016: Aging, Dementia & How to Navigate Both – Barbara Hament

[00:00:00] Marty Stevens-Heebner: Your parent gets a dreaded dementia diagnosis. You live in one city, they live in another. Who do you turn to for help? You'll find out in this week's episode of How to Move Your Mom and still be on speaking terms afterward.

Moving your mom or your dad or yourself. Isn't just about moving things from one place to another. It is much more complicated than that as are so many things having to do with later life. How to Move Your Mom and still be on speaking terms afterward provides in-depth conversations with professionals, older adults, and their family members who share their stories with warmth, understanding anything.

I'm your host, Marty Stevens-Heebner and here you'll find answers to many of your questions as well as different perspectives that I hope will inform and inspire you.

Barbara Hament, welcome to the show. Thank you so much for being here with me. 

[00:01:00] Barbara Hament: Marty. It's a pleasure to be here. I adore you can pay to be here with you

[00:01:04] Marty Stevens-Heebner: today, back at you. And you're so wonderful as a person, and you're just so resilient as a professional. Let me tell you a little bit about Barbara Hament of Senior Care Navigator.

LA has devoted her career in geriatric care to helping people age with. Dignity and the best possible professional care known for her work in dementia. Barbara is considered a pioneer in her field, providing expert support and caregiving services to older adults and their families in the LA area and beyond for more than 30 years.

For the past decade, Barbara has led caregiver support groups for Alzheimer's LA and UCLAs Eastern center for Alzheimer's disease research, including one for caregivers of persons with Lewy body dementia. And we're going to talk a little bit about that because there are all kinds of different forms of dementia. Barbara, I like to start out with asking you, what's your favorite memory of your grandparents?

[00:01:55] Barbara Hament: 

I had a wonderful relationship with my maternal grandmother. Tilly. Tilly was an amazing woman. She was very smart and very funny. And she was a terrific cook. She was a chef in New York city. We visited her in the city every week. And then I called her every weekend, every Sunday and on the first of the month, because that was good luck.

My favorite memories of her, I would have to say were her lenses and her borscht fabulous

[00:02:23] Marty Stevens-Heebner: cook. Yeah. You're making me hungry and about food and especially a chef. And I'm there, you were a very devoted granddaughter. And was it that relationship that led you to the work that you do now?

[00:02:38] Barbara Hament: I would say yes, that relationship has I'm the youngest of five.

And so by the time my parents had me, they were older. And so I was just used to being with older people. It came naturally. And so I gravitated to older people in high school. I volunteered in that local nursing home. I volunteered in the evemimgs. I was a candy striper in the local hospital in college. I went on and volunteered in the ER.

So I was just always around seniors. And of course my career has been. So it was a natural lead-in

[00:03:17] Marty Stevens-Heebner: for me and you and your cohorts, your colleagues at senior care navigator, LA your care managers. And can you talk to us about the focus of that kind of work?

[00:03:26] Barbara Hament: After 27 years of working in a hospital with a multidisciplinary team of doctors, nurses, and I asked the social worker, the department cloves, and I basically went out into the world doing geriatric care management, or we're now called aging, professionals. And so it was pretty much a tweak on what I had been doing at the hospital, which was working with seniors, connecting them with the community resources, but doing that in an outpatient clinic. And finally, as a care manager in their homes, wherever their homes are. So the focus of our work is seniors, obviously geriatrics.

And our caseload is comprised of either adult children who live out of town who want eyes and ears in. Or adult children who live in town and are just too busy with their families, their jobs, their lives, and really don't have time to deal with everything with their folks or people who just don't like their parents.

It doesn't matter where they live. So they hire someone to deal with their mom and it's. Okay.

[00:04:31] Marty Stevens-Heebner: Okay. And it's lovely because it gives them more energy to just keep. Or their entire family, including their parents, rather than be distracted by doctor's appointments and things like that. 

[00:04:42] Barbara Hament: It lets them just be the son or the daughter.

So I can be the bad guy. I have no history with their parents, so I can be the bad guy and they can remain the son or the daughter. And it's, it works out very

[00:04:53] Marty Stevens-Heebner: well, which is wonderful. Especially when somebody gets diagnosed with dementia. Can you talk a little bit about what can happen to the family and the family dynamics when.

[00:05:04] Barbara Hament: That's a difficult diagnosis because we both know that the road is long and hard. It's a gradual deteriorating aggressive diagnosis, and it's not easy to be the caregiver. What's so

[00:05:18] Marty Stevens-Heebner: sad is their mind can be going, but their body is completely healthy.

