Tis the Season: Manage the Holidays To Dos While Caring for Your Loved One with Dementia Like a Pro!

The holiday season is upon us!  How did November get here so quickly? I wanted to write a short piece so to not to add to your already mad rush of preparations.  This time of year, while fun, can be incredibly frantic.  There is so much to do in a seemingly short period of time, and this is all while you are trying to still juggle every day to do lists.

The hustle and bustle of the season are also stressful for our loved ones with dementia.  They quickly pick up on our emotions and the decorations can stir up a lot of childhood memories, which is fun to reminisce but can also be a bit disorienting to them.

 

Stay in the Moment

 

Staying Routine

Time management is probably the best thing you can do this Holiday season for your loved one living with dementia.  This means maintaining a regular schedule and adding additional time to get ready.  There may feel like there is no time to do much of anything and here I am telling you to add more time, I know, however, when we plan in advanced there is less disruption once you finally get to sit down and enjoy the festivities.  Your loved one will feel more relaxed and in the moment when you feel this way, and they too will be able to enjoy the festivities just like everyone else.

Include them in Activites

It is faster to decorate and bake cookies or meal prep when you do it by yourself. However, what is your loved one doing while your busy preparing?  Probably feeling a bit left out and alone.  Include them in the hubbub of the season and let them help where they can even if that means they become a taste tester. Not only is it fun but it helps build self-esteem and makes them feel more in control at the moment.  In my experience, many individuals living with dementia-like having tasks it is familiar to them and offers them a sense of self.

Reminisce

The holidays are always a bit nostalgic.  This doesn’t go away with dementia, and in fact, it can increase the memories of the past.  Listening to their stories and engaging them in conversations is a beautiful way to celebrate and engage with your loved one. Too much, however, can become disorienting so if you feel your loved one is becoming anxious or starts looking for their parents who they think are missing out on all the fun change up the conversation to something a bit more current like what yummy food is on the dinner menu.

Happy Holidays!

Above all have fun!  As adults, it is so easy to become caught up in the frenzy that by the New Year we can’t believe its all over.  Best advise I can give is to enjoy the time you have with each other and stay in the moment the best you can.  You deserve to spend as much time as you can with your parent and loved one even if that means not everything on your To Do lists gets checked off.

Staying Active: Why Helping the Older Adults in your Life Exercise is the Best Care you Can Provide

Guest Post Author: Kelli Huggins | Grace Ridge Retirement Community

Exercise in Older Adults

Exercise plays an important role in overall wellness and provides the strength to participate in the activities we love. As a Well4Life Wellness Coordinator and Licensed Recreational Therapy Assistant, I’ve dedicated the past 10 years to developing tactics and discovering programs to engage seniors in fitness.

Fitness can be as simple as adding small changes to your daily routine to build strength and balance or adopting more formal training, such as the Ageless Grace program or Tai Chi.

Below are a series of suggestions for caregivers and seniors to encourage movement and maximize health benefits with and without a certification.

Movement with Music

For seniors new to a fitness routine, music can encourage participation and keep them on track to achieve their fitness goals.

For the best results, tailor music based on resident experiences and personal preferences. If it is near a holiday, incorporate seasonal music. If there is no specific preference, soft music, classical and easy listening are great for any group.

Continue to modify the music by adjusting the volume, providing headphones if needed and incorporating song requests. 

Building Strength

As a caregiver or as you age, you understand how important it is to continue to participate in the activities you love. Doing so not only maintains a routine but can also provide a certain level of independence.

Strength exercises allow your body to move more easily, making everyday activities like climbing the stairs, picking up groceries, standing up from a seated position and opening jars much easier.

Adding strength training to your routine doesn’t need to be complicated. Household items and your own body weight are the perfect tools. Try using soup cans as hand weights or adding leg raises and overhead arm raises to your routine to help build muscle.

 

Group Of Seniors Using Resistance Bands In Fitness Class

Staying Balanced

Strength, in combination with balance, is incredibly beneficial to seniors. Adding short balance exercises to your daily routine can make a huge difference. Try standing on one foot while doing the dishes or brushing your teeth. Incorporate balance into your routine by holding both hands out and straight while walking or walk heal-to-toe as if you were on a balance beam.

Practicing balance exercises will help you navigate uneven sidewalks or foundation, reach items on high shelves, bend over to reach low items, turn around quickly and avoid falls.

