254 | Easing the Burden for Family Caregivers with Max Mayblum and Givers

Hilary Hendershott: Well, hey, money lover. You’ve heard me talk about the sandwich generation before, the generation that’s found themselves caring for both their children and their aging parents. It’s a tough place to be, so today I’m joined by Max Mayblum, who refers to the sandwich generation as the caring generation, a rebrand that acknowledges the typically unpaid work this generation does.

Hilary Hendershott: Max Mayblum is the founder and CEO of Givers, a platform that hires, supports, and pays family caregivers through existing state programs. Max started Givers in 2021 after connecting his professional experience in digital health with a personal experience in family caregiving. He’s passionate about building a sustainable system for care as our loved ones age. He is a certified senior advisor, and his work has landed him on lists such as Fast Company’s World Changing Ideas, and the Forbes 30 under 30. He lives in New York City, and he’s an avid traveler who loves to ski.

Hilary Hendershott: But before we get to the interview, there’s a couple of things I want to bring up when it comes to integrating long-term healthcare into your financial planning. It’s no secret that accounting for the potential need for future care is necessary, and, some of the numbers I’ve heard quoted in the media are really daunting. However, I’m heartened to share that the total average costs of care are less than what some of the media headlines would have us believe.

Hilary Hendershott: Here’s an excerpt from some research done by a UCLA professor of statistics, and it was published by T. Rowe Price in 2022. Quote: “We know retirees are concerned about the cost of healthcare in retirement. Two of the top three spending concerns in retirement are the cost of long-term care and the out-of-pocket expenses related to healthcare. So people are worried and they’re worried about how much care they will need and the cost of care depleting their savings.

Hilary Hendershott: But what does the data show? Surprisingly, the data shows that only half of us will go into long-term care before death, and half of those that do go into long-term care facilities will only be there for less than three months, a surprisingly short period of time, and oddly in line with the waiting period on most long-term care policies. And what about the fear of spending down your nest egg to zero because of long-term care or health expenses? The study showed that, as we know, the older you live to be, the more you spend on long-term care. And for those of us who live past age 90, 95% don’t run out of money paying for healthcare.” End quote.

Hilary Hendershott: Again, it’s heartening. But that doesn’t mean it’s something you don’t need to be concerned about. Luckily, I have more good news to share. There are a ton of resources that exist to support caregivers and their loved ones. The biggest barrier to access these resources isn’t availability, it’s awareness and access. That’s where companies like Givers, and today’s guest, Max Mayblum, come in. Max’s company helps connect families and caregivers with funding that’s made available, in many cases to recipients of Medicaid, which is a program that helps cover medical costs for people with limited income or insurance. Medicaid can be utilized as part of your financial planning in retirement, which is known as making a Medicaid Plan. This helps you qualify for things like nursing home coverage or the services covered by the programs Givers connects people with, without spending down your assets. There are also social security benefits and other ways to mitigate the cost of disability or the need for care.

Hilary Hendershott: This isn’t a substitute for prudent long-term planning or retirement savings, but it is an absolutely viable, legitimate, and legal way to cover health care costs as you age. And, that is definitely something you will want to discuss with an asset protection lawyer or elder law attorney. And that would be specific to your state. So you need to contact an attorney that’s located in and licensed in your state. You can learn more about that in episode 120 of this podcast called How to NOT Outlive Your Money. In that episode, I interviewed Michigan attorney Nicole Wipp to talk about how to make sure that paying for long-term care or assisted living doesn’t cause you to run out of money. You can find a link to that episode in the show notes at hendershottwealth.com/254. And now without further ado, let’s get to today’s show.

Hilary Hendershott: Welcome to Love, your Money®, Max.

Max Mayblum: Thanks for having me.

Hilary Hendershott: I am eager to have this conversation. I wish, of course, we didn’t have to have a conversation on such a topic, but, as we all know, people are forced– are sort of foisted into all kinds of situations, one of those being the potential health, limitation, diagnosis, or injury of a loved one, which means that they may need extended care. And so you have a personal example, a personal situation, that kind of drew you into this line of work. Let me just start by asking you, tell me about how that was for you. What happened?

Max Mayblum: Yeah. So I’ve been in digital health for most of my career. And as COVID started, like so many others, I moved into the home with my family. And I was working at this startup that was a telehealth platform for chronic conditions that helped lower the barriers to accessing quality care. And as I moved in with my family, unfortunately, my aunt was diagnosed with terminal cancer, and so I saw my parents put their lives on hold and really make caring for her their number one priority. And I wanted to contribute in any way that I possibly could.

