Dementia and Associations

Discussion with Legal Expert Jennifer Cunha, Esq. and Board-Certified Psychiatrist Dr. Ivan Cichowicz

Is your community struggling to support residents showing signs of memory loss, confusion, or unsafe behavior? Have you noticed neighbors wandering, forgetting to pay dues, or leaving stoves on — and wondered what your board can or should do?

Join us as we explore Dementia and Associations — how cognitive decline impacts safety, liability, and community life. Learn how to recognize the warning signs, provide reasonable accommodations under Fair Housing law, and protect your residents while reducing legal exposure.

We’ll also share practical steps your HOA or condo board can take to foster awareness, compassion, and safety — from emergency planning to neighborhood support systems.

Empower your board to act confidently and compassionately when dementia enters your community.

Here is a link to our handout: https://tinyurl.com/7kbh87km

Check out our website: https://jennifercunhalawoffice.com/   

Transcript

Welcome And Series Overview

SPEAKER_02 0:03

Good afternoon. Welcome to Association Mental Health and Law Podcast. We're gonna give it a couple seconds for Zoom to add everybody and then we'll get started. Um welcome. It feels like Zoom is a virtual conference room with a door. Um so welcome everybody. And I think we can get started. Um I'm Zen Kuna, an attorney, and this is Dr. Tikowitz, and he is a theeriatric psychiatrist. And today we're gonna be talking about dementia. Um, we do have a handout. I'm gonna put it in the chat, and I'll continue to put it into the chat um periodically as we go. Um, just by way of a reminder, we're gonna be doing this mental wellness series the first, especially the first Thursdays of every month. We have all kinds of different topics coming up, like the dark triad, the two fees, bipolar and borderline, and how that can impact associations, um, OCD hoarding situations. So um we have a we have a um skip schedule again the first Thursdays of every month, and Dr. Tikowitz will be joining us each time. Um this is not legal advice. Legal advice exists when you have a one-on-one conversation with your law team. It's the Dr. Tikowitz medical advice that exists when you have a one-on-one conversation with Dr. Two, but I'm gonna turn it over to you. Um tell us about yourself, what you do, and um, and then we'll dive into the menstrual after that.

SPEAKER_00 1:39

So, first off, everything, Jen, thank you for having me here. Um, like you had said, my name is Ivan Chikowitz. I'm an adult and geriatric psychiatrist. I am currently working in Boca Raton, where I co-own a practice, mindful behavioral health, and I specialize in geriatric psychiatry. So that means everything related to late life from anxiety and depression to dementia and the complications of dementia, as well as in treatment-resistant depression. Um, spent most of my time in clinical practice, but I also do clinical research and I am an assistant associate professor at FAU here in Boca. Um, I'm really looking forward to talking with everyone about dementia. This is a subject, I mean, super close and dear to my heart, as this is what I do most of my time.

SPEAKER_02 2:30

That sounds amazing. Thank you so much for joining us. And before we dive in, what's your favorite thing about your job?

SPEAKER_00 2:36

That I get

What Dementia Is And Isn’t

SPEAKER_00 2:37

to talk to people as opposed to just, I'm gonna say, move patients along and write prescriptions or anything like that. I actually get to hear their stories and try to help them figure out how we can make their lives a little bit better.

SPEAKER_02 2:51

So thankful for your work. And um, I'm glad that you're joining us here because I think that um this mental wellness series with um associations um is near and dear to my heart for a couple of reasons. One, um we have people who go sideways for mental health issues, you know, not infrequently in our associations. The dementia comes up again, not infrequently. You have someone who started a fire in the kitchen or somebody who's actually like treating people really, really badly and they used to be nice. Um, so along those lines, can you tell us what is dementia? So the algorithm is different than dementia, is it the same?

SPEAKER_00 3:30

Yeah, so the first thing to remember is dementia is like a you know trash can term that means any type of memory problems. It's not an official medical diagnosis. It's just like if you say soft drinks, it could include everything. And the most common cause of dementia by far is Alzheimer's. And this is why a lot of people associate the word dementia with Alzheimer's, but there's a lot of different types of dementia. Alzheimer's is the most common. Then we also have vascular dementia, which is where because of usually cardiovascular issues, you have dementia-like symptoms. We have Lewy body dementia, we have frontotemporal dementia, and we have a lot of dementias from medical reasons. For example, you can seem to have dementia symptoms from medicines that you're taking, from problems with your thyroid, problems with your blood sugar, vitamin B12 deficiency is another one, and also from being like acutely depressed. That one is called pseudo dementia. Some of these can be corrected if we get rid of the underlying cause, but if you have Alzheimer's or the main dementias, like the vascular, the frontotemporal, these are chronic and progressive conditions that unfortunately all we can do is try to rein in the symptoms. Um, and in some cases help a little bit, but these are things that we need to manage, we can't get rid of. So that's why it's really important to focus on prevention and identifying cases early.

SPEAKER_02 5:03

That makes sense. So, what is the difference between dementia and normal aging cognitive decline?

SPEAKER_00 5:09

Okay,

Normal Aging Versus Red Flags

SPEAKER_00 5:10

so that's a great question because I hear all the time people tell me, oh, you know, I'm 85, so what I have is normal memory loss or normal, you know, senile dementia. And that really doesn't exist. Normal aging, you don't lose memory. What you lose is processing speed. So as we get older, what should happen is if I run into you at the supermarket, you forget the name of the restaurant that you were at yesterday when you're trying to tell me. But then as you're walking out of the supermarket, you remember, oh, it was, you know, whatever the name of the place is. That is normal aging. Or walking into a room and saying, Why did I walk in here? and going back to where you were, and then remembering, oh, I was going to get the keys. That is normal aging. It taking longer for you to figure out how to, you know, calculate the tip, normal aging. Forgetting the name of loved ones, forgetting how to do that family recipe, not remembering how to get to your best friend's house, that is not normal aging. And that is always, you know, a red flag for underlying dementia. So again, as we get older, we should not have memory loss. We should just have loss of processing speed.

SPEAKER_02 6:30

That makes sense. Okay. Um, those who are here joining us today, please feel free to put any questions into the QA. We will take your questions as we go along. We also have questions that you said earlier. They can be related to dementia, they can be related to treatments or symptoms or things like that, and they can also be related to law. So um there are no limitations on the types of questions to ask. Please feel so comfortable um popping them into the QA, and I will um we will answer them as we go. Um let's dive a little bit into these different types of dementia because um I think of a couple of cases right off the bat. I didn't I didn't know about the dementia that makes people angry until recently in talking to you. So we had we had a woman who was a tenant, and she um she would scream like racial things to the groundskeeper. It was awful. It was awful. She would say things that like nobody nobody would like imagine hearing, right? And then you know the association called the police on her, and the police showed up and she was like talking to them about her refrigerator, like she had no kind of idea. She didn't like link it. Um could you tell us a little bit about and I understand now that that potentially could have been one type of dementia, but that the different types of dementia, especially the ones that are like chronic um and not related to stress or things like this, um, have different like symptoms.

