021: How to Get that Vital Assistance for Older Adults- Mary Winners

Marty Stevens-Heebner:
Finding the right healthcare is always so difficult, but when you're in your later years, it just becomes a quagmire and a nightmare. Wouldn't it be great to have someone with a background in healthcare help guide you through all of it? Well, today's guest on this episode is one of those people.
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.
Mary McDonald Winners, it is so great to have you here. I'm really honored our guest today.

Mary Winners:
Absolutely. I feel privileged to be here.

Marty Stevens-Heebner:
Here's a little bit about Mary. Mary McDonald Winners is a certified gerontologist and the esteemed founder and owner of About Senior Solutions. After more than a decade of experience in healthcare, Mary understands the other side of healthcare, getting through it all. Whereas physicians and nurses provide medical recommendations, prescriptions, procedures, Mary uses her wealth of knowledge in acute care hospitalization, general psychiatric issues, dementia care, hospice, and all these other senior care options that are available. She uses all that knowledge to guide her clients through all the quagmires of aging, so they can live as safely and comfortably as possible throughout their later years. She has an extraordinary ability to accurately pinpoint and guide families as they deal with the emotional, life altering, events during one's golden years. They're not always golden as we know. What's your favorite memory of your grandparents?

Mary Winners:
I have so many, but they were all so different, all from the Midwest. I remember my grandfather teaching me how to box, and paint, and repair things. He was an engineer and he would show me how to do my homework. And I caught onto the fact that he was actually doing my...

Marty Stevens-Heebner:
Brilliant. Thank you, grandpa.

Mary Winners:
He would say, "Right?" And I would just realize, oh, if I say right, then he just keeps doing the rest of it. He was a really bright man. My favorite story of my dad with my grandfather was my dad went out and drank too much one night, passed out on the floor, and my grandfather cut some calla lilies and put him on his chest. That was a big flower to use in funerals back then. He woke up with calla lilies on his chest and wondered if he was dead, and it made a very profound statement to my father about-

Marty Stevens-Heebner:
Yeah, that sure would. What a warning.

Mary Winners:
My grandparents, they were just really great people, very influential with all of their grandchildren, and my mom's side there was almost 20 of us. They had a big part of our lives.

Marty Stevens-Heebner:
Let's turn to your work, as first of all a gerontologist. Because, I don't think people understand what a gerontologist does, what they've studied, et cetera.

Mary Winners:
Gerontology is the study of aging, so I have a master's degree in gerontology. Basically, we look at the socioeconomic support of, the emotional support of, the resources available to, the biological changes, all of those changes that take place in a human body and the emotion behind that and the support and services that somebody may need and create that as a focus point of managing what we take care of, which is called care management or geriatric care management.

Marty Stevens-Heebner:
Very impressive. Let's talk about the kind of care options you offer through your company, About Senior Solutions, what you can do to help one of your clients and their families as they're going through the later years.

Mary Winners:
There are a lot of really great resources out there. We want to look at what the plan should be specifically for that individual. Sometimes, people just feel like they need home care or sometimes they feel like they need placement, and that's great. But sometimes we need a bigger plan, so we tailor a plan based on what the wishes are of the individual, looking at what their safety is or needs to be, or their financial dynamic, so that we can put a plan together to keep them safe that they'll be happy with. Once we get that organized with the resources that they might need, we're involved as much or as little as that family needs us.

Marty Stevens-Heebner:
Especially with healthcare, there are times when someone's doing wonderfully, but it's just great to know you're there. I'd love to hear a story about somebody you're helping now, how you got involved, what kind of help you're offering them.

Mary Winners:
We have some really challenging situations that we work with, but we have the most phenomenal people around us, and my team is amazing. Right now we're working on a woman, her daughter stole all of her money, she was the trustee, but she still took all of her money.

Marty Stevens-Heebner:
Isn't it frightening how often that happens?

