Episode 69: How Should We Care? Navigating Elder Care with Carrie Crawley, Part 2

00;00;08;29 – 00;00;56;03
Kelly Parbs
Welcome to OnTopic with Empathia! I’m your host, Kelly Parbs. Today we’re continuing our conversation with Elder Care specialist Carrie Crawley. In part one, we explored the importance of planning ahead, understanding available resources and the balance between caring for elders and caring for yourself. It struck me when earlier you said, sometimes people are just so afraid of the diagnosis that they- they don’t go and see a professional. And I would imagine that there’s times where families made the assumption that maybe there’s Alzheimer’s disease, when if they would have just gone and had the testing done, they they may have learned that it was something entirely different that they could have treated.

00;00;56;05 – 00;00;57;00
Carrie Crawley
Exactly.

00;00;57;02 – 00;00;58;17
Kelly Parbs
You’ve seen that?

00;00;58;19 – 00;05;26;01
Carrie Crawley
Oh, many times. Many times they make an assumption that just because you’re getting older, you’re going to get mentally feeble and forgetful. And that’s not true at all. As a matter of fact, if you’re a physical health is good, you have no family history of Alzheimer’s disease or any other cognitive issues. I would- my mind would go to, oh, maybe we should check for underlying organic issues, systemic issues, rather than Alzheimer’s disease being the first thing we’re checking for. I can tell you that a low grade, virtually undetectable infection in the body of an older person can also mimic Alzheimer’s disease. Many people that we have seen, they have a low grade bladder or kidney infection that could be easily treated with antibiotics. And they go on for months to years with this low grade infection that begins to affect them cognitively. So got to get a doctor, get a real diagnosis. Once you know what the problem is, it becomes much easier to treat it one, and it helps you to understand what kind of planning you have to do for the future. If it is Alzheimer’s disease. Probably, you know, don’t want to, move yourself into a situation where you can’t get the support that you need. I recently worked with a client who said that her dad started exhibiting behavioral issues and decided to fulfill his dream of moving to Belize and living on an island by himself to fish all day, where he was physically and financially able to do that. She stopped the process just before he moved. Told him he must have a physical before he went. The doctor noticed signs of his cognitive decline. Started out with a simple blood test, and we found out that he had kidney disease that was going to need to be treated for an extensive period of time before he was probably in a good position to move to Belize, live on an island and fish all day. So, once again, when you see signs you need to disclose the issues to your doctor. It was not Alzheimer’s disease at all. So be sure of what your diagnosis is. And even if it is Alzheimer’s disease or any one of 32 other different dementias, Alzheimer’s only being one of them. There are medications on the market that can extend your functional life and continue to enjoy life and you may never die of Alzheimer’s disease. You may die with Alzheimer’s disease, but, it’s something that can often be managed and needs to be managed. To give you a better quality of life for all the years you have to enjoy it.

00;05;26;04 – 00;05;46;26
Kelly Parbs
Carrie you told me a powerful story a while back about someone who had, and forgive me if I have this a little bit wrong, but someone who had been, admitted to a memory care facility only to find out that that was not indeed the issue that they had. Can you tell us that?

00;05;46;29 – 00;07;41;09
Carrie Crawley
That was a wonderful experience for me and a big teaching experience for me when, I helped a family move mom into a memory care facility, because over the course of a few months, she had become very confused, despondent. Behavioral changes. Even so far as to develop incontinence, she was unable to manage to prepare meals for herself, where she used to prepare a meal for everybody in the family, and they were very concerned about her. Took her to the doctor. The doctor diagnosed her with a type of dementia that is rather fast progressing, and so they decided to move her into assisted living. We had a caregiver here that I knew quite well. Greeted us at the door the day she moved in, and she took her by the hand and looked her in the eye and said, you don’t have Alzheimer’s, do you? And I was so shocked. The family was standing there. She took this little lady by the hand and walked her into the unit. To meet other residents there while we took her belongings to her room. The long and short of the story is caregivers who do this for a living are worth their weight in gold. Because she knew at a glance what the doctor did not.

00;07;41;12 – 00;07;44;09
Kelly Parbs
How did she know what came of it?

00;07;44;12 – 00;09;06;10
Carrie Crawley
What came of it was over the course of the next months. This lady came back into her own. He was no longer confused. He was able to function on her own. He was able to do everything. Normally it only took about a month and we started investigating. And what we found out is just the how she had been living in for decades had become so saturated with mold that what she had was a reaction to the mold in her house. So she moved from our memory care unit into our independent living unit for a little while. They tore her house down and rebuilt a new house. It could not be remediated from that amount of mold. It was between the exterior walls and the sheetrock, all into the insulation all over the world. It was just completely impacted by mold and several different varieties.