[00:05:23] Barbara Hament: Yes, that's exactly right. And they don't realize that their mind is going right.

So the adult children or the friends, or the neighbors, or whoever is involved in their. It's calling a person like me, a person, like you saying, oh my gosh, something's happening with my mom? My mom needs help. I'm trying to tell her that she's not listening to me because at the beginning we all dig our heels in a little bit.

I'm fine. What are you talking about? Okay, so I have a little forgetfulness, but I'm okay. I'm doing fine. They're not usually doing fine. The struggle. That's where this conflict, the adults will say, mom, you need help. You shouldn't be driving. I'm worried about you in the kitchen. It doesn't look like you're taking your pills and then the struggle begins.

That's often when we're called in there

[00:06:16] Marty Stevens-Heebner:. And what's frustrating is a lot of doctors don't want to diagnose dementia.

[00:06:21] Barbara Hament: Yeah, it does take a little bit to diagnose dementia. Oftentimes a diagnosis rules other things out. That usually takes a face-to-face clinical interview, getting scans of the brain and extensive blood work.

[00:06:37] Marty Stevens-Heebner: It is a process. Aren't there some things you can do to at least mitigate it somewhat to possibly slow the progression?

[00:06:42] Barbara Hament: That's what the drug companies say that the drugs that are out there slow the progression of. From what I've seen in everyday life, everyone's still, as you say, progressive,

[00:06:56] Marty Stevens-Heebner: Can adjusting one's diet and exercise and making sure that they're not socially isolated?

Can that help a little bit slow the progression?

[00:07:06] Barbara Hament: It depends on what the diagnosis is. Why is it good to get diagnosed early? I would say to get your affairs in order, because at the beginning you are able to make decisions for yourself. You're able to tell people what you want. And that is so important.

So if there's one thing that your listeners walk away with today, it's that if you have a diagnosis of dementia, go to your attorney and fill out your documents and your healthcare directive, do that so that your family doesn't have to guess what you want. They know exactly what you want. I can't tell you how important that is.

[00:07:44] Marty Stevens-Heebner: I had a discussion with Ken Kossoff and also Jamie Gonzales, who are wonderful estate planning attorneys, about how vital that is, and also about capacity with fiduciary Donna Bogdanovich about how tricky it can become to determine when people have capacity. So all the more reason when you do still have capacity, at least most of the time to really get that in order because that'll help take care of you and also take care of your family.

Those around you now, there are different forms of demands. Can you talk about that a little bit? I mentioned Lewy body dementia up front, all dementia is cruel, but that one is particularly unique because of the hallucinations. 

[00:08:28] Barbara Hament: So there are different types of dementia. I'm a social worker. I'm not a physician, but yes, we all know that there's Alzheimer's disease.

There's dementia related to small strokes called vascular dementia. You can have both of those, which is a mixed dementia. And then there are these ones like frontotemporal dementia. And Lewy Body Dementia. There is a dementia related to alcoholism called Korsakoff dementia.

[00:08:53] Marty Stevens-Heebner: I recently read an article that some of the police and firefighters from nine 11 are getting dementia and in early age,very early onset dementia.

[00:08:59] Barbara Hament: 

And those tend to be more aggressive. Sadly,

[00:09:04] Marty Stevens-Heebner: I just learned something. I didn't know that. So Lewy Body Dementia is related to Parkinson's, correct? 

[00:09:11] Barbara Hament: It's related to Parkinson's. Yes. And that's oftentimes the first symptom that people experience is the shuffled gait, the rigidity. And then oftentimes, like you said, the hallucinations start, and that is pretty typical with Lewy Body Dementia. It can happen at any age, but it's so difficult. 

[00:09:31] Marty Stevens-Heebner: That's what Robin Williams had. And not that we will ever know it's possible. He was in one of those few states when he died. I remember meeting with a client and she was 90. She had been with her late husband for 70 years and he had passed away a couple years before I met with her.

And she too had Lewy Body Dementia. As I'm sitting there talking with her, she keeps mentioning that she keeps seeing her husband around the house and I'm thinking, “That's just the dementia. She doesn't remember that he's passed.” 

But at one point she says, yeah, I see him by the pool. And I know he's gone, but I keep seeing him. And then ice came into my veins because I realized she was hallucinating and she knew he was gone. How tortured she must have been. So it's very haunting. I think it's wonderful that you lead these groups.

[00:10:14] Barbara Hament: I love support groups. I really do. I think magic happens in support groups. What kind of magic caregivers help each other in a way that professionals can use.

