Q&A with Shannon Braun, Director of ERS Center for Memory Support & Inclusion

Since 1951, Episcopal Retirement Services (ERS) has focused on providing a safe and welcoming environment for our residents, visitors and team members. Our newest step along this journey is the new Center for Memory Support and Inclusion.

The Center is part of a three-year, fully funded pilot program designed to support seniors living with dementia — across not only ERS’ retirement communities but also the Greater Cincinnati area. It combines the resources of ERS, UC Health, the Alzheimer’s Association of Greater Cincinnati and other health care and aging service providers to improve support for those living with Alzheimer’s or dementia and their caregivers on a community-wide scale.

Shannon Braun joined ERS in 2020 and leads The Center for Memory Support and Inclusion as its director. We recently sat down with Braun to learn more about the Center, memory care and caregiving during the COVID-19 pandemic.

Q: Now that caregivers are likely spending more time with their older loved ones due to the pandemic, how can you tell if someone needs a dementia screening? What are the warning signs?

For starters, it’s important to note that there are many different types of dementia, most of which are progressive and some are reversible. For example, severe depression or delirium can mimic dementia symptoms.

It’s crucial to narrow down the underlying issue, especially now with COVID-19, because our lifestyle is different. So, you have to ask yourself, “Is my loved one just so out of their normal routine that it’s causing problems? Are they not getting enough water or not getting outside enough because their situation is different or it’s harder to do? Is the decrease in social interaction affecting them?” There are many reasons why someone could decline in memory or give the perception that they’re declining in memory because of what’s going on right now. There are 10 warning signs that someone is developing dementia, including decreased judgment, personality changes and memory loss. If you notice symptoms in your loved one, they should be assessed by a doctor.

Also, when do you know that it’s time to have someone come into the home and help you care for your loved one? Similarly, how do you know when it’s time to place your loved one in a memory care commu- nity? I think a lot of that depends on the person who is the care partner. Sometimes it’s easier for non-family members to offer support with activities like bathing. People with dementia are often more agreeable to certain types of daily living assistance if it comes from a professional.

Also, when you’re an at-home caregiver, you are the cook, the cleaner, the activity director, the personal care attendant, and it really can take a toll. If you allow yourself to be the care manager and help coordinate your loved one’s professional senior care, it can benefit all parties.

Q: As caregivers, the need to pivot and reevaluate during the COVID-19 pandemic has become even more critical. Do you have any tips?

It’s always hard to ask for help, period. Especially for care partners and family caregivers.

The pandemic impacts all of us. But, for some, the impact is catastrophic. The peeling away of support that caregivers relied on before is unimaginable. And people who would have chosen to make a nursing home placement or an assisted living memory care placement have had to decide between, “OK, I can move forward with that choice because my loved one desperately needs it. But that might mean I am saying goodbye, and I don’t know when I’ll see them again.”

Luckily, with the development of the vaccine, care partners won’t feel like they have to make that decision anymore.

So, I think reaching out is vital. You are holding on to your support community, whatever that looks like for you. Support groups have been instrumental for so many people now. Most of them don’t happen in person anymore, which is such a loss. But if you can chal- lenge yourself to get comfortable with the virtual aspect of online support groups, there’s still benefit there.

Also, have a list in your mind of things that are helpful or would be helpful so that if someone asks, “How can I help?” you have concrete answers for them.

I had a client once whose neighbor knew she was caring for her husband. Her neighbor came over and said, “I’m going to help you by doing all your gardening.”

The client was so appreciative of her neighbor’s offer, but gardening was the one thing that brought her peace and calm. So, she almost gave up stress-relief. [It’s better for her to say], “Actually, that wouldn’t help. But if you could make me a meal, that would be great.” People are looking for ways to feel connected and purposeful right now.

Q: Many people in the Cincinnati area felt supported by the memory cafes you were instrumental in starting in the public libraries. Has the program been able to continue in a virtual or outdoor setting?

The Harrison branch is doing virtual ones. The attendance is lower than before, but attendees appreciate it.

Michelle Elliott is the branch manager at the Harrison Library, and what we’ve done is turned to storytelling. We’ll have a topic like a vacation and the attendees email her pictures beforehand. Then, during the virtual meeting, Michelle will pull up John and Bonnie’s snapshot in Alaska on a train ride. And then, both John and Bonnie will be on the Zoom call and together will share the story.

It’s good for them because there’s a visual and it’s a shared story. So, the person with dementia isn’t really on the spot for coming up with details.

Q: Can you explain the “Improv” technique of “Yes, and...” how it is used to enable caregivers to deal with challenging behaviors and situations?

“ Yes, and...” is an attitude. If you approach any situation with a “Yes, and...” attitude, what you’re doing is you are agreeing with the situation and adding to it.

Dementia is challenging because it challenges our perception of reality. If someone with dementia is having a conversation with me and telling me things that just aren’t true or they’re sharing a memory that we both were a part of, and their version of it just didn’t happen that way, my initial instinct is to correct them. It’s natural for us to want to tell the truth and to set the record straight.

When we provide someone with the simple “ Yes, and...” strategy, it frames the situation for them. So, now I have kind of a goal to work toward. My initial instinct isn’t to correct but to go on. It reshapes how I’m viewing the entire interaction. Now, it doesn’t matter whose version of the truth or whose understanding of the story is accurate. It becomes a way that I can interact with this person. We can have meaningful engagement. And it’s something that people do all the time anyway.”

Some people have a hard time with that. Some people say, “I can’t lie to my dad. I would never lie to my dad.” Other people say, “oh, that sounds fun!” Wherever you land on that spectrum of comfortability, the improv strategy allows people the opportunity to enter their loved one’s reality. Plus, the more you do it, the more comfortable you get and the easier it becomes.

Q: What part of your role do you find the most rewarding or that you enjoy the most?

Since family members are not allowed into the communities right now, it’s a real honor to be with the residents. It’s emotional. It’s draining. It feels unfair, but that’s where we are.

The pandemic has dramatically shifted my role and the way it was intended to be. While I’m eager to roll up my sleeves and dive into the community-wide dementia education and advocacy work as planned, I’m appreciative of my time working directly with residents and families at Deupree Cottages.

Q: Since family members are not allowed into the communities right now, you and the Deupree Cottages team started an informal “coffee talk” for family members. In your experience, have these moments helped families?

We can either be alone by ourselves, or we can be alone together. And I think that the conversation allows families to express how lonely they feel and how this time impacts them. And even just expressing and sharing these feelings and recognizing that you’re not the only person who feels that way makes such a difference. It’s such a unique position to be in that no one could have anticipated. And, yet, here we are, and everyone’s doing the best they can under these circumstances.

As a social worker, I’m always an advocate first. I think the conversations give the families an avenue to come together and advocate for their parents. And sometimes it is emotional. Sometimes the frustration comes out. A lot of times, their gratitude comes out. It’s a way to express themselves and realize that they’re in it together.

To learn more about Shannon Braun and the Center for Memory Support and Inclusion, visit www.theERScenter.org. To contact them, http://erslife.info/contact