008: A Holistic Approach to Later Life- Brenda Shorkend

Marty Stevens-Heebner: (00:00)
When the time comes, who'll create a care plan for you or your loved one? And who'll be in charge of implementing said plan? Moving your mom, or your dad, or yourself isn't just about moving things from one place to another. It is much more complicated than that, as are so many things having to do with later life.

Marty Stevens-Heebner: (00:26)
How to Move Your Mom and Still be on Speaking Terms Afterward provides in-depth conversations with professionals, older adults, and their family members who share their stories with warmth, understanding and humor. I'm your host, Marty Stevens-Heebner, and here you'll find answers to many of your questions as well as different perspectives that I hope will inform and inspire you.

Marty Stevens-Heebner: (00:51)
Today I get to talk to a dear friend and colleague Brenda Shorkend, of Shorkend Care Management. Hello, Brenda, thank you for being with me.

Brenda Shorkend: (00:59)
Hi, thank you. It's an honor to be here.

Marty Stevens-Heebner: (01:01)
Well, thank you for saying that. And let me tell you a little bit about Brenda. Brenda's worked with many hospital and community organizations, including Huntington Senior Care Network. She studied rehabilitation psychology, I'm going to ask you about that, Brenda. And she's also a member of the Aging Life Care Association. She is an incredibly strong advocate for her clients. I have witnessed it because we've shared clients together.

Marty Stevens-Heebner: (01:28)
And she focuses on maximizing her clients' independence and autonomy while still ensuring their safety and wellbeing, which is so important. So Brenda, what's your favorite story about your grandparents?

Brenda Shorkend: (01:43)
Probably my favorite story is the one about my grandmother who was a bit of a witch, and she had reasons. I mean, she had a difficult life. She had many reasons to be a witch, but once she got dementia she forgot that she was a nasty person. So this was when I was a teenager. Every Saturday, she and my grandfather would come over to my parents for lunch, and every Saturday she would get ice cream for dessert. And every Saturday her eyes would light up like a little girl, "Ice cream, my favorite dessert." And that was something that taught me at a very young age that people who have cognitive impairment can actually sometimes enjoy things more when they're sick them when they were well, in which is a huge paradox.

Marty Stevens-Heebner: (02:27)
Yeah. I had a friend whose father-in-law came down with dementia and beforehand, he was like your grandmother, and then afterward he had a smile on his face.

Brenda Shorkend: (02:36)
And she forgot that she had a chip on her shoulder, she forgot that her life had been awful and she became really nice.

Marty Stevens-Heebner: (02:43)
And in her way she started enjoy it, especially the ice cream. I'm with her. So I do want to ask you, what is rehabilitation psychology? I've never heard of that before.

Brenda Shorkend: (02:52)
I was actually brainwashed during my studies to look at a person wherever they are. If they've lost a leg, if they've got bad memory, if they have terminal cancer, whatever bad thing has happened to them, what can we do right now today to improve things? Not to cure, but to improve things and make life tolerable.

Marty Stevens-Heebner: (03:15)
Yeah. Just so that they too, like your grandmother can enjoy their parts of life that they're able to enjoy. So let's talk about the focus of your profession and of your own personal work, because I don't think a lot of people understand the difference between a caregiver and a care manager, very different.

Brenda Shorkend: (03:33)
And I should actually call myself an aging life care professional rather than a care manager, because almost everyone is calling themselves a care manager now. Is that we are a unique profession where we are people who are trained in a variety of backgrounds, with me it's psychology other people it can be social work, nursing, occupational therapy, physical therapy, gerontology. And we are trained to work in a holistic faction with people.

Brenda Shorkend: (04:00)
Most of us work with older people, but I for example, also work with people with special needs, developmental disabilities. We are the person who overseas and organizes. I don't do hands on care. I make sure that the family or the person has a plan and looking at the big picture, providing the support, whatever it is. I used to joke, "Oh, I can even find a dog Walker." But yeah, then the next day I had to find a dog Walker, because I never know.

Brenda Shorkend: (04:30)
Someone like yourself, a senior move manager, a professional organizer, an attorney, a CPA, a caregiver. So we do many different things, and each of us slightly different, I would say, take on how we do our work, but it's not the hands on work. It's the overseeing and the coordinating, and I really pride myself at pulling together really good teams.