I truly believe that as a fellow caregiver, trudging along this long awful road, the support and the advice that they give to each other is heard in a different way than when professionals say it. They give each other tips and techniques, ideas, love and support. We laugh and we cry in group and it's amazing.

[00:10:50] Marty Stevens-Heebner: I can only imagine and just being able to vent, to let it out.

[00:10:54] Barbara Hament: Exactly, because they understand each other perfectly.

No one can understand if your spouse is asking you the same question 10 times in 10 minutes - who understands the frustration of that? You're going out of your mind, basically they know each other's frustrations, so it's so helpful. 

[00:11:15] Marty Stevens-Heebner: I bet great friendships form, too. I can only imagine if you're living with that person and you've been with them for decades in those situations, it gets to the point where it's difficult to remember it's the disease that's doing that, not your partner, because you have your own frustrations and you're exhausted. And that's why it's great. If you can hire a care manager, an aging life professional, because that can ease some of that heavy burden. 

[00:11:39] Barbara Hament: I agree. If you're able to hire a care manager, it can be a good resource for you.

[00:11:44] Marty Stevens-Heebner: And what kind of things do you do for your clients and their families? 

[00:11:48] Barbara Hament: We help with taking people to the doctor if you're at work and you can't take your mom to her doctor's appointment. We'll take her to the doctor and we’ll tell you exactly what happened. So we're documenting everything that's happening at the doctor's office.

And then letting you know what happened, but medication changes there are what recommendations the doctor had. If your mom goes to the doctor and has a little bit of forgetfulness, she might not remember exactly what the doctor said. So it's handy to have someone else there.

[00:12:14] Marty Stevens-Heebner: And also somebody who understands the medical jargon, because I can imagine if you're an older adult and you're a little frightened by the possible diagnosis or the diagnosis you do have that the doctor can do.

I'm saying things and you might be too intimidated to ask what that meant. Exactly.

[00:12:31] Barbara Hament: They're embarrassed. They're a little bit ashamed and they might not ask questions because they're afraid. Most of the time people are aware that they're not quite right. They're not as sharp at the beginning stages.

So it's nice to have someone else. It doesn't have to be a professional. Anyone, the adult children or a friend can be, they're all.

[00:12:48] Marty Stevens-Heebner: It's so important to have an advocate.

[00:12:50] Barbara Hament: Yes. Especially in doctor's appointments. Cause you and I, if we go to the doctors, we don't always hear what they say. 

[00:12:55] Marty Stevens-Heebner: So I imagine when somebody gets the diagnosis of dementia, do they often get depressed or their family members get depressed?

And how can that be here?

[00:13:05] Barbara Hament: People do often get depressed, especially at the beginning. And there are geriatric psychiatrists out there who specialize in geriatrics and psychiatric issues, psychiatric medications. I would say any medical professional that specializes in geriatrics really understands the whole polypharmacy issue.

All the medications that get thrown at seniors. And Really good to have people who specialize

[00:13:28] Marty Stevens-Heebner: in seniors, making sure there isn't some kind of weird signer, just tick effect, some weird combination of drugs that create all kinds of problems. And even

[00:13:36] Barbara Hament: over the counter medications, supplements,

[00:13:39] Marty Stevens-Heebner: I think people hear the term social worker and don't really know what a social worker does.

And I'm wondering what you learned by doing that, that you carry into your practice as an aging life. Perfect. It's that

[00:13:50] Barbara Hament: person's tempered approach. It's the physical, the psychological, the family, the support system, or thinking about the finances and thinking about them in their environment as the person in their situation and social workers, they call the psychosocial approach.

We're thinking about whether they’re eligible for any sort of government program that we can tap into that we can apply for, or their veterans benefits - stuff they could get. There's all sorts of things. And that social workers are thinking about. We're trying to help keep them safe and where they want to be wherever that is as independent as they can for as long as they can and it's usually at home. 

[00:15:00] Marty Stevens-Heebner:  What do you love about what you do? 

[00:15:13] Barbara Hament: I love meeting people. I love meeting seniors. I think they're all cute. Most of their adult children think they're a pain in the neck. I love hearing their life story, their living history. I learn a lot of life lessons from them. I know that whatever stress I have in my life they've lived with, they've dealt with, they've gotten to their nineties and it'll all work.

[00:15:00] Marty Stevens-Heebner: I love seeing your kitty. We often see pets, whether it's in a zoom meeting or in a podcast, and it's great. It just makes it a little more human. What do you wish people knew about what you do?

