030: Call Light: Registered Nurses are Revolutionizing Home Healthcare – Courtney Hogenson

Marty Stevens Heebner:
Caregivers, whether they're paid or they're volunteering, make home life so much easier for older adults and their families, but they don't have the training necessary where serious health and medical issues are involved. Wouldn't it be wonderful if you could have a registered nurse on call? My guest today, Courtney Hogenson, has an app for that. 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. 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. Courtney Hogenson, it is so good to see you.

Courtney Hogenson:
So good to see you, Marty. I wish we were in person.

Marty Stevens Heebner:
I really miss you. You're in Austin, I'm in Los Angeles, but we used to hang out a lot. Let me tell you a little bit about Courtney's brilliance. Courtney Hogenson, who's a registered nurse and patient advocate with over 10 years of experience in elder care and healthcare worker empowerment. That's key.
She's also a serial entrepreneur, and her latest venture is Call-Light, an innovative healthcare platform where anyone can safely hire an experienced nurse or a clinician of their choosing for in-home healthcare anytime, anywhere. I just think that's so brilliant, but we'll get into that but first, what's your favorite memory of your grandparents?

Courtney Hogenson:
I think of my grandfather, my dad's dad who had Alzheimer's, which was not great, but it was such an amazing experience to be around him. When I was a teenager, he moved into my parents' home so that they could help care for him, and just being around him and living in the moment with him. My favorite memory was when I was 16, and I got the call from my mom, and she said, "Can you go pick up Paul from jail?," and I said, "What?" I was 16, so I could barely drive anyway, and she said, "Yeah. Paul escaped from the adult daycare today," and in a small town in Texas, people don't lock their car doors, so he just got in someone's car, and when the guy came back from the gas station, he got in, and Paul was just like, "Where are we going?" The guy's, "Who are you?," and he's all, "My name is Ralph," and so they had to call the sheriff's department, and they didn't know what to do with him 'cause he couldn't tell them where he lived, so I had to drive to jail and pick up my grandfather.

Marty Stevens Heebner:
I love that you sprung him from prison. That's so funny.

Courtney Hogenson:
And unfortunately, he wasn't able to go back to the adult daycare, 'cause safety reasons. He's a flight risk. But it was just seeing what that was like for families like, "What do you do when you need help?"

Marty Stevens Heebner:
It's this very funny, but also very poignant story. He was so lucky to have such a loving granddaughter, who would come and spring him from jail.

Courtney Hogenson:
I feel like he would've done the same for me.

Marty Stevens Heebner:
So as a nurse and a patient advocate, you really believe in trying to keep people living in their homes for as long as possible. What's so important about that?

Courtney Hogenson:
I think of myself and being at home. I mean, it's where your stuff is and it's where you feel most comfortable and at ease, and home is different for everybody. For some people, maybe being in a different kind of home is better. You have to really meet the person where they are. I remember having a big CEO who was a gabillionaire, and the family, the kids were like, "Oh, dad needs to be at the Beverly Hills Hotel. Dad needs to be at the Peninsula," and I'm like, "Your dad has severe Alzheimer's disease."
"If we were to take your dad back to the mansion or to one of these hotels, they're not equipped for him. They're unfamiliar to him, and they're so large." You can't do that to someone like that. It's not right. They need a familiar environment and something that feels secure and all those things.

Marty Stevens Heebner:
When we're moving people into, say, a board and care, or in other parts of the country, it's called a nursing home, it's so important to have those familiar family pictures on the wall that they've known for ages because, I don't have to tell you, the registered nurse, it's the older memories that last the longest. It's got to feel familiar.

Courtney Hogenson:
And every home's a little bit different. They try to recreate what they loved about their home, 'cause sometimes it doesn't make sense for them to stay in a big house or a big whatever. Sometimes you need to downsize. I find a lot of people move into condos and buildings so they don't have to deal with the yard work, and yeah.

Marty Stevens Heebner:
You're talking to a person who really appreciates living in a condo and not having to mow the lawn.