Tai Chi

Balance can also be improved through the practice of Tai Chi, an ancient Chinese art form and one of the most effective exercises for health, mind, and body. Dr. Paul Lam’s principles include mind integrated with the body, incorporating the fluidity of movements, controlled breathing, and mental concentration.

After your body is fully warm, starting with the top of the body and going down to the feet, you can move into the basic tai chi movement with a focus on improving range of motion.

For those suffering from arthritis, Tai Chi improves muscle strength, flexibility and overall fitness. The benefits of Tai Chi also extend to fall prevention as the movements focus on weight transference to improve overall balance.

Try to maintain healthy fitness habits, no matter your ageAgeless Grace

To further improve cognitive performance, the Ageless Grace program, created by Denise Medved, incorporates 21 simple tools for lifelong comfort and ease. The program helps develop and strengthen new neural pathways to support a long and healthy life.

The 21 tools are based on everyday natural movements and are focused on the ability to respond, react and recover. The tools are easy to follow at home and are designed to be performed seated in a chair, down on the floor, or standing.

The tools are uniquely named to make them easy to remember. Some of my favorites include:

  • Exercise Tool #1 Juicy Joints – joint mobility, flexibility and circulation
  • Exercise Tool #6 Try Chi – joint stability, eye-hand coordination and breathing
  • Exercise Tool #10 Rockin’ Rockettes – lower body strength, hip mobility, ankle and foot flexibility and arch support.

The Ageless Grace program helps improve joint mobility, spinal flexibility, right-left brain coordination, bone density, balance, fall prevention, self-esteem and confidence.

About the Author

Kelli Huggins_headshotKelli Huggins, Well4Life Wellness Coordinator and Licensed Recreational Therapy Assistant at Grace Ridge Retirement Community in Morganton, NC, has developed senior wellness techniques and educated professionals across the state for the past decade. Kelli recently presented at the North Carolina Recreational Therapy Association on exercise in older adults. Follow Grace Ridge Retirement Community on Facebook or YouTube.

Dementia Care: Identifying Triggers

Increased anger and aggression can be all too common side effects of dementia or Alzheimers.   Bad moods happen to us all, and sometimes we just can’t put our finger on why we feel so down on ourselves.  I imagine something similar occurs when our loved ones with Dementia or Alzheimer’s gets into a bad mood.  The difference is I’m able to vocalize (more like warn!) those around me that I’m just not feeling 100%.  Or if someone did something to upset me, I’m usually able to appropriately direct my feelings towards that person rather than anyone that crosses my path.

So why can’t our loved ones control their emotions?  And what makes them get so riled up that they feel they need to take a swing at you? In my experience, anger is usually a prolonged side effect of frustration.  Resulting from an individuals inability to efficiently get their feelings across and the disappointment that we the caregiver is unable to understand or help them accurately.

While working in the nursing home, it was essential to know and understand each resident’s triggers.  Triggers can be anything from a particular sound to a specific person and although we may not always know why this particular item can cause an adverse reaction we quickly learn to avoid these things at all cost.

A helpful way to learn and remember triggers is to write them down while also noting the time of day they occur and the details of the scenario. For example, Mom may start yelling at breakfast – This only happens on Monday and Wednesdays which just so happens to be the same days she has a shower right before breakfast.  The negative feelings she has towards her shower are carrying over into the rest of the day.  In this case, there are a couple of things we can try: 1. Offer a bit more time in between shower and breakfast, so that she can calm down. Maybe even play a bit of her favorite music in her room to relax too.  2. Change the time of her shower to after breakfast. 3. Assess whether a shower is still an appropriate method of care.

It is important to note that even though someone has dementia, it does not mean that their feelings are unjustified.  More often than not there is a rational explanation for the behavior.  It is our job as caregivers to be their detective.  Figure out what is bothering them and then doing what is in our power to remove these stressors from their environment.  Or add in additional supports to help them manage and calm them after a trigger occurs.

Caregiver Response

caregiver-stress

And let’s be honest, its never always so easy.  The times our loved one is angry, sad, or accusing us of something horrible are probably the lowest points in dementia care.  It is normal to feel frustration or even anger towards our loved one.  Keeping a notebook helps for this as well, recording our own responses allows us to better understand our breaking points and offers more insight while we provide care.

