Lisa’s special guest this week is Lance A Slatton, CSCM, of Enriched Life Home Care Services and Host of the Award Winning Podcast, All Home Care Matters. In this episode, Lisa and Lance discuss his newly released book, “The All Home Care Matters Official Family Caregivers’ Guide”. Some of the highlights of their interview include:               

•     His inspiration behind writing his new book.
•     Why this pivotal guide will become your ally during your caregiving journey.
•     What are some of the early signs of your loved one needing assistance.
•     What you need to know about caregiving.
•     Preparing for an emotional journey and how to manage resistance and denial.
•     At-Home Care Strategies.
•     When should you consider hospice care, and much more.

About the Guest:

Lance A Slatton, CSCM, is an innovator and compassionate leader in the healthcare industry. His company, Enriched Life Home Care Services, is a leading care provider based in Livonia, MI. He brings his wealth of knowledge and 20+ years of experience along with his innovative approach to providing care to the forefront of his industry. Lance is also an award-winning visionary in his field. Don’t miss this invaluable interview…

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

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Hello, everyone and welcome to another New episode of the Truth, Lies and Alzheimer's Show. I'm your host Lisa Skinner. And I have invited a very special guest back to my show, because I am so excited about the new book that he has just released. And he is here to tell you all about it. So we're gonna we're gonna have a really dynamic and deep discussion about his brand new book, but let me first introduce him to everybody. His name is Lance A Slaton CSCM, you can tell us what that stands for in a few minutes, Lance. And Lance is actually known as the senior care influencer. And he's a writer, an author, and a health care professional with over 20 years in the healthcare industry, and is the owner of a home health care business called enriched life home care services. But he is also better known for being a very popular podcast host on the show. All Home Care matters. And he hails from Michigan. And his show, actually, for the last several years has been named one of the top caregiving shows in the country. So without further ado, let's welcome Lance a Slaton. And I'm gonna start this conversation off today. By asking you I mean, you just have your hands into everything, I think you have got to be one of the busiest guys I know, on the planet. And you found time to write this magnificent book, which is going to be an incredible resource for caregivers. So why don't you tell us what inspired you to write the book?

Lance A. Slatton: Well, first, thank you, Lisa. It's always great to see you. And I appreciate you having me on. Really, the inspiration for the book was the fact that, you know, over 20, some years ago, my wife and I, we were newlyweds. And we had got a phone call that my father was not doing well. Wasn't dementia, or, you know, cancer, it was nothing that was a diagnosis that, you know, there was no hope or a cure for or even treatment, he had developed an abscess from a fall that he had sustained. And that abscess ended up bursting. And as a result of the abscess, bursting, the infection got into his bloodstream, which then developed into osteomyelitis, which was infection of the bone. And it was right on his tailbone. And so you know, when he's having to change this bandage and clean this wound, it really isn't too practical because of the location. And I'm fond of saying, I don't think anybody could do it just because of the location. So the home health care nurse, you know, reached out to my wife and I and said, you know, we have your father here. And we have some concerns. And these are the options really, that we're looking at. Either we find a nursing home or rehab facility that for him to go to for the next six to eight weeks, or what have you, or would you be open to him coming to live at your home for a while until he gets you know, healed up? And well, we said, of course, why not. Now I'm pursuing medical school at the time, my wife just graduated from college and, you know, a year or two prior and is newly started in her career. And we didn't really think too much of that, of course, we'd be happy to help however we can. And that decision, and I would never go back and change that decision for anything really changed the entire trajectory of my life, especially because I was pursuing medical school, I ended up changing that and pursued ways of helping families who, after two and a half years of us providing him with that 24 hour care seven days a week. It was just it was exhausting mentally, physically, emotionally, and even financially. And we wanted to find a way to help families that were going through what we were going through, and I had the idea one evening after going to visit a friend of mine, hey, why don't we start a company where we can send people into the home to help families that are going through situations like we are I'm sure there's more out there, right, the 53 million silent majority the family caregiver, and so we looked into it and we decided quickly, you know, this would be a great way to help people because that was my whole passion and motivation for medical school was to be able to have some meaningful, impactful have influence on someone's life by helping them, you know, whether it be medically or what have you. And so quickly realize

