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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.”

Health Care

Cultural Shift

Michael Taylor and Teresa Weybrew say Christopher Heights of Northampton is striving to be ‘the place’ for LGBTQ seniors.

The average age of a Christopher Heights resident is somewhere in the 80s, says Teresa Weybrew, director of Marketing & Admissions at the assisted-living community in Northampton.

That’s an age group that grew up in a less-open time when it came to gender identity and sexual orientation — and members of that generation often still feel anxiety around their peers. But what’s more surprising, Weybrew said, is that, for many, that fear of being openly themselves is heightened when they move into senior-living communities.

“There’s a statistic that, of people who have come out and lived an authentic life in their sexual orientation, when they come into assisted living or skilled nursing, 86% go back in the closet out of fear,” she told BusinessWest. “They’re in an environment where they don’t know how safe they are because they have some memory loss or physical ailments — they’re already vulnerable because they’re not quite physically themselves — and then they have this added layer of anxiety. We want to help them understand that we get it, and they’re going to be OK here.”

Christopher Heights recently hosted a workshop for staff, residents, and public on LGBTQ (lesbian, gay, bisexual, transgender, queer) cultural competency in the senior-living setting. Presented by Rainbow Elders, an arm of LifePath in Greenfield, the event was also part of the process of being credentialed by SAGE, the nation’s largest advocacy organization for LGBTQ elders.

“I want our community to be accepting of other residents,” said Michael Taylor, the facility’s executive director, “but we also want employees to feel comfortable and respected. I see this as making it a welcoming place for both.”

Not all communities are. Angela Houghton of AARP Research writes that three out of four adults age 45 and older who are lesbian, gay, bisexual, or transgender say they are concerned about having enough support from family and friends as they age. Many are also worried about how they will be treated in long-term-care facilities and want specific LGBTQ services for older adults.

“I’ve been working with SAGE in a conversation for a couple months,” Weybrew added. “But as I got into it, I realized this isn’t just about having a plaque on the wall. We want to live and breathe and walk the talk and really be the facility that does the work and where people can come in and say, ‘yeah, they really do know what they’re doing, and I feel welcome,’ whether it be an employee or someone who comes to live here.”

Subtle Spectrum

For the recent workshop, Rainbow Elders brought in four people — representing gay, lesbian, bisexual, and transgender perspectives — to talk about gender, identity, orientation, and how none of those categories are black and white, but rather a spectrum.

“It was good educational background. Each talked about their personal story,” Taylor said, noting that Christopher Heights already employs a handful of LGBTQ individuals and aims to create a more welcoming environment for staff and residents alike — which is why hearing these perspectives shared aloud is important.

The demographics speak to the importance of this issue. By 2030, the population of American adults ages 65 or older is expected to surpass 70 million, according the U.S. Census Bureau. The National Gay and Lesbian Task Force puts the number of LGBTQ seniors in the U.S. at 3 million and notes that this figure is expected to double by 2030.

However, LGBTQ seniors frequently report concern over the possibility of encountering discrimination from senior-housing staff or other residents. According to SAGE, 48% of lesbian, gay, or bisexual couples experience “adverse treatment when seeking senior housing,” and transgender elders face such treatment at even higher rates.

Meanwhile, a 2016 report from Justice in Aging notes that 78% of LGBTQ residents in nursing homes, assisted-living facilities, and long-term-care facilities responded ‘no’ or ‘not sure’ when asked if they felt comfortable being open about their sexual orientation or gender identity to facility staff.

Then there are cases like Mary Walsh and Bev Nance, a Missouri couple whose housing application at a local senior-living facility was denied because of a cohabitation policy that defined marriage as between one man and one woman. They sued the facility, but their lawsuit was dismissed by a U.S. district judge in January.

Yes, that’s January 2019, not 1959. Clearly, the work of SAGE and like-minded organizations isn’t done. Cases like this certainly help explain why only 20% of LGBTQ seniors in long-term-care facilities are open about their sexual orientation, according to Justice in Aging.