While you may feel overwhelmed and flustered at the moment, it is so important that your loved one is able to calm down.  Prolonged anxiety or anger creates a higher risk that they hurt themselves or even you.  It is important to first rule out that your loved one is in any pain.  If they aren’t able to directly tell you then assess their body language; are they holding a particular part of their body?  Are they wincing or is there a look of discomfort on their face?  If pain can be ruled out identify the trigger as soon as possible.  The Alzheimer’s Association offers a list of potential factors here.

Resources

Anger and aggression are common behaviors, and there is a ton of helpful information out there for you to learn different ways to both help your loved one feel more safe and secure and for you to feel more confident and in-control in these moments.  Below is a list of helpful sites and feel free to check out our Dementia Care and Caregiver Support Tags for more resources from the Upside!

New Approaches for Dealing with Difficult Dementia Behaviors

How can we control my dad’s violent behavior and find a care facility that will accept him?

Why does dementia cause suspicions, delusions and paranoia? 

Dementia Care: The Benefits of Staying in Their Reality 

Handling Dementia-Related Agitation and Paranoia

Hallucinations, Delusions, and Paranoia Related to Dementia

Dementia Care Dos & DOnt’s: Dealing with Dementia Behavior Problems

Caregiver Stress and Burnout: Tips for Regaining Your Energy, Optimism, and Hope

Taking Care of YOU: Self-Care for Family Caregivers

Dementia and Alzheimer’s Caregiver Stress

You Aren’t Alone

You may be the only one providing care for your loved one, but that does not mean you are alone in your experience.  The growing number of family caregivers is astounding, and the need for understanding and tools with Dementia Care is essential to your ability to sustain your role as a caregiver.  Although difficult, when your loved one begins to show signs of anger or aggressive behavior rule out pain and start investigating potential triggers within their environment.

For future reference, be sure to document the behavior, the time it occurred, and possible triggers.  This way you’ll better be able to identify trends in behaviors.  There are a number of ways we can help our loved one in these moments, reading others experiences and their tips and tricks may be a fast way to pick up your own tools for managing these behaviors that will allow a better quality of life for both you and them!

 

 

 

Do you Have a Plan for Your Future Health Care Needs?

First published on Sixty and Me.

Knowing how to recognize a good opportunity to start looking for long-term care options can be difficult. Whether we are looking for ourselves, a family member or a loved one, considering senior care can often signal an unwanted decline in our or their health.

In many cases, admitting that it is time to look for additional support is the hardest step. Ultimately, however, this is the best decision people can make for themselves and their family.

There are a few ways we can make this process a bit easier for ourselves and our loved ones. All it takes is a bit of research and planning to understand the senior care options in the area, even if we don’t plan on using these services for a couple of years.

Having a plan and a basic understanding of your options will make for easier decision making if our loved ones – or we – need senior care services sooner than expected.

Also, understanding our choices before we need them is the best way to ensure all parties involved feel at peace with the decision. The number of senior care options is growing, so no matter what our ideal age in place model is, there is certainly an option.

Below are three tips on how to get started!

Research Care Options in your Community

In-Home Care

In recent years, the demand to age in place has created a booming market for in-home care services. There are a variety of care services available to consumers ranging from need base to hospice care.

As we decide to age in place, it is feasible that we may require some, if not all, of these services over time. There is a difference between a Home Care Agency and a Home Care Individual business. Check out caring.com for a full overview of each.

Nursing Home Care

Nursing homes come in a variety of shapes and sizes. If you know you would like to remain in the area of your current home, you can start by reaching out to local assisted living facilities or continuing care retirement communities (CCRCs).

Although the thought of moving to a nursing home is not always pleasant, there are several reasons why this could be the right option for you. Nursing homes will provide around the clock skilled care and assistance whenever you need it, which takes the responsibility of care off of family caregivers.

Area on Aging

If you are living in the States, a great place to start your research is with your local Area on Aging. They will have an abundance of resources and knowledge of your surrounding area and point you in the right direction.

You can easily google search your county name area on aging or use the Paying for Senior Care tool.

Have Conversations with Close Friends and Family

A recent study by the University of Minnesota found that only 40 percent of Americans aged 40 to 65 think it’s likely that they will need long-term health care services.

