Episode 18: AI Is Coming For Your Senior - With Juliet Holt Klinger

[00:00:00] Speaker A: It's looking at you. And when you see the moon at night, that will always be you. [00:00:27] Speaker B: You know, it's very unusual that we have an actual precise start date to the recording without just kind of jumping in based on banter that we had. But here we are. [00:00:39] Speaker C: Wait, hold on. We're gonna start again? Because it's not a start date. It's just an actual start. [00:00:43] Speaker B: Okay. [00:00:45] Speaker C: All right. Well, why don't. [00:00:46] Speaker B: Okay, I guess now we really are just doing it. Maybe we just keep this. I was. We're trying to actually that. And that maybe that's a lesson. We should not try to actually, like, stew a star, like, beginning, because this is just how things roll in. And we'll see if that works or not. [00:01:06] Speaker C: We're better with a rolling start. I don't know if we would be as great if we said, hi, welcome to episode. What is this episode 18 of? If it's not one thing, it's Joanna. We're Karen Edelson and Andrew Edelson. Like, that's just not us. [00:01:21] Speaker B: We're. [00:01:21] Speaker C: We're. Chatters. [00:01:22] Speaker B: I agree. And though I will say I always love that when you're watching a TV show and it's a TV show about the making of a TV show and the producer, director behind the camera gives the, like, the anchor at the desk that, like, three. They say audibly. They say three, two, and then I think the one and the zero was silent. And then the point. [00:01:45] Speaker C: I always like that, but I always think it's funny because there's confusion about, well, wait, am I starting on one or do you say one? You know, I don't know. I don't know if we're skilled enough for that. We're better at just. We just start chatting and then here we are. [00:02:00] Speaker B: Yeah, I think that's correct. [00:02:02] Speaker C: They like it. [00:02:03] Speaker A: They like chatter. [00:02:03] Speaker B: They think it's the right approach. [00:02:05] Speaker C: Listen, I have to tell you, I mean, I'm gonna break some news here, but I was at, I guess we would call it Shiva yesterday, sort of like a memorial celebration for a dear friend's mom. We'll tell you about in a minute. Well, actually, let's just say that now. So our dear friend Jill Schumacher, who was on. Gosh, I don't even know what he'. I think Jill was, like, 6 or 7 early on. [00:02:29] Speaker B: She was on the series that was about family members being forced into the role of caregiving for their senior. I think she's the last one in that series. [00:02:41] Speaker C: Anyway, Jill was taking care of her mom, Joy. She grew up with us in Huntington Woods. She used the term kookalooka about how long she's been living in this role and just the craziness of her care of her mom. So I'm sad to report that Jill's lovely mother, Joy Schumacher, did pass away this week. She passed away very peacefully and in the way that she would want to be, you know, cared for by her loved ones and her daughters by her side and, you know, all the things that you would hope for when the end is near. [00:03:19] Speaker B: So she was pretty snarky to the end, wasn't she? [00:03:22] Speaker C: She was snark ola until the. It was kookalooka, to quote Jill, snarky. Snarky, really, until the last couple days. But I was at Shiva surrounded by, you know, so many people who are listening to our pod, which was really cool and exciting to hear. And every single person said, oh, I really like the banter and the connection between you and your brother, which I think is pretty sweet. [00:03:48] Speaker B: That's very nice to hear. Very nice to hear. And we should mention as a, as a warning or a caution that is, that is the second. [00:03:58] Speaker A: Hold on. [00:04:00] Speaker C: Should we say this? Nobody will want to come out. Well, maybe people would want to come. I don't know. Yeah, say it. [00:04:05] Speaker B: It's the second senior we've lost from guests that have been on the show. But, hey, that's the business we're in. This is going to happen. It's not going to be the last one because we're dealing with, obviously, the topic that we're dealing with. And we've got, by the way, if I may, segue out of tragedy into a great guest that we have coming. We are about to talk to a wonderful expert on the intersection between physically caring for seniors and the technology that can be used to support that care. Juliette Holt Klinger is one of the foremost senior executives, and she worked for one of the largest living senior living networks in the United States and has now pivoted and turned towards technology in other areas that are helping seniors live better lives. And we can't wait to talk with her about her thoughts on everything that's going on with AI and other technology and other ways to live better lives as a senior. And we've already talked a little bit about how we use technology with Mom, I think, in our first episode of this micro series on tech. So I don't know that we have to spend too much time on it. [00:05:16] Speaker C: You mean on our intro? [00:05:19] Speaker B: Yeah, I mean, usually because, you know, the format. If we, if we may Review the format of this podcast. We start with a section where we talk about an issue and how we dealt with it with mom. And then we get an expert on to kind of talk us through that issue and give us tips and insights into how to deal with that. And then we have a little recap at the end. And of course, there's mom singing tunes in the interstitials. And all I'm saying is I don't think we need to get too deep into our experience with mom in this particular intro, so. [00:05:48] Speaker C: Good point. Not to mention the fact that our. Our interview with Juliet is so chock full of information that we chat for a while. So I think we should just get to it. Let's hear mom sing and then let's jump right into our chat with Juliet Holt Klinger. [00:06:03] Speaker B: Sounds great. [00:06:05] Speaker C: Okay, we'll be right back. [00:06:13] Speaker A: Fly me to the mountain and let [00:06:17] Speaker C: me stay among [00:06:22] Speaker A: Let me see what spring is like on Jupiter and Mars. [00:06:30] Speaker C: In other words, hold my hand. Another words [00:06:42] Speaker A: darling is needed. Fill my heart with songs and let me sing forever. You are always here our worship and adore in other words. [00:07:10] Speaker B: And we are back here with Juliet Hol Klinger, gerontologist, dementia expert extraordinaire. I'm not sure if I got that right, Juliet, but I'm sure you're going to clarify that in a second. And Juliet, we're just so happy to have you here today and talking to us about tech and dementia and wherever the discussion may lead. So firstly, can you give us just a little intro on your background and how you got involved in all this stuff, what you're doing? [00:07:40] Speaker C: Sure. [00:07:40] Speaker A: Well, thanks for having me. I appreciate being on. I'm excited for the chat today. I'm a gerontologist and social worker by background and I've been working in dementia care for about 40 years now, short little career and have spent. Yeah, the bulk of my career has been spent in senior living settings, long term care. And then when assisted living came around, assisted living, I spent 18 years as the head of kind of dementia care everything at Brookdale Senior Living. So we had at one point, I think over 600 memory care locations. [00:08:21] Speaker B: And sorry to interrupt you there. That's like one of the largest networks around in the country, is that right? [00:08:25] Speaker A: Yeah, it is the largest senior living provider in America. Yeah. So it was a really large