On this episode of Make It Last, Victor hosts an interview with Mary Kay Krokowski, President and Founder of Aging Advisors. Mary Kay gives information on what Aging Advisors can do for families who are feeling overwhelmed with the future care of an aging loved one and when the time is right to call a geriatric care management service.
For more information on Aging Advisors visit their website: http://agingadvisors.com/
Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and Certified Elder Law Attorney (CELA®) and Certified Financial Planner™ professional (CFP). Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.
Click below to read the full transcript…
Victor J. Medina: Everybody, welcome back to Make It Last. I’m your host Victor Medina, I’m so glad you could join us this Saturday morning. I am really excited to present an interview I held with Mary Kay Krokowski, who is the principle and founder of Aging Advisors. She is a geriatric care manager.
We are going to talk through a lot of really interesting information about when geriatric care management is necessary and warranted, and what you can do to set yourself up to be in a great position for the future. Without further ado, here’s my interview with Mary Kay Krokowski.
I am joined today by Mary Kay Krokowski, who is the principle and the founder of Aging Advisors. I am so glad you can join us Mary Kay because we get lots of questions.
Our world is in around how do we help people who are facing long‑term care crises. I am going to hit you with a bunch of questions, but before I do that, just tell me a little bit about who you are, how you arrived at this stage, and what Aging Advisors is.
Mary Kay Krokowski: Thanks for having me, Victor. I have been a registered nurse since a long, long time ago, over 40 years. The progression of the things that I’ve done have been the typical things ‑‑ the hospital nursing,
I was really an emergency room nurse for quite a while. I went into visiting nursing, which I loved because it was walking into people’s homes and using my nursing skills in a really practical way.
I did a little three‑year stint in assisted living and then was grabbed by another care manager, actually, who was one of the original care managers from 1986 ‑‑ Connie Rosenberg, who still is a wonderful mentor for me.
She taught me the fundamentals of care management. I’m not a social worker, but it’s almost a combination of social work and nursing. In lots of ways it’s knowing the needs of, and I particularly enjoy older adults. There are some care managers that focus on people with disabilities or people with mental health issues.
Victor: Younger, but ongoing and persistent.
Mary Kay: Correct.
Mary Kay: Correct and using a different insurance mechanism. Most of the time they’re on Medicaid or they’re on SSI or something else often times. The majority of the people that I see are on some form of Medicaid or a pension benefit kind of Medicaid.
It’s always been very interesting, and it reflects itself in my history with emergency room nursing is that triaging. When I meet a family, going in and doing a lot of observing of body language and observing of vocal tones, and along with are they short of breath, are they worried I’m going to tell them they have to move out of their house yesterday.
Also dealing with the families because the families are very distraught. They’re very worried about an older adult most of the time. Sometimes there’s financial reasons for needing to make a change. Sometimes it’s a medical reason for needing to make a change. Sometimes the only bathroom’s on the second floor, and that’s why we have to make a change.
The nursing was the origin because it was the assessment skills that you need to be able to do care management, but from there it’s a lot of life experiences and job experiences that layer themselves on top of the ability to do this.
Victor: It sounds to me like you’d have to be equal parts social worker, psychologist, or family therapist…
Mary Kay: Lots of things.
Victor: …and having a medical background leads itself to being…It’s all that combination of stuff together for that. Aging Advisors is a geriatric care management company. Is that a fair way of describing it?
Mary Kay: Yes.
Victor: Where are the situations that it’s called in? What do we see? There’s no ideal client profile. Your business and my business is the same in that way. I can’t really describe a family that is a template going forward. What is a good way of describing what situations a geriatric care manger is called in?
Mary Kay: Sometimes we’re really lucky, you and I both, where people have done their planning ahead of time or they’ve had discussions with their family about, “I never want to move to a nursing home,” or, “I’m willing to move to a one floor house,” or “If my spouse dies this is what I’ll agree to do.”
It’s pretty unusual for somebody to make that kind of planning, but sometimes we’re lucky enough to have families that are open enough to be able to do that. Many of the times we’re dealing in crisis, families that are calling in that somebody has fallen a couple of times, is in the emergency room, is going to rehab, but they need a plan coming out of that.
