The Care Nobody Plans For: What Healthcare Professionals Need to Understand About Long-Term Care, with Raymond Lavine

[00:00] Michelle: We spend our careers caring for other people at their most vulnerable.

[00:05] But what happens when we become the person who needs care?

[00:08] My guest today, Raymond Levine, has spent his career helping families prepare for long term care.

[00:15] But right now, Raymond isn't just advising people about it, he's living it.

[00:20] He's recovering from a serious illness and is currently utilizing long term care himself. And that gives us a rare opportunity to hear about caregiving from both sides. The advisor who has spent years helping families prepare for the future,

[00:35] and the person experiencing firsthand what it means to suddenly need help.

[00:39] Raymond's journey to this work is anything but ordinary.

[00:43] From growing up in the Hollywood Hills in a family shaped by immigration and persecution,

[00:48] to serving as an airborne infantryman in Vietnam,

[00:52] to a career in banking, mortgages and insurance,

[00:56] his experiences have shaped a deep understanding of vulnerability,

[01:00] resilience,

[01:01] and what it means to truly understand another person.

[01:05] And for those of us in healthcare,

[01:07] there's a lot to unpack.

[01:09] What happens after discharge? Who cares for the caregiver?

[01:13] How do we preserve dignity when independence changes?

[01:17] And why are the conversations we most need to have often the ones we avoid?

[01:23] Today we're talking about long term care,

[01:26] but really we're talking about how we prepare to care for one another when life changes in ways we didn't expect.

[01:34] In the five minute snippet.

[01:36] Hello, Havana.

[01:38] Here is Raymond Levine.

[01:41] You're listening to the Conversing Nurse Podcast. I'm Michelle, your host and this is where together we explore the nursing profession one conversation at a time.

[01:54] Well, good morning, Raymond. Welcome to the podcast.

[01:58] Raymond: Good morning, Michelle. And this is Raymond from Washington State.

[02:03] Michelle: Thank you so much for joining us from Washington State.

[02:07] I love your state. I have been to Seattle. I know it's a huge state,

[02:12] but I certainly loved visiting Seattle and people there. Super nice. And love the weather,

[02:20] Love the weather.

[02:22] Raymond: Depends on the time of year.

[02:24] You know, in Central California you have more seasons. Southern California is usually you have a variation of the same season,

[02:31] but every once in a while then it get, will get really, really hot and then it'll go back to variation of the same thing. Where in, in Central California, Northern California, you have more seasons.

[02:42] In Washington state we, we do have distinct season.

[02:46] Michelle: Yeah. What I love about your state as we're flying over, so green,

[02:50] you get so much rainfall and just really beautiful, very green.

[02:55] So you're lucky.

[02:57] Well, Raymond, you're here today because we're going to talk about something that we don't really talk about in healthcare and that's long term care planning.

[03:07] So I'm glad that you're here. I'm gonna just start by talking a little bit about your history and your story. It's really fascinating.

[03:16] So you grew up in the Hollywood Hills,

[03:19] you were the son of immigrants and then surprised everybody by joining the army and thank you for your service and becoming Airborne Infantry.

[03:30] Raymond, what was it about that experience that changed the way you saw people and saw the world?

[03:38] Raymond: That could take a whole episode. But let me summarize.

[03:42] My father was in the military in World War II and very proud of it. And I guess, you know, sort of the DNA said, you know, that I should go into,

[03:51] into the military.

[03:53] And of course,

[03:54] when he was in,

[03:57] it wasn't, it wasn't a joyous war, but it's certainly a lot more popular than Vietnam. Vietnam was not a popular war.

[04:04] And although we, you know, say now we honor the troops, in the 60s,

[04:10] we. I didn't make the policy and I didn't make the, you know, the, the judgment about, you know, what we should do in Vietnam. But the public was mad at us, especially young people.

[04:19] They were mad at us.

[04:21] And you know, some got abused, you know, if they were wearing a uniform or insulted.

[04:27] Some were assaulted too. But I wouldn't recommend somebody that does is trained to assault. But anyway, yeah, there were, there was anger and frustration.

[04:37] But all that, you know, happened and it's known and you know, whatever you feel about the policy of Vietnam and whether we should or shouldn't,

[04:46] I found that there were aspects of it that I benefited as a very young person that I think has carried on with me in my life. Not the least of which is that we weren't affluent, but we certainly didn't have to worry about, you know, food and shelter and transportation,

[05:06] education, things like that. My parents were both lawyers and so, you know, they were both making, you know, nice incomes and we lived in the Hollywood Hills. We didn't live extravagantly,

[05:17] but in a way I was sort of isolated in a cocoon because I was, you know,

[05:25] the son of very educated people that they met at USC and in the 40s. In those days there weren't many women in law school. So my father was a year ahead of my mother and so he saw this good looking law student and so they begat each other.

[05:42] And then a few, five years later, they begat me. But anyway, I digress.

[05:48] And so I went, you know, so I went in the service. But there were a lot of things I didn't like about the service.

[05:53] But there are things that I that have carried with me I have, I think, a lot more empathy about people. How do you deal with, you know,

[06:01] people of every, you know,

[06:04] type of environment?

[06:05] I learned about people that, you know, I didn't know what, I didn't know what. Somebody that didn't graduate high school. I didn't know what that meant. I didn't know,

[06:13] you know, somebody 18 or 19 would be married and somebody already had kids. I didn't, that was an environment I, I knew nothing about.

[06:21] And so, you know, these are things of which, you know, I made friendships and I made acquaintanceships with people I never would have probably met, met in my life.

[06:32] And you know, you learn, you learn about their background. So that in that way it gave me a lot of life learning that I might not have, I might have, I might have learned later, but I got, I got it sooner rather than later.

[06:45] Michelle: Well, I imagine all those experiences so young just really prepared you for your career as professional because eventually your career took you into banking and mortgages and life insurance and ultimately long term care.

[07:03] And in those professions you are working with people obviously all day and you see them from all walks of life, all religions, all creeds, all ethnicities and you, I'm sure, hear their stories.

[07:19] So tell me about what happened in your family that made you look at long term care differently.

[07:26] Raymond: My father, three times in his life had very long term care that he needed.

[07:33] The first time he was in a automobile accident coming back from a meeting and it was a head on collision and it injured his back severely. So he was out of commission for over six months.

[07:46] And my mother, you know, took care of him and she had, you know, was developing a thriving practice. People always think, you know, that you're going to be a, you know, that somebody's always available to be a caregiver.

[07:57] And some, somehow it doesn't cost much. My mother was making pretty good money, so whatever she couldn't make, I mean, she was giving up very nice, you know, income in order to take care of my father.

[08:09] And the second time he had a heart attack and that was it. I'm sorry, he, he fell off a horse and broke his hip and his arm and he was out for a year and a half.

[08:20] Once again, mother had to, you know, put her practice on hold in order to take care of him. And that, that, that was even worse than the first time.

[08:29] And then the third time is when he had his final heart issues and that was, that was two and a half years. And those were tough two and a half years for,

[08:41] for, for a lot of reasons. Of which my parents were insurance buyers in the sense of they didn't try to own every kind of insurance you could think of.

[08:50] They were, you know, you know, they bought the business insurance and the homeowners and all that stuff. But caregiving insurance was not something that she or a lot of other people think about.

[09:01] You just, you just don't because you think of caregiving as later and you'll, you'll, you'll worry about it later.

[09:10] My mother in the early 70s bought a long term care plan.

[09:14] My father couldn't cause he already had severe preexisting. So it was over for him.

[09:19] My mother used her plan for over 20 years.

[09:22] She died a couple years ago at 100,

[09:25] at 103.

[09:27] So you know, that was that, that was that, that was direct experience.

[09:33] And then in the last three months I've gone myself through a severe health issue. So when you talk about nurses,

[09:41] I've been dealing with a lot of nurses in the last three months and in that I learned how to be a better patient than I've ever been. And I've been usually a pretty good patient.

[09:53] But the work that healthcare people perform,

[09:58] you know, for, for the patient is astonishingly difficult.

[10:02] Very intense in the sense that, you know, it's very detailed, you got to have notes, you gotta, you know, ask questions.

