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Business of Aging Special Coverage

Safe at Home

By Mark Morris

Cheryl Moran

Cheryl Moran says she increased staffers’ hours and pay to make sure they worked only at the Atrium during the pandemic.

Beth Cardillo said the arrival of COVID-19 caused a “wildfire effect.”

As executive director of Armbrook Village, a senior-living community in Westfield that offers independent and assisted living, as well as memory care, Cardillo said the first days of the pandemic created huge challenges for healthcare professionals who faced major decisions while working with limited information.

For example, hospitals were only admitting COVID-positive patients if they had a fever and showed respiratory symptoms. Some seniors at Armbrook, however, were testing positive but manifesting different symptoms.

“We had someone who tested COVID-positive, but he didn’t have a fever or a respiratory problem,” she said. “He felt weak, fatigued, and he almost passed out.”

Cardillo’s call for an EMT to transport the positive-testing resident to the hospital was met with disappointment when she was told the hospital would not admit anyone for the coronavirus unless they had a fever or respiratory symptoms.

“At that time, no one knew there were a host of other symptoms,” she said. “It’s nobody’s fault because nobody knew.”

Cardillo informed Baystate Medical Center about residents who showed different symptoms for the coronavirus, and the hospital quickly sent a team of specialists in infectious disease and emergency medicine to Armbrook to further examine these cases.

“Incidents like this were happening all over the country,” Cardillo said. “It’s how we learned that people can manifest other symptoms but still have the coronavirus.”

Similarly, at the beginning of the pandemic, health officials were not encouraging everyone to wear masks; later, with better information, they shifted course. As information on all aspects of COVID-19 improved and safety guidelines were implemented across the U.S., senior-living facilities that already had sanitizing and infection protocols in place increased their efforts to battle the spread of coronavirus.

Emily Tamilio, Corporate Marketing director for Rockridge Retirement Community in Northampton, said her complex revamped its already-strong infection-control policies before the state went into lockdown. “We’ve redoubled our protocols and to make sure all our staff is up to date on proper infection control, hand washing, and strict sanitization procedures.”

Beth Cardillo

“We had someone who tested COVID-positive, but he didn’t have a fever or a respiratory problem. He felt weak, fatigued, and he almost passed out.”

Meanwhile, at Atrium at Cardinal Drive in Agawam — an assisted-living facility exclusively for people with memory loss — Executive Director Cheryl Moran imposed strict screening procedures to keep residents and staff safe, such as requiring all outside agencies to get her approval before they could enter the facility.

In the caregiving community, it’s not unusual for workers at one assisted-living facility to take a second part-time job at a similar site or earn additional income by providing care at a person’s home. Moran knew she had to address this vulnerability to keep the virus away. “I met with all our associates and offered more money, more hours, and different hours to encourage them to work only for the Atrium.”

Tamilio said Rockridge also offered additional pay and hours to keep staff working only at that facility. “Having our people just work for Rockridge was key to preventing transmission.”

Both Moran and Tamilio said encouraging staff to work only at one community is one of the main reasons neither campus has had any COVID-19 cases to date. It’s an example of how senior-living communities across Western Mass. had to be creative and aggressive — and continue to do so — to protect the most vulnerable population from a pandemic that’s far from over.

Visitation Consternation

In mid-March, the state issued guidelines for senior-living facilities to allow visitors only after they’ve had a health screening prior to their entry. When the pandemic first hit, all three communities BusinessWest spoke with said they restricted all outsiders except health providers and other essential personnel. Unfortunately, that meant families were not able to visit their loved ones in assisted living.

“As disappointing as that was, we had a solid communication process in place, and we were transparent about any changes, so it was much easier to get the families, residents, and staff on board,” Tamilio said.

Cardillo also stressed that communication was key, and personally checked in with every family member. “We were honest with people and let them know what was going on, and they appreciated that.”

As a further precaution for those in assisted living, the Executive Office of Elder Affairs mandated that everyone be quarantined in their apartments. No communal dining or walking around the halls was allowed.

