An Interview with A Special Guest – Lance A. Slatton CSCM – Host of the Award Winning Podcast, All Home Care Matters

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everybody. Welcome back to another new episode of The Truth Lies in Alzheimer's Show. I'm Lisa Skinner, your host. I have a really special guest here with me today, and I'd love to introduce him to you. So let's, let's get on with the show, as they say. This is Lance A. Slatton, and he actually was a speaker at my summit week before last. And so I invited him back on because we are going to talk about a really, um, not only interesting but important topic today. So, uh, let me just tell you a little bit about Lance, and then we'll get started with our, um, discussion. So Lance is a certified senior care manager at Enriched Life Home Care Services, and he's also the host of the number one rated podcast in the US for the last several years called All Home Care Matters. He has been a senior case manager for— is it 8 years, Lance, or 10 years?

10 years.

Okay, 10 years. And has been the host, of course, of All Home Care Matters since its inception in the year 2020. Lance finds joy in helping families and those needing care and support, and this led him and his team at Enriched Life Home Care Services to create the podcast All Home Care Matters in 2020 to act as a continuation of his work that they have been doing for families and communities throughout southwestern Michigan. His commitment to the families and communities in Michigan has led Enriched Life Home Care Services to be recognized and awarded the number one home care provider in Michigan for the past 4 years in a row. Wow, that is quite a remarkable achievement. Congratulations. Thank you. As host of All Home Care Matters, he's always looking for ways to help listeners and viewers to find and have the information, have accessible resources and support that everybody, as we know, needs as they face long-term care issues and letting them know that they are definitely not alone. He also serves as a member of the board of directors for Senior Center in Monroe County, Michigan, and he has won the honor and award in 2023 of 50 Under 50, which was issued by the New York City Journal. Wow, you have really made a lot of just unbelievable achievements in your work, and so congratulations to you and all the wonderful work you're doing for this, you know, tough situation for most families. So, uh, I want to start our conversation with this question to you, Lance, because I personally, as you know, I've been counseling families for 30 years now, and plus I've had 8 of my own family members live with one of the brain diseases that cause dementia, and I have personally witnessed since COVID a shift in the way we're caring for not only our elders, but for people living with Alzheimer's disease and related dementia. So my question to you is, in this post-COVID world that we are all living in today, what shifts are you seeing that since you do own and operate an in-home care service company in the way people are being cared for, and why do you think that we have seen significant shifts since the COVID pandemic?

Yeah, well, first, thank you for the invitation to be here with you, Lisa Skinner Skinner, and the kind introduction. What we've noticed ourselves on the professional side is when COVID started, you know, a lot of people didn't know what to expect. They didn't know what to do, how to handle it, how to even prepare a plan for what was coming or what they were dealing with. And a lot of families, you know, we, you know, I said to somebody just yesterday, you know, we look at our healthcare providers with reverence. You know, we don't question a doctor. We don't question our pastors or our priests, right? It's, you know, it's a respect for their positions, their trainings, their education and experiences. But I feel a lot of families started taking notice when they had to visit their mom or their grandmother or their dad or whoever it may be through a window in the middle of winter in Michigan to be able to see them and to have any sort of interaction with them. So we started seeing a dramatic shift to people discovering who didn't even know that a home care industry existed to having their loved ones be taken out of these facilities and placed into a home. You know, that's one of the biggest shifts we've seen, is families are starting to stay away from more of the institutionalized care, if you will, and trying to get more into the personalized care. But the other shifts we've seen though is almost the polar opposite. We're seeing more people leave the healthcare industry, leaving the home care industry, and not returning. You know, and I don't know that anybody really has the answer for why that shift away from those types of services and employment have happened and continue to this day.

What are they doing instead?

Your guess would be as good as mine. You know, are they going into another industry? Were they not returning to the workforce at all? I don't know that anybody has a clear answer. You know, getting, you know, I don't want to make this about, you know, numbers and unemployment, but You know, we see where unemployment numbers are going down, but the help wanted signs are going up. And a lot of that is, I feel, people who, you know, went on to, you know, like the COVID relief and the unemployment during COVID you know, they just stayed there. They never returned into the workforce. And so a lot of those people have been on there for so long, they no longer qualify. So they're not getting an unemployment claim. But they're not being counted as being unemployed because they just drop off altogether. So they're kind of in that abyss of, well, they're not on unemployment, but they're not gainfully employed. And, you know, COVID really wreaked havoc on, you know, our society as a whole for, you know, services and, you know, work and, you know, factories, you know, healthcare. I mean, I know even here just a couple months ago in our communities, a lot of our local emergency rooms in our more community-style hospitals they actually would divert everybody to the major, like, university hospitals because they could not staff their ER.

