David's Alzheimer's Fight
Hosted by David Uhlfelder, who is facing early-stage Alzheimer’s with resilience and humor, alongside co-host Dr. Karen Gilbert, this podcast shines a light on living well with the disease. Together, they share personal stories, expert insights, and practical tips to help others navigate the journey with strength, knowledge, and hope.
David's Alzheimer's Fight
Caregivers Get a Break: Inside Medicare's Hidden Dementia Support Program with Dr. EriK Ilyaev
Dr. EriK Ilyaev (MedBetter Health) explains Medicare’s GUIDE model. A no-cost support program for people with dementia and their caregivers. Eligible participants (Original Medicare, dementia diagnosis, not in nursing home/hospice) keep their doctors and gain services like a $2,500 annual respite allowance, caregiver training, advanced care planning, medication reviews, home-safety evaluations, and the ‘Four M’s’ approach (Matters, Medications, Mentation, Mobility).
Questions: david@davidsalzheimersfight.org or education@alzcare.org
This podcast shares insights, not medical advice. Please consult a professional for your care. Hi everybody, this is David Ufelder and I'm the host of David's Alzheimer's Fight my journey and how I'm trying to help others. We're joined today by my co-host, dr Karen Gilbert DMP. She's the Education director for Alzheimer's Community Care in West Palm Beach.
Speaker 1:I have the following lifestyle approach that I've adapted since I talked to Karen in April and I'm fighting this in every way possible. I'm happy to report that by following the Mediterranean diet, I'm riding my bike at least 13 to 15 miles a day and I have been able to lose up to almost 19 pounds. So I'm convinced that taking this type of approach can help everybody. The idea of healthy living and healthy lifestyle is the key not only to Alzheimer's, but it's the key to everyone, whether you're one or whether you're 101. In the process of all this, my cognitive abilities have been muchly improved. Like I said from the earlier podcast, when I first started, I'd have to tell people I couldn't remember what I was talking about. In mid-sentence I'd forget words. So I think I'm doing a lot better since then and it's all contributed to what I just told you. Today we're having someone on the show that's talking about caregiving.
Speaker 2:So let me take it from here, david. Thank you so much. This new program we'll talk about today is actually based on legislation that was signed into law in 2011. And that legislation was called the National Alzheimer's Project Act. The law focused on taking action at the federal level to optimize quality of care and quality of life for people experiencing dementia and their family caregivers. We are so fortunate to have with us today Dr Eric Ilyaev, md and internist and chief executive officer of MedBetter Health, based in Broward County, florida. Dr Eric is a provider for this wonderful new federal program and he will share its benefits for both patients and caregivers. Welcome, dr Eric. Tell us a little bit about you.
Speaker 3:Hello, hello everybody. Hi, david, thank you so much for having me on your and Karen's podcast. So honored and humbled to be here. My name is Dr Eric.
Speaker 3:I run an organization called Med Better Health and we are one of the few selected organizations in the state of Florida that have been selected to partner with Medicare in rolling out this new program called the GUIDE model, which stands for people will say, well, guide, what does that stand for? Guiding an improved dementia experience. And you know my background, karen, since you asked, since I graduated residency, the first thing I did I remember was before it became popular Now it was popular in the fifties was I started doing house calls. Right, imagine a young physician just graduated residency with a bag, like in the 50s and in the 30s, going to people's homes, knocking on the door and seeing people where they live, which is a very different, intimate experience from seeing people in the office. And that started my journey in helping folks with dementia, helping folks in the geriatric space, and that's how fast forward now we are involved in the guide model.
Speaker 2:Well, I think both David and I are old enough to have experienced the house call, so it brings back those memories. That was certainly a very convenient way to get your health care and in some ways, it's coming back again. We have some mobile health services, so tell us CMSs, the Centers for Medicare and Medicaid Services, have developed this guide program. Who is eligible for it? Who can actually sign up for it?
Speaker 3:Number one. This program is specifically for patients who have straight Medicare. People say well, dr Arup, what do you mean straight Medicare? What do you mean traditional Medicare? Well, that means you can't have a Medicare Advantage plan like a Humana Medicare Advantage plan, an Aetna Medicare Advantage plan. You cannot be on hospice. If someone is on hospice, they are not eligible for this program. You cannot be on a program called PACE, which, karen, you and I know very well, right, that's a program where someone has Medicare and Medicaid and it combines into one called PACE.
Speaker 3:Can't be A person. Cannot be in a nursing home. Could be an assisted living facility, that's okay. Could be at home, that's okay, but not in a nursing home. So that's one thing straight Medicare, right? That's what Dr Eric means by straight Medicare. Then that person has to have a documented diagnosis of dementia, right, dementia. And we know there are different types of dementias Alzheimer's disease, parkinson's dementia, lewy body, dementia, vascular. These are all the sorts of different types of dementias and if a person has one of those and has traditional Medicare, they are eligible for the guide.
Speaker 1:With regard to that you said, is it okay though, for instance, I have Medicare but I have a supplement that's through Florida Blue? Is that okay?
