Heidi Garvis – Hospitalization, The File of Life and Key Money Saving Tips0
Today We Are Joined by Heidi Garvis of Caring Considerations> She shares with us:
- What to expect before, during and after a hospitalization
- She shares what a File of Life is and Where Paramedics go to look for it in your Home
- Lastly she explains the difference between Admitted and Observation Status and why the knowledge of this will help you avoid literally thousands in unexpected expenses
Links and all details are in the show notes and we also posted a File of Life for you to use and post on your refrigerator.
Get the full transcript including supplemental links by simply entering your email below:
READ TRANSCRIPT ONLINE
Price: Good afternoon everyone. This is Price Jett. Welcome to Elder Care 101. Hope you’re having a fantastic Friday. We have as a guest today a fantastic person named Heidi Garvis. Heidi is going to talk to us a little bit about things we should know about hospitalization. We are delighted to have her on the show and share her wealth of knowledge. Heidi, welcome to Elder Care 101.
Heide: Thank you for having me Price. I’m looking forward to talking about these subjects.
Price: Wonderful. Heidi, tell our audience a little bit about who you are, how you became involved in the elder care space, and what you’re doing now.
Heide: I started in the industry approximately ten years ago. Like many people who are in this industry, they have something in their lives that made them passionate about helping older adults. I had a mother who was a geriatric registered nurse, I have sister who’s a geriatric registered nurse, and my business partner is a registered nurse. Together she and I help seniors in many different aging issues, including their families and the professionals that work with them. My background is human services and some social work, but I’m also a certified senior advisor, which gave me a broad look at what are the things we need to be concerned about as we age. I became certified to be a better resource for people.
Price: Heidi, for those in our listening audience who do not know what a CSA or certified senior advisor is, tell us a little bit about that.
Heide: What you do is you study for a few weeks, you go through a course, and then you’re required to take a test to test your knowledge to make sure that you’re able to discuss these subjects with some knowledge, but also know what your resources are. I don’t pretend to be an attorney or a financial planner, but I know enough to understand when somebody might need help in those areas and have alliances and partners that I work with so that my clients can get the best help that they need. I also have to have a background check to ensure that when I am working with seniors that I am not going to take advantage of them.
Price: Heidi, the CSA certification, is this something that is nationwide? If there are people in our audience in various states around the country … I know you’re calling in from the Washington DC and Virginia area. Is this something that is in every state?
Heide: It is. It’s a nationwide society, Society of Certified Senior Advisors. Anybody can take the course. It was developed by AARP and a couple of other organizations because they understood that with the baby boomers coming down the pike and a silver tsunami, that they needed to educate people in various industries such as financial planning, real estate, home care, et cetera. It gave a good broad background and it helps us help our clients better.
Price: Wonderful. Listen, we are certainly delighted to have someone on the show who’s had so much experience in the space and has invested in themselves as well to help out this particular community. Let’s move straight away into the topic for today, and that’s all about hospitalization. I think as we were speaking before the show started, I told you my own mother has fallen at least three times that resulted in hospitalization. The first time she broke her shoulder. Then five months passed and she fell and broke three ribs. Then five months passed and she fell and broke her pelvis in two places. I told mom, “When the next five months comes, we’re putting you in bubble wrap and we’re not letting you move one inch.”
She made it through that and she didn’t fall during that five-month period, but we have certainly had our share of hospitalizations. Walk us through a little bit the things that our audience should know before, during and after the hospitalization experience.
Heide: Price, I’m sure you and your parents didn’t anticipate any of those hospitalizations, so it’s a little difficult after the fact to be ready for that. We talk a lot about planning. We know that as we age some of us will spend time in the hospital, so it’s really important to think about what’s important and how to be prepared. The first thing I tell people, grab your documentation. By this I mean have in some kind of form, it could be in a three-ring binder, it could be on your computer and shared with family members, but the best way is to have something called the File of Life.
That is readily available on the internet. A lot of counties will give out free Files of Life. It’s a simple document that you keep on your refrigerator, and you should update it twice a year. What kind of information would a File of Life have? It would have obviously your contact information, your emergency contact information, your family members, a neighbor, your attorney, your doctors, all of those people that support you. You’re medication list-
Price: Heidi, I’m looking at it right now. For our audience, is that fileoflife.org or folife.org?