Yeah, yeah, I'm aware of that. Yeah, one of the, the statistics that came out after COVID, and I believe it was the World Alzheimer's Annual, um, Health Study Report, and this was, um, probably after the vaccines came out that we saw a dramatic rise in deaths of people that were in assisted living communities, in memory care communities. I would say especially memory care communities, in long-term care facilities. And interestingly, It was the number one cause of these deaths that occurred in these populations was due to what you brought up a few minutes ago, isolation and loneliness. And I don't think any of us saw that coming, but they really didn't have a choice but to close, not allow visitors. And, you know, think about it, it's especially hard in a memory care arrangement environment How do you communicate to people with cognitive decline that they have to stay 6 feet apart and they have to wear masks? Have you ever tried to get a person living in their mid to later stage of dementia to wear a mask 24/7? It's almost impossible.

Very challenging.

Yeah.

And it's frightening, right? They don't know what's going on. They don't understand this. And we're invading their very close personal space. You know, and, you know, it was just, you know, people were trying to make do with what they had, right? We were trying to do the best with the circumstances given to us. But ultimately, you know, these families just realized, you know, I need to get my mom, I need to get my loved one, and we need to get them home. Because, you know, you don't know if your roommate might have had COVID, now it's getting passed on to your mother. And, you know, they just, you know, it was Very trying times, very trying times. And I know at least here in Michigan, you know, we had a big movement supporting these frontline workers. And the frontline was, you know, the caregivers and the home health aides who are trying to keep the people who are home, keep them safe and quarantine them so that they're not going out to the public and contracting it and then going here or going there. And, you know, we noticed it months before, at least in our state situation, before we were shut down, because we would do a lot of community events, educational talks, dementia seminars, fun activities, concerts, all for, you know, the senior centers and different, you know, facilities, just to, you know, bring a smile to their face, just to lighten the load and brighten their day. And we started noticing these events where you'd get 50 to 100 people. Now it's like there's 8 people, then there's 4 people. And so before we officially got shut down, we made the decision, okay, we're going to halt all of our events. You know, I And that's where we decided, you know, let's, let's start a podcast and we can do that for a couple of weeks, right? Thinking that's what it was going to be. And that couple of weeks turned into several years. You know, I remember here at our offices because our governor, you know, deemed and labeled us as essential. We would always watch the press conferences every 2 weeks, Friday at, you know, 1 o'clock, there's going to be an update. And, you know, the first week we're like, okay, let's What's the latest news? And then that second shutdown, then the third, every 2 weeks. Then it got to the point where it's like, we're not even going to watch because it's just another announcement that it's going to be a continuation of the shutdown. And that's when I think a lot of people, the general public started realizing, this is something a lot more serious than just a 2 to 4 week situation. And so, yeah. Let's just use the power of audio and video and help the communities that way.

So, I totally agree with you because I do my show because people really don't know where to turn or who to turn to to find information on the day-to-day challenges that they're faced with when it comes to Alzheimer's and related dementia. And that surprises me because my First experience dates back 50 years when my grandmother was showing obvious signs of, of what they called back then senile dementia. And understandably, I mean, they didn't even talk about it, let alone call it by, you know, its, its current name, Alzheimer's disease. It was senile dementia, which kind of infers that you have a crazy person on your hands.

Senility.

That's the way things were.

Yeah.

I mean, I've been doing this professionally for 30 years, and I know that it's been a real struggle for people to— because they don't get a direction or resources or expectations from the primary care physicians or the neurologists. They're not trained in these areas, in the psychosocial approach to living with Alzheimer's disease and related dementia on a day-by-day-by-day basis. But you know, here, fast forward 50 years, 30 years, I have not seen a huge change in people's ability to access reliable resources and information to help them through the daily challenges. And as you know, Lance, this is a disease that impacts every single person who is involved with somebody living with a brain disease that causes dementia.

Absolutely. So if I could just—

Go ahead.

Go ahead.

I was just going to say, if I could piggyback on that for a moment.

Yes.