Emily Tamilio

Emily Tamilio

“We’ve redoubled our protocols and to make sure all our staff is up to date on proper infection control, hand washing, and strict sanitization procedures.”

Cardillo noted that many residents in assisted living have cognitive impairments that make processing and retaining information difficult, so structure and constant communication are very important. Still, cognitively impaired residents who had been making progress before the quarantine began to backslide.

“They were confused again, depression was setting in, and their anxiety increased,” she recalled. “In some ways, the social isolation was almost worse than the virus.”

Staff dressed in full personal protective equipment (PPE) began meeting one-on-one with each resident in their apartment. Cardillo said reaching out and having conversations with the residents began to make them feel better.

Moran said the configuration of the Atrium made it possible to allow residents out of their apartments and still keep them safe. “Because we have the space, we were able to socially distance our residents while still allowing them to take part in modified programs and activities.”

As late spring arrived and the weather improved, residents in most communities were able to go outside more often and socialize with others. Cardillo said positive changes began to happen the minute residents were able to enjoy some fresh air. “Whether it was having a conversation or taking a walk or simply looking at the birds, we saw their depression and anxiety lessen once they could spend time outside.”

The warmer weather also enabled the facilities to resume family visits. Moran said the Atrium has a designated area for outdoor visits where families can schedule time with their loved ones either after breakfast or after lunch.

“We can only allow two family members at a time, and they have to wear masks,” she explained. “Unfortunately, they can’t hug or kiss their loved ones, so they do air hugs and things like that.”

Videoconferencing through platforms like Zoom, Skype, and FaceTime have been effective ways for families to stay connected — and send air hugs to their loved ones — when a physical visit is not possible. Tamilio said Rockridge staff will often work with families to coordinate a videoconference or even a phone call to help them feel connected during the pandemic.

“There are many times when our staff are the eyes and ears for the families of our residents, so we work very hard to stay in contact with them,” she told BusinessWest.

Using videoconferencing tools is one more way to be reassuring and transparent with families and staff, Moran added. “It’s important for families to know about the place where their mom and dad are living.”

Cardillo talked about a recent Zoom conference conducted like a town-hall meeting that included 80 resident family members, as well as Armbrook department heads. The purpose was to let everyone know what’s been done so far to keep residents healthy and engaged, and their plans going forward.

“Many family members had no idea about everything we’d gone through to keep their loved ones safe,” she said. “They want to do this type of meeting again.”

Meeting with potential new residents and their families is an important part of any senior-living community. The arrival of COVID-19 has moved much of that activity from in-person meetings to videoconferences. For families who want a tour of the facilities, Tamilio said virtual tours have been an effective alternative to an actual visit.

“We can connect them to our community and help them feel engaged,” she said. “Videoconferencing also allows us to bring together multiple family members from different locations to answer all their questions in one meeting.”

Cardillo is still able to meet with families in-person in Armbrook’s private dining area by using social distancing and requiring masks for everyone. Before the meeting, she will have a phone conversation and send information so that, when a family arrives for the meeting, they have some idea about the community.

“I will show them apartments, but we can’t wander around the building anymore,” she noted. “That’s the only thing that’s really changed.”

While Moran is not yet meeting in person, she depends on virtual tours and has identified a number of families willing to serve in an ambassador-type role.

“There are several family members of current and past residents who are willing to speak with new families about their experience here,” she said. “They are able to give their perspective on how things have been going for their loved ones.”

Winter Is Coming

Seven months into the pandemic, and with fall and winter coming, the Executive Office of Elder Affairs is allowing senior-living facilities to permit indoor visitation to specific areas of the building.

Moran said the Atrium will use office space in its main building to screen visitors and supply full PPE. She plans to limit visits to 30 minutes and restrict visitors to meeting in the front areas of the building.

A similar visitor policy will be in effect at Rockridge, which is about to install an air-purification system to use in common areas. The idea is to monitor air quality to make sure those areas are safe, especially as they begin to open the dining area and allow more visitors

“We are trying to find the right balance between mitigating risk and enhancing the quality of life for everyone here,” Tamilio said.

