213: Choice in Aging: How Medi-Cal Programs Help Seniors Age in Place
Release Date: 10/14/2026
213: Choice in Aging: How Medi-Cal Programs Help Seniors Age in Place
Absolute Trust Talk
What if staying home as you age cost a fraction of what a nursing facility does? In California, a shared room in a skilled nursing facility averages about $130,000 a year. Choice in Aging's Medi-Cal waiver program works with about $6,000 per person per year to help people remain in their own homes, with the care, connection, and dignity they want. This week, Kirsten Howe sits down with Debbie Toth, President and CEO of Choice in Aging, a 77-year-old Bay Area nonprofit that helps older adults and people with disabilities live and age in community. Debbie explains how the Multipurpose Senior...
info_outline
212: Childfree Wealth, Part 2: Pet Trusts, POAs, and Who Decides When You Can't?
Absolute Trust Talk
Most estate planning conversations start with who gets what. For childfree adults, a harder question comes first: who makes decisions for you when you can't make them yourself? In Part 2 of her conversation with Scott Barnes, CFP®, CLTC, Director of Financial Planning at Childfree Wealth, host Kirsten Howe moves from financial planning to the documents themselves — and to the people named inside them. Scott and Kirsten dive in where many childfree clients start: pets, and why a line in a will leaving an animal and $10,000 to a friend doesn't do what people assume it does. From there, they...
info_outline
211: Childfree Wealth: Who's Your Long-Term Care Plan If You Don't Have Kids?211:
Absolute Trust Talk
Most people already have a long-term care plan. Yet they have never written it down, never funded it, and in many cases never said it out loud — it is simply the assumption that a son or daughter will step in when the time comes. Roughly 25% of U.S. adults do not have that assumption available to them. In Part 1 of her conversation with Scott Barnes, CFP®, CLTC, Director of Financial Planning at Childfree Wealth, host Kirsten Howe looks at what financial planning has to account for when there is no built-in safety net. Scott explains why disability and long-term care coverage move to the...
info_outline
210: Aging in Place, Part 2: How JoeyCo Home Sharing Actually Works
Absolute Trust Talk
Once a student is living in your spare room and working for your household, the questions get practical fast. Can they have a friend over? What did the screening actually check? And if it stops working, how does it end? In Part 2 of her conversation with JoeyCo founder Alison Donnally, host Kirsten Howe asks all of them — and gets straight answers, including who tends to apply for these arrangements and, just as usefully, who doesn't. Every JoeyCo match rests on two agreements that reference each other — a lodging agreement and a household employment agreement — and Alison explains why,...
info_outline
209: Aging in Place: How JoeyCo Matches Older Adults with Student Housemates
Absolute Trust Talk
What if the answer to aging well at home isn't an expensive caregiver --- but a college student in the spare bedroom? In this episode, host Kirsten Howe sits down with Alison Donnally, founder of JoeyCo and a healthcare innovation veteran of Amazon Care and Kaiser Permanente. After three of her own family members experienced major health events while aging alone, Alison asked a question that wouldn't let go: if the au pair system gives American families relatively affordable live-in childcare, why isn't there an equivalent for older adults? Her answer is JoeyCo, which matches older adult...
info_outline
208: Downsizing on Your Terms, Part 2: Buy First, Sell Later
Absolute Trust Talk
In Part 1, host Kirsten Howe and real estate agent Nathan Jines of Jines Real Estate Group talked about why more people 55 and up are choosing to relocate --- and how to make that choice on your own terms. Now, in Part 2, they get into the how. Nathan's first piece of advice flips conventional wisdom on its head: if you're financially able, buy your next home first, start living your new life, and let a full-service team handle the sale behind you --- decluttering, staging, repairs, negotiations, all of it, even from across the country. He shares how bridge lenders make buying first possible,...
info_outline
207: Downsizing on Your Terms: Moving After 55
Absolute Trust Talk
When most of us picture an older adult moving out of a long-time home, we imagine a crisis — declining health, a loss of independence, a move someone else decided was necessary. This episode is about the opposite. Host Kirsten Howe welcomes back real estate agent Nathan Jines of Jines Real Estate Group to talk about homeowners 55 and up who are choosing to relocate — not because they have to, but because they want to. Nathan explains why this is his favorite group to work with, and why the most important question isn’t “where should I go?” but “what do I want this next phase of my...
info_outline
206: Estate Planning Misses: The Mess You Leave Behind
Absolute Trust Talk
In this episode of Absolute Trust Talk, managing attorney Kirsten Howe shares an estate planning miss that has nothing to do with your documents — the literal, physical mess we tend to leave behind. Drawing on years of trust administration experience, Kirsten explains what really happens when one child is named trustee and inherits the job of emptying a home filled with decades of belongings: stalled home sales, frustrated siblings, and inheritances delayed by months. She also shares the story of a daughter trustee who nearly hauled a box of "trash" to the dumpster, only to find $2,500 in...
info_outline
205: Estate Planning Misses: How to Document a Loan or Gift to Your Child
Absolute Trust Talk
In this episode of Absolute Trust Talk, managing attorney Kirsten Howe tackles a quietly common source of family conflict: parents giving money to their adult children without documenting whether it's a gift or a loan. Drawing on years of trust administration experience, Kirsten shares a real family story where canceled checks sparked a bitter dispute among siblings after their parents passed, and she walks through the simple documentation steps that could have prevented it. She also addresses a second pitfall most families overlook: when a loan is properly documented up front but the...
