Green House Blog

Three takeaways from the 99th and 100th episodes of ‘Elevate Eldercare’

This week, colleagues at The Green House Project highlighted some of the most profound insights from the variety of incredible guests that the Elevate Eldercare podcast has hosted. I’d highly recommend giving both a listen – they weave together an inspiring and optimistic narrative of where eldercare has been and where it’s going.

There’s lots more to unpack, but these are my top three takeaways

Eldercare is not one-size fits all

I’ve always thought it was ludicrous that medicine and society push and push for optimal care from the time we’re conceived in the womb – and then suddenly grow complacent when we hit old age. While all the guests on Elevate Eldercare are leaders pushing back on this “default” podcast guest David Grabowski of Harvard summed it up well when he said that we need to reimagine nursing homes while investing in home health care models – it’s not a dichotomous pairing but a complementary one. The needs of a complex and diverse society do not become any less complex when that society ages, and to truly place people at the center of the care they receive, we need to do a better job of getting creative, being flexible, and designing solutions that can fit all kinds of people.

Take more risks

Podcast guest Anne Montgomery of Altarum called it “negotiated risk” – perhaps no other branch of care is as risk-averse as eldercare, but the field is past due for a dose of boldness. If the goal is safety, then maybe perpetually cautious decisions are fair. But if the goal is the holistic wellbeing of elders, then it’s not safety we need to prioritize but social connection, autonomy, joy, purpose, and a connection to the outside world. As Alex Spanko, GHP director of communications and marketing, pointed out in conversation with senior director Susan Ryan, the federal government stalled the streamlining of visitation procedures in nursing homes for almost a full year in the name of “playing it safe.” That means that for one year, nursing home residents lived in isolation, and that should not be normal, even in abnormal circumstances.

Impactful leaders are humble leaders

I was so awed by podcast guest Deke Cateau’s approach in controlling the spread of the pandemic at the organization he leads, A.G Rhodes. During the height of the pandemic, rather than getting defensive at criticisms launched at the nursing home industry, he was humbled by it. One death for them was one death too many, which was a response in stark contrast to homes that defended their policies by saying that at least their death count was low.

The message of Elevate Eldercare has been consistent throughout its 100 episodes – that elders are people, not patients, and that eldercare needs to address the needs of elders, not its own agenda. Here’s to the next 100 episodes being just as radical, visionary, and inspiring as the past ones.

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.

Green House in Wyoming: A Story of Firsts

In 2007, Doug Osborn and Charles Scott of the Wyoming legislature brought a bill up for consideration. The bill would authorize three pilot projects, in three different communities in Wyoming, to study alternative elderly care homes. 

The passage of the bill was a catalyst for radical change in eldercare in Wyoming. Prior to this bill, Osborn and others had traveled to Tupelo MS to study the Green House model of care. They decided to bring it back to the community of Sheridan. 

Two cottages finished construction at the end of 2011, while two more finished in early 2012. The four cottages at Green House Living for Sheridan opened to residents on January 31 of 2012.

But what is truly remarkable about Green House Living for Sheridan is that it was built not by an established religious organization or nursing home company. Instead, it was conceptualized, funded, and constructed from the ground up by the individuals living in Sheridan. 

When it was built, Sheridan held the audacious title of being the only grassroots Green House community in the nation. 

The Wyoming Life Resource Center 

For a state that set one record with the conception of its first Green House home, it’s no surprise that they’re on track to set another. 

The Wyoming Life Resource Center (WLRC) in Lander, Wyo., is a state-owned Green House community that has long served the needs of the Wyoming population and is being rebuilt as the first Green House home to be established as an Intermediate Care Facility (ICF) for people with intellectual disabilities, in addition to housing cottages established as a traditional skilled nursing facility (SNF). In accordance with federal Medicare and Medicaid regulations, this means that WLRC will serve people who have organic brain syndrome, high medical needs, and those who are “hard to place.”

