Episode 10: How to Start the Senior Care Conversation
Episode 10
Guest: Mikelle Rappaport
Special Contributor: Bob Stanton
How to Start the Senior Care Conversation
In this real and relatable episode, Jill explores the often-avoided topic of senior living and long-term care. She’s joined by senior care consultant Mikelle Rappaport, who breaks down the various types of senior living and care options and how to plan for them—both practically and financially. Jill also speaks with Bob Stanton, who shares the journey of moving his wife of 54 years into a skilled nursing facility. Together, they unpack the real challenges families face when navigating aging, caregiving, and the difficult decisions that arise at their intersection.
What We Discuss
What long-term care really means and what types of care are available
Understanding ADLs (Activities of Daily Living) and IADLs (Instrumental ADLs)
Common misconceptions about family caregiving and what's realistically sustainable
How Medicare, Medicaid, VA benefits, and long-term care insurance factor into paying for care
What different types of senior living facilities offer, from independent living to skilled nursing
When it’s time to consider a higher level of care—and how to make peace with that choice
Resources and Links
Golden Lifestyle Partners – Learn more about Mikelle’s services: goldenlifestylepartners.com
Contact Mikelle directly at: mikelle@goldenlifestylepartners.com
VA Aid & Attendance Info: U.S. Department of Veterans Affairs – Aid and Attendance
Masonic Care Community: Skilled Nursing Care
Questions and Suggestions? Email Jill at Jill@DeathReadiness.com.
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Bob Stanton: (00:00)
And the thing that triggered her for the nursing home, for the skilled nursing facility, was the fact that she started to get sores and stuff, and UTIs [oh] and at that point, I said, “this is getting beyond us.” Then she spit out her medicine.
You know, I talked to the HASCA nurse, and I said, “I think we've gone as far as we can go. We can't do it anymore.” It's just, I don't think we were helping her, and the UTIs, and the sores, and everything else was just—we weren't doing the job. We couldn't do the job. So that's when I decided we had to go for a nursing home.
Intro: (00:37)
Welcome to The Death Readiness Podcast. I'm Jill Mastroianni, an attorney with more than a decade of practical experience in trusts and estates, here to demystify the complexities of planning for the inevitable. This podcast is your guide to navigating estate planning and end of life preparation with clarity, compassion, and empowerment. Let’s spark the conversation, shift perspectives, and explore how to embrace death readiness together, courageously and thoughtfully.
Jill Mastroianni: (01:07)
Welcome back to The Death Readiness Podcast. I'm your host, Jill Mastroianni. In this episode, we're focusing on something many of us avoid thinking about until it's right in front of us: senior living and senior care.
What does it really mean to plan for how and where we'll live as we age? What kinds of care might we need? And how can we start having these conversations before a crisis forces our hand?
To help answer those questions, I'm speaking with Mikelle Rappaport, the founder of Golden Lifestyle Partners. Mikelle is a senior care consultant who helps families navigate the maze of care options—from in-home help to assisted living to skilled nursing.
She started her career as a social worker in a local nursing and rehab facility, and later became a licensed nursing home administrator. Mikelle has managed both skilled nursing and rehabilitation centers, as well as assisted living communities.
(02:12) You'll also hear from Bob Stanton, a family friend who recently made the difficult decision to move his wife of 54 years into a skilled nursing facility.
Bob's story is so important because it offers an honest, heartfelt look at the emotional and physical toll of caregiving—and the financial realities of full-time care in a skilled nursing facility.
Bob's experience helps us better understand not just the logistics of senior care, but the love, loss, and resilience that shape these decisions.
This episode is important for each one of us—whether you're decades away from needing care, in the thick of decision-making with a loved one, or just beginning to wonder how to navigate what's ahead.
(02:58) As with every episode of The Death Readiness Podcast, my goal is to educate, empower, and remind us how important it is to stay connected—especially when it's hard. There's plenty in this world that divides us, but there's very much a need for compassion and meaningful connection.
We'll dedicate a future episode entirely to the experience of family caregivers and how we can better support those who carry that responsibility. Caregiving can be profoundly isolating, and too often, our instinct is to pull away—unsure of what to say or how to help.
Whether you're close to a caregiver or someone receiving care, when your first impulse is to step back, consider what it might look like to lean closer instead.
Now, let's turn to my conversation with Mikelle Rappaport.
Jill: (03:55)
Hi, Mikelle. Thank you very much for joining us today.
Mikelle Rappaport: (03:59)
Yes, hi Jillian. Thank you so much for having me. I'm excited to be here.
Jill: (04:03)
Great. Well, I really am at a very basic level in terms of understanding the types of care that we might need as we age. So, I know that you, being a Senior Care Consultant, there is a lot of information that you know and a lot of very specific information that you can impart to us.
But what I was hoping is for people who are like me and don't really have experience in this area, that we might start just understanding some basic terms, basic forms of financial support and sort of a general understanding of how senior care operates.
Does that work?
Mikelle: (04:47)
Absolutely.
Jill: (04:48)
Okay, great. The first thing I want to talk about is what I hear a lot of people worry about, but kind of can't get past the worry to action items. And that is long-term care planning. Can you give me an overview of what long-term care is?
Mikelle: (05:09)
Yeah, so long-term care in general is truly providing supportive care to an individual who is 65 or older, generally speaking.
Jill: (05:23)
What would you call a type of supportive care? What might that include? What are examples of supportive care?
