Green House Blog

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!


 

A Nurse Says, “Safety Third”

We could entitle the latest “Let me say This about That,” Nurse-Speak for Dummies as Mary Hopfner-Thomas, my co-host, and I (two non-nurses) unpack the conversation between two nurses, Green House Senior Director Susan Ryan and Tammy Marshall, chief experience officer at Thrive Senior Living. Tammy said, “There is a way of knowing that nurses have…that is unique to our profession…it is the gift of this time, because it is addressing the invisible needs of a person.” Their discussion, on episode 3 of Elevate Eldercare, echoes a guest column in McKnight’s in which Tammy said that nurses will see us through the pandemic. The focus of the conversation was not on the technical skills of nurses, but rather how to couple the technical skills with the human element—to see each person and support their individual needs, the task of nurses and non-nurses alike. 

Tammy Marshall, chief experience officer, Thrive Senior Living

As Tammy shared, COVID-19 has given us a magnifying glass and exposed the good things as well as the challenges in economics, leadership, long-term care, and basic humanity. 

Mary and I reflected on their conversation as a discussion in contrasts: Pathogenic vs salutogenic, adaptive vs technical leadership, and certainty vs ambiguity. I was fascinated to learn new terms from Tammy and then dive deep into the origins and applications in today’s world. Pathogenic is the treatment of the disease and it’s the most common way healthcare is delivered in our Western society. But Tammy reminded us that the U.S. is the most flagrant user of pathogenic model with regard to COVID-19. It would appear we keep using the same method and expect different results. Isn’t this the definition of insanity?

I was fascinated by Tammy’s mention of salutogenesis, so I did a deep dive into it. I learned that Microsoft Word does not recognize as a real word, as evidenced by the red squiggles appearing each time I type the word. Salutogenesis is defined as the “origins of health.” It was coined by Aaron Antonovsky in the 1979 book, Health, Stress and Coping. The chief question in the salutogenic model is “what makes people healthy?” Tammy answered this with a harken back to the basics of nursing a la Florence Nightingale: good nutrition, fresh air, sunlight, sleep, and movement. 

Mary was particularly struck by the simplicity and yet brilliance of this basic approach, and we agreed that a good question we can all ask is, “What would Florence do?” Imagine if long-term care providers approached care by seeking to answer the question, “What is the most healing environment for each elder?” and “How might things be different?” These questions move us into what Tammy described as “adaptive leadership.” It’s about asking the right questions and believing there is more than one right answer. It pushes us toward creativity. 

As Tammy described the steps she and her team took communicate with elders and staff, she noted that “we crave certainty.” COVID-19 has given us a lot of uncertainty and ambiguity. What is open or not open, how do we best stay safe, will schools open or not, should we or shouldn’t we do X, when will this end? I loved how Thrive Senior Living developed a compulsive communication strategy to give as much certainty as they could, with a measure of openness and transparency.

As part of our discussion on surplus safety, Mary and I shared one of our favorite Atul Gawande quotes from his book, Being Mortal: “We want autonomy for ourselves and safety for those we love.” As Tammy notes, safety needs to come in third, not first, as is the case in so many nursing homes. That discussion got me thinking—I’m blessed to be a grandmother to a wonderful almost one-year-old. A couple weeks ago I babysat her, and she crawled to her favorite end table with the coasters she loves to bang on the table. She was standing, but not quite an independent walker. She lost her balance, fell, and hit her toothless gums on the table. There was a looong silence before the heart wrenching wail. And there was blood. Never, ever, ever did I want I my precious granddaughter to experience pain or injury. But I do want her to walk independently, to gain confidence in herself, to know that if something happens, I will be there to love and support her. My job as grandma is to love her, foster her growth and development, and keep her safe. Safety third. 

How can we get more comfortable with that kind of an approach with elders? I know there are so many things about how the one-year-old and the frail 90-year-old are different. And yet, they, like all of us, may not be as different as we want to believe. In my opinion, safety third could be a gamechanger in long-term care. The Green House Project’s Best Life approach to supporting elders living with dementia calls this embracing the dignity of risk. 

On “Let Me Say This About That,” I introduced Tammy as a thinker and as someone who challenges me to think. She certainly delivered on that account and I hope Mary and I will likewise challenge you to think deeply about these important topics. In fact, you may want to go back the original Elevate Eldercare podcast and listen to the Susan and Tammy discussion one more time!

Listen to the podcast here:

Apple Podcast): https://lnkd.in/dxMNKrB

Stitcher: https://www.stitcher.com/podcast/elevate-eldercare

Spotify: https://open.spotify.com/show/6Exvwt070aeATvAC0uxFmo…

Marla DeVries is director of resource development for The Green House Project and cohost of “Let Me Say This About That,” the Friday Recap of the Elevate Eldercare podcast.

