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Marguerite Manteau-Rao
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Licensed Clinical Social Worker, CEO and Co-Founder of Presence Care Project, a new, innovative approach to dementia care. Founder of Mindfulness-Based Dementia Care program at UCSF OSHER Center for Integrative Medicine. Frequent guest speaker on mindfulness and dementia care. Ex-Volunteer with Zen Hospice Project. 2010 Blogisattva Awards for Mind Deep blog: Winner, 'Best Buddhist Practice Blog'. Included in San Francisco Examiner's 2010 list of "Buddhist Twitter Feeds to Follow". Can be reached at

Entries by Marguerite Manteau-Rao

A Mindful Journey

(2) Comments | Posted June 12, 2014 | 9:00 AM

Imagine a marathon you did not sign up for, and yet, you are told you have to run the race until the end. To add to the challenge, you are to carry a heavy load on your shoulders, and the load will get heavier and heavier as the race goes...

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4 No-Nonsense Solutions to the Looming Dementia Crisis

(0) Comments | Posted May 2, 2014 | 3:58 PM

The dementia tsunami is coming, fast. We all know it, and it will affect every single one of us, either directly or through our loved ones. That we are not prepared for such an onslaught is an understatement. Dementia is an expensive disease, and if we do the...

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6 Life Lessons Dementia Can Teach Us

(0) Comments | Posted December 2, 2013 | 3:28 PM

I spent Thanksgiving Day in the dementia care community where I work. Throughout the day, I got reminders about what matters in life, and what doesn't. Take a guess, then read on.

Few of us pause to appreciate the beauty of our human mind. Not until we...

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What Mindfulness Really Is

(6) Comments | Posted October 14, 2013 | 6:57 PM

Mindfulness is often times misunderstood, and that's unfortunate. Such misconceptions can lead folks to give up their practice prematurely. It can also prevent them from reaping the full benefits of true mindfulness. Here are some of the most common false views about mindfulness that I have encountered and ways to...

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Maximize Your Inner Happiness, With One Simple Mindfulness Practice

(0) Comments | Posted August 13, 2013 | 3:12 PM

I would like to share a little known mindfulness practice that can make a big difference in how we live each moment. It requires that we pay attention to the quality of our experience. And it is remarkably simple!

How we feel falls into three categories: pleasant, unpleasant or...

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8 Ways To Help Mom Transition To Assisted Living

(2) Comments | Posted May 17, 2013 | 7:00 AM

Moving into assisted living or a memory care community can be hard on both the person and their family. The good news is there is much family members can do to ease the transition. Here are eight tips that will bring more ease into the initial assisted living experience:

  1. Help...
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10 Ways You Can Help a Loved One With Alzheimer's Survive Hospitalization

(1) Comments | Posted March 15, 2013 | 11:29 AM

Two weeks ago, I got a call that my mother had suffered a stroke, and that she was in the hospital. For someone with Alzheimer's, like her, hospitalization can be a traumatic and sometimes fatal event. When I arrived at the hospital, I found my mother lying alone in a...

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STOP and De-Stress In 30 Seconds

(4) Comments | Posted February 26, 2013 | 12:02 PM

Part of Mindfulness-Based Stress Reduction (MBSR) and other mainstream Mindfulness-Based programs, is a simple practice called STOP, for 'Stop, Take a Breath, Observe, Proceed'. I have found STOP to be one of the favorite practices for mindfulness beginners. It can be a stand alone practice, or a...

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Living With Alzheimer's, Looking for a Home

(8) Comments | Posted November 13, 2012 | 10:44 AM

Their plea pursues me. "I wanna go home. Can you help me?" They try to get out. They look for a door, an elevator to open. They wander out, and sometimes get lost. They are searching for a home that no longer exists. They are the 5.4 million...

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How to Best Help Alzheimer's Caregivers? Teach Them Mindfulness

(4) Comments | Posted May 21, 2012 | 5:53 PM

For the 15 million in this country who are caring for a loved one with dementia*, this is what life is like -- according to the Alzheimer's Association 2012 Report:

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Making Alzheimer's Moms Happy With Just a One-Minute Call a Day

(0) Comments | Posted May 4, 2012 | 3:43 PM

This story is for the 2.3 million long-distance caregivers who have a loved one with Alzheimer's.

Being a long-distance caregiver is hard, especially when a loved one's mind can no longer dwell on the memory of prior times together, or the anticipation of a future visit. One...

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3 Zen Ways to Nurture the Very Sick

(3) Comments | Posted April 13, 2012 | 1:21 PM

Nowhere else have I seen serving food to the very sick elevated to such an art, as at the Zen Hospice Guest House. It does not matter whether the person is blind, can no longer smell, or can barely eat. Food is still served on a beautiful tray...

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Will New DSM-5 Diagnosis End 'Dementia' Stigma?

(5) Comments | Posted April 5, 2012 | 5:38 PM

If one day I get diagnosed with Alzheimer's or another type of dementia, I don't want to be told that I am "demented," or that I have "dementia."

Dementia is a loaded word, one that carries with it the baggage of hundreds of years of gross associations...

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3 Tiny Habits to Enhance Your Mindfulness Practice

(1) Comments | Posted March 13, 2012 | 4:23 PM

All the hype around mindfulness -- being aware of the present moment, on purpose and without judgment, has gotten many people interested in giving it a try. The big challenge for most has been how to sustain their practice past the initial excitement. Too many factors in our busy, task-oriented...

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3 Questions to Ask About Assisted Living Memory Care Communities

(3) Comments | Posted December 21, 2011 | 10:54 AM

Finding an assisted living community for a loved one with dementia can be a daunting process. I have been on both sides of the fence. First as a daughter, looking for a place for my mother after it became clear that she could no longer remain safe in her own...

