Our host, John Gonzales, speaks with Teepa Snow https://www.teepasnow.com. Teepa's life mission is to shed a positive light on dementia. Teepa and the Positive Approach to Care team share about dementia so that everyone (including investors in assisted living) can understand why this is happening and how to support those living with brain change in a more positive and respectful way.
Our host, John Gonzales, speaks with Teepa Snow https://www.teepasnow.com. Teepa's life mission is to shed a positive light on dementia. Teepa and the Positive Approach to Care team share about dementia so that everyone (including investors in assisted living) can understand why this is happening and how to support those living with brain change in a more positive and respectful way.
We've got to change maybe perhaps how we see this role of supporting care with hands on support as a stepping stone to moving into some of our professions rather than it's something when you're not very good, you become one of these. And if you're really good, you become a healthcare provider. It's like, well, that's not true. If you don't know how to do this hands on stuff, how are you going to be the leader of this unit? If you have no idea how to what it takes to help somebody take a shower, what it takes to help somebody who thinks they've already gone to the bathroom, get up and maybe go and use use the toilet rather than become incontinent. And yet, you're going to become a social worker. And it's like, well, frankly, I think it would help you to know some things about human beings.
John Hauber:Welcome to the senior housing investors podcast. If you are an owner, operator, investor, developer or buyer of senior housing, you've come to the right place. The best way to stay connected with us is to sign up for our weekly newsletter at Havenseniorinvestments.com. This podcast doesn't exist without you, our community. Thank you for listening, and reach out to us anytime. Welcome back, everyone. Today, John Gonzalez, Senior Vice President of Haven senior investments, sits down with Teepa snow with Positive Approach to Care. For those of you that are working or living with dementia, you'll enjoy this episode. John.
John Gonzales:Thanks, John. We're honored to have on today's show one of the world's leading dementia educators. She's dedicated her life to developing methods and tools for caregivers, so they can better understand dementia and support those affected and living with the disease. She's the author of Understanding the Changing Brain and her company Positive Approach to Care has helped people all over the world are dealing with this disease. My guest today is Teepa Snow. Teepa, welcome to the show.
Teepa Snow:Well, thanks for having me. And I you sure I'm the right person. I know. I have done those things. But I'm glad to be here. How about that?
John Gonzales:Teepa? I'm just reading from the script you gave me so
Teepa Snow:talk to somebody about that stuff.
John Gonzales:Oh, just That's a joke. Just kidding. Now, yeah, but I do have to tell you what my 20 something year old daughter found out that I was going to be speaking with you today. She was absolutely giddy. She's a big fan. And she you know what's interesting is she didn't know about you and what you do until Tik Tok, and she started following your videos. And she was just so excited. I wanted to just thank you for letting me be the cool parent for a little bit. When she found out
Teepa Snow:to tell you that wasn't like they said they kept saying you got to do tick tock and I'm like, what? Really? I don't dance and I don't do much singing they go no, no, no, no. Everybody's on tick tock and just like oh, K and then like Helens besties we have some of our videos have like over 6 million views. And it's like what in the world?
John Gonzales:That is so crazy. Yeah. So Teepa I wanted to start off talking with you a little bit about the craziness over the last couple of years. Between the pandemic and social distancing lockdowns, you know, restricting visitors? Not to mention, you know, the labor shortages. What impact has the last two years had on our nation's seniors, particularly those suffering with dementia and Alzheimer?
