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Bill Jaramillo, 79, had been diagnosed with dementia a few years earlier and it was Lepler’s mother, Lynette Jaramillo — the founder of Casa de la Luz Hospice — who had known every detail about his care.

The stress of losing his wife exacerbated Jaramillo’s memory problems and the family struggled to help him cope. “Some days he remembers she’s gone,� Lepler said, “and other days he has no idea.� The crisis peaked in April, she said, when her father fell and broke his hip.

The family arranged to have a caregiver with their father 24 hours each day, but they needed more than that if they were going to keep him home.

That’s when Lepler got connected with ElderHealth, a new ÃÛèÖÖ±²¥ medical practice that specializes in geriatric care, particularly for people with memory challenges, and offers a myriad of services including house calls, social work, caregiver support, and music and art therapy. The emphasis is on keeping patients home by bringing support and medical care directly to them.

The COVID-19 pandemic spurred the three women who started ElderHealth to get it going as soon as possible, they said, as an increasing number of people sought to avoid communal living for aging loved ones.

Lepler, who lives in Phoenix, is so grateful for that, and for having the ElderHealth staff available to call upon at any time.

“They have all been amazing,� she said. “I could finally go back to Phoenix and get back to work and take care of my family.�

‘Behaviors a way of communicating’

ElderHealth’s approach to patient care and family support involves some detective work, and also a bit of Maria Montessori’s philosophy.

Nurse practitioner Melissa Koon, who opened ElderHealth in April in partnership with Dr. Corinne Self and nurse practitioner Peggy Schmidt, said they learn all they can about their patients so their care and recommendations are sensitive to the person’s unique needs.

Part of that involves finding out about things their patients like to do, often from life before the cognitive challenges started, and part of that incorporates Montessori’s emphasis on children having tasks and being participants whenever possible. The same applies to people as they age, Koon said.

“These are the kinds of things that make people happy and remind them who they are,� said Koon. “What we forget is that people with cognitive issues still have the same needs.�

This approach also helps when a person’s behavior gets disruptive, which is the No. 1 reason caregivers might feel forced to move a loved one from home to communal care.

“We can use that information to do some detective work and find out what their behaviors are trying to tell us,� she said. “Behaviors are a way of communicating.�

As an example: Koon said when she worked in Louisiana, she was asked to do weekend rounds at a nearby nursing home where a man with memory challenges had been urinating in the indoor plant pots. “It was driving everyone nuts,� she said.

After talking to his wife and doing some research, Koon realized he was doing that only when the center started playing gospel music over the intercom. The man hated gospel music, it turns out, but loved rhythm and blues. The staff got him set up to hear his own music during that time. The problem? Solved.

Husband’s world was closing in

About three years ago, Tommijean Thomas fell getting out of bed, badly hit her head and suffered a brain hemorrhage.

That’s also when dementia was first mentioned and when, as husband Ben Thomas puts it, “the world started closing in.� Tommijean’s short-term memory loss was apparent earlier, he said, but the fall accelerated it.

It’s a hard shift for anyone, and particularly challenging for this couple who have been married nearly 50 years, raised six children and made 11 trips to India to study yoga with BKS Iyengar.

Tommijean worked as a psychologist in private practice and had been a professional dancer when she was young. Thomas, 82, worked in computer engineering for 40 years.

Now, Thomas just wants Tommijean, 79, to be able to stay with him at home.

He was told after that particularly bad fall that it might be time to begin investigating end-of-life care. He contacted Casa de la Luz Hospice but, as it turned out, she didn’t need hospice. However, she did need palliative care to help manage her medical and cognitive challenges.

Soon, through Casa de la Luz, Koon and a social worker named Laura Aylmer started visiting the Thomas home. They are still providing that care for the couple, but now it’s through ElderHealth, which the couple joined in April. Last week, physician Self made her first house call to their home.

As a palliative social worker, Aylmer helps Thomas by providing support and helping him navigate all of the information and options related to his wife’s care. Her training, she says, has taught her how to “hold space� for people as they go through difficult times or work out how to keep a loved one at home.

“At the heart of it all is being present, attentive, compassionate and interested in who the person, and family, is in front of me,� Alymer said. After she becomes familiar with their stories and what is important to them, she helps create a “plan of care that will improve quality of life and instill of sense of well-being as much as is possible along the road of a difficult journey.�

‘A memory is ignited’

Self has preferred house calls to office visits ever since she was exposed to the idea in medical school at the University of ÃÛèÖÖ±²¥.

During the pandemic, she said, those memories and the idea of ElderHealth began to take on more meaning.

“I thought, ‘OK, I’ve done all this work and now how am I going to take this to the next level and deliver the care that I want to deliver?’� said Self, who has a degree in internal medicine and, following a fellowship at Stanford University, a focus on geriatrics.

ElderHealth uses concierge medicine, also called membership medicine. That means that in addition to the costs of the care that are covered by a client’s health insurance, there is an extra fee to join: $2,200 per year or a little over $180 a month.

While ElderHealth takes Medicare and several commercial insurance plans, the membership fee enables it to provide the extras, Self said, such as caregiver support and music therapy.

“The reason music is so special is it’s not something we have to learn to process,â€� said Teresa Miller, their certified music therapist, who was in ÃÛèÖÖ±²¥ but is now living in Minnesota. “We just naturally respond.â€�

Miller provides therapy to patients mostly through video connections.

Music, she said, can provide a way for couples to reconnect or for people with memory issues to get to memories that are still intact.

“If a memory is ignited (through music),� she said, “that person is suddenly there, in their body again.�

‘Realized there was this need’

Self and Koon had children at the same preschool a few years back, where they did some talks there about the human body and, included in that, aging.

“Corinne and I partnered up to do the brain and dementia� discussions, Koon said. “We wanted the children to not be afraid of people with dementia.�

Koon and Self both knew Peggy Schmidt from the community’s network of geriatric providers and so this year, as the pandemic dragged on, the three women began to talk about a shared vision.

Schmidt knows well the toll of being a caregiver. She had just graduated from nursing school in Washington state when her father was diagnosed with Alzheimer’s disease. She was 24 at the time and he was 57.

She didn’t live in the same town as her parents anymore and so, for two years, she would drive home whenever she could to help him and give her mother respite. Her parents’ friends, unsure of what to do, didn’t reach out very often and so Schmidt’s mother was in desperate need of help.

“Everyone was afraid of doing anything with my dad,â€� said Schmidt, who has been in ÃÛèÖÖ±²¥ since 2005. “I told my mom, ‘You can’t keep doing this. You’re going to ruin your health.’â€�

It’s something she’s carried with her ever since, through a career that’s included geriatric work at Veterans Affairs.

“We realized that there was this need and that unless you had a lot of resources and a lot of family, it’s hard to provide for loved ones at home, especially for the spouses,� she said. “Spouses are just wearing themselves out trying to be a caregiver. It’s about their quality of life, too.