TRANSCRIPT

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Episode #25 - Navigating Healthcare in Your Golden Years

Introduction

Eric Blake: Welcome to another episode of the Simply Retirement Podcast, where we simply focus on retirement planning, so you can focus on retirement living. I'm your host, Eric Blake. On this show, we not only talk about the financial aspects of retirement, but also some of the more emotional and even non-financial aspects of living in retirement that many women face along the retirement journey. Today we're going to be joined by Pam Farris. Pam is the founder and chief care manager of Harmony Care Management, and we all know the challenges that we face in retirement when it comes to healthcare and the cost of healthcare, but care management is a relatively new concept that evolved from case management, that's been around for a long time, and I'm really excited for this episode. I think this topic could really be a game changer for many retirees, maybe just as much for also for the families of those retirees, which is where a lot of our clients fall as caregivers, or at least playing an active role in the healthcare process with their parents. So Pam Farris, welcome to the Simply Retirement Podcast.

Pamela Farris: Thank you for having me. I really appreciate it.

Eric Blake: Absolutely. So glad to have you on. Now actually, you shared some of the details of, as we were preparing for this, kind of what that care manager is, but if you wouldn't mind, just share a little bit about your background and how you actually got into care management in the first place.

Pamela Farris: Yes, of course. So I started my career in the hospital medicine, and then I am an entrepreneur at heart, so I pursued a health business degree and a master's degree, and my objective was to have my own business. I opened Care Homes in Plano, which I had for over 22 years. COVID kind of changed all that in '20, it was a crisis situation. So I got a job as a director of nurses and administrator at a hospice, and after two years of doing that, I was trying to supplement the homes. People just weren't moving at that time. So I decided it's time to go a different direction and started the care management business, where I could still be an entrepreneur at heart and serve people, which I enjoy so much.

Eric Blake: You are one of the most hardworking people that I've come across. We've done a number of events together, we're part of some different networking groups together and you are constantly on the go. So if you had to provide a definition of what you do, what care management actually is, if you can help the audience understand that, what would be a definition you could provide?

Understanding Care Management

Pamela Farris: What we do is, we work with the client and family to go with a holistic approach to managing their healthcare needs, financial needs. We get resources such as yourself to meet those objectives. To get their legal documents in order, we help them get their wills, trust, whatever set up with attorneys that we work with to get all the plan in place to either age in place where they are, or move to whatever setting that they need. But our objective is always to follow what it is the client wants and the family wants. If the client has to mention, can't really speak for themselves, we go on what their history was, what their known likes were, and try to adhere to what their wishes are in achieving a better outcome. We also do medication management, so if that's an issue, we go in and do med management, we work with physicians, we meet with the doctors at the doctor's office. We will get physicians to either come to the home or meet them at doctor's appointments if they do not have a primary care physician and/or specialist.

Eric Blake: Well, I think it's so great. I mean, the fact that you think about what we do as financial advisors, financial planners, we often think of ourselves as kind of the central point of somebody's financial plan. So we help coordinate, again, as you talked about, estate planning attorneys, tax advisors, we do the tax planning, all these different variables that people need guidance on, and try to bring those, try to simplify that process. And it sounds like you do a lot of those same things, but more from the healthcare aspect.

Pamela Farris: Exactly, yes. And we can serve as medical power of attorney for those who have no wonders. I think you and I talked about the solo aging issue that's happening, where there's not children involved and people don't have anyone that they can trust, or entrust their medical care and make sure their needs are followed through, and we can serve as that advocate for them. So we always advocate and navigate the healthcare system.

Patient Advocacy vs. Care Management

Eric Blake: Well, that was the next thing I wanted to ask you. I think that term, I've heard that term floating out there quite a bit recently, that patient advocate. Is there a different definition you would provide as far as a patient advocate versus what you just went through as far as care management, or how would you define patient advocacy? I think that's one of the challenges people face is just not knowing who to turn to. And I think from our conversation that's a lot of what you can do, is just simplify that whole process of getting people connected to the right professionals.

Pamela Farris: Exactly. And as an example, a person in a hospital, they don't have any or might not have family that's knowledgeable or who's overwhelmed. And so, we would go to the hospital. We do both long-term and acute situations. So if somebody is in the hospital, we will go and advocate and make sure that their care is optimal, that their wishes are being followed, that every provision for them is being met well, because so many times care is substandard for individuals who can't speak for themselves.

