Gerontology Expert Dr. Macie Smith Exposes The Shocking Truth About Long-Term Care Planning

Caring for an aging parent with dementia presents complex physical, emotional and financial challenges for families. In this insightful interview with leading affordable senior care platform CareYaya, acclaimed gerontologist and social worker Dr. Macie Smith pulls back the curtain on practical dementia care strategies that every caregiver and loved one should know.

Dr. Smith explains why planning for long-term care should start early, even if your elder seems healthy today. She shares a touching story about using normalization techniques to improve quality of life that changed her career path completely. You’ll also learn communication tips to prevent difficult dementia behaviors and engage meaningfully with your elder.

Finally, Dr. Smith highlights her new book, “A Dementia Caregiver’s Guide To Care” designed to help struggling families access expert advice on budget. With dementia cases growing rapidly, this compassionate gerontology expert provides hope, heart and affordable solutions for overwhelmed caregivers nationwide. Her little-known secrets to dignified care could give your loved one the safety, comfort and independence they deserve.


Dr. Macie Smith, a licensed gerontology social worker and Alzheimer's and dementia educator, discusses her career and advocacy work in the field of aging and vulnerable populations. She emphasizes the importance of long-term care planning and the challenges faced by family caregivers. Dr. Smith shares meaningful moments from her caregiving career and highlights the need for more awareness and support in the black community. She also discusses her book, "A Dementia Caregiver's Guide to Care", which provides practical advice for family caregivers. Lastly, she offers advice for student caregivers on supporting both the individuals they care for and their families.


  • Long-term care planning is essential for families caring for seniors with Alzheimer's or dementia.
  • Family caregivers need more support and resources to navigate the complex long-term care system.
  • Engaging in meaningful moments and providing a normalized environment can greatly improve the quality of life for individuals with disabilities or dementia.
  • Recognition and support from the community are crucial for advocating for underrepresented causes, such as dementia care in the black community.
  • Dr. Smith's book, 'A Dementia Caregiver's Guide to Care,' offers practical advice and communication strategies for family caregivers.
  • Student caregivers can make a significant impact by actively listening, engaging with individuals on a personal level, and supporting family units.



00:00 Introduction and Background

02:28 Advocacy and Education for Dementia Care

05:16 The Importance of Long-Term Care Planning

08:18 Meaningful Moments in a Caregiving Career

11:28 Recognition and Impact in the Community

12:50 A Dementia Caregiver's Guide to Care

17:33 Supporting Family Units as Student Caregivers

19:35 Conclusion and Appreciation


Full Episode YouTube Video:

Full Episode Transcript:

Leah (00:01.663)
On today's episode, we are speaking with Dr. Macy Smith. Dr. Smith is a licensed gerontology social worker, an award-winning Alzheimer's and dementia educator, and author working with aging and vulnerable populations in South Carolina. She is the past state president of the National Association of Social Workers. In addition, Dr. Smith is a professor at the University of South Carolina Benedict College.

Dr. Smith has been recognized as a top 20 under 40 leader by the South Carolina Black Pages Magazine for her work as a community and industry change agent. And last but not least, Dr. Smith is the author of A Dementia Caregiver's Guide to Care. Dr. Smith, thank you so much for coming to speak with us today. I'm really interested to learn all about your career and to start us off, do you mind telling us a bit about

Dr. Macie P. Smith (00:46.198)
Thank you for having me, Leah.

Leah (00:54.167)
your academic journey and your early career years.

Dr. Macie P. Smith (00:57.222)
Oh, yeah. So I attained my bachelor's in social work from South Carolina State University, which is an HBCU here in South Carolina, the only state-supported HBCU. And I got my master's from SC State University as well in rehabilitation counseling. My first job in the industry was with the Department of Disabilities and Special Needs. So I was working with adults with intellectual, developmental, and physical.

disabilities. And so I've been working in that industry from the beginning. So since I graduated, I got my undergrad in 95, 99, graduate high school in 95. Got my undergrad in 99, started working for this particular agency, the department in 2000. And what 23 years later, I'm still doing the same type of work with the same population, although it's with my own business now, but I've, I've worked through

various roles in order to be competent enough to be able to impact the lives of those who are in vulnerable situations, specifically adults and seniors, those over the age of 65, who may be living with Alzheimer's and or dementia. And so I've gotten some certifications. One was in gerontology. I've gotten case management certifications just to be able to better develop and hone in on my skills as it relates to

geriatric care management, which is what my business is about.

