Green House Blog

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. 

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!


 

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.”








National Nursing Home Week® 2014 Success Stories

Green House adopters and enthusiasts across the country came together last month during National Nursing Home Week to educate their local communities and policymakers about The Green House difference. This year, the American Health Care Association used the Hawaiian theme, “Living the Aloha Spirit,” for the week. The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, aligned closely with this year’s theme and we were excited to invite communities across the country to see the difference that our model offers for elders and their families.

Here are just some of our success stories from that week:

  • From February 2014 to today, we have gained 220 followers on Twitter totaling 1,635
  • From April 2014 to today, we have received 73 new likes on Facebook totaling 2,483
  • Two templates were added to our Support the Movement page
    • Sample Letter to the Editor
    • Sample Letter to a Policymaker
  • Editorial from the Guide at The Green House Homes at VA Illiana Health Care System in Danville, IL was printed in two local papers
  • The Guide with the Green House homes at Mirasol in Lakewood, CO wrote an editorial
  • Three policymakers site visits occurred in conjunction with National Nursing Home Week:
  • Photos like the one you see above from St. Martin’s in the Pines in Birmingham, AL were shared and added to our Flickr account

A big thank you to all who participated!

Want to learn more? Visit our Support the Movement page and use our policymaker site visit letter and editorial sample and share these tools with your Green House home friends and colleagues.

Contact Meaghan McMahon at (mmcmahon@capitalimpact.org) with your questions or comments.








Talk about Green House Core Values during National Nursing Home Week® 2014

Are you interested in spreading the word about the Green House model and bringing Green House homes to your community? You’re invited to join Green House adopters and enthusiasts across the country next week during National Nursing Home Week® to educate your local communities and policymakers about The Green House difference.

This year, the American Health Care Association is using the Hawaiian theme, “Living the Aloha Spirit,” for National Nursing Home Week. According to their website, this aloha spirit means that “… the people of Hawaii are encouraged to treat others with deep care, respect and humility, leading to individuals creating a better world.” The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, align closely with this year’s theme and we are excited to invite communities across the country to see the difference that our model offers.

Want to get involved next week? Click the Calendar of Events below for details.

 

Contact Meaghan McMahon at (mmcmahon@capitalimpact.org) with your questions or to share success stories, photos and letters.








Green House Model Gains Traction as Providers See Payoff

This may very well be the right time for your organization to consider Green House homes.

In a recent post by Senior Housing News they highlighted THE GREEN HOUSE® Project as a way to revamp traditional nursing care, explored the return on investment for Green House homes, and discussed how some providers have adopted the model to address specific concerns in their state.

The physical environment of each Green House home is designed to transform the institutional nursing facility into a small, residential environment that is home to 10 to 12 elders.  Green house homes fit within the current regulatory and reimbursement structures, and are thus able to nurture people of all abilities, disabilities and financial circumstances.

The story explained that “As regulations mandated by the Affordable Care Act emphasize initiatives related to providing better patient experiences, better outcomes and at lower costs—especially considering the looming threat of hospital readmissions for SNFs beginning in 2019—a Green House model may be able to produce cost savings and operational efficiencies for SNFs.”

Read the entire story here and find out how The Green House model has been developed in different parts of the country.

 








Talk about The Green House Project during National Nursing Home Week® 2014

Are you interested in spreading the word about the Green House model and bringing Green House homes to your community? You’re invited to join Green House adopters and enthusiasts across the country during National Nursing Home Week from May 11-17 to educate your local communities and policymakers about The Green House difference.

This year, the American Health Care Association is using the Hawaiian theme, “Living the Aloha Spirit,” for National Nursing Home Week. According to their website, the aloha spirit means that “… the people of Hawaii are encouraged to treat others with deep care, respect and humility, leading to individuals creating a better world.” The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, align closely with this year’s theme and we are excited to invite communities across the country to see the difference that our model offers.

Want to get involved next month? Here’s how:

Write an op-ed in your local paper in support of the Green House model & share with us!

– If you’re already an adopter, invite local policymakers to “see the difference” by visiting your Green House home during that week and sharing photos with us

– Help us launch a “Get Connected” campaign and share your National Nursing Home Week stories and photos using social media and connecting with us on Facebook and Twitter using #EldersRule

Need a template to get started? Visit our Support the Movement page and use our policymaker site visit letter and editorial sample and share these tools with your friends and colleagues. Contact Meaghan McMahon at (mmcmahon@capitalimpact.org) with your questions or to share success stories, photos and editorial letters.