Join us for a compassionate conversation about navigating dementia care with Natalie Leary, LCSW and Director of the Duke Dementia Family Support Program! Hosted by Nirvana Tari, Chief Patient Officer at CareYaya.
In this deeply practical episode, Natalie reveals why the most overrated caregiving advice is simply telling people to take care of themselves without explaining what that actually means or looks like in practice. Discover the truth about what really happens in the critical first forty-eight hours after a dementia diagnosis (hint: families either freeze completely or frantically scour the internet), and learn why the diagnose and adios approach leaves families stranded without support when they need it most.
From explaining why memory changes aren't always dementia (some causes are actually treatable) to sharing creative solutions like cutting the cord on an iron so a former linen worker can safely engage in familiar tasks for hours, Natalie offers guidance grounded in years of supporting families across North Carolina. Learn why the real villain is always the disease process, not your loved one, and why success in dementia care doesn't mean mastery but rather forgiving yourself when you say unhelpful things because you're human.
Key insights include how family relational history before diagnosis predicts caregiving challenges, why twenty-four-seven care immediately after diagnosis is probably too much too soon, practical tools like shared family calendars and TrueLink cards that preserve autonomy while ensuring safety, the breakthrough diagnostic tools including lumbar punctures and skin tests that provide earlier and more accurate diagnoses, and why interdisciplinary collaboration with everyone at the table (from neurologists to social workers to pharmacists) should be the norm, not the exception.
Brought to you by CareYaya, America's number one rated solution for in-home senior care, providing industry-leading quality care at the most affordable rates. CareYaya is known especially for delivering the most reliable and affordable overnight senior care and 24/7 care in many major metro areas including Atlanta, Boston, San Francisco, and Washington D.C.
This episode is essential for families noticing early memory changes in loved ones, caregivers feeling isolated and wondering if their experiences are normal, adult children in different states trying to coordinate parent care, future social workers and healthcare professionals who want to understand the critical gaps they'll need to fill, or anyone who needs permission to involve their loved one in conversations about their own care while the disease still allows it.
Episode Transcript:
Hello and good morning, everybody. My name is Nirvana Tari and I'm here with The Care Plan. I have the wonderful Ms. Natalie Leary with me today. How are you doing, Ms. Natalie? Doing well. Good morning. Glad to be here. So happy to have you here. Natalie is coming to us from the Duke Dementia Family Support Program as the director. She is a wonderful, if I'm not mistaken, LCSW? Yes. Awesome. So y'all already know the deal. We're going to go ahead and start with the lightning round. So let's just get into it. So tell me one conversation that every professional should be having with their parents this month. With their own parents, I would say conversations that are moving them towards discussions about the future. around what are your wishes what are your hopes where is the important stuff the important documents but beginning those conversations you're not going to resolve them in one sit down but moving towards understanding what our families or parents want and wish oh I love that really understanding that it's not just one one and done conversation it's like an ongoing thing that you just got to start and then once you get it started hopefully the ball will start rolling and It'll make things a little bit easier. All right. Best resource for dementia planning, maybe under like fifty dollars. Yeah. Great question. So I think it's hard to to assign one resource is the resource that everyone needs when we think about dementia, because there is not a universal answer to that. Everyone's in a different spot. Everyone has a different interest in what's important to them. So I would say your best resource under fifty dollars is a conversation with a program like ours. where you can say, hey, this is where we are. This is what we're most concerned about. And then starting from that point. So I would say investing in a conversation, whether if there's a cost or no cost, but starting there, I think is the best resource. You said, I'll do you one better. Fifty dollars, not free. I love it. That's great. And I'll put I'll be sure to put a link to the resource page for you guys in the comments of the LinkedIn. So if anyone needs that, you'll be able to find it there. So my next one is, if you could give families one piece of advice right before they get that diagnosis, what would it be? I would say before a diagnosis, it's already time to start thinking about the way we communicate with one another. Communication is key. The disease process requires that we change how we communicate with our loved ones. So even before the official diagnosis, being mindful of how we're communicating and understanding that our loved one likely has more insight into what's going on than they might be able to express or even accept. There's this idea about acceptance. So even if they're not accepting the potential diagnosis, understanding that they're likely is far more insight and awareness than we might realize. Oh, I love that answer. That's great. I really do. So my next one is, it's a little bit of a silly one, but if social workers had a superpower, what would it be? Well, I'm sure