Heide: That is correct, folife.org.
Price: Okay. Perfect. Thank you.
Heide: It’s very easy to get. Do it yourself. Print it up. Fold it up nice. Put it in a little envelope on your refrigerator and in case of emergency grab this.
Price: What a great idea.
Heide: It shouldn’t take somebody more than thirty minutes to fill it out. It does require you to list medications, which even your doctor could provide the printout when you see the doctor on a regular basis. That’s important to update that too, because medications can change. Things that may not change, your allergies, your insurance, your recent hospitalizations or surgeries are important to have on there.
As we evolve into electronic health records or electronic medical records, some of this stuff will be even easier to gain, but for now the best place is to keep it on your refrigerator. Why that is is when you call 911, that’s the first place that the paramedics or emergency medical technicians go. They’re instructed to look there first.
Price: I could certainly see where this could be so helpful, because you end up giving this to them anyway when they arrive. I’m sure they’re asking for the same kinds of information, and you may not be in the right frame of mind to do this anyway. Your loved one has fallen, something bad has happened.
Heide: Or what if you live alone and you can’t speak for yourself?
Price: Very true.
Heide: There are lots of things to talk about in case of emergencies, but this in particular is something that I see so many older adults … Even myself, if I had to go to the hospital tomorrow, I don’t even think my husband would know what medications I take, so it’s really important for everybody to have some kind of system in case of emergency.
Price: That’s great. How about medications? What we have done is we have taken all of mom’s medications and we keep them in a little carry bag, almost like a small shopping bag, a small handbag. I take them out to fill up her pills every week, but I put them back in there as soon as I fill up her pill dispenser so that in the event something happens we just pick up that pouch and go straight away to the hospital.
Heide: That’s excellent. That would probably be more current than anything you may have posted on your refrigerator as well. I think that’s an excellent idea if people will remember. Sometimes the emergency medical technicians will see that as well if there’s somebody there to help an older adult who’s going to the hospital.
Price: Anything else we should be thinking about in the pre-planning?
Heide: The other thing that people … In all my clients, I would ninety-five percent of them may not understand this process. I ask them, “Do you have advanced directives? Have you prepared documents with your attorney that gives some direction to medical professionals and your family how you want to be cared for in an emergency or end of life?” A document called a Do Not Resuscitate can be posted on your refrigerator as well. That’s another thing that the paramedics or emergency medical technicians will look for. It’s called a DNR. This is not a legal document, it’s a medical document that you and your doctor sign together.
When I ask people, “Do you want heroic measures taken if you had a heart attack tomorrow,” “Oh, no, no, no, no. I’m eighty-nine years old and I’m okay with having a heart attack and not being resuscitated. I’m comfortable with that.” Everybody has their own ideas about how that situation should go for themselves. They’re not going to look for your will in the drawer. They’re not going to look for your advanced directives. There is really nothing to indicate to the professionals that you are do not resuscitate. I tell people you usually have to bring it up with your doctor when the time is right.
Price: And the default … Heidi, is the default if there is not a DNR, is the default to take every heroic measure available?
Heide: Me, as a fifty-something year old woman, I don’t want a DNR. If I had a heart attack tomorrow, I would want to be resuscitated, but somebody who’s eighty-nine may not have the same feeling.
Price: It’s an individual thing?
Heide: It’s an individual thing and it’s for a certain time of life. There’s also one thing that is becoming more and more prevalent in the US. It’s called a Physician’s Order for Life Sustaining Treatment. In the State of Virginia, for instance, it’s called Physician’s Orders for Scope of Treatment, or POST, P-O-S-T. That’s another website that people can visit to learn a little more. It’s www.virginiapost, P-O-S-T .org. That is something again that you and your doctor have to discuss, because it is a form that only comes from the doctor. He signs it and you sign it. It gives much more detail of how you want to be treated or cared for or resuscitated when there’s an emergency.
Price: Got it. All of these are things to do ahead of time, as you mentioned, post them on the refrigerator. Would the POST document, is that something that you’d put on your refrigerator or is that-
Heide: Absolutely. The POST kind of takes the place of the DNR. It’s just a new document which goes into a little more detail about certain circumstances that tells people how you want to be cared for, depending on the situation.
Price: I see. Does one replace the other? Do you have a DNR or a POST or both?
