AgeSong Guru Week Video: Conversation on Forgetfulness Care vs Dementia/Alzheimer’s

The Guru Project brings together Dr. Allen Power, Dr. Richard Taylor, Stephanie Rothhman and Dr. Nader Shabahangi for a Guru Project Discussion About Forgetfulness. This recording, AgeSong Guru Week Video: Conversation on Forgetfulness Care vs Dementia/Alzheimer’s, shows the recent AgeSong Guru Project round table conversation on forgetfulness care vs. dementia/Alzheimer’s that took place on February 20th, 2015. The talk covers forgetfulness, stigma and how to humanize care for people with changing cognition.

A Conversation on Forgetfulness Care vs Dementia/Alzheimer’s

Some Highlights from this Guru Week conversation: In this talk and in the Guru Project as a whole we are looking at this phenomena called dementia and how it is becoming more medicalized and more stigmatized. We are also looking at how we can humanize the phenomena, reduce stigma and create better care environments. At AgeSong the emphasis is less on the biomedical diagnosis and more on recognizing human differences and individual needs when it comes to caring for those with “forgetfulness.”

The thesis of the Guru Project is to challenge current narratives regarding changing cognition. Contrary to popular belief, people who are living with changing congnition are not gone or fading away. They are actually the key to teaching the rest of us how to support people who’s cognition is changing. This is counter to the current narrative in our society where people with changing cognition are shut up in what are called “Alzheimer’s Units” of assisted living residences.

Dr Taylor expresses concern with the closing up of people with these conditions, with reducing stimuli and reducing their opportunity to enjoy their elder years.

Dr Power speaks to the stigma and suggests how offensive is it to generalize that all people with this label need to be keep all together and be treated the same way. The labels also predetermine a bias that can interfere with caring for the person as an individual. Diagnosis does not create a common denominator. From a care perspective this does not tell us about the individual and what their support needs are.

The systems that we have created to deal with individuals that are different are fundamentally “anti-humanity.” Dr Power suggests that perhaps the bigger upcoming problem is not that there will be more people dealing with changing cognition but the way we deal with them is the problem. The crisis is not that we will have “x” many people dealing with changing cognition in the next 20 years…the crisis is that we have such a dysfunctional way of seeing them and supporting them.

The idea that someone with dementia cannot have a life that is not full of tragedy and suffering sets us up for views and practices that actually make the suffering much worse than it needs to be.

This video of the Guru Project includes discussions on stigmatizing and integration vs segregation. Dr Power, Dr Taylor, Stephanie Rothman and Dr Shabahangi talk about how creating an environment that fosters relationship, encourages diversity of the individual, a tolerance for differences and promotes “Aging in Place” can reduce stigma and create better cultures of care for people with Forgetfulness.

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AgeSong Guru Week Video: AgeSong Interns Discussion with Guru Project Doctors

The AgeSong Guru Week Video: AgeSong Interns Discussion shares a discussion between AgeSong Interns and Guru Project doctors Dr Richard Taylor, Dr Allen Power and Dr Nader Shabahangi. This group session of AgeSong’s Guru Week includes discussion about how to look at Forgetfulness (Dementia/Alzheimer’s) from different perspectives, how to have a different viewpoint about the behaviors associated with Forgetfulness,  how to continue to evolve therapies and treatments for Forgetfulness and how to reduce stigma associated with Forgetfulness.

From an AgeSong Guru Project perspective Dr Taylor, Dr Power and Dr Nader Shabahangi talk with the AgeSong Gero-Wellness Interns on how “Forgetfulness” affects the patient and how to interpret the behaviors.

Dr Richard Taylor talks about being a person who has been diagnosed with “forgetfulness,” dementia of the Alzheimer’s variety. The AgeSong interns ask him questions regarding what he experiences. He talks about how the changes in his brain and learning to live with them. His insightful talk covers his experiences of the fear and frustration that accompanies the changes that happen in a persons brain. He gives these as examples of the types of things that can be behind what are called the “acting out behaviors.”

