Do you want to remain in your home as you age, avoid a nursing home, and have a plan for aging well and safely?
Join Kelly and me, Lynne Giacobbe, CEO at Kendal at Home, a unique aging in place program, as we discuss life care at home on the Steadfast Care Planning podcast.
In this episode:
🔹 What is a life care at home model? What types of services are provided?
🔹 What if you move to a facility, do life care benefits go with you?
🔹 How does LTC insurance fit/coordinate with a life care plan?
🔹 How much care is provided? Are there daily or monthly benefit limits?
🔹 How much does it cost? Is there a fee to join and then ongoing annual fees?
🔹 Who can join? Age and health limits?
Kelly Augspurger: [00:00:02] Hey everyone. Welcome to Steadfast Care Planning, where we plan for care to live well. I'm your guide, Kelly Augspurger. With me today is Lynne Giacobbe. Lynne is the CEO at Kendal at Home, which is a unique aging in place program. Lynne, thanks so much for being here!
Lynne Giacobbe: [00:00:18] Thanks for having me, Kelly.
Kelly Augspurger: [00:00:20] Glad to have you. If you want to remain in your home as you age, avoid a nursing home and have a plan for aging well and safely, then this is the episode for you. Today we're going to be talking about life care at home. So, Lynne, are you ready to jump right in?
Lynne Giacobbe: [00:00:35] Ready.
Kelly Augspurger: [00:00:36] Okay. Well, to start, Lynne, what is a life care at home model and what types of services are provided?
Lynne Giacobbe: [00:00:43] So this is really a very unique model. We started this program about 20 years ago and at that time we were just one of a few programs. And today there are probably about 30 to close to 40 programs now in existence across the country. But it's really about planning for your future. So it's taking a step while you're healthy and independent to plan ahead for all of the uncertainties that might lie in our future. So I think most of us think about that big event and ending up in a nursing home and place that none of us really ever want to be.
Kelly Augspurger: [00:01:17] Right.
Lynne Giacobbe: [00:01:17] But the reality is that we get sick, we have surgeries, maybe a fall, all those little bumps in the road that having a little extra help can help you to recover, get back to normal and go on with life as you would have prior to that accident or that illness. And Kendal at home is really about helping people preserve their highest level of independence.
Kelly Augspurger: [00:01:40] Ok which is what everybody wants, right? We want to be remain independent as long as possible and be at home as long as possible safely. Right. And that's something that life care communities are able to provide; those types of services. So within that program, what types of services are you all providing?
Lynne Giacobbe: [00:01:59] So I'd say the most important service that we provide is care coordination, and it's really someone who navigates aging with you. So the first thing we want to do is identify what are your goals? What's important to you? How do we help you remain healthy and independent? We want to evaluate your home. Are there steps that we can take to make homes safer for you? And are there ways as you age that we can help identify adaptations that will make it easier to remain independent? In the 20 years we've been in operation, 98% of our members have remained safely at home and not had to go to a nursing home.
Kelly Augspurger: [00:02:38] Wow.
Lynne Giacobbe: [00:02:38] So the idea is that if we really work at this, it is possible to provide the care and services that someone might need in their home. And those services can be home care. It can be skilled services that are covered under Medicare, but the private duty care is the majority of services that people need, and that's not covered by insurance. There are times when it might be covered by a long-term care insurance product, but that's a reimbursement down the road. Typically, someone needs assistance with at least two activities of daily living on a consistent basis. They have to meet a deductible period or an elimination period. They have to have certain criteria and they have to have a doctor's order for Kendal at Home. We're really evaluating you where you are today and if you need assistance. We're putting that care in place, but we're also identifying things. We have a personal training component. So we're really looking at how do we help someone maintain their independence if they're at high risk for falls. There are lots of things we can do to really help strengthen balance and help mitigate the disasters that could happen, right? If we can prevent them from happening, that's really the goal. So we're working a lot on the health and wellness side, on the preventive side, and then as we continue down that journey, when someone does need care and it could be for small things, you could have the flu or you get Covid, we're there to help support you through that period of time and provide the care and services you need. Over the years, I've learned that when someone can't take care of themselves because they're ill, they also can't take care of things like mowing the grass, the snow plowing, all of the things that we have to deal with in Ohio, Kentucky and Massachusetts and all the areas that we're serving. We need to be able to help people to remain in their homes independently. So we have a home maintenance component to the program and we help to coordinate all of those kinds of things. So making sure we have someone who can come in and provide those services when they need them, even bill paying services. And we don't pay for maintenance of the home or bill paying those types of things under our program, but we certainly will help to coordinate and bring all the things together that someone needs to be able to remain in their home.