Courtney Hogenson:
Yeah.

Marty Stevens Heebner:
One of the things with caregiving and having nurses come to the home, is that covered by insurance, or is it private pay?

Courtney Hogenson:
I'm glad you asked that. When I was working in the ICU, as a nurse at UCLA, I always thought when my patients were leaving, and they were going home with home health or hospice, I thought they're going to be taken care of at home. We're just going to do a handoff, and it was just such an eye-opening experience to find out, even if someone is actively dying on hospice, qualifies for all these things, the thing that's never ever covered by Medicare or insurance is round-the-clock caregiving. Let's say you do qualify for hospice. You don't just get to sign up for it.
You have to have two doctors sign on, that you have less than six months to live, and all these things. Even if someone is eminently dying, if that hospice company doesn't have someone available, someone can't just show up. I just remember families really had to either do it themselves or hire through an agency, hire through a registry, and there's tons of different caregiving agencies, and it's like a dime a dozen, but it's also, it's your home, and it's scary to just let anyone in your home. You're not going on Craigslist to bring someone in your home.

Marty Stevens Heebner:
Who can you trust?

Courtney Hogenson:
A lot of the patients, they have cognitive impairment, or they have memory issues, or mobility issues, and they're very dependent on these caregivers, to the point where it can become undue influence, it can become these gifts, all sorts of things. You've seen it all once you've been in home health, and sometimes it's not the people you think you have to watch out for, sometimes it's people that very much surprise you. Sometimes it's an attorney, sometimes it's a doctor, sometimes it's a nurse, sometimes it's the adult child. You just never know.

Marty Stevens Heebner:
And so frequently, it is a family member, and that's just heart-wrenching.

Courtney Hogenson:
I feel like I've seen the really good and the really bad, 'cause I have seen the daughter-in-law, who's husband passed away and it's her husband's dad, and she's left in charge of him. The man never spent any money on himself, so she says, "Dad, I can't wait to spend all this money on you," and she did that. She put him in one of the nicest homes. She had me come a few times a week. Those were his golden years.
He was happier in those last couple years of his life than he ever was before. He was taken care of. He's like, "They take care of everything here. They take care of me. They even wash me."

Marty Stevens Heebner:
I hope so. Well, yes, we like washing. It's so wonderful to be pampered like that. You and I are both part of that movement.
It's our mission in life, to make later life comfortable, safe, celebrated, cherished, for those who are in their later years. You and I have a huge goal, especially 'cause we'll be there eventually.

Courtney Hogenson:
Yeah. I mean, we hopefully get the privilege to live that long, and let's learn what we can from our clients, from our families. "Oh, that's what it looks like if you do take care of this. That's what it's like if you don't. I want to be more like her or him when I get to 100 or whatever."

Marty Stevens Heebner:
I would love it if you would describe what the big differences are between what a caregiver can provide to a client and what a registered nurse can do for them.

Courtney Hogenson:
There's really so many different levels of care, and every caregiver and every nurse may have different specialties, different certifications. So I always tell families, "The thing you need to know that a caregiver should not be held responsible for is if you're ever administering medication or you're putting something into an orifice anywhere." If you're inserting anything into an opening or taking something out, that should be a nurse, and that includes needles and G tubes, PEGs. If you're following all the rules and regulations, a caregiver that is not a nurse should never be touching or administering medications of any kind. They can remind someone legally for liability reasons.
You just want to make sure everyone's staying within their scope of practice, and that's why nurses can help in home because they're already covered by the board of nursing. When someone leaves the hospital, there is a doctor who's written any order or a medication, there's post-op, there's discharge orders, a nurse can do any of those things, but a caregiver sometimes get put in those positions to do things.

Marty Stevens Heebner:
It's wonderful what you're offering.

