July 25, 2025 • 26 mins
When Kathi Miracle started caring for dementia patients at just 22 years old, she was hit, kicked—even suffered broken ribs. But instead of walking away, she leaned in, launching a lifelong mission to improve dementia care.
Now, with over 30 years of experience, Kathi shares eye-opening strategies that challenge common assumptions. Hosted by Elder Law Attorney Bob Mannor, this episode of Advice From Your Advocates uncovers:
- Why 80% of dementia-related “behaviors” are triggered by caregiver approach—not the disease
- How adjusting personal space, vocal tone, and visual cues can dramatically reduce outbursts
- Why knowing a person’s life story is essential to understanding their reactions
- How caregivers can build a support network without guilt
Whether you're a family caregiver or a professional, this conversation offers life-changing perspective and practical tools.
Bonus: Get a sneak peek of Kathi’s upcoming book, Your Ticket to Compassion, packed with QR-code tools for real-life dementia challenges.
Learn more about Kathi Miracle and Silver Tsunami here: https://www.mysilvertsunami.com/
Host: Attorney Bob Mannor
Executive Producer: Savannah Meksto
Assistant Producers: Samantha Noah, Shalene Gaul
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ABOUT US:
Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.
We also help families dealing with dementia, Alzheimer’s disease, Parkinson’s disease, and other illnesses that cause memory loss. We take a comprehensive, holistic approach, called Life Care Planning. LEARN MORE...
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Welcome back to Advice fromyour Advocates.
I'm Bob Manor.
I'm a nationally boardcertified elder law attorney and
I have a particularconcentration on helping
families that have a loved onewith dementia.
(00:23):
As part of that, I'm reallyexcited to bring to you a
thought leader in the dementiaarea, which is Kathy Miracle.
I love that name, kathy.
Welcome.
Speaker 2 (00:34):
Thank you so much.
I'm happy to be here.
Speaker 1 (00:37):
Kathy, tell us a little bit about yourself.
Speaker 2 (00:39):
I am a Colorado native and I have a double
bachelor's degree in speechpathology audiology.
Native and I have a doublebachelor's degree in speech
pathology audiology.
And my master's degree is ingerontology, with an emphasis in
dementia and elder abuse.
I started my career in seniorliving back when I was 22 years
old as a certified nursingassistant in a nursing home and
I was assigned to an Alzheimer'sunit I because there was no
(01:02):
training back then aboutdementia.
I was hit and kicked andpunched and scratched and thrown
into a wall.
Ribs were broken.
Um, I did it all wrong and so Icommitted to learning how to
work with individuals withdementia and their families so
that I could do it right and sothat I could train my teams to
do it right.
So I've spent over 30 years insenior living.
(01:23):
Um, I've been ranked at a highlevel as a dementia expert.
I speak at conferences all overthe United States.
I consult nationally andinternationally.
I'm nationally approved as alegal subject matter expert, so
I assist in legal cases, and Ihave a book launching this fall.
The title of it is your Ticketto Compassion Navigating the
(01:44):
Dementia Experience, which we'resuper proud of, and it will be
a great handbook for familycaregivers and professional
caregivers on how to travel thedementia journey a lot easier.
Speaker 1 (01:53):
I'm excited to talk to you about your book, but
we're going to put that off fora second here, and what I'd like
to talk to you about first,right off the bat, is something
that you and I have talked aboutpreviously.
First, right off the bat issomething that you and I have
talked about previously.
You had mentioned in your introabout being kind of bitten and
hit and scratched and all ofthat.
How do we deal with behaviors?
Speaker 2 (02:16):
So what I have learned over my years of
experience is about 80% of thebehaviors are triggered by the
individual who is interactingwith them.
Only 20% are usually due to anactual dementia diagnosis.
Speaker 1 (02:29):
So that's really something worth repeating.
So 80% is based on a triggerthat the caregiver or someone
else interacting with theminitiated, and I believe that's
true and I know that might comeacross to our listeners, as I
hope you don't get defensiveabout that but you don't know
that you're triggering them, andthis is where Kathy's expertise
(02:52):
is really helpful here.
So I just wanted to emphasizethat.
So go further on that.
As far as the 80% that istriggered by the activity of the
other person, Sure, I mean.
Speaker 2 (03:03):
The first couple of things is I talk about approach,
and oftentimes if somebody withdementia is approached from
behind, we startle them and theywill react.
If we approach too fast, theperson can become startled and
then the individual reacts.
The big thing that most peopledon't know whether it's a family
(03:23):
caregiver or professional isthat if I were to get in your
personal space and we didn'tknow each other, you would back
up, you know.
I did it again, you might backup because we know to.
You know it doesn't feelcomfortable A person with
dementia.
Their personal space isactually six feet and when you
get into their personal spacewithout permission they just
start defending it.
And so I train staff on how toapproach gently and from the
(03:48):
right direction and so as to nottrigger that.
Another thing is communication.
People tend to communicate toomuch or too fast and the person
can't keep up and everybody getsfrustrated and then the person
with dementia will react.
Our environment can triggerbehaviors, whether it's
overstimulating orunderstimulating.
Even in an understimulatingenvironment it can cause the
(04:10):
individual to become grouchy orcranky and then they react when
someone does start to interactwith them and a medical need.
Sometimes you know somebody maybe on an over-the-counter pain
med and what they need is ascheduled pain med, or they're
on something every six hours andwhat they need is every four
hours.
And so anytime there's amedical need, like a urinary
tract infection or they're inpain, they can react to the
(04:33):
person who's interacting withthem.
Speaker 1 (04:35):
One of the things I think you'd agree with is
getting on the same level, likebending down or getting down on
the same level so you're nothovering over somebody in a
wheelchair or something likethat.
Speaker 2 (04:47):
That's correct and I covered that information when we
talk about approach is that youdon't ever want to stand over
somebody.
It's very intimidating andpeople with dementia will react.