Kelly Augspurger: [00:04:56] Got it. So there's really a wide variety of services that you're providing whether you need a little bit of care and help or you need catastrophic, extensive amount of care, right?
Lynne Giacobbe: [00:05:06] Absolutely.
Kelly Augspurger: [00:05:07] From my experience as a long-term care insurance specialist, my clients are buying coverage for really the catastrophic. You mentioned it's two out of six activities of daily living or if you need supervision due to a cognitive impairment. That's wonderful if you have protection for those catastrophic situations. What happens, though, if you need a little bit of help right before your policy kicks in, before you have those benefits coming in, what's the plan? No retirement plan is complete without a plan for long term care and that includes if you need a little bit of care or a lot of care. So it sounds like a life care program is really able to address from the beginning to the end and in between.
Lynne Giacobbe: [00:05:51] Yes. As members come into the program and I would say that probably somewhere between 35 to 40% of our clients have long-term care insurance.
Kelly Augspurger: [00:05:59] Okay.
Lynne Giacobbe: [00:06:00] You know, people that are attracted to this program are planners. They're the same people who probably bought long-term care insurance years ago, but they're also people that are highly intelligent and they realize that protection goes much further than that. And really, who's going to help navigate this with them? And for most of us, our children are working, have families of their own, have their own responsibilities, and they can't just drop everything. I think so many times when you ask someone, what's your long term care plan, they'll say, "Well, my children will help me." And I know from my own personal experience that as much as I love my parents, it is very challenging to be able to maintain a job, my own family responsibilities, all the things that I have and also manage all of their care needs over the years. And I experienced that as my mom was dying for a year and a half. I mean, my life was really dedicated to providing care to her and making sure that her needs were met. And so today, this is my dad, right? But it's I think having that care coordinator is someone who is knowledgeable, who knows the field, who understands what services can come into play, can really be that person that helps bring everything together. And on top of that, when someone has a long-term care insurance product in place, we're helping to file that claim for them, processing all of the paperwork, making sure the T's are crossed, the I's are dotted and helping them with their Medicare claims as well because when you think about it, when you're sick and in the hospital or you've had a catastrophic illness or situation that's occurred, you are not likely to be able to begin then getting all the documentation, submitting all the paperwork and taking care of all of that. And that care coordinator is really the key to everything that we do because people are coming into the program when they're healthy and independent. We're getting to know them so we understand their needs and we really can adapt a care plan specifically for them as they age. I think some of the other differences as we look at it, a long-term care insurance plan, they're going to look when we take eating as an activity of daily living: can you get the food from your plate to your mouth?
Kelly Augspurger: [00:08:14] Right.
Lynne Giacobbe: [00:08:14] And maybe they can do that, maybe they can feed themselves, but how are they getting their groceries? Can they prepare the meal? You know, so often if someone is not feeling well or they've had a surgery or something, they just aren't able to get to the grocery store and get a meal plan in place and prepare that meal, stand at a stove and cook and microwave meals. Those kinds of things aren't always the best options. So we're really evaluating the activities of daily living from a very broad perspective and when and if that long- term care insurance product is going to come into play, we're going to be there to help file those claims and work with them. So it's kind of managing all of that, even their Medicare covered services. So if they're entitled to therapy and rehab services, we're bringing those services in as well, and we can help to coordinate all of that and bring everything together seamlessly so that there's no duplication of services.
Kelly Augspurger: [00:09:11] Right.
Lynne Giacobbe: [00:09:12] And that the member has what they need to be independent as soon as possible. And some members as they age, we have a member who's nearing 100 years old, who's had care in her home probably now for 3 or 4 years, and she'll have care forever until she dies. And hopefully we'll get to celebrate her 100th birthday with her and she'll continue to be provided with care to help her remain at home where she wants to be. But I think on the other hand, if someone wants to go to an assisted living or needs a memory care or a nursing home, those are all services that can be covered under our plans as well if someone chooses that.
Kelly Augspurger: [00:09:51] Okay, interesting. So you don't necessarily, you're not losing benefits if you do move out of your home, you can still assist in the process?
