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
How To Tell If Assisted Living Or Skilled Nursing Is Right For Your Loved One
Choosing the right care shouldn’t be a guessing game. With placement specialist Tammy Weller, we break down the real differences between assisted living, memory care, and skilled nursing. From recognizing signs like wandering and sundowning to understanding costs, licensing, and dementia training, this episode gives caregivers a clear roadmap for confident decisions and smoother transitions.
This podcast shares insights, not medical advice. Please consult a professional for your care. Hi everybody, this is Dave, and we are joined with my co-host, Karen Gilbert, and today we have a very exciting program. We welcome Tammy Weller, Retired and Refined Consulting. She specializes in helping you find the ideal housing options that suit your needs and preferences. They provide resources and personalized guidance to assist clients in selecting the most suitable, independent, and assisted living communities from one-on-one consultation to continued follow-up after moving in with all the compassion and clarity that personalized support.
SPEAKER_02:Welcome, Tammy. This is such an important discussion at Alzheimer's Community Care. We are often helping caregivers who do need that additional level of help. For the most part, the caregivers who call us want to stay together in their home. They want to care for their loved one with Alzheimer's or related disorder for as long as possible in the home. But should that time come that they do have to consider a placement, we find that there's often a lot of confusion. So we know you can help clear up a lot of those misconceptions. So tell us a little bit about how you came to establish uh retire and refine consulting.
SPEAKER_01:Thanks, Karen, and thanks, David, for having me on. I was at my father-in-law's house when he passed away. I remember the day he died, and my mother-in-law was right there. And I called her over because I knew, I knew, called the four uh sons in and said, say, you know, talk to your dad. And within a minute or two, he was gone. And my mother-in-law was devastated, absolutely devastated. So, right after the funeral, those four boys were relentless. They wanted her to downsize, they wanted her to sell the home. Mom, we love you. And it was out of love. And they all had opinions and they were not shy about sharing their opinions. And I remember just saying to them, back off. I don't know if I said it in those words, but I asked them to back off. They weren't too happy with me. But she came to a compromise and she decided to downsize her items, the possessions, the memories. And she started that and it took several years. So, fast forward a few more years, she sat down on the sofa next to me one day and said, Tammy, I think it's time I get a smaller place. And I turned to her and I said, How can I help? And she was the inspiration for me starting a placement service. And she is still at this beautiful community where I assisted her. And this was back in 2015 that my father-in-law passed, and 2020 when she moved into the home.
SPEAKER_02:That is inspiring, and it is an indication of the same type of decisions that so many of our families need to make. So tell us that there is a lot of confusion for many as to when a skilled nursing home is appropriate versus assisted living. So, can you tell us how you guide a caregiver in understanding that distinction so it could at least help focus the type of facility that they're looking into?
SPEAKER_01:A skilled nursing uh facility is a medical facility. It's where you have the nurses, you have them performing the cleaning part. If somebody has a trach, they have a feeding tube, they have medical needs. They need 24-7 medical at least observation. So that is a nursing facility. Think of it like an offshoot uh from a hospital. It's not the hospital, but it's an offshoot. If somebody has major surgery, they may go there for rehab. Somebody that has a terminal illness and they need medical care may go there to um wait out the rest of their life and hospice will come and provide care. Assisted living is where people need help with the activities of daily living. So if the caregivers have ever been um thrown terms like ADLs, that's what that means. Uh ADL is the activities of daily living. Activities of daily living are things like bathing. Maybe it's hard for mom or dad to get in and out of the shower. Maybe you aren't able to install grab bars, things like that, or or have a seat. So they need help. What about feeding? Maybe they're a little uh nervous with their with their forks and their knives, and and they can't cut the meat. They don't have the strength. Maybe they have a hand injury. Dressing, pulling up zippers and doing buttons and doing shoelaces can be very tiresome. To be honest, what sometimes when I have to buckle my shoe, it's just it might be a little difficult buckling a high heel there, you know, um, getting it on. I'm like, wow, I need to work out more. So it's not just limited to older. Um, and they may also need help getting around. So they need a walker, they need a wheelchair, and maybe their house is not equipped. And for that, that's where assisted living comes in.
SPEAKER_02:I think some caregivers may be confused when they're caring for a loved one that has a significant impact from Alzheimer's disease or a related disorder, someone who's really moving through the middle stage of the disease as their needs increase. But again, as you say, often those needs really revolve around those common activities of daily living. They don't necessarily mean that that person needs skilled nursing care.