portfolio of memory care communities and I had a team of dementia care specialists, specialists that I oversaw that covered the country and supported those communities. So it was a big job. And as part of that Job I did a lot of work with technology and emerging technologies and piloting different technologies and really after 18 years managing the, managing the team, if somebody isn't emerging as another leader for that team, you're not doing something right. So eventually they were kind of leading themselves and I moved into more of an innovation role where I really worked on different deployments of new technologies and so forth and decided about four years ago that I really wanted to just pursue that path a little further. And I'm stepping down, stepped down to make, make room for the next generation at Brookdale and then really moved into, moved into full work on applying technology to dementia care. And so I worked for a company called Taproot Interventions and Solutions where we had developed a platform using algorithmic machine learning to help with behavior problem solving in senior living and in memory care settings. And then that actually morphed into more of an AI generated, AI powered platform for family caregivers in the consumer market and worked on that for a bit and now just. I have several clients actually right now that are tech startups in the age tech space and I help with, you know, really getting people into the senior living market and understanding the applicability of not just AI, but other forms of technology to dementia care in general. [00:10:30] Speaker B: And as I do, I recall, sorry, do I recall that you're also a caregiver yourself? [00:10:34] Speaker A: I am a unpaid family caregiver full time from my mother in law who lives with us with at this point mild dementia and so not, not a ton of big physical care. You know, I help her out. But, but yeah, that is a part of my, that, that's a new part of my, my profile for sure. [00:10:56] Speaker C: I was going to say that's an incredible trajectory and what a smart way to approach your expertise with dementia care and senior living facilities. Especially because we know how important that technology piece is not only for senior living facilities but specifically for people who are aging in place, which seems to be gaining a lot of momentum. [00:11:22] Speaker A: Yeah. [00:11:22] Speaker C: So I'm wondering, can you just give a little background and what kind of technology are you focused on right now that is available to help seniors? And obviously you don't have to get into everything because I assume there's a ton, but maybe a couple snippets. [00:11:36] Speaker A: Yeah, I think, you know, there's, there's so many things and it's, it's fascinating now with the, you know, the kind of intersection of my personal and professional lives, I also have a much better appreciation of what's needed and how far off some technology Quote, unquote solutions really are in the real world of caregiving. But there's a lot of things that are available out there right now and that aren't that complicated. And I also work with a few families privately as a dementia care navigator kind of consultant. And one of the things I always tell my families is don't adopt any technology into the home if it's going to increase your stress and burden. Right. I mean, as caregivers, we're really needing to decrease the daily demands of our day. And if technology is just one more thing you have to worry about, then it's probably not relieving any stress for you or solving any problems for you. But I think there's some very interesting things really emerging. I'm personally very excited about AI, I think, as is everybody, right? Everybody's talking about AI. [00:12:54] Speaker C: Well, I will tell you, I retired from teaching middle school last year where people are not very excited about AI and completely freaked out about it. I, on the other hand, because I am no longer in the classroom, having to spend my days detecting AI cheating, I will say, yes, I feel very excited about AI, and it's nice to hear other people embracing the joy of it. I think it is absolutely incredible. [00:13:18] Speaker A: Yeah, I think it has, you know, I think it has special applicability to dementia caregiving in the sense that, you know, one of the challenges of dementia caregiving is its complexity. So I always, you know, when I work with operators and work with providers, you know, remind them this is the toughest, one of the really, truly toughest diseases to take care of. It's psychological, it's psychiatric, it's neurological. There's, you know, functional, a lot of, lot of function issues with caregiving. So it, you know, it has all these complexities to it and these layers to it. And then we, you know, frankly pull in folks that aren't, you know, they get maybe eight hours of computer training, if we're lucky, depending on the state, and, you know, we're expecting them to just get in there and solve problems. So one of the reasons I love an AI application to dementia caregiving is that it does all that thinking for the caregiver, whether it's a private family caregiver who's burdened and can't make another decision and can't do another deep dive into a complexity, or whether it's a professional caregiver who's perhaps undereducated and under skilled. So I think, I think it really makes a ton of sense to utilize AI and the project that I The, the technology I mentioned that I worked on, directed after I left Brookdale was you know, really training this large language model to, to understand the mind of a dementia specialist. So you know, ChatGPT is great for things that kind of everybody needs to know about. But ChatGPT hasn't been all that well trained in, in the nuances of dementia problem solving and dementia caregiving. So it's, it, you know, it can be a really useful tool if trained correctly, which is sort of the process that we're in right now. So there are a lot of technologies that are readily available. AI is coming. I mean I think it's, it's there in certain aspects, but there's, there's a lot more on the horizon. That product that I worked on is now available to families. It's a, you know, cheap little subscriptions called LB E L B I and it, it's basically a CHAT GPT large language model for dementia caregivers. I mean it's a brilliant product. But there's a lot of other things besides AI that don't utilize AI as well that are, that are very helpful that are, you know, there's fall detection on an Apple watch, right? I mean, yeah, we use that, you know, $24 cameras set up, don't tell, right. But set up around the perimeter of the house, in the house so that I can do my work at my desk and still kind of know where my mother in law is. So presence sensors and things that help us to, you know, that's the burden of care of dementia caregiving is that you always kind of have to, you know this, right. You always have to know where that person is at any one given time. And this allows some distance between me and her. So I'm not right on top of her all the time, but I can see, oh, she's headed over there, I gotta anticipate that need and run out and help her or whatever. So the cameras have been super helpful and those are, you know, 20 bucks on Amazon. [00:16:48] Speaker C: We live on those for our mother and you know, we. My mom had a terrible fall and I saw it on the camera and at the time she was living at home, I wasn't living with her, but I was a mile away. And I can't really quite imagine what it would have been like if I had not been able to detect that. Even though we could get into the conversation about well, is it okay for us to have cameras in the house? And you kind