Don't Wait for a Crisis: Signs Your Aging Parent Needs In-Home Care

GABRIELLE I think usually people wait till there's a crisis, unfortunately, and give us a call. You know, someone's fallen, had a stroke, had some sort of life or health event. Sometimes people avoid physician visits. They don't want to go to the doctor anymore. And the reason is, is they don't want the doctor saying, "You need to look into a nursing home." I think the biggest one is probably, they're taking away my independence. And actually, we're helping you keep your independence.

MELISSA Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion, and half the time, you can't tell what's legit and what's just good marketing. And we get it. We're in it too. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode, we bring in the people who actually do this work. Providers, practitioners, the experts who seek clients and patients every day. We ask the questions you'd ask if you were sitting across from them so you can find the right people, make better decisions, and feel confident about what's out there. Whether it's peptides, gut health, water quality, ADHD, biohacking, or something you've never heard of, we're covering it. So let's get into it. Let's get dialed in.

MELISSA Welcome to Dialed In Health. My guest today is Gabrielle Hoing, who is the founder of Kore Cares. And it's a home agency that serves South Dakota. It's been serving families here for 10 years. And Gabrielle has spent more than two decades in geriatric care. She helped build 11 private agencies across seven states, all on your own, which is pretty incredible. So she knows this space better than anyone. Gabrielle, it's great to have you on the show today.

GABRIELLE Thank you for having me.

MELISSA So tell us a little — today we're going to dig into some of the questions that people have around home care, some common questions and obstacles that people run into, just family stuff. It's always kind of tricky.

GABRIELLE Yeah.

MELISSA Tell us a little bit about maybe one of the most common phone calls that you get.

GABRIELLE I think usually people wait till there's a crisis, unfortunately, and give us a call. Someone's fallen, had a stroke, had some sort of life or health event that precipitated a hospital stay. And now they see the true need for care. Occasionally, we get people who are being proactive and maybe notice that the aging process is slowing them down, and it's harder to do housekeeping or getting out of the shower, or they're noticing mom and dad aren't eating as well. And so we get some of those phone calls too that are kind of before a huge life event might happen. But sometimes it's hard for people to get care until there's something, some crisis going on.

MELISSA Well, I think it's pretty natural for people to want to assume the best. Like everything's OK, or you might notice something, but you just kind of tuck it away in the back of your mind and sort of wait. Right. So what's the danger of that, do you think?

GABRIELLE I think the danger is you're going to end up in the hospital probably at some point, and that's going to take a lot of time away from your family that they're going to have to come to the hospital and figure out what's going on, help you through the situation. And then you're going to have the recovery from that, the therapy that might be involved, trying to get back on your feet again. It's just going to lead to a whole lot of extra things that you weren't planning for in your life. And so if you can avoid that and keep yourself safe and independent at home, then you can avoid the hospital stays and the unnecessary time that your family might have to help you with navigating through that whole situation.

MELISSA So what might be a couple of signs that, you know, maybe I should give Kore Cares a call or maybe I should check into home care agencies? You know, what are some things that you might notice maybe as an adult child or as a spouse or a neighbor that like, hey, let's just check into it. What are some of those signs or symptoms that you would see?

GABRIELLE Sometimes it's simple things like you're wore out after vacuuming, sweeping, mopping. You avoid taking a shower because you're afraid that you might slip and fall, and you don't want to fall because you don't want to go to the hospital. Sometimes people avoid physician visits. They don't want to go to the doctor anymore. And the reason is, they don't want the doctor saying, you need to look into a nursing home. You need to look into an assisted living. They're afraid that the doctor is going to make them or suggest that they get care. So they avoid physician visits. It could be that people are losing weight because they're not eating as well as they used to. And then we see people maybe not want to leave the house. Maybe they know that their driving isn't quite what it used to be. Or maybe a family member notices their driving isn't quite what it used to be. And that might be a sign that some additional help is needed because of their eyesight or whatever they might have going on.