So you're absolutely correctyou want to be at eye level or
just slightly below eye levelwhen interacting with that
individual.
Speaker 1 (05:02):
I'm always amazed by the brain, because I always tell
people that the brain is alwaystrying to figure out and solve
problems, solve the situationthat's in front of them, but if
it doesn't have the data thatsome of us have, it's going to
come up with a solution.
It's going to come up with ananswer, and some of the times it
(05:23):
might be that the answer isthis person is a threat to me
based on their interactions, andso the brain's always trying to
still solve problems, even ifit doesn't remember.
It has no short term memory, andso one of those things is the
issue of the speed of speech,which I have trouble with
because I tend to talk reallyfast, and so the issue is the
(05:48):
brain processing especially withsomeone with Alzheimer's or
dementia might be slower andit's uncomfortable sometimes for
people to have that gap, thatsilence, silence, is
uncomfortable for a lot ofpeople, and so for someone to
make a request or explainsomething and then not get a
(06:11):
reaction right away, even 10seconds seems like an eternity
to allow the person to perceiveor absorb the statement that had
been previously made.
But that's exactly what needsto be done.
Is that slower reception ofinformation and sometimes
(06:31):
there's going to be silence.
That might be awkward and youcan't fill that silence because
that's just going to beconfusing.
Speaker 2 (06:38):
Correct.
That's one of the things Itrain is one you have to be
comfortable with silence, which,like you said, most people are
not.
I've even timed some of my ownstaff to say, let's see how long
you can be quiet, and they lastabout 10 to 15 seconds, and
that's about it.
What I also, you know, informpeople is that when we look at
the cognitive skills thatindividuals have in the brain,
(06:59):
auditory processing and auditorymemory will pull down
short-term memory if it's notstrong.
And so what I also tell is, forwomen specifically, that as men
age, the decibel range that menstart to lose their hearing is
the same exact decibel range aswomen's voices, and so women
tend to need to bring down theirvoice.
(07:21):
I will often demonstrate like ifyou were a DJ on a radio.
You know your voice becomeslower, and if you talk just
slightly slower, the person canusually understand that decibel
range and that rate of speech.
And then you do have to makesure you're continuing to
maintain eye contact with them,because some people learn how to
(07:42):
lip read with dementia andthat's what they rely on,
because visual processing andvisual memory stay intact longer
in the brain through thedementia journey than auditory
processing and auditory memory,and so by slowing down the rate
of speech, by lowering yourvoice, by maintaining eye
contact and then yes, by beingquiet and waiting for the person
(08:03):
to respond, helps withcommunication.
What I also will say is whatsomebody reads and understands
in the brain is completelydifferent than what they hear
and understand.
So using common words likehungry or thirsty or tired, and,
if you're going to go to thatlevel, using pale yellow paper
with gold black print, is easieron aging eyes, and I also
(08:25):
encourage people to laminatethose common words because
you'll use them over and over.
Or pictures also work very,very well with an individual,
because they understand thepicture a lot faster than they
understand what's being said tothem.
So there's a lot of differentcommunication techniques that I
advise and guide on so thatcommunication with this
individual is easier foreverybody involved.
Speaker 1 (08:47):
It's interesting what you said about the difference
between men and women, and I'mcurious if you have any thoughts
about interacting with someonewith dementia and how whether
they're a man or a woman has animpact on it.
Speaker 2 (09:02):
I think it has more to do with just man versus women
.
It also has to do with wheresomeone grew up, it has to do
with what their profession was,it has to do with the type of
dementia they may have and wherethey're at in their journey.
There's a lot of varyingfactors that I take into account
.
What I find more often than notespecially someone who has been
(09:24):
, you know, come into acommunity is that they don't.
The community doesn't do agreat job at getting history on
an individual.
So you know, just like I said,I was in Kansas a couple of
weeks ago doing training for thecommunity.
I was doing training forprofessional staff, but it's an
area of Kansas where my dad grewup, so I'm very familiar with
it.
(09:45):
But farming if you were a farmer, most men have a higher hearing
loss in their left ear thanthey do their right ear, because
driving a tractor they didn'tuse ear protection and the
engine was on the back left sideof the tractor, so they have a
higher hearing loss in the leftear.
If it was somebody who grew upin a metropolitan area, then
(10:05):
it's not going to be the sametype of hearing loss for that
individual, whether it's a manor a woman.
Somebody was a CEO of a companyversus a blue collar worker.
Your communication with themand your interaction with them
is going to be completelydifferent, and so the history of
an individual is just asimportant, and I like to know
where they grew up.
I like to know if they were inthe military or not and what
(10:30):
rank they were.
I'd like to know even for women.
I took care of a lady who wasthe first PhD in her family, and
so interacting with her was alot different than interacting
with the woman who had had 10children all at home.
She had one boy and nine girls,and so our interaction was
completely different, because oftheir education level or
because of the lifestyle theychose to have, and so knowing
all of that informationabsolutely helps to communicate
(10:53):
better with an individual, andmore efficiently as well.
Speaker 1 (10:56):
You know, that's really very interesting, and I
100 percent agree and agree andI feel like that is neglected
that there is a certain amountof when someone has dementia,
especially if they're going intoa care setting whatever the
care setting is, whether it'smemory care or a nursing home or
anything like that there is atendency just to focus on, you
(11:21):
know, their security andprotection and making sure that
they have less risk.
The reality, though, iseverybody is so different and
people need different things,and actually realizing that just
because somebody is diagnosedwith dementia doesn't mean
they're not a person anymore.
And they have all of this thatthey've brought with them, their
(11:43):
you know, their experience,their knowledge, their life.
Just knowing those things,which I think is often neglected
, can make a difference in howwe're naturally going to treat
somebody if we know that they'veworked really hard on a farm
for 40 years, or that they werecareer military, or that they
(12:07):
were an academic.
Speaker 2 (12:08):
Absolutely, it's a huge difference.