my colleagues would say we have many, many superpowers. I would say for me, it's our endless curiosity. And some might say, well, that just sounds like you're nosy. And no, it's endless curiosity with a purpose. Because when someone calls and they have a question or we're working with the family and it feels like the family is saying, this is all I need. I just need you to tell me xyz in order to do that in a way that is helpful we need more information we need to be able to ask more questions that give us context to the family to the situation and that endless curiosity really does shape our ability to support families I love that that's great it's it's I do think that like I guess That means you're always like learning and like open to evolving as well, which I think is like a really important skill to have as a social worker is just like that adaptability. So actually before we started recording this, Natalie and I were talking about kind of how just even in like the last like forty to fifty years, the amount of resources that are now available to people and just that there's so much more going on in the field. So I guess what is the most overrated piece of caregiving advice since there is so much out there now? in your opinion? Yeah. So the most overrated advice given to caregivers, I would say is take care of yourself, but hear me out. I don't disagree, but to say to someone just, you need to take care of yourself or. Put on your oxygen mask before you put on someone else's. I agree with the intention behind that. But we can't just say that without giving context or having conversation around what does that mean and what does that practically look like? Because when you say take care of yourself. I might hear that I should just go on a big vacation and that's not available to everyone. And so highlighting, how do we take care of ourselves when we don't have the time or those resources? What does that even mean? So I do think that that's, yeah. Like, and also I think something that tends to happen often with caregivers because they're making so many choices and decisions every single day, there is like a lot of decision fatigue that probably goes along with it. So, I feel like probably the most helpful thing is to just kind of like even suggest things and like even tell someone like, or be like, hey, this, I got, I sent the class here and I'm going to come sit with your mom for that hour that you're going to go to this like yoga class. And like doing little things like that are better than just saying, hey, you should take some time for yourself. What they're already doing that is a form of self-care that may feel like a mundane. It's just me doing life, but highlighting that personal care or what we eat. And if we're getting a ten minute walk in sort of those things are things that we're doing to take care of ourselves. So highlighting what's already happening. Yeah. Little pockets of peace. I love it. That's great. So, Natalie, you've seen hundreds of families get a life changing diagnosis and Could you maybe walk us through a little bit of what typically happens in the forty eight hours and maybe what should be happening instead? Yeah, so I think what we often notice is that, you know, leading up to a diagnosis, what we need to sort of remember is that there have likely there has been years of signs and symptoms that have been showing up that have gradually been building. Over the course of those years, families have likely noticed maybe a change in executive functioning, maybe a change in personality and or some behaviors that we might call behaviors or just differences with their loved one. And so when they come to the point of the appointment, they've spent a couple of years sort of not knowing is this is our is our family member just adjusting to retirement or Is something else going on? Do they just not enjoy being around me or want to be my partner anymore? There are lots of questions that they've already gone through before we get to the diagnosis piece. So I think within the first forty eight hours, what we often will observe is either a freezing where the family might say no. while we just we heard this news and while we might feel a little bit of relief because it actually gives us answers for where we've been right what we've experienced it can feel really overwhelming and so some families might say we hear you and we we just don't even know where to start so we won't start anywhere and we'll just sort of take a moment whereas some families might quickly move into scouring the internet for information, knowledge, sort of moving into this very active stage where we're trying to make sense of, understand what's going on, know what our options are. So I think both extremes show up and there's a place for both. There is certainly a place within that first forty eight hours for families to say, we just need to sort of absorb what we've heard. And there is a place for families to maybe decide we want to know a little bit more. Because what typically the way some of our systems are designed is that doctors or providers may not have the opportunity during a visit, once a diagnosis is made, to really answer questions. Sometimes this is referred to as the diagnose and adios interaction. I love that there's a name for it. there's a system that doesn't really give the provider time to answer the question. But I would also argue that we don't always have the capacity to receive more information. We will also be more limited than we realize to absorb all of the answers to all of the questions that we have. So what I would hope would be true for families within that first is that they would have an organization or a group that they can connect with to say, okay, once we get home and we take a