March 3, 2025 • 35 mins
The founders of Back Nine Nurses, Deborah O’Kelly and Kristen
Hyde join Chris Boyd and Jeff Perry for an in-depth conversation about how they are
responding to the growing needs of senior citizens and their families for trusted,
personalized, and compassionate navigation during times of transition and uncertainty
related to aging. Topics include homecare, assisted living, medical advocacy, hospice,
and the need for advanced estate and family planning. Deborah and Kristen offer
suggestions on looking for warning signs and how best to react. For more information,
see the link below:
https://www.backninenurses.com/
For more information or to reach Chris Boyd or Jeff Perry, click the following link:
https://www.wealthenhancement.com/s/advisor-teams/amr
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to Something More with Chris Boyd.
Chris Boyd is a certified financial planner, practitioner,
and senior vice president and financial advisor at
Wealth Enhancement Group, one of the nation's largest
registered investment advisors.
We call it Something More because we'd like
to talk not only about those important dollar
and cents issues, but also the quality of
life issues that make the money matters matter.
(00:22):
Here he is, your fulfillment facilitator, your partner
in prosperity, advising clients on Cape Cod and
across the country.
Here's your host, Jay Christopher Boyd.
Hey, welcome.
Thanks for being with us for another episode
of Something More with Chris Boyd.
I'm here with my co-host, Jeff Perry.
We are both of the AMR team with
Wealth Enhancement Group, and we have some great
(00:45):
guests today.
We're talking about really important issues for people
in the aging process.
Joining us today is Kristin Hyde and Deborah
O'Kelly.
They are the founders of Back Nine Nurses.
Thanks for being here.
Thank you.
Thanks so much for having us.
So who's the golfer?
I am.
(01:05):
Okay.
That's the name, huh?
Yeah, I love the double meaning of the
name.
It's been so much fun to combine a
couple of passions in life together, and we
found that it kind of creates some fun
curiosity when we wear our name tags that
say Back Nine Nurses.
It just creates some good conversation and some
opening areas to talk about the business.
(01:30):
Yeah, definitely double meaning there.
Tell us a little bit about, to start
off with, your backgrounds and how that led
to the creation of your business.
Okay, sure.
Yeah.
So Kristin and I are both registered nurses.
We are certified geriatric care managers, certified dementia
(01:52):
practitioners, and we work together.
We met together working at an assisted living
and memory care community, although we've worked in
many different areas of healthcare, including medical, surgical,
short-term care, long-term care, assisted living,
memory care, primary care, so many different areas.
(02:14):
But all along the way, and the reason
that kind of prompted us to launch Back
Nine Nurses was we heard so many times
over and over again from families, we wish
we had known this, we wish we had
known that.
And trying to navigate this world of healthcare
that is so busy, confusing oftentimes, and trying
(02:35):
to help, you know, we saw those families
struggling to navigate all the decisions that need
to be made.
And sometimes within record speed, they're confronted with
really life-changing decisions and needing to make
decisions quickly.
That's a great point about, seems as though
too often families find themselves in crisis when
(03:00):
trying to deal with aging in place or,
you know, aging issues.
Tell us about what leads to the kind
of instances that you work with people.
Is it that kind of scenario where someone's
visiting mom and dad and then says, gosh,
(03:20):
things have changed, we need help, and there's
a sense of urgency about it?
Yeah, so often, like, especially around the holidays,
like, especially being on the Cape, the parents
are retired here, kids come to visit from
out of state.
And, you know, they notice, oh, you know,
mom left the stove on last night.
(03:41):
And they kind of, when they're gone, they
don't really, they kind of put it on
the back burner, per se.
And then these things they start noticing.
And then, you know, it's great when people
are like, you know what, this is kind
of happening, we're seeing changes in mom.
Can you help us now?
That gives us a chance to actually, like,
start the proper planning.
(04:02):
What are some of the examples of the
kind of changes in mom or dad that
the family might be looking for as indications
of aging, creating some challenges?
Yeah, we see, you know, they notice cognition
(04:23):
changes, the way that- What does that
mean?
Not just the names, but- Expired food
in the fridge is like- A big
one.
Not keeping their food, like, they're letting it
sit there and they're not doing anything about
it.
Yeah, they're finding, you know, pill bottles that
may have expired.
Could be on the floor.
(04:46):
Yeah, yeah.
So there's so many signs where, you know,
even just during a conversation, when they're working
to have a conversation and they start kind
of struggling to retrieve what word they're searching
for in a conversation, maybe having some trouble
remembering names, especially immediate recall.
(05:09):
Those are definitely signs.
You know, people tend to remember their oldest
memories the best when they have trouble with
that immediate recall.
So those are kind of signals to kind
of say, hmm, what's going on here?
Is it common that you find issues of
hoarding and things like that come up as
well?
Or is that not so much a norm?
(05:30):
Yeah, no, that's a sign too.
And just the house being in general disarray,
you know, not the best food in the
fridge or- A weight loss, perhaps.
Expired milk, things like that.
So kind of, you know, somebody coming in
and taking a look around the house and
kind of identifying those factors that- The
(05:52):
clothing, maybe certain signs as to how they're
dressing or not, you know.
Dressed in animals, like some of our clients
have had animals and maybe they're defecating in
the house and they're not picking it up,
which is normal behavior for this person, typically.
Yeah.
All right.
So these are all examples of things to
be on the lookout for, huh?
(06:13):
Yeah.
Just like you said, yeah, not dressing appropriately
for the weather at hand, you know, it
can overheat them.
Yeah.
All those things.
I was going to say, it's so common
that I've seen in not only my own
family, but hear from friends and such is,
mom's fine, mom's fine.
And they're interacting maybe for 10 minutes here,
(06:35):
or a phone call, or even maybe a
half hour.
The elderly person really does a good job
at- Mascotting.
Yeah.
Just their routines and how are you, I'm
fine.
There's no difficult conversations when you call mom,
you know, it's like, what are you doing?
But when you're there, you know, your example
of visiting for the holidays or something, and
you're there for a substantial period of time,
(06:58):
hours or days, you can really start to
see the signs.
And what should you do?
What's the first thing a family member should
do when they have that- Aha moment.
Like, oh, something's not right here.
What should I do?
