Surviving the Holidays with Archangels' Alex Drane

In this conversation, Alex Drane and Dr. Mia discuss the challenges and realities of unpaid caregiving, emphasizing the importance of self-identification, data, and community support. They explore how caregivers often overlook their own needs while focusing on those they care for, and the necessity of finding respite and grace in their roles. The discussion also touches on the impact of caregiving on mental health, especially during stressful times like the holidays, and the need for a supportive community to help caregivers navigate their responsibilities.

Archangels website: https://www.archangels.me/

Intensity score quiz: https://www.archangels-cii.me/get-started/?utm_source=aacaregiverpage&utm_medium=weblink&utm_campaign=general

About Alexandra Drane

Alexandra is co-founder and CEO of ARCHANGELS — a women-owned, public benefit corporation and omni-channel platform shamelessly hustling to make change happen for the 43% of adults across our nation serving as unpaid caregivers. ARCHANGELS engages and supports caregivers across all 50 states through partnerships with employers, consumer brands, health-plans/systems, communities, and states.

Chapters

00:00
Introduction to Archangels and Caregiving

02:58
Understanding the Caregiver's Role and Identity

05:44
The Power of Data and Storytelling in Caregiving

08:28
Navigating Intensity and Self-Care as a Caregiver

11:38
The Importance of Respite and Support

14:23
Finding Grace and Permission to Care for Yourself

17:09
Community and Connection Among Caregivers

19:56
The Impact of Holidays on Caregivers

23:08
The Future of Caregiving and Advocacy

26:02
Closing Thoughts and Encouragement for Caregivers

Transcript

0:00

goal is light editing. Dr. Mia Yang does not have a lot of time because she is an unpaid caregiver supporting unpaid caregivers and also a paid caregiver. Yeah. So welcome back to Ask Dr. Mia. And today I am joined by Alex Drane from Archangels and Alex, welcome to the podcast. I'm so happy to be here. I'm grateful to you for the work that you're doing and the warmth and authenticity that you bring to doing it. So thank you. Well, thank you. Well, tell us a little bit about how you started Archangels and what is it for our audience who may not have heard of Archangels? So the concept behind it is incredibly straightforward, which is over 40 % of adults in the US right now are serving as an unpaid caregiver for friends, family, and or neighbors. And the beautiful and also unfortunate truth for most of them is they don't think of themselves in this role. They're not thinking of themselves at all, actually. They're laser focused on helping the the person and or more often people that they're looking out for ah get through their days. And so in so doing, they don't get a lot of support for themselves. So job number one is we use shameless hustling any way we can to find this gorgeous population who is not self-identifying. Then we help them get their intensity score, which for many people is an incredibly ginormous aha moment because I'll give you the data. If you think of a Leichert scale, a score of scale of one to five, 79 % of people who before they get their score would rank themselves a one on whether or not they're a caregiver, at the end are 4.2. So they have massively transformed to, my gosh, this is me. And that's really a big part of what we spend our time, all the data, the research, the experiential knowledge we've created over about 20 years, culminating in the last 10. And then our final thing that we work to do is match people with resources that already exist, but they're never gonna know about them if A, they don't know that they're in this role, B, they never think that it's relevant for them even if they do realize they're in this role, and C, they're too overwhelmed or exhausted to go find these things and they're spread all over the place. So our job is to sort of help make that process happen. We find, gather, take. deeply seriously how important data is in that process because data is what helps big employers or big policy and advocacy folks or folks in state or federal government make decision about allocating money. And unpaid caregiving on average costs between eight and $12,000 a year out of pocket. So we need to get some more money and resources to this population. And it also drives policy and advocacy changes and... big employers or big brands or big health systems gets their attention so they might invest differently in supporting this population. Yeah, thank you for sharing that. feel like there's such a difference in terms of how people come to caregiving, whether they identify themselves as a caregiver and how do systems, whether it's employers or government or policymakers think about caregiving. And we're all kind of speaking different languages. I I love that you share that. uh You guys have been really collecting important data and using that data for policy advocacy. But interestingly, I am actually coming from a conference, uh implementation science, and the plenary speaker is John Green, the author who wrote all about