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.I had an amazing conversation with Dr. Carolyn Clevenger for this episode of the aspire for more with Erin podcast. It really goes over in detail ways that physicians can collaborate with families to create a caregiving experience for residents and family members, caring for residents or people with dementia. We we go into topics like proactive caregiving versus reactive caregiving. And one of my favorite quotes is what got us here. Won't get us there. And a lot of good questions that family members can ask a lot of good takeaways for family members and leaders inside the senior living industry. So thank you Dr. Carolyn Clevenger for your expertise. And all of the work that you do at the integrated memory care clinic. Cope you enjoy this episode.Erin:
Hi, and welcome to another episode of the aspire for more with Aaron podcast, where I have a doctor on the episode today, which makes me very happy. So let me introduce you to Dr. Carolyn Clevenger. She is the founder of integrated memory care, which I am very excited to dive into today because I love memory care. Dr. Clevenger, take it away. Tell us about you and, integrated memory care.Dr. Clevenger:
hi, Erin. Thanks for having me. so I'm a gerontological nurse practitioner. I do have a doctorate, but you're welcome to call me Carolyn. I invite most of my patients and families to do that. And I founded this practice, Integrated Memory Care, about eight years ago. We opened in 2015. I had the idea a couple years before that took a little while to get things off the ground, but now we've served over 2500 patients and families originally at a clinic, like a primary care clinic, and now in senior living communities. So integrated memory care is at its core, three things. It is primary care, by geriatric specialists. It is dementia specialty care, which includes the neurology and the neuropsychiatry piece of it. And it is caregiver services, so like classes, education, and supports all under one practice.Erin:
A very holistic way of viewing dementia, which I do view as a trend that is certainly starting to show rapid, Agreement between communities and for families, I think for a long time, we thought memory care was just that's where they go. That's where our family members go. but as memory care has evolved and mental health has evolved in our society, we realized that holistic approach is the way to go. And I'm excited to know more about this and how you support your communities. But you are in the metro Atlanta area. Correct. And I met you roundabout ways from Georgia Senior Living Association, which I have a lot of new friends from Georgia, which I'm super excited about. And. When we talked, when we first talked, we talked about how you and your team offers support into the communities, which I found fascinating because I haven't had that type of support in my area. So talk about. What the benefits are and how you support a memory care community. And do you support assisted living communities as well?Dr. Clevenger:
Yeah. So I've now learned to talk to folks in senior living communities, as. This you've never seen care like this before. And we've said that in clinic too. And, and that we mean that in a good way. So integrated memory care. I. M. C. is now one of just six comprehensive dementia care models in the U. S. And so we are actually forming the basis for one of the new alternative payment models called guide based on our outcomes and the success that we've had in, for families. And for our senior living community partners, we don't want to just come in and see someone in the assisted living. We absolutely do serve assisted living as well as independent living and memory care. So it's that more congregate living or residential care, and we want to come in and partner with the community. I know that there are providers who come in and they see patients in senior living. For us, we are really clear that we are patient and family centered. We were actually seed funded by family caregivers when we opened the practice. And the model of care that we created was based on what family caregivers told me that they wanted in their ideal practice. So even people who had lots of resources would say, I was just getting sent. All over these places. I had primary care and then I maybe I got to neurology or a memory care specialist and then maybe I got sent to a support group or a class somewhere from one of our community agencies. And if I need a geriatric psychiatry, that was another service that we needed to go to. And there's really no 1. person really as the quarterback of my team. I didn't feel like one person was in my corner. So we are crystal clear that we serve patients and families with an expert in their corner. We're bringing everything under one team that we have created. The staffing for this is, this is a complicated population, right? So they're older. That might be frail. Lots of medical conditions. They've obviously got cognitive impairment. Maybe psychiatric symptoms, physical disability, all of this stuff going on with them. So I staffed this with nurse practitioners who specialize in geriatrics or palliative care. All of our nurse practitioners are dementia care specialists. we have geriatric psychiatry on the team. We have social work on the team, registered nurses, all with a direct line to our practice. So we are part of the Emory Healthcare Network, but you would call us directly. And so in our senior living community partners, we want to be good collaborators with them as well, because they see this person every day, 24 hours a day. They know if they've had a bad night's sleep or they know if they're just not themselves. And then my team, from the medical perspective, we see those kinds of changes as potentially, headed toward a medical problem, maybe a worsening of a chronic condition that's been fine, or maybe it's a new emerging problem and we wanna get ahead of it as quickly as possible. Maybe it's a side effect from all of this medications people get prescribed at this stage. And