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: Hello, this is Dave Parks and I'm the owner of Home Care Assistance, and I'm a certified senior advisor and the host of your podcast today, It’s My Turn To Care: Secrets for the Dementia Caregiver where we try to give you tips and strategies, and things to think about, as you maneuver through this journey of caring for a loved one.
Today we have Alex Nameth. Alex helps with the Encore Memory Care, which has operations in Plano and Bedford, and they just do a tremendous job. It's kind of an adult daycare center for those that have some cognitive decline. He’s also one of the first people I met in the business, and he's been a great mentor and friend to me over the years. [01:11.7]
Today we're going to talk about a subject that some of you may be struggling with, and that is does my loved one really have Alzheimer's disease or are they experiencing cognitive decline, or is some of it just normal aging? We want to kind of address that with you today and give you some things to think about as you analyze the situation.
Alex, welcome to the program, and if there's anything you want to add about yourself, please do so.
Alex: No, I'm good, thank you, and you're right, I've been in the industry now for a while. At one point, I owned a day center and really do the marketing for Encore and, of course, we work closely with Dave’s company as well in providing great services, Dave’s in-home services in mind for those that are still able to get out of the house and spend a day at the day center. I'm ready to go, Dave. [02:05.3]
Dave: Okay, very good. Let's kind of jump into some of the things that we need to be looking for to help us understand maybe what next steps are for a loved one, if they're suffering from cognitive decline. Why don’t you give us some ideas to think about?
Alex: Yeah, so let's talk about sort of the 10 warning signs of Alzheimer's and the public generally agrees with these, but before I even dive into those, I want to make sure that people understand that many of the conditions I'm going to talk about are really just age-related memory loss and conditions, which is true for all of us.
As we age, our muscles weaken. Our bones become more fragile and they shrink. Our heart stiffens up. We have vision problems. We have hearing problems. We start to slow down in a lot of different categories and, of course, the brain is one of the major organs that also is affected by age. I want to make sure people want to understand that. [03:05.1]
I also want to make sure, Dave, that they understand that the things I talk about may not even have anything to do with Alzheimer's disease. That is there could be memory loss due to a vitamin deficiency. B12 is one that a lot of the physicians are talking about these days and that deficiency can because of some of these behaviors I’ll talk about.
Stress. A lot of stress out there, Dave, isn’t there?
Dave: Yeah.
Alex: Yeah, we've got political stress. We've got COVID stress. We've got the [crosstalk] on age stress, and all kinds of stress. Those can also cause some of these conditions. Thyroid. Drug interactions. Again, don't go down necessarily the path that because I see these conditions in people around me or I am feeling them myself, that it's necessarily Alzheimer's, but in the end, Dave, you and I will talk about what would be the next step if, in fact, you see some of these in yourself or a loved one. [04:00.3]
Let me touch on them. I’ve got 10 of them and, again, I'm warning you right upfront you're going to have to experience some of these things. The first one is memory loss that disrupts daily life. The things that we do routinely, all of a sudden, are affected by something that's going on with our memories, and these can be things like forgetting events. Let's say that you are always a really punctual person and have never missed an appointment in your life, and all of a sudden, and I didn't realize we had that doctor appointment next Tuesday. You never told me we had that.
That might be a little sign. It could be just a hiccup, but that's one of those things that, if in the past you're always a very punctual person and, all of a sudden, you find yourself struggling with events that you never had a problem with before, it might be something to think about.
Dave: Yeah, I could see a situation where, if it's an event, it's something you'd been going to for the last…maybe your whole life like you go to church every Sunday and 11:00. [05:02.1]
Alex: Absolutely.
Dave: Then, sure, maybe one Sunday you might slip and go, Oh, it's already 12 o'clock. I missed it. But if you consistently miss church when you've been going your whole life, then I could see where that might be an indicator.
Alex: Yeah, that's a great example. Another one is, all of a sudden, you're relying on sticky notes, and they're all over the refrigerator and a calendar and everywhere else, where in the past, you didn't have to do those reminders to yourself, so that could be an indicator. That’s disrupting daily life.
The second one is challenges in planning and solving problems. Dave, you talk a lot about executive functioning in your mind-strengthening exercises that you do, and that's one area that can be affected very early in the progression of Alzheimer's. That's, again, just like when you talked about with church, trouble could be paying bills. I’ve paid electric bills, water bills, and all of a sudden, you're getting a past-due notice for a bill that you've paid for 40 years. How can that happen? Again, it could be a function of memory problems. [06:10.9]
Dave: Yeah, we had a client one time whose memory was actually pretty good, but when they got to a task, they had trouble sequencing. They had trouble figuring out, What do I do first? What do I do second? The example I use is they remembered that they needed to brush their teeth, but they couldn't think through how to do that.
