Transcription of Kate Adams for the show Aging in Place #208
Lisa: Our next guest is Kate Adams. Kate is a certified aging life care manager and since 2005, has owned three locations of Aging Excellence, a non-medical, in-home care agency with eight offices throughout New Hampshire and Maine. Kate lives in North Yarmouth with her partner, Beth, and three young boys and she’s a fellow Bowdoin graduate who I’ve known for many years. It’s really great to see you here today.
Kate: Thanks.
Lisa: Kate, you’re doing something that interests me on a few different levels. One is as a family doctor, because I see the importance of trying to help people work through aging issues and also help people’s families work through aging issues. Also my own interest in having had grandparents that have gotten older and have gone from being the one person that I knew to someone who over time changed into somebody I didn’t know quite as well. Why did you get into this field?
Kate: I got in it because I love helping people. That sounds cliché but I do love solving problems for people, providing support for people and I’m a firm believer that if people want to stay home as they get older they should be able to. Families are so busy right now that there needs to be other support, other services that can allow that to happen.
Lisa: You’re calling it Aging Excellence, which I love because it’s not just about, “Oh, let’s do the bare minimum.” It’s really, “Let’s keep people living these full lives.”
Kate: Right. It’s about staying active and independent. We hold up as our … People who are running into their eighties. We have been sponsors of the Beach to Beacon and the Senior Division. There are people who are running the Beach to Beacon road race in their eighties. They’ve run it for years and years. People just staying active, staying home, doing as much as they can, even with disease processes starting and Alzheimer’s or Parkinson’s or heart disease that is possible diabetes to stay active and healthy and focused on the good things in their lives.
Lisa: It’s maybe acknowledging whatever genetics you have or whatever environmental factors to whatever your health status is, but it’s not just accepting that there is one predetermined route for you to follow, as you get older.
Kate: It’s not, “Oh, I have this disease. I’m going to sit in a chair and decline or need to move to assisted living or that I’m going to end up in a nursing home and everybody’s going to be taking care of me and I’m going to be a burden to my family.” That’s something I hear from older adults all the time, from seniors, from people, I don’t want to be a burden to my family. One of the things that I say to families because everybody’s reluctant to ask for help is, it’s really about being proactive. It’s about being proactive about aging as opposed to reactive, as opposed to waiting for something bad to happen as opposed to waiting for a fall or waiting some major event, a car crash, something like that … That’s a game changer, that’s going to force someone to be in the hospital and rehab and maybe not even go home again if they don’t recover.
Lisa: You’re a certified aging life care manager. What does that mean?
Kate: The term has just changed. The redefinition, I’m part of a large organization, a national organization that has 35,000 members nationwide. It’s an accreditation, you have to meet certain criteria and pass certain exams to be in. That is social workers, nurses, that sort of thing. It’s someone that can do assessments that can pull resources together and create the support and a plan of care for someone to either age in place or if someone does want to transition to a facility, can really look at the big picture and solve problems or challenges.
Lisa: Before you did this, you actually worked in the film and television industry for twelve years in LA and Seattle. It seems like there would be some problem solving in a very different way in those areas. How has there been a translation for you?
Kate: I actually had this conversation with an employee recently because I used the analogy. Working in production, whether it be on, which I’ve worked in large feature films, I’ve worked in documentary films and I’ve worked on fashion photo shoots. It’s about showing up, there’s a lot of money on the line in production. If there’s a call time, if there’s a specific shoot scheduled you can’t not show up. You can’t. I used that with an employee who was a little wishy-washy about her schedule and I said, “Look. It’s what makes or breaks things around here.” For a lot of our clients that we see, besides the care management, the aging life care that I do, we do one-to-one care. We do one hour to twenty-four hour care for people so it’s about … For some people, it’s about getting them out of bed and making them breakfast in the morning. That’s not going to happen if someone doesn’t show up. It’s a roundabout answer, your question, I feel like making things happen and solving problems and pulling lots of pieces together to create something, whether it be in someone’s own home and for their ability to stay in their home or producing a feature film. It’s a big jump, but I feel like I bring a lot to this work from there.