Mikelle: (05:32)
Some examples of supportive care might be an informal caregiver in a home, someone who might be wanting to remain in their home as long as possible. So, they may engage the assistance of a family member or an outside private caregiver through an agency to assist them with Activities of Daily Living.
So, as we age, we may have changes in physical mobility which requires some assistance with bathing, dressing, toileting needs, and mobility.
Jill: (6:09)
So, what you just mentioned, and if you don't mind repeating those again for me.
Mikelle: (06:16)
Sure. So, the Activities of Daily Living, or sometimes the medical industry or the long-term care industry will refer to them as ADLs. So, Activities of Daily Living include bathing, dressing, toileting, and mobility. There are other Activities of Daily Living that are actually referred to as Instrumental Activities of Daily Living where someone may just need assistance with meal planning, shopping—it could be transportation because they're no longer driving. So, someone may be coming in intermittently to provide assistance with those IADLs.
Jill: (06:59)
Did you say IADLs?
Mikelle: (07:02)
Yes, so IADLs is Instrumental Activities of Daily Living. So those are things that we take for granted. For example, if someone can't drive anymore, that limits them a lot with shopping, being able to get food, to go to and from appointments. However, they may not physically need help with bathing, dressing, toileting, and mobility needs.
So, they may bring in a caregiver to help with those needs. For example, currently my mom no longer drives. She's 80 years old. And that limits her being able to come and go as she would like to. And so, she relies on me as a caregiver, if you will, to arrange for transportation to take her to appointments, to go shopping for groceries, for example. To assist her in being as independent as possible.
Jill: (08:03)
You're kind of like Driving Miss Daisy with Morgan Freeman.
Mikelle: (08:08)
(Laughter) With Morgan Freeman—I love that movie.
Jill: (08:10)
Yeah, you're just playing Morgan Freeman and your mom's playing Jessica Tandy.
Mikelle: (08:14)
Right. However, there may be some individuals, too, who have memory loss, but they can still perform certain Activities of Daily Living. Where it becomes more challenging is when someone has physical limitations that require the assistance of another individual for bathing, and dressing, and toileting needs, and mobility.
Jill: (08:35)
So, when you said IADLs, are those different than the bathing, toileting, mobility?
Mikelle: (08:44)
So bathing, dressing, toileting, and mobility needs.
Jill: (08:48)
Okay, and what are the IADLs, the Instrumental ADLs?
Mikelle: (08:52)
Needing assistance with meal planning. It could include assistance with driving, financial management…
Jill: (09:01)
Not providing physical care. [Correct.] Instrumentally, okay, would be not physical care.
Mikelle: (09:05)
If you were to distinguish between the two, IADLs is not requiring hands-on care, whereas your ADLs are requiring the assistance, physical assistance of another individual.
Jill: (09:17)
And the ADLs are four, and those are generally concrete, but it sounds like maybe the IADLs could be a little bit more nuanced as to the type of care that might be needed.
Mikelle: (09:30)
Correct. Because you could be in an independent living community, or in your own home, and not require going into a community that's going to provide more care.
Jill: (09:44)
Do you know what percentage of the population is going to need long-term care in the form of providing ADLs as opposed to someone providing supportive care in an at-home environment?
Mikelle: (10:02)
So, as an individual ages, obviously we've talked about needs changing. Once we hit 65 or older, our needs place us in a very vulnerable situation. So statistically speaking, about 70% of those who are 65 years of age or older are going to be needing some level of assistance.
Jill: (10:34)
…with the Activities of Daily Living.
Mikelle: (10:36)
…with Activities of Daily Living—which may include long-term care assistance.
Jill: (10:42)
Okay, and I think that many people assume that their family is going to take care of them. Is that realistic, in your opinion?
Mikelle: (10:54)
In my opinion, as well as my professional experience, it is not.
Jill: (10:59)
Why is it not realistic?
Mikelle: (11:02)
So not everyone is fit to be a caregiver. Not always are families equipped with the abilities to do that, which is why there's a lot of other resources out there. Families today, more so than yesterday's families, other generations before us, had moms or women who were staying at home caring for the family.
And now, when you look at today's family makeup, you have usually two people working full time.
Jill: (11:37)
Right. Like you said, most families, you've got two people working and often they're working because they need those resources. But I guess the other side is even if there are individuals in your family who are not working full time, who stay at home in some capacity, that doesn't mean that that person is going to be a good caregiver just because they might not otherwise be engaged in earning income.
Mikelle: (12:09)
I think we need to be honest with ourselves, when we assume our responsibilities of taking care of an individual who has the needs that they have, whatever level they may be, and realize that it does take a team, not just one individual, to care for a person who may have hands-on care needs, or may have cognitive impairment.
Jill: (12:37)
Okay. So, now that we have gone through what long-term care is, what might be needed as part of long-term care, and the fact that maybe families are not always going to be equipped to provide that type of care—even though a vast majority of us are going to need this care once we get to older than 65 years of age—I want to move on so that anyone who's feeling panicked right now can see that we're going to educate ourselves, and we're going to learn what options are available, and how we might pay for those options.
So, one thing that has always confused me a little bit are the different ways to pay for care, and what types of care different resources will pay for, or what percentage of care these resources will pay for.
So, if you don't mind, can we walk through the different ways that people might pay for senior care or long-term care and what those different methods are, just so we're aware of the full scope of what might be available? And I would say just starting with Medicare.
Mikelle: (14:02)
Yes, I think it's important to understand all various types of payer sources when it comes to the future of long-term care needs.