MELISSA What's interesting, it seems like, you know, the more that we become isolated, that we kind of start to insulate a little bit, and having home care helps to at least bring some other faces into your home as well. I saw this stat the other day that if you don't have six close friends or interact with six people, it's like smoking a half a pack of cigarettes a day. Maybe it's more than that. I don't remember, but it's a lot. It's not good. So that's another thing that happens. Humans are built for love and connection. Like, that is such a big part of our overall health and wellbeing that I think it's downplayed so much. But yeah, you do need connection with the outside world. You do need to build those relationships to have a really overall good wellbeing and health in your life. So if you feel like you're starting to live smaller and smaller, that might be another indication.

GABRIELLE Yes. Or if you notice that a loved one is starting to live in a smaller and smaller way. Maybe they used to go out and shop all the time and now they're not doing that as much, or whatever those behaviors are.

MELISSA Tell me a little bit about home care versus healthcare.

GABRIELLE So home care versus home health. You might hear someone say you need skilled home health, and that probably means it's a Medicare-covered benefit. And Medicare likes to cover things that involve therapy-type services. So you might need physical therapy, speech therapy, occupational therapy to rehab after an illness, injury, hospital stay. What we do in home care is help with whatever our patients' needs are. We really can customize what we do based on what our clients' needs are. We don't look so much at the diagnosis like Medicare does. So our services could be shortened duration or could be over an extended period of time. And it's really driven off of the patient's needs and what they need to be safe and independent at home. It could be housekeeping, laundry, meal preparation, help with those personal cares, but it could also be ongoing nursing services like med setups, wound vitals, health assessments.

MELISSA Okay. And you do have some staff who are nurses on your staff, right?

GABRIELLE Yes.

MELISSA So tell me about the age range that you serve. Now I know we've met some folks on your team who have worked with people in their fifties, which that was kind of a wake-up call for me. I was like, oh my gosh.

GABRIELLE Yeah. You know, people have life events that happen that precipitates care needs. So maybe it's a car accident. Maybe they were born with a disability, cerebral palsy or autism. We used to say that we serve mainly people 18 and older, and we can take pediatric cases on a case-by-case basis. We just want to make sure we have the appropriate care for the situation. But I'd say about 60% of our clients are over the age of 65, and about 40% are under the age of 65, which I think is shocking to people. They think, oh, home care is just for aging, for seniors, but it really isn't. It's for anyone who has a health event that precipitates a need for some additional care in the home.

MELISSA I didn't realize that, because as you think about anyone who has a caregiver — if you're a parent and you've got a child or even an adult child with some, you know, intense needs, that can be really taxing and a lot of work. So just getting a little break for them would be welcome relief. So tell me a little bit about a care plan. What is a care plan? What does that mean?

GABRIELLE A care plan really is an outline of what our caregivers are going to do to help the individual in their home and help them live their best life. So it's a roadmap. It's a guide for our caregivers, and it also helps set clear expectations between us and the client of what they expect of us when we're in the home. So the care plan will outline what tasks our caregivers are going to complete while they're in the home, but it also might provide details on how they like their routine, how they like things done. You know, do they want to eat breakfast first before they get dressed? Do they want to do their shower first, or do they want to read the newspaper? Because we're going into someone's home. So we really want to customize our care and services to what their normal routine is. We don't want to fit them into our routine. We want to fit into their routine and keep things as normal as possible for them. So it's not just about the tasks that we're going to do while we're there, but it's also about getting to know that person and how we can best serve them.

MELISSA Let's talk a little bit about the insurance side of things. So what does Medicare cover? What does it not cover? Help us understand that a little bit.

