Green House Blog

Pat Sprigg of Carol Woods leads through person-centered care

I loved listening to this week’s podcast, featuring senior director Susan Ryan in conversation with Pat Sprigg, the CEO of Carol Woods, a retirement community in North Carolina.

Referencing Maya Angelou

In 1975, Sprigg began her first job working with elders but entered the job with apprehension – she never saw herself working with elders and wasn’t sure whether she would like it. She was quickly struck by how harsh society’s views were on aging, and this one experience formed the philosophy that has shaped her entire career.

Sprigg referenced a famous Maya Angelou quote when she described the environment at Carol Woods: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Sprigg has worked hard to design a community in line with this sentiment. At Carol Woods, there is no segregation of elders with dementia – everyone lives together. If an elder seems to be having problems, the staff at Carol Woods is trained not to default to a textbook response but to sit with the elder and understand what might be triggering their discomfort.

An example that I absolutely loved was the approach that Carol Woods has taken in caring for elders with dementia that forget how to get back home if they’ve traveled out. Rather than control where elders can go on the Carol Woods campus, staff simply jump on the bus with them and make sure they can get back home. As Sprigg says, “person-centered means person-centered.”

Intentional design

Carol Woods is uniquely innovative in a space like eldercare, which has a long history of doing the same thing over and over, regardless of the negative consequences.

For example, none of the residential buildings are multi-storied – they’re all spread out, like a park, situated in acres of lush green grass, so that elders can get around without the hassle of an elevator or stairs. The health center, rather than being at the fringe of the community, is at the very center, so that the most frail and vulnerable elders are not relegated to being outsiders.

I took two things from this podcast: the first is that people who truly move the needle, in any field, are the people that are uncomfortable with stagnancy and comfortable asking “what if?”

The second thing I took away is that a strong moral compass as acting director can almost replace the need for a physical CEO or ED. In fact, as Sprigg reflected on her nearing retirement, she expressed that Carol Woods has never been dependent on her. That, to me, is the mark of a timeless organization – one that is not profit-directed, but mission-directed.

A flexible, diverse vision for eldercare with Jennie Chin Hansen

This week’s podcast episode with Senior Director Susan Ryan featured Jennie Chin Hansen, who has served as the CEO of On Lok, president of AARP, and a stakeholder in California’s Master Plan on Aging.

A happy, peaceful abode

Much of the podcast focused on Chin Hansen’s time as director of On Lok.

On Lok, which loosely translates to “happy, peaceful abode” in English, started out as a community center providing social services to elders in San Francisco’s Chinatown in the 1970s. When Chin Hansen joined in 1980, the organization merged social services with medical services.

In 1984, On Lok received funding from the Robert Wood Johnson Foundation to see if this model – which had nailed the concept of serving the needs of elders without infringing on their autonomy or desire to live in their own homes – could be replicated elsewhere. As Chin Hansen admitted, at the time, the stereotype of On Lok was that it worked only because it served a largely Chinese, tight-knit population. They aimed to upend this conception, and they certainly did: There are currently 250 PACE models based on the On Lok blueprint in 31 states, serving incredibly diverse populations.

An ecosystem, not a transaction

Chin Hansen talks a little about the role of serendipity in paving her path throughout her career. I thought the process of On Lok’s development was a perfect example of what can happen when you choose to seek out opportunity in the face of uncertainty and chance. For example, the eventual merging of social with medical services happened because On Lok took a look around and realized that the needs of elders were not being met with the single-pronged approach that they had started with. Rather than throw in the towel, they chose to rebrand, resulting in an organic merge that has made On Lok the holistic, reliable care model it is today.

Another story Chin Hansen shared was when On Lok ran into a lack of funding when they wanted to build a nursing home. They were forced to build a community without walls, but this flexibility ended up being its strength, especially during COVID-19, when elders that were ill could still be in their homes, surrounded by loved ones.

Having leadership that embodies adaptability, resilience, and flexibility is perhaps what leads On Lok to be what Chin Hansen calls “an ecosystem, not a transaction.”