Construction began in 2018 will host a total of 100 beds in 10 cottages, all built using the Green House model. There are four types of cottages in terms of licensure—ICF Medical Cottages, ICF Behavioral Cottages, SNF Medical Cottages, and SNF Behavioral Cottages. The campus also includes a recreation center with a pool, therapies and gym, an outpatient clinic with a pharmacy and lab, and a kitchen (existing) with a pharmacy and lab. 

Doug Osborn has since passed away, but his legacy lives on in the Green House community he helped to create.

The WLRC is an example of how best to meet the needs of diverse people with diverse needs, all under the Green House core values of Real Home, Meaningful Life, and Empowered Staff. The model of WLRC is innovation at its core. It sets an example that many residential care facilities across the U.S, Green House or not, are looking to replicate and learn from. 

What Is it About Wyoming? 

What is it about Wyoming that makes it such a hotspot for the sort of tenacious idealism demonstrated by Sheridan and WLRC? Former director of WLRC, Virginia Wright, describes it well: “Because we are a small state, we have a different mindset than some of the larger states. We still look at people as people and not just as numbers. I’ve worked in many states, and I have never seen as high of standards as I have seen here.” 

With Wyoming proving what’s possible in terms of diverse eldercare, it’ll be exciting to see how the eldercare landscape across the country shifts in response. 

Medical & Policy Perspectives on Eldercare with Michael Wasserman, MD

Meghna Datta
Meghna Datta, GHP Summer Intern 2021

Hello! My name is Meghna Datta and I’m an undergraduate intern with The Green House Project (GHP) this summer. I’m a student at Duke, originally from the Midwest, and working here has been a dream of mine for such a long time that being here feels surreal. 

I will be blogging about podcast episodes, webinars, and other GHP content for the duration of the summer and am excited to do a deep dive on developments in the world of eldercare. 

I’ve been following GHP since I read Being Mortal by Atul Gawande, MD, in high school. That book—combined with a rather serendipitous series of events in college—pointed me down the pre-medical path. Specifically, I’m drawn to eldercare and mitigating the impacts of neurodegenerative diseases. So, I am doubly excited to be sharing some reflections on the latest Elevate Eldercare podcast episode.

On His “Why” 

In this episode, Susan Ryan sat down with Mike Wasserman, MD, a geriatrician and tour de force in the world of eldercare and geriatric medicine. When answering the question of why he wanted to be a geriatric doctor, Dr. Wasserman made a joking admission that he was “born an old man”—which he later remarked is a common thread among many people that end up working with older adults. I really resonated with this. It seems like many of us who enjoy working with older adults have had multiple positive experiences with them in our own lives. He later spoke to the dangerous impacts of ageism, which brought me back to the idea of why certain people decide to go into geriatric medicine.

If there’s one thing I think could really bolster the national policy response to eldercare, it would be combating ageism. In other words, instilling in our youth-obsessed society that older adults are holders of a lot of generational wisdom and history, and that their wellbeing matters. Policy reflects priorities, and until the crippling problems with eldercare in the U.S are brought to the front, effective policy is unlikely to emerge.

Dr. Wasserman decided in his third year of medical school that he wanted to go into geriatrics but ended up diversifying later in his career with a gig as CMO and then CEO of Rockport Healthcare Industries—the largest nursing home chain in California.

Effective Nursing Home Reform 

This experience gave him the kind of unique perspective that few doctors are able to receive. Dr. Wasserman was able to speak to what he believes is the real obstacle to nursing home quality improvement, which is not poor administration but the larger hand at play. Criticism of the nursing home industry should really be criticism of the money in the industry, and not nursing staff or administration, who work tirelessly, generously, and with very little pay. So when talking about ways in which to elevate care in the nursing home industry, he pointed out that the profit in the nursing home industry exists in private equity and real estate, not in operations. In other words, when nursing home operators say that they need money, it’s wise to believe them. 