Dr Allen Power adds to the discussion by suggesting a talk about “terminology.” The APA in recognizing the stigma attached to the term has dropped “Dementia” from DSM-5 and is now using “Major and Minor Cognitive Disorders.” At AgeSong they use the term “forgetfulness.” In writing his first book, “Dementia Beyond Drugs” he rewrote the definition of ‘Dementia” because he acknowledges the stigmas around the words we use “behavior problems,”  ”acting out” are so powerful he believes that the make it difficult to see new solutions. In his book he re-defined it as a “shift in the way a person experiences the world around her or him.” Because this discussion is with the Gero-Wellness interns Dr Power jumps ahead into the more person-center approaches. He discusses the “Needs Based Dementia Compromised Behavior Model.” That basically says when people have expressions or actions it is often the result of unmet needs. Dr Power suggests that might not cover it completely…what about aesthetic enjoyment? If you just use this model and you have Alzheimer’s then everything you do gets pathologized as unmet needs. Dr Power suggests a model he has been working with which is a modified version of Maslow’s Hierachy of Needs. He goes through the pyramid diagram and describes his thoughts on the “needs.”

Nader talks about taking cues from the Existential Humanistic Psychotherapy model and not do psychotherapy as cognition but as emotion. Dr Shabahangi suggests that one of the gift sthat people with forgetfulness can bring in our lives is to give us the opportunity to be able to live more emotionally in the moment and not so much in our cognitive mind.

The AgeSong Interns and Guru Project doctors continue the topical discussions touching on more subjects  including dealing with our aging society, the changes that have occurred within the last 30 years in psychology, the challenges inherent in Existential Humanistic based eldercare.

The last 25 minutes of the video is a fantastic back and forth between the AgeSong Interns and doctors.

See the other Guru Week videos here on the AgeSong Video Library page.

The AgeSong Guru Project

The AgeSong Guru Project is a year-long initiative which focuses on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication.

To complete this project AgeSong has engaged in a partnership with Psychiatrist and Pacific Institute board member Dr. Richard Patel; Geriatrician, Dr. Allen Power; and Psychologist, Dr. Richard Taylor.
“I am honored to have the opportunity to partner with three of the industry’s leading experts in the area of mental health to thoroughly explore the approach of care for those who are in various stages of forgetfulness, what is commonly diagnosed as Alzheimer’s and/or Dementia, with reduced use of medications,” AgeSong CEO and founder, Dr. Nader Shabahangi said. “The AgeSong Guru Project will focus on learning directly from elders who are living with the changes brought on by forgetfulness (Alzheimer’s/Dementia). Much of the industry resources focus on “instant gratification” medications that often restrict the life of the person, whose lifestyle is shifting due to mental and physical changes. This project is solely based on what elders verbal and non-verbal communication is trying to tell us. We will look at any behavior as an expression of need we, the observers and care partners, must explore and understand more deeply.”

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AgeSong Guru Week Community Discussion on Forgetfulness Care video

AgeSong Guru Project partners, Dr.’s Richard Taylor and Allen Power, engage in a roof-top AgeSong Guru Week Community Discussion on Forgetfulness Care (Dementia/Alzheimer’s) at AgeSong’s Laguna Park residence. The open group forum includes AgeSong Community Residents, CarePartners and Interns from the AgeSong GeroWellness program.

 

AgeSong Guru Week Community Discussion on Forgetfulness Care

The video opens on a frank discussion starting with Dr. Richard Taylor. Included in this group discussion are AgeSong Residents, AgeSong CarePartners and AgeSong GeroWellness Interns. The participants share views both from the caregiver’s perspective and from the perspective of those with varying levels of forgetfulness (dementia/Alzheimer’s). Topics include the types of things we can do in a community like this that will give resident’s the fullest life possible, regardless of their mortality or abilities. The residents, interns and doctors discuss truth-telling in care, white lies, communication, being “present” with patient, labels and stigma associated with forgetfulness, dementia and aging.
What are the types of things we can do in a community like this that will give resident’s the fullest life possible, regardless of their mortality or abilities?

 

The AgeSong Guru Project

The AgeSong Guru Project is a year-long initiative which focuses on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication.

To complete this project AgeSong has engaged in a partnership with Psychiatrist and Pacific Institute board member Dr. Richard Patel; Geriatrician, Dr. Allen Power; and Psychologist, Dr. Richard Taylor.