breath, this is who we can reach out to and say, hey, we were just told this. Can you help understand where we go from here? So just really quick question so that our audience knows as well. For the Duke Dementia Support Program, are you guys national or is it just local to the Triangle area? Yeah. So we work with families across North Carolina. So though we are at Duke, you do not have to have any affiliation with Duke Health to reach out to our program. And we also, due to the generosity of donors over the years, we're able to offer our services at no cost. So we certainly have families that we work with outside of North Carolina, but typically there's some link to North Carolina. So I might live in New Jersey, but my loved one is living in somewhere within North Carolina. And so that's, I would say North Carolina is definitely our wheelhouse while we can offer general support for those outside of the state. So if you're completely lost and have absolutely nowhere to go, you got this place. They will be there for you. Absolutely. That's awesome. So, you know, I think most people, Any healthcare worker, any person who's involved with the healthcare or medical system probably knows that social workers are the unsung heroes of the whole healthcare system. But our audience at home may not even begin to understand the half of it, honestly. So tell us a little bit more about your role and maybe even what would happen if social workers were to just entirely disappear from the medical system tomorrow. Yeah, so I would say my colleagues have various roles across the health system, which I think is what's really very cool about social work, because there are different ways that we can put our work into action. And so the first place someone may encounter a social worker is within the clinic, wherever their diagnostic clinic, wherever they went for that appointment, whether it be a primary care doctor, a neurologist, a geriatrician, whoever that might be, most clinics have a social worker that is assigned to their clinic. And the role of that social worker is typically to be that liaison to other outside resources. So we highlighted that providers don't always have the time to address some of the questions, the concerns. And so the social worker can come in and be a resource to families and say, this is where I think you should start next. They can also be a very practical hands-on support where let's say you need a document for your long-term care insurance or you have questions about in-home health care. They can certainly get those referrals, get some of that paperwork moving. Then there are social workers within our system who are also LCSWs who function as therapists, right? So they're seeing folks more on a regular basis in person or virtually, and not necessarily linking to resources, but working on coping and responding to some of the stress created by life, by caregiving, by whatever the situation might be. So working as therapists within the health system. And our program is a little bit of a silo. So we are a team of five social workers. And really what we're focusing on is providing education, support, and engagement for those that are living with changes in memory and thinking. A huge part of what we do is education and support. if that's facilitating support groups if that's offering one-on-one education and support we also have a supportive counseling program so when you ask the question what would happen if if social workers were eliminated from the health care system I think what would happen is we wouldn't have someone to fill in those gaps so you would have folks Walking around with, you know, maybe the medical diagnosis or the medical information, but not sure what to do next. Yeah. Where are the resources? What's the education? Who do I connect with? You know, what's my at home support? You know, someone living with dementia may be shocked to know that. You typically will see the neurologist maybe every six months, maybe once a year, depending on which health system you're in. And so that's not a lot of support for something that's showing up every day in your household. So I think without social workers, you wouldn't have that link to the community that you need. That's a great way of putting it. Just really fabulous communicators and people who are bridging the gap maybe between medicine and public health even. Just because the whole spreading of knowledge and making sure that everyone has the right resources and information is public health at its core. like I guess like community community health as a whole, like that's social workers or doctors for the community. I'm going to put it in my head, but I love it. So I guess, you know, you you work with successful families who are kind of navigating the world of dementia really, really well. So what makes some people like sort of navigate dementia gracefully? while others maybe more so fall apart and is there a way to kind of realize that that's happening and bring yourself back and kind of yeah I guess open-ended yeah yeah so I think I think what creates challenges or a unique challenge for folks. And what we often forget as part of the process is that we come to in this case, we're talking about dementia and its diagnosis. We come to the table of changes in memory and thinking with our family history and our relational history. So one of the key sort of stress factors that we observe or risk factors even for how a unit might navigate dementia is really where were we as a couple, as a family before this started? So if you have, maybe if there's been a fractured family system or a system where maybe the parents sort of have a practice of not sharing information with their adult children and viewing their adult children always and forever