Mary Winners:
It is frightening. And I've obviously seen it more than once. This particular family's going to a mediation. In the past, I have worked with the family to guide them through some of the issues in court in respecting mom's wishes and so forth. Now, they're going into a mediation. We will be supporting her. We'll put pieces in place to make sure she gets to the mediation. She has enough extra food, and change of clothes, and a caregiver with her, and the family can sit and support her, but they don't have to worry about all those little extras for her. So, that's one little thing that we're working on.
We have another gentleman right now who is living in an assisted living and in skilled nursing care right now. He's a little scared to go back to his assisted living. They've not been that nice to him, so we will be supporting his best wishes for either advocating appropriate support and care at the current location, and creating some boundaries, and a care plan meeting with that individual, or through conversation, deciding that we just need to go in a completely different direction and he needs to move. So, we'll dig a little deeper and get some more information on that.

Marty Stevens-Heebner:
This is what's so important about the work you specifically do. Because, you have such an understanding, especially with being a certified gerontologist and having that master's degree, a real understanding of all the different things that can happen during later years, how there could be sudden shifts, and just being there for them no matter what they need.

Mary Winners:
We can be really involved for months, and then, "You know what? I think we're where everybody's stable. Would you like us to continue visiting or we can step back?" Whatever works for the family. We create stability for them. And I love being able to enhance their life with more activity outside, or having somebody come visit them, or participating in their church activities, creating a plan where a caregiver or family caregiver is familiar with what we can do that's supportive and creates joy for them. Because, we want to see them happy. We want to see them in places during their day where they feel fulfilled. There'll become a time when sometimes I feel like our purpose on earth is just to allow ourselves to be cared for by others.

Marty Stevens-Heebner:
I love what you just said. But there's so much living to be done in one's later years. And there comes a time when really the best thing to do for everybody else is to allow them to care for you to accept that care, to not say, "Oh no, you don't have to. I'm not a burden. I'm not a burden." No, you're not a burden. People want to care for you. I remember my father, when it was the last couple of months of his life, he'd say, "Oh, I'm so sorry. You've got to deal with all this." I said, "Dad, you've taken care of me for 50 some years, and it's really lovely to be able to give some back to you"

Mary Winners:
Absolutely. We don't like to ask for help period. So, just when the grocery kid says, "Would you like help to the car," maybe that's a good signal to say, "Yeah, maybe I should start asking for the help." Because, I think it's important, as we become older, to say yes to help and yes to support, and how blessed and fortunate we are to have others around us. People enjoy helping you when you ask. Whether you're a new business owner, or whether you're a student in school, people love to share their knowledge and their support.

Marty Stevens-Heebner:
But this whole reticence about asking for help, I recognize that in myself, and I have to take a dose of my own medicine frequently.

Mary Winners:
Let them help you at the grocery store.

Marty Stevens-Heebner:
Yeah, exactly. Or help you up the stairs. Or if you have a walker, hold the door for them, especially if the door opens out. I learned that the other day when I was helping somebody. She said, "Yeah, I can get out. Okay, but it's opening the door that's a problem."

Mary Winners:
Yeah.

Marty Stevens-Heebner:
What kinds of services do people ask for or need the most?

Mary Winners:
I think the most common questions that we get are, "How do I help my mom?" Or, "How do I help my dad? I don't know if I'm doing this right. Can you show me a better way? We want confirmation that we're doing it the right way. I think just coming in to support the decision makers, to help them with quickly finding and supporting them with resources, makes such a huge difference for people. So, that's a really common thing that we deal with.
"Mom's in the hospital, now what do we do?" "I don't know if she should be home." Or they're in skilled nursing, and we're definitely going to have to look at some kind of a change. Or, "Now that my mom's in assisted living, I'm not sure that she's happy there. What could we do that's different?" And working with the facilities, creating better strategy around their support. Everybody likes jumping in. They want to do the right thing for the most part. My dad used to say people instinctively are good. I think most people are good. Every once in a while you come across a bad apple, but people want to help others.