“I am honored to have the opportunity to partner with three of the industry’s leading experts in the area of mental health to thoroughly explore the approach of care for those who are in various stages of forgetfulness, what is commonly diagnosed as Alzheimers and/or Dementia, with reduced use of medications,” AgeSong CEO and founder, Dr. Nader Shabahangi said. “The AgeSong Guru Project will focus on learning directly from elders who are living with the changes brought on by forgetfulness (Alzheimers/Dementia). Much of the industry resources focus on “instant gratification” medications that often restrict the life of the person, whose lifestyle is shifting due to mental and physical changes. This project is solely based on what elders verbal and non-verbal communication is trying to tell us. We will look at any behavior as an expression of need we, the observers and care partners, must explore and understand more deeply.”

Dr. Richard Taylor

Dr. Richard Taylor is a retired psychologist and author of “Alzheimer’s from the Inside Out.” As a doctor with dementia himself he has experienced not only the change of state that happens internally but that which happens in external relationships also. He has experienced the change that occurs within the circle of family, friends as community. Dr. Taylor eloquently discusses his experience of living well with dementia.

Dr. Allen Power

Dr. Allen Power, is a board certified internist and geriatrician, clinical associate professor of medicine at the University of Rochester. Dr Power is the author of paradigm shifting books including “Dementia Beyond Drugs: Changing the Culture of Care” and the latest, “Dementia Beyond Disease.” As a practicing internist he discovered he was questioning the paradigm and efficacy of just using medication to treat dementia;that perhaps the “deficit-based view that focuses on neuropathology and tends to blame brain disease for distress” is not the best care paradigm for these patients. Instead he suggests: “the experiential approach holds that the best way to care for a person living with dementia is to understand them as a person and their individual experience; so I use the very holistic definition that “Dementia is a shift in the way a person experiences the world around her/him.” This idea of changing perspective is something to which we all can relate, and this commonality helps us build a bridge to better understand the person’s needs.”

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AgeSong Guru Week Biomedical Convention video

AgeSong invites Dr Richard Patel, Dr Allen Power and Dr Richard Taylor with Dr Nader Shabahangi to present at The AgeSong Guru Week Biomedical Convention to discuss insights into different perspectives on forgetfulness, Alzheimer’s and dementia care. The Biomedical Convention of the partners in the Guru project explores different viewpoints of Forgetfulness, Alzheimer’s and Dementia care with a focus on well-being and enablement.

The AgeSong Guru Project sponsors AgeSong Guru Week Biomedical Convention Presentation with Dr Richard Patel, Dr Allen Power, Dr Richard Taylor and Dr Nader Shabahangi.

The purpose of the AgeSong Guru Project, a year-long initiative, is to look at creating comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication. Not using a text-book to learn about a patient but having the patient be the textbook and teach us what they need. This is contrary to the trend of treating these individuals from a deficit-based perspective. This perspective looks at helping people with changing cognition have more comprehensive care that allows them to be enabled and re-enabled.

Dr Richard Patel

Dr Richard Patel is a professor at USCF in Psychiatry, works at San Francisco General in Psychiatry and Neurology in the ER and is in private practice. His experiences in these areas have lead him to the belief that patient care is about the whole person. And comprehensive care is about the friends, family, community and environment around the person.

Dr Allen Power

Dr Allen Power, is a board certified internist and geriatrician, clinical associate professor of medicine at the University of Rochester. Dr Power is the author of paradigm shifting books including “Dementia Beyond Drugs: Changing the Culture of Care” and the latest, “Dementia Beyond Disease.” As an internist he had been prescribing psychotropic medications to his patients. In his practice he discovered that he was questioning the efficacy of a medication-focused perspective. He started to believe well-being is more important than taking a deficit-based approach. He shares insights from his experiences.

Dr Richard Taylor

Dr Richard Taylor is a retired psychologist and author of “Alzheimer’s from the Inside Out.” As a doctor with dementia himself he has experienced and discusses some of the fundamental changes that happen in the process. He talks not only the change of state that happens internally but that which happen in external relationships also. He has experienced the change that occurs within the circle of family, friends as community. Dr Taylor eloquently discusses his experience of living well with dementia.