as fifteen year olds and not adults who can step in and help. I think that is where a lot of the challenge comes in. You know, there are also folks who are asked to provide care for, let's say, a parent who perhaps was not able to provide care for them when they were growing up and in their formative years. And so all of these factors really do have to be taken into consideration and more than considered, they have to be acknowledged. And I think asking whoever that primary care partner might be or appears to be, being able to check in with them and say, What is your expectation of yourself in this? You know, what not what do you think the outside world is telling you? But as you approach this journey as a caregiver, as a care partner, what is it that you expect of yourself? And so I think communication, communication, communication is is key. And I think one of the differences that we see for those who may navigate this journey more successfully, and we should probably define what that even means. Success doesn't mean mastery. It makes it really hard to master it, to get it right every time. We're going to say things that aren't helpful. We're going to respond in ways that we think, oh, we shouldn't. have done that. We're human, right? We've got to, how do we sort of forgive ourselves and move forward? Yeah, absolutely. I, I completely agree. And thank you for, for that clarification as well, because a lot of the times we can strive for perfection and that'll, that'll do more harm than good in the process. So that's really great practical advice. for sure so I guess for someone who's maybe starting to notice some early signs uh in their parents or something like that are there like a few or maybe even your top three things that you would uh tell them to investigate pretty immediately yeah so if you are noticing changes um in memory and thinking what I would encourage first is not to assume that it is that the changes that you're noticing are caused by something that is progressive. We know that when we think about the word dementia, dementia is an umbrella term, right? That makes up all the signs and symptoms that we're seeing that have us thinking that goodness, something is, changing, something is different here. Some of those signs and symptoms are showing up for reasons that can be treated. So when we choose not to go to a provider or choose not to have it investigated, we might actually be assuming that it's something that it's not. So I would say certainly consult with a primary care doc or a provider that your family member is willing to sort of ask the questions because there might be something that we can do to sort of treat that in a way that's not related to Alzheimer's disease or vascular disease. In the same token, if the cause for dementia is related to Alzheimer's disease, vascular dementia, et cetera, one of the many other sort of more chronic progressive causes, there may also be a benefit to that early detection. There might also be some sort of treatments that we can involve when folks are in the very early stages. So keeping that in mind as well. Yeah. No, sorry. I think that's really great just because sometimes as humans, we can be afraid of getting the answer, but nine times out of ten, having the answer makes it easier than, you know, not having that, just wondering and guessing and kind of having that anxiety like continuously. in the back of your head. But yeah, sorry to cut you off there. No, no, no, absolutely. And I think it's understandable why sometimes that's not necessarily a call that we want to make and we want to just see if it'll go away sometimes too. And that's understandable, but keeping in mind those signs and symptoms show up for a variety of reasons and it's worth investigating. Absolutely. So that would be my top, my top thing. My second top thing is always around planning. So if that is, you know, considering, you know, getting some documentation in order of power of attorney, sort of maximizing those decisions that can be made early that in the long run really will help everyone. It will help me honor my loved one's wishes if I have the tools in place to do so. And that would be important to get those things moving too. Absolutely. Those are all very practical pieces of advice that we could honestly apply this weekend if we wanted to. Conversations that we can have before even there is room for concern, I guess. So yeah. But I think that something else that's different and constantly changing every single day is the technology aspect of healthcare now that we see technology everywhere in healthcare. So I guess, are there any innovations that are actually helping dementia families versus things that are just, you know, shiny marketing, but don't necessarily have much benefit? Yeah, in your opinion? Yes, I think there certainly are some tools that folks can use. One, I think the increasingly popular and common use of electronic medical records is quite helpful. Everything that we'll discuss, there's a pro and con, right, to each item. Absolutely. with the electronic medical record where that can be helpful is as folks might be needing to connect with a provider on behalf of their family member, they can do so in a way that really in advance of an appointment through the electronic medical record to avoid them having to have some awkward and strained interactions one-on-one once they're in that room. So I can send my partner, my parent's provider a note and say, hey, we're just noticing this. Maybe we could talk about this at the appointment versus having to say that in front of them in a way that might create agitation, anxiety, you know, tension, all of those things. So I think there's a benefit to that piece of technology. Absolutely. I think also we