Lisa: It sounds like there are two things that you do. One is this proactive piece, which is planning and forward thinking and the other one is engaging with whatever it is that is happening on a day-to-day basis, which is like just being human.
Kate: Right. 85 year old guy wants to stay in his home and he needs help getting up and getting dressed and someone to cue his meds in the morning and be sure he has something made for lunch or he stopped driving. Someone needs to go get his groceries or take him to appointments and he’s fine with not driving but he needs that support. Yeah, just day to day. Socialization, someone to show up and hang out and read the paper and go play bridge and then come back and be sure they’re set for dinner. Those sorts of day-to-day care that people need is a lot what we do too.
Lisa: How did your work as a Parkinson’s support group coordinator, how did that filter into the work that you’re doing now?
Kate: I learned so much. I was asked by Lillian Scenna, who was at that time, head of the Maine Parkinson’s association. There hadn’t been a support group in Lewiston for a long time and she asked me if I would … I worked in the area, she knew that, she asked if I would start a new group. I did and it’s had some sporadic attendance, but I’ve learned so much about the issues that people with Parkinson’s face because it’s such a changeable disease. It’s one of those diseases that are different for everybody, one thing they say is you meet one person with Parkinson’s and you’ve met one person with Parkinson’s. The symptoms are so varied. I’ve learned a lot about the different medications and how they work with different people. It’s so helpful to bring people together so they can discuss those things. We’ve had presenters, we’ve had occupational therapists and physical therapists and nutritionists. I’ve just learned so much about the disease. It’s been really helpful to me.
Lisa: I’m thinking about some of the conversations that I’ve had with patients and their families. One common scenario is a patient that has been living elsewhere and then has moved either back to Maine where they had lived before, or they moved to Maine to be with the family. Both of those are pretty big transitions because you’re talking about moving, which is a transition, and sometimes you’re talking about moving in with a family.
Kate: Right.
Lisa: That you don’t really know as adults, you know them as your children. Just starting with the stresses of those transitions, and then on top of that, I think it’s interesting, it’s been interesting for me to see what people bring up as issues. There are the day-to-day things that you’re talking about, but the socialization piece you mentioned earlier, that is huge. Once you get them to a state of basic health, what do they do with their hours?
Kate: Long days. Especially families working, you’ve got to juggle that if you know mom’s going to just hang out at home while her son and daughter-in-law head off to work. How’s she going to fill those hours and what’s she going to do and so it’s about resources. We either in that scenario, hiring an aging life care manager to say, “Okay, what are Mom’s options here? What resources can she tap into in the community? If she is dealing with a specific disease process, what’s the trajectory of that and what can we expect and what might be the next steps or how can we plan for if it doesn’t work for her to stay here and she does need to transition somewhere else or what are the different pieces that can come together and the different supports that we can put together.” It works for everybody and that there’s wellness on all fronts for mom, for the family.
It may be just, “Okay. Hire someone to be a companion for her 2 or 3 days a week.” Some days, she can go to the community center. In Brunswick, for instance, there’s People Plus that does a lot of outreach and is a fabulous community center that integrates seniors and teens. It’s a really lovely place. It’s in those situations I would always recommend that someone reach out and get some advice, get some sort of analysis of the situation and what can we do to make it best. It’s again, about being proactive, and not waiting for people to feel resentment or struggle about the situation.
Lisa: How do you help the senior that we’re talking about, the grandmother, the grandfather, the uncle, the aunt. How do you help that person not feel like a burden?
Kate: It’s about communication so I think they need to voice that concern but I think getting support so they’re not a burden. As little as having the companion services or having someone that they can, so that they feel like they have their own life still. That there are some outlets and areas where they’re not feeling completely beholden to what their son or daughter-in-law or whoever it is or grandchildren or whatever that there’s … I use the example, so even if it’s not moving in with but say there’s mom and she’s declining and needs more and more assistance and her daughter’s now going and cleaning her house and going on the weekends and doing her grocery shopping.