Speaker 3:Amazing question, david. Thanks for bringing it up. Yes, if you have traditional Medicare and you have a supplement, whether it's A skilled nursing facility.
Speaker 2:No, because conceivably a skilled nursing facility is providing all of the support that guide would, so it would be, you know, doubling up. That makes sense. Pace also is an all-inclusive program that would be providing what guide does. So that all makes sense. And of course, hospice is a very intense program that provides a tremendous number of services for both patient and family. So my concern always is how many Medicare beneficiaries are not aware that this is available, and one of the greatest parts of it being available is that there's no cost to join this program, right? There's no financial obligation of the patient and they can opt in, opt out at any time.
Speaker 3:You bring up a good point because a lot of the time think about this, david, like there's a new program that comes out and someone's always trying to engage Medicare beneficiaries hey, there's this new program. Hey, there's this new that. And sometimes everyone listening to the listeners have to be careful, right when you're getting those calls. And hey, switch, you're going to get the gift card every month. Very careful. So the thing that we have to consider with the guide model is it doesn't change your doctor. You have the same primary care doctor, the same specialist. It doesn't change your insurance at all. It doesn't change if you're already receiving home care or already receiving services. Doesn't change that at all. It sits on top of all the other resources that you're receiving and gives more right. So that's very, very important to know.
Speaker 2:And at no cost to the family, no financial obligation. So tell us. There are several components, several types of services someone is eligible for when they sign up with Guide. Can you take us through each of those?
Speaker 3:Before we go through that, there's two things I want to touch on. Number one is data. Let's think about data. In the state of Florida, there was, in 2020, 580,000 people who have the diagnosis of Alzheimer's disease just Alzheimer's by itself right. In 2025, there's 720,000 people just Alzheimer's itself right, that's a 24.1 increase in the diagnosis. Now here's another Karen and I always talk about this, david, just so people know.
Speaker 3:The Alzheimer's Association came out with a study and they asked providers like myself and Karen how many providers don't feel comfortable or say they don't have the tools to make a diagnosis of dementia in the first place. Right, 40% of providers said we don't feel comfortable making the diagnosis or we don't have the tools to. Now think about the numbers I gave you 580,000, 720,000. If 40% of providers don't feel comfortable making the diagnosis, is there really that number of people who have the diagnosis or is it a lot more? So that's kind of stating the problem of why Medicare started the guide model. Karen asks we talked about who's eligible and now we're going to talk about, well, what does it do for people? Well, there's two stakeholders in the guide model. One is David. David could be the person who's living with the diagnosis of dementia. Right, that's one stakeholder. The second stakeholder could be either David's son or David's wife or someone who's defined as a caregiver. Now, look, that's a very broad definition. What is a caregiver? Medicare, for the Guide model, karen, has a specific diagnosis, a specific definition. The definition is a caregiver is a unpaid that's the key relative or non-relative who assists the person living with dementia with either activities of daily living, what is that? Bathing, right? All these different activities of daily living and instrumental activities of daily living, balancing your checkbook, executive, functioning, right? So, david, you may have someone I'm using you as an example, let's say that's a caregiver.
Speaker 3:Now Medicare said we know David's going through this diagnosis, but what about the caregiver? How can we also help the caregiver in this program, which is very different, right? What was Medicare? Always about the patient, the person, right. But what about the caregiver? So this program is for two Number one, for the person living with dementia and for the caregiver. Now you're going to say, okay, dr Eric, so what does it offer? What's the value? Right? Number one for the caregiver it offers respite, karen. What is? If you can, we'll kind of have a conversation. What is for people who don't know this term, what is respite?
Speaker 2:Basically it's a break, a break from caregiving, and you know, often we have a caregiver that does not have a job outside the home and they don't feel entitled to this help because they don't have to go to work. And we convince them you need a break, david.
Speaker 3:think about that. How many people persons living with dementia have caregivers who just want a break, a little bit of a break, just some me time.
Speaker 1:Okay, I'm thinking to myself, and I'm sure we'll talk about a lot more, but how do I get this? How do I get reimbursed? How does this work? I mean, maybe you'll get to. How does it work? I mean, because is there a limitation to the area you're in, or anything like that.
Speaker 3:We're definitely going to. That's a very good point. There is a geography, you're right, there's a specific zip code that we as participants and guide can see. And when it comes to how does someone get it, well, you're right, there's a specific criteria. So, number one how does one get respite? Make pretend, david, karen is Dr Gilbert, she is your caregiver.
Speaker 3:Now what we do is I'm going to have a one-on-one conversation with Karen and I'm going to do something called the ZBI, the Zared Burden Index, and Karen knows this very well. And, based on how Karen scores right, I'm asking how are you doing? And there's specific questions. She's like oh, everything's okay, there's nothing wrong, I'm all right. Then people are going to say why do you need rest? You don't need it. But the truth is that most people they say because they go through it, they're like I'm exhausted and they score high. I take that information and I submit it to Medicare, not the score, but actually Karen's answers to those specific questions and Medicare says oh, okay, yeah, karen is exhausted, she's the caregiver, she's taking care of David. Yes, let's give Karen respite. But that's not all. Medicare also looks at David's CDR score. What is CDR?