We want to be in good communication with them. it's really important for us not to just be accessible to families, but to be accessible to our senior living community staff. So we know, we take, after hours call, for example. So I was the after hours call person this past weekend. And for our folks who are living in assisted living, it's Friday night, it's Saturday, we have a new rash, we have a cough that's now productive. We want to be able to address those things right there as much as possible. It's always better if we can come to the community and see the person. but even if we don't have them in our community program, we want to make sure communities know they can get in touch with us and families can get in touch with us when they need something. It's been a terrifically important, The whole time that we've been open families describe us first as accessible, and I think they mean that in all the ways they can reach us. And then when they have questions or they're trying to figure out what's going on. I think we can explain that in a way that's accessible to them so that we can make a good plan goingErin:
forward. Yes, I think there's several things to unpack there, but I think the first thing is, when you deal with cognitive health, dementia, from a child's stage, like autism, I can speak to this personally, A, because I worked in a member care for, my entire career, and then personally, my life, having it. A network available to you to help you understand is important, having that coach, right? That social worker could be your coach, that caregiver could be your emotional support person. That nurse can help you solve the problem and they're all accessible to you at the same time. Because this day and age inside Senior Living, our nurses, our administrators, they're very busy. And some may have the ability to have that empathy factor and some may not. And if you have integrated memory care, then you have the built in, empathy factor, coaching factor. And to me, number one, that psychiatric nursing, which is very important. So let's unpack that a little bit, because in my experience, When I was a manager of a memory care, a 64 apartment memory care where I was solely responsible for that memory care, we had a medical director and a psychiatric doctor who came in. And that was glorious. That was amazing. Fast forward to when I was able to come back to that community later as an executive, executive director of an assisted living and the memory care, we did not have that psychiatric doctor that came to round and that was a big void for us. And. When we have to send residents to a senior behavioral health stay, we have a lot of pushback from family members because they don't understand it because the definition of failure, the definition of not understanding what this is, or it being like a psych ward, those types of things, there's a lot of obstacles to have to overcome. So I integrated. memory care having psychiatric support that is worth its weight in gold. So talk about how you support the communities that you're in with that service. Yeah,Dr. Clevenger:
I think, dementia is the syndrome of three parts, right? Cognitive symptoms, functional decline, and behavioral symptoms, which is kind of a misnomer. It should be psychiatric symptoms, but I think we expect the cognitive changes, right? This person will be more repetitive, especially if they're Alzheimer's, we know there'll be an amnestic. I think some of the other non Alzheimer's are also a little, throw people off, certainly. We expect some functional declines. Person's going to need more help getting dressed, more help with activities of daily living. We plan for that. The psychiatric symptoms really can be challenging for so many, everybody involved, right? Including the person experiencing them, we should add, right? the person who's experiencing this psychosis, this false belief that their spouse has left them and is with another, having an affair, right? That's very distressing to them as well. If they're seeing people who you and I are not seeing, or they're concerned that they're seeing family play or children playing in the street, all these sorts of things, they're agitated, they're restless, they're anxious, they can't sleep, all these psychiatric. Symptoms distressing to them, certainly distressing to their family, especially if this is the first time they've seen this person experiencing those kinds of changes. And it's not something people expect in the dementia journey, even though those of us who specialize in this certainly do see it quite a bit and we come to expect it. In fact, one of the first things that we do is that what we call anticipatory guidance. So that's something they do in pediatrics, as it turns out. In geriatrics, we should be doing it too, and that, so if you've taken a kid for their well check, right? Oh, this is what five year olds typically do. These are changes you might expect in your five to six year old over the next year, so you can anticipate, right? These types of dementias, whether they're Alzheimer's or frontotemporal or Lewy body, there's some predictability to this course of illness, especially when you're seeing a specialized team like ours. We are anticipating things are going to happen in the next six months, next 12 months. And so if we can coach families to know that these things may happen, that also takes some of the mini crisis out of it. I think the next thing is. When you have robust geriatric primary care, a couple of things happen. One, we catch things early. And and in our community program, I should add, we also have a team called Dementia Care Assistance. These are companions who do one on one, cognitive engagement, simulation, other activities with our patients every week or twice a week. So we catch things early. We catch things as they're escalating on the way up so that we can intervene quickly. If you've got a good primary care team, they're careful about their prescribing. So whether they're prescribing for psychiatric needs and good dementia specialists certainly can