Episode 68: How Should We Care? Navigating Elder Care with Carrie Crawley, Part 1

00;00;09;03 – 00;01;35;04
Kelly Parbs
Caring for aging loved ones is one of the most meaningful, and often one of the most challenging roles any of us will take on. It raises questions about health, independence, finances, and how to balance caregiving with the rest of life. And while every family’s journey looks different, the need for support and good information is universal. I’m Kelly Parbs. I’m a licensed clinical social worker, and I’ve spent my career helping people navigate change, care for loved ones and find strength in their community. My guest today is Carrie Crawley, an elder care specialist who has dedicated her work to helping families prepare for and manage the realities of aging. Carrie brings both professional expertise and heartfelt understanding to this conversation, offering guidance on how to support older adults with dignity while also caring for yourself along the way. Today we’ll talk about the practical decisions, emotional challenges, and unexpected gifts of the elder care journey. These conversations matter because elder care isn’t just about logistics. It’s about compassion, connection, and finding ways to walk alongside those we love. Please welcome Carrie Crawley. Hello, Carrie! And thank you so much for joining me today!

00;01;35;06 – 00;01;37;24
Carrie Crawley
Thank you Kelly, it’s my pleasure to be here.

00;01;37;26 – 00;01;49;14
Kelly Parbs
So you’ve described yourself as being a born caregiver. Can you take us back and tell us what what does that mean for you personally?

00;01;49;16 – 00;02;51;18
Carrie Crawley
Kelly, I’ve never met anyone who ever said they wanted to grow up to be a caregiver for their family. But, at age four, my younger brother was born prematurely with multiple disabilities. And my big sister task was to watch him, to allow my mom to tend to daily tasks, such as getting a shower for herself and preparing food for the family. So I started taking care of my little brother at age four. By five, I was feeding him and helping to change him. By ten, I was helping to care for an aging grandmother. Caregiver/caregiving responsibilities have never really stopped for me as my family aged and now my husband is a disabled veteran who is aging prematurely.

00;02;51;21 – 00;03;01;02
Kelly Parbs
So really, your whole life, it sounds like you’ve been in in roles, whether or not you chose those roles of being a caregiver.

00;03;01;04 – 00;03;40;09
Carrie Crawley
At some point, I did choose the role. You have to understand your relationship with the people in your life, and who the best person in your family might be to take on the role of primary caregiver. And in my family, it is me and I. I love that role. And feel very fulfilled in being able to support and make life better for every generation of my family.

00;03;40;12 – 00;03;55;14
Kelly Parbs
What a blessing to them. When you were at that age, Carrie, where you’re thinking about college and what you’re doing for a living. Am I right in understanding that that you didn’t start in in behavioral health or caregiving?

00;03;55;16 – 00;04;50;23
Carrie Crawley
I didn’t. I went to school. I think, like a lot of 18 year old girls, I went into marketing. I was looking forward to a career in fashion marketing. But, I was not happy in marketing, in the fashion industry and eventually went to work for a company, that was doing real estate marketing. So from there, I was hired by a company who built and managed assisted living and senior living properties. And that’s where I fell in love with working with seniors.

00;04;50;25 – 00;04;57;18
Kelly Parbs
There’s the connection from marketing to working with seniors. What was that transition like for you?

00;04;57;20 – 00;05;46;05
Carrie Crawley
A light bulb coming on. I know you’ve heard that expression before, but started working with families in their elder family members who needed to transition out of the big three bedroom, two bath home, into something where their life could be supported by things like housekeeping and transportation to medical appointments and that sort of thing. And that’s what senior living does. So meeting those people, understanding their needs, learning about their life story, their preferences for how they age, it, it became, a passion for me to help them achieve those goals.

00;05;46;07 – 00;06;12;01
Kelly Parbs
Excellent. You’ve mentioned, Carrie, that your work has always been supported by a team, and I think that’s interesting. I’d like to hear more about that. You told me you work with legal experts and financial advisors and geriatricians, mental health professionals. Why is a team approach so important when it comes to elder care? And can you just tell us a little more about that?