[10:09] And you know, we were also talking about, you know, what happens when you're in the hospital and then what happens when you make the transition. Trust me on this.

[10:17] I've been now in the last three months, I did the trifecta in this area but I've been through all three major hospitals for various things. I'm in a skilled nurse, I just got out a month ago, skilled nursing.

[10:27] So anything you want to talk about, you know, the hospitals and you know, how people were taking care of me. I'm just not, I'm not just talking about this as a long term care advisor.

[10:37] I'm talking about, you know, I'm, I'm a, I'm a veteran of all these things that, the questions that people ask you. But you're also mentioning about, you know, people in the health care understanding about caregiving benefits.

[10:51] Interesting you asked that because they would ask me, you know, what do you do? I mean, you know, what profession? What do you do to make money? I said, well, I advise people long term care plans and also say yeah, yeah, yeah.

[11:03] And some will say, well, you know, what do you mean? Well, I provide,

[11:06] I advise people on a long term care plan or have a long term care plan.

[11:12] So that they have funds to pay for caregivers for just, just as health insurance and Medicare,

[11:20] Medicaid pays for,

[11:22] pays for services.

[11:24] Somebody's got to pay for it.

[11:26] And trust me, it is. None of this stuff is free.

[11:30] And, and I will also tell you that it's very expensive. If you think gas prices are expensive,

[11:35] if you think food is expensive, you think shelter is expensive because of, you know, the way that we have, you know, our health care system in the United States and those that are employed in it,

[11:47] and because a lot of times there are employees that, you know, are immigrants of this country that we want,

[11:55] the cost of care is going up substantially,

[11:59] meaning what it takes for people to provide care is becoming more and more expensive.

[12:04] And,

[12:05] you know, where are the caregivers going to come from? And you can't just expect,

[12:10] you know, the spouse or the, or the, or the partner or, or family that can necessarily be available to help you with your care. A lot of times in some aspects of it, you gotta hire people.

[12:22] And to put it in good English, it ain't free.

[12:26] Michelle: No, I've, I've heard that. And it's, it's very expensive.

[12:30] So healthcare professionals, we see this all the time. We discharge a patient,

[12:35] but the family suddenly has to figure out what happens next.

[12:40] So, Raymond, from your perspective, what are we as healthcare professionals not seeing?

[12:46] Raymond: Well, it's not what you don't see, it's the process. And let me explain, because I'll tell you this on a personal basis, because each,

[12:54] when,

[12:55] you know, when you're in the hospital or when you're in skilled nursing,

[12:59] it's a process.

[13:01] They have a methodology of doing things.

[13:04] Sometimes the patient is almost even involved, but other times it's just,

[13:10] you know, they'll come in and say, this is what you're doing. They have all this paperwork and they'll, they'll talk, they'll, they'll, they'll go through things. So the first thing I, and I mean the first thing that everybody needs, and if you don't have,

[13:24] have this person find, it's called the advocate. You got to have an advocate.

[13:29] Because if, if, if you're not well, you really think you're going to listen to all the, all,

[13:34] all the, all the information that they're going to provide for you, do you really think you're going to read the 30 pages of the discharge? Do you really think you're really going to understand all your medications?

[13:44] But they will also ask you questions. At least they did for me. They will ask you about your home Life, you know, say, well, if you go home, who lives at home?

[13:52] But they'll also ask you personal questions. They'll say, do you feel afraid? You know, do you have a happy home life? They'll ask you, you know,

[13:59] would you be afraid if you went home?

[14:02] You know,

[14:02] do you think that you'll be abused? I mean,

[14:05] they don't say it directly, but you'll see on the form they'll have, you know, hotline, you know, abuse,

[14:11] suicide. They'll have, they'll have all that information. They won't necessarily do anything about it, but they'll say we inform, we inform the person.

[14:19] And if you're the patient,

[14:21] you know, they may, they may say a lot of things and you may hear, you know, 30, 40% maybe,

[14:27] and understand, you know, some of it. But most of the time you need an advocate, you know, that can listen and hear because they're just going through, you know, they,

[14:36] you're in and then they want to do the process and get you out, you know, to, to not dismiss you.

[14:43] Discharge, discharge. They want to discharge you. So then,

[14:47] then you come home. Then you come home.

[14:49] Now, depending on what you know, in my situation,

[14:53] I had rhabomyosis, which means I had a medic medication reaction where I lost. I, I, I didn't lose conscious, but I, I, I, I,

[15:03] it was,

[15:04] my body didn't function. It affected my kidneys, it affected my liver, affected my muscles. I couldn't move as if I had polio. I couldn't even lift a fork. Best I could do is lift a sandwich.

[15:15] That was the best I could do for two or two, two or three weeks.

[15:19] So then you come home. Okay, now what happens when you come home?

[15:23] Oh, you may need medical equipment, you know, the potty, the, the, the, the, the,

[15:31] the,

[15:32] the tub, the tub or shower, the home, the home improvement. Do you need, you know, do you need a walker? Do you need a cane?

[15:40] You know, you need, and, and I mean all these things that I'm saying, this is not in the abstract.

[15:45] This was my life and to a certain extent it still is.

[15:48] Now here, here's the, here's what happens after.

[15:50] Then you get the social services.

[15:53] Then, you know, they'll, they'll provide people for physical therapy.

[15:57] They will send out nurses. So they will help you, you know, in, in, in certain ways and there are good aspects of it and there are others where, you know, they'll call you at 2 o' clock in the afternoon and then they'll say, hi, can I come at 4?

[16:11] So what happens is they will,

[16:15] you know,

[16:15] it will be on their time.

[16:17] And yeah, Medicare is paying for it. So you can say, well, I'm not paying for it, but I just thought that the process was not efficient or it was just, you know, like just in time.

[16:28] Hey, are you home and available?

[16:30] Well,

[16:31] I didn't, I didn't find that efficient. And then, you know, I'll call it, I'll call you back.

[16:36] So there's a whole system of it, of physical therapists, of people who come out with nurses to ask you questions.

[16:44] And the other important thing is you've got, you've got to understand your medications. And if you, if you're not,

[16:50] you know, if you don't know here, and, and I know I shouldn't say it, but I'll say it anyway. Terrorize the healthcare system. What do I mean by that? Terrorize it is that in most situations, if you're multicare Franciscan or whatever system, they probably have a CRM site, they call it My Chart or whatever web portal they have.

[17:11] Use the web portal and if they don't answer the first time, then Send a message 2, 3, 4 times a day.

[17:19] And what I will also advocate is don't be angry, don't be abusive. Don't,

[17:26] you know, don't be demanding. It's just to say, you know, I have this issue, I'm in pain,

[17:32] or I need to understand it. Don't do it.

[17:35] Don't be challenging people. You know,

[17:38] be direct, be polite, be empathetic, but don't be, you know, angry or abusive. And it's the same whether you do it in writing.

[17:46] If you call the office,

[17:48] you know, and, and somebody's answering the phone, the first thing is, you know, I've been waiting for, you know, 25 minutes and, you know, you terrible people and you know, and I've been.

[17:57] And hung up twice.

[17:58] Whatever your experience is,

[18:00] sometimes it could be from frustrating and annoying.

[18:03] My recommendation is the high,

[18:08] you know, and, you know, you say, you know, it seems like you've had a, you know, a busy day. And then to get to the point of, you know, I'm calling because,

[18:17] you know, I, you know, I need this, but do it nicely. And my personal experience is I get what I want. Meaning that they say, well, we can get the appointment, you know, four years from now.

[18:28] Say, do you think you could do it sooner?

[18:31] Well, let's, let's look now, how about, you know, a week from now? Hey, that sounds good. What's it, you know, and then I,

[18:38] you know, my best time is in the morning, that's when I'm in the bet. I'm in the best mood you think you can get me in the morning.

[18:44] And you know, it, it may, it may, may not be possible, but I'm not abusing the person that, you know, is, has. If they, if they have command of the keyboard,

[18:55] they're powerful people. You may not know it, you may not see them, but they're powerful people.