Heide: You can just have a POST if you want. If your doctor is ready to … They have to go through training. The doctors’ offices have to go through training and have to understand how to execute that document.
Price: Great. Okay. Very helpful. Very helpful. We have the File of Life that we put on the refrigerator so the paramedics can find all of the information, allergies, et cetera. Their medicines, keep them in a bag so in the event of an emergency you can just pick it up and take it with you to the hospital or the emergency room. Any requests like a DNR or POST, have that readily available as well.
Heide: Yes. Uh-huh (affirmative).
Price: Wonderful. How about when you’re actually at the hospital? That’s a very stressful time. People aren’t thinking clearly, high drama at times. What should our audience know about the admitting process, the emergency room process, and then being there in the actual hospital itself?
Heide: It is a very stressful time for people. It’s very difficult with all the details and the communication issues to really have a good experience sometimes, but there is a difference. In the last twenty years there is … Let’s just say twenty years ago your primary care physician would hear about you going to the hospital and then they would come to the hospital to see you.
Heide: Most of the time that’s no longer the case. Hospitals now use hospitalists, which is like a primary care physician, but only for the hospital. That is the general practitioner who oversees all of the specialists, all of the things going on at the hospital. They don’t really allow your primary care physician to come to the hospital anymore. It’s up to the hospitalist. Not all hospitals employ hospitalists, but the majority of them do. That’s, again, a physician who’s focused on treating and coordinating care for people who are in the hospital.
Price: That’s certainly the case here in our experience in our family. That’s also a little bit disruptive for a senior, as they’re used to seeing their primary care physician. Now there’s someone new, and they wonder if they really know everything about them, et cetera. Do the hospitalists maintain contact in real time or daily with primary care physicians or does it happen post the hospital visit or is it completely dependent upon the hospital itself?
Heide: That’s a great question, Price, because I just spoke to a doctor recently who says, “I have elderly patients who go to the hospital and I never hear about it until they’re back at home and they’re required to make a followup appointment within a couple of days of their returning home.” You do have to be an advocate or have somebody advocate for you to ask the question, “Are you going to contact my primary care physician about my hospitalization?” Maybe a family member can also contact your primary care physician.
Price: It’s one of those as so many things in this space … It’s one of those things we have to take into our own hands, as you said, and be that pro active advocate. When is the right time to contact the primary care physician? While you’re in the emergency room or after being admitted? What’s most useful?
Heide: I think anytime is useful. If you do have time while somebody is in the emergency room, it can’t hurt. Again, they may be able to provide you some updated information that the emergency room doctor might need to know, when you had your last tetanus shot or something of that nature. I think it’s really up to the family or the advocate to make that call if the hospital doesn’t do that.
Price: All right. We’re going to take each of these tips as we’re going through them, Heidi, and we’ll make them part of the show notes, so family members can print these things out and have those as a checklist of things to do as well. As we’re talking about being admitted to the hospital, again we were speaking before the show began, I think there’s something that our audience needs to know that could potentially cost them thousands of dollars if they’re not aware of it, and that this topic of admitted versus observation. Could you speak a little bit about it and why that seems so important?
Heide: It’s extremely important Price. Medicare has two kinds … Or the hospital actually has two kinds of statuses for people who are in the hospital. You may be under observation or you may be admitted. It’s very important to ask that question. Sometimes when you go to the hospital they’re not exactly sure what’s wrong, so under observation they want to ask questions, they want to keep track of your vital signs, they want to maybe do some blood tests or something. They really want to determine what’s wrong with you. Depending on the results and the answers of those tests and everything, they will admit you to the hospital or not.
The question is, “Am I on observation status or have I been admitted?” You may be in a hospital bed, you may even be in a hospital room, but you still may be under observation. If you are under observation, Medicare will not pay.
Price: To the family and the patient it looks exactly the same? You’re in a hospital bed, there are devices connected to you, maybe fluids being administered, nurses coming and it going, and it looks the same under observation versus admittance? You said you may even be in a hospital room itself, but they’re two radically different things that Medicare doesn’t pay?
Heide: Correct. The other piece of this is you my be under observation for twenty-four hours and then you may be admitted for two days … The average hospital stay is only about three days. If you’re going to get Medicare to pay for your hospitalization, you have to be in the admitted status. In addition, if your next stop before going home is a skilled nursing or rehabilitation center, you also have to have a minimum of three days’ hospitalization as an admitted patient; not observation, but admitted. Does that make sense?