Teepa Snow:So I think we know that there's layers to this. And the first is that we already understood that for people who are living with dementia, the more they became socially isolated, the higher the risk, that there would be symptoms and the symptoms would be profound. And we also found out that without use of skills, they prematurely lost some skills. So they would actually lose abilities sooner than they would otherwise lose abilities because they're not practicing. They're not using them and those synapses get real rusty real quick. And then if you try to reengage them, it's just too much damage to jump back on board. And so, you know, pre pandemic, we already knew social isolation of any kind is not good for people who are living with some brain change, whether it's depression or hearing impairment or dementia. So now we have that pandemic, which everybody had to not only stay in a pod In a family group frequently, but we were for people who are institutionalized or in a residential setting, we were having them stay in a room in a bed room. I mean, we gave them spaces to sleep in and go to the bathroom in but we were supposed to have people in the whole reason for the community was come out into the common space come be part of the community come for this come to eat, come to engage, come to do volunteer work, come out and be part of the community. And then for an extensive period of time, we said, no, no, no, no. And most places just said, You got to stay in your room, because that was the quote unquote, guideline for public health. And quite frankly, nobody really thought about people living with dementia is having special needs, much as small children have special needs. And it's devastating. I mean, we know that close to 50% of people living with dementia have access disability, now, they have lost prematurely we've had so many deaths premature to what they should have had, our previous numbers were nowhere near and they weren't COVID deaths. These were related to loss of a desire and a will to live and advancing conditions and falls and fall related injuries because people were isolated and not monitored, because people didn't do it.
John Gonzales:I heard you use the word disuse atrophy. At one point, can you explain a little bit about how that affected our seniors?
Teepa Snow:Oh, yeah. So if you sit in a chair, even though you're physically mobile, unable to get up and move around and walk two miles, If however, you end up sitting in a chair for a week, you at the age that you are, you're not that old would feel the sense of Wow, okay, I'm gonna get back into this. If you're a senior with dementia, you may never be able to fully get up and move around again, because it can happen that rapidly if you don't move out of a fixed position, and people don't have a reason to move if there aren't people in their lives and things to do. And so why bother getting out of the chair and I have some arthritis, and it's uncomfortable to move, it feels okay, sit and spill. But I'm also losing things like continence control. Because you have to control yourself, when you get up and go to the restroom. I'm losing, possibly oral health, because I'm not brushing my teeth as often. I may not be I might be eating a whole lot of stuff and not burning off calories. So now I've put some weight on, or what's the point of eating, so I'm not eating and now I've lost muscle mass. So what you or I, with a healthy recovery could do. The disuse, atrophy puts people living particularly with things like dementia at high risk of not coming back.
John Gonzales:It strikes me as one of the biggest challenges caregivers had to face during that period of time is how to explain what's going on to someone with dementia. What did you see is some of the most effective ways of communicating to those to our folks.
Teepa Snow:Yeah, so one is often get rid of the news cast in the TVs because that that got people so anxious, so distressed, so scared, that they couldn't, they couldn't process. And so when we have somebody in distress, trying to get data in is really difficult. So for some people, frankly, they didn't really need to know that much about what was going on. And we have to gear what we're sharing with a person's ability, understand it. For instance, I could say, You know what, I'm not gonna be able to make it in this week. Is there anything though, that I could get you at the store? And I hate that I can't make it. I know, I'm really missing. Oh, let me ask you something. And so we do we go on to I explained, I'm not going to be there this week. I don't say, you know, I'm not going to be able to come for the next five months, as far as I know, because you're in court, you know, that's not valuable. Because time doesn't have the same meaning the passage of time doesn't have the same meaning. Or somebody who's more alert to time they go, why haven't you come? Now that tells me they didn't hold on to it the last time I brought it up. So you're wanting to know why I didn't come? Yeah, there's some new restrictions because this bug going around. It's sort of a virus and they don't want it to spread. And so what they're asking is we don't come in for right now. And I know that's really not something you want to hear. But I did send you a letter. And I don't know if it got there yet or not. It's got two cards in it and a picture. So rather than focus on what you can't have, I'm trying to come up with things that do matter. I think that there was a lot of mistaken Thinking about window visits for a lot of people, though, because if I can see you, why won't you come in?
John Gonzales:So do you think that that kind of approach the separate and save approach? Do you think that that really had more of a detrimental effect than actually, you know, being able to see your loved one through the window, but not be able to touch them?
Teepa Snow:Well, it didn't make sense for a lot of people. And they became frantic and they could see the person and all they want to do is be with them. And they were a part of their daily life, and suddenly, not at all, except I can see you outside. It's like, well, I'll just come out then. And it's like, no, you can't go out. I want out. So it raised the distress feature. And so for some people, they became quite distressed to the point of they would fight staff, right to get outside. And then they would cry at the window or beat at the window. Why won't you come get me out of here? What are you doing because they felt imprisoned? And there are large numbers of reports of people talking about being in prison. I feel like I'm in prison. I'm trapped. Why? Why is this happening? What have I done? I don't understand. I have never broke a law. I can't understand I have not. What have I done? What in this statement of what have I done? What have I done that sense of helplessness?
