In this enlightening episode of Caregiver Conversations, hosts Kristie King and Antonia Harbin Lamb are joined by Dr. Gwen Graddy, Director of Medical Education at PACE Southeast Michigan and a physician specializing in geriatrics and caregiver wellness. Together, they dive deep into the evolving definition of caregiving, the critical role informal caregivers play in our healthcare system, and the urgent need for systemic recognition and support. From shifting societal language to advocating for policy change, Dr. Graddy offers both practical insight and inspiring encouragement for caregivers navigating an often invisible and undervalued journey. Tune in to explore how we can better support caregivers, emotionally, financially, and structurally, and why the future of healthcare depends on it.
Guest: Dr. Gwen Graddy, Director Medical Education at PACE Southeast Michigan
Hosts: Kristie King & Antonia Harbin Lamb
Topics Covered:
Guest Contact Information:
Dr. Gwen Graddy, Director of Medical Education, PACE Southeast Michigan
Website: www.pacesemi.org
Caregiver Conversations Podcast: caregiverpodcast@miseniors.org
Senior Regional Collaborative:
Neighborhood Legal Services:
Kristie: [00:00:00] Welcome back to Caregiver Conversations where we explore the real stories, challenges, and solutions that matter most to caregivers. I'm your host, Kristie King, executive director of the Southeast Michigan Senior Regional Collaborative,
Antonia: and I'm your co-host Antonia Harbin Lamb staff attorney at the Elder Law and Advocacy Center and Program manager of Great Lakes Legal Mediation division.
Today we are honored to have a very special guest, Dr. Gwen Graddy. Director of Education at Pace Southeast Michigan. Dr. Graddy is a physician specializing in geriatrics with expertise in wellness and aging, dementia, spirituality, and caregiving. As the former Chief Medical Officer of Pace, Southeast Michigan, she is dedicated to preparing the next generation of healthcare providers.
To care for an aging population. Dr. Graddy, welcome to the [00:01:00] show.
Dr Graddy: Thank you. And thank you for the invitation. I'm excited to be here today.
Kristie: Yes. I think we're, I know, I'm excited. Me too. Um, it's gonna be a great conversation today and you know, we always focus on caregiving. Of course. That's what this conversation is about.
And really to get your perspective. We always hear the term caregiver is used often, but a lot of times people don't recognize themselves as caregivers. Some associate caregiving strictly with just the professional role. I work in a center, I'm taking care of someone. While others don't realize that, you know, just simply looking after their loved one every day, taking them to the store, taking them to a doctor's appointment is also a form of caregiving.
In your experience as a medical professional, as the doctor, and I'm gonna say the 'cause that's a, an important concept in this conversation, the doctor, what has been your experience in helping people define themselves as caregivers?
Dr Graddy: Yeah, I think that's extremely [00:02:00] important, and part of it has to do is being able to make the distinction between an informal caregiver, which also sometimes is referred to an untrained, and I don't like that word, because it implies that they don't know what they're doing, and nothing could be further from the truth.
But for the purposes of this conversation. An untrained and unpaid caregiver versus what will be considered a formal caregiver or paid caregiver. So the general definition would be any person who helps to care for an individual, their social needs, their health needs, their physical needs, who provides the care that they need to maintain their independence, whether it's maintaining independence in the community, in, in their own home, or whether it's helping them to just.
Maintain a sense of dignity and independence and so. I think an important concept for us this morning is to make the distinction between [00:03:00] that informal caregiver and the majority of caregivers. By the way, and you probably already know this, the majority of caregivers actually are the informal unpaid caregivers to the number of about 43 million caregivers or those that would fall into that category.
Typically, those are individuals that are caring for children. Are caring for people with disabilities, and as the population continues to age, more and more of them are caring for an older adult population. So it's a broad term and it captures a number of different, um, a number of different categories, but in particular, because often that informal caregiver does not really get the recognition that they deserve.
Mm-hmm. Mm-hmm. And so that's an important category.
Antonia: Right. And thinking just along those lines, according to the CD, C, about one in five adults [00:04:00] in the US are the informal unpaid caregiver that you mentioned for a family member or a friend. That's obviously a significant portion of the population, yet many don't see themselves as caregivers.
Why don't you think they identify as caregivers?
Dr Graddy: Yeah. Part of it is because they feel like this is what I'm supposed to do. Mm-hmm. Especially if it's a family caregiver. This is what I'm supposed to do. And especially for certain cultures, African Americans in particular. Mm-hmm. This is what I'm supposed to do, so you don't have to give me a title for what I'm supposed to do.