Leah (02:28.855)
That's all really incredible. It sounds like you have a wealth of knowledge and experiences across multiple fields. And that's really exciting. I love the work that you do now. And so I'm really curious, could you kind of define, you are an advocate and an educator for care for people with dementia and Alzheimer's. What does that kind of look like in your day to day?

Dr. Macie P. Smith (02:50.658)
So in my day to day, my actual target population would be family caregivers. So those caring for seniors who may have Alzheimer's, dementia, or even cognitive impairment, malcognitive impairment. Because typically when you work with the senior population, they typically don't think that nothing is wrong. You know what I mean? I ain't got the problem, you got the problem, right? Usually their children or their grandchildren, nieces, nephews, sisters, brothers, or what have you. And so my population I typically work with would be the family caregivers who are

trying their best to provide care and trying to figure out the long-term care system, which is a very convoluted, very difficult system to navigate, which it should not be. You know, when we think about vulnerable populations and older adults, you know, why y'all make things difficult for them to access the services they need now that they are at the point where they need some assistance? And so I help families, number one, identify the needs of that senior.

not necessarily what it is that you do for them, but what do they need? Because a lot of times we have a habit of just figuring or thinking, or our perception is that they can't cook for themselves, or they can't dress themselves, or they can't drive themselves. And we take that independence away from them. And so I kind of come in and I tell the senior that I'm their friend, you know, I'm their personal social worker.

advocate for them, which I ultimately do. And I help family members identify their needs as opposed to what they think they need. And really identifying the services and the supports in the community that would be an ideal match to support them where they are. And I always look for the least restrictive environment. So we try to bring supports into the home as much as possible, which is what you all do at CareYaya. And I have to say, I am just so proud.

of what you all have been able to accomplish in what you are doing. I am in 100% support of what you all are doing and I've actually made some referrals myself. And so the very first thing we wanna do is keep the senior in their home, in their natural environment for as long as physically possible and in a safe manner. So what does that look like? So my day to day is pulling together those resources.

Dr. Macie P. Smith (05:04.918)
developing a plan of care and executing that plan of care to get them the services, supports to be able to meet their needs, but not only their needs, their desire to want to remain in their home.

Leah (05:16.907)
Yeah, absolutely. I really love everything you just said. So much of care for aging adults is about maintaining their safety and removing their independence without figuring out what do they actually want and what they actually need to continue living a life that is meaningful to them and has purpose to them. So thank you so much for speaking on that. And I completely agree that these are topics that are not discussed enough.

Dr. Macie P. Smith (05:42.734)

Leah (05:43.231)
And so I'm curious, is there a specific issue or cause that you wish people knew and or cared more about?

Dr. Macie P. Smith (05:52.918)
So long-term care.

really rests on the shoulders of family caregivers. And what I mean by that is because Medicare and third party insurance and private insurance outside of long-term care insurance, which that's something we could talk about too later in another talk, but the responsibility rests on family members and family caregivers. And I wish we talked more about what that level of responsibility looks like. Wish we talked more about.

the impact of what that level of responsibility looks like. I wish we talked more about resources so that way family caregivers would not have to leave the workplace early. They don't have to just deplete their savings from 50, 60 years to pay for care for their older adult loved one. And now when they need it, they don't have financial resources to be able to.

pull from because they promised their mom or their dad or their grandparent that they're going to take care of them because they took care of them. So it's a reciprocal relationship, but not really realizing the police, the depletion of their resources. If you don't plan to replenish that, then it won't be anything left for you. So I wish we talked more about that in not only a candid way, but a

It's not just a conversation to have in healthcare. It's a conversation to have in business. It's a conversation to have, you know, in the food industry. It's a conversation to have wherever people are. So I wish we talked more about that.

Leah (07:32.331)
Yeah, absolutely. Planning for long-term care is so important and it's something that is just sprung upon so many families because it's not talked about, like you said. It's not something that people are even thinking about that they need to plan for. And so it just it can happen spontaneously. Someone has a fall or their needs change. And yeah, ultimately that can lead to family caretakers putting a pause on their own career or.

Dr. Macie P. Smith (07:47.185)
That's right.

Leah (07:57.207)
doing whatever it takes because they truly do care for this relative, but having these long-term kinds of solutions. Absolutely, and so having these long-term solutions in place is so important. And you are someone who clearly brings so much passion into your work, and I'm really curious, is there a particular moment in your career that has been especially meaningful to you?

Dr. Macie P. Smith (08:00.146)
Yeah, they become a caregiver overnight.

Dr. Macie P. Smith (08:20.234)
Mm. Ooh. I don't know. This is like all love on. Oh my gosh. I guess I would have to say, in my previous work, when I was working with adults with disabilities, whenever, it was this lady, she lived at one of the institutions here in South Carolina. We have five.

