Make It Last – Ep 47 – Shattering the Myths About Alzheimer’s Disease
This week, Victor addresses some of the risk and expenses of investment platforms like Wealthfront and Fidelity target date funds.
Also, two special guests join the show to discuss some of the innovative ways they are helping seniors suffering from Alzheimer’s and other dementia diseases. Jennifer Garcia and Mary DelValle from Brookdale-Hamilton join us for two segments to introduce the strategies they use to keep seniors dealing with dementia engaged emotionally and mentally.
Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and elder law attorney and Certified Financial Planner™. Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.
For more information, visit Medina Law Group or Private Client Capital Group.
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Click below to read the full transcript…
Bert: Welcome to “Make It Last,” helping you keep your legal ducks in a row, and your nest egg secure, with your host, Victor Medina, an estate planning and elder law attorney and certified financial planner.
Victor J. Medina: Welcome back to Make It Last. I’m your host Victor Medina. I am excited for today’s show. One of the reasons for that is that I’ve got two special guests on today. They are Jennifer Garcia and Mary DelValle from Brookdale Hamilton. Brookdale is a facility in Hamilton that specializes in dementia care, specifically in the area of Alzheimer’s.
I’m happy to have them on because they’re going to be just shattering some of the myths about Alzheimer’s. Specifically, what is appropriate for people to have as activities and things that they can be doing? They’re doing wonderful work over there. I’m excited to have them on as guests.
We’ll be doing that in segment two and three, coming up later in the show. When it comes down to segment one, one of the things I want to talk about is some of the stuff that’s going in these brokerage houses, investment advisors. These people that are dealing with your retirement money and making this value proposition about what kind of low costs are going on in there.
Let me set the stage for that for everybody. This show’s really about helping people in retirement. One of the things that I’ve been hammering on is how important it is to make sure that there’s a fiduciary in your life.
Somebody who is working towards your best interests and really working to make sure that whatever you have you have secured for your retirement and it’s not taken over by a lot of conflicts of interest and things like that.
As technology has advanced, one of the things that has happened is that these robo‑advisors or these large firms have been able to drive down the costs of investments. They advertise a lot about the costs. We would call that the commoditization of asset management, where it’s trying to make the asset management look like it is interchangeable.
It’s a commodity. A coffee bean is a coffee bean. Asset management is asset management. When you commoditize something, one of the economic principles behind that is you drive down the cost relative to the supply and the demand, so commodities like coffee beans, pork bellies and things like that. We know those from ‑‑‑ maybe you watched the Eddie Murphy movie ‑‑ “Trading Places.”
If you watch commodity prices, it goes on supply and demand. If there’s not a lot frozen orange juice out there, the price is going to go up. One frozen orange juice is interchangeable from another frozen orange juice. This is what the technology is trying to do in terms of the way that they’re handling investment fees and what you do for investment.
You’ll see Wealthfront, you’ll see Betterment, you’ll see Fidelity, and things like that. What you’re finding is that people are being presented with these options to do investments and turn it into a do‑it‑yourself proposition where there’s low cost, and just trust everything over, and go from there.
Recently, we’ve had some news come out that shakes that core. I think it’s important for you to know about it because I don’t want you to be hoodwinked by these sales pitches that come on and say, “Well, this is low cost, this is automatic, you should do it because it’s in your best interest.” Two pieces of news that have come out.
One of them was with respect to Wealthfront. Wealthfront is a company that essentially has used technology to streamline what it takes to open an account, manage an account, and things like that. They have criticized digital advice competitors for selling proprietary investment products.
Proprietary investment products ‑‑ besides being a mouthful to say ‑‑ are essentially those things that are created specifically for the people that are selling them. In my book, I talk about why that’s a bad idea. If you need a car, you want to be able shop around all the cars. You don’t want to always be forced to buy the Honda, because you’re at the Honda dealership.
Now, Wealthfront has, in fact, created its own mutual fund. Essentially what it does is it has proposed this fund as a way to do some risk strategy. Don’t worry about what it’s supposed to be doing. The point is that the cost of that is half a percent per year. That’s pretty high. When we do a blended portfolio for somebody, the whole blend is probably half of that fee for a full diversification.