GABRIELLE Yes, that's tricky. I think a lot of people think that Medicare is going to cover all their long-term care needs, and it just doesn't. Medicare does not cover our services. Medicare will cover therapy services in the home. So if you have a hospital stay, an illness, an injury, and you need help recovering from that with some physical therapy, occupational therapy, speech therapy, they're going to cover those services for a short duration of time, until you meet whatever your care goals are, until you progress to the point that they just don't feel like you can make any more progress. Then Medicare is going to step out. They're not going to pay for what they call custodial care. So that is your activities of daily living. That's your housekeeping. That's your showers. That's getting dressed. That's the meal plans, the laundry, the transportation, even ongoing nursing services like med setups, wound care. They don't always cover. It's unfortunate that Medicare won't cover those things, but your other payer sources then for what our services are, are Medicaid, VA, private pay, or long-term care insurance.

MELISSA Quick break. This episode is brought to you by Vitality Growth Labs. If you're a health or wellness practice and you're wondering why your phone isn't ringing in the way it should be, Vitality Growth Labs builds the systems to fix that. Get found, build trust, fill your calendar. AI authority stacking, videos that connect with your clients, real tools, strategy, and execution that results in real revenue. Visit VitalityGrowthLabs.com or check the provider directory at VitalityGrowthLabs.com/the-directory to find a trusted wellness provider near you. All right, back to the show.

MELISSA So tell me a little bit about those. What does that look like for maybe Medicaid? What do those services cover?

GABRIELLE So Medicaid, it just depends. There's a whole process with Medicaid and the VA. And I'd say to initiate the process with Medicaid or any state-funded services, you need to go through Dakota at Home. And they have different questions that they ask to figure out what program you might qualify for. They look at income in some programs, and some programs are based on diagnosis. So it's a complex process, but it all starts with Dakota at Home and filling out a questionnaire with them. And with the VA, it really starts with a doctor's order to the VA, to community care in the community, and then they evaluate things too. I mean, they look at what war you served in, what you did for the army or whatever military service you had. So it's also a very, can be a complex process, but it all starts with a physician order to care in the community, and then they evaluate things from there.

MELISSA So if you're not really sure where to start, you can always call, I'm assuming Kore Cares, you guys would direct.

GABRIELLE We can fill out the Dakota at Home referral form for you. And then we can also help check on the status of it. So if someone's kind of confused about the process or whether they're on the process, if we help them fill out the online referral form, we can continue to follow up on that and figure out where they're at in the process. And the same with the VA, we can give you instructions on how to get connected with the VA. But the simplest way is a physician order.

MELISSA So when I went to Google and I typed in home care, there's a ton of agencies, right? And it's hard to know, because there's some national agencies that might have a presence in your area. There's some that are locally owned like yours. How do you help people navigate this, or what should somebody think about when they go to Google and they're like, oh my gosh, I need to find one. How do I know who to select?

GABRIELLE I think there's a few different ways that you could identify who might be a good home care partner for you. So I first get to know the company. There are a lot of companies moving into South Dakota because they see our aging population. And I would say ask some questions. What is their mission? Who started it? Make sure it's a good fit for you and that you feel comfortable with the person that's on the phone or maybe coming to your house to do a consultation. So get to know the company. That's first. And then I'd ask about their training process. What do they do to train their staff? How do they support their staff? Do they provide CPR training, dementia training, ongoing training? What do they do to make sure that their staff are providing good quality care? And then I'd talk about their quality assurance program. Like, what do you do to ensure that we're satisfied with the care? Do you call the clients? Don't lead them — I guess I'm giving you leading questions. But ask them what they do to ensure good satisfaction with their services and that their staff are providing good quality care. And then I'd ask, do you do background checks, reference checks? Because there are no regulations at this time for home care agencies in South Dakota. So really you can hire anybody and start a home care agency. There are no regulations for the private-pay home care sector in South Dakota.

