In Episode #2 of Everyday Heroes: A COVID-19 Podcast, we meet Marla Kalin, Director of a Memory Care Unit in Colorado. She talks about how things have changed for the residents during the COVID-19 pandemic.

Transcript

“Memories heal the living. We pray for the living.”

Angela: On May 13, 2020, the number of new cases confirmed each day was declining across the United States. At this time, the total number of deaths due to COVID-19 in the United States was nearing 86,000. In Colorado, Governor Jared Polis reminded us that if we cannot be together physically to celebrate Easter, we can be together emotionally and spiritually. This is the context of our second episode of Everyday Heroes, a conversation with Marla Kalin, Director of a Memory Care facility in Colorado.

Angela: So, thank you for joining us today. My name is Angela Rothermel, and I'm here with Marla Kalin, who works on the front lines during the COVID pandemic. And I'm here to ask Marla a few questions about what she does and how she's coping with things. So Marla, thank you so much for joining us today. Can you tell me a little bit about yourself?

Marla: So I am a memory care director, so I work with memory care residents. Basically to explain memory care a little bit, it's mostly residents who… their dementia causes them to seek an exit and don't necessarily follow the exact same rules of dementia. They have different levels of dementia that… they need some extra care. So a lot more confusion, a lot more of what we call sundowning, and a lot more of what we would call behaviors. Some aggressive, some non-aggressive, but you know, weepiness to aggressiveness to wanting to leave to not understanding why they're where they are.

Angela: How has your facility been affected by this pandemic?

Marla: We've been very blessed in the fact that our memory care has not had a single episode, knock on wood, of COVID-19. So everybody is healthy, which I am hugely relieved and praying that that stays like that, because when you're talking about memory care residents, it's next to impossible to isolate them. So they don't understand enough to stay in the rooms and to cough in their elbow or, you know, to wear a mask, anything like that.

Angela: Right.

Marla: So they… you can't stop activities for them, because they wouldn't know what to do with themselves. So you know, it could be considered to be higher risk, in terms of the fact that we keep them all together. We can't social distance them. But we're doing our best to protect them. And that's the hard part, because protecting them breaks my heart, because part of protecting them, if you're familiar with the CDC guidelines, is we're not allowing family members to see them.

Marla: And it's hard on all nursing home residents and assisted living residents. But I would say it's especially difficult for memory care residents, because they don't really understand why. There's a few that do, and kind of know that there's a virus going on, but for the most part, they have no idea, so they can feel abandoned by their family members.

Marla: So it's really, really difficult. And, I go back and forth on whether it's a good thing. I mean it's never a good thing. That's not the right word. But whether it's for their protection or not. Like we make allowances if they're on… at what you would call actively dying. Like, if they're on hospice and they have a matter of, they're saying, you know, they can go at any time, they have weeks, we'll allow a family member to, you know, to come and see them. Which breaks my heart too. Because it's like we have to get down to that point in order to allow a family member to visit their loved one. And you know, I'm not… You know, it's like they're declining, and they have these high levels of dementia and in a month, yeah, maybe physically they're not dying, but mentally, their brain is deteriorating, and there's a risk that when all this is over, they're not going to remember their loved ones, and their loved ones have lost all that precious time. It breaks my heart.

Angela: That’s devastating.

Marla: It really does. It's really hard to talk to family members and explain to them, why they, you know, they can't see their loved one, and why some people have exceptions because their loved one is what we would consider actively dying. And you're like, is the family member like secretly wishing that they could be in that position, just to see their family, just to see their loved one? It's such a difficult place to be, and… But I know other places, and if you look on the state registry, there's so many places, they've had outbreaks and they've had people die. And it's so maddening when I talk to people who don't believe in this or say it's a hoax, who talk about their rights being violated because they're asked to be wearing a mask, and I'm kind of like, you guys are complaining about wearing a mask, when I've got a whole bunch of residents who can't see their families.

Angela: Right.

Marla: You know, it's offensive to me that they're saying, I can't get a haircut, or I can't play golf or… you know what I mean? How about you can't see your mother or your father, or your father and your mother can't see their child, and they don't understand, and they don't have any reason. They don't have any knowledge or comprehension of why that's happening. And you as a memory care director, as well as my wonderful staff, my caregivers, are the only ones that are there for them, and have to provide them that. And, in a way we're strangers to them, and yet, we're all they have. Yeah, it's just… it's hard, you know. At the end of the day, it's… I sometimes do come home and cry, because it's just so heartbreaking.