I mean, again, I've learned alot through just mistakes I made
or my team has made and I givethe examples when I train that
we were taking care of anindividual who was very
combative and very resistant tocare with one of my staff and it
just so happened I was in thebuilding on a weekend when his
(12:29):
son was there and the son askedme.
He pointed out the staff personand said is that the person who
my dad gets very irritable with?
And I said yes, and shehappened to be of Asian descent.
And he said well, what you needto know is my dad was in Pearl
Harbor.
He was stationed in the Navy inPearl Harbor when it was
attacked and I thought, ok, wellthen, no wonder we can't get
(12:52):
this individual to do anythingwith him at all.
And so it's little things likethat about people's history that
make a huge difference today inhow we care for them and how we
interact with them and maintaina positive relationship with
that individual.
Speaker 1 (13:05):
Just as an aside.
I know that there's a lot ofthought process about that.
We have to, you know, work pastour biases.
This is not the time to workpast biases.
When somebody has dementia orAlzheimer's, this is not.
You know, they could haveworked past that before, but
this is not the time to insertyour political or trying to make
(13:26):
a point of differences andthings like that.
At this point, there's notgoing to be a learning curve for
someone that has Alzheimer's.
Speaker 2 (13:36):
No, and the more I always told families you know,
the more I know, the better wecan take care of them.
You know things that happenedto them growing up as a child,
things how they were treated inthe workforce.
I mean, the more I know it, wewere able to set up care in a
much more specific andcustomized way for that
individual and we avoided a lotof problems that I don't think
(13:57):
other people avoid because theydon't take the time to find out
or they don't understand theimportance of finding out that
information and the numerousstories I could tell over the
things that I've learned justsimply by the importance of
understanding the history ofthat individual.
Speaker 1 (14:13):
And I have a book coming out.
I'm excited to read it yourTicket to Compassion for
Families and Others in theLong-Term Care Profession.
From what I've learned aboutyour book, it's going to be very
hands-on, useful, practical.
So tell us about your book.
Speaker 2 (14:30):
So we are very excited to be launching the book
this fall.
The title of it is your Ticketto Compassion Navigating the
Dementia Experience.
It is being pre-sold now for adiscounted price on our website.
Mysilvertsunamicom is thewebsite, but it is an entire
book.
I've often described thedementia journey as one walking
(14:50):
into an unknown amusement park.
Sometimes the ride is fun, somedays the ride is scary, some
days you get off the ride andyou're nauseous or you're sick,
and there are days you don'twant to go on the ride at all,
and so the entire book is themedaround an amusement park, from
communication tips to self-carefor the caregiver, to eating
(15:11):
habits, to just about anythingyou can think of in regards to
the dementia experience and thedementia journey, and so it will
be a practical guide for bothprofessionals and family
caregivers.
We will be having QR codesthroughout the book so someone
could scan, and we will alreadyhave documents pre-done for
people.
They just have to print themand fill them out and they can
(15:33):
create their own binder or theirown electric file.
But even as much as one of thefascinating things I came across
is somebody needs to go to theemergency room the person the
family caregiver, theprofessional caregiver doesn't
get to ride with that individual.
So, having a document you canhand an EMT or paramedic who can
hand that to emergencypersonnel, just to understand
how to interact with this person.
(15:53):
And do they wear hearing aids?
Do they need an assistivedevice?
Do they wear dentures?
What do they prefer to becalled?
I mean a very quick front andback page to help be able to
interact with that individualmuch better and much calmer than
what we see today.
Speaker 1 (16:07):
And this book would be helpful both for people that
are in the industry that workwith folks with dementia, but
also for the family itself andlearning strategies and trying
to minimize some of the moredifficult aspects of dementia.
Speaker 2 (16:23):
Yes, it would.
I mean the focus is truly onthe family caregiver.
As many years as I spent insenior living, what I come to
realize is that I do think thatpeople could take care of people
at home longer, which is filledwith a better quality of life.
Studies show that people livemuch longer, with better quality
of life, living at home, intheir own home environment, and
(16:44):
so being able to help familycaregivers understand the
guidance needed to be able tocare for that person as long as
they can at home, I think helpseveryone overall.
Speaker 1 (16:53):
Talk a little bit about the dynamic between a
husband and a wife, because Iknow that this could be very
challenging.
You know if a couple's beenmarried for 30, 40, you know if
(17:16):
a couple's been married for 30,40, 50 years and they've had
their ups and downs and they'vehad they know each other's
grumpiness and it's really easyto then start looking at some of
the symptoms of dementia orAlzheimer's as just my spouse is
being grumpy or they're justbeing obstinate or whatever.
So talk about that dynamic andhow to maybe help a spouse learn
(17:38):
the new reality.
Speaker 2 (17:40):
That is a huge issue, I guess I could say, because
I've seen everything from peoplebeing very on top of it and
something's wrong.
More often than not we ignorethe symptoms.
Families ignore it because theydo.
What I hear from families isI'll hear them say, well, you
know, he or she is just askingrepetitive questions to drive me
crazy.
(18:01):
I'm like, well, no, that's notwhat they're doing.
They don't see some of thewarning signs.
Like you said, it's comingacross as the person's
intentionally being irritable orbeing cranky, when that is
actually the prime time we needto hitting the individual with
dementia.
There's a lot of statistics outthere that is unknown about that
particular part of it.
(18:34):
But the other part is theharder part, I think is the
wedding vows.
I've seen so many.
I've had to redefine weddingvows so many times for
individuals because they believethat, for better, for worse, in
sickness and in health.
I'm going to see this processthrough because it's what I
committed to in front of God,family and friends X amount of
years ago, and so oftentimesI'll say do you know?
(18:56):
Nowhere in the Bible does itactually say that you have to do
this alone, you know?
you're honoring your weddingvows by bringing in a care team.
You're still honoring yourwedding vows by taking care of
yourself.