it just took you in a little bit different direction. It

Lance A. Slatton: did, it did. And so, you know, we we've had our family business now for close to 13 years, and I just enjoy every minute of it and the countless families we have helped over the years. You know, that's been enough for me, you know, that was the reason for medical school. And I'm helping people. And sometimes I think we're helping them on even a grander scale, because we have a more intimate relationship with these families when our staff are going into the homes or we're meeting with them. And so, you know, I write for several new sites right now. And I'm getting help out there in that way as well. But I, you know, I've really thought about this the last two, three years, I said, you know, I would love to have a book, where instead of having to go online, and you know, just read an article, or maybe cover a specific topic, I want to try to compile all this information, and really write a book that would be written to me, you know, those 20 years ago, when my father came to live with us, I never identified as a family caregiver, never even heard the term family caregiver. And this is with one of the best health care systems in the country literally coming to our house, sometimes three, four or five times a week to check on his wounds, because ultimately, my father had seven major, very serious surgeries and operations. And finally, it culminated with him needing more care than what could be safely provided in the home. Otherwise, he would have stayed there. And so he had to go into rehab. And you know, that is where he ended up spending the rest of his life at because the infection unfortunately had just gone throughout his entire system. And you know, the IV antibiotics were no longer enough to, you know, keep that infection at bay or to even cure the infection. And so I wanted to do something that would really be a resource like I wish I had in those first days before he came to live with us. And so we wrote the all homecare matters official family caregivers guide.

Awesome. So what you know, I, I wrote my first book, I had a very similar story. I, I had a consulting business, that was kind of the last thing I was doing. In the 30 years that I've been working with families myself, helping them understand the disease and guiding them through their Alzheimer's and dementia journeys. And the impetus behind me writing my first book was very similar to your situation where I went, I was called over to this client's house, and she was picking my brain for about two and a half hours, her father had been diagnosed with Parkinson's disease. And her mother had been died, her mother in law had been diagnosed with Alzheimer's disease. And I answered all our questions. And she stops me after about two and a half hours. And she said, Lisa, you need to write a book. And I said, Well, you know, funny thing, you should say that I've been thinking about it for years. And she said, No, I'm serious. She said, It would be very selfish of you to not share the information that you know, to help desperate families like me, who in the last two years, have had such a challenge, trying to find resources on what to do what to expect. And it sounds like, you were in that same situation, you found yourself in that same situation. So I did. And she was right. And it sounds like you've done the same thing. So you can also provide very much needed resources for people who are in this care giving realm, and also for family members, so they have a better understanding of what their loved one is going through. So what kind of information resources do you provide in your book that would be really helpful for people that are in this situation and really have had no guidance from anybody, including physicians about what to expect after they've gotten the diagnosis?

Lance A. Slatton: Sure. Well, you know, it's really a map is how I like to describe the book. You know, if if I was coming to see you Lisa, out on the West Coast, and I'm leaving the Midwest. I'm going to need that map. When I pull out of my driveway. What highway do I get on? How long do I stay on it? But let's say I get about halfway to your house. I still need the map, even though I'm halfway there. It's the same with a caregiving journey. When you start out you need that map at the beginning, but you're going to need it at the middle and at the end of your journey. And so we start out in chapter one really in I call it recognizing the shifts. And that's where you'll learn to spot the early indications pointing to your parents need for care, or your spouse or whoever the loved one may be. And then setting the stage to help initiate you know, the all important conversation with empathy and foresight. You know, when, especially if it's a parent that needs to care, or you identify that it's apparent that needs to care. You know, they're very proud, they've probably been independent for, you know, 5060, some even 70 years, it's hard for them to have one of their children come in and say, okay, Mom, you can't drive anymore, Mom, you're not capable of maintaining your house anymore. You know, those are really difficult conversations sometimes to have with a loved one who's proud and independent. And so it's really kind of setting the tone for how to have those conversations, how to recognize to because sometimes, you know, you'll have siblings, and one or two, the siblings will say, No, I talked to mom, she seems fine. But then you have the other sibling who's really the boots on the ground sibling who sees the day to day interactions and seize the day today, you know, Miss Madison's missed appointments, you know, unpaid bills, you know, things like that, or even new bruises on mom or dad, because they had a fall. But they don't want to tell anybody. Because I think two part of that independence is they're afraid of giving it up, obviously, first and foremost. But oftentimes, because you know, we see this as well with our company, they think of having or accepting care and acknowledging that they need care. Oftentimes, they think that just means they're going into the old folks home, and they're going to be put there and forgotten about not realizing there's some really great ways now to get that care, to stay independent, to stay safe. By having somebody just come in your home, even if it's a couple of days a week, just to help set your medicines helped make sure you know, you get your groceries and you know, simple things, they don't have to you know, help you bathe or toilet or even dress, if that's not what's needed yet. But they can help alleviate some of the extra pressure from all the other responsibilities that you may be facing. And that's how we start to book out, you know, just recognizing that shift. And then chapter two really goes through the basics of caregiving. And it helps to equip you with the knowledge to understand your role and set the expectations that are going to both honor you and your parents. And then it kind of you know, grows from there to the legal and financial planning, you know, and then chapter four, we'd call it the heart and soul of the caregivers emotional journey, because it's not just taking care of the parent or the loved one, you're also going to have to know you have to take care of yourself too, when you become that caregiver, because you know, and I know, a lot of times family caregivers, they neglect their health to the point where they end up sometimes passing away before the loved one they're caring for, or they end up with more serious health needs than the loved one that they're caring for. Because they're not taking care of it, because they're so you know, wrapped up and committed to helping their loved one.