SPEAKER_00 8:07

So I'm gonna just talk a little bit about all of them and I'll then super focus on that one because I could see how that could be an issue in a community where you have a disruptive resident. And the first thing is all dementias can be associated with behavioral disturbances. Um, I don't know if any of you, you know, see a lot of cable TV, but you see these brands or ads for this new medicine called Rexalti, which this is what it treats. Very common complication of dementia is behavioral issues. But some dementias have this a whole lot more than others. Um, I'll start with Alzheimer's, which is by far the most common. And the I'm gonna say characteristic of Alzheimer's, it's that it's slowly progressive. So your memory is here, and it just little by little, little by little, year over year, kind of comes down, versus vascular dementia, where your dementia kind of gets worse in blocks. So your memory is here, all of a sudden it comes down here, and it then stays there until a next vascular issue. Um, and then you have Lewy

Types Of Dementia And Behavior

SPEAKER_00 9:15

body dementia, which is characterized because you have Parkinson symptoms. So these are people who have memory problems, but then kind of seem to have Parkinson's, and they tend to have a lot of visual hallucinations, which can be disruptive in the community when you have a patient who feels that he's seeing ants or rodents in a clubhouse or in one of the units. And I think the dementia that you're talking about is frontotemporal dementia. And frontotemporal dementia has this unique characteristic where it primarily affects your frontal lobe. And the frontal lobe is the part of the brain that helps control behavior. It what makes you be able to go into a restaurant and see a steak that you like and not grab it from someone else's table, but say, no, I need to sit down and order it from the menu. As that gets affected, and by affected, I mean it loses its ability to work as intended because it's shrinking, your behaviors become very disinhibited. So things that you may have had known are wrong, like to point out someone's physical defects or like to use racial slurs or any type of derogatory comments about someone's weight or look, all of a sudden are second nature. Now, the challenge with frontotemporal dementia is they have patients have this, I'm gonna say, impulse control and filter problem. But when you talk to them, they don't seem to be that confused. So the police can come in and they can have a pretty normal conversation as long as the police officer is not pushing them or does not elicit any of these, I'm gonna use the word like racial slurs that this particular case was having. Um but it's important to notice that these are like little details that I don't want anyone trying to diagnose their family members because it can be hard. And Alzheimer's dementia, there's also significant um shrinkage of the frontal lobe. It just is going to be a slower progression, and you only tend to see these behaviors later on versus in frontotemporal, you tend to see this kind pretty quickly. And someone who doesn't appear to be that demented, but their behaviors are significantly altered. Um and the challenge here is it's not that the person is doing this on purpose, it's just that their brain doesn't have the capacity to filter out what's socially appropriate and and what's not.

SPEAKER_02 11:53

That makes sense. We have a question from Barbara. What is repetitive question conditions? Somebody ask the same question over and over and over again.

SPEAKER_00 12:01

Yeah, so that is most likely one of the most common signs of what we would say is traditional, like Alzheimer's, where because of the shrinkage in brain matter, you're just not able to hold on to short-term information. And I'll take a second to explain how dementia tends to work. I usually hear I don't have dementia because I can remember my kid's birthday, I can remember my wedding, I can remember details from my high school graduation. But that's not how memory issues happen. Dementia works by you not being able to remember what happened one second ago. And as dementia progresses, as opposed to be one second ago, it becomes two seconds, and before you know it, it's two days, it's two weeks, it's two months. So when you have someone who you explain, okay, this is you know what you need where you need to send a check to, and they're like, okay. And a second later, they're asking you, could you repeat that? And could you repeat that again? That is a classic sign of what would usually be like an Alzheimer's type of dementia, where you just don't have the ability to hold on to the information. And the challenge here is, you know, it's easy to be nice the first one or two times, but then it's, I'm gonna say, hard to not lose your patience and get angry. And we need to try to identify this as an illness so we can remember it's not that this person is doing this to annoy me. This person just doesn't have the capacity to hold that information in their brain for periods of time longer than again, like a few moves, but it could be a few seconds.

SPEAKER_02 13:46

That makes sense. Okay, so last question on this topic that I have, and then we have another one that just came in. Um, the question I like to dive into is what is the difference between stress, nutrition related dementia? Yeah, if we have a loved one who maybe is aging and suddenly they're like forgetting what appointments are, what's going on, or whatever. Um behavior things how you know, how can lifestyle and environmental conditions impact dementia and when does it, you know, are there symptoms that are very clearly um, you know, real like Alzheimer's?

SPEAKER_00 14:28

Okay. So it's important to note that whenever someone comes into my office with a memory problem, the first thing we do is we rule out every type of possible cause of dementia that is correctable. And I'll go over some of the basics and where some of this stuff that you're talking about is very important. Number one is vitamin deficiencies. Maybe the closest vitamin associated to dementia is vitamin B12 deficiency. And I hear all the time from people saying things like, oh, I take vitamin B12 every morning. But there's a challenge here. As we get older, vitamin B12 is not well absorbed by the gastrointestinal system. In our intestines, the vitamin is there, it's just not absorbed, kind of goes out when you go to the bathroom. So for a lot of people, you can take a hundred

Repetition, Short‑Term Memory Loss

SPEAKER_00 15:20

vitamin B12 capsules a day and you're just not getting enough vitamin B12. So it's important to check vitamin B12, thyroid issues, blood sugar issues are very important. Um, medication side effects, anything that is a narcotic or anything that can make you tired can lead to confusion and dementia-like symptoms. I'm gonna say very common examples are anything for pain, or if someone recently had anesthesia. Very common that even a few weeks later, mentally and cognitively, they're still just not doing okay. And then my favorite, which is depression. Bad depression can present as dementia, and it can be very hard to differentiate if you're just talking to someone and focusing on, oh, they can't remember this, they can't remember that, they got lost. It could just be an episode of very, very bad depression. Now, what other things can play a role here is, of course, healthy diet and exercise are maybe going to be one of the most important things here because one of the bigger issues when we talk about dementias is remembering that it's not just 100% Alzheimer's or 100% vascular. In a lot of cases, you have a little bit of multiple things going on. And even though we can't change genetics, we can change, I'm gonna say, cardiovascular things. So if you exercise and you eat healthy, you have more blood flow to your brain. So a brain of someone who has the same, I'm gonna use the word type of damage from dementia in a healthy vascular system versus an unhealthy vascular system, it is just not gonna be the same. The person who eats healthy and exercise will have more blood flow and therefore better cognitive function. And we can get into details about all those behaviors that one can do.

