Impact Of Behavior Acuity On Senior Living – with Dr. Paul Nussbaum Ph.D., ABPP

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Dr. Paul Nussbaum Ph.D.,ABPP
Dr. Paul Nussbaum Ph.D.,ABPP

If you are caring for a loved one with dementia (or the hundreds of forms of dementia), it is important to understand how the brain works. What is the purpose of your brain? The brain controls and coordinates actions and reactions that allow us to think and feel and enables us to have memories and feelings—all the things that make us human.

Today’s episode is with Dr. Paul Nussbaum Ph.D.,ABPP, President and Founder of the Brain Health Center, Inc., Clinical Neuropsychologist, and Adjunct Professor of Neurological Surgery University of Pittsburgh School of Medicine. He is board certified in Clinical Psychology and Geropsychology with specialization in Neuropsychology, aging, brain health and brain health lifestyle. He maintains a private practice in Pittsburgh where he conducts independent neuropsychological exams, record reviews, depositions, and courtroom testimony.

He maintains an active consulting business in Naples, Florida, which consists of serving as a face, an identity of brain health for companies and providing clinical programmatic training and strategic direction to senior living. He’s also a keynote speaker on the miracle of the brain and brain health across the lifespan to education, business, financial, health care, religion, and professional organizations.

Please join me and Dr. Paul Nussbaum Ph.D.,ABPP, Neuropsychologist, Consultant, and Keynoter. Hear him share his thoughts on behavioral acuity, and the importance of a healthy brain lifestyle across your lifespan from a neuropsychologist’s point of view.

Learn more about memory loss and behavioral acuity and why we should bridge psychiatrists, neuropsychologists, psychologists, social workers, and bring them on board and over into senior living facilities.

Dr. Nussbaum is Board Certified in Clinical and Geropsychology with specialization in Neuropsychology, aging, brain health, and brain health lifestyle®. He maintains a Private Practice in Pittsburgh where he conducts Independent Neuropsychological and Psychological Exams, Record Reviews, Deposition and courtroom testimony. Licensed in PA and FL.

Dr. Nussbaum maintains an active Consultant Business from his office in Naples. This includes:

Serving as the face and identity of Brain Health for companies.
Providing clinical, programmatic, training, and strategic direction to Senior Living.
Assisting start up companies in digital and mobile brain health.
Neuroscienttific and behavioral consultant to wealth managers
Providing expert advice to VC investors

Keynoter on the miracle of the brain and brain health across the lifespan to education, business, financial, healthcare, religion, and professional organizations.

Hanh Brown: [00:00:00] Hi, Paul, How are you?

Dr. Paul Nussbaum: [00:02:09] I’m doing good.

Hanh Brown: [00:02:15] . Well, Hey, how are things going over there? You’re in Pennsylvania.

Dr. Paul Nussbaum: [00:02:09] I’m in Marco Island, Florida. I have an office in Pittsburgh, Pennsylvania though. So things are great here.

Hanh Brown: [00:02:15] I am in Michigan, 15 minutes away from Ann Arbor. thank you so much for your time. So let’s learn more about the brain. What is the purpose?

Dr. Paul Nussbaum: [00:02:31] No book on that. And it’s, in my opinion, is to connect with God. I think it was granted us by God, so that we could communicate with him or not. And to do things that are neuro spiritually. Healthy such as love and forgiveness and kindness and compassion, those things that we know about, but that certainly in the medical field where I was trained, doesn’t talk enough about, and we never write prescriptions for that duly, but those are very, very healthy for us.

[00:02:57] And when you talked about in your own video with the boomers, things that we can do to plan is not just the diet that we eat, or the physical exercise of the socialization, that things that make up migraine health lifestyle. But it goes beyond that. Neurochemically to do the things that kind of keep us in balance and harmony and peace, and those things can be practiced.

[00:03:17] So that’s, I’ve been spending a little bit of time thinking about that. So that’s the short answer to that question.