Courtney Hogenson:
There's all these gaps in care. It's like you're taken care of when you're in the hospital, but I always feel like if you don't need to be in the ER or the ICU, go home. Bring someone to you. Something good that happened with the pandemic, 'cause there were some silver linings is telehealth. People are now starting to recognize that you can do things a little differently.
In a way, we're going backwards to go forward again. Telehealth was around a long time ago, but it never really took off 'cause people didn't need it. They were like, "Nah. No, I can go in," but now, you don't want to spread germs, you don't want to pick up anything you don't have to pick up. There's just so much you can get done at home, and I think if you can choose your own nurses, your own caregivers, you can choose your own doctor ...

Marty Stevens Heebner:
So important. So how does Call-Light work?

Courtney Hogenson:
So Call-Light is a double-sided healthcare marketplace. As a care manager, I was often tasked with building these teams of caregivers and nurses for patients for short-term or long-term care, and I typically would go to a registry, or an agency, and sometimes it would be awesome. Sometimes they'd send me a nurse with a pulse, and I'd be like, "You can't send that to this house," because I would be held responsible for each and every person that came in, but got to the point where I couldn't trust other people to do it, so I had to do it myself, and so Call-Light basically came to me when I was hiring my first part-time nanny for my son six and a half years ago. I remember I found this wonderful girl through a Facebook group, like a mom's group or something, but I said, "I have to check your references. You could be an ax murderer, I don't know," and she said, "Can I give you my review page from this babysitting site?," and I was like, "What is she talking about?," and so she gives me this rating and review sheet from UrbanSitter, and I loved it.
I was like, "Huh, somebody needs to do this for nursing so that people can hire nurses at home. This is so needed. This is going to help so many people." I had a newborn. I was like, "Somebody's going to do this. Someone's going to come up with this," and the pandemic happened, and it's, "Oh my gosh, we need this more than ever now," and so Call-Light is this tool, this platform where people can post a job.
I need someone to help three days a week with grandma for these specialties, so a daughter could do that, post the job, and then all these different nurses and clinicians can apply for it and say, "Oh, that's something I'm interested in. It's not too far from me. Those hours would work with me," and they negotiate like, "Hey, here's what I want to pay. Here's my hours. Here's what I can do," so really, what we're trying to do is trying to get rid of that middleman that puts so much cost on top of it, because it's 30 to 50% on top, and so in this way, if you have a nurse or clinician that's really good, they're going to be getting these ratings and these reviews over and over, and it's going to be tracking how many repeat clients, how many this, how many that.
You may have the best team of nurses or caregivers for your loved ones that works right in that moment, but what if a car won't start? What if one of them gets sick? What do you do? Would you go back to the hospital? You bring in a totally new person?
So to me, it's like there's four million nurses in the United States, and not all of them want to be working in a hospital, working 12-hour shifts, nights, holidays, weekends. Nurses that have done in-home care, private duty, they wonder, "How can I get more of these jobs?" I get to work one-on-one with someone where they want to be, and this person recognizes that they need my help so that they can stay home, and this person wants my help, and this person needs my help. It's a win.

Marty Stevens Heebner:
That's so brilliant because you found the need, you found the void, and you found the solution.

Courtney Hogenson:
That's the first business you start. I was a nurse, and then I started a home care company, 'cause I thought, "Gosh, there's so many gaps in our care system. People are always asking me as a nurse, 'How can we help them in that transition to home?,'" and so I kind of went down that route, learned a lot, so much.

Marty Stevens Heebner:
That was Heal at Home. That was Heal at Home. I remember, that's when I first met you. We've known each other for about 10 years now.

Courtney Hogenson:
That was the first business. I didn't have a kid. I was like bright-eyed, bushy-tailed, but it was such a great experience, and I think these other doors started opening, 'cause I was really great at what I did and I loved being a nurse and being in charge of all these caregivers, and I was then the director of nursing, but if the client was in a hospital or going to a doctor's office, I started to recognize the value of being there with them and being the patient quarterback, that, "Hey, let's make sure that this medication got picked up at the pharmacy. Let's make sure it got put in the pill box. Let's make sure that they're checking the blood pressure," and I just recognized the continuity of care that I was able to provide, and then families just kept saying, "Gosh, if we could hire someone like you to go to all of their appointments, to manage all the caregivers," so that's when I became a care manager. Those voids keep coming up, and I need to help these people.