As the weather gets cooler, Cardillo is looking forward to bringing activities such as exercise classes indoors. There will be limits on the number of people who can participate at any one time, but that’s just part of life in these times.

She reflected on the challenges facilities like hers faced with the sudden arrival of the pandemic back in March, and how far they’ve come. “At the beginning, we were all learning together at the same time. With all that we’ve learned since then, we have a much better handle on things now.”

She said residents are in a much better frame of mind these days, with no COVID-19 cases reported in months.

All the administrators we spoke with said a spirit of cooperation — with everyone pitching in and constantly doing more than expected — has been a true highlight of these last six months. To acknowledge that spirit, Cardillo is planning a series of recognition ceremonies for her staff in the coming weeks.

“We had people who got very sick, and our staff did some beautiful things,” she said. “Sometimes it was just sitting with a resident and holding their hand. Their families were really touched by it.”

With the pandemic still a daily reality, Cardillo said she and her colleagues are better prepared if there is another flare-up of the virus.

“We hope it doesn’t happen, but we’re ready if it does.”

Guide to Senior Planning Special Coverage Special Publications

Without a doubt, 2020 has been an unprecendented year. The COVID-19 pandemic has thrown the economy, family life, and, well, just about everything else into disarray.

Yet, one aspect of American life has definitely not changed — and that’s the need to prepare for one’s senior years.

As the Baby Boom generation continues to march into their retirement years — at the rate of 10,000 per day — Americans are living longer than ever. In fact, according to the U.S. Census Bureau, by the year 2030, more than 20% of U.S. residents will have passed their 65th birthdays.

But what that life will entail, post-65, can wildly vary depending on lifestyle preferences, health status, finances, and more. That’s why preparation is so important — the sooner, the better. And that’s what this special section of BusinessWest is all about.

For the second straight year, we take a hard look at myriad questions: what levels of care are available, and what do they include? What are some strategies for approaching mom or dad with concerns they might not be able to live alone anymore? How can families pay for all this? What’s an estate plan, and what documents are most important?

As noted, 2020 is already a year fraught with anxiety, and no one wants to add more. But the truth is, even if you don’t expect to be thinking about long-term care for yourself or a loved one, an unexpected accident, illness, or injury can change one’s health needs, sometimes suddenly — or the need might emerge gradually, due to declining health.

It’s a lot to think about, and no single guide can answer all those questions. But hopefully, the following pages will help you approach those decisions with a little more understanding and a little less worry.

According to the U.S. Census Bureau, by the year 2030, more than 20% of U.S. residents will have passed their 65th birthdays.

Opinion

Opinion

By Mary Flahive-Dickson

Seemingly, there is very little time for reflection these days. As we move from one news report, one Zoom meeting, one emergency to another, it is not lost on us that this is now our norm; life has changed. Restlessness is nationwide. Our communities are apprehensive at best, and our seniors are even more isolated now than any other historical time.

Social isolation, while defined as a lack of relationships and meaningful contact with society, needs to be further contemplated and gauged in our elder population as COVID-19 continues to force us to shelter in place, while begging for social and physical distance.

Caregivers, as catechized members of the front line, are being asked to rise to the challenge of defense against physical and social isolation of seniors.

Our elders are seemingly the target of so many evil pathogens and infections as their immunologic response has slowed and their physicality is compromised. Add life-changing risk factors such as retirement, death of loved ones, and the global nature of our society to the geriatric mix, and oftentimes the result assumes the form of social and physical isolation and loneliness.

Isolated and lonely seniors are at an increased risk for additional physical and emotional health conditions such as anxiety, high blood pressure, depression, and cognitive decline. With the loss of a sense of connectivity to the outside world and specifically their community, our elders run the risk of a decrease in wellness and a general decline in health.

Additionally, and especially in the current COVID-19 theatre, physical and emotional needs such as activities of daily living (ADL), companionship, and personal care may not be satisfied or executed. This situation is yet another nail in the proverbial coffin of enabling an immunologic response to infections, therefore rendering individuals less able to fight off disease, while increasing their risk of mortality.