Once you go off beyond that, there’s also a total return swap. Basically, that fee can raise as much as 1.25 percent per year, so it’s expensive. That’s the point. The point is that this new thing that they’re offering is expensive, and there’s a default when you enroll to have a certain percentage in that, and then you have to opt out of it.
Here they are creating more ways for them to make money and you are unsuspecting. You went through Wealthfront thinking, in fact, that it would be something that you could trust as a low cost provider, but here they are selling a proprietary investment. Is that the best thing for you? Probably not.
Let’s shift to the other side and another news report that came out about Fidelity. Fidelity is a custodian people know. They got these retail establishments. You can find them in main thoroughfares. You can go out and meet with a Fidelity adviser and essentially talk to them about your retirement.
For the last three years, there were a few funds that have outperformed their competitors, and you’re trying to figure out why that has happened.
It turns out that they took something that is a target date fund, something that is supposed to be managed towards a safer allocation, less risky allocation, less volatile allocation a little bit later in the career of somebody, but they’ve actively managed it.
What active management means is that they were trading toward performance in the short‑term as opposed to a passive performance over the long‑term. We believe in passive management, tends to be what the mass suggests works, but the report found that each of the 2020 funds and some of the other funds in there was, actually, essentially being actively managed to try to capture these returns.
All the amounts suggest that active management doesn’t work, especially when it takes into account the fees that are involved. What’s the point of this? One is that you really have to know ‑‑ I mean know ‑‑ the people who are investing your money and the advice that you’re getting, and you can’t just give that over to somebody, hoping that they’re looking out for your best interests.
These companies with whom you have zero relationship, and they have not signed a fiduciary pledge, and they haven’t had any of those things, these companies are looking out for their best interests and their bottom line and they’re doing it in ways you can’t even suspect because of the ways that they’re defaulting you into a proprietary fund that you have to invest in, or anything like that.
The point of it is you got to be watching out for your best interests. You have to essentially work with somebody that is a fiduciary that is looking out for what you’re doing, and has got your back, and that’s entity like ours, and there are other independent agencies that do that. You really have to be looking out for this because this is your retirement.
Victor: You get one crack at this and it’s very hard to recover from mistakes that can happen if you’re in a fund that’s too expensive or if you’re in something that’s too risky and you don’t even know about it.
Anyway, let’s cheer this thing up. We’re going to come back from break. We’re going to talk with Jennifer Garcia and we’re going to talk with Mary DelValle from Brookdale Hamilton. They’re going to talk to us about shattering the myths that are associated with living with Alzheimer’s and how to treat that.
I’m so excited that they’re going to be our guests, so stick with us. We’ll be right back on Make It Last.
Victor: Welcome back to Make It Last. I am joined today by Jennifer Garcia and Mary DelValle who are both Brookdale Hamilton. They are special guests today as we talk about shattering myths about living with Alzheimer’s disease. I want to welcome you both to the show, thank you so much for joining us today.
Mary DelValle: Thank you.
Jennifer Garcia: Thank you for having us.
Victor: Tell me about what your specific roles are, we’ll start with you, Jennifer. What is your role at Brookdale Hamilton?
Jennifer: Sure, I’m the Executive Director of Brookdale Hamilton, which is a memory care community in Hamilton, New Jersey.
Victor: Great, Mary, what do you do?
Mary: My name is Mary DelValle and I’m the Clare Bridge Program Director and my responsibility is to provide therapeutic recreation to our residents.
Victor: Great, it sounds to me that Brookdale, basically, is a facility that focuses on people with cognitive issues. Specifically on Alzheimer’s is one of the reasons that we have you on the show. I’ll tell you, more and more information comes out about all of the struggles people are having with Alzheimer’s. It’s everywhere in the news.
You turn around and someone has been impacted by what this disease does. Tell me a little bit. What are the misconceptions that people have about what Alzheimer’s is and what it leads to?
Jennifer: Sure, I think the misconceptions, the largest one that I’ve seen, is, “That’s it. It’s a terminal disease, it’s terrible and there’s nothing beyond that,” but what we bring is that it doesn’t have to be that way.
