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One of the toughest questions to answer when you’re helping a loved one with dementia is this:

“Who can help me when their behavior becomes an issue?”

Since most caregivers are doing this for the first time, you’re not aware of how much help is out there.

In this episode, I’m joined by Kristin Marsh so she can share her secrets for getting the best help for your loved ones and to help them (and you) stay mentally healthy while we’re social distancing.

Here Are The Show Highlights:

  • The single best place to send your parents dealing with mental health issues (1:41)
  • How you could be accidentally heightening anxiety in your loved ones with mental health problems (4:02)
  • What to do when the nursing home isn’t giving your loved one the care they need (10:35)
  • Doing this too late will sacrifice your loved ones quality of life (11:09)
  • 5 mental health tips for dealing with the chaos of the current crisis (13:46)
  • The best way for seniors to not feel isolated during the quarantine (14:32)

If you’re in Tarrant county and would like to meet with Kristin, send her an email at kristin.marsh2@hcahealthcare.com.

For daily 5-minute mind exercises, head over and like my Facebook page: https://www.facebook.com/hcafortworth/

You can also find additional support and resources by calling Home Care Assistance at 817-349-7599 or visit our websites https://www.homecareassistancefortworth.com/ and https://itsmyturntocare.com/.

Read Full Transcript

Welcome to It’s my turn to care, we know the challenges you face caring for someone with dementia. That's why each week we bring you tips, strategies, and most of all, support as you navigate your role as caregiver. Let's get started [00:15.6]

Dave: Welcome to, It’s my turn to care: Secrets for the Dementia Caregiver. My name is Dave Parks and I'm the owner of Home Care Assistance and we have this podcast so we can bring you tips, secrets and strategies to help you deal with that dreaded disease, dementia. So we are here today with, we have a special guest, of course all my guests are special, but Kristen Marsh, she's the Director of Physician & Provider Relations at Medical City North Hills- Legacy Care Unit and we met not too long ago and I think that she's got a lot of good things that she can tell us about for as it relates to mental health for those that are 55 and over, they refer to those as geriatrics, which that made me a little bit depressed when I found that out, but anyway…so Kristen, welcome to the program. [01:15.4]

Kristen: Thank you Dave. I'm happy to be here.

Dave: Great! So tell us a little bit about yourself and what Medical City North Hills does in that unit.

Kristen: So I have lived in Tarrant County and Colleyville for over 15 years. So I'm really involved in the community in all ways with all ages. So taking the role at Medical City, was really a dream for me. So I am able now to really help the seniors in our community. So we're a full service hospital and we also have a floor that's dedicated for mental health only for the geriatric population, as you said, 55 and over. And what makes that unique is the unit itself is very calm. It's beautiful, really. I always say to everybody, if my parents needed this level of care.

Dave: Hmm…hmm.

Kristen: To be somewhere inpatient to receive mental health treatment, this is where I would send my parents.

Dave: Hmm…hmm.

Kristen: It's a beautiful facility and again, just focuses on one age demographic. So they really, you know, they're amongst their peers and it's a very calm environment. [02:16.8]

Dave: Hmm…hmm….Okay, very good. So, and it's right there in North Richmond Hills.

Kristen: Yes.

Dave: Right.Okay.

Kristen: Hmm…hmm.

Dave: Very good. It's good to know that up in this area because I actually didn't know that y'all had that unit, so it's good to have that as a resource.

Kristen: Yes.

Dave: So tell us a little bit about some of the doctors and the other members of your team. [02:37.7]

Kristen: Okay, sure. Yeah, we have a wonderful team medical city, North Hills. So we're led by Mark Deno, who's our CEO, I mean he's been with HCA. So HCA - Hospital Corporation of America owns Medical City. So he has been a valued leader at HCA for a long time, so we're really lucky to have him and he believes strongly in mental health. So he provides lots of support for us. We're actually, I'm looking into Outpatient Services as well, again, for the senior community, but so that they can come in and out, whether they're in assisted living, still at home, nursing home, whatever level of care they're receiving, they could come to the hospital, you know, three times a week on an outpatient basis.

Dave: Hmm…hmm. Okay.

Kristen: So he believes in mental health strongly, and so we're happy to have him. [03:23.3]

Dave: So what makes y’all different? I know there's some choice in this area, not a lot of choice. So what makes you different than from some of the other hospital, the mental hospitals?

Kristen: Well, we're also like, we have a brand new medical director, so our medical director is Dr. Manu Mathews and he is local as well. So he has a private practice in South Lake and he's part of the community and he really cares like you and I very involved, so we're very fortunate to have him. But the other thing is just the fact that we only do geriatric care. So some of the other facilities, I think you're going to get a good level of medical care but the environment is very different. In my opinion it can be intimidating. Some of these facilities are so large and they serve so many different people with different needs that you can feel overwhelmed.

