We prepare our kids for middle school high school college. We do all the visitation with the school. We do all the prep. They meet all the counsellors the teachers everything. We do so much prep especially for these kids to go off to college. Why don’t we do that for our senior citizens to get them ready for a type of transitional living? You know moving out of their house or into another type of facility.
That is a killer point that’s just proliferating the ageism and by pretending it doesn’t exist.
This is FOXcast OT. A podcast for clinician’s made by clinician’s. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org
Jimmy McKay, PT, DPT: Welcome to FOXcast OT. I’m your host Jimmy McKay on the program one of my Fox colleagues Natalie Piccano. Natalie welcome to the show.
Natalie Picciano, OTR/L: Thank you so much. Thanks for having me.
Jimmy: Excited to talk about something that’s pretty current. We were interacting online about an article that we found in the New York Times. Marilyn Friedman was the author. The title was The Dementia Heist. And it chronicled a woman getting her mother into a memory care center and a little bit of her time there. It was a story about one individual family but we wanted to talk about that just a little bit and that transition of older adults out of their homes and into different facilities and where therapists. OT’s PT’s SLP’s can play a part in making that transition hopefully just a little bit easier. What steps could be taken maybe some tips from your experience Natalie into making that transition an easy one?
Natalie: This is a topic that gets swept under the table in a lot of families. It’s something that. Families just don’t want to have to deal with yet. And I’ve dealt with this like in my own personal family watching my grandparents having to transition not just into a memory care unit but assisted living facility. And as well as with my client. I see this a lot. It’s a taboo topic of where to put mom or where to put dad. But I really do think that it needs to be prepped earlier. I think the conversation needs to be had between siblings or whoever the caregivers are for parents. And also if the clients themself can handle it. If they do not have dementia or if they’re in a very very mild stages having the serious talks with them and saying hey you know we’re looking out for your safety we want to make sure you’re living the best possible way. Looking at your quality of life. And a lot of senior citizens do not want to leave their homes and that’s totally understandable. It should not have to be forced unless it were a matter of absolute safety. But that’s one of the things that you want to put into the heads of your parents or family members just to get them thinking how can I be living the best possible life. Even though I love my home I’ve been in it for 50 plus years. Is this really the best place for me right now? So in summary just being able to have that conversation earlier and get the conversation going.
Before we start recording I told you I wouldn’t ask any hard questions but here comes the hard one are you ready Natalie?
Natalie: I’ll try.
Jimmy: When is a good time to do that right? I mean this is never going to be an easy conversation. You’re really starting to ,this is really that tipping point. On children becoming the caregivers of those people that we love our parents who cared for us as we grow up this is really that tipping point. When do you suggest to start having that difficult conversation?
Natalie: Honestly it is difficult because I think it’s going to depend on every family. I think it’s going to depend on the situation. But I think even before the topic of dementia is ever even entered into the stratosphere. Like even before there’s ever a diagnosis thinking down the road just as you would for retirement or financial planning. Where do I see my parents living in the next 20 years? They’re in a big three story house in Northeast Philly or they’re in a small rancher in Gibbstown. And yes I’m giving examples from my own experiences. Is it going to be doable? Are they going to be able to get down the basement to their kitchen? Are they going to be able to handle all the financial bills and things like that coming in within the next 10 or 20 years? So having that conversation maybe I mean I don’t want to pick an age but early on maybe like 60s 70s when your parents are getting to a point where it’s like OK they don’t have to take care of kids anymore. They just have to take care of themselves. And what’s the best way to do that?
Jimmy: Yeah I mean it’s never going to be an easy conversation to have. But I imagine the sooner you have the better because you’re bringing up areas that are touchy right?Talking about cognitive health that’s difficult. Finances that’s difficult. Maybe having to leave your home that’s difficult. But the longer you wait the harder it’s definitely going to be so I love your suggestion of having that conversation earlier. And getting your older adult family members involved. Helping me it makes it their decision that that’s got to be a big plus.
Natalie: Exactly. And they and the earlier and more involved they feel in the beginning they’re more apt to saying yes than they would want to have to be either forced upon or when it’s later on in the stage of the game when they can’t think as clearly as they did before. And do that problem solving that higher executive functioning that reasoning and have the insight to say I need to look at all scenarios and think about myself and others.
Jimmy: Planning ahead is definitely going to help you in the long run in this situation. Shifting topics just a little bit the topic of therapeutic lying came up in the article as a strategy. Briefly describe that for the audience. And then and then go into maybe an explanation of where you’ve seen this come into play.
Natalie: Absolutely. I thought that was a great term honestly to use. I think therapeutic lying can be beneficial. I think it can be good or bad. So let me just say how it could be used poorly. So bad therapeutic lying I would say would be either a threat or like kind of out of the blue. Like let’s say a daughter or son said to their mom or dad look you stay in this house you’re definitely going to die or something like that. Or you have to get out of here because your blood pressure is going to skyrocket and you’re not to be able to live anymore. And doing something kind of like out there whether it’s even true or not. We do not have to get this severe this.
Jimmy: That sounds more like an therapeutic threatening.