of have to abandon those privacy issues in the interest of safety. [00:17:21] Speaker A: I assume you do. And I've worked with a lot of people with early dementia who are now advocates, a couple of great organizations where people have speakers bureaus and that kind of thing and talk about what, you know, the lived experience of dementia. And to the point, every single one of them has said I'd rather be monitored than left to my own devices and fall or wander away or, you know, and the privacy concerns are, they're real. But I think there's, I mean we could do a whole hour on, you know, privacy and dignity and you know, should influencers be featuring videos of their parents late stage, you know, struggles and so forth? I have a lot of opinions about that, but I think, you know, rather to monitor than over assist and over control, you know, and to allow for what I've always called sheltered freedom. Right. That old concept of we can secure folks a little bit and make things safe and allow them a lot more freedom than if things are not made safe. [00:18:32] Speaker C: Yeah, for sure. [00:18:34] Speaker B: Yeah. And I mean a couple of questions on the AI piece, which is fascinating because as Kir mentioned and as you're doing as well with the low hanging fruit tech like cameras, the Apple watch, fall detection, this is stuff that we definitely rely on. It's just like the base level of stuff that we do. And I'm working, as we discussed, I'm working in AI as well, trying to develop something that helps caregivers and the families even more so to understand what options are available and how to make decisions about senior care as they, as you confront them. And one of the things I've noticed in that is that as we've been developing our approach, there's always this challenge of talking about how amazing this technology is. But should we use the word AI? People are scared of it, they don't understand it. And so how do you tackle that, that piece of adoption? Because there's gotta be that initial hurdle that I'm sure not just like technical abilities and being able to manage it and understanding it, but like I heard I'm not supposed to use this type of stuff. What's that about? [00:19:39] Speaker A: You know, you know, actually the research on that, it doesn't bear out. I think that's all that, you know, that's, that's, we had that concern as well. But I think one of the things that really hasn't borne out too much is that I think people understand, I think elders understand technology a whole lot better than people think they do. We know that there's that bias, but also that, I mean, in my opinion people probably aren't as afraid as they should be. Right. You know, if you read some of these articles about people trying to, you know, trying to tame down Claude and stuff, I think there's, you know, there is really some. We found not much distaste to the word AI in our marketing research, you know, so I think that's dissipating quickly and I think when people see the beauty of everything that can be done with it, and I think again, it's about applying it to the right, you know, applying it in the right way. So the cameras are a great example to your point, Karen. I mean, you noticed the fall on the camera, right now all the camera is, is a stream, right? It's just a stream. The one you can buy on Amazon for $30, right. So the AI comes in, in a program like Safely youy, which is a brilliant fall detection system right now only utilized in senior living. And, and that detects, the AI detects with almost a 99 point detects a knee or higher on the ground. So it's been trained to know this isn't just a person looking under their bed for their shoes. This is someone who's fallen. Right. So the AI can come in and really hone in on the exact information that a person needs. So the problem is all this great technology is very often readily available in Senior Living for $13,000 a month in memory care, but it's bringing that technology into the home and making it accessible that I think will be our next challenge. Most of the startups I work in are interested in starting up in senior living because it's such a good incubator, right. It's such a good test bed. It's a great place to get a start. But I always encourage those clients that I'm working with to move as fast as you can to direct to consumer and think about how all all of this can get bundled into one. Right. So I'm a caregiver, I don't want 12 different devices and apps and I barely have time to deal with Alexa. Right, Right. [00:22:28] Speaker C: But we also found our mom was in assisted living for 14 months after her fall. It just wasn't the right fit for her for us. We ended up moving her back home. Fortunately, Andrew was willing to come back to Michigan and do that with us, but we found there were real limitations in terms of what they would allow us to even have in her room. And it was an issue because there were several times where she did fall and it wasn't detected. And I, by the way, never attempt to Bash senior living. I understand the limitations there. And the good news is she was in a safe place and she was okay. But I have found that that's an interesting piece that they have this potentially technology readily available. Probably would be more interested in using their own than having people come in and use their devices, et cetera, when they're moving somebody in. [00:23:25] Speaker A: Yeah. And I think to. I mean, 80% of all falls in memory care go unwitnessed. So you don't have any idea how the person felt. They can't tell you how they fell, you don't know if they hit their head, you don't know how hard they fell. So having that data is incred. I think the margins in senior living are such that there isn't huge investment in technology or when there is, it's generally by some of the larger players. And I was happy and lucky to work at Brookdale and a company that did forge ahead with a lot of technology, but it is small. Most senior living in America is. Is small senior living, you know, one or two or three homes. And, you know, those folks can't necessarily afford a, you know, $30,000 system or something like that. So I think it's. But I think consumers need to start asking for it too. And I think consumers in memory care especially need to have that as a part of their list of questions that they ask when they tour through a memory care. You know, what, what technologies are you utilizing and how are you monitoring? Because even with a one to eight staff ratio, which is pretty common in most memory care, you know, there's no way that eyes can be on your loved one all the time. [00:24:53] Speaker C: Sure. [00:24:53] Speaker A: And I love that. [00:24:55] Speaker B: Sorry. [00:24:55] Speaker A: Go ahead, Karen. Sorry. [00:24:56] Speaker C: We keep cutting each other out, but I think about how many times in the 14 months she was there, I think I had to take her to the ER twice for falls because they didn't know. What did she hit, how severe? She couldn't tell them. And those are. One, an ER visit can be very expensive. Two, we know for dementia care patients, it's probably one of the worst situations you can be in. And sure enough, we were fortunate. They were minor falls, there were no injuries. And I understand the stance of you have to be on the side of caution. I get all of that. But knowing something at a more in depth level would have really made a big difference for everybody involved. Also, I would imagine if you're in a senior living facility and you're watching people getting wheeled out by ambulance on a regular basis, that's pretty upsetting. [00:25:47] Speaker A: Yeah. It's not good for business to have folks go to the emergency room. And of