Elevate Eldercare

With the workforce crisis in long-term care more dire than ever, providers face difficult decisions on an almost daily basis around maintaining a high level of care while managing a growing shortage of qualified candidates.

Robyn Stone – senior vice president for research at non-profit provider organization LeadingAge and co-director of the LeadingAge LTSS Center at UMass-Boston – says that the solutions to the workforce problem can't be stopgaps. Instead of just seeking "warm bodies" to fill positions and accepting a kind of institutional mediocrity, Stone argues that leaders need to take bold steps to reimagine the eldercare workforce as we stare down a new COVID normal and the continued aging of the American population.

Stone sits down with Susan Ryan to discuss her career in long-term care from Washington to the world of academia, and why reforms need to be based in both solid research and the day-to-day reality of life on the ground for workers, elders, and their families.

Learn more about the LeadingAge LTSS Center at UMass-Boston: https://www.ltsscenter.org/

Follow Robyn on Twitter: https://twitter.com/DrRobynStone

Learn more about The Green House Project: www.thegreenhouseproject.org

This past summer, the American Bar Association overwhelmingly passed a resolution urging Congress to make private rooms and bathrooms, along with other small-home touches, a prerequisite for nursing homes to receive Medicare and Medicaid funding.

In this episode, Mary and Marla take a closer look at the work of the longtime director of the ABA's Commission on Law and Aging, Charles Sabatino, and his conversation with Susan Ryan and Alex Spanko.

Mary gives us a closer look at the ABA Commission on Law and Aging and their mission. She also highlights the key points of the resolution. Sabatino talked about incentives, so Marla gives us a quick history lesson in the term "carrot and stick" and also discusses the research behind incentives versus punishments. Marla also digs into grassroots advocacy, and we provide information on how YOU can support the ABA resolution and be part of the change needed in long term care!

Learn more about The Power of Incentives: https://fs.blog/2017/10/bias-incentives-reinforcement/

Learn more about the ABA resolution here: https://thegreenhouseproject.org/resources/aba-private-rooms/

Learn more about Grassroots Efforts: https://www.thoughtco.com/grassroots-movement-definition-and-examples-5085222

Check out all of GHP's advocacy efforts and learn how you can get involved: https://thegreenhouseproject.org/resources/advocacy/

Read Charlie's article – Eight Advance Care Planning Lessons That Took Me Thirty Years to Learn: https://www.americanbar.org/groups/law_aging/publications/bifocal/vol_34/issue_6_august2013/8_lessons_in_30_years/

This past summer, the American Bar Association overwhelmingly passed a resolution urging Congress to make private rooms and bathrooms, along with other small-home touches, a prerequisite for nursing homes to receive Medicare and Medicaid funding.

To learn more about this attempt to overhaul the landscape by radically changing the financial incentives at play – as well as the ABA's future plans for nursing home reform efforts— "Elevate Eldercare" welcomes Charles Sabatino, the longtime director of the ABA's Commission on Law and Aging.

In addition to the resolution and a similar plan currently before Congress, Sabatino talks about his history with eldercare reform movements, and how he thinks progressive groups with a variety of different policy prescriptions can work together toward the common goal of real change.

Learn more about the ABA resolution here: https://thegreenhouseproject.org/resources/aba-private-rooms/

Keep up with the ABA Commission on Law and Aging: https://www.americanbar.org/groups/law_aging/

Check out all of GHP's advocacy efforts and learn how you can get involved: https://thegreenhouseproject.org/resources/advocacy/

Read Charles Sabatino and Charlene Harrington's call for structural change for long-term care: https://www.americanbar.org/groups/law_aging/publications/bifocal/vol-42/bifocal-vol--42-issue-6--july---august-2021-/policy-change-to-put-the-home-back-into-nursing-homes/

Show notes/call to action: Learn more about The Green House Project: www.thegreenhouseproject.org

Research gives you a solid foundation on which you can build your ideas and opinions and in this episode of "Let Me Say This About That" we explore the work from two leading researchers in the aging sector.

University of Chicago researcher R. Tamara Konetzka, who was behind some of the earliest research into COVID-19 and nursing homes, which often generated provocative and unexpected results. And Sheryl Zimmerman, a distinguished professor at the University of North Carolina and the director of aging research at the School of Social Work – who has researched the Green House model since its inception.