Marty Stevens-Heebner:
Just like family caregivers provide help to their loved one, caregivers have to remember that they need help too. We know the statistics, especially if it's a spouse is the caregiver, how frequently the caregiving spouse may die before the person they're taking care of. It's so important to recognize that you need help too.

Mary Winners:
I tell our caregivers that all the time, we have to replenish ourselves. And we've heard the old adage, put your oxygen mask on first. And there's truth in that. Just like young couples who are raising little children, you need a break from them too. When you're caring for an older adult, it's tiresome. It may be very physical too. So, what are you doing to relieve your own stress? There's medications, there's equipment, there's appointments. What are you doing to enjoy yourself, so that when you come back at the end of the day to take care of your loved one that you feel like, 'Okay, I got my tea in today. I was able to leave for an hour so that I could go to the grocery store without worrying and our caregiver came to watch." I remember when I was raising my own children and going to the grocery store was pretty special for me.

Marty Stevens-Heebner:
Right. Being able to get away. Yes, my hat is off to mothers always.

Mary Winners:
Caregiving on any level is a lot of work and we definitely need to enjoy your afternoon walking through the garden or just finding something that replenishes you.

Marty Stevens-Heebner:
Mary, what do you wish people knew about what you do?

Mary Winners:
Geriatric care management is becoming a better known type of occupation. We look at planning and supporting, advocating for older adults. It can be something as modest as, "I don't know what to do for this individual," to, "I'm in a very serious crisis here." We're happy to talk with anybody on any level, any question. And we will direct them to either a resource or decide, through our conversation ,that we could be a fit to help them. We've moved people to and from all over the country. They become family to us too.

Marty Stevens-Heebner:
It's funny you brought up becoming part of the family. I once had a staff member say something brilliant. She says, "We're short-term family without the baggage," which is true, and also with all the knowledge. Because, I think one thing that can exhaust people, I know it exhausted me, was feeling, I've got to research this. And so, you're staying up late Googling everything imaginable. And of course, what is on the internet is not necessarily accurate. It's just so wonderful to have a professional like you who understands healthcare.

Mary Winners:
The other thing, too, is that people spend hours... And some people love digging into research. And others, they're just as confused, or maybe even more confused once they finish. I had a client, several years ago, who was in a very challenging process, and they said, "I don't know. I looked this up, and I spent eight hours on such-and-such." And I said, "All you have to do is this." And they went, "Really? That's it?"
Typically, a person only does this a couple times in their life. We've done it hundreds and hundreds of times, walking people through very unique processes, helping them get to where they want to be. I think it's all about saving your own time. Ultimately, it winds up saving money, especially if we were able to negotiate things or work things out that you didn't know were covered. I had somebody call over the weekend, they didn't realize their in-laws would be able to receive some Aid and Attendance through the VA. He was a Vietnam veteran. It just opened up a whole new world for them as far as resources, and care, and support, and options. So, when you don't know what you don't know-

Marty Stevens-Heebner:
And the point is there are resources that you can ask, like you. And me too, but we have massive lists of great resources we've used with other clients that can be relied on. And I bet that a big part of what you do is you build a team to take care of the client.

Mary Winners:
Oh, sure. Absolutely. And then, we dig deeper. Sometimes, we have to go into billing. I remember we had over $400,000 that we saved for somebody. It was a very interesting situation where this woman had been removed from her children. It was a very abusive relationship with her husband. When they divorced, she basically hid, and so she never even went on social security or on Medicare. She was living off of a small inheritance that she had very meagerly. She wound up having a few hospitalizations.
The social worker tracked the daughter down who had not seen her mother since she was six years old. Told her, "You're responsible for her." She was, "Okay." They contacted us and they said, "We've got this huge bill for her medical care." We wound up retroactively getting her into Medicare, reducing all of those bills that she had, getting her into appropriate level of care, setting the daughter up so that she had a relationship with her mom, so she could just have a relationship with her mom and not have to worry about all these other things. So, it was lovely to be able to do that. Just really great stuff.