Marty Stevens-Heebner: (04:54)
Yes, and I'm honored to often be among them, so thank you for that, because you're superb about what you do. With the care, they're really the ones directly administering the care day after day, is that correct?

Brenda Shorkend: (05:06)
Mm-hmm (affirmative), yeah.

Marty Stevens-Heebner: (05:06)
And as a care manager, you're really the quarterback or the coach ... It's really the coach overseeing everything and the players are on the field with the caregivers.

Brenda Shorkend: (05:15)
It depends, because sometimes I'm the coach, but sometimes I'm the coordinator, or the overseer, because I have clients where literally my role is providing the family with some direction and some advice. And then I have clients where literally I am the one that knows, how is this person? What time did they wake up this morning? Did they take a shower? How much did they eat?

Marty Stevens-Heebner: (05:38)
Did they take their medications?

Brenda Shorkend: (05:40)
Did they take their medication? Going with them to the doctor. And I also occasionally do assessments for the court. And that's the one that's the most fun, because-

Marty Stevens-Heebner: (05:48)
Oh, why's that?

Brenda Shorkend: (05:50)
Because then I can be completely objective. I don't have to be nice to anyone, I am only making recommendations that are in the best interest of the client. And if both sides get upset with me, I know that I'm doing the right thing.

Marty Stevens-Heebner: (06:06)
We all love the easy jobs, but frequently look, when families get along really well miraculously, they don't need us because they can take care of the situation on their own. They have enough people, people live nearby. So it's no wonder that we often get the problem cases.

Brenda Shorkend: (06:27)
But, I think in a way the clients who give me the most satisfaction are the ones where maybe I only meet them once. And maybe I don't even meet the older person or the person with the special needs. I meet with the people involved, the daughter, the son, the spouse, the neighbor, the cousin, we all meet together. And since COVID, I've been doing a lot more on Zoom, I help them come together and think in one direction and then they don't need me anymore. They couldn't manage before because everyone was going off in a different direction with unrealistic expectations, or a lot of pent up frustration with each other, and good families-

Marty Stevens-Heebner: (07:05)
Well, because in that case you're probably a bit of a referee, but you're also the professor teaching them, and the guide, the shepherd, teaching them about what they need to do. It's so important that people be heard during these times, especially when it comes to their fears and hopefully not too much angry stuff, but they need to be heard.

Brenda Shorkend: (07:25)
It's also a lot of frustration between siblings. I mean, I learned from you to talk about the ... Your phrase, the designated adult, right?

Marty Stevens-Heebner: (07:33)
The DA, right? The designated adult.

Brenda Shorkend: (07:35)
There's always one kid who's in charge whether they want to be or not, and then the other kids are upset with him by definition. And a lot of that is just hot air, and if it's clarified people could move forward. I also want to add in most of these situations, the good daughter isn't so good, and the evil daughter isn't so evil.

Marty Stevens-Heebner: (07:54)
People have all kinds of motivations. What do you wish people knew about what you do?

Brenda Shorkend: (08:00)
That I can help people six months, two years, 10 years before the disaster, you don't have to wait for a horrendous crisis to get help. And if you yourself are planning, then this will help your adult children or the other people, or your spouse to then when you need help know what to do.

Marty Stevens-Heebner: (08:19)
They're completely hit by fear and don't know what to do about it.

Brenda Shorkend: (08:22)
It's not just fear if someone is in the hospital and has used up all their savings and is at the end of their reverse mortgage, and now what are we going to do with him? We are probably five years too late for something reasonable. I'm not saying there isn't some kind of solution, but the good solution is gone.

Marty Stevens-Heebner: (08:44)
So, it's easier to attain and find a good solution if you plan ahead?

Brenda Shorkend: (08:50)
Yeah.

Marty Stevens-Heebner: (08:51)
Not only getting your estate plan and your trust, you're going to hear me say that in practically every episode. Like your healthcare directive, get all that done now no matter ... As long as you're an adult, get it done. And also be aware that if you haven't planned, it's going to be so hard on your family, and especially you're talking about the finances. People often have to scramble to pull together anything. And in my opinion, I've seen that people have to do GoFundMe pages to keep people alive, but that's the state of our healthcare system here.

