By Maggie Mah
Special to The Almanac
You know how it goes: You go about your life feeling like youth will last forever and that aging, with all of its implications, is just a concept. Then one day, you suddenly notice the skin on your arm looks different —like what you see on your older relatives — and the realization that no one is immune from this process starts to sink in. Along with the prospect of losing one's youthful looks and learning to cope with physical challenges, another specter looms in the distance: Alzheimer's disease and the loss of cognitive function.
The good news: We are living longer. The bad news: The longer you live, the more likely you are to develop some form of dementia. It is now the sixth-leading cause of death in the United States.
The medical field has advanced light years in treating many ailments caused by "birthdays," but for people with dementia, not much has changed in the last 50 years. Until science is able to crack the code, ways must be found to help the growing numbers of people afflicted with degenerative brain diseases.
Barbara Kalt has devoted nearly 40 years to doing just that. She retired recently from her position as director at Rosener House, Peninsula Volunteers' day care center in Menlo Park for adults with dementia. Although she has handed the reins of management over to her successor, she is continuing as a volunteer.
The Almanac caught up with her at Rosener House to talk about her experience, her thoughts on issues facing dementia patients and their caregivers, and of her dreams for the future.
Barbara Kalt's warm personality and easy laugh immediately put you at ease, and within a few minutes of meeting her for the first time, it feels as if you are talking to an old friend. She is also refreshingly candid and feisty, qualities that hint at her determination to improve the lives of people with dementia and their caregivers.
Originally from Wisconsin, Kalt grew up an only child and recalls being very close to her maternal grandmother: "I just loved her. She treated everyone like they were very special. That stays with you."
Kalt moved to Menlo Park in 1975 with her husband, Howard Kalt, a communications industry executive. Although she worked for a time as an instructional aide in the Portola Valley School District, she found the atmosphere too pressured and began to search for a different situation. She found it at Rosener House, and began working there part time while raising her two children.
"I started in 1981, when Rosener House was in a little school house. It was real mom-and-pop — I drove the bus," Kalt recalls with a laugh. Considerable changes have been made since then, many of which are due to Kalt's determined efforts to create what is now widely recognized as a state-of-the-art facility with a staff of 20 serving the needs of 120 regular participants in Rosener House's program.
Carrie Ramlow is the facility's staff social worker. She was hired last year by then-Director Kalt. What she has to say about her former boss is the stuff most people in positions of authority can only dream of: "In the short time that I worked for Barbara, I was reminded of why I initially went into my field of practice, and that being of service can still mean putting folks who are in need first, despite outside constraints.
"Barbara is a true visionary. She sees the big picture and doesn't allow politics, financial parameters, bureaucracies, bad weather, or anything else to serve as permanent obstacles to maintaining the quality of the RH program."
On the scene
On the day of The Almanac's visit to Rosener House, lunchtime was just concluding. We are invited into the large open dining room, a cheerful place with large windows looking out on the garden. Upbeat music from somewhere back-in-the-day is playing in the background. People are seated in attractively upholstered chairs around handsome round wooden tables — the kind you might find in a really nice restaurant. Colorful artwork adorns the walls and laughter is frequently heard above the buzz of constant conversation. Newspapers and magazines are arranged on a side table.
Kalt is there with her dog, Maddie. As they visit each table, people greet her by name and say how glad they are to see her. The atmosphere in the room and the woman making her rounds seem to be part of a whole, a sense that is echoed by Ramlow: "Rosener House reflects her and she is a reflection of it. Barbara just exudes this amazing light."
Maddie, a 3-year-old border collie mix, has been coming to work since she was an 8-week-old puppy. Maddie loves the interaction and is clearly happy to be back. One man is teaching Maddie the command for "shake hands" in Spanish. "Dame tu pata," he says. Maddie lifts her paw and the man chuckles with delight at what he has accomplished.
While people who are not afflicted with dementia might take it for granted, normal social interaction is another important aspect of the program. In many cases, people with dementia become increasingly isolated. Very often it is the caregivers, many of whom are struggling to maintain their own lives, who become the main source of interaction with the people they're caring for. "We see that people's friends tend to drop away when they are diagnosed," Kalt says.
When the dreaded diagnosis is made, Kalt says, it is often by a primary care physician who may not be attuned to the need to direct people to where they can be helped. "We still hear people say they've been told 'you're getting old, what do you expect? You have memory problems.' Our referrals are mostly from neurologists, but there aren't enough neurologists and hardly any geriatricians," she explains. This is due in part, she says, to the Medicare payment system. Partly in jest, she adds, "If doctors want to make a lot of money, they go into orthopedics."
Kalt says the first thing people often think of when it comes to a person who needs 24-hour care is "nursing home." Although options for people with dementia are limited, Kalt says that if at all possible, moving to a managed-care facility should be the last step.