Angela: What are some of your coping strategies, that you've taken?

Marla: I have my dog…

Angela: To take care of your own mental health? You know, because it is… What you've described to me is heartbreaking, heart-wrenching. How are you coping with that?

Marla: Well, I watch movies and lots of binge-watching of Amazon prime and Netflix shows, and I go for bike rides and walks and… yeah, I know I said that word, and sometimes social media has been angering me lately, with everybody that's kind of talking against some of the things that we have to do to protect ourselves, or asking people not to wear masks. And yeah, I understand where they're coming from. Everybody. I can understand both sides in a lot of ways, but at the same time, I feel like complaining that you’re wearing a mask when there are so many more serious things going on... You suck it up, you wear a mask.

Marla: I have friends that are RN’s. They say, this is really, this is real. I mean, it's not a big deal really. I mean, to me, I kind of look at it kind of go, I'm glad that we're being asked just to stay at home and wear masks. Our ancestors were asked to go to war to fight wars, and this is a war. It's a different kind of war – it’s chemical war or viral war, whatever you want to call it. But it's still a war on this disease. And we're complaining, and we have internet and we have TV and we have all of these ways. And when you think about the pandemic that was a hundred years ago with the Spanish flu, they had nothing. And they had to do more than we're being asked to do.

Angela: Our ancestors, our great-grandmothers, our great-great-grandfathers, our great-great-grandmothers, they went through far worse. You're so right on that.

Marla: Absolutely. We have to come up with some kind of solution though, with them seeing their family members, because three years from now, most of those people won't be around. So I don't know what the solution is. But I do appeal to the CDC to kind of maybe look at that a little bit and think about… While we're trying to protect everybody and protect our loved ones, are we doing more damage to them mentally? Because if they don't, if they don't understand what's going on, and their brains are shrinking with dementia and they're losing more and more of their memories, where they're forgetting more and more, and if they survive three years, they won't remember anybody. Or even like six months from now, they could forget who their daughter or who their son is. Are we protecting them? I mean, it begs a question.

Angela: Yeah.

Marla: So I don't know. I mean, is there a way that we can allow family members to see their loved ones and keep them protected? We can't leave it like that and say, well, it's going to be like this for three years. What are we going to do? Lock down all facilities for three years and not let anybody see their family members until they’re on their death beds? And if they have COVID-19, they can't see them at all. And we can't ask a family member to distance so that, you know, you can't hug your loved one. I mean, I'll be honest, I hug my residents. I don't care. When a resident comes up to me and asks me for a hug, I'm going to give them a hug. Because I know I've been very cautious and staying safe, and I have to hug them. You know, you can't not hold their hand. You can't do care without holding and their hand. So it's not a perfect… there's no perfect solution, but I don't... But I think there are a lot of flaws in this solution.

Angela: Yes.

Marla: It's a difficult solution, just isolating everybody the way we're doing it. And it's not, I mean, it's everywhere. It's all over the world.

Angela: Right. Interestingly enough that you bring that up. I heard from my mom that China is, you know, opening up schools for kids, and then the decontamination steps that the kids have to take in order to enter the school are extraordinary. We could do things like that here. Like we already have many countries ahead of us in this, in dealing with this.

Marla: Yeah. Yeah, we do. We need to do something.

Angela: We need to get all the best minds together and really come up with more viable solutions.

Marla: We can’t just leave it the way it is and say, “Oh, it's going to be another month.” Like when the governor was saying, well, we're looking at the same thing. We're looking at the same thing in May as we are for April, when the nursing home situation is… nothing's changed. All right, what's this? We need a solution. Nobody… Who is speaking for these people? Because there's not enough people that are speaking out for these people. Their rights are being violated in a way, because we're deciding to protect them. The government is deciding what's best for them. The government is saying to protect them. I'm like, you know, when everybody's screaming about their rights, about the right to not wear a mask. No. How about the rights of our elderly that are being trampled on in a way? Because we're trying to decide what's best to protect them, and we're not working on a solution to protect them better, to still allow them to have… What they need and crave is their family. You know, they're already confused about being there. They're already angry about being there. And then on top of it, you're taking away their family? I mean, that's the hard part for me is when they ask about their loved one and I, you know, I can't… you know, it’s, “Has my daughter come to visit me?” “Here, you can FaceTime with her.”