Dr. Wasserman also spoke of the impact of COVID-19 on nursing homes and elders. In his eyes, the key to managing a crisis of this type lies with the nursing home infection preventionist, which every nursing home has. But when talking about the crisis response on a national level, he minced no words, positing that the U.S. response to COVID-19 will likely be regarded as the worst crisis management example in the history of the country. It’s devastating to me that it took the loss of hundreds of thousands of lives, disproportionately from the most vulnerable populations in America, to bring the many problems in medical care access to light. On the other hand, I can’t help but think that sometimes, the largest transformations require the most massive catalysts. 

The Future of Eldercare 

In response to poor healthcare policy, grassroots activism has been especially effective—geriatricians and eldercare experts have been featured in news publications large and small, voicing opinions that have been needed to be heard for a while. But as Dr. Wasserman pointed out, the real impact is at a policy-making level, and few of these types of positions in government are held by geriatricians or eldercare experts. Until that happens, the fight for improved policies and funding to elevate nursing homes and eldercare is stacked, but certainly not insurmountable. 

If there’s one thing I took from this podcast, it’s that there’s no reason to be pessimistic about the future of eldercare. If anything, after COVID-19, there’s a momentum driving the need for change that many experts in the field are riding on. 

An Unlikely Partnership Solves a PPE Issue

At Green House we often say “It’s all about relationships” and that certainly was the case for Green House partner Jewish Senior Life (JSL) in Rochester, N.Y.. Early on in the pandemic, JSL had trouble finding PPE that was accessible and affordable.

An Unlikely Connection

It’s a story of creativity and relationships. The JSL team wondered if the local Amish community might be able to help. This is when JSL Chief Information Officer Travis Masonis stepped up to make a crucial connection. Masonis knew his father had a relationship with the Amish community, so he asked him to make an inquiry about creating cloth PPE.

Travis’ dad reached out to Moes, the general store manager for the Amish, who spread the word about their willingness to sew the gowns in their homes. Twenty women agreed to do so using a pattern created by Travis. The women sewed small, medium, and large gowns on pedal operated sewing machines.

Over a period of several weeks, the community sewed reusable cloth PPE isolation gowns–roughly 10,000 of them. JSL CEO Mike King drove up each Friday to pick up the completed gowns. As it turned out, the low incidence of COVID cases and deaths at JSL meant they didn’t need all of the gowns.

A Pay It Forward Opportunity

This turn of events enabled JSL to make a “pay it forward” contribution to other nursing homes. As a member of a New York non-profit alliance with five other nursing homes, JSL shared the gowns with the other homes dealing with larger coronavirus outbreaks.

We applaud the efforts and hard work by the local Amish community and the creative approaches to meet a practical need at JSL and within their nursing home alliance!

Ashton Applewhite on Aging & Ageism

Given how the events of past 10 months have affected older adults, my colleague, Marla DeVries, and I looked at how ageism has played a role in why COVID-19 has had such a devastating impact on those who live in nursing homes.

A recent interview on the Elevate Eldercare podcast offers an important perspective on this tragic phenomenon. For the Christmas week episode, Green House Senior Director Susan Ryan sat down with Ashton Applewhite, an author and activist in the anti-ageism movement. In 2016, Ashton self–published This Chair Rocks: A Manifesto Against Ageism. The book has since been picked up by a publisher and sold worldwide. It has since been named one of “The Top 100 Best Books to Read at Every Age,” by the Washington Post and one of the “10 Books to Help You Foster a More Diverse and Inclusive Workplace,” by Forbes.

Among other things, Susan and Ashton examine how the longstanding practice of warehousing elders away in institutional, medicalized settings helped the novel coronavirus spread like wildfire among residents.

