Join Kosta and his guest: Dr. Jennifer Stelter, Clinical Psychologist, Dementia Expert, and Johns Hopkins Press Author specializing in dementia care. Dr. Stelter is a Certified Dementia Practitioner, Certified Alzheimer’s Disease and Dementia Care Trainer recognized by the National Council for Certified Dementia Practitioners.
Today we’re talking about dementia, mental health, and how to lower the risk of Alzheimer’s.
Find out more about Dr. Jennifer Stelter and Dementia Connection Institute:
https://www.dementiaconnectioninstitute.org/
Find out more about Kosta Yepifantsev:
https://kostayepifantsev.com/
Join Kosta and his guest: Dr. Jennifer Stelter, Clinical Psychologist, Dementia Expert, and Johns Hopkins Press Author specializing in dementia care. Dr. Stelter is a Certified Dementia Practitioner, Certified Alzheimer’s Disease and Dementia Care Trainer recognized by the National Council for Certified Dementia Practitioners.
Today we’re talking about dementia, mental health, and how to lower the risk of Alzheimer’s.
Find out more about Dr. Jennifer Stelter and Dementia Connection Institute:
https://www.dementiaconnectioninstitute.org/
Find out more about Kosta Yepifantsev:
https://kostayepifantsev.com/
But inevitably we know that it's possibility for all of us now if there is a familial history of it, we have a higher chance of developing it does not mean that we're going to get it we just are more predisposed to it but we have some control over it to be able to say, Okay, I'm going to try to live the healthiest lifestyle I can, with the ability to lower my risk.
Caroline Moore:Welcome to Now or Never Long-Term Care Strategy with Kosta Yepifantsev a podcast for all those seeking answers and solutions in the long term care space. This podcast is designed to create resources, start conversations and bring awareness to the industry that will inevitably impact all Americans. Here's your host Kosta Yepifantsev.
Kosta Yepifantsev:Hey, y'all, it's Kosta. today. I'm here with my guest. Dr. Jennifer Stelter, clinical psychologist, dementia expert in John Hopkins press author specializing in dementia care. Dr. Stelter is a certified dementia practitioner, certified Alzheimer's disease and dementia care trainer recognized by the National Council for certified dementia practitioners. Today we're talking about dementia, mental health and how to lower the risk of Alzheimer's. Dr. Stelter, as a clinical psychologist, you've spent the majority of your career researching, developing and experimenting to provide innovative solutions and treatments in the dementia care space. How did you start working in this field?
Dr. Jennifer Stelter:Absolutely. First, thank you for so much for having me on, I appreciate it. You know, my journey is quite different than a lot of healthcare providers, or, you know, caregivers who move into this space. I'm a clinical psychologist by trade, as you mentioned, and the earlier part of my career actually was spent strictly in mental health. And so I work with a wide variety of clients, you know, anywhere from folks with me, you know, minor depression all the way through severe, you know, cognitive and psychotic, you know, events and things like that. And so, you know, when I was in my postdoc, actually, I started a project with Northwestern here in Chicago, Illinois, and the Heinz VA, where we were looking at helping seniors to live a healthier lifestyle. So that was kind of my first exposure to the senior population. And I just absolutely fell in love with working with them, spending time with them, talking hours with them about their, their life experiences, and I learned a tremendous amount. And so to myself, I said, you know, I really think I have something here in terms of where my interest might lie for the rest of my career. And so, after my postdoc had completed, I actually entered into senior living, and helped in the behavioral health realm. And so here in Illinois, a lot of individuals who have mental health challenges do end up seeking services in nursing home kinds of settings, because it isn't available mental health services, you know, to the spectrum that it used to be. And so that's kind of where I started in senior living, and then quickly transitioned into working in memory care. And so you know, in the same realm, when I was working with seniors, at the Heinz VA, Northwestern, I absolutely just fell in love with folks living with dementia. They're, they have so much fun during the day, and they are just the sweetest folks. And so when I started to kind of embark upon that journey, I realized, wow, I really can make a difference here. And where I started to kind of unravel the onion was talking to a lot of nurses, certified nursing assistants, family members, and they just struggled with understanding what the disease was about how it progressed, what happens to the person, and what can you actually do to connect with people living with dementia, because many of them were struggling with how to do this. And also further, I learned that there wasn't a lot of quality education out there for people seeking the need to be able to care for people living with dementia. And so at that point, I said, I can take my psychology, experience and education and really apply it to this world of dementia, and be able to really make a difference. And, you know, most people they enter into this industry because they have a loved one or someone that they were very close with who developed the disease. And I actually quite the opposite actually entered it because of a love and passion and a calling for it. And then later on actually had a grandmother in law who developed Alzheimer's disease and was able to be a good asset to the family. So it's kind of a reverse for me, and I just really haven't looked back ever since.