tuberculosis and how a scientist, uh researchers, our default of going to the data is actually not what the public wants to hear. People want to hear stories and things that connect with them. So for our listeners who are probably in the middle of caring for someone that, exactly, I think one of the biggest things that I wanted to kind of focus on is what do you think, you know, how do we get people to take one small step to do something that could help them? when they're most of the time sitting in overwhelm. Yeah, they really are. I appreciate you always bringing the attention back to that. So I would love to tell John Green, if you're still at that event, I'm sure he knows this quote. It's one of my favorites. Statistics are humans with the tears wiped away. And we like data only because it allows people to understand that the stories their bodies are living and feeling, they are not alone in them. And Language and stories can be so powerful. We always say data gives the brain permission to believe, but it is stories that engage the heart and stories is where behavior change happens. And so it's always a sort of a balance between these two things. That's why we have people get their score because it takes somebody from what I will call an othering like, that's someone, that's not me, that's someone else. to beginning to internalize, my gosh, this is me. And people in their own head, it's like, start to feel the stories that they're living. And that's so valuable for them in that moment so that they can get in that second match to resources. It's also invaluable because then they'll start, we always say, once you see it, you can't unsee it. And then they can start seeing the stories playing out for other people in their lives. and they can share those experiences with each other and share that expertise. And sometimes the most important thing in being an unpaid caregiver to reduce intensity, that's the word that we use, is knowing that you are not alone in it. We say if you're in the red, you need a red phone. So I know who my besties are who really understand what's going on in my life, all of its complexities. And by the way, we use the word intensity because caregiving, people use the word burden. I'm not a fan of that word. It is exhausting. It is intense. Sometimes I want to tear my hair out. I often swear. That's my way of reducing my intensity is I swear. It's also beautiful. You know, I love the people that I care for. And even if they're not family, and even if we weren't friends, that doesn't mean that I don't feel for some reason, if you're a caregiving for someone, you feel an accountability, a responsibility. It could be a cultural thing, right? There are a lot of cultures where caregiving is not even a word. It's not even in the language, for example, because it's like breathing. Like, of course you would care for someone. Why are you calling it out? So part of what we think is so valuable about stories is people tell them in their own way, with their own truths, in so doing they connect with others, and just in connecting with someone else on that topic, you realize that you're not alone in it, and that can be one of those small things you do to survive. The other thing I would say is um give yourself grace. Literally, it's one of the things that we do so well as unpaid caregivers is talk in our own minds about how much we're sucking at it. We never give ourselves credit. You're never going to be enough in your mind. So be enough by just giving yourself grace. Understand, and you know this, and you know the science behind it. If we keep beating ourselves up for something, I call it double jeopardy. You're going through your day. Let's say you're caring for someone with Alzheimer's and dementia. That's incredibly intense. And it can feel exhausting when you feel like you're saying the same thing over and over again, or you're not able to provide the love that you want because someone is not able to receive it the way that you want them to. And you're doing anything you can to survive in that moment, which might be, you you're thinking bad thoughts or you're trying not to like, an angry face. You're trying to stay calm, cool and collected. And that's hard. That is intense on the body. Then you wake up at two o'clock in the morning and you start beating yourself up for the fact that you would ever feel cranky with this person that you love and that you feel responsible for caring for. You do not have to do the waking up at two o'clock in the morning thing and beating yourself up. What I would say is if you wake up at two o'clock in the morning and you start feeling anything but awesome about who you are, flip that script and say, am I doing things perfectly? No. peaceful and everything else, sure. I'm not, but I'm showing up for my person. I'm doing it the best I can, and I'm gonna give myself grace for that. And then I'm gonna call my best friend and say terrible, terrible things because I know she's gonna understand that that's not really how I feel. I just need to vent for 60 seconds. Venting for 60 seconds is okay. If you're in the red, find your red phone, tell them