You know just as much as you'retaking care of this person and
so having to sit down andredefine individuals' wedding
vows so that they understandthat nowhere do they have to do
(19:17):
this alone, and the importanceof getting legal paperwork in
order, financial medicalpaperwork in order and reaching
out to the necessary network andcare team to help them have the
support they need to navigatethis journey.
Speaker 1 (19:32):
Yeah, very, very good .
So when you know a family isdealing with this and it doesn't
feel like they seem to be in alittle bit of denial or ignoring
the symptoms we had anotherguest that talked about that
many families tend to cocoon andwhat that means is they stop
interacting with the outsideworld, they don't accept help
(19:54):
from the outside, they'resomewhat embarrassed about the
situation.
So they just stay in theirhouse and never leave and really
try to hide the situation, andI've seen that from time and
time again.
Talk a little bit about that,about how negative that can be
and the resources that are outthere to help families.
Speaker 2 (20:14):
I've listened to families talk about cocooning.
It's termed a lot of differentways, but that's a great way to
term it.
But what they do, part of whatthey do is they convince
themselves they're protectingthe individual, you know this
individual can't keep up inconversations, or or it's a
dignity issue or it's a respectissue.
And if I can work with a familyor an individual earlier on in
(20:34):
their dementia diagnosis, whenthey're newly diagnosed or
there's concerns about it,socialization is one of the key
factors that helps in delayingthe progression of dementia or
in reversing cognitive decline.
So socialization is actually animportant factor.
So to do the opposite, I mean,I think we as human beings try
to do what we think is the rightthing for somebody and in
(20:58):
hindsight it becomes the onething that they shouldn't have
done.
But you know, we do the best wecan with the information that
we have.
And so cocooning there's allkinds of things that can happen.
The person may not be gettingthe nutrition, the caregiver is
burning out and they're notgetting hydrated, they're not
being stimulated cognitivelythrough socialization.
The home environment can becomeits own concern, with area rugs
(21:22):
or leaving a coffee pot on orsomeone turning on a stove and a
fire starts.
I mean, even havingunderstanding what a
dementia-friendly environmentlooks like would be helpful.
So cocooning can be problematicon so many levels, not just for
the person with dementia butalso for the caregiver, because
the caregiver is not getting thesupport or the interaction he
(21:42):
or she needs in order to staystrong to care for this person
throughout the dementia journey.
Speaker 1 (21:47):
Kathy, I know that you've mentioned that you're a
national speaker and among otherthings, but you also do some
coaching one-on-one.
So talk to us about thecoaching and who might be
interested in your coaching.
Speaker 2 (22:00):
So it depends on who calls me, but I do coaching with
professionals at all levels,from frontline staff to charge
nurses to executive directors,administrators on how to
transition someone into a seniorliving community more
successfully, how to not triggerbehaviors, how to care for
those individuals, how to helpfamilies learn, how to continue
(22:20):
to connect with someone up untilsomeone takes the final breath.
From a family caregiverstandpoint, I can go in and I
can do a survey of their homeenvironment and talk about this
is what's working well in yourhome environment.
This is something you wouldneed to consider, or this might
be more helpful in yourenvironment for a person with
dementia.
I can help families betterunderstand how to build a
(22:41):
network, take care of the thingslike legal decisions, financial
decisions, medical decisionsand who they need to get
involved in that network to getthrough those things.
Talking about self-care, Icannot emphasize enough about
self-care for the individualwho's caring for someone with
dementia and, if caught earlyenough, I have done a handful of
coaching and guiding with theperson who was diagnosed with
(23:03):
dementia to be able to delay theprogression of dementia.
In some circumstances we'vebeen able to reverse cognitive
decline for that individual andit gives them a much better
quality of life.
So we customize our coachingbased on the person who's
calling in for help.
Speaker 1 (23:18):
I think that's the key here, for everything that
we've talked about is treatingthe individual as an individual,
understanding their background,understanding their life, and
customizing our decision-makingbased on that, which is kind of
the opposite of what theindustry tends to do, which is
to group everybody together andso when they have activities,
(23:42):
everybody goes to the same musicsession or the same exercise
session, same bingo.
You know, music session or thesame exercise session, same
bingo, whatever it is, and theidea is that we'll have a lot
less behaviors, we'll have a lotless sundowners, things like
that, if we treat into you know,everybody as an individual
rather than trying to herd theminto everybody.
Do bingo at 10am.
Speaker 2 (24:02):
Absolutely.
That's absolutely correct, andit all starts with the
information that is collectedand gained through however
somebody wants to term that, thediscovery process or the
admission process.
I found that the more I have asolid understanding of the
individual where they grew up,what type of family did they
grow up in?
All boys, all girls?
(24:23):
Were they in the military?
Were they not in the military?
What rank?
What did they do in theircareer path?
You know how they raise theirchildren.
All of that informationcollected lends to how we
ultimately provide care for thatindividual, and so I very much
tried to customize every singleperson who came in the front
door, because you'll hear thephrase when you've met one
(24:46):
person with dementia, you havemet one person with dementia.
So we know that phrase, but yetthe industry as a whole doesn't
follow through and treat eachperson as an individual.
They lump everybody together,which actually can be more
problematic in the care thatthey provide.
Speaker 1 (25:03):
So, Kathy, this has been a fascinating conversation.
Kathy Miracle, she has a bookcoming out, your Ticket to
Compassion.
You can preorder it onmysilversunamicom.
Any thoughts that you want toleave our listeners with?
Speaker 2 (25:18):
I think you know.
What I would just say is thatI've never seen this be an easy
journey for anyone not theprofessional caregiver, not the
family caregiver.
I oftentimes see families.
They still try to compare thatperson to who they were 5, 10,
15, or 20 years ago.
And as a professional, you knowwe get to love, honor and
respect who that person is today.
And so truly for familycaregivers being able to, on
(25:41):
some level, let go of the pastand enter into their world,
because they no longer are goingto be capable in living in our
world.