John Gonzales:Yeah, I think sometimes, with so many things, the solution, you know, is sometimes worse than the disease or the cause. Yeah, I think we suddenly saw, you know, especially with residents that require mental stimulation, I'm wondering, did you see any, any new best practices for being able to provide residents with that kind of mental exercise in the midst of the lockdowns and the pandemic
Teepa Snow:we did, we saw folks getting really creative. And we saw folks recognizing that we've got to figure something out. And so the something is create family pots. So we're gonna put like this small group of people, and we're gonna say, We're all in this ship together, can you all agree you're in the ship together. And with like, eight people, we are not, they're not going to wear masks, they can be together, they're going to eat together, and we just those people are isolated. And what was found was actually, those smaller settings were people living with dementia. And they have masks on, they weren't isolated in their room, they still use the common space, they did do those things. And staff were incredibly careful about their entry and their exit, and being really super careful about covers and things like that. And they found that the rates of getting COVID Were actually often lower in those settings. And the loss of abilities was like not, so the the stats were applying to those groups. Now, families still in those settings were often not allowed in. But they created the community, and they found community in the building among the people living with dementia and the staff. And it made a big difference for people, there was no locking people in a room system, that doesn't make sense. It's like saying, we're going to put a two year old in this room and a five year old in this room and let them be in there all day long. And I'll check on him every hour.
John Gonzales:Having grandkids that same age, I can tell you that that's not going to work for very long.
Teepa Snow:I mean, it's exhausting everybody. And that's the other thing is, you know, this wasn't just exhausting to is not helpful to residents, it wasn't helpful to staff. Because when I opened that door, I don't know what I'm now going to see. I don't know if somebody's on the floor. Oh, my gosh, how long has she been on the floor? You know, oh, my gosh, she's in the closet. What am I going to do? Because people get bored. I mean, human beings are curious creatures, frankly.
John Gonzales:Yeah, I don't think anyone would disagree with that that knows any other living human being. I want to pivot just a little bit to the challenges that the caring professions are experiencing as a result of the labor shortage. You don't have to get into all the reasons for the shortage. But the truth is, our industry has always had an image problem. We've never really been attractive or thought of as a sexy place for employment, particularly in the eyes of the younger workforce. Before it was difficult enough attracting people with the right heart to work or their residents. But over the last two years, it's just made it more difficult. So here's the question, What should our message be in trying to attract this next generation of workers to our industry? And what tools should we be using to deliver that message?
Teepa Snow:I think one of the things we've got to recognize is whatever the ultimate profession you think you want to go into is, the first is you've got to really learn how to engage with human beings if you're going to be a good healthcare provider. So this is an opportunity and maybe we start regarding this, this process of working with individuals who have often a variety of health care conditions, a variety of abilities and disabilities, a variety of cognitive abilities and disabilities. A variety of mental health challenges a variety of physical challenges. We invite younger people to be challenged by these situations and learn from them and and become sort of master clinicians by working your way through providing support and care to a small group and then a slightly larger group of individuals. But you start to see that caring that provision of the support for daily life for daily routines. If you don't know how to do that, how can you be an excellent physician? Not understanding what people want to do with their lives? If you cure them? Or fix them? Or can't cure them? How can you be a terrific nurse? If you don't have any idea of what it takes to help somebody go from seat to a to a shower? Or they won't do a shower? Well, what are some options of helping? You know, I think we've got to change, maybe perhaps how we see this role of supporting care with hands on support as a stepping stone to moving into some of our professions, rather than it's something when you're not very good, you become one of these. And if you're really good, you become a healthcare provider. It's like, well, that's not true. Because if you don't know how to do this hands on stuff, how are you going to be the leader of this unit? If you have no idea how to what it takes to help somebody take a shower, what it takes to help somebody who thinks they've already gone to the bathroom, get up and maybe go and use use the toilet rather than becoming continent? How do you help two people who think they like each other and know each other, but they've never been in the same place? That they find a relationship that makes everybody okay, how do you do that? If you've never, and yet, you're going to become a social worker. And it's like, well, frankly, I think it would help you to know some things about human beings. And I think it's a very different take on I think, how we see professionals versus people who do hands on care. And it's like, well, maybe we should go back to knowing how to do hands on care before you come up become a professional.