info_outline
204: Estate Planning Misses: Addressing Separate Property in a Joint Trust
Absolute Trust Talk
In this episode of Absolute Trust Talk, managing attorney Kirsten Howe tackles one of the most common — and commonly overlooked — estate planning scenarios: what happens when one spouse inherits money, assets, or real estate after a joint trust is already in place. Kirsten breaks down the difference between separate and community property in California, explains why adding inherited assets to a joint trust doesn’t change their character but does affect who controls them, and walks through the two practical solutions her firm recommends. She also reveals a lesser-known complication: that...
info_outlineWhat if staying home as you age cost a fraction of what a nursing facility does? In California, a shared room in a skilled nursing facility averages about $130,000 a year. Choice in Aging's Medi-Cal waiver program works with about $6,000 per person per year to help people remain in their own homes, with the care, connection, and dignity they want.
This week, Kirsten Howe sits down with Debbie Toth, President and CEO of Choice in Aging, a 77-year-old Bay Area nonprofit that helps older adults and people with disabilities live and age in community. Debbie explains how the Multipurpose Senior Services Program pays for support that traditional Medi-Cal won't, such as transportation, emergency response buttons, and home modifications. She also describes how California Community Transitions helps people move out of skilled nursing and back into the community, and why Choice in Aging is building a $32 million Aging in Place campus with housing and services right outside residents' front doors. If you're planning for your own future or caring for an aging parent, this conversation shows what's possible with the right support. This is Part 1 of a two-part conversation. In Part 2, Debbie shares the story behind Choice in Aging's intergenerational program.
Time-stamped Show Notes:
0:00 Introduction
0:39 Kirsten introduces Debbie Toth, President and CEO of Choice in Aging, whose programs now reach Contra Costa, Solano, Napa, and Sacramento counties.
2:21 Choice in Aging's mission: helping people learn, grow, and age in community with dignity, and out of institutions.
2:33 77 years of evolving, from treating children with polio to the independent living movement to serving older adults.
3:51 The 1970s nursing facility exposés that pushed the California State Legislature to look for a better way.
4:33 How adult day health care works: skilled nursing staffing in a setting that looks and feels like a senior center.
5:06 Debbie's north star: no one should age or become disabled out of the ability to experience joy and community.
5:41 The Multipurpose Senior Services Program (MSSP), and what a Medicaid waiver actually is.
6:08 Who qualifies: adults 60 or older on Medi-Cal who need hands-on help with at least two activities of daily living.
6:34 Complex care management, explained, and why so few people know what it is.
7:07 The biopsychosocial approach: the nurse looks at health, and the social worker asks what brings you joy.
8:02 Caregivers, transportation, training, and in-home hours: building a plan around the whole person.
8:36 What MSSP can pay for, from emergency response buttons to a tablet so Mrs. Smith can attend church on Zoom.
9:35 Why these services fall outside what traditional Medi-Cal pays for, and the paperwork that comes with a waiver.
10:53 The Medicare misconception: Medicare is health insurance, and Medicaid is what pays for long-term care.
11:27 The cost gap: about $130,000 a year for a shared skilled nursing room, versus $6,000 a year to help someone stay home.
12:08 Why funding still favors institutions over community, and why advocacy matters.
12:36 In more than 2,000 presentations, Debbie has never seen anyone raise a hand for a nursing facility.
13:42 California Community Transitions, California's version of the federal Money Follows the Person program.
14:24 How the program begins when someone in a skilled nursing facility says yes to exploring community options.
15:01 Housing, care teams, ramps, and grab bars: a transition that can take three months to two years.
16:46 Why words matter, and how ageism and ableism live in our minds until we train ourselves to see them.
17:49 Saving adult day health care, and the realization that Medi-Cal doesn't cover the true cost of care.
18:25 The SWOT analysis that uncovered nearly two unused acres, and the board's “let's just build housing.”
19:08 Accessible, affordable housing for older adults, and the secret sauce Choice in Aging has had since 1980.
19:37 The Aging in Place campus: housing with health, social services, transportation, and nutrition right outside the front door.
20:35 Thousands of funding streams for housing, and none for the services that keep people housed.
21:02 Where the campaign stands: about $17 million raised toward a $32 million goal.
22:14 Why the right donor could close the gap, and how listeners can help.
22:58 Where to find Choice in Aging, and how to join a lunch-and-learn tour of the adult day health care program.
23:58 Coming up in Part 2: a closer look at Choice in Aging's intergenerational programs.
Take the Next Step in Your Estate Planning Journey
If this episode resonated with you, we'd love to help you with your own estate planning needs in California. Schedule a complimentary discovery call with our team at Absolute Trust Counsel. During this no-obligation conversation, we'll:
- Learn about your unique situation and goals
- Answer questions about our services
- Determine if we're the right fit to work together
Visit https://absolutetrustcounsel.com/scheduling/ or call 925-943-2740 to schedule your free discovery call today.
Follow and Review:
We’d love for you to follow us if you haven’t yet. Click that purple '+' in the top right corner of your Apple Podcasts app. We’d love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a couple second and it helps spread the word about the podcast.
Episode Credits: The Absolute Trust Talk podcast is brought to you with the help of Q2Mark, led by Chief Marketing Officer Susie Hays. Since 2016, Q2Mark has partnered with Absolute Trust Counsel on all marketing communications—from brand development and website design to this podcast series with over 192 episodes, social media management, video production, and more. If you're business owner looking for comprehensive marketing support, visit Q2Mark.com.