Jill: (14:13)
You said payer sources? P-A-Y-E-R?
Mikelle: (14:17)
Payer sources. And so, I think a common myth is that an individual—or I would think a lot of Americans believe—that as we get older, once we turn 65 and get the magic red, white and blue card in the mail from Medicare, that that is going to pay for a lot of things as we grow older.
Jill: (14:47)
What is Medicare? How would you define that?
Mikelle: (14:50)
So, Medicare is a federally funded program. It is funding that will pay for hospital stay, skilled nursing and rehabilitation care, your primary care visits, your doctor's visits, home health care—the short-term needs.
Jill: (15:14)
So, when you said, “skilled care” and “home health care”, you meant to qualify that into short-term, right? Short-term care options.
Mikelle: (15:23)
So, Medicare has a benefit under Medicare Part A—because there is Medicare Part A care, and then there's Medicare Part B care—and depending on which category the services fall under, for example, hospital stay is considered a short-term stay situation. So, that's more of under Part A category [okay]. Skilled nursing and rehab is short-term, and there are certain eligibility and criteria that one has to meet in order to continue to receive coverage under that service.
For long-term care, meaning we've met a certain level and baseline in our abilities to where we don't require the higher level of care, such as a skilled nursing and rehab stay, you transition to long-term care and Medicare does not cover that.
At that point, decisions are made. Are we paying privately? Do we have the means to pay privately for long-term care? Or do we need to explore the need to apply for Medicaid—which is the state funded program.
Jill: (16:50)
Just to back up a second, so I heard you say Medicare Part A, and you described that might be rehab, hospitalization, and short-term skilled nursing. What would Part B cover?
Mikelle: (17:05)
So, Part B is more outpatient services. You're going into a doctor's office and seeing your doctor.
Jill: (17:14)
That's not part of the long-term care? [Correct]. All right, I just wanted to clarify that [Yes].
So, we've just talked about Medicare and the short-term needs that Part A might cover. And Medicare is not going to cover your long-term care needs. So, let's move on to Medicaid. What is it, and what can it provide?
Mikelle: (17:38)
So, Medicaid is your state funded program. So, every state has different criteria and eligibility, although there are some similarities state-to-state, but there are different eligibility and criteria that one would have to meet to qualify.
Jill: (17:59)
And that eligibility criteria, it is based on physical need and financial need. Am I right?
Mikelle: (18:07)
That's correct. [Okay.] So, in the state of Virginia, where we are…
Jill: (18:14)
I'm not there, but you are. (Jill and Mikelle laugh)
Mikelle: (18:16)
So in the state of Virginia, it is a state funded program for individuals—and we're talking specifically for individuals that are seniors in need of long-term care, because there are also programs for children and disabled individuals [correct]—but in the area specifically for someone who needs long-term care, since we're on the topic of long-term care, there are financial criteria that need to be met as well as physical.
So, when we're working with clients—perhaps we're in a short-term stay at a nursing home, and perhaps the initial goal was for them to go home. Let's say, hypothetically, this individual was not able to rehabilitate to their prior level of functioning where it was safe for them to return home—What is the next step here?
Do we need to look at other options where the safest option would be perhaps assisted living? Perhaps the nursing home level of care would meet their needs?
And then the question remains—can I afford to remain in a nursing home at this point? And a lot of individuals don't realize how much nursing homes cost.
Jill: (19:50)
And I do want to get to the cost because that's extremely relevant. But with Medicaid, now we're not going to get into the nuances of eligibility.
But I just wanted to say that if there is a couple and one half of the couple is needing long-term care, but the other spouse—who is often referred to for Medicaid purposes as “the community spouse”—is not needing services, it's not possible to simply move all of your money into the community spouse's name and then cause the other spouse to become financially eligible.
The financial eligibility criteria is based on the eligibility of both individuals in the couple. And there are rules about what the community spouse may retain, and what the spouse needing the care may retain, but these are relatively low amounts. So, I just wanted to say, it's not as if there's a super easy fix for a couple.
Mikelle: (21:00)
Right. And then these circumstances—what we as consultants do is advise you to engage the guidance of an Elder Law Attorney, perhaps, or working with your local Department of Social Services to work through the application process, and to also look at what the legal ways are of protecting the spouse in the community in some way—under the Medicaid guidelines—in order for someone to become, in this case—their spouse to become eligible for Medicaid.
Jill: (21:37)
You're correct. There are attorneys, often referred to as Elder Care or Elder Law Attorneys, that can work with a couple and help you determine whether there is a path to eligibility, or whether you're going to need to look at other options.
Mikelle: (21:57)
Correct.
Jill: (21:58)
Now that we've discussed what Medicare and Medicaid cover, are there any veterans’ benefits that can help pay for some of this care?
Mikelle: (22:06)
So, veterans’ benefits are available to an individual who has served in the military and served during wartime. So, there are also specific eligibility requirements for what's called Aid and Attendance. And we're speaking in terms of long-term care coverage, if you will, or financial support and resources available to those who may have served in the military.
And this often is not a known benefit to individuals who have served in the military. And it could provide some pretty significant amount of support if someone is looking at assisted living or long-term care placement, as well as in-home care, because they also can provide support financially for in-home care as well.
Jill: (23:00)
I'm stepping in to elaborate on benefits that may be available to veterans—specifically through programs called Aid and Attendance and Housebound benefits. These are available to veterans and surviving spouses who already receive a VA pension, and who need a higher level of care due to disability or age.
