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Welcome to

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the next installment of Live

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Well with UCI Health.

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My name is Gina

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Grad from 98.7,

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and I would like to introduce you

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to someone very special: Doctor

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Sonia Sehgal,

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a board certified internist

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and geriatrician

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who specializes

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in the care and treatment of older adults.

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Doing the Lord's work.

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Her clinical interests include healthy

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aging, hypertension, osteoporosis,

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preventative medicine, elder

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abuse, and dementia care.

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Doctor Seghal,

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thank you so much for being here.

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We're so happy to talk to you.

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It's my pleasure, Gina. It's it's lovely.

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Thank you.

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And this is a subject that I think is as

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as we all get older,

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a subject

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that's very near

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and dear to our hearts

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with our aging parents and family.

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And, you know,

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I still feel like I'm 25,

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so this is never going to apply to me.

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But, you know, my mom,

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my dad,

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this is something

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that's really starting

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to become an issue.

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And and I'm just so happy

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that we get to talk to you about it.

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So let's start at the very beginning.

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And apologies

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for not having this answer,

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but that's why the expert’s here.

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What is a geriatrician?

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That is a great question, Gina.

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Should we just start at the beginning?

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That is a great question.

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I think many people don't know

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what a geriatrician is or what we do.

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Geriatricians are medical doctors.

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We go to school,

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we go to medical school,

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and then we follow

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that up with a residency.

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And our residency training

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is either in internal medicine

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or family medicine.

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So one of the primary care disciplines.

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And then to become a geriatrician, you,

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you, you decide on

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an additional year

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or two years of training. Okay.

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And during this training

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it's called fellowship.

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You basically focus your care,

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your attention.

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You are dedicated to the medical

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and psychosocial issues

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that happen to people as they age.

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And so you really do become

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an expert in the aging body

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and how to age well,

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and how to manage issues

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that arise, like dementia.

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And just out of curiosity,

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because I think

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that so many of us in our age

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feels kind of like a gray area.

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Is there a particular age

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where you are

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now like, well,

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a geriatrician

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would be better for you?

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That that is a great question as well.

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And no,

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I think that in general

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we take care of patients

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probably at least over the age of 50,

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but certainly more 60, 65, 70.

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And if patients are starting

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to have concerns

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about their body as it ages

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and they'd like to be proactive

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and engage

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in preventive care,

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then a geriatrician

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is a great resource for them.

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So given your experience with older

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adults, would a geriatrician

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be a better person to contact

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initially for memory issues

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than, say,

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just like going to your family doctor

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and be like, something's wrong?

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Yeah,

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I think that because of our training,

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because of that extra year

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in all, all facets of aging, we do

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have extensive training

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in cognitive disorders. So,

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you know, we are trained to

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recognize cognitive impairment

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or memory loss or changes

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in thinking and behavior.

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We're trying to evaluate it,

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and we're trying to manage it as well.

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And if we need to reach out to

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a neurologist

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for a very special case,

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we know when to do that.

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So under your sort of umbrella,

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you're dealing with

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not just

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what happens from the neck to the toes,

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but you're also really focused

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on the brain.

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Absolutely. Okay.

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So that

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but it's an all encompassing thing.

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It's not just, you know,

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I have back pain because I'm aging.

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It's an all encompassing thing.

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So patients can come to us

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in consultation for one thing, or

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they may choose to have a geriatrician

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as their primary care clinician.

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And it's it's so it makes sense

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and it's so meaningful

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that you talk about memory.

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My mom's best friend

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just just passed away.

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But, you know,

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she was doing pretty well

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in a, in a sort of

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nursing home situation.

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And then she was moved to the memory care

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wing, and I didn't know what that meant.

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And now I understand, like,

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that's that's incredibly serious.

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That's a lot harder

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because you do need a lot of extra help.

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And I would imagine in your

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area of expertise,

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you have probably sadly seen people,

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see that erode before your eyes.

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And I imagine that that's pretty tough.

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It is incredibly

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it's tough for the patient,

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but it's also tough

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for the caregivers, family,

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anyone in that patient circle.

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And I will say that geriatricians,

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when we train, we

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we are experts in managing patients

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through that trajectory.

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So not just

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when patients are at home,

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but if they do need to transition

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to an assisted living

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or skilled nursing facility

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or even memory care. I do,

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I have so many questions.

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But just as you talk about this

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and you seem so passionate about it.

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Why, geri?

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Why a geriatrician? What?

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What was it about

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taking care of older people?

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Because people love babies.

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People love kids.

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People love taking care of,

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you know, adults that they can relate to.

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But I sometimes I

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and this is just anecdotal.

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I feel like

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over 60, over 65,

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you're just kind of forgotten about.

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And that's and that's a horrible thing.

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But it's a wonderful thing

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that you do what you do.

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So why do you do it?