course, it's not good for the entire healthcare system in terms of costs and payers. Everybody has a stake in driving down these risks, whether people are living in senior living, in an organized living setting or whether they're living at home. It's a benefit to all of us to prevent falls, to, you know, monitor safe other, you know, high risk kind of things that come with dementia. So. And technology can be a really big player in that. Yeah. [00:26:23] Speaker B: Question about the training of the AI, because one thing that I also notice and seems to be a common problem with some of these basic chat models is there obviously sometimes hallucinations. There's always a degree of certainty. And the one thing with dementia care is there's a lot of uncertainty by definition. And so how do you go about training a system for that uncertainty and that sometimes we have to say, I don't know what she means, or I don't know if she's hearing me, I don't know if she's understanding me. Like, what do these cues mean? Like, there's a lot of stuff that is just. It's very difficult to come up with a definitive answer about because you don't know what's going on in their head. Is that something that's a challenge for what you build in those things? [00:27:06] Speaker A: It is. And I think that's where, you know, where I'm finding so much excitement here at the what for most people would be sunset of my career. For me it's like launching a whole new thing. But I think it's really fascinating because it's taken me 40 years to compile everything that's in my brain about what's best to do in a certain situation with somebody with dementia. I've worked with, with thousands and thousands of people, you know, so. So what's inside here in terms of interventions, if we want to use that word, or approaches that are going to be helpful, isn't out there in PubMed. Right. It's not out there in the sources that the LLM pulls from, that a normal LLM will pull from the Alzheimer's association website, the, you know, Lewy Body Dementia association website. It'll pull from all of the things that you could go on in Google. Right. But what it's not pulling from is this canon that is really in this expertise. So that was one way was learning as much as you can. And the beauty of Most people use ChatGPT just like a Google thing, you type in a Question. But, you know, true people who are really getting into using GPTs will train it, right. So my GPTs kind of know, and I have them all private because I know exactly what I'm doing and, and I know I've trained it with, here's the project I'm working on and I, I give it a lot of information. So the more information it has about, you know, your, your person, the situation that you're doing, the better, you know, the better the response would be. But you're absolutely right and AI makes mistakes all the time, so I can detect those mistakes because I know the difference. But it's, that's the beauty of using a particular system that's been designed with dementia in mind or designed with caregiving in mind. And then one that you can get into and privately enter all of your information, right? So you might enter that your mother had a, you know, previous, a childhood trauma of a near drowning and that might be, you know, or that she grew up, had an experience of food scarcity and hunger in her past or. Right. And so you might enter some of these very valuable, you know, bits of information that would then help with approaches and knowing what to do with her later on. So I think it is the details again in the personalization, something that we've known in good dementia care for decades now. It's called person centered care. Right. So this is a way to person center the resource, but I think it has to be done in a platform that's really specialized like an LB or like some of these others that are, that are out there. [00:30:20] Speaker B: And so taking that one step further, is AI then maybe is there a hope that AI could help with some of this miscommunication or this uncertainty? If you take the knowledge from someone like you, who has your lifetime of experience and then you match it with the personalized information that grows over time with each person, but also the collective experiences and qualitative feedback of everything around the world that feeds that. Are we eventually going to make breakthroughs and like, oh, she is hearing me right now or she does understand what I'm saying is that, is that a hope out there? [00:30:54] Speaker A: Yeah. Because I think if you, and you two know this, right? When you're dementia caregiving, you don't have the brain power yourself, right? I mean, we've all gotten used to this term like brain fog and you know, and a lot of us are middle aged women, so we got brain fog anyway, and we're, you know, so you're trying to think on the spot in a situation you're trying to get through. What is it I should try next? What should I try next? And I, you know, the psychologist Dr. Buscemi, who began Alby, you know, we used to joke all the time about just give them the answer. You know, just give them the answer that we don't need to spend 20 hours training them about plaques and tangles. Just give them the answer in the moment. What do they need to know to try next to get the. This person into the shower? And what's going to be the most effective thing? And getting that answer in the palm of somebody's hand is game changing. So that that caregiver, whether an overburdened professional caregiver or whether an overburdened unpaid family caregiver doesn't have to go and spend hours and hours researching and developing plans as to what to do next. [00:32:14] Speaker B: Wow. Sorry. I just gotta jump in there with a quick tactical question because you just mentioned the challenges of getting in the shower. And I need you to put your nurse hat on, your administrator hat on, because this is a conversation we're having right now where my mom has a beautiful, like, guest suite that was renovated for her and our dad years ago. But the shower has a small little step. It's like a couple inches that you have to step in. And sometimes she's fine, but sometimes she's just really. The caregiver's there with her the whole time, like holding her and escorting her through that whole process. But sometimes she just really terrified and every once in a while might throw a fit and she just refuses. Sometimes she gets in and she can't get out just because she's scared to take that step. What would you. How would you train your AI to give advice? [00:32:57] Speaker A: So a couple of questions. I would start with questions. What colors? [00:33:01] Speaker B: Karen's been in there, too, so she'll answer these for you. [00:33:03] Speaker C: And I also came up with. She had an. She has the walker with the wheels, and then she has her other walker that I actually found. My dad had used it. It was in the basement, the one with the, you know, the rubber stoppers on the bottom. And so I actually brought that in there so that she would go from one walker to the next, the stationary walker, which I think helped for a minute. But, you know, my thought is, all right, we gotta get a contractor in there to take that step out. Which I did talk to a contractor yesterday who said, oh, just so you know, that's not a small thing. And now, yeah, we're. No, it's not deep in Discussion over this. Cause we were thinking, oh, she's got this great first floor master. She's always had this. We've been so lucky. But wow, it's. It's a. To do. [00:33:45] Speaker A: So one question. So she's now wanting to step from the bathroom floor into the shower, even though it's just small lip of a. Of a threshold. What color is the bathroom floor? [00:33:57] Speaker