Conversely, elders who engage with society, continue to be active and cognitively stimulated, have conversations, and have their ADLs satiated oftentimes experience increased positive influential health opportunities and many times are able to maintain the state of wellness longer.

Our role as caregivers is to facilitate an improvement or at least a maintenance of independence, health, and well-being of our elders. By providing for and assisting them with activities of daily living, promoting self-care, and reinforcing social support and a sense of community, caregivers continue to promote and disseminate multiple dimensions of physical and emotional health and wellness among this population.

As society continues to seesaw under the cloud of COVID-19, the senior population is not exempt from partaking in groups, programs, and activities which can help in thwarting physical and social isolation and loneliness. In fact, for the seniors, it is just the opposite. No populace has seen a furthering of isolation more than the seniors.

And, with home care widely accepted as a significant player in promotion of health and wellness, staving off mortality and reduction of admissions to institutional care such as hospitals and skilled-nursing facilities, caregivers’ roles should be touted as the front-line essential necessity they have always been, albeit unpronounced.

Mary Flahive-Dickson is chief operating officer for Golden Years Home Care Services.

Business of Aging

Care Connections

Kathy Burns says Mercy LIFE’s team approach to care has helped seniors maintain and even improve their health.

Celina Conway tells the story of a man who arrived at Mercy LIFE after five years in a nursing home, and was so weak, he couldn’t even hold a cup with both hands. After five years receiving services there, though, he felt stronger than he had in a decade — since before his nursing-home stay, in fact.

“They’re getting stronger,” said Conway, the facility’s director of Enrollment and Marketing. “There are people who came here in wheelchairs and now walk — quite a number, actually. Those are not uncommon stories.”

Mercy LIFE is a PACE (Program of All-inclusive Care for the Elderly) program run by Trinity Health PACE that will celebrate its sixth anniversary on March 1. PACE programs are on the rise in the U.S. because the role they play — providing a range of health programs aimed at keeping seniors out of nursing homes — is becoming more prominent.

“We’re serving people who could be in nursing homes. The model was designed as a place for folks who need some care and need some eyes on them on a more regular basis than an elder living independently,” said Kathy Burns, the center’s executive director. “In fact, everybody who joins us has to be, in the eyes of the state of Massachusetts, clinically nursing-home eligible. And they tend to thrive here because of the intensive care management we do with this big, multi-disciplinary team.”

Indeed, that team includes primary-care doctors, home-care nurses, physical and occupational therapists, dietitians, social workers, among others, all working as a team on each enrollee’s individualized care plan. And it’s not just healthcare; it’s also a place for seniors to socialize, participate in activities, and be generally engaged in life.

“Everything is under one roof, kind of like a nursing home, but nobody lives here; they go home at the end of the day,” Conway said. “When people enroll in the PACE program, they agree to have all their services provided by the staff here, including primary care.”

It’s a managed-care model not far removed from accountable care, the model that has crept into hospitals nationwide, which involves teams of providers being paid by insurers to keep patients well over a period of time, rather than being paid for each treatment, test, and hospital stay.

“It’s actually the precursor to accountable care,” Burns said, noting that, about 40 years ago in San Francisco’s Chinatown neighborhood, families wanted a place for their elders to go instead of a nursing home — a central location where they could bring in health services. Medicare funded a trial run, and the model worked. A second PACE site followed in Boston, and today, 131 PACE programs provide services at 263 centers nationwide, serving about 51,000 participants.

Why? Because the model works, Burns said, giving one example of how such programs keep people healthier while saving money.

“We get a good idea how this person functions, what’s important to them, what their goals are, how we think we can meet their needs. They have the ability to say, ‘I don’t want to do this,’ but typically, once they walk in the door, they’re sold and they do want to enroll.”

“Everybody on the team is equally important in their observations of what’s going on with the elder. Let’s say a driver who’s driven Mrs. Smith here every week for a long time notices, ‘boy she’s really out of sorts today.’ He’s supposed to come in and tell his boss, who will come to the morning meeting and say, ‘Mrs. Smith isn’t right today.’