I just want to check real quickly for me to understand what you're saying here because what that is absolutely true factual statistic. This is not just conjecture, everybody, this is true factual statistic about caregiver, and caregiver burnout, how many do pass away because of the stress that they've taken on? Or develop medical conditions because of that. So this is really a very, very important topic to pay attention to.

Lance A. Slatton: Absolutely, absolutely. You know, and then from there, we move on. And chapter five, is ensuring that routine care and emergency responses become second nature to you, you know, and then we close it out with Chapter Six in this the valuable at home care strategies. And we offer actionable advice for creating a safe and nurturing home environment. And then in the end, we have, you know, common terms like a glossary, and then references for families to refer to Because oftentimes, they aren't aware of what a living will is, versus what an Advanced Directive is or power of attorney and, you know, there's different forms of power of attorney, you may have a power of attorney over health care, but not over finances, you know, all these different things that, you know, Lisa, families don't really sit down and plan or discuss, oftentimes until the need really arises. And then at that point, you're under such stress and pressure, that sometimes you make, you know, maybe a hastily decision that would have been better if you were more informed before making the decision under a less you know, pressure and a more ideal situation.

Yeah, um, you know, we can't emphasize that enough. As a matter of fact, if I'm not mistaken I think you and I had this similar conversation last time you were on my show about, have these conversations and be proactive instead of being reactive. Absolutely. And, you know, in the 30 years that I've been standing by and being involved in watching these situations, I have to say, and you probably will agree with me on this, that most people just wait until there is a crisis that happens in their loved one falls, they end up in the hospital, and then it's like, oh, my gosh, I don't have a clue what to do. And I don't even know what the wishes of my mom or my dad are. So we can't emphasize enough while they're healthy to have those conversations and just know what their wishes are. So, if or when a crisis does happen in your family, you'll know what their wishes are. And isn't it true Lance that the majority of older folks these days, especially in the United States, and especially since COVID, the majority of people's wishes are to be able to stay in their own homes as long as they can. Absolutely.

Lance A. Slatton: I always joke I, you know, and I don't fact me on the, the statistic, the last time I looked, I think it was like 90 plus percent of all adults over the age of 65. When asked where their choices, or preferences were for aging in place, was it a nursing home assisted living or in their own home, and it was over 90% wanted to live and remain in their own home until they passed away. And I often joke, I'd like to know the 10% reasons behind why they wouldn't want to stay in their home. You know, it could be maybe the upkeep and the maintenance, or, you know, maybe it's their downsizing, but yeah, over 90% of those assets will remain in their home until they pass. And you know, and when you get that care in the home, whether it's from your family, or a professional company, you know, you're in charge when you go on these facilities. And sometimes it's necessary, you know, like with my father, I would have kept him in the home until he passed, but it wasn't, it just wasn't, it wasn't an option because of the infection. So we didn't, we weren't really given or we really didn't have a choice in that matter. And oftentimes, when a person does have to go into a nursing home, sometimes it's the same situation, that's for a medical reason, where it's just not practical anymore, or even doable to remain in the home. And so they have to go in these facilities. And I don't disagree that facilities have a place and they serve a purpose. But you know, we've had families who, you know, it was a cognitive issue. And the family didn't know that there was the option to stay in the home. And then one way or another, they discover like our company, or another company, and then they say, Wow, we would have chosen that. And then they check their loved one out of the facility and they put them back in their home or maybe sometimes they go live in one the other one of their adult children's homes if they've already sold their house. Because they can they can have control over that care. You know, they can pick what they eat, when they eat what they watch on television, you know, and then I think oftentimes to these beds in the hospitals and nursing homes, they're so uncomfortable, they get to sleep in their own bed to at night, which I think also improves your health as well.