Speaker 3:People say, well, dr Eric, well, let's say a person was diagnosed with dementia, but does that mean we know what level of dementia? Is it mild, is it moderate, is it severe? How does one know? Do we just say, oh, I think you have moderate. No, right, it's a science. So we have conversations with David, with Karen, and we test David's memory, let's say, or anyone who does have dementia, and we're able to say what level of dementia it's staged Is it mild, moderate or severe? When we put those two together, then that qualifies for that respite component, right, because there's five components.
Speaker 3:One of the components is respite, and so in the respite component, both Karen would benefit as a caregiver, but David would benefit too. For example, what are some examples of respite right? What is it? Well, number one it could be home care, so you could have a home care, home health aid, who is in the home while Karen is going getting some break time as a caregiver, for example, a home health aid is there in the home. The other one, which I love, actually, I personally went to the Alzheimer's community care, adult daycares.
Speaker 3:I went and I saw, because my theory is, before I send someone somewhere, let me take a look, because that's my name, right. I can't just say, oh yeah, go there, but I want to see it. I was so impressed, first of all, with the energy within the Alzheimer's community care daycare centers that I visited one of them. I visited it was incredible. The staff, the people are happy, there's music, there's activities, right. So now think about it this way who benefits?
Speaker 3:David is not home? Let's say David. You know David's not home, he is not isolated, he is having fun in a daycare with people. People are engaging, there's games, there's bingo, it's fun. Karen, during that time when David's having fun as well, she has that break as well. That's the second respite. The third respite is an assisted living temporary. Let's say there is a caregiver. She has her dad who has dementia and she's always involved. Now the caregiver has a wedding of her daughter in New York and she lives in Florida. She's got to make that four or five day trip but she doesn't know who to live dad with. Through the guide model, the guide model will pay for that respite, stay in the assisted living for a short period while Karen's at the wedding and Karen comes back. She knows during that time the medications were given, the food was given, someone was watching dad, and so those are the three respites that are available.
Speaker 2:Now, in addition to that and that's just an amazing set of options and they can mix and match as well, so they can use some home care, some adult day there's a yearly allowance of $2,500 that CMS will pay the provider. In other words, they don't give the money to the family. The people providing those services through the guide provider, through, let's say, medbetterhealth, bills Medicare and gets reimbursed, so the family never has to pay for those services. So, in addition to those different respite type opportunities, we also have a couple of other support systems in place with guide. Can you tell us about those as well?
Speaker 3:Yes, we can. And, David, I think you wanted to say something, because when you heard 2,500, did that kind of.
Speaker 1:I'm saying there's no way $2,500 is going to cover everything we just talked about. So is it $25 a month, a year, six months? I mean there's got to be some limits.
Speaker 3:Yeah, I saw your brain light up with like an idea like well, how does that work? Right, you're on point. So the way that it usually works is initially one it's all a matter of perception. One could say, well, $2,500 is nothing. Of perception. One could say, well, $2,500 is nothing.
Speaker 3:Or, or, if you think about it, what if I were to tell you that once every two weeks, like every other week, you can have a caregiver replace Karen in the home for four hours, like every Wednesday every other week? Someone could give Karen a break for the whole year, for the whole year, and come and do the laundry, help out in the home, help with the ADLs, help with all. Every other week. Now, karen gets a break and she knows it. That's me time, it's scheduled, I'm waiting for it.
Speaker 3:Right, that's the way that it's intended to use for one. The other intent to use is, let's say, someone gets into the hospital and now they're coming home from the hospital and you need a lot of help and Karen's exhausted because she's like this is I need help. That time that week, you can get the respite. So, even though, yes, I agree with you, david, initially it's like, oh, it's only 2,500. The good thing is A. You could spread it out. Number two I believe with this program it's only going to go up. I believe that every year and this is a personal opinion I think that this is a starting point, but it's going to go up.
Speaker 2:Yeah, we believe that as well. We believe as CMS starts to get this positive feedback, they will increase the allowance. So it's a great starting point, but we really do expect that the outcomes will be proven Outcomes in when you decrease caregiver burden you're very often improving caregiver health, and so that's measurable. How often are caregivers requiring intense medical care or psychological care and so on? And the loved one as well, with this kind of support, is less likely to wind up in an emergency room in a hospital. So we do believe the Medicare program will start to realize that something really positive is happening here. So you know I understand why it started at this level, but we fully expect that that will expand because the family also gets additional services that are supporting them, even when they do not have someone from home health or they're not in a day center, a care navigator that they can call upon.
Speaker 3:And that's what you were alluding to. Dr Gilbert was asking. Well, which other services are included? We talked about the respite. Well, there's a care navigator and a dementia proficient provider. That's not any doctor, any nurse practitioner, they have to be proficient in dementia. That gets assigned to the person living with dementia who's in the guide model. Okay, then what? Well, one thing out of the four is caregiver education. So think about this. We come in, we do that assessment. There's an assessment it's about takes a significant amount of time because we really want to understand what's going on. So imagine we did that CDR and we find someone has a score of two right, moderate or three. There's caregiver education.