You know, a good friend of mine, and I know a friend of yours, Pete Hill from The D Word, You know, that name, I think, really just epitomizes what families are going through. You know, my grandfather had cancer, you know, 30+ years ago, and back then it was the C word, right? Because the medical community— I don't want to say they're afraid, but it's almost like they're afraid of saying the word of something that they don't have an answer for, right? Because the doctors, the nurses, the Hippocratic Oath, you know, We want to help heal and cure and treat cancer. Back then, there was very limited options on what you could do other than surgically removing it and cutting it out, right? Or the radiation and chemo has made some leaps and bounds since then. But now it's almost like dementia has replaced cancer as that B word, which was the C word. So now they don't want to say dementia because it's like what they dealt with, with cancer. They don't have real solutions for curing, treating, and, you know, any sort of positive prognosis. So they want to— you know, I know families that have gone to their doctor with all these concerns, the signs, the symptoms, but they yet would never receive a diagnosis of dementia of any form, type, from that physician because physician didn't know how to tell them, this is what you have, but I have nothing to offer you after I tell you you have this diagnosis, you know. So they feel almost like a, you know, a failure in some level, I think. And so, you know, it's just like almost unspoken. They want some other doctor to give you that diagnosis.

Yeah, yeah. This is, uh, probably the toughest— one of the toughest things that any family members will ever encounter in their lifetime because it's a long process. The average person lives with it for 8 to 15 years. My grandmother was 20 years. We had a woman, a speaker at our summit. I was blown over when she said her mom lived with it for 30 years. I don't think I'd ever heard that length of time. So that's a long time to kind of watch your loved one, or even caring for somebody that you know will be living with this for a long period of time. So let's talk about the dementia aspect, because there's a very, you know, significant difference between caring for people in their home environments who do not live with Alzheimer's disease or dementia and those who do. It, you know, it's just 100 times more challenging and difficult. So how do you, as a company, how have you adapted to the shift that we've both agreed we're seeing that I, you know, I think the whole COVID thing freaked a lot of families out. Because they weren't allowed access. But the thing is, I wanted to bring this up a little earlier. One of the challenges I think that nobody really factored in until they actually saw it happening is it's not uncommon for caregivers to work at more than one facility.

Oh, right.

So what we saw happening was they, you know, the facilities, whether they were assisted living or memory care, were, um, inaccessible to family members and visitors, but the caregivers were coming and going. Can you, can you speak to that?

Because, yeah, I will say, you know, you hit the nail on the head. We had so many families because— so our staff weren't working for the facilities, but they were working for families. So oftentimes, Lisa Skinner Skinner, you know, and I'll get deeper into this in a minute, but We have staff who are taking care of Mrs. Jones at her house. Family decides, you know what, let's downsize because we, you know, property taxes, homeowners insurance, utilities, you know, lawn care, snow removal in Michigan, and let's put her in a facility. But yet we still want, you know, Mary, who her caregiver is, to stay with her. I mean, we have families, we continue with them in hospital admissions and nursing home admissions and when they move into some type of senior living community because it has that familiarity and it's a great, you know, way for the family to have an extra pair of eyes and ears, right? And so often families would say to us, we don't understand, you know, Mary can go in and take care of mom. Mary's working at a couple of other homes. She's going shopping, you know, she's doing, you know, she's not quarantined from the outside world like all of the residents are. So why can't we go in and see our mom, but Mary can? What is the difference?

Oh, that's a really good point. So what was the response to that?

Well, the facility would just say, you know, healthcare professionals, you know, that's what they would kind of put it off on. So like for us, you know, we would have all of our staff would pre-screen, do a questionnaire survey before going on to a shift. But again, that wasn't foolproof, you know, You don't, you could be carrying the germs, you could be carrying COVID right now and not even know it until 2 or 3 days later you start showing symptoms. And it's too late. But then the other part of that is how can you trace it back? If you've been to 17 different places in the past 2 days, you can't pinpoint where or who you might have contracted it from, but then you got to go back and do the contact awareness we were working with like our Department of Health and Human Services. Thankfully, honestly, we did not have one single person ever test positive for COVID during those— that 2.5, 3-year period. And we only had one lady step down from employment, and that was because she was in her 60s and her family was asking her to do that for their own peace of mind. They were concerned mom was going to get something. And, you know, you know, because it was terrifying. Families were terrified, and rightfully so, of their loved ones or themselves getting COVID. And then, you know, are they going to die? Are they going to be in the ICU? Are they going to need a ventilator? All these different things. And so she voluntarily stepped down, and then once that was resolved, then she did come back. But, uh, yeah, I mean, it's just— it was terrifying. But your point though, you know, those caregivers working at multiple different facilities or going to different homes I never did really understand other than they felt like, again, they used a professional versus a layperson. They're going to be responsible because they're, you know, professional versus a layperson may not take the appropriate steps or measures and, you know, things like that. So I don't know that there was really a good answer to it, but that's the explanation we had gotten.

