[SPEAKER_03]: Mrs.

Haging Ford, a podcast from Mayo Clinic about the science behind healthy aging and longevity.

[SPEAKER_03]: Each episode, we explore new ways to take care of our long-term health, the health of our loved ones, and our community, so it can all live longer and better.

[SPEAKER_03]: I'm Dr.

Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota, and this episode we are talking about what home health care looks like.

[SPEAKER_03]: So 98% of people would prefer to live at home in their place of comfort for as long as they can, but that can be challenging as health needs change.

[SPEAKER_03]: As the nation ages, more people will be finding themselves leaving their homes for senior living communities or skilled care facilities.

[SPEAKER_03]: And so our guest today is Dr.

Jeffrey Kong, who is the founder of well-be senior medical and in-home medical care group with a different approach to the future of home care.

[SPEAKER_03]: In the past three decades, Dr.

Kong has worked for the Centers and Medicare Medicaid, helping with decisions about national coverage.

[SPEAKER_03]: He was also the chief medical officer at Signa, Vice President of Walgreens Health and President of Chen Med, a primary care medical group for disadvantaged seniors.

[SPEAKER_03]: So today we really look forward to having this conversation about home health care transfer older adults.

[SPEAKER_03]: Welcome, Dr.

Kong.

[SPEAKER_04]: Good to speak with you, Dr.

Chen.

[SPEAKER_03]: Yeah, Dr.

Kong, it's so amazing that you started well-being your own geriatric home healthcare company to change the way we deliver care to our older adults with chronic needs.

[SPEAKER_03]: And I learned that one of your earlier jobs was working for a non-profit group, making home visits to frail older adults in their place of residence.

[SPEAKER_03]: Can you share that experience with us?

[SPEAKER_03]: What did you learn about caring for homebound patients?

[SPEAKER_04]: So first of all, all of us have had an aunt or a grandparent, 90 years old, very difficult time getting around, seven or eight chronic diseases.

[SPEAKER_04]: Maybe a little dementia in those situations, those people have a very difficult time getting into the doctor's office.

[SPEAKER_04]: And what we've learned actually is about 90, 95% of what can be in a primary care doctor's office.

[SPEAKER_04]: can actually be done at home.

[SPEAKER_04]: You can do a history.

[SPEAKER_04]: You can do a physical exam.

[SPEAKER_04]: You can draw blood tests.

[SPEAKER_04]: You can even take an electrocardiogram.

[SPEAKER_04]: You can even do X-rays.

[SPEAKER_04]: And we learned that it was much better to bring the care to the patient rather than bringing the patient to the care.

[SPEAKER_04]: You know, we were not for profit.

[SPEAKER_04]: It wasn't financially a good thing for doctors to do.

[SPEAKER_04]: But the way we thought about it is, [SPEAKER_04]: dignified and respectful to see people in their own home.

[SPEAKER_04]: It's patient-centric.

[SPEAKER_04]: You improve access to care.

[SPEAKER_03]: Right.

[SPEAKER_04]: So it's just the right thing to do.

[SPEAKER_03]: And I find that they're more comfortable too.

[SPEAKER_03]: They're not coming to you in the clinic, which can be a very anxiety-provoking experience.

[SPEAKER_03]: You know, they were checking their blood pressure and asking them probing questions.

[SPEAKER_03]: In their home, they just feel like, okay, we're in their space.

[SPEAKER_03]: They're more willing to share their concerns.

[SPEAKER_03]: And it's a more honest space if anything.

[SPEAKER_04]: it's less intimidating and really from a patient care perspective, you really want honest communication between both physician and patient.

[SPEAKER_03]: Yeah, and part of your inspiration for creating a new standard of care also came from a very personal place, your mom, what was her health journey like for her, but also for you and your family members?

[SPEAKER_04]: So at that time she was 88 years old and unfortunately it came down to a metastatic esophageal cancer.

[SPEAKER_04]: And then towards the end, despite all the treatments, was exhausted from the chemotherapy and the radiation therapy, et cetera.