Because sometimes it's too, you know, I've seen
it, not in my family, but I saw
(07:18):
it with a neighbor in that it was
almost like an anger from the children towards
the parents.
Like, you got to shape up here.
You got to do something here.
You know, you're not taking care of the
house rather than maybe something a bit more
compassionate or constructive.
Right.
Yeah, exactly.
Do you see that in your experience where
family members act in a- Scold them,
(07:39):
you know, say, hey- Yeah, exactly.
That's the word I was looking for.
Yeah.
Yeah.
There's so many different emotions involved because, you
know, their memories themselves of their parents are,
oh, my dad was always an athlete and
he's strong and he knows, you know, he
does business finances and he's smart.
And then, you know, they get frustrated about
(08:01):
what's going on and they don't really understand
it themselves quite as well as they may
want to.
And so we strongly recommend reaching out to
anyone in the healthcare world that can kind
of advise them and give them a little
guidance, whether it's a care manager like us.
(08:21):
We belong to an association called the Aging
Life Care Association, which is a wonderful network
of well-certified people who are qualified to
kind of guide people in that area.
And there's also, you know, primary care, reaching
out to their primary care doctor and just
(08:43):
trying to start to get some guidance on
what's going on.
So what would you folks do if a
family member called in the kind of scenario
that we're painting here?
What would be some first steps that you
might take?
So we normally start with when the family
member calls, we like to do a meet
and greet and free consultation.
(09:03):
And doing that starts because this whole relationship
is based on trust.
I mean, we're reading their medical records, we're
finding out the whole family history, you know,
this one, getting the family dynamics.
So we'll go in person.
And clear, not every instance someone is in
crisis.
Not every instance, but even we'll still go
(09:24):
for a meet and greet, see if we're
a good fit for them.
And it almost takes a sense of relief
when we're like, you know what, we'll meet
you at the then how we can help
them.
And then if they do decide to sign
on with services with us, we start with
(09:45):
an initial nursing assessment, which is a comprehensive
whole assessment that looks at like home safety,
the health, like all the whole, your whole
life, basically.
And then we make recommendations and give them
options and implement a plan of care.
(10:08):
I don't think a meeting goes by when
we talk to clientele and because we work
with retired people as well.
And their plan is to age in place.
And, you know, Firmly, that's their plan.
The discussion of anything else.
We're not going to do that.
Absolutely not.
(10:29):
You know what I mean?
Kind of mindset.
Um, with all the extreme, uh, alternative as
a way to deal with it.
Oh, just, you know, smother we're with the
pillow or, you know, the sort of silly
stuff, you know?
Well, that's the deflection though.
Yeah.
They don't want, they don't want to talk
about it.
Right.
But there as a practical reality, that's not
(10:50):
really what happens.
And there's not always the option to age
in place.
Now, sometimes there are.
So when you come in and do this
comprehensive assessment, um, what are some of the
instances that, you know, things can be done
to help someone to be able to age
(11:11):
in place, uh, certain renovations, maybe it's certain,
uh, assistance that can be brought in with
some regularity.
How do you help people identify what those
things are?
And maybe you can elaborate on what are
some examples of, uh, you know, should someone
who's starting to have a little bit of
forgetfulness be managing their own medication as an
example, or whatever it might be.
(11:33):
Um, maybe you can elaborate on some of
those kind of, let's start with that trying
to age in place kind of scenario.
Sure.
And we agree.
I mean, that that's pretty much the, the
goal of most people is, is to age
in place and stay at the home that
they're used to and that they love and
that they feel comfortable in.
So.
Wouldn't prefer that.
Right.
Yeah.
Yeah.
I mean, right.
(11:53):
Exactly.
It makes complete sense.
Um, so, I mean, we really, that, that
the assessment that we do, it talks about
those goals and the, you know, we always
want to align as best as we always
can.
What are the goals and what are the
preferences of that person and the family?
Um, so we look at all those areas
and then just for instance, if somebody has
(12:16):
Parkinson's disease, um, and they've experienced a few
falls at home, um, we can reach out
to their primary care provider, um, set up
a visit.
Uh, there's a certain timeframe that you need
a visit within to get a referral to
say a home care agency to do an
in-home PT OT referral so that they
(12:37):
can come in and look, um, through the
lens of a physical therapist.
Um, what could be done as far as,
you know, could we raise the height of
the, the toilet seating to make it easier
for this person when they're in the bathroom,
the bathroom is one of the top areas
in someone's house that falls occur.
Um, so we, we look at, you know,
(13:00):
what does the environment look like?
Um, how are the medications being taken?
Are they taking them out of pill cases?
Are they trying to take them out of
their bottles?
Um, how are they ambulating?
Look at every kind of safety area, um,
and, uh, take into account what the diagnoses
are, you know, what their med list is.
(13:22):
One of the huge things that we do
is reconcile med lists.
Um, you know, some people have so many
different providers that they're going to.
And so that's one of the top things
we look at immediately is when people, um,
engage in our services, we have a HIPAA,
(13:42):
um, release and consent form that they fill
out so that we then immediately send that
out to all of their providers so that
we can gather their information, look at their
med list, look at their, um, visit notes
and see, you know, what kind of supports
can we put in place to keep this
person at home and keep them at home
safely to, to help them achieve that goal
(14:06):
of staying at home.
You know, it's funny.
I, I had a meeting, uh, in the
last week or two with an octogenarian who,
um, cognitively seems pretty sharp, um, but identified
that she's been having falls and, uh, is,
um, insistent.
She wants to stay where she is and
(14:28):
she's presently living on two levels, uh, probably
could if she wanted to live on one
level.
Um, but, you know, just, uh, the thing
that I was trying to impress upon her
is that things don't stay stagnant.
You know, it tends to be that things
(14:48):
evolve and generally as we age, they progress
for the worse, not for the better.
So how do you help someone find that
path to maybe now while you have your
cognitive and largely good health, uh, maybe, uh,
that independent care living community would be a
(15:09):
good choice for you sooner rather than later,
or I don't know what, you know what
I mean?
How do you help someone figure out what's
their next step, uh, to help them?
And if it's at home, how do, how
do they avoid problems where they're living alone,
but having falls, you know, is there a
lot of resist?
And to add to Chris's question, is it,
(15:31):
is the typical response resistance to these changes
or is it acceptance?
I think we would both say there's resistance.