see this may seem really simple, but I think when we're thinking about caregivers across locations, being able to have a family calendar system that we have tools now where we can merge our family calendars so that sister in Utah has the same information that I have about upcoming appointments for our parents and that we can even assign tasks. those things are really helpful because then it takes the texting out of it. It takes me feeling like I've got to call and make an ask when we have this shared calendar that we can use. I had not even thought of that, but that is such a good idea. There's like, I didn't even think of that. Like a calendar would be beneficial to like a caregiving schedule, especially when there is long distance caregiving going on. Yeah. I just, I guess I only think of the calendar and like a work setting, but wow, that's, that's like shared Google calendar, especially where like, it's like, all right, mom's got an appointment on this day. Dad's got an appointment on this day. Who's, who's got the most flexibility to be able to help out there. Wow, I love that. That's a really good one. Sorry, I didn't mean to cut you off. Are there any other ones you're excited to share? I think there are several. I think we have pill dispensers that can help as well as though this, again, I would say we could talk through this a little bit more. Some folks are using cameras in their loved one's home to help prolong independence. And we can talk about privacy and issues of all of that. I think those are things to consider. But there are tools that allow folks to be independent longer while having some support, while having some safety net. I also think about I was in a support group yesterday and there was a lot of conversation around Trulink, I believe it's called. Yeah, TruLink, it's a card that essentially that folks can manage. We know that the population we work with is often incredibly vulnerable to scams. And so having TruLink is a way that families can help their loved one manage their finances While still helping them be independent, while still they still have a card, they can go to the grocery store, they can go out to lunch with friends. But there again is that safety net. So I think those are some of the I would put that in sort of a technology category because it can be managed from an app, from a phone, I mean, from a computer device. You said it's called TrueLink? TrueLink, yes. I've not heard of that. That's pretty cool. That's really, really great. And any bank, you can like connect any bank account to it? There's a monthly fee. I think right now, I think it's twelve ninety five perhaps per month. So we were identifying that that can feel a little steep in some cases, but it allows you to, you know, put money on the card quickly. So it allows you to see every purchase that was made. So things like that, that again, I say I can help you. I can support you. I don't have to take over right away because that might be one of the myths is that with the diagnosis of dementia, regardless of the cause, what that means is I immediately need to step in and take over every area. And that's not true. You know, I think. Culturally, maybe through media and when we think about Alzheimer's disease or Lewy body dementia, we might think about the more progressed state of that. What we often miss, and I will certainly acknowledge, I think we've done better at acknowledging this, but it's the beginning stages where there is still autonomy available to our loved one. And we want to honor that and balance that with safety. And so technology, like we've mentioned, makes that possible. That's such a good point. The other day, maybe last week, I was speaking to a family who had just gotten an Alzheimer's diagnosis and like maybe like three days ago. And they were like, yeah, like the father lived alone. So they were like, we would like put into place immediately. And I was like, I don't know how that's going to go over. That seems like a really big step, especially given that three days ago, he was living completely by himself. And between three days ago and now, the only thing that's changed is you have the name of a diagnosis. It's not like his disease actually progressed. His brain changed that significantly in those three days. I was like why don't we start with three four hours a day and kind of see how that goes and then see see what what dad thinks about it because because they're already concerned that like he wasn't gonna have want to have any caregivers in the home and I was like I really I really don't think the twenty four seven is gonna go over well I think it was care further down the line when it's super super needed to be kind of like absolutely not like I don't want that in here So, yeah, I really do think and also remembering that your loved one is still a part of the conversation. You know, you don't need to make these decisions without them. And actually, it's probably a really lovely thought to probably involve them in in any conversation to any capacity that you are able to. I think the point that you just made of to the extent that you're able, you know, I think we want to include folks in conversations while being flexible, that the way we do that might also have to change. And that... will be changing. So how we engage them in decision-making and conversation today, you know, six months, XYZ months down the road, the disease might require that we change how we do that. It doesn't mean we have to abandon it completely, but that we might change what that conversation looks like. And more importantly, what our expectation is of that conversation and their ability to understand all of the moving parts. Because again, the real sort of villain here is the disease process, right? That's