“Letting go of fear and embracing acceptance” is easier said than done. As a Licensed Clinical Social Worker specializing in issues related to aging and caregiving, Rachel Deaton’s passion is to help people draw upon their own resilience to find the courage to successfully navigate change and to empower them with the tools needed for the journey ahead. Learn more about counseling and coaching/consultation services offered through Positive Aging Counseling and Consulting, LLC at www.positiveagingcc.com and Facebook.
To read more about the challenges facing individuals (and brands) in the long-term care field, read the full discussion article that inspired the interview.
AM: Describe your background and why you created your business, Positive Aging Counseling and Consulting.
RACHEL: Many people who pursue a social work degree are drawn to work with children. I, however, have always felt more of a connection with the other end of the life spectrum. I was close with all of my grandparents and also have fond memories of making friends with a fellow antique doll collector at an assisted living facility. I’m a helper by nature and also have an interest in seeing big pictures and connections in the world. This spurred my interest in my undergraduate degree of sociology, and I think of social work as its applied arm.
With the world’s population aging rapidly and the number of people age 60+ estimated to nearly double between 2015 and 2050, I saw some needs in the community that I wanted to fill: specifically, to address mental health counseling for the aging population and support for caregivers. I’ve noticed that grief over a variety of losses can become cumulative and magnified as people age, especially if they are isolated and lonely which increases the risk of developing depression.
Additionally, caregivers are often an invisible and forgotten group which is why I offer coaching and consultation for specific caregiver related issues: pointing caregivers in the right direction for resources, helping guide and frame conversations and long-term care planning while also addressing underlying emotional challenges.
AM: Studies have found that 70 percent of people over age 65 will need long-term care. How do you even begin to have those discussions? How do you define long-term care? How should people start thinking of it?
RACHEL: As a youth-oriented culture, discussions surrounding aging and mortality can pack an emotional punch and many people avoid them. However, by allowing ourselves to face the fear of planning for the future for ourselves and for our loved ones, we can help to ensure that the choices we make now, during a period of careful research and planning, are the choices that will be respected later, often during times of crisis.
In my experience having these conversations with loved ones myself as well as with clients, I’ve found that it’s helpful to frame them in a way that communicates our motivation for having the conversation in the first place: love, concern, and a desire to maintain the highest possible quality of life. For more specific examples, a group of healthcare pioneers created a free resource called The Conversation Project which provides conversation starter kits addressing end-of-life care and wishes.
Traditionally, the image many people have in their heads of “long-term care” is of old, sterile-looking nursing homes with long hallways. However, long-term care encompasses a wide variety of services over an extended period of time ranging from at-home assistance with activities of daily living, to adult day services, assisted living, skilled nursing, and long-term care facilities.
Long-term care can be temporary or permanent and is based on need, rather than age. Additionally, if you or a loved one are needing temporary assistance at home and are homebound, I would encourage you to speak with your primary care physician about the possibility of qualifying for home health services provided through your insurance.
AM: How do you help aging family members and their caregivers to navigate the expanse of options for their care? What services do you provide? Do you have relationships with elder care attorneys for example? Or trust attorneys?
RACHEL: The need for flexibility is key. I understand that humans are complex and though people may have similar planning needs/desires, the road to get there can look very different from one family to the next.
As a therapist, I pay attention to why people are seeking services at this particular moment and try to help them identify what barriers kept them from having this conversation sooner. Addressing the emotional needs of aging family members and their caregivers is an important part of developing a holistic plan. So, not only working to address the concerns of all involved, but also identifying and addressing the priorities of the aging family member themselves. Our priorities and values greatly influence our motivation to create necessary changes.
I have met with a variety of financial planners, elder care attorneys, visited continuum of care facilities, etc. and keep a running list of resources to share with clients. I don’t necessarily recommend one company or individual over another but will provide a list of at least 2-3 potentials for clients to contact.
AM: Can you help make recommendations on in-home care?
RACHEL: For private pay, there are a plethora of home care companies that provide assistance ranging from companionship to light housekeeping to personal and nursing care. Typically, these companies require a minimum of 3-4 hours of care at a time and prices usually begin around the $22-26/hour range for private pay clients. The state of Oklahoma offers a Medicaid waiver program called ADvantage for people making $2250/month or less with limited assets which provides services which may include case management, assistance in the home, occupational and physical therapy, home-delivered meals, and adult day services. Another similar but more intensive wraparound program is called PACE (Program for All-Inclusive Care of the Elderly, available in Tulsa, OKC, and Tahlequah).
AM: How do you define the differences between assisted living, skilled nursing and memory care? How do you help people decide what level of care they may need? Can you assist people in other states or is your expertise Tulsa based?
RACHEL: Assisted living is a lower level of care than a long-term care facility/nursing home. In assisted living, people live in an apartment (typically with no stove/oven) and have access to 24/7 support, assistance with medication, hygiene, and enjoy prepared meals and scheduled activities. Many assisted living communities have different tiers of services and prices increase with level of need/services provided. Medicare does not pay for assisted living. Medicare does pay for skilled nursing which requires at least a 3-night hospitalization. Skilled nursing services focus on occupational and physical therapy to increase patients’ strength and ability to return home either to independent or assisted living arrangements. Memory care can be both assisted living and long-term care/nursing home facilities. Memory care units are secured so that patients cannot wander out of the building. Typically, someone who is diagnosed with dementia and is needing more assistance would start out in regular assisted living and then transition to a memory care unit as the disease progresses. If the person seeking care assistance or their spouse is a veteran, they may qualify for aid and attendance benefits through the VA. While my experience and expertise has been limited to the Tulsa area, I’m always happy to answer questions and to attempt to connect individuals seeking assistance with local service providers.
AM: How are you different from other options for aging and consulting services or are there other options?
RACHEL: As a Social Worker, I prefer to utilize a collaborative approach. Because I see a fairly specific population, if I receive referrals that aren’t in my niche, I refer out to other capable clinicians. I think it’s important to be knowledgeable about resources in the community and specific needs of the populations with which we work. I am well-versed in the aging field, having worked at INCOG Area Agency on Aging, LIFE Senior Services, and with the Alzheimer’s and Parkinson’s Associations. Also, most of my counseling clients are on fixed incomes and prefer to use their insurance for services. Currently, only licensed clinical social workers and psychologists can bill Medicare for psychotherapy services. In terms of coaching and consultation for caregivers, I enjoy helping problem-solve, create plans, provide resources, role play conversations, etc. but for more extensive and/or detailed work or for guardianships, I would refer out to somewhere like Purview Life.
AM: What would be your advice to health care brands trying to connect better to seniors needing care? What about their caregivers?
RACHEL: For anyone who finds themselves confused about where to begin looking for services/community resources, I recommend utilizing Eldercare locator, a public service created by the Administration on Aging. Just type in your ZIP code and a list of local service providers will pop up. I would start by calling the Information Specialist at your local Area Agency on Aging (the Oklahoma state-wide number is 1-800-211-2116) who will be able to provide a more in-depth explanation of local resources and non-profits that serve the aging population and caregivers. In Tulsa, for instance, that would be LIFE Senior Services which provides a variety of assistance, including annually publishing a Vintage Guide to Housing and Services that is a compilation of services available to older adults in northeastern Oklahoma. Additionally, the Alzheimer’s Association has a 24/7 helpline for caregivers in need.