Good Neighbor Podcast: Milton & More
Bringing Together Local Businesses & Neighbors of Milton, Crabapple, and Hickory Flat
Good Neighbor Podcast: Milton & More
Expert Episode: Integrated Memory Care with Dr. Carolyn Clevenger & Meredith Sawyer
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Discover a revolutionary approach to dementia care with Dr. Carolyn Clevenger and nurse practitioner Meredith Sawyer at Emory's Integrated Memory Care program. Offering a unique blend of primary, memory, and psychiatric services, this model provides unparalleled support for both patients and caregivers. Our guest Kelly Crawford shares her father's transformative experience, emphasizing the profound impact of personalized care and dedicated dementia care assistants. You'll gain insight into how this structured program not only improves patient outcomes but also offers peace of mind for families navigating the complexities of dementia.
Learn about the importance of anticipating disease progression and preventing unnecessary medical interventions. Through Kelly's personal narrative, we highlight the critical role of dementia care assistants, who engage one-on-one with patients to support cognitive health and enhance quality of life. This episode emphasizes the reassurance that comes from having a comprehensive care team, as well as the collaborative efforts between nurse practitioners and wellness directors to meet individual needs. Hear firsthand how this supportive network can significantly improve the well-being of those living with dementia and their families.
Kelly's candid recounting of her journey navigating senior living options paints a vivid picture of the emotional challenges faced by many families. She opens up about the support she received from the Integrated Memory Care Clinic, underscoring the value of community and formal advisement in making critical care decisions. Listen for practical advice on connecting with the IMCC team and learn about the services available in the Metro Atlanta area. This episode is a testament to the power of empathy, advocacy, and personalized care in transforming the lives of individuals with dementia.
This is the Good Neighbor Podcast, the place where local businesses and neighbors come together. Here's your host, Stacey Poehler.
Speaker 2Hey everybody. I'm excited today to be chatting with the Integrated Memory Care Community Team. I have with us Dr Carolyn Clevenger, who is the founder and director of the Integrated Memory Care Practice at Emory. I also have with us a nurse practitioner, meredith Sawyer, who is dual certified in both primary care and psychiatric medicine. And we have a local caregiver with us, which is really exciting. We have Kelly Crawford. She is a caregiver for her dad who is a resident at Village Park, milton. So welcome everybody. Hey Stacey, thanks for having us, thank you. So I'd like to start with Carolyn. Why don't you tell us a little bit about the program and how it got started and how it kind of all come together over the last few years? Yeah, program and how it got started and how it kind of all come together over the last few years.
Speaker 3So integrated memory care and you might hear us say IMC for short, it's a bit of a mouthful is a primary care practice only for people with a dementia diagnosis and we do very unique type of care. It's the only one of its kind in the US at this point because we do that full-scope primary care and the dementia specialist care and caregiver services under one practice. We're part of the Emory Healthcare Network and have an outpatient clinic at the Executive Park campus. We've been seeing patients in that clinic since 2015. And a couple years ago we opened what we call the community program so that we do that type of all-inclusive care at people's senior living communities, which we might call an assisted living or memory care facility, and that includes house calls. It also includes weekly visits with a team we call dementia care assistants who are companions. It's a nurse practitioner-led practice with a fantastic team including social work, registered nurses, physicians as well, and we are delighted to be in the neighborhood there and the good neighbor folks.
Speaker 2Awesome, Meredith. Why don't you share with us the different communities that you serve?
Speaker 4us, the different communities that you serve. Yes, I serve in the North Metro area, arbor Terrace, crabapple, the Georgian Lakeside, arbor Terrace, south Versailles and the Solana of East Cobb, as well as Village Park Milton and Village Park Alfreda.
Speaker 2Great and Kelly, I know your dad is at Village Park. Milton, tell us how did you find the IMC community program.