There are places like our community that provides a safe, secure, and home‑like environment for these residents. They still can flourish. They still can do so much. There’s still so much love to give and for them to give to us. That’s what we want to focus on.
Victor: When you meet them, they might be at various stages of a disease. Talk about what it looks like a little bit in the beginning. I know you’re not a medical doctor in that sense, but you have a lot of experience watching these families. What does it look like in the beginning? What does it look like when it’s a little bit more progressive?
Jennifer: At the beginning, they’re still physically capable. They still might be able to feed themself, dress themself, do a lot of the day‑to‑day routine aspects, but with more so of forgetting the time, or the schedule, or what their appointments will be, so things of that nature, of the future planning.
They will still remember things from their past ‑‑ from when they were first married, or their children, or their parents. You still can have that conversation and still live that present time.
Victor: Is that a time in which they’ll be looking at assisted living yet, or they’re still at home in that beginning stages?
Jennifer: At the beginning stages you see people still living at home, spouses still trying to provide care, children still trying to provide care in the house. There might be times where they might end up at the hospital for other medical reasons, but you might see some still living at home at that moment.
Victor: As the disease starts to progress, what does that start to look like?
Jennifer: Usually there’ll be some more forgetfulness, they will start declining, not be able to do as much self‑care at that point. You might see some additional medical issues, more falls, things of that sort, leading them back to the hospital. Maybe sometimes wandering off, not really remembering where they live, and how to return back home.
Victor: In that concept about wandering and people not being able to care for themselves. That’s really more of the stereotypical idea around that. There’s another element that starts to come in where people get very concerned about incontinence and starting to lose that.
Is that the final stages or is that somewhere in the medium part of it? Where does that really start to come in where that becomes a big concern and, obviously, when you start to need a lot more help to care for somebody?
Jennifer: I would say more medium to later stages, usually, that becomes an issue. Again, we have to look at it overall, too. Not just for the physical needs, but also for the emotional and psychological aspects taking care of your loved one.
It’s not just a matter of physically being able to provide that care, but also what is their quality of life, what can you still focus on and do with them that still, day‑to‑day, will be meaningful and purposeful?
Victor: I want to take the next segment to talk about what Brookdale does specifically, because it’s unique and one of the reasons why I wanted to have you on. Before we get to what you all do specifically, what are the needs in that emotional and mental area?
What is not provided or what are people overlooking besides making sure someone’s protected, not wandering off, that they’re not a fall risk? What are the mental and emotional stuff that they’re looking for?
Jennifer: Mentally, again, they’re still very able to do things. They’re still able to do…For example, what we do day‑to‑day is trivia, mental exercises, things of that sort. They still can live back in the past. You can still ask questions about who the president was at a certain time or about their personal life in their past. They’re still able to have that conversation, still laugh, enjoy, and live life.
The other thing that we like to focus on is the emotional part. Just as people may see them maybe upset, or unhappy, depressed at times, you can also focus on the wonderful things of joy, and happiness, and love. That’s still there and that’s actually one of the last things to go, so that’s what we try to focus on and hone in on.
Victor: Do you see that a lot of the education is as much on letting people know what the residents themselves need, but also on educating the families? Are the families missing an education about what that can look like on the other side?
They’ve already turned into, “Well, jeez, we’re just going to have to park them and they’re going to get very, very sick soon.” The families having that need as well, you find when you…?
Jennifer: Absolutely. That’s something that we strive to focus on. That’s why we have support groups and we provide a lot of care and support for our families as well to try to provide them that information. Yes, that’s something that definitely we try to invest time in our families to help them understand the disease process, but also because, again, everyone tends to focus on the physical needs.
Are they safe? Medically, are they OK? Are they taking their medications? Which is definitely vital and important, but it’s also important to hone in the emotional and the mental well‑being of our residents.
Victor: What do you experience as a trigger point for when people no longer can take it at home and need to look at getting help from assisted living? Maybe not just home care because all that is is replacing the care that they were doing. I’m going to ask the question in a different way.