C: It's sort of like a. What would you describe that, Andrew? [00:34:00] Speaker B: Like, maybe like light gray, like between gray and light blue, Something like that. Topy. [00:34:06] Speaker C: Very natural. [00:34:07] Speaker A: What about the shower floor? [00:34:09] Speaker C: Same. It's the exact same. I mean, it's a different tile, but it's. [00:34:13] Speaker B: It's a little darker. I think there's some tans and some darker colors of tile in the shower, as I recall. I'm not certain. [00:34:19] Speaker C: Yeah. [00:34:20] Speaker A: So one thing that happens with dementia beta is that people have a lot of damage to the centers of the brain that receive sensory information. So your eyes are a sensory organ. Right. They're bringing in a lot of information, but they don't process anything. They just tell you what you're seeing. It's your brain that says what it's for, what it does, how to get around, you know, all of those things. Right. So as well as positioning, understanding our space, you know, three dimensional from two dimensional, all of those centers of the brain can get damaged. And so people with dementia don't see surfaces, environments, any of it the way that we do. I asked about color because contrast can. It can help and it can hurt. So the rule of thumb is if you want someone to see the contrast, so you want somebody to sit down on a chair or a toilet, that the arms of the chair or the toilet itself should contrast about 30% between that and the floor. So at Brookdale, one of the things we did was paint all the adjacent walls to the toilet. The toilets were white, obviously. Paint the adjacent walls of the toilet a nice dark green. The toilet pop, they can see the toilet much better. So sometimes thresholds are an issue, going from one floor surface to another floor surface. If there is a stark contrast in the color, sometimes they'll feel as if they're stepping into a hole she may not see. It may be all just a sea of beige, as I used to call it, where she's not seeing. So it may help. It may her. May help. You could try putting maybe a bit of electrical tape or some kind of waterproof tape on the lip of the threshold to see if she can better appreciate where it is. Or try putting a dark Towel, perhaps, or a dark, you know, a colored towel maybe on the floor or using a shower bench or a shower seat. [00:36:33] Speaker C: Yeah, she has a seat and she has, obviously, grab bars in there as well. [00:36:38] Speaker A: Yeah. So sometimes making those a little, you know, putting a darker color towel on the seat so that she can kind of see where she's going. Does she say anything when she's crossing in? [00:36:52] Speaker C: Oh, yeah. [00:36:53] Speaker A: What does she say? No, I'm not. [00:36:56] Speaker C: I'm not doing it. I'm not going. [00:36:58] Speaker A: Have you ever asked if she's afraid? What are you afraid of? [00:37:01] Speaker C: Yes, I have. I have said, tell me. Can you tell me what worries you? And, you know, she's. She can't. She can't be clear on that. And I'll say, are you. Do you know that I'm here to hold you so you're not going to fall? But if I'm being honest, I share her worry. I think, oh, my God, what if she. I mean, listen, we're getting into the shower, we're already in a vulnerable position. She might not be wrong that we're all a little nervous about with her unsure footedness. She has a valid point. She could be slipping because. [00:37:38] Speaker A: And sometimes people with dementia very much read energy and take cues from caregiver energy as to how they are supposed to feel about situation if they are unsure. So being relaxed, calm and confident yourself will help. But I would try some different things with, you know, seeing whether it is actually because it is at that moment of stepping over that might, you know, that might help. The other thing might be to, I don't know the confines or how big it is, but might be to get her into a wheelchair where you could get the front wheels over the threshold and then stand her up and move her into the. That might. Or even a wheeled walker or something where she could sit down. And then, you know, so you. You get her over the threshold yourself and then stand her up and get her to sit. [00:38:34] Speaker C: Yeah, yeah. This is fascinating. All right, so then here's a question. If we were using AI tools, would this kind of information be something that a caregiver could look up? [00:38:44] Speaker A: Yeah, well, some of it, but I think that's, you know, what you just saw right there is the process. Right. Of. [00:38:53] Speaker C: Right. I mean, the concept of colors and depth. I would have never thought that. But you're right. She could be thinking. She is. And we think, oh, come on, it's this little tiny step. You've done it a ton of times. Her head might be saying, I am stepping into a Deep, dark hole. Yes. Wow. [00:39:10] Speaker A: It's a step to nowhere. And yeah, and it's pretty common in bathrooms. The flooring in bathrooms is often shiny or has a higher sheen than others. So you might try a rug, you might try a bath mat that could go from one of the surface over the ledge into the. I mean I would just experiment with different things that can change visually how it's looking. But yeah, is AI going to know that rudimentary. They would say check, you know, check the, you know, check to make sure it's not an issue of depth perception. But they weren't, you know, they wouldn't know to kind of all those suggestions unless you're in the other app, you know, that's been trained by the specialist. I think that's. [00:39:54] Speaker C: But the, the concept that maybe in the future that could happen is pretty fascinating. I mean the idea that you could ask questions that could be readily solved without the frenzy that goes with it. I mean, even just when you said stay calm and you know, have a calm demeanor, you're right. I mean I immediately thought, oh, my mom loves music, I should bring the Alexa in the bathroom and no, no, not you Alexa. And sorry. And she wants to know what I want and then play music while we're getting her in and out of the shower. That would be such a, such a. [00:40:31] Speaker A: I think the other thing that could progress is we could just start building dementia friendly showers and for people to age into. And I do think that there's an awful lot of when, when people age in place, as we like to call it, you know, people are aging into a home that was not built for them. And you know, I know that, that, that kind of work too is, you know, I just went through this, we just remodeled, we moved into a home and we're remodeling bathrooms. And I said this bathroom, which is my mother in law's bathroom, has to have, you know, I wanted zero entry and we did the zero entry with the drain. Well now it leaks like crazy because they, you know, so it was this whole thing to try to get, you know, and wear glass walls the best option. No, they were not the best option. They look great, which is important in Palm Springs. But you know, where do you put the grab bar? Right? So it, you know, the whole thing about if you are in going to age in place, part of what you have to set aside is an understanding that the home is going to have to be modified and for dementia that doesn't always just mean grab bars and, and you know, the kind of elder friendly things that we want to put in as we age in place or all one level or all of those considerations. But it does mean really paying attention to, you know, one of the things I'm worried about in my mother in law, her closet doors are mirrored and they're huge. It takes up a whole wall of her bedroom. And I know at some point that's gonna probably be an issue. We'll have