Lois Sonstegard:

Hi everybody. Welcome to Building My Legacy podcast. Today I am so excited to have with us Merrily Orsini. She is President and CEO of …

Merrily Orsini:

corecubed.

Lois Sonstegard:

corecubed. I can’t read, I don’t have my glasses on. [crosstalk 00:00:23]. corecubed. And what fascinated about Merrily is … I was fascinated by her resume before, but as we begin to look at how are we going to come out of dealing with the coronavirus, what’s its impact going to be on our systems and our thought process about how we need to care for one another, how we need to plan for that care. Merrily has some wonderful wisdom to share with us. And so let me just give you a little bit about her background because it’s very rich and you need to know the perspective that she brings to this discussion so that you can really think about it.

Lois Sonstegard:

So here’s her background. She is President and CEO of corecubed As I mentioned. She’s considered a thought leader in healthcare at home industry and is involved in numerous organizations providing insight and advice, especially regarding home care and at-home care.

Lois Sonstegard:

Merrily is leader in the Help Choose Home Initiative and podcast creator and host of where she focuses on educating how when to choose home care or healthcare at home. She has won the Lifetime Achievement in Business Award at the 2017 Stevie Awards for Women in Business, so congratulations on that.

Merrily Orsini:

Thank you.

Lois Sonstegard:

Her business ownership began with a geriatric care managed in-home care agency adventure that garnered her prestigious Ernst and Young Entrepreneur of the Year Award in 1996. So you are very accomplished. She is the past Chair of the Private Duty Home Care Association of America, and has served on the boards of the National Association for Home Care and Hospice Care and the National Association of Geriatric Care Managers.

Lois Sonstegard:

So Merrily, that is your background. Anything you want that hasn’t been said that you think is important, just about who you are as a person. And then I want to get into our podcast.

Merrily Orsini:

I think the other interesting thing is that I’ve also been involved in technology. My first job in 1969 was as a computer programmer and systems analyst, and obviously because I’m an extrovert, I got out of that. But what that left me with was an understanding of technology. And so when I started corecubed in 1998, we started it as a virtual business. So all of this work from home, be remote, work collaboratively is not new to me. I’ve actually been doing that and have a successful business now with employees all over the country. And we are totally remote. We have not had a brick and mortar business. So that’s the other interesting thing, which would not in a normal time be interesting, but right now it’s in high demand, because everyone’s trying to figure out how to do it.

Lois Sonstegard:

You know, isn’t that the truth? Every everything is shifting, isn’t it? We have no standing ground. It is all in movement. So that brings, and right now, legacy, we talk about what’s our future, what’s life like, what’s it going to be, how are we going to contribute, what’s the end of life, how do we plan for that. Leaders, that is part of what people look to us for. And we’re thinking about it ourselves because that’s our lives. We’re looking at who is it we will be as life ends and what is it we’re going to give back?

Lois Sonstegard:

So you have spent a lot of time thinking about and talking about how are we going to care for those who have chronic illnesses. We have a lot of people with chronic illnesses, whether it’s immune systems, diabetes, chronic heart disease, the list goes on. Right? How do we deal with them in the coming world and then also our aging population? [crosstalk 00:04:33].

Merrily Orsini:

That is a huge question. I will tell you how I used to start. I used to do aging 2030, or healthcare 2030 presentations around the country where I talked about the demographics and talked about the health of our country and talked about what can we do now to get ready for the future. And this is not funny today, but I will tell you, I used to start my presentations by saying, if we don’t have a global pandemic, we’re going to have a huge aging problem. So as you know, now we’re in a global pandemic, so that statement that I used when I started those talks is not really so entertaining anymore. It’s more realistic.

Merrily Orsini:

The numbers of people that we have in this society, actually it’s global. Some countries, Italy, as you know what’s happening today, is suffering from an increased rate of death, and a lot of it in older people. But it’s around the world. I mean, because of our fabulous healthcare systems, we’re living longer. So this move to how do we provide care for people, I think will be, I shouldn’t say helped by this pandemic right now, but what I mean by that is the technology that has to be applied now will help us.