Well, the other aspect of it is is you will know Lance that when people have dimension are suffering from cognitive decline. Familiarity is a critical aspect for quality of life. And so if if it is doable to provide a safe and healthy and familiar environment to the folks who do live with Alzheimer's disease or related dementia, studies have actually shown that it enhances their quality of life because that's one thing, they lose so much of their cognitive abilities. But the one thing that doesn't go away is the need for routine, the need for familiarity, the need to feel purposeful, these are all you know, basic human needs on that Maslow's hierarchy of scales. It's it's basic, and basic. Those don't go away. They don't leave us right. I mean, I personally would want to stay in my home and want to sleep in my own bed. My sleep comfort is extremely important to me. So you know everything that we're talking about families really need to take into consider ration but there's also the financial aspect of it because insurance does not typically cover care for assisted living or memory care or in home care unless you happen to have taken out a long term care policy years ago. And it's triggered by you starting to show symptoms of needing help with your activity of activities of daily living, or you qualify for veterans benefits. Other than that is it's out of pocket expense, which can be prohibitively expensive for families. So absolutely, you know, it's kind of a catch 22.

Lance A. Slatton: It is, it is. And, you know, going back to the familiarity, you know, we explain to families too, when, you know, when they're looking at what the options are, you know, maybe they're just starting to explore, should mom go in assisted living? Should mom go into, you know, independent living? Should she have homecare, you know, they're all sometimes very cost prohibitive. But we explained to them, when you have a loved one with dementia, they don't have the luxury of being able to retain the new environment that you're gonna put them in. And oftentimes, not always, but often, when you take a person with dementia, and you put them in assisted living, they're on a probationary period, no matter, you know, what the age or what the circumstances, but especially somebody with dementia, and now the facility is evaluating whether or not this person is a good fit after you've already signed up and you've moved in. And sometimes it's 90 days, 100 days, 45 days, every facility is different. And then you get a report back saying, Well, they didn't pass the probationary period for assisted living. So now instead of paying X amount of money per month for assisted living, they have to advance to our next level of care or living arrangements, which then is usually like, they call it a step three, or their memory care wing. And now you're paying considerably more money. And now all this nice, you know, fluff and fufu that teas assisted livings have, they don't have as much of that in the memory care wing, you know, and we explain to families, your loved one will not adjust. Sometimes they can, but most often times, they're not going to adjust to this new environment. And Lisa, we've had so many families over the years, who you know, they they go that route with assisted living, they go that route with independent living, and then they get this report back. And then one of the other options is or you can hire an outside homecare company to bring in a class. Yeah, then in that, yeah, we had a lady not too long ago, her daughter met with us. We were helping her just two days a week at her mother's home. And we kept recommending, you know, you asked what CSCM was, I'm a certified senior case manager. So I actually was meeting with this family and with this daughter, and, you know, said we're getting a lot of feedback from the staff that your mom really should have a little more help two days a week for four hours. They're concerned because we were going Monday, Wednesday. And so when we leave on Wednesday, nobody's there until the following Monday, that's a long time. You know, and they would find, you know, milk that was left on the counter, probably since Wednesday night or Thursday after we left, they would just a lot of a lot of things were left on kept, you know, in hadn't taken her meds. And you know, the daughter was going to think about it. And they were fortunate that they had long term care insurance. So this wasn't anything they were having to pay for out of pocket either. And mom ended up sustaining a very serious a serious, significant fall down the steps of her home. We were not there. This was on a Friday, I guess the story went, that mom was going to go to the movie with a neighbor. Mom was always prompted, if anything, she was always early. The neighbor got concerned because she didn't come over, you know, all these things. And she had fallen and she was unconscious behind her door to her house. Fire Department had to break through the window, got her to the hospital. She was in ICU for several days. At that point, she was then signed up by the family to move into assisted living in the facility said oh, she passes all of our, you know, assessment, you know, and I could never understand how could you say she passes an assessment when she's in the ICU. And so she moved in there. And two weeks later, maybe the daughter called just in tears very frantic, you know, and said, I don't know what to do. The facility says Mom is not a candidate for assisted living. And you know, I would rather be wrong than right in that situation. But I knew she wasn't a good candidate. And so they ended up having to hire our company. Our company is now going into this place. Now all I know and all I'll say is they were paying that place several $1,000 a month, for a room. That's all not hands on care, nothing like that. And in order for her to continue living there, they would have to bring in an outside company for 24 hours a day, seven days a week until mom either moved out or passed away, they would release themselves of all the liability. And so we convinced them get mama one bedroom apartment, because in the meantime, between the hospital and moving her into the facility, in those first couple of weeks, they sold the home very quickly, it's a beautiful home great location had no trouble selling it. So it's not even like they could just move mom back into her home, unfortunately, and the daughter did not have room for mom, because they had a smaller home, and she still had kids living at home, in their bedrooms. And but you know, these situations, it's like, you know, sometimes, you know, you can only give the information and then the family and those you're giving it to have to make a decision based on what you give them. And the information they're collecting. And in this case, they trusted this assisted living that mom would have been a great fit was a great fit. And, you know, we knew better and it was just very unfortunate that the family had to experience and go through that because, you know, is very, very traumatic, not to mention the significant amount of money that it was costing them to have a room at the assisted living plus, you know, having homecare 24 hours a day, seven days a week. Yeah,