to change those out. [00:42:16] Speaker C: Well, that segues really nicely into my next question for you, which is that you have a passion, I understand, for retrofitting houses and getting them prepared for people to age in place. Can you tell us a little bit about, you know, just kind of what you're up to in that world? [00:42:33] Speaker A: I would say I'm, you know, it's an interesting, it's been an interesting transition from, you know, my work at Brookdale. I worked, you know, one of my strongest partnerships at Brookdale really was with the interior design department and the architect. And as we developed new memory, because pretty much everything new that they were building at that point or retrofitting older buildings, there was a lot of converting to memory care. Right. Because there's never enough memory care. So it was a big part of the, you know, bringing in the gerontological, environmental, gerontology into that, but also the dementia, you know, aspect of, you know, so there was a lot of that work that I did in terms of, and still do in terms of the environments for senior living. And it is harder in a private home. And, you know, it's everything from safety to accessibility to making sure, you know, the doorways are wide enough for wheelchairs to, you know, all of that ada accessibility, peace. But then it's also about thinking about furniture and thinking about, you know, having the person remain in that environment successfully for as long as possible. So are things out and available and, you know, are they very, you know, we just selected a new refrigerator for this kitchen remodel. Is it something that went through our minds? How is she going to be able to get ice? Because that is, is her biggest concept. So, you know, we selected one with a drawer and a scoop. I'm like, oh, I'm gonna have to teach, you know, so you have to think about every single thing. And yeah, and then there are kind of a deeper, you know, the deeper look at, you know, okay, you've removed all the throw rugs now, but how should the rooms be designed for easy access? You know, it's very common in memory care communities. You should never build a resident room where the head of the bed isn't, you know, you can't sit up and immediately visualize a toilet. So the head of the bed should always be in a line of sight to the adjacent bathroom. You know, should. Should be visible from the head of the bed. [00:44:53] Speaker B: Interesting. [00:44:54] Speaker A: You know, those kinds of tricks that we've used in memory in residential memory care for a long time aren't always possible at home. Right. The bathroom may be down the hall and maybe, you know, so I think really, you know, my first advice to. Because everybody's goal is to age in place. I haven't met with one, you know, family who says we are dying to get into memory care. You know, so everybody wants to stay in that home. But the first thing you have to really look at is can we do this in the environment that we're in and, or do we need to select a different house to take this on? And so, you know, as my mother in law was moving in with us, that was a decision we were in. We had already downsized as a, as a couple and, you know, we had to upsize again because we needed more space and she needed more space and we needed to be able to select finishes and do things that were, that were gonna be easier for her. You know, we had to replace the faucet in here because it was one of those that you have to, you know, that's motion sensor, right. [00:46:01] Speaker C: Which sounds like a great idea, but [00:46:03] Speaker A: I can barely figure out on a good day, you know, so [00:46:07] Speaker C: like a [00:46:09] Speaker A: good example of something that somebody probably designed as, oh, this is going to be great for old people because they don't have to use the handle. Well, nobody can figure it out. So I think it's, you know, you have to really make sure that you're planning ahead and first doing an evaluation of where you live. And is this even possible? Are there too many stairs? Are there, you know, other dangers, you know, that, you know, what does the outdoor space, you know, look like? All of those things. [00:46:37] Speaker B: Yeah, we had. Actually, it's interesting you mentioned rugs because we also had people come in. We'd had a bunch of different conversations about retrofitting the house that she had been living in for 50 years before she went into the assisted home. And rugs was a big discussion because we were like, okay, yeah, that seems like a good idea. She could catch the edge of the rug and fall, and so we should get rid of those. But then she falls on wood floor floor instead of falling on a very cushy thick rug that we have and we took some out, but, like, the main ones we kept in there. And she's, you know, I'm knocking on wood here. So far, she's probably gonna take a tumble tonight, but she's been navigating them just fine. And we. Eventually we just. We decided to keep them in there, and it worked out okay. But I totally understand the other argument. [00:47:25] Speaker C: We took out throw rugs, you know, the little. The small ones, but the big ones, we just made sure they were very deeply secure for that very reason, because I thought, oh, my gosh, if she lands on the wood floor, now we've got a whole other set of problems. [00:47:39] Speaker A: And there's a very different dynamic. When you move an elder in with you, when you move a parent in with you, it's your house, right? And you kind of are able to design the house or set up the space. It's a new space to them, right? Going in and altering a place where somebody's lived first several years. I mean, my father is 95, just passed away in last June, almost a year ago. And, you know, my joke with him was, you know, I'd say, you know, you gotta get rid of that rug. And he was like, no, no, it's fine. I've never had a trouble. I said, okay, well, we'll just wait till you fall then. And then he would fall, and then we'd take the rug out, you know, and that was kind of how this is a brilliant man and PhD, you know, but he was gonna hedge his bet, like, you know, that it was okay until it wasn't okay. And that's kind of how we did with a lot of the sort of hazards in his environment. We finally did get him into a. You know, he was in an independent living apartment, so it was pretty safe. But even in that, you know, the talking them into making changes in a place where they've lived for a lot of years is a much different conversation than. Than, you know, you creating a space together. And this was ideal because we all purchased the house together. We came in, you know, so we're all coming in at the same time or, you know, really able to make it be what we need it to be, which I understand not everybody has the ability to do that, but I think if you can create, like, you were talking about a suite or a spot that is, you know, pretty much elder friendly and dementia friendly, that that can really be helpful. But you have to have means to do that. I mean, it's, you know, you have to have a commitment and an ability to do that. [00:49:29] Speaker C: It's interesting because I'm, I'm still a ways away from that stage, but I do think about it a lot. And right now I live in a two story house and I really am already on the search for. I want a 1200 square foot ranch house. Yeah. That I know that will be my last house. But you've given me some interesting pieces to think about because when I bring my mom over to my house, of course she's not going to the second floor, but just getting her up and down the two steps to get in from my garage or a challenge and up isn't even as bad as down is. And I feel like, oh my