WEBVTT

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Welcome to the Light Keepers podcast. I'm Clayton

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Vandiver, your Light Keeper, with a show dedicated

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to everyone who wants to get the most quality

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out of life that they can. My co -host, as always,

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Charlene, our very own licensed clinical social

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worker, certified in the state of Florida, joins

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the conversation this week about the population

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who thinks that they're covered, and they might

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not be. We'll have that and a whole lot more

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on this episode of the Light Keepers Podcast.

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And before we start, please leave your questions

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or comments below. We always love to hear from

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you. Questions this week will be answered during

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our next show that appears online every Wednesday

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evening at 7 p .m. Eastern. The Light Keepers

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podcast is an exclusive production of A Guiding

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Light. We'll tell you more about A Guiding Light

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at the end of the podcast, but we don't have

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much time, so let's get right into this week's

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conversation, Charlene, about people who think

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that they're covered. but they're not necessarily.

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What do we mean by that? So what we mean by that

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is that a lot of times people think that Medicare

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will cover everything. And sadly, that is not

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true. As someone who has worked in the hospital

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setting, in the hospice setting, it can become

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a very difficult conversation when I... am talking

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with someone who finds himself in a situation

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where they're needing long -term care placement.

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For those that may not know the lingo, that means

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a nursing home. Oh, yeah. Nursing home placement.

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And nursing homes differ from ALFs and ILFs,

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or do they not? I'm a little confused about that.

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So an assisted care facility. or an uh long -term

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care facility so here's your different levels

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of care okay okay and These can be a little confusing

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to someone who's not familiar with them. So you

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have your independent living. Right. These are

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for individuals who are still capable of taking

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care of themselves. Right. They're still ambulatory.

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They get around. They go shopping a couple times

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a week. Go out to dinner with the family. Exactly.

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A lot of times you'll hear these places referred

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to as senior living communities. Okay. All right.

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This is someone who can still live in their own

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home without any assistance. Okay. Okay. Then

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you have your assisted living facilities, your

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ALFs. Okay. Okay. These are facilities for people

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who can do most things on their own, but they're

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starting to need a little bit of help. You know,

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maybe they can't cook for themselves anymore.

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Maybe they can't do the housework. Well, I've

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seen some of the meals in the assisted living

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facilities that I've visited, and they really

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lay out a beautiful spread. They make wonderful

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meals, many of them, most of them. Most of them

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are really good. In order to be able to go into

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an assisted living facility, you have to be able

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to do some things for yourself. Like, for example,

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you have to be able to ambulate. You have to

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be able to move around on your own. You have

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to at least be able to transfer, and that means

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you have to be able to go from one sitting position

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to a different. like you have to be able to go

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from a wheelchair to a bed. Oh, okay, or just

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get from point A to point B kind of on your own.

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Exactly. So assisted living facilities do have

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minimum requirements that someone has to be able

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to do. Now, assisted living facilities are not

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paid for by Medicare. Those are private pay.

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That's an important point to understand. Very

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important point. Who pays for these? Is your

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skilled nursing facility. Okay. Your long -term

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care facility, your nursing home. Okay. So that's

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where we were going was the nursing home when

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I got distracted by all those other facilities.

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And nursing homes, skilled nursing facilities,

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these are where people go who need rehab. If

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they're not strong enough to go back home, if

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they need some physical therapy. So they have

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a few extra features, maybe a few therapists,

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physical therapists, more of a nursing staff.

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Exactly. But if you are someone who can't go

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home, if you are not able to be cared for at

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home, maybe you don't have any family. Maybe

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your family is not physically able for whatever

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reason. If you are not able to be taken care

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of at home and you're not capable of taking care

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of yourself, then a skilled nursing facility

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is where you would need to go. And where the

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conversation can become difficult, and I've actually

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had this conversation with an older gentleman

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who became very distraught when he found out

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that the Medicare that he's been paying into

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his entire life does not pay for skilled nursing.

