Rory Bellina (00:15):
Hello everyone and welcome to Health Law Talk, presented by Chehardy Sherman Williams. Before we get started, please be sure to subscribe to our podcast and follow us on Facebook, Twitter, LinkedIn, and YouTube – links in the description below. We hope you enjoy this episode.

Conrad Meyer (00:35):
And good morning everyone. Welcome to another edition of Health Law Talk with Chehardy Sherman Williams, and in the studio Conrad Meyer.

Rory Bellina (00:43):
Morning everyone. This is Rory Bellina.

Conrad Meyer (00:45):
And today we are very again, very timely topic, very interesting topic. we are in, in our part three Rory of our Covid Mental health podcast series. And this time we’re talking about older adults.

Rory Bellina (01:00):
Yes. Yeah, we’ve, like Conrad mentioned, we’ve done adolescents, we’ve done the adult population, and now we’re handling the older population. So very timely. This is gonna wrap up our series on covid and mental health, and we hope you’ve

Conrad Meyer (01:13):
Enjoyed it. Absolutely. And today we have a, another special guest, one of our resident experts here on on the older population. Gina Rossi is a licensed clinical social worker. She’s on the panel with us today. Gina, how you doing?

Gina Rossi (01:28):
Good morning, you guys. Thank you for inviting me.

Rory Bellina (01:30):
Thank you for

Conrad Meyer (01:31):
Joining. We really appreciate your time. Gina, give, give our listeners a little background about you and, and what you do so that they can understand your, your, your level of experience.

Gina Rossi (01:41):
Okay. Well let’s see. I’m a clinical social worker with over 35 years here in Louisiana. And I’ll tell you, I never expected to my career to move this way and working with older adults, I started off working in psychiatric fields, and I became a manager and soon I, I opened up a Gerald Psych unit. And that was where I first started working with older adults. I also worked in home health and I started to become very interested in this. And I’m, it became my specialty. But, you know, one of the things I tell people is that, to be honest, one of the reasons that, that this particular field attracted me was my own fear of aging and what would happen when I was older, because I became acutely aware of the really lack of resources to persons who were older and alone.

(02:36):
And I thought, Well, maybe if I start heading and pushing my energy that way, I can learn about it. I can learn about resources, I can maybe even contribute to building resources. So that it was, you know, that is kind of a a that was why I did it was almost for myself. So I’m, I’m I’m very invested in this. I became a clinical soc. I mean, I became a, a social worker, a geological social worker when I started studying more about old adults. I retired from the Office of Aging and Adult Services where we looked at giving services to people who had very little resources and helping them. Our focus was on helping them stay at home, home and community based services, is what we call it. And then I opened up a private practice and I started seeing people in a private practice, and I started teaching adjunct mm-hmm. at Louisiana State University teaching young interns and social workers about this population. And throughout the time, I’ve always been very involved in the Alzheimer’s community here in Baton Rouge. very, very involved in Alzheimer’s services, Alzheimer’s Association. And presently I just started working with Hilarity for Charity, and that’s a safe Rogan organization, nonprofit as a family support facilitator. So yeah, I spent a lot of time in this.

Conrad Meyer (04:00):
Well, it sounds like it. Yeah. I mean, I, it sounds like you have a vast amount of experience. I mean, I, I, sounds like you’re pretty much qualified to me.

Rory Bellina (04:08):
Yeah. Very, very impressive background. And thank you again, Thank you again for joining us. So, you know, Conor and I are just going to jump right in and, and if you listen to this serious before you, you’ll kind of see a pattern that we like to take. But, you know, the focus of this series is covid and mental health and what we’ve, what we’ve seen work, or a big issue is that there’s been a shift in the mental health practice from pre covid to during covid. And now hopefully we’re coming out of this Covid period, but, you know, some things that are sticking around and some things that are not. So I’d like to just jump right back in and if you could tell us a little bit about your practice. And by practice, I mean, you know, were you in pa in in person, or did you have any virtual patients? Tell us about your practice, pre c your practice population, kind of how a visit looked, and then we’re gonna phase right into what was going on when Covid hit, per se. And in that time period,

Gina Rossi (05:07):
Well, pre covid, I had retired and decided I was gonna start doing private practice again. I had done it previously, but I was gonna be able to dedicate more time to it. And I enjoyed the thought of, you know, getting up, going to the office and meeting with my office mates and seeing people come into the office and seeing them and seeing them sitting in front of me, seeing their movements, seeing if they were fidgety, seeing, you know, you know, really having a good observation of how they were presenting. Sure.