gosh, my mother's demise would be falling, getting in and out of my house. It's a scary feeling. But you're right, those are pieces that I wouldn't have even thought about. The widths of doorways and furniture and all of those pieces which really do make a difference. It's so much to think about, but great to be proactive if you can. [00:50:31] Speaker A: Yeah. [00:50:31] Speaker C: And I think there's corrector is going to come in and things like can't even get anybody to show up at your house. [00:50:37] Speaker A: Yeah. And I think that, you know, there's always the option now too of, of ADUs. And you know, the many more cities now are, you know, I think originally everybody was, you know, entire cities were banning the use of or building of ADUs. But I think ADUs are, I mean they're super common out here in California. I know it's maybe not true everywhere where lot sizes are smaller or you [00:51:05] Speaker B: know, for our listeners that may not know what that is. [00:51:07] Speaker A: Can you explain accessory dwelling unit? I refuse. I will use the term granny pod. You know that's, that's out there. Right. [00:51:15] Speaker B: Or Airbnb apartment. [00:51:17] Speaker C: Yeah, I want a granny Bud. [00:51:19] Speaker A: I like that little accessory dwelling unit. Right. So it's generally a studio or a small, small one bedroom that gets built in the backyard or the front yard or where, you know, on the, the same lot as the adult child, then the parent can move into that. [00:51:36] Speaker C: Yeah. [00:51:37] Speaker A: The other, you know, thing that can be done that I've seen out here quite a bit too is that the caregiver, if you have a live in caregiver, you have, you know, you're able to provide housing for a caregiver. Maybe the caregiver lives there and the parent lives in the house, which is probably what we would do. But I think, you know, there's a lot more options now with bringing folks In. But yeah, not all cities are adu friendly. You know there's, there's places where lots and you know I, we just moved out here from Chicago and you know, in Chicago there wouldn't have been space to do all that with the alleys and all of that. But I think, you know there's some, there's some advances too with the tiny home because if you look at, if you stay in your, you know, I had a Neighbor in Chicago, 4300 square foot bungalow and she was so proud of staying in her house and she was so, you know, she was in her late 80s. She was so proud of staying in her house. She probably lived in less than 150 square feet of that. She had her recliner and her TV and one little bedroom off the kitchen and then the kitchen and she ate in her kitchen and she'd just go back in the little bathroom and it was just, I mean it was her little circle. Right. And the rest of the house she never, you know, she never went in and I think is that really, you know, she's, there's a lot of people that argue too. You're keeping a 4,300 square footage foot home from a family that could be using it. Right. So you know, but her kids could never convince her, you know, really to, to leave it, so. [00:53:15] Speaker C: Oh, we hear ya. [00:53:16] Speaker A: It's interesting. [00:53:17] Speaker C: My mom lives in her 3,000 square foot, five bedroom double lot house that she's owned since 1973. But you know, fortunately that worked out well because it left space for you know, when Andrew came back and he was able to have his own almost sort of like his own version of an apartment kind of and you know, but, but, but yes, I am constantly thinking of I want to take up less space in this world. And I wonder if maybe that will start to be a philosophy that we'll all start to adopt as time goes on. Especially when we, if we can start thinking about what life will be like for us earlier than later and knowing that people are living longer and in generally healthier longer. Those are good conversations to be having right now. And maybe that's nutritional next pod that we can. [00:54:09] Speaker A: Yes. Advanced planning is everything your life. [00:54:13] Speaker B: Yeah, yeah, that's. And well and the whole, there's a whole separate discussion on group homes and how seniors are living in these four to six unit or resident places which obviously come retrofitted like you're saying Juliet. But let's get, let's get you out of here on this, this, this quest to obtain all the technological advancements that are out there, and most people are just not savvy in that way. What are. What are steps someone or family can take to try to learn something new about what's happening? [00:54:44] Speaker A: Yeah, well, I think there's, you know, like I said, I think there's really good things out there already that exist that you don't have to, you know, learn a whole bunch of new skills for. My best advice, really, to anyone, you know, in our job, I'm 61, right, so I'm the last year of the baby bowman, you know. So my advice to other boomers is to not get left behind. Not, you know, to keep up enough so that, you know, don't be afraid, don't, you know you're not going to break it kind of thing. And so introducing things like, you know, $200, you know, echo show into your kitchen where you can ask it questions and you can ask, you know, to pull up a recipe for you. And you can start with things like that that maybe, you know, by the time you need a caregiver, I call the caregiver hq, right? The headquarters where you set up everything on that, on that show that has the calendar and it has the medications and it has. You'll be more savvy, you'll be ready to use those kinds of things for the duty of caregiving. So I do think there's very inexpensive things. Learning about Apple Watch and learning about health monitors and biometric health monitors that, you know, CORA rings or things that enable you to be able to help monitor people's sleep or help monitor, if you have to monitor blood pressure or if you have to monitor pulse or those kinds of things can be really helpful. The cameras, things that, you know, getting used to that, to having those types of technologies in your house before you really need them, I think is always helpful. If you're trying to learn all this at once, it's going to be complicated. The other thing I really strongly recommend is that families have a conversation early on post diagnosis, that with a person living with dementia, with a person with a diagnosis about monitoring, because there will come a time, and people living with dementia know that there will come that time, right, when they will need to be monitored. And what are your fears about that? How can we make it more comfortable for you? What. What's your contract around that? What. What are some, you know, deal breakers for you around being monitored? You know, is it only at night? Is it, you know, can, you know, working on all of those things together and really creating that care Partnership. But having that person living with dementia weigh in very early on that. Yeah, that is a whole nother podcast. Probably all that advanced planning. [00:57:36] Speaker B: That's great. Well, Juliet, thank you so much. This has been so illuminating and it's just fascinating what's headed out there in the tech world as it relates to seniors. And we're just overjoyed to have you. Thanks for all the helpful info. [00:57:50] Speaker A: Thanks. [00:57:50] Speaker C: Thank you. It was fantastic. By the way, I'm going to call all my friends and tell them that we're ready to build our pods together now. [00:57:56] Speaker A: Okay. We have a real. [00:57:58] Speaker C: I have a great group of women surrounding. We're all like, let's just do it. [00:58:01] Speaker A: Just do it now. Just don't call them Granny