Marty Stevens-Heebner:
It was such a gift to both of them. And I just thought of another thing with caregivers, especially family caregivers, who are probably inexperienced, is that not only is their loved one probably fearful, but they're fearful too.

Mary Winners:
Sure.

Marty Stevens-Heebner:
Because, they feel they have this life in their hands, and so they're desperately trying to figure out what's best.

Mary Winners:
Oh, for sure.

Marty Stevens-Heebner:
There's a lot of legislation in both here in California and on the national level regarding later life care. You've been on the outskirts of working on some of that. Is that correct?

Mary Winners:
Minorly. There are lobbyists and people who are heavily involved. I have had opportunities to speak to some of our representatives. It's always very interesting to me how they're not familiar with the systems. They're not familiar with the licensing, their government body that is in charge of assisted living or skilled nursing, and they propose a bill. I spoke with someone a few years back and said, "This is not even the legislative body or the governance body that you're asking to be part of this bill." And he said, "Oh, that's okay. We just needed to pass, and then we'll revise it later." No, I think we'll make sure that this doesn't get through, because it doesn't make sense, because it's not the right government body.

Marty Stevens-Heebner:
It's disturbing to hear that they don't really care if it's done correctly, not when it doesn't make sense. That's great work that you do. What's your favorite thing about your job?

Mary Winners:
I think my favorite thing is I can see, visibly see, or hear in the voice of somebody I'm speaking to on the phone, I can hear the stress just roll off their shoulder. I like phrasing it as we roll the boulder off your shoulder. That sounds like heaven to be able to have that kind of relief and support. "You can do that?" "Yes, we can do that."

Marty Stevens-Heebner:
I know that question well. When you're in a group of anywhere from six to eight people, and invariably somebody asked one of two questions, either I wish I knew about you three years ago-

Mary Winners:
Sure, yeah. When my mom needed you to move, yeah.

Marty Stevens-Heebner:
Or needed care, and we didn't know where to turn. Or they just get this amazed look on their face, and they say, "You do that?"

Mary Winners:
Yes.

Marty Stevens-Heebner:
And I bet you get a lot of that, "You can do that?"

Mary Winners:
Yeah, we can do that.

Marty Stevens-Heebner:
And if we can't do it, we know how to recommend. I frequently will tell people, if it's seniors and their stuff, call me. Because if we don't do it at Their Own Solutions, we know somebody fantastic. We don't do care. We don't do care management. We call Mary.

Mary Winners:
We don't do financials, we don't pay the bills, but we're making sure that things are happening the way they need to happen. We have some really great, loving, staff members, because if their heart's not in it to begin with, then nothing else matters. We have the benefit of having a team who we can problem solve bigger issues with. We have a lot of variety in our office, different cultures, different faiths. I think our solutions are more creative and very results driven. It's important to have great quality people. You can't create heart in someone. You can create proficiency and knowledge, but you cannot create heart in someone. And like I said, you become part of the family after you start with us.

Marty Stevens-Heebner:
One of the things we have to look for too when we're hiring is extraordinary empathy, and that's what you're talking about. And they call that a soft skill. It's the hard skill.

Mary Winners:
Yeah, it is.

Marty Stevens-Heebner:
I can learn how to run a machine. I can learn how to code, but when it comes to empathy, either you got it or you don't. If you don't have it-

Mary Winners:
It's not your deal. I also call it a get it factor. I have a client who, every time I see them out in public, "Oh, my gosh, when we were in the room with my dad and Mary, and he was asking, 'Is it 3:00 in the morning,'" and I said, "Almost." And he said, "Oh, okay," apparently it had been a really big bone of contention where they were trying to get him to understand that it's not 3:00 in the morning. But before, they were all just beating their head against the wall saying, "No, dad, can't you tell" it's not dark outside. You would be in bed if it's 3:00 in the morning," and da, da, da. And they said, "It was such a game changer for us when you said, 'Oh, almost.'" So, that became their catchphrase with their dad. They started getting how to communicate differently so that they didn't feel upset and anxious and argue with him, and not everybody gets that. Sometimes, people can be guided, and prompted, and God bless them, they just don't understand how to communicate with somebody who has cognitive challenges.