[SPEAKER_04]: And I was helping her get from appointment [SPEAKER_04]: But finally, at the end, advocating for her.

[SPEAKER_04]: And so what I did was, I said, let's have a meeting with the oncologist.

[SPEAKER_04]: So we have a family meeting, and I asked the oncologist to answer one question to my mother.

[SPEAKER_04]: is the chemotherapy you're giving her, will it cure you?

[SPEAKER_04]: And unfortunately, oncologist says, look, I'm sorry, Mrs.

Kong, it's not.

[SPEAKER_04]: She, of course, after listening to that, just says, well, you know, if it's not gonna cure me, [SPEAKER_04]: Then why am I doing this?

[SPEAKER_04]: I'm suffering, I'm losing my hair, I'm throwing up and, you know, I just assume have as best quality of life as I can have in my remaining months.

[SPEAKER_04]: Now you see this time and time again.

[SPEAKER_01]: Absolutely.

[SPEAKER_04]: The point though is I find these really difficult, challenging, frail elderly situations, what they're looking for is someone to help them through the whole system and understand what's going on and to advocate on their behalf.

[SPEAKER_03]: Yeah, so that they can ultimately make their own decisions.

[SPEAKER_03]: If you paint a clear picture for them, present those options that are available for them, have them choose ultimately it's better organized care.

[SPEAKER_03]: And then it's easier for all of us.

[SPEAKER_04]: and the single piece of missing information for her was, was that chemotherapy going to occur?

[SPEAKER_03]: Um, right.

[SPEAKER_04]: But once she heard that missing piece of information, she's, do your point.

[SPEAKER_04]: Made her choice on her own.

[SPEAKER_01]: Yeah.

[SPEAKER_04]: You know, a lot of people ask me why geriatric, I'm sure people ask you.

[SPEAKER_04]: And so the way I think about it is we're giving back [SPEAKER_04]: to the generation that took care of us.

[SPEAKER_04]: This is a cultural thing you and I share with both Chinese Americans.

[SPEAKER_04]: We grew up and were taught to respect and honor the elderly or parents or grandparents.

[SPEAKER_04]: And the reason why was because they raised us, [SPEAKER_04]: they sacrificed for us, right?

[SPEAKER_04]: And the many cultures share that, but I just really feel that we all this generation, a debt.

[SPEAKER_03]: Absolutely.

[SPEAKER_03]: And I think the act of honoring is different for each culture, like for trans Americans and others honoring someone as tankarving physically.

[SPEAKER_03]: But I feel like the American culture honoring someone is giving them the independence.

[SPEAKER_03]: or giving them the ability to live on their own for as long as possible and not, quote unquote, get in the way, or not burden them with having to live with someone else.

[SPEAKER_03]: So I feel like we all want to honor all their delts, but just in different ways, I imagine.

[SPEAKER_03]: So how have you observed that aging has changed over the years?

[SPEAKER_03]: Not just physically, but our general attitudes towards aging.

[SPEAKER_03]: And what have you noticed to evolve in the past 40 to 50 years?

[SPEAKER_04]: From a statistics standpoint, you're actually right.

[SPEAKER_04]: Life expectancy from 40 years ago has increased from 75 years roughly to 79 almost 80 years.

[SPEAKER_04]: Now that's pre-COVID by the way.

[SPEAKER_04]: So life expectancy is certainly increased.

[SPEAKER_04]: Interestingly enough, life span, which is the maximum you can live, has not changed.

[SPEAKER_04]: You won't really find anyone over the age of 120, and it's unusual really to find anyone over the age of 100.

[SPEAKER_04]: So that's not changed.

[SPEAKER_04]: I do think you find people living longer and functionally enjoying a really high quality of life, much better than previously.

[SPEAKER_04]: I can remember 30 years ago, some of my colleagues would say, well, they're 80 years old, what do you expect, the expectation of completely changed?

[SPEAKER_04]: You got 80-year-old marathon runners, but I also think what people have realized because [SPEAKER_04]: is we're not immortal.