Dr Nader Shabahangi

Dr Nader Shabahangi, AgeSong CEO and founder, is a licensed psychotherapist. He is founder of Pacific Institute, a non-profit that offers innovative forgetfulness (dementia) and eldercare and has with the Pacific Institute Internship team,  implemented the Gerontological Wellness Program (GeroWellness Program.) Dr Shabahangi in his work with AgeSong advocates for a shift in focus from labels for patients with changing cognition. At AgeSong they refer to patients with changing cognition such as Alzheimer’s and dementia as experiencing “forgetfulness.” This change to a broad non-clinical description is reducing the stress and stigma in the associated care of the individual. The AgeSong vision is one of a humanistic and whole-person approach to the culture of care provided within AgeSong residences and programs.

The speakers at the Biomedical Convention of the AgeSong Guru Project speak about comprehensive care partnerships with people who are experiencing changing cognition. The goal is understanding the need-driven behaviors and minimizing risky use of psychotropic medication. The talk covers forgetfulness, dementia, dementia care and the importance of changing the culture of care. Included are the personal insights offered from Dr Taylor from the perspective of an individual who is working to achieve a state of  ”living well” with changing cognition in the world as it exists today.

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Related Posts:

Dr Allen Power presentation: The Biomedical View vs the Experiential View in Dementia Care video

Dr Allen Power with Nader Shabahangi presentation: Dementia Beyond Disease video

The AgeSong Guru Project: Shedding New Light on Forgetfulness

The AgeSong Guru Project is a one-year initiative that focuses on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication. Psychiatrist and Pacific Institute board member Dr. Richard Patel welcomed geriatrician Dr. Allen Power (Dementia Beyond Drugs) and psychologist Dr. Richard Taylor (Alzheimer’s from the Inside Out) to San Francisco and Oakland for a series of lectures, discussions, and workshops…
Following are excerpts from AgeSong Guru Project: Beyond Labeling:  Exploring the Elephant, Feb 17-20, 2015:
I’m not fading away.  It’s others who are fading away from me.  They didn’t have anything to say to me.  They thought I was dying.  I decided to speak up.  Not only am I still here.  I’m all day.  Don’t ask em to play bridge or chess because I’ll just soil on myself while I’m playing it.
— Dr. Richard Taylor, psychologist and author,
Alzheimer’s from the Inside Out
The more I try to understand how they [those with changing memories] are perceiving the world, the more I understood that it is possible to see the world differently.  I look at the experience of changing through seven different needs:
  1. joy
  2. growth
  3. meaning
  4. choice
  5. security
  6. connectedness
  7. identity

What does the person need to have a full life and how can we contribute to that?
—Dr.  Al Powell, MD, geriatrician, author, Dementia Beyond Drugs

If we put too much focus on cure, than we place too much value on fixing you so you become ore like us. Need to change more to how we include people whose abilities might not be just like the rest of ours…t’s not just about the person, it’s about the community, their environment, their community. Some family & friends don’t want to be with you as much because they can’t deal with the changes in you. There are lots of side effect of medications.
— Dr. Richard Patel, Psychiatrist and Pacific Institute Board Member

Who is the client that irritates you the most? Be that client, be that elder.  Think what it’s like to be in his or her shoes.
— Dr. Nader Shabahangi, AgeSong Founder & CEO

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AgeSong Launches “The Guru Project”

AgeSong announces an initiative aimed at learning from elders called
“The Guru Project” The Guru Project logo

San Francisco, CA – February 11, 2015 – AgeSong, the San Francisco Bay Area’s leading lifestyle communities for elderly care, announced today a partnership with three of the industry’s leading experts in the care for elders to launch a new initiative called “The Guru Project”. This partnership is focused on minimizing the use of medication in geriatric mental health care.

“I am honored to have the opportunity to partner with three of the industry’s leading experts in the area of mental health to thoroughly explore the approach of care for those who are in various stages of forgetfulness, what is commonly diagnosed as Alzheimers and/or Dementia, with reduced use of medications,” AgeSong CEO and founder, Dr. Nader Shabahangi said.  “The AgeSong Guru Project will focus on learning directly from elders who are living with the changes brought on by forgetfulness (Alzheimers/Dementia).  Much of the industry resources focus on “instant gratification” medications that often restrict the life of the person, whose lifestyle is shifting due to mental and physical changes.  This project is solely based on what elders verbal and non-verbal communication is trying to tell us. We will look at any behavior as an expression of need we, the observers and care partners, must explore and understand more deeply.”