SPEAKER_01:That is correct. If the person needs, let's say they're in assisted living and it's a lot less expensive than skilled nursing. Skilled nursing is very expensive. If a resident of assisted living needs a nurse to come by, they can hire that nurse to come by and give them medication. Maybe they need some help with that medication. A CNA cannot administer the medication, it has to be a nurse, it has to be a medical professional to actually administer. So that is a difference, but assisted living can provide that. And it's all the technicalities as far as licensing and things like that. But most of the assisted living around here in South Florida, in Palm Beach County, Broward, Miami, the assisted living will have a nurse on duty, and it's usually a 24-7. And so if somebody needs that medication administered, why not save the money, be in a home-like environment, a community environment versus a hospital type environment? That is the difference.
SPEAKER_02:When it comes to Alzheimer's disease and related disorders, the state of Florida mandates that staff and assisted living have an initial eight hours of training with minimum four-hour annual updates. The requirement for that same training in nursing homes is only four hours with no required updates. So if the need really does revolve around the Alzheimer's or similar disorder, assisted living may be that better environment. And they are often more home-like, uh set up in neighborhoods, uh, so smaller number of people sharing a dining room and a social setting. Can you tell us a little bit about what those cost differences are on average?
SPEAKER_01:It's more expensive for memory care. So let me introduce memory care. You had mentioned a person with Alzheimer's, pretty much let's say at the middle, right? So they're they're medium functioning, they're not low and they're not high. All right. So somebody at the beginning stages would be high functioning and they can maintain that for a while. They don't need, unless physically they need assistance, they don't need to be in assisted living if they're mobile, if they can do things on their own, if they have family support, everything's fine. When you get to a progression where there is definite cognitive decline and it interferes with daily activities, then assisted living works for them. Once they progress and they start sundowning and get very agitated, and maybe there's some behavioral aspects that enter into the picture. And when they want to wander, if you not all Alzheimer's patients want to wander, but some of them do. Some of them are a little escape artist, you know, they can be called. So a memory care community, we don't like to call them facilities. These are communities, these are neighborhoods, these are people's homes, and they are secure to where it keeps the memory care residents safe from getting out. Now, all the communities that I've been to have a secured courtyard, they can go in and out as they please, unless there's a heat advisory, and that is for safety reasons. It's so hot in South Florida. They can go out anytime they want, walk around, they have free reign, they have autonomy in memory care. People are not making them do what they want them to do, they're letting the resident dictate their day. They're just providing guidance. And I highly recommend for the progression, once your activities of daily living are seriously impaired and you need that help, assisted living, but if you are wanting to escape, then memory care is the safest place.
SPEAKER_02:They uh really are uh directed toward understanding does someone have a history of wandering, a history of elopement? Uh, and the assisted living facilities generally identify that. They will make sure uh that everyone, the employees of the facility know someone who might be more inclined. And you know, we do believe that that inclination is uh worse in those first few days when they're making that transition, when they've when they've experienced that relocation. So I think it's very important that a caregiver tell the facility, don't be afraid to tell them that mom has had wandering episodes, because the more they know, the more they can protect. And so another question that we encourage caregivers to ask is to what extent can you mimic the way my loved one lived as an adult? So let's say during their adult years they worked at a job where they got home at midnight and they typically typically would sleep until 10 or 11. Can you accommodate that? Because when their long-term memory takes over, they tend to uh revert to those habits and those patterns. And you know, we'll say, look, ask the question. And if the answer you get is, oh no, no, no, we wake up everyone at seven for breakfast, well, your loved one might not do very well.
SPEAKER_01:Exactly. And this is where I come in and ask those kind of questions, especially with memory care, because typically, depending on you know how far the disease has progressed, they really can't advocate for themselves. So I am their advocate, and I'm making sure they they get in a community that's going to honor them and respect them, and everyone deserves dignity and respect and autonomy, and they still have autonomy. So let me share a little story about a location in uh Delray. I walked in and it was it was an event being held in the memory care area, and I wanted a tour of that memory care, and I saw this desk, and I'm going, oh my gosh, my heart is melting. I want to cry, my heart is melting. It was so beautiful because there was there was a director of nursing and she had a desk job. She's a resident there and she had to go to work. And it did not matter if the residents were doing activities, if breakfast was not even served yet. She had a routine, and when she got up and she got dressed, she went to her desk that the staff had set up for her. There is a phone, it was a rotary phone. There is a file. They put fresh papers in there every day, and she files papers and she makes her phone call. She is happy because she's working. There was another just on the opposite side of the hallway, a stand, like a coat stand, and there was a vanity with a mirror and lights and pictures all over. I'm like, oh my gosh, pictures of a young woman just dressed to the nines. And there were a couple of different women on there. And there were women that were in the fashion industry, and they got ready for work, or they were getting the models ready for work. And they had beautiful gowns, they had jewelry, there was makeup. That is a community that I would put my grandmama at, you know, and that's the kind of thing I find out what was this person like before Alzheimer's progressed. And if the community is open to providing the desk, the um vanities, or the baby dolls, there are women that are 30 years old in their mind and they have to feed their baby, or they have to burp their baby and then put them to bed. They had a row of bibs out, they had diapers, they had everything for these women because after dinner they had to burp the babies. I loved it. That's the kind of combinations that caregivers need to look for.
