You need a nurse, here's how to find one with Courtney Hogenson

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You are connected and you are listening to specifically for seniors, the podcast for those in the remember when Generation Today's podcast is available everywhere you listen to podcasts and with video at specifically for seniors YouTube channel. Now, here's your host, Dr. Larry Barsh

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Larry (03:22):

We were curious what services were available for older adults who wanted to remain in their homes, but required more care than a caregiver or aide could provide. So we asked Courtney Hogenson, a registered nurse and patient advocate with more than 10 years of experience in elder care and healthcare worker empowerment to be on the podcast. Courtney is the founder of Call Light and innovative healthcare platform that enables patients and nurses to directly negotiate private in-home care engagements anytime, any place. Welcome to specifically for seniors. Courtney,

Courtney Hogenson (04:11):

Thank you for having me.

Larry (04:14):

I was looking through your qualifications and that introduction really doesn't, doesn't give you credit for a number of things.

Courtney Hogenson (04:25):

Aw,

Larry (04:26):

Thank you. You are a certified nurse. You are a registered nurse rather. Correct. And a certified aging life nurse manager. Correct. What, what is that?

Courtney Hogenson (04:40):

So they used to be called geriatric care managers. So G C M is what they used to call those, but then they changed the name to Aging Life care specialist or nurse, depending on your background. But it's, I'm a member and I'm certified through the Aging Life Care Association, which is like the national you know, board for patient advocates who are care managers.

Larry (05:07):

And you are also an advanced legal nurse consultant?

Courtney Hogenson (05:13):

Yeah. You know, I just found that a lot of cases, you know, they, they, especially attorneys and elder law and estate planning elder abuse cases, they really valued having the nurses input and expertise and translation. And so I thought, well, if I'm gonna do this, I should go ahead and get certified. So I took the time to get certified for that as well.

Larry (05:36):

We have a guest coming on named Diane Diamond, who wrote a book, we're Here to Help When Guardianship goes Wrong About Senior Guardianship. Does that fit into the same picture?

Courtney Hogenson (05:49):

Absolutely. I have guardians and fiduciaries and trustees reach out to me quite a bit because they're in charge of putting together all sorts of teams for their clients.

Larry (06:02):

And do you, you are an official Alzheimer's Association public policy ambassador?

Courtney Hogenson (06:09):

I haven't been as involved as I used to, now that I have a kiddo, but I used to actually go up to Sacramento and participate in, you know, the days when we would get to go and talk about it. And I, I was actually one of the representatives for Adam Schiff's office when I was in Los Angeles mm-hmm. <Affirmative>. And so I would go talk to his team and he was actually a great advocate because he had family history of Alzheimer's. I believe his mom, his dad, maybe even his mother-in-law had it.

Larry (06:40):

How, how did you get interested in elder care management?

Courtney Hogenson (06:44):

<Laugh>? Well, we're all getting older. I think it just goes back into our blood. Like my parents were always the people that took care of people. They took care of their parents. My dad's dad had Alzheimer's and they moved him into our home when I was 15 or 16. And so I just grew up around it. They were always older adults. My grandparents were a bit older. And just, it was very much a part of our life. They were, they were in our home, really. And I think I didn't, I thought I didn't want to be a part of that, but then the universe kept pushing me, you know? Mm-Hmm. <Affirmative>, oh, you're going back to that, you're going back to that. So it's all come full circle and now I'm, you know, trying to take care of everyone else and

Larry (07:34):

Yes, <laugh>. Yeah. I understand. Yeah. Let, let's first talk about advoc advocacy in a hospital with a patient who cannot advocate for themselves. What services can you provide and people you work with provide?