Victor: My experience has been that the majority of clients that we see, we’re not getting the person that we’re caring for reaching out to us for help. We’re getting the rest of the family. Is that similar in geriatric care management where the principal that you’re caring about is not the one that’s calling you for the help, it’s the rest of the family that’s trying to figure out what to do?
Mary Kay: Exactly. It’s most commonly an adult daughter or son that’s calling and saying, “I have no idea. I’m a wonderful accountant. [laughs] I do real estate but I don’t know anything. It should be easy enough to know how to take care of my mother, but I don’t know where to begin.” Those are the phone calls I get.
Victor: The set of services that a geriatric care manager provides are what? What could someone expect by reaching out and saying, “OK, I need help”?
Mary Kay: What I explain to families ‑‑ I call it a global assessment ‑‑ I’m looking at everything. A lot of people call me in particular because I am a nurse. They feel like, “Oh, mom will let a nurse come into the house. She may not let a social worker come.” [laughs] It’s just a little scary undertone to that sometimes.
Victor: Which you’re happy to explain. If they’ll let you in as a nurse, that’s fine. At least you’re going to help them.
Mary Kay: I’m proud of that. That initial assessment is the key piece, which is also something that social workers are obviously very trained in doing. Nurses are, too, just from a different perspective.
That assessment is the initial piece. We look at everything from what’s your medical insurance. Do you have a power of attorney? People are always worried about their wills. I always say, “What about the power of attorney?” [laughs] That’s almost…
Victor: We’re not dead yet. Right?
Mary Kay: Right.
Victor: We’re still living. We’ll see the living doctor first.
Mary Kay: We’ll worry about that later, making sure of those things. What’s your medical history? What’s your social history? Were you somebody that was always outgoing? Were you somebody that was never outgoing?
That’s really hard to put somebody that’s never been outgoing into an assisted living, because they’re just not social that way. It’s like being uncomfortable in your own skin sometimes if you’re not in the right setting.
Those are things we take into consideration. Also, what is the crisis at the moment? What are the adult children’s perspective on that, which is often very different from the older adult’s perspective on that?
Then we look at the functional strengths and weaknesses. Have there been a lot of falls? Are you needing help in the shower? Do you need help getting dressed, because the arthritis is worse, because spinal stenosis, because you can’t remember how to sequence clothing or the laundry’s in the basement?
Now, we need somebody to carry things down the stairs for you. Can we get somebody in the house? Then I take the smallest of snapshots of a financial situation, because the finances determine what a care plan can be.
If you’re down to your last $30,000, that planning is very different from somebody that’s at least got $500,000, that we can make a bigger plan with or we have more options when somebody has more finances.
Victor: When we come back from the break, I want to explore a little bit more about what an end result from that assessment looks like and then what obstacles you encountered that families have in either implementing them or carrying them through. It’s what the next step after the assessment is. Stick with us, we’ll be right back on Make It Last with Mary Kay Krokowski from Aging Advisors.
Victor: Welcome back to Make It Last. I’m joined today by Mary Kay Krokowski, who is the founder of Aging Advisors, geriatric care management company based out of New Jersey but doing work really in Mercer County, Bucks County. You help families all across. Wonderful.
When we left to the break, we were talking about this concept of a global assessment, which you do on initial basis. What’s the end result of that? Is there a set of recommendations that you’re giving people?
What comes out of that other than looking around and saying, “You can’t go upstairs anymore to do your laundry,” or whatever else that comes from that? What’s the end result?
Mary Kay: Within about 72 hours I produce for them, I call them “care recommendations” and it’s usually sent in an email form to the adult children. Sometimes the older adults want an email form or I mail them one if it’s appropriate.
That goes from soup to nuts. It’s that same emergency room triage format in that if things are very serious and there’s no power of attorney, that’s my number one is, let’s decide who should be making decisions should things go south even more than they are right now.
Victor: The concept of triage basically saying the most important thing that we need to attend to first by giving a list of everything that if we had limited resources and time, emotional resources as well as financial resources, how can we knock everything to bring this client to their best possible position?
Mary Kay: It’s very much based on the client’s goals and the client being the older adult. In that interview and that global assessment, it’s really determining what they’re going to be willing to do. I always say I like to find their soft spot.