I thought so, but that's what I was
reading as well.
We haven't encountered anybody that just says, oh
my gosh.
Yes.
Let's go move to someplace else.
(15:54):
Let's go exercise, right?
The idea of a move, a lot of
logistics in that.
Yeah.
I mean, really it's, you know, sometimes there
is a crisis mode where maybe, maybe a
move does need to happen fairly quickly, but
you know, ideally it's something that they kind
of ease into.
(16:15):
And just as we were saying, you know,
we get to know these families so well,
we almost become surrogate family members with them,
which leads, leads to trust in a lot
of open conversations about, you know, the advantages
that they might not even be aware of.
A lot of people go to assisted living
who didn't want to go there.
(16:35):
And then after they get there, we talked
to them.
Why didn't we do this sooner?
This is so wonderful.
That was my mom.
Yeah, exactly.
Yeah.
I mean, there's, there's, you know, there's so
many opportunities with socialization where at home, you
know, they didn't even realize how isolated they
(16:56):
were.
They were.
Not all the time, but yeah, that's about
it.
Right.
And it was really affecting, honestly, you know,
the isolation can lead to a little depression,
which can lead to not showering as much,
not, you know, which could lead to a
urinary tract infection.
It can just really snowball.
(17:17):
Yeah.
Yeah.
Good points.
You know, I think one of the things
I wanted to talk about with you as
well is you mentioned becoming surrogate family members.
I imagine a lot of times you're dealing
with people where, you know, the, the, the
(17:38):
actual family is not geographically local and you
know, when it comes to like, are you
helping people navigate going to doctor's appointments and
who's going to take them?
It's not, that's not something you guys do
yourselves, is it?
You do that.
You actually do that.
(17:58):
Yeah.
So there's the logistics of that.
Then there's the aftermath of that, right?
You know, what are the outcomes that a
particular occasion might require doctor's appointments, logistics in
and of itself could be an enormous task.
I don't know how you guys would have
time to do that for a lot of
people and continue doing all the assessments and
(18:21):
so forth.
I mean, it is an important piece and
not everybody needs that, but we find that
the people who are requesting that are people
who are, you know, their family doesn't live
close by and they love their family member,
but they're not able to manage their care
from far away.
(18:42):
Even when somebody's already in assisted living, there's
still a lot to manage because essentially assisted
living is it's like living in a home,
but with the extra supports of, you know,
activities of daily living, bathing, dressing.
But when that person goes off to the
doctor, they're going by themselves.
(19:04):
And you know, who's looking at the paperwork
afterwards when they do that?
Cognitive decline too, right?
You know, are they going to remember everything
that comes out of that appointment?
Exactly.
Exactly.
So, you know, those, those appointments are really
big, especially in addition, if there's unfortunately an
ER visit followed by, you know, a discharge
(19:25):
where there's all sorts of recommendations on that
discharge list saying, you know, follow up with
cardiology in the next week, visit primary care
within, you know, and then they come back
to assisted living and, you know, there's a
lot of communication that needs to go on
between the family, getting those appointments followed up.
(19:48):
So yeah, attending those appointments are big.
And again, you know, medication reconciliation during those
appointments, making sure the primary care physician is
updated because sometimes it's not.
So yeah, this is hugely valuable.
You can just hearing you talk about it,
you can get a sense of the importance
of how this can really add value.
(20:09):
Obviously it's not free and it's, you know,
it presumes people need some resources to be
able to get this kind of help.
We are, point to ourselves as a fiduciary
in the way we work with people.
There are business models in your field where
(20:30):
people are compensated through some kind of commission
for connecting people with an assisted living or
that kind of thing.
Would you talk about your business model a
little bit that I think positions you maybe
as the client's advocate, as opposed to trying
to find where you get compensated directly, that
(20:51):
kind of thing?
Yeah, absolutely.
And I'm glad you brought that up because
we, as again, we mentioned we're members of
the Aging Life Care Association that has a
huge ethical standard that we always follow as
well as our nursing ethics.
So no, we don't take any commissions, there's
(21:14):
no money, favors, anything being exchanged ever for
the recommendations we make, whether it be for
in-home care, a home healthcare agency, an
assisted living community, a long-term care facility,
there's nothing that we're getting back from them.
We simply are trying to find the absolute
best situation for each individual person in their
(21:37):
own individual unique circumstances.
So tell us how it works after the
initial consultation, which you said you kind of
come in and do an initial consultation.
Do people hire you on a contract?
Is it hourly?
Just how does it work?
So it's a service agreement that we have
that we can send them electronically for them
(22:00):
to read over.
We try to keep it as simple as
possible.
One of the things that we've been happy
that we've done over the last year that
kind of we feel sets us apart from
maybe some other care managers out there is,
you know, we're coming into families at a
time when they are already stressed, making difficult
decisions.
(22:21):
So within our service contract, you know, we
do have an hourly rate, we are private
pay, but we realize that, you know, that
can be a scary thing.
So if there's a really difficult month, families
can be wondering, oh my gosh, what could
this add up to?
If mom's going to the hospital, she needs
doctor's appointments.
(22:41):
So we do have an hourly rate option
on our service agreement, but we also do
want to kind of taking the stress level
down for people, we also have an option
for them where they can set their own
monthly budget cap rate where we will not
go over that.
So if they choose that option, once the
(23:03):
assessment's done as nurses, one of the biggest
things we do is prioritize.
So we can then take a look at
the assessment, see what everything looks like.
And if they choose that monthly budget cap,
we can then say, here's what we feel
are your biggest priorities.
Do you agree?
Do these line up with your goals and
your preferences?
And this is what we can do within
(23:25):
your means to help you the best that
we can.
Yeah.
Are you finding there's an abundance of need?
Yes.
That's my impression.
How are you going to be able to
keep up with that need?
Are you guys growing?
Are you expecting something?
Yeah, we are actually just talking to some
(23:45):
other nurses now because, and we want those
nurses to be in line with us because
everything is a representation of what we want
to present and how we want families to
feel when they work with us.
So we are in talks with other nurses
now because it is such a huge need
out there.
(24:06):
Yeah.
It sounds like you've got a good model
and it just seems like there's a lot
of need for help in this regard.
Yes, there is.
So this is an ongoing endeavor for most
people, right?
Because things change and evolve.
