduit of communication. I give no medical advice. I can't give any consent. I can't offer any kind of medical advice. So it's very important that anybody who works with me has advanced directives because somebody has to be in place to make decisions if somebody cannot make decisions. And so that's the first thing that has to happen, is that they have to have that conversation and they have to have that in place. Otherwise it's a liability for someone like me to be there and there's nobody to make a decision or give consent.
Carole Hirsch: So the next thing that I really need is the prescription, all the prescription drugs, when they take them, who is the doctor that prescribes them, how long they've been taking them. So having a very complete picture of their medications and what they're for and when they take it, really changes the scenario for the hospital because they'll have a better understanding if somebody is taking blood pressure medication, whether they've had that blood pressure medication, if they're having a reaction to a brand new medication. So, that's critical to providing optimal care, is having medical info, having the pharmacy information, or their medication list. And then second to that is the medical history. And believe it or not, if somebody is used to having a drink every day at 5:00, they might have a reaction in the hospital from not having the medication, from not having the alcohol. They might go through a minor withdrawal and might become confused.
Carole Hirsch: So when I collect information, I collect both the social information and their history so that I'm on top of what they might need so that they have the best appropriate care and it's really important when you go to the ER that anything that's a comorbidity, like whether they have afib or diabetes, everything is affected by having these major illnesses and they complicate every picture. So I really like to have that medical history in place because it also again affects the possibility or prevents something untoward happening.
Frank Samson: So it sounds like it's not that you're just with people that are alone, you may be there even if a family members there as well. Am I right?
Carole Hirsch: Yes.
Frank Samson: Okay.
Carole Hirsch: And the goal is to serve at somebodies pleasure. But yes, I have a certain level of expertise that makes me somewhat indispensable, but at the same time, I am as a patient advocate or my services, I'm happy to just be the person who says this is the right time for you to come down or this is not the right time for you to come down. They're going to be fine. I have this. Come down when they're coming out of the hospital and make sure that they have a smooth transition, that information can be really valuable as well.
Frank Samson: Yeah, I mean, for those of us in the industry and as you know, I am as well, sometimes we forget that when a family is confronted with a situation and they do need to reach out for help, they may never have done this before. This could be their first time and they're trying to learn real quick and there's so many different resources out there today. You being an extremely important one, but I'm sure they're going to hear the term, geriatric care manager, you just said the term patient advocate. Tell us a little bit more about the differences, so people can understand the difference between those two and any other similar type of a service.
Carole Hirsch: I would say that care managers are patient advocates, but patient advocates are not care managers. So anybody that ... A patient advocates goal is to give voice to a patient's choice in care, to make sure that they understand what care is being offered, whether it's necessary or whether it has implications or side effects or issues. And so I as a patient advocate, want my patients to understand what their choices are and to implement their choices. My goal is to be transparent in any relationships that I have and to be as ethically bound as I can possibly be, and I think care managers are also do that. Care managers, their goal is, or their general focus, is on overseeing care in the long run. So where I may come into a situation where somebody is basically healthy, they have a short term problem that they have to solve. They get the information, they solve their problem, they move on. They may continue to have an ongoing relationship or not, but a care manager is for somebody that you know is compromised and will continually need oversight. And so you hire a care manager, they advocate for you. They also provide continuous oversight. Not that a patient advocate can or cannot do that and I'm sure there are plenty of patient advocates that do care management, but it is a different focus.
Frank Samson: So what about a hospitalist? How does that fit into everything here?
Carole Hirsch: Well, I think of a hospitalist as a doctor that works in the hospital and doesn't have a private practice. So I don't know if they're ... Yeah, I'm not sure. There's patient advocates that are also in the hospital and they deal with some of the ethical issues. If somebody has a complaint about how they're being cared for, but that's possibly a different role.
Frank Samson: So, do you ever, on behalf of the family, are you ever communicating with a hospitalist as well?
Carole Hirsch: Oh, absolutely. Absolutely. So, I deal with 90 percent of my clients, their children are not here, otherwise I would help them set up their care so that they can do what they do. So, what is the biggest problem for children whose parents are sick and in the hospital, away from them, is being able to talk to the important people that they need to get information from right? Like they're going crazy. I can't reach the doctor. The doctor is not returning my call. The nurse isn't speaking to me. So having boots on the ground, somebody right there who can get face time, talk to the doctor, be there when the doctor comes, talk to the nurse, can be just a huge relief to somebody who's not able to be in insight of their parents or their loved one when they're ill. It's a huge bonus.