And so I think in some ways they don't see themselves as caregivers simply because they feel like. It's what they're supposed to do, but on the other side of that society. May view them as the family member who's taking care of a family member. And so they also don't [00:05:00] recognize them as a caregiver in the total sense of what a true caregiver is.
So I, I think that's part of it. Feeling like this is what I'm supposed to do. I don't need to be acknowledged for this from the individual who is the caregiver and from a societal perspective, do we actually recognize them for the role that they perform? Mm-hmm.
Kristie: I think the other part of that too, you know, you talked about society doesn't recognize it's the narrative.
It's just the narrative of the expectation. If a lot of times if you go to the hospitals, it's who are you here with? Right. Who's, who's helping you at home? It's, it's those narratives, and I think it's important for us in this work to make sure that we begin to change that narrative or influence the narrative and make that association between, yes, this is what I'm supposed to do, but it also has a broader terminology.
As caregiver and it's, it's a [00:06:00] good terminology,
Antonia: right? I think that too helps to get resources to those individuals as well. If we could identify. Them as caregivers. So we all know that term and then we can have, you know, those resources flowing,
Dr Graddy: but it's gonna require a change or a shift in mindset.
Absolutely. So when a daughter or neighbor, whoever it is, goes with an individual to a doctor's appointment, for example, typically the chart will say the daughter was here with her mother. Mm-hmm. And that's fine. Mm-hmm. But how about the daughter who is the caregiver, is here with her mother? So what it does is it adds an additional layer of the importance of that role.
Right. So we begin to recognize that the role of the caregiver is greater than just the daughter is here with her mother. Right. But it then defines who that individual is and we, we have to change our language. Yep. It has [00:07:00] to be a mind shift. Mm-hmm. About the value and the importance of the caregiver. And I know we're gonna talk about it a little bit later.
I'm jumping around a little bit later. That's fine. No, that's fine. We're, we're gonna talk about what would happen if that caregiver was not there, and that's a whole nother conversation and it's an important conversation. So we, we need to change the way we think, we need to change our language even to the way we document things in records and medical charts as a physician.
We need to identify that person for who they are so that the value that they bring to that individual is then recognized.
Kristie: I think that goes back to something you said earlier. You know, you are head of medical education at Pay Southeast Michigan now. I think that's important because it has to start from somewhere.
It has to start. It's not always the conversation. Doctors like to listen to doctors. Yeah,
you know, I
Kristie: may be a social worker and you know, we're touchy Philly [00:08:00] or however, and yes, we're gonna say that daughter is the caregiver. But when it comes from another medical professional, a doctor of a certain level, we, we know how that works.
It's important that that education has to start there has to start somewhere. And I think also that. Oftentimes our, our experiences with doctors and when we're in the office or whatever, it's fast. It's moving, it's moving, or the medical assistant, it's moving, it's moving. But making sure that even we, at this level being in the community, that we are educating those that are caring for their loved ones to say, make sure when you go in the hospital that you, you let them know that you're the caregiver.
So our education, you know, it has to come from your side, but it also has to come from our side being directly in the community as well. And like you said, changing the language, influencing the narrative so that people can begin to, to hear that shift. And it's, it's everywhere. I was in a meeting yesterday and one of the groups, um, [00:09:00] once again, you know, it's, it's so huge people not identifying themselves as caregivers.
And going back to what you said, Antonio, about missing out on resources. No one's gonna share with me 'cause I'm the daughter. I already know everything or I have everything already taken care of because I'm the daughter.
Antonia: Right. Then there's also, I just, sorry to deviate just a little bit, but there's also the language that I'm hearing now is caretaker.
Hmm. Um, which I don't really particularly care for. 'cause it sounds. More like, I don't know, something different like
a funeral home. Yes. Yes. That's exactly it. That's
Kristie: the first thought that came to my mind. Exactly.
Antonia: That is it. And so I'm like, no,
Dr Graddy: I don't like that term. That's not it. We're talking about life. We're not talking about death.
Kristie: Yes. Yes. So yeah, giver givers. Givers, yes.
Antonia: [00:10:00] Absolutely.
Kristie: And so, you know, we talked about the health, the healthcare system. We, we begin to have that conversation. And caregivers, even on a broad spectrum, they always talk about they're the backbone of the, of the healthcare system.