[19:01] So on their keyboard they will do things or they'll say, you know,

[19:05] you've been pleasant,

[19:07] let me put you on standby, you know, and so if something comes up, you know,

[19:11] we'll let you know. But I guarantee you, if you call and you're just an annoying person,

[19:16] oh, they'll make the appointment.

[19:19] But, you know, they're certainly not going to give you much, much, if any consideration.

[19:24] So these are all the things, you know,

[19:26] in the healthcare system that you need to do. Now if you're not proficient at it, again, you have your advocate that can do it. Because everything,

[19:34] whether it's personal,

[19:36] you know, or you're the patient or needing the caregiver or those providing everybody has a lot of tasks and responsibility and none of it, in my judgment, is all that much fun.

[19:47] And we also think of caregiving as, you know, eating, bathing, transferring, you know, helping somebody go poopy and, and, and, and bathe and do all that other stuff. Well, that, that's, that, that's a function.

[19:57] But there are all these other process. You gotta make the,

[20:00] the appointments. Well, that might be 25 minutes on the phone going through the telephone tree, the AI to eventually and you put it, and, and you put in the information.

[20:11] That's also something else too.

[20:13] Now I, I could do it myself because I was conscious, but supposing I wasn't able. You gotta have, you know, your advocate or your fiduciary, your spouse or partner, they gotta have your information they got.

[20:24] Yeah, most people will know their spouse or partner's birthday, I hope. But they gotta know their medical information,

[20:32] their Social Security number.

[20:34] So if you don't, if somebody doesn't know or you don't have it, you know, have all that information in advance because if not, you know, and they'll, and they'll all ask you, I mean, I guarantee you, I don't care where you are, I don't care what state you are,

[20:48] what, what area you live, they're all going to ask us. They're all, all going to ask your name,

[20:53] they're all, and, and every one of them is going to ask you your birthday and they're going to ask you, you know, if they don't have it on file and what insurance do you have.

[21:03] And so you got it, you got to some, either you have to have it or the,

[21:08] so your spouse or partner or your advocate. The reason I say partner when I first got started in the business, you know,

[21:16] it was after the stone age and before the dinosaur experience is that it used to be a husband and wife. Yeah, everybody had to be married. Everybody had to be, you know, man and wife.

[21:28] But the world has changed now. You know, we have, you know, so that's why I say partner, because I, you know, I don't assume,

[21:34] you know, somebody's marital status, relationship. Now the only reason I will say partner is for long term care benefits.

[21:41] If you want to, you know, couple, they've got to be in a domestic relationship in them because they have to summarize, they have to live together.

[21:50] So you know, you have all these things that, you know, are sort of evolving, but most things in the healthcare system now are either my chart, digital AI.

[22:01] But eventually you can get to a live person and what, what, whatever happens. I mean, you just have to, you, you have to be patient. And I know I'm going off, but I mean, I'm just, you know, giving you my saga, my, you know, my, my odyssey.

[22:16] You know, it was a movie odyssey. Now it's very fun. Yeah, this is, this is, this has been my quest, this has been my odyssey, this has been my journey.

[22:23] So, so I'm not just saying this is. Hi, Raymond Levine. You want to buy long term care insurance? Because it'll do that. Well, yeah, but I can also say I had all that stuff, but it didn't make me any healthier,

[22:36] but at least I didn't have to worry about, you know, hey, how, how am I going to pay for this? And, and let me just also say one, one other thing that in this process,

[22:46] if you're in the hospital, it's at least a thousand dollars a day, if not more. Now when I was in skilled nursing,

[22:53] at least where, where I was, it's $850 a day now.

[22:57] You know, some people will rent rooms, you know, at a hotel, you know, and a resort area and they'll spend, spend that much. But if you're doing it, you know, for three weeks, $850 I think, I think I had, it's like $17,000.

[23:12] Oh yeah, I have 17,000 in my reserve fund. You know,

[23:17] no problem where I'm getting at it. It's Expensive,

[23:21] it really.

[23:22] And, and the work that they did, you know, all the, all the staff. Because for two weeks I couldn't move, so I couldn't go to the bathroom. So I was at, you know, I had the little urinal thing, which actually I got pretty good at.

[23:34] I should probably shouldn't say that in the. But I got pretty good at it.

[23:39] But, you know, three, four times a night when you have to call somebody, you know, to come in, I mean, they're working the night shift and they're coming in, they're working hard,

[23:49] they are working.

[23:50] And so if they don't come right away, it's not because they don't like you unless, you know, you're an unpleasant person. They may not come as quickly. But my point is they may have 25 other people that are ringing the bell that need you.

[24:04] And some,

[24:05] based on, you know, what I saw, were in a lot worse shape and needed a lot more help than I did.

[24:12] But there's still things. I mean, I had an IV in me. I mean, I, I couldn't just move because I wanted to move. The other thing is that I couldn't get out of bed,

[24:20] you know, to make sure I didn't fall.

[24:23] And also, if I got out of bed without somebody help, my wife and my daughter would be brutal to me. So they didn't want me to do things that would fall.

[24:34] Because there are two things that happen in the healthcare thing.

[24:39] People return to the emergency room or hospital usually for two reasons.

[24:45] The first is because they overdose or something happens with their medication.

[24:50] I didn't overdose, I just was prescribed and it was just the wrong reactions that caused all my problems.

[24:57] And the other reason that people go back to hospital is because they fall and they get a concussion or they break something or they hurt themselves.

[25:04] Why does that happen? Unless you have your home modification and you either have a caregiver or,

[25:11] or you're careful.

[25:12] It's just, it's, it's just easy to fall. It really is. And,

[25:16] you know, do you have your home monitor? Do you have your lights?

[25:20] Do you have,

[25:21] you know, what's, what's around you? You know, carpets, things you can, you can trip on. Don't even. Actually, they'll ask me, they say,

[25:28] do you need to use stairs to get home?

[25:31] I said, well, no, you know, I can go to the front door, I can go through the garage. But they will ask you all these questions. They want to know if there's stairs.

[25:38] You know, do you have the mobility to get up the stairs? Now, when I came home, I didn't have the mobility to get up the stairs.

[25:44] You know, I.

[25:45] So they will, they will ask these questions because they want to know, if you go home, can you, can you get into your home? I mean, they don't say it direct, but that's what they really mean is, can you get into your home?

[25:54] So if you have a home that has, you know, several levels, steps,

[26:00] you know, I mean,

[26:01] they will ask it. And if you say, well, yeah, I got all these steps, you know, they'll say, well, you know, how do you have somebody to help you up the step?

[26:09] And you. And you may think, oh, it's no big thing. You know, I'll get up the steps. When I'm in skilled nursing,

[26:15] it was astonishing, you know, because I had to go through rehabilitation. I had to learn, you know, to walk.

[26:20] But I saw a lot of people that were in worse shape that, I mean, they needed to be on, you know, the handlebars. They had those demonstration steps to go up and down.

[26:32] So what you think you do naturally and you don't think about, trust me, when you have to actually learn to do it, it is astonishing. You know, it's like, it's like, you know, a little child that's learning to walk.

[26:44] And then, you know, they'll say, oh, yeah, I can get up. And then they say, oh, you know, mommy, I can walk. And then they fall down, they cry, and then you,

[26:51] you encourage them.

[26:53] And in a way, you know, when you're an adult, you're sort of internally crying, saying,

[26:59] these are all things I've been doing for, you know,

[27:01] forever,

[27:02] and now I have to relearn it. And, and, and, and it takes a lot of energy. It takes a lot, you know, it, it take, it takes a lot of focus, Focus.

[27:10] And I can't say that there's anything fun about it.

[27:14] I didn't enjoy it, but I, I did it because I said, look,

[27:17] if I don't do the occupational and physical therapy,

[27:22] I'm never getting out of here.

[27:24] So I'm gonna do, you know, whatever I need to do to be mobile enough to leave. To leave and come home. Because I wanted to come home.

[27:32] Michelle: Yeah, absolutely. I mean, that's your primary motivation for doing all those things and your first person experience of being a patient. I mean, it's, it's incredible.

[27:44] First of all, I love that, you know, you talked about when you are at home and you're trying to make all these appointments and you're,

[27:54] you're weak and you're recovering and you haven't had sleep, and maybe you're in pain.