Ageism Exposed

Ashton’s impact on the anti-ageist movement is unparalleled. In addition to her book, she has done a TED Talk, spoken at numerous conferences (including our own in 2016), guest-starred in dozens of podcasts, and quoted in many media stories on the topic. When Marla and I recorded our recap episode, we were surprised that a manifesto is needed to combat negative stereotypes that have the potential to affect nearly the entirety of society. What’s more, I would agree with Ashton that aging is the most fascinating field there is, because if there is one thing all of humanity has in common it’s that we are all getting older each and every day.

In her discussion with Susan, Ashton notes that while the pandemic has not made ageism worse, it has exposed what’s been there all along. In fact, ageism is a “prejudice against our future selves,” as Ashton says in her 2017 TED Talk, which has been watched more than 1.6 million times.

Attitude Is Everything

In the podcast episode, Susan and Ashton talked about lifespan versus health span and how our attitudes toward aging affect how our minds and bodies function at the cellular level. When it comes to aging, she wants people to be fact-based rather than fear-based, because when we do that, we’re more likely to recover completely from severe illnesses and disabilities.

In other words, the goal needs to be about health, not about youth. And that health, as she said, is not binary. It’s really on a spectrum.

Get On Board

So how does one go about tackling ageism, you wonder? Well, there is a resource for it that Ashton helped to create. It’s a website called Old School, and it serves as a clearinghouse of “free and carefully vetted resources to educate people about ageism and how to help dismantle it.” The site includes blogs, books, articles, videos, and speaker information.

For more insight about Ashton and what she’s doing now, take a listen to her podcast episode below:

On Apple: https://podcasts.apple.com/us/podcast/ashton-applewhite-ageism-covid-19-grassroots-opportunities/id1524700411?i=1000503852177  

On Spotify: https://open.spotify.com/episode/6PnDdu7UKmlKe2XG4PXR5z?si=c-oE8VP1Tp2ddlmqGJHV6Q

On Stitcher: https://www.stitcher.com/show/elevate-eldercare/episode/ashton-applewhite-ageism-covid-19-and-grassroots-opportunities-80478859

Living with Early-Onset Dementia: A Story of Courage & Hope

After a career in telecommunications as well as serving as a member of the Rhode Island National Guard for over a decade, Mike Belleville was diagnosed with early onset dementia, at the age of 52. Although the news was devastating to Mike,  he has not let it define him.

Watercolor by M. Belleville
Mike Belleville has discovered a talent and love for watercolors since his diagnosis of dementia.

Since his diagnosis some seven years ago, Mike has become a strident advocate for people living with dementia. He speaks around the country in support of research and better understanding of the disease and he serves on several boards, including the Dementia Action Alliance

I first met Mike when he gave a keynote speech at our 2018 annual conference, and I have had the great pleasure of getting to know him more since then. So, when I had the opportunity to record a recap of our latest episode for Elevate Eldercare with my colleague Marla DeVries, I was delighted to get an update on his life.

True to form, Mike, who was joined by his wife Cheryl for the episode, offered his unfettered opinion about the importance of dispelling myths about people living with dementia and how the diagnosis has affected his life recently.

The Myths of Dementia

As Marla and I dive into the very compelling conversation the two had with Senior Director Susan Ryan, we have fun going a little deeper into something Mike calls the Four Myths of Dementia. And as he seeks to debunks many misperceptions about dementia, Mike himself is an example of someone who defies them: since his diagnosis he has become a very talented artist, chef, and public speaker.

In addition to the exploring the power of family and relationships, the couple explain how they found hope and tangible solutions on their journey. They also examine the need for caregiver support and respite, as well as the impact of the pandemic on routines, normalcy, and vital human connections.

We also take a look at a scene in one of his favorite movies, Shawshank Redemption, from which he draws inspiration and motivation for living well with dementia.

There is so much more about Mike to learn, just as there is about dementia. Get to know him better on our latest podcast episode below:

Avoidable: David Grabowski’s Take on the Pandemic’s Impact on Nursing Homes

COVID-19 has had such an impact on so many lives over the past several months that when you hear a well-respected researcher in long-term care say the impact could have been significantly reduced in nursing homes or AVOIDABLE…it makes you lean into the conversation and hear how he backs up that statement. And Dr. David Grabowski does back it up!