they're your red phone. Mia, I'll be your red phone, you can be mine. ah and use that red film when you need it. Thank you. uh the intensity score is really helpful. And I took the quiz and looked at my own intensity. And I'm no longer caring for my mom because she has passed. But I can definitely think back to when she was alive. And um I was definitely in the red zone. And now I'm lower. I think I'm a yellow. There are still things that, uh you know, as a parent that I find that I don't have the time for myself, but you know, I'm just curious how, how, are you doing today, Alex? Are you in the red? So lit today, I am not in the red. And I think your point is so important. Not only do we have sort of when you're caring and loving deeply on someone who's going through cancer. and maybe dimension Alzheimer's and maybe add other things. It can be hard to get out of the red. However, you can at least reduce intensity on things that you can control. So I might not be able to make everything better for you as you're in this role, but it can help on the things that it can influence. And one of the things that we see a lot is the biggest driver of intensity when you're in the red is no time for you. The biggest driver in the clear or in the yellow is needing more support. It might be needing more support at work if you're in a job or a formal job since let's face it, unpaid caregiving is a job, or it might be needing more support in other aspects of your life. And what's interesting, let's just use someone who's an employee as an example. When you're in the red, you're showing up at the door of HR and saying, I need to take leave. I need to, I might have to quit. And what we see with a lot of unpaid caregivers is they don't want to quit. Because work, first of all, pays, they need the money. And second of all, for many, work is respite. It's the place they go to work on something they believe in. It might be the only place they go all day to pee by themselves, right? Like have that little moment to do what they want to do. Have a cup of coffee, whatever it might be, exactly. So how we support people in the red might be something like respite. And respite takes a lot of forms. How we support someone in the yellow or in the clear, is to help make sure they're tapping into the things that they can tap into when they have the capacity to get support. That might be the right time to get connected to a navigator, to an expert, and here's how you navigate Medicare, or here's how you navigate being dual eligible, or here's how you get those financial questions answered, because it's overwhelming to think about the finances, or legal questions. How do I become a power of attorney? Or I am the power of attorney, why does my bank keep asking me to keep proving the same things? When you're in the yellow or in the clear is when you can get those tactical things solved more because by the time you're in the red, we really need to just be helping you keep breathing moment to moment, get that time you need to breathe for a second. uh And so you're looking to support people in different ways at different times and the intensity score is a quick, it's like, my God, I'm way older than you, but remember those things you would cram last minute before a literature. It was like the crib notes. It's like the crib notes to cliff notes, cliff notes to caregiving. That's really helpful. So let's talk more about respect because I know this is such a thing where from the outside I can tell when people are in the red and that they could really benefit for some time for themselves. But I encounter a lot of resistance and I understand where it is coming from. One is how do you find someone you trust to how do know that they're doing a good enough job and three How do you feel not guilty enough to be able to walk away and actually take that time for yourself? What are your thoughts? Start again with give yourself grace. Whatever you're doing, give yourself some credit for what you're doing. You're starting on it that's terrific. Respite, people often immediately go in their head to respite is time. And, you know, I'm caring, let's say for a parent with Alzheimer's. And it's a 24-7 job and what I need is time. One way to get time is someone comes into your home and lets you leave to go shopping, because shopping could feel like a great adventure. Someone comes into your home and lets you go just into the other room and read a book. It could be you take the person you're caring for someplace and get respite. So that type of respite takes many forms. And one thing I would say is a hack. Let's take someone who every Sunday goes to whatever faith they practice. Let's say they go to church. Going to church is a really wonderful hack for respite because a neighbor will really get, every Sunday Mia likes to go to church. And I can go over and sit with Mia's mom for two hours while Mia goes to church, right? It's like, building into a pattern that people understand, that person feels great about doing it, you actually feel okay about doing it because you're going to church. But guess what? On the way to church, you stop and you