Lynne Giacobbe: [00:09:59] Yes. People could come into the program under what we would consider a foundation plan where they have really just the care coordination component, but if they want additional care coverage, they can layer that on so they can add daily benefits to that. And a daily benefit someone selects, let's say, for example, maybe a client of yours has a long-term care insurance plan in place. Maybe they don't need a daily benefit to add to that foundation plan, but maybe they want to have a little extra so that they have those situations where it's not a catastrophic situation and they can add some care coverage in. They can select a plan where we are adding some care coverage and that coverage is going to go with them, whether they're at home, in assisted living, or in a nursing home. So it can help to cover that care. Maybe they picked a $250 a day long-term care insurance benefit, but nursing home costs today are rising and they want to add a little to that with a benefit through Kendal at Home, they can combine the two and will help coordinate their benefits under both Kendal at Home's plan as well as their long term care insurance plan.
Kelly Augspurger: [00:11:06] Okay, great. So really, how much care is provided? There's probably a big range. What would you say is like the minimum and then what would be the maximum as far as like a daily or monthly benefit?
Lynne Giacobbe: [00:11:17] Kelly, I'll give you an example. Let's say that someone has surgery and they come home from the hospital. It's likely that we're putting in 24 hour care for a little while, maybe a couple of days, depending upon the surgery and depending upon the person. I had a woman who just had a total hip replacement over the weekend and came home yesterday. And she doesn't want any care because she feels like she's doing fine. So it's really driven by the individual and what their demands are, what their needs are. But let's say they have a benefit of $265 a day, but that those first couple of days, they need 24 hour around the clock care. So that's going to exceed that daily benefit during that period of time. But over the next 30 days, we're going to really reduce the level of care as they become more independent and they're more stable after they've gotten home and kind of gotten a little recuperated, at least from that surgery. Right? So they're going to get a little more independent and we're going to reduce that level of care, but we're going to average the cost of that care, even though it's a daily benefit, we're going to average it out over that 30 or 31 day period of the month. And even though they might have exceeded the daily benefit in those first couple of days, over the next 25 days, we're going to be reducing care as they get stronger and more independent and they're likely not to exceed that daily benefit at all. I think where we see people really needing that high level of 24 hour around the clock care is really more near end of life and they've chosen to remain at home and needing someone constantly at their side to help navigate things, but that typically isn't a very long period of time for most individuals.
Kelly Augspurger: [00:12:58] Sure and I would imagine, we talked about if there's an event, if there's a hip replacement or there's an illness, but just due to life and the aging continuum, sometimes there's not a big event, right? It's just due to the fragility of aging. We just become less mobile. We don't have as much strength, and so we just might need some help throughout the day. And so it sounds like a life care program, it's going to meet you where you're at, whether it is that illness, injury, accident, something like that, or just due to aging, I need some help. I need some help with meal preparation, grocery shopping, those types of things which we would consider in the industry "instrumental activities of daily living," right? Those like homemaker services, things that aren't physically helping you with activities of daily living, but you're receiving assistance when you need it, which when you've got a long-term care insurance policy, if you've triggered it by those two ADLs or need supervision, you can also get those types of things, but you need to trigger the policy first. So within a life care program though, you can provide those services up front before that catastrophic event if needed, which, when it comes into play, if there's not a catastrophic event, most people need help with those things first, right? Like the transportation and the meal prep and and all of those homemaker services that people do every day, we take for granted when we're healthy and younger. So, Lynne, tell me who can join? You did say earlier independent, someone needs to be independent. So talk to us about like age and health limits. How do you get accepted into the program?
Lynne Giacobbe: [00:14:40] So really, we're looking at a couple of criteria as we're considering who's appropriate for this program. So if they're coming in under this foundation plan where they're going to have the care coordination benefits, there's a set of criteria we're going to look at. We want to make sure that we're going to be able to meet their needs. So we're doing a health evaluation. We also want to be able to set a baseline for where they are when they come into the program because we're going to be continuing to evaluate that over time, over their lifetime. So one of the things that happens is someone comes into the program today, they're healthy and independent, and we're continuing to do annual assessments and evaluate where they're at in terms of their independence. But when you start to see small changes and I can give you a great example of this. We have a member who lives in Cincinnati. Her name is Norma. The care coordinator did her annual evaluation, her assessments, and there was an indication that there was some cognitive decline and Norma was very concerned about that. And she's a very health conscious individual, works out all the time, really focused on remaining independent. She's a solo ager, so making sure she's as healthy and independent as possible is really important to her. So we were able to help get her into an Activate Brain Health program and it's both physical exercise as well as cognitive exercise, and her cognitive scores went right back up. So seeing the difference and the impact that something like that can make is really what we're talking about. So knowing where someone's at when they come into the program is really important. So we're doing assessments around cognitive, depression, nutrition, balance, mobility and really identifying where someone is and what their baseline is today. We also want to make sure that this program is affordable to them over their lifetime. So when someone's coming into that foundation plan, there's a $25,000 entry fee and I think a $300 monthly fee. So they're coming in and we want to make sure that this is affordable to them over their lifetime. So do their assets and income, will it make it possible for them to continue in this program over the long haul without putting them in any financial jeopardy? We're evaluating all of that when they come into the program. If they're adding levels of daily benefit, the criteria then is going to be a little bit higher because we want to make sure that they are independent today when they're coming into the program. So it's a little bit stricter under when we're adding the daily benefits or daily coverage care coverage, we're really just looking to see where someone is today and how we can best meet their needs as they continue to age. And what are their expectations? Is this really what they're looking for? It's the same thing I think when someone's buying long-term care insurance, they're selecting the pieces that fit best with their financial situation as well as their goals moving forward.