So in the very beginning, you know, I agree with you, it was a terrifying prospect to think about contracting COVID because it was like the Spanish flu epidemic. I mean, if you contracted it, it meant it could have been a death sentence for you. And it turned out that it hit the elderly population worse than any other population. Do you remember how many years the facilities were shut down? I'm losing track of time.

I, I want to say, I could be wrong, I'm guessing here, um, I believe it was about 3 years.

Yeah, that's what I believe.

It's about 3 years. It might have been 3 years and some months or 2 years and some months, but it was right because when we launched the show, um, in May of 2020, um, it was— we spent several months researching and, you know, I took some, uh, training with a broadcaster and things. And that was at the later stages of '19, right around there. Um, yeah, so it was— I think it was March of 2020 is when things officially became shut down.

And then until the vaccines came out.

Yeah, but that was, I think, late, late '21.

Yeah.

How did that impact your business during the shutdown period?

You know, it did, but it didn't. So, you know, I tell people, you know, our staff already had PPEs, we were already practicing, you know, safety precautions. You know, if the staff, you know, had a sniffle, and this is unrelated to COVID, you know, they would wear a mask when they're with their client. If they had a fever, they didn't go to work. If they were doing hands-on care of any nature, they're always wearing gloves. Now the difference is now they're also going to wear a mask. So it— what being in the industry, there weren't a lot of changes for us other than, you know, the staff all had to do their, you know, pre-assessment survey before going to work. You know, do you have a temperature? Have you been exposed to anybody knowingly that tested positive for COVID? You know, things like that. Um, but it really amplified the need for home care. It amplified it dramatically because you know, families weren't— who maybe they're a retired couple and they would take care of Mom on Monday, Wednesday, Friday, and, you know, the other siblings would do it Tuesday, Thursday, Saturday, Sunday, or whatever the case may be. They're not even going to Mom's now because, again, a lot of unknowns. They're being extra cautious. They don't want to go to Mom's house to help her on Monday, Wednesday, Friday. So now they're looking, who can we get to help Mom? Because we can't leave her alone either, and Mom is, you know, older. Highly susceptible to getting, you know, sick. And it just— it really shined a light on the home care industry. People that have never even known of home care didn't even know that you could have help come right to your home. They're doing some serious research and learning about all kinds of things. So in a way, it was a positive, and I don't mean that from a business standpoint, but it's a positive that people became more aware of resources for their loved ones than thinking, you know, my option is assisted living, nursing home, or hospital. You know, a lot of families, they thought that's just what their choices were, right?

So since the— especially the memory care environments shut down and were not even an option for people for 3 years, and since then we've agreed that we've seen a shift and a pivot to more people staying home with in-home care. What, how did you as a company and adapt to caregivers now caring for people with Alzheimer's disease and related dementia in their homes and keeping them safe and stimulated when it's just more of a one-on-one relationship versus a bigger care staff taking care of a group of people, and they have programs in place and things like that, because we know it's even more important to be able to provide these things when you live with dementia. So how did you adapt your approach to the new kind of the new way of caring for people in their homes?

The biggest adaption, because we, we already, you know, we offer families, uh, specialized customized memory care programs already before COVID was ever a thing.

Okay.

The, the biggest thing though that we had to adapt to was we're not taking, you know, Mrs. Jones to her chair exercises or to her ladies church group, you know, luncheons. They weren't able to go out places, so we were filling that time in with more engagement, more, you know, stimulation and things., but especially for the people, you know, living with dementia or cognitive impairments of some nature. We were always doing these activities, these engagements, stimulations, different things. But what we were sharing with families who never heard of home care, and they're finding, hey, you know, my mom is at, you know, ABC Nursing Home. I can't stand it anymore. You know, it's 8 degrees out, snowing, and I'm standing out in a window outside her room and it's upsetting my mom more than helping her because she can't hear me. I can't hear her. She looks just, you know, out of sorts. What, what choices do we have? So they would meet with us at our office. We do, uh, kind of like when you go to the doctor the first time, there's a lot of questions, a lot of history to get, medications, you know, conditions and different things. And then we would work with them to customize a memory care program specifically for their mom, you know. And we tell people, Lisa, all the time, you know, if your loved one has dementia, there's no reason they can't continue living at home as far as their care goes. Now, what I will clarify that though, when our case managers go in and if the person is excessively violent, if they're going to be trying to assault or attack staff, that person probably needs a locked memory care unit or geriatric psychiatry. Because we can't put our staff in harm's way or that person's, uh, well-being in harm's way either. And but I would say 99 out of 100 people, we're able to care for them better in their own home. And we explain— and you, you will know this too— the longer you keep that loved one in their home, in those familiar surroundings, the far better they're going to perform and be. Because, you know, they may not remember what you and I had for breakfast this morning with them, but they'll remember, this is my living room, this is my bathroom.