His insights and observations are part of the latest Elevate Eldercare episode. Marla and I thoroughly enjoyed listening to him and doing our recap podcast.

While I’ve only met David Grabowski once when he was doing research on the Green House model in 2013, he was so down to earth. But his current position as a professor of health care policy at the Harvard Medical School is impressive. He has dedicated his career to shaping policy and making a difference in the lives of elders. And what I really admire about him is that he’s not afraid to share his very candid and data-based opinions with those in governmental agencies that could implement change for the good.

“So, the reason avoidable was my word is that it didn’t have to be this way. And we know with greater preparation, with greater infection control, with testing, with personal protect equipment, with investment in direct caregivers, we could have really mitigated the spread of COVID in long term care facilities broadly, and nursing homes specifically,” he said “If we had made the investments early in this country to really put resources and attention into nursing homes, we could have avoided this huge outbreak.”

Dr. Grabowski was one of 25 people on the Coronavirus Commission for Safety and Quality in Nursing Homes. The results of that commission should be announced this month, and it will be interesting to see if the innovative suggestions he offers in the podcast are included in new policies or regulations.

You will be intrigued by the research he uncovered during this pandemic. Are you someone that thinks a 5-star rating automatically means fewer COVID cases?  That’s what Dr. Grabowski alluded to in his hypothesis. He said you would assume those homes with prior infection control problems, or low-quality care numbers would be where COVID hit – but that wasn’t the case. It didn’t matter if a nursing home was a one-star or five-star organization OR if there was a high Medicaid census. Tune into the podcast to find out what the determining factor really is when it comes to COVID.

And I really appreciate a researcher that readily admits when he regrets an earlier statement on an issue. Dr. Grabowski initially thought isolation for all elders was a good idea. Since those early months during the pandemic, he has come full circle on that issue. He says it’s not only COVID that kills, it’s isolation! AND he is very concerned about the exhaustion level for direct caregivers fearing that nursing homes will lose “the best of the best”.

Dr. Grabowski has so many unique nuggets of information in this podcast, I encourage you to listen to the original episode and then see what you think about the highlights that Marla and I share with you!


 

Disparties, Racism & Ageism Amid COIVD-19

The Elevate Eldercare podcast this week is most timely given the headlines concerning protests about social injustice in Wisconsin. Susan Ryan, Green House Senior Director, interviewed Karyne Jones, the president & CEO of the National Caucus and Center on Black Aging (NCBA). It was amazing the wide variety of topics they covered – everything from COVID-19 and the health disparities that exist among people of color to the devastating impact of social isolation, our shared humanity, and implicit bias.

For those of you are not familiar with NCBA they are the preeminent national organization on issues impacting African Americans age 50 & over. They have three areas of focus: employment, health and wellness and housing. I was struck by Karyne’s description of their mission to provide affordable housing and their philosophy with health and wellness. Many of their concepts match the work we do at The Green House Project. We want Green House homes to be available to all regardless of their ability to pay. We believe elders should direct the life they live in the home and the importance of their voice at the table. In fact, NCBA was established 50 years ago as a result of leaders from a few African American nursing homes who wanted the voice of black communities included in the creation of the Older Americans Act. President Nixon agreed and their successful participation in that work made them decide they should form an organization to address all kinds of issues that affect older African Americans and older poor people who want to improve their life – thus, NCBA was formed.

And while none of us like the pandemic, for Karyne and their organization it has shined a light on the health disparities for those in poor, racial communities. In terms of the issues around police brutality she explained that racism, – and classism are things they have dealt with over the years. The good thing now, she explained, is that people are asking NCBA for ideas, on how can they address the problems – and she said, “we welcomed that”.