Max Mayblum: So at night, when I wasn’t working on the telehealth startup, I was looking for resources, online support, different companies that could be helpful, insurance benefits… to really just provide my parents, as the primary caregivers, some sort of support. What I found was a really broken system, and I remember vividly having a conversation with my parents about other families and what they might be going through in a similar situation. Questions of, could this derail a plan for a kid to go to college? Could this delay retirement? Could it throw a family into bankruptcy? And that’s what inspired me to start Givers, where we hire, support, and pay family caregivers to allow them to sustain themselves while they care for a loved one.

Hilary Hendershott: I’m so sorry about your aunt. How long were they providing care for her? May I ask?

Max Mayblum: They were caring for her over the course of two years during COVID.

Hilary Hendershott: Oh, wow. So I think, being such a hands-on person, I think if I were thinking about how to help my parents care for my aunt, I might say, how many days a week do I need to take off work and show up at the house to actually physically provide care? But, was it your work experience in digital health that led you to kind of trying to figure out the regulatory morass? Or why was it that that was inspiring to you to take action?

Max Mayblum: So it was the middle of COVID. So we were being really careful about who would go over and take care of her.

Hilary Hendershott: Oh, my goodness.

Max Mayblum: Especially given her vulnerability. So my parents were doing everything they needed to to stay quarantined so they could get in the car and drive from Florida to Atlanta and take care of her, and it was just so tough to watch them, and I wanted to do anything I could while I was at home. So I was really the one just thinking about supporting the caregiver, knowing that they were there to support her.

Max Mayblum: And I realized that we, you know, we have a saying at Givers that “the burden of caring isn’t the care itself, it’s everything else that surrounds it.” And I learned that firsthand, and if you can help family caregivers find support, whether financial or not, it can help allow them to be more present. And I know, with my own parents, there was nothing more that they wanted to do than be in the room sitting next to my aunt, taking care of her. What they didn’t like doing was stepping out of the room and taking a phone call or going onto an insurance website or dealing with the different things they may be looking up at that time, and so I was trying to play that role for them.

Hilary Hendershott: Wow, yes, I remember all the restrictions on moving around the world from COVID. I can’t even imagine. They couldn’t even go grocery shopping. So what are you, in the time between then and now, what are you most proud of that you’ve developed at Givers? What subsection of people who are giving care are you most able to provide resources for? What does that look like?

Max Mayblum: So when I went through this experience with my family, I started to ask myself, How might I be able to scale my experience that I had in just my household to the entire country? And there was a whole process of learning involved there. And what I saw was really eye opening. And it was really this underbelly of family caregivers who actually make up 53 million Americans that are taking care of their loved ones, sort of outside of the lines, sometimes not discussed and sometimes taking away from work. And, and I saw there’s enormous costs involved in care. Family caregivers spend over $7,000 out of pocket per year on caring for their loved one. If they’re caring for a loved one with dementia, for example, it’s over $10,000 per year. And there’s also opportunity costs. They’re giving up wages. They’re less productive at work, or they may even drop out of the workforce. And so when I decided to start Givers in 2021, what I really wanted to do was find a way to provide financial support where there was a lack of information and a lack of resources.

Max Mayblum: I read a story at that time that Arizona had launched a program to provide a million dollars to support family caregivers, and after a number of months running that program, it essentially failed. They failed to distribute the money, and the problem was that people didn’t know about these benefits. And so that’s really what became eye opening to me, was that there’s support out there, the problem in many cases is about accessing the support.

Max Mayblum: And so what, what we did at Givers is we built a free tool that’s kind of like a TurboTax, where any caregiver anywhere across the country, from any financial background, any demographic, any zip code can come onto our website at joingivers.com, answer a few questions, and get a really personalized recommendation to programs that are available in their area that they appear to be qualified for. And we’ll tell them how to actually navigate their way towards applying. And then, in some specific states, we’re actually able to hire support and pay family caregivers.

Max Mayblum: So if you’re caring for a loved one who’s on Medicaid, for example, and you’ve needed to actually move in the home with them, and you’re providing more than five hours of care per day, so caring for your loved one has become a full time job. That’s where we can come in and actually hire support and pay you so that you can sustain caring for the loved one. So we’ve really seen the whole spectrum from Medicaid, lower income individuals and families who are struggling with making ends meet, and the ability to sustain care all the way up to higher income families who are self funding all the care that they’re providing or paying for out of pocket. And they’re realizing that this is making a big impact on their financial sort of longevity or plans. And they’re looking for things that can be helpful to them in remedying those costs.