Merrily Orsini:

There will have to be triages of what types of procedures do we do. For instance, when someone is at end of life or close to end of life, what types of invasive procedures does one agree to, and is quality of life a question that should be brought up at that time? Or do we just continue to, as Dr. Timothy Ihrig says, do we continue to do things to people or will we work with people to find out how they want to live?

Merrily Orsini:

And what I’m hoping is that this timeout we’re having right now, which is really making us all stay at home, look to our own resources, strengthen our own community ties and our own family ties, I’m hoping that that will help. The other thing I see happening is a more realistic approach to how are we going to deal with aging in America, because right now, home care always been the redheaded stepchild. And I can say that because before I was gray, I used to have red hair.

Merrily Orsini:

So home care has always been that stepchild, but right now what’s happening is it is becoming the care place of choice for people. And because that’s happening, some of the stringent regulations that were put into place to prevent things like telehealth being used or simple video conferencing being used, some of those things, those are being relaxed now. Some of the stringent regulations about geographic boundaries are being relaxed. So if I live in Kansas City, Kansas, can I also serve someone in Kansas City, Missouri, or Louisville, Kentucky, Jeffersonville, Indiana? So you have geographic boundaries that have also stopped.

Merrily Orsini:

So I really think that when we come out of this pandemic, we will have created some better understanding of what is available with healthcare at home and how can we better use that in our system.

Lois Sonstegard:

So when you talk about home care, there are so many pieces at home for elderly people. Right? There are many pieces that go into that. What are the pieces? What are the services? What are the systems that you need to think about bringing together to really make it work so the children don’t sit at home fretting over how are mom and dad?

Merrily Orsini:

I always say start with a geriatric care manager. And the Geriatric Care Manager Organization, they’ve changed their name. They’re now the Aging Life Care Professionals. But I recommend you start with a geriatric care manager. As you know from our prior discussion, I have a master’s in social work and I have been a geriatric care manager. Actually I was a geriatric care manager before we even had a name for it. I didn’t know that I was doing it. But what a geriatric care manager does or an aging life care professional is really assesses a situation for a family, because if you’ve taken care of an 85 year old person, then that’s your experience. No one ages alike, no one has health issues alike. So you can’t take your one experience and extrapolate that into how you’re going to care for everybody else, because you might have physical limitations, you might have mental limitations, there are financial considerations, there are family support or neighborhood support situations.

Merrily Orsini:

So there’s a lot of moving parts that come together to make sense of where should you age and should it be aging in place in your home, because as you become more frail, as one becomes more frail, one is going to need more support. Unless you die in your sleep, you’re probably going to get in a situation where you’re going to need some kind of help.

Merrily Orsini:

So there’s not a universal one size fits all way to do this. Financing it is probably one of the most crucial barriers and obstacles, because right now there is very little support for aging in place or staying at home that is funded by someone. You either have to be very wealthy and be able to afford home care that you’re paying for out-of-pocket, or there is a whole structure of community-based services if you have no resources. The Medicare programs do have a very good support system that will allow people to stay at home.

Merrily Orsini:

But those people in the middle are going to have a harder time doing it. So those people in the middle are the ones that really need the geriatric care managers because they need to know, can I stay in place? What is that going to cost? How are we going to fund that? How can we put together resources? And lots of community resources. There’s Meals on Wheels, there are all different kinds of other delivery and help programs. So there’s lots of programs out there, but you have to know how to get to them, how to access them, and when they’re appropriate.

Lois Sonstegard:

So the care manager puts all those services together, manages them. Who manages all of the disparate pieces?

Merrily Orsini:

Well, the care manager can guide you along the way. Now, the care manager cost is an out-of-pocket cost. That’s not reimbursed. Medicare advantage is paying for some of that now and starting to pay for some services that are the nonmedical services at home. But, the care manager is the one that could do that. Or oftentimes there’s a family member, usually the oldest daughter. I hate to say that, but that’s usually who it is, that can come in and also tackle that and work in conjunction with the care manager to make sure everything is working together.

Merrily Orsini:

And as you know, my background is heavy into organizations that support the healthcare at home industry, which means I’m supporting businesses that provide the care, not individuals who decide they want to provide care and are working as independent contractors. I think that’s a very dangerous model, although it seems to be what a lot of people are comfortable with, but it’s a dangerous model.