Hanh Brown: [00:03:21] Memory care and dementia care, both are a huge undertaking and will require staff members to be properly trained. And to do that effectively, you need to understand how the brain works.

Dr. Paul Nussbaum: [00:03:33] No, that’s right.

[00:03:33] And it’s not the cool thing about this is your brain really doesn’t know how old it is. It just wants to be stimulated in ways that you articulated in your website video. But these things are really important all across the lifespan and can be beneficial to all of us, regardless of where we live.

Hanh Brown: [00:03:50] What is senior living mean to you?

Dr. Paul Nussbaum: [00:03:52] Yeah, so that’s something that’s an interesting concept and it’s really, that’s a pretty broad concept. I think traditionally what it means, at least in the United States is. It’s sort of an industry that’s set up to provide what has been traditional housing and sort of hospitality, which then migrated into medical issues and housing out of need because the boomers in particular made some decisions for their parents that they didn’t want them to live in nursing homes.

[00:04:20] That tended to be two clinicals. So this migration got shifted over into the buildings that had the fancy chandelier’s and the nice carpeting. And so what happened was an evolution of this pretty good business model for housing and hospitality, that then got shifted into medical acuity and increased frailty and vulnerability and senior living quote unquote, which can include a full continuum of care, independent living through.

[00:04:47] Uh, late stage dementia, I really had to add to adapt. And I think that adaptation is still taking place on, I’ve been doing this a long time, but had the opportunity to be in the senior living industry. As I’m thinking about it right now, I’m talking to you about it for like 30 years. So we’ve done a pretty good job of getting medical personnel into these buildings and into the continuum to make sure that the diabetes and frailty and all those things are being managed.

[00:05:15] My biggest concern is that there’s going to be an onslaught and there already has started to be a kind of a tsunami of dementia. And so we have this new product called memory chair. There’s still not enough memory care facilities or. Units within the senior living continuum. Nonetheless, it’s the number one growing part of the business, but what I’ve told CEOs and what I’ve written about and talked about for anybody that wants to hear my opinion is that that’s not going to be the biggest problem.

[00:05:41] It’s not the biggest problem for senior living industry is behavioral acuity. And so with memory care memory is really not a problem. I mean, it can be managed, but behavioral acuity is a problem. Right now, senior living, as I’m talking about it is not sufficiently prepared. It’s not sufficiently expert.

[00:06:01] They’re going to need to really think innovatively. They’re going to need to think differently about how to manage behavioral problems. This includes things such as sleep disorder, acting out anxiety, psychosis. Depression loneliness. And the industry is not sufficiently prepared for that now. So that’s a challenge.

[00:06:20] The good news is we have a lot of smart people in the business and housing and hospitality and medical field that can, that can rise to the occasion, but we’re not there right now.

Hanh Brown: [00:06:29] What impact are you making in the senior living for the baby boomers?

Dr. Paul Nussbaum: [00:06:32] Yeah, so I, I don’t know that I can answer that fairly.

[00:06:35] I don’t know that there’s probably other judges that I’ve been, I’ve been writing, reading and speaking to hundreds of thousands of people across the planet on aging, which actually doesn’t begin at 65. It begins in the womb and it’s a lifespan issue. Right. So, and what I’ve been trying to do is to help.

[00:06:52] People people be proactive to be empowered, to not just live a lot of years, but live quality. And so that has to begin early. What I learned. And I’m a board certified general psychologist. One of the very few there you talked about only 6,000 geriatricians. There’s even fewer general psychologists. So I’m a pretty rare animal.

[00:07:12] I think there’s less than a hundred in the country. And one of the things I learned was that in order to sort of. Age in the latter life span successfully, you have to start very early in life. So my work has really been to help with training and development, with working alongside the executive directors and CEOs and boards of senior living.