Natalie: Yes exactly. So by going to the article though they brought her to the hospital they brought their elderly mother to the hospital for the doctor to kind of check the blood pressure and say oh you know it’s looking a little high. We really do have to get you monitored. The best place to do that is in the assisted living facility. Now that’s something that it’s a reality check for the mother. It’s a reality check honestly for the family. And it’s also a kinder a little bit more at ease method to say, this is something we need to keep an eye on and we’re not going to be able to do that if you are in your home if you want to stay healthy. We gotta go somewhere else even if it’s just for a little bit. And that’s also what I say to my clients when they don’t want to leave their homes. I’ll say assisted living facilities offer these things called respite programs. You can stay for a week, two weeks , 30 days just to see if you like it or get used to it. It’s no commitment. And then you can leave after the 30 days try somewhere else. So that’s another type of what could be a therapeutic lying. Let’s say you initially bring your mom or dad to be there only for the respite care but then end up staying there and not going home. That’s where you’re still doing that lying if you will, does that make sense?
Jimmy: Yeah. In the story of the New York Times it was done really in very very small stages this therapeutic lying. It was first they brought them to the hospital to get her blood pressure checked out. And then it was we’re going to bring you this place. And she she really recounted that painful moment. They had already gone into the memory care center and set up their mother’s room with her clothes with her belongings and her pictures and they were sitting in their car watching their mother being taken by the ambulance into the facility. And the staff actually recommended that they not be there to make the transition seem more like a regular medical event. That had to be terribly painful but you can see when you do this therapeutic lying in stages it really eases someone into a situation instead of being jarring.
Natalie: Yes exactly. And I give the family a lot of credit for going through with that because I don’t know a lot of families that I’ve worked with personally that either could have that bravery that courage or would even have that ability to kind of think that up and like play it all out. I feel like someone would crack in the process that takes a lot of courage.
Jimmy: Listening to this story in The New York Times especially about that situation with therapeutic lying. It really made me think back to when my closest cousin was sending her firstborn off to school and her son didn’t want to go. It was in stages. We’re just going to go a little bit and test it out. So it was done in bit so those two situations seemed to mimic when you’re trying to talk a kid into going to school and stay there and be happy.
Natalie: You know I’m so glad you mentioned that to me because while I was reading the article and reflecting on it I couldn’t help but think of this. Well it is a type of ageism that we have that we put off these topics that we don’t talk about it and then ends with being forced. But on the flipside we prepare our kids for middle school, high school, college. We do all the visitations to the school. We do all the preps they meet all the counselors, the teachers, everything. We do so much prep especially for these kids to go off to college. Why don’t we do that for senior citizens to get them ready for a type of transitional living? You know moving out of their house or into another type of facility.
Jimmy: That is a killer point. That’s just that’s proliferating the ageism and by pretending it doesn’t exist or only dealing with it when it’s a complete emergency moment. Why aren’t we? Were neglecting the fact that aging and being an older adult is a part of life that we hope that you get to.
Natalie: Exactly. It’s a stage of development that everyone goes through just like everyone looks into OK when am I going to do after high school? Why not for when you’re aging?
Jimmy: That’s brilliant. Last topic I wanted to bring up any takeaway points for therapists OT’s is also PT’s and SLP’s please help clients in this transition time. Clients their families their caregivers. Any tips that you’d throw out there in your experience and how to actually make that process a little bit easier?
Natalie: Sure I have one specific example that I can bring up. So I had a lady about six months ago. Living at home by yourself. Had got into a car accident and was told by her doctor that she couldn’t drive anymore. And I had to go and do that evaluation. What they call community mobility evaluations do the steps of OK are you safe to drive? And if not I need to contact your doctor who needs to contact the DMV to take it away. So I go in and I just noticed she’s not safe in that house and she’s living by herself. And she obviously has dementia. Her family is scattered all over the place. So what I did was I contacted daughters her family whatever numbers I could get from the client herself. I recommended and we did it. They all come to the house that we have a sit down meeting together and talk about what I was seeing in the client cognitively. I mean and we were putting it mildly. Some in front of the patient, some of the conversation was separate from the patient. Talking about what I was seeing what functions she was having impairments were what I was trying to do to help. But then also what the eventual next steps had to be. And that really was to sell the house, move out of the House and consider assisted living if not a memory care center. So really if you can have that sit down conversation with the adult children remotely taking care of their parents or directly involved. I think it’s a great idea because you get to show them your knowledge. Show them that you care and it gives them the opportunity to maybe vent out their frustration or talk about their concerns that maybe they can’t talk about with their parents face to face.
Jimmy: Get in the same room and talk about this and stop whispering about it in hallways and behind backs. And you do did mention having a couple different conversations. That’s perfectly fine. You don’t make it jarring so having these side conversations is fine but have the conversation. Earlier is better than later seems to be a general theme when we’re talking about this transition process.
Natalie: Also often definitely often because it’s not going to happen in one or two conversations and everything gets settled it’s going to take multiple.
Jimmy: Do you know of any places people can go for more information about something like this or strategies online any resources that you use?
Natalie: Yes called a place for mom. They have a lot of articles really talking about how to have these conversations with your parents. How to go through the financial planning. How to look into local resources. And then because I’m in South Jersey in Gloucester County. I see a lot of times contact the Office of Aging. Every state and county office has their own or should have their own office of aging department and they can help you find meal delivery services or maybe transportation services they might have direct contact to the assisted living facilities or long term care facilities in the area. Let’s say if you don’t know of it. So I always go through those resources. I also try to hit up some occupational therapists online who are talking about senior living and how to keep everyone aging in place. So there’s one occupational therapist Mandy Chamberlain. She has a blog and a Web site called seniors flourish.com.
Jimmy: Love that. Natalie appreciate you taking some time out. Glad we got to discuss this New York Times article. Anybody looking forward again December 7th was the release date. The title was The dementia heist. A really good first person account of what that situation was like for a caregiver a daughter and her mother. So glad we got to talk about this a little bit for the audience now. Thanks for taking your time.
Natalie: Thank you. I appreciate it.
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