Kelly Augspurger: [00:17:46] Ok. What about age limits? Is there a minimum or a maximum or are we we're really focused on health and finances?
Lynne Giacobbe: [00:17:53] Yeah, I think we're really looking at affordability. I would say that people can join our pricing goes down into the 50s so people can join. I mean, there isn't really any reason someone couldn't join younger than that. I think we tend to see people beginning to plan right as they're planning for retirement. As you said, they're starting to look at these options, you know, in their 50s and so really, I think our youngest members have probably come in in their late 50s, but there's no age limit on the other side. So we've had people in their 90s join the program and when you're adding the care coverage, that pricing increases based on their age. So that pricing is going to be based on the age and the daily benefits that they're selecting, just like long-term care insurance would be.
Kelly Augspurger: [00:18:39] Okay. Good to know. Well, Lynne, you've been just a wealth of knowledge today. Do you have any final advice for our listeners on how people can plan for care to live well?
Lynne Giacobbe: [00:18:48] It's planning, right, Kelly. That's the key is that people really do need to be planning for the future and really getting a good understanding of where your Medicare benefits come in, what's covered under your health insurance and those types of things. I think people often think that Medicare or Medicaid is going to take care of me as I age.
Kelly Augspurger: [00:19:08] Right, misconception.
Lynne Giacobbe: [00:19:09] Unfortunately, it is a big misconception for folks that really don't understand that Medicare has its place. Medicaid will come into play when someone has really depleted all of their assets, but for most of us, we've worked our whole lives and planned for the future, but very few of us are really planning effectively for what care costs we might incur as we age. So that retirement plan needs to include all of these things. They're all factors that we should all be thinking about and considering as we get closer and closer to that retirement and just having the benefit of having someone there who can support you through whatever lies ahead and hopefully helps to mitigate some of the crisis that might occur and prevent things from getting worse than they need to be.
Kelly Augspurger: [00:19:53] Yeah, having an advocate.
Lynne Giacobbe: [00:19:55] Absolutely.
Kelly Augspurger: [00:19:56] So that your kids don't have to step in. Maybe leave their home, leave their city, quit their job, reduce hours at their job to come and provide care. I mean, it's unrealistic for parents to assume that their kids can and will do that and want to do that. And I think some parents realize that and I think others might be in denial, but, if we really take time to think about it and to talk to our family about it, I think too often these conversations don't happen. And so there are a lot of assumptions that are made. So we want to be proactive and talk to our spouse if we're married or talk to our kids, talk to our family, what's realistic? You know, what is the plan? Who's going to provide care? Where do I want to receive care and how am I going to pay for care? Those are the big three.
Lynne Giacobbe: [00:20:41] Right.
Kelly Augspurger: [00:20:42] And so you need to have a plan. Well Lynne, where can people find more information about Kendall at Home?
Lynne Giacobbe: [00:20:49] They can go to our website, Google Kendal at Home, and Kendal is with one L or kahome.kendal.org or they can call our phone number is (440) 835-8681. They can reach us any number of ways, but we are always happy to talk with people and help explore whether or not this might be a good fit for them. It isn't for everyone, but we certainly would be willing to spend the time to just explore what they're looking for and see whether or not this is a good fit.
Kelly Augspurger: [00:21:20] Okay. Lynne, thanks so much for your time today. Have a wonderful day!
Speaker3: [00:21:23] You're welcome, Kelly. Thank you. You too.
Kelly Augspurger: [00:21:25] Thanks. Bye bye.
Watch this episode on YouTube: https://youtu.be/-8APJmW_1XQ
For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.