[00:07:32] I was a national director of brain health for 13 years at Ameritas. They were purchased by Brookdale. I then took on that post for them. And I’ve been in and out of a lot of different senior communities, helping them from everything from like I say, training and development, helping with the families to help him with the color of the walls should be for certain programs to developing memory care programs and to help to answer the kind of questions that boomers have.

[00:07:56] Not only for themselves, but also fair for their parents as boomers tend to be primary caregivers of aging parents now. So, and I’ll continue to do that. And I have my email and my contact information available across the planet. Do a lot of quiet work, helping to answer questions of those who maybe need.

Hanh Brown: [00:08:14] So your website is brain health. again, it’s brain health, and listeners. You can follow Paul on Twitter at brain health lifestyle again on Twitter it’s brain health lifestyle. So is your work internationally then?

Dr. Paul Nussbaum: [00:08:36] Yeah, my work is really international it’s I live in near Naples, Florida. My office is in Pittsburgh, Pennsylvania, and Pittsburgh, Pennsylvania.

[00:08:45] I do some, some clinical work, although that’s really short. So basically people go to my website, which is brain health, And I’ll be contacted. And I’ll be asked to come in, perhaps for example, and do a talk to, uh, help, to review programs that are being strategically designed to help, to answer some of the questions you’re raising to me now, where the industry should go to help create digital apps that can help cognitive stimulation, this type thing to help provide expertise and to where the whole industry needs to go.

[00:09:15] And so I kind of get out without having a formal office. I get about all over the country and. I dunno, probably I’ve been with, I don’t know, 50 or more quote-unquote companies within the senior living industry. Helping them on a contractual basis.

Hanh Brown: [00:09:31] your services are in brain health, managing behavior care, Alzheimer’s disease and dementia.

[00:09:38] Is that right?

Dr. Paul Nussbaum: [00:09:38] Yeah. Yeah. I need to call it. And a lot of it has been in brain health, but I came on and still I’m still supposedly quote, unquote, an expert in things like Alzheimer’s disease and dementia and how to manage care and behavioral care. And certainly I’m now very interested in passionate about what we all need to do to kind of live proactively healthy lifestyle and a brain healthy lifestyle across the lifespan.

Hanh Brown: [00:10:01] So you mentioned behavior acuity issues are going to be a bigger undertaking than the issues associated with memory loss from dementia. So what is being done right now to address this. And, um, what do you see the direction that we need to head into to do a better job?

Dr. Paul Nussbaum: [00:10:16] Yeah, that’s a great question. So I just gave a presentation last year at the national conference for our gentlemen, and I’d never done that and they really hadn’t had any talks on mental health.

[00:10:25] Interestingly, she tells you because that’s the conference for the national leaders, the CEOs of senior living. And I raised this with them and dementia, as you know, is just a clinical description of. Symptoms and signs and there’s a hundred different types of dementia. The number one type is Alzheimer’s.

[00:10:41] So when we say dementia and there’s a lot of things that go on with that, that need to be managed, but what the industry has done and senior living is they’ve thought about this in terms of memory care. And that’s why you hear this memory care product. And it’s the fastest growing product along the continuum that you are teacher, you’re a website video.

[00:11:00] And so independent living assisted living memory care, you have outpatient programs and this and that. The issue with memory care though, is it sort of as a marketing thing and what happens is in the industry they have now separate buildings just set up for memory care. Sometimes within the assisted living facility, they’ll have separate units.

[00:11:19] And so there’s a fragmentation and a kind of a splitting of those with sort of cognitive impairment to find this dimension. And what I’m saying to them is you can call it memory care, but we’re not recognizing what the real issue is going to be, and it already has started. So the thing that keeps CEOs up at night are the residents who were screaming out loud at night and they’re not sleeping and they’re hitting and they’re acting out and they’re incontinent and they’re psychotic and on and on and off.