Most of the time, when they encounter your facility, it’s because they have that physical need that they’re trying to cure. Is that accurate?
Victor: What are those types of things? Are they the falls? Are they the catastrophic type of events that cause them to really face the reality that they’re going to need some help?
Jennifer: Yes, it’s usually as you said. Definitely falls. They’ve had incidents where it’s become unsafe ‑‑ unfortunately left something on the stove, or they wandered off out of the community, or they, unfortunately, somehow drove a car and now are lost, end up in a hospital. Yeah, it’s usually something of that severity that causes someone to look for other options.
Victor: I remember my grandmother. The thing that changed it for us is she was driving a car, and she drove it into a tree. Ended up breaking her ankle. Was in recovery for a little while. We say, “OK now the car comes away.” We’re in this now. She was more of an independent living situation, but it was really…It took something like that in order for it to make a change.
Specifically, with respect to Brookdale, tell me a little bit more about the facility. How many spaces do you have? How full is it from time to time? Then, when we come back from the break, I think we’ll want to talk a little bit about specific programs that you guys use.
Jennifer: Sure, sure. We have, actually a smaller community. We only have 50 residents. That is the max amount of residents. We specialize in memory care, so all of our residents do suffer from some form of Alzheimer’s dementia. Also, that’s most importantly what we specialize in.
Victor: Right, it’s some form of dementia. Do I understand it correctly that we don’t really know if it’s Alzheimer’s until after somebody passes away? They can do an autopsy to figure out if it’s the myelin or something like that? Most of the time, if we see it in a younger age, in the beginning it’s not just getting old and dotty, it’s some form of dementia and often Alzheimer’s or something similar to that?
Jennifer: Correct. Yes.
Victor: There’s about 50 beds and I would imagine you guys are fairly full from time to time.
Jennifer: We are, we are. There’s certain, of course, times that…We always try to have our residents age in place. Of course, as they come in and the disease progresses, we do lose some of our residents. That’s definitely the most difficult part of what we do because we love our residents. They become our own family. The families become our families. It’s quite difficult.
Jennifer: Unfortunately, this diagnosis is just increasing. As time passes, we have more people diagnosed with the disease, so the need is definitely there.
Victor: OK, great. Listen, what we’re going to do is take a quick break. When we come back I’m going to want to speak with Mary a little bit about the programs. As the program director, I want to hear a little bit more about what you guys are doing specifically in your facility, and how it’s unique, and why it is so special.
Stick with us. We’ll be right back on Make It Last.
Victor: All right, we’re back with Make It Last. Our guests today are Jennifer Garcia and Mary DelValle who are both from Brookdale Hamilton. It’s a facility in Hamilton, an assisted living facility that specializes in people who have cognitive decline, specifically dementia, Alzheimer’s related.
It’s a 50‑bed facility, and this is all that they do, is helping people who have these sort of cognitive issues. I got to meet Mary just making the rounds around and got to hear about the programs that you’re doing, the activities specifically.
I thought this was so unique and really important because one of the things Jennifer talked about in the prior segment is the need to fill these emotional and mental needs for these residents often not seen by the family when they’re making that transition and then you’re able to fill that.
Tell me a little bit about where you saw the need for what you were trying to fill and what are some of the first steps that you took to try to create the activities?
Mary: I just wanted to say that we have a lot of fun with our memory chair residents and the company’s very supportive. The company has outlined some of the things that we need to do and one of the things that we do every single morning is we do the Pledge of Allegiance. Our residents grew up doing the Pledge of Allegiance.
We do the Pledge of Allegiance. We sing “God Bless America.” We do a mental exercise. We also do a physical exercise. That’s every single day. More importantly, we meet the emotional needs of our residents, and physical needs, and spiritual needs.
Some of the things that I do with them is that each morning I have a discussion with them to try to stimulate them. One of the things may be I may talk about Nat King Cole. They certainly will remember him.
They may not remember how to get back to their rooms. They may not remember how to go to the dining room. The past, they live in the past. It is wonderful to see them react, respond, smile, bring back those memories when we play the music. They really enjoy it. I try to tap into each and every single person and try to meet their needs.