Hilary Hendershott: So then, being on Medicaid or being extremely low income, isn’t necessarily a prerequisite to receive public resources. Is that accurate?

Max Mayblum: That’s right. Yeah. Every state in the country has regional area agencies on aging. These are local, regional entities, and one of the national mandates for these area agencies on aging is that they offer caregiver support. Those supports can come in the form of respite care, counseling, financial assistance, Meals on Wheels. So there’s programs that are available to every person, no matter income level, in any state. And then there are some specific programs that are targeting populations of lower income, whether they’re offered through Medicaid or a private grant program.

Hilary Hendershott: Oh, I have so many questions. I can’t even imagine what it’s like for you, as a company, as an entity, to take on trying to learn the legal morass of every one of 50 states. Is that what you’re doing?

Max Mayblum: Yes, that’s what we did. It was a ton of time and energy, but we mapped the entire country for all these different programs. And because I’ve been there myself, we didn’t want to just say, here are the four programs that exist in your zip code. We’re asking you the questions and we’re algorithmically finding out, what are the ones that you seem to be qualified for? And then not just that, here’s the phone number to apply. And when you call that phone number, you’re gonna need to dial extension number 2 to get to the person you want to speak with.

Max Mayblum: So really, what we realized is, caregivers do not have the time or energy to jump over these hurdles, and so, if you can lower those barriers for people, they’ll be able to access the support that they need. And it’s a win-win for everyone that’s involved. Right? The caregiver gets the support that they need to be able to show up every day and care for their loved one. Of course their loved one benefits from that, and then also the state and the government benefits when we’re able to provide sustainable long-term care in the home rather than institutional settings that are so costly, and places that people don’t usually want to end up, anyway.

Hilary Hendershott: So I played around with your finder tool. My 8-year old daughter actually had a pediatric diagnosis. But that diagnosis wasn’t on your list. So I started thinking about what I wanted to talk with you about. What have you found are the diagnoses that are most likely to make you entitled to public funds?

Max Mayblum: So there’s really two sorts of categories here. And I think, I’m sure you’ve heard the term sandwich generation, which is people who are taking care of elderly parents and children. And I like to call that generation actually the caregiving generation because they’re caring on both sides of the spectrum, and those two sides of the spectrum really represent the two subsets that we see most often, which is elder adults, often dealing with Alzheimer’s, dementia, or a physical disability. And then we also see children with intellectual and developmental disabilities. And when you look across the country, those are the two populations that are really being targeted with these programs. And so every state has its own flavor of programs that can support those two populations. But, generally speaking, those have been identified by Medicaid, Medicare, health insurance as two of the populations that are most dependent upon family caregivers. And so those supports are coming to exist now.

Hilary Hendershott: Okay, so and forgive me for my naivete, but specifically with your aunt, who had a cancer diagnosis which of course, led her to probably limited activities of daily living, etc. Were there public funds available for her diagnosis in that situation, based on declining ability to manage her own activities of daily living, or, I mean, cause so many people have cancer Max, right?

Max Mayblum: Yeah, unfortunately, she declined too quickly and so those programs weren’t even going to be helpful. But what I did find for cancer specifically is that in most cases those types of supports are offered through private grant programs. So some hospitals may have a program, some states may have a nonprofit that’s running a program. And so what I would suggest for people dealing with that sort of diagnosis is to talk to a case manager at a hospital or talk to a social worker at a local agency and see what support is available. The number one thing I’ve learned in this entire environment is that you won’t get what you don’t ask for. And so if you can find just the right person to ask for support, sometimes it takes 10 min, and I know when you’re a caregiver, those 10 min are precious and they’re hard to come by. But if you’re feeling that financial strain, they’re they’re well worth the time to just kind of find out what’s available.

Hilary Hendershott: I’m thinking specifically of a couple, they’re clients of mine, and you know, income close to $400,000, caring for young children as well as one of their parents is quite ill and living with them, and they just always seem, first of all, I know they’re resource stretched, but each time I see them and talk to them they seem more energy stretched. Like the saying, “burning the candle at both ends.” It’s like they’re educated, professional, hard working, career building. And yet it’s sort of all being taken from them. And my heart just goes out to them.