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I do it for the, for

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for the very reason

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that you just said, that

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often people who are over

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60 are forgotten

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and and they shouldn't be.

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There’s a lot of life to live.

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There's a lot of life to live.

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They are vibrant.

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They have so much to give,

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to give society, to give us.

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And I think geriatrics

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is the one field

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where you visit with a patient

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and you as a physician gain more.

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I love that. The, the,

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the knowledge, the wisdom,

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you gain so much more

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than you could ever give a patient.

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I don't know if you're allowed

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to tell me these things,

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but I'm nosy, so feel free to

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just tell me to shut up.

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But in general,

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I know you've probably dealt with

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people like you said from 50 on.

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What is the oldest patient

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you've dealt with?

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104. What?

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I'm so glad I asked.

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Hundred and four.

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Wow. Living by herself.

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In the community,

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you know, just living life.

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And and sort of cognitively aware

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and doing fairly well? Absolutely.

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Oh that's amazing.

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So you're here to

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tell us about this new program

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being offered to patients

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at the senior health center called

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CMS GUIDE.

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Am I saying that right?

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That's the program I'd love

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just a quick overview

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and you to talk about that. Sure.

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So GUIDE is a program that was launched

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in 2024 by CMS

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to provide comprehensive care

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coordination for patients who are living

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with dementia and their their caregivers.

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And GUIDE

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stands for Guiding

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an Improved Dementia Experience.

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And it's a program

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that's available

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for Medicare beneficiaries.

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And it's something that,

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it's a way of practice that we hadn't

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followed before.

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And in what way?

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So, you know,

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typically when I think of

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patients and caregivers

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reaching out to the health system,

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they reach out to us

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and a lot happens

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in between appointments, right?

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So, you know, as a patient,

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you might call

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you might ask for an appointment.

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You get it. Time goes by.

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See you in two months.

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See you in two months.

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You have a very limited time

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with your your clinician, right.

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This program works in the opposite way.

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So we actually proactively reach out to

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folks who are enrolled

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in our GUIDE program.

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We reach out to them every single month

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and make sure

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that the patient living with dementia

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and their caregiver

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have what they need to be successful

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in their home.

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And what would be an example of something

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they need to be successful?

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Gosh, it could be anything.

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It could be

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I need medications,

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I need my medications delivered.

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It's,

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you know, my caregiving

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responsibility is,

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you know, it's taking a toll.

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I can't get to the pharmacy,

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and we can arrange for that.

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Maybe,

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the caregiver needs education

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on how to manage

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dementia and behaviors

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and what to look for in the future.

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And the program can provide

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that education and guidance as well.

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That's such a beautiful thing,

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because that

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the question that popped into my mind

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is, who's caring for the caregiver?

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And you are, you providing that support

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is just unbelievably meaningful,

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as I'm sure you know.

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Again, I'm

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not afraid to ask stupid questions,

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so I'm just going to keep going.

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When you talk about dementia,

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I and I think I'm not alone.

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I don't really know the difference

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between dementia and Alzheimer's.

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Could you help me understand that? Sure.

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So dementia is an umbrella term,

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and it encompasses

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many different types

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of illnesses that cause dementia.

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I guess I would say. Okay.

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And Alzheimer's is one of them.

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It's the most common form of dementia.

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Okay.

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There are other forms of dementia

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like vascular dementia. Lewy body.

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Lewy body, FTD. Okay.

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But Alzheimer's is the most common

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kind of dementia.

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So dementia is just really

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that umbrella term.

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And and the other question

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that that always that I have

00:09:00:15 - 00:09:01:21
I guess I could have Googled it.

00:09:01:21 - 00:09:02:12
I never bothered,

00:09:02:12 - 00:09:03:25
but I'm so glad you're here.

00:09:03:25 - 00:09:05:12
When people say of, you know,

00:09:05:12 - 00:09:06:16
they they passed away

00:09:06:16 - 00:09:07:25
because of dementia.

00:09:07:25 - 00:09:09:07
I don't really understand what that means

00:09:09:07 - 00:09:10:22
because I always thought that, you know,

00:09:10:22 - 00:09:11:06
like you said,

00:09:11:06 - 00:09:12:16
like it's more of a cognitive thing.

00:09:12:16 - 00:09:14:03
How how would a physical body

00:09:14:03 - 00:09:16:03
respond to dementia? Yes.

00:09:16:03 - 00:09:20:04
As dementia and cognitive loss occurs,

00:09:20:13 - 00:09:22:18
it starts to impact

00:09:22:18 - 00:09:24:13
how we live our life, right?

00:09:24:13 - 00:09:26:12
So it starts off by having some very mild

00:09:26:12 - 00:09:27:23
memory impairment.

00:09:27:23 - 00:09:29:03
Then as it progresses,

00:09:29:03 - 00:09:30:10
we start to become more

00:09:30:10 - 00:09:31:16
and more confused.