If their soft spot is, “I can’t let go of my dog. My dog’s been with me for 15 years and I’m not going anywhere without my dog” then I need to find a solution or an option that’s going to keep that dog.
That may be for the next six months at least. We’re going to have a caregiver in the house versus an assisted living as a solution because mom’s going to buy into that knowing that she’s not going to lose her dog.
Victor: We are very similar in our professional attitude towards our clients which is, I’m OK manipulating a situation that leads to my client’s better results. In that soft spot if the dog solution eventually gets them into a protected environment with their medications managed, into the plateau and level out from a decline, I’m OK using that.
Similarly, I’m OK using someone’s concern about what they leave behind for their kids to make sure that they’ve got a plan in place. That also includes disability planning and anything else they might need for that. What obstacles do you see in implementing that plan going forward? Are they more on the client side, or are they on the family side, or are there unequal parts of that?
Mary Kay: It’s normally on the client’s side so on the older adult’s side in that you’ve got to get them to buy in even if it’s just a small baby step. Then it’s convincing the adult children that, “Work with me.” We’re going to have to go more slowly then you’re wanting this to be solved. There is resistance on both sides but trying to look at how to optimize the plan.
How do we take those steps forward? Those stepping stones which are really the only way to go. You can’t normally pick somebody up and drop them into a nursing home and say, “Well, that problem’s solved.” That person is extremely unhappy and the adult children are having to deal with anger, sadness, depression and all kinds of things.
Going at a slower pace than sometimes people want to go when it comes to moving a person. Certainly, as a financial planner, you may want to do things in a more rapid series.
But when somebody’s talking about their future, their home that they built, the legacy that they want to leave for their family, whether it’s “I want to make sure that my grandchildren get these dolls or these books or these whatever,” we need to be really sensitive to those small things because what sounds like a small thing to us is a really big thing.
That’s how you get the leverage to try and talk them into taking the next step. I’ll add hours of a home health aide because Monday, Wednesday, Friday isn’t enough but I get to stay home longer.
Victor: As older adults realize the risk that they’re at, they understand little bit more about their frailty. They get security conscience then they latch on in a very concrete way to the things that they know and realize. If it is not moving out of a particular space home or if it’s something that’s concrete like that, they’re going to hold on tighter to that.
We have to understand that’s to move that stone does require a lever that might be little bit smaller and it’s initial move that will get them down that path. The same thing if we talk about in terms of investment management.
We have a client that we’re working with now that we’re doing work to get their finances organized for Medicaid application but she can’t let go of the Disney stock. I don’t know what it is but there’s Disney stock and she’s inherited it and it’s something that has meaning for her.
We can work around that because somebody that comes out of it without empathy for it can’t put themselves in that person’s shoes. “There, but for the grace of God, go I” scenario. We’ll just come in, sledgehammer and try to knock it out, not understanding that this is something that they need to hold onto before they can release something else.
It’s really going to be the last thing that they let go of going forward. You can counter that. Do you face challenges with more and more families get scattered? We don’t have that kind of nuclear families, raised in the same community, everyone stays there and they’re living next door to another.
Do you face challenges where you have family members that don’t understand what’s going on with mom or dad on the ground and having to translate that? Do you serve as a form of a mediator or translator for them?
Mary Kay: Yes. There’s a lot of mediation that goes on in families. You’re right. There’s families that are scattered all over the place. I’ve had people in Russia and Seattle, and mom and dad are here in Pennsylvania in that circumstance. It’s being the eyes and ears.
I remember distinctly sitting in a very dark room with all the shades pulled hot, hot, hot, in the house. The woman gets on the phone. The son calls and says, “You know, she sounds fine to me,” and I said, “I’m going to describe to you…” This was a little bit before we had all the phone cameras. “I’m going to describe to you what this house looks like right now and what she’s wearing.”
She had four or five layers of clothes on, including a stocking cap and it was dark and extraordinarily hot and she was not drinking enough water. The list goes on. She was…but on the phone, boy, she sounded great. It was very difficult to convince that son that we needed to make a move. The daughter was on board but the son was not.
This just happen to be this circumstance. Creating that visual for him took a little while but it is that mediation piece that was important to continue to describe the situation.