[00:15:13] Barbara Hament: It would be good if people knew we existed. I don't think most people know that there is this profession out there that can help you with your folks.

I don't think most people know that. And although we're a private pay service, if you don't have the resources, maybe you can tap into case management at your local senior center. Or maybe there are case managers at the local hospital they can tap into for resources. We're there to help you. We have so many resources at our fingertips that we can save you a lot of time and effort and give you advice and help.

You can just do an assessment. We’ll meet with you for an hour or two, and say here are my top three referrals for this particular thing or that particular thing. And it's really helpful. 

[00:15:58] Marty Stevens-Heebner: And you deal with this every day. Also, I find even in a city as big as Los Angeles, that the professionals working with older adults and their family, we're a very tight group.

[00:16:07] Barbara Hament: We are, we're a tight-knit group exactly. Here in a big city. We know each other, we've known each other for a long time. Like I've known you for many years. It's really great to have those connections in a lot of different

[00:16:18] Marty Stevens-Heebner: areas. It's so important. The care manager can have such a major impact on the lives of everybody in the family, especially if somebody lives out of town and just wants updates and that sort of thing.

[00:16:31] Barbara Hament: I would say, if you're looking for an aging life care professional, we all belong to the Aging Life Care Association. So you can go in there and locate a care manager near you. You can put your zip code in or your mom's zip code and find the local aging life care manager. The association is wonderful.

They have conferences, and regional conferences, national conferences. 

[00:16:54] Marty Stevens-Heebner: What you do is really difficult work. It's tough, especially when you're dealing with something like dementia. You often come in somewhere in the middle or the beginning and you see them to the end.

[00:17:04] Barbara Hament: It's a long-term relationship. You said it exactly. No one calls us when things are running smoothly. We usually hear from when a family situation is not going well, and they're implementing services for people who don't want them. So it takes some creativity and some massaging to build the relationship and the trust, and then trying to introduce things slowly. It's not easy.

[00:17:31] Marty Stevens-Heebner: I can't imagine that it is at all. And I think a lot of it is really learning to read people's emotions and really getting inside their shoes. Because to me, there are people who manipulate, who are awful people. And then for me, I consider persuasion, not such a bad thing. I feel when I'm trying to persuade someone it's because I really feel that what I'm talking about, what I think they should do will really benefit.

[00:17:54] Barbara Hament: And that's the tricky part. And so we come in, we try to find an angle. For instance, let's say the doctor just reported your mom or your dad to the DMV, and now there's issues with driving, right? So maybe instead of saying you need a caregiver, which sounds. We say, how about a driver, someone to take you to the grocery store?

And most people are like, oh no, I don't need a driver. Just saying, what about if we find someone just to take to the pharmacy when you need to go well, okay. Yeah. I suppose just a little door open can go a long way and then we can get someone, even if it's an actual caregiver from an agency, if we call them the driver or whatever, we're good.

We're good.

[00:18:41] Marty Stevens-Heebner: Especially for this generation, that's in their eighties and nineties now. And they were the greatest generation because of World War II, but they're also the deprivation generation because of the depression, all the rationing during World War II. And even if they were born shortly after World War II, their parents had been traumatized by all of it and certainly imprinted those feelings on the child.

And part of that was. Keeping everything you've got, which keeps my company busy, but also it's about never being a burden. Can't be a burden. And so that's a wonderful way of having a caregiver drive them or something like that. To finally start getting them to accept some help and finding out that it's not such a bad thing.

[00:19:22] Barbara Hament: When you think about a little bit of help can keep you at home. That's what people want. We want to keep people at home safely, and then if they can get. So that's the whole goal is to remain wherever you want to be safe. And if it's not as well, that's okay, too. So as care managers, we often move people into assisted living facilities,

[00:19:41] Marty Stevens-Heebner: and there are so many wonderful communities now with COVID people have become so socially isolated and social isolation is so dangerous with anybody who has depression.

[00:19:51] Barbara Hament: And that's oftentimes what happens. A spouse dies or adult children move away, and here's the senior living at home. Let's say they do finally bring in a caregiver. Then it's just the caregiver on the senior at home, unless you're still running around town, which oftentimes they're not seeing their friends are going to play Mahjong. Sometimes they're not doing that anymore.

There is something about the social interaction that takes so much more of your brain and also just the companionship. I always say, I want to move into assisted living. I am such a social person. I can't imagine living at home by myself, but you can be in your room and close your door and you're by yourself.

You might not need that caregiver because you can walk out your door and get the help that you need when you need it. 

