Transcript
Ash de Neef: Thank you so much, Michelle, for joining us on the program today.
Dr. Michelle Olson: Thanks for having me Ash – glad to be here.
Ash de Neef: Can we start with a little bit about your story and what it is – the work that you do?
Dr. Michelle Olson: Absolutely. So I have been in the elder care field for over 20 years and I’m a gerontologist, a social gerontologist.
So I study the ageing perspective from the whole life course, the whole life span. I’m also a creative arts therapist. So basically what I do is I work in elder care settings and not for profit organisations. And as we’ll talk about, I have a not-for-profit of my own as well that I have recently started.
Ash de Neef: Fantastic. So the work that you’re doing as a social gerontologist, is that mainly working with specific organisations or what does the work look like in that field for you?
Dr. Michelle Olson: Yes. So actually, in a couple of different ways. I do adjunct professor work through, Concordia university and I do some work at Vassar college at the lifelong learning center.
So that’s one kind of aspect where I bring my gerontological lens in and then I do some home care management for a company called Clear Guidance and I help people who are living in their homes and they might need some assistance with planning or organising or transition to, another setting perhaps.
And then I also do consulting for elder care organisations that may need some dementia consulting, perhaps some environmental consulting or even consulting with policies. Sometimes that type of work comes up.
Ash de Neef: So with your consultancy work, you mentioned environmental advice or consultancies, is that to plan environmental spaces or the area around older adults to be more suitable for them?
Dr. Michelle Olson: Right. So particularly in the area of dementia in regards to environmental setting. So how do we plan people’s day? How does the space look? How was the lighting? How was the, the actual movement of the space, how are meals being served and is enough autonomy and agency given to people in these settings?
So that it encompasses a lot of that type of thing when I say environment. And of course my focus is really on incorporating the outside and the inside, and really keeping people as independent and active as possible.
Ash de Neef: The fact that you’re being consulted for these sorts of ideas that implies that there is a lack of information sometimes within the aged care system or those sorts of settings.
Dr. Michelle Olson: Right. I think there is a lack of awareness even. So sometimes, people don’t even know, like I work in a lot of long-term care settings and I’m never approached about it. And sometimes I’m chomping at the bit. I really want to say something, because I know things could be improved. [Like] how could we add a kitchen to this area to make it more like a home?
Or how can we bring people easily to the garden? But people don’t always ask. And so when I am asked about, different areas in dementia care it makes me so happy because, then I feel like, okay, they get it. They’re on board. They want to change – change is never easy. So it’s great when that happens.
Ash de Neef: You said the change there, what is the change that is slowly happening that you’re seeing?
Dr. Michelle Olson: Right. Oh my gosh. That’s such a good question because we know that person centered care or individual center care, that is the gold standard. That’s what everybody wants. And some organisations, they implement bits and pieces, they pick and choose, but really according to guidelines, we should be doing that.
But from what I’m finding and talking with staff for many years of different levels of staff, it’s challenging. And it’s challenging for different reasons, right? So it might be environmental, but it might be they feel they don’t have enough support from management.
I’ve been told obviously the staff to resident ratio is another challenge. So meeting people’s daily preferences is a challenge when there’s say 200-400 residents and maybe seven staff. So, there’s a lot to consider. And moving it – it doesn’t happen overnight, but we can start doing things in stages and get there.
And it’s important to just start, rather than saying this is how it is, this is how we do it. This has worked for us this far, but in reality, it hasn’t worked and we need to get out of that kind of medical mindset and really merge it with a more social and compassionate model.
Ash de Neef: Hmm. Now, one of the areas you mentioned is you’re a creative arts therapist. And creative arts is definitely an area in which this can move from a clinical space into more of a personal or emotional or even a spiritual sort of realm. Can you talk about a bit of the work that you’ve been doing with creative arts?
Dr. Michelle Olson: Oh yeah. So with creative arts for many years, I have worked directly with older people – most of which have some form of dementia. And we create art together. And I would go into the setting. It might be long-term care or assisted living, or even adult day centers. And it’s really an opportunity for exploration for creative self-expression.