SPEAKER_02 17:31

That makes sense. Um, David asks on this question, at what point can people not drive anymore?

SPEAKER_00 17:39

So that is maybe the hardest question that I ever get when I'm in the office. When is it not okay to drive? And I'll preface this by saying the challenge with dementia is particularly at the beginning, other people can say that your memory is not okay, but you can't tell that because your brain is hardwired to kind of convince you that you're okay. Um, so I will tend to get people telling me, I've

Reversible Causes And Lifestyle Factors

SPEAKER_00 18:09

been driving for 50 years. I am an amazing driver, even though they've had three accidents in the past, you know, two or three weeks. Um even though they're having issues with figuring out how to navigate within their community, they're still telling me I'm perfectly capable to drive. Now, what we do clinically is we tend to do some type of objective testing. So we can do memory testing that's done usually by a neuropsychologist, or we do what what I do is testing on the internet. It's like an online questionnaires, where we can then sit down with family and explain to family why the person not driving is important. And we can try to show this evidence um to the patient and explain to them why it's important for them not to drive, but it is a difficult conversation. Every now and then I get someone who says, You're right, I shouldn't be driving. Uh, but a lot of times we get a lot of pushback. Um now, just for everyone to know, FAU has a driving program, it's uh in conjunction with the Florida DMV, where people can get evaluated and assessed. And if they feel that they shouldn't drive, it gets reported to the DMV. And if they feel that they could drive with some, I'm gonna say remediation, then they'll be enrolled in cognitive exercises or in practice driving. Um, so it's a great service. It takes a little bit of time to get in because there is a huge need for this, but that's out there. Um, additionally, communities can report people to the DMV. It's anonymous. So if you feel that there's someone in the community who is unsafe, and sometimes when patients give me pushback, like I'm gonna drive anyway, what I end up doing is I'll report it to the DMV, and then the DMV does their own investigation. They basically reach out to doctors, get their doc different doctors' opinions, and they'll revoke someone's license. Now, this doesn't guarantee that someone's not gonna drive, but if you get a letter from the DMV saying we know you shouldn't be driving, it just makes it feel a little bit more real for a lot of the patients that we see.

SPEAKER_02 20:27

That makes sense. So one thing associations can do is if somebody has questionable has has gotten to the place where you're not sure they should be driving. Um concerned, you know, um, they can call the DMV anonymously and say, can you talk? Okay, that's amazing.

SPEAKER_00 20:46

Yes. Um I'm gonna add one more thing. You know, the easiest thing is always to talk to family. The challenge is family a lot of times struggles with being able to set limits.

Driving Safety And DMV Options

SPEAKER_00 20:59

So if it's a spouse, it could be hard for them to tell significant other no. If it's children, a lot of times they have trouble saying, I'm gonna tell mom or dad that they can't do something. Um, so you just need to be aware that for some kids it will be hard. Of course, other kids have no problem going in there, taking away the keys and saying that's it, but you can't assume that every family member is gonna say, I agree, I'm gonna do something. What I tend to get is I agree, but I don't want to be the one that has to do something or it's scary for me to have to do this.

SPEAKER_02 21:38

That makes sense. Um, another question is how do you handle a person who has dementia that keeps coming to the office and kind of like interrupting the manager?

SPEAKER_00 21:50

Okay. So the challenge here is you have to remember that that person just doesn't have the capacity to understand that the issue is resolved or is in the process and that they need to wait. So I think number one is not getting angry, not getting upset, and trying to avoid the argument. It's all about redirecting.

unknown 22:17

Okay.

SPEAKER_00 22:17

Telling someone, smiling, oh, it's super nice to see you. Um, I'm gonna like have you come this way and I'm gonna have someone, you know, work on this problem, or I have your phone number, you are up of the list priority. As soon as I hear more, I'm gonna give you a callback. Or if not, just saying, you know, why don't you sit down here? Let me get you a glass of water, and as soon as I finish what I'm doing, I'm gonna try to help figure out your problem. And because of the nature of dementia, a lot of times patients will actually kind of lose focus and stop interrupting, but you do need to just deflect, redirect. It's not easy, and particularly if you're just one office manager trying to manage a bunch of stuff and you have phone calls plus someone knocking on the door. I I know it can get hard.

SPEAKER_02 23:12

Okay. Um, that makes sense. So let's dive into some of the treatment. Oh, um Pam says I'd find older homeowners that have a UTI show symptoms of dementia, but it's not. I had two that's ear alone. Once they were treated, they were fine. Can you talk about that a little bit? Because I have heard that UTIs can just really make and it's violent UTIs too. As a doctor, you've treated like, I mean, you've you did rounds on all different aspects of Yeah.

SPEAKER_00 23:40

No, so like UTIs cause um, I'm gonna say the brother of dementia, which is something called delirium. Um the difference between dementia and delirium is delirium is acute confusion, um, kind of happen comes on all of a sudden and it clears up all of a sudden. Now, delirium could last for a few hours to a few months. Uh the difference with delirium is people with delirium can't sustain focus or attention. People with dementia can't sustain focus and attention until the illness becomes so severe. But for the community purpose, it will seem very, very similar. And yes, the reality is anything that disrupts brain functioning can cause confusion. So it could be um UTIs, it could be new medicines, it could be dehydration, it could be pain, which is another common thing that you can find in communities uh where you have older adults. Um someone falls down, has any type of a fracture, the intensity of the pain can also lead to confusion.

Redirecting Residents Compassionately

SPEAKER_00 24:50

And and as well as it could just be there is a lot of things that can go wrong that can cause delirium or but we'll use the word dementia to to just make it easier.

SPEAKER_01 25:03

That makes sense.

SPEAKER_02 25:04

Um, we got a question about the FAU program. I'm gonna grab that link and I'll put it into the chat. And um Gail asked, yeah.

SPEAKER_00 25:18

No, before we finish, I can get you the information on the FAU program.

SPEAKER_02 25:22

Oh, perfect. That sounds great. Um okay, so then um Gail asks about symptoms and what the association can do. We're gonna get into that in just a few minutes. Um Dr. Tuco, it's what are some of the treatments that exist for preventive um measures? I guess treatment for demand for dementia. What exists to help out when somebody actually has dementia?