Marty Stevens-Heebner: (09:24)
It's so important to have that together and to name a really competent DA, a designated adult as your trustee, as your executor, power of attorney, make sure it's somebody who's really competent and who you talk to about it. Talk them through it because especially with an executor, if somebody dies and suddenly the executor is the CEO of the whole estate-

Brenda Shorkend: (09:51)
I had a client recently where I sat with his wife and his daughter and we read through his advanced healthcare directive. And I was trying to help the wife understand what his wishes were, because right now he wasn't at a point where he could express what his wishes were. And she understood what was written something completely opposite to what the daughter understood, because it wasn't really ... And so what is written isn't so important, what's important is when I started having the conversation with her, "Well, what would he want right now? Would he want a feeding tube? Would he want to go to a nursing home for rehab? Would he want to go home? Which of these are we talking about right now?"

Brenda Shorkend: (10:37)
Let's say someone who's 92. I mean, I have a client like that right now. The client is 92 who has kidney failure and heart issues and let's add diabetes for fun and then they get pneumonia. So what do you do? There are people who just choose to stay home and let this take its course. There are people who know will go to a hospital and want to be treated, but what if they don't get better? You can do a lot of things. You you can put them on a ventilator, you can start with tube feeding, you can do a bunch of things. And it's very similar to what's been have with people who've had COVID of course. People who are younger and stronger, it might be worth it.

Marty Stevens-Heebner: (11:23)
There was an article recently about the dangers with drug interactions. Is that something you watch out for?

Brenda Shorkend: (11:29)
Of course. So I'm not a nurse, I'm not a doctor, but I certainly know how to look at the medications because if there's some medications there that's maybe should not be taken together.

Marty Stevens-Heebner: (11:41)
They don't get along very well. Yes.

Brenda Shorkend: (11:42)
They might. I mean, again, sometimes there's a very good reason for a person to have these medications, it's not necessarily wrong, but then the doctor needs to say explicitly, the reason why they're taking these two medications is because we don't have any other option. So first all I would go with primary care physician, and if they're able to do their reconciliation, the drugs, then it's fine. But you can obviously, just go to the regular pharmacist, or if you need more of an in-depth consult, especially if it's complex medications, it might be a geriatric pharmacist, a geriatric psychiatrist, someone who can really look at the drugs at the interactions

Marty Stevens-Heebner: (12:16)
And understand them. Yeah. And no one it's really a time to be concerned about that.

Brenda Shorkend: (12:20)
I haven't emphasized yet talking about all the bad stuff, I like to help families sort out the bad stuff come to a point where people are doing okay, and then look at quality of life. So then we start weighing, staying at home, moving somewhere, taking 20 meds or taking three meds, going back to the hospital for every little exacerbation of their COPD or deciding to maybe be at home on palliative or hospice care.

Marty Stevens-Heebner: (12:49)
What do you feel is distinctive about your service?

Brenda Shorkend: (12:54)
Well, first of all, I advocate really strongly for my clients. Someone said to me the other day that I don't let people push me around.

Marty Stevens-Heebner: (13:01)
You don't. So they think they might because you had that wonderful British accent and I'm sure people just think, "Oh, she'll be a pushover." Little do they know you are a powerful advocate.

Brenda Shorkend: (13:12)
So, so what I say to people, when come in to a situation let's say the son or the daughters ask me to meet with their parents. I say to them, "You have to understand, obviously I'm taking your lives and your abilities into account. I'm not going to go in to recommend things you can't do, but I'm advocating first and foremost for your mother. And if you want your mother to go into an assisted living because you can't sleep, that's not a reason. The point here is, is it safe for your mother to live in her own home? And does she have the quality of life there? Maybe she really doesn't need move." And many people, and we saw this a lot during COVID became so lonely and isolated.

Marty Stevens-Heebner: (13:49)
Yeah, which is the great contributor to dementia as we know.