Both Marla and I teach a class that discusses how important self-awareness and self-management are to each person. What are the biases we might have? What judgements do we hold? So, it wasn’t a surprise to me that Marla took at special interest in the discussion of implicit bias. It’s not a term we all use, and the information is good to have during these times, especially if you are looking to learn more about yourself. Marla shared information on a unique graph by a doctor entitled “Becoming Anti-Racist”.  Take a look at the graph and assess yourself. Be honest and take this opportunity to grow!

Karyne also talked about our need to help others and stated, “It’s our humanity to make sure that we help people”. To me that is such a beautiful phrase. What better feeling can you possibly have than when you offer your assistance to someone who could use your skills or talents – it’s such a wonderful gift. When you have one community suffering, she went on to say, it drains another community. There’s an opportunity for us to shift from being independent to understanding our interdependence of one another. Some might consider that a real paradigm shift for our humanity, to embrace compassion, to be empathic and support other people, I believe we are capable. I feel Shahbazim in a Green House home do it every day. They give to the elders and the elders give back. There is such a wonderful “interdependence” in the home.

One final word about NCBA – they have one awesome newsletter. Seriously, it is filled with such good information, it’s worth taking a look at it. Hope you’ll listen to both podcasts, Elevate Eldercare with Susan and Karyne Jones and Let Me Say This About That with Marla and me. Enjoy learning and growing!

How They Made the Mold

We had a trip down memory lane and the inside scoop from two innovative

The first Green House home in Tupelo, MS.

leaders on the most recent Elevate Eldercare episode. Susan interviewed the creator and founder of The Green House Project, Dr. Bill Thomas, MD, and the CEO of Methodist Senior Services (MSS), Steve McAlilly. MSS pioneered the first Green House homes on the campus of Traceway Retirement Community in Tupelo, Miss., in 2003.

It almost didn’t happen at Traceway. MSS had dedicated funds, to the tune of 12 million dollars, to build what would have been a pretty traditional facility. Emboldened by the vision Bill cast, Steve persuaded the board to take a leap of faith. We often talk at Green House about building the bridge as we walk across it. I guess that DNA harkens back to when Traceway “made the mold,” to quote Bill.

Among our favorite questions at Green House are: “Would you have it at home?” and “Would you do it that way at home?” These questions were birthed years ago as the Tupelo team wrestled through what should go into those first homes.

There is this constant pull between Real Home, a Green House core value and an institutionalized way of doing things, which we call institutional creep and often refer to it as the institutional dragon always lurking just outside the home. Bill said, “it is always, always, always easier to do things the usual way…. The pressure to conform to the traditional system is enormous and it never lets up.” But pushing the easy button doesn’t ultimately get us to how Steve describes Green House homes: “a vessel that enables life and living and loving and learning together.”

More than just a history lesson on Green House homes, the conversation moved us to consider how to not waste a pandemic. I love that Steve said, “It is a sin to not do as much as we can as fast as we can; the real sin is apathy. The sin is accepting the status quo and not acting to change it.”
The pandemic has shed a light on long-term care and rather than vilify “traditional” nursing homes we need to seize this moment to do something different. Both Mary and I resonated with what Bill described as, “big house, small life, small house, big life.”

When it comes to the deep knowing of elders, reciprocity, interdependence, building community, and autonomy and control, smaller is better. I think there is opportunity for any long-term care organization to consider how they might take bigger sections of their homes and make them smaller.

On our podcast I got to share one of my favorite books, “Community: The Structure of Belonging” by Peter Block. Whether you work in long-term care, are a part of a church, social group, or a neighborhood, there is application to you. Bottom line—we need to be intentional about creating community. It doesn’t just happen.

In 2008, Block wrote that we live in an age of isolation. That is even more true in this pandemic era. What Thomas, McAlilly, and Block teach us is that we can author a different future for our elders and for ourselves if we seize upon this opportunity to shift the paradigm once again.

For even more insights and takeaways, take a listen to the original interview and then join Mary and me for, “Let Me Say This About That.”
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