Kosta Yepifantsev:Well, let's give our audience some background information for the rest of the episode. How does dementia affect the brain?
Dr. Jennifer Stelter:Yes, so when we talk about specifically Alzheimer's disease, Um, because there are many forms of dementia. So with Alzheimer's disease being the most common, we'll kind of start there. You know, there are I like to really kind of talk in, in, you know, words that anybody can really understand, right? So there's plaques and tangles that form in the brain that are called protein deposits, right, they can kind of they can glom together like a, what I like to call like termites on wood, right. So, you know, we know when termites affect wood, they actually eat away the wood until it's gone. So the protein deposits are actually doing that they're eating away that portion of the brain work formed. And unfortunately, several protein deposits kind of form around the brain. Now, the reason that these Protein Protein deposits form are from many different factors. Some are lifestyle factors, some are genetic factors, okay? And when these protein deposits form, they don't break up. Okay. Now, you and I may have protein deposits formed in our brain, but they're, they break up, right. Okay, interesting. And so what's happening is they don't, they're forming together, and they're eating away parts of the brain. Now, those parts of the brain that are being kind of eaten away, are, you know, they how has many functional skills for us that keep our brain and our body going. And when that part of the brain is gone, the person can no longer use those skills are no longer present anymore. And so that's like kind of high level what's happening with Alzheimer's disease. Now, there are other forms of dementia that we, you know, more commonly know about now, because of folks like you who are spreading the word. Many different kinds of gurus in dementia care myself, and so on and so forth. Right. So things like we've learned more recently about frontal temporal dementia, right? We've learned about Lewy bodies dementia, right? We've learned about vascular dementia, right? These are all forms of dementia. And they affect the brain differently. But when we talk about Alzheimer's disease being the most common, that's really what's going on as the disease progresses.
Kosta Yepifantsev:So the other forms of dementia and believe it or not, I did not know that dementia was a symptom of Alzheimer's, even though I've been in this industry for a decade. That is a misconception that a lot of people get wrong, you know, and so I've been educated as well. And I'm glad that people that tune in they get an opportunity to understand the difference. So if Alzheimer's is caused by the proteins, the built up of the plaque, and the tangles, are the other forms of dementia, the Lewy Body, the vascular dementia, are those also caused by the same plaque buildups in the brain? Or is that is that a different? Cause?
Dr. Jennifer Stelter:There are different causes related to that. So for example, when you talk about, like Lewy bodies, dementia, or I'm sorry, like vascular dementia, with vascular dementia, it's brought on by a series of strokes. And so depending on where the stroke was in the brain, that is going to impact those functional deficits. Now, if the person has multiple strokes that affect various areas of the brain, then of course, the brain is more impacted. Right. Okay. And so yeah, it depends. I mean, obviously, you know, we can go into each one of those. But I think that what's important to know is that these various forms of dementia do impact the brain in different ways. And unfortunately, it does cause what is a loss of mental functioning, which is what dementia is. And that loss of mental functioning can cause deficits and orientation, memory, language learning ability and judgment, right. And so depending on which symptoms they have, that can equate to this form of dementia. And as we were saying, you know, dementia is just an overarching term that it can be shown up in all of these various diseases. So when folks say something like, my mom had Alzheimer's disease, she didn't have dementia. That's not accurate, right? Because if she had Alzheimer's disease, she had dementia. Right. But when someone has dementia, they may not have Alzheimer's disease, it might be something else. Yeah.
Kosta Yepifantsev:So let's focus on Alzheimer's. Two questions. What are the stages of Alzheimer's disease? And at what stage? Is it normally apparent to the people around you?