Do you find that people hire you once
initially and then come back?
(24:27):
Or is it just something that is an
ongoing thing and then periodically reassessed for what
should our role be now kind of a
thing?
Yeah, that's a good question because what we
found is people tend to keep us on,
but it can taper down.
So say we, for instance, we've helped somebody
(24:48):
when they were in the home and then
we helped them transition to assisted living and
then they flourished once they were in assisted
living.
And we still see that person, the one
we're talking about, but cut it down to
we see them quarterly now just to kind
of keep that relationship in touch so that
(25:10):
if she did have an emergency, she knows
who we are and we can jump in
if there was an emergency room visit or
something happened.
And then additionally, we have families that we
may start working with a sibling and then
all of a sudden something happens to the
spouse.
(25:31):
So with multiple people within a family.
Yeah, I can see how that could happen.
Without violating any kind of privacy, could you
share just a few examples of the kind
of things you've been running into recently?
What are some examples of the kind of
stuff that comes about?
(25:55):
Advocacy is a huge piece of what we
do.
So sometimes, just to give an example where
advocacy can come in, we've had a situation
where somebody was in the hospital, they were
clearly declining.
(26:15):
Their ultimate wish was to spend their last
days at home.
This wasn't really an expected thing.
This was kind of sped up.
And when they were just playing in the
hospital, the term hospice was not brought up.
(26:36):
But Kristen and I have seen so many
situations where sometimes you can recognize visibly when
somebody- And you knew their preferences.
...
would be appropriate for hospice.
So even though they hadn't brought that up
at the hospital, we did contact one of
the specialists there to prompt the conversation and
(26:58):
say, look, do you think a hospice evaluation
would be appropriate here?
And the answer was absolutely yes.
They had a diagnosis that would qualify them
for hospice.
And they got to get discharged with that,
bringing those services on board, they got to
be discharged, go home, have hospice in place,
(27:22):
and have all of those supports that come
with hospice to- But the comforts of
home.
...
have comfort, to have the emotional support for
the family, and to be in the place
that they wanted to be during that time.
Advocacy is so important in healthcare, especially for
all of us.
I mean, we find ourselves at any age
having to be our advocate sometimes and pushing
(27:43):
back.
But especially with someone who's older and maybe
diminished physically or cognitively, they're not really in
a position to challenge the medical community.
Oh, it's time for me to go home?
Okay.
Right, right, exactly.
And we see that coming up in primary
care too, where, I mean, no disservice to
primary care, it's just very busy.
(28:04):
And sometimes, especially older adults don't realize how
much you need to push for something sometimes
where we've been with someone who had had
a few falls over the prior year, had
been experiencing some balance issues, noticing on his
(28:27):
own that there were some lapses in memory,
cognitive changes.
So the primary care at that visit had
put in an order for an MRI, and
that person was good with that.
But I actually asked for an additional referral
to a neurologist to kind of take a
(28:48):
deeper look at what could be going on.
And lo and behold, they had a very
thorough evaluation from the neurologist, and there was
a diagnosis that came from that visit.
So we can't say enough about advocacy.
Good.
(29:09):
Well, I mean, this just scratches the surface.
I'm sure that you guys have numerous anecdotes
of the kind of ways you've been able
to help families in one form or another.
I think one of the things we've had
similar conversations with people is the idea of
sooner is better than later.
(29:31):
When it comes to talking with professionals like
your firm, don't wait till there's a crisis.
Get some manner of a plan in place
as to, this is what your needs are
now, this is what it looks like we
might need to be looking toward.
Do you help people sort of navigate a
(29:52):
plan of sorts of where we're at, where
we might be headed, and what are the
things to look out for as to when
the timing might be coming, that kind of
a process?
Yes.
Yes.
So even though one of our clients has
Alzheimer's and the mind is still working fine
(30:16):
right now, but we're already talking about, what
are your goals for the future?
You're going to need more care in the
next few years.
So do you have our funds allocated for
this?
Do you want to do an assisted living?
Do you want to stay home?
So we'd like to talk about all of
(30:37):
that early.
A game plan and then- And come
up with the resources that they'll need.
Some people haven't updated their will.
They may not have a durable power of
attorney in place, health proxies, things to set
up preserving their assets.
(30:57):
So we look at every, we love it
when people are planning, when they're planning because
- It avoids strife as well.
If the parent has, I'm thinking of the
traditional setting, but if the parent has their
wishes known, it will decrease the likelihood of
siblings arguing about what's the best plan for
(31:20):
mom when she maybe can't make those decisions.
Oh my gosh.
It's so important.
It's a gift, actually, to your family.
Yeah.
One will be like, mom would want to
be on life support.
And the other one's like, no, she wouldn't.
If the wishes were already spoken by the
parent, then that takes the burden off the
kids.
(31:41):
And we talk to them too and give
them guidance on sometimes people, seniors have a
tough time picking their healthcare proxy and they're
like, they don't want to show one over
the other.
But one of the things we've gathered along
the way as far as helping them guide
that, it's almost like, hopefully they understand football
(32:04):
because I think it's a great analogy.
But if you think of it this way,
who would you want to be your quarterback
where there's a stressful situation and who is
going to make the decisions that you would
want made for yourself in a time of
stress?
Who can stay level-headed and make the
(32:24):
decision the way you would want it made
for yourself?
And try to go- Not impose their
own priorities.
Yeah.
Yeah.
Challenging stuff, right?
Well, you guys come back again.
This was really good.
We could probably dig into some particular circumstances
(32:46):
and elaborate on the kind of planning that
could be benefited from.
Found this really worthwhile.
And let's tell everyone a little bit more
about how to reach you if they have
interest or need to do some planning of
this sort, or to get an assessment for
a family member or their own kind of
assistance with their care planning.
(33:06):
Share a little bit about how you can
be reached.
Sure.
You can always call us at 508-737
-4277, or you can go to our website
at www.back9nurses.com.
It's all spelled out B-A-C-K
-N-I-N-E, nurses.com.
(33:29):
Excellent.
I'll put that website in the show notes.
So if people are listening, they can just
directly click the notes in the show.
Wonderful.
Thank you.
All right.
Thanks for being with us and hope everyone
got something out of this.
The bottom line is you've got to be
planning for these kinds of challenges.
Plan or not, they may occur.
