Experts share practical advice on communication, burnout, decision-making, and preserving dignity throughout the caregiving journey
The questions in this issue’s roundtable stem from the personal experiences of many of our colleagues. Together, they describe a shift that happens as our loved ones age and need more intensive care. Communication becomes more challenging ; physical abilities change, leading to frustration for everyone; and caregiving itself becomes so demanding that burnout is a common reality.
We’re fortunate to have so many experts we can reach out to on the many issues that arise while caring for someone you love. Read on for their perspectives on some of the challenges that crop up, and how they meet people where they are.
Meeting someone where they are is often easier said than done. Describe a time when you got it right – or wrong – with an older adult and what that experience taught you.
Matt Field: We got a call from an independent living community. A new resident with dementia was calling the police from every phone she could find, saying she was being held against her will. She tried to escape daily. Everyone was focused on containment. We asked her about home. She softened immediately. She told us about her dog. She didn’t have a behavioral problem. She was grieving.
Jennifer Novy: A client with dementia kept trying to “leave for work” each morning, growing distressed. Instead of correcting her, we set up a small desk with familiar tasks. The agitation vanished. It taught me: Don’t argue with someone’s reality; step into it. Validation, not correction, is how you meet them.
Mark Mullahy: I once worked with a family whose mother was living in independent living and beginning hospice care. The family was trying to decide whether she should remain in her apartment or move to our healthcare center. We spent time discussing the pros and cons of both options, focusing mostly on the care and support available in each setting. From a clinical standpoint, I knew healthcare could provide a higher level of care. But because I knew the resident personally, I also knew what mattered most to her. Every morning she would wake up, make a cup of coffee, take her book, and sit on her patio. That simple routine brought her peace and joy. I shared that with the family and said, “The one thing she would lose in healthcare is the ability to sit on her patio with her coffee and book each morning.” That caused everyone to pause. The conversation shifted from “What care can we provide?” to “What would Mom want?” She remained in independent living with hospice support and was able to stay in the home she loved until she passed. Her family later thanked me for helping them see beyond the clinical decision and focus on what mattered most to her. That experience reinforced for me that meeting someone where they are means understanding not only their needs, but also the routines, choices, and moments that give their life meaning.
People’s needs, abilities, and preferences shift with age, sometimes daily. How do you stay current with a person’s present state?
Erica Schaefer: Working in a continuing care retirement community allows me to support older adults through every stage of aging. As needs change, collaboration among caregivers, nurses, therapists, and other team members helps identify concerns early and connect residents with the right support to maintain their quality of life.
Mark Mullahy: I believe the best way to stay current with someone is to focus on the who rather than just the what. Abilities and preferences may shift over time — sometimes even daily — but a person’s passions, values, and sense of identity often remain consistent. When we take the time to understand what matters most to someone, what brings them joy, and what gives them purpose, we gain a much deeper understanding of how to connect with them in meaningful ways. Those connections create trust, and trust allows us to better recognize changes, respond appropriately, and continue meeting them where they are in that moment.
Jennifer Novy: I treat every visit as a fresh assessment. Formal caregivers track small changes in appetite, mood, balance, and word-finding, and report them daily. What was true last week may not hold today, especially with a dementia diagnosis. Staying current means listening more than assuming and trusting the caregiver feedback closest to the person.
What’s one assumption families or professionals commonly make about older adults that you wish they’d let go of?
Jennifer Novy: That a diagnosis defines the person. It does not. Someone with dementia is still curious, still joyful, still themselves. When families see only the disease, they stop offering choices and connection. There is value in every person, at every stage. Honoring their wishes amid decline sustains dignity and love.
Michael Zywicki: That their loved one might get better. The unfortunate reality is that your loved one will not get better. They may have good days; they might adjust to a new environment or routine and thrive for a while. Treat every day as their best day, embrace the good moments, and make the most of your time.
Matt Field: That the goal isn’t always to restore what was lost. Sometimes the goal is to live well within what remains. When families spend every visit grieving what their loved one can no longer do, they miss what is still possible. Presence in the present is a form of care.
When health issues such as dementia, stroke, or hearing loss make communication with an older adult challenging, what shifts have made the biggest difference in your experience?
Erica Schaefer: Effective communication starts with slowing down and adapting to the individual. Simple strategies such as one-step directions, visual reminders, or allowing extra time can make a meaningful difference. One of my favorite interventions is a handwritten note from a trusted family member. Familiar words and handwriting can encourage participation in care when staff reminders cannot.
Jessica Katz: I truly value the annual state requirement of 10 hours of dementia training per year that our staff receives. Learning about person-centered care and how to meet a resident with dementia wherever they are in their reality is so special. If a resident is dwelling on an afternoon in 1978, for example, I’m more than happy to meet them there and learn all about their life at that moment in time.
Jennifer Novy: Slowing down changes everything. I move to eye level, cut background noise, speak clearly, ask one thing at a time, and leave time to respond. After a stroke, the words may be trapped, not the mind, so I offer yes/no choices, gestures, pictures, and try not to finish their sentences unless they are asking me to help.
