On the evening of March 4, 2018, David Snyder suffered a brain aneurysm that ruptured—three times. He endured an emergency ventriculostomy, a craniotomy, and the insertion of platinum coils into the aneurysm to control the bleeding.

Three weeks later, surgeons placed a tracheostomy tube, a ventricular shunt and a feeding tube in his body. David spent five weeks in the ICU and seven weeks in rehab, where he had to re-learn how to walk, feed himself, shower, dress and go about his daily tasks.

“He had a 5-percent chance of survival,” David’s wife, Colleen, recalls. “He was responsive very early on, and they were very surprised. They didn’t expect him to respond as well as he did. The surgeon felt he would make a 100-percent recovery, but would never be the same again.”

Colleen, a dental hygienist at Penn Dental School, had already been caring in their home for her mother, who has dementia and COPD, a lung disease. She and David have been married for 28 years and have three children: Patrick, 26; Olivia, 24; and Alex, who is 20. With David home after rehab, she now had both her husband and mother to look after.

Caregiving for an elderly or ill loved one is an overwhelming responsibility, encompassing tending to health care, basic needs and supervision over daily tasks. It requires an enormous investment of energy, emotion, resources, and time. For many caregivers like Colleen this happens against a backdrop of managing work and a household. Traditional respite care provides much-needed breaks for caregivers to rest or take care of personal errands; but it is expensive, and most health insurance won’t cover it unless there is a physiological need.

Taking time out

Enter Time Out, a joint venture between the Penn Memory Center (PMC) and The Intergenerational Center at Temple University that provides low-cost respite care to those supporting an older adult. First launched in 1986, the program recruits Philadelphia-area college students to bring temporary relief for caregivers of those with physical or cognitive impairments.

Students are matched with older adults based on shared interests to offer companionship. Older adults enjoy much-needed social time and a chance to mentor a college student who is gaining caregiving experience.

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The lynchpin of the model is the intergenerational approach, a framework that Meg Kalafsky, the program coordinator with Penn Memory Center working on the Time Out program, believes is unique.

Kalafsky ascribes her passion for the program to her relationship with her grandmother. “She tells me all the time that she has more friends in heaven than on Earth,” Kalafsky says. “That’s a reality for a lot of our older adults. It’s harsh, it feels really uncomfortable to hear, but it’s the truth.”

Over the course of the last 150 years, Americans and much of the developed world have shifted from living in multi-generational households to smaller, nuclear family-based households. Today, we move out of communities for work and education opportunities, when in the past, we would stay in one place for many generations. Much of the support that developed naturally out of the way we lived has disappeared.

She tells me all the time that she has more friends in heaven than on earth,” Kalafsky says. “That’s a reality for a lot of our older adults. It’s harsh, it feels really uncomfortable to hear, but it’s the truth.”

“Isolation is something that we have always looked at with older adults who, as a whole, frequently become less connected to their community and have fewer opportunities to socialize,” Kalafsky explains.

And Covid-19 has exposed a severe vulnerability concerning older adults. A year into the pandemic, some individuals have not left their homes for anything not deemed absolutely necessary. In February of this year, the Alzheimer’s Association journal Alzheimer’s & Dementia published a study indicating that people with cognitive disabilities are twice as likely to contract Covid-19 than someone in better health. This weighs heavily on caregivers and families trying to stay healthy and keep loved ones motivated and active at the same time.

As it became clear what impact Covid was having on people and operations, Time Out worked to identify the needs of families and students and how best these needs could be met. “Rather than a top-down Here’s what we think you want,” says Kalafsky, “We asked, What do you need, where are these gaps, and how can we help?”

That’s how Kalafsky and her team came up with the Time Out Weekly Smile program, a virtual version of their 35-year-old program that creates the same one-to-one connections between students—who haven’t been on campus anyway—with clients over phone or video chat. The program consciously tries to reach low- to moderate-income seniors, and there’s a pen pal option for those who might not have internet connections or a reliable phone.