Dave: Hmm…hmmm.

Kristen: And if you're already in a fragile state of mind, I think that can heighten your anxiety.

Dave: Hmm…hmm.

Kristen: So I think we're really special that we focus just on the geriatric population. [04:23.1]

Dave: So for those that are taking care of either their mother or father or spouse and they sense there might be something that's not “normal.” What are some of the types of things that y'all handle in thinking more about the geriatric unit itself?

Kristen: Yes. So that's a great question. So when I first came on board to medical city, I was on the floor day after day, just observing what do our patients look like, what is their level of care look like? How are we helping? And one of the things that I noticed is the families, they're a big part of treatment. And because we're a security unit, you know, families can't just come in and visit anytime that they want. There are certain visiting hours, there's rules. So what I started to do was provide not support groups, but actual education classes for the families because they really need to be involved in the treatment. This isn't like they're going to come into the hospital and there's a cure, right? There's a diagnosis and a cure. This is going to be ongoing treatment. So what I've done is I've partnered with the Alzheimer's association.

Dave: Hmm…hmm.

Kristen: And we've come up with a class once a month for families and what it is, is understanding the behaviors that are associated with dementia. [05:40.3]

Dave: Okay.

Kristen: So when you're with your parents every day, it's going to take you a long time to realize you need this level of care. You know, Oh mom or dad, they're getting a little bit grumpy. You know, they're, they're in a bad mood, they're angry. And a lot of times you don't seek help until it's that 911 call.

Dave: Hmm…hmm.

Kristen: Until there, it's becoming aggressive in nature.

Dave: Hmm…hmm.

Kristen: A danger to themselves or others. So a lot of times we're actually the first stop of care. This hasn't been a mild progression. [06:10.6]

Dave: So its typically someone already been diagnosed at that point or just.

Kristen: It can be dementia is often an underlying issue.

Dave: Okay. Okay.

Kristen: So we don't treat dementia per se.

Dave: Right.

Kristen: But we are for the behaviors.

Dave: You treat the behavior side. Got it, okay.

Kristen: Yes. Just because of our demographic. You know, a lot of the people on our unit, do you have that? Some don't, but some do have that underlying, but it's the actual behaviors that can stem from that. [06:33.8]

Dave: So what gives, give, give our listeners kind of an idea, I'm assuming it's things like aggressive behavior or withdrawn behavior.

Kristen: Yea.

Dave: Or their habits have changed significantly.

Kristen: Hmm..hmm.

Dave: Things of that nature. So give them a little bit of color around the types of things they should be looking for. [06:53.6]

Kristen: So when we actually have an intake department.

Dave: Hmm…hmm.

Kristen: You can call it's 24 hours a day and I'll give you that information to give to everybody afterwards.

Dave: Hmm…hmm..okay.

Kristen: So it's an 800 number and if you have somebody who needs that level of care, whether it's somebody that you're caring for or it is a loved one, you'll call this number and speak to a clinician. So you will talk to a medical professional who will go through the criteria for admission. What they're looking for to receive this level of care is the easiest way I can describe it is a danger to themselves or others.

Dave: Hmm…hmmm..Sure.

Kristen: And that can manifest in a lot of different ways. And it can be significant changes in behavior, like you said, like not caring for themselves, not showering, not eating, not getting out of bed.

Dave: Hmm…hmm, hmm…hmm.

Kristen: A danger to themselves. And it can also be aggression, hurting themselves or others. And we see that a lot in nursing home environments and, but even at home they can sometimes get by, you know.

Dave: Sure.

Kristen: I hesitate to say violent, but they can, [07:55.5]

Dave: Sure. Yeah. So give folks an idea, they do the intake and then they're admitted and I'm assuming that it's covered by the traditional insurances and Medicare and all that kind of thing. [08:07.6]

Kristen: Yes. So we're a full service hospital.

Dave: Okay.

Kristen: So we do take insurance, but we also, one of the things that makes us unique compared to anybody else in the County is we do take Medicaid.

Dave: Okay.

Kristen: And Medicaid pending.

Dave: Okay, okay good to know.

Kristen: And I get that question all the time.

Dave: Okay.

Kristen: So we get Medicaid, Medicaid pending Medicare of course, but we also, because we're a full service hospital, we can take the more acute patients. So the other question I get a lot is do we take dialysis? And the answer is yes. [08:33.7]

Dave: Okay. So what's the typical, and that's kind of a dangerous question I realize, but maybe average is a better way to say it, but if someone is caused at the intake, they come in, I'm sure you'll do some sort of an assessment.

Kristen: Hmm…hmm.