[SPEAKER_04]: So I do think people are being understand.

[SPEAKER_04]: I need to be realistic about end of life from an attitude perspective.

[SPEAKER_04]: We're going to live a really healthy life enjoy life up until and then when I get to the end, I just want to go peacefully.

[SPEAKER_03]: I think that's the goal for most people is to be able to live to a certain point.

[SPEAKER_03]: And I'm not everyone wants to live to 99 years old and die peacefully and they get to a certain point.

[SPEAKER_03]: And they're just like, I think I've enjoyed my life long enough, but what I'm generally seeing is that [SPEAKER_03]: people don't realize the consequence of chronic disease and how it impacts their independence until it's kind of too late.

[SPEAKER_03]: And they don't really understand how much suffering that is.

[SPEAKER_03]: So my whole goal is to try to change attitudes earlier and help them realize the beauty of living long, but also living long to the best of your functional abilities.

[SPEAKER_03]: And so [SPEAKER_03]: That's where I love practicing my geriatric medicine is helping people find that kind of art to living well.

[SPEAKER_04]: I love it.

[SPEAKER_04]: I love it.

[SPEAKER_03]: So you've already made a clear case for why home health care is preferable to nursing home is, but for those who've never been to nursing homes and long-term care, can you give us some insight into what life and a nursing home can look like?

[SPEAKER_04]: You know what people are basically forced to leave their home.

[SPEAKER_04]: Is it really comes down to something weird Jerry Trishon call activities of daily living?

[SPEAKER_04]: So, activity is daily means the ability to bathe oneself, the ability to toilet, the ability to walk from the sofa to the bed, the ability to feed yourself, right?

[SPEAKER_04]: The ability to dress yourself.

[SPEAKER_04]: When you're unable to do that from a functional standpoint, you can no longer live independently, right?

[SPEAKER_04]: Personal care system can help dress you.

[SPEAKER_04]: can help bathe you cook for you feed you if you're at risk for falls can be there to make sure you can get up from the couch which really if you do that you can keep people independent at home right until they're death all those personal care things that i talked about bathe feeding feeding toileting those could also be done in nursing home [SPEAKER_04]: But in a nursing home, it's a stranger every time.

[SPEAKER_04]: There's someone different every time.

[SPEAKER_04]: You don't have that companionship, the aid, or whatever is taking care of 20 people, so it's not dedicated.

[SPEAKER_04]: And the other thing that they do is they over-medicalize the situation.

[SPEAKER_04]: So for example, if you're going to say, [SPEAKER_04]: Your loved one is a little disruptive, has impulsive behavior, right?

[SPEAKER_04]: We've seen this in dementia, that response in a nursing home is to tranquilize them.

[SPEAKER_04]: And then what you do that, people are sedated, they're no longer themselves, etc., etc.

[SPEAKER_04]: In your home, they're not bothering anyone.

[SPEAKER_04]: The home, it may be a little more risky, but it's personalized.

[SPEAKER_04]: It's familiar, it's dignified.

[SPEAKER_04]: So those are it's why I think most people prefer a home.

[SPEAKER_03]: A lot of my patients that told me I do not ever want to leave home.

[SPEAKER_03]: Do not ever put me in a nursing home.

[SPEAKER_03]: I want to stay at home for as long as possible and many people are unwillingly having to leave their homes to go to a different environment.

[SPEAKER_03]: And it's just sad because we want them to thrive but they can't thrive at home.

[SPEAKER_03]: What are some of the reasons that people have to leave their homes?

[SPEAKER_04]: See, this is a perfect point because this is where I think we have over medicalized things a little bit.

[SPEAKER_04]: The pressure then to put someone in a nursing home is because they're deteriorating, they're falling.

[SPEAKER_04]: But then we say, well, we can treat that.

[SPEAKER_04]: We can put them in a nursing home, you know, they're not going to fall.

[SPEAKER_04]: But actually, if the family and the people understood that this is almost like an informed consent issue, it says, look, I'm prepared, I'm gonna stay at home.