Marty Stevens Heebner:
We know the healthcare system is a mess, and it's difficult, it's scary. I think the world knows it's ridiculous and that people literally can go bankrupt taking care of people.

Courtney Hogenson:
The private duty registry that I had in LA and the care management, not everyone could afford that, and that's what was tough. I tried to do what I could, and I never left anybody like, "Oh, you can't afford my services, I can't help you." I would always try to help them as much as we could, but I wanted to make it so that more people could get help, because sometimes you don't need a nurse 24/7, round-the-clock. Sometimes you just need someone for a week, or someone's a newly diabetic patient, and they just need a little bit more than what home health will offer, because home health, even if you qualify for it. It's just a few, short visits for a few weeks, and that's it. It's great to have it, but you don't know when they're showing up, who it's going to be.
You can't plan your life around that, so with Call-Light, I really want nurses to be able to ... Just like when you're in the hospital, and someone pushes the Call-Light, you can go and help them. If you're available, you can say, "You know what? I'm going to go help that person Because they're five minutes from me," or what have you.

Marty Stevens Heebner:
I remember when you had Heal at Home home healthcare, and this is what you do when you're a business owner, one of the caregivers at the last minute couldn't show up, so I remember you said, "I'm putting on my scrubs and going and doing the shift." I think you mentioned that after your shift, they said, "Oh my God, why can't we have somebody like you all the time?," your skill as a nurse and being able to translate to people. For example, you mentioned a G tube and a PEG before. What are those, 'cause I don't know?

Courtney Hogenson:
A G tube is something that goes into your nose and your gastro area, and then a PEG goes into the side of your stomach.

Marty Stevens Heebner:
Somebody who understands that and also knows the perils of having those things, if they're not looked after properly, and that's something a nurse knows.

Courtney Hogenson:
Just going on those shifts. Those are some of the most memorable ones, when I put on the pair of scrubs and had to show up, 'cause they needed help, and I thought, "You know what? Today's my day. I'm going to go." I just wanted to make sure they were taken care of and they could stay home.
I feel like if you really have never walked in those shoes, as a business owner, it's hard. I always had such an easier time to be like, "I know what that's like, and this is what I would do if I were you," and it's hard. It's not for everybody, and it takes a village too. You could have the best nurse in the world or the best caregiver in the world, but they can't be everywhere 24/7, so you have to find allies, and you have to find other people to help.

Marty Stevens Heebner:
And the experts at each area.

Courtney Hogenson:
What are the odds, and what does the usual course look like for someone in their 80's going through this? They don't talk about it, and they should.

Marty Stevens Heebner:
That generation, they revered doctors, and it wasn't the same kind of system that we have now, where it's just a conveyor belt, and often, as you know all too well, they're afraid to ask questions. They feel they're being disrespectful, and also, if they don't know what to ask, what are the kinds of questions people should ask a doctor? Ideally, take an advocate.

Courtney Hogenson:
Yeah, that's what I would say. I just think of the difference. I noticed when a caregiver would go to a doctor's appointment, or when I would go, or a daughter. It's great to have anybody. Taking notes is the biggest thing.
Have someone record it, if the doctor's okay with that, and asking questions. Before you even go into any doctor's appointment, you need to have a list of all your current meds, who prescribes them, exactly what you take. If you take vitamin D every day, put that on there. If you take a multivitamin, put that on there. Even if it's over-the-counter or a nutritional supplement, put it on there, because things can interact that you don't know about, or something can make something work even more.
You need to be in charge of your master medication list. Look how many times things get lost in translation from one system to another, to the pharmacy, when you pick up the wrong dose. We're humans. We make a lot of errors and-

Marty Stevens Heebner:
Computers also make mistakes.