(05:34):
And with family members as well. So it was a lot easier when I had an office and I still have an office, but then Covid hit, and boy, I, and I will tell you, I was one of those that I did not have high tech skills. I, I didn’t even have low tech skills. I don’t even know why I say high tech. I didn’t have tech skills, period. So I had to learn pretty quickly you know, how to pull this together. you know, I tried different platforms and then presently I’m, I’ve found, I found the Zoom platform, the, the HIPAA compliance Zoom platform because mm-hmm. , at first it was an emergency. Everybody just started seeing people cuz people were in crisis. And there were even people seeing people on FaceTime. I didn’t do that. I would try different platforms, and when I had to tell the people who I’ve been seeing face to face that we were gonna be doing this, this way, there was a lot of reluctance. I’m gonna tell you, people were anxious about it because they were low tech too. They did not have a, a background, a lot of older adults of course, and not what we called digital natives. Right, Sure. So they had to learn it. And so I would spend time with them on the phone telling them how to get on to the Zoom emailing them and saying, Do this. And eventually I kind of developed a little cheat sheet that I was able to send them.

Rory Bellina (06:52):
Oh,

Conrad Meyer (06:52):
That’s great. So, so Jean, and let me, let me just ask you this real quick. So, so there wasn’t some sort of resource that you as a provider could go to and say, here, no, here’s how you do telehealth, here’s what you need, here’s the cameras, here’s the software. No. So y’all did this really on the fly,

Gina Rossi (07:12):
? Maybe there was, but I wasn’t aware of it. Okay. You know, a later, you know, now later things have been developed. Sure. Now there are providers are doing much better. I did have clients that, that dropped off that just, they just did not wanna do it. And I, and I couldn’t, you know, I wasn’t gonna go into the office. I couldn’t risk it. Sure. so I, I would talk to my telephone and I tried to find them, somebody who was seeing people in, in the office.

Rory Bellina (07:39):
And Gina, what do you think the biggest issue was for your patient population? You know, Right, right. When Covid hit, was it the, the technology portion where they, you know, didn’t have the, the physical devices to, to communicate and talk with you? Or was it the reluctance of, you know, older population they’re used to going to in person, in person visits? You know, was it, was it that, was it more of a, a mental thing per se?

Gina Rossi (08:04):
I, I think that the, the clients that I see, they had the, they had the re financial resources to be able to, to buy these. Okay. but they, they really did not want to. They were too anxious about trying it out. And I wanna tell you, people that came to see me, they were already anxious. Right. Sure. And that’s why they’re coming. They’re an, and so then you throw this on top of it, it’s, it’s really asking a, a lot. I mean, it’s you know, it’s almost incredible bravery for somebody who is already dealing with anxiety, dealing with problems, and then to throw this at them.

Conrad Meyer (08:36):
I mean, well, in what, what I meant for that Gina also, I mean, like, my, my, my father can’t even turn the TV on. You know, my father is an older, you know, adult and he has trouble turning the TV on. Right.

Rory Bellina (08:49):
So, did you, Conrad, did

Conrad Meyer (08:50):
You, I’m gonna tell

Gina Rossi (08:51):
You , I’m gonna tell you by some, by somewhat. My parents who lived Uhhuh in Houston were here the December, you know, we got, we got the notice in March, in December. I decide, I, I, they were still playing around with the flip phone. And I said, This is it. So got them iPhone and thank God I spent the time. Now the guy at a t and t, I’m, I can’t even look ’em in the eye anymore. , he doesn’t wanna see me coming. I got them two iPhones and I taught them how to do FaceTime. Mm-hmm. text and, and now Zoom. And my dad is 88, my mom is 90. Wow. Wow. It’s not like, you know, so be very careful cuz a lot of people, you know, they put older adults in this homogeneous box and it’s a wide spectrum of functioning. Sure.

Conrad Meyer (09:38):
Well, let me ask you this. So, so based on what you just told us, so did you find that older adults responded in kind and said, Hey, we, we are jumping right into this and, and adapt to the technology and, and were able to do telemedicine with you

Gina Rossi (09:52):
When somebody spent the time to help them through it? Okay. Got, Okay. I gotta tell you, it’s been a little disappointing. when I hear about some of the assisted living facilities or, or nursing homes that, you know, maybe a family member brought an iPad and they just left it there because they weren’t able to stay. They, and no one spent the time to say, you know Mrs. Bro this is how you use that. You press this button and I’m gonna write the instructions down right here. And like, number one, which is what I did for my dad, number one, I, boy, I, you know, emailed it to him. Remember number one, it looks like this, this is a screenshot. This

Conrad Meyer (10:29):
Is, so you’re telling, so you’re telling me, let me ask you this. So you found in assisted living or nursing homes that there was a lack, number one lack of equipment for their residents to reach out to family members. And then secondly, the staff mm-hmm. wasn’t working with the residents to reach out to family. Is that, is that fair to say? Either they had the lack of knowledge or they just didn’t spend the time? Right.