[27:59] And how it could be natural or it could be expected that you lash out at those people that are trying to give you help.

[28:10] But I do love that you emphasized don't bite the hand that feeds you. Right? It's like you can. You can still choose to be,

[28:21] I guess,

[28:22] nice to people or courteous.

[28:24] And you perfectly described what nurses think when they say this person is medically ready to go home.

[28:33] But medically ready and actually prepared to live at home can be two different things.

[28:40] And yeah, you. You perfectly described that.

[28:44] Raymond: You bring up an interesting thing too, is if you don't.

[28:47] If you have whatever personality, if you're. I'll put it. If you're a curmudgeon,

[28:52] then you take a modification course or listen to your spouse or partner when they say, you know, you're being a. You know, you're being.

[29:01] Man, I think I get it. You're being a jerk. You're being, you know,

[29:05] unreasonable. And even if you. Even if you're not feeling well, even if you're tired, everybody. Let me just tell you, everybody's tired. You.

[29:13] You don't have the,

[29:14] you know,

[29:15] you

[29:15] Michelle: don't have the corner.

[29:17] Raymond: Exactly.

[29:18] Every. Everybody's feeling frustrated, everybody feeling pressure. You're not the, you know, you're not. You're not. You're not alone with this, and you're not unique. You're not even distinctive,

[29:28] you know,

[29:29] so if you're not used to having people care for you, and it's tough. I have a caregiver now that when I came home, I have. I have a partner. I'm a caregiver Monday through Friday for four hours a week.

[29:40] That helps, you know, drives me and helps helps me. The first two weeks, actually, was more,

[29:46] you know, she needed to do more things than she needs to do now. But I still have a caregiver along with.

[29:51] Along with my wife, because there's just so many, you know, activities and things that you do that one person doesn't. Doesn't have. Have the time or they're do. Or they're doing.

[30:02] Doing other things because there are all these tasks. You know, again, it isn't just taking somebody to go poopy and, And, And. And get out of bed and, and transfer.

[30:10] You got to make phone calls. You got to administrative. You got to pay bills.

[30:14] You know, the utility. Trust me, the utility company is gonna say, gee, we're really sorry that you're not. You're not. Well,

[30:21] pay us, you know, or your home loan or your insurance. You know, I mean, they may give you some quality of mercy,

[30:29] but in most cases they'll say you gotta pay us.

[30:32] So who's, who, who's, who's writing,

[30:35] writing the checks if they're not writing the checks? Do, do, does somebody have the password so they know how to get to your account? That's also another thing in caregiving is that used to be, you know, you know, you'd get a, you'd get a, you'd get bills in the mail and then you'd write a check.

[30:52] Now most times you're paying through a web portal and you're using your checking account. Well,

[30:59] if, you know, if you can't do it, then you've got to give somebody the passwords. Passwords are really important.

[31:06] If, if, if you can't do it, then you're going to have to give somebody that you trust the password. How to get into your utility account and your Comcast account.

[31:15] And you know what,

[31:16] the home loan and the car loan and all the, all those accounts, they're all, they're all, they all have passwords. So it's a lot more complicated.

[31:24] That may seem like I'm being,

[31:26] you know, overemphasizing this or, oh no, it won't happen to me, trust me, you know,

[31:33] in some way this is going to happen and you just going to have,

[31:38] you're going to have to have some patience to do it. So if you're frustrated and you're annoyed and you're agitated, your amygdala, your endorphins are, you're in decision fatigue, you know, get, get up, take a few, you know, some breaths,

[31:51] have some water, some vodka or something.

[31:53] And then you know, when, when, when you're, when your emotions are feeling better, then you can make the phone call and hopefully you know, the person, you know, if you're, if you're pleasant, the person that you're talking to or however you're doing it.

[32:08] Michelle: Well, you, you know, you've outlined a lot of the things that we don't think about, a lot of the little day to day things because as you pointed out, when you're sick,

[32:20] life goes on.

[32:21] Life goes on and the bills still need to be paid and appointments need to be made and all of these things still need to happen. So the best advice that you're giving as far as having advocate for you,

[32:36] that is number one,

[32:39] in my family,

[32:40] we are a family of nurses and our parents have both been at certain times hospitalized and there's always been one of Us at the bedside, a nurse to talk about the medications, to talk about the plan of care,

[32:58] to talk about what's going to happen at discharge to make sure our father, our mother are understanding what they're being told.

[33:06] So that would be ideal if everyone had their own nurse at their bedside, right, 24, 7 when they're hospitalized, to make sure things are going correctly. But that's, you know, that's not the reality for so many of us.

[33:22] But I want to talk about families because you, you work with families and you as a patient were getting care, are getting care from family members.

[33:33] So you work with people around something they don't often want to talk about.

[33:39] And that's the possibility that someday they might need significant help from someone else.

[33:46] Raymond, why is that conversation so difficult?

[33:50] Raymond: It's,

[33:51] it would take me hours to. But let me just summarize what we just don't think about caregiving.

[33:58] There are no courses in caregiving. It just sort of happens. It's like, you know, it, it, it evolves. It might be earlier where you're taking care of your parents or grandparents because,

[34:08] because they have some health issues. So even if you're a teenager or something, a lot of teenagers, a lot of young people, you know, help, help their parents or grandparents because they get a stroke, they have cancer, they get an automobile accident,

[34:23] you know, they, they,

[34:25] they have, you know, some health issue where it requires, you know, some family member to help you. But they don't think of it as, you know, caregiving. They think, oh, I'm helping you.

[34:35] And they also don't think about, you know, the cost of, of, of care and all the things that you have to, have to do. I mean, if you're a caregiver, depending on, you know, what your responsibility and you have, you know, other, you know, a career or another job,

[34:49] you can't, you can do both, but you won't do either one of them well.

[34:54] And so if you're the full time caregiver,

[34:57] you know, let's say your salary is 70,000 a year.

[35:00] That's the, that's the cost of care that begin.

[35:04] You've given up 70,000 of income in order to take care of something.

[35:08] 70,000 is a lot of money, at least to me.

[35:12] And whether it's 70,000 or 700,000, whatever it is you're giving, that's your cost of care and that's expensive.

[35:20] And you know, if you're the full time caregiver, what makes you think that the care,

[35:25] those are involved in caregiving sometimes that they will give up. You know, they won't make the doctor's appointment. They'll get frustrated. They get, they have mental health issues. So it isn't just those that need caregivers.

[35:36] Those that are caregivers,

[35:37] whatever you're training, whatever your knowledge,

[35:40] they are affected too, or they will give up, you know, or. And social relationships and,

[35:45] and all the other things that people want to do say, well, you know, I can't get together to play poker. I can't play, you know, play golf. I can't do all these other things because I got to take care of, you know, the spouse or partner or child or something.

[36:00] And, you know, and we need that. We need, we need to have other things that we're doing because it's, it's, it's, it's good for, it's good for our amygdala, it's good for our endorphins.

[36:10] You gotta do it,

[36:12] you know, you gotta go to the movies. You know, if you have faith, you know,

[36:15] you go to temple or church or if you like sports activities or any kind of social activities, you.

[36:22] You, you have to, you have to do it. It's not, it's not that. Whether you want to, you have to do it. Because if you're in crisis all the time, if you're taking care of somebody that isn't sleeping well and you're not sleeping well,

[36:37] you, you, the caregiver are going to be affected, isn't just those that need caregiving. It's those that always responsible. That's also something else too,

[36:45] that if you know somebody that needs caregiver, you know, ask them, how are you doing?

[36:49] You know, can we go out and have them, how are you doing? Not, you know, how's Jim or how's Mary? How are they doing? How are you? How. What's going on with you?

[37:00] You know, would you, would you like to go to the movies? Would you like to go, you know, to Applebee's and have,

[37:05] have a meal? I actually, I like Applebee's. We have an Applebee's around here. So I just had to think Applebee's,

[37:11] but, you know, is to go and you, and you have some other social. Go out for ice cream. I like ice cream. For ice cream,

[37:19] or just, hi, you want to go sit outside?