Speaker 3:Hey, mrs Smith, I know your mom is. You know she has dementia. Is she ever alone at home? Yeah, she is. Were there any incidents of her turning on the knobs of the stove, any incidents of trying to leave the home? Well, yeah, actually they were right. That's identifying a problem. Potentially that will happen, because she didn't know it was moderate, severe. She just thought mom had dementia, right?
Speaker 3:So have you ever thought about buying specific knobs for the stove that can protect and be a safety? Have you ever thought about disconnecting the stove from. These are some things that you start. Did you ever think about a GPS watch, which I actually learned from Dr Gilbert and her team? The GPS watch is an option and one can track where dad is if there was a situation. But a lot of the caregivers I talk to they don't even know that's an option.
Speaker 3:So that's one. Caregiver education. Caregiver education part two. So you and your organization, alzheimer's Community Care, and my organization, medbetterhealth, we're actually partners together and guide with Medicare and David. What we do is this is where this all comes. This was never done before. Doctors and organizations didn't do this kind of stuff. Right. Have hypertension here's medication. Diabetes here's medication right. There's no coordination. So when we get a patient and we see wandering risk because I did a CDR and I see there's a wandering risk who do you think I'm going to call in north of Florida? Who's going to help us? I'm calling Karen. Hey, karen, there's a patient. We spoke to them. They're interested. Can you make a home visit and give them that bracelet? They would really benefit from it.
Speaker 1:I didn't fully understand how and who gets reimbursed. And you gave an example of someone being able to be there for several hours a day. I mean, how does that work? I mean, how do I get that money? How do I pay that person, how does that person, you know, I mean. And then and the other thing is the geography, I mean you just gave it a good example. You don't have to. I mean, you're in Davie, which is probably 75, maybe 80 miles from me or less, so how could you help me? You know that, far away.
Speaker 3:The reimbursement is relatively simple. For example, let's use Karen organization and my organization, right, alzheimer's, community Care and MedBetterHealth. So I have a patient who needs respite, I'm partnered with Karen's organization and Karen and I are partnered with Medicare. Medicare pays MedBetterHealth, pays MedBetter Health. Medbetter Health is not allowed to take a single penny from that amount, that $2,500. That money is going for respite of the person living with dementia. And then Dr Eric's team and Karen's team would say hey, this person living with dementia wants to go to a daycare once a week or twice a week. This is the cost because Medicare has a specific fee schedule that we have to, as the organization, reimburse Karen's organization so that you, david, don't have to pay, right, but Medicare pays for that and that's how the reimbursement works. Questions on that?
Speaker 1:No, and I understand With Karen's organization. I know I've heard that if you can pay, it's like $125 a day. But there's a lot of places but there's a lot of the people that do get reimbursed or are taken care of. So it's a sliding scale to some degree, I guess.
Speaker 2:Well, it depends on funding. We really have very, very few. That would be private pay. Most of our attendees are funded veterans of active service. Even just one day in active service, the VA will cover the day center. We work with all the Medicaid plans that serve our three counties Palm Beach, martin and St Lucie. Medicaid will cover the services and then we have other state funding. We're very fortunate. We have excellent support. The state really has supported families dealing with dementia and so some might have a copay. It's based on income. That copay is often $1 a day but again, if they're in the guide program they have allowance. One of the fortunate things we're able to do is possibly have other funding so they might retain more of that $2,500 allowance toward home health or toward that assisted living respite visit. So the family pays nothing out of pocket when they're in the guide program.
Speaker 1:So the bottom line is this $2,500 doesn't sound like a lot, but it does sound like it can go pretty far to help.
Speaker 2:It can and once again, we believe it will be extended because of the feedback that CMS gets from caregivers and also what they see happening in the healthcare realm. For both the patient and the caregiver They'll see the benefit. Hopefully that allowance will increase over time. But what so impresses me and I've been a nurse for 50 years and three months is the first time a government program has really come up with something specifically focused on supporting those family caregivers. Dr Eric talked about 700,000 some odd in Florida just with Alzheimer's. That's not counting the other disorders head trauma, down syndrome and the other disorders that Dr Eric mentioned.
Speaker 2:I always tell people when I teach nursing students and physicians please double that number, because you have a second patient. That second patient is that caregiver whose health and well-being is at risk because of the burdens and the stress of caregiving. So we also worry about all the people who are still under the radar. They have symptoms and they're on their way, but they have not been evaluated. And that's where, david, the message you're sending out is so critically important. Because you saw symptoms, you went to get evaluated, you were able to jump on this diagnosis of early stage Alzheimer's and the changes you made started making a difference within two weeks. People who miss that early stage, which can be short, miss that opportunity, which can be short, miss that opportunity. So that's another message that we try to get out Get evaluated, find out what's happening so that you can have a plan to attack it.
Speaker 1:The services or during the services. I assume there's surveys that are done and people give feedback. That's part of what's going to happen that help move this along, I assume. I mean, am I correct? There's gonna, there's something that that you get back from the, the client or whatever, that gives you the ability to say this is working, this is working so therefore, it's a good thing. So that's going to have.