Courtney Hogenson (07:59):

I would say it's so hard to be a patient in the hospital these days. I mean, I used to work in the I C U at U C L A, I was a nurse there. And I would say if you can afford to hire a patient, advocate, someone with healthcare background who understands that language, like a nurse, a social worker, it, it makes sense to hire someone, to be your advocate, who knows all your medications, knows who all your doctors are, is really the expert on you. Because if you think about it, when you're in the hospital, you may have the best team of doctors and nurses on earth, but they don't know you and they don't know your baseline. They don't know what's normal, what's abnormal. But someone, if you have someone in your life that is regularly checking up on you and knows, Hey, something's a little off here you know, they can catch something so much quicker and communicate it in a way that's meaningful to other healthcare practitioners.

Larry (09:02):

I'm most concerned about those patients with with dementia, even early dementia where they can't express their needs. And the hospitals at times seem to leave them alone and don't tend to them very well at all.

Courtney Hogenson (09:22):

Yeah, I mean, I think for anybody being in the hospital, you kind of feel like a prisoner sometimes. They keep you in your room, in your bed for safety reasons. They don't want you to fall. And I find even if you're not cognitively impaired, it's so confusing. You're not getting good sleep, you're being interrupted all the time. So I think what's actually the most dangerous part about adults that have cognitive impairment is you can't, you can't see it in them. They can seem okay. And so I think a lot of times, you know, if you saw a child somewhere and they were alone, you would automatically think that child is missing a parent or an adult. But if you saw a grownup, you can't tell just by looking at them if they're cognitively impaired, if they have aphasia, what have you. So it's much harder to recognize that. And, and some people, frankly, they, they hide that cognitive impairment really well because they're very high functioning or, you know, they're ashamed of it. And so they sometimes will pretend to be okay and mm-hmm. <Affirmative>. Yeah.

Larry (10:35):

And as the aging population increases there can be a time when an older adult, because of cognitive or physical impairment needs help when they're home in day-to-day living. And it becomes stressful for family members to, to help beyond the ability of a pers person to help. What, what can be done?

Courtney Hogenson (11:12):

I, I think you bring up some important issues. I know people say to me, I couldn't do what you do as a nurse or as a patient advocate. And one of the first things I say is, it's not my parent, it's not my family. It's a very different role. When you're hired as a professional, you don't have all that baggage of the lifetime of things and all the family members that have their own version of histories and things. So I would say, I mean, the best thing you can do is just find someone who is an unbiased medical professional who's not in the will, who doesn't have any skin in the game, who, whose main job is to make sure that this older adult or person is happy, healthy, all the things. Because sometimes you end up having people and you don't know what their motives are, and sometimes they're not necessarily looking out for the older adult or the cognitively impaired person. So you just have to be really careful about who you can also choose who's in charge of you. You know, if you have your advanced healthcare directive, you can say, if at some point in time I'm not able to make decisions for myself, put it in writing and have a legal document and make sure, make sure your fam, your family and your friends know where these documents are and what your wishes are. And that's much easier that way.

Larry (12:38):

Okay. As long as you brought it up. Let's explain to the listeners what an advanced care directive really is. How is it set up?

Courtney Hogenson (12:49):

So there's different types of things. In advanced healthcare directive, the part that I work on mostly with patients is what your wishes are, what you would and wouldn't want done in the case of a medical emergency. If your heart were to stop, do you want someone to do everything possible to bring you back? It's even, it even comes down to like, if I needed a feeding tube, do I need it short term or long term? And it's, it's just knowing, having something in writing, specify what your quality of life is, what's most important to you. And 'cause look, for some people, quality of life might just be eating Rocky Road Ice Cream and watching Grey's Anatomy, and that's all I need. But for someone else, if they can't drive a car or they can't walk or they can't do those things, then you really have to weigh, you know, what is quality of life to them.

Courtney Hogenson (13:48):

And you have to look at the advanced healthcare directive. And I think it's, it's important to talk about it because there's so many gray areas when it comes to treatment. And I've seen families end up in the ER and the I C U and they don't know when to stop. They just keep treating and treating and treating. And it's like, does this person want that? Are they likely to recover from it? What are the, you know, you really have to look at the big picture and everyone's different. You may not do the same treatments for a 40 year old that you would for a 90 year old. Mm-Hmm. <affirmative>, you know,

Larry (14:24):

Who, who sets up the advanced care directive?