MELISSA So that's honestly kind of terrifying if you think about that. So if you're an adult child and you're trying to find help for your parent who might be in their seventies or eighties or beyond, right, and you look at that list on Google, there's no way of knowing. Like you said, there's no regulation, potentially no background checks in some of these companies, and they're in your home and they're home with your family members. Right. So that's terrifying. So how do you guys, how do you make sure that your staff has all of the training that they need and the checks? What do you go through? What does your process look like?

GABRIELLE So first we do reference checks, background checks, a drug test. We do an interview, we have a screening process, and then we kind of look at that person's background and what training are they coming to us with? If they have very limited training, we have a training room in all of our offices with a mannequin, a hospital bed, a Hoyer lift, you know, a catheter bag, ostomy bag, bedpan — everything where we can do hands-on training in our office. We also have online learning training that they can do that will show them how to do personal cares, housekeeping, everything. And then we put them through an eight-hour dementia course with Teepa Snow that people have found really, really helpful on how to approach those with dementia. We also do training in the clients' homes, because each client is a little bit different. So sometimes we have our new staff shadow other caregivers, or sometimes we'll meet them at the home, or we'll call them at least and brief them on what the expectations are in the home and what they need to do while they're there. So we have a variety of different ways. And then we also do ongoing training. It's not just a one-and-done training. We have ongoing training and professional development for our staff.

MELISSA What would you say are some big red flags? You know, you are primarily located in South Dakota. So this podcast may reach somebody in Missouri or Texas. What would you say in general — here's some red flags that you should really consider before hiring a home care agency.

GABRIELLE You know, can the person that you called on the phone answer some of the questions, or at least get you to someone that can answer questions about training and their staffing, their quality assurance, those type of things? If they can't get you to someone that can answer some of those questions, that probably is a red flag. It's good to meet with them in person. We do a free in-home consultation. So get to know the person that you're going to be doing business with. It does become a partnership in some regards. So you want to make sure that you feel comfortable with them. So doing that in person is an interview kind of for us. You know, you're asking us questions and making sure we're a good fit, but we're also asking the client questions and getting to know them and developing a care plan. So in that process — is the person that's coming to your home and doing that consultation, are they asking good questions? Are they getting to know you? Are they taking this seriously and developing a comprehensive care plan?

MELISSA I would bet in many instances — because I have run into this even myself — where the person that you're supporting says, I don't need your help. I'm fine. How do you approach those conversations with the family members? Maybe they're starting to live a little smaller, maybe they're driving less, maybe losing some weight, but they're like, just stay out of it. I want to stay in my home. I'm fine.

GABRIELLE Yeah, that it is tough. I think you got to get curious. You also have to kind of know the person. Every situation is going to be a little bit different and how you approach it. And they may not be accepting at first. I've come into situations where we've had families tell me before I entered the home, like, hey, she's apprehensive about care. We really feel like it's important, but she's going to be really resistive. And so I'll come in, I'll explain who we are, who I am, how I started this company, what we do. And sometimes we'll get ushered out of the door and say, yeah, I don't need this. And then people just need time sometimes just to think about this and think about the impact that care will have on not only themselves, but their family members that are maybe trying to help them. And sometimes that's enough — just to be able to sit with that and kind of think about why someone might have suggested this care. People come around eventually, from what I've seen.

GABRIELLE So I mean, sometimes people aren't jumping up and down for help. Some people are very accepting of it, and then no, but sometimes it just takes some time. And I think you have to let go of your own fears too. If you're an adult child approaching that conversation, sometimes you're like, oh, mom and dad are going to hate this idea. They're not going to like this. And so let go of some of your own fears going into that conversation. And also it can be helpful to identify how this care is going to help you as an adult child. Maybe don't do it for you, mom. Do it for me, because I have four kids. I'm running them around to basketball games. I love you. I want to be able to care for you, but I just can't. And I see that you're losing weight, and it's tough on me to see that your house isn't taken care of, that you're not showering, and it's not you. You know, I know that you did these things for years on your own. It's just the disease or the process or the health issue that you're encountering. And I want to help you get the care that you need so I can sleep well at night. Sometimes if you say, hey, do it for me, sometimes that helps. Like I said, every situation is a little bit different on how you approach it. And we can help you strategize over the phone. And sometimes you just have to draw a hard line and say, hey, if you don't get this care, we're looking at probably a lot of hospital stays in the near future, and we're looking at a nursing home, and you've told me you're going to die in this house. So to help you accomplish that dream, this is what we need to do. So like I said, every situation is a little bit different on how you might want to approach that.