When they first come into our community, we’re asked to do a life story and we get some basic information on them. Off of that basic information I’m able to gear my program towards their needs.
Victor: Basic information like what? Like their occupation and what they did?
Mary: Their occupation. The music they like. How many siblings? Were they married? How they met their spouse. Anything that would be relevant to providing some type of therapeutic recreation. We do ask, “When they’re upset, how do they calm them down?” Somebody may say, “Well, they need a hug.” Now I know that.
If I see that person upset, I’ll ask. How do we know they’re upset? They have a frown. They may become quiet. All I have to do is give them a hug. You get to know them and you know that something’s not right, but, for the most part, our residence are very happy. They’re engaged.
I will cite some of things that our company has taught me in doing dementia training. One of the things that the company says is, “Well, we when have an individual that wants to leave the community because they want to go home.” One of the things that we do is we always validate what they’re saying.
We don’t dismiss what they’re saying. We say, “Well, if you want to go home, why don’t you come eat first?” or we distract them, but we always validate where they are. We may have a person that every morning wants to exit the community, but when looking at their background we notice that every single day they’re doing this at the same time, first thing in the morning.
Well, that person always had a dog. In their mind they have to walk the dog. The person that likes to go shopping because that’s a form of relaxation for them. Where are they going to go shopping? They’re going to go shopping in other residence rooms. We really get to know them and get to know who they are.
It is absolutely wonderful when you see residents engaged, smiling, answering. It’s a wonderful feeling to look out at my residents in the audience and see that they’re stimulated. They’re not sleeping. They’re not bored. They are full of life. We do a lot of dancing. We do a lot of music. I can specifically give you more examples if you like.
Victor: Yeah. I’ve heard you say that you would go back and pull them into whatever was their history. I would have to do a history lesson, I’ve got to tell you. I’m not sure that I could keep up.
Victor: I know who Nat King Cole is only because I’m into jazz, but I’m not sure that I could do anything else that they had in their background. Apparently you feel comfortable enough to go back in history. I don’t know if you’re…Wikipedia is now your friend when it comes to that.
The activities that you do, is this a one‑session thing? One of the things that I thought was really interesting was more that Brookdale looks at this is almost ‑‑ I don’t know what did you call it? ‑‑ 24/7, that it’s basically all around.
Victor: That kind of programming is all the way through. What is the value of keeping it consistent rather than just doing it as a morning type of thing or just as an afternoon thing as opposed to all day? Where is the value to the residents?
Mary: The value is that the residents do know. They may not know what time it is, but they do know the routine. They know that when they leave our area ‑‑ and we call it town square ‑‑ that they’re going to go into the dining room. After the dining room they’re going to go in and relax for a little bit. The consistency does help.
Our residents aren’t able to tell you where they want to go, what they have to do, but the routine is there. They know what to expect.
One of things that they often tell you with residents when you get to know them is that the resident many not know what you’re saying, may not know what you did, but they’ll always know how you made them feel. They really respond to that.
I will finish a program and when I finish a program I will escort them to the dining room, I’ll escort them to wherever they have to go, and they know. They know that the dining room is a familiar place. They know that they’re going to go into the living room after that, so the consistency is very, very valuable.
Victor: You’re providing a great service in terms of where they are and making sure that they get good stimulation from whatever it is.
Victor: Do you see any impact to their progression of the disease state? Does it at all affect what their journey in Alzheimer’s is? Does it flatten the downhill descent for people? Does it keep it fairly constant? Any real impact to what they’re…?
Mary: I would say, yes, I do see an impact. What I’ve noticed is that, when they’re not actively engaged, our residents will not know pretty much what to do with themselves. You can see that they’re sort of lost. We constantly are stimulating them. We’re constantly are trying to keep them engaged.
Yes, you will see them engaged, laughing, singing. The greatest gift you can see is someone who doesn’t really speak, but all of a sudden they’re singing. It tapped into a memory. You see them when they get up, they hear a particular song, they got up and they dance. Nobody’s asking them. They’re dancing with you.