They make things move, they, they move. You know, when we talk about the care economy, how much they contribute in your experience, what makes that backbone so crucial in that role? Yeah. For them to be the backbone. And the other thing, and it goes back to value, have you experienced caregivers in your practice that realize that they are the backbone of the healthcare mm-hmm.
Of the healthcare system? You
Dr Graddy: know, I, I think I'm, I'm gonna go back to some statistics. First of all, when we think about the informal caregiver, we're talking about, about 43 million people fall into that category. They work 34 billion hours a year. Now, I want you to think about that [00:11:00] for a minute, because when we go back and talk about what if they weren't there mm-hmm.
As it relates to being the backbone, where would those 40, those 34 billion hours be captured? Who would be taking care of those individuals? Mm-hmm. Right. You know. We're all about, not we, but when we look at society and we look at government and we look at many institutions, we are about the dollar sign.
Absolutely. So those individuals, if we were to pay them now, remember they're not being paid. Mm-hmm. We're talking about $470 billion a year to pay for those informal caregivers who are not getting paid. Mm-hmm. So now let's talk about backbone. Backbone from a physician perspective has to do with the vertebrae, which is the spine.
And without it, we can't stand. We can't walk, we can't navigate. Yeah. So think for a minute about not having a spine or your vertebrae. [00:12:00] Your head wouldn't stay up straight. Mm-hmm. You couldn't walk, you couldn't function, you would not be operational. So. Let's look at the caregiver now, is that backbone? And without them, I believe the system would fail because those 34 billion hours of care would mean that those individuals would have to get care from somewhere.
Would it be an emergency room? Would it Unfortunately, and I don't mean to play down nursing homes 'cause there's a place for nursing homes. Yeah. Thank God for nursing homes. But would people prematurely end up in nursing homes? Or in group homes. Mm-hmm. Or in boarding homes sometimes where they're not really getting the best care.
So to understand the true power of a caregiver, one has to understand what would happen without the caregiver. That's how you determine their value. If they did not exist, then what would happen to that population? [00:13:00] And we know that more and more caregivers are really taking care of an aging population.
And we also know that by 2030, which is just a few years away, right, talking about 73 million. People over the age of 65, you guys have some time to go. Isn't that a
wonderful thing?
Dr Graddy: I'm already there. I'm, I'm already there. And so one has to think about, so what happens when those caregivers are not there to hold the system together?
Because in some ways, literally they hold the healthcare system together, literally.
Kristie: I just want, I wanna jump in. One of the things I was thinking about is a model that I'm seeing. Talked about more, and that is bringing the caregiver into the medical discussions as part of that care team in the hospital.
And so, you know, it makes sense.
Mm-hmm.
Kristie: You [00:14:00] know, instead of leaving them out. But having them in those meetings, um, and, and escaping me, the name of the me, there's a. You know, our medical term of the meeting, there can
Dr Graddy: be ethics meetings, there can be palliative care meetings. There can just be collaborative care meetings, the collaborative
Kristie: care meetings, and having them having their voice there.
That's part of being the backbone, that's making that system work. And it's also changing systems at a broader level as well, because now we're involving that caregiver. We're showing the value that that caregiver has. To the medical space.
Mm-hmm.
Kristie: As well as in the life of their loved one as well. So I think that's important too, when we talk about the essentials to our healthcare system, is making sure that that becomes more prevalent.
Right. Than less prevalent. And not just assuming, oh, that's just the daughter. Right. Well, the daughter has probably better information than anything.
Antonia: Exactly. I was thinking too, as it pertains to, we had a discussion about how the telehealth. Appointments now [00:15:00] and how that can also capture the caregiver from the next state or you know, many states away that that person, or even in the same community, but just not able to access a vehicle or something like that, or it's just convenient.
But they're able to be a part of those discussions more and more because of that telehealth model.
Dr Graddy: Yes, exactly, and, and although the social workers do such a phenomenal job of including the family, the caregiver, what has to happen is there again, has to be a reeducation. So that now the physician, the medical student, the resident says, are there any caregivers that need to be involved in this discussion today?
Is there a caregiver that I need to call and talk to? Is there a caregiver that I need to get on the phone? 'cause this is one of the things that I've done with some of my family members and I'm a physician and it's not always received well. [00:16:00] I'll tell them, ask the physician if it is okay for you as the caregiver.