What’s one assumption families or professionals commonly make about older adults that you wish they’d let go of?
Jennifer Novy: That a diagnosis defines the person. It does not. Someone with dementia is still curious, still joyful, still themselves. When families see only the disease, they stop offering choices and connection. There is value in every person, at every stage. Honoring their wishes amid decline sustains dignity and love.
Michael Zywicki: That their loved one might get better. The unfortunate reality is that your loved one will not get better. They may have good days; they might adjust to a new environment or routine and thrive for a while. Treat every day as their best day, embrace the good moments, and make the most of your time.
Matt Field: That the goal isn’t always to restore what was lost. Sometimes the goal is to live well within what remains. When families spend every visit grieving what their loved one can no longer do, they miss what is still possible. Presence in the present is a form of care.
When health issues such as dementia, stroke, or hearing loss make communication with an older adult challenging, what shifts have made the biggest difference in your experience?
Erica Schaefer: Effective communication starts with slowing down and adapting to the individual. Simple strategies such as one-step directions, visual reminders, or allowing extra time can make a meaningful difference. One of my favorite interventions is a handwritten note from a trusted family member. Familiar words and handwriting can encourage participation in care when staff reminders cannot.
Jessica Katz: I truly value the annual state requirement of 10 hours of dementia training per year that our staff receives. Learning about person-centered care and how to meet a resident with dementia wherever they are in their reality is so special. If a resident is dwelling on an afternoon in 1978, for example, I’m more than happy to meet them there and learn all about their life at that moment in time.
Jennifer Novy: Slowing down changes everything. I move to eye level, cut background noise, speak clearly, ask one thing at a time, and leave time to respond. After a stroke, the words may be trapped, not the mind, so I offer yes/no choices, gestures, pictures, and try not to finish their sentences unless they are asking me to help.
How do you handle the moment when an older adult wants something different than their family, and you’re caught in the middle?
Michael Zywicki: You handle the conversation with grace, but also with confidence. Many families are not educated about the disease. They rely on us as experts to help guide them through this difficult time. If a resident voices their needs and is clashing with their family, we must be the advocate for the resident and help make their needs understood by the family.
Erica Schaefer: Family disagreements often come from a place of love, fear, guilt, or a desire to protect. When tensions rise, I slow the conversation down and ask, “Tell me more.” Those three words often uncover what people are truly worried about and help refocus decisions on the older adult’s wishes and quality of life.
Matt Field: I go back to the person. They are the focus. Families act out of love and fear, sometimes in equal measure. But the older adult’s voice has to be the anchor. My job isn’t to mediate. It’s to make sure that voice doesn’t get lost.
Caregiver burnout is constant in this field. What helps, beyond the usual advice?
Jessica Katz: I try to remind my residents’ loved ones to do something nice for themselves. Take a pleasant walk along the lake, or treat themselves to a fancy cup of coffee or glass of wine on a difficult day. Taking time to heal, reflect, or grieve on a daily basis is an important part of caregiving.
Michael Zywicki: Providing opportunities for the caregivers to step away and reset when days are stressful. This isn’t always easy when each day is busy and full of challenges. But even an unplanned 10-minute break to walk outside and get some fresh air can help. The key is to know our staff well enough to know when they need a moment to regroup. I also think providing ongoing education can help with burnout. If caregivers feel empowered and knowledgeable, they are much more likely to be able to work through the difficult situations with confidence.
Matt Field: Honest conversation about what the role actually costs. Most caregivers — family or professional — are carrying losses they’ve never named out loud. The usual advice treats burnout like a logistics problem. It’s not. It’s a grief problem. When people feel genuinely seen in what they’re carrying, something shifts. That’s where it starts.
How do you build genuine continuity of care when staff turnover is an industry reality?
Mark Mullahy: I believe continuity of care is built through culture. In our field, people will come and go — that is a reality of the industry. Residents move in, staff members change, and teams evolve. But while people may change, the culture of an organization should remain steady. A strong culture creates consistency in how people are welcomed, supported, and cared for. It gives new staff a clear understanding of expectations and helps them feel connected from the beginning. When people feel respected, prepared, and part of something meaningful, they are more likely to stay and more likely to provide consistent care. Turnover may be part of healthcare today, but culture determines whether that turnover disrupts the resident experience. A supportive, welcoming, mission-driven culture allows continuity to continue beyond any one individual. Residents feel it, families feel it, and staff feel it. That is where genuine continuity of care begins.
Michael Zywicki: Help the caregiver understand that care is just one part of a resident’s overall sense of purpose. If a caregiver only provides care, they will often receive resistance because care can place a resident in a vulnerable position where the focus is on what they need help with rather than what they can still contribute. Building relationships through engagement, purpose, and shared experiences helps balance that dynamic and creates trust. It also eases staff members’ constant resistance from residents, which leads to more enjoyment in their jobs. This reduces turnover.
Erica Schaefer: Staff turnover is inevitable, but continuity of care should not depend on one person. Families want to know their loved one is known as a person, not just a task list. Strong communication, detailed care plans, and thoughtful handoffs help ensure that knowledge and connection continue despite staffing changes.