[37:22] Anything, you know, to break, you know, the routine. So when we think of caregiving, we always think of old people. We always think of, you know,

[37:31] that they have no life and no mobility.

[37:34] And we do.

[37:36] We just need care, you know, people to Help us with our daily activities. That's why they call it daily activities. But that doesn't mean that you can't look, you could, there are a lot of things you can do, but you need a caregiver to help you.

[37:47] You know, driving, you know, getting dressed, helping you go poopy.

[37:51] Hygiene, bathing,

[37:53] transfer, those are, those are just the functional things. Everybody knows that. But you know,

[37:58] hi. Did you take your medications?

[38:01] You know,

[38:02] let's talk about appointments. Let's talk about making sure that, you know, you're, you're, you know, you're paying your bills or, or taking care of your CDs and your treasury bills.

[38:12] You know,

[38:13] have you been to the bank? You know, make sure you have enough funds in your bank account?

[38:17] Are you, if,

[38:18] if you're not getting your bills by service mail, are you paying, you know, paying your bills online or can I help you?

[38:24] And so, you know, you can sit together and they, you know, they could say, all right, you know, go in and I'll, and I'll help you. Because there may be vision issues, it may be cognitive issues, maybe all kinds of things, or you just on medication, you're just sort of out of is what the medications are doing for you.

[38:39] So it isn't just all the, you know, the, the, the things that you think, you know,

[38:42] and it can happen at any age.

[38:45] You don't have to be old to have, have problems. You don't have to be whole to have problems. You know, it's at any time now it's more likely, look that when you're older that you're going to need, need caregiving.

[38:57] But you know, it's, it's whatever it is. You also have to have a plan.

[39:01] You have to have your, your, your documents.

[39:04] You know, you have to have power of attorney. That's the other thing too though. Do you have, do you have a medical power of attorney? Do you have a legal power of attorney?

[39:11] Because you know, they'll ask you say look, you know, if you, if your heart stops you, you know, if you what, what should we do about reviving you? They'll ask you that because yeah, like

[39:21] Michelle: do you have an advanced directive?

[39:23] Raymond: Yeah, you have, and you have to have these in or, or to tell them, yeah, yeah, yeah, I have them.

[39:31] Or you can have the other way. I can get, and I get phone calls periodically. Hi, I'm at my parents house and they either died or they need caregiving. And they'll say, now what do I do?

[39:43] I can't find anything.

[39:45] These are things of which you know, you gotta pre plan in caregiving. You do with that, and most of your life you plan for. There are people that have a better plan for their funeral than they will for their caregiving when they're alive.

[39:57] You know, I also have that. I gotta have perspective. People say life is short.

[40:01] And I'll say, well,

[40:03] it'll be a lot shorter if, if, if you don't take care of yourself. It'll be a lot shorter if you.

[40:09] For your lifestyle. I mean,

[40:12] I don't want to make it any shorter. And the other thing that I say is, you peop. Most people have something to live for,

[40:18] not to live shorter. Most people have.

[40:21] Want to live as long a life and as useful a life as you can because they have family that they love, that they like. Hopefully they like being around, or they have their, their, their children that they enjoy being around.

[40:33] I hope. Or they have, you know, life events, a graduation, a, you know, a wedding,

[40:39] an 80th birthday. You know, that there are a lot of things that, you know, people want to live for because it's, it's, it's a life activity.

[40:49] And most people say, you know, hey, I want to, I want to, I want to die before Doris's wedding. You know, I feel like you don't like doors. You don't want to go.

[40:57] But, but I wouldn't, I wouldn't, I wouldn't die for that. I think, I think of another reason that what I'm getting at is most of us, you know, but the thing is, if you have, you know, your caregiving support,

[41:09] you can get to all these things. You can get to Doris's wedding, You can travel. My mother traveled. She had a caregiver with her, but she, she traveled all over the country and, and took cruises and stuff.

[41:20] So she wasn't isolated.

[41:23] She would have been isolated. If she didn't have the means of caregiving, she would have been isolated. But you want to be isolated. You want to feel afraid and vulnerable.

[41:32] Don't have a caregiving plan. Make sure you don't have a spouse and partner and definitely make sure you don't have friends. You definitely don't want to have friends.

[41:41] And then, so then you have an.

[41:43] You live alone and then you want to depend on social services.

[41:47] They can be helpful on their time, on their terms.

[41:50] Now, most Americans, at least the ones I know, are usually impatient and they want things their way. You want things your way. Then have a care plan.

[41:59] Have people, you know that will help you with your caregiving and that you can then Negotiate, you know, the days, the times, what you want to do. Because if you have social service, it's not that they won't do it, but they will do it on their time, on their terms,

[42:12] and only for so long,

[42:14] you know,

[42:15] it isn't forever.

[42:17] So you have need a caregiving plan in my recommendation is at least three to four years. They say, well, everybody, you know, look, unless you're a soothsayer. And you say, and I've had this.

[42:28] People say, well, everybody dies at a certain age.

[42:32] Everybody dies, you know, everybody dies on both sides of the family dies. And I'll say, well, then if you know the predictor and you're so sure you know, then, then don't do anything, you know, because you know, you, you know the day and time.

[42:46] But I also say supposing you're wrong, supposing you know, something happens with your life, that you live 10 years longer now, what are you going to do?

[42:55] Michelle: Yeah, exactly. I mean, we all think we're immortal, right?

[42:59] Raymond: Well, I am, I am, except when I'm immortal till I die. I just don't know. I don't, I don't know when the expiration.

[43:07] A few months ago, I really thought that the warning, well, the certainly the warning lights were on.

[43:11] They weren't flashing, but they certainly the warning lights. Now I'm at that point where I'll tell people, you know, people say, how, how are you doing? I say, I'm, you know, I'm.

[43:18] I'm incrementally I'm getting better. He said, well, you look great. And I said thank you, thank you. I'm still, I'm still recovering. The other thing I do, I say, but I'm pretty sure I'm actually assured I'm not actively dying.

[43:30] I don't feel unactively dying at the moment.

[43:34] Michelle: There's a difference, right?

[43:35] Raymond: That's right. Well, I mean, there is a term, you know,

[43:38] actively dying means that your organs,

[43:41] they can, they can actually predict based on certain vital signs.

[43:46] You know, when, when, when, when you're, when you're, when you're likely to die. But there are even exceptions to that. I mean, I've heard stories of people, we say, look, you know,

[43:54] Ed should be dead, but he wanted to wait till somebody showed up or, or they wanted to wait for some event and then they die. It's, it's astonishing how people can't choose the day and time they want to die or that they want to stay, stay, stay alive.

[44:09] And it's not, it's not as Unusual as. As I would have thought.

[44:13] Michelle: Yeah, I definitely have seen that in healthcare circles and just been amazed by that.

[44:19] Well, you know, healthcare professionals, they spend their careers taking care of everyone else and,

[44:25] you know, and be nice to them. And be nice to them.

[44:28] Raymond: Yeah, really. Really, you know, humor them. When I was a skill, you know, my wife, we brought, you know, somebody come in and they do something, you know, take. Take a blood test or weigh me or something.

[44:38] And then it was, would you like a cookie?

[44:40] And. And some even took me up on. Some said, nah, I can't, you know, my weight or so. But,

[44:45] you know, wherever you are, get, get snacks and, and, and offer. They'll. They'll. Even if they deny, you know, they. They decline, they'll. They'll appreciate. And you know why? Because nobody.

[44:55] No, nobody does it. No one.

[44:57] Michelle: Yeah,

[44:58] I know. We always love that when patients would bring us things. Absolutely.

[45:02] So,

[45:03] you know, one of the things that we do in healthcare circles as caregivers is we use dark humor. Right?

[45:10] Because things.

[45:11] Raymond: Dark humor.

[45:13] Michelle: It's dark humor.

[45:14] It's. It's just when things get, you know, really bad. Like here, here's an example. So my sister,

[45:21] longtime ICU nurse,

[45:23] and, you know, they would have patients come into ICU that were just a complete mess and super, super sick. And,

[45:30] you know, they would say to each other, if, If I ever get like that, just take me out back and shoot me,

[45:37] right?