00;06;12;03 – 00;08;38;12
Carrie Crawley
Well, our lives are very complex, and there are segmentable areas of life that need quite often some expertise. Starting with attorneys, elder law, attorneys can help an aging adult prepare for times when they may not be able to call their own shots, where they’re going to need to tap into personal resources, family resources. Who’s going to be responsible for managing your health care? Who’s going to be responsible for paying the bills if you’re not able to do that and making a plan for the future. And that’s one of the things that elder law attorneys do. They’re not just about planning the estate, which is formed after you’re the end of your life, but how to live successfully and well supported until that time. So an elder law attorney I quite often turn to because I am not a financial or legal expert. So I let the experts handle that. Setting up, a good plan for how you’re going to transition. Includes a lot of financial decisions that need to be made fairly early on. How are you going to pay for the care that you need? And the answer to that question is as varied as each and every individual. Everyone has their own ideas about how they want to age, but not necessarily how they’re going to pay for that. And so bringing in a financial planner to help answer those questions and help them to achieve their vision of what aging looks like, is a key component of what we do.

00;08;38;15 – 00;09;36;00
Kelly Parbs
And I just want to be transparent here. I turned to you, Carrie, as as a resource specialist with Empathia. When I had questions about, these kinds of things with a family member, and you recommended I speak with an elder care attorney, which is not something I would have thought of. And through the employee assistance program, which I know not everyone has access to, but many people have access through their organizations. I was able to speak no cost, no cost at all to me with an elder care attorney who went through paperwork that we had, including health and financial power of attorney paperwork, and pointed out what we could do differently or do better. And I paid nothing for that service. So that was such valuable information that you shared with me that I would not have understood that I even had that resource or ability to do so. I thank you for that.

00;09;36;02 – 00;10;24;23
Carrie Crawley
Many elder law attorneys, even if you do not have an EAP, and have that benefit available to you through your employer, will do a 30 minute consultation, at no charge, answer some basic questions. They’re not going to do any planning during that 30 minutes, because it’s a much more complex process. But at least they can help you identify areas that may need to be clarified and codified. So, I suggest that anyone who is doing long term care planning speak with an elder law attorney who can help them navigate that.

00;10;24;26 – 00;11;06;01
Kelly Parbs
It sure was a great resource for me, and I know that a lot of caregivers really feel isolated. And I love your message, which is no one has to do this alone. We want people to feel the relief of being able to lean on professionals. And, and the broader community. So thank you for that, Carrie. When people hear elder care, I think they often think about very old people. But the clients you work with cover a wide range. Can you paint a picture for us of the type of callers that that you get for the services that you provide?

00;11;06;03 – 00;11;44;02
Carrie Crawley
I work with caregivers. A caregiver or a care partner is any person who is providing assistance to another person with the activities of daily living, so that covers the full spectrum of ages and relationships. Most caregivers are family members, but a caring video of her can also be a friend or a neighbor, or even a person appointed through a legal process to ensure the safety and well-being of an aging or disabled adult.

00;11;44;04 – 00;11;52;18
Kelly Parbs
What’s something that people might be surprised to learn about in terms of who counts as a caregiver?

00;11;52;20 – 00;12;37;21
Carrie Crawley
Care comes in many forms. If an adult is unable to manage any aspect of daily living without assistance, the person who provides that assistance becomes a caregiver or a care partner. An older adult may only need somebody to oversee their medical care, or someone to ensure that the bills get paid every month. The person that assists them with these routine activities is a caregiver, even though they may not even interact on a daily basis. Many older adults, they may have a team of care partners who have varying responsibilities.

00;12;37;24 – 00;14;01;25
Kelly Parbs
So certainly you don’t have to live with the person that you’re helping to be considered a caregiver. And if you’re listening right now, think about your own situation. Are you helping someone with rides to appointments? Checking in with meals or managing medication? If so, you might be a caregiver. And even if you haven’t been calling yourself one, and I think it’s important to make that distinction and name it. Because the next step then is taking care of yourself as a caregiver to avoid burnout. I’m thinking about a podcast that I did with psychotherapist Philip Chard. It was on the topic of compassion fatigue. It was one of the earlier episodes, maybe 3 or 4. And in that podcast, Phil quoted an author, and this really stuck with me. Her name was Doctor Rachel Naomi Remen and she’s the author of a book called Kitchen Table Wisdom. And she says the idea that we can be immersed in the daily suffering of someone and not be touched by it is as unrealistic as thinking we can walk through water and not get wet. So my point here is, if you are a caregiver, think about yourself in that way so that you can care for yourself accordingly.

00;14;01;27 – 00;15;15;15
Carrie Crawley
Absolutely. So a caregiver is a big job. It takes you outside of yourself and places you in a position of responsibilities that you may or may not have volunteered for, but find yourself in because of that compassion that you speak of. And what we want to do is always, live to and guide caregivers to the support systems that are readily available. There are many different avenues to get that support, whether it’s online support groups, discussion groups through your local area Agency on Aging that have educators in almost every community that can help you in that caregiving role by doing, if nothing else, saying, I hear you. I’ve been there. Let’s talk about it.