get a coffee and you sit by yourself in Starbucks. And on the way back, you stop at a store and you wander through every aisle, right? So it's like, you find the hacks that give your own self permission to take that break by tapping into traditions or things that the community you know will support and you won't feel guilty about. You also have to, and you're going to be a greater expert, everyone's going to be a greater expert for themselves in this, but I do come down to 40 % of people who are caring for somebody with Alzheimer's will pass before the person they're caring for because it is so intense and they are not caring for themselves. So if either the person you're caring for is saying, no one else can come in this house, you're the only one who can care for me, or you're telling yourself that narrative, add this narrative. If I don't give myself this time. I will not be able to care for this person because I might have a stroke or I might have a heart attack. Therefore, it is in the interest of my being able to care for this person, which is the only thing that turns a caregiver on, caring for the person they're caring for. So flip that script for them, right? Or flip that script for ourselves in our own head. And the last thing I'll add on this topic is respite takes other forms, money. So if you're trying to help somebody who's in the red, first of all, or the yellow, resist saying, can I help you? because someone who is in the midst of it will not even have the mental or emotional capacity to answer, here's how you can help me. What they're gonna say is, I'm fine. So say, I wanna get your score with you. And then look at the things that are driving their intensity and think about what you can do to support those things. With no time for you, we've done a couple and we do a lot of work with respite and people presume respite is time. This one example, it was actually a Roomba because one of the things that was really hard is this person had an elder living with them and they had young kids. And the time to keep the floor clean was not happening. It was torturing them. Someone gave them a Roomba because they got there and all this cool stuff happened. And that literally brought their intensity down because that was one thing they didn't have to add to their list. For someone else, it was... putting monitors in the house so they would know if the person that they were caring for had left their bedroom, right? And that would wake them up so they could actually sleep soundly so they were not constantly on alert. You can do that remotely as well. So if you're caring for someone who's not in your home and you're not sleeping because you're afraid they're gonna get up and wander in California or you live in Boston, then this can set up an alert mechanism. So, rest of it can be time, it can be sending someone money, can get their score of them and figure it out, and then you use your brain, don't ask them to use theirs, to come up with ways to get them whatever they need to bring that intensity down. So if someone is actually in the overwhelm and they're, you know, can't think of what to ask and or maybe embarrassed to even ask for help, allowing other people to know what their intensity score is and kind of have a conversation to go from there. Yeah, because one of the things that's really interesting, it's what's so beautiful about caregivers. It's why I love them. They're not sitting around thinking about them and what do they need. So if we're not in the red, our job is to, I think of it as, if you're drowning, right, my mom taught me this when our kids are very young, people who are drowning don't wave their arms around yelling, I'm drowning. Their body begins to shut down. Their arms go straight up or they go straight down and they sink under the water. So if you're a lifeguard and what you're looking for is this, it's not working. What we need to do is be scanning the horizon and look for the people who are not asking for help, but you know their life circumstance, and you march straight up to them or you pick up the phone and call them and say, Mia, you know, I know you are in the thick of it, and I have a sense that you don't have time or energy to think about yourself. We're gonna do this exercise together. I'm gonna become your partner in this. I'm your red phone. You don't have to say yes or no, let's just do this thing together. We also collaborate with Joint Commission on something called the Care Badge, which literally can mean so much to folks just to get in their email or print it out on a piece of paper, or you can actually get someone a challenge coin that honors the work that they're doing. And send that to the via email, be like, I just want you to know I see you. Just being seen in the role for someone who's in this role. and saying I respect you, I appreciate you, what you're doing can mean the world. Absolutely. And I think the people who are doing the caring oftentimes feel so alone because they're so busy. They're so busy doing the caring. They're not connecting with other caregivers, which is why, you know, support groups and communities, whether that's