go first line, second line of a medication treatment guideline, and then they may say, okay, and now I need psychiatric help, right? So then we have our psychiatric, Nurse practitioners with two of them on our team and they can jump in as a consultant. They can do something like actually talk with the primary care nurse practitioner where we may do a consult between colleagues. So this is what I've done. These are the symptoms I'm still seeing. and we can get that expert input. And then in cases where we really need, we are at, more, maybe a more intensive need is there than the psychiatric nurse practitioner can see those patients as well. But they've also got. A lot of information built up before they get there. So they're not walking in cold either. the challenge of when somebody needs to be sent out, right? Whether it's for a medical emergency or for psychiatric symptoms that are just not been well managed. If you look back. You do a root cause analysis on many of these, some can be prevented by identifying a symptom as it's escalating and intervening sooner. Sometimes they can be, anticipated and maybe we can do a lot of things that are medication and non medication, interventions to address. Sometimes we send people out for psychiatric stays because the medications that they probably require to manage this symptom. Symptom is severe enough. It's potentially harmful to them and other residents around them. So we need a more intensive medication management and there's medications All medications carry risk. But you get into some high risk medications. And so for our team, having those Geri psych nurse practitioners as part of the team means that they can do that management. And these are medicines where you would want to maybe adjust the dose delicately. You might be adjusting the dose every day, every three days. Now I have a team large enough that can actually see this person, determine how they're responding, and we can make those adjustments that are very intensively, closely monitored, and keep them there in the assisted living without having to send them out. So I think that's really been the sweet spot of having the whole team, everybody's on board. We understand dementia is all of all kinds and you've got that Geri psychiatrist expertise when we need it so that we can really, we can make those changes, even high risk medicines. Everybody's on the same page, including the family and the community. And we can do that without having to send them out. I understand why it's so distressing to send someone out to a hospitalization. it's really challenging to have this hospital stays, especially for an older person with dementia. And I think the media probably hasn't done us any favors in terms of what you've seen. If you've seen movies or TV shows about the psych ward, it doesn't look like anywhere. Any of us would want to be. It doesn't feel like it's healing. It could be, but in most parts of the country, You would be hard pressed to find a psychiatric hospital that specializes in geriatrics or dementia. And, the reality of our practice, the reason we exist is we believe you need a specialist in those things, to treat these patients safely and to do it well.Erin:
Yeah, I think one of the things that leaders inside of the industry, but also family members, because I'm walking with my in laws on something that's very sensitive right now. And when people are not used to living a proactive life, or thinking long term, or thinking, what can I avoid by taking which path? That's a lot of education, and if you don't understand that, and you're talking to long term thinkers, but you're a short term thinker, it's hard to navigate that. And I just feel, I say this phrase all the time, you never know what you avoid by acting proactively. And that's a blessing. And you have to think about committing to Things from that perspective, you'll never know. You will never know what you avoided because you acted in a proactive way, but you will always know what you could have avoided, if you would have acted proactively. And I think that's a process, especially if you're not used to it, but it's something that can be started immediately if you have. A community network, like, what you are offering with that and mental health and cognitive health is very it's a slippery slope. It's changes for everybody. just in my own situation, My grandmother, I had to send her out, she was an assisted living resident, and I had to use a senior behavioral health stay. And that was one of the most heartbreaking decisions I ever had to make as a granddaughter and as an executive director of the community she lived in. It turns out it was one of the most Long overdue decisions, and her last six months were less obsessive, less reactive to pain, and much more calm. But We had to go through acting reactively because she was never, ever going to be proactive ever in that mindset. So there are blessings in walking the broken road, but you can always reestablish choosing proactivity instead of reactivity. So that's what I believe integrated memory care offers. Proactive approach and it's what I think everyone needs.Dr. Clevenger:
I think it's helpful for people. I'm with you. I think there is, when you're talking about dementia, we're getting to something that's late in life, people who are caring for them in terms of family caregivers. and our practice are about half spouse and adult child and they've had a whole lifetime of experience and they have a certain way of dealing with. Challenges. So we're probably not going to change that whole, that whole approach at this point. I think I probably have 20 percent of people who are proactive and who just really would rather intervene and not take the risk that something will happen that's a crisis. And then 80 percent of people are waiting for the crisis. But if they've got a coach in their corner, then we can at least talk about what is a trigger? What is a milestone that would make us say, okay, now it's time to go a different direction. Sometimes we call out, what got us here, won't get us there. So I think that the move to assisted living is like that. So for patients we're seeing in clinic and we've been there, primary care clinic, outpatient provider, and they're coming to see us and they're considering when is it time to make that change? We can also talk about, here are some things that sometimes trigger, or so when this happens, you've already pre thought. Through how you're going to respond. That's really helpful because you don't want to make, try to make well reasoned, rational, like really important decisions in the moment of crisis. So what's a milestone that's maybe not a crisis, but okay. When you see this, or this it's time for a change.Erin:
Yeah, that's great. That's great. Okay. So what got us here won't get us there, right? That's right. Yes. Yes. Yes. Let's steal that. So when you were inside, because you see people in a private practice and inside of communities, correct? That's correct. when people move into assisted living or memory care, they have a choice of if they want to keep their own physician, if they want to use the medical director, if the community has a medical director, and integrated memory care, correct?Dr. Clevenger:
That's correct. So we are currently in six senior living communities in the metro Atlanta area and growing. It's a new practice. This practice has been around about 18 months at this point, and when families are visiting or touring or looking at different communities, that's one of the things that they want to know. So what is the medical care? What are the medical care options? And we are one of those options. We're quick to say we're not for everyone in the community. Probably we only see people with a dementia diagnosis for one thing. And I do realize that there is a high prevalence of dementia in most senior living communities, and some communities are exclusively for people who are living with dementia. And so certainly would be appropriate for any of those. So they have that option to see us. if there's a medical director, of course, they may see that person. I'm Yet to talk to a community where the medical director sees all of the patients in the community. I guess it's possible, but most communities would say it's a mix and that's a residence, right? Of course, to choose to see their medical care provider is whether they go out or whether the providers come to them. In our case, I think the things that are important to know is that, Yes, we do come to them. We are dementia specialists, and that includes, like we mentioned, the geriatric psychiatry piece. It's we are board certified in that area. It's a whole team, not just the provider who's coming out. It's also the social worker. It's the registered nurses, and it's our dementia care assistant companions who are working with this person on activities are tailored to them based on their preference and their ability every week or a couple of times a week and families do pay separately for that service and any of the other components that practices sometimes charge for we roll all of that into a monthly fee that families pay. We're glad to talk with them about what that is and explain it, but I think it is that, you have this medical team that is specialized for this population, highly accessible to you, the family. And also works collaboratively with the community there.Erin:
And again, psych nursing, which is huge, not only is it psych nursing, it's psych prescribing too. I cannot, to any community or to any family member listening, I cannot tell you how important that is in this day and age, and especially as the next 20, 30 years unfold, that is worth its weight in gold, honestly. So we have talked a little bit about the, care team, you have you, you have nursing, you have psychological nursing, you have the social worker, but then you have family support through caregiving and you also have, you help train and teach. Inside of the community, like you could host an in service. let's talk about those two things, because as a leader inside of a community, always having a guest to come in and do a training is always exciting. So what services are those that you offer?Dr. Clevenger:
So we, as I mentioned, we like being very collaborative with the community, and that's not just the leadership relationship. It's also our dementia care assistants, our nurse practitioners who are coming into the community. We want to do both informal and semi formal. I don't think any of it's too formal. In services, and then on the spot coaching. I think it makes, it's one of our missions. It's one of our values. We really care about the, services that are delivered to our patients, not just by us, but by our partners as well. And that includes, of course, our senior living community staff. So some of the things that we do when we're with the community are those. I call them micro learning just five minutes. Probably if there are staff meetings, we'd like to insert ourselves. We like to be there for a number of reasons. We want your staff to see us as a resource. So I think last month we did sleep and dementia. So tips on helping your residents get a better quality sleep at night. better for everyone. Everybody has a good day the next day after they've slept well, right? we might do something on dehydration and dementia. It's very easy to get dehydrated for older folks. The thirst sensation declines. They might be on medicines that cause more dehydration, and you certainly will see more behavioral symptoms when someone is dehydrated. It's really pretty astonishing. So we like to take the opportunity to have a few moments at those types of, Events where staff are congregated and we like to share with them and make sure we do that again and we're providing information that is accessible. brief just a few minutes, and then we're right there. What we've also found is that we like to be in the community. So our dementia care assistants are there, just about daily if there are, more than 10 residents there, who are on our service. And we're glad to take the opportunity to do some of that just in