the real villain. It's not our loved one. It's not me. It's what the disease is requiring of us. Yep. That should have been the title of this podcast, honestly. The real villain. Who is the real villain? I love it. That just means that we have to do another recording, Natalie. There you go. Put it on the calendar. There you go. You know, you're at Duke, and we all know that Duke is at the cutting edge of all research, but particularly dementia and Alzheimer's research as well. So I guess while we're on the topic of technology, I guess we were on the topic of technology, but then we kind of left. But now that we're back on the topic of technology, are there any breakthroughs that you're kind of pretty excited about for the future of care, whether it's, I guess, clinical or not? Yeah. So I think absolutely. I think one of the big changes that we've seen in the past couple of years, maybe the past year and a half, two years, has been new tools to help us with an earlier diagnosis. And that may seem sort of, well, it's still the diagnosis. You know, we want curative tools. you know, inventions or creations. Absolutely. I agree with that. But again, there's a benefit to an accurate early diagnosis. So we think about the use of lumbar punctures or spinal taps, as some might know them, in diagnosing folks with Alzheimer's disease more appropriately. because I think for a while um for probably decades there has been the belief or the feeling that alzheimer's disease was kind of that catch-all um that if we couldn't quite pinpoint it we would call it alzheimer's and then upon death we could confirm it with an autopsy right so that's sort of been the message for a while but recently um knowing that we have tools where we can more accurately diagnose and say yes we see the proteins that are showing up that let us know this is alzheimer's disease same thing with lewy body disease or lewy dementia I'm using the skin test um Yes. The skin test helps us detect the alpha-synuclein, which is the protein that shows up with Lewy body disease or Lewy body dementia. And again, that's important because we want to know if it's Lewy body or Alzheimer's disease, sort of how we move forward, normally speaking. likely will be differently. Now in the day-to-day, there is some crossover, like some challenges that care partners might encounter. There's certainly some similarities and there are also some really big differences. So being able to more appropriately support the care partner and the patient when we know what the cause is, like what is actually going on. And then, yeah, and then The new, you know, we've had Lekembe, Kizunla. These are pharmacological interventions that can be used for folks who have early stage, very early stage Alzheimer's disease. And while we're still learning a lot about that, I think what I've seen in the use of those pharmacological tools is hope. I think it has given families hope that maybe maybe we're moving towards a more sort of permanent solution here. We don't, and we have no, the big question mark there, right? But I think giving families hope is important. I really do think hope is the greatest gift that you can give someone. And that's really, really beautiful because, you know, before I got into this work, I didn't really know much about early onset. I didn't realize that early onset means early onset. Like there's, I've seen cases as early as like late forties come to us like asking, and it's just like, wow, I didn't, well, I'm going to get emotional. I didn't even know that that was like a possibility. I didn't even know that that, so there's, I do think that it's, it's important for people to kind of, first of all, know that that is something that can happen and really wonderful to know that there's hope and that there are innovations being done. And there's, there's hundreds, if not thousands of scientists, like hard, hard at work, doing everything that they can to kind of help us navigate this whole, I guess, like, realm in an easier and better way. Yeah, I just looked at the time. And oh, my goodness, there's about a million questions that I still want to ask you. So I'm going to have to narrow them down. Goodness, what am I going to ask? All right, all right. I got to ask this one. I've been wanting to ask it the whole time. So I guess if you could redesign the American healthcare systems approach to dementia care from scratch, what would be the first thing that you would change? I think the first thing I would change would be outside of our traditional disciplines that work with folks living with memory change. So beyond geriatricians, neurologists, some primary care docs, but the larger health system as a whole would have more complete training. around and skill building around working with patients who are living with memory and thinking changes. And I think, you know, a lot, unfortunately, a lot of the folks we work with spend a good amount of time in emergency departments for various reasons. And so, you know, what does it look like for the team in the emergency department? Because, boy, we're asking a lot of them, right? But what does it look like for them to have the training that they need to be successful in that setting. So that would just be sort of a large system dream that I would have. And then I think the other piece is more interdisciplinary. collaboration so at the table and this would be viewed as the norm not the exception but at the table you have um the medical provider for all um sort of specialties that this patient needs right like we're bringing pulmonology we're bringing cardiology whomever needs to be at the table is there because we're looking not just at our body part our organ our part of the the brain the body we're looking at them as a complete