Marla: One of my heartbreaking experiences is I had a resident… she tried to do a window visit with – or her daughter tried to do a window visit with her. And her daughter was like… it was just so emotional, because her mom was like, didn't understand why her daughter was out in the window and not in her room. And it upset. It was more upsetting for that. It was, she couldn't, she can't do it. She has to stick with phone visits. And I'm sure I'm not the only one. I'm sure that's all over, going on. And I know some places aren't even offering window visits.

Angela: So what are some of the things that bring you hope. What are some things that have, that you've experienced? Or anything that resonates with you that brings you hope?

Marla: Part of working in memory care is playing detective in a lot of ways, and because of the fact that I've been allowed, I've been blessed to have a lot of different trainings and a lot of workshops… I, one of my favorite trainings was validation training with Naomi Field, and just being able to validate their feelings, and just identifying those unmet needs and finding out what each resident's unmet need is. And when I can actually discover that unmet need and help them so that they can get off their psychotropics or that they, when they're sundowning, they have something that makes them happy and they aren't as agitated. That is… I enjoy that. That gives me hope. And being able to pass that information on to my caregivers and to my staff. This is what will help, you know. That's what I enjoy, because I know at the end of the day that I've made a difference.

Angela: That’s wonderful. It is detective work, and you have to find the question, like the hidden question, the…

Marla: They call it the unmet need. Like, because if somebody is yelling, they're not just yelling for the sake of yelling. There's a reason behind it. Sometimes it's something in the past that they're reconciling, and sometimes it's something they're reliving. Sometimes it's they can't communicate what they want. Sometimes it's the frustration, and honestly, some of the best results I get is if I see somebody that's really upset, and I go up to them and say, “You're really upset right now, aren't you?” You know. And they're like, “Yeah.” You know. I said, “I'm sure it's frustrating that you can't find the words to describe it right now.” Just by talking to them and just validating what they're feeling makes all the difference.

Angela: Like, “I hear you” type of thing.

Marla: Yeah, “I hear you.” Like when a person's like, “I want to go home. I don't understand why I can't go home.” Or they're sitting in there a little bit more with it than some others. Their dementia is different. You know. They still have a lot of their… they're at a point where if somebody's screaming or really agitated, it bothers them. And so there's like, identifying that this is triggering this person right now. Like they're sitting here in an activity, they're having a good time, and then all of a sudden somebody starts screaming or does something or doesn't understand, and then this person gets mad and identify that's because they start thinking, “Oh my gosh, I'm in a loony bin here. What am I doing here? What did I do that was so bad? Why am I being punished?” And going over to that person and saying, “They're driving you nuts. Aren't they?” And having that person go, “yes”. “Would you like to get out of here and play some cards?” “Yes.” Just being able to recognize that's going on. Then take them away from the situation and avoid a whole escalation. That's some of the stuff that I enjoy about my job.

Angela: I was just wondering if there was something else that you would like for us to know.

Marla: It’s probably the most rewarding and yet the most difficult work a person can do. It really involves putting yourself out there and opening up your heart. You can't work with seniors, in any capacity, and do a good job, if you don't open up your heart and really just love them. And really just let yourself love them and love on them. And, you know, the bottom line is they're only here for a short amount of time and you do… I've dealt with a good amount of passings and deaths in my profession, for the last twelve years, and it's hard on the heart, but I sort of try to look at it as: they're at the train station waiting to get onto their train to the next journey. And my job is to make their life as fulfilling and comfortable and happy as possible while they're waiting for their, their next journey. And that's, you know, and I guess it's… my regret is I never get to know them way they were. And sometimes you can see sparks of who they were, and man, it would be wonderful to travel back in time, meet them when they were in their prime.

Angela: Looking for a solution, looking to others, you know, that have dealt with this and gathering those resources and finding hope in a hopeless situation…

Marla: Let's find a solution.

Angela: Thank you so much.

Marla: Yeah. Let’s find a solution. Let’s not leave it as this.

Angela: Right.