Alex: Yeah.
Dave: Yeah. Actually, your memory could be in decent shape, but your sequencing could be where you're having the challenge.
Alex: Absolutely, and because long-term memory is really one of the last things to be affected through Alzheimer's disease, that's going to remain strong. What we're finding is it's the short-term memory that suffers, so we end up with difficulty completing familiar tasks at home. [07:03.4]
It could be cooking. Man, I used to be a great cook and, all of a sudden, I can't remember the ingredients for the roast that I used to make. I'm having trouble driving places where that's a big one, and you see that exhibited right on your freeways. You see the silver alerts. I would guess most of the time that's going to be somebody in early-stage Alzheimer's whose plan was to go to the 7-Eleven right down the street, and now they're halfway to Oklahoma and are completely turned around and lost. It's that difficulty completing familiar tasks.
Dave: Okay.
Alex: Confusion with time and place, and that's another one, losing track of dates sort of like we talked about with church, but now this is happening more often, trouble understanding an event that's happening later, again, forgetting about that event. It's that time and place that becomes very difficult for the person to grasp and really understand about it as far as allowing them their daily activities. [08:07.3]
Dave: Yeah. We have a client, and you would think this would be late stage, although I don't think she is late stage, but she doesn't even recognize her own home sometimes. A lot of times it's at night when sundowning kicks in, and it only happens periodically, so she'll say, I need to go home. I need to go home. Of course, you can't necessarily say, You are home. We try to do things like, Tell me about your home. Why don't you think this is your home? and just trying to meet them where they are, but even something as familiar as home can become unfamiliar.
Alex: Yeah, absolutely. We would see that oftentimes with our clients and I would find caregivers that would actually take their loved to maybe the home they were born in or a home that they would be more familiar with from the past, drive up, whatever expense was required to get them there, pull up in front of the home, and the loved one says, Well, that's not my home. [09:07.4]
Dave: Yeah.
Alex: Oftentimes, what they're fine to find is a place that's comfortable for them. They're not sure what it is. They don't know how to express it, but that seems like an easy one and it would help. Then it'd be a great thing to do, but I think your answers are more appropriate. That is let's talk about your home. That’s like going or trying to find that physical appearance of the home, right?
This is a good one. You spent a lot of time on this in your class, Dave, trouble understanding visual images, spatial relations. I mean, that's something that's been difficult for me forever. Terrible. If you gave me three suitcases to load in the trunk, I could only get two in there. I'll guarantee you, I could never get the third in there. My wife will come in and load three and add two more to it.
Dave: That's right.
Alex: I've got a history, right, of problems with spatial relations, which now means probably not a problem as far as my memory because that's the way I’ve always functioned, but if you were the guy that always could load them up and do it well, and now you can't, that could be a warning sign for you. Again, we're typically seeing clusters of things that come together, not an individual warning sign. [10:16.5]
Dave: Yeah, and you're right. We do a lot of activities around that. One thing we do is we break up a picture and then we ask them to put it back together in their head and tell us what it is or we'll do the opposite. We'll put pictures on top of each other and we'll ask them to break it apart and tell us what the pieces are. It's just a way of stimulating that part of the brain.
Alex: Sure. No, absolutely. Yeah, that's a great one. Number six, new problems with words, and speaking and writing, and you see this a lot and all of us are victims of, we call it, tip of the tongue. It seems like when we get older, we're looking for that word that we can't find.
Dave: Right.
Alex: You can see the individuals starting to get frustrated as they try to find what that word is and, all of a sudden, their loved ones trying to give them the word, increases the frustration of both the loved one and the person potentially with the disease, which increases the stress, which makes it even more difficult. [11:14.5]
Dave: Right.
Alex: So, we see that. I remember my dad who had middle- and late-stage Alzheimer's, he’d be trying to describe where his watch was, but he couldn't come up with a word, but he said, “You know, the clock, the clock that I have on my wrist.” We knew where he was, but the connection to that image in his mind was broken. Your mind is always trying to repair itself, right? It's trying to do the best job it can under this situation, so clock was the best thing, which allowed me to understand what he was talking about.
Misplacing things and losing the ability to retrace your steps. Dave, do you ever misplace your car?
Dave: Oh yeah.
Alex: A couple times, right? Jean probably has, too.
Dave: Sure.
Alex: Not sure what time it is sometimes.