Courtney Hogenson:
Oh, yeah. You also need people to be able to ask questions like, "Hey, why am I taking this medication?" I found that when I did these master medication lists for patients, I would always put, "This is so you don't pee so much at night." Put it in terms they understand.

Marty Stevens Heebner:
Translate it, and that's something you're great at, and you can find the nurses who are great at that too. I know you're big on getting people to plan for later life, or it's not even later life. What if you're in a car accident, you wind up in a coma?

Courtney Hogenson:
What if you're Britney Spears, and you have a lot of money and a lot of people that depend on you? Wouldn't it be nice to pick who's in charge of you?

Marty Stevens Heebner:
Yes, it would be. Took a court case for her, but finally. I remember a story you once told me, I think it was after your first shift at UCLA's ICU, and you saw these critically ill patients, and you went home, talked to your husband, and ...

Courtney Hogenson:
I printed out an advance healthcare directive for both of us. I just went to the state of California, advance healthcare directive, printed it out, it was a couple of pages long, and said, "I do or do not want this to happen to me." You basically are saying, "When I want you to pull the plug, don't keep me alive for 50 years in a coma." So I filled that out, and then we walked over to our neighbor's house, had him sign as a witness. We both did those right then and there because I was actually in a nursing school rotation, and I was in the ICU, and it was two youngish patients who nobody wanted to be the one to say, "We don't think they're going to recover," but they were both comatose, brain-dead. You pray for a miracle, and look, miracles happen, but it was not very likely that they were ever going to wake up or have any sort of meaningful life, and no one wanted to be the person to say, "Let's not try everything."
So both of these patients were getting sent to get trached and PEGed, so they were getting an airway put in here so they could have a ventilator, breathe for them, and they were getting PEGed so nutrition can go in through their stomach, and then they both got sent off to a skilled nursing facility. The families said if we had had something in writing or if we had ever talked about it. We just never talked about it, and so I saw that as where you go, when you don't talk about it and nothing's in writing, 'cause you can't just have it in writing and you can't just talk about it. You have to do both. Well, and some people will write in their advance healthcare directive, like you ask them, "What's super important to you?"
"As long as I can sit and watch baseball and eat chocolate, that's enough for me," and so for that person, put that in there. As long as they can still do that, keep treating them, but once they lose the ability to do whatever it is that's super important to them, that's their quality of life. That's their choice.

Marty Stevens Heebner:
Yeah, it really is.

Courtney Hogenson:
I remember some of my doctor friends, we would talk about, "Oh, you're on the list to pull the plug for me. If you have to trip over the cord, you better pull that plug. If you don't, if I suffer for years and years, I will haunt you. I will find a way," and we joke about it, "But I just want you to know, this is definitely what I want."

Marty Stevens Heebner:
It's so important. The statistics say that about a third of new entrepreneurial ventures are being started by people who are over 50, and there are multitudes, including younger people, who are launching endeavors to serve later life and all the different issues involved. It's a challenge to become an entrepreneur. I don't know if you hear this as much as I do, you'll be at a party or something, you're meeting somebody and they say, "Oh, that's so great. You can make your own hours," and I always say, "24/7, I make my own hours." Yeah, it's just great.

Courtney Hogenson:
There's definitely good things about it, but it can be lonely too, and I think that's why we found other entrepreneurs. As women, it was so nice to find a group of people that understood, 'cause I think people have these conceptions of, "Oh, if you have a business, you're already super successful, you're already rich." No. I didn't pay myself for the first couple of years. You have no idea what it's like until you start a business, and even though it's successful, doesn't mean you're making any money.

Marty Stevens Heebner:
Yeah, you and I. We've talked a lot about the challenges and everything, but there's a term called the loneliness of leadership. You're married, you have this adorable son, and you have your friends and everything like that, and yet, you're the one who has to make the decisions. People can give you all kinds of information, but ultimately, you have to say, "We need to do this," and it's a risk, and that's the loneliness of leadership, and that's what keeps people up till 3:00 AM and you got the squirrels going around in your brain.