And so these opportunities when the home calls me in to do these sessions, which I absolutely love doing it. I’ve done it for many years. However, it’s very short, right? It’s short lived. It’s like I’m there once, maybe a month, or it might be there twice a month if they can provide that service. But really these creative arts, they encompass so many different types of self-expression and they should be really woven into the culture and not just as a one-time program, offered on the activities calendar and then that’s it.
And it should be a choice, obviously, because not everybody would like to participate in creative arts, but for the ones that do or have an interest in it, or even a history with creative arts that choice should be there. So it’s really, really important just as human beings, we need a creative outlet. Whatever form that is, we need it.
Ash de Neef: Would you say that it’s going to help bring extra meaning to the lives of people who are in long-term aged car. Or what apart from self-expression, what other things do you think it can bring?
Dr. Michelle Olson: Oh, my goodness. So with the creative arts there’s so many health benefits to it that I don’t even think elder care settings are even quite aware.
Maybe they are, but if we’re seeking non-pharmacological ways to enhance quality of life, these are the creative arts are one way to do that. So with the creative arts, there’s so many different, it includes so many different types of expressions.
So we might be talking about visual art, or music or dance or movement, poetry, writing, drama and improv. And so some of these health benefits about in these visual arts or expressive arts, they reduce cortisol. They reduce stress, they reduce depression. There’s research to back up, pain reduction when people participate in the arts.
It can also stimulate our parasympathetic nervous system. So it helps calm us down – our body and our mind – and really improve our mood. I am a creative arts therapist, so I’ve been trained to provide therapy through these different modalities.
It’s another way for people to express themselves, stimulate memories. Again, some research suggests that creative arts can perhaps improve cognitive function. And you know, cause it really is a whole brain workout. It’s not just that right side. A lot of people think, “Oh, you’re creative, that’s your right side.”
It’s not so. So when we’re playing music or we’re making art it’s using our whole brain. So recognising these benefits, bringing creative arts and elder care, it just, it makes sense. To provide these opportunities for imagination self-expression and inspiring moments of joy, it just makes perfect sense.
Ash de Neef: Mm, and how did the residents react? How do they respond is there any difficulty getting them engaged or is it what’s the response like?
Dr. Michelle Olson: Well you know what? It just like anybody. There are people who really gravitate and go right for creative arts and some people they’re not interested and that’s okay.
But I could say that a very common challenge that I’ve experienced over many years of creating with older people is resistance. And resistance happens for different reasons. It might happen because they fear they might do it wrong or they feel they aren’t artists. I’m doing my air quotes, which you can’t see, but because of the common assumption that really only artists can create.
And in my clinical work, I’ve dealt with this resistance from older people, but even people who are artists. So that’s interesting. I find that people who are artists and have spent their lives creating art in some form, but now they’re living with dementia. Sometimes they have the strongest sense of resistance.
And I believe this occurs because they recognise that their expressions are different than they once were. And so they refuse to create for that reason. So this is something we talk about in the art therapy process. So validating these losses and encouraging that individual to really embrace that new approach to their art.
So I would say resistance, and then, you know what, and I just want to say this too. On the other hand, I want to point out that people who are living with dementia are often extremely imaginative and creative, and in some ways the disease actually enhances these creative expressions. So there’s, there is a positive, right?
There’s a flip side that I don’t know that everyone’s aware of. And this is particularly true with Alzheimer’s disease [and] frontotemporal dementia. There’s an interesting phenomenon called paradoxical functional facilitation. So when one or more parts of your brain are damaged or they stop working properly other parts make up for it and they kick in.
And they get enhanced. So we see that, with these forms of dementia, where people who have never created in their life, perhaps now they might be drawn to creative modalities and it is beautiful – it’s so beautiful to witness.
Ash de Neef: And that really underscores something that was said in a conversation we had a few weeks ago with an author, Christine Bryden, she’s an Australian dementia advocate.
She’s been living with Alzheimer’s for over 20 years. And she was describing how she may have lost some of the analytical function of her brain, but her ability to perceive things holistically and feel moods and be much more aware of the environment that’s definitely increased for her. So I find that fascinating that we have such a preconception that dementia and Alzheimer’s are the loss not a gain.