An individual may qualify for Aid and Attendance if any of the following are true:
You need help with daily activities like bathing, dressing, or feeding yourself
You're bedridden or spend much of the day in bed due to illness
You live in a nursing home because of physical or mental disability
Or your eyesight is severely limited, even with glasses or contacts
There's also something called the Housebound benefit, which is available to veterans who are largely confined to their homes due to a permanent disability.
It's important to know that you cannot receive both Aid and Attendance and Housebound benefits at the same time—it's one or the other. But either one can provide meaningful financial help when you or your family are facing care-related expenses.
Back to my conversation with Mikelle.
Jill: (24:16)
We've discussed Medicare, Medicaid, and veterans’ benefits. Is long-term care insurance another option for paying for care?
Mikelle: (24:25)
So long-term care insurance is an additional insurance that one can buy into, just like an auto insurance, for example. You would pay a premium on a monthly basis, or annually, to plan for the future need of long-term care.
Jill: (24:46)
Okay.
Mikelle: (24:47)
And I would say, if you're looking at long-term care insurance and you're 80 years old, you probably will not qualify.
Jill: (24:58)
When should you be looking for long-term care?
Mikelle: (25:00)
You should be thinking about and exploring the option of long-term care insurance between the age of 50 and 60 years old. Of course, if you're 40, you can certainly explore it. No one's going to say, “no”. However, 50 and 60 is usually the average timeframe individuals are looking at long-term care insurance—we're entering in that second phase of our lives, we're still hopefully relatively healthy, there's no pre-existing conditions that will disqualify you at this point.
As you age and age-related diseases begin to present themselves, that can often disqualify an individual for long-term care insurance.
Jill: (25:49)
What's an example of something, or an illness that might disqualify somebody?
Mikelle: (25:53)
Well, I do know that autoimmune diseases, certain autoimmune diseases, can place someone ineligible. You may have already had a stroke, for example, that has already presented with some physical limitations at that point.
So, when you're working with a long-term care insurance, you certainly want to make sure that you understand what those diagnoses are that may disqualify you.
Jill: (26:23)
Right. And one thing that's helpful—because I know it can be very overwhelming to go through this process, you know, it's kind of like any type of insurance, you know, life insurance, long-term disability insurance—there are lots of questions, there are applications, and there are certain reasons why you might be precluded from getting, you know, life insurance or long-term care insurance, and you can ask your financial advisor—can I get a list of conditions that would prevent me from obtaining this type of coverage?
Mikelle: (26:55)
I always caution families not to Google everything. You want to equip yourself with the professionals that can guide you appropriately.
Jill: (27:06)
Right, and I think that's really important information because it's often hard for one person to try to navigate all the information that they might need. So, having a professional who works in the industry is usually a shortcut to getting information and making sure that information is vetted, which is also another important thing.
Mikelle: (27:29)
100%.
Jill: (27:30)
Mikelle, can you give us some examples of situations in which long-term care would be required?
Mikelle: (27:38)
One of the things that I get asked a lot is, when is it time for an individual to consider long-term care at this point? I am often getting calls that, “I'm not able to do this anymore… I'm overwhelmed... My husband keeps falling all the time... I don't have the support of my family... I'm feeling guilty because I promised them that I would never put them in a nursing home...”
And so, I always validate their feelings because they are honest feelings, they're human feelings, and it's okay to feel that way, because if you are unable to meet their healthcare needs safely, or perhaps it's come to a point that their medical decline is having an impact on their health, it's time to ask the question, what support would I need to feel that my loved one is getting the care they deserve, and I am also able to take care of my own self-care needs as well.
Jill: (29:00)
Yeah, I think that's really important, especially as we age. And if we're married or have a partner that one of us might require care and the other not require care—and I'm sure we all make those promises to each other, that I'm never going to put you in a facility—but your point is really good, that sometimes it's simply unsafe to keep someone at home if you don't have the support you need available.
And I do see that a lot when one spouse is physically incapable of tending to the needs of the other spouse, because you know, we're heavy, and it becomes more difficult to lift people. And then you've got a dangerous situation of bed sores or, you know, it can be very overwhelming and dangerous.
Mikelle: (29:55)
Yes, and as adult children, particularly those that may live long distance, you may be hearing on the phone, “Oh we're fine, everything's good.” You get there Christmas time and you're there a week, and your eyes are opening up to the true situation that's going on.
Jill: (30:18)
I'm pausing the conversation here to share a portion of my separate interview with Bob Stanton, who I mentioned in the introduction to this episode.
Bob and his wife, Eleanor, have been married for 54 years and have three children—one of whom is Pat Stanton, who you'll hear referenced in this conversation.
During COVID, Pat moved back in with his parents while working remotely and ultimately chose to stay, in order to help care for Eleanor as her needs increased.
Eleanor worked as both a math teacher and a registered nurse. Bob spent his career as a Social Security District Manager in upstate New York. They moved into the home where Bob still lives, nearly 20 years ago.
Eleanor lives with Parkinson's disease and dementia. For a long time, Bob and Pat cared for her at home with the support of caregivers from a local agency called HASCA.
But more recently, Bob made the difficult decision to move Eleanor into a skilled nursing facility so she could receive the level of medical care she now requires.
This excerpt of our conversation begins with Bob recalling how Eleanor's primary care doctor had been seeing her every six months—but despite her visible difficulty walking, the doctor never raised any concern.