Courtney Hogenson (14:28):

You know, when I was in nursing school, I had two patients. My first clinical rotations in the I C U two patients who were clinically brain dead they were, they didn't have advanced healthcare directives. And so the families didn't wanna be the person to pull the plug, per se. And so both of these patients were being trached and pegged. They were getting a artificial airway and artificial nutrition and then being shipped off to a skilled nursing facility. So I came home and I googled advanced healthcare directive and I printed it out on the internet and I had my husband sign it, our neighbors sign it, but really, if you want it, so you can do it that easily, but if you really want it done and have the whole package, I would hire an estate planning attorney to have your will, have your advanced healthcare directive, your power attorney, all those things kind of go together.

Larry (15:27):

You mentioned the word peg. Could you explain to the listeners,

Courtney Hogenson (15:32):

Hopefully you never need a peg. It's it's a percutaneously, it's basically a feeding tube that comes out through your stomach. It's a, it's a longer term. They, they're able to do feedings medications, someone who can't swallow. Usually it's, it's, it's much safer to have it go through here than it is to have them aspirate. You know, there's a risk of aspiration for pneumonia, for choking. And so if someone is not able to swallow medications or food or nutrition, they will often get a peg, which is a a gastrointestinal tube. So it goes into your stomach and through your digestion

Larry (16:14):

Rather than a nasogastric tube.

Courtney Hogenson (16:16):

Yeah. You don't, you don't want something going up there for very long. They're usually temporary.

Larry (16:21):

Let's get back to the home care situation. Sure. People come home from the hospital or have a chronic illness and they need someone to take care of them. There are different levels of care from an aide to a nurse.

Courtney Hogenson (16:41):

Yeah.

Larry (16:42):

Can you explain the difference and how someone would make that decision?

Courtney Hogenson (16:50):

I would say, well, I think you bring this up. And I, I found as a nurse in the I C U, I used to think that when my patients went home, that they would have this continuous, you know, care by someone, like a team of people. I thought it was like it was in the hospital. Even if someone is actively dying and qualifies for hospice, home health, all these things, very, very rarely does it ever cover 24 7 continuous care at home of any level. So a lot of that comes out of people's pockets, or if they're fortunate enough to have like long-term care insurance, then sometimes that will be covered. But as far as home health and hospice goes, all you get is like nurse visits, home health aide visits. You don't get that continuous 24 7 care. So that's why there's non-medical home care agencies.

Courtney Hogenson (17:43):

There's a lot of those around today, and that's where someone can hire a companion or they can hire an aide. So that's typically someone who can't do IVs, they can't touch medications, they can't do a lot of these things. And then once you get up to the nurse, like an L V N or an L P N or an rn, then they can start doing IVs. They can administer medications, they can do different skill sets based on their training, based on the board of nursing, wherever they're located. And as long as there's a doctor's order in place, they can do any of that type of care, any, anytime and anywhere really.

Larry (18:25):

So a an will help with bathing, toileting feeding dressing, getting a person in and out of bed. Showering.

Courtney Hogenson (18:40):

Yeah, an aid is really meant for like those activities of daily living, those ADLs. Yeah, like dressing, bathing, clothing, feeding, and then a nurse. I would say anytime that there's a medication or some type of you know, some type of intervention happening that's going into an orifice of some type could be anywhere, that's usually a nurse. And that usually involves a higher level of training and experience because technically and legally AIDS and caregivers should not even be touching medications. They can only remind people to take them.