[45:38] And. And it comes from that place of like,

[45:41] I don't want to be dependent on anybody. I don't want to have anybody taking care of me. I don't want to be a burden.

[45:50] What would you tell the nurse who is very good at caring for other people,

[45:55] but has never thought about what happens if they themselves need care?

[46:00] Raymond: I'll say it in two ways. One will be humor, and the other will be factual.

[46:05] It's a, if somebody says shoot me, it's illegal. It's a crime. You. You have killed someone. It is, you know, it is a crime. They, they, they, they, they will bring charges against you.

[46:15] The other way that I would say it is usually they'll say because they don't have a plan or they're depressed,

[46:26] and so they will make assumptions. And the other thing is,

[46:29] look, I was in Vietnam. I saw people badly hurt. Nobody ever said, kill me. Nobody ever said, shoot me. I mean, it was, get me medevac,

[46:38] help me to stay alive.

[46:41] Because if your perspective on life is you want. You want to die, you're going to be dead a long time. You know,

[46:47] work to to stay alive. And the way to do it is to have a plan. And the reason that, you know, you. You feel, you know, hey, my life is over.

[46:54] And, and if it is, if you, if you, if you know that you have terminal cancer, if you're in a lot of pain, if you're in a state where you can have assisted dying,

[47:05] I, I recommend it. I, I would recommend it for myself. If I have no life and I know that I'm dying and I'm in a lot of pain, then I'll have, you know,

[47:14] I'll have the party, I'll have friends over, we'll have schnapps, we'll have brisket sandwiches and stuff. Then they give me, you know, the pill or whatever it is, and I die.

[47:24] But I'm doing it on my.

[47:27] And there was actually a movie about that. Supposing somebody says, you know, if I'm get. If I cognitively get to that point, I want to kill myself.

[47:36] You know, I say, depending on where you are in your car, you're going to remember.

[47:39] You're going to remember where the gun is or the poison or, you know,

[47:43] whatever. You're not going to remember what to do.

[47:46] And if you're at that state, in my experience,

[47:50] it's, you know, you have,

[47:51] it's mental health. You are depressed,

[47:54] you feel alone. And the other things, you know, that I always say, is that what people.

[47:59] And I'll say this for myself,

[48:02] because you don't want to feel alone,

[48:04] you don't want to feel afraid,

[48:06] and you don't want to feel vulnerable.

[48:08] And if you're. That stage where you say, look, you know, my life isn't happening, it's because you're probably in one of those three states. But, you know,

[48:16] where are people that need caregiving in the best mental. They're out doing stuff. You know, some, you know,

[48:22] they're out with the boys or girls, they're playing poker. You don't have to have great mobility. I mean, you have to have certain hand coordination and cognitive to play poker.

[48:32] You can go to the movies.

[48:34] There isn't a lot of aerobics watching a movie that I'm aware. I mean, getting there is, you know, getting the popcorn and all, all, all the other. But, you know, once, once you're sitting, there's.

[48:44] There's a lot to do other than, other than watch the movie. And then, you know, then you can go and eat. And where I live, I mean, there are lots of old people.

[48:52] I mean, we're all, you know, walkers, canes,

[48:55] we, we, you know, oxygen tanks or we're sort of, you know, straddling in order to, to, to get to where we're going. Hopefully we don't fall into the bushes.

[49:05] And so, you know, everybody's got, you know, something, but it's how you deal with it.

[49:10] My wife and I have been married over 40 years. We love each other, we've annoyed each other, we've done all kinds of things to each other. We've even had fun,

[49:18] actually. We still are.

[49:20] But I, I, I am very direct. I said, I do not want to be a full time caregiver. I don't,

[49:26] I, I, I wouldn't enjoy it. I wouldn't be happy with it. So, so we have a plan that will hire caregivers to help her to do the things I, I just don't want to do.

[49:35] Now. I'll, I'll do the shopping. I'll, I'll, I'll drive her places, I'll go get the medication.

[49:41] You know, there are a lot of, there are a lot of tasks that I will do, but I don't want to help, help her go poopy and I don't want to bathe her and I don't want to do all those, you know, transferring and all that.

[49:50] I mean, I will do some of it if I have to, but I'd rather do the administrative task, pick up the, the medication,

[49:57] take care of the bills. I mean, they're, you know, those are, you know, and they're useful tasks, but I just don't want to do all the, you know, things that either I don't want to want to do or how to do.

[50:07] And you know, some people need injections, some people need bandage changes. They're like,

[50:12] and I could, I could do some of it, but I really, I don't enjoy doing it and I don't really want to do it. I'd rather have somebody that does it, that is more efficient at it than, than I do.

[50:22] So if it makes me a bad person,

[50:24] you know, my wife knows, you know,

[50:27] the tasks that I will perform and she knows the tasks that I will do, but I won't be happy about it.

[50:33] Michelle: Well, that's, that's the first step towards planning is knowing what to expect, knowing what your partner expects from you, knowing what you can provide.

[50:44] Right?

[50:45] That you have to, you have to know each other to, and, and man,

[50:50] you're brutally honest, Raymond. Like, you're like, I'm, I'm going to do some things, but not other things.

[50:57] And you got to appreciate that for sure.

[51:01] So as we get ready to close here, I have another question for you.

[51:05] After everything you've experienced, from your family history to the military to your career,

[51:11] and now working with families facing these decisions,

[51:15] what have you come to believe about how we take care of one another?

[51:20] Raymond: My experience, it depends on the relationship.

[51:23] If you have a good relationship with your family,

[51:26] it makes it a lot better. But if you're estranged from your family, if you,

[51:30] especially if you don't have a partner, whether you're widowed or divorced, or if you don't have a partner,

[51:37] then I would recommend, you know, you have planning issues for caregiver and you have a plan for somebody to come in. Because you can't do all this stuff yourself. It's not possible.

[51:47] I mean, it is possible, but you're not, you're not going to enjoy it.

[51:50] And especially,

[51:51] you know, I'm in my 70s and I've just got my driver's license renewed. And the reason I say is, I said, you know, gee, there's going to be a point where they may, they may not let me drive.

[52:02] So I was thinking, supposing I'm not able to drive now, what do I do? I mean, that's a big deal. Depending where, where you live. If you can't drive,

[52:09] you don't have to have public transportation, you know, what are you going to do? I mean, that's a, that's a big deal. And there are a lot of, there's a lot of literature about that.

[52:17] How do you take away your parents keys? You know, it's usually the true.

[52:21] So the, so these are things you know, that you need. Supposing I can't drive,

[52:26] supposing I have vision issues,

[52:28] supposing I have hearing issues,

[52:29] supposing, you know, I have mobility issues.

[52:33] These are things that you know, that you need to think about in advance to say if I had these, in the unlikely experience which will happen in some sort,

[52:42] what should, what, what's your plan? Because if you have people that are helping you,

[52:47] you're going to be in better mental health. You're going to know you're not going to feel as vulnerable and you know you can get, and you can get tasks done.

[52:55] One of the things I learned, I had a heart attack 14 years ago and I've had heart issues since then,

[53:00] is keep a record of all these things.

[53:06] Keep notes of what your medical issues have been. And when you're talking to a healthcare provider,

[53:15] they say, how you doing? Don't say, oh, I'm feeling fine, just to say,

[53:20] be factual. I'm taking my medications,

[53:22] I'm exercising, or I'm not exercising.

[53:25] I'm doing all these things. And then if you have annual physical,

[53:28] I write a memo and I'll say, you know, this is the state of Raymond. It's not, you know, hey, I'm feeling. It's, you know, I'm underweight, I'm overweight, I'm not exercising as much.

[53:38] I have some aches and pains here. You know, tell them all your issues.

[53:41] Sometimes they'll ask you, you know, you know, do you feel depressed? I mean, sometimes on a form,

[53:46] it'll ask you, do you feel depressed? Be authentic with yourself,

[53:50] because when you're talking to a healthcare professional and they've got 20 minutes, then I make those 20 minutes count. Meaning, you know, I. I'll get. I'll give them a memo and I'll, you know, they'll sort of look at it.