SPEAKER_00 25:51

So I'm gonna say the challenge with dementia is there is no cure. What we have our interventions that can help prolong your memory function. Uh, but it doesn't mean your memory comes back. It just means it takes longer for your memory to get worse. The most common one is something called arisps or done. It's a medicine, you take it usually at bedtime, and it's by far the most common like introductory treatment. Um, there's a competition for that called Exilon, it comes in a patch. If you're having trouble swallowing pills or you have any gastrointestinal side effects, you can use the patch. And then there's something called namenda or mementine, which is usually a little bit stronger and used further down the line. Um if you've been again watching TV, you may know that there is a new treatment that was recently approved. It's called Lequembi or Lacanimab. Um, this is a treatment for amyloid plagues, and amyloid plagues are kind of what happens in the brain when you have Alzheimer's. Now, again, the treatment doesn't cure Alzheimer's, it just helps decrease the speed of the progression. Now, the only challenge with Lequembi is you need to have a PET scan

Delirium, UTIs, And Confusion

SPEAKER_00 27:20

that shows that you have amyloid plagues before Medicare will agree to cover the treatment. And not everyone who has dementia of any type will have amyloid plagues. Uh, but this is now starting to pick traction, and it's something that you may see people in the next year or two using this as a regular intervention. And then mostly what we do is we treat the complications of dementia. People tend to get, you know, anxious because they're noticing that their memory is not good. They tend to get depressed because, again, they're aware that they can't do the things that they used to be able to do. And without that frontal lobe working well, they have a harder time just monitoring or managing their emotions. You know, if most of us have a hard time managing that when our brain is working at 100%, just imagine when it's not working at 100%. And then sometimes we'll need to use things like antipsychotics when people have significant behavioral issues or sleeping medicines, if people have insomnia. Um, but it is a lot of just you know patchwork trying to control the symptoms.

SPEAKER_01 28:31

That makes sense.

SPEAKER_02 28:33

Um how often would you say like if somebody has dementia, ideally they're seeing their doctor, like psychiatrist or alphabet?

SPEAKER_00 28:44

So dementia is usually treated by one of three providers. I'm gonna say most of the cases are treated by your primary care doctors, um, neurologists, and then geriatric psychiatrists or regular psychiatrists that are comfortable um working with older patients or that geriatric population. Um the I'm gonna say the pros and the cons is your primary care doctor is the one who's the easiest to get into. Um, but primary care doctors usually carry big patient loads. It's a little bit harder for them to be 100% specialized on everything. They know a little bit of everything, uh, but they're a great place to start. Neurologists are very good at you know helping you get the diagnosis. And then geriatric psychiatrists like myself are usually the ones who are very good at helping you treat the symptoms or manage the progression of the disease. We should all be able to help with prevention, which is really the most important thing. The treatments are not that amazing, so we spend most of our time focusing on prevention.

SPEAKER_02 29:53

Okay, that makes sense. Um, and when you talk about the treatments that slow memory progression, um Um and that is not going to stop it, but are we adding three months? Are we adding a year? Are we adding five years? Does it vary?

SPEAKER_00 30:08

Yeah. So the reality is it varies, but we're talking about usually months.

unknown 30:12

Okay.

SPEAKER_00 30:13

The challenge is we can't slow down the illness at this point for two or three years. We can, you know, if you're getting the infusions, we think you we slow it down by about six months. If you're getting the medicines, we're talking about two to three months of decreased progression. I mean, it's not much, but it it does make a difference in terms of your ability to enjoy your life.

SPEAKER_02 30:36

That makes sense. We have some questions that have come in. Um, how can an association um

Treatments, New Drugs, And Limits

SPEAKER_02 30:45

determine if someone has one of these problems? Like, what would you say, like an association average or you know, like what are they looking at?

SPEAKER_00 30:54

So I I'm gonna go over what are maybe the most common complaints or issues. And what you can do is if you suspect any of these things, of course, it's reaching out to family and just encouraging them to be on the lookout, or you can say, hey, I'm just worried about your loved one. But what are the complaints? The most common is gonna be that their memory is affected, and I mean in any type of way. So you're talking to someone and you explain what they need to do and they just can't hold on to the information. You tell them the amount that a payment needs to be, and it's not that they forget the payment, it's they forget that they spoke to you about it. So that's the number one thing, just general memory not being the same way it used to be. Uh, but other very big notable things are gonna be that they have trouble problem solving. So they need you to explain how to do every little thing because it seems very complex to them. So if the association is saying you are going to come to the clubhouse, you're gonna get your, you know, your ballot, you vote, and you drop it in the ballot box. People who are like, wait, wait, that's that's hard to follow. Can you explain to me again what the process is? Those are red flags. People who are having difficulty doing familiar tasks. So I see this a lot. Associations that have like big, you know, card games. All of a sudden there's a member who is struggling to play in the card game or is having difficulty following the card game. Again, that's another, you know, I'm gonna say red flag. And not to say that this always means dementia. Again, it could be the delirium that we talked about, it could be a lot of things, but these are red flags. Then people getting confused or disoriented, so not being sure where they are or why they're there, having trouble keeping track of dates and times, they're showing up at the wrong time for the wrong event. And again, in a pattern. If someone is anxious, they can show up at one for something that was at two. It's the pattern of constantly showing up at the wrong time. Difficulty expressing themselves. And what I mean by that is patients with dementia will a lot of times just kind of give you a one sentence and then kind of say, oh, it's it's too complicated, forget it. Or if you ask for details, they say, yeah, no, and they just stay in the and and the details never come. So if I ask them who's the name of the president of the United States, they'll tell me, oh, it's that guy who always like looks sharp and you know loves to talk on the microphone, but they can't provide more details from that. Um at home, you tend to notice that they're misplacing things. So they can't find, again, not you can't find your glasses, which is not that uncommon. It's they have no idea where the plates are or they're forgetting where where are the forks. Um if you left your wallet in your bedroom versus

Who Treats Dementia And Follow‑Up

SPEAKER_00 34:10

the kitchen, that's not dementia. It's if you can't remember where your shirts are, that's like a red flag for dementia. And of course, then they tend to withdraw from the world. Patients with dementia notice that there's something going on, so they'll tend to withdraw. And by this, in an association, what you can see is they're not going to activities anymore, they're not participating in social events, they're not interacting with neighbors. And as it progresses, you can see behavioral changes, but usually that's once the dementia has already kind of set in.

SPEAKER_02 34:47

Um, okay, so and again, a lot of these things that are symptoms can also be related to delirium that you've been from UTIs or medical conditions or depression and things like this.

SPEAKER_00 35:01

So um Yeah, and and it I sorry, I just want to add also, you know, just because you're, you know, 45, 65, or 85 doesn't mean you can't have ADHD or that you just can't have a you know scattered personality in terms of just not being organized with where things are or keeping track of things. So we don't want to say that anyone who forgets something has dementia. It's patterns of behavior and it's taking all these symptoms like you know together, as opposed to just saying, oh, one thing and um diagnosing you as you have Alzheimer's or any of these other types of dementias.