They're a lay person to call me so that I can hear the discussion. Most of the time, they will not call me. Interesting. Right. I'm, I'm a physician and I'm telling my family member, say, my cousin is a doctor. Can you call her so she can hear what's being said? So when we talk about. Retraining or rethinking the way we do things.
There is a role for the healthcare provider and right now I'm putting some of the burden on physicians. Yeah. Say, is there, is there a, uh, caregiver that we need to include in this discussion? Because a, a team of physicians go in a room, talk to a participant, a patient, they don't know what they're saying and they're not gonna remember it.
So the physicians taking the stance that, wait a minute before we have all of discussion around the surgery, around what we found. Is there a [00:17:00] caregiver that we need to include? The caregiver can be the daughter, the caregiver can be a pastor, somebody from the church. A caregiver can be the next door neighbor, but is there a caregiver that we need to include?
But that takes a new way of thinking, a change in mindset.
Kristie: I was thinking, the first thing I was thinking when you were saying that, I was thinking it removes the hierarchical Yeah. Point of view that we're so used to when it comes to our physicians, like the physician is God, you know, whatever they say, I'm just gonna listen.
I'm not gonna say anything and I'm definitely not gonna invite anybody else in. And the doctor definitely is not gonna say, well, do you want to, you have someone, a caregiver or someone, or, sure. I'll call your cousin. To, to have them in the conversation as well, and it makes sense. But, and on the other end then it's like, well, the, the, the patient was non-compliant because they didn't do X, Y, and z.
Well, [00:18:00] you didn't include the entire team. That team include, could include the cousin who's a physician. It could include, should include the caregiver as well. So, and definitely some different thoughts to, to think about. System change is never easy.
Antonia: Well, I always like that collaborative model, just having, you know, the weigh in and the buy-in and.
Because in those conversations too, when you have other people involved, those people that do care about you, they might think of something that, you know, maybe something else that needs to be said or something else that needs to be addressed. So, you know, it's more holistic and it's just a better form all the way around.
Dr Graddy: That's one of the benefits of the PACE model. Mm-hmm. Which stands for Program of All Inclusive Care for the Elderly, because in the PACE model, there's an interdisciplinary team. Sometimes you refer to it as an interprofessional team, but there's this interdisciplinary team. There are 11 people that come together around the table every day to [00:19:00] talk about what the needs of that individual is.
And those include a physician, a social worker, a registered dietician, a nurse, um, a transportation, a person who is responsible for providing the home care. There is less of the hierarchy that you would see in traditional models. Mm-hmm. Because the physician is at the table, but the physician isn't necessarily the most important person.
Yeah. It may be that the social worker is the most important person for what the issue that needs to be addressed here. So it really isn't important from a collaborative team, interdisciplinary team perspective that all of the right members are at the table and that each person is bringing equal value and.
Who is the most important person? It is that participant. It is that person that the caregiver's caring for in the community. That's, that's what this is all about. It's about that person and making certain that their needs are met.
Kristie: Pace is definitely a wonderful program. That's all I can say. I, I, [00:20:00] I love pace.
Love pace because of that inclusiveness, because you don't have to go to 12 different places. You get everything you need. Mm-hmm. Right there. Um, that, that all around that, that holistic care, right. That you talked about? Absolutely. So. We've talked a lot about the system and things like that, but even bringing our caregivers into the system, it can be very overwhelming.
They're coming in, you know, it's that hierarchy that we talked about. It's all these people talking at me or talking around my loved one. And from your experience, what are the most important things new caregivers should know right away?
Dr Graddy: One of the things I think is to understand that as a caregiver, they don't have to be alone.
That there are resources and supports that are available to them, that we have to help them understand how to access those, but they're not alone. The second [00:21:00] one is, and I think this is extremely important because again, as the population continues to age and the need for caregivers will continue to increase, they need to learn how to take care of themselves.
I. And I, I, I don't remember where I got the statistic from. I think it was from an A a RP, um, article, but it says that presently there are about seven potential caregivers per family member. But in the next six to 10 years, there's only gonna be about four potential. Family member. So the number of caregivers that are gonna be available to actually take care of individuals is gonna decrease as the number of individuals that need care will increase.
So it's extremely important that the caregiver. Take care of themselves. It's important for the caregiver to partner with the physician or whoever the healthcare provider [00:22:00] is taking care of their loved one. Don't wait for them to ask what you need. Mm. You tell them, yeah, what you need. So those are some important issues.