it's such a difficult situation and to know, because we all as adult children, we want to feel that we are doing or have done the best for our parents. Yes, that's an emotion that we all realistically struggle from. And we feel tremendous guilt if we don't think we've done the best thing. And how do we know what that best thing looks like? Because we've never been in this situation before. But one thing I curious about, because I know that the regulations differ in assisted living and memory care, which in my state, California are considered social models that are not medical models. And they are a little different than what we call a nursing home, long term care facility. Those are medical models. But in California, if you if your loved one even has a diagnosis of one of the brain diseases that causes dementia, they cannot they're no longer eligible to be in assisted living, they have to go in memory care. It has to be a diagnosis of mild cognitive impairment to remain eligible for assisted living, but of course, that could change in several months. And once that dementia or Alzheimer's diagnosis is made up certain by their doctor, they no longer can stay in in living. It doesn't sound like that's the case in Michigan.

Lance A. Slatton: No, well, I can speak to home care. And I can speak somewhat to our assisted livings Our offices are located right next door to an assisted living. And I can tell you, there are people in the assisted living that really should not be in the assisted living. Um, we've had to call the police several times where somebody's walking down the middle of the road, or, you know, they're trying to cross the road not at a crosswalk. And it's a very, very busy road. I mean, they'll show up at a neighbor's house knocking on the Windows thinking it's their home at two o'clock in the morning, just really sad. homecare in Michigan is not regulated at all whatsoever in any way, shape or form. I'm not sure if that still applies also to assisted living. It may I'm not I don't want to speak to that because I'm not sure. But I do know, unfortunately there are there are people in assisted living in Michigan, that really should not be in true to the true to the word assisted living, because there's not a lot of assistance, you know, and that's the thing that really gets families. You know, like that family. I was speaking about this lady, the daughter was so devastated because she said well, they told me they had 24 hour nursing care. And we explained to them, Well, they do but that doesn't mean your mom is going to have 24 hour care watching over her. That means a registered nurse is either on the campus or available by phone and we're talking one nurse at all hours and days, you know, that doesn't mean she's right there with your mom. You know, your the cost of assisted living would be dramatically higher. If everybody in there had 24 Our nursing care, you know, sometimes I think, you know, some yeah, sometimes I think families have the impression and I can understand how they could have that impression that assisted living is just a much fancier nursing home that you're just going to pay a little more money for, to have that more fancy environment. But you're not paying for care. That's what you're not doing. Now. Let me rephrase,

in California, and we are heavily regulated in California. Yeah, it is considered a social model versus a medical model. And that's part of the reason you've got caregivers who are responsible for the oversight of the care for, you know, handfuls of people. So they really need to be able to be more on the independent side. And the other thing in California, and I don't know if this is true in Michigan, you got my curiosity on this one. One of the problems with assisted living in the state of California, it's illegal to tell a resident that they can't come and go as they please. They can building they can come back, they can go where they want, they can go out and go for walks. Whereas in memory care, it's a secure facility. And this is for their safety. So as you said, and I've seen for decades, people living in assisted living, who have no business being there, they can walk out the door anytime they want. And they lose their cognitive senses of logic and reason. And like you said, they don't know how to use a crosswalk, and you just walk out in the middle of the street. It's it's a safety risk for everybody. But at least in my state, the staff can't stop them in assisted living, but they can make it a safe environment once they move on to memory care, because they have to be able to code to get in and out of the environment. Yeah,