Gina Rossi (10:53):
Well, you know, and, and to be fair, this was at the very beginning. Okay. St you know, they were very stressed for staff and at first not everybody had these had the equipment. And I don’t know, maybe the staff didn’t know how to do it. Maybe the staff didn’t feel competent to be able to teach it. But when you look at it, it’s, when you look at the options, it would not be hard to bring in a, a college kid or Oh, really, Even a fourth grader to say, Can you spend some time helping the residents, helping the assisted living residents learn how to do this so they can call their grandson. So

Conrad Meyer (11:33):
Is that still going on? Let me ask you. I’m sorry to interrupt. Is that still going on or is that, do you think it’s better now?

Gina Rossi (11:39):
I think it’s better now, but it went on a long time and, and, and these are nice facilities that I’m aware of, so Wow. That was very disappointing that, you know, these were not, you know, facilities out there where they didn’t have those kind of resources and, and it doesn’t take much to be able to improve somebody’s

Conrad Meyer (11:55):
Life. So, And I can tell you, I mean, I’m just from a, just from a, a personal standpoint or like just from people, just from people Rory that, that if you’re not able to reach out and, I mean, you’re already isolated in an assisted living a nursing home already. Right, Right, right. And I mean, the inability to reach out, you know, or to see a family member or a friend,

Rory Bellina (12:14):
Especially when a lot of them close and weren’t Yes. Allowing even family members to come visit during the, the

Conrad Meyer (12:19):
Peak of this, imagine the effect that being able to do tele, not even telemedicine, I mean, just to FaceTime a friend contact.

Rory Bellina (12:28):
Right.

Conrad Meyer (12:29):
Right. I mean, Gina, do you think that would’ve made a, a big difference in the mental health at the time?

Gina Rossi (12:34):
Absolutely. Now it’s not the same. People say, Oh, well it’s not the same as a hug. Well, it’s not the same as a hug, it’s not the same as green your seeing your grandchild. Right, right. You know, and kissing them. But it’s a connection. You know, I talk to people who said, you know, my mother has literally been in a room for a year

Rory Bellina (12:51):
. Sure, sure. So for Gina, for your patients that were able to get up to speed and that were able to get the assistance, whether it was from, you know, someone at their facility, if they were lucky enough or a family member, tell us about how some of those visits, those tele visits went and you know, did you find that they were an effective therapy session? Did you, you know, what were kind of the pros and cons? What you, what did you like about them? What didn’t you like about doing a televi with an older population?

Gina Rossi (13:22):
So I’m still doing telehealth. Okay. I, I feel like I’m getting better at it. Great. you know, you, it, it does take a, it’s a different skill. You have to, it’s a different type of attention. but when I ask a lot of my clients now, some of the ones that we’re driving, for example, they’re, they’re okay with staying there at telehealth because they don’t wanna deal with the baton rouge traffic. Sure,

Rory Bellina (13:43):
Sure.

Gina Rossi (13:44):
But some are, are, are saying, Can we please meet in the office? And so for very few I meet in the office, cuz I’m, I’m still very cautious about covid myself and bringing it to my loved ones. Sure. and it’s, at least in telehealth, you don’t have to wear a mask in the office. I do use a mask. Right. And so you really can’t see the facial expressions anyway. You can see the rest of their body, if they’re fidgety, if they’re anxious, how they’re dressed, if they’re, you know, how they’re grooming, things like that. And

Rory Bellina (14:13):
We’ve heard that from a lot of our guests is that there’s something about having that person sitting across, you know, on a sofa directly across from you or a table. You just pick up on more cues to really find out how their, you know, how their life is going, what their issues are.

Gina Rossi (14:28):
Yeah. And it’s easier to have a family session because now I do do family sessions online. some people prefer to say, Well, I’m gonna be on the computer in my room. My mom will stay right here. And so they’ll be like kind of family session with little boxes. And sometimes they’ll be sitting right there next to their loved one. And that’s a little awkward cuz they’re like really tight right next to each, each other. And it doesn’t make for a very comfortable setting. So sometimes they’ll, they’ll separate and be able to share, you know, in their different areas.

Conrad Meyer (14:58):
So Gina, let me ask you this question. In terms of telemedicine now definitely in your opinion, does you know, is telemedicine now and going forward gonna be an integral part of your practice? Or is it just a tool right now because of the covid restrictions and so forth?