And so, and be kind to yourself.
You know, as a family caregiver, give yourself some grace.
You're doing the best you can,but, most importantly, make sure
that you're taking care ofyourself, because you won't be
here to take care of the personwho needs you if you don't take
(26:01):
the time to take care ofyourself.
Speaker 1 (26:04):
Very important information here today.
I appreciate you, kathy, andall the work that you do.
If you've enjoyed this podcast,don't forget to subscribe to
Advice From your Advocates.
You can find us on anywherethat you listen to podcasts.
We're also on YouTube or youcan find us on our website,
manorlawgroupcom.
(26:24):
So thanks for joining us today.
So thanks for joining us today.
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Welcome back to Advice fromyour Advocates.
I'm Bob Manor.
I'm a nationally boardcertified elder law attorney and
I have a particularconcentration on helping
families that have a loved onewith dementia.
(00:23):
As part of that, I'm reallyexcited to bring to you a
thought leader in the dementiaarea, which is Kathy Miracle.
I love that name, kathy.
Welcome.
Speaker 2 (00:34):
Thank you so much.
I'm happy to be here.
Speaker 1 (00:37):
Kathy, tell us a little bit about yourself.
Speaker 2 (00:39):
I am a Colorado native and I have a double
bachelor's degree in speechpathology audiology.
Native and I have a doublebachelor's degree in speech
pathology audiology.
And my master's degree is ingerontology, with an emphasis in
dementia and elder abuse.
I started my career in seniorliving back when I was 22 years
old as a certified nursingassistant in a nursing home and
I was assigned to an Alzheimer'sunit I because there was no
(01:02):
training back then aboutdementia.
I was hit and kicked andpunched and scratched and thrown
into a wall.
Ribs were broken.
Um, I did it all wrong and so Icommitted to learning how to
work with individuals withdementia and their families so
that I could do it right and sothat I could train my teams to
do it right.
So I've spent over 30 years insenior living.
(01:23):
Um, I've been ranked at a highlevel as a dementia expert.
I speak at conferences all overthe United States.
I consult nationally andinternationally.
I'm nationally approved as alegal subject matter expert, so
I assist in legal cases, and Ihave a book launching this fall.
The title of it is your Ticketto Compassion Navigating the
(01:44):
Dementia Experience, which we'resuper proud of, and it will be
a great handbook for familycaregivers and professional
caregivers on how to travel thedementia journey a lot easier.
Speaker 1 (01:53):
I'm excited to talk to you about your book, but
we're going to put that off fora second here, and what I'd like
to talk to you about first,right off the bat, is something
that you and I have talked aboutpreviously.
First, right off the bat issomething that you and I have
talked about previously.
You had mentioned in your introabout being kind of bitten and
hit and scratched and all ofthat.
How do we deal with behaviors?
Speaker 2 (02:16):
So what I have learned over my years of
experience is about 80% of thebehaviors are triggered by the
individual who is interactingwith them.
Only 20% are usually due to anactual dementia diagnosis.
Speaker 1 (02:29):
So that's really something worth repeating.
So 80% is based on a triggerthat the caregiver or someone
else interacting with theminitiated, and I believe that's
true and I know that might comeacross to our listeners, as I
hope you don't get defensiveabout that but you don't know
that you're triggering them, andthis is where Kathy's expertise
(02:52):
is really helpful here.
So I just wanted to emphasizethat.
So go further on that.
As far as the 80% that istriggered by the activity of the
other person, Sure, I mean.
Speaker 2 (03:03):
The first couple of things is I talk about approach,
and oftentimes if somebody withdementia is approached from
behind, we startle them and theywill react.
If we approach too fast, theperson can become startled and
then the individual reacts.
The big thing that most peopledon't know whether it's a family
(03:23):
caregiver or professional isthat if I were to get in your
personal space and we didn'tknow each other, you would back
up, you know.
I did it again, you might backup because we know to.
You know it doesn't feelcomfortable A person with
dementia.
Their personal space isactually six feet and when you
get into their personal spacewithout permission they just
start defending it.
And so I train staff on how toapproach gently and from the
(03:48):
right direction and so as to nottrigger that.
Another thing is communication.
People tend to communicate toomuch or too fast and the person
can't keep up and everybody getsfrustrated and then the person
with dementia will react.
Our environment can triggerbehaviors, whether it's
overstimulating orunderstimulating.
Even in an understimulatingenvironment it can cause the
(04:10):
individual to become grouchy orcranky and then they react when
someone does start to interactwith them and a medical need.
Sometimes you know somebody maybe on an over-the-counter pain
med and what they need is ascheduled pain med, or they're
on something every six hours andwhat they need is every four
hours.
And so anytime there's amedical need, like a urinary
tract infection or they're inpain, they can react to the
(04:33):
person who's interacting withthem.
Speaker 1 (04:35):
One of the things I think you'd agree with is
getting on the same level, likebending down or getting down on
the same level so you're nothovering over somebody in a
wheelchair or something likethat.
Speaker 2 (04:47):
That's correct and I covered that information when we
talk about approach is that youdon't ever want to stand over
somebody.
It's very intimidating andpeople with dementia will react.
So you're absolutely correctyou want to be at eye level or
just slightly below eye levelwhen interacting with that
individual.
Speaker 1 (05:02):
I'm always amazed by the brain, because I always tell
people that the brain is alwaystrying to figure out and solve
problems, solve the situationthat's in front of them, but if
it doesn't have the data thatsome of us have, it's going to
come up with a solution.
It's going to come up with ananswer, and some of the times it
(05:23):
might be that the answer isthis person is a threat to me
based on their interactions, andso the brain's always trying to
still solve problems, even ifit doesn't remember.