And if you're not prepared, better to have
(33:51):
some planning in place than to be in
a moment of crisis that inevitably may arise
for many people.
So start early.
All right.
Thank you both for being here.
Thank you so much for having us.
Okay.
Until next time, everybody keeps striving for something
more.
(34:54):
Transcribed by https://otter.ai Any
financial decisions.
Welcome to Something More with Chris Boyd.
Chris Boyd is a certified financial planner, practitioner,
and senior vice president and financial advisor at
Wealth Enhancement Group, one of the nation's largest
registered investment advisors.
We call it Something More because we'd like
to talk not only about those important dollar
and cents issues, but also the quality of
life issues that make the money matters matter.
(00:22):
Here he is, your fulfillment facilitator, your partner
in prosperity, advising clients on Cape Cod and
across the country.
Here's your host, Jay Christopher Boyd.
Hey, welcome.
Thanks for being with us for another episode
of Something More with Chris Boyd.
I'm here with my co-host, Jeff Perry.
We are both of the AMR team with
Wealth Enhancement Group, and we have some great
(00:45):
guests today.
We're talking about really important issues for people
in the aging process.
Joining us today is Kristin Hyde and Deborah
O'Kelly.
They are the founders of Back Nine Nurses.
Thanks for being here.
Thank you.
Thanks so much for having us.
So who's the golfer?
I am.
(01:05):
Okay.
That's the name, huh?
Yeah, I love the double meaning of the
name.
It's been so much fun to combine a
couple of passions in life together, and we
found that it kind of creates some fun
curiosity when we wear our name tags that
say Back Nine Nurses.
It just creates some good conversation and some
opening areas to talk about the business.
(01:30):
Yeah, definitely double meaning there.
Tell us a little bit about, to start
off with, your backgrounds and how that led
to the creation of your business.
Okay, sure.
Yeah.
So Kristin and I are both registered nurses.
We are certified geriatric care managers, certified dementia
(01:52):
practitioners, and we work together.
We met together working at an assisted living
and memory care community, although we've worked in
many different areas of healthcare, including medical, surgical,
short-term care, long-term care, assisted living,
memory care, primary care, so many different areas.
(02:14):
But all along the way, and the reason
that kind of prompted us to launch Back
Nine Nurses was we heard so many times
over and over again from families, we wish
we had known this, we wish we had
known that.
And trying to navigate this world of healthcare
that is so busy, confusing oftentimes, and trying
(02:35):
to help, you know, we saw those families
struggling to navigate all the decisions that need
to be made.
And sometimes within record speed, they're confronted with
really life-changing decisions and needing to make
decisions quickly.
That's a great point about, seems as though
too often families find themselves in crisis when
(03:00):
trying to deal with aging in place or,
you know, aging issues.
Tell us about what leads to the kind
of instances that you work with people.
Is it that kind of scenario where someone's
visiting mom and dad and then says, gosh,
(03:20):
things have changed, we need help, and there's
a sense of urgency about it?
Yeah, so often, like, especially around the holidays,
like, especially being on the Cape, the parents
are retired here, kids come to visit from
out of state.
And, you know, they notice, oh, you know,
mom left the stove on last night.
(03:41):
And they kind of, when they're gone, they
don't really, they kind of put it on
the back burner, per se.
And then these things they start noticing.
And then, you know, it's great when people
are like, you know what, this is kind
of happening, we're seeing changes in mom.
Can you help us now?
That gives us a chance to actually, like,
start the proper planning.
(04:02):
What are some of the examples of the
kind of changes in mom or dad that
the family might be looking for as indications
of aging, creating some challenges?
Yeah, we see, you know, they notice cognition
(04:23):
changes, the way that- What does that
mean?
Not just the names, but- Expired food
in the fridge is like- A big
one.
Not keeping their food, like, they're letting it
sit there and they're not doing anything about
it.
Yeah, they're finding, you know, pill bottles that
may have expired.
Could be on the floor.
(04:46):
Yeah, yeah.
So there's so many signs where, you know,
even just during a conversation, when they're working
to have a conversation and they start kind
of struggling to retrieve what word they're searching
for in a conversation, maybe having some trouble
remembering names, especially immediate recall.
(05:09):
Those are definitely signs.
You know, people tend to remember their oldest
memories the best when they have trouble with
that immediate recall.
So those are kind of signals to kind
of say, hmm, what's going on here?
Is it common that you find issues of
hoarding and things like that come up as
well?
Or is that not so much a norm?
(05:30):
Yeah, no, that's a sign too.
And just the house being in general disarray,
you know, not the best food in the
fridge or- A weight loss, perhaps.
Expired milk, things like that.
So kind of, you know, somebody coming in
and taking a look around the house and
kind of identifying those factors that- The
(05:52):
clothing, maybe certain signs as to how they're
dressing or not, you know.
Dressed in animals, like some of our clients
have had animals and maybe they're defecating in
the house and they're not picking it up,
which is normal behavior for this person, typically.
Yeah.
All right.
So these are all examples of things to
be on the lookout for, huh?
(06:13):
Yeah.
Just like you said, yeah, not dressing appropriately
for the weather at hand, you know, it
can overheat them.
Yeah.
All those things.
I was going to say, it's so common
that I've seen in not only my own
family, but hear from friends and such is,
mom's fine, mom's fine.
And they're interacting maybe for 10 minutes here,
(06:35):
or a phone call, or even maybe a
half hour.
The elderly person really does a good job
at- Mascotting.
Yeah.
Just their routines and how are you, I'm
fine.
There's no difficult conversations when you call mom,
you know, it's like, what are you doing?
But when you're there, you know, your example
of visiting for the holidays or something, and
you're there for a substantial period of time,
(06:58):
hours or days, you can really start to
see the signs.
And what should you do?
What's the first thing a family member should
do when they have that- Aha moment.
Like, oh, something's not right here.
What should I do?
Because sometimes it's too, you know, I've seen
it, not in my family, but I saw
(07:18):
it with a neighbor in that it was
almost like an anger from the children towards
the parents.
Like, you got to shape up here.
You got to do something here.
You know, you're not taking care of the
house rather than maybe something a bit more
compassionate or constructive.
Right.
Yeah, exactly.
Do you see that in your experience where
family members act in a- Scold them,
(07:39):
you know, say, hey- Yeah, exactly.
