Mark Holly and his late wife, Tina, met when they were in third grade.They dated a little in college while he attended the University of Washington, but their relationship ended prior to him joining the military during the height of the Vietnam war, and it wasn’t until about 10 years later that they reconnected. From 1979 on, they were together, and even when she had to be moved into a memory care unit due to her health, Holly would frequently visit her with a jukebox in tow. It was a hard time, he said. But it was still special to them. Tina struggled with her health for 13 years until she passed away just a few months ago.
Most of us want to imagine our end of life as peaceful, enveloped in love while we’re asleep in the home we created for ourselves — our mental and physical abilities still firmly intact. Unfortunately, life rarely runs that smoothly.
The Hollys initially started planning for end of life when they were in their mid-60s. They’d had a will and testament drafted, but decided to visit one of Rajiv Nagaich’s seminars after hearing him on his radio show Aging Options, an educational platform Nagaich created to help people and families plan for their elder years.
In 2016, the Hollys began working with Nagaich’s team to establish a life plan, one that comes with a library of legal documents that outlined how they wanted to be cared for, who had the power to legally make decisions for them, and how they wanted their bodies handled once they passed.
It sounds fairly simple: Just sign a few documents, and you’re good to go. But the reality ends up being much more complicated.
Nagaich, an elder law attorney who founded Life Point Law and Aging Options, which has several office locations in Western Washington, said he gets two types of clients: those in their late 50s or early 60s who are preplanning for their later years and families who come to him in an emergency state with a loved one who needs
“When families come together, they approach (the conversation) with, ‘How can we make sure this person lives as good a life as possible without us running out of money and without me losing my sanity?’” Nagaich said. “But it never actually happens that way. You spend most of your time putting out fires. You protect their money, and then you get up in the morning and start becoming their caregiver, and then you start to resent that and then you decide this person needs to go to a home.”
Thirty years ago, Nagaich was living in Chicago and rising through the ranks at Allstate Insurance when he met his wife, Jamie, and, subsequently, met his father-in-law, Bill. After moving to Federal Way, Nagaich and his wife visited Bill at a nursing home, and it was the first time Nagaich had ever seen one in person.
“We’re about to leave, and Bill was hanging on to Jamie, thinking she was going to take him home, and she was just bawling,” Nagaich said. “We walked out of there with Bill still stuck there, and for the first time, I walked away thinking to myself, ‘How does the richest country in the world take care of their old people if they can’t take care of themselves?’ We just hide them away. It just didn’t leave me.”
According to AARP, 52 percent of Americans who turn 65 will need some kind of long-term care or services at some point in their lifetime. Having been born in India, where the cultural expectation is to allow your parents to live with you, Nagaich wants to help people safely stay in their homes for as long as possible by ensuring family members have the tools and support they need.
He went to law school and has ultimately revolutionized the way people approach end-of-life care. Obtaining legal documents (power of attorney, will and testament, living will, etc) are a first step, but it’ll hardly get you anywhere, he said. Sure, you’ll have the legal power to make decisions, but when a problem arises, then what do you do?
Life is a continuum, Nagaich said. No matter what age you are, you’ll be impacted by health, housing, finances, and legal issues. If your health starts to fail, it impacts your housing, which impacts your finances, which can trigger the legality of who can help make your decisions, and all the while, your family or friends are stuck in the middle.
With this in mind, Nagaich has established, essentially, a campus of care businesses to help clients with every aspect of their life planning — from social workers to lawyers. It’s difficult to understand the intricacies of elder care until you’re in the thick of it. If you have the power of attorney for someone, there are no guidelines for how to react when that person needs you. If Mom’s health fails, whom do you call? What questions do you ask? What do they need from a financial planner? Do they qualify for Medicare? How do you get Medicare? What should you request from an insurance agent?
This is where Nagaich and his team step in. Nagaich calls it life planning, and his team spends roughly a year with clients understanding the intimate details of how they want themselves and their affairs handled, and then drafting up specific guidelines for their loved ones to follow, all the way down to what nurses to call and questions to ask. If someone is in an emergency state, this process is shortened to about three weeks.
By the time Holly and his wife started drafting their life plan, Tina was already really sick, so gathering and understanding the paperwork was difficult and all-consuming.
“It wasn’t an easy process,” Holly said. “When you’re dealing with a spouse that has significant health issues, your energies are focused on your spouse, and any other energy you have you’re using to focus on the documentation to understand what the meaning is and how (the documents) work as a package.”
Holly just turned 75, and he wished they had started planning when they were in their 40s or 50s.
“We didn’t get immersed into it until our mid- to late- 60s,” he said. “You can do it, but it would have been nicer if people thought it was important to do when you’re younger, because you can always update it. That’s a lot easier than starting from scratch when you’re 70.”