Dr. Jennifer Stelter:Sure, absolutely. So for simplicity purposes, there's early middle and late stages. Okay. Now, for any folks who are turning and who are tuning in who might be a little more clinical, I like to use the functional assessment stage called the fast assessment, and that breaks it down into seven stages. And that just allows us as clinicians to be able to pinpoint a little more fine tuned ly where they might be in in the progression. But for early, middle and late stages, where we start to actually see some changes where other people can notice is definitely in the later parts of the early stage. Now, early on folks who are living with it, do notice that there's a difference but they may not want to talk about it, they may not want to admit it, right. But they know something's different. Where again, where it's picked up on with from other people is when it's later in that earlier stage. And so what loved ones or even clinicians might start to pick up on is, you know, when the person has repeated their stories, you know, over and over again, and they are saying it as if they have never said it before, right? It's not apparent to them that they're repeating it, right. They're losing things quite often. So it's not where you lose one thing. So people, you know, they freak out, like, oh, my gosh, I lost my keys today, do I have dementia? Probably not. Right. But you know, if you start to lose subsequent amount of things, driving to places and not knowing how to get home, especially places that they've driven to quite often, and it's, you know, what we call a skill of procedural memory, where it's almost automatic, you know, how to drive to and from, and now you struggle with that, right? When there's problem solving challenges, right, you're not able to kind of work through some of the day to day things that we are normally can. When there's challenges around compliance of medication, right, they're either not taking their medications or they're overtaking them. Financially, there's challenges where we start to see that either they're not paying bills, or they're overpaying bills, right? Or, unfortunately, we see quite a number of seniors being scammed financially, and falling into kind of those buckets, right. And so when we start to see an impact, like I said, on driving skills, medication management, financial management, you know, problem solving organizational skills, some short term memory deficits, that's where we start to say, we need to start to seek help.
Kosta Yepifantsev:And I see a lot of people, in my opinion, think that this is a very small population that are going to develop a some form of dementia. But individually, how do we come to terms with the fact that roughly one in five will have some kind of cognitive impairment in their life?
Dr. Jennifer Stelter:Yes. And even after age 85 is wanting to why. So how do we come to terms with this? I think that we have to understand, you know, one, that we have the ability to likely prevent this. Okay. Right, by lifestyle changes, and, you know, various health entities that we have control over okay. to, I think it's to stay educated, the more educated we are on this disease, and, and we're willing to talk about it, and we're willing to learn more about it. I think that can only make us more powerful, right. So I think that inevitably, we know that it's a possibility for all of us. Now, if there is familial history of it, we have a higher chance of developing it does not mean that we're going to get it we just are more predisposed to it. But we have some control over it to be able to say, Okay, I'm going to try to live the healthiest lifestyle I can with the ability to lower my risk, right?
Kosta Yepifantsev:Can you expand on that healthy lifestyle? Like, what do you believe are the key tenants? And I know most people say diet and exercise, but I want you to go a little bit deeper than that. What are the things that we can kind of start right now in terms of creating a healthy lifestyle?
Dr. Jennifer Stelter:Yeah, so there's a lot of clinical evidence around this. And you know, we've a lot of research has been spent on trying to find a cure for Alzheimer's and other forms of dementia. But I know a lot of entities are shifting towards brain health, right? And so if you do see any educational forums or discussions or blogs around brain health, read it. Okay, take the time to read it. Right. So where do they pinpoint? Right, I will start with diet and exercise, but I will be more specific, the Mediterranean diet has been most studied to help with you know, lowering the risk for cognitive impairment. It also has shown some great entities for our physical health, as well, as well as our mental health. It's actually shown to lower depression and anxiety in men and women. Wow. So the Mediterranean diet is a focus a lot on like leafy greens, foods that are high in omega three fatty acids, and if you don't, like you know, fish is kind of a big one for that. If you don't like that, you can always take supplements, you know, that kind of thing. There's a point towards you know, nuts and lagoons, you know, various kinds of beans, you know, things like that. Staying away from you know, lots of like a high sugar diet and whatnot. You can have like red meat but you know, in moderation, you know, those kinds of things. So, I highly recommend looking up the Mediterranean diet and actually, the mind diet and that's it An acronym mi n. D, was studied extensively by Russia University here in Chicago. And so if you Google that you'll find some clinical evidence wrote. Absolutely. So that's diet when we talk about exercise. And looking at the evidence around it, there actually pinpointed having about two and a half hours a week, at a rigorous, like a rigorous rate. That'd be like a brisk walk could actually lower your risk for developing dementia. So two and a half hours a week, you break that down as maybe 30 minutes a day, five days a week, right? Where you're walking briskly around your neighborhood, right? So it doesn't have to be something where you have to go buy an expensive gym membership or anything like that, you can actually use the resources at home to be able to do this. And so it can be implemented if you're carving out the time to do that.