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So he assumed that it did and that he was covered

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and good to go right there. And see, and it gets

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complicated. It gets complicated for people because

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Medicare does pay for skilled nursing if it's

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short -term for rehab. Oh. But they do not pay

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if it is where you're living. So they don't exactly

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make it easy to follow because some conditions

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follow this and some conditions follow that.

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Let me ask you. How do you find out? Let me ask

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you. Would your insurance pay for physical therapy?

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You know, I honestly don't even know. Yes, your

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insurance would pay for physical therapy. So

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the standard employer's insurance covers for

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physical therapy. If the doctor prescribes it,

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it'll pay for it. Okay. Would your medical insurance

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pay your mortgage? I would assume not unless

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there's the difference. There's probably not.

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But there's the difference. Medicare is for medical

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and they're not going to pay for you to live

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somewhere. They're not going to pay your rent.

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They're not going to pay your mortgage. So they're

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not going to pay for your skilled nursing stay.

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So a good standard to sort of understand it by

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is if it's purely medical, like a hospital where

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you're going to get treatment. they're very likely

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to cover that. Your insurance is very unlikely

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to cover it if it's just a place to live. Exactly.

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That provides your meals. Now, does that change

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if it's an assisted living facility that has

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a memory care unit, for instance, where someone

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with dementia or Alzheimer's would be receiving

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more specialized care, but they're also living

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there? So memory care units are usually found

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at skilled nursing facilities, and they're very

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specialized units where they have special safety

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features in place. Most of them are locked down

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units, which means once you go in, you can't

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get out without being buzzed out. You have some

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key that will let you out, and that's for the

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safety of the residents to keep them from wandering.

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And anyone who's ever worked in the news, as

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I have, and has seen a silver alert come across

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when someone is like a funny quick story, I've

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got to tell you this anecdote. I've got to share

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this with our listeners and viewers. I'm editing

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the morning news many years ago, and I'm seeing

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a feed that came over CBS. from the Carolinas

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and I'm seeing my cousin. And I said to our producer,

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I leaned out of the edit bay and I said, this

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is my cousin. He's on this story. And he ran

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over and said, what's the story? I said, well,

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it's a silver alert. And oh my Lord, it's my

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own uncle. My own uncle had driven the mile to

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church on Sunday. And here it was Monday and

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he hadn't been heard from and he never arrived

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to church. Well, he was found, thankfully, alive,

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well, everything was okay. Two states over, because

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he got to driving, and then things didn't look

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familiar to him. And so he kept driving. Because

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he thought to himself he was able to thankfully

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tell us after this all happened. He kept thinking

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to himself, nothing looks familiar, and I'm confused.

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And if I stop and ask for help, they're going

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to come and they're going to take my driver's

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license from me. So, of course, when he was found

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two states over, having slept in his car several

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times when he got tired along the way, they took

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his driver's license away from him. Rightfully

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so, unfortunately. But it was a real awakening

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to me to realize that here I am editing a news

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story about my uncle, my cousin. All of this

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had happened. It was almost too close to bear

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because it was family. And unfortunately, that

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can happen. So those assisted living facilities

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that have memory care units are so important

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and they do such a wonderful job. The lockdown

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does not mean it's like a prison. they make it

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as much like home as possible. They help you

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decorate usually. They bring things from home

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and they make it look as much like the familiar

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environment that you know so that your loved

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one will feel very much in a place that looks

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familiar, that they know. In a place that feels

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safe because that's critical to controlling the

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behavioral issues that can sometimes come with

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memory care. Right. Yeah. It's a tough time in

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life. It's a tough condition. And it's one you

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hear so much about. And we have the amber alerts

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or silver alerts both come over our phones quite

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often these days. And, you know, maybe that's

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a topic for another day where we can tell our

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listeners and our viewers about how to recognize

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when someone... might be struggling with some

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memory care issues because people who do have

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memory care issues they develop crutches that