Advantages of Engaging a Care Management Organization

Eric Blake: Well, I think it's so challenging, because a lot of times you just don't know what to say. It's not that even some people, they may be willing to do it, but it's just the words, when you're talking about insurance and doctors, and all that whole mess between how does something get coded incorrectly and all of a sudden you've got this huge bill, where otherwise insurance may have paid for it. And just knowing some of those ins and outs I think can be so crucial. And I know you've kind of touched on this already, I think as far as your definition of care management, but if you had to identify maybe two, three, four, and there's probably way more, but maybe just a few advantages that engaging with a care management organization like Harmony Care Management can have over trying to manage all this on your own, or maybe even if a caregiver having to try to figure all this out for a parent or a relative.

Pamela Farris: Well, it's overwhelming, so it's very reassuring to family members when somebody who is knowledgeable comes in and takes over managing everything for them and relieves that burden, so they can go back to being a daughter, or son, or husband, or wife instead of trying to be overwhelmed with facts that they don't understand. So there's so many examples, but making sure that there's optimal skincare, something that seems minor, but can lead to so many issues for immobile people. So we go in and make sure that the mattress is right, the bed is right, the medications are right, that they're being turned, that they're being changed, because that can have a negative impact on their recovery.

Case Study: Successful Care Management

Eric Blake: And I think one of the things that would be really helpful is if you think about maybe over the last year or so, a couple of years, is there a particular client that you've worked with, and you don't have to reference any names, but somebody that represents maybe what the best example of the value that Harmony Care Management can add to someone's life, what you were able to do for a particular client?

Pamela Farris: Well, actually there's a few, but one just really stands out, because I just wrapped up a tele-visit with her UT Southwestern physician on Wednesday, and he is just so impressed with our services, because he's been treating this client for three years, and he never heard the term, "I'm good," out of her in three years.

And he attributes that to my care. She is my client. When I started seeing her last fall, the daughter contacted us through a placement company who referred us, because they did not want to move, and the lady has Parkinson's. I don't really feel comfortable using her name, even though she's great with that. HIPAA is just, anyway, she has Parkinson's. She would be immobile for days, frozen in her bed. She lives with her physically disabled husband, and financially they're okay, but they did not know what to do, how to help her.

They hired caregivers that weren't necessarily doing what they were supposed to do. I came in, managed her medications, which helped improve the situation, worked with her neurologist to get a more effective medication that actually can be used in between her regular medications and in an inhaler form, which has allowed her to now get back to therapy, to get back to being more mobile. Her little episodes are few and far between. She's leading a more active life. Her husband, who has disabilities, saw that what I could do for her, and he hired me for him. And he was in the bed all the time, sleeping, very weak, but doing his medication management, meeting with his physicians, improving his medication regime has caused him to increase his mobility, and now they're both leading a more active life. Very rewarding.

Working with a Care Manager

Eric Blake: That's amazing. Well, so let's talk about that. So if an individual, whether it's for their own care or they're caring for someone, or at least they're involved in that process, who's interested in your services, what are the first steps in your process for evaluating a new relationship?

Pamela Farris: So we do a 30-minute free consultation, and it's a consultation consult, and we can talk on the phone, talk about the situation, and anyone can contact us. It can be the client, it can be a family member, it can be a physician, it can be a provider for that person. And what we do is go and do an in-person assessment. We also do a safety assessment of the home, a physical assessment of the person. We get a care plan in place. We also do a little mini cognitive test on everyone, just to see what our baseline is, to see if there's any indication that we need to help with that direction. So we do an assessment and then we develop the care plan, and based on the care plan and needs, we visit accordingly.

Eric Blake: So how would somebody typically, or where do you typically get your referrals, or where does the initial contact typically come from?

Pamela Farris: My partners in healthcare, people that I use, resources, people that I don't use that have heard about me, personal care companies, wealth managers, attorneys, physicians, nurse practitioners, visiting physicians, next door neighbor, they see what I do. I have gotten so many referrals from next door neighbor, "This lady could help you." When people are expressing their frustration of what do they do, they don't know what to do next.

Eric Blake: Well, as far as just a relationship with Harmony Care Management, is it always a long-term relationship? Can you help with one-off situations? What does the variety of services look like?

Pamela Farris: One-off is not usual, unless it's just for a hospital stay. Most people need ongoing medication management, and that takes a nurse to do that, unless we can educate the family to do that. Also, we meet with the doctors. So honestly, most of our clients have long-term conditions, chronic conditions that are ongoing. We may get them improved in their functioning, but a lot of them need us, or for example, veterans that will have an acute hospital stay. We get them through their hospital stay, get them home, get the resources that they need, and then we're just as needed. I have clients in Denton that we are just as needed. They have chronic conditions, but this is a little bit out of their budget, so they can call us. We can help navigate things virtually. We don't have to be in person, and come as needed. So it's either short-term, long-term, or just during an acute crisis.