The AgeSong Guru Project is a one-year initiative that will focus on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication.  To complete this project AgeSong has engaged in a partnership with Psychiatrist and Pacific Institute board member Dr. Richard Patel; Geriatrician, Dr. Allen Power; and Psychologist, Dr. Richard Taylor.

“As people progress with Alzheimer’s/Dementia, their humanity increases. As care takers, we must be prepared for that humanity as it is ‘unleashed’,” said Dr. Richard Taylor.  “Having been diagnosed with Dementia over ten years ago, I am delighted to support one of AgeSong’s key core value’s with this project, enabling elders to live a balanced and uninhibited life.  I am looking forward to witnessing our results being implemented within an organization that is changing the way eldercare is approached.”

Lectures and workshops are open to the public. To register for an upcoming event associated with the Guru Project, click here. If you would like to be informed about future educational resources and events, please click here to join our mailing list.

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AgeSong Guru Project with visiting guests Dr. Allen Power & Dr. Richard Taylor

The AgeSong Guru Project
The AgeSong Guru Project is a one-year initiative that will focus on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication.  To complete this project AgeSong has engaged in a partnership with Psychiatrist and Pacific Institute board member Dr. Richard Patel, Geriatrician Dr. Allen Power, and Psychologist Dr. Richard Taylor.

AgeSong Visiting Guests Dr. Allen Power & Dr. Richard Taylor
Psychiatrist and Pacific Institute board member Dr. Richard Patel welcomes geriatrician Dr. Allen Power (Dementia Beyond Drugs) and psychologist Dr. Richard Taylor (Alzheimer’s from the Inside Out) to San Francisco and Oakland for a series of lectures, discussions, and workshops inspired by the wisdom in changes associated with aging and forgetting. Dr. Taylor has been living with forgetfulness (diagnosed dementia) for over ten years. He will give the audience a revealing account of his experience. Beyond Labeling: Exploring the Elephant is a forum for sharing the vision of the AgeSong Guru Project and celebrating the mystery and richness of being human.

Biomedical Convention
REGISTER FOR THE EVENT

Dr. Power, Dr. Taylor, with Dr. Patel
Tuesday, February 17th, 11:30am – 1:00pm
AgeSong Laguna Grove, Laguna Grove Terrace
624 Laguna Street, San Francisco, CA 94102

Guru Launch Gala
REGISTER FOR THE EVENT

Dr. Power, Dr. Taylor, with Dr. Shabahangi
Friday, February 20th, 5:00pm – 8:00pm
AgeSong University, University Chapel
350 University Street, San Francisco, CA 94134 guru

 

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AgeSong’s Guru Project Turns Tables on Long Term Care

Reprinted form California Health Report: http://www.healthycal.org/not-crazy-not-bad-aging-gurus-mental-health/

Not Crazy, Not Bad: The Aging Gurus of Mental Health

By Matt Perry

A visit to most long-term care facilities – a nursing home or assisted living facility – quickly reveals who wields the sword of control. Managers dispense orders to staff. Then able-bodied caregivers roam floors full of seniors compromised in either mind or body.

And frail residents dutifully follow the house rules.

Yet AgeSong assisted living – which has long considered older adults its revered elders – is taking another step in the fight for culture change inside the worlds of aging and mental health by introducing its Guru Project.

And it turns the tables on long-term care.

“Those residents who are the most difficult and challenging are our gurus,” says founder and CEO Nader Shabahangi, who oversees AgeSong’s four San Francisco facilities.

As a psychotherapist steeped in humanistic studies, Shabahangi has long insisted on the need for drastic new approaches within behavioral health and senior living.

Long-term care facilities, especially those populated by adults with dementia, often house residents who are strident, fearful, even combative; they may hit, yell, and throw either objects or tantrums.

The Guru Project deepens AgeSong’s core philosophy by helping staff uncover the root cause of so-called “bad behavior” – whether it’s physical, psychological or environmental.