John Gonzales:I think there's a lot to be said for that. It's almost like an entry course into bedside manner. You know, if you know how to deal with this particular segment of the population, you're going to be a better healthcare provider to all of your patients, because you're looking at things through a different lens. So we want to attract employees. So the message is, hey, you know what, this is a great first step on your career path to becoming a social worker or a physician, a nurse. How do we communicate that message? How do we reach these people? We talked a little bit about tick tock and I was talking with my daughter again last night, she said, throughout Well, YouTube and Twitter and she goes down, those are antiquated. No one uses YouTube and Twitter anymore. We're using tick tock and she rattle off a couple other things. And now Okay, fair enough. How do we reach that next generation?
Teepa Snow:Yeah, I think we learned how do they like to learn and what's valuable for them and, and that's where my TIK TOK here's option one, here's option two. And it gives people like, Here's a more typical thing that people do and it's like, and here's the outcome. And here's what I'm suggesting. You could try and here's the outcome and people go well, I'll try option to this like, cool let me know how that works for you. And I think what we're seeing his people like practical simple, like okay, so he gave it to me and it's under three minutes. Let me go try it out. And then they like to comment on it. They like to give it's like a mini coaching session, if you would, in real time with with situations that ring true to them, because they don't like
John Gonzales:Yeah, absolutely. And I think understanding the way they absorb information I'm you know, I've learned so much just in conversing with my kids who now are young adults and what they gravitate towards. But the other thing that has happened over the course of this pandemic and the lockdowns in addition to the effect it's had on our residents is the effect it's had on our frontline employees. And we saw a lot coming out of the pandemic, as the vaccines are being rolled out. We still saw a lot of anxiety, a lot of stress. I was talking with executive directors, I was calling it PTSD post pandemic stress disorder, because there was so much of it. It was so prevalent. What is it that employers can do to help employees through this? God forbid we have another outbreak or another lockdown, but what can we do as employers to address those those needs in our frontline staff?
Teepa Snow:Yeah, I think one of the really, sort of really stand out thing is the sense of being time pressured. If you ask staff they'll say I don't think my employer has a clue how many minutes it takes to get somebody from a bedroom to a bathroom, use the toilet and you can't leave them alone for that. I mean, you you can't just leave them there because they won't stay without, you know, you got to be visually present. Now I can be doing a few things. But, you know, the appreciation for I'm not not working, not trying and acknowledge when I make a mistake, I mean that instead of feeling like being you're being watched, and you're being judged, a sense of being supported and I, the number of times I, I heard on tick tock people saying, we don't we have six minutes to get people up into the table. And it's like, that's an unrealistic expectation, I can say, realistically, that is an unrealistic expectation of anyone to be able to get another human being up out of bed into clothing and prepared to eat a meal in a dining area. So I think part of what we have to somehow appreciate is, okay, well, how many people could you care for? Asking a real question? Because if we continue to overload our workers, with not enough time and too much to do, and then continue to say, you're not getting it done, you need to go faster or work harder? Like, I'm not sure we're gonna keep very many people.
John Gonzales:Right, right. Now, it doesn't sound appealing even to me. So you're saying appreciation, understanding the individual's problems. So it's almost like a person centered approach to your staff as well as to your residence? Correct?