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The Reason You Don't Meditate

(8) Comments | Posted October 17, 2011 | 8:42 AM

The health benefits of mindfulness practice are now well established.

Consider this: Mindfulness practice can help cope with serious chronic pain, succeeding in making a normal life possible again for those otherwise debilitated by the pain itself, or the adverse effects of becoming addicted to pain medications.

Mindfulness practice,...

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The Essential Checklist for Good Dementia Care

(1) Comments | Posted September 24, 2011 | 12:10 PM

In my work with persons with dementia, I have found Jane Verity's 5 Universal Emotional Needs to be an essential framework for good care:

People with dementia often express themselves in uncharacteristic ways such as a burst of anger, accusations or repetitive actions. Traditional approaches deal mainly with...
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13 Essential Tips for Dementia Caregivers

(6) Comments | Posted August 24, 2011 | 9:20 AM

The journey of dementia is never easy, and it can be made many times worse if family members do not have the internal tools to take care of themselves and their loved ones. Here, based on years of experience in successfully navigating the dementia care landscape, are 13 tips that...

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Memories of the Forgetful

(0) Comments | Posted July 25, 2011 | 9:26 AM

I came in to introduce the Presence Care Project, a new type of mindfulness-based approach to dementia care. I came out with tears in my eyes and a master lesson in wise acceptance.

Sitting in a circle, waiting, were 13 elders and a few helpers. Each one, very...

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The 'Presence' Approach to Care With Alzheimer's and Other Types of Dementia

(6) Comments | Posted May 26, 2011 | 10:49 PM

We can put all our efforts into looking for a cure:

That's one way.

Meanwhile, the 5.4 million persons who have been dealt an Alzheimer's diagnosis are left waiting, and so are their 15 million caregivers. The stress involved is tremendous. According to the 2011 facts and figures from the Alzheimer's Association:

Forty-three percent of caregivers for people with Alzheimer's disease or other dementia reported that the physical and emotional stress of caregiving was high to very high. The physical and emotional impact of caregiving on Alzheimer and other dementia caregivers is estimated to result in $7.9 billion in increased healthcare costs in the United States.

Sixty-one percent of family caregivers of people with Alzheimer's and other dementias rated the emotional stress of caregiving as high or very high. In addition, about 33 percent of family caregivers of people with Alzheimer's and other dementias report symptoms of depression. Family caregivers of people with Alzheimer's and other dementias reported a good amount to a great deal of caregiving strain concerning financial issues (56 percent) and family relationships (53 percent).

Caregivers of people with Alzheimer's and other dementias said they were somewhat to very concerned about maintaining their own health since becoming a caregiver (75 percent). Dementia caregivers were more likely than non caregivers to report that their health was fair or poor, and they were more likely than caregivers of other older people to say that caregiving made their health worse.

Caregivers of people with Alzheimer's or another dementia are also more likely than non caregivers to have physiological changes that may reflect declining physical health, including high levels of stress hormones, reduced immune function, slow wound healing, new hypertension, new coronary heart disease and impaired endothelial function, which may be associated with increased risk of cardiovascular disease.

Spouse caregivers of people who were hospitalized for dementia were more likely than spouse caregivers of people who were hospitalized for other diseases to die in the following year, even after accounting for the age of the spouse caregiver.

Whichever help is currently provided to care partners is obviously not enough. Support so far has mostly been in the form of information sharing, skills training, stress-management techniques, peer-support and behavior modification solutions. While important, these types of external interventions tend to not stick. They fail to provide care partners with the inner resources that will sustain them over the long run. The basic attitude is unchanged, and that is what needs to be worked on.

The Presence-based approach* to Alzheimer's care focuses on cultivating one's innate ability to be present in the moment, otherwise known as mindfulness, along with a wise understanding of the reality of the person with memory challenges, and developing a mindful care community. It aims for no less than a radical and enduring shift in the care partners' attitude. It also allows care partners to meet the forgetful ones in their present-moment reality, which is where they most successfully engage.

The Presence approach draws its legitimacy from several sources. First, is Jon Kabat-Zinn's mindfulness-based stress reduction (MBSR) training, a clinically proven way to reduce stress in the general population, through the practice of mindfulness. Second is the culture change movement in elder care, most particularly the work of pioneers such as Christine Bryden, Richard Taylor, Olivia Ames Hoblitzelle, Nancy Pearce, Bill Thomas, Allen Power and Nader Shabahangi. All emphasize the need to be present for the entire reality of the person, and also focusing on the many gifts from forgetful states. Third is the Zen Hospice model that emphasizes the importance of a mindful care community and environment to sustain one's mindful care practice. There is qualitative evidence that such an approach can lead to dramatic increases in well-being, both for the care partner and the person with memory care needs.

For now, because Presence training is not yet available to the general public, here are three steps that you can take on your own:

  1. Start a mindfulness practice, either joining an MBSR class or taking instructions in Vipassana meditation. If there's no instructor in your local area, you can learn to practice online.
  2. Become wise about the care needs from your loved one, and read the following books:

    • "Dementia Beyond Drugs," by Dr. Allen Power, geriatrician
    • "Alzheimer's from the Inside Out," by Richard Taylor, a psychologist living with Alzheimer's
    • "10,000 Joys and 10,000 Sorrows," by Olivia Ames Hoblitzelle, wife and mindful care partner
    • "Inside Alzheimer's," by Nancy Pearce, geriatric social worker
  3. With other family members, friends and care partners, start a mindful care community. Invite them to train in a mindfulness practice with you. Get them to read the same books. Sit and meditate together, and share your joys and sorrows.

There's no need to wait.

*Full disclosure: I am the co-founder of the Presence Care Project:, along with Dr. Allen Power, geriatrician and author of Dementia Beyond...

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