From student to psychotherapist to administrator, Montgomery (Monte) Ostrander has followed a calling to address issues of depression and dementia in senior care facilities by integrating therapeutic mental health services into a senior residential care program. As founder of Tree of Life Elder Care in El Cajon, Calif., Ostrander has created an integrative, therapeutic and holistic program for his residents.
He shared his philosophy on eldercare in an interview with Long-Term Living Managing Editor Sandra Hoban.
How—and why—did your career transition from social work to senior residential care?
During my final semester at University of Southern California’s online Master’s in Social Work program, MSW@USC, I interned at different locations, serving the needs of different populations from a mental health standpoint. I was working with foster children, which was difficult for me. A court verdict (Katie A v DSS, 2011) led to new regulations in foster care and clinical case management. Seeing firsthand how policy can affect mental health made me more curious about community welfare.
The foster care model extended my practice of psychotherapy to informal residential settings. This “take the couch to the streets” philosophy made me rethink how to use my new therapy skills. I took a course with Thanatologist Professor Cynthia Rollo-Carson, and noticed a massive need for mental health professionals in eldercare facilities. From grief and loss counseling to family systems counseling, all families with aging members need support. Imagine the suffering a daughter feels whose mother doesn’t recognize her.
I opened Tree of Life Elder Care to provide free informal psychotherapy to the elderly residents of my homes and their families, integrating holistic support for the Bio-Psycho-Social-Spiritual needs of this population.
What guidance helped you transition your skills to the aging field?
MSW@USC helped find me a new internship once I discussed this new idea with their team. There just aren’t that many social workers interested in palliative care and mental health, let alone any who create their own hospice.
I also did personal research and enrolled in certified state classes with Laura Ferrall from Elder Care Inc., who mentored me in developing the business model. I become a certified administrator and applied for a state group home license (RCFE).
How does Tree of Life differ from traditional nursing home care?
The idea of integrating psychotherapy into Tree of Life has been rewarding, but also challenging. I attribute both my own learning curve, and our collective learning curve to understanding dementia. It’s very difficult to build a therapeutic alliance with someone suffering from cognitive impairment and the emotional healing work becomes more prescient while working with the families. Aging and dying are such difficult topics for most people to discuss that my mental health practice has been truly helpful for family members during the dying process.
Having realized that these patients who are essentially nonverbal and respond more to less external stimuli, my therapeutic approach focuses on anxiety relief, mindfulness and stress reduction. Originally my idea was to engage with each client one-on-one and begin addressing psychodynamic or case management issues, but as things usually go, the patients taught me how to treat them. Engagement was my top priority-I imagined that building new bonds, relationships or trust would improve their quality of life, make them feel more connected to a world that increasingly looks like it wants to ignore them.
In the first six months, all of my residents were able to discontinue antidepressant medication. This was not a success for psychotherapy. I believe the most important change that affected their well-being was their change in diet.
Why place such a strong emphasis on specialized diet rather than traditional food service?
I researched diet change and learned that gluten and sugars in processed food create free radicals that create inflammation, the source of all disease. Of course, no one is going to send their elderly parent of the “Greatest Generation” to a gluten-free raw, vegan board and care, so we implemented these changes subtly. Spinach infused orange juice, fruit smoothies with fresh kale from a hydroponic table on the patio, ground turmeric on eggs; many of these are hardly noticeable to the patient but they represent radical changes.
Here is what we know about dementia: It is caused primarily by free-radicals as they break down protective cellular lining, which causes inflammation and disease. When it happens in the hippocampus or amygdala, as people age, memory loss occurs. Memory is cellular, it exists as chemicals inside the brain. Until about five years ago we all believed that brain cells were gone forever once destroyed. Now we know about neurogenesis. New brain cells can actually be formed and there are certain foods that assist in this process, antioxidants, fresh whole fruits and vegetables. I found this journal article to be helpful.
An ironic twist in special diets is water thickener, which is powdered gluten. It makes water easier to swallow for patients with dementia to prevent aspiration. The simple fact is when you eat better you feel better.
Several months ago, a hospice patient was put on a total anti-inflammatory diet; he recovered and moved out. Food is medicine, without question.