Here's Bob:
Bob Stanton: (31:40)
Finally, I said, “I'm going in with you, this is ridiculous—he doesn't notice your walking?” And by this time, it was deteriorating a lot more. And she says, “no, he never says anything.” Well, I found out what was happening—it was, they'd weigh her, and they’d put her in the room the doctors have, and he’d breeze in—he never saw her walk! So, I was there with her this one time—he said, “oh you're all set, I'll see you in six months.” I said, “what about her walking?” And he said, “what about her walking?” He never noticed it.
And he said, “stand up and walk.” He goes, “Oh, oh my God, I think you have Parkinson's.” Anyways, the walking continued to decline. And then people started telling me, “You know, she's repeating herself often.” Then I finally paid a little more attention, and I started noticing. And then it just snowballed from there.
You know, every six months there was a further decline. Then she went to a walker. Then she went to a wheelchair. And then, I got some people that come in from this agency around here, three times a week and help me.
Jill: (32:44)
Is it HASCA?
Bob: (32:45)
HASCA, yes. So, they came in and they would help us out. But again, her condition declined further. She started getting combative. She was difficult. She was always angry. So, time went on and we used to—my son, Pat and I, and the HASCA person—just to get her in the shower was a struggle.
And the thing that triggered her for the nursing home, for the skilled nursing facility, was the fact that she started to get sores and stuff, and UTIs [oh] and at that point, I said, “this is getting beyond us.” Then she spit out her medicine.
You know, I talked to the HASCA nurse, and I said, “I think we've gone as far as we can go. We can't do it anymore.” It's just, I don't think we were helping her, and the UTIs, and the sores, and everything else was just—we weren't doing the job. We couldn't do the job. So that's when I decided we had to go for a nursing home.
Jill: (33:42)
Was Ellie a combative person prior?
Bob: (33:46)
She's the exact opposite. She’s very mellow and laid back, shy, and she never was combative at all. I'm kind of argumentative—she never argued with me or nothing. She's a very laid-back person.
Jill: (34:01)
Now back to my conversation with Mikelle.
So, let's say that a decision is made to move to a senior living facility. Can you explain the different levels of care that an individual might receive at different types of senior living facilities?
Mikelle: (34:16)
Yes, so I like to think of the different or varying levels of community living as a staircase. [Okay.] So, let's think that the bottom of the staircase is your independent living situation. You are looking to be more in a maintenance-free environment.
Say I'm at home, we're getting older, we don't want to have to worry about the maintenance around the house. Perhaps the home we live in is too big for us and we want to downsize. Independent living may be an option because it does offer that maintenance-free living situation.
You have an apartment-style living setting among peers that are the same age. And they offer, in addition to an apartment, meals—they may have a meal plan—because oftentimes independent living, you have a full-size kitchen. However, you may want to not have to prepare your meals as often. So, there is a meal plan.
Then you also have assistance with your housekeeping as well as transportation is available. So, I think I remember referring to those IADLs. [Mm hmm.] That is…
Jill: (35:45)
The Instrumental ADLs.
Mikelle: (35:46)
The Instrumental Activities of Daily Living. [Right.] Those needs can be met in an independent living situation. [Okay.] Not having to worry about meal planning, going to the grocery store, all of that is in one setting, in one environment.
Jill: (36:03)
Are independent living facilities, are they often part of what we call CCRCs—Continuing Care Retirement Community—or is that something different? I'm trying to get an understanding of what's available for somebody who wants to be able to stay within the same facility as perhaps their care needs increase.
Mikelle: (36:28)
Yes, all great questions that because there's so many options out there can be quite confusing and overwhelming.
Jill: (36:36)
I feel overwhelmed just talking to you.
Mikelle: (36:37)
And all of these options, like the whole spectrum of care that we have is overwhelming. I like to think of it as two different buckets. So, you have your Community Care Retirement Communities…
Jill: (36:53)
Okay. Also known as CCRCs.
Mikelle: (36:56)
Yes, often known as CCRCs—which are residential communities that provide a range of housing options. They have one campus that's meeting the needs of aging adults. Right?
And you also have all of these other independent living communities, standalones, also assisted livings. And then you have a combination of assisted livings and memory care. And then you also have a nursing home and skilled nursing facility.
Jill: (37:29)
So, if we're talking about Ted Danson in A Man on the Inside, which is a new Netflix show, where was he? Was he at a CCRC?
Mikelle: (37:39)
He was at, from what I recall, what they call a retirement community. So, it's not really specified within the show, however, it appears to me that…
Jill: (37:54)
They did have memory care.
Mikelle: (37:55)
…he had been in a community that had all three. So, when you think of retirement community, that's a very broad reference to long-term care. So, retirement community could include all three levels: independent living, assisted living, and memory care.
Community Care Retirement Communities are also independent living, assisted living, memory care—but they may also include a nursing facility. We here, locally, have three different Continuing Care Retirement Communities that offer all of those levels of care.
You have the Continuing Care Retirement Community option where you buy into the community, with a lump sum. You certainly want to enter a community like that when you are on the younger end of the spectrum to get the full advantage of the community and the amenities that you're looking for.
Or, perhaps the better option in this circumstance, based on your financial resources, would be to look at this other bucket, where you're doing a lease option, month-to-month situation, and you still have the levels of care, the varying levels of care, if you need them over time. [Sure.]
We want to age in place. We don't want to have to move again if we don't need.
Jill: (39:25)
So, what might that cost to move into, let's say, an independent living? What might be your monthly lease, just a range—or maybe just one that you recently looked at?