Kosta Yepifantsev:So one more follow up question. Yeah, go ahead and finish your thought first,
Dr. Jennifer Stelter:I was going to add to that, because there are a number of other things that we can do to lower our risk too. And I do want to try to spread the word on being able to stimulate us cognitively. Though, a brain games is a really great way to do this. And you have to kind of pick and choose what your favorites are, whether it's to duco, whether it's crossword puzzles, word searches, right. And these are easily accessible apps on your phone. Now, I'm still old school. And I really do encourage folks to still use paper and pencil versions of these because you're actually utilizing other parts of your brain that you may not otherwise when you're using just the phone, like maintain your writing skills and things like that. Absolutely, it's very important, we do that. And unfortunately, we're seeing a lot of, you know, fine motor skills, kind of struggling for our younger folks, because they're so used to using computers and phones and things like that. So it would be in our best interest to still use paper pencil as much as we can. But you know, the research is actually pinpointed to about three times a week, 30 minutes at a time, engaging in some form of cognitive stimulation. Okay, now that can come from those games that I mentioned, but can also come from things like using your baking and cooking skills, gardening skills, anything tactile in nature, can be really beneficial to your cognition. The research shows that nothing less than that, because if you do less than that, you're not really benefiting your brain. But you don't need more than that, right? So that three days a week, 30 minutes at a time. And if you can't sustain attention for 30 minutes, then I say break it down to 15 minutes, right?
Kosta Yepifantsev:Because that is a problem nowadays. Actually, we were just yeah, my wife and I were just talking about that this morning about ADHD and they've actually developed to have children. So going a little off topic. They've developed a video game that is meant to address children with ADHD, because they can focus on games, but typically they it works as a detriment. So now there's a game that actually is a benefit to teach them how to focus more. So anyway, that was a tangent. I'm sorry. One more follow up question. When you said that one in two people over the age of 85, are at risk of developing some form of dementia. Do you does that correlate to if you look back through the statistics of Americans that struggle with being overweight or obese? And that's usually about 48%. does that correlate to the sense that because half of Americans, you know, obviously, put it, frankly, are either overweight or obese, that that is why one in two people when they get to the age of 85, and you know, closer to the end of life that they develop this disability or this disease, there's not a direct
Dr. Jennifer Stelter:correlation. obesity is a risk factor for developing dementia. Things like diabetes as well that make you know, type two diabetes that may go along with that. But the reason that those folks aged 85 and older may develop it more readily is because age is the number one risk factor for developing Alzheimer's. So just as we get older, we are at a higher risk. But folks who are obese whether they are younger than 85 or not, they it is a risk factor for developing dementia as well. Unfortunately,
Kosta Yepifantsev:speaking to caregivers, specifically, what do you think are some misconceptions about dementia and Alzheimer's disease that even the caregivers of those living with the symptoms might not understand?
Dr. Jennifer Stelter:Yes, so I think we hit on a big one earlier, which is, you know, dementia is an overarching term, many forms of dementia. And so we have to just understand that right in terms of what might be going on with our loved ones. I think another one is in the earlier stages, this is more towards the later part of the earliest dangers we start to see. And then you know, medium moderate, we start to see challenges around speech, right? Where the person is just really trying to find that word. And what something's called, like, it's almost like that feeling of like the tip of the tongue. Right? It's right there happens to me a lot. And worse things where it's, I know, right? So it's kind of one of those things where you start to see that a lot. But what caregivers start to think is, well, if they can't remember these words, that means that they really don't know what's going on. And that is not true. Because although we lose the ability to grab those words, they can understand meaning for a very long time, a lot into the later stages of the disease. I'll give you an example. I'm gonna pull something from my desk here, right? This is a pen we know is identified as a pen, we know that is used to Write Right. So they may be thinking of what does that call, I need a pen, right? But that can't say the word pen. And as a caregiver, you're like, oh, my gosh, how does she not know what it's called? Right? So then we assume mom is confused, doesn't know anything, right? But really, if you just show mom the pen and say, Were you looking for this mom, the pen? Oh, yes, that's what I was thinking. Right? She will know what this does for a very long time and is independently able to use it without any assistance needed. Right. So we have to understand that, you know, there are really we need to dive into what happens during these stages. And that may be for another podcast. But also, when we get to that it's what happens early, but what happens later on. Right. So I think that's one thing that we have to understand is so you know, at face value, you know, there are yes, some challenges, but there are a lot of things that they can still do, we should focus on what they can still do, and reinforce those skills as much as possible. So they can hold on to them for as long as they can. So So I think that's that's a big
Kosta Yepifantsev:mess. I agree. And so essentially, just to summarize into one complete thought, instead of just throwing the baby out with the bathwater, like, oh, they can't remember the name of for pen or the word for a pen. You know, that's it, it's over. Right? Instead, I think you're saying reinforce, even the fact that they recognize the pen, and they can still use the pen, they may not remember what it's called, or they may need help being prompted. But overall, let's not just throw in the towel and say, Oh, my gosh, you know, I'm I'm at stage seven. Right, when you're still at stage three. Right. Good point. Right. So aside from diet and exercise, because I know we touched on that earlier, are there any other effective treatments for dementia? And more importantly, how do you think that these treatments will evolve over the next decade?