[00:11:44] So the senior living industry is not sufficiently. Staffed or trained or organized yet to manage this. And the more these memory care programs come online, the more dementia is going to be part and parcel and a primary focus of senior living. The more behavioral issues are going to be problematic. So what do we do?

[00:12:02] I think, first of all, we strategically have to conceptually. Recognize the issue. And so we haven’t done that. I’m sort of like sometimes for like a lone Wolf out there trying to alert everybody to what’s coming and what is already here. And so we have to, we have to have training programs set up specifically to train the staff on the front lines, not just about different types of dementia, but literally about the behaviors.

[00:12:23] We don’t want to send these residents to psychiatric facilities where they go in and tend to get medicated and come back and. Sometimes they’re worse off than when we send them out. We definitely don’t want to send with the acute care medical system because they don’t know enough about behavioral issues.

[00:12:38] So we have to kind of create programs that says I’m the senior living, living facility. I’m adequately staffed. I’m adequately expertise expert in the management of those who have behavioral problems. We welcome them. We believe we’re expert at managing this. We have to have adequate staff. Adequate number of staff or ongoing training programs.

[00:13:00] We have to begin to introduce technology in ways we haven’t introduced technology into these facilities. We have to be able to make sure that we have the caregiver family as part of the treatment team on an ongoing basis. We have to have sufficient expertise from psychiatrists, neuropsychologists, psychologists, social workers on board.

[00:13:17] Oftentimes this is done in a way where the psychiatrist only comes out once every three or four weeks. And that’s really not sufficient. I believe there should be like a psychologist on staff. Yeah. And that there need to be behavioral rounds where Intergen or inter disciplinary team, including the dietary spiritual rehab.

[00:13:37] Medical, psychological nursing staff, all meet. There need to be sections of the charts, set up for behavior, and I can go on and on and on. And we have to have an empirical approach where we’re measuring intensity and frequency of certain target behaviors, right? Because that’s the only way our intervention is going to be shown to be effective.

[00:13:54] So these are ways. That I think at a minimum need to be thought about, I work with senior living facilities on these issues. I think it can get done, but it needs to be sort of recognized first and admitted to that.

Hanh Brown: [00:14:08] coming training for gerontology, geriatric neurology and its subcategories.

[00:14:15] Are you saying that all of these disciplines and sub-disciplines need to be integral to the senior living operation?

Dr. Paul Nussbaum: [00:14:21] So within the medical field, as you just mentioned, some of the sub disciplines that they have adequate training, they know what to do, that the issue becomes the bridging of those folks into what you and I are talking about is senior living.

[00:14:32] For example, I was national director of brain health for the largest senior living company in America. So that was pretty unique. So what that said was the CEO thought it was valuable not to have a guy that’s a neuropsychologist neuro-psychology to kind of be around work with the staff, right. Uh, to answer questions.

[00:14:50] What we need to do from a senior living industry perspective is bring that talent that is in the medical field. Isn’t the nursing field is in the psychological field, more frequently into the campuses, the facilities, the buildings where senior living occurs there is if I’m a senior living person right now, listening to this, I’m going to fight back a little bit, push back on dr.

[00:15:11] Nussbaum here and say, you know what? We have really good ongoing training programs, I would say. Yeah. You know, I agree with you, but it tends to be on things such as Alzheimer’s versus vascular dementia, depression years, our activities program, or residential program. This is what we do. We have a wellness program now, but it’s just not sufficiently expert to the point where, in my opinion, there need to be more, if not full time, certainly consultants that come in on a weekly basis that have the sufficient expertise, because then, like, for example, what I do is I teach them.

[00:15:44] The men and women on the front line on an ongoing basis who were actually the most important because they’re caring for these folks. I teach the families, I teach the CEO. I teach the maintenance people about what goes on in the brain when you have a dementia specific type and the behaviors that can occur and will occur and how we manage them.