Speaker 3:That's part of it all right, we report medicare. You're right, david. Medicare requires us to report back from patients specific surveys. One of them is called the Promise 10. There's a few others that then they can evaluate. You're correct. But if it's working Now, we don't only want to think about the guide model as just a respite right, because there's five components.
Speaker 3:One of the other components that we've talked about is caregiver education. That's huge. Here's an example. I always use this one Mom does not want to take a shower, refusing to take a shower, says no.
Speaker 3:I come to mom and I say well, you got to take a shower, come on, it's been two weeks. Right, that's the approach Most people. You already get upset, agitated. Why can't she just take a shower? So what we do is we do caregiver education, one of two ways. Number one we actually train the caregiver.
Speaker 3:So you don't start off saying, mom, you have to take a shower because persons living with dementia, they feel like they're losing control. You're not going to go and take control and make it worse. You say, mom, it's one o'clock. When do you want to go to the spa with me? Are we going to go at one o'clock or one? Oh five, when is it better for you to go to the spa, cause I missed you so much and I really want to spend some time. So you take the bathroom, you put music there, you put some some flowers, you put some candles, you bring mom in. Mom comes in. Now, think about it. I'm a father. Do I want to take off my clothing in front of my children? No, but we're assuming, oh, someone has dementia. Yeah, let me take it off. Come on, dad. Come on, mom, take a shower. No, I have privacy. So what if I flip the control and say mom, what do you want to take off first? Do you want to take this off first? And I'm going to help you, but I know you could do it yourself. Mom, why don't you start and I'll help you right?
Speaker 3:So education like that is part of the guide model and we do it in one of two ways. One is through one-on-ones, like I just did. Two is we send you videos that actually are skits, are three-minute skits and there's role-playing and caregivers can look at that. So that's the other component of the guide. There's three more, but there's a lot. One big one, david huge, is the support and education of advanced care planning and goals of cares conversation when I was a resident.
Speaker 3:I remember there was a elderly man in the intensive care unit and he was intubated, he had all these tubes all over right and he had something called, dr Gilbert knows, anisarka. That's where your whole body swells because you're in the intensive care unit and you have IVs and you're laying and you're moving and your body becomes swollen. And I see the daughter and the mom there and the daughter tells the mom, mom, did dad like, did you guys talk about this? Did dad want this for himself? You know, it's been like two, three weeks like this and I'm a young resident, I'm hearing this. She's like no, dad, and I spoke about this.
Speaker 3:But we actually never documented it and we never had a DNR DNI, which is in Florida, a yellow paper has to be the yellow color right. We never had that and when the EMS came, no one knew what's going on. We never had that document and they intubated and now we're here in the ICU but dad never wanted this. Now I'm not saying DNR is bad or good. I'm saying it's a personal preference and we help the family have that difficult conversation because it is a very difficult conversation to have, but we do it so that we can avoid a difficult situation later on. It's better to have a difficult conversation than to be in a difficult situation.
Speaker 1:I think you need to explain what a DNR is, maybe because I'm what is a DNR?
Speaker 3:A DNR is and a DNI do not resuscitate, do not intubate. What does that mean? Let's say mom is at home, she has a home health aide or a caregiver. So let's say mom is at home, she has a home health aide or a caregiver, someone's there and all of a sudden, mom's heart stops. Caregiver panics. Who do I call? Not Ghostbusters, you're going to call 911, right? So you're calling 911. They come. They're seeing the patient who has no pulse, is not breathing. They're saying ma'am, do you have any documentation? What's the code status? The code status means what do we do?
Speaker 3:Do we actually do resuscitation like you see in the movies, one, two, three? Do we put in a tube like we see in the movies, right? Or do we say no, no, mom never wanted that. Mom said if her heart is not working and she's not breathing, don't press on her chest. Oh, that's what mom told you. Yeah, yeah, prove it. Maybe you have life insurance on mom, prove it. Oh, here, I'll prove it. You see the refrigerator here. It's hanging there. Here's the yellow paper. Mom and I signed that before. Or I'm mom's healthcare proxy and I got this signed. Oh, okay, we're not going to do it Right, that's, do not resuscitate and think how important that is, that one little thing. And think about if you do have that yellow paper but it's in your safety account in your bank or it's in your brother's house.
Speaker 2:When I teach about advanced planning, I encourage people, of course, try to create that plan while you're able to do so. Once you start to have serious problems with symptoms of dementia, you may not be able to execute such a document. But choose that surrogate wisely. Tell them what you're putting in the document and ask them if they're okay with it, because if they say oh, no, no, no, I would have to let them resuscitate. Well, that might not be the best surrogate because they can go against your wishes. They can rescind at the moment of an emergency and the professional EMS and the physicians in the hospital would have to go ahead and follow their wishes. It's counterintuitive, but it's the way it is. So I always say the best surrogate might not be a blood relative, it might be someone that can be more objective. Interview them, tell them here's what I am writing. Are you okay with it? I have to count on you. So that's a super, super important when you're making those decisions as well.