00;15;15;17 – 00;15;51;16
Kelly Parbs
And one of the things that we know about resilience and people who are resilient is that they know their resources and they use those resources. So I’m so glad that we’re talking about this today. I think one of the real challenges that families face is financial. I think that money is often one of the big first worries that families have. Can you tell us what are some of the misconceptions that you see around paying for elder care?

00;15;51;19 – 00;18;09;25
Carrie Crawley
There are a couple of things. First of all, there are a lot of people who feel that Medicare is going to help pay for ongoing elder care or daily care, and it really does not. Medicare is 65 and over, or those with disabilities pays for medical care. So hospitalization seeing your doctor’s that’s medical care. And in some cases various therapies like physical therapy and occupational therapy are paid for by medical care because they are provided by medical professionals that when it comes to daily care, someone to help you with meals and transportation and getting to those medical appointments that is not paid for by medical care. If you needed to move into assisted living or you needed a caregiver in your home that is not paid for by Medicare. So we have to look for alternative sources of funding to help pay for that, whether it’s your own savings, long term care insurance policies, moving into a care facility, or even for those who do not have any resources. Looking to state programs such as Medicaid to help pay for the care that you need. But there are a lot of options out here. And I think that and this is a topic I will harp on a lot. Preplanning, knowing what those options are in advance so that you can understand how to best utilize your resources to age as well and as comfortably as possible.

00;18;09;28 – 00;18;20;24
Kelly Parbs
How does someone get started with preplanning? That all seems to make sense, but if one of our listeners today is saying I need to do that, what would a first step be?

00;18;20;26 – 00;21;17;09
Carrie Crawley
It depends on when you start your planning. I quite often and in my my own practice, I recommend that people start planning at age 50. At age 50, most adults are at a place in their lives where they’re looking at the second half of their career. They’re looking at a career change. They’re looking at new horizons. They’ve got a lot of life in the rearview mirror at that point. So it’s time to make a plan. And plan includes elder care, but it also includes how to live your best life. And I think some of the best advice I ever got from an elder law attorney when I was talking to him about my own aging life. I said to him, so when do you think I should retire? And he said, I don’t think you should retire. And I said, but there’s things I want to do. And he said. Is and it was really an eye opening experience for me. I had always wanted to live on the coast. I love the beach. I love the water and I love warm weather, warm winters. So, I said about after that conversation with him, and of course, we were working on other long term plans at the same time. But I started working on a plan to move to the beach. We none of us know what is in the future. And the last person I had in my family to care for at that time was my mother. And I went to her, and I said, mom, want to move to the beach? She said, oh, that sounds like fun. You know, at 91, I picked her up and moved her to the beach, and we had so much fun being on the coast. And I have never for a moment regretted making that move, even though I felt like it’s something that I should do. Am I am I taking my mom into consideration? Can I be a caregiver and also pursue my own dreams? And the answer is yes. Yes you can.

00;21;17;11 – 00;21;30;07
Kelly Parbs
That’s a great reminder, Kerry. And and thank you for telling us that preplanning also means figuring out how to live your your best life and maybe review that bucket list. I love that.

00;21;30;10 – 00;21;55;02
Carrie Crawley
Exactly. Being a caregiver can be life enhancing, where a lot of people think about it as being limiting and it it doesn’t need to be. You just have to think creatively and get a team of good, short people around you that can help you, figure out how to do it.

00;21;55;04 – 00;22;09;14
Kelly Parbs
So again, I want to go back to the question maybe, maybe our listener is that person who’s in their 50s, like you mentioned, and they want to start the pre-planning. What might step one be for them?

00;22;09;17 – 00;22;12;13
Carrie Crawley
I think it’s the financial planner.

00;22;12;16 – 00;22;14;04
Kelly Parbs
A financial planner.

00;22;14;06 – 00;22;59;10
Carrie Crawley
Right. Certified financial planner I typically only recommend based financial planners who are a fiduciary. In other words, they have a legal responsibility to act in your best interest. Most of them do not sell products like insurance or annuities in order to make a living. They make their living advising people and have no personal stake in it. So, I would not recommend, even though your stockbroker may be very financially savvy. They may not be the right person to help you do that. Long term planning be great.

