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BTG COVID-19 Ep. 5: How to Maintain Peace in Memory Care in a Confusing Time with Gerontologist Mikki Firor

BTG COVID-19 Ep. 5: How to Maintain Peace in Memory Care in a Confusing Time with Gerontologist Mikki Firor.

This series is designed to provide resources, share the love stories and encourage those who are overseeing the care of aging adults during the COVID-19 pandemic. We believe in you!

Lucas: Welcome to Bridge the Gap podcast with Josh and Lucas on our special COVID-19 Series. We’re bringing on thought leaders in all areas and aspects of senior care and senior living to bring the most up to date interview and questions to our audience to help elevate thought leadership and education in the space. Today, we have Mikki Firor. She’s a gerontologist on the program. Welcome to the show.

Mikki: Hello. How’s it going?

Lucas: It’s going really well. You and I connected on LinkedIn. We got on a phone call. We had a great conversation. We’re like, we’ve got to bring this to our audience. We’ve got to bring Mikki on. So maybe give our audience some context. What got you interested in dementia?

Mikki: I was really young so I actually started a club in high school and I really learned very quickly that I just saw people with dementia completely differently than everyone else in my age group. And that really helped me just throw myself into learning everything I could about dementia. And when I got my master’s degree in gerontology, I went to working for for-profits and nonprofits and no matter where I was, I just felt like there was something missing and we weren’t giving all that we could give to people with dementia. So it just, my passion just started really young and just continued to grow and grow and grow until I opened my company.

Lucas: That’s fascinating. And I’m so glad. We talk a lot on our program about the love stories of the industry and just how missional this can be and to know that you’re wired to do this, to help a very, very desperate population that needs help and assistance. And especially for the families that are having a very hard time dealing with it and understand there’s a lot there. So let’s talk about right now the state of affairs in our country or the globe in fact. And how this is impacting memory care communities, people with dementia. What are you seeing and hearing out there and what are some ways that people can engage with this population now that we are all remote?

Mikki: So I’ve reached out to some of my contacts recently and just asked, you know, how are they doing? How could they use support? Where are they struggling? And pretty much every single community has said that they’re having a hard time coming up with creative activities and keeping a routine while following extra strict protocol within the community. They’re also having trouble with family members feeling very disconnected. A lot of them who visit every day, every week, every couple of weeks, they’re now not able to come in. And that’s been a challenge. Just setting up phone calls has been difficult as well. And you know, family members, they’re struggling too. They miss their, their loved ones that are in, in dementia communities.

Josh: Wow. That is a ton of challenges. We have seen a lot of creativity on the activity life enrichment front. We know our teams are working overtime on infection control, working longer hours seeing a lot of success stories and really difficult times. So on some of those topics, what is some of the creative things that maybe you’ve seen, maybe your team’s been involved with that you’ve been involved with that you could share with our industry? And our listeners that may need just some creative ideas. I know everybody’s searching right now specifically on multiple digital platforms and doing a great job at sharing resources. So what are some that you might be able to share?

Mikki: Yeah, so getting the performers that would usually come into the community, getting them on a Zoom or something like that so that they can perform for the community. A lot of communities have movie theaters or they have large TVs in common areas where you can still have the performers come in virtually and still perform for the audience. And I think one, it really, really important thing to remember. And this is something that when I was the director of a memory care community that I had to constantly remind myself of is that we always want to see a ton of activities going on. But I mean most of us by like 2:30 we want to take a nap and then and, but we’re always trying to push people with dementia to keep going and going and going. And we have to remember to give them a rest.

And also remember that caregivers like the CNA is and the GNA is or you know, whatever they’re called in your state, their forte may not be doing singalongs or coming up with really creative activities. So finding ways to maximize their strengths. So either working with different communities to find those ways and help them understand what’s gonna be right for their CNA is to do. It might be, for example, if you have one of your aides and she is super organized and is really, really good at getting things done and completing tasks, it might be that you partner her up with some other residents who are very organized and really like to do more low key things and maybe you guys are folding and sorting things together and that is engagement. So it doesn’t have to be a huge production. It can be little everyday things that we’re doing together as well.