Gina Rossi (15:22):
I would say that it is going to be an integral part of my practice. So, you know, people use the term hybrid. sometimes in the office. Ideally what I would like is to see somebody in the office see them, really get to know them. And then when I see them on a telehealth visit, then I already have an idea. I can sense about them. You know, I’ve already seen ’em at least once. Okay. I think that was really, that’s really the ideal. Not everybody is a good telehealth client though. some people, you are gonna have to say that all, especially, you know, I have seen people in crisis on telehealth. but it’s, it’s better to see them in the office Now. I’ve had clients who have, when we first started off or just couldn’t deal with it and they were going back and forth and, and they couldn’t figure it out and, and then they just went off. You know, they clicked off. And that happened with some of my clients, also with their psychiatrist, cuz they’ve had to learn different platforms. Right. I use this, somebody else might use a different platform. And it’s, it’s a lot for people who are already dealing with anxiety and being, having trouble focusing.

Conrad Meyer (16:26):
And that’s hard when someone, like when you’re on Zoom or they’re on Skype and someone’s using FaceTime and that person should go to meeting. I mean, I’m not, you know, we don’t get any, just so, you know, we don’t get any sponsorship from them. Right, Right. But, but when you’re using these platforms it’s hard. If you aren’t using that, then how do you think and how do you get to these

Rory Bellina (16:44):
People? And jumping around,

Gina Rossi (16:45):
It takes a lot of pre prep with them. I tell them, and now here’s the guide we’re gonna use when I meet with you. You have to be someplace that you feel very comfortable, that’s very confidential, that no one’s gonna interrupt you. And I tell people this and, and I say, I want you to, to be as if we are in my office seeing each other face to face. And sometimes I gotta tell you, people are in their bed laying down and, and I say, you know, I’m, I’m making up a name Tom, I really feel like I have your attention if you sit up. Sure. And so he’ll sit up mm-hmm. mm-hmm. . And then I’ll see somebody’s family member walk by in the background. And I’ll say, Tom, you know, it’s really important that, that you and I speak confidentially. Right. And need you to go to a room that’s, that’s really private, Please.

Rory Bellina (17:31):
And, and, you know, con and I both went through that for just during the pandemic trying to work from home and, you know, we’re on calls or doing working or, you know, a ton of times when I was on calls that you’d hear kids in the background or, you know, the microwave going off or it’s just, it, it’s hard to get that dedicated concentration, I would think in therapy sessions, you really need that focus. And, and I could just imagine, you know, the, the issues that were faced during this

Gina Rossi (17:58):
And sometimes the, if it’s an older adult that doesn’t have the experience wisdom their loved one, a caregiver will come in, set them up and I’ll see them and I’ll see their caregiver and then I’ll ask the caregiver, you know, Thank you. It’s, if you, you don’t mind. Now we’ll have some private time with, you know, Tom as I’m making up his name. So that’s okay. Cuz they’ll set them up and then they’ll leave.

Rory Bellina (18:21):
That’s great. That’s great. So from a, from a standpoint you know, I want to talk more about the, the issues that you faced, but from a device or a, you know, a technology physical standpoint, what, what’s the biggest barrier that you saw? I know you mentioned in the beginning that most of your patient population had the financial resources to, you know, get the devices that were needed for these tele visits. But, you know, was it just the educational part of teaching them how to use it? Or was it that there was a hesitancy for them? Like what, what kind of physical barriers do you think that you, you faced? You know, getting people set up?

Gina Rossi (18:58):
Well, it’s different for everybody. I mean, there’s not one answer. For some people it was a hesitancy, I don’t wanna do this. And some people feel like this is, they just, they were really rigid about how they were gonna go into therapy. And remember for older adults, therapy is basically a new mode for them anyway. A lot of them are, are reluctant to go into therapy because they see it as a, they see it as very negative. They see it as a weakness. it embarrasses them. So just to get them to therapy is important. And then now we’re asking them to do it a do sure high tech way for them. Mm-hmm. , that’s, that’s double now. Now for some people it is, it is just, it is the education. And once they get a hang of it, they press this button, this button. If we give them the, the, you know, the tip sheet, the, the, they feel stronger about it. And it actually, the accomplishment adds to their sense of self-esteem and that they, you know, that they’re learning and they’re keeping up. They feel better about themselves too.

Rory Bellina (19:58):
Now I know we’ve talked a lot about the barriers, but I’d love to hear from your perspective with your older population, what are some of the things that you’ve loved during the, this, this period? What are some things that your patients have loved, Whether it being they don’t need a caregiver to drive them through, like you mentioned, the baton rouge traffic or, you know, sit in your office, wait, get checked in. Like what are some of the, the good things? What are some things that you’ve really loved with this switch over to a, a telemedicine practice?

Gina Rossi (20:28):
Well, I do like that it feels like we’re all learning together. And I tell them up front and I say, You know what, Hank I’m learning this too, and I’m not perfect at this, but we will work through this together. And for us, that creates a bond between him and me. Sure. We are, we are, we are figuring this out together. And so it’s a sense of teamwork with that.