[SPEAKER_04]: And I know I am taking some risk.

[SPEAKER_04]: And if I end up falling, that's okay.

[SPEAKER_04]: That's my choice and that's my risk.

[SPEAKER_04]: I think people ought to be able to entitle to make that decision.

[SPEAKER_04]: But what the medical profession is done is said, no, you can't take that risk and we're gonna put you in the nursing home.

[SPEAKER_04]: I think it's a real plan.

[SPEAKER_04]: And I think that's a discussion we really need to have.

[SPEAKER_02]: Yeah.

[SPEAKER_04]: And if that's the person's goal, we should honor it even if it means their life might be three, six months shorter because that's their goal.

[SPEAKER_03]: I understand that point and I think that the fall example is a very black and white one but there's many situations where it's a slow deterioration, right?

[SPEAKER_03]: They start to have troubles with like one ADL and then [SPEAKER_03]: like they're living at home for years just they're vulnerable and it's not just the falling risk but just the nutrition risk and they're not getting enough connections and not living well and as a physician we can't let that happen either even if they say oh just let me they just let me rot I can't let you just sit at home and rot so let's talk about some resources we can bring [SPEAKER_04]: If you really look at what's really critical to keep people at home, it's actually not the medical care and it's not nursing care, it's personal care.

[SPEAKER_01]: Yeah.

[SPEAKER_04]: It's someone to bathe me, feed me, toilet me, that's the personal care, right?

[SPEAKER_04]: But it's not covered by insurance.

[SPEAKER_04]: Now, if you look at in this country, the people who are able to do that, they're paying privately.

[SPEAKER_03]: Yeah.

[SPEAKER_04]: They're paying for 24-hour personal care, or they're paying for live-in persons to help with that, all the way into the end of life.

[SPEAKER_04]: But those are for people in a 40.

[SPEAKER_03]: So how has the way that we care for older adults evolved over time, for example, what trends have been noticed?

[SPEAKER_04]: Unfortunately, I've been doing this for 30 years.

[SPEAKER_04]: I actually think it's gotten worse.

[SPEAKER_04]: I think part of the challenge here is we have increasingly specialized medicine.

[SPEAKER_04]: So now the frail elderly patients find themselves going to seven eight doctors and so the care is fragmented from a physician perspective and then it's also fragmented from a location or geography perspective in the sense that you get a different care team in a doctor's office versus in the hospital versus in the nursing home versus in assisted living.

[SPEAKER_04]: But when I was doing this, I was a single doctor that took care of the patient, regardless of what's setting.

[SPEAKER_04]: They were, I would see them in the office and if they had the misfortune of being in the hospital, I'd go see them in the hospital and then if they ended up in a skilled nursing facility, I'd go see them in the nursing facility.

[SPEAKER_04]: There's that theme of advocacy, navigation, being that constant person to help them through a very complicated system.

[SPEAKER_04]: It's never the same doctor anymore in different places.

[SPEAKER_04]: It's always someone different.

[SPEAKER_04]: I think we've made it worse quite frankly.

[SPEAKER_03]: That's interesting.

[SPEAKER_03]: It sounds like if anything, maybe we did it better in the past because we didn't have all these different options to choose from, but there's so much to choose from now that's gotten more complex.

[SPEAKER_04]: Yeah, in the old days, there really weren't many nursing homes.

[SPEAKER_04]: And so it was either home or hospital or doctor's office, really.

[SPEAKER_03]: What about the just general systemic and financial issues?

[SPEAKER_03]: How has that changed or gotten better or worse?

[SPEAKER_04]: The reason why that's called a care in the home has not taken off in the last 30 years is because of the financial issues.

[SPEAKER_04]: I think the financial pressures really push care to the clinic not to the home.

[SPEAKER_04]: Unfortunately, physicians make more money if they see more patients in the same day.

[SPEAKER_04]: So a doctor and a doctor's office, [SPEAKER_04]: can see whatever 20, 25 people a day versus at all, I could see maybe four patients a day.

[SPEAKER_04]: So that's one of the challenges.