Pod. [00:58:05] Speaker B: Of course I like the name Granny Pod. I don't know what's wrong with that. [00:58:10] Speaker A: Not all elders are grandparents. [00:58:12] Speaker C: Exactly. [00:58:13] Speaker B: Oh, I guess that's right. [00:58:14] Speaker C: Yes. Thank you. I will not be in a Granny Potter. [00:58:16] Speaker A: But either. Thank you, Juliet. [00:58:19] Speaker C: We really appreciate you taking your time with us today. [00:58:22] Speaker A: Yeah, thanks for having me. Appreciate it. [00:59:11] Speaker C: And we are back. So, Andrew, let's talk takeaways from Juliet. [00:59:17] Speaker B: I loved our discussion. It was long because it was very interesting. And I. It's funny because we listened to our interviews, obviously after we record them, we go back and say, okay, there's little snips here we need to make. And there just wasn't any snips to make because I really thought everything we. We talked about was very relevant and interesting and useful. Couple things that I really noticed, and some of them I didn't really expect from the discussion. First of all, very interesting to hear her say that people aren't as afraid of AI as media reports. There's a lot of fear out there about people, and of course, there's doomsday. And it's important that we think about those fears and we address them and we think about how we can protect ourselves from the worst of what could potentially happen. But it's interesting that she shows that a lot of people aren't as fearful and aren't as taking this approach of like, oh, I don't want any AI near me, because bad things can happen. And it seems to be especially the case within the senior community in the senior world. [01:00:22] Speaker C: Sure. [01:00:23] Speaker B: And healthcare in general. That seems to be one of the places where people shine a bright light and say, hey, this is one of the areas where AI can really help. Help with disease and what we're talking about with care. So that I thought that was very interesting. Right. [01:00:35] Speaker C: And I Also do notice that of course, whenever something new comes up, especially technologically, people get very nervous about it, and understandably so. But I also feel that once we kind of settle into the do's and don'ts of it, so to speak, there can be a lot of good that comes from it. Listen, if I were still teaching middle school English, AI would rattle me. I think I would probably be spending all my time trying to detect cheating. But the fact is that, you know, I'm a big traveler and I just used AI to help me find a little town that I wanted to go to. And it was right on the money and even helped me choose between, you know, two different hotels, different locations, what to do at night, what was safe for me, what wasn't safe for me. So I think that if we immediately say, oh, this is terrible and we should be banning together against its use, we're missing out on a lot of the beautiful nuance that AI has. But specifically when it comes to the idea technology in general, not just AI as it relates to senior care, we would really be missing the boat if we weren't paying attention to the helpful tools that are going to be available, readily available, not just to those who have more media savvy. I think this is, this could be. I think we're turning an interesting corner here. [01:02:00] Speaker B: Absolutely. And it's interesting how that ties into this idea that seemed to emerge over a couple different aspects of our discussion, which is the sense of community and trying to develop the senior care ecosystem so it doesn't have this massive burdening footprint on society at large and the healthcare system at large and housing at large. And just thinking about our discussion about fall detection and how important it is that we have tools like that in the home or in assisted living facilities so that there aren't so many emergency room visits, you know, this default emergency room visit that you had to do with mom and that a lot of facilities make you do because of liability concerns. That's very traumatic, not just for the senior and the family member, but also for the healthcare system. It's very expensive. Resources are being drawn to do something that oftentimes is just out of precaution and ends up everything being fine. And that's a big deal. And to just prevent that more than we're doing today I think would be a huge help. [01:03:11] Speaker C: Yeah, I really, I mean, even our discussion about mom shower really got me thinking about. Oh, right. Even occur to me or I wouldn't have known those pieces about what she's looking at when she looks down and is that safe for her to step in? And why is she getting more nervous? Julie, our sister, messaged the other day that she had a hard time getting mom in and out of the car, which is something that we do all the time. There are going to be changes that occur. And so to be able to figure out how to mitigate disaster, because we know that this is coming, I think it's really, really helpful to have pieces, people, tools in place to help us figure out what our next steps are so that we are not constantly living in a state of, oh, my gosh, this terrible thing is going to happen. And maybe as a result, we'll find ways to sort of. I mean, I know this sounds so Pollyanna of me, but. But, you know, that's not my usual default, but the idea that maybe we could start to find more joy in being with our aging loved ones as opposed to spending so much time just worrying about them. I mean, wouldn't that be so delightful? [01:04:27] Speaker B: Well, we've already experienced that. I mean, that we're in a much better place than we used to be with Joanna than when we had a lot of issues going around that now seem to be solved, at least for now, with this system that we have in place. But. But yeah, the. The interesting intersection that Juliet has between AI and technology and the retrofitting of homes, all that ties into this making the environment less prone to some accident happening and taxing the system. And this concept of. And mom is not one of those anymore because I'm living with her, and we have caregivers in and out of there all the time. [01:05:08] Speaker C: Time. [01:05:08] Speaker B: But like, aging in place, it's certainly what everyone wants to do, but sometimes you have this older person that lives in a huge house and they're occupying very little of it during their normal day. And yeah, I mean, it's something to think about. I think that's a little aggressive to say. We shouldn't, obviously, should allow people to do whatever they want to do, but, you know, it's just something I hadn't really thought about at all. And so it was interesting to. To have that point raised. But clearly it's such a good thing that there's so many good, positive tools and technology that are going to help the aging. And I think the takeaway, ultimately, is that you really should look for what's available, push to be your own students about what's available. It's very easy to take some of these tools and try them on for size and see how they feel and just gradually be open to learning about what's happening, and I think that'll only be only add a lot of value and help in your own senior care challenges, for sure. [01:06:14] Speaker C: Indeed. [01:06:15] Speaker B: Indeed, indeed. All right, and as we always like to say, please send us your comments, questions, experiences, anything. You can email us at if it's not one. And as always, here's mom to play us out. [01:06:37] Speaker C: I feel pretty, oh, so pretty. [01:06:42] Speaker A: Oh, so pretty and lovely and nice. And you're gonna have a lot of these beautiful things because it's always [01:06:56] Speaker C: just to be in your heart.