[00:20:33] Marty Stevens-Heebner: What's the toughest part of your job?

[00:20:38] Barbara Hament: So I think we touched on it, getting people the help that they need, getting them to accept it, to pay for it. That is probably the toughest.

[00:20:48] Marty Stevens-Heebner: But what a difference it can make.

When I first met you, you were just yourself and you've now expanded. So you have other great care managers, aging life professionals, on your staff. What do you look for and listen for when you're considering bringing somebody onto your.

[00:21:04] Barbara Hament: I feel like the one thing that I cannot teach is passion for geriatrics, the love of seniors. I teach you everything else, the nuts and bolts, the paperwork, whatever. I can't teach you to love seniors. Like you were talking about, you were asking me about my relationship with my grandmother and that you can tell it brings me joy. If you have had that, you come, I believe, with what you need. No one can teach you to love seniors. 

[00:21:34] Marty Stevens-Heebner: And to admire them, even when times are tough. And maybe they're giving you a hard time or what have you, but think of all that they have lived through, it's extraordinary. The stories can be really wonderful. And for us, it's a story of stuff. You never know what you're going to find.

That's great. The story of stuff I love. It's intriguing. It's fun. It's curious and being a bit inquisitive, not overly curious, but wanting to know more. That's one of the things I look for along with the empathy that you're talking about when I'm hiring, it's so important. So

[00:22:06] Barbara Hament: it's one thing to take someone to the doctor, but if you're building a relationship, when you're in a car, taking someone to the doctor, it's not just the mere act of going to a doctor's appointment.

It's hearing about their life and everything. It's rewarding. It's hard work, but it's really rewarding.

[00:22:20] Marty Stevens-Heebner: And you must go home at night knowing that you've really done something to ease people's burdens, even if it's just being their companion for a time. But, of course, with your professional skills, there's a lot more going on, but that's what they may experience. They may appreciate it.

[00:22:34] Barbara Hament: It's true. And just assessing along the way. So the minute we get to your dad's house, we're assessing how many steps to the front door and what does the law look like? That we get in the front door? What do we see? How is he navigating? Can he get up the steps? 

[00:22:47] Marty Stevens-Heebner: Is there expired food in the fridge? What are they eating? Hopefully not just candy bars or something. 

[00:22:54] Barbara Hament: Taking a look in the pill box. Are they taking their meds? It doesn't look like they did today. Just putting pieces together, doing an assessment, coming up with a plan, take it slowly but surely.

[00:23:05] Marty Stevens-Heebner: And one thing working with the care manager is you're not seeing them every single day.

You come at different times and if there's been a shift, even a minor one, you can see that a shift has happened. 

[00:23:15] Barbara Hament: Like they look more tired and you can say, God, you just seem exhausted today. Are you sleeping at night? Well, no. Are you calm? And they've fallen. What happened to you? See the changes? Yeah.

[00:23:27] Marty Stevens-Heebner: What kind of questions should people ask when they're interviewing professionals like you care managers, aging, life specialists, what should they ask?

[00:23:36] Barbara Hament: On our association website they give you a list of questions to ask your managers. So go to www.aginglifecare.org. There's a list of questions there. Of course it talks about what we do, but I would say basic questions. What area do you cover? How much do you charge? If there's an emergency on the weekends or in the evening, can I call you?

[00:24:26] Marty Stevens-Heebner: What kind of backgrounds do they have?

[00:24:46] Barbara Hament: Yeah. So the profession draws mostly from nursing and social work. Absolutely ask, “What's your prior experience? Your degrees?” People are savvy these days. So they've gotten on the website. They checked us out, they looked at our education. They've seen who we are and what we've done, but people just want to talk to you and get to know you a little bit.

Some people on the phone you click with and some better than others and say, go with that gut feeling.

[00:24:26] Marty Stevens-Heebner: And usually your. And so we'll add the national website as well as your website information on www.HowToMoveYourMom.com with your episode so people can find you if they're not in Los Angeles to find others like you in their area. Barbara Hament of Senior Care Navigator, thank you so much for spending time with me today.

[00:24:46] Barbara Hament: Alrighty. Thank you for having me. It's been a pleasure.

[00:24:52] Marty Stevens-Heebner:

Thank you so much for listening to, How to Move Your Mom and still be on speaking terms afterward. Please visit www.HowToMoveYourMom.com for more information about this episode and for additional podcast episodes, featuring other extraordinary guests and conversations. Until next time, this is your very grateful host Marty Stevens-Heebner