Rory Bellina (20:48):
And, and what are some of the things that your patients have liked about the, have they mentioned things that, Oh, I really like doing a televi because X, y, z

Gina Rossi (20:57):
Mainly the reason has been traffic. I gotta tell you, having to get out in the traffic saves them so much time. Sure, sure.

Rory Bellina (21:03):
And I would assume that it saves, does it save you time as well? Has it Oh yeah. Allowed you to be more efficient, see more patients, kind of book them closer so you have less of a, a tr you know, documentation time mean. Tell us from a practice perspective what you’ve named some things that you’ve really liked from switching over to a health telehealth model.

Gina Rossi (21:24):
For me personally, it has been not having to deal with the traffic as well, but I, you know, I’m in several groups where people specialize in different areas. There’s a group about telehealth, and I’m very careful to make sure that it’s not about my needs because I’ve seen that happen too. And people put people in telehealth, clients in a telehealth that really aren’t, they need more, they need more than telehealth. They absolutely need. And if that’s gonna be something that I’m seeing and I’m not seeing ’em in telehealth, I’m gonna have to refer them out because it’s not for me, it’s for them. you know, if just because I’m happier here and I’m, my cat gets to sit on my lap, you know? No. some people, if they’re in crisis and they need to, they need eyes on somebody, I, I usually refer them to somebody that needs that.

Conrad Meyer (22:12):
So, So Gina, let me, I wanna pivot just a minute here. We, we’ve gone in detail about telehealth and how it changed and in terms of covid and, and how it’s really affected the older population in terms of, and, and you and your practice. but tell me this, let’s talk in general. What has Covid done to the older population in terms of the, I mean, mandates, social distancing, can’t see your family you know, now, I mean, you gotta get to vaccines, gotta get boosters. What have you seen in your practice with the older population? What has this done to them?

Gina Rossi (22:50):
They are weary. They are weary. Aren’t we all weary? But think about it, a lot of older adults who maybe may not drive and are dependent on other people to get them out, have tended to become isolated. And one thing I like to tell people is that we generalize it, that older adults are isolated or they choose to be, but honestly, we isolate them or we isolate ourselves from them. So that’s a problem, is that they have become more isolated and we know that we’re, you know, human beings need other people around them. It is good for our health. Mm-hmm. , I mean, this is now evidence based. This is now science that shows us this. And so there was just a study done recently about 2000 respondents. And, and these were people from like 50 to 80 years old. And they said, yeah, you know, most people, their mental health was not really worse, but guess what, for 28.3%, they had worse anxiety and 19% had worse depression and less sleep. So, so maybe the majority or not, but 20, 28% is a

Rory Bellina (23:57):
Lot, you know, and, and ConEd brought up the mask and the vaccine. And I definitely wanna jump back to that. But, you know, this just came to my mind because of your, your older population. And, and, and I think you mentioned this with the facilities or the nursing homes. So in, and I’m sure this was across the country, but our focus in Louisiana, how did the, the nursing home lockdown or shut down per se? You know, what do, what, what effects do you think that had on that population where literally the only people going in and out of those doors were, were staff, were staff, family had to, I mean, we’ve all seen the pictures of the family members standing out, you know, on the balcony down, looking down or, you know, the patients are right or

Conrad Meyer (24:39):
Outside in the grass,

Rory Bellina (24:40):
Outside of the, the window, or they’re in little bubble tents. What, what effect do you think that had on the mental health of, you know, they could all have, even if they had the FaceTime or they had the phone calls or they were standing on another side of a glass. What effect did that have on the mental health of the older population?

Gina Rossi (24:56):
Well, that isolation really, that really hit a lot of people in terms of help making them more disoriented. Because if you are in a room and you lose track of time, yeah. The shifts change. And, and you know, Susie here is three to 11 shift, but you start to lose track of time. And actually I was at LSU school social work and, and we were contacted by one of the retirement communities and they reached out. They said, We are noticing a significant difference with our residents that their dementia symptoms have increased. And not just that our, our staff are struggling too. Sure. So, so my class, you know, they went right to work at looking at different options. And a lot of them, you know, a lot of the options were related to technology, getting iPads figuring out ways to, you know, increase communication or finding groups that would reach out to people who were in retirement homes or nursing homes, helping them connect with the outside. It might be, maybe there was a school group that recognized, you know, what can we do as a service? let’s get some service hours and let’s reach out to older adults in a facility and, and help them connect. Sure.

Rory Bellina (26:11):
Now we, we talked about this in our previous episode with the adolescents, but I wanna talk about masks for a few minutes. Have you seen any issues with the older population and the mask mandate when it, you know, was in effect and then when it went away and now it’s back again, at least in Louisiana, You know, with our, when we had our guests on for a, for adolescents, they, that was a big issue that they said that that kids really struggle with the masks and it’s hard for them to pick up on social cues from their teachers or their parents and see facial expressions. That was really hard. Have you seen that with the older population?