I—

and they'll have that innate built-in sense of being safe because this home rings true to them, because that's in their long-term memory. So they know where they're at is okay. You take that person out of that environment and you put them into a white walls, cement, you know, everything, strange people coming in and out. Long hallways, they're not going to have the ability necessarily to adapt and adjust to this new place. So they're never going to have that sense of safety and, you know, comfort. And I just— more families, I feel like, have to have that education part of dementia. Yes, we can all say dementia makes you forget things and this and that, but there's a lot more to dementia than just that. And one of them is understanding that long-term versus short-term memory. You know, I just met with a lady a couple weeks ago with her daughter, and the daughter is doing most of the talking, and her mother, very pleasant, just sweet lady, you know, a lot of smiles and yes and, you know, very superficial. And, uh, the daughter says, well, we think Mom may have the beginning signs of dementia. And I said, well, why do you think that? Because she'll ask me the same questions a lot, and, you know, but I'm not so sure. She's not sure if mom really does. I said, well, what did you ladies do before you came to us? She says, well, mom and I went and had breakfast at her favorite place. This was like 10 minutes ago, right? And I said, okay, let me try something. So I said, you know, Mrs. Jones? Yes? You know, and she's smiling. I said, what did you have for breakfast today? She looked at her daughter, she looked at me, and she says, I haven't had breakfast yet. I said, there's your prime example of dementia. 10 minutes ago, you guys just had breakfast. Mrs. Jones, where do you live at? 124 Squirrel Lane. There's your long-term memory. She's been there for 60 years. That part is not affected yet. So it was, it was so, I mean, I didn't want to embarrass the mom, but I wanted the daughter to have a better understanding. I don't think it's my mom may have dementia. Your mom does have dementia. You know, and but again, it goes back to what we originally talked about— doctors sometimes shying away from giving that diagnosis because once they give that diagnosis, the next question the family's going to have is, well, what can you give us to cure it? What can you do to help it? There's not a lot the doctor can offer you once you get that diagnosis. So now the doctor, you know, feels like he's not doing the job. And a lot of the average layperson is not going to understand there's not a lot of options available that the doctor is going to be able to give you. They're making some great headway and a lot of great trials and different things, but, you know, your average GP or, you know, internist is not probably going to be as up to speed on it because they're not a geriatric psychiatrist, they're not a gerontologist, they're a general practitioner. You know, they are your family doctors, which are wonderful and they're great and they're needed,. But I always tell families, get a referral to a geriatric psychiatrist, get a referral to a gerontologist that specializes in dementia. There's going to be a lot more options and resources from them than necessarily your family doctor who doesn't specialize in this. Correct.

Yeah. So now that the COVID and I'm going to quote-unquote pandemic part is kind of behind us. I mean, it's still out there, it's still alive and well, and we all still need to take a certain amount of precautions. Are you starting to see a shift back to the more institutionalized facilities, or are they pretty much kind of staying status quo with people trying to keep their loved ones at home as long as they can.

I would say in our area right now, I think we— I don't see us going back to the status quo yet, and maybe we never will, Lisa. I don't know that. I think time will tell. But right now, there are more people asking for help for their loved ones in their home than not, um, which is a good thing because I feel like, you know, if home care is done the right way, you you have a legitimate, reputable company, um, it could be one of the greatest benefits not only for your loved one but also for the family, right? Um, but the one of the unfortunate things about Michigan anyhow, and we try to do a lot of education on this, we're actually a non-licensed state for home care. What does that mean? It means, you know, my neighbor who, you know, works as an IRS agent She could decide tomorrow to start a home care company in the state of Michigan. That's all she'd have to do is decide to start it. There's no DHS, there's no government, there's no Health and Human Services involvement, no regulatory, um, departments. You can just start a home care company and say you're a home care company and hire whoever you want, and you're well within your legal means in Michigan to do so. And that's terrifying to us, you know. We do with our company as much as you possibly can because some resources aren't available because we don't fall under DHS or Health and Human Services, right? But we do complete screenings, background checks, the whole nine yards. We require a minimum of, you know, X amount of professional experience. And the other big thing is we don't hire temp service employees. All of our employees are direct hires, so they're not subcontractors. We don't use temp companies. And they're not, you know, paid cash under the table, if you will, you know. But there's certain things we can't do. Like licensed states, you would have to— there's a registry where, you know, when people are hiring, it would just be like a nurse going to the hospital. They're going to check their license, make sure there's no, you know, complaints or, you know, violations against it. We don't have that per se in Michigan, uh, being in home care.