Max Mayblum: This is the caregiver burden that millions and millions of Americans are dealing with quietly. And even when you’re talking about the wealthiest of individuals, they’re dealing with the stress of,” Hey, I had this plan. I thought that I did all the right things, and now I can sail off into the sunset.” And next thing you know, you run into a family situation, and you’re rethinking all the plans that you had made. And it’s, it’s stressful. I mean every family goes through it, no matter what level of income bracket they’re in.

Hilary Hendershott: Let’s see, what are some of the more interesting, creative ways, if you have insight into how lots of families are dealing with this kind of situation. What’s a more surprising or impressive thing you’ve seen people do to mitigate the individual or concentrated costs of caregiving?

Max Mayblum: Hmm. One of the things that I’ve actually seen is sort of a “pass it on group”, where there’s durable medical equipment, whether it’s crutches, wheelchairs, any sort of any sort of heavy duty hardware that a family might use temporarily, and they can pass it on in a Facebook Group. And so I’ve seen these informal groups been stood up between a bunch of caregivers, and I think that that’s one of the most creative solutions I’ve seen, because when you look at that $7,000 plus that’s spent out of pocket, in many cases hardware is driving a lot of that cost. And so I would say, if you need one of these–a bed or a wheelchair, or some sort of durable medical equipment–I would say, check out your local community groups, whether it’s a Facebook Group or somewhere else online in your neighborhood. Because a lot of the time people have used something, maybe for six months, maybe for a year, and it’s still in pristine condition, and you can get more use out of it.

Hilary Hendershott: That’s really interesting. So the way you’ve described it with the money being available but not claimed, and also private and public funding and sources and things being sort of really nuanced and anecdotal, reminds me a lot of scholarship money, paying for college.

Max Mayblum: Mmhmm.

Hilary Hendershott: There seem to be a lot of things that this topic has in common with that, and there’s no way around it. But yeah, just to reinforce what you said, you don’t get what you don’t ask for. Ask for something a hundred times, maybe ask a hundred different people. I’m sure you’ll get a hundred different responses, but perhaps a path to something you didn’t know existed. Okay. So your company is called Givers, and is the app live? Or are we doing the website tool now?

Max Mayblum: We have the website tool and an app live. So the website tool is free, available for any caregiver to use across the entire country. They can come, answer a few questions, find out what programs they’re eligible for and how to apply. And then our app is what we actually provide to the caregivers that we hire. So when you get hired through one of these government programs, there’s a lot of work that needs to go on between us and the caregiver to make sure that they’re getting paid and supported. And so that app is where they can document what they’re doing on a daily basis, chat with a coach, access trainings, and then also access their pay.

Hilary Hendershott: And what’s the range of compensation these folks are earning?

Max Mayblum: So these programs vary. In some states, they’re hourly rates, and they can be anywhere from 15 to 20-something dollars. And then the programs that we serve, generally speaking, are actually stipends. So they’re on a per diem basis, and those stipends can add up to $2,000, if not $3,000 per month, tax free. And so that’s one of the really unique things about these programs that we’re serving, is they’re actually considered foster care sort of programs. And so the income made through these foster care programs for the caregiver is actually tax free for them.

Hilary Hendershott: Oh, wow, that’s nice.

Max Mayblum: It’s a really big benefit. And we’re working with the Medicaid population. So when you think about how much someone may be making at a job already, maybe making minimum wage. And they’re paying taxes. And then they’re also paying out of pocket for mom or dad to get care. The math really can add up for a lot of people to make the switch into these programs. And what we find is, generally speaking, we don’t have to really convince anyone to join this program. Once they understand the math behind it all, and look at the opportunity to be in the home every day with the person that they love, it’s a clear answer for them.

Hilary Hendershott: Yeah. And so if someone’s listening and Medicaid isn’t something they know much about, would you share–and I I know you don’t hold yourself out as a Medicaid expert–but how does someone know if they should consider being on Medicaid? What sort of period of time would that be? And what does that mean for them financially, if they really see themselves having a wealthy financial life in the long run, does being a Medicaid person limit that. What would you say about that?

Max Mayblum: Yeah, so I will caveat, I’m not a Medicaid expert, but I’ve learned a lot in building Givers. And the 101 is really important. Sometimes we need to just clarify the terms here, because I know when I started, I didn’t understand the difference between Medicare and Medicaid. Medicare is health insurance offered through the federal government for people over 65, and with some specific conditions, otherwise, under 65. Medicaid is focused on lower-income individuals across the US. It’s the largest health insurance program in the entire country. During COVID, there were up to 90 million people on Medicaid. And so that’s a federal program that’s run at the state level. So every state has their own rules, but it’s all funded in part by the federal government. So to qualify for Medicaid, you need to be below the federal poverty line. And so you need to be making, in many cases, less than $2,000 per month and you’ll also have to have a certain amount of limitation on your assets. So there are strategies that I don’t know too much detail about, but that concern spending down in order to qualify for Medicaid.