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“We tried to keep it as open and broad to meet the seniors wherever they may be and whatever capabilities they may have,” says Kalafsky.

Generally, program participants meet up to an hour once a week. However, some families may seek out more interactions, and others might be matched with more than one student to give caregivers additional respite opportunities.

David and Ian forge a bond

David Snyder is a friendly, popular guy whose friends joke that he should be the mayor of Ardmore, considering how many know and like him. He is one of seven siblings, and a big sports fan who doesn’t just pull for the Eagles and the Sixers, but also admires athleticism and often offered tips for his daughter on trimming her swim times. He shares a love of music with his son Patrick.

He’s a veteran of the home health care industry, spending the first part of his career selling medical equipment. He spent time working at his church as a Sacristan, responsible for the care and preparation of sacred items like vessels and vestments. Almost three years before he fell ill, he had partnered with a friend in the home improvement business and enjoyed his newfound talent for handiwork.

Today, David’s brain injuries have resulted in a level of cognitive impairment that necessitates someone be with him at all times. The trach and feeding tube were removed just before he was discharged from rehab, at the same time he began having seizures. The seizures continued fairly regularly, but now occur only every few months with the help of an epileptologist at the University of Pennsylvania. “I’m over that, over the hump, looking forward to today and tomorrow,” David says.

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Through her husband’s recovery, Colleen has been maneuvering caregiving for him and her mom, working, and keeping her loved ones safe and healthy. The couple’s children sprang into action the night David’s aneurysm burst, and were putting time in taking care of their dad whenever they could. Home healthcare agencies were within her reach, but a series of strangers coming and going from the home was not ideal at best, and intrusive at worst. For a time, Colleen found the right balance with an adult center where both her mother and David could spend time during the day.

Just as she became comfortable that things were working out, Covid-19 struck.

For just over three months, Colleen was at home, which made things simpler. When she returned to work over the summer, her children and her brother pitched in during the week. But Colleen was looking for someone to keep David company to allow her some downtime. One of her coworkers forwarded an email from employee assistance referencing a program for older adults and caregivers through the Penn Memory Center.

“They said You need help. You should try this,” Colleen remembers.

In September, Weekly Smile connected David with Ian Millstein, a Penn junior who had marked an interest in sports, specifically the Eagles and the Sixers, on his forms. Millstein also enjoys tennis, is an avid reader, and is interested in investing. He studies chemistry and biology in his pre-med program, and is preparing to take the MCAT.

Last spring, he volunteered at HUP, hoping to gain some clinical experience but though he had completed the training, he never had the chance to serve before the arrival of Covid-19. Over the summer, however, he learned about the opportunity with Time Out’s Weekly Smile.

“One of the things that is so unique about this is there is no one who is giving without receiving,” says Kalafsky. “It’s mutually beneficial for the caregiver, for the older adult, and for the student.”

“I thought it would be a great way to get to know people and get experience from a different angle, something non-traditional, given the circumstances. I’ve always loved getting to know people, talking to people, and the whole social aspect of it made it really attractive for me,” he says.

David and Millstein have been connecting about once a week outside of vacation breaks and holidays.

“Ian’s been great,” David says. “Making friends with someone on a personal level has been very helpful. It’s helped me learn to process day-to-day and stay focused. The recovery process is coming along better than I’d hoped. I’m deeply appreciative and very grateful. I’m blessed, I really am.”

For students like Millstein, the Weekly Smile has helped to stay connected during the pandemic as well. They too face isolation in the wake of Covid-19. Instead of establishing new friendships and professional networks, typically social college students are struggling to maintain relationships virtually. “We mostly just talk, and that’s the best part about it,” Millstein says. “I really look forward to it every week, just seeing what’s up and shooting the breeze.”