When asked who would provide their care if they needed it, many people based their answer on current living arrangements, which did not account for changes in family dynamics or children moving away.

Taking such a critical need for granted can do a disservice to you and your family members. Making assumptions about your future needs, without discussing with those involved, could result in an unwanted change to your plan.

To start, have a conversation with friends and family to see if they have considered their future health care needs. Most of us don’t, so “no, I haven’t” is a reasonable response.

This makes sense – it is hard to think that there will come a time when we would actually need help doing our everyday tasks. But, asking this question can help all parties narrow down options and create a feasible plan that you all could agree upon.

Write Down Your Plan and Tell It to Whoever Will Listen

Once you have identified the right plan for you, write it down. Having your wishes written down on paper is just an added security that your future health care choices are honored.

This process doesn’t even have to be formal, so don’t worry about calling a lawyer (unless you want to). If you would like to have some formality, you can sign your letter in front of a witness (who can be a close friend or family member).

Communicating our plan with our loved ones is an excellent way of ensuring that they will know what to do if ever in a situation where they must make decisions for you.

These types of conversations are also beneficial because they normalize the process. Too often we are afraid to broach the conversation about senior care. However, it is a highly important conversation to have if we would like to have a say in the way we age.

Preparing for A Piece of Mind

Aging is a natural part of life, and if we are lucky enough to experience it, there are still many things to learn and be involved with even in our later years.

There may come a time, however, that we will be unable to make decisions for ourselves. This might sound scary, but if we prepare for this ahead of time, there is no reason why we can’t age in a place we feel comfortable and at home.

Dementia Care: the Benefits of Staying In Their Reality​

timeIndividuals living with dementia or Alzheimers will often speak of their younger years as if it was their current reality.  They tell stories of their childhood home, their parents, and will even feel the need to go home and make dinner for their young children.

Sometimes the need for this reality is so great that they become anxious and even angry when they can’t find what in their mind should be there.

How trapped and powerless they must feel in these moments!  Imagine if we woke up one day and everyone we know and loved were no longer there or if our once routine and purposeful lives were now only a distant memory.

If you’ve cared for someone with dementia you’ve most likely had to “fib” at one time or another. When asked where their mother or father was, you may have said they were at the store; When asked to go home, you may have said it’s too cold to go outside; Or when asked when their kids will be here, you may have replied they are at school today.

These types of answers may not always work as well as we hope they do, but more often than not these responses offer them comfort and a peace of mind in knowing that their mother is still alive and will soon return.

I’ve had many people ask about the ethical implications of lying to someone with dementia or Alzheimers.  However, there are multiple benefits from the practice of being in their reality for both them and us. Because when we engage them in their stories of the past, we learn and connect on their terms, not ours.

Reality Orientation

First, I want to mention the practice of Reality orientation, which is the method of reminding the person with dementia or Alzheimer’s the facts of their current situation. If they wonder where their parents are we tell them that their parents are no longer living or that they can’t go home because they no longer live in their childhood home. We will also remind them of the actual date and time and their current living situation. 

In my experience, reality orientation causes anxiety and can even scare the person with dementia or Alzheimers.  Arguing with someone who has dementia is futile and will often exasperate the situation.  Whether we think they are making up these stories or not when we attempt to correct them we are essentially calling them a liar and taking away any sense of control they may have in telling these stories. 

The Alzheimers Association also stresses the importance of communication with those living with dementia and Alzheimer’s and notes that communication requires patience, understanding, and good listening skills.

Read more: http://www.alz.org/care/dementia-communication-tips.asp#ixzz4r9g3YquZ

Nostalgia

Therapeutic Lying

There are several names we can give to the practice of staying in someone else’s reality:  therapeutic Lying, embracing the reality, or empathy.  No matter what you feel comfortable calling it, the practice itself has multiple uses and benefits for those living with dementia or Alzheimer’s.

Therapeutic lying reduces stress and pain of loss for both the caregiver and the person receiving care.  The Family Caregiver Alliance notes:

People with Dementia Do Not Need to Be Grounded in Reality.
“When someone has memory loss, he often forgets important things, e.g., that his mother is deceased. When we remind him of this loss, we remind him about the pain of that loss also. When someone wants to go home, reassuring him that he is at home often leads to an argument. Redirecting and asking someone to tell you about the person he has asked about or about his home is a better way to calm a person with dementia.”