“So Mrs. Smith is sent right down to the clinic, and we’re going to look at her,” she continued. “And if she’s got, say, a UTI brewing, we’re going to get her on some antibiotics and take care of her right here instead of her going home, where the infection gets worse, and she ends up in the ER with delirium because the infection makes her delirious, and all of a sudden she’s in a psych ward spending Medicare or Medicaid’s money unnecessarily because what she needed was antibiotics, which we can take care of right here.”

Safe Haven

Mercy LIFE currently enrolls more than 300 seniors, about 100 of whom are on site on a typical day.

“We explain to people this is a different way to have your healthcare delivered, and we have conversations to make sure they want care delivered this way,” Conway said. “We want to help them live safely at home.”

If, after being assessed by a nurse, they meet the criteria of needing nursing-home-level care, team members speak further with them and their family members, she went on.

“We get a good idea how this person functions, what’s important to them, what their goals are, how we think we can meet their needs. They have the ability to say, ‘I don’t want to do this,’ but typically, once they walk in the door, they’re sold and they do want to enroll.”

Conway said Mercy LIFE enrollees are assessed and placed into one of four different activity levels, from totally independent to needing more help to memory care, and it’s not uncommon for people to move from one level to another over time. “If people are concerned they won’t find people like them, they will.”

The rehab gym is a popular spot where participants can get stronger, she added. Some sign up for time with a personal trainer, while others might work in small groups or one on one to deal with specific issues, such as balance.

“They always think they’ll get weaker and less mobile as they age, but we’re lifers; we’re planning to be with them for life. So we’re trying to do preventive care, which is less expensive than dealing with a crisis after an episode where somebody falls.”

Occupational therapists on the team also spend time in the home, and are always scoping out issues that could be dangerous, Conway noted.

“We are responsible for everything. So if someone needs a grab bar, or someone needs a toilet set, we are going to order it and deliver it ourselves, which is better than getting a script and going to the medical equipment store. It’s very personalized service. When we work as a team, we prevent so many hospitalizations, emergency-room trips, that sort of thing.”

Burns added that the attention and engagement seniors get at Mercy LIFE brings a richness and measure of security they might not find on their own. “It’s an intensive model of oversight that really keeps them safe at home, happy at home. A lot of folks who come here had spent years at a time just sitting at home watching television. Now they’re doing all kinds of interesting things in our day room, while they’re seen by doctors and therapists.”

And the care plan is different for everybody, Conway said as she walked with BusinessWest past a conference room where an interdisciplinary team was meeting, as they do multiple times each day, to discuss whatever issues may have arisen with some of the people in their charge.

“We’ve helped 550 people over the past six years,” she added. “We don’t discharge people to hospice. We serve people until the end of their life. It’s a beautiful model. To see people when they enrolled and then see the progress and the support they get is very rewarding.”

Burns agreed. “A lot of families have been incredibly grateful for that gift.”

Effective Model

Burns and Conway both came back repeatedly to the financial benefits of preventive care and the value of preventing incidents before they arise. “If you don’t have an ambulance ride, an ER visit, a hospitalization, and a rehab visit, you’re saving a ton of money right there,” Conway said. “I know our interdisciplinary team members work hard to prevent those four key things. Everybody’s happy as a result of that.”

There is no cost to the vast majority of the seniors or their families (there is a private-pay option for a small percentage of participants). Medicare grants the program a flat monthly premium, while MassHealth provides funding as well. However, this year, MassHealth reduced its rate by 2.1%.

“We’re advocating for some of that to be brought back,” Burns said. “The problem for small but effective programs like ours is they’re easy targets for things like that. And we’re really hoping MassHealth will consider pulling back that decrease.”

Those who work at the West Springfield site see that effectiveness every day, Conway said. “This is mission work. I don’t think you’ll find anyone working at Mercy LIFE for the money. They stay here because they enjoy it so much.”

She told BusinessWest she appreciates the chance to tell the Mercy LIFE story because many people still have misconceptions.

“People think it’s home care, they think it’s adult day health, they think it’s a doctor’s office … but it’s all of those things,” she said.

“It sounds too good to be true,” Burns added. “But it just works.”

Joseph Bednar can be reached at [email protected]