SPEAKER_02:They they need to um understand that their loved one will live in that earlier time. So what's important? Uh what could you conceive will give them purpose? Uh now we we've had uh former male carriers who would deliver something to the different people at the day center. Tying into that sense of purpose is incredibly important. And I think sometimes uh families don't realize they think their loved one has forgotten, but those memories are stronger. So the more you can convey about how they lived, the easier that transition will be. It it may even boil down to certain uh uh cosmetics, certain flavored toothpaste, the things that they remember will help make the transition versus forcing them to use all new products that are foreign to them.
SPEAKER_01:The memory care communities that I love to place families at, you know, take them on tours and place them. And when I say place, I mean finding a new home. And these are the communities that want to know everything about the new resident. This is not a patient, this is a resident. They're in a community, they'll have a shadow box outside of their door or some kind of bulletin board, something where there's new pictures, old pictures, pictures of family members. They may not recognize the family members, but one day they might, and it helps them find their room. Another thing that is very important are work activities. So you may have somebody who's back in her housewife days, and I say housewife, not disrespectfully, but she may have been a stay-at-home mom. And we're talking 80, 90, 100-year-old people. And she needs to set the table because it's dinner time, and that's what she does. Another gal was a stylist, an event planner stylist, and she put flowers on the table every time they had an event. That was her job. And the community will give people jobs, whatever it takes to make the residents feel like they have a purpose, they are belonging, and they have a community they call home. It is the most important thing.
SPEAKER_02:I remember uh in my early days with Alzheimer's Community Care back in 2013. I visited all of our day centers. And the first time I went to this particular day center in Del Rey, I met all of the participants, and then I saw someone off in the kitchen. And I said, Oh, I haven't met your volunteer yet. And one of the staff whispered in my ear, She's not a volunteer, she's one of our participants. What was she doing that made me think she was a volunteer? Lunch was over, and she was finishing the cleanup, organizing the refrigerator. So I went to meet her. She took so much pride in how clean and organized everything was, sense of purpose. So the staff recognized this is something that she enjoys, she's good at. Uh, and it really added quality, self-esteem, sense of accomplishments. Uh, and you know, we we we try to remember uh that uh those who are moving through middle stage disease have have lost control over so many aspects of their life. Wherever we can give it back is really going to add quality to their days. So uh that is very important. And I think that is such a benefit of working with a consultant such as yourself versus just doing an internet search for assisted living facilities. That's uh just an incredible uh uh distinction. And of course, you can give them uh that lead. In other words, they're not starting from scratch.
SPEAKER_01:No, not at all. I do a lot more than just find a place, I help restore their independence because somebody that may want to stay at home and they love their home. And I get that. I love my home. I mean, I've got a great view, you know. I I love my home. But I understand that, you know, safety is more important than your surroundings, like, you know, at your own home. You need to be safe in your home. And if you have a strong social life and you have strong family support and they're able to modify your home to where you are safe, then by all means stay at home, love your home, and be happy. If those cases aren't true, if you don't have social interactions on a regular basis with friends, if you don't have the family support, and maybe renovating your home and retrofitting it is cost prohibitive. If that's the case, then assisted living or memory care would be your better choice. And that's what I help families understand. I provided a service this morning by hooking this uh gentleman up for his mom, Evan Stewart, uh, for at home care. I don't benefit financially, but the mom did not need assisted living at this time.
SPEAKER_02:That's a really important question. So we know for most, and now the caregivers who reach out to us already have a loved one in middle stage disease. Um it's very rare that we get a call for someone who's very early. Uh, we make the appropriate recommendations, then they're they don't need our day center. What they need are many of the things that David's been doing at that early stage that are effective. By and large, most who call us are in middle stage. We know middle stage, there's nothing medically for them. Lifestyle strategies might help a little bit, um, but by and large, we know those needs are going to increase, which means the burden on the caregiver increases. What would you suggest is um a good time, the right time, even if they're not ready to make the move, what's a good time to actually begin the discussion to learn uh what facilities are available and what might be the best arrangement when the time comes?