Mikelle: (39:38)
You know, every community is a bit different. The monthly fees will vary on the size of apartment. If you're looking at a studio…
Jill: (39:46)
Let's say a studio. We want a studio, in a nice place (chuckles). What are we looking at?
Mikelle: (39:52)
So here in the Hampton Roads area, I'm going to put a range in there based on the affordable—and again, affordable is based on what you think affordable is—but I would say a low range studio without any assistance, no care levels, would be about $3,500…
Jill: (40:18)
…a month. And then let's say, you end up needing assisted living. How much might that increase your monthly rent?
Mikelle: (40:29)
So, in assisted living, again, you have to think about size apartment. If we're talking studio [studio], without any level of care, again, could be $3,500 to $4,500 a month—here in Virginia.
Jill: (40:45)
For the assisted? So, it might only be another $1,000 a month for the assisted element of it?
Mikelle: (40:51)
And keep in mind, that's just the rent for the apartment. And then your rent and the room and board.
Jill: (40:58)
Oh yes, thank you, because I did not understand that. So that's why it's about the same as the independent. Now, how much am I going to have to pay for the actual care in the assisted living?
Mikelle: (41:10)
So that will vary community to community. And I do also make sure the families that I'm working with understand that a level of care at one community may be defined differently at another. So, if let's say, Community A has different levels 1 – 5, [mm hmm] Community B may have levels 1 – 9.
Jill: (41:36)
Oh boy.
Mikelle: (41:38)
So, more the reason to have an individual, a Senior Living Advisor or a Senior Care Consultant, like myself, to help vet the communities beforehand, making sure that their financial resources can afford the community. So, we've narrowed that.
Jill: (41:56)
Yeah, that's so helpful. Once you know how much you're going to be able to spend, you can get rid of a lot of options, right?
Mikelle: (42:06)
You can.
Jill: (42:07)
Most likely.
Mikelle: (42:08)
Most likely. I mean, we work with families—we look at the care needs first. Then we look at finances. And then we narrow down—okay, are we looking at memory care here? Are we looking at assisted living?
The level of care will also have a range depending on the individual communities. They use an assessment tool. It could be points related. It could be more defined on how much assistance they need with those activities—bathing, dressing, toileting, and mobility.
Jill: (42:43)
Can you help us understand the difference between assisted living and a nursing home in terms of the level of care provided?
Mikelle: (42:51)
Assistant livings are what I call ‘yesterday's nursing homes’. They are social model. They're going to really focus on the psychosocial needs of an individual. However, they're also providing medical care.
Each state also has prohibited conditions that will not allow an individual to go into assisted living because of the level of nursing support.
So, some assisted livings may only have Medication Aides that are trained, as well as your CNAs or Nursing Assistants, plus an LPN. Whereas a nursing home has round-the-clock Nursing Assistants, Licensed Practical Nurses or LPNs, and Registered Nurses that can manage a certain level of medical need—scope of practice.
Jill: (43:52)
So, the nursing home care is the highest level of care?
Mikelle: (43:58)
It could be tube feedings. There are some more complex levels and services, such as ventilators. So, you can see why there is a separate community for those in assisted living and then those that require more long-term high-level acuity care. And that's your long-term care.
Jill: (44:25)
As Mikelle just explained, the kind of care provided in a skilled nursing facility goes well beyond help with daily tasks—it can include everything from wound care to tube feedings and other complex medical needs.
To give a more personal view of what the transition to a skilled nursing facility can look like, I want to return now to my conversation with Bob Stanton.
In this next excerpt, Bob shares how he chose a facility for Eleanor and what it's been like for both him and Eleanor since the transition.
He also talks openly about the emotional impact of this shift—including the loneliness of coming home alone, and the comforts that remain, like bringing their dog to visit Eleanor at the facility.
Here's Bob.
Jill: (45:16)
When you decided that she needed better care, what did you do? How did you figure out where she might go, and how did you start that process?
Bob: (45:25)
Well for social security, I had contacts. I also have a cousin that's an administrator of another good-sized nursing home in the same area. I was aware of what they were like. I had been in most of them. And by far, where she is now is the best of all the ones that I visited. And their reputation is...
So, I didn't do a whole lot of research as far as, you know, going out. I did visit a couple of nursing homes.
But again, from the very beginning, I thought I would put her in—it’s called The Masonic. Have you ever heard of it?
Jill: (45:57)
No, I've not.
Bob: (45:59)
It’s a big place. It's a big campus. They have a heart research lab and a national one, too. It's sponsored by the Masons. One time it was only for the Masons, but in recent years they got Medicaid people in there, like that. And so, they got everybody in there. So, it's a beautiful place, very good care, and I decided it would be the best place to go.
Jill: (46:23)
Was there a spot available for Eleanor, or did you have to wait?
Bob: (46:27)
There must have been because I called up and she got in right away. They came up and do the evaluation the next day and that was it. So, I don't know exactly how I got in, or how she got in, but she did get in immediately, within days, and I'm very satisfied with them, too.
Jill: (46:42)
How are you paying for the skilled nursing care?
Bob: (46:46)
I'm paying cash… uh cash (chuckles). I'm paying out of my pocket.
I think this is kind of interesting. I'm paying $11,600 a month. It's very expensive, but that's about average. The other ones weren't much different. And I think all over the country, that's about average, maybe a little lower.