I think it's also important for that new caregiver to be, um, understand that asking for help is not a sign of weakness. Asking for health actually can be seen as a sign of strength and love for yourself and for the individual that you're taking care of. So those would be a couple of there. I have a whole list of them, but that would be
couple
Dr Graddy: starting points for a new caregiver.
Antonia: And what about your advice on caregivers and their self-care and managing burnout? 'cause we are seeing that a lot more now.
Dr Graddy: Absolutely. I think it starts with recognizing that they need to take care of themselves to be [00:23:00] able to continue to take care of the loved one or whoever the person is. And that starts with just like you make certain that that individual gets to their doctor's appointments, that they need to also make certain that they're going to their doctor's appointments.
So that's part of it. The second thing is recognizing there are some signs or symptoms that they need to be aware of. You know, we, we talk about three big ones, exhaustion, anger, and insomnia.
Mm-hmm.
Dr Graddy: If you begin to notice that, oh man, I am more and more angry. I am so fatigued, I can barely get up in the morning to do what needs to be done.
I can't sleep at night. Those are warning signs. That means you need to go and have someone evaluate you, but this may be a perfect time to do a couple of things. Ask for help. Is there a family member or somebody else that can step in to give you [00:24:00] some me time that that me time may be going to a movie that me time may be going to get a pedicure or manicure?
And so recognizing that there are certain things. That you need to be watching out for that says, you know something, it may be time for you to step back and get some help, but taking care of yourself is important and one should not feel guilty. I'm speaking to caregivers. Mm-hmm. Do not feel guilty because you say, I am tired, I need a break.
Don't feel guilty. Rather identify. That is a sign that you may need to bring somebody else in. It may be that the one that you're caring for, you need respite. Maybe they need to go to a day program for a couple days a week or whatever. So mm-hmm. Being able to identify some of those, those are warning signs and one has to identify them.
Not feel guilty about them, but rather think, okay, [00:25:00] if I'm gonna continue to really care for this individual, I need to also focus on taking care of myself, eating right, getting a little exercise in. Being really careful that you don't now try to replace your fatigue and your anxiety and worry about caring for this individual with alcohol.
Hmm. Or drugs. Mm-hmm. Those can be warning signs. So those are the kinds of things I like to, I like to caution caregivers because they are so, so valuable. So those are some of the, the caution signs, warning signs.
Kristie: I know guilt is often something. Mm-hmm. That when we are talking to, when we're actually interviewing the caregiver's, guilt comes up every time.
It, it comes up every time. And really taking that time for themselves is always a conversation because this is a never ending caregiving is a never ending job. It doesn't, it, it, it is not nine to five. It's, it's, it's 24 [00:26:00] hours in figuring out how to make it work in their life. It's the most important is, is an important piece.
And so that whole piece about ask for help
mm-hmm.
Dr Graddy: Caregiving is a, I read it someplace and I don't remember where. Caregiving is a marathon. It is not a sprint.
Get your and take your time. It's a marathon.
Kristie: You've talked about how things are gonna change over the next few years, and we know the demands are are gonna grow. Um, you've given us some great statistics around that. How can caregivers and their families best prepare for the evolving needs of their loved one, understanding that their life and their health is gonna change.
Also understanding that, um, their loved one life and health will change as well. And it may be, it may deteriorate.
Dr Graddy: It really goes back to how can the caregivers take care of themself? So one of the things to prepare for the future of [00:27:00] caregiving for from the caregiver's perspective, and we'll talk about policy change, is that the caregiver must take care of themselves.
The caregivers need to be a voice that advocates for their needs as well as the individual that they're taking care of. So for instance, I go back to the role of the physician. The caregiver can help make certain that the physician and the physician's office is prepared. To address the issues of the caregiver from the time that they walk into the front desk, the receptionist, oh, you are the caregiver.
Even having a two or three question questionnaire about what are the challenges that you're having and what do you need from us? It starts from the front desk. So by the time they get in the room and the nurse comes in, she says, he or she says, I noticed that these are some of the [00:28:00] challenges that you're having, and these are some of the things that you need from us as a caregiver.
And then whether it's a social worker in that office or whether it's a physician, then having a list of resources that they can provide to that individual really becomes very helpful because what it says to the caregiver is, oh, you are concerned about me too as a caregiver. So the caregivers taking care of themselves, the caregivers, then speaking out, um, you know, start a support group.