Teepa Snow:Yeah. I mean, if you want them to, if you want them to have a person centered approach to care, then you've got to be person centered with them. And just as we're saying, We want families to be satisfied, well, then I got to have a connection to families other than I only call them when well, she your daughter, you know, she failed last night, and I want you to wanted you to know she's okay. And it's like, I got a call and say, Oh, I wanted to let your mom know what your mom just had a terrific morning. And I had, you know, we had this thing where we do the video, I'm gonna go ahead and send it to you, because I want you to see her. She was so excited. That's my phone calls. So that when I call there's not this, oh, my god, what is it this time the other shoe is gonna drop? You know, and there is a sense right now among the public in families that there aren't enough staff. So it's a little because that was somebody with her. And I was like, actually, yeah, we were. And she just surprised everybody, cuz she stood up, and she decided to turn and she doesn't usually do that. And sure enough, she usually just stands up, as you know, you know, surprises happen. But, you know, this whole thing of litigious society, it puts carers and again, carers are feeling in the crosshairs.
John Gonzales:That's interesting, the tight labor market. And what we're talking about here is really given rise to okay, how do we deal with this? And one of the things and I think, justifiably so that the industry has moved towards increasing those wages for those frontline people, you know, if we can't even compete with fast food chains, then shame on us. So it's been something that's always been kind of a problem that I've seen. And yet, in order to address it, you have to convince the powers that be that, hey, we're going to take 1% less than our profit margin so that we can provide quality services, and we can compensate our staff fairly for what they're doing. But that's creating another problem, you know, the largest growing demographic we have right now is the senior population. But within that growth, the middle market really is the section that's burgeoning. So how can we continue to provide care services, even Person Centered approaches to our staff without pricing the middle market out, and really, you know, giving them fewer and fewer options?
Teepa Snow:I think what we we I mean, this is this is going to be the radical statement is I don't think we can leave family out of it, I think we really have to look at support networks that are friends and family, and we've got to build them into the care support system. We've got to quit viewing them as these nice to visit but not essential elements to care. And we've got to sort of start being realistic about you're not going to be able to cover this care with with the cost that it is unless we get buy in this is part of the package that you know this is done. And this is we can talk about Would you rather be involved in doing laundry? Or would you rather be involved in in food prep? I mean, we've got to look at this, I believe it's more of a community effort, and less as a drop her off, and we'll take it from here model. I think the same thing, unless I'm mistaken is happening in childcare as well, where that middle group is being priced out. And there's no way to get childcare in the middle group because you have to pay the childcare providers more. And we've got to figure this out. And that means our workforce is going to have to figure out how to do it. What's interesting is how we're doing this in foodservice which is there are elegant restaurants for sure very few of us go and do a full scale. You know, all stuff, we go and we order our food at the at the bar, and then it gets served to us. But then we have to do our own cleanup. And we're comfortable with that, because we get it. I mean, somebody manages the big cleanup, but we participate in this thing of doing food prep and food cleanup, because we recognize, well, that makes it more sustainable for us.
John Gonzales:Right, and keeps it more affordable. And I think there's a recognition of that for things like you're talking about things like food service, or you know, there's some grocery stores that we go to, and we bag our own groceries, because, you know, and it keeps the overhead down, not to kind of dial it down into that simplistic. Yeah, but I think what you're saying is, it makes a lot of sense that there's a need already for a new model providing care and services, right? Yeah. And I think what you're talking about is integrating the family, having them participate in order to compensate or offset for the fact that it is a tight labor market, you know, inflation isn't going well hasn't gone away for, you know, a year and a half now. So these expenses are going to continue to rise. And, you know, I'm just thinking of, as an executive director, I would want to sit down with my families, and say, you know, what, guys, this is the reality, we have an idea, and what do you think about this strategy? If you know, we're going to integrate you into the care, we're going to keep those costs down? And we're going to partner with you. And that's something that you advocate all the time, right. It's care partners?
Unknown:Yeah, I mean, there's no new funds coming in. It's not like I have this new source of income that I have to put in. For now, let me get a sitter or let me have you know, so no, okay. No, we'll be able to be there select families who have that kind of cash, but most of us are looking at, wow, that's
going to be:how we can do this?
John Gonzales:Yeah, it's a big problem. Do you see technology as being, you know, part of the solution? Or have you seen any technology that's being used effectively now, in the care of residents with dementia.