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can make it look like they're managing perfectly

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fine when really they're struggling and they

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may not realize and the family may not realize

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and so That can be an issue. And, you know, this

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is something we've had personal experience with

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family members where the doctor was telling us

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they're perfectly fine and we were going, no,

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something's off. The doctor only sees them once,

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twice a year. For a few minutes, we see them

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every day. It's lengthy. We see them when they

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sundown. That's a different thing we'll talk

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about at some point, I'm sure. Because sundowning

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is weird for the caregiver. That, hey, they're

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fine, they're fine, they're fine. And then somebody

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flips the switch. And the sun begins to go down.

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It's later in the day. Their energy levels become

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lower. And just as a preview of that show that

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we'll do, all of a sudden you've got the lovely

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little Dr. Jekyll followed by Mr. Hyde. And that's

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exactly it. That's exactly it. But to get to

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answering your question, even the memory care

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units, be they at assisted living or skilled

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nursing facilities, are not covered by Medicare.

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They're not covered by Medicare. Really? Really.

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Wow. So to get back to where we were when we

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started all this, we kind of went off on a tangent.

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Good information. Great stuff. But we were really

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looking at the population who thinks that they're

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covered, but they're not. So anyone who is on

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Medicare, who's been paying into it their entire

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lives, a lot of these people go into their golden

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years thinking that whatever they need is going

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to be covered. And truth of the matter is, that's

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not true. And that can be a rude awakening for

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some people. The gentleman that I was talking

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about that I had this conversation with actually

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became quite belligerent when he found out that

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what he had saved to leave to his family, he

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was not going to be able to leave to them because

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it was now going to cost that for him to be able

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to receive the care that he needed. Oh, wow.

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That could be a very... It was very upsetting,

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not just to him, but to the entire family. I

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mean, and it really does put our seniors in a

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delicate position because here you have someone

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who is on a fixed income. You know, they're only

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getting a certain amount each month. And now

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you're looking at a facility that is going to

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cost thousands of dollars a month. And you have

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most of the time. You have a spouse who's going

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to be at home with all the same expenses, but

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now with half the income and the added expense

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of that facility. Of course, of course. And that's

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important to, it's one of the topics, one of

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the things, one of the very purposes of this

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show is to allow people to live. More in control

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of their destiny, more in control of their resources,

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of their life, of their medical choices. To be

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able to prepare, to plan. To be aware, to know

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these situations are possible would have saved

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that family and that particular patient a lot

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of shock at the moment. Absolutely. When they're

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already not doing well, not feeling well, and

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all of a sudden they realize. Now everything

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I ever saved for, everything I paid into Medicare

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isn't going to pay for what I have to have done

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here. Correct. And I'll tell you, Medicare is

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a whole other topic that we're going to talk

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about at some other point. And we've run out

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of time. We're going to have to push this off

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until another show. But I wanted to ask specifically,

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when people, a community center or a church has

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a... a gathering and passes out the five wishes

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and has everyone fill it out and then everyone

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goes home all happy thinking, yeah, I've taken

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care of all my paperwork. Is that really the

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case? Not all the time. Not all the time. So

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we're going to talk about that in an upcoming

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episode. So stay with us. Is there anything you'd

00:15:24.320 --> 00:15:29.000
like to follow up with here to top off this particular

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show? Yes. So there are things out there called

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long -term care policies. that can be bought

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that will help offset the cost of care if a facility