Dr. Michelle Olson: Absolutely. Yeah. Thank you, Ash. That’s so true that we have this kind of doom and gloom around it. And that’s not to say that loss isn’t sad and that we mourned these losses, but there really can be such, beauty and vitality. And not just in spite of dementia, but because of it, people are really, really spontaneous and imaginative and expressive.
Ash de Neef: Yeah, for anybody listening, who might be trying to encourage someone to use creative arts or that they’re in a space where they might be able to implement more creative arts practices in aged care setting. Do you have anything that would be helpful that for them to hear, to help people overcome their resistance?
Dr. Michelle Olson: Yes, I would say definitely do not push. One thing that I noticed is well-meaning staff or family members. They want to push because they have an agenda, right? They want their loved one or their care partner, whoever it is, their resident to create. Maybe they were an artist, so they kind of pushed them, but really we’re there to just support them and provide these opportunities and encourage them.
So, one thing that may work is to have materials, simple materials, it might be oil pastels or watercolors. Or if it’s music or whatever it is, and just have it there, start doing it. And kind of invite someone to come in. If they seem a little resistant and they say no, say, “okay, that’s okay.”
“You know what? You can just watch, you can just be with us if you want.” Just sometimes I like to use humor, right. So that’s a big part of it. And I’ll say “just supervise, make sure I’m doing things okay.” Or, “just be with us. You don’t have to even participate. It’s fine.”
So that would be my biggest thing is to just honour that person where they are, don’t push them and always inviting and always encouraging.
Ash de Neef: Fantastic. In what ways are you seeing creative arts being used as participatory activities in longterm care facilities at the moment in America?
Dr. Michelle Olson: If we’re talking about specifically long-term care communities, I am a huge fan of Anne Basting’s time slips.
Have you heard of time slips?
Ash de Neef: No, I haven’t no.
Dr. Michelle Olson: Oh yeah. It’s beautiful because it’s all about using imagination. It’s for people living with dementia, utilising imagination. Asking what they call beautiful questions and creative storytelling. And I just, I love that because the program is not focused on memory, but rather expression in different ways that are really vibrant and meaningful.
There’s another program that’s used in long-term care homes. It’s called OMA Opening Minds through Art. And it is an intergenerational program in long-term care homes. And so this program, it really focuses on creative self-expression social engagement and they work to reduce those ageing stereotypes about dementia.
So OMA -Opening Minds through Art. That’s another great one that comes to mind.
Ash de Neef: Fantastic. Can we talk a little bit about Evergreen Minds? Your not for profit.
Dr. Michelle Olson: You absolutely can. So Evergreen Minds, it’s a new not-for-profit organisation that I’ve recently founded and I’m so excited about it.
It just combines everything I love. And I feel like who I am. So I would describe it really as a philosophy, as much as it is a nature-based dementia care. So at Evergreen Minds, we’re really on a mission. I’m shooting big here, Ash. We are on a mission to transform the world, to make access to natural spaces, just a normal part of the ageing process.
And how we care for people living with dementia. So, we also have plans down the road…We’re new, but we have since I am in touch with Vassar, we have plans to incorporate some college students within our program and really honour those inter-generational relationships and connections and also help.
And those stigmas around that surround dementia in our culture. And so I guess the reason, it kinda came to fruition with Evergreen Minds is. As we age I have found, and I’m gonna say we kind of collectively, we get caught up in our busy-ness right. And we lose touch with being outside, and we forget that we’re interconnected with nature.
And we can see this in how we care for older adults in long-term care communities something we touched on a little earlier. So people obviously for COVID reasons, it’s even a little more difficult now. So people are kept inside and it becomes normal and accepted that people generally do not interact with natural space in their day-to-day lives.
So when they do go out, this is something that I found. So when older people who have been kept inside, they do go out, it can be uncomfortable, right? It’s hot, it’s cold. And it’s just, it’s not routine. It’s not a normal part of their lives.
So I believe long-term care communities. They’re not designed with nature in mind. So, especially when we in long-term care tend to keep people kind of locked up and when someone has dementia, we lock them behind doors. And I found that really sad, and I think that’s kind of what sparked this whole idea.
So, I know there’s organisations like the Greenhouse Project and the Eden Alternative. They and other care communities they do a lovely job with this. So it is happening where people are connected with nature.