00;22;59;11 – 00;23;08;25
Kelly Parbs
So if someone is starting there, what exactly would they put into their their search on the internet for what they’re looking for?

00;23;08;27 – 00;24;09;02
Carrie Crawley
Certified financial planner they’re excellent association of certified financial planners that has an extensive list on their website. Financial planners, you just go in and type in your zip code and read about what each one of them does. Find a good match. I would talk to 2 or 3. You need somebody that you feel very comfortable talking to. You also want to make sure that they’re asking the right questions of you, to help understand how they can best help you achieve your goals. So if they’re if it’s somebody that’s too busy, telling you about how great they are and, not asking you about how great you are, I think you may have the wrong person.

00;24;09;05 – 00;24;22;03
Kelly Parbs
Good advice. Are there community based financial workshops or nonprofit programs that can help families get started with these conversations? And and again, how do people find those.

00;24;22;06 – 00;25;27;21
Carrie Crawley
Your local ADRC or aging agency is going to be a great starting point. Aging and disability resources are in every county in the country. Some of the agencies may serve multiple counties in less populated areas, but there is one that serves your area. They have workshops. They have specialists that can refer you to professionals in the area, and they also administer many of their own programs. So I think that’s the best place to start. I have met, a number of financial planners at places like libraries that may sponsor workshops. And of course, AARP is a good resource as well.

00;25;27;23 – 00;25;55;27
Kelly Parbs
So reach out to your local Department of Aging as a great start. And by the way, if your local library doesn’t have programs like this, certainly most libraries look to the community for suggestions. So be a great advocate and go to the library and say, hey, I really think we could use, some type of workshop put on by the Department of Aging, and they might just do that for you.

00;25;55;29 – 00;26;46;18
Carrie Crawley
That’s a great idea. Kelly, I, I particularly like the ones that, AARP sponsor know, the library can bring in AARP, who has their own list of people that they use. And, I think one of the first they do in a series is on social Security. And when do you take Social Security? So, that’s a big one to start out with because for so many people, there’s Social Security is the basis. If not the entirety of their retirement income.

00;26;46;21 – 00;26;51;14
Kelly Parbs
So think about that before you have to make that decision years in advance.

00;26;51;16 – 00;26;53;10
Carrie Crawley
Correct.

00;26;53;12 – 00;26;59;22
Kelly Parbs
Are there any surprising sources of funding that people don’t know about?

00;26;59;24 – 00;29;40;15
Carrie Crawley
There are a lot of surprising places. And I think of many people do not know, particularly with the cohort that we’re working with now. The ones who have moved into what we call the oldest old, these are people who are in their late 80s up all the way up into 100 and beyond. At this point. And that is the benefits. Veterans who served prior to 9/11 have one set of benefits, and veterans who served after 9/11 has a different set of benefits. They have different needs. They fought in different kinds of conflicts. And but the cohort that we’re dealing with now, they are mostly Vietnam veterans. And this is the the group we’re working with. And they have a very extensive list of VA benefits that they can tap into. That will either pay them money if they have a disability that’s traceable back to their time in the service, or, just to save money. They have lots of different things, including health care that these veterans and their surviving spouses are entitled to, that will save you money. Health care being one of the biggest expenses in retirement. I think it’s important to look into what is available through VA that can be done by contacting your local veteran service officer. And once again, like aging services, there is a veteran service officer available to you in every county. So just type in your county and state and veteran service officer. And you should find a person that serves your area. They can educate you. They can help you file for benefits. They can explain benefit options to you.

00;29;40;18 – 00;30;04;17
Kelly Parbs
And again that’s advice that you gave me. That turned out to be very, very helpful. And, and in my area anyway, the officer got back to me within a couple of days and shared with me resources that I didn’t know about. So certainly I second that idea of reaching out if your loved one or you are a veteran.

00;30;04;20 – 00;32;27;17
Carrie Crawley
Another unexpected, I believe, sources of resources for a lot of people that they don’t think about is the equity in their home. And, that’s not for everybody to tap into the equity in their home. But in many circumstances, you’ve got, a little pot of gold sitting there and, and older folks think, well, I want to leave it to my kids. I want to leave my home to my children. Generally speaking, by the time adult children would inherit that piece of property, they already established their own homes. They probably don’t need that family home either. It’s not located in the area where they need or want to be. Or like I said, they’re they’re already established. And so think about using the equity in the home to pay for your care. So the extent of care doesn’t fall to your children. Your home is your asset and it could be liquidated in whole or in part. And find an alternative living situation that may better support your needs. Like, something without stairs or something much smaller. Since you no longer need three bedrooms. Maybe 1 or 2 bedrooms will do. And, find something that will accommodate aging in place, where as the bathrooms are big enough to get a walker into in the event that you need that, showers, that you don’t have to step into a tub to get in and out, which is a huge fall risk. Handholds that are firm places that are well lit and convenient to all of the outside resources that you need. Getting to the grocery store or getting to your doctor’s office. Close proximity to your family.