Dementia-ism, Grace, and the Value of the Outdoors

In our Friday recap of this podcast, “Let Me Say This About That,” Marla and I take a wonderful journey to further explore what Dr. Wright would like to accomplish. We discuss how he will use his voice and why we see his 25 years of experience as a way to help pave the path toward a better lifestyle for all elders.

A tragic and overwhelming loss of more than two dozen elders at a nursing home in Virginia due to COVID-19 propelled its medical director to use his voice to educate the media—and to crystalize his goals for a unique community designed for elders living with dementia. Dr. James Wright is that medical director. I believe you’ll be impressed by his passion and determination to set the record straight and his candid explanation that we live in “a society that feels that they can ignore their elders, warehouse their elders, especially those that are poor, especially those that have dementia.” Strong words, but he is ready to be the advocate that uses a devasting situation to significantly enhance the life of elders, especially those living with dementia. COVID-19 for Dr. Wright was a back-handed gift to provide that sense of urgency for him.

He has three distinct principles that guide his vision, and some may surprise you. Why would outdoors be on the list? And why might he suggest that federal/state surveyors, often the group of people who only seek out what is not being done correctly, be the group that should become mentors and guides to support the staff at nursing homes? Can you imagine welcoming surveyors to your community instead of being concerned about their arrival? Oh…and what about community integration at a community for people living with dementia? We are not talking about just childcare on campus, or a café, but what about a brewery and lots and lots of open acreage? Not what most would envision when thinking about a community to support the growth and care of elders…especially those with dementia. However, you might find yourself asking “Why not?” They are all part of Dr. Wright’s vision for the future.

In addition to exploring the meaning of grace, Marla and I delve into the devaluation of elders living with dementia. Dr. Wright, who also has a degree in theology (a nice combination for a medical doctor wouldn’t you say?), took time to explain how society values youth and power and undervalues the poor, the dependent, and those with dementia.  

As we examine the stigma of dementia, we discuss what Dr. Wright calls the last acceptable form of prejudice: “dement-ism.” 

So, grab some coffee or tea and take a listen to both podcasts. Episode 3 is the interview with Dr. Wright and episode 4 is the “Let Me Say This About That” recap that offers insights from Marla and me. I believe you will find it enlightening.

>>Listen HERE on Apple Podcast

>>Listen HERE on Spotify

>>Listen HERE on Stitcher

Awe and Gratitude Amid COVID-19

Audrey Weiner
Audrey Weiner
Former President & CEO
The New Jewish Home

On behalf of the entire Board of Directors, Vice Chair Audrey Weiner delivered some very heartfelt remarks to Green House partners last week as they gathered virtually to share updates about their work during the COVID-19 pandemic. We thought her very eloquent words were worth sharing with everyone, as her message applies across all of senior living:

“First, good afternoon or good morning to each of you. And many thanks for taking time out of your day. Each day, I am sure, is becoming increasingly more complex for each of you.

“My message, on behalf of the board of directors, is really a very simple one. It is one of awe and gratitude to each of you for all that you are doing.

“While we have all lived through uncertainty and crises, hurricanes and tornadoes, horrible fires, economic downturns, blackouts and civil unrest, September 11th, flu, SARS, H1N1, and for some, the AIDS crisis, nothing in my view has prepared us for this pandemic. We are simultaneously desperately wanting to do the right thing for elders, the individuals who work in our organizations, our volunteers, and the community, while also being concerned about our families, knowing that the demands across communities are extraordinary and complex.

“In some cases, some of you have parents who are older and in at-risk groups. In other cases, you have children who are concerned that you are going to work every day and what you might bring home. There are new babies, new grandchildren, and every day, greater unknowns.

“There are the realities of supplies, concerns about the shortages of medications and antibiotics, challenges in physician visits, challenges in providing rehab, and attempts by government to do the right thing around telehealth, testing, and survey. There are heartbreaking stories about visitors restricted amid moments of death.

“But what is clear to me is that the values of The Green House Project, the ways in which living, care, and relationships are structured in Green House homes, provide what seems like the strongest framework for the best outcomes.

“As I read about nursing homes around the country, especially in the state of Washington, and the surprise on the part of the press that staff are rotating throughout facilities, the issue of inadequate staff, staff working in multiple facilities and multiple shifts, I wonder if anyone has really been listening to the concerns about providing the best possible care of elders.

“I do hope, on a macro level, that there are lessons we will learn as part of this pandemic, and hopefully there will be lessons that allow us to strengthen the long-term care system not only in America, but around the world.

“So, I end where I began, which is with awe and inspiration for all you are doing every day and how you are juggling myriad responsibilities. On behalf of the board, we are endlessly grateful for your intellect, your heart, your inspiration, and your values.

“Please know that we want to be there for you in any way we can be helpful. Above all, please do try to take time to care of yourselves.”