00:09:31:16 - 00:09:31:24
Right.

00:09:31:24 - 00:09:33:19
Patients at the end of their life

00:09:33:19 - 00:09:36:15
can forget how to swallow, how to walk.

00:09:36:15 - 00:09:38:29
So your body literally forgets how to...

00:09:38:29 - 00:09:39:23
To function.

00:09:39:23 - 00:09:42:11
I see, to move and function. Wow.

00:09:42:11 - 00:09:45:19
So we talked a little bit about about,

00:09:45:21 - 00:09:48:01
you know, help them get their medication.

00:09:48:01 - 00:09:50:04
And you know that it's not even something

00:09:50:04 - 00:09:50:23
I would have thought of.

00:09:50:23 - 00:09:51:25
And it's literally

00:09:51:25 - 00:09:53:06
a matter of life or death.

00:09:53:06 - 00:09:55:03
So what is GUIDE providing?

00:09:55:03 - 00:09:56:01
What else are they providing

00:09:56:01 - 00:09:56:15
that wouldn't

00:09:56:15 - 00:09:58:05
be readily available

00:09:58:05 - 00:09:59:25
that hasn't been readily available in

00:09:59:25 - 00:10:00:18
the past?

00:10:00:18 - 00:10:02:04
So GUIDE offers

00:10:02:04 - 00:10:04:04
comprehensive care coordination, right?

00:10:04:04 - 00:10:04:24
And by care

00:10:04:24 - 00:10:05:16
coordination, again,

00:10:05:16 - 00:10:06:26
we're reaching out proactively

00:10:06:26 - 00:10:09:04
every single month. On enrollment

00:10:09:04 - 00:10:12:13
we evaluate the patient and we understand

00:10:12:14 - 00:10:13:26
where they are in the trajectory

00:10:13:26 - 00:10:15:15
of their, of their condition.

00:10:15:15 - 00:10:17:06
But we also meet with the caregiver.

00:10:17:06 - 00:10:17:22
And we

00:10:17:22 - 00:10:19:24
we begin to understand

00:10:19:24 - 00:10:21:16
the caregiver’s role

00:10:21:16 - 00:10:24:09
and the caregiver’s stress and strain

00:10:24:09 - 00:10:25:02
as a... as

00:10:25:02 - 00:10:26:16
they are caring for their

00:10:26:16 - 00:10:28:06
their loved one.

00:10:28:06 - 00:10:29:01
And by understanding

00:10:29:01 - 00:10:30:27
that we then know how to tailor our,

00:10:30:27 - 00:10:33:06
our future,

00:10:33:06 - 00:10:35:00
our future interactions.

00:10:35:00 - 00:10:37:01
And so maybe we are

00:10:37:01 - 00:10:39:06
we are starting to take that caregiver

00:10:39:06 - 00:10:40:15
and encourage that person

00:10:40:15 - 00:10:42:24
to join a support group that we offer

00:10:42:24 - 00:10:44:12
or join an education class.

00:10:44:12 - 00:10:46:28
And like you said, that that you offer. Correct.

00:10:46:28 - 00:10:47:19
Not just, well,

00:10:47:19 - 00:10:49:03
hope you find a therapist. Correct.

00:10:49:03 - 00:10:51:15
No, no. Correct. We we do offer that.

00:10:51:15 - 00:10:53:21
And if we don't offer something

00:10:53:21 - 00:10:55:14
and they need very specialized support,

00:10:55:14 - 00:10:56:28
we know who to get them connected to

00:10:56:28 - 00:10:57:27
in the community.

00:10:57:27 - 00:10:58:26
That's incredible.

00:10:58:26 - 00:11:01:18
The other facet of GUIDE,

00:11:01:18 - 00:11:02:19
is that if you fall,

00:11:02:19 - 00:11:05:19
if you qualify in certain tiers of GUIDE,

00:11:05:28 - 00:11:08:13
in terms of severity level, there is

00:11:08:13 - 00:11:09:06
there are funds

00:11:09:06 - 00:11:11:15
set aside for respite care giving.

00:11:11:15 - 00:11:14:00
So it does allow the caregiver

00:11:14:00 - 00:11:15:13
to have some hours

00:11:15:13 - 00:11:17:13
where they can take care of themselves.

00:11:17:13 - 00:11:18:22
They can go to the doctor,

00:11:18:22 - 00:11:20:28
they can have their needs met

00:11:20:28 - 00:11:22:00
and get things done

00:11:22:00 - 00:11:23:03
that they really need to,

00:11:23:03 - 00:11:25:07
that maybe they've been putting off

00:11:25:07 - 00:11:26:27
in caring for their loved one. Wow.

00:11:26:27 - 00:11:28:26
And just again,

00:11:28:26 - 00:11:30:16
the idea that you're bolstering

00:11:30:16 - 00:11:31:24
the caregiver... Exactly...