time coaching. Some of the things that I think people slip into, right? So maybe they're making some, they make an assumption about a behavior. One of the interesting things about behavioral symptoms is that those of us watching someone on the outside have our own lens through which we are judging and assigning intent to them, right? residents living with dementia, this really, this is one of our early cases. our patient had been going down the hallway and removing the name tags from other residents doors. And so it's creating a little bit of havoc, right? I think one of the staff members was talking to our team and they were like, just creating trouble, basically, trying to, stir things up and, It's really a problem for us. And, our team, observed, talked to the resident about so what's going on? What's up? She was cleaning. She was, she was cleaning. I don't know that was her profession previously, but, behind the name, she had just perceived that there was dirt. She needed to pull that off there so she could clean their door, uh, signage. So having a moment to start thinking about in terms of behavioral symptom management, one of those principles is behaviors have meaning. She's not doing this randomly. So let's figure out what the meaning is behind it and join her. in that or maybe let's redirect that energy somewhere else. I'm sure they're there, on our team as we were talking about this. We're like, Oh, we have lots of things we could clean together, but that was creating a problem for the staff. She had no idea, of course. but, so some of that just in time coaching with the staff to start thinking about. maybe somebody, they've probably done training and someone has maybe used that principle. I think that's a common one. Behavior has meaning. So you figure out what the meaning is behind the behavior, but to actually apply it in real life can be so helpful for that staff person, right? Because then the next time a resident is exhibiting some type of behavior that is a problem for them. Maybe that causes them to pause and think about, what, what might be driving this? How can I redirect this in a way that's helpful? as opposed to redirecting, what the resident sees is totally off topic. let's go over here and do this. yeah, but I was cleaning. yeah, I think we, we want to really, we like to raise the bar for everyone. I think we like to see good dementia care, for our patients, for other patients in all of the ways that we can make that happen.Erin:
Yeah. Behaviors have meaning, and that's so true, and the way that we assign what that definition is without even trying to understand it is important too, and it's the easiest thing to do. It's the easiest thing to assume, but really we just have to be curious. Curiosity is really the answer to that. Let's figure out why she's doing that. I used to have a resident. Pull all of the signage off the wall. like off the wall. That was a real problem. Like she was pulling it off the wall. honestly, I don't remember why she was doing that or whatever, but we certainly had to figure out how to stop that. But yeah, we had one nice resident who was acting very against her norm and it took us a long time to figure out that she was thirsty. She was hot. She had a sweatshirt on, two shirts, a jacket, and she was walking constantly and was fighting us, didn't want us to touch her, and finally we redirected with food and drink, and we watched her drink. That drink and then we realized, oh, and we gave her like four more and she drank them all up and then she let us take the jacket and the sweatshirt off and then she ate and then she was fine going about her merry way behaviors do have meaning. They really do. It's really important to understand, especially if you're a family member, or if you're inside the community. Not only for our memory care residents, but for our associates too. We all have reactions in a certain way because it means something, right? this is a question that I wonder, like when you train your dementia specialist to come in, To the communities and assist families and do some of the caregiving. How do you train them?Dr. Clevenger:
the Dementia Care Specialist is the certification that our nurse practitioners get. But I think you're asking about the Dementia Care Assistants, our companions. Assistants, yes. Perfect, yes. So the Dementia Care Assistants, are hired for personality and fit. Because they're not doing any hands on care, right? So we're clear where our lane is and then where the lane is in the staff at the community. So they are, then they take a course we developed for dementia care assistance, and it covers things like understanding foundations of dementia, different types of dementias, They get some basics in geriatrics. That's actually what it's called is the big basics in geriatrics and their 10 principles. They get content on cognitive symptoms, functional symptoms and yes, psychiatric symptoms. We offer them and they get some content from occupational therapy. So an occupational therapist did a big component of their course and their training. So that is how to break down a task. How to, devise meaningful activities that are engaging for this person. they get training in those pieces, and then, when the dementia care assistant meets someone, they get to know them as a person. they will tell you, they have said to myself, they tell guests when we have people come to the practice to tour, to learn about our practice, they have the best job. They are paid to be a friend to their panel of participants. So they come in. It's their only out expectation at the end of their time with this participant, and they meet with their I call them participants because they're not patients for them, right? There's an hour with them. That's about what we figured out. Our patients can tolerate in terms of that much simulation engagement. The end of their time together, that person needs to have just basically a positive regard for the time they spent together. That dementia care assistant has a plan in terms of what the priorities and goals are for