No matter what strategy or answer we find works best for our loved one staying within their reality rather than bringing them into our own will make them feel more safe and secure at this moment. This practice has a beautiful way of redirecting them so they are no longer concerned about the safety and whereabouts of their loved ones and they can then, in turn, enjoy the moment with you.

Doll Therapy with Dignity for Loved Ones Living with Dementia

pexels-photo-272056Babydolls.  Traditionally, a toy for little girls to play with, hold, and take comfort in has become a popular therapy tool for some individuals living with Dementia. Although this device should not be used for everyone, a baby doll does bring great comfort to those who have had an affinity to caring in their earlier years.

One particular memory care unit I worked on had a whole nursery set up in a quiet room at the end of the hall fixed with two cribs, a diaper bag, and a rocking chair.  These Items, of course, you would not ordinarily expect to see when the average resident was age 92. And yet, two women, in particular, would frequently come in throughout the day to lay the baby doll down for a nap, sing him a lullaby, or like any good mother would show him off to all the other staff and residents.

Sweet and endearing as it may seem the site of an older adult holding a baby doll and “pretending” that it is real can be alarming.  I’ve had several family members come up to me over the years questioning the practice partly out of concern for the persons well-being and partly because a women holding a baby doll is a visible reminder of dementia.

Dolls with Dignity

While caring for someone living with Dementia and Alzheimer’s we have a duty to uphold their dignity.  Dignity is so important that the Right to Dignity is an actual federal mandate in nursing homes. This right is particularly important while using Doll therapy. Like most treatments in Dementia care, while addressing or interacting with the individual and the baby doll, we must always treat the doll as if it were a real baby. And never correct the way in which the individual cares for the baby doll.

It is not uncommon for someone to swaddle and swoon over the doll in one moment only to drop them on the floor (by accident) the next.  They may leave the baby doll lying around, spill food on the doll, or even hold them upside down by the foot.  But this doesn’t mean that WE can do this.  Even if we think that the person isn’t watching we should always hold and treat the baby doll as if it were an actual baby.  Otherwise, they will probably perceive us as negligent, and they won’t be afraid to tell us this either.

 

Alzheimer's care doll therapy
Image Source NPR: Doll Therapy May Help Calm People With Dementia, But It Has Critics

 

There are several common questions people want to ask when they see doll therapy in use, but these questions are often the ones that we should avoid. For instance, we shouldn’t ask what the baby’s name is, how old the baby is, or who the father is.  Most likely they won’t be able to tell you and realizing that they have forgotten such important information can be quite upsetting. Instead, statements like “oh look at those cheeks” or singing a lullaby, are more engaging and empowering ways to enhance the therapeutic nature of baby dolls and will make the individual feel secure and even a bit prideful in that moment.

We don’t have to be ashamed or embarrassed by doll therapy.  It brings great joy and comfort to care for a baby in this stage of their life and your support enhances their quality of life.

 

Does this Mean I should Buy Mom a Baby Doll?

No. As mentioned above, doll therapy is not for everyone, but if you notice that your loved one is feeling a bit more anxious laying a swaddled baby out where they can find them is a good way to see if they are interested.  Even placing the swaddled baby in their arms to see if they attach to them is okay. However, it should not be a forced process, and if uninterested you will surely know.  But, if their face lights up and a big smile appears you will know you’ve just given them a great gift of comfort.

The Use of Robotics in Long-term care Facilities: A Step Into the Future?

 

RobotAndFrankMN
Robot and Frank (Click for Movie Trailor)

The use of robotics and other AI Technology in Long Term Care is a highly debated topic, and there are fair arguments both for and against. Their use, however, seeks to solve a  grave concern in the field.  The number of adults 65+ by 2050 is expected to rise to 88 million. At such large numbers, resources are essential to the ability to provide and care for our older populations.

The greatest resource is the caregivers themselves, and currently, there is a significant shortage in the United States. Recruitment of employees is hampered by negative stereotypes of nursing homes and the often deeply emotional realities of caring for someone at the end of their life.

The most common reason people choose to work in long-term care is that they had a good relationship with an older adult (commonly a grandparent) at some point in their lives. The lack of senior caregivers will become a national endemic if the issue is not addressed.