Brenda Shorkend: (13:52)
And depression and just general decline. I also think it's very important, if someone is thinking of moving that they move early enough. If there's someone in their seventies who's saying, "I don't know if we want to move into an independent living community or not." Don't wait till it's too late.

Marty Stevens-Heebner: (14:14)
Don't wait till you fall and break a hip, don't wait for the heart attack.

Brenda Shorkend: (14:18)
Because the independent places work for people when you've already built community, if you're living in your home and your friends have moved away, and your friends are dying, or just getting older and you feel that you need more community, that's the time to move and create a new community.

Marty Stevens-Heebner: (14:35)
People make a whole new batch of friends. There are all these wonderful activities. Yeah.

Brenda Shorkend: (14:40)
I had a client, for example, who moved in when she was very, I would say young, and vibrant. She started a movie group, and they played bridge every week, and a bunch of things. And then she started having issues, but because she had friends, her friends made the effort, they'd come to the room to visit her. They wouldn't wait for her to come to bridge. They'd come and encourage her to come out and do things with them.

Marty Stevens-Heebner: (15:10)
It's interesting too, because nobody has to get in their car and drive to you. You're up one floor via the elevator or you're on the other side of the building, so it's possible to just walk there and check on your friends. And a lot of friends just do check on each other, it's really quite lovely. It really is.

Brenda Shorkend: (15:27)
But of course, I mean, moving into one of these communities is very much like going to college. It has to be the right fit.

Marty Stevens-Heebner: (15:33)
It's like the college dorm. And that's where somebody like [Sue Pamaran 00:15:37], who is in her first episode, who does placement that she knows all the personalities of the different communities and what a good fit for the client would be, which is so important. Are you living there? You're living there, it's your home, so make sure it feels like a good neighborhood for you.

Brenda Shorkend: (15:56)
And that's of course something to take into consideration if you stay in your own home and if your neighborhood is changing. If you lived on the street with people and you all brought up your kids together and everybody's staying and basically aging in place together, it can be a real good thing, but if there's been this huge turnover and you're the matriarch of the street, and no one talks to you, the important point for me is there's no hard and fast rules.

Marty Stevens-Heebner: (16:24)
You are very adept at putting great teams together here. When it came time where things were happening with your parents back in Israel, did you put teams together there to take care of them? How did you go about that?

Brenda Shorkend: (16:39)
Well, my father died the week I turned 30, so he was very sick for most of my twenties. And my mother who was a doctor, was the one who actually pulled together the care that she needed. And I learned a lot from her, including putting together hospice for him before there was even such a thing as hospice. So that's my dad. When my mother started having problems in her late eighties, we had the whole dynamic between me and my brother, that you have a lot of the time between a long distance caregiver and a local caregiver.

Brenda Shorkend: (17:10)
And of course, I'm the oldest sister and I'm the expert, and he's the little brother who never listened anyway. And I ran away and left him, holding the baby, et cetera, et cetera. And you have to work with that and you have to be aware of it. I managed to convince him to hire a care manager like myself, because he was calling me about every two months. "Okay. I'm going to pay for a ticket. You have to come." And I would say, "I can't solve the problems in a week or two weeks, you need someone to help you." And he finally, I mean, the best thing we did was to hire the care manager who brought in the caregivers and help my brother oversee things. And then she was also someone that I could communicate with as much as I needed to and actually provided her with a lot of training. So I was telling her what to do with my mother, but it wasn't me with my mother.

Marty Stevens-Heebner: (17:57)
Right. That makes a big difference. The families to family is still butt heads over things like that.

Brenda Shorkend: (18:03)
And so they went to a really important medical appointment about whether she should have surgery like a big deal. And they went in my brother, my mother, the care manager, and I was on the phone. And I thought it went really well. I mean, they asked the doctor questions, they got all the pros and cons, as they're walking out, my brother still has his phone on. And I hear my mother say, "I'm never going to an appointment with you again, you talked over me, you didn't let me ask questions. Next time I'm going to Rachel," the care manager.

Brenda Shorkend: (18:32)
So I'm starting to dance here, because that's what we want as a family. We want our parent to feel that they have an advocate, and who listens to them and not these children. I mean, I changed your diapers. Why would I listen to you? And there's all the buttons that they know to press so that we then behave like seven year olds with them. And when you have the care manager in between, suddenly things can go much easier.