Josh: Oh, I love that. And you know I think when you said that about maximizing the strengths of your CNA is, I think that is extremely important, especially in really difficult times when they’re already stretched probably way out of their comfort zone. They’re tired and things like that. And I’ll tell you, I don’t know if you’ve seen this and I can’t think of the names right off the top of my head, Lucas, you might be able to say some of them, but I know there’s resources on our website at there have been some partners and different resources that we’ve had on the show that there’s actually some tools out there. You know, we do these resident assessments and life stories all the time, but there’s actually those, some of those similar technologies out there where you can actually assess the strengths of your team members and what their interests and their natural abilities are even outside of the caregiver role. So I think, one of the things that we’re seeing Mikki now that you may be seeing as well is that our, our, our industry is kind of being forced to use technology and digital platforms more than we’ve ever had to. And we were just talking to the guests not long ago. Some of this we think post COVID, the lessons we’ve learned and, being pushed and forced out of our comfort zones may actually end up the creativity results may really push our industry even further forward. What are your thoughts on that?

Mikki: It makes me a little bit nervous to be honest because I, you know, I read a lot of things about how we’re trying to use more technology to provide patient care. And I just still think that, and you know, maybe I’m an old girl or a little old fashioned, but I still think that it’s not a replacement for human connection and the human connection is so, so important, especially in dementia care that if we just start replacing it with technology rather than using it to supplement the care, then it’s going to be a problem and we’re going to take the person out of it as a whole, just all the people out of it, literally and figuratively. So I do a lot of behavioral interventions where I observe the behaviors that are happening and coach the caregivers and change the environment to make that behavior go away or to deescalate it faster.

And I haven’t been able to go into communities to do that. And I have residents or clients who have become residents in communities in the past few days or weeks, and they’re having some of these challenges, which we knew they would have. And normally I would go in and help coach and get them acclimated and transition. But now I have to do it virtually like this and it’s working, but it’s not, it’s working, which is awesome. It’s going to mean that in the future I’ll be able to help more people across the United States without having to get on a plane, which is great, but it’s so much better when I’m there and I’m able to touch the person and talk to them. And not just the person with dementia, but the caregiver who is exhausted and frustrated and they just need a pat, a literal pat on the back. So I think that it can help supplement things and give more access to people and more resources at a more affordable cost. But I don’t think it should be a replacement.

Josh: Huge point. And we’ve heard, Lucas, several of our previous guests, the experts say the same thing, that the high tech will never be a replacement for high touch is, I think how some of our guests put it. And I love that. And I love that. That’s exactly what you’re saying as well. So what are some of the challenges? You know, right now there’s just a ton of infection control limitations that are limiting not only entertainment or activities, but also the regular routine visits from loved ones. And that’s a lot of that human touch. Right. What are some of the, I guess, replacements or substitutes that you’re seeing right now for that side of things that can be specifically helpful to the families, the communities that caregivers and residents?

Mikki: So I think the most important thing to remember with all of this is that somebody with dementia, sometimes they, we don’t give them enough credit and they can completely understand and grasp what’s going on in a moment or maybe for several moments or days or whatever it might be. And other times it’s just too much to comprehend. And depending on what symptoms they’re having, what stage of dementia, what type of dementia, there’s just so many factors that go into play. So understanding their reality may not be that there is a pandemic going on out there in the world and it’s not safe to go out and it’s not safe for their family to come in. Their reality may be that they’re sensing the stress from everybody else in there, in the community. Cause you know, the age of 18 months old, we start to pick up on the nonverbal subconscious cues that other people put out.

And it’s not something we can necessarily control. So they’re picking up on that from the caregivers who are worried about their family. And we have to make sure that we’re doing whatever we can to monitor that. And you know, I teach mindfulness practices when I do my trainings because getting into the different mindset is the only way to try to control those subconscious non-verbals. So that’s one thing we have to be aware of. The second thing is to try not to bring them into our reality. Some people will understand that it’s not safe out there because there is you know, this virus going around, it’s really dangerous, but others are not going to be able to get that. They’re still not going to understand why they can’t see their family. And so we may have to use other techniques to kind of make them feel a little bit better.

This is where empathy is such a big thing and it comes into play and it’s not just empathy for the person with dementia, but for the caregivers providing the care as well. Because like you mentioned, they’re working over time. They’re on overdrive. You know, they’re feeling the stress in and out of the community and they’re tired as well. As far as replacing some of that human connection that we used to have coming into the building. You know, we talked about this with performers and setting up Zoom, but a lot of family members are now wanting to have phone calls or have a Zoom or video chats as well. And we just have to remember that it sounds like a great solution. But for somebody with dementia, they may not be able to comprehend who’s on the other line of the film. They, and if you say to them over and over, hey, it’s me, it’s Mikki your friend that might upset them and they may say, oh well I know who it is.