The participants who come to Rosener House can remain in their homes and benefit from the range of programs designed to maintain good quality of life for as long as possible. "They get to make new friends, have a different social life and talk at the dinner table about what they did that day," Kalt says.
Relief for caregivers
As good as it is for Rosener House's participants, for caregivers, it is a godsend. Menlo Park resident Richard Grossman is 82 and has Alzheimer's disease. He has been attending Rosener House on a regular basis for over two years. His wife, Linda Grossman, who is his caregiver, says: "Rosener has been a sanity saver for me. Three days a week I have that five-hour block of time I can count on and a huge weight lifts from my shoulders.
"Caring for someone with Alzheimer's is emotionally exhausting, and it is now becoming physically taxing as well. Keeping Richard occupied, happy, and safe for five hours frees me from worry and allows me to have a little bit of a life. I love those remarkable people who envisioned the program and the devoted staff who lovingly and joyfully carry out the mission. Richard always leaves with a smile on his face."
Is Rosener House unique? "Yes it is, Kalt replies. "I'm sure there must be others somewhere in the U.S., but there's nothing like it in California that I know of."
As to why there aren't more places like Rosener House, Kalt explains: "The overall concept of adult day care is not well known and nonprofits don't have budgets for marketing and advertising. It is such a needed program and so much more cost-effective than either private home care, skilled nursing or assisted living."
According to Kalt, the cost for participants at Rosener House is about $95 per day. There are also reduced rates, the lowest of which is $40 per day. Cost of attendance can be covered by long-term-care insurance and through a contract with the Veterans Health Administration.
The program also receives funding from San Mateo County and the Sequoia Healthcare District. Surprisingly, Kalt says Rosener House does not have a waiting list and could take more people.
According to the Alzheimer's Association, 5.8 million Americans are living with Alzheimer's disease. As the country's population ages, this number is projected to rise to 14 million in the next 30 years. Kalt says the reality for people who are losing cognitive function is that not much has changed in the nearly 40 years she has worked at Rosener House.
"From a pure science perspective, there is a lot of research going on as to what causes Alzheimer's, but there is so much that is unknown," she notes.
Although there are drugs that can help in the short term, Kalt doesn't see that medications are currently a solution. "Social interaction and physical activities are really more important," she says. "This is what we have to do while research is going on. I wish there could be more recognition for the value of these programs and how hard people work to help the participants."
Although she has officially retired, Kalt isn't done; she expresses definite opinions on what can and should be done now as well as into the future.
"Maybe we should actually focus on the caregivers and what they are doing for society," Kalt says.
The numbers associated with elder care are stunning. According to AARP's Public Policy Institute, in 2013, 40 million family caregivers in the U.S. provided an estimated 37 billion hours of care. The value of this unpaid service was estimated at about $470 billion, which is roughly equivalent to Walmart's annual sales or the combined annual sales of Apple, IBM, Hewlett Packard and Microsoft..
Some 60% of family caregivers are caring for an adult while employed full or part time; one in four workers age 25 or over are family caregivers. A majority are women who manage by leaving early, arriving late and taking time off. Although the cost to businesses from lost productivity is said to be $33 billion annually, the human cost is much harder to pin down..
Also, unlike maternity leave, employers tend to have a different view of a worker who takes time to care for an older relative. While time away to care for a new baby is fairly well-defined and usually limited to a few months, a person caring for someone with Alzheimer's could be coping for years.
"With elder care, it's not that easy," Kalt notes."Some corporations who are more social-minded might have child care facilities. But do you know of anyone who has elder care? My dream would be to have some farsighted corporations make that investment."
Until then, Kalt says, there are things that companies can do now to help. "They can make people aware of FSA accounts (flexible spending accounts), which reduce income but provide tax-free money that can be used for care. More companies offering that would be helpful, as would EAPs (Employee Assistant Program) making people aware of resources in their community."
About her decision to retire, Kalt says: "I'm comfortable with the staff and where everything is at Rosener House right now. We have this tradition of innovation, and bringing the Tango Project was the top. When that happened, I said, OK — I'm done now!"
She's referring to an experimental therapeutic tango program she brought to Rosener House earlier this year. (See The Almanac's story on the program here.)
Kalt's enthusiasm for the Tango Project bubbles over: "In the beginning, Clarissa, the Argentinian instructor, asked people what they thought of the whole thing, and they were so articulate — I couldn't believe it! One man said, 'I feel that we are all just one here.' It was just so wonderful."
As a newly retired volunteer, Kalt participates in the program. She recalls a recent exchange: "I was dancing with a woman today, and I said, 'You have such good balance,' and she said, "Well I learned it here."
Kathi Minden has been Rosener House's family services manager for 12 years, and says: "I would follow Barbara into battle. She's a great leader."