Gina Rossi (26:46):
I certainly do see them struggle with having a mass, but I, I guess the difference might be that a lot of the older adults feel are are more concerned about the covid and the delta variants. So they’re less likely to take it off and say, I don’t need this. They, they want them on. The ones that I work with want them on, and they want others to be messed as well. You know, it makes them anxious because think about it, this strange, mysterious disease comes and who initially, who, who is a population that it starts to wipe out really is, you know, they’re thinking it’s me. Right. This, this illness is wiping

Rory Bellina (27:25):
Me out. Right, Right. When this started, the, the statistics were that it was affecting the older population, the hardest,

Gina Rossi (27:33):
The worst. And already some of the older adults that were feeling depressed, anxious about aging, here comes this next message. Well, now the whole world is saying that it’s older people. And then the saddest part to me, you guys, I’m gonna tell you what, maybe the angst, because you know, one of my, one of my next, you know, things that I work on a lot is on ageism and almost a disrespect for what this was, what this was causing older adults. And the whole thing about, well, it’s just the older adults or it’s just people in nursing homes. As if, as if, well, you know, it’s just, it as if that

Conrad Meyer (28:12):
Like, like there’s some sort of like stale milk, Right? Like we just throw ’em out. That just, and

Rory Bellina (28:18):
That’s a good point to bring up because I remember when this all started, the statistics were, it was affecting the older, popping at LE and seeing the most, And you heard a lot of people say, Well, just keep them in their nursing homes or their facilities and they’ll stay in there. We should, you know, continue to keep the economy alive and go to work and go to the office and let’s just keep them locked up until this thing fizzles out. And, and I’m sure that had a, a terrible that, that came across as a terrible message.

Conrad Meyer (28:44):
I, I just think overall, I mean, and then I’m sorry to inject on this, but I think that just overall, I find that there’s just a lot of lack of respect Sure. For older, the older population. And I mean, if you, I mean, one is the most heavily regulated section healthcare market. Right. And, you know that, so, but still, I mean, just the lack of like decency and respect just strikes me in this and, and so Well,

Gina Rossi (29:09):
And that’s been going on for so long. Oh yeah. And this has just made it worse. I mean, I have seen, I I’ve shown this to some of the students I work with is know, here are some signs of ageism. And since Covid, let me show you some memes that have come out that are so hateful about older adults, you know especially around covid. Sure. Boomer, like, like, you know, the saying boomer remover.

Conrad Meyer (29:33):
What’s, I haven’t heard that. I haven’t heard that one, but Yep. I don’t know what that means, but I understand. it’s, it’s terrible. But you, let me ask you this. On the same front vaccine mandates, Okay. we’ve, we’ve heard different responses across the board, and I’m curious to see what you’ve seen in the older population more receptive, less receptive, mixed bag. What’s, what’s been your sort of, what, what’s your take on that with the, with the mandate?

Gina Rossi (30:05):
I would have to say mixed bag. And I’m gonna tell you the truth. I don’t ask them, I try to avoid asking about those kind of topics that are political that can be polarizing between me and them because I, I want us to focus on their issue because once we start going down that way of, you know, politics, the next session they wanna the session, they wanna talk about this or, and, and I’m trying to, to stay away personally, of course, I have my own personal feelings about mandates. You know, I, I’m a very safe person. I, I, I’m not, I don’t have a sense of safety unless people are vaccinated. But I would never tell them that. Of course, I probably just did right now on the podcast. That’s okay.

Conrad Meyer (30:47):
That’s . Well, you know, I guess the thing is is, is is is it really that political with your patients now? I mean, do they see this as a political issue and not a health issue? what are, what are the older patients, what are the older populations saying to you about that?

Gina Rossi (31:07):
I think that they’re, the, the ones I’m seeing right now, I’m gonna tell you, a lot of them are they’re very delicate about it when they talk to me and it, and actually it makes me wonder if maybe they, they don’t wanna offend me either. They, they, you know, they don’t wanna offend me. They know that I’m very careful, but they recognize that we have not talked about mandates. Right. Okay. You know about, about that

Conrad Meyer (31:28):
Now. And, and another thing too, So everyone is being affected by this. This is not, I mean, you, you, we, we’ve, we’ve seen across the board from kids adolescents, right? Families, elderly you know, older population has been affected by the pandemic. Now, do you think that some of the lack of communication or the lack of reaching out is simply because everyone is so stressed and, you know, there there’s not enough capacity for some of the, the the families and ad young adults to reach out to the older population? are you seeing that as well?