SPEAKER_02 35:41

Yeah, I've heard of I've heard of like that um condition where you think you have everything you're hearing. Um my god, sometimes I misplaced my keys. So what you're talking about is that there are patterns, patterns, patterns, patterns, which are all like coming together as patterns and patterns, not the one time, you know, like that John Doe missed the board meeting or thought it was the day before or whatever, but you're just like seeing patterns and patterns of these behaviors.

SPEAKER_00 36:09

And and these are changes in ways of normal behavior. So if you have a board member who always shows up late for a board meeting because he's always distracted, but this is what

Costs Of Care And Financial Strain

SPEAKER_00 36:20

he always does, and he's sharp at keeping track of the numbers, he always can help other people, that's not dementia. Versus if you have a board member that shows up on time, but is having a lot of trouble keeping track of the numbers and can't really help people because he doesn't understand the issues himself, that is more worrisome for dementia than the first case.

SPEAKER_02 36:42

That makes sense. Okay. Really interesting. It's really, really interesting to learn about the different types of domestic, the treatments, the symptoms that come up. And that I think the biggest thing is that it's like patterns of behavior. It's not a one-off thing, it's all these, you know, behavior things.

SPEAKER_00 36:57

And the interesting thing for dementia is it's not like blood pressure where we can just check your blood pressure and say, oh, it's high or it's low, or it's you know, just right it needs to be. These are things that we have to like tease out, like get a lot of background, talk to family, just be around the patients to be able to clarify because we have tests that can say there's something going on, but we don't have tests that can say, oh, this is 100% Alzheimer's versus 90 Alzheimer's and 10% vascular.

SPEAKER_02 37:25

So let's talk about that. We have some questions coming in about what we need to elderly people who live alone, you know, what can the association do? And we have another person, we have like a wave of black people coming in. What are we gonna do if mental health is declining at the same time? But let's go into first how are these things diagnosed?

SPEAKER_00 37:43

Um so the the real answer is these are clinical diagnoses. And by that, what I mean is you have to sit in front of someone, you have to ask questions, you have to get background history, you have to follow patterns of behaviors. But there are tests nowadays that we can do that give us a lot of insight. There are some blood tests that can show that you have markers that predispose you to have dementia. And if you're predisposed to dementia and you're having some memory problems, then that kind of says it's likely dementia. There are PET scans that can show decreased brain activity, particularly in that frontal lobe, that can say, that kind of sounds like dementia. Um, there's PET scans that can help detect something called amyloid plagues in your brain. And if you have a lot of amyloid plagues, you're at higher risk of dementia. The challenge is a positive test doesn't mean you 100% have a diagnosis. Okay, so the challenge here is this is not like a blood pressure or your blood sugar, where elevated blood sugar, elevated blood pressure, yeah, it's we we can't argue with that. With this, it's you have a much, much higher risk. So we have to take the clinical information in conjunction with all these testings. The other thing that we can do is neuropsychological testing, usually done by a neuropsychologist. And this can give you a lot of information. It just can be hard to get someone who has mild dementia to agree to this because these are hard tests. You're sitting down for about an hour and you're going over difficult questions. So a lot of patients, once they figure out that they're not doing well, will just kind of stand up, walk out, and say, like, I'm not doing this. But in a way, that is kind of diagnostic in itself.

SPEAKER_02 39:38

That makes sense. Okay, so umce somebody has it, it's hard to, you know, like it's impossible to get better from where they were. But you've mentioned prevention. Um, and there are some strategies that can be done to prevent prevent it or screen pretty early on, and maybe you know, have a lifestyle adjustment. Could you tell us a little bit more about this? So we are just we have some questions that we give we're gonna oh sorry.

Diagnosing: Tests, Scans, And Patterns

SPEAKER_02 40:10

We're gonna get back to um some association risk litigation, you know, nuisance things. We're gonna get to that in just a minute. Um and then after that, like some ways the association can help, you know, people who have dementia. But now kind of getting into the prevention part.

SPEAKER_00 40:26

So if everyone walks away with one thing, it is the importance of physical activity. That is the number one thing you can do to help your brain. We can't control our genes. Some people have genetic, you know, baggage that predisposes them to dementia. Some people do not. If you don't, you know, you can eat cheeseburgers all day and lay in bed and you're not gonna get it. But if you do have a genetic predisposition, physical activity is the most important. And by that I mean getting that heart pumping. So it could be walking, if you're walking briskly, it could be going to the gym. Whatever you do is good. If you ask me what is ideal, it's a mixture of cardiovascular with a little bit of weight training because that helps increase blood flow to the brain. Now, other things that you can do that push the ball in the right direction are number one, eating healthy. And I always tell people it doesn't mean you can't eat ice cream or cheeseburgers, but if you eat a little bit healthier than you did last week, you're ahead of the game. Of course, if you wanted the ideal solution, it's a Mediterranean diet. Um, socializing is super important. So, this is why I'm a big fan for associations, trying to make sure that they have activities going on. The brain is meant to interact with other human beings, and having to read emotions in other human beings is a great workout for the brain. So, socializing is super important. And this is why you see all these like recent studies that have come out where they say people who don't hear well are at higher risk of dementia, or people who don't use hearing aids, it's not the hearing, it's that they stop socializing. And that's what kind of really gets them into trouble. So these would be the most important things. Now, another thing that is good is using your brain. Um, and by that I mean having to think. So for some people it could be doing math problems, but for most people, it just means, you know, having interesting conversations about subjects or having, I'm gonna say, healthy arguments, doing sudoku or wordle, whatever it is that you enjoy that kind of challenges your brain. Um again, there's a bunch of things that you can do. Anything that's healthy lifestyle is going to help. But if you had to pick and choose, I would say we start with these things.

SPEAKER_01 42:58

That makes sense. That makes sense.

SPEAKER_02 43:00

Um, okay, so let's get into some of the impact that this has on individuals, families, the association. Um what are we gonna what's gonna impact families the most first? And then let's get into association and law.

SPEAKER_00 43:19

Okay, so I mean the the challenge with I'm gonna say families is that these patients are gonna struggle with their daily activities. Um, so families are gonna need to invest a lot of more time and resources into making sure that these people are safe, are well taken care of, and it's gonna be costly if they need to have aids or take them to day programs. And then the way this all relates to associations is if they're spending a lot of money on care, they may find themselves financially strapped and not able to cover association fees or any other cost related to upkeep of their property.

SPEAKER_02 44:02

How much is care? What would you say? How much does cot care cost for that?

SPEAKER_00 44:06

Yeah, so I mean, it it can be really, really expensive.

