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Sally Hurme

Episode 50: What Baby Boomer Women Need To Know About Caregiving, with Sally Hurme

Sally Balch Hurme is an estate planning elder law attorney and an author of six books. She worked on Capitol Hill for six years, and she realized that it became apparent that a woman needed an advanced degree. She took the LSATs right after a congressman recommended that she learn shorthand and then recommended that the male staffer go to law school. She went to law school in the ‘70s when there were very few women students or professors. She started a practice in Alexandria, Virginia, when there were very few women attorneys. When she decided to start a family, she withdrew from the partnership. She cobbled together part-time positions for a couple of years, so not to have a gap in her resume. Networking brought in opportunities but she never really applied for a position. One position led to another, but the grand finale, we should have a drumroll here, are 23 years at AARP, 8 years teaching elder law as an adjunct professor, and having written six books. 

This will be the first of three podcasts with Sally, on the topics of caregiving, which we’ll talk about today. Secondly, getting the most out of retirement, and lastly, what to do when a loved one dies. Welcome, Sally.

Well, thank you, Lynn, I’m really pleased to have the opportunity to have this conversation with you and your guests.

I can’t wait for this conversation, because I know that this is one topic that so many baby boomer women really want to know about. All three of these topics, they’re very important in our lives. And as you and I discussed before we began this conversation, both of us are dealing with caregiving to spouses who are facing dementia and other diseases of this sort, my husband has a few others to throw in there. But it’s a really really critical conversation, and I thank you for doing this. So let’s start by defining: what is caregiving?

Well, I think most women probably know that they have been caregivers for a very long time. They’ve been caregivers for their children. But I think now, with most boomer women, we’re finding that we’re caregiving for our parents, we’re caregiving for our spouses, as well as whatever caregiving we’re providing to our adult children now. But, caregiving can–

And also, I’m going to throw in there: in-laws!

And in-laws! Yes! Been there, done that!

Uh-huh, yup!

Yes. So we’re called the sandwich generation because we have caregiving responsibilities all around us. The generation ahead, the generation with, and the generation following. So caregiving, to define it, is pretty vague. It can be all-encompassing of a wide variety of things. Part of caregiving is just worrying about someone else, and part of the caregiving is wanting to make sure that whoever that other person is is okay, or is getting the best care that they can receive. Caregiving can be anything from just checking in with mom and dad, making sure that spouse gets to doctor’s appointments that are scheduled, making sure that everything’s okay, whether you’re close by or long distance. Two, on the other end of the continuum, is kind of that 24-7, all-encompassing caregiving where you’re providing medical assistance, you’re providing, guiding meals and nutrition, you may be helping with bathing and nutrition, you’re helping them in the hospital, you are helping them with basically every aspect of their life. And this can be done either long distance or it can be done at home, or it can be in some other community setting. So the range of what is included in caregiving is really pretty vast.

Yeah, and I think that there’s an important distinction that we want to make here between caregiving from a professional perspective, people we can hire to do some of those things you mentioned, and then there’s also the majority of people who are caregivers who are untrained, and they’re usually family members. So, my question is one that, I know you and I have shared this, there’s a time when the family member as an untrained professional has to recognize that the caregiving needs of the loved one is something that is far greater than what they can offer them. And so they need to say, “It’s time for me to get professional help.” Or, as we said, it can be care in the home or care outside the home. How do we make that determination of when that time comes?

At least for me, it was when I was getting exhausted, I wasn’t sleeping at night, I was feeling overwhelmed. And…probably knowing what I know about caregiving, I should have reached out for help a lot sooner than I did, because we all know that if caregivers don’t take care of themselves, they’re not able to care for other people.

So one of the things that I think is very important and I talk about in my book Checklist for Family Caregivers is to, before things get into a critical mode, recognize that you don’t have to do it all yourself. There may be other family members who can assist you with some segment of the caregiving, such as helping with transportation, getting to doctor’s appointments, or making the run to the pharmacy, or helping as financial, with financial power of attorney, and doing some of the banking and working with the insurance companies and taking over help with the financial issues. It may, in addition to family members, it may be neighbors or someone else within the community, or within the faith community who can spell you. You know, I think one thing that’s really important for caregivers to do before they get overwhelmed is to know how to say “no” as well as how to say “help.”