Price: It does. Let’s back up just a little bit and see if we can make it really clear for people listening in. If your loved one goes to the hospital and on day one they’re under observation and day two and day three they’re under admitted status, who pays for day one?
Heide: The patient does.
Price: The patient?
Heide: Uh-huh (affirmative).
Price: That’s why it’s so critically important … If you’re under observation status for day one and then you’re admitted day two and day three and you need to be there three days before you can go into therapy, do they count all three days or only the two days when you were under admitted status?
Heide: On the two days you were under admitted status.
Price: This is so important. You said a few minutes ago it’s important to ask the question, “What is my status, observation or admitted?” To whom do we ask? Is it the doctor? Is it the nurse? Who do you reach out to in that moment and say what is my status while you’re there in the hospital bed?
Heide: That’s a really good question. If I was in the hospital bed I would probably ask that more than once, maybe to the doctor, the nurse, and especially the social worker or discharge planner. Let me back up a little bit. As soon as you walk in the door at the hospital they’re already planning your discharge. I know that sounds kind of strange, but because the turnaround time is usually an average of three days, they need to work on what’s the next plan of care for this patient when he leaves the hospital. A social worker will absolutely know what your status is. When I say social worker, it could also be a registered nurse who is a case manager or discharge planner. That’s their official title, case manager or discharge planner.
Price: Okay. This piece of news alone, Heidi, could save our listening audience thousands of dollars and lots of grief as well, because if your three stay was split up between observed and admitted it would jeopardize your therapy stay, wouldn’t it?
Heide: It does.
Price: Let’s move on to that three days. How should family members and the patient be posing questions? Do families even say, “I know I need to be in here three days if I’m going to get quality therapeutic care afterwards.” What do you advise people every day about that three-day rule?
Heide: I think that’s your time to ask questions. It is almost an hour-by-hour, day-by-day change in somebody’s status. It’s very hard for the medical professionals to anticipate what somebody is going to need. We all want answers and none of us have a crystal ball. The professionals at the hospital will be very reluctant to commit to saying this person will be discharged on the fourth day, or this person will need skilled nursing and rehab afterwards. It is kind of a wait and see.
One of the things I also want to mention … Two things actually in this process. Not to change gears too much here, but some of the risks associated with hospitalization, the falls. Really communicate to the hospital staff that my loved one has fallen in the past. Lots of times people in their older years get very confused in the hospital. Not only do they have something medically wrong with them, but they might be in an area they don’t understand what’s going on, they don’t feel well, they’re susceptible to infections, et cetera. Be aware that confusion, although not normal, it can be an issue. Talk about falls. Somebody may get up in the middle of the night to go to the bathroom and fall, so talk to the professionals about your loved one being a fall risk and try to minimize that as much as possible, maybe with a bedside commode for instance.
Second of all, the questions you might want ask to the hospitalist, how long will you be on duty? Will there be other physicians that will be working with our family? How and when can I contact you? Who else will be involved? Try to get the big picture of how it all fits together. The communication is really, really important. Ask what other questions should I be asking? I love that question, because we don’t know what we don’t know. Sometimes just asking somebody who has been through it, who works in the industry, will have some good questions and answers.
Price: Heidi, what is your advice to families when a loved one is in the hospital? Some families, if it’s possible they like to stay in the room with the patient. How do you stay on top of all of the moving parts when the loved one is in the hospital? What are some of best practices?
Heide: Good question. If you can have somebody there twenty-four hours a day, depending on the situation, that’s ideal, but that’s very difficult to be at somebody’s bedside for a long time. Hospitals are very supportive of families, especially if somebody is having confusion or is a fall risk, et cetera. I would ask may I stay here, and more often than not they’re going to be open to that.
Second of all, I hate to say it, but sometimes the staff and the whole procedures on the weekends are different. Your staff Monday through Friday is going to be different than the weekend staff sometimes. I think it’s important that people stay involved even on the weekends, and if you have family members that can alternate, because it is very exhausting being at somebody’s bedside twenty-four hours a day.
Price: Those families that have in home care, while they’re in the hospital do those caretakers become advocates? Do they continue to assist while they’re in the hospital? What’s the best practice there?
