Caregiver Support Is The Best Medicine-Interview with Dr. Warren Wong

Welcome To Patty’s Place

SPEAKER_02
0:08

Welcome
to
Patty's
Place,
a
place
where
we're
going
to
talk
about
grief,
dementia,
and
caregiving.
This
podcast
is
in
honor
of
my
mom,
Pat,
who
passed
away
from
dementia
about
two
and
a
half
years
ago
now.
I'm
your
host,
Lisa,
and
this
is
a
place
where
you'll
know
that
you're
not
alone.
So
grab
your
cup
of
tea,
your
cup
of
coffee,
or
if
you're
having
a
really
bad
day,
a
glass
of
wine,
and
we
will
get
talking
today.
Today
I'm
very
excited
about
our
guest.
It's
Dr.
Warren
Wong
out
of
uh
he's
a
clinical
professor
with
the
University
of
Hawaii
School
of
Medicine.
Uh,
and
you
focus
on
geriatric
services
uh
with
in
design
for
the
senior
segmentation.
So
I'm
very
excited.
Thank
you
for
being
here
today.

SPEAKER_00
0:48

Thanks
so
much,
Lisa.
I'm
happy
to
be
on
Patty's
place.

SPEAKER_02
0:52

Yes,
I
think
there's
just
so
much
to
talk
about.
Uh
you're
also
the
founder
of
geriatric
services
at
Kaiser
Permente
in
Hawaii,
is
that
correct?

SPEAKER_00
1:02

That's
right.
And
uh
I'm
uh
I'm
retired
from
Kaiser,
but
uh
I
was
part
of
the
National
Planning
Committee.

SPEAKER_02
1:08

So
okay.

Dr Wong’s Path To Geriatrics

SPEAKER_02
1:10

Well,
can
you
tell
us
a
little
bit
about
your
background?
Like
what
drew
you
to
specialize
in
geriatric
medicine.

SPEAKER_00
1:17

Well,
you
know,
I've
been
at
it
for
uh
40
years,
and
um
even
before
I
ever
applied
to
med
school,
um
I
was
really
drawn
to
care
of
seniors.
And
uh
it
was
a
way
of
both
serving
the
community
that
I
I
um
felt
uh
affinity
to
that
I'm
Chinese
American
and
I
felt
a
strong
affinity
to
um
uh
uh
my
uh
hometown,
Chinatown,
San
Francisco,
Chinatown.
And
uh
there
were
some
very
uh
innovative
things
being
done
back
then,
and
I
was
thrilled
to
um
experience
the
working
in
in
a
team
with
one
of
the
original
PACE
sites,
or
the
actual
original
PACE
site
uh
called
Onlock
in
San
Francisco.
And
I
just
really
enjoyed
the
um
the
work,
the
um
more
holistic
way
of
providing
care
for
seniors,
not
just
putting
them
in
nursing

How PACE Keeps Seniors Home

SPEAKER_00
2:19

homes.
So
and
what
what
is
the
PACE
program
The
PACE
program
is
a
national
uh
program.
It
started
in
San
Francisco
at
Onlock.
Onlock
is
Chinese
for
peace
and
happiness.
And
it's
a
program
that
uh
people
enroll
in
and
get
all
their
services,
both
traditional
Medicare
services
and
an
expanded
set
of
support
services,
uh,
while
continuing
to
live
in
the
community.
Um
and
there's
a
lot
of
emphasis
on
them
being
at
a
day
health
center
uh
to
get
services
during
the
day.
Uh
during
while
they're
at
the
day
health
center,
they
uh
can
get
uh
physical
therapy,
a
lot
of
recreational
therapy,
socialization,
and
your
providers
are
right
there.
So
uh
it
would
be
typical
for
uh
a
person
to
be
involved
in
activities.
And
if
I
wanted
to
see
the
person,
uh
that
person
would
just
be
wheeled
into
a
separate
area
and
we
would
do
uh
a
short
clinic
visit.
Or
once
in
a
while
I
would
just
drop
by
into
the
activities
area
and
just
feel
the
person's
pulse
just
to
make
sure
that
person
was
doing
fine,
and
that's
the
work
way
uh
the
PACE
sites
work,
they're
all
across
the
country
now.
It's
a
Medicare
benefit
for
people
who
qualify,
and
there
are
a
large
number
of
uh
of
Medicare
um
programs
across
the
country,
uh
PACE
programs
across
the
country
now.

SPEAKER_02
3:51

Oh,
okay.

When 911 Is The Wrong Answer

SPEAKER_02
3:52

And
in
your
opinion,
how
should
healthcare
for
seniors
evolve
to
better
meet
their
unique
needs?

SPEAKER_00
4:00

Well,
I
think
it
it
must
it
really
needs
dramatic
change
in
terms
of
not
just
thinking
about
disease,
but
thinking
about
the
person,
how
it
impacts
the
person
and
how
to
um
to
optimally
provide
you
know
quality
of
life,
dignity
and
and
and
respect
for
older
people.
And
the
uh
I'll
give
you
a
very
specific
example
of
of
that,
uh
Lisa,
is
that
uh
you
know,
throughout
the
country,
you
you
when
you
call
your
physician,
they'll
it'll
pretty
much
end
with
the
comment
if
you
are
have
any
kind
of
emergency,
please
call
911.
Right.
Well,
that
doesn't
really
serve
a
lot
of
older
people
very
well.
I
mean,
if
you're
a
frail
older
person,
uh
I
always
like
to
make
the
point
that
if
you're
frail
and
elderly,
calling
911
can
be
a
one-way,
a
one-way
call.
And
by
that
I
mean
it's
invariably
that
if
you're
if
you're
about
age
of
85
or
older,
um
if
you
go
to
the
emergency
room,
there's
a
50%
chance
you're
gonna
be
hospitalized.
And
once
you're
hospitalized,
there's
about
a
50%
chance
you're
not
gonna
go
straight
back
home.