[54:00] No, you. I want you to read the memo. I'm not, I didn't. I didn't write this because I enjoy writing memos. Actually. I'm good at writing memos. I'm very good at it.

[54:09] But the point is that I. I'll write a memo, the state of Raymond or whatever, and I'll say, I want you to read this.

[54:15] You don't have to like it.

[54:17] I want you to read, you know, what, what I've written that will give you an understanding of where I think I am with my health. And then if you have questions or you want to, you know, take my blood pressure and do all that other thing, that's fine.

[54:28] But I'm. I'm informing you of where I think I am at this day in time.

[54:35] Michelle: I think those are such great messages. Like, first,

[54:38] surround yourself with your people, with your clan, right?

[54:44] Like, don't be an asshole. Don't ostracize people.

[54:48] You know, have. Have those people by your side ready to go in case you should need something.

[54:57] And be authentic. Be authentic.

[55:01] Don't say you're feeling a certain way if you're not. And if you are feeling a certain way,

[55:08] that even makes you more vulnerable. Talk about that, too.

[55:13] I think those are such great messages to have for caregivers and also for people receiving care.

[55:21] And I'll tell you what, I have learned a ton through our conversation,

[55:27] and I've been surprised at how many times the word poopy has come up.

[55:35] Raymond: The same thing out there. Did you have a bowel movement? I keep a record.

[55:39] You know, I went poopy at 7:45am or when? Cause they'll ask you. They will come in and they will ask you. So if you say, I don't know, I wrote it down.

[55:46] If they had a blood pressure when they gave me medication, when I took a poopy, Whatever is, write all that stuff down. Cause they'll ask you.

[55:53] They won't.

[55:54] Michelle: I love it.

[55:55] It brings me back to my days as a pediatric nurse.

[55:59] So I love it. I love your exuberance.

[56:02] And we have a special surprise. So you have a poem for us, Is that correct?

[56:07] Raymond: Raymond,

[56:08] if you'd like me to read my poem,

[56:11] I'd be happy. But let me give you a preamble of what this is about.

[56:17] This is a modification of a poem written by Rudyard Kipling, who was a poet and writer. He wrote Kim and he wrote Ganga Din and he wrote the Jungle Books.

[56:28] Michelle: Jungle Book. Yeah.

[56:29] Raymond: Yeah. And he wrote a poem to his son to talk about adulthood, about being responsibility.

[56:38] And the name of the poem is if I have. But I've modified it to talk about caregiving.

[56:44] So here goes.

[56:46] If you can sit beside the kitchen table and speak the words that no one wants to say.

[56:52] If you can plan today why you are able to for caregiving seasons that may come some distant day.

[56:59] If you can love enough to ask it truly, where will I live and who will have my care?

[57:05] If you can have that talk and speak it newly.

[57:08] Before the time when choice grows thin and spare.

[57:12] If you can see beyond the present hour to years when strength may falter,

[57:17] hands may shake.

[57:19] If you can choose with quiet lasting power what care looks like and for whose care for you?

[57:26] If you can write it down in language clear.

[57:29] A blueprint that your family will have.

[57:32] So no one stands bewildered, gripped by fear, with only questions, haunting heart and mind.

[57:38] If you can shield your caregivers from the cost both what is owed in dollars and in soul.

[57:44] The careers interrupted, sleep filled nights lost.

[57:48] The way that caregiving takes its toll.

[57:50] If you can turn what frightens you most into a plan of action firm and true.

[57:56] And spare your loved ones from the silent ghost of.

[57:59] If we'd only talked when we still knew then when the day arrives and come in May, your family will walk the path you've laid. They'll carry forward love,

[58:11] not death to pay.

[58:12] And you will leave behind a debt that repaid. You'll leave them not just what you came to own, but clarity and grace and dignity.

[58:21] A promise kept,

[58:22] a future gently known.

[58:24] The rarest gift, the gift of a caregiving plan.

[58:28] Michelle: Well, that's brilliant. I know the original poem that you spoke of. And I love your adaptation.

[58:36] I think it's just perfect. And I just have loved talking with you today. Raymond dear,

[58:42] your expertise in your field is just phenomenal and your humanity also has, has touched me. So thank you so much for joining me.

[58:51] Raymond: Welcome. And if you, if you ever want me back, there's always stuff to talk about. If you ever want me back someday I'll be happy to come back as a guest.

[58:58] Michelle: Very good, Very good. Well, for those that want to contact you, Raymond, how can they do that?

[59:04] Raymond: Www.la v I n e l t c I-n s.com that's Lavine. Lt is with an A L A V I N E L T c I n s.com or you can call me at area code 253-275-6091.

[59:19] Now, I'm not just the only licensed watch to say I'm licensed in most, most western western states. But if, you know, you call and you're from Wyoming or you know, Mississippi or something, someplace, I can certainly refer you to a long term care person that can help you.

[59:38] One other thing,

[59:39] when you go to my website,

[59:41] you know, most websites, you know, it's hi, you know, here's the contact, you know, here's how wonderful we are. But there are two things that I will recommend. In the top left corner, there are three lines you can, you can put in.

[59:52] What it is, is it'll talk, it'll show you, based on your lifestyle, what your life expectancy might be. And then it will also show you how you know the cost of care.

[01:00:02] Because everybody says to me, raymond, how much does long term care costs? I said, a lot. I said, no, no, no, that's not what I mean, is it, what's the premium?

[01:00:09] I said, I don't know because I don't know your health, I don't know a lot of other things. But the first thing is, you know that you understand what is the cost of care, not what the cost of the premium, because I'll guarantee the premium is a lot less than,

[01:00:21] you know, the actual care.

[01:00:22] The other thing is they go to the lower right and there's, there's a chat box and it's AIC. So rather than, you know, the 40 frequently asked questions, and I had to write that down years ago and that was painful because, you know, it sometimes changes.

[01:00:37] Is that in the lower right corner you can put anything, you know, hi, who's Raymond Levine? Or what's the difference between a traditional plan and a hybrid plan? So It'll give you a lot of that information, at least,

[01:00:48] you know,

[01:00:49] questions or things that you might want to immediately know. So then when you talk to me or somebody else,

[01:00:54] you sort of have an idea of what the terms are. But just because you've read that doesn't mean, you know, you're knowledgeable about it. And let me just say, what is that?

[01:01:02] I've been doing this a long time, and I'm two, three, four times a week. I'm still taking webinars and continuing education because it constantly changes. And the way that we're having caregivers,

[01:01:13] it changes. So I'm not talking about, you know, 20 years ago, what it was. I try to say, what is happening in 2026? What's likely to happen in the future, and how are we going to think about it rather than, well, everybody did it, you know,

[01:01:28] this way 20 years ago.

[01:01:29] You know, there are a lot of other things that change. You know, partnerships changed, relationships change.

[01:01:35] Even, even, even, you know, even sex change. You know, you might start off as Dorothy, and then you end up at Fred. I mean, there are a lot of things that are changing.

[01:01:43] And so even at my old age, I'm, I'm, I'm trying to keep pace with not what happened years ago and be stuck in it. It's.

[01:01:51] Where are we at in 2026? What recommendations can I make that will help you now and in the future?

[01:01:59] Michelle: So I love that you're staying up to date with everything,

[01:02:02] and I have been on your website and it's very informational, very easy to navigate.

[01:02:08] So thank you for that contact information.

[01:02:11] I will put those in the show notes.

[01:02:13] And thank you again, Raymond, for joining us today.

[01:02:17] Everything that you've brought, your humor,

[01:02:20] your experience,

[01:02:21] your stories,

[01:02:23] I really appreciate you.

[01:02:25] Raymond: My pleasure. Thank you.

[01:02:27] Michelle: Well, we're at the end, and at the end we have five minutes left to play the five minute snippet. It's just a fun game where we do a lot of giggling and laughing and Are you ready to play?

[01:02:42] Raymond: I would say, you know, there used to be a host where somebody would say that, and I can't think of the name of the host. It's like, you know, okay, Johnny, you know, let's do it.