Chin Hansen’s vision for eldercare

Chin Hansen ends the podcast suggesting that medicine, for all the good it has done, may not be the ultimate solution to our health and wellbeing. We see this in eldercare all the time –when we prescribe anti-psychotics, limit favorite foods if they’re deemed “unhealthy”, time bathroom breaks, and resign elders to tiny clinical rooms in the name of health and safety.

Though this care is often well-intentioned, I resonated with Chin Hansen’s sentiment that it’s the most inexpensive expenditures that lead to wellbeing. In fact, as she further mentions, studies have suggested that clinical medicine accounts for only 15% of our health outcomes. While we still have a while to go in ensuring that all people have access to this 15%, On Lok and the leadership of Jennie Chin Hansen makes me optimistic that around the country, eldercare will start to look less like a pill and more like family, friendship and feelings of home.

An age-friendly vision for America’s capital city: in conversation with Gail Kohn

Gail Kohn was the latest guest on the “Elevate Eldercare” podcast, in conversation with Senior Director Susan Ryan. A powerhouse leader, particularly in pushing for diversity and community, she is the former executive director of Capitol Hill Village and Collington. Now, she leads the Age-Friendly DC initiative, as part of a World Health Organization project to establish a network of cities dedicated to better aging all over the world.

Simple fixes for a more inclusive city

As Kohn describes, the story behind age-friendly cities is an interesting one, involving the popularity of Rio de Janeiro’s Ipanema neighborhood skyrocketing as a residential area for elders after the real-life “Girl from Ipanema” relocated to a high rise there. Dr. Alexandre Kalache noticed that Ipanema was creating a lot of difficulties, particularly for its aging population, and identified several small but impactful fixes the city could make. For one, he noticed that buses would often pass by stops when elders were waiting there, knowing that it would take a while for them to get on the bus. The bus system at the time was touted for being incredibly punctual, leaving bus drivers no leeway to wait for slower customers. So he pushed for a restructuring of the system that put an emphasis on the number of customers a bus could attract – not the exactness of the time in which it arrived and departed. This quick fix made the city far more accessible to elders.

I was struck by the simplicity of this solution, because it raises the question of what other quick, easy, and effective solutions to people’s problems we’re missing simply because we take our circumstances for granted. As someone who is perpetually running late, I would depend heavily on the punctuality of the Ipanema bus system. I’d likely never consider that the very same system may be rendering the city inaccessible to people who can’t get on the bus fast enough. There is incredible power in empathetic leadership – and significant results that can be obtained just by working to better understand the concerns of others.

Age-friendly DC

Kohn then transitioned to talking about her experience leading the Age-Friendly DC initiative, which comes up on its 10-year mark in 2023. As she describes, the initiative is positioned on top of three main pillars – the built environment, changing attitudes about growing older, and lifelong health and security. It was remarkable to hear about how the built environment was approached. One example that Kohn gave was of a block-by-block walk taken by politicians, students, and community members alike. The walk allowed them to identify possible hazards – such as unclear intersections, potholes, and cracks in the sidewalk – that were promptly fixed.

As Kohn mentioned, 95% of surveyed elders want to live and grow old at home, but for many people, that is not a reality. Considering the rapid demographic shift that not only the U.S but the world is going to experience in the next few decades, rethinking how our cities cater to the elderly is not just a unique, interesting pursuit but incredibly crucial to the quality of life for everyone, young and old.

On discrimination and diversity

There was comment of Kohn’s, attributed to Susan Donnelly of LeadingAge, that particularly stuck with me:We’re discriminating against our older selves when we dislike older people.

This is why I think Age-Friendly DC, and the network of cities under the WHO, is so powerful. Fixing cracks or potholes in a sidewalk helps those of us that are already nearing older age, but those changes will still be around as the rest of us grow older and require more thoughtful design of our communities. Moreover, potholes and cracks don’t just pose a problem to elders – fixing them would help young parents pushing strollers, or people riding a skateboard.

One of my favorite quotes, from Paul Hunt in A Critical Condition, says “The quality of the relationship the community has with its least fortunate members is a measure of its own health.” As a leader, I think Kohn embodies this sentiment remarkably. Whether it was pushing for diversity and neighbor-to-neighbor relationships with Capitol Hill Village, Collington or now Age-Friendly DC, Kohn proves that as a society, we can be committed to lifting everyone up – we just need leaders courageous enough to push for it.