that patient and that's mapped out by the nurse practitioner. And then they have tools in their toolkit and I mean that both literally and figuratively when they spend time with this person. So Maybe this person what they really would benefit from is something that's more cognitively stimulating. So maybe there are games and puzzles. Those would be some of the actual objects they have in their kits to work with this person. They may be doing sorting activities. Maybe they're doing some brain games. Maybe this person needs something that's more just engaging. So it could be, It might be reminiscence. It might be a video. It might be, audio. It might be other more active games. We have one community where a pool is a big hit. And it may be more physical activity. So they may do walking. They might use some chair exercises. We certainly have people for whom hydration is really important because this person, maybe the nurse practitioner knows medically, they're prone to dehydration. They take medicines that might dehydrate them. Maybe they have recurrent urinary tract infections, which the first intervention is hydration. maybe for them when they're together, they're setting up what we call hydration station. in their room and we have some, motivational water bottles, things that are more queuing for them or snacks, same concern if there are concerns like weight loss or so, so forth. the dementia care assistance course gives them the foundations and then the plan for this individual is mapped out by the nurse practitioner in terms of what the goals are, what the priorities are, but on a week to week or a day to day basis, the dementia care assistant has the ability to pull. From, the things that they can do, and including activities that we keep for them in the closet that they can use and then leave with that resident. they've done some cool things. They do some cool things. I never quite know. So we had a guest and we were, do we do, Monday case conference. So we discuss all of our patients on Mondays together as a team. I think that's the other important thing when you have a team that you actually have structured times that you communicate with each other. So our families can tell that we all know what's going on with their person. So I asked the dementia care assistants, give me some examples of what you did last week. And it could be anything from They do, they have built some audiovisual slideshows they might go through together for reminiscence. One person had designed a scavenger hunt for her participants in the buildings and, leveled it appropriately depending on the person and if they're in a locked unit, that would be a little bit adjusted. One of them had done a build your own burger bar. So they had, done some things with, food and drink and what's their ideal burger. We have, as it turns out, some retired flight attendants. Who apparently really enjoy our dementia care assistance. we'll do a beverage cart in the hall down the assisted living and they have a good time with that. if you just think about it and I will also say it sounds like it's always fun and games. But the other thing is, sometimes the dementia care assistant gets there. This person has had maybe a bad night's sleep. Maybe something else has happened, they're emotional, they're anxious, they just need a friend to sit quietly with them and hold their hand. And that's also an absolutely, valid thing our dementia care assistants might do with them that day.Erin:
Yeah. Sounds like to me, like I used to tell family members all the time, home health and hospice are important programs because it's another set of eyes on your loved one when you can't have them. And especially if you have loved ones who live out of town. And this to me sounds just like that, except for the resident or the loved one doesn't need home health or hospice services. They just want that extra set of eyes, that extra level of care, that extra level of comfort. Especially if the family is far away, or maybe there isn't a family connection network that this resident has. This sounds like a perfect opportunity to have a family, foster family in ways, which I think. Is very important for our elderly loved ones who are aging without children, which is important. So I am a huge fan of this. I was an executive director. I would be giving you a call because, hey, just for the psych nursing. Just for the training and the added element of here's what we're doing. Here are the options that we have available for our residents. That is important and it is a point of difference for any community too. Especially in the metro area and if you're not in the metro area of Atlanta, and if you're not in Atlanta, is there something like this in your area that you can offer which would be important to your residents. last word. Is there anything else that you want to brag about your team or let the world know about your passion? IDr. Clevenger:
think the idea of integrated memory care is that this was created by families, as I mentioned. highly collaborative and, we absolutely keep that patient and family at the center. We also want to support our senior living community colleagues to leverage and optimize the best care that they can bring as well. So I think we've seen ourselves and we've been described as an expert in my corner by many families over the last eight years. And now we'd love to partner with more senior living communities around the metro area and, to Be that expert in their corner as well.Erin:
Absolutely. It sounds like a excellent way to age gracefully, So thank you for your time today. I really appreciate it. And I always like to end every podcast with aspire for more for you. But I think in this situation, aspiring for more for you is important, but aspiring for more for your loved one who has cognitive impairment. Who could benefit from the collaborative approach seems to be important. So aspire for more for you and your loved ones today. Thank you, Dr. Carolyn Clevenger. I appreciate it. And thank you for listening to our podcast today. Have a great day.