Dave: Right. [12:00.2]
Alex: And when we get nervous about that, we've all misplaced and we've all walked out of the mall at Christmas time in the old days and couldn't find your car.
Dave: Right.
Alex: That's fine and, again, if you have a history of that, that's nothing to worry about at all. But if you can't, when you discover the car keys are in the freezer compartment of your refrigerator, you find your eyeglasses in the dishwasher, that's a problem because that's a displacement of somewhere where they really shouldn't be, and it wasn't even uncomfortable for you to put them in the freezer because you just thought that's where they always go.
Dave: Yeah, I see that. I see that a lot. Of course, my family used to always get on to me because I would always put the peanut butter in the refrigerator and then we would have this big debate on another peanut butter that goes in the refrigerator.
Alex: As long as you always did that, then you're good. They should've got worried when you started putting it in the pantry. [13:01.2]
Dave: Yeah, that's right. That's right. Absolutely.
Alex: All right. We've got number seven, misplacing things and losing the ability to retrace the steps, the keys. I guess that's what we were talking about just now where they end up in a different place.
Dave: I heard another example about that. See if you agree with this. A lot of us walk into a room and we're like, Why did I come in here? I can't remember why I’ve come in here. That happens to me periodically, but someone told me the contrast to that in someone who might be experiencing cognitive decline is a normal person may walk into a room and forget why they went in there, but someone with cognitive decline walks into our room, forgets why they're in there and then can't figure out how to get out.
Alex: Yeah, absolutely.
Dave: Yeah, but anyway…
Alex: Yeah, that's scary, a scary time. Number eight is a decreased or poor judgment. I would believe that TV preachers prey on people with early-stage Alzheimer's because they become victims of scams very easily. They become trusting of these people. [14:09.6]
Not managing your money very well. All of a sudden, you find Amazon packages at the front door where you see needless money being spent on things. We find less attention to hygiene. Again, that's part of poor judgment, where in the past, that was important to them and, all of a sudden, it's not important to them. Those are all judgment errors that it can be pretty serious.
Dave: Yeah, another example I heard was going out and it's the middle of August, and your loved one grabs their heavy coat. Right, just it’s the middle of winter and they're outside getting the paper. I can't say that's too bad, but they're outside taking a walk, and it's 30 degrees, in their short. [15:00.5]
Alex: Yeah, absolutely. This one is interesting and it's an early sign, and it may not be an obvious one, but it's withdrawal from work or social activities. All of a sudden, your spouse is saying, I don’t feel like going to church this week. I just don't feel that good. The spouse will buy off on it, right? Don't feel good. Next week comes around, time to go to church. Loved one says, I just didn't sleep that good last night. Let's go next week. Let's plan on doing that.
We start to see this pattern of social withdrawal and really what's going on there is that they're uncomfortable in these situations. They're aware of the fact that they're struggling with everything that's going on around them, so they want to pull themselves from those situations.
Dave: Sure.
Alex: When I think of checking out at Kroger and the cashier at Kroger says, Are you playing the bingo game? Are you credit or cash? Are you plastic or paper? They're firing 10 questions at you, rapid fire here. [16:05.7]
If you are suffering in any way from memory conditions, you're not going to put yourself in that position. So, what do you do? You withdraw from those situations and that's what we see. That withdrawal, and this is not a big topic for today, but social isolation is one of the worst things you can do for these people. They need that interaction, as you know and I know as well, so withdrawal becomes a big one.
Dave: Yeah, I saw a study that social isolation for seniors, whether they have a cognitive decline or not, can be as dangerous as smoking 15 cigarettes a day.
Alex: Oh, yeah. I believe that. I believe that, and you go to the neurologist hoping for an elixir, some kind of pill that's going to save the day. He's going to say I’ve got something that may or may not help, but I’ll tell you what will help and that is keeping your loved one engaged, and they'll tell you that's more powerful than any of the medications that are out there. [17:04.2]
Dave: I say the same thing when I go out and talk to senior groups, and we do all these fun activities and I say, at the end of the day, if there's one thing that you can apply or remember from our time together is the fact that they're socially active, but you may have a friend, a loved one or a relative that is not as active and that's the people that we're concerned about.
Alex: Absolutely. Then the last one really changes in mood and personality. Sometimes the loved one because they're almost there too close, they don't recognize the changes in their loved one or in the person with the potential with the disease, because they're in the forest. They're not pulling back, looking at the trees. Yet the friends will say aside, What's going on with your husband or your wife here? That's not the guy I know. What happened to the smiles and the jokes? Why is he getting upset so often? [18:05.4]
The other thing you'll see, Dave, is that the individual becomes more suspicious. You may be on the phone and, all of a sudden, your loved one is just going after you, Who were you on the phone with what was all that about? So, paranoia starts to present itself, and then they become more suspicious and it's a very, very vicious cycle.