00;09;06;13 – 00;09;21;21
Kelly Parbs
Wow. So yet another thing we should have in the back of our minds is if we see a change in behavior in our loved one to really assess their their surroundings and what might be impacting them, and not just make that immediate assumption that they have dementia.

00;09;21;27 – 00;09;49;22
Carrie Crawley
Exactly. And even the doctor missed it. So use your spidey senses and when you see something is wrong, begin to investigate the, what the cause is. Of course, it did cause them to build her a new little house. But, within just a few months, she was back in her own home, living independently and driving.

00;09;49;25 – 00;09;52;23
Kelly Parbs
Wow, what a story. Thank you for sharing that.

00;09;52;28 – 00;09;59;06
Carrie Crawley
It was a wonderful experience. And like I said, a huge teaching experience for me.

00;09;59;08 – 00;10;32;01
Kelly Parbs
And maybe that isn’t your story or your family’s story. And maybe there really is dementia going on. And again, the idea of seeking out resources in your community, right Carrie? Calling the Department of Aging in your area, seeking out, you know, are there dementia friendly programs in your community or other types of support that can be offered? Do you have anything to add in terms of seeking support for people who do indeed have dementia?

00;10;32;03 – 00;12;16;09
Carrie Crawley
The Alzheimer’s Association is a fabulous organization that helps to build community near you. And once again, it’s not just Alzheimer’s. Alzheimer’s is better than 50% of the, dementia cases out there, but there are 32 different types of dementia. They support all of them. There’s also the Alzheimer’s Foundation out of Chicago that, does a very good job with education. They, there are a number of different experts who put abuse information out on the internet to help to educate you both as a family member or care partner with an aging adult. UCLA has a wonderful program. There is, an educator by the name of Teepa Snow who has done fabulous work around the country, starting support, educating and training caregivers. And she’s still quite active, but, all of the information that we have learned over the last few decades about dementia and supporting people with dementia is readily available thanks to the internet.

00;12;16;12 – 00;12;49;17
Kelly Parbs
So, again, resilient people, no one use their resources. And there are plenty of resources out there. I’d like to transition to, like, recovering from a health crisis because I know a lot of times for older people, that’s where the stress begins. Everything was going okay, but then they have a health crisis. It’s time to be, It’s time to leave the hospital. But resources are needed. Can we talk a little bit about being discharged from hospital?

00;12;49;20 – 00;14;55;22
Carrie Crawley
Absolutely. It’s a scary process because usually after a health event, life has changed. The picture does not look like it did before the health crisis. And so it all depends on what it is. But the typical pattern for most hospitalizations for older adults is that they will be treated at the hospital until they can successfully the transition to a different level of care. A step down, as it were. Hospitals do not keep people for long periods of time. I have witnessed in the last year or two, even hip replacement surgeries being a 1 or 2 night hospital. Yes. And it kind, but they don’t keep people in hospitals. And there’s several reasons for that. One of the things that we learned from Covid, and we did learn many things, is that a hospital is a place for acute medical care, and it is not the best place to heal. And it is also not a good place for older people or people with compromised immune systems, because you can’t control all the germs there. So a home setting, a rehabilitation center setting is going to be a much more homelike environment where the patient is supported physically, but also mentally and emotionally and encouraged back to their baseline, whatever that was. And sometimes even an improvement.

00;14;55;24 – 00;15;47;17
Kelly Parbs
And you know, that really takes some adjusting of how you think of things. Because at least for me, you think you’re going to heal in the hospital and you need time to be there and to find out that your loved one is going to be discharged so quickly. That’s helpful. What you said, Carrie, to think of that in a more positive way, rather than they’re just trying to get rid of my loved one who I don’t know how to take care of, and that can be a very, very scary time. And in some hospitals, there’s very helpful social workers to walk you through that process or unfortunately, with the experience we had in my family, not so much. So I’m really interested in hearing what you have to say about that transition and how to do that in the most mentally and physically healthy way possible for a family.