And I should say most communities do have like patios. They have little garden areas and those are excellent and we need those. The differences I believe that sunshine, fresh air and the change of all the different seasons, right? Not just summer and spring, all the seasons, those should be woven into the daily lives and practices of long-term care and kind of getting back to those non-pharmacological ways.
We’re always seeking new ways to help enhance quality of life, right? Whether it’s, through AI and virtual reality, we’re always thinking of ways to improve the quality of life of people living in these care homes.
And again, like with nature, the reason that I’m so passionate about it is because there are these physiological health benefits about being in natural spaces. That it, again, it just makes sense. Like why wouldn’t we try nature?
Ash de Neef: And you’re running some programs through that where you’re taking people on sort of creative arts walks through nature. Is that right?
Dr. Michelle Olson: I am. It’s challenging now, Ash with COVID.
So what we’re doing now is we are doing public events. I live in New York and a lot of our board members live across the country and Montana and California. And so our hope is to spread across the country. But right now I’m doing very small public events. We’re physically distanced. We wear masks.
So I keep the groups very small, not just for safety, but really for that connection. Because I want people to feel welcome and I want people to have the opportunity to share what they want to share. So these events are always outdoors, always in a natural space, might be in the woods.
Yesterday I was on a riverbank. The sessions are very mindful and we offer different expressive offerings. So it might look like creating art with natural materials. We move our bodies with nature. We explore our surroundings with all of our senses and how it feels, how this experience of being outdoors feels in our minds.
And in our bodies, we might do a little drumming, a little poetry, so whatever form it arises. And it’s quite simple, right? It’s just all about bringing people together and closer to the natural world. And kind of like what we’re talking about with time slips before – memory and language are not a prerequisite.
So when we’re out together and we’re enjoying this sensory experience of being in the outside, natural world – memory, language are not required.
Ash de Neef: Yeah, absolutely. And the idea that an experience itself is worthwhile whether or not it’s remembered in a week or a month or even a few hours.
It’s I think that’s really important to, to tap into.
Dr. Michelle Olson: People either they come themselves, if they are someone who is living with dementia and sometimes they come with a care partner. And just to see that connection, and I’ve been getting some emails and even some text messages, thank you that even like hours after it’s still ripples
That effect stays with you, even if that memory of that, whatever it is that we were doing, the drumming or that project has gone, but the feeling of connected-ness remains and that’s pretty awesome.
Ash de Neef: Yeah. Well, you mentioned something there about going out and all the seasons, not just summer and spring.
And that seems to tap into, to a phenomenon where as people age, we tend to want to protect them from things which are less comfortable or which we deem to be less comfortable. And one area that you’ve done a lot of research in is the way that death is handled in long-term aged care settings.
It seems like there’s a lot of work here to hide death from people in aged care settings. Is that what you’ve found and is that necessary?
Dr. Michelle Olson: So it is what I found and I don’t think it’s necessary. So I think what we should do in long-term care is ask older people, “do they want to be protected from death of their peers?”
And I can tell you from my research and exploring this topic for several years, the answer is no. So older people are quite aware of their mortality, right? News flash, they are. They they’re going to die. But I can also say some people do not want to know when someone else dies.
I’ve talked to older people who didn’t want to be a part of the study and we’ve had a conversation about death and they were like, “no, you know what? I’m not comfortable talking about it or my roommates not comfortable talking about it.” And that’s totally okay. And that is what person centered care is.
Like that’s all about choice and that’s one of the things that we don’t give choice in. We just automatically assume what’s best for them. I guess like too with COVID it’s so prevalent now, these losses and it’s almost overwhelming. But it’s even more important I think that we address it and we acknowledge, and we honour, these relationships.
Ash de Neef: Yeah. And did you think that there are perhaps some opportunities that are being missed by glossing over death and in that scenario or not giving it a chance to be addressed fully?
Dr. Michelle Olson: That’s a very good question. There are incredible opportunities that can arise when we create a space for grief.
So older people, as I said, they know that they’re going to die. So when we provide opportunities for them to say goodbye. People have told me they wanted to say goodbye to their friends. They wanted to pray for them. They wanted to – one woman said, I just want to lay my hands on them before they go.