Leah (08:25.386)
I'm sure there are many.

Dr. Macie P. Smith (08:48.526)
still for people with disabilities. And I mean, she was tearing up stuff. I mean, like fighting people, you know, and she in a wheelchair, right? I mean, fighting people, property destruction. I was like, well, how she get so close to y'all to even assault y'all, you know what I mean? But she was very, very angry, upset. Clearly she was responding to her environment. When you're in that type of milieu, you're gonna take on the behaviors of those you see. And one of my roles was to

Leah (09:02.979)
Thank you.

Dr. Macie P. Smith (09:16.326)
transition individuals from the institution to the community for a better way of life, a better quality of life, and it's cheaper for the state, right? And so we were very nervous about transitioning her to a community setting in a home with another adult. It was just one other person in the house with her. We were nervous about doing that, but when we transitioned her and she was able to have her own room.

she was able to have one-on-one attention, support, and engagement from someone who did not have a disability. You know, so the quality of life that she gained as a result of transitioning to a lesser restrictive environment, a more normalized environment, because how many people live with 23 strangers? That's not normal. And so when I saw that normalization...

positively impact her life. I mean, she was going to the hairdresser to get her hair done. She was getting her nails done. Leah, she was going on cruises that I ain't never been on. And that, oh my God, that, my heart just, it was like jelly. It was like jello because it warmed my heart so much to know that something as simple as.

Placing someone in an environment where they can be as normal as they possibly could be, just like everybody else, can make a major impact. Now how difficult is that to do? And so that would have to be the most profound. I don't know if she's still living. That was Miss Dorothy. Miss Dorothy, I love myself now. Now, I'm going to tell you, Miss Dorothy, she would roll up in my office and she had a problem now. And I'd be like, oh, I see some of that coming out. But she has a right to be angry. She has a right to her emotions. But it was very much...

Leah (10:47.387)

Leah (10:55.596)
I'm sorry.

Dr. Macie P. Smith (11:00.942)
really an eye-opening experience for me. And I think it fueled a lot of why I do what I do today and why I'm still in the fight.

Leah (11:11.347)
Absolutely. You clearly made a very powerful impact in Ms. Dorothy's life. And I can see why you have been named a top 20 under 40 leader by South Carolina Black Pages magazine. And I am really curious, what does this recognition mean to you?

Dr. Macie P. Smith (11:17.031)
Oh, thank you.

Dr. Macie P. Smith (11:29.122)
So that was about four years ago when I was under 40. Number one. So, but the South Carolina Black Pages, which is a black owned magazine, and they would highlight 20 leaders across the state of South Carolina, African-American, who have and are making an impact in the community, which means a selfless impact. And so to be honored by my own community.

was very not only insightful, but it was very rewarding because in the black community, there are a lot of things that we don't talk about. Mental illness is one of them, and Alzheimer's and dementia is another one that we don't talk about in a responsible way. And so to be able to highlight those causes in the black community by elevating someone from within the community was and still is very powerful for me and actually use that to fuel us.

to feel what I do also and being able to speak candidly within the black community about the issues that concern us the most.

Leah (12:34.839)
Yeah, it's truly an incredible honor and well-deserving for sure. So you've written a dementia caregiver's guide to care. Can you give us the rundown on what readers can find in this guide to care?

Dr. Macie P. Smith (12:50.398)
Yeah, and I wish I had it, you know, and I had it in my hand, but it must have just really slipped out because I was just going to pop it up on the screen for you. But the book is called A Dementia Caregiver's Got to Care. And it is a quick read. It's about 54 pages. And it is about the most frequently asked questions that I've gotten over the past. How long have I been doing this? Thirteen years.

Leah (12:57.387)

Dr. Macie P. Smith (13:15.006)
of providing community and family and corporate education and training around Alzheimer's and dementia. I would have family members attend my trainings over and over and over again, Leah. And I said to myself, you know, I'm going to say the same jokes. I'm going to say the same information. And they, and I would tell them that because I was like, I hope they're not coming for something new because I don't have any, I don't have any new material, you know, like I'm a comedian, right? And they said, that's not a problem. We want to hear it again because

we have a new situation. And so even though it's the same information, it's being applied at different times and with different scenarios and situations in a caregiver's life. And so I felt bad that they continued to like, kind of follow me across the state and come. I was glad that they were there, but you know, that's time, that's gas, that's, you know, travel, we're in town cars. So I said, well, actually my husband said it, we'll just write it down, like real simple, right? We'll just write it down.