SPEAKER_02
5:19

Oh,
I
did
not
know
that.
Okay.

SPEAKER_00
5:22

Yeah,
so
um
it's
not
the
most
supportive
way.
And
uh,
you
know,
a
lot
of
older
people
say,
please
don't
send
me
to
the
emergency
room.
And
there's
a
lot
of
reasons
for
that,
and
they're
legitimate
reasons.

SPEAKER_02
5:34

Yeah,
I
I
wasn't
aware
of
that
statistics.

Culture Guilt And Asking For Help

SPEAKER_02
5:38

Can
we
talk
a
little
bit
about
like
cultural
expectations
and
like
the
language
barrier
and
maybe
the
prejudice
that
plays
the
role
for
caregivers?
I
know
uh
you
highlighted
this
in
uh
the
the
your
future
book
coming
out
that
you
sent
me
some
information
on
it.
But
I
think
that
cultural
expectations
plays
a
role
in
things.

SPEAKER_00
5:59

Yeah.
So
uh,
you
know,
uh
it'd
be
really
great
if
we
talk
about
the
importance
of
support
for
caregivers.
Um
and
you
know,
the
whole
concept
is
that
uh
you
you
know,
the
traditional
healthcare
system,
you
go
to
a
physician,
then
you're
always
expecting
a
medicine.
Uh
and
of
course,
as
you
know,
Lisa,
uh
medicines
for
all
Alzheimer's
disease
and
dementia
in
general
are
only
modestly
effective
at
most.

SPEAKER_02
6:32

Yes.

SPEAKER_00
6:33

And
I
like
to
make
the
point
that
the
the
best
medicine
for
a
person
who
lives
with
dementia
and
for
the
caregiver
is
to
get
support.
And
that's
more
effective
than
than
uh
the
the
just
getting
a
medicine
from
your
doctor.
And
there's
some
cultural
aspects
of
that
is
in
that
you
know
many
people
uh
who
are
older
have
uh
you
know
come
from
different
cultures,
and
getting
support
uh
means
a
lot
of
different
things.
Um
a
lot
of
caregivers
feel
like
within
their
culture
that
it's
their
obligation,
um
and
asking
for
help
from
other
people
and
imposing
that
help
from
other
people
on
a
person
uh
who
uh
in
a
frail
elder
person
is
is
not
uh
it's
not
what
is
expected.
It's
it's
um
it's
expected
within
culture
that
it's
done
within
the
family.
And
um
uh
I
think
there
are
things
some
things
that
need
to
be
overcome
with
that.

SPEAKER_02
7:43

Yeah,
I
think
that
is
hard
because
I
know
that
when
with
my
mom
when
she
was
in
memory
care,
uh
there
were,
you
know,
I
got
to
know
different
family
members
of
other
patients,
uh
other
residents,
and
that
came
up,
you
know.
The
the
one
woman,
she
was
like,
Yeah,
she
was
Hispanic,
and
she
said
it
was
just
in
the
culture
that
she
was
supposed
to
take
care
of
her
mom,
and
she
had
to
fight
her
brothers
because
her
mom
was
getting
into
cars
with
people
she
didn't
know,
you
know,
and
like
they
just
they
just
kept
saying,
Well,
you
can
take
care
of
her,
and
she's
like,
No,
I
I
can't.
I
need
help.
And
she
struggled
with
that.

SPEAKER_00
8:18

Yeah,
yeah.

Getting A Dementia Diagnosis During COVID

SPEAKER_00
8:20

Why
do
you
think
what
are
your
thoughts,
uh
Lisa?
Uh,
did
you
seek
out
uh
help
uh
in
caring
for
your
uh
for
Patty?

SPEAKER_02
8:30

Well,
my
mom,
I
noticed
my
mom
was
wasn't
herself
for
quite
a
while.
And
I
tried
to
get
her
help
and
she
refused
to
go
to
the
doctor.
I
even
had
her
at
our
at
our
primary
doctor,
uh,
who
she
knew
and
loved
for
years.
She
refused
to
take
the
simple
little
memory
test.
She
just
would
not
take
it.
Wow.
Yeah.
She
just,
and
um,
I
think
on
some
level
she
knew
something
wasn't
right,
but
if
you
brought
it
up
to
her,
she
got
very
upset.
So
finally,
when
she
didn't
know
who
my
dad
and
I
were
in
the
house,
I
told
my
dad,
we
have
to
do
something.
You
know,
and
luckily
my
parents
had
done
powers
of
attorney.
Uh,
and
and
this
was
all
during
COVID
as
well,
of
course.
And
uh,
we
took
my
mom
to
the
emergency
room
with
the
power
of
attorney,
and
you
know,
they
diagnosed
her
right
away
with
dementia.
And
uh,
she
they
diagnosed
her
with
moderate
to
severe.
Um,
she
lived
with
me
for
a
month,
and
that
as
we
were
trying
to
find
a
place
for
her
because
they
told
us
we
weren't
gonna
be
able
to
take
care
of
her
at
home
because
she
was
very
mobile
still,
even
though
which
was
highly
unusual
for
the
state
of
her
dementia.
So
it
you
know,
it
did.
It
took
a
while
and
it
was
very
overwhelming
because
I
was
like,
I
I
don't
know
where
to
go.
What
do
I
do?
You
know,
like
what's
the
best
place
uh
for
that
uh
with
that.