Speaker 3:And that's just the other component. I'll say another component, david, which we recently had it's care management. Now, what does that mean? Are we going to take over the medical care of the person living with the dementia in the guide model? No, they have a primary care doctor, they have specialists, right, but we're going to help coordinate. So what does that mean? We do something called medication reconciliation. That means we take a look at all your meds every month and we see is there anything new added? So last week we had a Karen. You're going to love this and this is important for the listeners as well. Be very careful.
Speaker 3:So I had a husband whose wife has dementia and he said oh yeah, these are the list of meds she takes. I said anything else? He's like yeah, there's some over-the-counter stuff. I said okay, what is it? He's like well, it's a sleeping aid from Walgreens. I'm like okay, sleeping aid from Walgreens, what is it? I'm like can you show me the box? So he shows me the box. It says Walgreens sleeping aid. I said can you zoom in, because we're doing virtual? And he zooms in and it says diphenhydramine, which is Benadryl.
Speaker 3:Now Benadryl, as we all know, is from allergies, but it can also make you a little sleepy. It can also make you dizzy. It can also cause constipation and urinary retention. It can cause a lot of different things. It can cause falls, especially if you're taking some other sedatives and then you're topping that up. So imagine no one would have asked With a guide model. Someone asks every month and says oh no. So I said please let's remove that, throw that out, because that $8 box would cause his wife to fall at night, break her hip and then never come out of the hospital or rehab and her life would change.
Speaker 2:We encourage families and really everyone should for their annual physical, bring everything they take, not a list. Fold it up in the wallet outdated. Bring the bottles. Show the provider exactly what you're taking. One classic example I always give is people see on TV turmeric. It's a powerful antioxidant. It fights free radicals. It will decrease inflammation in the body yes, it will. But it's also a blood thinner, and if you're already on a prescription blood thinner, you could actually have a serious bleed somewhere in the body that can threaten your life. And so just because things are over the counter doesn't necessarily equal that they are safe, especially when combined with the prescriptions that you really need your medication bottles just hoping that they also say not just the prescriptions but also anything else you take over-the-counter supplements, allergy meds, sleep medications herbs, vitamins, minerals it's all important.
Speaker 1:I had a specific thing happen with me. I went to see my cardiologist and I went through the list of things that I had and I was taking Prevostatin and he said I'm going to take you off of that because it's been shown that it could cause loss of memory. I take his word for it because what he told me. But there's things like that that certain doctors know about certain don't you know. So you really don't know for sure exactly. So the question then becomes is how do you really figure out if it's the right thing to do? You know. You just have to take the doctor's word for it, I guess, if you trust in them.
Speaker 3:Having a good doctor, of course, and also the best advocate. You know, your accountant isn't the best person to manage your money. You're the best person to manage your money right. So same thing with your health You're the best person. And today, with chat GPT, even though it hallucinates here and there, but with a lot of the online access to knowledge that we have. You know, we have a lot of access to data.
Speaker 1:And I did look it up and it did say it could be a possibility.
Speaker 3:But then on the flip side, right, it's always balance. For example, like someone who has really bad heart disease, multiple stents in the heart right, Multiple like strokes, and they're at risk for more Balancing, okay, taking away a statin which is used for cholesterol versus memory, you know so. Therefore. Therefore, that's that conversation that one needs to have.
Speaker 2:Well, and I think that leads into another very important conversation how people want to live. And if someone says it is more important to me that my memory remain intact, to me that my memory remain intact even though I might have fewer days, then that's their choice and that's your interpretive physician who will go through that kind of discussion.
Speaker 3:And you're right, because unfortunately, a lot of times traditionally physicians are like but you have to take it, but you have to do it. No, no, no. I always tell my patients I'm not here to tell you what you do, it's not my place. I'm here to educate you and together we make a decision, you being the 90% decision maker, me being maybe 10%, just giving you education, but ultimately it's what you want. And as part of the guide model we actually on my board of advisors is Dr Pandya. Dr Pandya is from Nova Southeastern University, she's the geriatric clinic here, she's the chief and she also was on the board of advisors for the White House. So she is you know. So she taught me the four M's that we focus on the first M and this is studied and it's published. The first M is what matters most to you. So I would ask David, what matters most to you in your life?
Speaker 1:That's the first thing. And what happened to me was he said your cholesterol might go up, but in the meantime I've lost the weight, I'm doing the exercise, so I probably don't need it anymore. So it's the healthy lifestyle thing all over again. It's always go back to that. Exactly that's what we're talking about. It's really what it's all about, because we get off on that and we just start doing all these habits, the sugar, the fatty foods, all this stuff. It's just part of our American living and we've been told wrong. And it's up to the parents, it's up to the doctors like yourself, dr Eric, that are able to make sense and be truthful and honest about what's going on.
Speaker 3:And a lot of time. It's just here's another pill and that's the the worst, and I always tell people that's how that medication reconciliation is so important. Like you know, we have a medication called quietapine Seroquel, and it's very often used in the elderly who have. Well, it's actually it's an antipsychotic. It could be used for psychosis. Right, oh, I'm yelling, screaming, breaking things around here. All right, let's calm somebody down. But in the elderly who have dementia, they have dementia-related psychosis sometimes, depending how severe the dementia is. Now one could say, okay, let me give the Seroquel, the Quietapine. On the Quietapine it actually says black box warning Do not give, should not be used in patients who have dementia for related psychosis because it increases their death. It increases mortality, right, it says that.