Prevention: Exercise, Diet, Socializing

SPEAKER_00 44:10

If you end up in a assisted living facility, we could talk be talking anywhere from five to like around fifteen thousand dollars a month um for care, and that's for one person. So the the spouse may need to try to still manage the family budget with that huge expense over their head. Um, if they have AIDS, you're usually talking of anywhere from I'm gonna say $15 to $25 an hour. In some cases, it could be as high as 33, depending on the market that you're in. So these are you know financially intense endeavors for family. And you know, these are just costs that are not easy to absorb. Or if not, the family has to do it, and that means they don't have time to take care of them things themselves.

SPEAKER_02 45:03

Does Medicare cover any of those?

SPEAKER_00 45:06

Unfortunately, Medicare does not cover any of these costs. Medicare will cover nursing home care, but only once you have exhausted all your funds.

SPEAKER_01 45:18

Okay.

SPEAKER_00 45:19

So that usually means these people have to have had sold their units, spent all their money before Medicare will agree to cover. And there's a lot of, I'm gonna say, legal stuff that goes into here. A lot of times Medicare will allow for a spouse to stay in a unit and allow some money for the spouse to manage the unit while they cover nursing home care um for the other spot. But usually again, this will require a lot of like legal intervention to be able to figure out.

SPEAKER_01 45:48

Gotcha, gotcha. Okay.

SPEAKER_02 45:50

That's intense. And what if somebody were to go to like a day center, right? So if somebody would go to day center, what are those costs?

SPEAKER_00 46:00

So you can find day centers that are as cheap as five dollars a day to as expensive as a few thousand dollars a month. I'm gonna say there may be places that are, or not there may be, there are places that are free of costs. The the challenge is getting your loved one in there can be very, very difficult. So if some place has a waiting list of three to six months, I mean, yes, it'll help in three or six months, but in the meantime, you're gonna still need to like, you know, pay out of pocket uh for care.

SPEAKER_02 46:37

What do you think is the best situation? The most ideal scenario, somebody has dementia, or like somebody's loved one has dementia. What kind of care have you seen work out the best?

SPEAKER_00 46:49

I mean, so the ideal situation is for someone to be able to stay at their home while going to some type of day program that keeps them busy. Keeping the brain busy is going to be good. Staying at home is always preferable. The challenge is, you know, the cost of having an aid. Um, and of course, can the family manage some of the behavioral symptoms or just the repeated questions um like people are putting in in that question thread? It's not easy for a spouse sometimes to hear the same question like 25 times. And it it's again, it's not as easy as just saying this is what you should do and always do that, but ideally people stay at home.

SPEAKER_02 47:34

If a caregiver is getting fatigue, do you think that um care, like care centers for elderly people like assisted living, are a better choice than being home if caregivers are really fatigued or frustrated?

SPEAKER_00 47:49

Yeah, so I think the reason to move into a facility is one caregiver fatigue, or just the cost of having care at home is outweighed by the cost of having care at some type of a facility. And again, these are important questions because you know, the other

Caregiver Fatigue And Support

SPEAKER_00 48:10

the spouse still needs to pay for you know for food, for clothing, for all their expenses. So those are usually the two bigger determining factors here.

SPEAKER_02 48:21

So on the handout, we talk about caregiver fatigue and caregiver challenges. Tell us a little bit more about the caregiver side of things.

SPEAKER_00 48:30

Well, it I mean, it's not unexpected that caring for someone who has dementia is just extremely emotionally taxing and overwhelming. And the reason is because it's like caring for a one-year-old, but that is, you know, a full the size of a full adult that gets angry at you and that never says thank you because they can't appreciate what you're doing. And and what I mean by that is you'll get the same question 10 times. And if you get that with a toddler, eventually the toddler grows out of that. That's not gonna happen with someone with dementia. They'll ask the same question 20 times in next month, it'll be 25 times. It's not gonna be 15. Um, if a toddler gives you, I'm gonna say, attitude, you can always put in a timeout, or you can kind of like have like behavioral consequences. You can take away their phone. You can't do that to someone who has dementia because they they just they're not aware of it. So they're giving you a hard time, and it's very difficult to manage that behavior. So even the most patient persons at some point start to struggle, and this is why it's important for caregivers to to have support.

SPEAKER_02 49:50

Yeah, that makes sense for sure. Um I can imagine, you know, how much empathy really needs to be around not just like caregivers people who have to mention all of this, the hard situation that nobody asks for, like, of course, it's sympathy if that comes. Um, so it can be really challenging, I can imagine.

SPEAKER_00 50:09

No, it it is super challenging, and it's also in terms of an association, you have to remember that the forward-facing people that deal with people in the community may be exposed to something pretty similar. Someone who's there for managers, yeah, like may have to deal for an hour with something that should take five minutes, and then you can't go tell the manager, like, why aren't you like working faster? It's because you know, it's hard to work fast when someone asks the same question like 25 times, and you're trying to not make a scene or not make the situation worse. So we need to be aware of of a lot of these things when we're interacting in our communities.

SPEAKER_02 50:50

That makes sense. Um, okay, so let's go into just a handout here. Um somebody asked about devices for wandering and getting lost.

SPEAKER_00 51:04

What kinds of what kinds of technology can assist with individuals who might be wandering or okay, so as dementia progresses, one of the bigger fears is always that people either wander away and get lost, or even worse at their driving and they get lost. The the good thing is nowadays with technology, computers, microchips, um, you can have family members who have bracelets who you can track, and you can track patients by using phones. There's apps on your phone that you can use to keep track of a loved one of a loved one as long as they have their phone with them. Um, some of these, particularly the bracelets, will also let you know if someone fell. And the newer versions of some phones will also have features where they could alert um emergency medical systems if they believe that someone has fallen down. So technology is definitively

Tech For Wandering And Safety

SPEAKER_00 52:00

a big help here. And there's now versions of cell phones that are very, you know, simple, just one button and it costs the significant other. So all these are things that could be very helpful.

SPEAKER_02 52:13

That makes sense. That makes sense. Okay, so how dementia affects the association. I mentioned we had this woman who was kind of screaming um racist slurs at the groundkeepers. Um we have had a woman who, you know, like started having bizarre behavior and forgetting things, but then also again, like being deceptive with their behavior, getting mad at people, I think like not wearing clothing normally. Um, so so you have these behaviors that come out um and have to get addressed. Um when it comes to associations, the first thing I think of is like fair housing, that anybody who has the bunch of you know considered a person with a disability, they fall under the Fair Housing Act. Clearly, I don't think anybody would think twice about this here, but they would be allowed to have a caregiver or a living caregiver who, you know, isn't considered a household member, does it have to go through the normal, you know, credit check screening processes or anything like this? You probably can still do a background check on the caregiver. Um, but you know, if you have various limitations on household members or um unrelated family, like unrelated people living together, uh caregiver, caretaker would be exempt from this. Um I think of like the modifications that associations um may have to make and accommodations with allowing somebody to have a ramp or other assistive technology, you know, changes the unit, etc. Um, these are all things that the owner would need to pay for. Um if the association when they move out wants to remove, then the association would pay for the removal, then it is on the owner to um to pay for these these accommodations generally. And let me just see what other questions we have here. Um okay, so we already talked about Gail said we have many elderly people who live alone. And if you see symptoms, what if anything can actually we haven't talked about this? What can the association do? So you start to see symptoms, you say reach out to family. What do we start to do when somebody has when we think somebody has dementia?