Lance A. Slatton: and as far as regulation, I am not sure. But I would say everything you just said lines up with assisted living versus memory care here. The problem is, as you mentioned, Lisa, they're allowing residents to continue living in assisted living, or even independent living that have no business doing so. And that's where the trouble comes in. Because yes, they can come and go, it's not a locked facility. We had just about a month ago, the neighbor is, you know, this is multiple times this has happened to her. She has resonance from this assisted living facility, walking and showing up on her patio at all hours of the night. And they're convinced they live there. And one time she had a man, you know, come up the driveway, and he was convinced that she was in his home, and he was getting really upset. You know, I mean, there's a lot of safety issues there, you know, and until the facility identifies it, I don't I don't know what the answer is for them. You know, I know with like our company, even though we're not regulated, you know, if there's somebody where it's not safe for either a for them to live in their home, or be for our staff to be in their home taking care of them, because maybe they're violent, maybe they're aggressive. You know, there's several reasons why we may not want to take care of somebody, but we'll have a very, you know, very honest conversation with the family and say, you know, it's not safe for your mom to be here because of XY and Z. And it's to the point where it's not safe for our staff. That's only happened one time in 13 years. And this gentleman in the family did not know it. He did not when he was in the beginning early stages of his of his dementia, he had not turned in his all of his guns to his kids. And I guess he still had one and, you know, the staff showed up and you know, he had it out. And, you know, it's very, very concerning. It wasn't loaded or anything like that. But, you know, we had to make the family aware and this wasn't when we were there. The police ended up having to get involved and he ended up having to go into a locked a locked Geriatric Psychiatry, you know, geriatric psych facility, because he just really took a bad turn and he never recovered back down to his, like his baseline because of it. You know, I mean, there's all kinds of situations, but like these facilities, I think there's a great purpose for them if you meet the right criteria, but if you are dealing with cognitive issues, you might be in your room and you know, like this family, I'm speaking about who we ended up having to go in 24 hours a day, seven days a week for, you know, one of their biggest complaints other than the facility. They felt like really kind of hoodwinked them and I kind of think they did in a way to I don't know how you approve somebody who's in the ICU, you can't really do a true assessment of somebody's baseline cognitively or physically, you know, they were just asking the facility, the first, the first two weeks, would you find a resident who wouldn't mind, you know, kind of befriending our mom, take her to the activities, take her down to the lunchroom, or, you know, just the kind of get her acclimated and, you know, make her feel welcome. And they said, Well, we can do that for the first two days, three days, but after that, we just, we can't expect residents to do that. And I understand that. So the family said, well, would staff and they said, We don't have the staff to do that, we can't do that. Because if everybody asked us to do that, we would need, you know, how many more employees here. And, you know, it's just it was a very, very, very bad experience for this family. And, you know, I really felt for him, you know, all they wanted, what was was what was best for their mom. And, you know, the facility, if you didn't go to the lunchroom, you know, we're sorry, but you know, we're not delivering it either. You know, it's just, you know, things like that, that I don't think families truly understand when they're, you know, looking at placement for a parent or a loved one. You know, if if you can be in assisted living, you can live in your own home. That's what a family told me once I said, you know that that is the best way to sum it up. If, if your mother, your father, you or whoever it may be is able to be in assisted living, you're more than capable of being in your own home. And

I honestly believe, and every case is different. When I did assessments and helped with placement, I looked at every single individual situation separately. And if they were past a certain point in their cognitive decline, sometimes I did recommend that going to a memory care was going to be safer. But you have to look at all the factors, how close are the families, and bla bla bla bla bla. But I also believe, and I believe this wholeheartedly, that with the proper guidance, people who are knowledgeable and experienced and skilled, can replicate a safe environment and a very meaningful environment in a person's own home that they offer in memory care. And I think really, the key to the success is finding somebody that knows how to make that happen, because they have gone through the specialized training, which is very different than taking care of people who have had strokes or, you know, maybe my mom, for example, she had had multiple strokes over about a 10 year period of time. And she had suffered zero cognitive impairment, but she was bed bound. And we took care of her for three years, because she couldn't do anything, she had a feeding tube. And that disqualified her from going into assisted living. Right, we brought her to our home, and we had a full time caregiver. But she had no cognitive impairment whatsoever. I can't stress enough to our listeners out there. And I'd be interested in to hear your feedback on what I'm about to say, to make sure that the people that are either working at the facilities, the assisted living or the memory care, have received specialized training in dementia care, because it's very, very different type of care than somebody who is needing help with activities of daily living for other reasons. Like maybe they have Parkinson's disease, but they don't have the dementia component to to it. That would be an example because they do have tremors and have difficulty getting dressed on their own and things like that. But in my experience, I think that it is very possible to create a safe, which is the number one thing and also a meaningful and purposeful really environment for our loved ones until possibly they reach a certain stage and I think that really is going to come down to safety issues. But I agree with what you're saying if they qualify for assisted living. I believe that we can provide guidance with how to make those to their homes safe for them to stay in for as long as possible. And you know, even if they can stay till the end, hospice is there to come in and help with the end of life. aspect of it too. A lot of people don't realize that. I mean, I worked two buildings, I was a regional director, I managed five buildings. And I can't tell you how many family members had no idea that their loved one could stay in assisted living or memory care for ever, if they wanted to have a spring hospice care in and as long as they did not want them to be their life prolonged with assistance, right? Absolutely.