It has no short term memory, andso one of those things is the
issue of the speed of speech,which I have trouble with
because I tend to talk reallyfast, and so the issue is the
(05:48):
brain processing especially withsomeone with Alzheimer's or
dementia might be slower andit's uncomfortable sometimes for
people to have that gap, thatsilence, silence, is
uncomfortable for a lot ofpeople, and so for someone to
make a request or explainsomething and then not get a
(06:11):
reaction right away, even 10seconds seems like an eternity
to allow the person to perceiveor absorb the statement that had
been previously made.
But that's exactly what needsto be done.
Is that slower reception ofinformation and sometimes
(06:31):
there's going to be silence.
That might be awkward and youcan't fill that silence because
that's just going to beconfusing.
Speaker 2 (06:38):
Correct.
That's one of the things Itrain is one you have to be
comfortable with silence, which,like you said, most people are
not.
I've even timed some of my ownstaff to say, let's see how long
you can be quiet, and they lastabout 10 to 15 seconds, and
that's about it.
What I also, you know, informpeople is that when we look at
the cognitive skills thatindividuals have in the brain,
(06:59):
auditory processing and auditorymemory will pull down
short-term memory if it's notstrong.
And so what I also tell is, forwomen specifically, that as men
age, the decibel range that menstart to lose their hearing is
the same exact decibel range aswomen's voices, and so women
tend to need to bring down theirvoice.
(07:21):
I will often demonstrate like ifyou were a DJ on a radio.
You know your voice becomeslower, and if you talk just
slightly slower, the person canusually understand that decibel
range and that rate of speech.
And then you do have to makesure you're continuing to
maintain eye contact with them,because some people learn how to
(07:42):
lip read with dementia andthat's what they rely on,
because visual processing andvisual memory stay intact longer
in the brain through thedementia journey than auditory
processing and auditory memory,and so by slowing down the rate
of speech, by lowering yourvoice, by maintaining eye
contact and then yes, by beingquiet and waiting for the person
(08:03):
to respond, helps withcommunication.
What I also will say is whatsomebody reads and understands
in the brain is completelydifferent than what they hear
and understand.
So using common words likehungry or thirsty or tired, and,
if you're going to go to thatlevel, using pale yellow paper
with gold black print, is easieron aging eyes, and I also
(08:25):
encourage people to laminatethose common words because
you'll use them over and over.
Or pictures also work very,very well with an individual,
because they understand thepicture a lot faster than they
understand what's being said tothem.
So there's a lot of differentcommunication techniques that I
advise and guide on so thatcommunication with this
individual is easier foreverybody involved.
Speaker 1 (08:47):
It's interesting what you said about the difference
between men and women, and I'mcurious if you have any thoughts
about interacting with someonewith dementia and how whether
they're a man or a woman has animpact on it.
Speaker 2 (09:02):
I think it has more to do with just man versus women
.
It also has to do with wheresomeone grew up, it has to do
with what their profession was,it has to do with the type of
dementia they may have and wherethey're at in their journey.
There's a lot of varyingfactors that I take into account
.
What I find more often than notespecially someone who has been
(09:24):
, you know, come into acommunity is that they don't.
The community doesn't do agreat job at getting history on
an individual.
So you know, just like I said,I was in Kansas a couple of
weeks ago doing training for thecommunity.
I was doing training forprofessional staff, but it's an
area of Kansas where my dad grewup, so I'm very familiar with
it.
(09:45):
But farming if you were a farmer, most men have a higher hearing
loss in their left ear thanthey do their right ear, because
driving a tractor they didn'tuse ear protection and the
engine was on the back left sideof the tractor, so they have a
higher hearing loss in the leftear.
If it was somebody who grew upin a metropolitan area, then
(10:05):
it's not going to be the sametype of hearing loss for that
individual, whether it's a manor a woman.
Somebody was a CEO of a companyversus a blue collar worker.
Your communication with themand your interaction with them
is going to be completelydifferent, and so the history of
an individual is just asimportant, and I like to know
where they grew up.
I like to know if they were inthe military or not and what
(10:30):
rank they were.
I'd like to know even for women.
I took care of a lady who wasthe first PhD in her family, and
so interacting with her was alot different than interacting
with the woman who had had 10children all at home.
She had one boy and nine girls,and so our interaction was
completely different, because oftheir education level or
because of the lifestyle theychose to have, and so knowing
all of that informationabsolutely helps to communicate
(10:53):
better with an individual, andmore efficiently as well.
Speaker 1 (10:56):
You know, that's really very interesting, and I
100 percent agree and agree andI feel like that is neglected
that there is a certain amountof when someone has dementia,
especially if they're going intoa care setting whatever the
care setting is, whether it'smemory care or a nursing home or
anything like that there is atendency just to focus on, you
(11:21):
know, their security andprotection and making sure that
they have less risk.
The reality, though, iseverybody is so different and
people need different things,and actually realizing that just
because somebody is diagnosedwith dementia doesn't mean
they're not a person anymore.
And they have all of this thatthey've brought with them, their
(11:43):
you know, their experience,their knowledge, their life.
Just knowing those things,which I think is often neglected
, can make a difference in howwe're naturally going to treat
somebody if we know that they'veworked really hard on a farm
for 40 years, or that they werecareer military, or that they
(12:07):
were an academic.
Speaker 2 (12:08):
Absolutely, it's a huge difference.
I mean, again, I've learned alot through just mistakes I made
or my team has made and I givethe examples when I train that
we were taking care of anindividual who was very
combative and very resistant tocare with one of my staff and it
just so happened I was in thebuilding on a weekend when his
(12:29):
son was there and the son askedme.
He pointed out the staff personand said is that the person who
my dad gets very irritable with?
And I said yes, and shehappened to be of Asian descent.
And he said well, what you needto know is my dad was in Pearl
Harbor.
He was stationed in the Navy inPearl Harbor when it was
attacked and I thought, ok, wellthen, no wonder we can't get
(12:52):
this individual to do anythingwith him at all.