Marty Stevens-Heebner: (19:01)
Yeah. The somewhat neutral third party, so to speak. Yeah. All of us who are in professions related to the care of older adults in later life, we often become that neutral third party who comes in and people will listen to. My father used to say, "Oh no. Oh no." To everything I said, and then somebody else would say it. "Oh really?"

Brenda Shorkend: (19:23)
So I also say to families, don't roll your eyes and say, "Oh, mom." Just say, "Oh, what a wonderful idea." And I know that you've asked them to do this for the past five years, but I'm coming in from the outside as a professional and they're going to listen to me, so just thank your lucky stars that they're listening. And if you start rolling your eyes and getting upset, then we're done and then we're not going to be able to do it.

Marty Stevens-Heebner: (19:46)
Yep. Oh, yeah.

Brenda Shorkend: (19:47)
So I almost do coaching with the adult children, and for the spouses, how to get things done the way you want them to be done.

Marty Stevens-Heebner: (19:55)
Yeah. Yeah. And that need to be done. So I'm imagining, that's the toughest part of your job, is setting up the plan and getting everyone involved to respect that plan.

Brenda Shorkend: (20:08)
Yeah. Well, the only difficult clients are the ones where the people who have the responsibility don't follow through. So I've never had a client I don't like, even the one who cursed me and told me to get out of his house. I understood why he was upset with me. I didn't take it personally. But when it's the family member or the family friend or whoever it is, who has the legal authority to take care of the them and they just don't follow through, those are the ones that I have a hard time with.

Marty Stevens-Heebner: (20:39)
Yeah. They are very difficult. So what are some reasons why clients or their families don't listen to your advice? Or what reasons do they give?

Brenda Shorkend: (20:50)
"Oh, I don't want to upset my dad."

Marty Stevens-Heebner: (20:53)
Oh, yes.

Brenda Shorkend: (20:57)
"Well, yeah. I think it's a good idea, but I think I know my mom better than you do."

Marty Stevens-Heebner: (21:03)
But you don't know how to take care of her better and understand the medical jargon and all that. I imagine acting as a translator for all the medical jargon and that sort of thing.

Brenda Shorkend: (21:16)
Some of it is, people are just overwhelmed. It's just too much, or they've been doing it for so long they're just burnt out. And that I completely understand, but the one that concerns me and it seems to be more typical in families where perhaps there was history of abuse, or at least some kind of bullying or very authoritarian behavior by a parent, the kids can't make the switch between dad who was impossible before and dad who's impossible now.

Brenda Shorkend: (21:51)
So I can give the example of my mother, my brother at one point got so sick of her behavior that he said to her, "I don't want to be your POA for finances anymore." So I was ready to kill him. That's a different issue, but why did he get to that point?

Marty Stevens-Heebner: (22:05)
And let me just point out. I'm just going to point out that POA for finances is somebody who is the power of attorney.

Brenda Shorkend: (22:09)
That's the power of attorney. He was the one who was overseeing her finances.

Marty Stevens-Heebner: (22:13)
Yeah. Thank you.

Brenda Shorkend: (22:14)
So she was declining and she was losing her language. What she was trying to say to him, I think is, "I want to be sure there's enough money in my account." What he understood is, "You don't trust me with handling the money." Because he was very stressed and overwhelmed.

Marty Stevens-Heebner: (22:33)
And they're family, and they're family. He's assuming his mother is criticizing him.

Brenda Shorkend: (22:37)
And you see that in a lot of cases. I mean, not that my brother ever abused my mother, he didn't.

Marty Stevens-Heebner: (22:41)
Basically right.

Brenda Shorkend: (22:41)
But they do get to the point where they abuse family members. Not because they're evil, but because they're at the end of their tether and don't know what to do with them.

Marty Stevens-Heebner: (22:51)
And especially with clients who have advanced dementia, that can be so frustrating. And it's not the person's fault who has dementia it's the disease. And that is so difficult. I wanted to ask you what questions should people ask professionals like you, as they consider working with you or someone in your profession?