00;15;47;19 – 00;20;20;15
Carrie Crawley
There are a number of options. You could have, the option to go to a rehab facility. And most rehabs are nursing homes. They are one in the same. Nursing homes are divided into essentially two categories. There’s one for long term patients and there’s one for short term patients. And they reside under the same roof. So for long term care in a nursing home, this is a person who cannot be supported in their home environment for whatever reason. And they need the assistance and the oversight of medical professionals on a daily basis. For short term patients, there, the route is through rehabilitation. Rehabilitation can include many things. So it can be, respiratory therapy for someone who maybe had pneumonia or some sort of breathing issue in the hospital. And that’s the reason they were there. There’s physical therapy for people who have fallen, suffered a break, or even if it’s not a break and a bone or tissue injury through a fall or something like that, and they then off their feet, they may be weak and at risk for going home, to try to manage after that hospitalization. So they work with physical therapist. You can exercise with them, assess their needs to help prevent another fall, and occupational therapist who will teach you how to do things, maybe in a different way. To accommodate your disability or your weaknesses and rethink how you approach daily life. Like how do you get in and out of the bathtub in the safest possible way? There are other types of therapies. I won’t go into all of them, but they are performed in rehabilitation. If the goal stay in rehab is 21 days, because that is what Medicare will approve without review. So in other words, it’s kind of an automatic thing. You could go in and get 21 days of rehab, without Medicare, asking any real questions if you need to stay longer than that. And there’s a medical panel review, and Medicare has to approve additional weeks. But that’s usually the best first step out of the hospital. If the hospitalization has been serious. Other things that you can do is hire in-home care agencies that will come in and take care of day to day activities, while the physical therapist and home health agencies come in to take care of the medical side of it in your home. If that is an appropriate discharge. The other things that you can do is look at a respite, stay a short term respite for care at an assisted living. So that would be somebody there to help you go to the bathroom, get a shower, get you two meals in a common dining room, manage your medications while you relax. Engage in the activities and socialization that is there while someone else looks after your physical care to make.

00;20;20;17 – 00;21;08;28
Kelly Parbs
And what I would what I would add to that, Carrie, is that as a caregiver, or maybe as the person you know themselves who had the accident, know what those therapies are that are available, like you said, occupational therapy, physical therapy, and be a great advocate for yourself or for your loved one. I’ve seen that time and time again where someone could benefit from those therapies, but they are not offered to them. But if you stand up and make a case and say, I really think I need to get stronger before I go home, you know, I’m unable to manage the steps that I’d have to go up to get into my house or whatever the case may be. You might get a couple more sessions authorized. Whereas if you are not a great advocate, they’re not always going to offer those services for you.

00;21;09;00 – 00;21;52;10
Carrie Crawley
Exactly. The other thing is understanding what is paid for through Medicare. And what would the private pay. So any medical facility, hospital, nursing home, rehab facility, in-home care by a medical professional. These things are all paid for by Medicare. Where your choices might be limited. Is assisted living. Hiring an in-home care agency that is just a caregiver and not a medical professional. These things all have to be paid for out of pocket.

00;21;52;12 – 00;21;57;02
Kelly Parbs
And we have to prepare for those, which can be very difficult for families.

00;21;57;05 – 00;21;58;20
Carrie Crawley
Exactly.

00;21;58;22 – 00;22;17;04
Kelly Parbs
So, Kerri, you mentioned before the risk of falls. And while we don’t need to spend a whole lot of time on it, I think it’s important that that our listeners be thinking about how they might prevent that so that we can prevent some of these this falls. What would you have to say on that topic?

00;22;17;06 – 00;22;29;28
Carrie Crawley
Fortunately, once again, we turn to the internet and the key words to look into are aging in place.

00;22;30;00 – 00;22;31;12
Kelly Parbs
Aging in place.

00;22;31;14 – 00;23;31;29
Carrie Crawley
There are a lot of companies out there that specialize in this. They use occupational therapist who are trained to go into an existing living environment and help to determine the best ways to arrange the house, possibly remodel the house, and make changes so that you can age in place in the least restrictive, environment. So there are companies that do that. They are usually, remodeling companies. They can come in and take out that tub and put in a shower. If that’s what is needed, they can build ramps. They can do all sorts of things to modify your existing living situation.

00;23;32;01 – 00;23;35;13
Kelly Parbs
And and to do this before there’s a fall or an accident.

00;23;35;14 – 00;24;36;28
Carrie Crawley
Exactly. Because falls are one of the first signs that your loved one or you are actively declining intervention, such as this cold therapy. Putting yourself on a good exercise program. Many of these exercise programs are available through programs called Silver Sneakers. The YMCA has a program. Most senior centers have a program. Balance is the biggest issue. And so if we work on our balance, not necessarily having to work on your strength, but if you work on balance, that’s the key that helps to prevent falls, because 70% of the people who go into the hospital due to repetitive falls have a life expectancy of three years or less.

00;24;37;01 – 00;24;44;03
Kelly Parbs
Something we all can be thinking about no matter what our age, right? Working on our balance and also our strength.