Victor: In full disclosure, I’ll say that you and I have shared clients over the years. One of the things that you excel at and one of the reasons why we love bringing you in on cases is you have an extraordinary ability to establish rapport with the entire family, including a pain‑in‑the‑butt client, who doesn’t want you there in the first place.
You bring in this level of gravitas to situation. People respect what you’re saying and then you can get people to move in the direction that they need to. I’ve always admired that you had that skillset.
When we come back, I want to then have you explain to us, what do we identify as situations where people should be reaching out to a geriatric care manager? The other area I want to explore is we’ve talked about this concept of assessment.
It also seems to me, Mary Kay, that we should be talking about the implementation phase, too. We take that as almost like a foregone conclusion. Would you agree that there’s a need to have an ongoing if not relationship but more help in that area, too?
Mary Kay: There certainly are families where ongoing care management…I have clients right now that I’ve had for nine years where one of the spouses has died, but he’s 99 and a half. [laughs] He is still with us. He threw me out of the house the first time I met him because he didn’t need any help.
This family actually, the adult children, I have suggested more than once that they move this gentleman closer to a family member in Massachusetts. They won’t do it because they know that we take better care of him than this daughter could.
Victor: He would lose you.
Mary Kay: A face‑to‑face…Isn’t that sweet? It’s just a thing. [laughs]
Victor: It is.
Mary Kay: The ongoing piece is very important for somebody. I always say to families, “I want you to not need us anymore. I want to stabilize this situation in a reasonable amount of time as quickly as we can so that you can put us on the back burner, and I’m not bleeding through your money.”
We certainly would love to see them once a month even for an hour just to make sure that we can continue to patch up any part of the plan that’s falling apart at that point.
Mary Kay: Maybe there’s dehydration or maybe there’s something else that we can patch it up, so we don’t end up in the hospital or have it fall or something.
Victor: A little bit more when we get back. I’m going to take a quick break. I’m joined today by [laughs] Mary Kay Krokowski from Aging Advisors. This is Make it Last. We’ll be right back after the break.
Victor: Welcome back to Make It Last. In America, we were just talking about the implementation phase. I tell you, in my practice, one of the phrases that I like to say is, “I watch this to become boring quickly.” There’s no need for this to become exciting any longer.
It seems to me when we’re talking about your desires in implementations, you’re looking for something similar. You’d like to get to the point in time where the drama of what’s going on has faded to the background. Is that a fair way of describing it?
Mary Kay: Right. It also becomes a period of trust so that down the road ‑‑ I work with older adults ‑ there’s going to be a change in status whether it’s financial. Most the time, it’s going to be medical or functional ‑‑ the ability to walk across the room or get up the stairs or whatever. There will be a change down the road.
If we can find a period of stabilization, it’s great reinforcement. We can optimize that person’s day‑to‑day life so that they have some peacefulness for a period of time. When the next crisis comes, they know that we’re the go‑to person. That older adult is going to say, “We’ll just call Mary Kay or Aging Advisors and they’ll be able to fix this because they fixed things before.”
Victor: It’s how I walk around our practice. If I see any of those situations, I’ll say, “We just gotta call Mary Kay and she’ll help or Aging Advisors.” We talked about a goal of getting to the non‑drama stage, but I would imagine that there’s the drama stuff that causes somebody to want to reach out.
How would you lay out a set of stones and say, “Look. If somebody sees these kinds of situations, we really…That’s a hallmark of when it is appropriate to reach out for help by a geriatric care manager.”
Mary Kay: One of the things I would suggest is when families are in stalemate, one adult child is disagreeing with another. In the meantime, the person that we’re talking about, the older adult, is really falling apart.
Their safety. Maybe they’re wandering out of the house. Maybe they continue to fall. Maybe they’ve been in the emergency room too many times in the last six months, and the doctor is getting very frustrated.
Those are the times where calling in an outside person is very helpful. I stress that with families. We know it in our own families that sometimes people will listen to an outsider before they’ll listen to that adult child that they raised from three years old because they still see them from…
Victor: The kid.
Mary Kay: [laughs] Still their kid, so they’re not going to listen. Even if they’ve got the ”New York Times” in front of them [laughs] or Victor Medina said, ”This is what we need to do,” you’d need that outside person sometimes to help them hear it in a different way maybe.