It's great when you can join a support group, but start a support group around what it is that we need as caregivers that is gonna greatly influence. The future of caregiving and then going to our policy makers to legislation congress and saying, this is what caregivers need you to do. You need to make certain that there is money available because typically.
The states. Some states do, and I think [00:29:00] Michigan does, but it's not a lot making certain that those informal or unpaid caregivers, the family caregiver in particular, that there are some resources, including dollars because many people actually have to leave their jobs. I, I think I read 35 to 40% of them have to leave their jobs to provide the care that is needed for that individual.
So, um, speaking up. Making certain that the doctor's office has something in place to address what your needs are from a policy perspective. You know, you know, our, our vote counts, but we need to be our greatest advocates. We matter.
Matter.
Dr Graddy: Yes, we do matter. Mm-hmm. Yes, we do matter. Caregivers matter. Mm-hmm.
Uh, we need to be the greatest advocates for the policy and the strategies and how the government sees us and recognizes us. We need to do that.
Kristie: And it's those things as simple as there's some legislation going through [00:30:00] paid time off. Allow, you know, caregivers having just paid, I just need some days off.
Yeah. Mm-hmm. Just to help, just to take where you get paid. Yeah. Where I get paid where I'm not at a loss. Right. Um, exactly. So
Dr Graddy: FMLA is great, but it would be great if I get paid. If I can get paid. Exactly. Exactly. I still have bills to pay. That's
Kristie: right. That's right. And I don't want my job in jeopardy.
Dr Graddy: That's exactly right. And even if it was possible, you know, we did this with childcare where you could take your kids to work and they had a space for them. Yep. Wouldn't it be wonderful if I could take Mom to work? Absolutely. And there's a daycare that the company pays for. Mm-hmm. Yep. That will take care of mom for five or six hours.
Yep.
Kristie: Absolutely. Wouldn't
Dr Graddy: that be great?
Kristie: Once again, system that, that's that visionary thinking, right? That systems change right there. That's investing. You know? That's investing in your employees saying you matter.
Dr Graddy: Absolutely.
Antonia: Now, Dr. Graddy, many families wait until a crisis to make these care [00:31:00] decisions.
What steps can caregivers take now to plan? Ahead and then, you know, to avoid maybe that last minute stress.
Dr Graddy: You know, I've really thought about that one, because often caregivers are in a position where almost all of their focus. Thought time and resources is on being a caregiver. So the real question is what systems changes need to be in place that will help the caregiver recognize that we need to start having these conversations and thinking about those things early again.
Whether it is a system in a physician's office where there's some form or some reminder that says, have you put things in place? Mm-hmm. For your loved one? Is it. [00:32:00] The social worker or the case manager at the hospital before the individual leaves, they're trying to get them set up to have their follow-up appointment, make certainly the prescriptions that they've got, whatever, but have you put things in place for your loved one if something happens?
So it really starts with a conversation that sometimes the caregiver is inundated with, how am I gonna. Take care of paying the bill and making certain that I get mom's medicines and that I get her home and et cetera, et cetera, et cetera. So I, I, it would be wonderful if there was some type of, um. For, for instance, maybe even the national caregiver Giver's day, and I don't know what all that in consists of, would include a piece that says, let's make certain that you have things in order before there's an emergency, and why is it important to have things [00:33:00] in place before there's an emergency?
Because you love the person that you're taking care of and you wanna make certain. Everything is in place that allows you to honor what they wanted, to honor their wishes to know what matters most to them. And then put things in place to honor it. So it's almost like every time an individual goes to their doctor's appointment, if there was a discussion about, now as a caregiver, do you have things in place?
What do you need us to help you with? So things are in place because when there's an emergency, it's almost too late. To try to try to figure things out because you're concerned, you're stressed, you're pulled multiple ways. So I, I just feel like that's also a systems change. Antonio, we, we have to do better.
Antonia: Yeah. There's another thing too that I'm thinking just from the attorney perspective is the, you know, power of attorney documents, [00:34:00] um, that's something we always, you know, stress a lot and that's something you can do in advance, obviously the care. Recipient has to be in favor of that. But if that can be done, then those important legal decisions that authority can be given to the person and things can be a lot smoother.
I.
Dr Graddy: Absolutely. So who, who starts that conversation so that the caregiver knows about the documents and then works toward having them complete it? That's the missing link for me. Mm-hmm. Who does it?
Antonia: Yeah, I mean, coming from a legal services perspective, we're always doing that education and having, you know, we even, we have a workshop where we're educating older adults and their caregivers every month about those documents.