Victor: Yeah, I know. There was a great viral video of somebody in Norway that was a musician. One of the younger people that was going around doing activities noticed that he would get up and he kind of goes to the piano. He reassembled the guy’s band.
He’s about 90 years old. He’s a piano player. They weren’t really sure how he was going to react with all of the change, but they rolled the piano out. The whole band came together. They played a bunch of songs. It was probably the most alive that he’d seen that individual.
Mary: It’s wonderful. I’ll give you some of the ideas that we have at Brookdale that we’ve implemented. We have two women that worked in New York City. These two women took the subway every day into the city. I said, “Well, why don’t I take them into New Brunswick from Hamilton, New Jersey?” I took these two ladies on the train, one stop, 15 minutes on the train, to New Brunswick.
Victor: That’s great.
Mary: There were three staff members because both of these ladies had a walker.
Victor: Right, this is the ultimate chaperones.
Victor: They’re like kids on steroids, going there, making sure everybody there, two to one.
Mary: It was wonderful. Not only did they enjoy it. It brought back memories. They spoke to the conductor. They heard the train whistles. It was so wonderful. We took the train into New Brunswick. We walked two blocks to Old Man Rafferty’s. We sat down the five of us and had lunch. After lunch we got back up, walked two blocks to the train.
It was a wonderful experience. What did we do? We tapped into that memory of working in New York. One lady was a ballet teacher and the other lady was in business. She was a secretary. They talked about it. They don’t always remember everything. They remembered that.
We also had a man who was 104 years old. The company is very big on making a wish happen. This particular man at 104 years old wanted to…He was in the Civil Air Patrol. He was a pilot. He wanted to go back up in an airplane. Jennifer and I spoke about it. We spoke to his daughter and she said that would be wonderful.
We don’t know how it happened. We just know that everyone we spoke to got involved and, before we knew it, we were able to take this man to the Trenton Airport, put him on a plane, and he went up in the air in a Civil Air.
Victor: Oh my goodness.
Jennifer: Mm‑hmm, at 104.
Mary: This man was very impressive. Not only had he won in Atlantic City, he was in the National Guard. He was a pilot in the Civil Air Patrol. He was an amateur ham radio operator. He was a rodeo rider. He had an RV that he went all over the country. At 99, you could see him on Facebook talking about going with his daughter to go renew his driver’s license.
Victor: That’s great.
Mary: The man lived. Unfortunately, we just lost him. He was shy of his 105th birthday by one week.
Victor: I’ll tell you, the facility looks like it’s really doing super creative stuff. Jennifer, if people want to know more about Brookdale, where can they find out more information about not only your programs, but what it’s like to be in your facility and maybe take a tour.
Jennifer: They can always call our community directly, which is the phone number’s (609) 586‑4000. They can visit us online at brookdale.com. They could also always check out our Facebook. We always upload all of our pictures, all of our events, every informational session we have for families, for the community, on our Facebook page.
Victor: That’s Brookdale, B‑R‑O‑O‑K‑D‑A‑L‑E.com, is that right?
Jennifer: You got it, yep. You can specifically ask for Brookdale Hamilton.
Victor: Excellent. Right, because there a few different facilities in the state.
Victor: I want to thank you both for joining us today. It has been a wonderful time talking to you, especially about the unique things that you folks are doing in Brookdale.
I think that it’s an incredible service that you’re providing to these residents that not only engage them on their physical needs, what they need to make sure that they’re secure and safe, but also on the emotional and mental area to make sure that what they are experiencing in this last journey of life. Whatever is has is really at its top level.
If you want to hear more about it, certainly go and visit with Brookdale, Brookdale Hamilton specifically. Visit with Jennifer and with Mary. Learn more about what they’re doing.
If you like this show and want to hear more about it, please send us an email at firstname.lastname@example.org, or you can jump onto any of the platforms where you can get a podcast like iTunes, Spotify, Android. It doesn’t matter where you find it. We’ve got a video feed over at YouTube that suggests not only more topics like this, but comments and future shows.
I want to thank both Jennifer and Mary for being my guests. Thank you both for being here today. We will catch you next Saturday on Make It Last, where we help you keep your legal ducks in a row and your financial nest egg secure.
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