SPEAKER_00 54:32

I mean, so the challenge here is because of of course, like HIPAA laws, you just can't call someone's doctor, or you just can't ask someone for their diagnoses. But what you can do, again, number one is I would always reach out to family first. And in a non-judgmental way, I would say, hey, I interacted with your loved one. I'm a little bit worried. Can I share with you um a phone number or the name of a primary care, a neurologist, and geriatric psychiatrist that I've referred or I've used in the past, and I think they could maybe just, you know, give

Fair Housing, Caregivers, Accommodations

SPEAKER_00 55:10

us a good idea of what's going on. So that would be step number one. If that doesn't work, you can always then, you know, I'm gonna back up. I'm gonna say step number one should really be try to talk to the person about, hey, like I'm worried and and see how they respond. Step two should be um engaging family. And and then the last thing that you can always do if there's concerns is you can call what's called DCF or the Department of Childhood and Family. They have a I'm gonna use the word, a hotline where you can report um any person who is above the age of 65 who you feel is in danger, and it could be because of abuse, because of neglect, or just because they're unable to take care of themselves, and they'll send a social worker just to do an evaluation. Now, this is anonymous, there are no negative ramifications for reporting. Um the the challenge that you have is you you report and it's up to then to that social worker and to the state to decide what to do. Now, what can the state do? Sometimes they can say, nothing is going on, the person can live independently. They can say, We're gonna, I'm gonna use the word try to get a family member to be more involved. And they can, in a worst case, say, we're removing this person from the property and we're placing them in a more supervised level of care. I think that's always, you know, your last option. But if you're worried about someone's safety, I would always err on the side of caution because the problem is once things go wrong, there's kind of little you can do to fix it. So if someone falls down and has a hip fracture, has kidney damage, or just isn't eating, this could just make their dementia worse. And there's no way of making this better now. That makes sense.

SPEAKER_02 57:16

Diving a little deeper into that topic, Lynn says our community had a resident who was confused and knocking on doors late at night. She had no family. We tried to make a report to adult protective services, but they were unreachable. Please were only able to walk her home. How can the community intervene? So you mentioned DCF.

SPEAKER_00 57:37

Yeah, so D DCF, um, and I put the number in the handout. I mean, I I don't want to say I can guarantee you that they're reachable, but it should be a 24-hour hotline, and there should be someone answering this literally like every second of every day. Of course, I I can't promise you what actually happens. Um, now, what can you do in the community if you're worried? Is I mean, number one, you can try to have someone who has some knowledge of the person, um, redirect them or kind of say, Hey, um, how about we go and we, you know, get a glass of water or I invite you for, you know, a sandwich at home and just try to get them to go back home. Um, if you have contact with family, we can maybe try to get a family member on the phone and see if that works. We can always call EMS or or the police, but you have to remember they will only do something if they feel that there is an imminent threat or a danger to the community. Um, someone who's just, I'm gonna say, wandering in the community may not qualify, but someone who's harassing another neighbor could qualify for the police to like intervene.

SPEAKER_02 59:04

Okay, so that gets to the question we have, um, which is like, what do you do if someone's just really, really, really obnoxious? Maybe this is a big change behavior. Maybe they weren't this way before, maybe they have some other symptoms, they're really, really obnoxious.

When And How Communities Intervene

SPEAKER_02 59:20

Um, and you suspect maybe it's dementia, right? Because now we know that some forms of dementia really are characterized by aggression and obnoxiousness. Um call the police. What are you thinking about?

SPEAKER_00 59:33

I mean so this is one of the areas where we have a little bit of a challenge where it's if someone is obnoxious, but their behavior is not inappropriate, violating any of the association laws or putting anyone in a position of feeling threatened or uncomfortable, you can call the police, but the police are likely going to say, There's nothing we can do here. Um, if the behavior does put Other people in danger or it makes other people feel threatened, then you can call the police and the police will intervene. So I think again, step number one is if you have someone who knows the person, try to say, hey, you know, in a calm way, what's going on? How can we help? We're worried about you. And try to reach out to family.

SPEAKER_02 1:00:21

That makes sense. I want to add that you can have in your application package like emergency contacts. That's just part of the application. It's on file. Who are the emergency contacts for every individual? You could do an updated one. You could say, hey, we're, you know, coming around and finding out everybody's updated emergency contacts. Please fill this out and return it to us. So having emergency contacts on file, I think is it's really key. We have had situations where individuals um, you know, have a bunch of they started fires multiple times their units. And what we end up doing is a docent letter. You know, it's one of those like really strict letters that kind of throws the book. And I know this is a tough situation, but sometimes they think family members need the book thrown at them to say, you have to get involved. If you this happens again, we're suing. We're filing a lawsuit. It's been two two fires. It's been, you know, this person waking everybody up at the middle of the middle of the night multiple times. Like this point, if this doesn't stop, we're filing a lawsuit. And in my experience, in every single instance, family got involved. They just always have. We've never had a lawsuit because family didn't get involved. Now, if you have someone who's single and doesn't have any family at all, I'd still say like get emergency contact for everybody and still reach out. Again, we've never had a lawsuit about this. We have had situations where the police were called, their um, you know, social workers were called and did get involved. It doesn't, um, Dr. Chicovitz, like, this would be an advanced situation where a social worker determines, okay, you know, this person really does have dementia and they can't live by themselves anymore. What happens then?

SPEAKER_00 1:02:12

So again, in that case, usually the social workers will have, you know, the ability to relay this information to a judge who will then declare the person like incompetent and will tell the state that they have to place him in him or her in a place where that person would be safe. And we're usually talking about a nursing home or an assisted living facility. Um, at that point, the person has no say. Once a judge declares you incompetent, then the state basically takes over and they'll look for a family member to be the, I'm gonna say, surrogate decision maker. And if none is available, then the state assigns someone to do that, usually a social worker or a lawyer.

SPEAKER_02 1:02:56

So people will no matter what, if needed, end up in a nursing home. Like this is not a situation where they're gonna be released to the streets because they can't afford their unit anymore. And you know, they do have dementia, and a judge has decided they have dementia. If somebody has dementia and they need care, their state resources, how does that work?