Lance A. Slatton: Yeah. And you know, I would also point out to hospice is not going to cost a family out of pocket.

And I recommend, just from my experience, that, don't wait until the last minute to start talking to the hospice organizations, I think it's really important from what I've seen to start nurturing your relationship with one of the hospice companies early on. So, so interviewed a couple of different companies and go with the one that you feel most comfortable with, that you feel is aligned with your philosophy, and what are the care that you want for your loved one? Because, like everything else in this world, not all hospice companies are created equally.

Lance A. Slatton: Yeah, well, yeah, yeah, they, you know, hospice, for hospice providers, all can have different philosophies, and they can all have different views on what treatments are going to be appropriate or not appropriate for your loved one, just for instance, you know, some hospice providers may not believe in rehydration, if somebody is dehydrated, you know, with my father, the hospice company that we ended up going with, they believed in providing fluid hydration. And, but they wouldn't do it via IV, but they would do it as a subcutaneous hydration, which is how you rehydrate animals that are dehydrated, you know, they just take the needle, and they put it in the fat of your thigh, your arm, what have you, and the fluids all go in that way. And, you know, some hospice companies won't do that, like with my father, they said, you know, we will, basically we'll do it twice. After that. We won't do any more hydration, you know, some believe in certain things where others don't, you know, so I'm just my point is, hospice providers are not all created equal. They all have different beliefs and practices and philosophies. So that's just important to keep in mind when you do start having that conversation about hospice and, and don't rule out palliative care. You know, palliative care is a wonderful resource. It's a little newer on the scene, if you will, than what hospice is. But that's what

it is just might not be familiar with that term.

Lance A. Slatton: So. So hospice is end of life care does not mean your loved one's going to pass away. When you get admitted into hospice. It's with the diagnosis that you don't expect to ever cure or to be rid of, if you will.

Graduate off of hospice. Yes. Yeah. A lot of people don't realize that they think, okay, if my doctor is telling me that it's time for hospice, that said, that's the end. That's not true. Right. A lot of people come off.

Lance A. Slatton: Well, yeah, absolutely. And it's a six month expectation of life. So in order to go into hospice, you have to have a diagnosis where the doctor is potentially saying, you have six months or less to live, that doesn't mean you will pass away within six months. I know people who have been on hospice for over two years. Another note, I would point out about hospices, you still have full control. If you want to discharge yourself from hospice, go to the hospital for a certain medical treatment that you need or that you want, you can do that. Go get it, you know, first discharged yourself from hospice, then go to the hospital or your doctor or whatever it is you're wanting, that's not under the hospice, you know, treatments and then readmit yourself back in the hospice. I had a hospice nurse once tell me, she has this little man, little sweet gentleman, and she says, Every few months, he checks himself out of hospice and I forget what it was. He goes, gets this treatment, Donner gets these medications. And then a couple days later, he's readmitting himself back in the hospice, you know, it's, you know, like I said, hospice, they provide Add your supplies for free. Your medications are free, you know in a lot, again, hospice philosophies and things, a lot of your medications that you take, they may discontinue, but you know, pain meds and other types of medications that are covered and provided by hospice, you're not going to have to pay for out of pocket. Yeah,

and this is just another area where we both would advise, be proactive about it versus reactive about because you want to be comfortable with the, the folks you bring in to care for your loved one to make sure their last months or days or EAGERs are, are good ones, and they're being taken care of. And you need to find the right organization that you feel comfortable with. It's like breathing, you know, all any of us who have had children, we didn't want to just settle for any, you know, teenager coming in to watch our kids. So we should go out to dinner or something. Because if we didn't feel comfortable, we would be worried the whole entire time. So what's the point, it's the same with with our parents, we don't want to have to spend every waking minute of our time worrying, if they're being well cared for, it's just human nature to want to make sure that we're doing the best for our loved ones, whether they're our kids, or our parents or our grandparents. So these things are really important things to take into consideration. And that's why we're talking about it. So people, you know, can maybe stop and think, you know, I never would have thought about talking to a hospice organization until I was told by my doctor that we needed one, but then what are you doing, you're scrambling around trying to find one to serve you. And it might not be a good fit for anybody in your family, especially your loved one. Right, exactly.