Speaker 5Well, I discovered them not at Village Park Milton, but when our dad was in rehab at the terraces at Peachtree Hills. He'd been in the hospital for a few weeks after a fall at his assisted living memory care facility. It was apparent that his cognition was in decline and he was going in for some significant rehab. The attending physician there recommended the IMCC, and we were able to get a virtual visit with dad to get him assessed, and he had indeed, was you know, experiencing some decline, and so we were able to share that information with the physical therapy team and the caregivers there, which significantly contributed to his rehabilitation. That's how I learned of the group. We ultimately moved dad to Village Park Milton, and Carolyn and the team came out and did a community visit. I was like, oh, I already know them. This is amazing. That's how I came to find them.
Speaker 2Meredith, can you share a little bit about what you and the team do, how you're set up and how you would serve a caregiver like Kelly and her dad?
Speaker 4Yeah, so I provide. I'm a dually certified family and psychiatric nurse practitioner. I provide primary care, memory care as well as psychiatric care in the comfort of their assisted living facility, so essentially I provide a house call. One unique thing about the integrated memory care program is our model allows for longer visits. We also have a team supporting us RNs, social workers that are also providing a lot of education and support groups that our patients and families in the community program get to participate in, and so our visits are longer participate in, and so our visits are longer, and we also in this community program.
Speaker 4We know mobility a lot of times declines and becomes an issue, so it's really challenging for a lot of these families to take their loved one to an appointment in the clinic. So us being able to come on site and provide these services is huge. We also have contracts with mobile imaging, mobile labs so that all of that can be done on site In these facilities. I also work closely with the wellness directors and they've got our contact information so if they're noticing any changes they can quickly get in contact with us and they provide the medication list each appointment. And, as Carolyn and Kelly mentioned earlier, another unique part of the community program is each week they're having a visit with a dementia care assistant. This is a one-on-one visit that provides companionship as well as engagement. We have multiple meetings throughout the week that we're talking about. You know our patient panel and if they're noticing any subtle changes, that information is also getting communicated to the nurse practitioner. So it's a very comprehensive model in the comfort of their home.
Speaker 2Yeah, awesome, definitely sounds that way. Kelly, why don't you talk about your experience with having the nurse practitioner in the IMCC?
Speaker 5Our experience overall with the IMCC team has been exceptionally positive. Meredith is dad's nurse practitioner. She's very proactive with dad's health and very attuned to his medication list and how they may be interacting with each other. Just for some history, our dad experienced multiple hospitalizations, our visits, over a period of two years. We moved him from Texas, we had two different living facilities and by the time I was able to really fully engage the IMCC I mean he'd been through it.
Speaker 5So one of the first things she did was she really, you know, took a look, evaluated his medication list. He had literally in two years, gone from three medications to, you know, over 13. And that doesn't include vitamin. Okay, so I was learning along and she was very great. She was really good to educate my sister and I on, you know, the drug, certain drug interactions, you know, starting there first to see if anything was impacting his cognition. So there was that he's had some sleep issues and she's been very good to help educate us on, you know, defining is it, is it the dementia or is it a sleep disorder or something else that's going on. Having her see him on a monthly or bimonthly basis with with really great follow up and discussions before and after have made all the difference. So I still take my dad out for his specialist visits, but for day-to-day care. It's been an amazing convenience to have him be seen in his community. It really helps.
Speaker 2That's great and, carolyn, I know from speaking with you in the past that there are some things that present very differently in someone who has dementia. Can you talk a little bit about why it's so important that you have this comprehensive care where people have the experience and understand dementia and the different ways that it's going to impact their loved one?