MELISSA What if — I'm sure you've run into all kinds of instances — but sometimes siblings don't always agree on if mom or dad might need care or not. What do you do in those instances?

GABRIELLE Sometimes it's hard to see that your parents are declining and need that care. Like you almost, you want to turn a blind eye to it because you just don't want to believe it's true. Or you've got your parents calling you, Susie says that I need home care, and that's just not true. And here's all the reasons why it's not true. So you're just like on their side like, oh yeah, I'll talk to my sister. She's, you know, she's definitely wrong in this situation. I believe mom. And I think sometimes you have to sit down your siblings and say, these are the things we're observing. This is what we're identifying. This is what we're noticing. And this is why we think that we need care. Like here's the situation. Here are the facts. Here are the scenarios. She had three falls. We've been in the hospital three times. You live in Texas. You're not here every time that she goes to the hospital. I am. And I have to drop everything and go there and figure out what's going on, and then get her care in the home for at least short term, or wherever she needs care. So I think laying out the facts and helping them realize that this isn't the best interest of their loved one. And here's why.

MELISSA So the other thing that I imagine happens a lot is like, you know, I feel guilty. I don't want to — I should be doing that, or I should be taking care of my loved one. How do you navigate that?

GABRIELLE Yeah, I mean, that is tough. You want to be there for everyone in your life, and you want to care for your kids and your parents and your neighbors. And there's only so much time in the day. And you have to really decide, you know, what can you handle? And maybe you can't do all of the care, but maybe like, I'll still do the grocery shopping. Or maybe you don't want to do any of it because you want to be the child. You don't want to be the caretaker. It changes the dynamic of the relationship when you become the caregiver. And so you have to think about protecting that relationship as well. And sometimes getting care protects your relationship with your parent. So think about that. Do you want to go and have a good conversation with your mom or dad and be able to spend time with them and converse with them and do fun things with them? Or, when you're there, are you frantically running around the house trying to clean and get them a shower and run and get groceries and make sure they have meals for the week? And is that the relationship you want to have with your loved one?

MELISSA Yeah, that's a brilliant answer. And I guess I hadn't thought about that so much, but you're right. When you do start having to take over that too, you're no longer the child. And now you're the one kind of making orders or directions or whatever. And it does probably change everything to a degree. I'm curious, what are some of the biggest myths or maybe misconceptions that people have about home care?

GABRIELLE I think the biggest one is probably, they're taking away my independence. And actually, we're helping you keep your independence. We're helping you stay in the place that you've made memories, that maybe you worked your whole life to pay off that house. We're helping you maintain your safety and your independence in your home. We're not trying to take it away from you. So I think that's probably the number one myth — is like, I'm giving up. I'm dying now because I've got help. And this is it.

MELISSA This is the beginning of the end.

GABRIELLE This is the beginning of the end. Here we go. Sometimes people just need care for a short duration of time. And sometimes we've had people on our care for years, and they've maintained a really good quality of life at home. And so that's what we're trying to help people do, is maintain that good quality of life.

MELISSA So this is amazing. So I'm curious, you are currently in how many counties in South Dakota?

GABRIELLE We're in 43 different counties. We're in the last time I counted 111 different cities throughout South Dakota.

MELISSA So if anyone wants to find you and Kore Cares and wants to learn more, where do they find out more about you?