00:11:31:24 - 00:11:34:08
is going to make everybody's life easier.

00:11:34:08 - 00:11:34:18
Absolutely.

00:11:34:18 - 00:11:36:16
Does this also, is GUIDE

00:11:36:16 - 00:11:38:13
also available to somebody

00:11:38:13 - 00:11:39:26
living in a facility

00:11:39:26 - 00:11:41:09
who might not have a

00:11:41:09 - 00:11:43:10
one on one caregiver in the same way.

00:11:43:10 - 00:11:44:26
So currently,

00:11:44:26 - 00:11:45:16
if you're in a skilled

00:11:45:16 - 00:11:47:28
nursing facility or then no.

00:11:47:28 - 00:11:49:13
It probably being taken care of. You're being.

00:11:49:13 - 00:11:51:03
Taken care of, God willing, 24 hours a day.

00:11:51:03 - 00:11:51:25
Exactly. Okay.

00:11:51:25 - 00:11:52:26
So this is for the people

00:11:52:26 - 00:11:54:07
who are still kind of out

00:11:54:07 - 00:11:56:01
on their own and,

00:11:56:01 - 00:11:57:22
and are having either

00:11:57:22 - 00:11:59:22
a loved one or somebody caring for them.

00:11:59:22 - 00:12:00:18
Correct. Yeah.

00:12:00:18 - 00:12:02:08
Although there are some patients that we,

00:12:02:08 - 00:12:04:07
we do care for in this program

00:12:04:07 - 00:12:06:12
who live in an assisted living facility.

00:12:07:21 - 00:12:09:08
I wonder if anyone who

00:12:09:08 - 00:12:11:04
is maybe at the early stages

00:12:11:04 - 00:12:12:10
of some form of dementia

00:12:12:10 - 00:12:14:24
has reached out on their own and doesn't

00:12:14:24 - 00:12:15:14
isn't at the stage

00:12:15:14 - 00:12:16:13
where they have a caregiver

00:12:16:13 - 00:12:17:04
saying like,

00:12:17:04 - 00:12:18:18
I'm kind of seeing the signs on the wall

00:12:18:18 - 00:12:20:15
and I'm hoping you can help me.

00:12:20:15 - 00:12:21:03
We do.

00:12:21:03 - 00:12:21:18
We do have

00:12:21:18 - 00:12:23:13
patients come to our

00:12:23:13 - 00:12:25:19
our geriatrics clinic.

00:12:25:19 - 00:12:27:15
Asking for an evaluation

00:12:27:15 - 00:12:28:20
because they are concerned.

00:12:28:20 - 00:12:31:06
They're seeing changes in themselves.

00:12:31:06 - 00:12:32:20
And they want to be very proactive

00:12:32:20 - 00:12:33:16
about that.

00:12:33:16 - 00:12:34:19
And it's important to know that,

00:12:34:19 - 00:12:34:25
you know,

00:12:34:25 - 00:12:35:16
not all

00:12:35:16 - 00:12:38:16
cognitive change, not all memory loss

00:12:38:16 - 00:12:40:00
is associated with dementia.

00:12:40:00 - 00:12:42:00
There are so many things that do impact.

00:12:42:00 - 00:12:43:08
Oh, like perimenopause.

00:12:43:08 - 00:12:45:10
Like perimenopause, hormones.

00:12:45:10 - 00:12:46:18
Just being stressed out.

00:12:46:18 - 00:12:47:07
Being stressed

00:12:47:07 - 00:12:49:02
out, sleep... I can keep going.

00:12:49:02 - 00:12:50:26
Exactly. And mood.

00:12:50:26 - 00:12:52:27
Depression. Anxiety.

00:12:52:27 - 00:12:53:19
And so it's important

00:12:53:19 - 00:12:54:24
to get a thorough evaluation.

00:12:54:24 - 00:12:56:24
What does an evaluation look like?

00:12:57:28 - 00:12:58:20
Great question.

00:12:58:20 - 00:13:00:13
So for

00:13:00:13 - 00:13:02:02
a full comprehensive evaluation,

00:13:02:02 - 00:13:03:02
you'd want to meet with someone.

00:13:03:02 - 00:13:05:03
You’d want to meet with a geriatrician

00:13:05:03 - 00:13:07:00
who can ask you very detailed questions

00:13:07:00 - 00:13:08:09
about all of these things.

00:13:08:09 - 00:13:08:22
Like what

00:13:08:22 - 00:13:09:27
stage of life are you in,

00:13:09:27 - 00:13:12:10
what is your sleep look like? What?

00:13:12:10 - 00:13:13:24
What are the exact symptoms

00:13:13:24 - 00:13:15:04
that you're experiencing?

00:13:15:04 - 00:13:15:24
We really do

00:13:15:24 - 00:13:18:24
try to understand that with great detail.