That's the word I was looking for.
Yeah.
Yeah.
There's so many different emotions involved because, you
know, their memories themselves of their parents are,
oh, my dad was always an athlete and
he's strong and he knows, you know, he
does business finances and he's smart.
And then, you know, they get frustrated about
(08:01):
what's going on and they don't really understand
it themselves quite as well as they may
want to.
And so we strongly recommend reaching out to
anyone in the healthcare world that can kind
of advise them and give them a little
guidance, whether it's a care manager like us.
(08:21):
We belong to an association called the Aging
Life Care Association, which is a wonderful network
of well-certified people who are qualified to
kind of guide people in that area.
And there's also, you know, primary care, reaching
out to their primary care doctor and just
(08:43):
trying to start to get some guidance on
what's going on.
So what would you folks do if a
family member called in the kind of scenario
that we're painting here?
What would be some first steps that you
might take?
So we normally start with when the family
member calls, we like to do a meet
and greet and free consultation.
(09:03):
And doing that starts because this whole relationship
is based on trust.
I mean, we're reading their medical records, we're
finding out the whole family history, you know,
this one, getting the family dynamics.
So we'll go in person.
And clear, not every instance someone is in
crisis.
Not every instance, but even we'll still go
(09:24):
for a meet and greet, see if we're
a good fit for them.
And it almost takes a sense of relief
when we're like, you know what, we'll meet
you at the then how we can help
them.
And then if they do decide to sign
on with services with us, we start with
(09:45):
an initial nursing assessment, which is a comprehensive
whole assessment that looks at like home safety,
the health, like all the whole, your whole
life, basically.
And then we make recommendations and give them
options and implement a plan of care.
(10:08):
I don't think a meeting goes by when
we talk to clientele and because we work
with retired people as well.
And their plan is to age in place.
And, you know, Firmly, that's their plan.
The discussion of anything else.
We're not going to do that.
Absolutely not.
(10:29):
You know what I mean?
Kind of mindset.
Um, with all the extreme, uh, alternative as
a way to deal with it.
Oh, just, you know, smother we're with the
pillow or, you know, the sort of silly
stuff, you know?
Well, that's the deflection though.
Yeah.
They don't want, they don't want to talk
about it.
Right.
But there as a practical reality, that's not
(10:50):
really what happens.
And there's not always the option to age
in place.
Now, sometimes there are.
So when you come in and do this
comprehensive assessment, um, what are some of the
instances that, you know, things can be done
to help someone to be able to age
(11:11):
in place, uh, certain renovations, maybe it's certain,
uh, assistance that can be brought in with
some regularity.
How do you help people identify what those
things are?
And maybe you can elaborate on what are
some examples of, uh, you know, should someone
who's starting to have a little bit of
forgetfulness be managing their own medication as an
example, or whatever it might be.
(11:33):
Um, maybe you can elaborate on some of
those kind of, let's start with that trying
to age in place kind of scenario.
Sure.
And we agree.
I mean, that that's pretty much the, the
goal of most people is, is to age
in place and stay at the home that
they're used to and that they love and
that they feel comfortable in.
So.
Wouldn't prefer that.
Right.
Yeah.
Yeah.
I mean, right.
(11:53):
Exactly.
It makes complete sense.
Um, so, I mean, we really, that, that
the assessment that we do, it talks about
those goals and the, you know, we always
want to align as best as we always
can.
What are the goals and what are the
preferences of that person and the family?
Um, so we look at all those areas
and then just for instance, if somebody has
(12:16):
Parkinson's disease, um, and they've experienced a few
falls at home, um, we can reach out
to their primary care provider, um, set up
a visit.
Uh, there's a certain timeframe that you need
a visit within to get a referral to
say a home care agency to do an
in-home PT OT referral so that they
(12:37):
can come in and look, um, through the
lens of a physical therapist.
Um, what could be done as far as,
you know, could we raise the height of
the, the toilet seating to make it easier
for this person when they're in the bathroom,
the bathroom is one of the top areas
in someone's house that falls occur.
Um, so we, we look at, you know,
(13:00):
what does the environment look like?
Um, how are the medications being taken?
Are they taking them out of pill cases?
Are they trying to take them out of
their bottles?
Um, how are they ambulating?
Look at every kind of safety area, um,
and, uh, take into account what the diagnoses
are, you know, what their med list is.
(13:22):
One of the huge things that we do
is reconcile med lists.
Um, you know, some people have so many
different providers that they're going to.
And so that's one of the top things
we look at immediately is when people, um,
engage in our services, we have a HIPAA,
(13:42):
um, release and consent form that they fill
out so that we then immediately send that
out to all of their providers so that
we can gather their information, look at their
med list, look at their, um, visit notes
and see, you know, what kind of supports
can we put in place to keep this
person at home and keep them at home
safely to, to help them achieve that goal
(14:06):
of staying at home.
You know, it's funny.
I, I had a meeting, uh, in the
last week or two with an octogenarian who,
um, cognitively seems pretty sharp, um, but identified
that she's been having falls and, uh, is,
um, insistent.
She wants to stay where she is and
(14:28):
she's presently living on two levels, uh, probably
could if she wanted to live on one
level.
Um, but, you know, just, uh, the thing
that I was trying to impress upon her
is that things don't stay stagnant.
You know, it tends to be that things
(14:48):
evolve and generally as we age, they progress
for the worse, not for the better.
So how do you help someone find that
path to maybe now while you have your
cognitive and largely good health, uh, maybe, uh,
that independent care living community would be a
(15:09):
good choice for you sooner rather than later,
or I don't know what, you know what
I mean?
How do you help someone figure out what's
their next step, uh, to help them?
And if it's at home, how do, how
do they avoid problems where they're living alone,
but having falls, you know, is there a
lot of resist?
And to add to Chris's question, is it,
(15:31):
is the typical response resistance to these changes
or is it acceptance?
I think we would both say there's resistance.
I thought so, but that's what I was
reading as well.
We haven't encountered anybody that just says, oh
my gosh.
Yes.
Let's go move to someplace else.
(15:54):
Let's go exercise, right?
The idea of a move, a lot of
logistics in that.
Yeah.
I mean, really it's, you know, sometimes there
is a crisis mode where maybe, maybe a
move does need to happen fairly quickly, but
you know, ideally it's something that they kind
of ease into.