00;24;44;06 – 00;24;45;14
Carrie Crawley
Exactly.

00;24;45;16 – 00;25;02;13
Kelly Parbs
So maybe it’s not a fall, or maybe it’s not dementia. But what about chronic diseases in in the aging population, what’s the biggest challenge you see in helping older adults manage having multiple health conditions?

00;25;02;15 – 00;26;57;14
Carrie Crawley
You know, like so many other things, you’re going to follow your doctor’s recommendations because they truly do know best. Even with chronic conditions, I find a lot of older adults say I’ve never exercised. I’ve never eaten any differently. I’m not going to change. But even chronic conditions can be well managed by your doctor through exercise, with diet, with the right medications. With participating in social activities, not becoming isolated. Social well-being is a huge part of aging well and if you become proactive in your own care, then we see tremendous outcomes and great improvements in quality of life. Those who say, I don’t feel I get well, I have arthritis. And I will tell you a lot of days I don’t feel like it either, but I push myself to get out and do the walking, to go swimming, to do the physical activities that I know are good for my health and my body. And believe me, if I skip a couple of weeks, I feel the difference. I know that I’m setting myself back. If I don’t, if I don’t stay in that routine and work on, fighting aging every step of the way. Kelly.

00;26;57;16 – 00;27;21;20
Kelly Parbs
So really, just being a, a cheerleader for our loved ones and helping them do what’s good for them even when they don’t feel motivated. Walking alongside of them and and giving them suggestions like, hey, did you take your walk today? And hey, I know it’s frustrating to have to take all of those different medications. But to be there for them, to encourage them.

00;27;21;23 – 00;27;26;28
Carrie Crawley
I’ve got a better idea – you just go for a walk with them!

00;27;27;00 – 00;27;32;01
Kelly Parbs
Absolutely. That human interaction is is part of their wellness as well.

00;27;32;03 – 00;27;33;06
Carrie Crawley
Exactly.

00;27;33;08 – 00;27;35;05
Kelly Parbs
And then you’re getting your walk in too!

00;27;35;07 – 00;27;35;28
Carrie Crawley
That’s right.

00;27;36;01 – 00;28;03;18
Kelly Parbs
Another thing that I’ve noticed being in this stage of life with, with loved ones, helping them stay organized is is huge. There’s sticky notes everywhere and little chicken scratch notes that don’t make any sense all over the condo and, you know, putting systems in place, maybe a pill organizer or a family calendar can really take a lot of weight off of of the aging adult and off of the caregiver.

00;28;03;20 – 00;29;11;03
Carrie Crawley
Absolutely. I love big wall calendars that you can write on and then erase as you, need to move on to the next date. But, also the smartphone is one of the best tools that we’ve got now for communicating and managing things. And with, Siri and Alexa. All you have to do is say, Siri, make a note to call Kelly and discuss our conversation. I can add to my grocery list. And the nice thing about it is you don’t have to type it in anymore. You know, we have, AI assistance to help us with all of those things. So, maybe just a small learning curve to begin to integrate those tools into your life and hopefully eliminate the sticky notes that don’t always stay.

00;29;11;06 – 00;29;32;05
Kelly Parbs
Let’s talk a little bit more about technology. Honestly, technology baffles me most of the time, but it does impact everything, including aging. And you mentioned AI. Let’s talk more about how technology can really help us with with this whole topic of aging.

00;29;32;07 – 00;30;24;07
Carrie Crawley
I’m really excited for the future. I think it’s going to be so many tools in place that help us on a daily basis. And I had concerns years ago about the technology’s sort of taking over human interaction. And what I have found is absolutely the opposite. I think it gives us a common point to have conversations and to learn new things, and to be able to, relate to a younger generation. If you don’t know how to do it, ask your grandchildren. Sure.

00;30;24;10 – 00;30;25;28
Kelly Parbs
That’s true.

00;30;26;01 – 00;32;34;25
Carrie Crawley
We have, tools coming on board, that are more sophisticated than what we had in the past. But you mentioned, medication organizers. Just for convenience sake, I have the one with the little doors that you open up and put the pill in the compartment, but they now have them that are operated, by. I and other, programed technologies that remind you when to take your pills. And if you don’t follow the instructions, they will remind you again and again and become annoying. If you don’t take your pills. There are ways to mentally engage through games and communication, and there’s so many different things that came out as the result, once again, of Covid. I can sit down and listen to a concert. I can also make my own music through… I- we have found that music therapy is very beneficial for all kinds of things. Everything from depression to Lewy body dementia, which is the dementia that is has extreme behavioral disturbances associated with it. And we have found that I can tell us what kinds of sounds music, rhythms we need for that type of cognitive disease we are experiencing.