So, even before you really have to start thinking about reaching out to professional help, there’s all sorts of ways that you should explore and call upon and don’t feel like you’re imposing on other family members, friends, and neighbors, who may say, “Oh, how can I help?” Well, just have a list!

Please go to the dry cleaners and pick up the clothes that have been there for 30 days before, because I haven’t had time to run that errand. Have a list of things that others can do that’s, you know, episodic. Reach out and find someone who can help you. Of course, when the family, I know in my situation, I have one child right here close, and my other child lives in New York. So, and most of my family, my husband’s family as well as my family, those who are still alive, live way far away. So I’m… much of my help has to be done long distance. But you can be sure that I’m letting them know that when I need help and what sort of help that they can provide, even from afar. But, there obviously will be some point where you need more assistance than just your family. And that’s, I devote a whole chapter in my book about building your team. And that can be your financial advisor or your banker, it can be the plumber and the automobile mechanic, it can be the superintendent in the apartment complex where your loved one is living. It can be your faith-based help that you can get from your faith community. It can be the barber that your spouse relies on. Build that team, both all of the various professionals who can help you do your job, and obviously there’s going to be all of the medical people who may be involved in helping you care for your loved one, so you need to really know, you know, the physician, the primary physician, the specialist, the nurse practitioners, the speech therapists, the occupational therapists, the music therapists, whoever might be within the medical community, that hopefully is not only taking care of your spouse or your loved one, but is also recognizing that they need to be taking care of you.

Well, there’s the issue, the taking care of you. I was just going to say that I know when you build that list, and you build your team, so often that it’s much easier to ask people to do something for the person who is suffering from the dementia or whatever, but to ask somebody to do something for you, it’s really hard. I have a stepson who lives in New York, as well, and I feel very reluctant to call him and say, “Hey, I need a weekend off.” You know, it’s just, that’s hard to do. But he’s been really wonderful about helping with that. It’s not easy for him to be physically with his father, because that’s just not something he can do. But I find that, you know, the first time I asked him to do that, I felt really uncomfortable asking him, because I felt like I should be able to take care of myself, like why do I need… but then I went through that whole thing and said no, this is, this is what I need. I don’t just need somebody to take him places and do those things, I need somebody to give me some space, some place to go back and recharge myself, because I’m being depleted by all this caregiving. And I think that it’s one of the things that most of us do not ask for, because we somehow feel it’s a vulnerability, it’s a weak thing to do, and I just think that’s insane. And having said that, I still find it hard to do this, to take the time for myself. But I think that is something we’ve got to move up on the scale of things that are a necessity for caregivers, it’s to find time for ourselves, even if it’s to go out with friends for dinner. And it’s just that, just being out with some other people that do not require you to cut their food and think about, you know, all this stuff!

Are they going to be able to get to the bathroom?

Yes! Exactly. Exactly. So I think that is something that we should really, we really need to do something about that as a society, and to just give ourselves more room to say, “This is something I need too. I need it for me.” And the other thing I wanted to talk to you about, when you said about being present with the medical community that you’re involved with, with the team. There’s a big question here about whether you need to physically be there with that person, or whether you can send somebody else, the neighbor who says, “Yes, I’d be very happy to take him to his doctor’s appointment.” There’s a fine line there, between wanting to know what the doctor says, and being able to offer behavioral information that the neighbor can’t possibly know.

Right.And with people who have dementia, it’s even more difficult to try to get somebody to tell you what the doctor talked about, because they don’t remember! So, you know, I think it’s one of those things where you have to figure out what of that list are the things that you can give up to people, to others, and what are the things that you must know about, because you need to know!