That's $11,600. I've looked it up, and the Medicaid reimbursement rate for most of those people in there—I believe are on Medicaid—and it's $7,000. So, I'm thinking I'm not only paying my share, but I'm also paying up-and-up the other ones, because if they've charged me $11,600, and they're only getting $7,000 for the rest, they're making it up. [Right.] With my pay.
I can't get on Medicaid, I have too much money. So that's out. [Right.] And I can't get partial help either. So, I've got to pay $11,600. Which I can do, but it's a lot of money. It cuts into my activities a little bit, though (chuckles).
Jill: (47:42)
Sure.
Bob: (47:43)
But, what are you going to do. It's a good thing and I can do it. So, I'm doing it.
Jill: (47:48)
Well, she's very fortunate that you're doing it. I'm sure she would have done the same.
Bob: (47:53)
Well, and the people on Medicaid, they don't know they're on Medicaid. They get the same level of care, which is good. That's fair. They can't afford it, or they've run out of money.
Most of the people in her unit are in their 90s. She's one of the young ones there. They're up there. I think there's one that's 100.
And the thing I don't like, Jillian, is that they got all the dementia people in one unit and they're kind of, they’re isolated. They don't do as much with them. That's the only negative.
I think I understand that they go shopping, they go out to dinner, they do things for the rest of the facility... They got several units of these dementia people, but then they got the majority of the people are elderly, that's all. And they got their wheelchairs and what have you. But they do take them out, they got all these buses.
These people never go out. They have music and I go down there when they have music, and I take her down to see the performers. But the other people, if they don't have a family or company that comes in, they don't get to go anywhere, because they don't have enough help to push the wheelchairs down to this place to watch them, you know, perform.
So, I do feel sorry for the dementia people because they just don't do much with them.
Jill: (49:01)
How was it moving Eleanor into the nursing home? Was she aware?
Bob: (49:08)
It was no problem.
Jill: (49:09)
It was not a problem, for her?
Bob: (49:11)
Not at all. It was strange. You know I thought of that. It bothered me, a lot. But the day came, and I asked the people to help us pack, and we put her in the car and drove her down, and the doctor came, and that was that. So right on, it was—she was there.
She hasn't asked to go home much at all. I don't know if that's part of the disease or what, but once in a while she’ll say, “we'll go home now.” And I say, “no, no, you stay here.” And I always tell her, “Once you start walking…” which she never will… “you can come home with me, but you gotta walk first.”
And I also tell her every time I say, “I'll see you tomorrow.” But I don't go every day. I go almost every day. But I always say, “I'll see you tomorrow.” And she doesn't know if I'm there every day or every 10 days (trails off).
Jill: (49:54)
But she still knows who you are?
Bob: (49:56)
She knows me. She does. Pat went with me yesterday and she said, “there's my baby,” or something like that to Pat. So, she knows who Pat is.
And you know, I tease her and stuff like that, but there's not much conversation anymore. You know, very little. And she can't finish her sentences. I notice that lately, you know. It’s a steady decline. It's probably more drastic than I realize, you know.
She's like twisted too... She's rigid. That's the word I mean… She's rigid. She can never walk at all. And she's kind of twisted in the wheelchair. There's a couple others like that. I guess your bones freeze up. I don't know what the medical reason for that is, but they get rigid.
Jill: (50:39)
Does she sleep in her bed though? They get her into the bed?
Bob: (50:42)
Yes, they do. They use that Hoyer lift. [Okay.] They pick them right up out of the bed and put them in a wheelchair. They use it constantly for all the patients in there, so.
They have, not for Eleanor, but they have those, like they do prisoners, they get ankle bracelets on them, so they don't escape. [Oh, okay.] They'd wander off.
And they take good care of them. The only knock I have is, like I say, they don't do any activities. [Right.] Part of it is, you know, they're not really ‘with it’, either.
Jill: (51:10)
How far of a drive is it for you to go visit her?
Bob: (51:13)
It’s 60 miles one way (chuckles).
Jill: (51:15)
Do you go on your own usually?
Bob: (51:17)
Most times, yeah. I have, people go with me sometimes, you know, somebody calls me up to see if I'm going down to see Eleanor, yeah, and they'll ride along with me. But 90 % of the time it's just me, I go down.
And I buy her donuts or something. She likes sweets, so I buy her sweets.
She eats pretty good. And if I feed her, it's better than with, you know, because they're trying to feed three or four of them. So, you gotta spend time and feed them. They'll eat more.
Jill: (51:45)
Do you think she's developed more of a taste for sweets since her dementia?
Bob: (51:49)
Yeah, it's funny you say that. I didn't think of it, but she has.
Jill: (51:52)
Yeah, I noticed that with my mother also. [Yeah?] That she developed more of a taste for sweets.
Bob: (51:59)
You know, milkshakes and kinds of things you wouldn't want to, you know, it's not healthy for you. But when you're in that state—not a lot I can bring her and that's what, you know, as long as she eats it, that's important.
It's a terrible disease. It really is.
Jill: (52:14)
It is. And did you feel a little bit unprepared [yeah] to go down this path? Because I know that it can be very isolating, too.
Bob: (52:25)
Yes, yes. I never expected this. I guess I was married 54 years. You know, we always did everything together and we had a good time, and that's all gone. I come home alone. It bothers me. It really does. It really does.
But that's life. I never expected her to, you know, she's actually a very smart person, very smart. But that doesn't matter with this disease. It doesn't make… you could be the brightest person in the world, and you get some form of dementia. It's kind of a haul.
But I go down every other day just about—every day, actually. I've been starting to go more because I get down there and I see her sitting there in the wheelchair. I feel so bad.