Just one last time to say goodbye. So when we provide these opportunities, we’re really honouring the living as well as the dead and that’s important and something that we really should not lose sight of.
And the other opportunity Ash that comes to mind is. In the research study that I did once I opened that door to sharing and talking about these losses, they really started opening up about their personal losses in their lives.
Whether it be their spouse, their child, their twin or their grandchild. And it was actually quite beautiful because people felt supported and afterwards they were like, one woman said, “this is such a release” because she could finally talk about it. And I had a man in his nineties talk about his wife who had died 70 years ago.
He never remarried. So 70 years had gone by and now he was able to talk about. His wife and nobody in the room had ever heard about her before. So it felt good for him to talk about her and speak her name. And so we could create together around that and just be together. It was really moving.
Ash de Neef: Yeah. You mentioned a word a few minutes ago that I want to circle back to in case there is something here, but you mentioned that some people didn’t want to participate in the study because their roommates weren’t comfortable with death. From my understanding in Australia, people in long-term care, all have their own room.
In the situation you described, where it was a roommate, is this sharing a room because they’re friends or they’re in a relationship or is this something that’s common more in just as the setup of aged care in America?
Dr. Michelle Olson: Yeah. So it is, excuse me, it is common that they have double occupancy. That sounds so clinical, but yes, two people to a room. So there are places that have just private rooms, but more commonly there’s a choice. So you either have a private room at a much higher cost or majority of residents do share a room. That’s not all the homes.
That’s many of the homes, and I think that may change too. Out of COVID coming through this because sharing rooms and sharing a bathroom and it just there’s so many things things that really need to shift.
And aside from privacy, the, the health benefit just, we need to move away from that.
Unless of course, partners of any kind of want to share a room. That’s fine. But yeah, we should definitely move away from enforcing people when they move in to share a room. It’s so interesting that in Australia, they don’t even do that. Yeah,
Ash de Neef: it’s interesting to me that in America, they do do that.
Dr. Michelle Olson: It’s very common very common. And it does cause distress sometimes because everybody needs space.
Ash de Neef: And I imagine for people who’ve, spend the best part of 50 or 60 years either living in their own room or sharing with a partner to then be sharing with a stranger, it must be quite overwhelming.
Dr. Michelle Olson: Absolutely because you’re experiencing so many losses and now you’re moving in and you’re in a very small space with someone you don’t know. You’re absolutely right. And sometimes I have to say too, I have seen where the relationship between people is a good thing, right?
Like one person may be very introverted and the roommate helps them and brings them out of their shell a little bit. So in some ways I’ve seen positives too. You know, I don’t want to do like this blanket statement, like get rid of them all. But yeah. So there are some positives too, where people do like having that person with them.
Ash de Neef: Hmm, I guess it can come back to what you were saying before about, when somebody is about to enter an aged care facility asking, would they like to share a room with someone? Will they like the company and having that option is always, that’s going to be key to having a more successful person centered approach.
This seems like an example of something where perhaps the emotional or mental or non-physical needs of aged care recipients are not being put as a first priority. This is something we’re hearing quite a lot about in Australia as well. And the, the kind of climate around this is changing.
What do you see as some of the challenges to overcome in making non-physical needs more of a priority in aged care?
Dr. Michelle Olson: So getting back to what we talked about. I think with COVID it is teaching us a bit more about empathy and what it feels like to experience forms of isolation, heightened, anxiety, depression, and so going forward, I really believe we must remove the medical mindset of care and programming too.
Like, I don’t know, in Australia, if they, before COVID like, it was the natural way to just pack the house. When people had entertainment or any type of daily activities, it was very important for administrators to tell the activity engagement staff, please fill the seats, get people in here, keep them busy.
But, moving forward, we really have to look at people as unique individuals and view them more holistically, with a humanistic lens. And not just this kind of medical, “keep everybody busy, keep everybody active,” because that’s what, again, what we want our agenda pushing our agenda onto them.
That’s definitely a challenge that we talked about before and just stepping into their shoes.
Ash de Neef: Yeah, absolutely. One of the distinction points in Australia that has been raised as an area of concern is that private aged care providers sometimes don’t have the same standard of care as public aged care providers.