Right, well, exactly. And particularly whenever there’s a medical emergency and I just spent the last three days in the hospital with, sitting with my husband, because we were waiting for the specialists, and waiting for that specialist, and waiting for this test, and that procedure, and as you well know, things in the hospital do not run, like, on schedule. And you’re always hurrying up to wait and wait and wait. But I felt, I have to admit, that I felt like I could not run down to the cafeteria in the hospital for the chance that that’s the moment that the nurse or the doctor or the specialist is finally going to make their appearance, and I’ve missed it! So I would try to, you know, I just literally ran downstairs and ran back up, and of course, waited for another couple of hours. But I agree that for routine medical check-ups, yes, maybe somebody else could go. But at least, I’m not at a point that I’m willing to let anybody else sit in on those doctor’s appointments.

Mm-hmm. Yeah, I agree, I think that’s the kind of stuff where you have to draw the line and say, “I need to be there.” But besides all that, I’m concerned about something that I’m sure you see all the time, even though you and I are both dealing with it personally. It’s interesting that with the increase, dramatic increase, in the diagnosis of Alzheimer’s disease, more women are being affected by that than men. And if women are the caregivers, and we have more of the so-called compassion and I guess, mental patience, the wherewithal to deal with this, how, what are we going to do when the caregiver is the husband, and there is no recognition that that’s something that they can do?

Well, I’ve seen some wonderful examples of husbands who are absolutely marvelous, generous, dedicated, devoted caregivers for their wives who have some form of dementia. But I think that within our society, men don’t have either the ingrained or lifelong experience of being in that caregiver role, to the extent that women do, and so I think, I don’t have any statistics on it, but I think in those situations where the husband doesn’t really have those nurturing genes, that’s it’s going to devolve upon the daughter or the daughter-in-law.

Yeah. You’re right, I think that’s what usually happens. Is there any trick or any magic to hiring some at-home caregivers that our listeners should keep in mind?

Having gone that route, get recommendations, recommendations from multiple sources, particularly from the, from people who are using the particular service. Get recommendations from your primary care physician. Get recommendations from the area agency on aging. Get recommendations from other people in the community and see what, see what names or companies sort of rise to the top. And then do, interview more than one, if you’re in a community where you have the option for more than one, and that sort of opening interview is critically important to get an idea as to sort of their philosophy of care. And I would want to sort of listen how they’re not only going to help the patient or the client, but what are they going to do to help you? Do they have a practice of leaving notes? Do they, does the management check in on a periodic basis, wanting to know, you know, “How are we doing, what do we need to do?” Formulating that care plan, and then making sure that the agency recognizes that that care plan may change on a month-to-month basis, and you may need more care or less care, or different hours, or different skillsets. And also listen for how they assign the individual caregiver. Is there going to be continuity? What happens if there just isn’t good chemistry? How do they go about matching you with whomever is available on the staff? Of course, we do need to recognize that from time to time they’ve got a staffing crisis, you know, somebody’s sick, and they have to bring in a substitute, or whatever. But it’s wanting to be sure that they’re listening to what you know as their care needs, and how they are going to be flexible in making sure that the care plan is accurate, up-to-date, is serving the purpose that it should, that they’re providing the services that make you happy and make the patient happy, and that flexibility and that they listen to you, as to what you think that they, that you think you need, and what they can provide.

And what happens if you decide that you want to hire caregivers who are trained caregivers, but they’re not affiliated with any agency. They may be neighbors, they may be… How do you do all that, so that you’re within the law?

I’ve got to put my legal hat on!

Okay, good!

Because that…you’re taking a lot on, more administrative burdens. You’ve got to make sure that that individual is…qualified, has the appropriate training, you’ve got to verify that training. You also need to do a background check on that individual. It may sound over-the-top, but a background check is essential. You want to check—

How do you do that?

You go to your, it varies from state to state, but you’re going to have to go to your local police department and find out what the requirements are.


But they’ll probably have to…it varies from state to state, so I just can’t say.

You’re going to want to check with Adult Protective Services in your community to verify that there is no…that this individual has not popped up on their screen.

Is this on your checklist?


Okay, and let me just say at this point, I want to make sure that people know that this checklist will be available the website Power Of The Purse Podcast, and so you’ll be able to get this if you need it. I’m sorry, go ahead. I just want to let people know.