Speaker 3Yeah, I think families get this. But our medical system is not set up right in this way, which is the brain is connected to the rest of your body. As a matter of fact, when there are problems in another body system and you are living with a brain disease like Alzheimer's or frontotemporal dementia, it's going to affect cognition and behavioral symptoms even more so than somebody who's not living with brain disease. All of us feel foggy and can't clearly when we're not feeling well. Even though our medical world looks very siloed and separate, it works well when you look at the whole person. That's the idea of primary care. You should have that person also as the quarterback of your team, if you do have specialists who are involved. But dementia is what we call a dominant illness, which means that at some point it is sort of like the lens that you manage all of these other problems through, because it affects so much of someone's day-to-day abilities and quality of life. And so when you're making decisions about how to treat someone's overactive bladder, you have to do that understanding that maybe they have trouble independently toileting. They might need some assistance or some reminders. They also are really vulnerable to the side effects of the most commonly used bladder medicines that cause a lot of confusion for them. So those are sort of ways that you think about managing symptoms in the context of dementia.
Speaker 3Dementia is an epidemic in this country that is really difficult for so many reasons. But from the perspective of we have some idea what this disease trajectory looks like, because so many millions of people are living with this. When you're in a team of dementia specialists, we have an idea of common symptoms that come next. Meredith is anticipating to some degree, things that happen commonly. If you are not aware of that or your clinician is not aware of those things, everything that comes up is an emergency of that, or your clinician is not aware of those things. Everything that comes up is an emergency as opposed to okay, this symptom evolved.
Speaker 3Yes, that lets us know we are looking at some progression of disease and hopefully avoids those emergency department visits. It avoids a hospital stay, which are not just an inconvenience for our patients, they really can also make them decline further. It's a hard place to be for somebody living with dementia and it doesn't necessarily solve the problem if the problem is progression of their dementia. So many things are helpful about nurse practitioners, frankly, and that role is not only the management of some of the illness but, like Kelly was saying, some of the education on. Here's why we're doing what we're doing and we may have that expertise, but we still want to make sure family members like Kelly are in the driver's seat and they're making those decisions based on what's important to them and their person, since they know him better than we do, can you?
Speaker 2talk about the dementia care assistant who works with you in the community program and kind of what that role is and how that person interacts with you as the nurse practitioner to make sure that the resident is getting the best care.
Speaker 4Yeah, so we're lucky. We have several dementia care assistants at our different assisted living facilities and blessed with an excellent team. Their role is to provide one-on-one engagement for an hour each week with our patients. They do all types of different activities. They're very creative. We had one patient that was a pilot and they tailored the activities towards you know his interests, so they're very creative in what they do. But there's a lot of research that this one-on-one engagement helps in cognitive reserve. So it's not only companionship. There is research behind it that this is really helping. And they're also kind of picking up on those subtle changes that the nurse practitioner is not there every week. So they will relay that information to us so that we can work proactively.
Speaker 2Great and Kelly, can you talk about what your experience with the dementia care assistant and your father has been like?
Speaker 5Yes, dad's dementia care assistant is Michelle and she has been amazing and she has been amazing. She has a great personality and she really dives with my dad. I'm not sure why, but it's such a blessing. She visits him once a week, usually on Monday. We actually requested it on Monday because the weeks are very busy and structured at his memory care community. The weekends are more quiet. There's not as much engagement. So having her visit on Monday early in the week is great because she can assess him and it sets him up for the week. She comes on Monday morning. She spends an hour to an hour and a half, depending on their activities. They do all sorts of things. They talk about how he's feeling. They talk about music. They talk about food he loves food. They talk about nature. He loves to be outside so, weather permitting, she always makes sure to take him outside. He's in a wheelchair. He can go on a walker assisted so they do both Sit outside and talk.
Speaker 5I see my dad three or four times a week. The caregivers see him, but I think it's so important for him to engage with someone outside that group. When I come to see him he's like I have a doctor's appointment or what are you doing here again? They just sort of hang out and she usually plays music. She'll do a puzzle, you know, and to ask him questions and while she's doing this it seems simple but it's an icebreaker to get him comfortable and they talk about things and and while she's doing it, you know she's able to assess, you know how is he responding. Can he hear me? Can he multitask? And it seems like something so simple for us to. You know, I'm taking notes and talking to at the same time.