00;32;27;19 – 00;32;50;09
Kelly Parbs
And really using that equity for your care is a way of loving your family, even though it might not be what you had in mind to be able to give them the money from from your home or give them the home. You’re loving them by giving them that confidence that you are being cared for, and that you are safe. And that might be more of a gift to them than inheriting that house.

00;32;50;13 – 00;32;54;18
Carrie Crawley
Absolutely.

00;32;54;21 – 00;33;13;25
Kelly Parbs
So, Carrie, I think a lot of times, about people who are starting this process, and I think it starts when they see their loved one having cognitive decline. Can we talk a little bit about what that looks like and what some of those early signs are that we should be paying attention to?

00;33;13;27 – 00;37;38;03
Carrie Crawley
Well, first of all, there’s a lot of fear based around cognitive decline because a lot of people immediately think, oh my gosh, this is Alzheimer’s disease in me. And that’s really scary. But the truth is, as our bodies are aging, our brains are aging. There’s an absence don’t fire as quickly. But the way I like to describe it in, in layman’s terms is you’ve lived a very long life. And if you think of your brain as being a filing cabinet of every experience you have had in your life. Sometimes after a period of time, that filing cabinet gets full and maybe things were misfiled. So it takes a little bit longer to access information to be able to put a name with a face, to remember where you put your car keys. This is not necessarily dementia. It is a brain slowing in a natural aging process that as a simple conversation with your primary care physician, they can do a simple cognitive test. Usually you’re going to do it anyway at about age 65 when you go on Medicare, because it’s part of the Medicare profile. But they’re going to ask a series of questions, and they can gauge, by the way you respond to those questions, whether or not you are having any cognitive issues, and then test periodically over time. Because if it is a slow decline in cognitive processing, it may very well just be normal aging. But when you see things like behavioral disturbances being unable to complete tasks, if you see personality changes, someone who has always been very even keeled and all of a sudden they are having depression symptoms, losing interest in the world around them, not caring about themselves, not caring that they no longer look good or not caring about engaging in family activities, going to, things that they’ve always enjoyed. Then I think it’s really time to have a deeper conversation with your primary care physician. And maybe do some neurological testing. The other thing that they can do is behavioral health testing, because older people quite frequently have a level of depression that doesn’t look like we think of depression. When we think about depression, we think about, oh, they’re sad, they’re withdrawn. They’re not engaging, in life. And that’s true. Those are symptoms of depression. But in older people it might look different. They have become very resilient through life, and they know how to hide depression.

00;37;38;06 – 00;37;40;21
Kelly Parbs
They kind of know the right things to say or do. So that’s.

00;37;40;21 – 00;37;41;13
Carrie Crawley
Exactly.

00;37;41;18 – 00;37;42;10
Kelly Parbs
-Caught.

00;37;42;12 – 00;38;17;26
Carrie Crawley
So it’s not obvious. And that’s- that’s a skill that we all to a certain extent, I think, learn over a lifetime. But depression is the elderly can look quite different and it can mimic dementia. So I think at that point it’s very important to, again, talk to your primary care physician and ask for a referral to behavioral

00;38;17;26 – 00;38;20;04
Kelly Parbs
health- a behavioral health specialist.

00;38;20;04 – 00;39;00;02
Carrie Crawley
A behavioral health specialist who will then continue to do testing and may determine that you need to see a neurologist if it is related to brain dis ease, then a neurologist can test and take a look at the brain through very sophisticated imaging and determine if there is an organic cause of what you’re seeing.

00;39;00;04 – 00;39;31;08
Kelly Parbs
So again, know your resources and don’t try to do this alone. Stay tuned for part two of my conversation with Carrie Crawley on navigating the challenges and opportunities of elder care. To hear that episode and other episodes of OnTopic with Empathia, visit our website, www.Empathia.com. Follow us on social media @Empathia, and subscribe to OnTopic with Empathia so you don’t miss an episode. I’m Kelly Parbs – Thanks for listening!