What’s one legal or planning step families consistently put off that you wish they’d handle earlier?
Rachel Paus: Complete every legal and financial document much earlier, before there are questions about the person’s cognitive abilities. Families often think they have more time than they do. Having powers of attorney for healthcare and finances, discussing end-of-life wishes, and organizing important accounts spare families an enormous amount of stress later.
Erica Schaefer: Early in my nursing career, I was uncomfortable discussing death, so I understand why families avoid these conversations. However, advance care planning is not about giving up hope. It is about ensuring wishes are honored and helping loved ones avoid the uncertainty, conflict, guilt, and second-guessing that can follow a crisis.
Jessica Katz: Advance directives, estate planning, and end-of-life preparation. I tell my families, “It can never be too early, but it can always be too late.” I prepared my estate planning and power of attorney documents two years ago, at age 38, as a direct result of learning this important lesson.
What one piece of advice would you give to a family just beginning its caregiving journey with an aging loved one?
Jessica Katz: This is something I learned from my parents’ thoughtful caregiving journeys with my grandparents: It’s not about us as caregivers. A family’s primary focus should be on facilitating their loved one’s wishes as much as is feasible. It can be tough to get past a lifetime of difficult family dynamics, but setting a loved one up for success at the beginning of a care journey will set the tone for everything that follows.
Erica Schaefer: As someone who is walking this journey with my own parents, I remind myself that not every problem needs to be fixed immediately. Sometimes the most important thing is simply being present. The paperwork, appointments, and decisions matter, but so do the stories, laughter, and moments you still have together.
Rachel Paus: Don’t try to do it alone. Accepting help is one of the hardest lessons many caregivers learn. Whether it’s family, friends, support groups, or community resources, building
a support system early can make all the difference. Caregiving is often a marathon, not a sprint, and preserving your own well-being is not selfish.
As your loved one feels increasingly frustrated by physical limitations, how can you help them find hope and meaning? How can you encourage physical activity at whatever level they’re able?
Michael Zywicki: As abilities change, focus on what remains possible rather than what has been lost. Purpose doesn’t require physical strength. Helping fold towels, watering plants, welcoming visitors, or setting tables can create meaning. Physical activity is most successful when it’s connected to something the person enjoys or values.
Rachel Paus: Purpose matters just as much as physical ability. As people age and lose some independence, they can begin to feel like they’re no longer contributing. Remain engaged. I found it was important to have my children continue visiting my dad even after his dementia progressed. This provided a renewed sense of meaning.
Mark Mullahy: Hope and meaning often come from continuing to feel engaged, included, and capable — even when physical abilities change. It’s important to focus on what someone can do rather than what they can no longer do. Small successes matter, and celebrating those moments can build confidence and motivation. There are more ways than ever to stay physically active at any level. Chair exercises, stretching, walking, music-based movement, water exercise, or adaptive fitness programs can all be meaningful. I find it helps when activity feels enjoyable rather than clinical. Adding music, humor, companionship, or doing the activity alongside someone can make it feel less like exercising and more like living. Technology and adaptive equipment can also open doors and create new opportunities for movement and independence. Most importantly, encouragement should always be personalized. When activity connects to something a person enjoys, it becomes less about exercise and more about maintaining quality of life.
Many older adults refuse help even when assistance would clearly enhance their day. In your experience, how have you shown someone the benefits of help?
Matt Field: By not leading with help. Lead with the relationship. Once someone trusts that we see them as a person and not a problem to be managed, the conversation about help becomes possible. Resistance usually isn’t stubbornness. It’s self-protection. Earn the trust first. The rest tends to follow.
Jessica Katz: I’m a big proponent of animal-assisted therapy; I volunteered weekly at Selfhelp with my certified therapy dog from 2017 to 2020 before I started working there in 2022. Research has shown that having a friendly pet present encourages people to work harder in physical therapy and to feel less anxiety or fear.
Rachel Paus: There were times when introducing help gradually worked better than presenting it as a major change. Small successes built trust. Above all, patience and empathy are critical. Many older adults are grieving the loss of independence, and acknowledging those feelings can go a long way toward helping them accept support.
Mark Mullahy: I think many people, especially older adults, grew up valuing independence and self-reliance. Accepting help can sometimes feel like losing control or becoming a burden. Because of that, I think it’s important that support never feels one-sided. One of the best ways to show someone the benefits of help is to create a relationship where there is still a sense of give and take. Older adults bring a lifetime of experience, wisdom, and perspective. Even while we may be helping with physical tasks, there is still so much they can offer in return — advice, guidance, stories, humor, and insight. I try to approach those moments as conversations rather than tasks. While assisting someone, I ask for their thoughts, invite their opinions, and genuinely listen. When people feel respected, valued, and included — not simply cared for — they’re often much more open to accepting support. Help feels less like dependence and more like connection.
Jennifer Novy: I never lead with the word “help.” I start small and let the value speak for itself. A caregiver who shares a hobby or cooks a favorite meal, frees them for what matters most that day. Once someone feels more capable, not less, resistance may soften. Care should promote independence, never surrendering it.
Originally published in the Summer/Fall 2026 print issue.