So it's always something that's coming out. But I think too, in the [00:35:00] healthcare system, in the past we had a medical-legal partnership where the. Lawyer was on that collaborative team as well, and so that helped to get those documents in place and those conversations to be had as well. But I think in the medical healthcare area, that could be a conversation too, just to know there has to be this proper legal authority if something happens.
You know? And I, I hear doctors, I hear the nurses asking. Do you have your healthcare power of attorney? So we can scan it in. But a lot of times that's in the setting of like, I'm having a procedure or surgery or something like that. I think it just needs to be a more mainstream conversation.
Dr Graddy: Yeah, a regular conversation.
Mm-hmm. And almost to the point that. Hospitals will be held accountable because when you start talking about CMS dollars and them getting paid,
yeah,
Dr Graddy: somehow it kind, they perk up. Even hospitals are responsible [00:36:00] that that's something you are supposed to do in a doctor's office. You know, there's some compensation for the wellness visit, right?
Mm-hmm. The Medicare wellness visit. That should be a part of the wellness visit. And if it's done, then somehow there's some additional brownie points, right? Yeah. That this was done because it's so important,
Kristie: right? It is definitely. It really starts a difficult conversation. Mm-hmm. And I think that's sometimes why we don't talk about those documents is because it's a difficult's, a difficult, you want me to talk about dying?
I don't wanna talk about that. You don't wanna talk about that. Although we're all faced with it. Although it's really about how you wanna live. You know, how you want things to move forward if you can't speak for yourself at any, any given time. Right. So it's definitely something I think. I think once again, another point to put, I have a list of systems changes.
Yeah. We need to be working on. Yeah. And so when we think about that. Are there any other gaps in our caregiver support system today, Dr. Graddy, that you think we can look at? 'cause we've [00:37:00] talked about a number of 'em. I just wanna make sure that we haven't missed any from your perspective being in this work for a while.
Dr Graddy: I think another one, uh, you know, we talk about social determinants of health, right? Mm-hmm. I think that there are some social determinants of health that also put additional pressure on caregivers and one big one, from my perspective, has always been something as simple as transportation. Yeah. How do I get mom there and if I call an ambulance, am I gonna get a bill because my insurance is not gonna cover that?
Mm-hmm. Making certain that. Anything that that caregiver needs to be able to provide the best care to their loved one or that individual is readily available and their resources to provide it. So transportation again, for me is a big one. Mm-hmm. Another one is really access to healthcare. One of the things that bothers me is that an [00:38:00] individual will call their physician's office.
And the answering machine says if this is an emergency, call 9 1 1 or go to the emergency room. And even if it's not an emergency, if the person that I trust to provide my healthcare is not available, but they're telling me if it's an emergency, and by the way, who defines what an emergency is, if it is an emergency, call 9 1 1 and go to the emergency room.
So how do we even change the conversations around? What is an emergency and when does one go to the emergency room? Too much. Primary care, and this is getting off subject a little bit, but it still applies to the caregiver too much. Primary care is provided in emergency rooms. Emergency rooms are great and I'm glad we have emergency rooms, but they were never intended to provide primary care.
They were never intended to provide continuity of care. So how do we identify what some of those gaps are? [00:39:00] That will then make the caregiver feel that if I need something, it's gonna be available. I'm gonna have somebody to talk to, and I can provide whatever it is that I need for my loved one or the person that I'm caregiving for, so that I can make certain they get what they need.
So that, that's a big one for me. Transportation's huge.
Antonia: Anything additional you can think of that you'd like to see that would support caregivers in any way?
Dr Graddy: I do think it's extremely important that caregivers have documents, legal documents, power of attorney, that those things need to be in place, number one.
Number two, that there is also, for lack of a better word, like a hotline or someplace that a caregiver call, you know, if somebody is suicidal, if somebody has taken too much of a medication, there's a hotline. Could [00:40:00] we have a hotline for caregivers? I, when they're feeling like I'm at the brink, I can't go any further where they can call and there's somebody who says, okay, I'm gonna, I'm gonna talk to you.
What do you need? Can I send somebody out there to maybe be with you to help you work through whatever you're going through? So some type of a hotline. Mm-hmm. For caregivers I think is extremely important. And then one of the things we've already talked about, but I'm just gonna say it again 'cause I think it bears repeating, is we need to have a way.