SPEAKER_00
9:56

So
it's
interesting.
Um
you
raised
so
many
points
there
right
away.
One
point
is
that
um,
and
that's
a
whole
different
subject,
but
uh
how
people
are
so
afraid
of
memory
loss.
You
know,
they're
afraid
of
memory
loss
in
a
way
that
they're
not
afraid
of
a
failing
heart
or
failing
kidneys,
they're
much
more
afraid
of
a
of
a
failing
brain.
And
I
think
uh
those
kinds
of
fears
actually
make
the
problem
worse,
not
better.

SPEAKER_02
10:28

Yeah,
and
my
dad
had
a
very
hard
time.
He
just
kept
telling
me,
you
know,
oh,
she's
fine,
and
it's
just
age.
And
I
was
like,
something's
not
right.
And
so
I
I
struggled
for
a
long
time.
So
in
many
ways,
I
feel
like
I
lost
my
mom
years
before
I
actually
lost
her.
You
know,
because
I
I
could
just
tell
she
wasn't
and
people
came
to
me
and
said,
something's
not
right
with
your
mom.
And
I
was
like,
I
know,
but
I
can't
get
her
to
go,
you
know,
even
though
as
you
as
you
said
previously,
there's
really
not
a
lot
of
medications,
there's
not
much
they
can
do
for
it
um
with
that.

Trust Routines And The Green Light Days

SPEAKER_02
11:08

So
you
talked
about
too
uh
that
people
with
dementia,
they
resist
a
lot
of
new
routines.
So
what
advice
can
you
give
the
caregiver
for
that?
Because
I
I
noticed
that
with
my
mom
about
with
that.

SPEAKER_00
11:22

Yeah.
Well,
you
know,
there's
the
the
emotional
dementi
dimension
to
people
who
are
starting
to
um
lose
memory,
and
there's
uh
less
a
feeling
of
comfort
and
security.
So
the
space
that
a
person
feels
comfortable
becomes
smaller
and
smaller
and
um
and
there's
more
and
more
uh
anxiety
about
unfamiliar
situations.
So
um
uh
that
that
that
is
um
something
that
uh
you
know
need
needs
to
be
um
dealt
with.

SPEAKER_02
12:08

So
um
and
and
I
did
notice
that
with
my
mom,
like
she
didn't
want
to
go
out
as
much,
like
even
to
the
grocery
store
where
my
dad
ended
up
going
to
the
grocery
store
more
and
more.
Um
and
then
even
when
she
was
in
memory
care,
little
by
little
she
didn't
want
to
come
out
of
her
room
anymore.
You
know,
so
I
I
did
notice
that
she
just
she
just
didn't
want
to
do
it
anymore.
Like
I
could
tell
that's
where
she
felt
safe.
And
you
know,
uh
with
that.
So
would
you
oh
go
ahead.

SPEAKER_00
12:43

Well,
underneath
all
that
is
the
subject
of
trust
um
and
trust,
you
know,
if
it's
important
to
build
up
as
much
trust
as
possible.
And
it's
very
similar
to
building
trust
in
a
child.
You
know,
if
a
tr
a
child
trusts
you,
uh
they're
willing
to
do
more.
And
uh
trust
is
something
that's
really
important
uh
when
people
are
are
seeking
uh
out
to
um
move
things
along.

SPEAKER_02
13:17

I
was
gonna
say
that
is
very
true
because
there
were
different
times
with
my
mom
that
I
knew
she
trusted
me,
even
though
she
didn't
know
who
I
was,
even
in
memory
care.
Uh
she
would
get
very
upset
with
showers.
She
she
did
not
like
getting
showers,
and
she
would
like
get
so
upset.
And
if
I
was
there,
she
would
like
grab
onto
my
hand
and
be
like,
please
don't
leave
me,
please
don't
leave
me.
And
and
I
didn't.
And
I
it
sometimes
it
took
me
over
an
hour
to
calm
her
down
with
things,
but
it
was
like
I
knew
she
trusted
me.

SPEAKER_00
13:50

So
yeah,
and
it's
really
interesting
that
uh,
you
know,
there's
a
lot
of
uncertainty
when
you're
taking
care
of
a
person
uh
who
has
uh
uh
dementia
or
Alzheimer's
disease,
and
every
day
is
different.
There
may
be
a
day
in
which
everything
seems
fine,
and
it's
it's
a
green
light
for
things,
and
other
days
in
which
it's
a
yellow
light,
and
other
days
in
which
it's
a
red
light.
When
it's
a
red
light,
you
may
as
well
not
try.
Uh
the
skill
is
when
it's
a
yellow
light
and
turning
that
yellow
light
to
a
green
light,
and
sometimes
what
you
find
is
that
you
can't
get
things
done,
but
sometimes,
you
know,
for
whatever
reason
somebody
else
can
get
things
done,
which
I
which
gets
back
to
the
whole
issue
of
why
support
is
so
important
and
getting
different
people
to
help
out.