Frank Samson: So I know we've talked about what I'm going to ask you. We've talked a lot about this on our show throughout the course of the years I've been doing this but we can't talk about it enough. All right. And that is what advice can you give to the families out there to make sure that they're prepared? What are the types of things that they should have from a legal standpoint? Information. So when someone like you steps in or they don't have someone like you all right? And then they're gonna be dealing with the doctors and the hospital or whatever and what information at a minimum that they need to have put together.
Carole Hirsch: I actually am so glad you asked this question because I really wish people would do this because it'll just make a difference. Right? So the first thing is that nobody, we have a very anti death society and anti aging society. Nobody wants to face the fact that nothing lasts forever. This is a natural part of life. And so people need to really have that conversation in a loving way, whether it's inviting your parents to speak up about their choices, or parents knowing that their kids really want to know and they're not afraid of hearing that you are going to go and they want to be prepared for that. So having advanced or having a real conversation about advanced directives, having kids hear from their parents, I want you to know I had a great life. You don't have to keep me alive at all costs. I'm okay. I don't want to be here and be hugely compromised. It would be just a huge relief for parents and for children. So, advanced directives is my number one thing.
Carole Hirsch: If you want to be on a practical level, the most important thing that you can know is their medical history and of course their medications, who prescribes them, what they're prescribed for, and what the possible risks are for taking that medication. And if you did those three things, if something untoward were to happen and somebody ends up in the hospital, whether it's ... They could have a heart condition, but they ended up taking a spill. You have enough information to give somebody so that they have a leg up on providing that care. And if there's a cousin or a friend or a significant person, somebody who has some interest in the loved one that they're worried about, that they should know ahead of time when so and so goes to the hospital, we're going to ask you to be there with her or hire someone like me, or him, so that nobody goes to the hospital alone. Just the fact that somebody is by your side will make a difference in outcome.
Carole Hirsch: Even if it's just to say, if you want water, can you get water? Can you get a pillow? Can you get a blanket? Can I eat? When will the test results come? You know, somebody who was compromised isn't going to be able to speak up for themselves. And having somebody there just makes a big difference.
Frank Samson: Right, right. Great. Well, you know, I could talk to you all day about this. We only have a couple minutes left, so I'm gonna just ask you to, certainly I want you to share with everybody how they could reach you. Whether you have a website, phone number, whatever you want to share with everybody, but maybe before you do that, certainly you're in the southern Florida area, I think, in Palm Beach and that area of Palm Beach County in that area. So certainly if people listening are in that area, they could contact you. But how would outside, throughout the country, if somebody wanted to bring on or get advice from somebody like yourself in other parts of the country, how would they go about doing that or finding the right person? Any advice you have?
Carole Hirsch: Yes. I just want to say one thing, just to make sure that we get this in, which is that it's really important to have positive communication and I just give you a little snippet of it, which is that I tell my mom all the time, don't worry, but she never listened. And I said to the daughter, I said, why don't you just say to your mom, I want you to know you're safe. I got you. You know, I want you to feel safe and that is something that the mom finally heard. So we want to always look at how we can communicate positively with our loved ones, especially in a nervous situation. I just wanted to say that in case I don't get that in.
Frank Samson: That's a great point. I'm glad you did.
Carole Hirsch: Okay. So, there is an alliance of professional health advocates and the website is aphadvocates.org, And it's the alliance of professional health advocates and they have a directory of people all across the country that you can get as a resource. There is also a directory for care managers. I don't know that off the top of my head, but if you were to do a google search on either one of those things, you would find a directory of professionals who have signed up and want to be and represent themselves as professionals in their respective organizations.
Frank Samson: Great. And how and how can people reach you?
Carole Hirsch: So you can reach me, my web address is preparetocare.com. That's all words, P-R-E-P-A-R-E-T-O-C-A-R-E .com, and my business is Prepare to Care Emergency Companions and my number is 561-758-5630.
Frank Samson: Carole Hirsch, check it out. www.preparetocare.com. Thank you so much for joining us Carole. You're a wealth of information.
Carole Hirsch: Yeah, and I will say there is no one roadmap to aging. Everybody has a different bump on the road. You need resources. You know, you should ask for them because it is uncharted territory. Nobody has the same path as you, so get help.
Frank Samson: Thank you. And thank you for all you do. Really appreciate it.
Carole Hirsch: Thanks so much for the time.
Frank Samson: I want to thank everybody for joining us on the show today and just be safe out there and we'll talk to y'all soon.