What are some of the biggest concerns that you hear from people that you interview and do assessments on from the family members when they are really kind of feeling torn between— because, you know, the family members, they're just so scared of not doing the right thing for their loved one and, um, making a wrong choice. And that's natural and understandable, and I think everybody kind of lives with that fear. It's a very real situation. But how do you address that when, well, you know, for 3 years it wasn't an option, but now they're back to having options. Do you get that concern a lot from people that, you know, I don't know if having my mom stay at home with home care services is the right choice for us, but I don't know if putting her in a memory care facility it's going to be the best choice for her either. So how do you address that? Because I'm sure you get that a lot.

One of the biggest questions we get is, if my mom or my dad or whoever it may be, if you're not able to properly care for them and you don't feel like they should still remain in the home, would you let us know? And we tell them absolutely unequivocally, we're not here to provide a service that's not going to be helpful to you. You know, our reputation means more to us, and the care and the safety of your loved one means more to us than, you know, just telling you what you want to hear.

And we—

so when we do that evaluation, we just— we can determine usually within the first half hour, 45 minutes, this is a good candidate for care in the home. And if they're not, we'll tell the family, you know, these are your options. You can do memory care, right? Or you can go into a facility You can't just go from home to nursing home, though, because Medicare is not going to pay for it. You got to have an admission into the hospital for 72 hours before you can do that. But if we don't feel it's safe for your loved one to remain in the home, or we don't feel that we are going to be qualified to give them the care that they need in the home, we will let you know immediately. You know, we care probably as much, if not more, than you do because we want your loved one to be properly cared for. And we'll tell them the differences. You know, memory care, you're going to be in a locked unit. Some have outside grounds you can wander, some don't. You know, some have very restricted visiting hours. You know, and one of the hard decisions families need to make if they decide to do memory care facilities, at least in our area, is your loved one really at that point? Because some of these memory care facilities, these people are very far gone on the stage. You know, they're late, late stages. And if your loved one is still semi-coherent and able to, you know, relate and things like that, that might do a lot more harm to them than good. You know, you want to make sure they're at least around people of equal abilities or as close as possible. Um, with the care in the home, as long as there's not a safety risk to your loved one or to our staff, you know, we can create— and we do create, you know, memory care programs for them, do, you know, engagement of all the senses and You know, it's not just putting them in front of a television and, you know, sitting there. You know, it's very hands-on, and everything is custom-tailored to each individual family. You know, I tell people, you've seen one person with dementia, you've only seen one person, because everybody's going to react and relate to it differently and have different levels of capabilities, even in the same stages.

I think one of the problems that needs to be factored in to this whole scenario is most family members don't— aren't aware of what their loved one needs to provide them with the highest, most meaningful, purposeful, and high quality of life because they've never dealt with this before. So how do they know that what their loved one needs is the person-centered approach to care and not just being plopped in front of a television? Because we all know that that can accelerate their decline. So, um, I'm sure if they meet with you, you're going to explain that to them. But what if they, you know, they don't even know that that's really what they should be looking for in, um, a good care approach? Because they don't know what they don't know, right?