[SPEAKER_04]: I think the other financial challenge is from an insurance perspective, insurance will cover the physician care, the medical care, all right.

[SPEAKER_04]: and we'll cover skilled home health care, but we'll not cover personal care.

[SPEAKER_04]: You have a care that's needed for activities of daily living, helping me bathe and toilet and feed.

[SPEAKER_04]: So that's a big gap that's really not covered by insurance.

[SPEAKER_03]: As you said, our population is getting older and living longer, and I think we are seeing things trend in that direction of trying to move into more of a geriatric home-based care delivery model.

[SPEAKER_03]: So what has been your experience in the space?

[SPEAKER_04]: I will say, because of the baby boomers, the demand for in-home cases, certainly growing.

[SPEAKER_04]: In this country, this is a rough estimate, maybe five million people could use in-home care for the frail that are only complicated.

[SPEAKER_04]: And so, well-being, senior medical, for example, we're a new company.

[SPEAKER_04]: We are caring for 170,000.

[SPEAKER_04]: to get to that 5 million.

[SPEAKER_04]: It's just going to take time.

[SPEAKER_03]: So let's break down the types of care that are included in home health care options.

[SPEAKER_03]: So you described the custodial needs which are the most basic needs we all need to survive.

[SPEAKER_03]: We need to be able to feed ourselves, get dressed and clean ourselves and transfer and mobilize.

[SPEAKER_03]: where the role of a primary care comes in, and that can include changing wounds, for example, or medication set-up needs, and Medicare Part B does cover that to a certain degree.

[SPEAKER_03]: Can you talk about how your company works with Medicare, and what other care is risen covered?

[SPEAKER_04]: So we're covered in medicare, so the skilled care is covered, and then the physician care is covered, that personal care is not covered, the custodial care.

[SPEAKER_04]: Now the way we put that together is A, if they're private pay, they have the resources we work with and the figure out, private duty nursing, or I think the best thing quite frankly is a living.

[SPEAKER_04]: because you get the same person.

[SPEAKER_04]: The other resource that's out there is some states will actually pay for personal care assistance through the Medicaid program.

[SPEAKER_04]: And then what we'll do is we'll end up getting them enrolled into Medicaid, certifying that they need certain number of hours of personal care assistance, and then get that into the home.

[SPEAKER_04]: So we facilitate that.

[SPEAKER_04]: we don't provide it ourselves.

[SPEAKER_04]: The states that are willing to do that and pay for the personal care is because they realize the alternative in these situations is a nursing home.

[SPEAKER_04]: And a nursing home turns out to be much more expensive than in the home.

[SPEAKER_04]: So there are states I would say right now about maybe 25% of them that will do that in the U.S.

[SPEAKER_03]: This just sounds like such a complex and convoluted system.

[SPEAKER_03]: I mean, it took me years to figure this out.

[SPEAKER_03]: You know, imagine a patient and their family members trying to navigate this on their own.

[SPEAKER_03]: Oh, this must be so frustrating on so many levels from your observations.

[SPEAKER_03]: What do you think needs to be changed to make this better for the patient and just the system?

[SPEAKER_03]: How can we make this better?

[SPEAKER_04]: So there is one program that I think is the best for this, the pace program, it's called program for all inclusive care in the elderly.

[SPEAKER_04]: And what it does is it takes the Medicare dollars that I talked about and the Medicaid dollars puts them all together in one integrated delivery system.

[SPEAKER_04]: And when I say integrated, some of the past programs will decertify the medical care, but they'll actually, for those patients who have some deficits, but aren't homebound, they'll provide adult day care, socialization, home care, if needed, and actually some of them may even provide housing, essentially like assisted living housing.

[SPEAKER_04]: So that's a really interesting program that pulls all those pieces together in a coordinated fashion.

[SPEAKER_03]: I wish they would have more of these programs.

[SPEAKER_03]: I know a lot of states have them.

[SPEAKER_03]: Why do you feel like we haven't migrated towards that standard, yet, or perhaps we're just still looking into the outcomes, which we know reduces hospitalizations and improves quality of life.