online or in person, are so incredibly rejuvenating because, you know, it's hard, but the alone part is the part that doesn't have to be there. No, and if you don't like we'll hear from a lot of caregivers I don't have time to do a support group then we'll say you will Unfortunately, it might be when you're grieving Make sure you take the time for that then for now You know Be intentional about what's 60 seconds that gives you a break And if I, Alex, am supporting you, Mia, and you're in one of those places where you're like, I don't even have time to do the support group, then I gotta figure out what can I do when you have 60 seconds that will make things feel better for you. And it might be that I just remind you if you just wanna say a lot of swears, you can call me and say a lot of swears and then hang up and I'm gonna get that that just helped you get through the next hour and I'm gonna do that with you, right? Showing up for somebody when they're in the middle of it and for you when you're in the middle of it. And someone says to you, gosh, hey Alex, I know you're in the thick of it right now. You should start doing yoga. Do you know what I want to say to people when they say that? I want to give them, and I apologize, you can bleep this out, what we call in my house, the double finger. Like, sure, Alex, you should meditate. Yeah, you know what I do? I drink prosecco. Because that helps me calm down. And I look forward to a stage of my life where when I feel I'm in the red, I meditate and do yoga. That's not where I am right now. So. I don't think anyone can actually do the quote unquote healthy thing when they're in the place of overwhelm. I think you can only do that when your level of overwhelm is not at the highest intensity. It's like eating healthy. Like if you're stressed out, no, I don't want to have a salad. I'm just human nature. candy, right next to me, right next to me. I just don't, well I know a salad's good for me. I know exercise is good for me. But do I want that? No, I wanna have a piece of cake because I want to, it was a hard day, you know? I need to give myself some sort of treat. And I think Mia, that's another thing. know, people will say to us all the time, I gained 70 pounds, I went on anti-anxiety medication, and I thought it was because I was, and then they'll say the worst things, like I was weak, I wasn't coping well, and then they'll say, and you helped me realize, no, it's my mom with Alzheimer's moved in, and I'm actually. a badass and am I doing it perfectly? No, but I'm bringing my best self and I'm trying really hard and I can work on other things later. Right now my job is to be able to survive each moment and so I'm not going to beat myself up on this. On top of it, I'm just going to roll with it, take deep breaths and work to stay alive as I help someone else stay alive. Yeah. So let's talk a little bit about what are some of the things that you're excited about that Archangel does aside from the intensity score, which is kind of the step one in terms of figuring out where you are right now. And I'll link to the intensity score quiz in the show notes so people can find it easily and find out where you are, which color zone you are in. Yeah. Yeah. And it's interesting because, yeah, I think one of the things I'd love to, to let people know is intensity changes based on a lot of things, right? It can change based on, or it can be more likely to be in the red different life stages. So when we go through perimenopause and we are a sandwich generation caregiver, you know, I grew up in an age where we thought menopause was like, turn 50 and you've been through menopause. Like, no, it's actually 15 years. There's things like... flashes and a mental health impact of 2 to 4x the mental health impact and you're also not sleeping. And on top of this, you're likely, these are the years of being a sandwich generation caregiver. So I think some of the ways that just to help people put into context, you might be going through life feeling particularly like this is a hard moment and not giving yourself the added grace of, wait a minute. I'm doing caregiving for everyone. My body is going through this change. let's add something else. It's the holidays, right? People think of the holidays like, yay. And we're gonna, I'm gonna open up my computer or some data on the holidays. Like the holidays, actually for a lot of people is a time of enormous intensity intensifying, if that's a word. 40 % of all caregivers are extremely concerned for their mental health during the season. One and two say caregiving will impact what they can spend during the holiday season, and that's true for all income levels. A quarter of unpaid caregivers say, I'd like to just skip the holidays altogether this year. And one and three say world events are further increasing their worry about their responsibilities. If you're in the red, that was just across caregivers. If you're in the red, you know, I'll give you an example that... quarter of unpaid caregivers would prefer to just skip the holidays altogether, it goes to one half, one in two unpaid caregivers who are in the red are