Right. And then you have to recognize that you’re going to be responsible for pay, withholding, their Social Security, you’re going to have get involved with withholding worker’s comp and doing that paperwork and reporting, workers’ compensation. You’re going to have to check with what kind of homeowner’s insurance that you have, if that’s going to cover the individual if there is any sort of accident. If the caregiver is going to be either driving your car or transporting your loved one in their car, you’re going to have to make sure that either your automobile insurance is going to cover this additional driver, or that they have adequate insurance in case they are involved in an automobile accident while driving your loved one. Those are all on the checklist, but I think I got most of them. But doing the background check, and scoping out their individual, you know, who they are, are they really who they are and do they have the skills. Because we see so many incidences of caregiver abuse who come in and then ingratiate themselves with the individual and pretty soon they’re on their bank accounts, their powers of attorney, they’re on their deeds, and they’re robbing them blind and using their caregiving as their entrée for financial exploitation.

I think we see incidents of that probably once a month, you know, around where I live. It’s a constant thing. I understand, and I’m sure you know, that you understand how physical abuse can occur. You know that we’re all human and we all have a certain point. I’m not saying I do that, I’m not saying you do that, but when I see these situations where that happens and people are hauled off, you know, because they were taking care of Grandma Smith, and something happened in the house, and there was some picture of it going on, everybody’s quick to blame that person, but I don’t think unless you’ve been in that situation you could understand how that level of frustration can manifest itself. And it’s a hairline trigger between saying, “Oh, I get that and this is where I have to talk myself off the ledge, this is where I have to not be reactive, I have to stop and think about this.” And I think about that commercial on television, I believe it’s the one that’s the Alzheimer’s Foundation does, where they show the picture of the person sitting next to the patient and screaming without the sound, just the screaming, the frustration. And then they show the person actually doing something differently, and getting around the situation with a lot more grace and temperament, okay? But I do, when I saw that the first time, I was sitting with my husband, who is the person who has the dementia, and watching that and saying, “Wow. Do I get that?”


So the physical abuse I might be able to understand, but I think that financial abuse is a whole different story, and having people do that. You see it all the time, where someone, a niece or a nephew of a person who is alone, and this person’s niece or nephew comes in to take care Aunt or Uncle Whomever, and then you see them being hauled off and saying they stole a hundred thousand dollars or more and it all came from putting their names on a checking account or a savings account. And the person who has dementia has no idea any of this is going on. So it’s not necessarily, I just want everybody to know, it’s not necessarily that it’s hired caregivers who do this, but it’s also family members, and somebody needs to be able to say, “We need to take a look at that every now and then.” And it can’t be the same person who’s got the power of attorney.

Right. And statistics that we know from Adult Protective Services show that the vast majority of financial exploitation is done by a relative rather than by a primary, I mean, by a professional caregiver.

Yeah, and I don’t know if there’s an answer for that one but, any other mistakes that you see caregivers make that you wish, that they wish they would have known?

I think you’re looking, I think there probably are a good number, you mentioned five as we started this. But I think that learning to say no, being comfortable with saying “help,” reaching out, getting the help that you need from however you define your community. Being aware of the potential of financial abuse as well as physical abuse for vulnerable individuals from multiple avenues. Knowing that you don’t have to do this alone, and recognizing that there really is a vast amount of information out there for caregivers everywhere from the Alzheimer’s Association, from AARP. Of course I will have to say there’s lots of good information and resources in my book Checklists for Family Caregivers. But I’m on the web a lot, looking up if there’s discussion of a new diagnosis or a new medication that someone is talking about, looking for a support network. And I think that is one of the other, sort of the final thing which is sort of, they’re all interwoven. But look for a support group. I know my husband has kind of a weird kind of dementia, it’s not Alzheimer’s, it’s one of those other dementias, and I have found that reaching out to that specific support group of people who know what it is to have sort of a strange kind of dementia. Those other caregivers, whether it’s by telephone or actually an opportunity to do it face to face, support groups within the disease, and it may be cancer, it may be Alzheimer’s, it may be MS, whatever that is, finding people who are caregiving for a loved one with that same disease can be a lifesaver.