00:15:44.549 --> 00:15:47.330
is needed there's the added benefit here that

00:15:47.330 --> 00:15:50.090
long -term care policies can also pay for care

00:15:50.090 --> 00:15:53.110
in the home so it might help people remain in

00:15:53.110 --> 00:15:56.190
the home longer and maybe avoid those facilities

00:15:56.190 --> 00:15:58.610
and something to think about you know you could

00:15:58.610 --> 00:16:03.289
need a long -term care policy uh well one of

00:16:03.289 --> 00:16:05.690
the i've talked about this actually done lectures

00:16:05.690 --> 00:16:10.070
on this before that When you can afford a long

00:16:10.070 --> 00:16:12.330
-term care policy, you're generally young and

00:16:12.330 --> 00:16:15.330
you're generally not thinking about it. By the

00:16:15.330 --> 00:16:17.870
time you're old enough that it enters your mind

00:16:17.870 --> 00:16:21.190
and you need a long -term care policy, you're

00:16:21.190 --> 00:16:24.250
already too old for it to be affordable. And

00:16:24.250 --> 00:16:26.509
they get very expensive, the older you get, because

00:16:26.509 --> 00:16:30.129
you require more care. But the important point

00:16:30.129 --> 00:16:33.950
that I've always made in those lectures, you

00:16:33.950 --> 00:16:37.259
can need long -term care at any age. Absolutely.

00:16:37.259 --> 00:16:42.059
I've known 20 -year -olds, unfortunately, involved

00:16:42.059 --> 00:16:46.379
in bad accidents who are then made necessary

00:16:46.379 --> 00:16:49.000
for long -term care their entire lives. Correct.

00:16:49.120 --> 00:16:51.320
And long -term care may not necessarily mean

00:16:51.320 --> 00:16:54.240
end of life. No, not at all. It just means a

00:16:54.240 --> 00:16:57.779
situation where your care is going to be prolonged.

00:16:58.539 --> 00:17:01.539
And it's going to take place where most recovery

00:17:01.539 --> 00:17:05.200
is weeks, months. Long -term care means you're

00:17:05.200 --> 00:17:09.259
looking at years. Or potentially could need services

00:17:09.259 --> 00:17:13.339
and procedures and regular maintenance that family

00:17:13.339 --> 00:17:16.160
members are neither trained nor sometimes even

00:17:16.160 --> 00:17:18.720
willing to provide for you because it's way out

00:17:18.720 --> 00:17:21.740
of their wheelhouse. So it's something that,

00:17:21.759 --> 00:17:24.400
again, we're going to talk about in the future.

00:17:24.420 --> 00:17:26.880
We've got a lot of great topics to tell you about.

00:17:27.099 --> 00:17:30.960
And again, going into these situations with that

00:17:30.960 --> 00:17:34.009
knowledge is what this show is all about. because

00:17:34.009 --> 00:17:35.869
you can live a better quality of life and make

00:17:35.869 --> 00:17:38.309
better decisions. So we've run out of time. We're

00:17:38.309 --> 00:17:40.750
way over time. And I appreciate you being here.

00:17:40.769 --> 00:17:42.950
Of course, it's all a highly personal choice.

00:17:43.049 --> 00:17:46.009
No conversation that we have on the Light Keepers

00:17:46.009 --> 00:17:48.670
podcast should ever take the place of your own

00:17:48.670 --> 00:17:51.029
medical care team or other professional advisor

00:17:51.029 --> 00:17:54.019
who should always be consulted by you. for your

00:17:54.019 --> 00:17:57.619
specific situational needs. And it's always good

00:17:57.619 --> 00:17:59.859
to be willing to talk about quality of life because

00:17:59.859 --> 00:18:02.799
every single one of us will face some of these

00:18:02.799 --> 00:18:05.519
issues some of the time. Either not prepared

00:18:05.519 --> 00:18:09.549
at all... We're very well prepared indeed from

00:18:09.549 --> 00:18:11.589
joining us here on the Light Keepers podcast

00:18:11.589 --> 00:18:14.730
each and every Wednesday at 7 p .m. Eastern.

00:18:14.890 --> 00:18:17.210
This is an exclusive production of Animation

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00:19:40.410 --> 00:19:43.130
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You'll catch every single episode. I'm Clayton

00:19:53.869 --> 00:19:56.650
Vandiver, your light keeper. We'll see you next

00:19:56.650 --> 00:19:59.940
time. Thank you.