Hilary Hendershott: You’re talking about elder law planning. Yeah, I’m familiar.

Max Mayblum: Yeah. And so I wouldn’t claim to be an expert on it. But what I’ve seen is, if your family is kind of stuck in the middle, where you’re not able to pay out of pocket for all of these costs. But you’re just above the cusp of Medicaid, I would say, consult an elder law attorney, and potentially look into spending down in order to qualify for Medicaid, because Medicare does not cover long-term care as much as we think would for an insurance plan that covers long-term, older adults. It doesn’t offer long-term care. Medicaid does. So you have to qualify for Medicaid to have the insurance kick in for those types of benefits.

Hilary Hendershott: So it’s conceivable that during a period of time where you choose or feel that you’re forced to leave your job in order to provide care for a sick or disabled family member, that you and or they could be on Medicaid during that period of time. And then, once that need is resolved, for whatever reason, you could go back to a normal– you could be rehired, you could have private healthcare insurance, it sort of could be a phase of life.

Max Mayblum: Yes, and Hilary, you made a very good clarification there. They are the ones who need to be on Medicaid. So if you’re caring for your mother, the program is offered through her Medicaid. And so that’s actually a really good point to make is, you don’t have to be on Medicaid yourself to be the paid caregiver. Your loved one needs to be on Medicaid.

Hilary Hendershott: Okay and I’m gonna say this incorrectly about elder care planning. We’ll do– I’ll put a point about this in the intro. But essentially, there are ways to strategize having your assets either not be in your name or be held in different ways, so that it doesn’t look like you’re a rich person, which of course you’re not if you’re providing care full time rather than building your career. But it’s a well-known strategy. It’s all above board and elder care attorneys do that. Okay, let’s see, what would be something you’ve seen someone or a typical stumbling block that you would kind of warn people against. What do you wish people would know?

Max Mayblum: Well, the first thing I would say is it’s the emotional burden of caring. And I know this is a money podcast but money is tied to emotions, and…

Hilary Hendershott: It’s called Love, your Money®!

Max Mayblum: Right. So to me, the first thing I always see is emotional burn. People are stressed, people are tired, people feel guilty for the way that they’re feeling about caring for a loved one. And I would say, know that you’re not alone. Know that your coworker, your neighbor, your friend may also be dealing with the same thing, and there’s support available. So that’s the first stumbling block, is really about identifying yourself as a caregiver and coming to terms with the situation. And then from there, it’s really about accessing resources, is the big barrier, and that’s why we exist is really to help bring down those barriers. You can go to joingivers.com for free. But you can also go to your local area agency on aging. You can call your loved one’s health insurance. You can talk to a social worker out of a hospital or a physician’s office. A lot of experts do exist to help you find resources. Like we said earlier, the key is asking.

Hilary Hendershott: Amazing. Is there anything you want to mention today, Max, that I haven’t asked you about?

Max Mayblum: No, I’ve had a great conversation with you. I appreciate you having me here.

Hilary Hendershott: Yeah, I appreciate your time. I hope this is of use to you if you’re listening, and we’ll put links to all of Max’s resources through his company, which is called Givers, in the show notes from today’s episode. Thank you so much for being here. Oh, Max, I forgot, I have a question for you.

Hilary Hendershott: A signature question which I ask everyone who comes on the show. Yes, it is a podcast about money, but of course, our emotions are intertwined with almost everything we do. So for you, and we haven’t talked about your money much, but of course you have a money life. If your money were writing you a love note, what would it be thanking you or acknowledging you for?

Max Mayblum: Mmm. I think it would be thanking me for being patient. I had the pleasure to run the New York Marathon a few years ago, and one of the things that I learned during that Marathon is that you can’t run mile 22 on mile 5, and just being patient, especially as a startup founder, wanting to see success in the future and feeling like what you’re building is so inevitable and so needed. It takes time, and being patient and knowing that you can, you know, take it one day at a time, I think is, is a thing that both benefits me and my money.

Hilary Hendershott: Thank you for sharing your wisdom. I appreciate it.

Max Mayblum: Thanks.

Hilary Hendershott: All right. Good luck.