00:13:18:27 - 00:13:21:03
And then we do a comprehensive

00:13:21:03 - 00:13:22:19
physical examination

00:13:22:19 - 00:13:25:19
with a focus on the neurological exam. Okay.

00:13:25:19 - 00:13:28:10
And we can perform some in-office

00:13:28:10 - 00:13:29:13
cognitive testing.

00:13:29:13 - 00:13:30:14
Oh, wow. Yeah.

00:13:30:14 - 00:13:33:00
Now this is basically anecdotal.

00:13:33:00 - 00:13:34:21
So and I'm sure you have the stats

00:13:34:21 - 00:13:35:20
on the top of your head.

00:13:35:20 - 00:13:36:18
I don't,

00:13:36:18 - 00:13:39:07
but I was told by a doctor at one point

00:13:39:07 - 00:13:42:07
that there was a study done whenever

00:13:42:08 - 00:13:44:00
there was a group of men,

00:13:44:00 - 00:13:45:01
different ages, different

00:13:45:01 - 00:13:46:15
economic background,

00:13:46:15 - 00:13:48:07
you know, different walks of life,

00:13:48:07 - 00:13:51:08
and they all were experiencing dementia.

00:13:51:08 - 00:13:52:25
And the one thing they all had in

00:13:52:25 - 00:13:55:10
common was terrible sleep hygiene

00:13:55:10 - 00:13:56:09
throughout their life.

00:13:56:09 - 00:13:57:03
And I'm wondering

00:13:57:03 - 00:13:58:22
just just out of curiosity,

00:13:58:22 - 00:14:00:08
if that's something that you think is

00:14:00:08 - 00:14:01:12
a is a big deal

00:14:01:12 - 00:14:02:28
when it comes to staving things off

00:14:02:28 - 00:14:03:16
like this?

00:14:03:16 - 00:14:05:01
I think sleep is definitely important.

00:14:05:01 - 00:14:06:26
We're you know, science has gone

00:14:06:26 - 00:14:08:26
quite far in understanding sleep,

00:14:08:26 - 00:14:10:15
how we sleep, why we sleep,

00:14:10:15 - 00:14:11:14
and what exactly is

00:14:11:14 - 00:14:12:19
happening in the brain

00:14:13:19 - 00:14:15:28
while we are sleeping.

00:14:15:28 - 00:14:17:15
So I think we all should prioritize

00:14:17:15 - 00:14:18:21
good, good, high quality.

00:14:18:21 - 00:14:19:27
Sleep, and I don't.

00:14:19:27 - 00:14:21:04
I think there was always like

00:14:21:04 - 00:14:22:06
it was a badge of honor.

00:14:22:06 - 00:14:23:21
Like, well, I only slept four hours.

00:14:23:21 - 00:14:25:24
And now we realize that that's nothing

00:14:25:24 - 00:14:27:04
to brag about. Exactly.

00:14:27:04 - 00:14:29:06
So getting back to GUIDE, I'm wondering

00:14:29:06 - 00:14:30:25
who are the people that would be involved

00:14:30:25 - 00:14:33:00
in providing GUIDE services?

00:14:33:00 - 00:14:34:04
You know, we've talked about

00:14:34:04 - 00:14:36:08
just the the program as a whole, but

00:14:36:08 - 00:14:37:21
like what are the care teams look like.

00:14:37:21 - 00:14:38:24
Who is that?

00:14:38:24 - 00:14:39:24
That's a great question.

00:14:39:24 - 00:14:41:18
So our care team is made up of a dementia

00:14:41:18 - 00:14:42:20
care specialist

00:14:42:20 - 00:14:44:27
and a dementia care assistant.

00:14:44:27 - 00:14:46:15
And our dementia care specialist

00:14:46:15 - 00:14:48:07
is someone who has over

00:14:48:07 - 00:14:49:19
20 years of experience

00:14:49:19 - 00:14:51:13
caring for patients with dementia

00:14:51:13 - 00:14:54:13
and caring for their caregivers.

00:14:54:14 - 00:14:57:14
She's a physician assistant, and she

00:14:57:24 - 00:15:00:10
will do the initial intake,

00:15:00:10 - 00:15:01:24
which is very comprehensive,

00:15:01:24 - 00:15:03:02
and then meet with individuals

00:15:03:02 - 00:15:04:20
on a monthly basis. Okay.

00:15:04:20 - 00:15:05:14
And for some folks,

00:15:05:14 - 00:15:07:09
she even will do a home visit.

00:15:07:09 - 00:15:07:19
Wow.

00:15:07:19 - 00:15:10:03
And assess the home environment

00:15:10:03 - 00:15:10:28
to make sure

00:15:10:28 - 00:15:13:13
that, you know, safety is addressed

00:15:13:13 - 00:15:14:28
and that it's an environment

00:15:14:28 - 00:15:15:24
that is conducive to

00:15:15:24 - 00:15:17:20
healing and wellness.