SPEAKER_02
14:48

Yeah,
because
sometimes
uh
I
used
to
be
able
to
get
my
mom
to
change
her
her
pants
when
she'd
have
accidents,
and
then
after
a
while
I
she
wouldn't
let
me
do
it,
but
a
caregiver
could
do
it
for
her,
you
know,
with
it,
the
ones
that
she
knew
and
she
liked
uh
with
that.
Uh
do
you
do
you
have
any
idea?

SPEAKER_00
15:08

The
really
things
in
life
really
change
uh
when
a
support
system
uh
gets
put
in
place.
And
sometimes
you
may
be
the
most
familiar
person
and
less
likely
less
able
to
get
things
done
than
someone
who's
less
familiar,
but
somehow
seems
to
be
in
a
different
role.
Um
so
that's
why
it
takes
a
whole
team.

SPEAKER_02
15:33

Yeah,
it
definitely
does.
Do
you
have
any
insight
as
to
why
people
with
dementia
don't
like
to
take
showers?
Like
on
the
medical
side
of
it?

SPEAKER_00
15:44

Well,
uh,
you
know,
um
that
is
a
very
common
um
problem.
And
my
own
personal
opinion
is
that
it's
it's
it's
a
very
um
it's
it
it's
not
it's
in
the
more
in
the
primitive
areas
of
the
brain
about
the
relationship
between
living
in
water
and
and
fear
of
water.
And
uh
that
uh
being
in
an
environment
that
uh
being
surrounded
by
water
is
something
that
uh
people
start
to
feel
a
fear
of.

SPEAKER_02
16:29

Well,
my
mom
always
had
a
fear
of
water,
so
that
would
explain
a
lot
for
my
mom.
Uh
with
that.
And
and
you
mentioned
before
that
it
takes
a
village,
and
I
know
that's
uh
one
of
your
is
that
the
gonna
be
the
title
of
your
book,
or
is
that
was
the
title
of
the
one
chapter?
So
let's
talk
about
you
have
a
book
coming
out
soon.

SPEAKER_00
16:47

It's
it's
a
theme
in
that
one
chapter.
I
think
the
title
of
my
book
uh
will
relate
it,
relate
will
relate
to
gold,
G-O-L-D,
which
is
an
acronym
for
for
getting
older
with
love
and
dignity.
And
uh,
you
know,
when
you
talk
about
the
healthcare
system,
uh,
does
it
really
help
people
get
older
with
love
and
dignity?
I
would
say
if
you
look
at
the
way
things
are
actually
done,
um,
you
know,
in
some
ways
yes,
but
in
many
ways
no.

SPEAKER_02
17:20

I
would
agree
with
that.
Uh
and
you
have
a
lot
of
information
uh
that
you
had
sent

Medicare GUIDE And 24 7 Support

SPEAKER_02
17:26

me.
So
you
said
that
there's
some
uh
Medicare
has
some
new
initiative
guide.
Where
could
people
find
some
of
that?
Because
that's
very
overwhelming
too
with
Medicare.

SPEAKER_00
17:40

Yeah,
so
um
there's
a
new
uh
program
uh
from
Medicare
called
Guide,
G-U-I-D-E.
And
uh
it's
not
available
everywhere,
but
it
uh
was
created
because
there
was
a
broad
understanding
that
uh
the
traditional
healthcare
system
doesn't
really
provide
for
the
needs
of
people
who
have
dementia,
uh,
especially
as
it
gets
more
severe.
And
what
the
guide
program,
and
you
need
to
uh
do
a
little
bit
of
a
search
for
the
Medicare
guide
program,
and
they
will
actually
tell
you
sites
in
which
it's
offered.
It's
only
offered
via
traditional
Medicare
fee
for
service,
which
means
that
if
you
have
a
Medicare
Advantage
plan,
uh
they
won't
offer
it.
But
it's
being
rolled
out
across
the
country,
and
what
it
does
is
it
does
something
that
the
healthcare
system
doesn't
do
now.
Uh,
for
instance,
one
thing
it
will
do
for
is
that
24
hours
a
day,
it
will
provide
uh
uh
on-call
services.
So
if
you
have
any
question,
somebody
is
on
the
other
end
of
the
line
who
actually
knows
the
person's
record
and
history
and
has
expertise
in
dementia
care,
and
that's
24-7.
And
then
uh
for
certain
people
who
qualify,
they
will
actually
get
some
in-home
services
as
well.
Oh,
so
that
is
an
innovative
program,
yeah,
that's
being
um
rolled
out
across
the
United
States,
but
it's
not
uh
well
developed
in
many
sites
yet.
Um
but
it
is
something
that
is
important.
It
is
only
specifically
for
people
with
dementia.
They
also
offer
sometimes
some
degree
of
respite
services,
and
they
offer
uh
training
and
education
for
caregivers.

SPEAKER_02
19:46

Oh,
well,
it's
just
important
because
I
think
the
more
training
and
education
a
caregiver
gets.

SPEAKER_00
19:50

It's
much
better
than
what
exists
now
in
general
for
people
with
uh
dementia
and
their
caregivers.

SPEAKER_02
20:00

That's
good
to
know
uh
with
it
because
it's
so
overwhelming.

Care Navigation Versus Care Coordination

SPEAKER_02
20:04

You
also
mentioned
about
uh
care
navigation
and
care
coordination.
What
is
that?