Speaker 3:So now do I prescribe it? Sometimes I do, I have to. But what do I do? I sit down with the healthcare proxy, the caregiver, and I say look, mom is throwing stuff. You're saying it's hard for you. This is the black box warning. We've tried everything else. I don't have any other, better tools. I don't. Now, let me send you to a psychiatrist, let me send you to if we've exhausted all that, and then that's the only tool that works and I have. I let again the family and myself, we make that decision together. But just for me to prescribe it and oh, this will help, and never to mention that it can cause that. That's a problem. That should never be done.
Speaker 1:I try to make people laugh, so one of the things I'm going to say is this All these ads on TV about all these medications, it drives me crazy. There's four, five, six at a time, and my thing is they all end up with you get diarrhea and die.
Speaker 2:Well, my beef is with the diabetes ads that say when coupled with diet and exercise. My point is if you did the diet and the exercise right? So I really am concerned that many of these drug ads give the wrong impression that a pill will solve your metabolic problem and it's really not the case. But we need to hear about those other three M's.
Speaker 3:And the first one is what matters most. The second one is medications. Right, we focus on that. Are there any? For example, we look at medications that are on the BEERS criteria, b-e-e-r-s, and Dr Gilbert knows those are meds that are not recommended to be given to the elderly. Now, sometimes you have to, like, aspirin is on the BEERS criteria, but if someone has coronary heart disease or heart attack, you're not going to say I'm not going to give it to somebody. But if someone's just taking I'll give you an example Om nexium, right, so it's on the beer's criteria.
Speaker 3:And why? Why? Well, first of all, unless someone has gastric bleeding, right, severe esophageal inflammation of the esophagus, unless your gastroenterologist told you hey, you got to take this for life. You should only be taking it for eight weeks and not more. And then the question is why? Why? Well, it can cause C diff, which is an infection, diarrhea, really. You said diarrhea, david. So it can cause diarrhea and literally kill you. Diarrhea, not simple diarrhea, kill you diarrhea. It can cause gastrointestinal cancer, like that's no joke. And it can cause bone loss and fractures. And how many patients are on? Now I'm not giving medical advice, right? Disclaimer, I'm not telling you and the audience. Who is listening? Oh, I'm going to stop it, but it's important. When you go to your doctor, say, doc, I've been taking this for two years, do I really need it? So, david, share with us.
Speaker 1:I took it for more than two years, omeprazole and it's also been shown possibly to possibly cause part of my problem, at least what I've read. So I mean I'm looking at all this and saying exactly this is what people need to know. What we're talking about is real life situations here that people need to know. What we're talking about is real life situations here that people need to know, and that's what we're doing here.
Speaker 2:There's another point I make. With those proton pump inhibitors the Prilosec, prevacid and Nexium they can also cause kidney injury and in some people further damage, up to and including end-stage renal failure. So the fact that you can buy it over the counter doesn't mean you should. They're intended for a short period, to kind of break a cycle, and what I encourage people to do is keep a diary what are you eating and relate it to when you get the heartburn and maybe eliminate those foods. It's always about root cause.
Speaker 2:So there's so much that we can teach about that and critically important because so much now is available over the counter. And you know I always say, if you're compelled, at least go up to the pharmacist and tell the pharmacist what other meds are being taken and make sure there's no potential immediate danger, because sometimes you can speak with a pharmacist in the off hours where you wouldn't be able to get your physician, but they work seven days a week in the drugstores, so we really have to be careful about that and so often just the natural way of handling the issue, like eliminating the food that causes heartburn, will solve your problem without a drug. We've got two, ms. We need two more Mentation.
Speaker 3:That's focusing on mental health. That's very important. Then mobility Evaluating are you a fall risk? Is your home safe? Because as part of the guide model, once you've been approved for the guide model, we have to do a home safety visit. Now that goes back to David's question about the zip code and the access right, because David's 80 miles up and I'm here in Davie, so that's where we partner organizations like mine, for example, partner with organizations like Alzheimer's Community Care, where they do have the reach. So I could have my care navigator do a virtual assessment. I do the virtual medical assessment and my team, my nurse practitioners.
Speaker 3:But then once David, someone is approved for the guide model, I'm going to call Karen and say, karen, I know you're in Jupiter and you have reach in Jupiter. For example, can you please do a home safety evaluation for us? Do they have grab bars? How are they getting up? Do they have a walker? And let us know so we can incorporate it. Because if they do, for example, how important is gait training, not physical therapy, that someone comes to your home and says, pick up, go down, and then they leave and they mill Medicare and it's not really valuable. What if someone actually works with you on your gait and helps you become stronger and you don't fall. That is what the guide model is about. I mean, I could talk about it for hours. I know we're hitting the top of the hour with this, but we're very excited about it.