00:15:17:20 - 00:15:20:02
And then our dementia care assistant

00:15:20:02 - 00:15:22:00
is responsible for

00:15:22:00 - 00:15:24:13
getting our patients through the process,

00:15:24:13 - 00:15:26:12
making sure... The logistics

00:15:26:12 - 00:15:27:14
and also connecting them

00:15:27:14 - 00:15:28:28
to community resources.

00:15:28:28 - 00:15:30:02
I mean, we're very lucky here

00:15:30:02 - 00:15:31:02
in Southern California

00:15:31:02 - 00:15:33:13
that we have rich resources

00:15:33:13 - 00:15:34:14
that we can reach out to.

00:15:34:14 - 00:15:35:18
So what does that look like?

00:15:35:18 - 00:15:37:12
Because, you know, you often hear,

00:15:37:12 - 00:15:38:10
we want to connect

00:15:38:10 - 00:15:39:13
so-and-so to resources.

00:15:39:13 - 00:15:40:24
And I always think like,

00:15:40:24 - 00:15:42:06
what could that be like?

00:15:42:06 - 00:15:42:27
You just think

00:15:42:27 - 00:15:44:04
like, well, that couldn't apply to me.

00:15:44:04 - 00:15:45:27
I don't qualify for anything.

00:15:45:27 - 00:15:47:02
What kind of resources

00:15:47:02 - 00:15:48:13
could people be connected with?

00:15:48:13 - 00:15:49:03
Absolutely.

00:15:49:03 - 00:15:50:01
So we would connect

00:15:50:01 - 00:15:51:22
someone who needs therapy,

00:15:51:22 - 00:15:54:20
maybe to a psychologist in the community

00:15:54:20 - 00:15:56:13
or mental health specialist,

00:15:56:13 - 00:15:58:20
and that could help with sleep, maybe.

00:15:58:20 - 00:15:58:28
Right?

00:15:58:28 - 00:15:59:14
So cognitive

00:15:59:14 - 00:16:00:27
behavioral therapy has been shown

00:16:00:27 - 00:16:03:07
to be a great sleep intervention.

00:16:03:07 - 00:16:05:14
But also to help caregivers

00:16:05:14 - 00:16:07:01
cope with change, right?

00:16:07:01 - 00:16:10:03
And loss and grief as they are watching

00:16:10:03 - 00:16:10:22
their loved one

00:16:10:22 - 00:16:12:12
go through the, the, the,

00:16:12:12 - 00:16:14:01
the stages of dementia.

00:16:14:01 - 00:16:15:09
So that would be a community

00:16:15:09 - 00:16:16:03
based resource.

00:16:16:03 - 00:16:17:14
Well, it... isn't that interesting

00:16:17:14 - 00:16:18:26
because you hear people say,

00:16:18:26 - 00:16:19:13
you know,

00:16:19:13 - 00:16:20:20
you're you're grieving

00:16:20:20 - 00:16:22:01
before the person dies

00:16:22:01 - 00:16:22:22
because you're grieving

00:16:22:22 - 00:16:24:24
the person that they no longer are.

00:16:24:24 - 00:16:26:18
And how and I sort of

00:16:26:18 - 00:16:27:19
went through this with my father,

00:16:27:19 - 00:16:29:09
but just thinking like,

00:16:29:09 - 00:16:30:15
you're right in front of me,

00:16:30:15 - 00:16:32:02
but you're not right in front of me.

00:16:32:02 - 00:16:34:21
And it's just it's such a strange

00:16:34:21 - 00:16:36:07
headspace to be in.

00:16:36:07 - 00:16:36:28
And then,

00:16:36:28 - 00:16:37:13
you know,

00:16:37:13 - 00:16:38:06
so many of us

00:16:38:06 - 00:16:40:07
and I think societally we think, well,

00:16:40:07 - 00:16:41:10
you have nothing to complain about.

00:16:41:10 - 00:16:42:25
You're the healthy one. Shut up.

00:16:42:25 - 00:16:45:06
So to hear someone like you, an expert,

00:16:45:06 - 00:16:47:01
say that's not really how it works.

00:16:47:01 - 00:16:48:19
If you're not taking care of yourself,

00:16:48:19 - 00:16:49:18
first of all, that's bad.

00:16:49:18 - 00:16:49:26
Second of all

00:16:49:26 - 00:16:51:01
you certainly can't take care of

00:16:51:01 - 00:16:52:03
another person.

00:16:52:03 - 00:16:54:14
Is is just the kind of black and white

00:16:54:14 - 00:16:56:00
thinking I think a lot of us need

00:16:56:00 - 00:16:57:18
in those situations.

00:16:57:18 - 00:17:00:00
I always think back to when I'm flying.

00:17:00:00 - 00:17:00:20
Right.