Unknown:I am seeing a better use of technology than what we've done historically, which is chair alarms that go off and irritate everybody. And the only people is the other people living with dementia who say, sit down, you're making the alarm go off, or she's getting out. That's not the thing about so I do think there are new technology opportunities, where it allows us to monitor a system for changes in mobility changes in frequency changes of intensity, that then warn us that we have somebody who is showing some changes that we want to pay more attention to. So I need to really change my focus from this to this, or I'm noticing that somebody is moving much slower. So there's a variety of technologies, including things that can be programmed and currently can be programmed. So I can activate a screen in my mom's room from home, but would say not not Mom, it's me. But at the same time, it notifies the nursing staff that I'm spending some time with my mom on the Zoom screen.
John Gonzales:that's great. It's the same thing, isn't it with voice activated technology, you know, in residence rooms, they don't have to get up and turn the light off, they can just say, you know, turn the light off. Now, in dementia care, there's always a hesitancy to integrate too much technology,
Teepa Snow:rightfully so. I mean, because it can get you in trouble. And let's say I put a control mechanism so that it's voice activated in the person gets an echo going and go turn it on, turn it on, turn it on, turn it on, like and it gets brighter and brighter and brighter and brighter, not what I intended.
John Gonzales:So one of the other models I know that we're looking at are intergenerational environments. So if you have the opportunity to integrate almost dorm like amenities for college students that can come in and a portion of the rent maybe subsidized by working with the seniors by providing that care, either as a caregiver or activities, aid or something like that. Do you see that as being kind of a viable environment moving forward?
Unknown:I think there are numbers of towns, cities, areas where that could be viable because there is sort of a vibrant community education base going on there. You know, like, for instance, where I am, which is near Chapel Hill, North Carolina, where we have you and C we have Duke in Durham, we have North Carolina State, we have AMT we have like six or seven universities and then five community colleges. Wow, that can be a real plus because some of my tuition some of the relationships that we have All of a sudden we again are building into. So I think it's a great model. And one that we've advocated, you know, trying to, we're working with high school students already in the adult day health that we're we're partnering in in our area, to help them have relationships with people who may be different and maybe older and may have lots of issues. But at the same time, this is a reality. I mean, it's, as you said, it's the fastest growing segment of the population. And if they don't have a lot of experience in their own families, this is a great opportunity to start recognizing what role I do want to have with elders and older adults, whether it's healthcare or something else, there's a lot to be learned in fingered out.
John Gonzales:Teepa. This is kind of my own personal interest. But how did you get involved in doing what you do? It's clear that you have a passion for teaching and coaching and providing resource for people. But what drove you into this line of work?
Teepa Snow:Well, it's interesting when I was in high school, I either wanted to be what I thought was a special ed teacher, or I wanted to go into medicine. So I decided I did undergraduate at Duke. And then as I went through five majors before I finally there was like, Well, I don't know what I want to do either one of those. I don't know what I want to do. So I you know, it took a year. And I worked as a desk clerk at night and learned about people and gave service. I'd worked in restaurants before. But I also worked as an N A before there was a C, in a nursing home, where would you follow Somebody's around for three days, and you got your nursing assignment, which meant you went with somebody else and did some of my habits. Yeah, it was back in the day. It was a long time ago. But I think I've always been a curious human being. And so having worked in developmental disabilities, having worked in as an OT and head injury, it was like, Ooh, so I love brains. And I love how brains sort of work built work, and, and then I got opportunities to help other people figure that out. And it turns out, it's a fairly decent match because I can get other people curious.
John Gonzales:Yeah, I think that's awesome. I know, our industry is blessed that you moved into that field into the field that you're in, you've, you've helped so many folks, including myself throughout the years, and, you know, thought leaders like you, you're critical to solving the issues that we're facing today. And I just want to thank you so much for spending a little bit of your time with us today and sharing your thoughts. If people want to learn more about Positive Approach to Care and the resources that are available to them, where can they go?
Unknown:Well, you know, we're on all the whatever those media channels those get to jails, but we also have a website, teepasnow.com which is my name is such an unusual name that usually that catches people so teepasnow.com We'll get you there and then you pick your audience. Am I somebody living with dementia? Am I somebody supporting it? Am I an organizational leader? You get to pick who you are, and then let us know how we can help you.
John Gonzales:Teepa, thank you so much. It has been a joy.
Teepa Snow:Thank you so much for having me.