And so it's little things likethat about people's history that
make a huge difference today inhow we care for them and how we
interact with them and maintaina positive relationship with
that individual.
Speaker 1 (13:05):
Just as an aside.
I know that there's a lot ofthought process about that.
We have to, you know, work pastour biases.
This is not the time to workpast biases.
When somebody has dementia orAlzheimer's, this is not.
You know, they could haveworked past that before, but
this is not the time to insertyour political or trying to make
(13:26):
a point of differences andthings like that.
At this point, there's notgoing to be a learning curve for
someone that has Alzheimer's.
Speaker 2 (13:36):
No, and the more I always told families you know,
the more I know, the better wecan take care of them.
You know things that happenedto them growing up as a child,
things how they were treated inthe workforce.
I mean, the more I know it, wewere able to set up care in a
much more specific andcustomized way for that
individual and we avoided a lotof problems that I don't think
(13:57):
other people avoid because theydon't take the time to find out
or they don't understand theimportance of finding out that
information and the numerousstories I could tell over the
things that I've learned justsimply by the importance of
understanding the history ofthat individual.
Speaker 1 (14:13):
And I have a book coming out.
I'm excited to read it yourTicket to Compassion for
Families and Others in theLong-Term Care Profession.
From what I've learned aboutyour book, it's going to be very
hands-on, useful, practical.
So tell us about your book.
Speaker 2 (14:30):
So we are very excited to be launching the book
this fall.
The title of it is your Ticketto Compassion Navigating the
Dementia Experience.
It is being pre-sold now for adiscounted price on our website.
Mysilvertsunamicom is thewebsite, but it is an entire
book.
I've often described thedementia journey as one walking
(14:50):
into an unknown amusement park.
Sometimes the ride is fun, somedays the ride is scary, some
days you get off the ride andyou're nauseous or you're sick,
and there are days you don'twant to go on the ride at all,
and so the entire book is themedaround an amusement park, from
communication tips to self-carefor the caregiver, to eating
(15:11):
habits, to just about anythingyou can think of in regards to
the dementia experience and thedementia journey, and so it will
be a practical guide for bothprofessionals and family
caregivers.
We will be having QR codesthroughout the book so someone
could scan, and we will alreadyhave documents pre-done for
people.
They just have to print themand fill them out and they can
(15:33):
create their own binder or theirown electric file.
But even as much as one of thefascinating things I came across
is somebody needs to go to theemergency room the person the
family caregiver, theprofessional caregiver doesn't
get to ride with that individual.
So, having a document you canhand an EMT or paramedic who can
hand that to emergencypersonnel, just to understand
how to interact with this person.
(15:53):
And do they wear hearing aids?
Do they need an assistivedevice?
Do they wear dentures?
What do they prefer to becalled?
I mean a very quick front andback page to help be able to
interact with that individualmuch better and much calmer than
what we see today.
Speaker 1 (16:07):
And this book would be helpful both for people that
are in the industry that workwith folks with dementia, but
also for the family itself andlearning strategies and trying
to minimize some of the moredifficult aspects of dementia.
Speaker 2 (16:23):
Yes, it would.
I mean the focus is truly onthe family caregiver.
As many years as I spent insenior living, what I come to
realize is that I do think thatpeople could take care of people
at home longer, which is filledwith a better quality of life.
Studies show that people livemuch longer, with better quality
of life, living at home, intheir own home environment, and
(16:44):
so being able to help familycaregivers understand the
guidance needed to be able tocare for that person as long as
they can at home, I think helpseveryone overall.
Speaker 1 (16:53):
Talk a little bit about the dynamic between a
husband and a wife, because Iknow that this could be very
challenging.
You know if a couple's beenmarried for 30, 40, you know if
(17:16):
a couple's been married for 30,40, 50 years and they've had
their ups and downs and they'vehad they know each other's
grumpiness and it's really easyto then start looking at some of
the symptoms of dementia orAlzheimer's as just my spouse is
being grumpy or they're justbeing obstinate or whatever.
So talk about that dynamic andhow to maybe help a spouse learn
(17:38):
the new reality.
Speaker 2 (17:40):
That is a huge issue, I guess I could say, because
I've seen everything from peoplebeing very on top of it and
something's wrong.
More often than not we ignorethe symptoms.
Families ignore it because theydo.
What I hear from families isI'll hear them say, well, you
know, he or she is just askingrepetitive questions to drive me
crazy.
(18:01):
I'm like, well, no, that's notwhat they're doing.
They don't see some of thewarning signs.
Like you said, it's comingacross as the person's
intentionally being irritable orbeing cranky, when that is
actually the prime time we needto hitting the individual with
dementia.
There's a lot of statistics outthere that is unknown about that
particular part of it.
(18:34):
But the other part is theharder part, I think is the
wedding vows.
I've seen so many.
I've had to redefine weddingvows so many times for
individuals because they believethat, for better, for worse, in
sickness and in health.
I'm going to see this processthrough because it's what I
committed to in front of God,family and friends X amount of
years ago, and so oftentimesI'll say do you know?
(18:56):
Nowhere in the Bible does itactually say that you have to do
this alone, you know?
you're honoring your weddingvows by bringing in a care team.
You're still honoring yourwedding vows by taking care of
yourself.
You know just as much as you'retaking care of this person and
so having to sit down andredefine individuals' wedding
vows so that they understandthat nowhere do they have to do
(19:17):
this alone, and the importanceof getting legal paperwork in
order, financial medicalpaperwork in order and reaching
out to the necessary network andcare team to help them have the
support they need to navigatethis journey.
Speaker 1 (19:32):
Yeah, very, very good .
So when you know a family isdealing with this and it doesn't
feel like they seem to be in alittle bit of denial or ignoring
the symptoms we had anotherguest that talked about that
many families tend to cocoon andwhat that means is they stop
interacting with the outsideworld, they don't accept help
(19:54):
from the outside, they'resomewhat embarrassed about the
situation.