person So they're around the table with the pharmacists, with the social workers, sort of the therapist, the PT, OT, speech therapy. So everyone is sitting together considering, okay, what is the best next step for this person? And I recognize in saying that, that's a lot of moving parts, but you told me I could dream. So that would sort of... There you go, your magic wand. And I do think that the... so much more like accessible and possible these days with technology and with like, I mean, ideally these would be done like synchronously, but like it's, it's really possible to get this done even asynchronously as well. Like there's, you could have these conversations in like chat rooms and kind of really be able to like move things forward faster maybe, and even come up with more personalized and more catered. care plans, which is the first thing that we could potentially ask for. So I do want to say I see an effort moving towards that. It just takes time, right? So I will say I see an awareness and an acknowledgement that, yes, this is a good thing. It would be helpful just getting all of the moving parts organized. Yeah. I think we're on the right path too for that, absolutely. And again, with the right tools, it's becoming more and more within reach each and every day. But this one I just want to know for like kind of entertainment purposes. I don't know what your answer is going to be, but I'm excited. So is there anything that comes to mind, but what's the most creative solution you've seen a family come up with when it comes to managing dementia care? Well, I believe care partners, caregivers are the most creative and resourceful folks out there. So we've had the privilege to witness a lot of creativity. I think, I don't know that this will be as entertaining as you hoped, but I definitely, I think even just watching siblings coordinate their schedules and taking each one take a day and viewing it as... Nope, Tuesday's my day. And then when sibling B tries to jump in on your day, like jokingly and playfully, it's like, no, no, that's my day. Don't touch my Tuesday. But just being creative to say it doesn't have to be one of us all the time. I think sometimes we feel like it has to be one of us all the time. So I think that's been a creative tool. I think also creativity in how folks introduce third party care and support, like the the storylines that they will come up with. to introduce something that really aligns with their loved one's values and what's important to them. It is, you know, if I say to my loved one, hey, we should, you're going to go to an adult day program three days a week. It's what you need. Oftentimes the answer is like, no, no, I don't need that. I don't want that. If we can position that with something that is important to them, that connects with them, they're more inclined to say yes. And so I think seeing families figure out, all right, what is my mom's value? What matters to her? What's important to her? And so I think about one a family we worked with whose loved one happened to be going to adult day. And she was told it was her job because she was had a high work ethic. Oh my God. And so she went to her job and then one day said to her daughter, I've been here a while and they have not paid me. Like she was able to connect that if I'm working, I need some money, girl. And so the daughter said, you're exactly right. Let me look into that. And so the next day I think she gave them twenty dollars or something. Hey, will you pay mom today? And it was the other one I think about is there was a family member who said, did a lot of her career was actually in linen services okay and so she worked a lot with an iron and with folding and um and she needed some help with some activities and so the family got an iron that was an actual iron they cut the cord so that it couldn't be plugged in and would never be an issue and gave her stacks of washcloths and said, it would really help me if you could iron and fold these. I need some help. She would do that for hours. And it was a familiar task. gave her a sense of purpose and it gave them sort of a little bit of a reprieve as well. And so something like that, that is very personalized, not going to work for everyone, but it worked for her. I think that that is what you said right there. Give them a sense of purpose because a lot of the times, you know, families get a diagnosis and you're like, oh my gosh, I need to keep my loved ones safe. I need to make sure that, you know, I'm going to wrap them in bubble wrap. I'm going to, um, you know, keep them at home. I'm going to make sure that nothing bad's going to happen to them. And a lot of the times that can do a little bit more harm than good, you know, um, to kind of just like disconnect from the rest of the world that quickly. But I think as humans inherently, we just want to help and we just want to be helpful. So a lot of the times when, you know, like through Kariaya, when families come to us and they're like, yeah, mom or dad is like really hesitant to getting this care and doesn't really want, like, it's just like saying they don't want like a babysitter and like things like that. And I'm like, well, have you told them that this is actually like a mutually beneficial relationship where they're allowing a future doctor or nurse, like get the hours that they need in order to apply for medical school? Like this is a mentorship program, if anything, where the students are learning how to care for someone from your parents. And then she was like, wow, like I hadn't framed it like that. The older adults love it. Absolutely love it. Because at the end of the day, knowing that you're helping someone reach their goals and dreams or like doing something like folding your or matching