like, I'd prefer to tap out. Because they don't have the energy to go do all the things you're supposed to do on top of that. So we just find that there are moments that intensify when you're caring for somebody with different conditions, caring for someone with a substance use disorder, there's a level of hypervigilance that exists. always because even if someone, this is not a type of caregiving we think about a lot, caring for someone with a mental health impact, right? So I think recognizing when you're in the right, has a huge impact on our relationships. Whether that's friends, like you pointed out, when I'm in my most intense times, I have had friends call me and say, Alex, you've dropped off the face of the earth. Like, what's, you're not a good friend right now. They say it more nicely. And then I'll have to be like, my gosh, I am so sorry. I'm not a good friend because I really, all of my time is here. And then I'll say, let me just tell you what happened in the last month. And then they'll say, well, why didn't you tell me that? And I'm like, I'm too overwhelmed to even explain to you what's going on. So that's another reason why staying, pick the people that you enforce yourself to let them stay inside with you on what's going on. When someone calls you and says, how are you doing? Tell them really how you're doing. Laugh about it. I'm in the red. And it's effing freaking is hard right now, right? Try and resist saying, I'm fine, it's good. I know you're do that anyway, but try not to. Yeah, I think opening up and being vulnerable is so hard and I'm not sure how much of it is internalized and we tell ourselves versus kind of society telling us, you know, everyone's supposed to be happy during the holidays. And if you're not happy, you're doing something wrong where maybe it's just because of my professional field and also personally, know, grieving my mom. uh loss over the holidays. I feel like the holidays are, you know, not that great. And I think holiday, like the holiday magic is really based on the ampe labor of a lot of women. Absolutely, and we know that. We know the number of tasks, the number of hours. What's interesting, and hey ladies, in the end, the fact that unpaid caregiving is about to cripple our economy, let's take a couple. Assume it's a man and a woman. Assume they each have parents who are still both alive. Maybe those parents are on their second marriage. So you could have a situation where one couple is responsible for six, seven, eight folks who are aging. We're getting to a place where there is not enough for that woman, she doesn't have enough time. So she's having to her job, but guess what? The guy's having to step up and do the job too. I just spoke at a, which a lot of guys would do, they just don't even see it. I just spoke at a... event the other day and it was primarily men in the audience. And I was giving this example of how, it's women. And guess what, guys, you're doing it too. You don't realize you're doing it. And I gave examples, like you're paying bills, you're coordinating care, you're making sure the house is safe, right? Those are all sexist examples, but let me be sexist for a minute. And I hope everyone lives in an evolved household where everything is shared. That might not be true. And the number of men who came up to me after and said, my God, while you were saying that, I was paying my mother's bills. This other guy, while you were saying that, my mom called me for the third time in a row. I couldn't pick up because I was sitting in the audience, but I knew I figured out, she's calling because she needs a ride to the doctor's appointment. And so I arranged the ride, Sharon, called my sister and asked her and texted my sister to say, please go make sure it happens. So the good and bad of if over 40 % of adults are in this role, And if we look at the demographics shifting the way they are, we're getting to a place quickly as a country where all of us are going to have to pitch in. And once everybody's pitching in, then everybody is aware of the impact of it. And I think that's we'll start to see the amount of resources available, the amount of dollars that are going to it, the amount of policy and advocacy going to it change. But forget all that. If you're listening, just think about your own stories, ask your friends to tell their stories and love on each other in it. And also reframe for yourself any negative to the extent that you can and think about, I'm an archangel, right? I'm spreading my wings out over these people that I'm caring for. Am I doing it perfectly? No. Is it, are like puppy dogs and lollipops, is it all glory? No, it's incredibly intense. But I'm here and I'm showing up and I'm doing my best. Yeah, and I think that's a great place to stop. And I just wanted to say to those who are listening that I see you, I see the great work that you're doing. I know Alex feels the same and we just wanna share so much of our love and well wishes to you during this holiday season. And I will catch you all. Next time in the next season of Ask Dr. Mia, which will be back in early 2026. Thank you. you're a boss. Thank you.