That we can support caregivers. Yeah. Physically, mentally, spiritually, affiliations and associations with their, their, um, places of worship. But let's make some money available. If you've got people, these are statistics that 40, uh, 40% of caregivers have stopped saving money. Because they have to use an average of [00:41:00] $7,000 of their own money each month to be able to take care of the individual that they're taking care of.
38% of them have either missed or have late payments on their bills because they just don't have the money, and a significant percent of them have increased debt because they just don't have the money anymore. Mm-hmm. To do the things that they need to do because their priority right now. Is caring is caregiving for that individual.
Mm-hmm. So can we somehow make more money available? Can we increase programs that provide. Money to family caregivers. Now, Michigan does have something for family caregivers, but it's not a whole lot of money. Yeah. Mm-hmm. And when you compare the amount of money that they're spending and the amount of money that they're no longer saving because they're taking care of this individual, can we go back and maybe look at that a little more closely about how we can financially support them?
And if it happens to be a formal caregiver, [00:42:00] they make. The bottom of the barrel in terms of being paid, right? So now I'm talking about normal caregivers that work in nursing homes or assisted living. Let's also sort of enhance what it is that we give them because their roles are still important.
Mm-hmm.
Mm-hmm.
Dr Graddy: So let's make certain that we're paying them better, that there's opportunities for advancement. That we acknowledge the work that they do, not. It's just the nurse's aid. It's just the, yeah, medical assistant. Can we acknowledge the work that they do and demonstrate more gratitude toward them also?
So those would be some of the areas that I'd like to see us look at a little more closely. Put those under the microscope and let's look at those a little more closely.
Kristie: Just some final thoughts from you. You know, through this conversation we've talked about the journey of caregiving. You know, this filled with challenges and rewards.
What words of encouragement would you offer to those currently navigating this experience?
Dr Graddy: First of all, I would say the role of a caregiver is a [00:43:00] selfless. It's a selfless job. It's one that you made a decision to do because you wanted to make the life of someone else better, and that's extremely important.
So the job that you have. As a caregiver is one that even though it may feel challenging sometimes, and sometimes you wonder, what am I doing? I'm not doing it enough, I'm not good enough. Please understand that without you, that individual would have a completely different life, and so your role is a valuable one, and it is one that should be rewarded.
That's extremely important. The next thing is please understand that you deserve to give yourself [00:44:00] self-care. Also, you deserve to take care of yourself and from a societal perspective, we should be obligated to making certain that you provide that, that you get that self care, that you get what you need Also, because without you.
We talked about the backbone of healthcare. Without you, things would look so different. For those that you care from, your role is vital. You're important. We can't do it without you. We are vital. We cannot do it without you. So we, we commend the work, we commend the, um, sacrifices that you make for the benefit of someone else.
We just want to get to a place where we acknowledge those sacrifices and you know how much the work that you do is appreciated.
Antonia: Thank you for that. Dr. [00:45:00] Graddy, if listeners want to learn more about your work or access to resources from Pay Southeast Michigan, where can they go?
Dr Graddy: So Pace again, which stands for Program of All Inclusive Care for the Elderly.
You can go online, Google us, www dot pace, PACE. Semi SEM i.org and it will show you who we are. It'll show you what we do. It'll show you if you might be interested in seeing if your loved one would be eligible to be in a PO pace program where we provide. Caregiving and we provide a day health center so they have some place to go during the day and we provide healthcare and we provide transportation, and we provide meals, and we provide access and information about housing.
Those are the social determinants of health. We address each of those and we help to put things in place that will allow your [00:46:00] caregiver, your care, your loved one, to have good life. And also support you as a caregiver, an important member of the team as the caregiver. So www.pacepacesemi.org.
Kristie: Thank you Dr. Graddy. And thank you for joining us today and sharing your expertise. Your insights into caregiving both now and in the future are truly invaluable.
Antonia: To our listeners, if you found today's conversation helpful, please subscribe. Leave us a review and share this episode with caregivers and advocates in your community.
For more resources and updates, follow us on social media or visit www.semisrc.org. You can also reach us at info at MiSeniors, and that's mi seniors.org or [00:47:00] call 8 8 8 3 4 1 8 5 9 3. To learn more about Neighborhood Legal Services Michigan Elder Law and Advocacy Center, visit www.nlsmichigan.org or call 3 1 3 9 3 7 8 2 9 1.
Until next time, take care
Kristie: and keep
Antonia: caring.