00;32;34;27 – 00;33;15;24
Kelly Parbs
Interesting. These are things I don’t know about. I don’t know much about AI at all. But when thinking about technology, I do think about, like online puzzles that your loved one can do in our family personally. That’s been really helpful. Because maybe it’s hard to keep track of all the puzzle pieces, but you’re able to maybe on an iPad, put puzzles together and GPS monitoring. Maybe your loved one still is driving, but you’re starting to wonder if if they have any potential for for getting lost. And you can keep an eye through technology on where they are and help you feel that they’re a little bit more safe.

00;33;15;27 – 00;33;58;10
Carrie Crawley
And fall detection is big now. I know we all, at least our generation, we’ve all seen the commercials of ‘Help, I’ve fallen and I can’t get up!’ And now the pendant you wear around your neck or the watch that you wear has not only GPS, but, fall detection technology. So if you fall and bump your head and you can’t push the button and call for help, it will call automatically. And through the GPS will tell a first responder exactly where you’re located.

00;33;58;13 – 00;34;08;12
Kelly Parbs
So what would our listeners look up in terms of how to find resources, in terms of how technology might help them?

00;34;08;15 – 00;34;45;15
Carrie Crawley
Once again, AARP has a lot of that information. The Alzheimer’s Association has information for people who have dementia. And I find out about the newest, latest and greatest things quite often from just reading the news headlines. They’re always announcing new ways that AI and other technologies are being expanded to support aging.

00;34;45;17 – 00;35;31;23
Kelly Parbs
Thank you, Carrie, and I’m aware of the time now and that we need to wrap up. But for someone listening right now who’s feeling overwhelmed by caring for an aging loved one, think about just maybe 1 or 2 of the doable steps that we’ve talked about today that that you might be able to do this week. Maybe think about whether there’s a neighbor who could just get your mom’s mail each day, or maybe just every other day, and help her open it. Simple, little doable tasks that maybe could take a couple of things off your list and and help you with this journey. Carrie, looking back on our conversation, if you could leave listeners with just one core message about eldercare, what would that be?

00;35;31;25 – 00;36;41;03
Carrie Crawley
Start out with your primary care physician as your best friend. And if your primary care physician is not familiar with aging and doesn’t have a big aging practice, you might want to look for a geriatrician like a pediatrician. But for older adults and they have the specialized knowledge, within their practices. And some are family physicians who take the whole family, but then would have a specialization in geriatrics. And you can typically go to the website of your local hospital system and where it says, look for doctors who look for geriatrics. Also, your area Agency on Aging or Aging and Disability Resource Center in your county can help to educate you on all of the resources that are available in your area.

00;36;41;05 – 00;36;54;28
Kelly Parbs
Carrie, what are some of the untapped resources that people should be reminded of in terms of supporting their loved ones and not having to walk this journey alone?

00;36;55;01 – 00;37;21;01
Carrie Crawley
Communities have wonderful networks and you can engage friends, neighbors, church families who often step in during times like this. They’re senior centers with vast programing, extended family and existing social groups.

00;37;21;03 – 00;37;49;17
Kelly Parbs
And I think we have to remember that it’s hard to ask for help a lot of times, but really, when we allow someone to step in and be a support and help us, oftentimes we’re giving them a gift because maybe they feel helpless just watching and not knowing what they can do. So by asking them, we might we might actually be giving them the gift of being able to step in and in little ways.

00;37;49;19 – 00;37;54;24
Carrie Crawley
And renewing connections. And I think that’s very important.

00;37;54;26 – 00;38;12;24
Kelly Parbs
I entirely agree with that. Renewing connections and just introducing that, that human connection can make all the difference in getting through a difficult experience. Carrie, thank you for the important work that you do and for spending this time with me today.

00;38;12;26 – 00;38;17;00
Carrie Crawley
Thank you so much for having me. Kelly, it’s been a pleasure.

00;38;17;03 – 00;39;07;05
Kelly Parbs
Caring for elders is never a one size fits all journey. It can be overwhelming at times, but it can also be deeply meaningful. As Carrie reminded us, approaching this season with preparation, compassion, and community support can make all the difference for both caregivers and their loved ones. Wherever you are on this path, I wish you strength and patience and hope. It’s not easy, but you don’t have to walk it alone. To hear more episodes of OnTopic with Empathia, visit our website, www.Empathia.com. Follow us on social media @Empathia, and subscribe so you don’t miss any new conversations when they go live. I’m Kelly Parbs – thank you for joining us on OnTopic with Empathia!