Dr. Jennifer Stelter:Absolutely. So we know that there's no known medical treatment right now for dementia, it's definitely you know, when we talk about approach to care, it's about socialization. And so we talk about our health 70% of our health is actually made up of our social determinants, meaning that how we socialize and relate to others, our relationships, our interpersonal skills, right? I mean, as humans, generally speaking, we are social creatures, right. And I think we all learn that during the pandemic of how much socialization is a key to our mental health, right, and our cognitive health. And so a lot of approaches to care that have been developed in this industry are around socialization and around that ability to be stimulated, myself included, I developed the dementia connection model, over a 10 year period, really focusing on how our brain works, and how stimuli from the outside coming in and can impact our brain in positive ways. Okay. And you know, so a lot of treatments or a lot of approaches to care out there are around this kind of socialization and utilizing the skills that are still present, to reinforce them in order for them to stay as independent for as long as possible. Okay. We talk about some of the recent medications that have come out. So there are two sets of medications that have been involved in this field one is neuroleptic medication, which is medication that allows for the brain to have a little more functional ability. As the disease is progressing. It does not resolve dementia, it's not a cure. And actually, it's a bit controversial because of the side effects to these medications. Even Canada actually has stopped prescribing these kinds of medications because the risks have outweighed the benefits right over time. Then the other set are these newer medications that just came out. Lucano Ma was the lit the most Most recent medication that came out, the very first version actually was a medication where it was IV therapy, it was about 45 to 60 minute infusion that can only be done in hospitals or in treatment centers. And so for some of them who have dementia to be able to sit that long and to take in this infusion was quite cumbersome. And the efficacy rate was very low is low in like the mid 20 percentile with lots of side effects. The second version Lucano mob is the most recent, as I mentioned, that come out pill form, which is great. The controversy here is that it still has a lot of side effects and efficacy rate is in the higher percentile rate of you know, it being effective. So the challenge is is you know, Medicare has been looking at do we cover this medication? Do we not? If you're thankful for the work of the Alzheimer's Association, they have verbally agreed to cover it? It just has not gone into kind of written formal agreement, what is
Kosta Yepifantsev:it meant to do? What does the medication actually meant to address? Like, how does it How does it react once it's in your body?
Dr. Jennifer Stelter:Yes, the great thing is it's meant to break up those protein deposits.
Kosta Yepifantsev:And what are the side effects? Yes.
Dr. Jennifer Stelter:Lots of side effects. So. So the highlight Yeah, no, no, no, yeah, no, it's okay. So, unfortunately, there's been edge atheria to the brain, there's been, you know, kind of, I want to say seizures to the brain. There's been looks at you know, different kinds of like, you know, your typical your dry mouth, your diarrhea, that kind of stuff. There was in the study for Luca anima, there was one death that had occurred. So I think that there's some delicacy around it, obviously. But this medication is specific only for Alzheimer's disease is not for other forms of dementia, it has to be started early on to have an impact. Because if it's breaking up those protein deposits, it's not known yet to be able to break up all their protein deposits in the brain that form as a disease progresses through moderate late stage. So it has to be done started. What
Kosta Yepifantsev:about like, every day, when I turn on the TV, I see a commercial for no Riva plus, or any other you know, vitamin that's supposed to increase memory, D, you know, decrease the risk of cognitive decline? How do you feel about those types of vitamins?