Larry (19:20):

Right. So it has been historically difficult for someone to find a nurse

Courtney Hogenson (19:34):

<Laugh>. Yeah. I mean, I, I found it very tough as a patient advocate. I would get calls from people and they'd say, we wanna hire a team of nurses like you. And I'd say, well, that's very cost prohibitive. That's very hard to find. You don't know who you're gonna get. And so I would go to these registries or agencies and sometimes they would send me a nurse with a pulse. Maybe it wasn't the right nurse for this case, you know, you didn't get to choose who you have. But with call light my new thing, I really wanted to make it so that people can choose who's coming to their home because it's a very, you know, it's a very intimate environment and you're very vulnerable in your home. And you don't just want anybody coming in there. And I figure if you can choose your doctors, you can choose, you know, your plumbers. Surely you can choose the nurse or the caregiver who's gonna be with you hours and hours at a time. Ongoing.

Larry (20:35):

How did you think of developing a company called Call Light?

Courtney Hogenson (20:41):

Yeah. Well, I mean, I had a non-medical home care agency. So I had families reach out to me to hire aides, companions. And then I transitioned into being a care manager, patient advocate, where I'd be like the patient quarterback. I'm the person who would refill the pill box once a week. I'd go to all the doctor's appointments. And I kept having these clients who said, we want, we don't need a nurse at home, but we want a nurse at home for mom or dad or whoever. Can you help us do that? And so it naturally happened as a patient advocate, I was setting up these teams. And so over time I started to know all these nurses and I started to recognize that with my skillset and my experience, I was really good at putting together these teams of healthcare professionals for people.

Courtney Hogenson (21:34):

But I wanted to do it in a way where it's more affordable, it's more efficient, and it's, it's more accessible to more people. I, I feel like my grandparents could have really benefited from just having a nurse visit once a week. The same nurse, you know, who could come in and triage and check him out and see if he needed to go to the doctor. And, 'cause I feel like most people, if you don't need to be in the ER or the OR, or the I C U, can't you do most of that stuff at home? Can't you have a nurse or a doctor come to you? And so I'm just trying to, you know, fill that need that I know people have been asking for.

Larry (22:15):

Is the need part-time or can be full-time as well?

Courtney Hogenson (22:21):

It can be part-time, it can be full-time, it can be short-term, long-term. Sometimes I find that if someone's being discharged from the hospital or they've had surgery or some sort of acute event like a stroke or a heart attack, they may just need a little bit extra support for like that first week back home, you know, 'cause think of how many things fall through the cracks when someone's being discharged from the hospital. They have this discharge packet that's 20 pages long. Even a healthcare professional isn't gonna read that whole thing. A lot of it's just, you know, garbage. And a lot of times medications, new medications don't get picked up at the pharmacy. And a lot can happen in that first week before you're supposed to go for your post-op visit at your doctor. Mm-Hmm. <Affirmative>. And sometimes people don't even make it to that post-op visit. So if you could hire a nurse or a healthcare professional who can help you navigate and really get you set up at home, it, it, you know, it reduces readmissions, it increases, you know, medication compliance. It just, it really helps people stay at home and have continuity of care and they don't end up back in the hospital if they don't need to be.

Larry (23:35):

Is it available around the country?

Courtney Hogenson (23:39):

I wish it was available all around the country. Right now, call light is in specific areas. We're trying to be very intentional. We wanna make sure we get the tech right because I'm a nurse, I'm not a technical person, so I've had to hire a team to build this. And so right now we're in a couple of areas. We're in California, we're in Phoenix, Arizona, we're in the Nashville, Tennessee area, and we're in West Palm Beach, Florida. So it just kind of depends on the need. To be honest, I didn't plan on starting anywhere in Tennessee, but I had a former client that was moving from Los Angeles to Tennessee and they said, gosh, we heard you're building call light any chance you're doing it in Tennessee? And I said, not yet, but I had to help them, you know, and so I said, if I can build a team of nurses in Franklin, Tennessee, then I can do this anywhere. So really it's just a matter of how much time you have to get these teams in place and, you know, put that together. So I would say if you have like two weeks or more to put a case together, you can, you can set this up almost anywhere if you know what you're doing and how to go through it.