Marty Stevens-Heebner:
It's just living in the world that they're living in right now. It's almost 3:00, cool. Or, you think I'm your sister. Okay, I'll be your sister for a sec. It's that acceptance. And I tell the story of one mother and daughter, I got asked the same question 10 times in an hour. You create the answer the first time, and they often just say, "Oh, thank you. Thank you so much." Exact same question A few minutes later, you already got the answer, just say it again sincerely. You don't even have to think of it.

Mary Winners:
Like you never heard it before. I know. Very few of my clients know my name. They just know that I'm that tall lady. So, if you're listening, I'm 5' 10." That's fairly tall for a woman, so when I walk into a room, especially if I have heels on, "Wow, you really tall." And so, "Just tell them the tall lady's coming today." "Okay." Emotionally, they can connect knowing that the tall lady's coming. They don't have to know my name. "I'm Mary. Nice to meet you. I'm the tall lady."

Marty Stevens-Heebner:
Yeah. Yeah. Don't take it personally. It's the disease.

Mary Winners:
I have to say, it's very hard for families when it becomes a new thing, especially with vascular dementia. It pops in and out of reality sometimes. "Oh, we had her for a minute. Now all of a sudden, she's not remembering." That's really hard for families, and it does catch you by surprise sometimes, and people know that she's back where she's not remembering.

Marty Stevens-Heebner:
That's all you can do. I really feel that, as a family member, one of the best things you can do is just accept what's happening, accept them as they are, know things are going to change, and do everything you can to take care of them and to take care of yourself.

Mary Winners:
And it's a process. It's just like grieving a death. So, you bargain, and you're angry, and you go through all those steps to where you finally do accept. But relationships are very different when you're a spouse or a long-term relationship versus a child. You're losing a very intimate part of yourself to that decline in comparison to the relationship you have with a parent.

Marty Stevens-Heebner:
My father used to say, no one knows what it's like to lose a beloved spouse unless they too have lost the person they love. Because my mom died, she was only 58.

Mary Winners:
Oh, wow, yeah.

Marty Stevens-Heebner:
And my dad made it to 90. Yeah, I was 26. And my dad never remarried. She was the love of his life.

Mary Winners:
That happens a lot when it's the love of your life. There's no replacing her. I remember my grandma, my grandfather was only 67 when he passed away, and she was 99, and she never remarried, or dated, or anything. She's like, "I don't need to be a nurse or a purse for anyone."

Marty Stevens-Heebner:
Right? And she had all you guys to love and to be loved by.

Mary Winners:
When you're from a large family, you just think that there are others around to help you and to take care of you. I didn't realize, until I started in this industry, how many people don't have their person. We're here to communicate with that family member who is remote and wants to try to help but doesn't know the system or doesn't know how to support them. That's been a great pleasure, to support those people who don't have their people. We're their people.

Marty Stevens-Heebner:
That's so important.

Mary Winners:
Those have been really wonderful families that we work with. The daughters who have the nuisance family members, the other sister or brother who thinks they know everything, but they have no idea how they really behave during the day. "Well, mom doesn't really do that." "Yeah, she really does." And they need the backing with care management. Or the daughter who places her parents and the brother doesn't think that they should be there and doesn't even think they have any cognitive issues. We're having some really bad judgment issues now and decision making problems, which are resulting in some very serious issues at home and dangerous for them. But the guilt that goes along with that, and the need for support... Or can they go home? Are they okay? If we had some extra technology or help, can we do that? Can they afford to do that? All of those things play into how somebody rolls into a specific plan.

Marty Stevens-Heebner:
You're going to save them so much time and agony. Because, if you wind up thinking you made the wrong choice for your loved one, you're going to beat yourself up the rest of your life.

Mary Winners:
Right.

Marty Stevens-Heebner:
What's the toughest part of your job?