Why do you keep saying that? Or they may need to know it and you don’t know until you try. So equipping the families with tools on how to deescalate if they get upset is really important. And also knowing that a video call, that might be a hard concept to grasp because they didn’t grow up with video chats. They didn’t, may not have even grown up with internet. So understanding that their loved one is on a screen and it’s not that they’re on the TV, but they’re in their living room. That could all be very, very challenging and distressing for them too. So you have to play it by ear and make sure that you’re adjusting as necessary.

Josh: Wow. So, so much to consider. And it sounds like to me that particularly for Alzheimer’s dementia is that there’s not really a one size fits all that you’ve really got to kind of take it a day at a time and some days maybe a lot better than others for, for the same resident. And so equipping your team members with some tools and resources more than just one option is probably best would you say?

Mikki: Absolutely. And I think educating the family members of the residents is really important because, you know, I still have clients now whose children are like, well, they’re not processing this and their thought process isn’t logical why isn’t it like that? And they need education around dementia even though they understand their loved one has dementia. A lot of people still think that it just has to do with memory loss. And there’s, you know, a lot of people have dementia and their memory is great. They still have their short term memory, but other, they have other challenges, other cognitive abilities are lost. And so helping families understand all of that as well.

Josh: I think that’s key. Education and communication. Lucas, we’ve talked so much about that and not only is it beneficial for the obvious reasons, but you know, it seems like the more you can educate, it helps to paint some realistic expectations for those families, which makes everyone communicate a lot more clearly. And ultimately we’ve heard from risk mitigators that that really lowers a lot of risks for the communities as well. 

Lucas: Yeah, it, it does. And you know, Mikki, we, we’ve heard a lot of love stories as we call it here on the program. There’s so much positive that’s going on right now. As we round out the show, some words of encouragement to caregivers or is there a story that you’ve heard recently that could bring joy to people that are working so hard amidst all of these challenges?

Mikki: The one that actually is kind of a success story for myself right now and for my clients is that I had a client and she had been receiving care in the home, but she had become very depressed. She wasn’t getting out, she wasn’t getting up, she wasn’t showering. Sometimes she wasn’t eating and we decided, you know, it’s probably a good idea for her to make a move into a community and they were going to wait a month. And I know a lot of people are waiting to make moves into communities right now, but there are still some communities that are accepting them. Well, she, they decided, you know what, why don’t we push it up and let’s just pull the trigger and do it. And they were so nervous. They knew it meant that they weren’t going to be able to visit her, that I wasn’t going to be able to visit her.

And they were so nervous about it. But within 24 hours of being there, that client started yelling from her room for someone to come in and they came in and she said, I don’t want to be alone. Can I come out with you? And she got up, she took a shower, she ate and she was in the living room and she, I mean, it would take days sometimes to get her into that in her house. So there’s so many benefits of living in that kind of community that you see it as soon as they move in. And right now with everybody being, you know, confined to this, everybody that’s working there and living there is almost forced to get to know the person that much better because there’s no outside distractions and it’s really improving the care in my opinion. So I think that if you are on the cusp or you’ve got someone on the cusp make sure that they know it can actually be really beneficial and now might be one of the best times to make them move. Because there’s that extra care there from the whole team.

Lucas: What a wonderful story that is, Josh. You know, we’re hearing that quite frequently from the people that we’re out talking to on and off the program, right?

Josh: Yeah, absolutely. And thank you for the very unique perspective, Mikki, this morning. I know this is going to be very valuable information to our listeners during this time where we’re all having to come together to share ideas to share what’s working, what’s not working. And obviously Bridge the Gap platform is just designed to be just that, to be a platform for communication of information sharing educational resources. What an awesome resource you are to our industry and now our listeners and really appreciate the time that you’ve taken out of your busy schedule to be with us today.

Mikki: No problem. Thanks for having me!

Lucas: Mikki Firor on the BTG program. We’ll definitely link you in the comments. I’m sure our guests will want to reach out to you and connect with you on LinkedIn and other social platforms. Please feel free to reach out to us and thanks for listening to Bridge the Gap.

Thanks for listening to this episode of Bridge the Gap podcast, the COVID-19 series. If you are company, community or caregivers are going above and beyond in their daily duties, we want to hear about it. Tag @BTGvoice on social media, or send us a message

BTG COVID-19 Ep. 5: How to Maintain Peace in Memory Care in a Confusing Time with Gerontologist Mikki Firor