April Sage, founder of Senior Housing Advisory Services entered the elder care industry for similar reasons as Nagaich: She helped their own family members and wanted to provide assistance for others.
Sage, who established her housing services business in August 2019, helped both of her grandmothers at the end of their lives, including transitioning one of them into two care facilities. After working for KeyBank for 16 years, she decided it was time for a career change. She works with clients to decipher the best option for their housing needs, whether they want in-home care or need to be moved to a facility. Occasionally elderly clients approach her for housing services so they can take time picking the best option before it’s truly needed, but most families come to her because of an incident that
requires immediate help — they’ve fallen, had a medical issue, or the house can no longer
Through research and in-person interviews, Sage has vetted care facilities and service providers throughout South King, Pierce, and Thurston counties. Clients of hers undergo a medical evaluation to determine their health status and potential longterm needs, and then Sage meets with her client to understand what’s important to them.
“What I think is very important is finding out what their most important needs are. Aside from the medical and the economics of it, what are non-negotiables or things they must have to be well when they move to a place?” she said. “Must they have their own private room with a bathroom? … Must they have the ability to go outdoors on their own and garden? That will lead me to the best fit for that person based on some of those key items. When needs are met at the deepest level, there is a higher likelihood of happiness and thriving.”
The facilities she contracts with pay her for placements, which allows her to provide these services for free to clients. After clients are moved into their new homes, she visits them several times to ensure they’re happy.
If she could go back in time, she wouldn’t have placed her grandma based on location as one of the main deciding factors. Geography can be a major decision maker for some, but care facilities aren’t a one-size-fits-all. You want to make sure the person can age in place, meaning he or she won’t need to be moved to different facilities if other needs arise.
“When you’re passing, there is no more intimate, deepest time of need — to me,” she said. “Navigating the decision-making and care support and being there prior to that, being there to make them happy or give them joy, visiting them at their facilities, just being there for people, I feel like I’m doing what I was destined to do.”
And though housing, health, and legal affairs are top of mind when people think about aging, there are many more elements that come into play. Think about all the things you do on a regular basis: manage your finances, arrange appointments, hire services, make travel arrangements. Staying organized and on top of all your responsibilities can become impossible as you get older, especially if you’re experiencing memory failure.
Debora Morris and Teresa Harbottle of Evergreen Elder Concierge offer a laundry list of services to help people manage everything from paying bills to planning social affairs. After starting with one client, they realized he had been paying for two Medicare plans for five years. Another was paying for a warranty on a refrigerator she didn’t own anymore. Worse yet, one of their clients lost her home because she was forgetting to pay the property taxes, and then had to leave her apartment because she kept forgetting to pay the rent. She was later diagnosed with dementia.
More often than not, Morris and Harbottle also are brought on after an incident occurs.
“It’s hard for people to come to grips with their situation,” Harbottle said. “It’s very hard for people to talk about end of life. I know it’s frustrating for family members, too. In our state, there’s really nothing between caregiving and full guardianship. There’s no middle step or steppingstone, and that’s kind of what we are.”
Very few companies provide a bill pay or account management service, because it’s considered a liability, which is, in part, why it’s the most sought-after service they offer. Morris and Harbottle aren’t taking over anyone’s financial accounts, but they do ensure bills are being paid on time. They have an active role in many of their clients’ lives, but some people seek them out so that their concierge service is on standby. Morris said for those clients, she’ll call and check in every few months to ensure things are going well, and she’s there if she’s needed.
“We’re not making decisions for people, and we aren’t holding any of their money,” Harbottle said. “We make their lives simple and help them make decisions. Our goal is to ease anxiety and stress. We want future clients to know that you can get help without losing control.”
Morris added: “It doesn’t have to be expensive, either. In a lot of cases, we save our clients money — stopping fraud and insufficient funds — there’s a whole host of things we can do to help clients.”
Over and over again, service providers — including Morris and Harbottle, Sage, and Nagaich — say that prevention planning is key. No one expects emergency situations to occur. Everyone thinks they have plenty of time to get their affairs in order, until something happens and you’re in panic mode trying to stabilize the situation.
As Holly said, doing this planning is doable at 70, but it would have been much easier at 40 or 50.
When talking to Nagaich, his passion was palpable. After all, he’d still be in the insurance business if it hadn’t been for his father-in-law.
“I left my own country to come here, so there must be a purpose and a higher reason for that,” he said. Others have balked as his attempts to rewire the way people approach their elderly years. He’s trying to make a paradigm shift in the way society reacts to people getting older, one law professor told him. But Nagaich said he knows he won’t change the entire industry.
“I care to change the paradigm of one person at a time,” he said.