In this episode, Mary and Marla take a deeper dive into the research conducted by both of these women and discuss the results. Marla also gives us a closer look at the nursing home regulations and those "F-Tags". Mary gives us insight into the government website designed to help inform members of the public about nursing homes – what it includes and what is missing. And finally, Marla explores social support and resilience – plus a look at why systems are important and what composes the three main system categories. All topics Konetzka and Zimmerman highlighted in their comments concerning research and COVID-19.

Learn more about the Social Support and Resilience: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/

Learn more about Tools of a System Thinker: https://medium.com/disruptive-design/tools-for-systems-thinkers-the-6-fundamental-concepts-of-systems-thinking-379cdac3dc6a

Read the JAMDA article: https://www.jamda.com/article/S1525-8610(21)00120-1/fulltext

Review the Nursing Home Care Compare website: https://www.medicare.gov/care-compare/

Learn more about The Green House Project: www.thegreenhouseproject.org

University of Chicago researcher R. Tamara Konetzka was behind some of the earliest research into COVID-19 and nursing homes, which often generated provocative and unexpected results: While media coverage focused on individual outbreaks and historic lapses in infection control, Konetzka's work suggested that past quality didn't have much of an impact on a nursing home's pandemic risk when compared to bed counts, overall community spread, and the racial demographics of residents.

More than 18 months into the pandemic, Konetzka joins Susan Ryan and "Elevate Eldercare" to discuss how policymakers should apply those lessons learned, with a particular focus on ensuring that future emergency response plans recognize long-term care's vital role in the overall health care delivery system – something that was missing during the early focus on hospitals as epicenters of pandemic-related support.

Konetzka also critiques the government's longer-term responses to COVID in nursing homes in 2020 and 2021, including focused infection control surveys and performance-based bonuses for facilities that kept case counts low during certain periods. While those solutions might head off isolated issues, Konetzka argues that real reform must focus on much larger systems – as well as harder-to-measure metrics such as quality of life and patient-centered care plans.

Konetzka is the Louis Block Professor of Public Health Sciences at UChicago, where she also holds a secondary position in the Department of Medicine, Section of Geriatrics and Palliative Medicine.

Check out a summary of Konetzka's research on Google Scholar: https://scholar.google.com/citations?hl=en&user=BAjRCdAAAAAJ&view_op=list_works&sortby=pubdate

Read coverage of Konetzka's May 2020 testimony before Congress: https://skillednursingnews.com/2020/05/no-connection-between-nursing-home-ratings-profit-status-and-covid-19-but-race-a-major-factor/

Show notes/call to action: Learn more about The Green House Project: www.thegreenhouseproject.org

Evidence-based practices form the bedrock of quality health care services, but as we continue to seek real reforms in long-term care, Sheryl Zimmerman believes researchers need to flip the script – and also embrace practice-based evidence.

Instead of waiting years to see which new theories and ideas may eventually pan out into best practices, Zimmerman – a distinguished professor at the University of North Carolina, where she serves as director of aging research at the School of Social Work – calls on academics and policymakers to examine the best aspects of models that already work in the real world, and find ways to replicate them far and wide.

Zimmerman demonstrated the power of examining an existing model through as volunteer research probe into the effects of COVID-19 in Green House homes in 2020, leading to a widely publicized paper showing substantially lower rates of infections and deaths as compared to the overall nursing home system. In this week's episode, Susan Ryan sits down with Zimmerman – also the co-director of the Program for Aging, Disability, and Long-Term Care at UNC's Cecil G. Sheps Center for Health Services Research – to discuss her Green House research, her background in social work, and her vision for system-wide reforms.

Read Zimmerman's research on COVID and Green House homes: https://thegreenhouseproject.org/resources/research/covid-19/

Read the New York Times op-ed that references the research: https://www.nytimes.com/2021/08/01/opinion/aging-nursing-homes.html

Show notes/call to action: Learn more about The Green House Project: www.thegreenhouseproject.org

Safe and effective COVID-19 vaccines brought a long-overdue end to a blanket federal ban on nursing home visitations this past March, but the surging delta variant has brought back the isolation and uncertainty of 2020 to nursing homes and other communal care facilities across the country.

This week, Susan Ryan and Alex Spanko sit down with a pair of grassroots leaders working to ensure that family members and other loved ones will never again be locked out during a public health emergency.

Mikko Cook and Carrie Leljedal share their deeply personal reasons for pursuing the Essential Caregivers Act (H.R. 3733), a piece of federal legislation that would provide a clear blueprint for loved ones to maintain uninterrupted access to their loved ones in nursing homes during this pandemic and future emergencies – while also ensuring everyone maintains proper safety protocols.