Yeah. You know, I’ll say something here that I think probably makes me be the odd man out, so to speak, but about two years ago, when my husband was diagnosed with, he has something called frontotemporal dementia.

Welcome to the club! Bingo, behavioral variance.

So when we discovered that, people were telling me, “Oh, you should go to the local Alzheimer’s support group, and they’ll be very, very helpful.” And their intentionality was that, to be very helpful. But I found, every time I went, which is maybe three or four times, most of the people there were dealing with Alzheimer’s.

With memory loss.

Yeah, but it was a different kind of progression, as you know, versus what you and I are dealing with. But I watched these people, and some of them came in with their affected spouse, and they would, they had a situation room where they would allow these people who were the patients to sit there and wait while the caregiver spouse was in this meeting. And so, I would go to these things and look at these people in various stages of the Alzheimer’s diagnosis, and the progression of it, and then we would go into the meeting and I would listen to people, maybe there were fifteen, ten to fifteen people sitting in a circle, and a woman who was trained by the Alzheimer’s Foundation to, what’s the word—


Yes, thank you, facilitate the group. And every time I would leave there, I would feel so depressed and so, I said to my husband, not to my husband, but to somebody else, I said I just felt that when I left there, that I wanted to take a gun to my head, because it was just so depressing, and so non-supportive in the sense that there was nothing there that I gained out of this experience that made me feel any better. It made me feel worse! And so I stopped going. So, I am not saying that I am telling people not to go to support groups because other people in other places may get something very different out of it, and it may be very supportive and very wonderful for them. But I found it to be just the opposite. And so I stopped going.

Well, and good for you to recognize that this was not helpful, and it was detrimental to your personal well-being and you got out of there when, you know, sooner than later.

And I think about what you said before, about knowing when to recognize that you need help and to get the help, and I thought that’s what I said to myself when I would leave there, “I’m supposed to be reaching out to get help here, and I know that, but I ain’t feeling helped.” You know?


So it’s knowing that, and saying, “Okay, it’s time for me to do something else,” which for me was simply to say, “I need time with other people.” So I would make sure that I would find friends and go and visit them, even if it was for the day, and I would say, “I’m going to do that.” And then I would say, “Maybe I’ll go to see something on Broadway for the day, with some friends.” But that’s the kind of help that made a big difference to me. It wasn’t the support groups. And I think that, I just want people to know who are listening, that that is not the end-all and be-all for getting help. There are other ways to get help. There are other ways to feel better than going to a support group, and knowing that maybe it does not support you to do that.

Right. And what I have found as my most recent lifesaver, I know it’s both for my husband as well as for myself, is that he is going to adult daycare, which is working out beautifully. We had some issues getting started, but now that he is getting accustomed to the routine, he looks forward to going in the morning, it gives him that association and activity. Because I was concerned that he was too…that he was getting isolated at home. And I’m finding adult daycare is not only really working well for him, I can go to the grocery store, I even got my hair cut. You know, it lifted a lot of just that every moment “What’s he doing?” burden off of my shoulders and I’m not doing anything fancy. I’m just enjoying the opportunity that somebody else is worrying about him.

Yeah, yeah. That is a blessed relief, right there. It truly is. Well, I’m going to have to say that we’re going to have to wrap this up, because otherwise, you and I’ll have this private conversation for the rest of the evening! I do want to say thank you so much to my guest, Sally Hurme, who is an attorney, who is an elder law attorney and an author, and we are going to have two more sessions with Sally. And I’m so excited for the next two. But in the meantime, Sally, tell everybody how they can get a hold of you if they have some questions or want more information.

Sure, it’s very easy. My email is just my name, sallyhurme@gmail.com.

Okay, wonderful. Thanks again for sharing your time and your knowledge, and until the next time, thanks for listening. Remember, money is not the enemy, your ignorance of it is. Goodbye!

How to contact Sally:


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