I’ve had calls from daughters who say, “I just can’t do it anymore. I’ve got my own life and I just … ” She needs the help and it’s so simple. Even just two visits a week, even one visit a week of someone who can go and do some light housekeeping, get the groceries done or take her to a doctor’s appointment and just taking that level of support off of the daughter that’s been going in and doing it, then the daughter can go and hang out with her mom like she always does. She can remain being a daughter and support in that way and not be doing the day-to-day care that that her mom needs more of. Again, it’s about support, it’s about communication, it’s about everybody acknowledging their concerns and where it’s going to be and coming up with solutions, coming up with ideas that everybody feels better about.
Lisa: Do you find that there are sometimes psychological overlays that maybe have not been dealt with for …
Kate: Oh sure.
Lisa: A long time or ever, perhaps?
Kate: Yeah. There’s always lots of baggage. That’s why I think those buttons … I’ve witnessed it in my family, it’s so much easier for me to go and help and talk to people who aren’t my family members. I have an aunt who had a stroke in her fifties and became aphasic; she could no longer speak but could communicate. I was doing some work with her and I found myself so much more easily frustrated with her than … For no fault of hers, but just it’s family pushes buttons. There’s no question. We are much quicker to judge and feel resentment and feel something when we’re stressed or being asked more by our family members than if it was someone else. That’s why I’ve witnessed so often is that call from the daughter that said, “Kate, I can’t thank you enough. Just somebody doing my mom’s grocery shopping has changed my life.” It’s as simple as that. Because the little fights and you bought me the wrong butter or whatever it is, that’s just … It’s oddly stressful for families. Yes, absolutely, I think there’s baggage, there’s un-dealt with issues that easily bubble up when these additional requests are being made of children for parents or vice versa, I get some cases too.
Lisa: There’s also the very significant witnessing of decline that can be really hard on a person. Really difficult to see your mother not the strong, capable, sometimes less loving now person because she’s drawn back into herself, just has enough oomph to keep on living and she just can’t be the person that you remember her to be. I think doesn’t that cause us to face our own possible decline, mortality? Doesn’t that trigger something in us as well?
Kate: Absolutely because it’s asking us to make a switch too. I see this with families as well, that there’s a reluctance, perhaps mom is still home and there’s dementia involved and she’s making some poor decisions or … There needs to be a switch at times, sort of a transition of roles so that the child needs to step in and make some decisions. It is a bit of role-reversal at times where children need to take more responsibility and feel more like the parent than the child. That’s hard. For sure, Mom’s having a decline and I’m going to too. I don’t know, that may be the underlying thing but I feel like it’s more; I don’t know that people are really looking that far ahead. I think it’s more the death of childhood that’s just occurring to me that it is that role reversal and I see some families really resisting making that change. If dad wants to do it, dad can do it. Dad wants to keep driving, that’s his decision, as opposed to being proactive and saying, “No, we need to talk to his doctor and we need to make some changes because Dad really shouldn’t be driving.” It’s a real resistance to believing that I’m not the child anymore, that they’re leaving, they’re on their way out and I’ll be the next grandparent. Role changes, absolutely.