[00:16:02] So that everybody feels sufficiently expert. I created one time, a thing called the behavioral intensive care center that sat within a nursing home. This was 25 years ago for pizza. And the idea was that we would have sort of our special forces training. There for that staff. Interestingly, you would think that because we had the worst of the worst from that continuum, go to that behavioral chance of care center for a short stay, rather than go to a psychiatric facility.

[00:16:29] You’d think that the staff would not want to work there because it’s too difficult. Right? Well, it turns out the rate of departure, the turnover there for that staff was lowest in that intensive care centers. So what we learned was that not only can we manage these behaviors within us efficiently, Using a sufficiently trained staff, but that staff is so, so psychologically committed.

[00:16:48] They don’t leave. So that’s the idea of how do we bridge the expertise that’s out there that tends to find his way in silos of medical fields and medical departments and hospitals, and get it transitioned over into the senior living facilities where it’s desperately needed.

Hanh Brown: [00:17:06] I love the folks that are in dementia care.

[00:17:08] Who’s facing Alzheimer’s depression. What percentage of those folks have behavior issues?

Dr. Paul Nussbaum: [00:17:13] So it varies by setting interestingly. So in the nursing home, about 90% in quote unquote assisted living, it’s going to be over 50%. And my point is, and that’s today. And on my website, there’s a white paper there on important documents where I went over all this and have all the statistics.

[00:17:34] But my point is, and you know, this very well that this is a dynamic system, right? So the senior living industry is moving and changing rapidly. Part of it’s because of the demographics and what we’re talking about right now today, you and me, those numbers are only going to increase because. Memory care is becoming more and more pronounced.

[00:17:51] There’s more facilities going up. We’re going to go from 5 million to 15 million Americans with just Alzheimer’s disease in this country, let alone the other 99 types of dementia. So there’s just, it’s a real, it’s a real problem. And it’s an economic issue as you point out. And it’s a quality of life issue.

[00:18:08] And for the boomer, who’s the caregiver right now is the son or daughter of a person with. Behavioral problems, dementia. I’m going to sleep better at night. If they know that mom or dad’s being managed by individuals who cared for my individuals who really know what they’re doing, it’s not just pretty chandelier’s carpeting.

Hanh Brown: [00:18:26] In the early stages.

[00:18:27] People with dementia may experience, uh, behavior and personality changes such as irritability, anxiety, depression. And then later they may have symptoms like aggression and anger, anxiety and agitation, um, some emotional distress, maybe physical and verbal outbursts, um, pacing, shredding of paper, hallucination, delusions, and sleeping issues.

Hanh Brown: [00:18:55]So, when a dementia patient goes through this, what happened?

Dr. Paul Nussbaum: [00:19:01] Yeah. So typically what happens is this is in facilities where there are resources because a number of these facilities don’t have the resources. So it’s not uncommon that they would call the medical doctor that they would call a psychiatrist.

[00:19:13] Like I said, who doesn’t come in frequently and not because he or she’s busy, the staff will try to manage the behaviors as best they can. Medications will be prescribed to settle the behavior down. Behavioral interventions will be attempted, hopefully. And probably more often than not the person who cannot be managed will be sent to a psychiatric facility for a short-term stay to have behaviors, hopefully resolved.

[00:19:40] And then the person will be sent back. Problem with that is oftentimes all of that movement. Within an acute care to an acute care facility only increases the behaviors. So they don’t necessarily come back any better. I’m sure if you talk to frontline staff, they would agree with that. These folks tend not to facilities, tend not to be staffed quite well enough.

[00:20:04] And so the ability to have. Sufficient resources there to manage. These behaviors is always problematic for folks within memory care. The staffing is a bit better approaches a bit better, but we’ve got to do a better job in the senior living industry. It’s one of the calls to action that I’ve been trying to announce here to folks over the past year, two years.

Hanh Brown: [00:20:25] What does aging mean to you?