Lance A. Slatton: And just to piggyback on that for a moment. You know, hospice is about making sure the person is getting comfortable, and is pain free. You know, palliative care is kind of the step before hospice, that's in the hierarchy, if you will, they are treating an illness or a disease with no expectation of curing it, but they're still treating it. So if you're in hospice, and you were diagnosed with cancer, your chemo and radiation is done, you know, that's going to be discontinued. If you're in palliative care, you're getting all the benefits of palliative care, you can still continue your chemo and your radiation, but there's no expectation that it will be cured. It's not to say it can't be but they're, they're still going to treat it but they don't expect it to be cured. That's really one of the biggest differences. When you're in hospice, they're going to make sure you're comfortable, but they're not going to be treating the cancer anymore.

Well, Lance, wow, this has been a really deep conversation, I could just go on and on and on and talk to you all day long. But looks like we are just about out of time. But before we say goodbye, I would like to let you tell people how they can find more information out about you your homecare services, your podcast, and your brand new book that is, you know, I think not a want to have a need to have. So it becomes, you know, a resource for people, they can refer to it all along the way. And again, especially with cognitive diseases. These are long, long journeys forever. They're not for six months. They're not for two months. I mean, my grandmother lived with her Alzheimer's disease for 20 years. And I know the average is four to eight years, but that's kind of on the fast side. But during our summit, we had a speaker on whose mother lived with it for 30 years and I think that was probably one of the longest I'd ever heard. The living with Alzheimer's

Lance A. Slatton: Was that was that was that Lori la Bey? Do you remember? Because I think her mom lived about 30 years.

Sorry, maybe? Worry. Yeah, I wanted to say it might have been Teresa, but it could have been. Yeah, but one of our speakers at the summit 30 years and I thought my grandmother had it for a long time. 20 That's a long time. caregivers and family members to you know, kind of watch this person that they, you know, probably adored at one time of their life just decline into some thing they don't even recognize anymore. But how do you give them the best quality of life during that? Absolutely.

Lance A. Slatton: And like we've said before, Lisa, it's cliche, but it is so true in the world of, you know, dementia and you know, cognitive diseases. When you've seen one person with dementia, you've only seen that one person because it does affect everybody so dramatically differently. And you know, that's why it's so hard for families because you can't just rely on what may be a friend of yours experience with their parent or loved one, because it may not hold true for yours, you know, everybody's case and situation can be entirely different than anyone elses.

And one thing I want to emphasize because I actually have gotten to know Lance, and I have complete respect for his philosophies, he practices what I practice, which is called person centered approach to care. So really, what that means is the focus is more on the individual person versus just focusing on their disease. So in the dementia world, instead of focusing on dementia is just just dementia symptoms. We tailor and customize the care plan to meet each individual. And this is, this is what Lance and his company and his caregivers all offer and it's very, very important. I'm so excited about your new book. Thank you, buddy. I would recommend you checking out Lance, a slatkin's brand new book called all homecare matters, how can we find it? Yeah,

Lance A. Slatton: so you can find it on Amazon, Barnes and Noble, all major retailers. If you just type in either my name as the author or the book's title, the all homecare matters official family caregivers guide, it should populate. They're welcome to also go to my official website, Lance a slaton.com, there's a section for the book there, or just go on Google and type it in and it will pop up and you get it on Google, Apple books, anywhere books are sold, it's available. And it's been quite an experience. You know, I wrote this wanting to just provide resources and information. And you know, I've been watching the Amazon has a really cool chart where it shows all the new releases. And the book is in the dementia category, the Alzheimer's category and the aging parents category. And it's been in the top five and the top 10 and top 20 Since its release on March 5, so we've just been having a lot of fun with it. And, you know, just hoping it's going to help some families who are you know, starting out or in the middle of this caregiving journey, have the support and resources they need to continue caring for their loved ones.

And that is one of the biggest comments and complaints that I hear from family members and I have for 30 years is they really have a difficult time finding reliable and trustworthy resources. So they're, they're so desperately needed. So check out Lance's new book. Lance. Thanks again for

Lance A. Slatton: Thank you, Lisa. Always great to see you. Oh, it

is you too. So that wraps up this episode today for the truth lies and Alzheimer's show. I'm Lisa Skinner, your host and we will be back next week with another brand new episode that we bring you weekly that hopefully provide you with a lot of this valuable and and helpful information to help you have a much easier time through your Alzheimer's or dementia journey. So thanks again for being here. Have a great week. We look forward to seeing you back next week. Take care