[01:02:51] I mean,

[01:02:51] I, I'm so. I remember game shows, you know, I

[01:02:54] Michelle: mean, yeah,

[01:02:57] Raymond: but I, but I always mean, you know, you know, like, you're ready to play. Yes. Art Fleming or something. But anyway, go ahead.

[01:03:04] Michelle: Okay.

[01:03:05] I promise you'll have fun.

[01:03:09] Hey there. Before we get to the five minutes of fun I'd like to ask a favor of you.

[01:03:15] If you're enjoying this podcast podcast, please give me a rating or review.

[01:03:19] It means so much to me. An indie podcaster. It's how I get found.

[01:03:25] And you can always find my guests bios and book recommendations on my website TheConverSingNursePodcast.com you can find me on Instagram at the Conversing NursePodcast and LinkedIn. As Michelle Harris,

[01:03:41] I appreciate you listening. And now let's have five minutes of fun.

[01:03:46] Your best purchase under $100,

[01:03:51] Raymond: believe it or not. Interesting. Interesting. You asked that question. Interesting.

[01:03:56] I, I purchased,

[01:03:58] you know, one of these ear water things,

[01:04:01] you know, to keep your ear clean and for 20 bucks and, and I tried sticky ear cleaner for $25 and,

[01:04:12] and I spent, you know, $70 on this electronic ear thing and I had these little sticky things and it's getting out all kinds of earwax. Who, who would have thought of this thing that was under a hundred dollars?

[01:04:24] Michelle: Okay, very good. If you had to spend 24 hours with one historical figure, who would you choose? And who would you. Absolutely not choose?

[01:04:39] Raymond: Well, you know, I mean there are, there are a number of people because I, I, it'd be, it'd be fascinating to talk to George Marshall. He was the army chief of staff during World War II.

[01:04:50] I think he'd be, I think he'd be an interesting person. David McCulloch was a writer.

[01:04:55] Stephen Ambrose.

[01:04:57] I mean there are a number of people that, that would be interesting to have a conversation,

[01:05:02] unfortunately. I mean, these days, I mean there's some, you know, former electorate official like George Mitchell might be an, an, an interesting person to talk to. Leon Panetta.

[01:05:13] You know, there, there are, there are a lot of interesting people that, you know, have, have good stories if they're, if, you know, there's, there's, there's some, they may be prominent, but they're just not personable people.

[01:05:22] I, I don't think I, I want to, let me say, ask, say it this way. If you're prominent or known and you're not personable and you don't want to have a conversation, then there's no point.

[01:05:33] I would like to have with somebody that would be interested in the conversation and you know, and would enjoy it and want to be involved. If you don't enjoy it, you don't want to be involved.

[01:05:43] No matter how prominent.

[01:05:45] I don't want to spend any time with you.

[01:05:47] Michelle: Yeah, for sure. Leon Panetta, Very interesting individual. I like it. Okay, what's a skill you learned in the military that has no practical application in civilian life.

[01:06:00] Raymond: Well, in a way it is. And I,

[01:06:03] I didn't like kitchen police and I didn't. Oh, I'll tell you.

[01:06:07] Guard duty, I never Kitchen police, I, I, I dislike. But guard duty, I, I, I didn't enjoy because usually it was late at night or early in the morning. I,

[01:06:17] it, it was essential. But I never liked guard duty. I, it was just boring and, and, and tiring and annoying. I never like. I ne. I never liked guard duty.

[01:06:26] Guard dude. The other thing you used to have every year is called Inspector General ig inspection.

[01:06:33] And you spend a lot of time, you know, cleaning toilets and stuff. And then they always flunked you. Didn't matter how clean. They always flunked you. And then they'd fire somebody and then, you know, they do it all.

[01:06:41] They had to do it all over again. So I didn't like guard duty and I didn't like preparing for Inspector Generals.

[01:06:49] Michelle: Doesn't sound very fun.

[01:06:51] Raymond: It isn't.

[01:06:51] Michelle: Okay, if your life were a movie, Raymond, what actor would play you and what would the movie be called?

[01:07:01] Raymond: Well,

[01:07:01] there are people that there was somebody leaving wrestler thought I looked like Henry Winkler. I don't think I resemble Henry Winkler. And then there was another one where

[01:07:11] Michelle: maybe with shorter hair.

[01:07:13] Raymond: Could be he was the love interest of Marlo Thomas in that Girl. They always thought I resembled him. I never thought about who would, who.

[01:07:25] Probably I'd say, why would you want to play me? And, and the other, the other thing is, you know, in, in this is.

[01:07:31] I don't know if there's enough of a screenplay that would be, you know, interesting enough, you know, to carry for 90 minutes. I mean, I'll give you an example.

[01:07:43] Bob Mackey just died and we actually met him last year.

[01:07:47] Nice man,

[01:07:48] was a, you know, costume designer. And he had an, he wasn't a great story, but I mean, it was an interesting story of, you know, designing.

[01:07:55] And so, you know, he had, he had a good story. I don't know if I have as good as good a story as, as he, as, as he did because he had a, you know, he designed clothes for entertainers and he was good at it.

[01:08:10] And he had a, he had an interesting, you know, personal story and he had, you know, an interesting story that he could talk about Cher and, and, and, and Barbra Streisand and Bette Midler and Elton John.

[01:08:23] So he, it wasn't just his personal story. So I don't know if I have enough, I don't know. Who would I,

[01:08:28] who would want to play me? And I'm not sure, you know, what the plot would be or what the screenplay would be. I'm not sure. I'm not sure.

[01:08:36] Michelle: You'll have to give it some more thought.

[01:08:38] Okay, last question.

[01:08:40] We're in your home, Raymond, and there's a picture on the wall of your favorite travel destination.

[01:08:46] Where is it and who is in the picture?

[01:08:49] Raymond: Oh, Cuba.

[01:08:51] We were in Cuba I think 2001.

[01:08:56] Love Cuba. If we could own a place,

[01:08:59] it would be Cuba. It was those magical place.

[01:09:03] If you see the movies of the 40s and 50s of Cuba, it's, that's what Cuba still is. You know, the cars and, and the entertainment and the people. It's, it's just, and a colorful Havana is probably one of the most beautiful capital cities.

[01:09:17] Even though it's deteriorated a lot. Probably one of the most fascinating, beautiful capital cities we've ever been to. We, we, we, we loved it. So if we could own, you know, a, a, a condo or home, you know, line the water or have an apartment or something in, in Havana.

[01:09:35] I mean the music, the people, the food, I mean it was, it's, it's a, it is a magical country.

[01:09:44] Wonderful, wonderful people.

[01:09:46] And you know, other than the government, they didn't want Yankee to go home.

[01:09:50] You know, I mean, I don't care for the government but, but I, but I have great respect and honor for the Cuban people.

[01:09:58] Michelle: That's so fascinating that you said Cuba. That's very cool. I don't think first of all, many people think of that as a travel destination, but wow, you've schooled a lot of people today.

[01:10:09] Raymond: We have. You know, my daughter took a photo along the Malecon, which is the waterway in Havana and she took it. We were, we were on a horse driven buggy and she took a photo that actually made a portrait.

[01:10:22] And we also have some other portraits. Cause see the Dupont family actually had a resort, it's called, in a resort area in,

[01:10:31] in Cuba called Valladero.

[01:10:33] And that was all. That was a magical afternoon. You go and it was a wonderful beach. We had a, you know, a lovely lunch and, and beverages and stuff. It was just one of those, you know, magic, wonderful tropical moments where you know, it was a nice restaurant, it was a nice ocean.

[01:10:49] It was,

[01:10:50] if you were annoyed by anything and you spent, you know, a couple hours in Valadero doing what we're doing,

[01:10:55] you'd have no pain or stress. It was just a wonderful moment.

[01:10:59] Michelle: Love it. That's so cool.

[01:11:01] Well, you did awesome on the five minute snippet, Raymond. I knew you would. You have such a.

[01:11:08] Such a breadth of experience,

[01:11:10] life experience,

[01:11:11] career experience.

[01:11:13] So,

[01:11:13] again, thank you so much for sharing that. And have a wonderful rest of your day there in Washington.

[01:11:19] Raymond: You're welcome.