Lisa: I’ve also seen some physical things that we just … Maybe we don’t talk about it that much, they become very big issues in families. I’ve seen for example, an older man in his seventies start dealing with incontinence issues and his daughter get very frustrated and him trying to hide the fact that he’s having incontinence issues and he’s not able to move around as much to take care of himself, so he won’t tell her that this is going on. It just creates this big, big cycle around something that … We’re not very good at dealing with things that are kind of …
Kate: There are very few families that are. I think incontinence is a … There are very few children who want to deal with their parents’ incontinence. The parents have dealt with the children’s incontinence, but the other way I find that doesn’t happen very often. It’s a line in the sand for a lot of kids. I am not going to deal with Dad in the bathroom, with the shower, with toileting, any of that. Which is fine. Again, that’s where it’s about that child then reaching out to say, “Okay Dad, this is what we’re going to do. We need some help here. I know this is happening. I’d rather not deal with the mess of it than have some help so your needs are addressed.” There’s a lot of embarrassment and shame, maybe, just denial about how things are progressing and changing and the challenges of aging and incontinence is very common challenge for a lot of people as they age. Easily remedied, but it’s not one that anybody wants to deal with, but can be.
Lisa: That’s what I keep hearing from you is, “Okay. So here’s these issues that might be difficult, they might be embarrassing.” They might seem completely insurmountable but you’re just saying, “All right, show up. Have a conversation. There are probably some practical solutions.” At least start with that, maybe you can’t get through the entire psychological overlay right now but just start with this is where we are.
Kate: Right. It’s about communication, it’s about naming it and at least acknowledging the elephant in the room that everybody’s avoiding and by avoiding it and being in denial about it, you’re on the fast track to something not good happening. Incontinence, Dad’s going to get a UTI if he remains in defense and isn’t changing them more … Isn’t cleaning himself properly. Basic stuff like that, and that could get … It’s just so much easier to name it, find a solution, even if it’s just a small one, to start with, even if it’s just, “Dad, you’re going to wear briefs, disposable briefs and not wear regular underpants anymore.” Simple as that. Hard for a lot of families, easy for me to say.
Lisa: I was just thinking about it. I was thinking about a patient that I had who unfortunately has passed away. She and her son, towards the end of her life, their biggest fights were about the fact that he thought she should do something, I think it was to go see a cardiologist and do something related to her heart, and she had gotten old enough where she just was not going to do it. She just, “I am done the cardiologist. There’s not really that much that can be done. Let go.” I think that there’s that interesting question, it’s one thing to say, “Dad, you can’t drive,” or “Dad, you have to wear briefs” but then there’s this other question like, where does this all lead to eventually?
Kate: So there are those bigger questions of let’s make some bigger choices about what … What do you want, what are your goals here. What are your goals? Whole current discussion, Atul Gawande’s book Being Mortal, about even end of life, what’s most important to you here? What’s most important to you … Is it staying home, is it that you’re able to see your family, or is it that you just want to be able to open your eyes and watch TV everyday and that can happen anywhere. In your patient’s case, yeah. Does she want to keep her heart going at all costs? Maybe not because if that means if she has to sit in a chair and she can’t move around a lot or because her heart’s too weak. That may not be her goal, she may want to continue going out and being in her garden. We have a client now that the doctor’s saying she really shouldn’t be walking. She’s like, “I’m going to keep walking.” What are your goals?
Lisa: I’ve also enjoyed the book Being Mortal by Atul Gawande so people who are listening, you may want to go back and if you’re struggling with some of these issues, it’s an interesting read for you. This is one of these conversations I think that we could continue because there are so many different aspects to it. For those who might have questions, how can they learn more about the work that you’re doing, Kate?
Kate: They can go to our website and all of the offices are listed there and call any of them. Our website is seniorsonthego.com. They can email or contact me directly. That’s probably the best way to be in touch and learn more. Our website is pretty comprehensive about what we do. The organization that we’ve been talking about, Aging Life Care Experts, it’s … alca.org, I believe gets there or caremanager.org gets there.
Lisa: Thank you. I really appreciate the work that you’re doing. It’s very important. It’s important and there are a lot of conversations that are happening as a result of the fact that we’re a rapidly aging state here in Maine.
Kate: For sure.
Lisa: We’ve been speaking with Kate Adams. She’s a certified aging life care manager and owner of three locations of Aging Excellence. Thanks so much for coming in and being a part of our conversation.
Kate: Thanks Lisa.