Speaker 5It's for memory care patient, a dementia patient. It's very difficult, it's very challenging. So you know she pushes him. He has a Rolodex of stock answers that he'll just you ask him a question and he'll say it has nothing to do with what you asked. So she sort of pushes him a little to help him think it through and develop his communication skills. And it's been great.
Speaker 4It really helps improve that overall quality of life which is our goal.
Speaker 5Yeah it does I mean my dad thinks I work there now at the facility, just knowing that there's another set of eyes and ears with him to let us know if he's dressed properly or his hearing aids in? Does he seem rested? Little things that we maybe take for granted, it gives a great peace of mind.
Speaker 2What did your dad say about Michelle? Does he talk about her with you?
Speaker 5He sometimes remembers her name, but he always remembers what they talk about. So if I say, did Michelle come to see you? He might say I don't think so. And then I said, when you guys talked about the line of ants on the sidewalk and then you talked about how they each have a role, and he goes oh yeah, I remember that, you know. So he does remember the engagement, not everything specifically about her, but I am noticing that it's improved. It just improves his mood, especially on Mondays.
Speaker 3He's always in a great mood, Stacey that's a common thing that we hear. For some people they have a hard time in the late afternoon and for some of our patients that might mean more behavioral symptoms that are challenging for the staff and maybe some of the other residents. Generally, the evening after they've had a visit with their DCA, many people family members and staff have told us that the rest of the evening just seems to go much more smoothly. As Meredith says, there's a lot of science behind what we do. It looks like they're playing a game or doing a puzzle. One of the pieces about this is that your emotional memories are stored in a different place in your brain than your content of your memories, and so it's the deeper brain less affected by some of the changes in dementia, especially early.
Speaker 3Setting the tone for someone at the beginning of the week or during the day that does tend to last, and the same thing is true if somebody has a bad interaction with someone. Unfortunately, we really do try to start people off with that pleasant mood, because when Michelle's there, she's just there for him. When our DCAs are with that person, it's about them, what they're interested in, what they prefer and also what they're able to do. It's not going to be overly challenging and it's not going to make them feel like they're being babied either. They're really so incredible, so talented at what they do, and they have the most fun job of anyone on the team. The only outcome I hold them to as the director is that at the end of their hour with that person, they need to be in a better mood than when they started, and they are wildly successful.
Speaker 2That's great, meredith. Can you talk about a time when a DCA came to you with a concern about a patient after one of these sessions, and how you two worked through?
Speaker 4it Definitely Lots of examples, but I would say probably one of the most common is noticing, since they're there every week, those subtle changes. Maybe they're more confused or a little bit more tired that week. So they'll report those things and we'll talk through. Well, is it sleep? Are they sleeping well at night? Increasing confusion could mean a lot of things, but what about? Are they having any urinary tract symptoms that could be contributing? So then, that just helps me be proactive and maybe catch a UTI earlier and provide the appropriate treatment or treat the sleep.
Speaker 4We have several meetings and our nurse practitioners if there's something very urgent or concerning, pick up the phone and call us, which we encourage.
Speaker 2Kelly, what would you tell families supporting a person living with dementia about the senior living communities?
Speaker 5That's a challenging question but, I'll try to answer it.
Speaker 5I think if I've learned anything, it's that every loved one's situation is unique, based on their health and their diagnoses and their stage of their need of assistance. You know, when our dad had he had an accident in his home and went to rehab, and my sister and I in Texas and we thought, oh, he's going to go to rehab, he's going to be able to come home and live and just pick back up his life, and that became very evident that that was not going to be able to happen. So we started our journey as a family to make decisions about his safety and wellbeing. So you know, two years, an interstate move and now three senior living communities later. You know you're kind of like okay, how did we get here? Where are we going?
Speaker 5It's emotional. It's an emotional decision for your loved one. It's very emotional for your entire family. Making decisions for your mom or dad is hard. We were fortunate that our father was very agreeable and trusted us to make decisions for his best interest.