(16:15):
And just as we were saying, you know,
we get to know these families so well,
we almost become surrogate family members with them,
which leads, leads to trust in a lot
of open conversations about, you know, the advantages
that they might not even be aware of.
A lot of people go to assisted living
who didn't want to go there.
(16:35):
And then after they get there, we talked
to them.
Why didn't we do this sooner?
This is so wonderful.
That was my mom.
Yeah, exactly.
Yeah.
I mean, there's, there's, you know, there's so
many opportunities with socialization where at home, you
know, they didn't even realize how isolated they
(16:56):
were.
They were.
Not all the time, but yeah, that's about
it.
Right.
And it was really affecting, honestly, you know,
the isolation can lead to a little depression,
which can lead to not showering as much,
not, you know, which could lead to a
urinary tract infection.
It can just really snowball.
(17:17):
Yeah.
Yeah.
Good points.
You know, I think one of the things
I wanted to talk about with you as
well is you mentioned becoming surrogate family members.
I imagine a lot of times you're dealing
with people where, you know, the, the, the
(17:38):
actual family is not geographically local and you
know, when it comes to like, are you
helping people navigate going to doctor's appointments and
who's going to take them?
It's not, that's not something you guys do
yourselves, is it?
You do that.
You actually do that.
(17:58):
Yeah.
So there's the logistics of that.
Then there's the aftermath of that, right?
You know, what are the outcomes that a
particular occasion might require doctor's appointments, logistics in
and of itself could be an enormous task.
I don't know how you guys would have
time to do that for a lot of
people and continue doing all the assessments and
(18:21):
so forth.
I mean, it is an important piece and
not everybody needs that, but we find that
the people who are requesting that are people
who are, you know, their family doesn't live
close by and they love their family member,
but they're not able to manage their care
from far away.
(18:42):
Even when somebody's already in assisted living, there's
still a lot to manage because essentially assisted
living is it's like living in a home,
but with the extra supports of, you know,
activities of daily living, bathing, dressing.
But when that person goes off to the
doctor, they're going by themselves.
(19:04):
And you know, who's looking at the paperwork
afterwards when they do that?
Cognitive decline too, right?
You know, are they going to remember everything
that comes out of that appointment?
Exactly.
Exactly.
So, you know, those, those appointments are really
big, especially in addition, if there's unfortunately an
ER visit followed by, you know, a discharge
(19:25):
where there's all sorts of recommendations on that
discharge list saying, you know, follow up with
cardiology in the next week, visit primary care
within, you know, and then they come back
to assisted living and, you know, there's a
lot of communication that needs to go on
between the family, getting those appointments followed up.
(19:48):
So yeah, attending those appointments are big.
And again, you know, medication reconciliation during those
appointments, making sure the primary care physician is
updated because sometimes it's not.
So yeah, this is hugely valuable.
You can just hearing you talk about it,
you can get a sense of the importance
of how this can really add value.
(20:09):
Obviously it's not free and it's, you know,
it presumes people need some resources to be
able to get this kind of help.
We are, point to ourselves as a fiduciary
in the way we work with people.
There are business models in your field where
(20:30):
people are compensated through some kind of commission
for connecting people with an assisted living or
that kind of thing.
Would you talk about your business model a
little bit that I think positions you maybe
as the client's advocate, as opposed to trying
to find where you get compensated directly, that
(20:51):
kind of thing?
Yeah, absolutely.
And I'm glad you brought that up because
we, as again, we mentioned we're members of
the Aging Life Care Association that has a
huge ethical standard that we always follow as
well as our nursing ethics.
So no, we don't take any commissions, there's
(21:14):
no money, favors, anything being exchanged ever for
the recommendations we make, whether it be for
in-home care, a home healthcare agency, an
assisted living community, a long-term care facility,
there's nothing that we're getting back from them.
We simply are trying to find the absolute
best situation for each individual person in their
(21:37):
own individual unique circumstances.
So tell us how it works after the
initial consultation, which you said you kind of
come in and do an initial consultation.
Do people hire you on a contract?
Is it hourly?
Just how does it work?
So it's a service agreement that we have
that we can send them electronically for them
(22:00):
to read over.
We try to keep it as simple as
possible.
One of the things that we've been happy
that we've done over the last year that
kind of we feel sets us apart from
maybe some other care managers out there is,
you know, we're coming into families at a
time when they are already stressed, making difficult
decisions.
(22:21):
So within our service contract, you know, we
do have an hourly rate, we are private
pay, but we realize that, you know, that
can be a scary thing.
So if there's a really difficult month, families
can be wondering, oh my gosh, what could
this add up to?
If mom's going to the hospital, she needs
doctor's appointments.
(22:41):
So we do have an hourly rate option
on our service agreement, but we also do
want to kind of taking the stress level
down for people, we also have an option
for them where they can set their own
monthly budget cap rate where we will not
go over that.
So if they choose that option, once the
(23:03):
assessment's done as nurses, one of the biggest
things we do is prioritize.
So we can then take a look at
the assessment, see what everything looks like.
And if they choose that monthly budget cap,
we can then say, here's what we feel
are your biggest priorities.
Do you agree?
Do these line up with your goals and
your preferences?
And this is what we can do within
(23:25):
your means to help you the best that
we can.
Yeah.
Are you finding there's an abundance of need?
Yes.
That's my impression.
How are you going to be able to
keep up with that need?
Are you guys growing?
Are you expecting something?
Yeah, we are actually just talking to some
(23:45):
other nurses now because, and we want those
nurses to be in line with us because
everything is a representation of what we want
to present and how we want families to
feel when they work with us.
So we are in talks with other nurses
now because it is such a huge need
out there.
(24:06):
Yeah.
It sounds like you've got a good model
and it just seems like there's a lot
of need for help in this regard.
Yes, there is.
So this is an ongoing endeavor for most
people, right?
Because things change and evolve.
Do you find that people hire you once
initially and then come back?
(24:27):
Or is it just something that is an
ongoing thing and then periodically reassessed for what
should our role be now kind of a
thing?
Yeah, that's a good question because what we
found is people tend to keep us on,
but it can taper down.
So say we, for instance, we've helped somebody
(24:48):
when they were in the home and then
we helped them transition to assisted living and
then they flourished once they were in assisted
living.