There are several different types of robotics for senior care, but the most commonly used are robotic caregivers, social robots, and teleconferencing robots.  Their use has grown increasingly more popular over the years and can now be found in Japan, throughout Europe, and the US.  As the number of older adults increases, their use could be the solution we are looking for.  But can a robot actually replace the human connection and socialization we as humans need?

The Pros and Cons of Robotics in LTC

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Robotic Caregivers

Designed and developed in Japan, the Robobear is a transfer and lift machine for people who have difficulties getting up and moving on their own.  Traditionally, this is a job for Certified Nursing Assistants who assist in lifting and transferring individuals from the bed to their wheelchair or from the wheelchair to the bathroom.

Nowadays, there are Hoyer lifts and sit to stand lifts which help take some of the strenuous burdens off of the caregiver, but they are still in the room and able to talk or calm a resident during the transfer process.

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The Robobear (as pictured above) is designed to make this process a bit less scary and jarring for seniors. However, the idea that a cute smiling bear is more inviting and more receptive to seniors is a bit unfounded, but it does offer a friendly alternative to the more sterile machine options on the market today. In their use, we should keep in mind the potential for confusion they may cause our residents with dementia or Alzheimer’s.

Prototypes of humanoid robots are still being developed.  And one day we may find that robots that look like humans could replace our caregiving staff.  Although this still seems like an idea of science fiction, Carebots are already developed and on the market and their use is specifically targeted to assist the elderly.

Social Robots

Social robots are developed to simulate real pets.  Most common are dog and cat robots as seen in the video below.  The company Hasbro’s found that their children’s toys were being used by a growing number of seniors and decided to create a line especially for older adults living in nursing homes.

 

These “pets” act and respond just as a real cat or dog would.  The cats will purr and vibrate while being pet and meow in response to being held.  Since pets aren’t allowed in many long-term care settings, this type of companionship is a welcome replacement.  And especially for those living with Dementia or Alzheimer’s can offer a sense of comfort and purpose.

Hasbro is not the first to unroll a line of robotic pet companions.  Japan has a line that was established in 2003, which was purposefully designed as a therapeutic intervention for seniors.  Unfortunately, this line is a bit pricey and not as easily obtained whereas Hasbro’s Lifelike pets are much more reasonable at about $100.00.

Robotic Conferencing

The Cruciferous Vegetable Amplification episode of the Big Bang Theory parodies the idea of sending a virtual self out into the world through video conferencing. Funny or extreme as the concept of this was, this type of technology is available and for the medical field has great potential to allow physicians to be two places at once.

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Image Source: CBS Network

One such technology is the GiraffPlus, already on the market and providing In-Home help care to the elderly throughout Europe.  The GiraffPlus is a vacuum cleaner, monitoring system, environment evaluator, and a telehealth conduit for seniors living in their home.

As the number of older adults remain in their home, these types of technologies make aging in place a sustainable living option even as care needs change. Alternatively, however, does the lack of a personal visit to the doctors or the now “traditional” form of health care offer something more than a teleconference can offer? Particularly to a more vulnerable population for isolation.

Can a robot console the way a human can?

Seven million Americans over the age of 65 suffer from depression. This number will continue to increase over the next several years, but without enough caregivers, it’s hard to care for the emotional and physical needs of our older adults.

And as many movie and TV representations show us, although some robotics are advanced with many capabilities true human connection is not one of them. Although robotics have become increasingly popular throughout Europe, Japan, and the US one French non-profit the Society of Saint-Vincent-De-Paul
 created a short clip that portrays the ill-effects this lack of human console can have on an individual.

 

The Future of Long Term Care

Technology has been incorporated in nearly every field so it is no surprise that we would find a way to advance our caregiving methods. Personally, I am still on the fence when it comes to robotics specifically and maybe only sold on the cute toy kittens and a bit weary of a giant smiling bear capable of lifting a person.

As a field, we still have an opportunity to invest in real live humans to fulfill our caregiving needs.  In an earlier post, Addressing Our Caregiver Shortage through Intergenerational Programs: Introducing our Youth to Seniors Living in Long-Term Care I discuss the importance of intergenerational interventions now so that our youth will grow up wanting to care for their elders.

I would love to know what you think about the use of robotics in Long Term Care?  Is it cool, weird, innovative?  Leave your thoughts in the comment section below!!