SPEAKER_01:My philosophy is please do not wait until a crisis, because once a crisis is hit, no one is making good decisions. You may think you're making a good decision, but you're in the middle of a crisis and you're making a rash decision because of need. Now, even if you're not ready for it, know what's out there. Reach out. Free consultation. I'm not pressuring, I'm not a salesperson, I'm an advocate and a guide. And reach out while the person is still in early stages of Alzheimer's, because they should have some say-so about their life. They should have some sense of control while they still have some control and have a say-so into where they're going to be spending time. They need to feel comfortable there, they need to feel safe. And even if they're not able to verbalize that, in the early stages, they'll be able to verbalize that.
SPEAKER_00:Also, I know that you prefer provide a checklist of questions that give you the ability to actually numerically figure out is if it's the right time, which I think is very critical because there's a lot of good questions on there and they all have to be answered. And most people have no idea what those questions are. So I know you give that out as something that they can make that judgment by.
SPEAKER_02:I I think the point you made about early uh disease is really important. Now, in in our healthcare system, unfortunately, we miss many people early. Uh the family often thinks the changes are normal aging, so there's nothing to do about it, which we know is now is not true. Uh, or the person resists getting an evaluation. That's happened as well. But one of the benefits that we talk about in identifying cognitive impairment early is that, again, the lifestyle interventions will be more effective. But we can also start that thought process with the caregiver and the family, as you say. Planning is in there's there's confidence in planning versus having to make an urgent decision in a crisis. I think that's incredibly important. So uh that is a wonderful opportunity uh for people to take advantage of. So tell us how would a family reach you?
SPEAKER_01:Well, um, email is always uh effective. So it's Tammy T A M I, last name Weller, W E L L E R at Retirefineconsulting.com. A phone number 561-270-4825.
SPEAKER_00:One of the things that interesting about you is that you don't charge the patient anything. And that's critical because people are saying, well, how do I how do I get your services? And I'm not, you're not, I'm not paying you. Well, can you explain how that works?
SPEAKER_01:It amazes me how many people just want to do everything themselves. And I'm thinking, why? They spend over 40 hours a week researching communities. I already have the information and I have the inside information. So the my services are free. How I get paid are by the communities. The communities have a fee structure, a referral fee, they call it. These are marketing dollars. So because of me bringing in people to their community, if that resident chooses to move into that assisted living or memory care, then after 30 days, they will pay me a referral fee to make sure that that resident is happy, they're comfortable. If they leave before 30 days, I don't get paid. So it behooves me to find the best residence, not housing necessarily, but residence for my clients. And I dig deep. And that checklist you mentioned, I have so many different guides and checklists. If you want to email me and ask for a guide, I will spit it out to you. It's absolutely free. The families and their loved ones.
SPEAKER_02:I think you're also conveying a benefit to the facility because you have already done the work to determine if their loved one is likely to succeed there, to feel comfortable and to uh engage with the others. So I think there's a benefit for everyone.
SPEAKER_00:There's another thing we discussed is I said, well, you're local here. How do you handle somebody that's not here?
SPEAKER_01:I work all over the country. I have relationships with executive directors in multiple states, multiple companies. What a lot of people don't realize, the newer assisted living and memory care communities are managed by a management company. And this management company may have communities in various states. And I get to know that was the number one thing I did when I opened up my company. I reached out and I made connections. And through those connections, you get an idea of what leadership is like from the top down. If the culture is there at the community, more than likely it's going to be filtered down to the employees and you're going to have happy employees because you have a leader that cares, that truly loves his or her residents. Then another option would be to look at the placement specialists like myself in that city, in that area. And I've gotten to know several that I will refer the client to them. However, I still take care of the client. The placement specialist will tour the communities that I pick for the client.
SPEAKER_00:You also tell me that if you have to travel, you do not charge them for that travel.
SPEAKER_01:No, I do not. I've gone to New York for a client. It was very important that they get unbiased opinion that it was a pretty rough family dynamic. And because I'm outside of the family dynamics, I make decisions based on my client, what their true needs are, and the things that they don't say, I pick up on.
SPEAKER_02:I I think it's an incredible service, and I think it can really serve to reduce the stress on the caregiver. They've already, uh, they're already experiencing a great deal of stress and burden in providing the physical care, the the emotional uh aspect of caring for a loved one, certainly the financial stress of caring for a loved one with one of these disorders. So uh that's an incredibly important service. So we'll be happy to also share the information posted for those who are watching the podcast to see. And we thank everybody for listening or watching, and we encourage you if you have questions or stories that you would like to submit, you can reach David, David at David's Alzheimer's Fight.org. You can reach me very simply, education at allscare.org. That's al Z C A R E dot org. And we'll be happy to take questions, comments, requests for additional topics. I hope to see you all again. Thank you so much, Tammy.
SPEAKER_00:We are here on this earth as humans to help others. 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.