Gina Rossi (32:05):
I, I am seeing that. And, you know, one thing I wanna make sure that I talk about today is when we talk about a lot of time when we talk about adult older adults, we’re also talking about their family and their family, c and family caregivers. cuz you know, I’ll, I’ll never forget when this first started you know, I was highly anxious thinking about, you know, supplies, you know, how we all got about supplies and everything. And I, I talked to a lady who was a caregiver, and I thought, Oh my God. I said, How might this be for you? Because you are worried about you and your family and, and you also have to go to go to your mom’s house and be concerned that she also has supplies. So it’s when, when you work with old adults, you are also constantly thinking, there is another client here too, and that’s the family caregiver that’s worried about mom or their husband or, you know, their, their loved one. So it’s a, that, you know, that whole popula that grows, you know, who this, who this affects really grows exponentially. It’s not just the, the person that we’re talking to. A lot of times there’s a support system, hopefully the support system that we’re trying to help as well.

Rory Bellina (33:12):
Sure, sure. Now, let’s, let’s, you know I also want to get your opinion on how things are going. Now as far as, you know, we’re in late September, 2021. You know, where do you see, you know, where’s your practice right now as far as, you know, your visits go, breakdown of in person verse verse, virtual, and then, you know, kind of where do you see things going for your practice? You know, what would you like to keep? What would you like to change and, and for your, your patients as well?

Gina Rossi (33:44):
Well, I gotta tell you, when the vaccines came out I, I had such high hopes, many of us did. We thought that this is great. This is what we’re wait for, We’re getting back to normal life. And I saw myself getting back to the office and I, I went back to the office, saw some people, and we would look at each other and I said, I am vaccinated. And they said, I’m vaccinated too. So we took off our masks that was very short lived. Okay. Because soon afterwards we, we started learning that it, it wasn’t everything we thought it was gonna be, and there were breakthroughs. So I’ve gone back to telehealth of course, hoping now maybe the booster, maybe that’ll send us back and deliver a little bit more normalized whatever that is. So I’m hoping to go back on a more regular basis. Okay.

Rory Bellina (34:33):
What about your patients? Where, what, what, what are you seeing with them? Do they want to come back to in person or a lot of them saying, Hey, this virtual’s working fine, let’s, let’s stick with this. Let’s keep it,

Gina Rossi (34:43):
A lot of the virtuals do wanna stick with it. They wanna stay virtual. The new people that are calling, when I tell them that I am still virtual I can kind of hear, oh, you know, I can hear some disappointment. Okay. So I, I say, you know, really, I, I can’t guarantee you when I’ll be seeing somebody in the office. So I, you know, I, I’d be happy to refer you to somebody who has seeing people in the office.

Rory Bellina (35:06):
Sure, sure. Now, from a, you know, it sounds like you’re set, you’re set up technology wise now, and, and you talked about how your patients are as well. Let’s talk about kind of the big bad wolf in the room of reimbursement and insurance, because I know that was brought up on our other two series issues that, that their practices have had. And with billing for this, with figuring out how to bill for it, some payers pay for it, some don’t. you know, tell us a little bit how that’s been on your practice in your office from an, from an insurance standpoint.

Gina Rossi (35:37):
Well, I gotta tell you, I’m, I’m kind of I’m, I’m a small population. I don’t, I do it very differently. I am only taking private pay. Okay. I am not on the computer trying to figure out claims because I’m a very small operation. So, you know, other people would be able to give you a better idea. And people, they send a check, they send a check, or they drop a check off, or, you know, and I’ll pick up later. I’ve had very little problems with people not paying me. Well, let me, and I tell them, You know what? I trust you’re gonna pay me.

Conrad Meyer (36:07):
Gina, let me ask you this. Well, so have you gotten to using Venmo, PayPal, Cash App, anything like that? Do you do that for your patients or as always, have

Gina Rossi (36:17):
You been I started, I had started that, but there are some HIPAA problems with that now. So Venmo and those things are no longer appropriate for for HIPAA reasons.

Rory Bellina (36:28):
And is that because it’s showing on the portal that, So andSo paid you?

Gina Rossi (36:32):
I don’t, I don’t know why. that’s just what I’m understanding from my professional colleagues. But, but, but when I did it was, you know, it was secret. You know, nobody could see it. Of course. Sure. You know. Sure. There’s a, some people have all their friends do that. No, I, I never did that. Okay. But I’m, I’m, you know, I’m going to IV pay, which is a hipaa. Okay. HIPAA approved. I have a IV pay account. Okay,

Conrad Meyer (36:53):
Great. Gotcha. Okay, great. That’s good. Well, so, so, so since being private pay, you don’t have to worry about reimbursement or insurance or anything like that.