I was like, do you mean a book? He was like, oh, okay, yeah, right? And so I meant for it to be a very quick read, the question and my response, how do I get mom to drink more water? How do I get dad to stop cousin? You know, how do I stop mom from driving the car? So very basic questions, but also a really tangible answer. I also break down the acronym BREED.

Leah (14:13.095)
I'm sorry.

Dr. Macie P. Smith (14:35.906)
The BREATHE acronym, each one of those letters represent a communication strategy. Cause one of the biggest things we see with those living with dementia, when they have what we call behavior challenges, which they're not behavior challenges, they're just responses just like everybody else has. And so how do we better respond to those types of engagement, the way they engage? Cause you can't manage something that you don't own, right?

That's their behaviors, that's not yours. So when people say to manage behaviors, you can't manage something that don't belong to you, right? So what we have to do, I teach people how to effectively engage with someone living with dementia in order to prevent the challenging behaviors from occurring in the first place. And it's not challenging to the person, it's challenging to the caregivers or the caretakers or the staff. That's who it's challenging for. And so I teach them how to communicate

in a responsible, respectful way that promotes independence. And what that does is it reduces the behaviors that are challenging to them or prevents them from occurring in the first place. And so I start off the book with talking about the difference between Alzheimer's and dementia and what some of the treatable types of dementia are and how to have that conversation with the doctor. And so if you're a family caregiver currently caring for someone with dementia or someone you think might have it, you wanna pick up the book.

If you have a family member in your life that's over the age of 65, 75, 85, you don't see any signs of dementia, but they're a part of the aging population, you too need to get the book, because if somebody is 87 years old and they forgot where they put their glasses, you're gonna sweep it down, they got dementia. So the book is gonna help you identify what's reasonable and what's not reasonable and how to have those early conversations with the doctor. So they won't be over-diagnosed or misdiagnosed.

Leah (16:24.099)

Dr. Macie P. Smith (16:31.626)
And the book can be found on and also

Leah (16:36.139)
This is truly such a valuable resource because it is written with all of your clinical expertise and knowledge, but it is written in a very accessible way. It is for family caregivers. It is written with your expertise, but it is very much directed towards people in these situations. And I completely agree, going back to what we were talking about with long-term care plans being necessary, even if your loved one is not yet experiencing signs of dementia because...

Dr. Macie P. Smith (16:46.146)
Yes. Yep.

Leah (17:04.351)
dementia is so prevalent across the population, having these resources accessible to you at an early stage is so important because even if we're fortunate enough to not have a direct relative or direct family member impacted by dementia, chances are you are going to have someone in your life affected by dementia and having these resources at hand before you need them is really, really important. And to wrap this out, I have one final question for you, a piece of advice that I would

Dr. Macie P. Smith (17:07.211)

Dr. Macie P. Smith (17:27.15)

Leah (17:33.779)
All the students on our platform are going into homes and they are there to take care of a person to provide assistance to allow people to maintain as much independence as possible, but they're also there to support family units. So in that regards, what can student caregivers be doing? How can they be acting in a way that not only supports the person they are there to provide care for, but also supports these family units?

Dr. Macie P. Smith (17:57.81)
Listening. Listening, taking the time to sit down next to them, engage with them eye to eye on a personal level and listen more than you talk. That is so vitally important. Some of the homes that you all go in, you're the only person that senior sees all day or even all week sometimes because the family members are busy or they don't have family members.

And so you actually being there, you know, not talking while you're sweeping or talking while you're doing this, but really sitting down next to them on their same level. You're not standing over them or anything like that. Looking them eye to eye and saying to them, how are you doing? And waiting for a response. I had one gentleman who was this one lady, a lady and a gentleman, it was exactly...

Dr. Macie P. Smith (18:56.302)
30 seconds before they would respond to me. And so I would not, I talk a lot, I do, and I talk fast, but I realize if I'm talking too fast for them, because they'll get ready to say something and I say something, they stop. Because if I keep talking, they're gonna forget what they're gonna say anyway, whether they have dementia or not. That's just how it goes sometimes, especially if you're not engaged and you're not engaging that brain, you're going to forget that's natural. And so allowing at least 30 seconds before you come with your next.

thought, your next statement. So really engaging with them, sitting down, listening to them and being genuinely interested in what they have to say.

Leah (19:35.203)
Dr. Smith, thank you so much for sharing your expertise with us today. It has truly been a pleasure.

Dr. Macie P. Smith (19:40.88)
You're welcome anytime Leah and you know you guys keep doing what you're doing. You're making a wonderful impact.

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