Dr. Jennifer Stelter:You know, I mean, I'm, I'm a bit controversial on the whole FDA approval thing, because I'm, I'm big too. I'm big into alternatives. As you can see, I use essential oils, I've used aromatherapy with a number of folks living with dementia, I highly encourage, and I teach folks about this type of stimulation. And so FDA approval is not a requirement for me in terms of being able to look at it for a, you know, a person living with dementia, I think we have to look at the clinical evidence behind it, their efficacy rate, you know, I don't know specifics around you know, what each one has to offer. But I always say, number one, discuss this type of intervention with your physician, or if you're already working with a neurologist to talk with them about the benefits of this, because these types of supplements are not for everybody. And not everyone receives the benefit of it. So we have to kind of look at short term versus long term benefits. And also look at what other medications you're on to make sure there's no contraindications. So, you know, the thing is, is make sure you do your research before you take anything that you can order offline or online, excuse me, or that, you know, someone recommends to you that maybe not not, you know, who's not a clinician in the industry. Just make sure you do your research before consuming
Kosta Yepifantsev:anything. Are you optimistic that in the next 1020 30 years, we are going to be able to find an effective medical treatment for Alzheimer's and dementia, and all and 100% Okay, good. Good. So, you know, there are a lot I mean, I'm assuming there's a lot of people working on this because I think it's, it's safe to say that this is going to become a lot more of a topic of conversation because we're becoming more of an aging society. More people are developing this disease, it's affecting more and more families and, you know, if you really can, if you really think about it, in my This isn't this is just purely my opinion, when someone suffers a physical disability like a fall, right? So they're going to need a lot more support with, you know, transitioning, you know, in terms of like, you know, from bed to chair, wheelchair, all that stuff, and that could be very difficult for a family to reconcile with when somebody starts Getting you, you know, as a son or a daughter or somebody from for starts forgetting you as a spouse, or a loved one or a partner life partner, that's a lot harder to reconcile. When people disconnect from the life that they've spent 40 5060 years building. I mean, you can't it's hard to rationalize it
Dr. Jennifer Stelter:is it is and that caregiver, you know, and or family member, they really will start to go through the grieving process, right. And so it's an it's unfortunate that it's a long bereavement process, especially with Alzheimer's disease being a longer progression, that this person will be in kind of this morning phase, because they're losing the person that they fell in love with, or they got to know. And it's, it is unfortunate, because it's very difficult on both ends.
Kosta Yepifantsev:So we always like to end the show with a call to action. How can we start building communities more knowledgeable about and accessible to those with dementia?
Dr. Jennifer Stelter:Yeah, so I, for folks who have who follow me on my socials and all of that out, I always promote, educate yourself. Because when we educate ourselves, we have more knowledge and power to be able to understand this disease better. If we are helping someone who living with dementia, we know how to and what's available for treatments, you know, treatments, approaches to care, those kinds of things. We are more knowledgeable on how the disease is going to progress. And then we can better connect to that person living with dementia. And so staying educated is important. And there's so much out there now, you know, wonderful folks like yourself that have podcasts around this. There are our blogs, you know, there's a new show that actually came out that deepest note was a part of you know, that people can actually watch it on TV. There's commercials now about getting tested earlier. Right. It's phenomenal to see a commercial about dementia. So I think that we're headed in the right direction with advocacy work. I think the Alzheimer's Association amongst many healthcare professionals and organizations are taking a stand to say, Let's educate ourselves. Let's have information out there. Folks, don't even go to my website dementia connection institute.org. I've got a resource page with podcasts that I've been in blogs that I've done articles, I've written those kinds of things. So there's a lot out there. And I think that the more that we can stay educated and knowledgeable about this, we're going to be able to recognize symptoms and our loved ones or patients, whatever it might be. We can intervene earlier, which a lot of the treatments that are out there right now in terms of the medications that we've talked about, you have to start early for it to be effective, right. So I think that it's really important that we continue to just talk about it. Let's let's let's not, let's let's kill the stigma. And we can do that by talking about it. And that's me really important.
Caroline Moore:Thank you for joining us on this episode of Now or Never Long-Term Care Strategy with Kosta Yepifantsev.If you enjoyed listening and you wanna hear more make sure you subscribe on Apple podcast Spotify or wherever you find your Podcasts,leave us a review or better yet share this episode with a friend. Now or Never Long-Term Care Strategy is a Kosta Yepifantsev production.Today’s episode was written and produced by Morgan Franklin. Want to find out more about Kosta? Visit us at kostayepifantsev.com