Lois Sonstegard:

So are we growing businesses that are getting involved in this, or what’s happening in that arena right now?

Merrily Orsini:

There is a huge influx of businesses, in not only the nonmedical in-home care industry, and there’s a National Association, the Home Care Association of America, and also I’ve mentioned the National Association for Home Care and Hospice. And both of those, the Home Care Association of America just deals with the private pay industry. There are lots of franchises now out there that provide this nonmedical longterm care, and that industry is continuing to grow. And because my business, corecubed supports that particular industry, we are seeing that growth, and as the population ages that growth is continuing.

Merrily Orsini:

There’s also growth in the home health model, which is funded by Medicare and is for skilled services. And that also would include hospice. So there’s hospice funding, there’s home health funding, that’s through the federal government, and those businesses are actually consolidating at this point. We have a lot of venture capital money or large investors who see, because of the aging population, they’re going to need health care. And so a lot of those businesses are growing. But where you see that growth is in the big businesses getting bigger.

Lois Sonstegard:

You know what’s interesting Merrily is there’s a juxtaposition going on right now. We have a growing number of aging people, boomers, who are healthy. They have been exercising, they don’t have heart disease, they don’t have high blood pressure, their weight is under control, they continue to exercise, they’re vital. The interesting thing is in that group, I was just reading some research that people with incomes around 200,000 or so, in that neighborhood, 75% of them are now starting businesses at the age of 65 or 70.

Lois Sonstegard:

So part of what I also see is a beginning, a new thinking that we’re going to have to have. People who are already there is one thing. But then you have this other group who’s vital and not consuming yet, but someday they will have to consume. Everybody will have to consume something at some some point. Right?

Merrily Orsini:

Right.

Lois Sonstegard:

And so it’s how do we begin having those discussions? And what do you say about that? How do families go about that? How do you structure those discussions, especially if somebody is healthy at the moment?

Merrily Orsini:

Right. I’m going to fall back to Dr. Timothy Ihrig, who is a palliative care physician and has been leading a charge nationally for a long time, to get people to start talking about how is it you want to live. And to me that’s a very important question. And if you answer that question, how do you want to live, then that will answer all the other questions about how do you want to die or how do you want the end of life to be.

Merrily Orsini:

And that’s one of the things I’ve been striving with my own family, my own friends, to try to get people to talk about it. What Dr. Ihrig also says is that as a physician, he was taught that death was a failure. So if someone dies, you failed. And he says what we need to be thinking about is that we start dying from the day we’re born. So we literally are born and we’re going to die, and everyone’s going to do it. So it’s not something that we should be so taboo in our society that we don’t bring it up.

Merrily Orsini:

And I hate to say this, but we’re at the very beginning of this flattening the curve, and we are seeing increased deaths around the country. So as people close to us are dying and will be dying, that conversation is going to have to come to the forefront more, so that we are each thinking about how do we want to live. And if you start thinking about how you want to live, that’s probably also why more people are starting businesses and why more people are exercising.

Merrily Orsini:

I live in the mountains of Western North Carolina, and since we’ve had this embargo of staying at home, I live literally out my back door is Pisgah National Forest. And so I go out and forest breathe every day, and I’m now seeing lots of families out forest breathing, hiking, biking, getting outside and exercising, keeping our social distance from each other. We move over when someone’s coming down the path. But, I think that that conversation of how do you want to live is something we should all be doing today, and start today by adding in those things that are not fulfilled in life, social interaction.

Merrily Orsini:

For instance, I’m an extrovert. On the Myers Briggs scale, I’m as far E as you can get, which means I get my energy from people. And although I’ve worked remotely for 22 years, what I’m finding is, I worked remotely, but then I had a lot of social activity after that workday. I don’t have that anymore. So I’m working hard on building a community that will allow me to continue to have that social interaction that I need, but at a distance, at a safe distance, and virtually.