Heide: That’s an excellent way to create some consistency if somebody is very confused or frightened about being in the hospital. If somebody has had eight hours of care for many weeks or months or years, it’s great if you can continue that care in the hospital. It’s just somebody to be by their bedside to reassure them that everything is going to be okay, I’ll be right here if you need me.
Price: The word consistency I think is key, isn’t it? Making sure that there’s not too much of a change. There’s no way you can avoid all change, but minimizing as much as you can at a time like this. As much familiarity as possible certainly is helpful. Heidi, what else should families be aware of? We said we were going to talk today about being ready ahead of time, and we talked about the documentation there and the File of Life, things to be aware of while in the hospital and things post-hospital. Before we move into the post, I’ll take your tip … Is there any other questions we should be asking ourselves and things we should be talking about for the listening audience during the hospital stay?
Heide: This is kind of a combination of during the hospital stay and planning for going home. When people are in the hospital they get very concerned about how quickly they have to plan for going home. What I mean by that is you may only be given twenty-four hour notice that your loved one is going to go home tomorrow. If you’re not already thinking about home care, if you’re not already thinking about the accessibility in the home, it can really catch you off guard.
Price: Right. Absolutely. We’ve had less before. I remember one hospital stay, we were told that morning we were going to be discharged later in the day. While on one hand it was good news, on the other hand it was a bit of a panic, start to figure out what do we need at home to get ready if we need to be discharged in a matter of a few hours?
Heide: I don’t think the hospital wants everybody to go through that panic and that stress; however, people should know that it’s insurance fraud to keep somebody in that care situation longer than they need to be. For instance, if skilled nursing and rehab is the next step, that is a better plan of care than somebody staying in the hospital, where they’re not going to get the type of therapy as much as they would get if they went to a rehab. There is a grand plan for this. Nobody wants to make this difficult for families.
But I also say talk … If you’re not completely ready yet, and nobody is ever completely ready perhaps, but if you’re not completely ready talk to the discharge planner, “Can you please just give us twenty-four hours, please?” Be that squeaky wheel, be that advocate. “This is why we need an extra twenty-four hours.” Usually they’re a little more flexible; not always, but it’s worth asking.
Price: The discharge has come, people are excited on the one hand because the discharge is coming, and then the next step is either to some sort of therapeutic program or discharge back to home. What should people be thinking about at that phase?
Heide: This is where all of the resources that a discharge planner or case manager can alert you to is really important. Although they won’t give you one resource, they’ll give you several to choose from, and that’s where it takes family members to find out who can help with building a ramp up to the home, for instance, who can help expand the home care. Try to find out what the discharge orders are from the doctor, and that might be some indication what you’re going to need at home, whether it’s twenty-four hour care when somebody didn’t need twenty-four hour care in the past, or somebody to make meals or other equipment. The nice thing about the equipment, such as a bedside commode or a wheelchair or walker, that the discharge planner can help order. That’s what we call durable medical equipment, DME, and it’s usually covered by insurance.
Price: Is that both Medicare and Medicaid? Who pays for durable medical equipment?
Heide: Medicare will pay for many pieces of durable medical equipment, or at least on a rental to own basis if it’s a certain kind of wheelchair or something like that, or maybe even a hospital bed. Of course the doctor has to write prescriptions for all of these. While it may be convenient, it has to be a medical need for insurance to pay for it. It’s always going to be Medicare or your secondary insurance such as Blue Cross/Blue Shield, AARP, Tri-Care, AETNA. All of those insurances, depending on if it’s your primary or secondary, should provide some payment for durable medical equipment and other things that you may need.
Price: Got it. Does Medicaid play any role in that at all for those that are receiving Medicaid?
Heide: Medicaid is actually custodial care for somebody that has no assets and their medical costs exceed their incomes. Medicare and Medicaid often get confused, but Medicare is like short term disability, that’s the way I describe it. Medicaid is when you need twenty-four hour care. You have to qualify medically and financially for twenty-four hour care and have little or no assets left, and it’s usually in a nursing home situation that you receive [Medicare 00:34:03] services.
Price: I see. Folks now are discharged. Talk a little bit about post-hospitalization. That’s not the time we breath a sigh of relief and say finally we’re out and life moves on as normal, is it?