SPEAKER_00
20:13

Yeah,
there
there's
a
big
difference.
So
it's
pretty
traditional
uh
I
I
don't
know
if
your
mom
Patty
was
ever
in
the
hospital,
um
Lisa,
but
it's
very
very
typical
that
after
a
person
is
discharged
or
in
the
process
of
being
discharged
from
a
hospital,
it's
a
little
bit
overwhelming
because
a
lot
of
things
have
changed.
Um
a
person
uh
may
become
maybe
significantly
less
physically
capable,
and
people
will
say,
How
come
mom's
being
discharged
from
the
hospital?
She
isn't
well
yet.
And
the
answer
is,
well,
that's
not
the
purpose
of
an
acute
care
hospital.
It's
the
purpose
of
an
acute
care
hospital
is
to
just
get
them
out
of
the
woods
for
now
to
get
them
out
of
their
acute
illness.
And
uh
when
the
person
is
discharged
from
either
a
nursing
home
or
from
a
hospital,
a
lot
of
questions
is
uh,
where
do
we
uh
go
from
here?
And
the
typical
response
is
well,
this
is
what
you
need
to
do.
And
they'll
give
you
a
list
and
said,
You
need
to
do
this,
you
need
to
do
this,
and
you
need
to
do
this.
That
is
called
care
navigation.
It's
widely
available,
it's
done
in
most
hospitals
throughout
the
country.
It's
one
of
the
things
hospitals
are
rated
on
is
did
you
tell
the
family
what
to
do?
That's
a
lot
different
from
helping
the
family
do
it.
That's
true.
And
that's
what
care
coordination
is.
And
so,
care
coordination,
when
you
look
at
it,
is
not
widely
available.
And
that
is
one
of
the
things
that
the
Medicare
Guide
program
really
helps
with.
It
doesn't
just
tell
you
what.
To
do,
but
helps
you
get
things
done.
And
um
it's
a
little
bit
overwhelming
for
most
caregivers
to
say,
just
get
a
piece
of
paper,
well,
you
need
to
do
this,
this,
this,
and
this.

SPEAKER_02
22:13

And
it
was
overwhelming.

SPEAKER_00
22:17

And
that's
a
lot
different
from
care
coordination,
which
says,
Well,
this
is
what
needs
to
be
done.
Would
you
would
would
it
be
okay
if
I
help
you
do
it?
And
I'll
help
you
coordinate
this,
I'll
help
you
set
this
up.
That's
not
typically
available
from
hospitals.
It
is
available
sometimes
from
specialized
programs.
Uh,
like,
for
instance,
uh,
in
some
places,
like
if
they
have
a
a
memory
care
uh
clinic
in
a
major
hospital,
uh,
sometimes
they'll
do
things
like
that.
It's
very
similar
to
what
happens
when
a
person
has
cancer,
that
they
will
actually
coordinate
care.
They
will
make
sure
that
care
is
seamless.
They
won't
just
give
you
instructions.
And
that's
a
big
difference
between
navigation
and
coordination.
And
that's
a
big
gap
in
our
healthcare
system.

SPEAKER_02
23:10

I
would
agree
with
that.
Yeah,
because
they
gave
me,
you
know,
here
and
I
had
to
do
most,
pretty
much
all
of
it
on
my
own.
Uh,
you
also
talked
about
uh
dementia
villages
and
memory
cafes.

Dementia Villages And Memory Cafes

SPEAKER_02
23:23

Uh
I
know
in
is
it
Finland
that
they
have
like
a
dementia
village,
but
you
said
that
there's
some
places
in
the
United
States
are
starting
to
possibly
do
this.

SPEAKER_00
23:33

Yeah,
it
it's
a
concept
that
uh
is
uh
was
started
in
uh
Holland
and
uh
is
has
been
replicated
in
very
in
which
people
live
in
very
safe
environments.
Um
they
they
they
become
eligible
when
they
have
dementia.
And
the
safe
environments
are
environments
that
feel
uh
very
familiar
to
them,
and
so
it
might
be
something
that
feels
stuck
in
time.
Now
it's
it's
an
interesting
concept,
and
they've
also
had
some
similar
efforts
in
Japan.
Um
and
in
the
United
States,
um,
there
is
one
site
that
is
preparing
that.
I
think
those
are
interesting
things.
I
don't
think
they're,
you
know,
those
things
are
definitely
not
widespread
in
the
United
States.
But
uh
the
memory
cafes
are
um
also
a
concept
that
is
somewhat
familiar
in
the
United
States,
and
you
need
to
Google
search
it,
but
various
sites
will
uh
have
little
social
meetings
in
which
people
with
memory
problems
get
together
and
uh
either
have
activities
or
um
just
talk
about
uh
things
from
the
past.

SPEAKER_02
24:51

So
and
I
have
to
say
sometimes
it
was
quite
entertaining
listening
to
uh
two
or
three
different
dementia
patients
talk,
you
know,
because
like
they
talked
about
all
kinds
of
things
and
you
just
followed
along
with
them.
And
sometimes
it
was
funny
just
listening
to
them.
And
I
didn't
mean
I
don't
mean
that
in
a
bad
way,
but
like
it
was
just
entertaining,
and
like
you
just
listened
and
went
along
with
them,
and
you
I
would
laugh,
you
know,
uh
for
it.

Doing Things With Not To

SPEAKER_02
25:17

You
also
talk
about
a
cut
these
concepts
of
doing
two,
doing
four,
or
doing
with,
and
you
recommend
doing
with.
Can
you
explain
that
for
people?