Speaker 5I wish we had sought advisement in a formal way, either from a care advocate or you know, you're just sort of there's doctors and all the communities are different and they have different levels of service. Some of them are beautiful but not great service, and some of them need a little updating but have great care teams. So you just have to decide what's best for your loved one, seek out some support and get some information, because there's so much out there. In the end, you just want your loved one to be safe and as happy as they can be. Not everyone's journey is the same. We were in a situation where some things had to happen very quickly. A lot of times the family gets together and makes this decision over a period of months and we didn't have that luxury and so you know we made some mistakes along the way, but we're very happy at Village Park, milton and with Emory IMCC. So I mean this is it's been a blessing. Can you talk a little bit?
Speaker 2about how IMCC has supported you as a caregiver and how they've helped you with that process.
Speaker 5Yes, when I met Michelle at Village Park and we did the assessment fortunately my sister lives in Texas. My dad we moved him here from Texas mainly for the access to care we met with her. You know, from the outset it was very evident that this was a different approach. Right questions, because when you are trying to juggle so many different specialists and doctors and trying to figure out what's going on with your loved one and you couple that with their fright and sometimes resistance to what's happening with them, it's overwhelming. There's no other word except it's overwhelming. There's a phrase they use in the community called meet your loved one where they're at.
Speaker 5I didn't really know what that meant until I realized. To be honest, my sister and I were very resistant to an Alzheimer's dementia diagnosis because we just didn't see it with our dad. And all of a sudden, there it was. I think once you let go of what was and stop trying to revert your loved one back to their old self, it frees you up to really participate in their care and their health. Where they're at changes every day, it changes every week and sometimes it seems like everything's fine and then the next day it's not, and sometimes it's a progression, sometimes it's temporary, due to maybe a UTI, as Meredith was saying, but having the IMCC team as an advocate and an advisor has really helped us, from answering our questions to also radically improving our father's overall health and his mental state, everything from his sleep to perhaps depression. It's been amazing. So I don't know what else to say, except it's been a blessing. And call me for any questions. I'll answer any questions for anybody. Well, that's great.
Speaker 2Thank you, Meredith or Carolyn. Anything you want to add in conclusion about the program or how people can reach out and get in touch? That would be helpful, Sure.
Speaker 3So IMC community is now in with agreements in about 21 Metro Atlanta senior living communities and continuing to grow. We're starting to get requests to add new ones every week. We are within the Emory Healthcare Network but you don't have to call the Emory Call Center to find us. So first of all, our direct number where you actually speak to a person or leave that person a voicemail we'll get right back to you is nursingemoryedu slash IMC. You can Google integrated memory care and find us pretty quickly as well, and then our direct number is 404-712-6929.
Speaker 3Glad to talk with you. On that website. There's also an interest form if you'd like to just let us know that you're interested and a convenient time for us to call you so we can explain more about the program and you can find out if we are in your area senior living community. But we are glad your area senior living community. But we are glad to have you. We exist to improve quality of life and to keep people as independent as possible for as long as possible, and we'd be glad to support your family as well.
Speaker 2Meredith maybe share how, if they have a loved one living in one of these centers, how they can connect with you and your team there connect with you and your team there.
Speaker 4Yes, I'm happy, when I'm rounding, to speak to families who are interested. Just to further explain our program. We get a lot of referrals that way. They see myself and the dementia care assistants in action and they're like I want that for my loved one. It's very rewarding supporting both the patient and the caregivers along this very challenging so that's as Carolyn said, that's why we're here to really ease and support them along the way.
Speaker 2Well, I want to thank all three of you for joining us today. I think this was a great conversation and hopefully our listeners have learned a lot. But I thank you so much, kelly, for being willing to share about your dad, um. You know it's definitely a difficult process, but you speaking about it and sharing your experience is going to help so many other people, so thank you for doing that thank you for listening to the good neighbor podcast milton and more.
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