Larry (24:55):

So a bulk of the listeners to this podcast are in Massachusetts, New York, the Northeast. Is it feasible for them to call in or check in at your website?

Courtney Hogenson (25:09):

Absolutely. some of my biggest clients are other care managers and patient advocates and different states who are looking for you know, nurses or different things all around the country. And so I've had a lot of them reach out to me. And that's kind of when we start to have a need in an area. And it kind of takes like a critical mass of nurses. Like, you know, there was this case in Franklin, Tennessee, I posted a job, I needed four to six nurses to fill this whole schedule. I got 50 applicants. About 10 to 20 of them are keepers. Those are the nurses you wanna hang on to. And so now I'm sort of ready if and when someone else needs care in that area. I've got the infrastructure set up. So it really is just a matter of time. If someone needs in Connecticut or New York, they could reach out to me and look, the more time we have, the more notice, the more options you get, the more you know, so it, it's definitely, if there's a need and there's nurses nearby, look, there's almost 4 million nurses in the United States and there's probably a nurse near everyone.

Courtney Hogenson (26:17):

And there just needs to be tools like call light that enables people to connect safely and efficiently and affordably and all the things.

Larry (26:26):

How do you find your nurses?

Courtney Hogenson (26:28):

You know, some of my favorite nurses come from nurses. I have found that great nurses wanna work with other great nurses. So if you say, Hey, do you know any other great nurses that would love to do private duty in home healthcare? Send them to me. And if they end up taking a job, they work a shift, then I send that nurse a thank you. I send her a hundred dollars or him and say thank you, because that's a huge lift for us. We're not getting a, a nurse off a Craigslist. You know, you, I don't recommend that, don't do that. And don't, don't go outside of the hospital at change of shift and look for nice nurses and scrubs. It's not a good way to find people.

Larry (27:12):

What qualifications do you require of your nurses?

Courtney Hogenson (27:15):

So of our nurses we, we basically are like the matchmaker, the vetting. We really are, we make sure that they all have a current license, a clinical license to practice in the state, wherever that patient is. We also make sure that they carry their own malpractice and liability insurance for their own safety and for, you know, protection of clients. We make sure we check at least two or three professional references. 'cause I've found that just because someone's perfect on paper or perfect in an interview doesn't mean they have a good track record or anyone would recommend them. So I find it's very important to get professional references. And then really it's just a matter of making sure, you know, the nurses are staying within their scope of practice. You know, like a nurse practitioner can do things that an L V N cannot. And so every nurse needs to know their scope of practice, what they can and can't do, and just really protect their own license. So we're really doing the vetting. We're, you know, we've done this for so long we can usually tell if, if someone's a good fit. Here's the thing. Sometimes it's a great nurse, but it's not a good fit for that client or that family, that situation. So there's so many factors that are involved.

Larry (28:41):

And of course, what are the costs?

Courtney Hogenson (28:46):

So with my private duty registry that I had more than a year ago, it was acquired. It was quite expensive. You know, there was a 30 to 50% markup, which is what any agency or registry is gonna do. So I found, for example, let's say you were paying the nurses 50 to $75 an hour, just for example, you'd be charging the clients anywhere from 75 to a hundred an hour. And so it really started to add up. And what I'm doing with call light is I'm trying to get rid of all those middlemen that aren't needed and create this tool where it's safe and efficient and all these things for people to negotiate directly with these nurses. Because it comes to a point where you kind of know what the going rate is in a certain area. And the thing is, if a nurse is willing to do it for that rate, that's the rate.

Courtney Hogenson (29:44):

So I've found that if you open it up to the nurses and you say, Hey, what's your, what's your desired rate, hourly rate or whatever they'll tell you, and they'll usually give you a range. Like, oh, if it's a 12 hour shift, I'm gonna charge you a little bit less. If you're just having me drive over there all the way across town, I could have taken another job. I'm gonna charge a little bit more for a visit. If it's a long-term case, it's generally, you know, more affordable, they'll come down in pricing. So it just, we help guide people, but really it's up to the nurses. They kind of make their own rates and then the clients say, this is what I can pay, this is what I want to pay, this is what I can afford to pay. And we just try to match them up together so that it works.