Behavioral health staff focus on a humanistic approach rather than repair –which often means simply being present and listening.

“There’s no ‘fixing’ anyone here,” says Stephanie Rothman, AgeSong’s Guru Project liaison.

“Instead of doing ‘to’ you, we’re doing ‘with’ you,” adds executive director Janna O’Sullivan.

Suffering from Alzheimer’s disease, Carol Finkelstein’s father Ted was considered a troublesome and combative resident at his east Bay facility. He stole floor keys, wandered throughout the facility, pulled fire alarms, and barricaded himself in an elevator. He even admittedly touched a female resident’s breast.

“He was acting out because more and more restraints were being put on him,” sighs Finkelstein. “They didn’t have the ability to work with him.”

Supervisors called Finkelstein endlessly with this demand: “You need to do something about your father’s behavior.”

After moving him to AgeSong, Finkelstein was shocked by the facility’s silence, so she placed a phone call.

“Isn’t my father causing problems?” she asked.

“Of course he’s causing problems,” replied an AgeSong manager. “But they’re not his problem. Or your problem. They’re our problems to figure out.”

Shabahangi says AgeSong staff – not residents – shoulder this basic responsibility: “Constantly pay attention to the meaning behind a behavioral expression.”

“They never tell me there are issues because they don’t see them as issues,” explains Finkelstein. “It’s an attitude that’s just fantastic.”

There are several reasons for such behavior.

Residents may be frustrated at a loss of freedom. Perhaps the facility activities are boring. Maybe staff members aren’t paying attention to a resident. Or there’s not enough time spent in nature. It could be that a diaper needs to be changed, or hair combed. The root cause may be a deeper emotional issue – loneliness, or the loss of a loved one.

Guiding The Guru Project is a large multidisciplinary team that meets weekly to produce an Active Care Plan for each resident: executives, clinical directors, nurses, and both pre- and post-doctoral psychology interns. Also attending are Engagement and Education team members, along with staff who guide spiritual development. Finally – and perhaps most importantly – front line caregivers are involved, what AgeSong calls its “care partners.”

In fact, it’s these very care partners – who groom, toilet, and transport residents — who are frequently the centerpiece of The Guru Project.

“They don’t spend a lot of time learning about psychology and the dynamics of behavioral health,” says Rothman. But by interacting with the team of clinicians and staff – and attending the Guru Academy for an hour each week – they receive a crash course in psychology and mental health that will ease difficult interactions.

Consultants are also made available for more individualized training. And those residents on antipsychotic drugs will be enrolled in the Guru Registry to help prevent overuse.

Critical to AgeSong’s success is the education of psychology interns drawn from surrounding Bay Area schools trained in an existential-humanistic therapeutic approach and form the backbone of AgeSong’s behavioral health team.

Residents are typically visited weekly by a behavioral health professional.

Rothman says The Guru Project standardizes what already exists at AgeSong: “Having a plan written down that is implemented, checked off and assessed.”

Shabahangi has long infused his therapeutic work with a humanistic spin. In 1992, he founded the Pacific Institute to train psychotherapists inside a more humane, less prescriptive model. Two years later, after seeing the dismissive treatment of the elderly, he launched a Gerontological Wellness Program.

He eventually fused his compassionate counseling model with residential care, and today oversees AgeSong’s 200-plus residents.

Last fall’s keynote speaker at a California Elder Mental Health and Aging Coalition meeting, Shabahangi has noticed a shocking failure in behavioral health treatment: mental health professionals are now being infected by the same cookie-cutter approach common to physical health.

“It’s mindless, unsophisticated, almost a mathematical model,” says Shabahangi. “Therapists are becoming more like car mechanics.”

Rothman says the ability for residents to communicate extends far beyond verbal skills, and that the most potent connection comes through the eyes. Often, she says, residents don’t know her name or her occupation but know her as a friend.

“Everyone’s aware on a different level,” says Rothman.

At AgeSong, Shabahangi does weekly group supervision with his interns and asks them this simple question.

“Who is the client who irritates you most?”

Then he offers them an assignment in role reversals.

“Be that client, be that elder,” he tells them. “Think what’s it’s like to be in their shoes.”

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