At the same time, what's interesting is that they become more dependent on you. While they're mad at you, they also become more dependent. If you leave the room, they want to know where you're at and, of course, as you know and I’ve seen, they'll stand outside a loved one's bathroom door until they're finished with their business and they may not even allow that door to be closed at some stage in progression of the disease because, again, they're afraid. They don't know how to express it. [18:56.8]
Dave: Yeah. Your point you make about families, that it's hard for them to see it for themselves, because we see families. We may see a client once a month. I mean, I'm talking about our office staff. Maybe once a month, maybe every two months. We'll try to talk to the family like, There's some decline here. We need to start taking this more seriously. We may need to increase care. You may need to see your neurologist, and the family is like, I just don't see it. It becomes obvious to us, right? But to them, it's like, Yeah…no, I'm not sure I see what you're saying, but maybe they had a slip up the time you were with them, that kind of thing.
Alex: Yeah, they don't want to go down that path, and our business would always increase in January and I always kind of wondered why.
Dave: Sure.
Alex: Right? We know what happens. It's the kids coming in from out of town. They walk into that house. It's a disaster. Whoever is taking care of the loved one is stressed out to the max. They can't make the decision because they feel like a failure, like they're letting their spouse down, especially the male taking care of the wife. [20:07.3]
Dave: Right.
Alex: They struggle with that as well. It's important to get that third, get an opinion by somebody outside of the family.
Dave: These are really good tips. If someone were to suspect that they need to go to the next step, so they suspect maybe they are experiencing cognitive decline. I need to do something about that, what would be their next step?
Alex: Yeah, the first step really should be and, fortunately, our regular doctors are getting more and more educated and aware of the disease. There's more and more people presented with the disease. That's really the first place you want to go.
You don't necessarily need to jump to the neurologist, but your general practitioner should be able to through a short test, maybe just some questions that most of us in the industry already know that will help them say, Okay, I see there's some loss. They are the ones that can help rule out the vitamin deficiency, the thyroid condition, talk about the stress. [21:04.5]
They kind of narrow that down to say, Okay, this is where we need to go next. Ultimately, the neurologist is going to be the guy. He's the guy who spends his life worried about the brain and understanding the functionality of that brain, and to be able to coach them, that family, through the process.
Dave: Right. Very good. Unfortunately, our time is coming to an end, but I want to thank you, Alex, for giving us some of these tips and things to look for, signs of cognitive decline or Alzheimer's disease. But if someone has some questions or wanted to find out more about Encore, how would they do that?
Alex: Yeah, the best way is good old Google, right? Encore is spelled E-N-C-O-R-E, so if you need day center services, whether it's in Bedford or in Plano, you can Google specifically by the Encore name or adult day centers. That'd be the easiest way. Then you're going to get a phone number and they'll come over. We'll invite him in, talk about their loved one and see if our services would be beneficial. [22:08.5]
Dave: I want you to tell them really quickly about the VA benefit?
Alex: Yeah, so we've got a couple of ways to pay for the service. One obviously is private pay. The second one is long-term health care, which a lot of people have those policies, Dave. I know some of your clients rely on those to pay for your services as they could through ours.
But we're particularly proud of the contract we have with the VA. We're now in, I think, our fifth for six year with that, and in that case, for those veterans that were honorably discharged that, in fact, are suffering from some form of dementia, whether it's Alzheimer's or frontal temporal lobe, or any of the other, in many cases, Dave, the VA will pick up the cost of that care in our center, I can't say a hundred percent of the time, but I’ll say it many times.
Dave: In a lot of cases, it's over and above any other benefits they get. [22:56.2]
Alex: That's correct. You can have dual benefits going on at the same time. I'm actually the guy, I'm kind of the VA guy for Encore, so anybody that asks that question, they'll end up with me and what I’ve got is I’ve got the contacts. That's what people need more than anything when working through the VA. It’s who do I go to? And I can help them out with that.
Dave: Very good. That's a great benefit. I'm glad we're doing that for our veterans.
Alex: Sure.
Dave: Thanks, Alex, for the time today, and this is Dave Parks with Home Care Assistance and this has been It’s My Turn To Care: Secrets for the Dementia Caregiver. We always encourage you to visit our website, HomeCareAssistanceFortWorth.com, or call us at (817) 349-7599, and we will talk to you again next week.
This is ThePodcastFactory.com