00:17:00:20 - 00:17:00:27
You know,

00:17:00:27 - 00:17:02:01
the overhead announcement

00:17:02:01 - 00:17:04:15
is put your mask on first... Absolutely.

00:17:04:15 - 00:17:04:22
you know,

00:17:04:22 - 00:17:07:12
before you put the mask on anyone else. Absolutely.

00:17:07:12 - 00:17:09:18
And that's, that's so perfect for this

00:17:09:18 - 00:17:10:23
because everybody

00:17:10:23 - 00:17:11:20
thinks, well, you know,

00:17:11:20 - 00:17:13:26
I can sacrifice myself. I can afford it.

00:17:13:26 - 00:17:15:22
You can't afford it.

00:17:15:22 - 00:17:18:04
So are there limits to this service

00:17:18:04 - 00:17:19:19
and how does this work with insurance?

00:17:19:19 - 00:17:20:22
Which I know

00:17:20:22 - 00:17:22:13
could be a sticky question in general,

00:17:22:13 - 00:17:23:18
but I know a lot of people

00:17:23:18 - 00:17:24:27
are going to be curious.

00:17:24:27 - 00:17:27:21
We hope that... we would love to offer

00:17:27:21 - 00:17:28:26
this service to everyone,

00:17:28:26 - 00:17:30:10
anyone and everyone who needs it.

00:17:30:10 - 00:17:30:19
Yeah.

00:17:30:19 - 00:17:32:18
But currently GUIDE is available

00:17:32:18 - 00:17:34:20
to Medicare beneficiaries.

00:17:34:20 - 00:17:35:22
So individuals

00:17:35:22 - 00:17:37:25
who have Medicare A and B. Great.

00:17:37:25 - 00:17:39:00
And that is not signed

00:17:39:00 - 00:17:41:12
over to a commercial… Facility…

00:17:41:12 - 00:17:42:13
or managed plan. Right.

00:17:42:13 - 00:17:43:06
Okay.

00:17:43:06 - 00:17:45:00
Well that's, that's amazing.

00:17:45:00 - 00:17:46:21
That's, that's a lot of people.

00:17:46:21 - 00:17:47:10
A lot of people.

00:17:47:10 - 00:17:49:01
And so far

00:17:49:01 - 00:17:51:06
I know this is sort of a new venture,

00:17:51:06 - 00:17:52:19
but do you feel like,

00:17:52:19 - 00:17:53:10
oh boy, we

00:17:53:10 - 00:17:55:18
sure could use more resources on our end

00:17:55:18 - 00:17:57:06
or you feel like staffing wise,

00:17:57:06 - 00:17:59:07
people are getting the job done?

00:17:59:07 - 00:18:00:06
I think at UCI

00:18:00:06 - 00:18:02:07
we are doing a great job,

00:18:02:07 - 00:18:04:18
we are very well staffed

00:18:04:18 - 00:18:07:16
and our staff are highly qualified.

00:18:07:16 - 00:18:08:06
Yeah.

00:18:08:06 - 00:18:10:15
I'm sure people come from all over.

00:18:10:15 - 00:18:12:21
They do. Yeah. Not...

00:18:12:21 - 00:18:13:12
You don't have to pat

00:18:13:12 - 00:18:16:00
yourself on the back, I will.

00:18:16:00 - 00:18:17:23
So now that the program has hit this one

00:18:17:23 - 00:18:18:15
year anniversary,

00:18:18:15 - 00:18:20:04
what are some of the key takeaways

00:18:20:04 - 00:18:21:27
and why should patients and caregivers

00:18:21:27 - 00:18:23:09
take advantage of this program

00:18:23:09 - 00:18:24:06
if they're kind of

00:18:24:06 - 00:18:25:03
maybe they're on the fence?

00:18:25:03 - 00:18:26:01
I don't know if I need it.

00:18:26:01 - 00:18:27:10
I don't know if I qualify.

00:18:28:25 - 00:18:31:22
I would encourage anyone

00:18:31:22 - 00:18:34:09
who is managing a cognitive impairment

00:18:34:09 - 00:18:35:07
and dementia

00:18:35:07 - 00:18:36:14
and their caregiver to

00:18:36:14 - 00:18:38:06
to seriously consider the program.

00:18:38:06 - 00:18:40:22
This is one of the only opportunities

00:18:40:22 - 00:18:41:20
we have

00:18:41:20 - 00:18:44:10
in healthcare to focus on the caregiver.

00:18:44:10 - 00:18:46:12
Yeah. You know, this is

00:18:46:12 - 00:18:48:19
the program is definitely for patients.

00:18:48:19 - 00:18:49:28
But so much of what we do,

00:18:49:28 - 00:18:51:01
so much of our effort

00:18:51:01 - 00:18:52:21
is in ensuring

00:18:52:21 - 00:18:53:26
that the caregiver has

00:18:53:26 - 00:18:55:15
what they need to be successful,

00:18:55:15 - 00:18:56:21
that they have what they need

00:18:56:21 - 00:18:59:03
to be well... Right.