Many of these students are heading into professions like the medical field, social work, and psychology. Recognizing that older adults and their families will be much of their client base, students are using these encounters to see what these various specialties are going to be like and get perspective on what it looks like to provide community-based interventions. It gives them a chance to develop the soft skills that learning anatomy and CPR don’t teach.

“One of the things that is so unique about this is there is no one who is giving without receiving,” says Kalafsky. “It’s mutually beneficial for the caregiver, for the older adult, and for the student.”

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Time Out has also built in virtual activities to combat the monotony of interactions between on-screen talking heads. There is a workout class that meets twice a week; like all of their programming, it’s student-led. They hold a meditation and mindfulness class on Wednesdays that is designed for both caregivers and individuals with cognitive impairment.

This semester, Weekly Smile began holding Smile Socials, a party thrown monthly over Zoom. A counsel of five students organizes the events, which are themed and include games and other group activities. February’s party was based around Valentine’s Day, and so the attendees sent their favorite love songs which were used in a trivia game. There was sharing of favorite Valentine’s Day stories and how everyone met their partners.

“Our goal with that is we know everyone has these 1:1 connections, which are beautiful, but we really want to make people understand and feel the community that is Weekly Smile,” Kalafsky says.

Learning from each other

While Millstein considers his future, his experience volunteering for Weekly Smile has affirmed what he learned from his father, an internist. “He’s told me that when he deals with patients in a clinical setting, it’s important that you get in touch with people and understand them on a more personal level,” Millstein says. “I know that when you are working with someone who is going through a significant medical challenge, not to forget the fact that you are also dealing with a person who lives a fascinating, cool life. There’s a lot of commonalities you can find. It has stressed the social aspect of medicine in a lot of ways that go beyond what I learn in my classes.”

Though working in-home is preferable to meet the needs of many individuals, there are some for whom that isn’t an option. For those people, Weekly Smile can continue to serve long after Covid-19 has passed as a permanent piece of the program.

“Initially, my expectations were that I would be in the role of a respite caregiver and that I would be the one providing something in these conversations, but what I quickly found out is that this is something really mutual,” Millstein says.

Time Out’s in-person respite care costs far less than what home healthcare agencies generally charge, but the Weekly Smile Program is offered at no cost to families. Before the pandemic, students were being compensated for their participation in the in-person program, but are now volunteering for the virtual component. Right now, there are around 30 families signed up for the program. Additional students are waiting to be matched with families.

“One of the things I always say about Time Out is that it’s fun,” says Kalafsky. “If you’re not having fun with Time Out, you’re not doing it right, and we’ll figure it out. That’s the objective.”

For Colleen, Weekly Smile proved to be exactly what her family needed. “For me, it’s very refreshing,” she says. “To see Ian gives me hope in that generation, that it’s not all about them. He’s so kind and so willing to be here and be present with us, and I love that.”

Millstein feels he too has learned from his time with the Snyders. “Initially, my expectations were that I would be in the role of a respite caregiver and that I would be the one providing something in these conversations, but what I quickly found out is that this is something really mutual,” he says. “Every week, I see something that I aspire to. Just seeing how they’re there for each other is something that I want to emulate in my life.”

The Citizen is one of 19 news organizations producing Broke in Philly, a collaborative reporting project on solutions to poverty and the city’s push towards economic justice. Follow the project @BrokeInPhilly.

TAKE ACTION ✊

DO SOMETHING: If you’re a senior (or caring for one) and looking to connect with a young person, apply for the Weekly Smile Virtual Program here. If you’re a student enrolled at a Philadelphia-area college or university, apply here for the summer semester of Weekly Smile. (Check out the student blog to learn more about what to expect.)

DELVE DEEPER: “Caregiving for an elderly or ill loved one is an overwhelming responsibility, encompassing tending to healthcare, basic needs, and supervision over daily tasks. It requires an enormous investment of energy, emotion, resources, and time.” Take advantage of Time Out Care’s resource page for helpful info and support.