And we still see that person, the one
we're talking about, but cut it down to
we see them quarterly now just to kind
of keep that relationship in touch so that
(25:10):
if she did have an emergency, she knows
who we are and we can jump in
if there was an emergency room visit or
something happened.
And then additionally, we have families that we
may start working with a sibling and then
all of a sudden something happens to the
spouse.
(25:31):
So with multiple people within a family.
Yeah, I can see how that could happen.
Without violating any kind of privacy, could you
share just a few examples of the kind
of things you've been running into recently?
What are some examples of the kind of
stuff that comes about?
(25:55):
Advocacy is a huge piece of what we
do.
So sometimes, just to give an example where
advocacy can come in, we've had a situation
where somebody was in the hospital, they were
clearly declining.
(26:15):
Their ultimate wish was to spend their last
days at home.
This wasn't really an expected thing.
This was kind of sped up.
And when they were just playing in the
hospital, the term hospice was not brought up.
(26:36):
But Kristen and I have seen so many
situations where sometimes you can recognize visibly when
somebody- And you knew their preferences.
...
would be appropriate for hospice.
So even though they hadn't brought that up
at the hospital, we did contact one of
the specialists there to prompt the conversation and
(26:58):
say, look, do you think a hospice evaluation
would be appropriate here?
And the answer was absolutely yes.
They had a diagnosis that would qualify them
for hospice.
And they got to get discharged with that,
bringing those services on board, they got to
be discharged, go home, have hospice in place,
(27:22):
and have all of those supports that come
with hospice to- But the comforts of
home.
...
have comfort, to have the emotional support for
the family, and to be in the place
that they wanted to be during that time.
Advocacy is so important in healthcare, especially for
all of us.
I mean, we find ourselves at any age
having to be our advocate sometimes and pushing
(27:43):
back.
But especially with someone who's older and maybe
diminished physically or cognitively, they're not really in
a position to challenge the medical community.
Oh, it's time for me to go home?
Okay.
Right, right, exactly.
And we see that coming up in primary
care too, where, I mean, no disservice to
primary care, it's just very busy.
(28:04):
And sometimes, especially older adults don't realize how
much you need to push for something sometimes
where we've been with someone who had had
a few falls over the prior year, had
been experiencing some balance issues, noticing on his
(28:27):
own that there were some lapses in memory,
cognitive changes.
So the primary care at that visit had
put in an order for an MRI, and
that person was good with that.
But I actually asked for an additional referral
to a neurologist to kind of take a
(28:48):
deeper look at what could be going on.
And lo and behold, they had a very
thorough evaluation from the neurologist, and there was
a diagnosis that came from that visit.
So we can't say enough about advocacy.
Good.
(29:09):
Well, I mean, this just scratches the surface.
I'm sure that you guys have numerous anecdotes
of the kind of ways you've been able
to help families in one form or another.
I think one of the things we've had
similar conversations with people is the idea of
sooner is better than later.
(29:31):
When it comes to talking with professionals like
your firm, don't wait till there's a crisis.
Get some manner of a plan in place
as to, this is what your needs are
now, this is what it looks like we
might need to be looking toward.
Do you help people sort of navigate a
(29:52):
plan of sorts of where we're at, where
we might be headed, and what are the
things to look out for as to when
the timing might be coming, that kind of
a process?
Yes.
Yes.
So even though one of our clients has
Alzheimer's and the mind is still working fine
(30:16):
right now, but we're already talking about, what
are your goals for the future?
You're going to need more care in the
next few years.
So do you have our funds allocated for
this?
Do you want to do an assisted living?
Do you want to stay home?
So we'd like to talk about all of
(30:37):
that early.
A game plan and then- And come
up with the resources that they'll need.
Some people haven't updated their will.
They may not have a durable power of
attorney in place, health proxies, things to set
up preserving their assets.
(30:57):
So we look at every, we love it
when people are planning, when they're planning because
- It avoids strife as well.
If the parent has, I'm thinking of the
traditional setting, but if the parent has their
wishes known, it will decrease the likelihood of
siblings arguing about what's the best plan for
(31:20):
mom when she maybe can't make those decisions.
Oh my gosh.
It's so important.
It's a gift, actually, to your family.
Yeah.
One will be like, mom would want to
be on life support.
And the other one's like, no, she wouldn't.
If the wishes were already spoken by the
parent, then that takes the burden off the
kids.
(31:41):
And we talk to them too and give
them guidance on sometimes people, seniors have a
tough time picking their healthcare proxy and they're
like, they don't want to show one over
the other.
But one of the things we've gathered along
the way as far as helping them guide
that, it's almost like, hopefully they understand football
(32:04):
because I think it's a great analogy.
But if you think of it this way,
who would you want to be your quarterback
where there's a stressful situation and who is
going to make the decisions that you would
want made for yourself in a time of
stress?
Who can stay level-headed and make the
(32:24):
decision the way you would want it made
for yourself?
And try to go- Not impose their
own priorities.
Yeah.
Yeah.
Challenging stuff, right?
Well, you guys come back again.
This was really good.
We could probably dig into some particular circumstances
(32:46):
and elaborate on the kind of planning that
could be benefited from.
Found this really worthwhile.
And let's tell everyone a little bit more
about how to reach you if they have
interest or need to do some planning of
this sort, or to get an assessment for
a family member or their own kind of
assistance with their care planning.
(33:06):
Share a little bit about how you can
be reached.
Sure.
You can always call us at 508-737
-4277, or you can go to our website
at www.back9nurses.com.
It's all spelled out B-A-C-K
-N-I-N-E, nurses.com.
(33:29):
Excellent.
I'll put that website in the show notes.
So if people are listening, they can just
directly click the notes in the show.
Wonderful.
Thank you.
All right.
Thanks for being with us and hope everyone
got something out of this.
The bottom line is you've got to be
planning for these kinds of challenges.
Plan or not, they may occur.
And if you're not prepared, better to have
(33:51):
some planning in place than to be in
a moment of crisis that inevitably may arise
for many people.
So start early.
All right.
Thank you both for being here.
Thank you so much for having us.
Okay.
Until next time, everybody keeps striving for something
more.
(34:54):
Transcribed by https://otter.ai Any
financial decisions.
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