And she can't use a phone. That's the other thing. If I could call her, I would like this. Or just a phone call you know. But you can't call her… How you feeling? What you doing? You don't have that. You have to be there.
And it's depressing too because everybody, you know, she's surrounded by the same people… everything’s ground up. They got health problems, and they all got dementia. And it's kind of a depressing day down there, I'll tell you that. It's not fun.
Jill: (53:40)
They don't let dogs into the facility, do they?
Bob: (53:43)
Yes, they do. I take the dog down (laughs).
Jill: (53:44)
You take the dog down—oh that's so great.
Bob: (53:47)
Not every time because he's kind of crazy, but he's (chuckles), he comes down and she likes that. The other patients, some of them don't like him, but most of the patients want to pet him and they ask the same questions every time.
It's just like a Groundhog Day down there, because they say the same exact thing every day. I'm going there almost a year now. It's the same thing. The same people, know what they're going to say.
Jill: (54:14)
But it's also the same new joy that they're experiencing.
Bob: (54:18)
Probably, yeah.
Jill: (54:19)
It's not, “oh this old dog”. It's a new dog for the first time.
Bob: (54:24)
Yeah, a lot of dogs go in. They give you a little tag, you have to show the fact that he's got his shots and all that, make sure he's okay.
Jill: (54:32)
What kind of dog do you have? I saw your dog walk behind you.
Bob: (54:35)
Pomeranian. Where is he? Around here somewhere.
Jill: (54:37)
How old is he?
Bob: (54:38)
He’s two. Two and a half.
Jill: (54:39)
Oh, so he's a relatively new dog.
Bob: (54:42)
He's a puppy. Yeah. The people down there, the staff, the nurses, they're very good. You and I wouldn't, I shouldn’t speak to you, for you, but I couldn't do that. What an awful job that is, all that.
And most of them are minorities and I'm sure there's ethnic slurs, and these older people say things they'd never say in a million years, and they do. I've heard the F-bomb down there and everything else, you know, from these very placid older ladies, you know, there’s a personality change.
There's no appreciation for, they don't say, “thank you for the help.” So, it's a terrible job. So, whatever they pay them, they deserve it. They don't pay them enough. There's not enough of them, either. Like every place else, there's not enough staff.
Jill: (55:27)
Well yeah, that's part of the equation. One, right, is the availability of a spot in the nursing facility and then having enough staff to take care of everyone properly.
Bob: (55:38)
You got whole units closed because there's no staff, there's not enough staff. Rather than take on more patients, they just close the units.
It's a well-run facility, it really is. Like I say, it's a big place, very big. When you come down and see your father, we'll take a ride down and see.
Jill: (55:55)
A summer field trip, I'm always up for that.
Jill: (55:58)
I know that talking about senior care and senior living isn't easy.
It brings up a lot—questions about our future, our loved ones, and how we'll manage the care we may need.
And yes, the financial side can feel like a lot to wrap our heads around.
But it's real. It's present. And it's already a part of the lives of so many people we know and love.
These conversations aren't meant to scare anyone.
They're meant to open a door—to education, to understanding, and to compassion.
And like I mentioned earlier, I'm still learning too.
When my daughter and I visit my dad this summer, I'm planning to take Bob up on his offer to visit Eleanor at the nursing home.
(56:44) I want to better understand this stage of life—not just as a concept, but as an experience. I want to know what it's like, and I want to spend more time with Bob.
Because while we cannot pretend that hard things don't happen to good people like Eleanor, we can celebrate people like Bob—who show up every day with love, commitment, and care, even when it's hard.
And we can also be grateful for people like Mikelle Rappaport, who guides families through these complicated decisions with clarity and heart.
If you want to learn more about Mikelle's work, you can visit her website at goldenlifestylepartners.com or email her directly at mikelle@goldenlifestylepartners.com. Mikelle is M-I-K-E-L-L-E.
You can find this contact information in the show notes.
Before we go, I want to leave you with just a few small steps you can take if this episode sparks something in you:
Identify one supportive service or resource in your area—just to know what's out there.
Have a conversation with a parent or a loved one about what kind of help they'd want if the time ever came—and share what you would want too.
Take a walk through your own home and ask yourself: Could I live here safely with limited mobility?
Remember, the goal isn't to have all the answers.
It's simply to start asking the questions. Because the sooner we do, the more choice—and peace—we can create for ourselves and the people we love.
Thank you again to Mikelle and Bob for sharing so generously today, and thank you for listening.
Disclaimer: (58:40)
Before we wrap up, I want to remind you that while I am an attorney, I'm not your attorney. The Death Readiness Podcast is for educational purposes only and should not be considered legal advice. Use of this information without careful analysis and review by your attorney, CPA, and/or financial advisor may cause serious adverse consequences. I provide no warranty or representation concerning the appropriateness or legal sufficiency of this information as to any individual's tax and related planning. For legal guidance tailored to your unique situation, consult with a licensed attorney in your state. To learn more about the services I offer, you can visit Oversimplyllc.com.
April: (59:30)
Hi, I'm April, Jill's daughter. Thanks for listening to The Death Readiness Podcast. My mom always says that death readiness isn't just about planning. It's about the people you leave behind and the legacy you create for them. We hope today's episode helps you think about how to take care of yourself and your loved ones, now and in the future. If you liked what you heard today, share this episode with someone you care about. Follow our show for free on Apple Podcasts, Spotify, YouTube, or wherever you're listening right now.