Brenda Shorkend: (23:10)
So first of all, are you comfortable with them? I would just first of all, just chat to them and see whether this is someone whose personality is right for you. That's the most important. They're going to be involved in some intimate things in you and your family's life. Second of all, of course, what is their background? How do they work with their clients? How do they communicate with the families? What are their professional experience? Do they know what they're talking about?

Brenda Shorkend: (23:38)
I like to recommend people who are members of my national association, that's the Aging Life Care Association. There's a look up by zip code on the website where you can find aging life care professionals. You can also see whether they are certified or not, and if they're certified, that means that they're one level higher of experience and have been through some exams.

Brenda Shorkend: (24:02)
Number three, also nobody asks about liability insurance, they should. I would say if the person does not have a liability insurance don't work with them, cyber insurance for the same reason. In case any of my information is hacked. And just the fact that I have cyber insurance means that I understand that there's a risk and that shows that I'm taking things more seriously than maybe some other people.

Marty Stevens-Heebner: (24:25)
And with cyber insurance that you're protecting their very private information.

Brenda Shorkend: (24:30)
And their privacy as well, that I'm taking it seriously.

Marty Stevens-Heebner: (24:33)
So important. I'm wondering, because that makes me think about elder abuse and the different forms it takes. Do you encounter that? And what do you do about when you do?

Brenda Shorkend: (24:43)
First of all, if I'm working with the family, people who are looking to the future, I help them set up things to protect themselves from a lot of these things, make sure that they've been to the right attorney, that they have their documents in order, that they have someone who's keeping it, even if they're completely independent, someone else is checking on their accounts to make sure that there's no fraud in their bank accounts.

Brenda Shorkend: (25:07)
Putting together a lot of things to make sure that as a person gets older and perhaps they're declining in their cognitive abilities, someone is just helping to keep an eye on them. And then I often get referrals of very messy situations where someone is taking advantage of a person. I rarely work with awful physical abuse cases, it's just too difficult for me. There's a very good care managers who will do that. With me it's more the undue influence, the money disappearing, the son buying a brand new with mother's money because he has to drive mother to the once a month, those kind situations. And sometimes it's very subtle, and some of it is not on purpose.

Marty Stevens-Heebner: (25:53)
Can you give an example? You're talking about subtle, what do you mean by that?

Brenda Shorkend: (25:57)
Well, for example, someone who thinks that it's quite okay to buy themselves a new car with mom's money because they occasionally drive her to the doctor or take her to lunch. And there's also the people who getting to the end of their tether and are just very impatient and can just shovel, push. And then there's the insidious nasty undue influence where someone slowly weasels their way into a person's life and takes over. And it can be a family member, or it can be a stranger, or it can be a caregiver, or it can be a neighbor. And those cases are difficult.

Marty Stevens-Heebner: (26:37)
They can get very divisive very quickly unfortunately.

Brenda Shorkend: (26:40)
But it's usually, not in every single case, it's usually when a person has either isolated themselves or being isolated, or if you're part of a village, if you're part of a group of people, if there're a number of people looking out for you, it's less likely these things will happen.

Marty Stevens-Heebner: (26:57)
Yeah. My dad had a whole cadre of friends who would come and check in with him and hang out with him, which was really lovely back in Buffalo, although [crosstalk 00:27:04].

Brenda Shorkend: (27:04)
But it's rare these days with everybody moving around and leaving.

Marty Stevens-Heebner: (27:08)
And ones they're staying in Los Angeles. Yeah, which is where we are. It's a very different dynamic. That's such important information. And all the information Brenda you've given is so remarkable and helpful, and I just really want to thank you for being here and sharing your extraordinary knowledge and experience with me and everybody.

Brenda Shorkend: (27:28)
I just hope I have the energy to advocate for people for as long as I can. Thank you, Marty. It's been a true pleasure.

Marty Stevens-Heebner: (27:38)
Thank you so much for listening to, How to Move Your Mom and Still be on Speaking Terms Afterward. Please visit howtomoveyourmom.com for more information about this episode, and for additional podcast episodes featuring other extraordinary guests and conversations. Until next time, this is your very grateful host, Marty Stevens-Heebner.