[SPEAKER_04]: Yeah.

[SPEAKER_04]: So first of all, it is rapidly growing.

[SPEAKER_04]: There is a lot of interest in there.

[SPEAKER_04]: I would say in the last 10 years, it's like doubled or tripled in size, but still that's only reaching maybe 100,000 people all together out of that 5 million I talked about.

[SPEAKER_04]: So the biggest challenge actually is it's very time intensive.

[SPEAKER_04]: So you actually have to have a lot of capital to do it.

[SPEAKER_04]: and then you're essentially both the provider and the insure.

[SPEAKER_04]: It's a pretty complicated model.

[SPEAKER_04]: It's called a value-based model.

[SPEAKER_04]: It's very difficult, and it's not something they teach in medical school.

[SPEAKER_03]: But right now we're kind of reacting to what happens to people when they fall.

[SPEAKER_03]: It's like, okay, now we have to get PT involved, get them some gay days, install lighting in the hallway and whatnot.

[SPEAKER_03]: But this really needs to start 10, 20, 30 years even beforehand of how can we get feeling members and patients to proactively prepare for these different types of situations to just not happen in the first place?

[SPEAKER_04]: Yeah.

[SPEAKER_04]: that's really tough.

[SPEAKER_04]: You described up a patient who said their wish was to be at home period never going to nursing her right.

[SPEAKER_04]: So I think you have to have that discussion early on.

[SPEAKER_04]: So you kind of know where you're going.

[SPEAKER_04]: It's not a very popular discussion to have, but you really have to have that discussion.

[SPEAKER_04]: And it's either the parents or the grandparents initiating discussion or the children and the citizen.

[SPEAKER_04]: And your family, there's all sorts of tools, advanced care plans, five wishes.

[SPEAKER_04]: There's living wills.

[SPEAKER_04]: So I think that's a vehicle to have that discussion.

[SPEAKER_04]: That's first.

[SPEAKER_04]: Second, once you understand the goals, then the fourth thought here is critical.

[SPEAKER_04]: I'm going to divide this up with private pay versus Medicaid.

[SPEAKER_04]: So if you're someone who's reasonably wealthy and well-off, and the goal is to stay at home, like your patients, right?

[SPEAKER_04]: And that's it.

[SPEAKER_04]: Never go to a nursing home.

[SPEAKER_04]: I think you have to focus first on your living situation.

[SPEAKER_04]: And that could be a home or a sister living, but you gotta say, this is where I wanna be.

[SPEAKER_04]: Okay.

[SPEAKER_04]: Then, let's say it's your permanent home.

[SPEAKER_04]: I would actually make sure you have a second bedroom, free for living, because the best models I've seen, or the best approach I've seen for someone who can afford it, is you hire a living companion, and you do it early, [SPEAKER_04]: So for example, my father who passed away, he had a living companion who saw apathy Asian, which was great because there was a cultural connections.

[SPEAKER_04]: The food was the same and everything.

[SPEAKER_04]: we started that before he really needed it, part time, but then when he needed it, full time.

[SPEAKER_04]: It's someone he knew, it's someone he trusted, the person knew him.

[SPEAKER_04]: All that is really important because one of the problems with these personal care assistance is they come in, it's a stranger, you don't trust them.

[SPEAKER_04]: So I think that's what I would talk to a private pay person.

[SPEAKER_04]: Figure out your living situation, early on begin to find a living companion of some sort, if you don't have means, then the reality actually is you have to get it on Medicaid.

[SPEAKER_04]: And actually think about being in a state that has one of these personal care programs.

[SPEAKER_04]: And that requires a fair amount of financial planning to do it.

[SPEAKER_04]: There are financial consultants that will help you do this.

[SPEAKER_04]: You have to deal with your assets and stuff.

[SPEAKER_04]: but that's probably where the planning starts getting on Medicaid and getting on Medicaid as early as possible, then understand the resources benefits that are offered.