SPEAKER_00
25:28

Yeah.
So
doing
two
is
something
that
the
healthcare
system,
again,
uh
does
too
often
to
um
people
who
are
frail
and
ugly.
Doing
two
means
if
you
have
an
emergency,
call
911.
Because
doing
two
means
that
it's
not
something
that
is
very
friendly
or
supportive
of
dignity.
Um
and
it
actually
imposes
something
on
a
on
a
on
a
person
that
the
person
may
not
actually
want.
Um
so
a
very
typical
example
of
doing
two
um
is
putting
a
person
in
a
nursing
home.
So
there's
a
double
whammy
that
you
become
frail
and
elderly
and
you
may
have
memory
problems,
and
then
on
top
of
that,
you're
re
you're
instead
of
being
supported
uh
with
all
those
challenges,
you're
put
in
a
nursing
home,
which
is
probably
you
know
one
of
the
reasons
that
people
don't
like
to
be
diagnosed
as
having
memory
problems
because
of
the
fear
that
this
is
what's
going
to
be
done
to
them.
Now,
I
can
see
that
yeah
to
them
is
worse
than
for
them,
which
is
a
lot
of
times
people
say,
Well,
this
is
good
for
you.
You
need
to
do
this,
and
people
say,
Well,
this
is
good
for
you,
take
a
shower,
get
a
bath,
this
is
good
for
you.
And
it
is
good
for
them,
uh,
but
it's
not
something
that
they
really
necessarily
really
want
to
do.
And
the
optimal
is
when
a
person
is
able
to
do
something
that
says,
I'm
doing
this
with
you,
so
that
the
person
feels
like
this
is
helpful
to
me
as
well.
Now,
it's
it's
an
ideal
goal
is
doing
things
with
a
person,
um,
but
um
I
think
it
needs
to
be
thought
of.
So
when
it
comes
to,
for
instance,
like,
what
are
we
gonna
do
with
mom
as
she
gets
into
a
more
advanced
stage,
or
what
are
we
gonna
do
with
mom
when
uh
when
it's
just
becoming
overwhelming
in
various
ways,
people
have
to
make
decisions
and
they
have
to
think
a
little
bit.
Are
we
doing
this
to
her,
for
her,
or
with
her?
And
you
really
want
as
much
as
possible
to
do
things
with
her.
It's
not
always
possible,
but
certainly
you
don't
you
really
want
to
avoid
doing
things
to
a
person,
which
means
for
your
benefit,
but
not
really
something
they
wanted.
And
uh,
you
know,
as
a
geriatrician,
uh
that's
a
a
conceptual
framework,
but
what
it
actually
means
in
specific
situations
needs
to
be
tailored.
For
instance,
you
were
saying
that
despite
your
mom
having
a
significant
degree
of
cognitive
impairment
dementia,
she
was
still
able
to
walk.
And
so
uh
an
intervention
that's
tailored
to
her
is
a
lot
different
from
an
intervention
that's
tailored
to
somebody
who
can't
walk.
And
of
course,
somebody
who
walks,
one
of
the
common,
you
know,
specific
issues
that
comes
up
is
wandering.
And
how
do
you
manage
that?

SPEAKER_02
29:04

Yes,
and
she
did,
uh,
she
got
out
twice
in
one
night
uh
when
she
was
living
with
me
in
the
house,
and
I
was
right
there
when
she
did
it.
I
mean,
she
was
fast,
and
luckily
I
caught
her.
She
only
got
to
like
my
neighbor's
driveway
and
is
like,
you
know,
in
the
middle
of
the
night,
you
know,
and
she
just
thought
she
was
gonna
go
visit.
And
I
was
like,
no,
no,
no,
we
we
need
to
come
in,
but
it
is
really
scary
when
that
happens,
you
know.
I
I
I
see
how
easily.

SPEAKER_00
29:33

Yeah.
The
Alzheimer's
Association
really
uh
talks
a
lot
about
wandering
and
it's
uh
Lisa,
you
mentioned
how
scary
it
is,
and
it's
scary
for
a
reason.
The
statistics
actually
are
really
concerning.
Um
if
a
person
gets
lost
for
more
than
24
hours,
you
can't
find
them
for
24
hours,
there's
a
good
probability
um
that
there's
a
major
injury.

SPEAKER_02
30:06

Okay.

SPEAKER_00
30:07

So
if
you
don't
find
a
person
within
the
first
24
hours,
it's
definitely
a
situation
uh
in
which
the
outcomes
become
more
and
more
problematic.
So
um
that's
why
when
somebody
gets
lost,
it's
important
to
to
to,
and
there's
there's
a
different
chapter
in
my
book
about
special
situations
that
it's
really
important
to
seek
out
help
right
away.
And
um
you
really
want
to
find
a
person
within
the
first
hour.
Um
the
the
it
gets
more
and
more
difficult
to
find
a
person
as
the
time
passes.

SPEAKER_02
30:49

I
would
I
would
believe
that
because
they
they
don't
know
where
they
are
in
in
that.
So,
but
yeah,
that
was
very,
very
scary.
And
I
remember
calling
my
dad
at
4
30
in
the
morning,
and
he
came
like
a
few
hours
later
and
he
changed
the
lock
on
my
door
and
and
all
that.
But
I
I
didn't
sleep
well
because
I
knew
what
if
she
got
out
through
the
patio
door
and
stuff
like
that.
So
it
was
very
scary.