Eric Blake: Well, that's a good question, and I'm not sure we had this on our list, but I think it is something worth discussing. As far as where your relationships are at, are they mostly local? Do you have the capabilities of working with somebody maybe in another part of the country?

Pamela Farris: I'm licensed across the state, so yes, I can work virtually with anyone.

Eric Blake: So for your services, primarily in Texas though, am I understanding that right or do you have-

Pamela Farris: Yes, in the Dallas-Fort Worth area are primarily, we are all over the Metroplex.

Eric Blake: Okay.

Pamela Farris: I have four nurses and a social worker on my team.

Eric Blake: Well, like in our case, for example, we do have a number of clients that are in different parts of the country. For those folks who may be interested in somebody like you, do you have a network of other professionals that do what you do in other areas of other states?

Pamela Farris: Yes. Aging Life Care professional. I'm a member of the Aging Life Care Association, and I can connect them with an aging life care professional, really anywhere across the country.

Paying for a Care Manager

Eric Blake: Excellent. Well, when we wrap up, we'll talk about maybe some of the resources you could suggest for people that may be looking for that type of service. Now, my guess is you don't do all this for free, as it sounds like. I know you do a lot of work, and again, you're one of the busiest people that I see on a daily basis. How do people pay for your services? Are we talking insurance, Medicare, long-term care, self-paid? How do your services get paid for?

Pamela Farris: Depending on the long-term care policy, some do have care management benefits. Typically, it's limited to two to four hours a month, so I would have to explore that long-term care policy. Medicare has recently, just very recently approved only one company, and it's very select and very narrowed on what type of care management they can do. And once they do get involved, they will be telling us, now we advocate for what that client needs, what that person needs. And if Medicare, and insurance, and managed care does become involved, they're going to want us to do it according to what they want to provide. So I do like it that it's independent, it is private pay. The assessment is a little bit more, and then we go on an hourly rate, either in person or virtual charge.

Eric Blake: And I would think that if somebody has that initial 30 minute consultation, and they're trying to figure out, "Well, what are some of my options for paying this?" Again, if it's out pocket, it's out pocket, but would you be able to actually help people understand some of the benefits that are available to them, that might help with paying for your services? Could you talk about that just a little bit?

Pamela Farris: Well, it would go over what type of insurance they have, if they do have long, long-term care is the only insurance right now that will cover their... So none of the Blue Cross, Blue Shield, Humana, none of those will cover their management as of right now. So it is mostly private pay.

Eric Blake: Now, one of the things that I thought about is, again, I was preparing for our conversation was thinking about what are the costs of not having somebody like you, versus the cost of having somebody like you on their side of the table to help deal with doctors, and insurance, and hospitals. I don't know if you've actually had a chance to break that down, but to me it's almost a scenario where maybe it ended up costing you more if you don't use somebody like yourself, than it would to actually pay for your services.

Pamela Farris: Well, in some cases, we can actually save by, we do insurance appeals, so bills insurance, hospital bills, hospital stays, and you get a exorbitant bill, and you don't know what to do, and you think that you owe it, and you're going to pay on it for the rest of your life. We can actually go in and review the bill, appeal the bill, and get the bill down by a quarter most of the time. So that can pay for itself. We can help medication management get some of the things that you don't need to be taking, or find the lowest cost option that still is going to work.

We work with Medicaid clients, we help people with Medicaid. So we're not all just about working with people who have money, so we'll go. We can be less than an attorney oftentimes for a Medicaid. However, Medicaid attorney is more experienced than we are, but we do know how to do a Medicaid application. We do help many people get on Medicaid pending communities. So therefore, you're be saving eight to $10,000 a month for room and board from a Medicaid facility, if we can get you in a Medicaid pending community. We help get VA benefits, so that can help with medication costs, provider costs, health costs. So there are programs, and again, we don't just exclude our services to wealthy people.

Eric Blake: Well, again, that's where I think potentially that argument could be made that, again, paying for your services through whatever the most effective way of doing so could be more cost-effective than trying to do it on your own, where you may end up with a lot more cost, insurance not covering what you thought it should, but not knowing how to dispute that or how to argue that. And having somebody like you on their side of the table, I could see that being a huge emotional advantage, number one, but also, again, potentially a financial advantage.