Well, you hope that they trust what you're telling them. Right? You know, we go in and part of, I think, helping them to realize we're not there just to quote unquote sell them something. We don't need to, nor do we have any interest. We want what's going to best benefit that loved one and the family. One of the reasons, Lisa, we don't even use contracts with our families. You know, I mean, tell me a business that's going to do that without contracts. We tell them, you use this as long as you want. Maybe maybe we start this, we get the care plan put in place, the memory care put in place, and then after, you know, the second or third visit, you guys decide, you know what, maybe this isn't what's going to best suit our family, then we just stop coming. You know, it's really that simple. Um, but I tell people, you know, talk to your doctors about it. You know, again, hoping you have a doctor that has a good understanding of, you know, the effects and, you know, um, process of dementia. And, you know, sometimes they do, sometimes they don't. And, but every doctor, regardless of their experience, they tell the families the best, most effective treatment for your loved one is keeping them in their comfortable, familiar surroundings for as long as you are able. Now, one of the things that home care does have going against it, unfortunately, but it is a reality for any home care company, you can't bill Medicare. You can't bill private health insurance. You know, it's either done— I was going to say you can either do it through long-term care insurance. Veterans has aid and attendance. Um, Michigan has auto injury coverage like all the other states, but ours had gotten, uh, reduced on the reimbursement. It's a whole nother topic for another show. Um, and then it's private pay. But I tell them, your assisted livings and your memory care facilities, they're not going to take anything different than what home care will. So it's not, you know, then you're down to nursing home and, you know, that's about it, right? Um, unless they have to be options for family, there's, there's not, you know.

That really brings me to my, um, the next question I was going to ask you since that kind of it's relevant to what you just said.

Yeah.

Are you also seeing a new trend because, you know, we've, we've talked about it and I agree with every single thing that we've been talking about today. It's just so important for families to understand all of this. We agree that somebody staying in their familiar environment for as long as possible is a good thing for a lot of different reasons until it's no longer safe. Or, you know, really, they're going to get probably better care when they really need help with every activity of daily living. And, you know, it's probably now the option that makes sense, but we want to prolong that as long as possible. But are you seeing that happening more regularly than families bringing their loved one into their homes with their families? And then you see— so what are you seeing out there in terms of keeping them in their own with, with maybe their spouse living there too, but having caregivers, maybe primary care partners, but they live, they're still living together as husband and wife. Um, or by themselves versus a lot of families are, uh, you know this probably better than I do, but a lot of families, um, are kind of being put in a position where they have to move their mom or their dad in to the— excuse me— to their homes, and maybe they have younger children. So what are you seeing there?

I have not seen a lot of, uh, the children having to move their parent into their home. I've actually seen more of the child, of course adult child, uh, moving into their parents.

Okay.

But, but overall, I would say it— the child and the parent have typically stayed in their own, uh, address, their own home. Um, and that's just, you know, the benefit of the parent usually have already paid off their house, or, you know, maybe 10 years ago they sold the home and bought a nice little condo. But for the most part, they have stayed in their own home. What we have seen though, and again, not common, but it happens, I'd say semi-regularly, where we'll meet with families. Like I said, we would, you know, families that we started off helping their loved ones either in a facility or in their home, and if they transition to another type of living environment, they— 9 out of 10 times we continue on with them. Until they no longer need our services, which is usually on their passing. Um, but what we have seen a lot of is families discovering home care after they sold mom or dad's home, put them in assisted living, and then after their probationary period, the assisted living says, well, we've determined mom is not a candidate for our, you know, community. Here are your choices: you either bring an outside company in to take all responsibility to provide the care for her, or we can advance her up to our next level of care, which just means more money. And that's usually a locked unit. And the family's stuck because they've already sold mom's house or dad's house. They can't move them out and just say, well, no, we're just going to take dad out and put him back in his home because a lot of them sold that property to then fund the living in the senior community. Right. So we've actually counseled a couple of families who ran into that and they ended up going and getting mom or dad just a one-bedroom apartment because essentially that's what they're going to have at the assisted living is a one or two-bedroom apartment. And why pay all that money to the facility who is now saying, we're, we're not going to retain any responsibility or liability because we're now officially informing you that mom or dad's no longer a viable candidate for our living arrangements here. You have to get an outside company that's going to assume all responsibility, but they can keep their room, right?

And I think for a lot of people who are listening, will be listening to this, uh, if they're not aware. So assisted living and memory care are what's called a social model, not a medical model, which is actually synonymous with a nursing home. And the difference is you don't get one-on-one care in assisted living and even in memory care because they are— they do fall under the category of a social model. And so if a person needs more care with, with, you know, either if it's socialization, interaction, or because of activities of daily living, they do ask you to bring in outside help, and you're still paying the cost of the assisted living and/or the memory care, plus the cost of the additional care. And a lot of families want to, you know, feel that their loved one is getting adequate attention. So do you want to speak to that? I know that you probably have to—

Yeah, I could close with this. I I just implore families and, you know, your listeners, when shopping for assisted living and weighing your options for care, ask yourself two questions. One, does my mom or dad—

do—

would they be happier living in a facility or in their own home? I think number one is always going to be happier in their own home.