SPEAKER_00 1:03:16

No, so Florida um puts a lot of value

Adult Protective Services And Escalation

SPEAKER_00 1:03:20

on its geriatric community. And by that I mean it's the state of Florida significantly invested in being the retirement capital of you know of the world. And it will make sure that no one is on the streets because of either financial issues or cognitive issues. So anyone who is at risk will receive state intervention and will be placed in a safe um, I'm gonna say, situation. And by that, it could be a family member, it could be a nursing home, it could be an assisted living facility, and the state will figure out how to cover the cost of that care. And a lot of times that's that's done by putting people on a combination of Medicare and Medicaid, and Medicaid will then pay for um nursing home level of care.

SPEAKER_02 1:04:07

Okay, that makes sense. Um, so let's we have one last question on Alzheimer's, and then I would love to reimagine our associations in a space of supporting dementia prevention. Um, and and maybe even, you know, as people do have dementia, if it's not a dangerous situation or causing a problem for the community, like a lot of our communities, you know, have a lot of aging population, and this is okay, it's a natural part of life, right? So, what does it look like to support this with activities? But first, we have a question: is there a difference in Alzheimer's with men and women?

SPEAKER_00 1:04:48

So there's, I'm gonna say, when you look at numbers, there's difference in when people develop dementias, but no, it this is not a male or a female-based condition. Um in all honesty, we don't fully understand Alzheimer's, and this is why we don't have an effective treatment. All that we have is things that, you know, prolong the course or how, you know, the time of onset of the disease. But you're basically at risk, not based on if you're a man or a woman, you're at risk depending on if your parents had or didn't have dementia. Um, there's genetic factors that are the number one contributory issue. And again, yes, if you eat cheeseburgers and you don't exercise, you're more likely than the person who doesn't eat cheeseburgers, but if genetically they're at no risk, it that's more important than any other thing that you're doing.

SPEAKER_02 1:05:45

That makes sense. Um okay, so it's really kind of a genetic component to it, not so much the um gender. Um, okay, I just put Dr. Chikkowitz's phone number, email, and website into the chat. Um and let's go into reimagining associations. Now you told me before we met today that sometimes it can be helpful to have easier card games or card games where people just move slower as people age and and want, you know, a little bit easier um gaming strategy. Thomas, what kinds of things can associations do if you're to reorganize an association in a like a normal average association, not an unlimited budget, but what are some things that associations can do to support an aging population that can include some people with dementia?

SPEAKER_00 1:06:36

So I I like this idea because I think this is what can really make a difference and help communities manage the problem before it even starts. So I think number one is having you know, community liaisons or be people who anyone who's above the age of 65 that moves in is I'll use the word welcomed and introduced and people make contact. So there's

Guardianship, Placement, And State Help

SPEAKER_00 1:07:00

someone who knows this family and who can provide feedback on how you know they interact, where are they at? And and again, remember, someone who's scattered, if they're scattered a year from now, it doesn't mean anything, but someone who's you know very GI and is scattered a year from now, that can be an issue. So one a place a person of contact. I have some patients who live in communities where someone reaches out to you every month just to say, hey, um do you want to get together? We're getting like you know, all our above 65, you know, members just to be able to like chit-chat or interact, or you know, just in our little street, we try to get everyone above the age of 65 together so we can you know keep in touch, um, you know, organizing breakfast or anything to form a little bit of community. Number two is yes, activities. There's a lot of communities that have card games, but if you're not at the top of your game, you are kicked out of the card games. And we need to have activities for people who aren't, you know, that you know who can't process at that speed or who aren't that good, or who may be having mild issues with dementia. And it could also mean book clubs that have simpler books, or that it's okay if you don't, you know, have a great insight into what the book is or what what is going on. So it's just a matter of being more inclusive because the more these people socialize, the better their outcome is gonna be. If these people feel, and I hear this all the time, I stop going to the book club and to the card game because I can't keep up, then they isolate, and that just is gonna make the memory problem worse. So it's trying to keep them engaged. Additionally, it helps the community know who the family members are and who are the people who can provide support and who you can kind of reach out to in case of there being issues. Then remember, if you had a little bit of like memory issues, what would you like? You'd like to be able to have a sign that says, you know, your home. So it's having the streets well lit, having a lot of signage, um, having safe places for people to walk so they don't have to sometimes, you know, go over grass or get onto the roadway. It's just trying to make it as simple and as easy as possible for someone who has a little bit of confusion or memory is just to be able to navigate.

SPEAKER_02 1:09:35

That makes sense. Uh Dr. Tikovitz, thank you so much. Thank you, everyone who joined us today. Um, we are excited about this podcast series. The usually on um our webinars and then podcasts go until about 1.15. 115. Um, this one does not have a CE attached to it. We are um looking at getting CEs for this webinar series, probably an HR. Um, so check the invitations, you'll see more information about that. As always, if you need help with anything at all, um, you know, when it comes to the

Activities For Aging Residents

SPEAKER_02 1:10:10

law side of things, our association law practice handles all aspects of community association law from collections to um rule enforcement letters, but we've had people who are older who fall into collections. We've linked up quite a lot with community resources. Um, we you know have various organizations that can help people who've gotten behind to get caught up, or we we really work with people quite a lot. It's not like a kick em out situation. Um and when it comes to rule enforcement, again, we reach out to family quite a lot, we try to get the family involved, we try to make it as gentle a situation as possible while also protecting the association as their highest priority. Um, so so on that side of things, um, we try to we try to make it as kind but safe a process as possible for our associations. And Dr. Sikkowitz, you have a whole practice, right? You have psychologists, you have counselors, um, you handle all aspects of adult mental health.

SPEAKER_00 1:11:12

Yeah, so I'll first say thank you for inviting me. It's been a pleasure talking to everyone here. Um, I hope I never see anyone who's here, but if you do need us, um, our contact information is there. And we do everything that's mental health related. I myself focus on geriatric psychiatry, but we have a full set of offerings at our practice.

unknown 1:11:33

Yeah.

SPEAKER_02 1:11:33

Awesome. Um, sounds good. And um, Claudia says, I would like to send this webinar to my board. Would you send a link? We are looking at potentially having this podcast as um as a podcast available on demand. Um, so when we have that set up, we'll let you guys know and we'll send a link afterwards. Um, and we'll go from there. Guys, thank you so much. Uh upcoming webinars include um narcissists and associations, how to handle OCD and you know, um hoarding situations, or people who are very detail-oriented, kind of like hard for the association to manage, um, people who have emotional regulation challenges like bipolar and borderline and and what these are and and how you can navigate that type of stuff. Um all kinds of fun classes to to help you see the mental health side of things and feel empowered around it. So we will see you again next month for this. And anything else, Dr. TikTok?

SPEAKER_00 1:12:33

No, I just again want to thank everyone for their time.

SPEAKER_02 1:12:36

Sounds good. Everyone have a great day.