00:18:59:03 - 00:19:00:10
and take care of themselves.

00:19:00:10 - 00:19:02:12
And, you know, it's a long road.

00:19:02:12 - 00:19:03:19
It's a journey

00:19:03:19 - 00:19:05:01
to care for someone

00:19:05:01 - 00:19:07:10
with cognitive impairment, with dementia.

00:19:07:10 - 00:19:10:10
And and the program allows us to,

00:19:10:10 - 00:19:12:16
to help the, help the caregiver.

00:19:12:16 - 00:19:14:07
That's, it's just I, I'm

00:19:14:07 - 00:19:16:06
So, it's so heartwarming to hear

00:19:16:06 - 00:19:18:01
you keep coming back to the caregiver

00:19:18:01 - 00:19:19:01
because it...

00:19:19:01 - 00:19:21:10
I worked for a program where it was,

00:19:21:10 - 00:19:22:01
you know, children

00:19:22:01 - 00:19:23:08
with certain disabilities

00:19:23:08 - 00:19:23:28
and it was horrible.

00:19:23:28 - 00:19:25:19
But but the program was amazing

00:19:25:19 - 00:19:26:14
because it also

00:19:26:14 - 00:19:27:25
focused on their siblings,

00:19:27:25 - 00:19:29:03
because their siblings would go without,

00:19:29:03 - 00:19:29:21
because they're not

00:19:29:21 - 00:19:31:04
the ones that needed anything.

00:19:31:04 - 00:19:33:10
So this is just really heartwarming

00:19:33:10 - 00:19:33:26
to hear that.

00:19:33:26 - 00:19:34:22
I don't know if you've heard

00:19:34:22 - 00:19:37:22
this phrase before, but in terms of,

00:19:37:25 - 00:19:39:22
like, say, helping someone who's,

00:19:39:22 - 00:19:40:07
you know,

00:19:40:07 - 00:19:41:10
who, whose loved one

00:19:41:10 - 00:19:41:21
had passed

00:19:41:21 - 00:19:45:06
or being a caregiver: comfort in, dump out.

00:19:45:06 - 00:19:47:07
Oh. And I didn't understand it

00:19:47:07 - 00:19:48:08
until somebody showed me,

00:19:48:08 - 00:19:50:07
like a bull's eye with circles around it.

00:19:50:07 - 00:19:51:10
And you're

00:19:51:10 - 00:19:53:02
you're helping to comfort the caregiver

00:19:53:02 - 00:19:54:09
so that the caregiver

00:19:54:09 - 00:19:56:12
can comfort the person with the ailment,

00:19:56:12 - 00:19:57:00
and then

00:19:57:00 - 00:19:58:14
they can dump out when they need to,

00:19:58:14 - 00:19:59:28
when it just gets too hard.

00:19:59:28 - 00:20:02:10
So thank you for doing this.

00:20:02:10 - 00:20:04:00
It's it's really incredible.

00:20:05:00 - 00:20:05:18
Could you give

00:20:05:18 - 00:20:06:19
the phone number or the website

00:20:06:19 - 00:20:07:09
or just something

00:20:07:09 - 00:20:09:12
so we all know how to get in touch.

00:20:09:12 - 00:20:10:03
Absolutely.

00:20:10:03 - 00:20:12:00
So people who are interested

00:20:12:00 - 00:20:12:19
can reach out to you

00:20:12:19 - 00:20:13:09
UCI Health

00:20:13:09 - 00:20:19:06
and our phone number is (714) 456-7007.

00:20:19:06 - 00:20:20:13
That was impressive.

00:20:20:13 - 00:20:21:18
I don't even think I have my own phone

00:20:21:18 - 00:20:22:25
number memorized.

00:20:22:25 - 00:20:23:21
It was really,

00:20:23:21 - 00:20:24:12
really impressive

00:20:24:12 - 00:20:25:14
these days that anyone has a phone

00:20:25:14 - 00:20:26:09
number memorized.

00:20:26:09 - 00:20:27:13
Doctor, I cannot

00:20:27:13 - 00:20:28:24
thank you enough for your time

00:20:28:24 - 00:20:30:06
and bringing awareness to this

00:20:30:06 - 00:20:31:25
and for doing what you do.

00:20:31:25 - 00:20:33:08
We are all so grateful

00:20:33:08 - 00:20:34:18
because God willing

00:20:34:18 - 00:20:36:00
we’ll all be geriatrics

00:20:36:00 - 00:20:37:12
and we will all need support.

00:20:37:12 - 00:20:39:06
So thank you so much for your time

00:20:39:06 - 00:20:40:15
and for explaining this to us.

00:20:40:15 - 00:20:41:18
Thank you. It's my pleasure.