So they just stay in theirhouse and never leave and really
try to hide the situation, andI've seen that from time and
time again.
Talk a little bit about that,about how negative that can be
and the resources that are outthere to help families.
Speaker 2 (20:14):
I've listened to families talk about cocooning.
It's termed a lot of differentways, but that's a great way to
term it.
But what they do, part of whatthey do is they convince
themselves they're protectingthe individual, you know this
individual can't keep up inconversations, or or it's a
dignity issue or it's a respectissue.
And if I can work with a familyor an individual earlier on in
(20:34):
their dementia diagnosis, whenthey're newly diagnosed or
there's concerns about it,socialization is one of the key
factors that helps in delayingthe progression of dementia or
in reversing cognitive decline.
So socialization is actually animportant factor.
So to do the opposite, I mean,I think we as human beings try
to do what we think is the rightthing for somebody and in
(20:58):
hindsight it becomes the onething that they shouldn't have
done.
But you know, we do the best wecan with the information that
we have.
And so cocooning there's allkinds of things that can happen.
The person may not be gettingthe nutrition, the caregiver is
burning out and they're notgetting hydrated, they're not
being stimulated cognitivelythrough socialization.
The home environment can becomeits own concern, with area rugs
(21:22):
or leaving a coffee pot on orsomeone turning on a stove and a
fire starts.
I mean, even havingunderstanding what a
dementia-friendly environmentlooks like would be helpful.
So cocooning can be problematicon so many levels, not just for
the person with dementia butalso for the caregiver, because
the caregiver is not getting thesupport or the interaction he
(21:42):
or she needs in order to staystrong to care for this person
throughout the dementia journey.
Speaker 1 (21:47):
Kathy, I know that you've mentioned that you're a
national speaker and among otherthings, but you also do some
coaching one-on-one.
So talk to us about thecoaching and who might be
interested in your coaching.
Speaker 2 (22:00):
So it depends on who calls me, but I do coaching with
professionals at all levels,from frontline staff to charge
nurses to executive directors,administrators on how to
transition someone into a seniorliving community more
successfully, how to not triggerbehaviors, how to care for
those individuals, how to helpfamilies learn, how to continue
(22:20):
to connect with someone up untilsomeone takes the final breath.
From a family caregiverstandpoint, I can go in and I
can do a survey of their homeenvironment and talk about this
is what's working well in yourhome environment.
This is something you wouldneed to consider, or this might
be more helpful in yourenvironment for a person with
dementia.
I can help families betterunderstand how to build a
(22:41):
network, take care of the thingslike legal decisions, financial
decisions, medical decisionsand who they need to get
involved in that network to getthrough those things.
Talking about self-care, Icannot emphasize enough about
self-care for the individualwho's caring for someone with
dementia and, if caught earlyenough, I have done a handful of
coaching and guiding with theperson who was diagnosed with
(23:03):
dementia to be able to delay theprogression of dementia.
In some circumstances we'vebeen able to reverse cognitive
decline for that individual andit gives them a much better
quality of life.
So we customize our coachingbased on the person who's
calling in for help.
Speaker 1 (23:18):
I think that's the key here, for everything that
we've talked about is treatingthe individual as an individual,
understanding their background,understanding their life, and
customizing our decision-makingbased on that, which is kind of
the opposite of what theindustry tends to do, which is
to group everybody together andso when they have activities,
(23:42):
everybody goes to the same musicsession or the same exercise
session, same bingo.
You know, music session or thesame exercise session, same
bingo, whatever it is, and theidea is that we'll have a lot
less behaviors, we'll have a lotless sundowners, things like
that, if we treat into you know,everybody as an individual
rather than trying to herd theminto everybody.
Do bingo at 10am.
Speaker 2 (24:02):
Absolutely.
That's absolutely correct, andit all starts with the
information that is collectedand gained through however
somebody wants to term that, thediscovery process or the
admission process.
I found that the more I have asolid understanding of the
individual where they grew up,what type of family did they
grow up in?
All boys, all girls?
(24:23):
Were they in the military?
Were they not in the military?
What rank?
What did they do in theircareer path?
You know how they raise theirchildren.
All of that informationcollected lends to how we
ultimately provide care for thatindividual, and so I very much
tried to customize every singleperson who came in the front
door, because you'll hear thephrase when you've met one
(24:46):
person with dementia, you havemet one person with dementia.
So we know that phrase, but yetthe industry as a whole doesn't
follow through and treat eachperson as an individual.
They lump everybody together,which actually can be more
problematic in the care thatthey provide.
Speaker 1 (25:03):
So, Kathy, this has been a fascinating conversation.
Kathy Miracle, she has a bookcoming out, your Ticket to
Compassion.
You can preorder it onmysilversunamicom.
Any thoughts that you want toleave our listeners with?
Speaker 2 (25:18):
I think you know.
What I would just say is thatI've never seen this be an easy
journey for anyone not theprofessional caregiver, not the
family caregiver.
I oftentimes see families.
They still try to compare thatperson to who they were 5, 10,
15, or 20 years ago.
And as a professional, you knowwe get to love, honor and
respect who that person is today.
And so truly for familycaregivers being able to, on
(25:41):
some level, let go of the pastand enter into their world,
because they no longer are goingto be capable in living in our
world.
And so, and be kind to yourself.
You know, as a family caregiver, give yourself some grace.
You're doing the best you can,but, most importantly, make sure
that you're taking care ofyourself, because you won't be
here to take care of the personwho needs you if you don't take
(26:01):
the time to take care ofyourself.
Speaker 1 (26:04):
Very important information here today.
I appreciate you, kathy, andall the work that you do.
If you've enjoyed this podcast,don't forget to subscribe to
Advice From your Advocates.
You can find us on anywherethat you listen to podcasts.
We're also on YouTube or youcan find us on our website,
manorlawgroupcom.
(26:24):
So thanks for joining us today.
So thanks for joining us today.
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