Speaker 2:Well, you've also had families as far north as St Lucie County that we were able to visit for you and complete that part of the evaluation. We also ask about weapons in the home. We ask about unsecured power tools.
Speaker 3:Drano. Think about Drano. Hey, I think it's orange juice.
Speaker 2:That has to be secured. Yep, all of these chemicals that your loved one might innocently think looks like apple juice and it's Pine Sol. So we talk about securing those items so that you don't have those issues. So, ultimately, what guide is looking to accomplish? Is what Alzheimer's community care is trying to accomplish keeping the family together in the community, either preventing totally or at least delaying nursing home placement. Families really do not want to have to resort to that level of care if it can be avoided. So knowing the program actually is fairly new, but even so, have you started to get feedback?
Speaker 3:Huge feedback. So some of the things that we've mentioned. For example, when I'm talking to a and I teach my team because we have a large team I teach them. If there's no value exchange, if there's no value given to the caregiver or the person living with dementia, we didn't accomplish our mission right. There was no value of us talking with that. So when I talk to someone and I tell her about advanced care planning, they're like wow, doc, no one ever spent that 20 minutes, 30 minutes, telling us about it, thank you. When we talk about the Benadryl that was a huge thing for that family the caregivers are like thanks so much for letting us know. We didn't even know about that, right? I remember we linked somebody to your organization as well where they didn't know that there's a state funded adult daycare program. They had no clue. When we linked people to support groups right to support groups we both know Tino Negreek. I'm not sure, david, if you know Tino as well.
Speaker 1:I know, I know Tino. Yes, I haven't met him personally, but we've had many conversations.
Speaker 3:Tino is a rock star and Tino has an organization that's also a partner called Comfort Cares. They're amazing, amazing. And he has these support groups which I joined as well. There's like 15, 20 people there and I told people about it. Imagine being in a support group for free, like this, and people are telling you advice of what to do. And then Tino, who's a dementia certified individual who knows so much. I linked people to him, I gave value. Now we're linking people to respite. Now we're actually giving them the respite because people just got approved. Right now we're in that phase. That's going to be the next phase. So the feedback has been incredible.
Speaker 3:You know, there's many organizations that do guide and one has to be. I'm obviously biased because I like my organization why wouldn't I? But a lot of them are funded by venture capitalists and David, you know, when there's an investment into something and, david, you know, when there's an investment into something, people want a return and the return isn't always aligned necessarily with what's best. It's what's best for the return and what differentiates MedBetterHealth and organizations like Alzheimer's Community Care, which are not that way. We actually are.
Speaker 3:You know, we're doing this individually. There's no one who I have to say there's a return. So when I train my team it's about yeah, you're going to spend that initial hour doing the intake, then there's going to be another hour for the clinical intake, then there's going to be Karen's team or our team if it's geographically going to the home. So we're making sure we're doing this right, because it's on us on me and Karen and others to make this program work. Because if we don't make it work the real way, then in seven years Medicare will say there's no benefit, let's cancel it, and we will be directly responsible for that. And I don't want that on me. I want the opposite.
Speaker 2:No, we've got to make it work, so we would like you to tell everyone how they could access MedBetterHealth and learn more about your guide program.
Speaker 3:Definitely so. The best way. If you go on MedBetterHealthorg right M-E-D-B-E-T-T-E-R health, h-e-a-l-t-horg On the top of the page there's going to be dementia program learn more and there's actually a informational video that you'll see me with the same type of microphone talking about the guide model, giving you all the details and specifics If you want to jump into it. That's one way. The second way is just give us a call, 305-339-1756, and say hey, I heard Dr Eric talk about the guide model. We'd love to learn more and our team will take it over from there.
Speaker 2:Sounds terrific. Thank you so much for your time, so hoping that many that would be eligible will take advantage, and it really strengthens everyone working in this field professional caregivers, that family caregiver and, of course, the benefits for the patient themselves. So thank you everyone for listening to this important program. Please continue to join us, Give us your feedback, Give us your questions and your ideas for additional programs, and you can send questions to David. It's David at davidsalzheimersfightorg. We are all orgs and you can reach me very simply education at alzcareorg A-L-Z-C-A-R-Eorg, same as our website. So we look forward to you listening in again as we continue to bring topics so important for patients, for their caregivers.
Speaker 1:Thank you, dr Eric. It's been excellent. I'm very happy to have you, have had you on the program and I'm sure we'll have you again.
Speaker 3:Thank you, david, and thank you for everything that you're doing with Dr Gilbert about spreading awareness. This is so much needed. Thank you very much.
Speaker 2:His message is you know, I'm so many years at this and David is the first person that has had this situation, seeking an early, early evaluation, jumping on it immediately. That's amazing and if, like I say, if, you can inspire one more person to have that success that you had but I think you could have far greater reach than just one- we are here on this earth as humans to help others.
Speaker 1:That's what I believe. Please note this podcast provides information only. Podcasts should not be considered professional advice or a substitute for professional advice. Viewers of the speakers do not necessarily reflect those of Alzheimer's, Community Care or David Ufelder. Listeners and viewers are encouraged to consult with appropriate professionals and are responsible for how the information provided is used.