Pamela Farris: Well, we also reduce the hospital's revisits. That's a big thing of what we can accomplish is stop that revolving door hospital stay, where people just can't seem to get stabilized, because they don't have the care and they're managing their healthcare needs met, and so they're constantly going to the hospital. I have a client that I just admitted two months ago. She was constantly going to the hospital. She has not been to the hospital since I started working with her.

Solo Aging

Eric Blake: Wow. That's awesome. Which, that kind of leads me to another concept that I wanted to touch on with you and you and I, again, we've had these conversations, but that term of solo aging, and we've discussed it, because a good number of both of our clients fall into this category. It's basically an individual that's going to be going through their later years, either without children, or maybe they don't have a great relationship with their children, whatever the case might be. Again, you've touched on a lot of this already, but I think it is a good point to make, but in terms of Harmony Care Management being a tremendous resource for these individuals who are really going to be on their own.

Pamela Farris: Exactly, yes. I actually have a client that contacted us early on to make sure that we knew exactly what it is they want. And I don't have to see her very often, but whenever something comes up, she calls me. I go and be her advocate, and navigate through that situation, and I know what it is that she wants to happen when she can no longer actively speak for herself.

Eric Blake: And you had talked about some of the organizations you're actually connected with around solo aging. What was the, I'm drawing a blank on the term that you used or the organization that you're a part of, around solo aging?

Pamela Farris: Solo aging, the Solo Aging Associations, and it's mostly women.

Eric Blake: That's simple enough.

Pamela Farris: Yes. Yes. So I'm involved with several boards and different associations all to advocate for the aging population, which all of us are going to be. So it's very important that we are heard and that we effectively get what it is that we need.

Engaging with Harmony Care Management

Eric Blake: So whether it is an individual that's trying to manage their care on their own, or a caregiver looking for resources for a family member, or a solo ager, how can the audience connect with you to learn more about Harmony Care Management and how you can help?

Pamela Farris: So this at my website, HarmonyCareManagement.com and call, email and I'd be happy to talk with you. Let's see what it is that we can do for you. It's always scary to try to let go of total control when you really don't have control. Things are not going well. It's difficult. But what I hear over and over again is I wish I had hired you a long time ago.

Eric Blake: Right. And you touched on a couple of these different things, but as far as the other resources in addition to Harmony Care Management, again, whether it's resources for people are in different parts of the country or any other resources, websites, things like that, that you might be able to share for people who are looking for these different services.

Pamela Farris: Right. The Aging Life Care Association website, you can find a care manager in your zip code. And also, it is very detailed on what it is a care manager can do. There's also patient advocates and you can look up patient advocates, and find a patient advocate in your area. They're similar to what a care manager is. We all advocate for individuals, and there's so many people that need assistance, that either one of these avenues are the best way to go. But the Aging Life Care Association is an ethical organization that serves everyone across the state. There is care managers in a little tiny Alaskan town, so they're all over the country.

Eric Blake: I just thought about this. It popped into my head. Are there any specific qualifications, or any specific training, or designations, anything like that that people should be aware of to avoid maybe getting stuck in a relationship where they don't really have the skills and the qualifications to do the things that you're talking about?

Pamela Farris: So the Aging Life Care Association, you do have to have a higher level of education in order to get into the organization, or you have to be a few years experienced and supervised as a care manager before you're allowed to join the organization. So it's not just an organization that allows anyone. You have to be experienced or very high level of education to be in it. Patient advocates, you have to be board certified to join that organization. So experience is extremely important, that there are people who hang a fine care manager, who aren't a part of either one of these organizations, and I would just encourage you to be sure that they have licensure in whatever state and profession that they are professing for you.

Conclusion

Eric Blake: Well, again, I think this is really valuable. Is there anything that you would like to add? So maybe something I didn't ask, or I should have asked, or that you wanted to make sure that, did you share it as part of our conversation?

Pamela Farris: I'm not sure what to say about that. I just know that it makes a difference, and that we're here to support and encourage the family, and just so helpful and beneficial.

Eric Blake: Right. That's perfect. That works. Well, Pam, thank you so much for joining us today. Please be sure to reach out to Pam in Harmony Care Management if you are looking for somebody to help guide you through this maze when it comes to healthcare, healthcare planning, insurance, doctors, all these different things that can be just so overwhelming and so confusing, as Pam has very knowledgeably shared. Also, please like, follow, and share the show. If you would like to learn more about our firm, you can visit our website at www.blakewealthmanagement.com to listen to previous episodes, ask a question for the show, access some of our other free resources. You can go to www.SimplyRetirementPodcast.com. We will see you again on the next episode of the Simply Retirement Podcast. In the meantime, please remember, retirement is not the end of the road. It is the start of a new journey.

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