Gina Rossi (37:00):
Yeah, I’m, I’m fortunate in that

Conrad Meyer (37:02):
Way. So let me ask you this. So let’s, let’s pivot to resources and, and go from there. So what do you tell older, you know, the older adults or even their family members or friends what can they do to, to get resources to help, Right? For the times that you, you can’t be there for therapy. what are some resources available for family members and friends and even the older, you know, to help the older population? yeah. And even the for the older addicts themselves,

Gina Rossi (37:39):
Well, it, depending on, on, you know, where they are in their functioning. it might be somebody who has depression, or it might be somebody who has dementia. luckily, you know, we are, we do have a lot more telephone resources that have come out. And for example, you know, there’s the SAMSA National Helpline, and that’s a 24 hour line. Let me give you that number while I’m right here. I’ve got a list in front of me. Absolutely. So that national help line is 1-800-662-HELP. So that’s 1-800-662-FOUR 3 5 7. And what

Conrad Meyer (38:13):
Does that do? What that, what does that help line for? Is that for anyone that needs to talk to somebody? Anybody

Gina Rossi (38:17):
Can, anybody can talk to somebody 24 hours a day. And it’s English and Spanish for, for family members for people who have mental or substance abuse. And, and there’s another one because, you know, let’s recognize it, that things can escalate quickly for some people and they’re thinking that things, they’re feeling hopeless. And there’s a, there’s a National Suicide Prevention lifeline as well. I’m gonna give you that number. And this is the National Suicide Prevention Lifeline. It’s 1-800-273-TALK.

Conrad Meyer (38:50):
Great. Good. That’s good Res. Now let me ask you this. Good resources for reaching out. Is there anything that that, that either families or friends can look up on the internet to that, that would, you know, or resources or call that would help them reach out to nursing home residents or assist their, their other friends and family? Is there anything available for them?

Gina Rossi (39:16):
Well, if let’s see. So if there’s some for, there can be many issues. It could, they could be wanting to talk about their own stress or their own concern about their loved one. And maybe they have a loved one who has dementia. And there are thankfully we have more and more, you know, Alzheimer’s help lines. And I’m gonna give you one right here. The Alzheimer’s Association helpline is 1 802 7 2 3900. And there, there are many phone numbers. And basically if somebody has a, a, a computer that you can Google Helpline Crisis Line. But these are ones that I give out on a regular basis. and I also encourage when, if I’m seeing somebody a lot of times if they’re, you know, once we’re set and they’re doing better, I also kind of, I, I like to supplement their treatment with a support group and I will try to put them in touch with support group wherever they are in town. Cuz there’s nothing like being able to talk to other people who are in the same position as you. Sure, I have lots of information, guidance, whatever, but it’s not like, you know, this other lady who is experiencing the same thing as

Rory Bellina (40:24):
You. Sure. So, Gina, you know, this has been an amazing podcast. I really appreciate your, your time and, and insight on everything. Kind of a final thought from you, what changes do you, do you hope to see from the, you know, the mental health in, in the older population? You know, what, what do you, where do you see things going? What would you like to see, or, you know, what are you continuing to work on? Like kind of what’s your, what’s your your mission at this point?

Gina Rossi (40:49):
My mission is to really give mental health for older adults a lot more attention if we don’t do it now. Well, we’ve had this huge covid, you know, examination and study about how this has affected older adults and what isolation has done to increase their depression. If we don’t do this now, you know, we are really, we’re, I don’t know how we can go forward, but my thing is to recognize that we have tended to because we are basically in an ageist society, we have tend to put them someplace. And when that happens, we alienate ourselves from them and instead of bringing them back into our world, our community. And I’m hoping that that is a major change that comes about from all of this.

Conrad Meyer (41:36):
Fantastic. Well, Gina, we won’t, we won’t really thank you for coming to on today’s show. It’s been very pleasant to have you here. Very

Rory Bellina (41:42):
Informative. Thank you so much.

Conrad Meyer (41:43):
Extremely informative. So we wanna thank you for that. And for all of our listeners here, we wanna just let you know, please, if you like this podcast, please hit subscribe, share

Rory Bellina (41:51):
With your friends,

Conrad Meyer (41:51):
Share retweet and subscribe to the podcast so you get announcements when things come out. If you have any questions, comments, or anything you wanna see on, please feel free to email me at cm@chehardy.com. And Rory –

Rory Bellina (42:03):
R bellina@chehardy.com, which is, it’s all linked in our bio as well.

Conrad Meyer (42:07):
Great. Good deal. So thank you so much, Gina. Sit tight. Thank you. And we really appreciate you coming on the show today.

Gina Rossi (42:14):
I appreciate you all listening to me .

Rory Bellina (42:22):
Thank you for listening to Health Law Talk presented by Chehardy Sherman Williams. For more information or to contact us, please visit our website linked in the description below. Also, please be sure to subscribe to our podcast and follow us on Facebook, Twitter, LinkedIn, and YouTube – links in the description below. Thank you for listening.