[SPEAKER_03]: I agree with all that.

[SPEAKER_03]: And from my observations, I feel like the best success stories I have observed are older adults who are cared for by that one or two dedicated caregiver, who knows the situation while knows their parent well, [SPEAKER_03]: is committed to their role, is well-resourced, or knows where to find the resource.

[SPEAKER_03]: Typically, it has had some education about how to take care of aging needs, and then they're creative too, because they just need to know how to be flexible and work with the system.

[SPEAKER_03]: But also, to your point, [SPEAKER_03]: just being close by is so critical.

[SPEAKER_03]: They don't have to live in the same home or in the same unit, but even next door, you know, in the same neighborhood, even because it really takes a village and a community to take care of each other.

[SPEAKER_03]: And I think that's what we've sort of separated ourselves with over the past several decades.

[SPEAKER_03]: It's we're so far apart now.

[SPEAKER_03]: We're so separated that we're just used to being on our own.

[SPEAKER_03]: And I don't think humans are created that way.

[SPEAKER_04]: Agreed.

[SPEAKER_04]: In fact, what is your rather be cared by your loved one that knows you, rather like than some stranger?

[SPEAKER_03]: Do you have an example of a patient where you work within the past who you may think of often who just did well with your caring, with the team that you worked with them, and had a good outcome or success story that you can share.

[SPEAKER_04]: The one that really sticks out to me that I just always remember is a well-being patient where we did exactly as if we helped get the custodial care and got them Medicaid.

[SPEAKER_04]: We were with her until she passed away at home.

[SPEAKER_04]: and the nurse practitioner who was caring for in the care team, they went to her funeral, and they felt bad because they thought that they could actually do more, because you know, she died.

[SPEAKER_04]: The nurse practitioner walks up to the cat's get.

[SPEAKER_04]: and the deceased is actually wrapped in a well-being blanket.

[SPEAKER_03]: Oh, my goodness.

[SPEAKER_03]: That is so meaningful.

[SPEAKER_04]: And what that said was, we essentially became her family.

[SPEAKER_03]: Yeah.

[SPEAKER_04]: We became her advocate, caring.

[SPEAKER_04]: But that's what it's really about.

[SPEAKER_04]: And I think about this my mother.

[SPEAKER_04]: I was basically the doctor in the family.

[SPEAKER_04]: And who do you trust?

[SPEAKER_04]: You talk to the doctor.

[SPEAKER_04]: So the way I like to think about well-being is, [SPEAKER_04]: We can be the clinician and the family that helps the advocate, the navigate, coordinate everything.

[SPEAKER_04]: And when I hear that story and I just say I'm that's making a difference to someone's lives.

[SPEAKER_03]: Yeah, and you certainly made a big difference in their family's lives, such that they saw you as part of their entire care team and care team family, so really added to her quality of life in many ways I imagine.

[SPEAKER_03]: Well, as we wrap up our conversation today, there is one last question we'd like to ask our experts is how do you personally age well?

[SPEAKER_03]: What does ageing for mean to you having worked with older adults and we're all going through the ageing experience what do you do personally?

[SPEAKER_04]: So it's actually no different than what you as a geriatrician would tell your own patients.

[SPEAKER_04]: It's physical activity, it's mental activity, it's socialization.

[SPEAKER_04]: Really, if you want to live a rich and meaningful life, those are the three things.

[SPEAKER_04]: It's actually less about the pills quite frankly.

[SPEAKER_04]: It's more about mental, physical, spiritual health.

[SPEAKER_04]: And the way you do it is you just keep using those facilities.

[SPEAKER_04]: You may not know this, but I'm actually 70 years old and I'm running this company and I'm still gonna keep going.

[SPEAKER_04]: And I actually think that's a trend.

[SPEAKER_04]: You're seeing people working way past retirement.

[SPEAKER_04]: and they're actually doing it to stay meaningfully engaged and feel like they're giving back to society.

[SPEAKER_04]: I think you're going to see a lot of that.

[SPEAKER_03]: Well, you have aged very gracefully, Dr.