Heide: No. That first week is extremely important. Hospitals and the discharge planners are very concerned how that first week goes. You are required to see your primary care physician within the first week, and I’m speaking in generalities here. Everybody’s situation might be a little bit different, but in general the hospital does not want you to come back because if you do-
Price: Why is that?
Heide: If you do they can be penalized by Medicare. If you had a condition such as urinary tract infection and you were sent home and it didn’t get any better and you fainted or you became delusional from the urinary tract infection and you went back to the hospital within thirty days, the hospital can be penalized for that. In other words, Medicare will not pay a second time. That being said, that first week or two weeks is really important for the family and caregivers to make sure that the patient is getting what they need nutritionally, hydration, exercise, physical therapy, occupational therapy, going to the doctor, all of the things they need to get better.
Price: Got it. Any other tips post-hospitalization?
Heide: I do think that if this is a new arena for some families it can be extremely overwhelming and frustrating. Sometimes just having somebody to explain how things work makes it so much easier. A lot of times the health care professionals in the hospital situation don’t have time to explain a lot of things. They’re dealing with very busy days. What I like to tell people, there’s something called an aging life care professional and they’re also called geriatric care managers.
Two reasons somebody might want to tap into the expertise of a geriatric care manager, and that is if you feel like you need support, more information, if you’re having trouble learning how things work in a quick amount of time, you might want somebody to explain to you what’s important, all of these things that we talked about. The other side of it is people who don’t have family. Maybe you’re a neighbor trying to help somebody who was never married, never had children or something. You really should talk to an aging life care professional or a geriatric care manager to see if they might become that advocate for that person who has little or no family support.
Price: Heidi, where would one find a geriatric care manager?
Heide: There’s a website called aginglifecare.org, so it’s www.aginglifecare.org. That’s the Aging Life Care Association. There you can search based on zip code who the geriatric care managers or aging life care professionals are in your area.
Price: How expensive are these services? Are they provided for by Medicare? Is it an out-of-pocket expense? Talk to me a little bit about the aging life care managers.
Heide: They’re usually not covered by insurance. Sometimes long term care insurance, which is something different, may cover it. It’s a private pay situation. They usually have an hourly rate of anywhere between a hundred and a hundred and eighty dollars per hour.
Price: That’s expensive, isn’t it?
Heide: It is, but then sometimes people just might need a couple hours.
Price: Got it. I got it. They come in for a couple of hours, help the family reorient themselves, maybe lay out a plan of care. It’s not someone who is providing in home care for an extended period?
Heide: No. But they do understand how home care works and they can make recommendations on how to care for somebody better. They act like a quarterback for the older adult and their families.
Price: Got it. I must admit this is a role I had never heard of, didn’t even know it existed. It’s great.
Heide: It is becoming more and more known about, but it’s also been an industry that doesn’t brag. They’re usually social workers, registered nurses, psychologists perhaps, gerontologists. They’re people that work on a freelance basis and they connect well with the other professionals that work with older adults such as doctors, attorneys, financial planners. You’re right, the general public doesn’t know enough about aging life care professionals and they can be extremely beneficial, if just for a couple hours or on a long term basis, just to give people quality of life.
Price: Heidi, this has been very helpful and very informative. I’ve been taking notes here as we’ve gone along, and I’m sure our listeners will be doing that as well. This was just filled to the brim with tips and things to actually do, both in the time of crisis and beforehand. Thank you so much for taking some time. I’m sure we’ve just scratched the surface.
Heide: I do think so, but it’s a good start. Thank you so much for having me.
Price: You are welcome. Heidi, how can our listeners get in touch with you and learn more?
Heide: My website is www.caringconsiderations.com. Caringconsiderations is one word .com. My email is heidi, that’s H-E-I-D-I @caringconsiderations.com.
Price: Wonderful. Heidi, thank you so much. I really appreciate you spending this time with us today. I think people are really going to benefit from it. I’ve learned a few things.
Heide: Great. That’s super Price. Thank you so much.
Price: All right. Have a wonderful rest of the day.
Heide: Will do.
Price: If you found today’s podcast helpful, go to our website, www.eldercare101.com. Click on the get started here button to let us know the types of things that are most helpful to you, to let us know the things you’re struggling with so we can tailor content to meet those needs. We’d love to hear from you. I personally would love to hear from you. God bless. Talk to you soon. Bye-bye.
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