Dave: And then treatment starts. So what's a kind of the typical treatment plan that may not be fair but kind of an average? What should someone expect? [08:56.0]

Kristen: So you know, again, I'm not a medical professional, but that is exactly how they're admitted. So first they need to have a medical clearance. So if they already have their clinicals done within, I think it's three days, I think it's within three days, you know, blood work and things like that, they're medically cleared to come on our floor. Then there is the behavioral assessment that they need that level of care. And from there they'll come onto our floor and it is an individualized plan for each patient. So they may already be on medication.

Dave: Hmm…hmmm.

Kristen: So it could be medication management. And we have wonderful social workers, therapists, they do group activities. And the average stay for a patient with us is 10 to 14 days. [09:35.1]

Dave: Okay. So once you kind of get them under to where the, you've treated the behavior.

Kristen: Hmm…hmm.

Dave: You've got them on the right meds, and you've given them coping ways to cope with their stress and things of that nature. And you've probably coached the family on how to interact with them maybe a little differently than they were before.

Kristen: Hmm…hmm.

Dave: What happens to them? It's time for them to be discharged. So I guess I'm looking for kind of the role of the social worker. [10:01.0]

Kristen: So, well this is actually another role that I have really immersed myself in is I want to be sure that we are part of a full circle of care and a lot of the patients that we see, unfortunately, we'll see them again. So we get to know the patients and the people in our community. And so I can give you an example. We have a, a wonderful nursing home that we deal with often and they have a patient that they sent to us and they've sent to us again and they realize that they cannot provide the level of care that this patient needs. So this is something that I'm really passionate about. I work with our social workers and I go out into the community and I visit all the nursing homes. I get to know the leadership, the staff, and that way I can again recommend where they should go to receive a higher level of mental health care. So I am very proud to say that I know a lot of people in the community, that's how I met you.

Dave: Hmm…hmm. Sure

Kristen: And I'd really like to meet more people.

Dave: Sure.

Kristen: So I can give the families more options. [11:09.6]

Dave: Yeah, a lot of it's education, right?

Kristen: Hmm…hmm.

Dave: Because we had a client the other day that we referred to you.

Kristen: Hmm…hmm.

Dave: And we gave him your information and Tammy's information and they didn't realize that that was really available to them.

Kristen: Hmm...hmm.

Dave: Like they just thought that they had to kind of suffer through the behaviors that they were experiencing. And so, I mean, we deal with that all the time and we're not medical.

Kristen: Hmm…hmm.

Dave: But we kind of have an idea when frankly it's above what home care can do for them and they really need to seek a medical intervention of some sorts. So [11:38.5]

Kristen: That's a great word. It is like an intervention because it really, everything else stops. And then it's just about you and your mental health. And that's all you're going to do. You're in an inpatient unit and we're going to work on you 24 hours a day.

Dave: Hmm…hmm.

Kristen: So it's not, you know, just little glimpses of help. I mean, it's focused on you.

Dave: Hmm…hmm.

Kristen: So yeah, that's a really good way to think about it.

Dave: So y'all have done some neat things with the COVID-19 crisis.

Kristen: Yes.

Dave: That’s going on, so why don't you talk a little bit about that? [12:09.1]

Kristen: Sure. As a marketing person, my role in this changing day by day with the crisis that’s going on. And like you, I'm trying to figure out a way that I can still stay connected with everybody in the community.

Dave: Hmm…hmm.

Kristen: And so I try to think about what are the, some of the things that I'm personally looking for. And then I vet it out to a very trusted group.

Dave: Hmm…hmm.

Kristen: And if it passes that test, I go forward with it. So one of the first things that I did was I came up with just a simple checklist to stay mentally healthy through the COVID-19 crisis.

Dave: Hmm…hmm.

Kristen: So I think it's something that it's easy and you can just read it every single day. I mean, it's kind of a self-affirmation with the first one being no, that this will end.

Dave: Sure, yeah.

Kristen: So say it out loud, [12:51.7]

Dave: There is something we all need to kind of remind ourselves.

Kristen: Hmm…hmm.

Dave: Because you can get caught up in the chaos of the CNN and Fox news and all that.

Kristen: Yup.

Dave: That kind of thing. [13:07.6]

Kristen: And that goes to number two.

Dave: Yeah.

Kristen: So number one is to know that this will end, and number two is to set a limit for news exposure.

Dave: Hmm…hmm.

Kristen: You know, a lot of us, because we're home, we'll just turn on the news and it just runs.

Dave: Right. Hmm…hmmm.

Kristen: 24 hours a day and you don't really think about it, but it's heightening your anxiety.

Dave: Hmm…hmm.

Kristen: So you really should get a schedule together, check in with the news. You know, you need to say updated to be sure that you're doing everything you can to stay safe. But I think a good plan would be maybe three times a day for up to 30 minutes of time. [13:32.1]

Dave: Sure. So once you run through some of the highlights of.