Dr. Paul Nussbaum: [00:20:27] Yeah, that’s a good question. I read a thing the other day where, um, Are beginning to scientists are beginning to really tweak the, the genome and the animals to literally stop the aging process. So some people look at aging as a disease. Some people look at aging as natural process.

[00:20:44] For me, it’s a continual process, continual normal process of the human condition. And we, we tend to kind of screw it up a little bit. The United States of America, if not across the planet, in that we try to segment the aging process into Lordy Lordy. I’m 40, when you’re 50, you get the ERP car. And when you’re 65 and over all these policies kick in and we don’t know why they kick in at 65, but they do.

[00:21:06] So we think about aging and the latter life span differently than the younger life span for me. Aging begins in the womb and it continues until the last. Day that the moment that we breathe and the idea for me is to try to try to create quality during those two anchors. Right? So from the womb out until the last breath, let’s create as much quality as we can.

[00:21:28] And most of that tends to be along the psychosocial behavioral continuum, not along the medical continuum. Interestingly.

Hanh Brown: [00:21:35]What are your thoughts or plans for your loved ones? Uh, senior living option.

Dr. Paul Nussbaum: [00:21:39] Yeah. So my, my mother right now is going to be turning 96 months and my dad just passed at 92. They were living together in an apartment when I finally convinced them to leave their three-story home and go into a one level apartment.

[00:21:54] Part of getting older successfully, as you tend to be a bit stubborn, but I would’ve seen you’re living. The continuum has to include the home. We all tend to find quality of life in our home. Home has a lot of. Psychological spiritual, meaning health health promoting, going into a hospital in our country is a risk factor for depression.

[00:22:14] So I don’t need to say anything more. So my thought is at least with my loved ones to do everything we can. To try and keep them in the place where they want to be, not in a place where I want them to be in a place where they want to be in that tends to be home. Yeah. So we do everything we can to bring in.

[00:22:29] Sometimes the services where we call assisted living is not just a building assisted living or services provided to a person wherever that person may be. And if they can be in their home, that’s always going to be the most health promoting. And so, for example, from a policy perspective in United States of America, we should really be thinking about how we can use all of our resources, provide tax incentives, to use our technology, to use our artificial intelligence, to keep people in their home for as long as we can.

[00:22:57] A lot of this stuff tends to be cost prohibited. A lot of people can never even get into assisted living in this country because it’s too cost prohibitive. So they have to literally use all their resources. So they go into skilled nursing. That’s fundamentally philosophically moralistic. Wrong. So for me anyway, at least my loved ones and try to treat everybody that I talked to when they call me and ask me as if it’s my loved one, that would be my first, you know, where does your loved one want to be?

[00:23:22] And what do we need to do to try to help him or her stay there for as long as we can. And then from there, when a new setting is needed in your own advice, from your steps on your, on your website, Is accurate. We have to look into, I would say first and foremost, the sophistication of the staff, some talk to some residents and families who have been there.

[00:23:43] Look at the training and development. That’s there on an ongoing basis. Look at whether or not they have experts around that consult with a team that would be a way to go about the next step. If it’s assisted living or memory care.

Hanh Brown: [00:23:56] For my parents, my dad pass away due to a brain tumor. And my mom stayed at home with my sister as long as she could.

[00:24:04] Um, but my sister also works full time. She’s a physician. And, um, it came to the point where my mom needed 24, seven hour care around the clock. And then we had to hire a caregiver to, to take care of her. And also one that was speak her language.

Dr. Paul Nussbaum: [00:24:19] Yeah. And that’s the decision process that families hopefully go through and it’s unique to each person, but there’s a lot of commonality.

[00:24:27] You’re right.

Hanh Brown: [00:24:29] Well, thank you so much, Paul. I really appreciate your time and your wealth of knowledge listeners.

Contact Dr. Nussbaum today (724) 719-2833 to discuss how he may assist you personally, your organization, or your business. Email is and website is

You can follow Paul on LinkedIn at


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