Cook and Leljedal are living proof that people can come together to bring a vital issue from their local communities all the way up to Congress, and we hope you walk away from today's episode inspired to join their growing movement.

Learn more about the Essential Caregivers Act: https://thegreenhouseproject.org/wp-content/uploads/Essential-Caregivers-Act-Fact-Sheet.pdf

Download a template to help guide your outreach to federal lawmakers: https://thegreenhouseproject.org/wp-content/uploads/Essential-Caregivers-Act-Advocacy-Template.pdf

Get involved with the groups working to protect the rights of essential caregivers:

https://essentialcaregivermovement.org/ https://www.essentialcaregiverscoalition.org/

Learn more about The Green House Project: www.thegreenhouseproject.org

Safe and effective COVID-19 vaccines brought a long-overdue end to a blanket federal ban on nursing home visitations this past March, but the surging delta variant has brought back the isolation and uncertainty of 2020 to nursing homes and other communal care facilities across the country.

This week, Susan Ryan and Alex Spanko sit down with a pair of grassroots leaders working to ensure that family members and other loved ones will never again be locked out during a public health emergency.

Mikko Cook and Carrie Leljedal share their deeply personal reasons for pursuing the Essential Caregivers Act (H.R. 3733), a piece of federal legislation that would provide a clear blueprint for loved ones to maintain uninterrupted access to their loved ones in nursing homes during this pandemic and future emergencies – while also ensuring everyone maintains proper safety protocols.

Cook and Leljedal are living proof that people can come together to bring a vital issue from their local communities all the way up to Congress, and we hope you walk away from today's episode inspired to join their growing movement.

Learn more about the Essential Caregivers Act: https://thegreenhouseproject.org/wp-content/uploads/Essential-Caregivers-Act-Fact-Sheet.pdf

Download a template to help guide your outreach to federal lawmakers: https://thegreenhouseproject.org/wp-content/uploads/Essential-Caregivers-Act-Advocacy-Template.pdf

Get involved with the groups working to protect the rights of essential caregivers:

https://essentialcaregivermovement.org/

https://www.essentialcaregiverscoalition.org/

Learn more about The Green House Project: www.thegreenhouseproject.org

As president of the National Association for Home Care and Hospice, Bill Dombi is a prominent supporter of the Choose Home Care Act of 2021 – a piece of federal legislation that would expand Medicare coverage of in-home health care services.

In this episode Marla takes a closer look at what is included in the Choose Home bill – what does it mean for discharge planning from hospitals, the implications and history of the "3-Day Rule", AND a look at the cost savings from the bill to Medicare.

Mary explores the national association that Dombi heads up and what their 35,000-member organizations receive in return. For example, a HomeCare University filled with educational resources for those connected in the business.

We also discuss compensation for the Certified Nursing Assistant (CNA) and what it takes to become one today. We look at the anticipated demand for that profession and react to the comments from Dombi calling the CNA compensation levels "pathetic".

Learn more about the Choose Home bill: https://homehealthcarenews.com/2021/07/snf-diversion-bill-choose-home-introduced-projected-to-save-up-to-247m-annually/

Learn more about reasons to repeal the 3-day requirement: https://medicareadvocacy.org/end-medicares-3-day-hospital-requirement/

Learn more about becoming a CNA: https://nursejournal.org/cna/reasons-to-choose-a-career-as-a-cna/

Learn more about The Green House Project: www.thegreenhouseproject.org

As the CEO of National Association for Home Care and Hospice, Bill Dombi is a prominent supporter of the Choose Home Care Act of 2021 – a piece of federal legislation that would expand Medicare coverage of in-home health care services.

Addressing the relative lack of home care alternatives to nursing facilities has become a rallying cry for lawmakers and advocates alike in the wake of the COVID-19 pandemic. But even Dombi, whose organization represents a variety of home-based care providers, believes that true reform will only happen with a comprehensive approach that both bolsters home care options and revolutionizes the traditional nursing home.

Instead of looking at home health expansion as a threat, Dombi asserts, operators of nursing homes and other communal settings should see spectrum-wide reform as a significant opportunity – to provide better care for elders, to support and develop a stronger and more durable caregiving workforce, and to invest in the health of their businesses throughout the ever-changing pandemic landscape.

Learn more about the Choose Home bill: https://www.congress.gov/bill/117th-congress/senate-bill/2562?s=1&r=5

Learn more about the National Association for Home Care and Hospice: https://www.nahc.org/

Show notes/call to action: Learn more about The Green House Project: www.thegreenhouseproject.org