Kristen: Sure.

Dave: And then we'll talk about how folks can get this from you. So, [13:45.6]

Kristen: Okay, sure. So the first one, knowing that it will end, it's just something you can say every morning to yourself. Set a limit for news exposure. Third is to keep your daily routine, so make sure that that includes your hygiene, your exercise, your eating. A lot of people, they could be doing things in excess right now…they're eating more, they're drinking more. So just make sure that your daily routine stays the same. Incorporate regular exercise and something now that we have a little bit more time is you could really start doing some mental exercises.

Dave: Hmm…hmm.

Kristen: There's so many wonderful apps out there that you could incorporate. There's these meditation videos, they're wonderful. I mean you can start incorporating that into your day, just taking a minute to make sure that you're mentally exercising and books, puzzles, that type of thing. Oh, this is a good one, especially for the senior population to make their social distancing manageable. So I thought, this might be a good one, just for everybody to makes sure they have a check-in buddy. [14:35.8]

Dave: Hmm…hmm.

Kristen: So have a scheduled time each day that you were going to communicate with somebody, whether it's texting or phone call or FaceTime, just to check in.

Dave: Hmm…hmm.

Kristen: A lot of times if you are helping somebody else, you feel better about yourself too.

Dave: Hmm…hmm.

Kristen: Let's see, think about today. So this is another one too. A lot of people right now I think are thinking about the past, how much fun it used to be to go get coffee.

Dave: Right…right.

Kristen: Things like that. Or they're thinking about their future, but they're not thinking about today.

Dave: Sure.

Kristen: So just be really present. Take a minute to go outside, look outside and then just really enjoy your day.

Dave: I like that one.

Kristen: And then the last true tip is to really to rely on the experts to make the difficult health related decisions. You'll lot of times you listen to so much information and you try to come up with a plan for yourself, but it's good to stay educated. But you really should rely on, on leadership in your medical community to let you know when it's safe to go back out. [15:32.4]

Dave: Absolutely. I completely agree with that. Unfortunately, I think a lot of people think they're essential here in Colleyville because.

Kristen: Hmmm..hmm.Yes.

Dave: It does its thing that different than a normal times.

Kristen: Yeah.

Dave: But I do want to make a plug for when you talk about keeping your mind active. I'm actually doing a daily mind exercise on my Facebook page.

Kristen: Awesome.

Dave: HCA Fort Worth. I have ever since the official Tarrant County shelter in place, I do like a five minute mind exercises. So if anybody wants to check that out, there's 15 different, I do three activities a day. And so anyway.

Kristen: I'd like to say something about that.

Dave: Sure.

Kristen: So I've tuned in.

Dave: Oh okay.

Kristen: And I will say it is not an exercise. It is a workout. My brain hurt

Dave: Some of them are pretty tough.

Kristen: My brain hurt.

Dave: Yeah.

Kristen: But with the help of my family, we were able to answer the questions.

Dave: Oh good, good, good, good.

Kristen: So it was fun. We, we, the whole family did it.

Dave: Oh okay.

Kristen: So it was a lot of fun. [16:29.0]

Dave: Well good, good, good. So last week I did a one in the only submitted correct answer happened to be from my son who's a PhD student.

Kristen: I am not surprised. They're pretty tough. Yes.

Dave: So well Kristen, thanks so much for all the good information and particularly those tips.

Kristen: Hmm…hmm.

Dave: And if somebody wanted to get a copy of these tips or to get in touch with you or to find out more about what y'all have to offer, how would they do that? [16:54.8]

Kristen: So you can email me anytime. So it's kristen.marsh2@hcahealthcare.com and I'd love to come out, especially to the people that are listening that are in our medical community in Taron County. So if you have an assistant living, if your home care, nursing homes, anything that I could help our families.

Dave: Hmm…hmm.

Kristen: Provide them an option when we're discharging. I would love to meet with you. [17:29.6]

Dave: Great, great. Well thanks so much, we'd like to have you back on.

Kristen: Yes.

Dave: Maybe down the road. And that's Kristen.Marsh the number 2

Kristen: Right.

Dave: @hcahealthcare.com.

Kristen: Hmm…hmm.

Dave: And thanks so much.

Kristen: Thank you.

Dave: Being on It’s my turn to care: Secrets for the Dementia Caregiver and this is your host Dave Parks with Home Care Assistance and we look forward to another show next week. Thanks so much. Have a great day.

Kristen: Thank you.

Home care assistance knows the effort you already put into caring for a loved one and we would be honored to help you on your journey. Please visit our website@ HomeCare AssistanceFortworth.com and to sign up for our free caregiver survival guide today. [18:04.8]

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