Oh yeah.

But is it safe for them to do so if we have outside care come to them? And the other nice thing about that is you can make the schedule. Maybe they only need help every couple of days for you know, 4, 5 hours. Maybe they need 24-hour, 7-day-a-week care. But if your answer is they need care, assisted living is probably not going to be the right choice for you. But if you decide maybe it is and you go that route and you're doing a tour, I always recommend do a tour unannounced. Don't let them know you're coming. Just go in, walk around. They're going to think you're a family member just visiting somebody in one of the rooms. They're not even going to ask you a question. But you also want to ask the tough questions when you are ready to talk to them. Find out exactly what's covered, what's not covered, and how do they judge and, you know, assess the, the residents. How do you know your mom's going to be a good fit, even though she is today, that she's going to be a good fit in 6 months or 12 months? You might be making another move either to another level at that facility or having to take her out and put her into a different facility. Just ask the tough questions. You know, we had a family real briefly that, you know, we were helping, um, 5 days a week. We kept telling the family, Mom needs more help, Mom needs more help. They had long-term care insurance, so they were very fortunate. They weren't having to private pay or anything. And the son lived out of state. He would call Mom, everything always sounded fine on the phone, very superficial conversation. The daughter was you know, a very busy business person working, you know, seemed like 7 days a week. And she also had young children. So she wasn't— and she lived about an hour away, so she couldn't come and see things firsthand quite often. Mom ended up taking a serious fall. We weren't at the home because, again, we were only there a few days a week. Mom took a serious fall. The family called us the next day and said, you know, Mom's in the ICU. They found her at the bottom of the stairs. I mean, we were devastated because it was the nicest lady. While she was in ICU, they set up an interview with an assisted living in our community. They came while mom's in the ICU and evaluated her as being qualified to move into their community. And the family, we explained, we said, we don't think your mother is going to be a good candidate, not at all. And they went ahead and moved her in. Within 48 hours, the daughter's calling us in tears, just devastated. The facility said, Mom's not really a good candidate. Well, I mean, we knew that, and the facility probably knew that too, Lisa, but they moved her in because, you know, once you get them in, a lot of families aren't going to bother loading and packing and moving out. And so they paid for the next level of care. So it was like almost double what they moved Mom in at. She got to that level, and after a month, the facility is saying Mom's not a good candidate for this level of care either. Now your choices are move Mom out, or you have to hire an outside help to come in to be with her 24 hours a day, 7 days a week. And I mean, it was— it— I just— my heart went out to that family because they just were so taken advantage of, you know. And the daughter finally was realizing, you know, how could you say my mom was a good candidate when she's laying in an ICU bed to be in your assisted living. You had no way to judge her abilities or capabilities, and it was just— it was really hard. It was a tough decision. So we always tell families, make, make time to really ask the tough questions and get direct answers.

Yeah, that's really, really good advice. So before we let you go, Lance, um, I've got two questions for you real quick. Do you You only, you know, correct me if I'm wrong, you only serve the state of Michigan?

Southeastern Michigan. Yes. So like the bottom half of the state.

Okay. But your podcast is broadcast, is it globally or just—

Globally.

Okay.

It's globally.

Yeah. So I'm sure a lot of people that have been listening to our very powerful discussion today would love to tune into your podcast. You are a, you know, wealth of information. And so how— tell us about how they can access your podcast.

Well, they can go to our official website, which is allhomecarematters.com, all one word. But they can also find us on all the major podcast streaming platforms, or the videos are all on YouTube and social media. Just type in All Home Care Matters.

Good. Okay. Thank you so much for taking the time to be here. I really enjoy our conversations. This is our second net one. We had the one at the summit and now today, and I hope that you would come back on and we can—

Oh, anytime.

You're a delight to have, and I really appreciate you being here.

My pleasure.

Okay, well, you take care, and we're gonna have you on our show.

So we'll have that.

I love that. Okay, so, um, that all— that's our episode for today's show of The Truth Lies in Alzheimer's. I'm Lisa Skinner, your host. I hope you've enjoyed, uh, my very powerful conversation with Lance Slatton today, and, um, If you are interested in what else he, great advice he has to offer you, then now you've got 2 podcasts to turn into.

All right.

Take care.

Bye-bye.

Bye-bye. Thank you for listening to Truth, Lies, and Alzheimer's. We hope you found something in today's episode that helps. We understand that Caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.