Courtney Hogenson:
I think that's always going to be there, and I think the thing that's helped me is I just try to refocus on like, "Why am I doing this? Why am I choosing to do this?" It's funny, I didn't go into nursing to become a business person or to become an entrepreneur. I went into nursing 'cause I just wanted to help people. I left Hollywood.
I was like, "Oh, this wasn't what I thought it was going to be. It sucks."

Marty Stevens Heebner:
It does.

Courtney Hogenson:
I'll never become richer, famous, or all these things, but I will know that my time here was spent helping people. I'm making a difference every day, and then finding out, being a nurse, there's so many things I could do outside of the hospital, like a legal nurse consultant. I could be an advocate, I could be so many things, and I just wanted to help other nurses figure out how to do that. Being an entrepreneur, it's not for everybody, but it's-

Marty Stevens Heebner:
It's in our blood, and it's really great to go home at the end of the day and know that you really eased a burden for someone.

Courtney Hogenson:
And selfishly, who's going to take care of my parents, and my aunts and uncles? Who's going to take care of us? We don't create these systems. No one else is going to do it.

Marty Stevens Heebner:
That's so true. I was kind of like, "Stop complaining and just do it." We're talking about planning and how important that is. It's also very important to sign your documents.

Courtney Hogenson:
And make sure everybody knows where it is, and that will save you. I mean, there've been people who didn't know that had an advance healthcare directive, and they're in court fighting over the care, and I remember an advance healthcare directive came out of a safe, an accountant, or somebody found it, and was like, "Oh, no, he actually chose who he wants to be in charge," and he was like, "Thank you for having done that," and telling somebody where that was, because it's saved them, I think years and probably millions of dollars.

Marty Stevens Heebner:
I bring this up basically every episode, about planning, because it's the gift you give those you'll leave behind. The wonderful thing about you is that you're not just a patient advocate, but you're really an advocate for healthcare workers. What can all of us do to support healthcare workers and nurses, who we came finally to really appreciate during the pandemic? What can we do now that we're getting past the pandemic to really support them?

Courtney Hogenson:
I think the current thing you can really do to help support nurses and healthcare workers is ... There's this initiative. Most people don't know this, but the billing system for nursing goes back 100 years, and a nurse's services, unlike a doctor's, a doctor can bill for his or her services with a billing number, NPI. When you go into the hospital, your nursing services are put on your bill like a box of tissues. Like it's just part of the room charge.
It's like they're not even treated like the professionals that they are. I just think there are so many different levels. There's nurse anesthetists, there's nurse practitioners, there's all sorts of things. It's been in that place for so long, and I think people don't even realize that it's still like that, so now, what we're trying to do is we're trying to get nurses to have their own billing codes, and there's a commission that has started. We're just trying to make nurses get the professional due that they should be able to bill for their services.

Marty Stevens Heebner:
That is awful. A nurse next to a box of tissues on an invoice.

Courtney Hogenson:
Yeah.

Marty Stevens Heebner:
With all that training and all the trauma they see, all those patients and the families, they're so vital, and they're the ones who the people see all the time in hospitals.

Courtney Hogenson:
Unless they start to do that and nurses have their own billing codes, just like all these other types of therapists, then people are going to be able to choose their own nurses. "Oh, I want to choose my home nurse, and I'm going to contract with her directly." Right now, we're doing all private pay, but at some point in the future, when nurses have their own billing codes and their NPIs, you're-

Marty Stevens Heebner:
What are NPIs, National Provider Identifier or something like that?

Courtney Hogenson:
Yeah, that's a way that people can get billing for Medicare, for Medicaid. When you have something like that, you don't have to go through a registry or an agency, just how you can choose your own doctors.

Marty Stevens Heebner:
And the great thing with Call-Light is that you can choose the nurse or clinician that you want to work with, and I just think that's such a brilliant idea. I'm so glad you've done it. Thank you so much for being with me, and thank you for all the vital information, for everything you do.

Courtney Hogenson:
Thank you, Marty.

Marty Stevens Heebner:
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.