Larry (30:32):

Is it covered by Medicare or insurance?

Courtney Hogenson (30:35):

I wish. I wish, no, and that's the, that's one of the things that I found so disheartening when I left the I C U is I thought these things would be covered and they're just not. I have seen a couple of cases where someone has really fantastic long-term care insurance or really fantastic health insurance where, you know, they just have this policy that's like unheard of that would cover these types of things, but it's very rare. So that's why we're trying to make it more affordable because most people are paying out of their pocket for this type of stuff.

Larry (31:12):

I want you to give us the u r l of your website.

Courtney Hogenson (31:20):

Sure. It's, it's pretty easy. It's, I named it call light because I feel like when you're in a hospital or you know, you need a nurse or you need someone to help you push the button and then, you know, a nurse will come answer the call light. So we're called call light, it's www.calllight.com.

Larry (31:43):

Callen light.com.

Courtney Hogenson (31:45):

Perfect. Yep. Great.

Larry (31:47):

Anything we missed that you'd like to cover? No,

Courtney Hogenson (31:51):

I, I think, you know, it's just, it's something I, it's an idea that's been on my heart for six, almost seven years. That's how old my son is. And I just remember thinking, you can hire a driver, you can hire a babysitter, you can hire all these people. Why can't we do that with nurses? And at the time, I had a newborn, so I thought, well, somebody else will come up with this. And I just don't trust anyone else other than a nurse and a patient advocate to do this in a way where nurses won't get exploited, patients and families won't get exploited. I just feel like it had to be done by someone sort of with my training and expertise and experience to do it the right way and really advocate for patients, nurses, and families.

Larry (32:43):

That brings up a good point. Advocacy is, is important. Do your nurses handle that as well?

Courtney Hogenson (32:51):

Yeah, there's a lot of nurses that are patient advocates, and there's several organizations where you know, you've got nurses with all different types of experience and specialties, some who are really good with cognitive impairment or Alzheimer's or Parkinson's or, you know, you name it a l s. So you really wanna make sure that you hire an advocate who specializes in whatever you know, your loved one's needs are for, and you really can find such a diverse, you know, group of advocates out there. And I feel like it's just a matter of matching up someone who's not too far from you, someone who you get along with, and someone who you know is bringing value to what you need.

Larry (33:38):

How would somebody find one?

Courtney Hogenson (33:41):

Well, you can reach out to me. I have a handful of different associations. I would highly recommend the Aging Life Care Association, which I'm a member of. And it's just aging life care.com. And you can Google it, but there are several. I would go with someone who is a member, someone who's certified, someone who really, you know, is beholden to, there's certain values and rules and regulations that you wanna make sure this person is following because it's a very vulnerable position to be having someone come in and kind of making those decisions for you.

Larry (34:22):

The need for someone who can advocate for a patient who doesn't have someone to advocate for them becomes a very, very important role in the way hospitals are set up now.

Courtney Hogenson (34:38):

Yeah, I mean, I always say if you're going into the hospital, don't go alone. Take someone with you and, you know, hopefully it's a medical professional, someone with some experience, someone who speaks that language. It's like going into a courtroom without an attorney. And if you're not an attorney, you don't understand the language, you don't understand the rules, you don't know what you don't know. So if you're going into a healthcare setting, take someone with you, have them taking notes, hire a patient advocate, hire a nurse. If you already have a caregiver, if you have your own private nurses, take them with you. Have them be at your bedside because they're already an expert on all your medications, all your, all the people in your life, all the, you know, your vital signs. So it's like you have to kind of advocate for yourself. But one of the best things you could do is hire an advocate.

Larry (35:32):

Courtney, this has been very helpful. I'm sure the listeners are gonna get some much needed information. Thank you for coming on specifically for seniors.

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