GABRIELLE So you can go to our website. It's www.korecares.com, or Facebook slash Kore Cares. Or you can call any of our offices. If you go to our website, all of our numbers to each office are listed on our homepage. So you can just call our offices or fill out an inquiry form on our website too, and we'll reach out to you that way.

MELISSA Now I forgot to ask you about — you know, you come from this industry. You've built out the private centers across seven states. You started Kore Cares. You have a different lens on this than many people. So in terms of your background, what brought you here? What do you love about this work? Why do you keep doing it? You've been 10 years now in the industry — or now you've built Kore Cares over 10 years. You've seen a lot of things.

GABRIELLE Yeah, I have seen a lot of things.

MELISSA So that was a lot of questions in one sentence, but yeah, tell me about, you know, what drew you to this and what keeps you in this work?

GABRIELLE I think, you know, I love getting to know people and how we can help them in their journey in life. And so that's what keeps me in this business is the curiosity about people and their journey and how we can help them live out what their vision is for life. And so whether it be our employees or the clients that we serve, I love hearing people's stories. And so that's what keeps me — and then being able to make a difference each and every day. Like, what we do is so impactful and life-giving. And our clients have as much impact on us as we have on them. I could tell you stories for days about clients that have had a significant impact on me and my life or taught me something. And I think that's what keeps me going, is just knowing that each and every day we're touching life. We're making a difference. We're making a positive impact. We're keeping someone where their memories were made, in their home where they feel safe and comfortable.

MELISSA So last question — what is one lesson that you've learned from a client that has stuck with you? I know you probably have a lot. What's one of your favorite ones?

GABRIELLE Jeez. Yeah, it's one of the simple things. Like, when one of my very first clients taught me how to make homemade mac and cheese. And I'll never forget that. It was a fun experience that we had together. Sometimes it's simple things like that. One time I walked into a client's home and I saw a picture on their wall and I said, I know that place, and that's Rockford, South Dakota. And he goes, well, yes, that is Rockford, South Dakota. And then we got into this whole story about his life and what brought him to Rockford and how he ended up in Sioux Falls. And even hearing those journeys and those stories, but also seeing sometimes what people persevere through, through life, is really touching. And we've had people, very young people who are in wheelchairs, trying to navigate the streets of Vermillion or Sioux Falls. And thinking about each and every day, not only the challenge that they have to get up and just get ready, because we have to come and get them out of bed and help them with their shower. But then when we leave — because sometimes we're not there for the whole day — when we leave, their challenge has only begun. And now they have to try to navigate the streets of South Dakota in the winter. And maybe they're not plowed. They just keep persevering, and they keep going through life. Sometimes such little things get us down, you know, or things in life I'm like, oh, this is just terrible. You know, like, I can't believe this is happening to me. And then I think about the challenges that some of our clients go through, and they just get up and they go and they persevere. And it's like, okay, if they can get up every day with a good attitude and fight through their challenges, I can overcome this little thing in my life.

MELISSA That's an amazing way to end this episode. So I love that. I'm sure so many great stories and lessons you and your staff have learned over the years. So if you're watching or listening and you've been putting it off, or you're thinking about, well, maybe I should check into this a little bit, go to korecares.com. K-O-R-E-C-A-R-E-S. And you serve all kinds of areas of South Dakota, including Aberdeen, Brookings, Mitchell, here, Sioux Falls, Watertown, Yankton. You said 43 different counties.

GABRIELLE 43 different counties. If you're not sure we're there, just give us a call.

MELISSA There you go. Give them a call at korecares.com. Thank you so much, Gabrielle.

GABRIELLE Yeah, thank you.

MELISSA Hey, that's our show. If someone came to mind while you were listening to this — if you thought, hey, my sister needs to hear this, or I should send this — the brands I actually use, so I've put together a list of sponsors and favorite products that have worked for me and my family. If you're curious, that link is in the show notes too. Thank you for being here, and I really mean that. I'm Melissa Goodwin. The line is open. See you next time.