Victor: Do you find that the adult children have to overcome an emotional sense of failure in reaching out? Is there a frustration point hey reached that causes them to overcome that? Are they hesitant at all because they think they can handle on their own? What family situations do you encounter like that?
Mary Kay: I would say probably the biggest worry they have when they call is what’s this going to cost. We keep things really reasonable. That’s probably the first.
Then I don’t really think this is going to work. You’re not going to be able to convince my mother because I’ve been telling her the same thing for five years. It’s amazing how sometimes they just need to hear it from somebody else maybe from a different perspective.
Victor: In somebody’s skills, too. I’m going to pump you up and let people know that you have particular skills in this area that where people think that it might not happen, when you come in, we find that it in fact does.
It’s OK to reach out when we see situations where things have changed, hospitalizations happening too often, the person at home not thriving. That’s probably a good point in time to reach out. If they’re interested in reaching out, how do they reach out to Aging Advisors to start that process?
Mary Kay: A phone call. Sometimes, I get emails from our website, agingadvisors.com. I carry the phone, so I’m the one that answers that number. I get a little snapshot, again, of what’s going on.
Many times, a family member will say, “Well, how would you even approach this? How do you even think you can get through to my mother?” That’s when I use that word again, that soft spot.
I need to see her. I need to understand whether there’s dementia. We’re not going to get through to that person. We can tell her 500 times that she needs to leave the house. All she’s going to remember is that something negative is going on. Let’s stop saying that. Let’s find another way to approach this.
Victor: We’re going to give you the opportunity for the shameless plug. What is the phone number that people can call?
Mary Kay: It’s (609) 815‑5959. (609) 815‑5959.
Victor: If you listen to this on Saturday and you call it, Mary Kay is going to answer the phone on Saturday.
Mary Kay: [laughs] I do answer the phone on the weekends. Sometimes, it goes to voicemail, and I can see how critical it is. If it’s not so critical, I might leave it till Monday morning.
Victor: I want to thank you for joining us today. I find it an incredible blessing that in my practice we have the opportunity to invite you into families that really benefit from the services that you provide.
We find that families even out whatever is going on and find a direction from where they need to go when they’re lost. We’re trying to do that on a legal and financial side. You’re providing that on a emotional boots‑on‑the‑ground care side.
When I’m done with them, they’re not calling me on a regular basis. I don’t know what mom is eating. I don’t know what medication she’s taking. I don’t have that picture, but they need that part of it solved in order to feel comfortable that this person in their life is going to continue to thrive. If you had to leave people with one message before we broke for today, what would that be?
Mary Kay: To try and plan ahead, to try and open the door, to have a conversation and not make it threatening [laughs] with an older adult in your family that there is help out there. There are these people called care managers.
There’s a national website. That’s aginglifecare.org. If you happen to be in Seattle, there’s a whole way to find someone in an area. You just put the zip code in. If it’s Orlando Florida, you put in the zip code on to find an Aging Life Care Professional page.
You will find a host of care managers in that area. You can pick up the phone and call any of them or email any of them to test them out on the phone and see if you feel comfortable having a conversation with them.
Victor: I think that finding that comfort level is important. I think people want to work with somebody they trust like, especially if they’re going to be remote, far away, if there’s going to be an ongoing relationship. If you want to learn more about Mary Kay, her company Aging Advisors, pick up your phone. Go right to agingadvisors.com. Take a look at their services.
I can’t emphasize enough that if you’re facing a situation where you’ve got somebody in your life that you’re caring about and you’re concerned what’s going on, one of the best things that you can do is reach out to geriatric care manager and start that process.
Our recommendation will certainly be starting with Mary Kay and with Aging Advisors and seeing what they have. Mary Kay, thank you for joining us today. We really appreciate you having on.
If you want to share this with other people, remember that we broadcast the show as a podcast. It’s available on iTunes, Spotify, anywhere that you go in makeitlastradio.com. This would be a perfect episode to share with somebody else, because you’ll give them the opportunity to get this information.
Victor: I’m sure you know if somebody in your life that’s struggling with this. We would appreciate you sharing this information with them. We’ll be back next Saturday on Make It Last where we help you keep your legal ducks in a row and your financial nest egg secure. Catch you next time.