The First Step Toward Support

SPEAKER_02
31:10

So
when
what
do
you
know
when
your
book
will
be
coming
out?

SPEAKER_00
31:15

Uh
there's
a
good
you
know,
it's
taken
me
years,
um,
but
there's
a
good
chance
it's
gonna
come
out
this
year.
Okay.
Um
the
the
chapter
that
I
shared
with
you
is
about
um
uh
what
kinds
of
support
exists.
And
the
that
chapter,
I
won
uh
there
were
a
number
of
different
things
I
I
I
uh
I
delved
into.
One
is
that
you
know
it's
important
for
everybody
to
get
support,
um,
but
there's
a
large
number
of
people
who
really
hesitate
to
get
support,
and
there's
a
lot
of
different
reasons
for
that.
Um
and
then
I
also
talk
about
the
different
kinds
of
support
that
exists,
and
there's
a
lot
of
evidence
that
people
who
reach
out
for
support,
the
um
the
outcomes
are
a
lot
better.
Um,
the
outcomes
are
better
for
the
caregiver,
and
the
outcomes
actually
better
for
the
the
patient
as
well.
Um,
you
know,
caregivers
who
get
support
do
much
more
better
on
their
own
uh
emotional,
physical,
um
uh
well-being,
and
uh
are
able
to
lead
lives
that
are
that
still
feel
a
lot
more
connected.
Um
and
for
patients,
um,
when
support
is
in
place,
they
actually
are
able
to
live
at
home
a
lot
uh
significantly
longer.

SPEAKER_02
32:34

So
and
I
did
you
had
a
lot
of
good
information
on
in
there,
you
had
um
uh
were
people
books
that
you
recommended,
uh
different
things
they
could
watch
or
listen
to.
You
also
said
there's
a
best
practice
caregiving
database
that
people
could
have
access
to
as
well.

SPEAKER_00
32:55

Yes,
yeah,
and
and
again,
it
it
does
need
to
be
tailored.
And
part
of
it
is
that
you
know,
everybody's
different.
Like
some
people
will
readily
reach
out
for
help,
other
people
are
uh,
you
know,
for
a
lot
of
different
reasons,
maybe
cultural,
maybe
feeling
like
like
this
is
my
responsibility.
Some
people
feel
like
I
can
do
this
better
than
anybody
else.
Um
people
just
feel
overwhelmed.
Uh,
some
people
feel
um
that
um
they're
that
they
they're
that
the
help
out
there
is
not
really
that
good.
So
a
lot
of
people
approach
it
in
many
different
ways.
And
my
my
my
message
is
always
take
take
a
first
step,
no
matter
how
small
it
is.
If
it
if
you
want
to
just
start
out
with
a
really
small
step,
that's
fine.
But
uh
it's
really
important
that
to
seek
some
sort
of
help,
just
the
same
way
that
for
your
mom,
you
know,
she
was
not
willing
to
take
that
first
step
of
actually
getting
evaluated.
But
taking
a
small
step,
and
then
it
even
if
it
doesn't
lead
you
immediately
to
the
to
the
best
tailored
in
intervention,
the
best
tailored
support,
it
gets
you
started.
And
um,
then
you
kind
of
tailor
it
from
them.
And
you
know,
a
lot
of
times
when
people
have
at
the
early
stages,
they
mostly
want
education,
and
there's
a
lot
of
different
ways
to
do
that.
So
things
such
as
your
podcasts,
there's
some
um
uh
websites
that
just
provide
information.
Alzheimer's
Association
is
wonderful
for
that.
Um
there
are
some
sites
that
provide
structured
trainings
that
are
either
on
your
own
timeline,
like
you'll
you
go
through
different
modules
about
managing
this,
managing
that,
managing
financial
issues,
managing
behavioral
issues,
um,
uh,
managing
laundering.
Uh,
and
then
there
are
more
structured
uh
uh
courses
that
say,
well,
on
this
day
we're
gonna
talk
about
this,
we'll
discuss
it
on
this
day.
And
so
you
just
pick
out
what
works
best
for
you.
You
know,
there's
the
educational
aspect,
and
then
the
which
your
podcast
is
mostly
educational,
then
there's
others
that
are
more
about
caregiver
support,
emotional
support,
you
know,
support
groups
and
people
chat
together,
and
I
I
belong
to
some
of
those.
Um
uh
and
support
groups
are
really
good.
People
once
they
start,
they
really
find
uh
a
sense
of
being
able
to
talk
with
people
who
are
in
the
same
situation,
similar
situations
to
them.
But
what
I
find
is
that
a
lot
of
people
hesitate
to
ever
get
involved
in
a
support
group,
and
then
you
know,
then
other
things
like
you've
done,
Lisa,
is
which
actually
get
hands-on
support.
You
know,
you
you
got
your
mom
into
a
memory
care
unit
and
stuff
like
that.
And
so
there's
different
kinds
of
things
that
you
can
try.
Um,
and
of
course,
it
because
it's
very
individualized
because
uh,
for
instance,
there's
more
resources
in
urban
settings
than
there
are
in
rural
settings.
In
urban
settings,
you
know,
you
might
actually
find
programs
that
are
readily
available,
whereas
in
rural
settings,
you
might
need
to
just
get
more
help
online.
Um
and
then
there's
always
also
the
financial
issues,
you
know.
I
mean
if
you
have
a
significant
amount
of
money,
it's
gonna
help
a
lot.
If
you
don't
have
money
though,
you
should
not
just
give
up
and
say,
There's
no
help
for
me.
Um,
right.
You
know,
the
Alzheimer's
Association
is
very
good
for
that
with
the
helpline
with
live
people
that
say,
you
know,
how
can
I
get
help?
Um
in
every
region
in
the
United
States,
there
is
an
area
offices
on
aging,
and
they're
usually
more
knowledgeable
about
what
actually
exists
in
specific
areas.
But
it
does
take
that
first
reaching
out,
and
part
of
um,
you
know,
what
I
find
is
that
people
are
just
so
overwhelmed
with
just
what
they're
doing
that
they
really
don't
have
any
time
to
even
reach
out
for
that
little
bit
of
help
that
would
actually
make
a
difference.
Uh,
but
they're
so
they're
drowning
basically
in
their
immediate
day-to-day
activities
that
even
reaching
out,
and
the
analogy
I
use
is
you
know,
somebody's
in
the
water
and
they're
they're
they're
they're
afraid
of
drowning
and
they're
they're
they're
you
know
um
moving
their
hands
and
their
legs,
and
somebody
in
a
in
a
in
a
rescue
boat
comes
out
and
says,
just
grab
my
hand,
and
and
they
won't
grab
the
hand
because
they're
just
so
busy
just
trying
to
stay
alive
that
they
don't
reach
that
hand.
I
just
I
I
just
really
want
to
make
people
recognize
that
that's
the
that's
the
critical
time
they
need
to
reach
out
when
they're
when
they're
at
what
I
call
the
red
light
zone,
when
they're
not
sleeping
well,
uh,
when
they're
not
eating
well,
when
they
feel
totally
isolated,
when
they're
turning
to
sleeping
pills
and
and
alcohol
and
drugs
and
and
just
uh
uh
being
feeling
like
totally
overwhelmed,
that
is
a
big
red
light
sign.
That
is
exactly
the
time
you
desperately
need
to
reach
out
for
help.
And
the
help,
you
know,
it's
there.
I'm
not
saying
it's
always
easy
to
find,
but
it's
there.
You
just
have
to
take
that
first
step
and
just
reach
out.