Mary Winners:
I think the toughest part is watching people sit in their grief or sit in the anxiety, sit in the dilemma that they're dealing with and not make a decision to move forward. It's not easy for someone to go through the emotional steps of losing a loved one. Especially with cognitive issues, it's like you're being constantly robbed of that individual. Just like you said earlier, doctors don't do surgery on their own children, and you don't represent yourself in court as an attorney, because you have that emotional component that changes your perspective. By having a professional's perspective, you can put the emotion behind you a bit and look at a better result

Marty Stevens-Heebner:
For all involved.

Mary Winners:
Right.

Marty Stevens-Heebner:
Not just for the one who's dealing with the medical issues.

Mary Winners:
If you don't have a whole picture, if you don't have the whole vision of where you need to go, you're just ripping a little bandaid off when you're bleeding out. We need you to perform the right kind of surgery, we need you to have the right kind of plan to move forward.

Marty Stevens-Heebner:
And sometimes it's plan C, D, and F, because that's how life rolls.

Mary Winners:
You think that they're going to go to one location, then all of a sudden, especially with COVID, nope, that one's closed. Or nope, he walked too far down the hallway, so he is just going home. Okay. It's all about pivoting and rolling with the punches, and making changes as needed, and putting the right resources, the right plan together, based on the specific situation is just really important. You have to look at the whole person. If you're not walking correctly, it's going to do something in regards to your hip or reduce your muscle mass, and you'll become less able to ambulate. Our whole body is connected. We need a whole plan.

Marty Stevens-Heebner:
What kinds of questions should people be asking professionals like you when they're considering working with them?

Mary Winners:
I think they should ask how many years of experience they have. I think they should be asking if they have a referral base for the area that they're looking to get service for their loved one.

Marty Stevens-Heebner:
Can you explain what referral base means? I'm thinking not everybody might understand.

Mary Winners:
We know how to work in a system. Medicare is federal. There are lots of things across the board that are the same everywhere, but there are things that are very unique to a region or a territory. Maybe somebody needs to move somebody, or they need a new roof. Are we acquainted with really good resources to make sure that they get what they need? I think you want somebody who can do an initial consultation. Can we walk through what they need in regards to assessing their personal welfare and their body?
What kind of background in training do you have? Some people help their moms, so they thought this is a really great business to get into. And I'm sure they have the heart to want to do it. They just may not have the expertise. Are they part of different associations? Are they part of an organization that offers home care? Is that going to be a conflict of interest, because they may recommend more home care than they need? I've seen some care managers who have facilities. Maybe they never place them as a conflict, but I think disclosures are important. Those are things to consider.

Marty Stevens-Heebner:
They certainly are. Care managers like you are just so valuable and so helpful. How are you drawn to working with older adults? What made you want to go into gerontology?

Mary Winners:
I think it found me like a cat finds its owner, just shows up in the back, asks to be fed, and you start feeding it. Actually, when I was a kid, I grew up over in Pasadena and my parents bought a home that had been severely neglected, that was in a probate sale, and needed a ton of work. It was the early seventies. When we moved in, there were bars all over the doors. And all the neighbor kids came up on their skateboards, and their bicycles, and were like, "Hey, you guys are the ones who moved in this creepy house. And there was a lady who lived here and she was crazy. She used to go down to the end of the stop over here and wait for the bus, and she's saying that she wanted to go home, and she already was home."
It always stuck with me. Why would somebody want to leave their home? Why did she think that she needed to go somewhere else? It was something that sat in the back of my head forever. Interestingly enough, I wound up meeting some of those family members through a client situation and helping them too. Very interesting how life comes full circle. When I started working in hospitals, specifically on gero units, that's where I became really intrigued and realized that this was an area that I could study further, work with dementia, and training, and putting programs together, and thought, this is it. This is good stuff. I love this.

Marty Stevens-Heebner:
You've just given us so many insights and a lot of great information to move forward with. And you do great work, Mary. Thank you so much for being here with me. I really appreciate it.

Mary Winners:
Thank you. Thank you.

Speaker 2:
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.