So in Australia, there are a number of aged care facilities that are funded majoritively by the government. Is that the case in America as well? That there are public care homes as well?
Dr. Michelle Olson: Yeah. So there’s private care homes and then there’s homes that are funded by Medicaid and Medicare. And so these are the ones where you will find, that the double rooms and these mandates, which are important.
They, they have mandates for a person centered care. So that is one of those challenges really that’s actually that topic right there is what got me to pursue my doctorate. With these Medicaid, Medicare funded homes in America, we are supposed to give people who move in choice. They have rights, of course, and they are supposed to have choice in their daily lives.
And there’s like pages of these yet at the same time, there’s really no follow through. And it’s very challenging to make sure that these rights and these choices are met every single day. There’s no follow through and I’ve actually, I did a poll.
Like I think it was 2015 on this topic, and I wanted to know what care staff felt about it, is it even possible to meet everybody’s daily preferences who moves in, technically according to, CMS, we should be meeting everybody’s daily preferences. It was a resounding no, like the staff felt it was, it really wasn’t even possible.
And that has to change. That is definitely one of the things we have to look at. They residents deserve to have all of the rights, whether we’re talking about death, sleeping, eating, the right to know about someone when they pass away, there’s just a broad range.
And these are people and this is their home. And we’re going to have to shift towards thinking along that line.
Ash de Neef: Are you noticing that the standard of care or the ability to address people’s individual needs is better met in the user pays system than it is in a Medicare Medicaid system?
Dr. Michelle Olson: I would say yes.
Yes. It shouldn’t be, if you have more finances available to you, more resources, it shouldn’t be that way, but it is true. I do think people get a little bit I don’t want to say better care because I know people work so hard. Gosh. I don’t want to people think that I don’t recognise the hard work that they’re doing.
Yeah. But it, but as far as when people move in, yes. They’re splitting their time. Like I said, there’s say 40 people in a neighbourhood and there might be two or three staff to look after them and help meet these needs. And is that sustainable and practical to say, could you meet all of these 40 peoples daily preferences, and they’re expected to.
Ash de Neef: Yeah. And I don’t think it needs to reflect at all on the staff who are doing a fantastic job with the resources available to them. But it’s just a product of the system at the moment. It’s interesting that in Australia, the perception is inverse that the facilities that are doing the most effective care or that are having the least amount of issues arise or the public ones.
And the private ones are under a lot of scrutiny at the moment for perhaps prioritising profits or some other factor over care for the residents. Yeah. An interesting switch there. What changes would you like to see within aged care in the coming years Michelle?
Dr. Michelle Olson: Okay. So I want to see older people and staff really have a seat at the table when it comes to all of these things that we’ve talked about today. So rather than policymakers and admins coming up with these ideas, give older people and staff some voice. And in regards to environmental and architectural design, those resident rights, we just talked about the way the care is provided.
And honouring these daily preferences. Yeah. So in a nutshell, I would say what changes, okay. I would say less doors, more fresh air more imagination and creativity and no age-ism.
Ash de Neef: Yeah. Some of those seem simple to implement and some of those seem like they’re going to be issues. We’ll be dealing with for a number of years.
What does it take to change the approach to imagination and creativity within aged care settings?
Dr. Michelle Olson: Even though changes is difficult. Like I said, we don’t have to do it all at once. But start with programming that in small groups and weave in meaningful programming that engages people and utilises imagination and forms of expression throughout their daily lives, giving them choice and asking them what they want.
And, if we’re going back to the death topic like what would they want to do? Like what kind of things would they want to do? Always putting it back to the people who live there. Do you want to have a tea? Do you want to create some kind of a board or a quilt? It’s really just weaving that creativity throughout the program.
And it always comes back to choice. And even with COVID, I think people who work in these homes are doing a phenomenal job, and they’re just doing the best that they can with what they have. But I do think, here the government, they have very strict guidelines.
But why aren’t we like getting outside? For example, everybody should have some opportunity. If they choose to get some fresh air every day, do you want to play a little, sing a song today? Would you like some art materials?
However it comes to be good – just provide options. Choice.
Ash de Neef: Yeah. Fantastic. Michelle, thank you so much for your time today.
Dr. Michelle Olson: Oh, thank you so much for having me. My pleasure.