SPEAKER_02
38:23

I
would
agree
with
that
because
all
the
time
we
spend
on,
you
know,
Instagram
or
Facebook
or
any
of
the
other
social
media
sites
just
doing
silly
stuff,
you
could
take
that
five
minutes.
And
even
if
you
start
with
like
the
Alzheimer's
Association,
you
know,
and
or
calling
the
helpline,
just
little
by
little,
even
if
you
do
it
for
five
minutes
every
couple
days,
it
it
helps
a
lot.
And
I
would
agree
with
you.
And
even,
you
know,
um
support
groups
sometimes
in
the
memory
care
facilities,
they
have
a
support
group
there.
Um
I,
you
know,
I
was
never
really
a
support
group
type
person,
but
now
I
go
to
a
few
of
them,
and
it
helps
just
because
I
know
that
there's
people
there
that
understand
what
I'm
going
through.
You
know,
they
they
understand
the
feeling.
And
a
lot
of
times
you
don't
even
have
to
say
anything.
If
you're
somebody
that
doesn't
want
to
participate,
you
could
just
sit
there
and
then
later
on
just
talk
with
the
person.
And
it
just
helps.
You
don't
feel
so
alone
with
that.

SPEAKER_00
39:18

So
so
you
you
like
that's
that
sounds
really
great,
Lisa.
That
that's
exactly
right,
you
know.
Uh
and
this
whole
point
you
make
is
you
don't
have
to
say
anything.
I
think
that's
a
really
important
point.

SPEAKER_02
39:30

Yeah,
you
don't.
You
could
just
listen
and
then
talk
to
somebody
later.
So
uh
we
look
forward
to
your
book
coming
out.
So
it's
uh
gold,
is
that
gonna
be
the
name
of
it?

SPEAKER_00
39:41

Uh
well,
we're
working
on
it,
but
the
concept
of
gold,
you
know,
getting
older
with
love
and
dignity.
And
uh,
you
know,
we
have
a
long
way
to
go.
I
I
sometimes
think
about
geriatrics
as
being
the
mirror
image
of
pediatrics.
And
uh,
you
know,
when
people
have
Alzheimer's
or
dementia,
it's
there's
an
analogy
to
to
children
with
special
needs
and
autism
and
issues
like
that.
And
you
know,
there's
a
very
strong
community
in
the
pediatric
world.
Um,
the
community
for
seniors
is
not
nearly
as
strong,
and
we
need
to
get
there.

SPEAKER_02
40:18

Yes,
I
would
agree
with
that.
We
really
do.
So
uh
so
I
hope
we
get
to
see
your
book
out
soon
then.
At
least
this
show.

Closing And Staying Connected

SPEAKER_02
40:27

Yeah,
thank
you
so
much
for
joining
us.
So
I
hope
you
enjoyed
this
edition
of
Patty's
Plays.
So
um,
I
hope
you
enjoyed
your
cup
of
tea,
your
cup
of
coffee,
or
if
you're
having
that
really
bad
day,
your
glass
of
wine.
Make
sure
you
leave
us
a
review
or
subscribe
to
our
YouTube
channel,
and
just
so
you
know
that
you're
not
alone
in
all
of
this.
We're
here
in
this
together,
and
hope
you
join
us
for
another
edition
of
Patty's
Plays.