Lois Sonstegard:

You know, when you’re at home, that becomes an issue, doesn’t it? Because now people do need that interaction. And I look at some of my elderly friends, and they’re holed up in their condos or apartments. They’re well, they take care of themselves, but there is a loneliness that I’m beginning to see emerge. And what we think of as being lots of interaction, as you get older and isolated and fear sets in, a lot of interaction by our definition isn’t enough interaction by their definition. And so that’s been a fascinating thing to observe and to realize, there’s a whole lot of systems pieces that you need to think about.

Merrily Orsini:

Yes. I saw an interesting thing. I belong to an art organization, and one of my friends who lives in Scottsdale posted on Facebook yesterday, some pictures of her baking with her granddaughter on Facebook. So they were baking together, sharing that experience, but she’s in Scottsdale and I don’t know where her granddaughter is, but in somewhere around the world.

Merrily Orsini:

But I’m seeing more of those things. I’m having a meeting actually this afternoon with this arts organization. I’ve reached out to the entire membership. We’ve got about 600 members. And have said, let’s talk about our arts community. Because right now the galleries, the artists, all of the people who normally see people and show their work are totally isolated and they can’t do that. So, I’m reaching out to this group of 600 people that’s all over the world to say, what can you in your own community do to keep this community? How can you share? How can you interact? How can you promote individual artists or art? Because creativity is one of those things that as we’re isolated, we still need to have. So it’s an important component of keeping us upbeat and positive, I think.

Lois Sonstegard:

It surely is. And I look at that beautiful quilt behind you, and we do. You know, one of the things that always has uplifted people, you look at from Middle Ages, you look at art from that period of time, have always looked at something that we behold as beauty to uplift our spirits somehow. And so that creativity, innovation. And I think how we respond, how we decide, how we choose to live, as you say, really impacts that ability to continue to create.

Lois Sonstegard:

We’re almost out of time Merrily, and I’m sad to say that, but before we leave for this interview, what I’d like you to just share is, as you look at things that need to be done systematically for us to really work with this issue of what are we going to do with our elderly population, how do we serve them to their maximum life quality, what would you suggest? What would you say to leaders who want to think those thoughts and perhaps have the ability to do something about it?

Merrily Orsini:

Well, number one, I would say that age is not the relevant factor. It is frailty or disease state. So I think we have done a disservice to ourselves by setting a retirement age, because 65, when that retirement age was set, that retirement age was set because the average life expectancy at the time was 62. I don’t know if you know that, but Bismarck was the one, they went back to Bismarck and that was the age that was beyond when people lived. So that’s how they set the retirement age. And at 65, people might still have 30 more years of active work. So I think rethinking how we think of aging, rethinking ways to use older people who still have contributions to make. So, that would be my first thing.

Merrily Orsini:

My second thing would be to actually … I mean, I hate to say this, but from my social work days, we need a national assessment. What is it that’s important to people? We have our laws and the acts that are taken by the few people that represent us in Congress. They’re not connected to the people in terms of what it is we as a society needs.

Merrily Orsini:

So I just think we really need to step back and do a good assessment of where are we in the healthcare system and try to move forward. That’s been difficult because we have lobbyists and we have special interest groups, and a lot of the policies that we’ve put into place are antiquated and absolutely have nothing to do with what we need to do as a nation, which is figure out a way to take care of our elderly population, keep them engaged in society and in productivity, and use them in the best ways that we possibly can.

Lois Sonstegard:

I think one of the points that you make, and it’s one that we’re going to have to have an increasing discussion on is separating functionality from age, because we’ve had one discussion, and its age. Right?

Merrily Orsini:

Right.

Lois Sonstegard:

And it’s many-faceted. And so we’re going to have to begin to separate. So we know what to do.

Merrily Orsini:

Right. Well, it’s been a pleasure talking with you. This has been fun. I’m so glad you’re doing this.

Lois Sonstegard:

Thank you so much Merrily, and thank you for all of you who have listened. If you would like to get a hold of Merrily, you have questions, just email me and I will be glad to make those connections if that’s okay with you, Merrily.

Merrily Orsini:

That’s fine.

Lois Sonstegard:

I should ask you ahead of time. But I think this is the beginning of many such discussions we must have, and so thank you so much for your time, and thank you everybody for listening.

Merrily Orsini:

Thank you. It was a pleasure.