your granddaughter socks with one is like, oh, I did something that helped someone else today. And what more can you ask for? You know, like I feel like and it's really, really beautiful. But we're getting we're cutting it down to the wire here. I know there's a couple of questions from the audience. I definitely want to get to. Oh, thank you. Someone put in the Duke Family Support Program link in the comments for us. But we have a question from a future social worker, actually, that says, you are doing amazing work, Natalie. What's something your MSW program didn't fully prepare you for that you learned through hands-on experience in your current role? Oh, I like that question. That's a great, great question. I would say, so my program offered a class on working with older adults and one class and one week we had a speaker come in and talk about dementia, sort of a sixty or seventy minute opportunity. So I think a lot of what I have learned about working with families about the disease process itself and what the strategies are that are helpful in responding to what the disease requires has come from my job what my school what my program gave me were certainly um familiarity with modalities that I can use in my one-on-one work with family that we're thinking about, you know, strengths-based approaches or using the ACT modality in helping folks figure out what their values are and what it looks like to live according to their values. Those are really helpful. And I use them regularly, but the actual disease process and what is beneficial sort of hands-on for caregivers came from doing the work. Wow, that's really cool. And I mean, I guess that is to be expected. But that shocks me to my core that there's only one class still. I think that that's actually the case for even medical school, where I think the rotation for a geriatrics program is one week, and it's not required at most universities. That's right. What do you mean? People don't even know that this is an option. Me, for example, a former pre-med student, not even once had it crossed my mind that I could go into this field. But now I'm like, if I were to go to medical school, I couldn't imagine doing anything but that. So there's so many people that are probably in the same boat, but there's just not enough information and education out there. So. Well, and I think, I mean, even in that one class, it regularly, because now I present to that class annually, there may be five or six students in it, and it is an interdisciplinary class. So you have folks from the Department of, or from the School of Public Health, and we still only have five or six. So I wave the flag, too, that we need more folks working with this population. I know. That's one of my goals with this podcast, is to get the word out there that Old people are so cool and people should want to hang out with them and everyone wants to hang out with them. We kind of covered this a little bit, but I want to thank you for being on and sharing your insights. Has there been something a caregiver has shared with you, tip, advice, hack that you now share with others? We kind of talked about the whole like sense of purpose, helpfulness thing, but is there something else that comes to mind regarding this topic? I think in general, it is being able to normalize through my conversation with caregiver A and hearing what they're going through, and then I have a conversation with caregiver B, completely separate, without disclosing any information to be able to say, What you're experiencing is genuinely normal, not in a therapeutic, maybe empty feeling of what it's so normal what you're feeling. But no, legitimately, I just had a conversation with someone about this exact topic. You are not alone in that. And I think. you can feel so isolated that you don't imagine that anyone else's situation is like this and you must be doing it wrong and the whole mastery idea. So I think being able to normalize it for folks is invaluable. And so that's something that, again, without disclosing, you can do for folks. You can say legitimately, you're not alone in this. Oh, I love that. And I think that that is something that that's why support groups like yours are just so, so important as well, because there, you are not alone in this and there's so many other people as well. And even the craziest thing that might seem like this, why, I don't know what just happened is still probably normal. And someone else has experienced that too. But I do, I do want to be mindful of your time. So I, Just going to leave us with this last question because you have given us some wonderful insights, Natalie. What's the one thing that you want every listener to remember when they leave this conversation? I would say dementia is hard, but there are strategies and tools that can make it better and make it easier. And I don't mean curative better, but I mean the day-to-day life that we have with our loved one who's having changes in memory and thinking. there are tools and strategies that we can use to make that more enjoyable for both of us. So it's hard, but there are ways where it doesn't have to be as hard. Yeah, I love that. That's very practical advice. And I'm going to actually edit the post and kind of put that in at the end of it so that anyone who is scrolling by is able to see it. But thank you so much for spending this morning with me. I've had a wonderful time and I just wish I could give you a hug right now. But thank you for all the work that you do and the amazing thoughtfulness that you put into every single one of the answers. And thank you to our audience for listening as always. I hope you have a great rest of your day and a wonderful start to the weekend. Thanks so much. Bye, Natalie. Take care. You too.