Kong.

[SPEAKER_03]: I cannot tell you.

[SPEAKER_03]: Tell it you're almost 70.

[SPEAKER_04]: There's some genes.

[SPEAKER_04]: They're also good genes, what?

[SPEAKER_03]: How about one parting question you'd like to ask our listeners today, perhaps a thought that they can think about what can they do for themselves or the loved ones on how they would want to experience care as they age?

[SPEAKER_04]: If you're an elderly patient, I really do think a lot of it comes down to communicating and being clear about your wishes because as you become more dependent, your family is going to end up making decisions for you.

[SPEAKER_04]: It's really being clear about those wishes and what's your goals.

[SPEAKER_04]: I think if you're the children, it's about trying to anticipate and find a situation whether it's financially or physically where you can eventually meet the personal care needs.

[SPEAKER_04]: It really is those custodial needs.

[SPEAKER_04]: And I don't think people completely understand that until they're the thick of it.

[SPEAKER_04]: And by then it's too late because there are only choices that put loved one in the nursing home or something.

[SPEAKER_04]: So I think maybe the etch for the children's understanding is not about the drug.

[SPEAKER_04]: It's not about the doctor.

[SPEAKER_04]: It's not about the skilled nurse.

[SPEAKER_04]: it's about that custodial care piece.

[SPEAKER_03]: So maybe I can summarize it into I'm thinking two questions here.

[SPEAKER_03]: How would you like to communicate your wishes to your loved ones today?

[SPEAKER_03]: And I'm already thinking that's for myself.

[SPEAKER_03]: What does living in home?

[SPEAKER_03]: And your nineties look like for me.

[SPEAKER_03]: It's I've got like 50 books that I want to read That I haven't read yet.

[SPEAKER_03]: I want to be able to get up and read my books.

[SPEAKER_03]: I want to be able to get up and make my own breakfast Be able to watch the bathroom use the bathroom on my own and not fall I want to be able to still use my phone and text people and people to watch TV just do whatever I want and not have to do it Depending on someone else That's what I want to do in my nineties [SPEAKER_04]: Well, summarized, I should be interviewing you.

[SPEAKER_03]: Well Dr.

Kahn, what a delight.

[SPEAKER_03]: This is a great conversation, especially for people who are trying to navigate options and resources as a family caregiver or just even as healthcare providers.

[SPEAKER_03]: We see that it really takes a village, like I like to mention, and it requires very individualized care coordination process that needs to be dynamic and creative and proactive.

[SPEAKER_03]: And you have also proven that if the current system does not work great, we have to do it on our own for ourselves and [SPEAKER_03]: Thank you for having that conversation.

[SPEAKER_04]: Well, thank you.

[SPEAKER_04]: I actually rarely get to speak to Gerry the Chishol who understands this, so I really enjoyed it.

[SPEAKER_03]: We'll have to do this more then.

[SPEAKER_03]: So that's all for this episode.

[SPEAKER_03]: Hopefully you're feeling a little bit more informed, inspired, and empowered.

[SPEAKER_03]: On the next episode of Aging Ford, how to take care of your joints as you age.

[SPEAKER_00]: Now, I don't want you doing a crazy cross-fit jumping class or something where you're jumping a bunch and doing all this heavy activity on it, but I do want you to move it.

[SPEAKER_00]: Motion is lotion.

[SPEAKER_03]: To learn more about Dr.

Kong's company, we'll be seeing our medical.

[SPEAKER_03]: Check out our show notes.

[SPEAKER_03]: If you have a topics suggestion for future episode, you can leave us a voicemail at 507-538-6272.

[SPEAKER_03]: And we might even feature your voice on the show.

[SPEAKER_03]: For more ageing fort episodes and resources, head to MayoClinic.org slash ageing fort.

[SPEAKER_03]: And if you found this show helpful, please subscribe and make sure to rate and review us on your podcast app.

[SPEAKER_03]: It really helps others find our show.

[SPEAKER_03]: Thanks for listening and until next time, stay curious and stay active.