Yet, attitudes have been shifting — and prejudices hopefully diminishing — over the decades when it comes to this population, and facilities should be welcoming them as an untapped market, notes a report by Sodexo titled “Why ‘LGBTQ-welcoming’ Will Soon Be a Hallmark of the Most Successful Senior-living Communities.”

“Developing a marketing strategy that attracts LGBTQ older adults is the right thing to do,” the report notes. “And it’s good business. Given the opportunity for senior-living operators to advance their growth agenda, developing a strategic plan that attracts and retains LGBTQ older adults and allies is a vital lever to business growth and to improve quality of life.”

To help facilities move in that direction, SAGE launched its credentialing program for retirement communities around the country aiming to create more understanding and resources for these marginalized groups. Its program addresses the specific difficulties LGBTQ older adults face, including abuse, neglect and hurtful comments.

“Most people work with older adults because they have a caring orientation,” said Tim Johnston, director of national projects at SAGE. “We are giving them the tools they need to help older adults feel more comfortable.”

Watch Your Language

In developing a culturally competent and welcoming environment, it is important to address a number of factors, including language, inclusive visuals in company materials, programming, and outreach efforts, according to the Sodexo report.

At Christopher Heights of Northampton, it begins with the application, which used to give only two options for gender — male or female. It may seem like a small thing, but it’s a detail that sets transgender and non-binary individuals on edge right from the start.

“If you’re trans, what do you put?” Weybrew said. “That’s your first exposure to us — and you’re already thinking, ‘all right, they expect me to be a man or a woman,’ when you don’t identify as that.”

She recently asked a resident from the LGBTQ community what might have improved her experience, and she did mention the application form, but she also stressed the importance of respectful communication.

“She said, ‘just ask.’ And we are afraid. We don’t want to offend anyone, and yet, in our fear, we are offending people by not asking them the questions. We want to connect, we need to connect, and that’s what I think this training will offer us — ways to have the conversation. Many people have lived their whole lives feeling either offended or accepted or some awkward in-between. It’s not like we’re going to do something that’s going to shock them.”

Sodexo’s report affirms that idea, noting that “one of the simplest ways to cultivate both understanding and respectful relationships with LGBTQ older adults is through appropriate use of language. Keep in mind, however, that some terms still used by older LGBTQ people may be seen as outdated by younger LGBTQ people. Become familiar with key terminology and pay close attention to how residents use terms and how they refer to themselves and others.”

Indeed, the report continues, “the LGBTQ community is not a monolith. This must be kept in mind when addressing the needs of LGBTQ older adults as well, who have a totally different set of life experiences than younger LGBTQ people. The former grew up in a time that was far less welcoming, when LGBTQ people guarded their sexual orientation and gender identity as a dangerous secret that could cause them to lose their homes, jobs, families, and freedom. They risked being labeled anything from criminal to mentally ill. That generation still carries a lot of this baggage today as they attempt to navigate issues related to housing and healthcare.”

That may be an understatement. SAGE notes that, just a few decades ago, homosexuality was still classifed as a mental illness by the American Psychiatric Assoc., not to mention a crime in some parts of the U.S. Housing, employment, and healthcare discrimination were common. As a result, many LGBTQ seniors remain fearful or distrustful of medical and social-service providers.

Weybrew has assembled an advisory board that will continue to meet regularly going forward and bring in educational opportunities for residents, staff, and the larger community.

“It won’t end. It can’t end,” she told BusinessWest. “We have to keep learning, and we have to say, ‘yes, we see you.’”

She knows she’s already dealing with a vulnerable population. “You’re talking about a potential resident who’s scared because they’re leaving their home of 40 years. Their spouse died, they’re losing their health, and they’re coming to a place where they don’t know us. I know what’s like because I did it with both my parents. Now you add that layer of sexual orientation. We want them to know, ‘yeah, it’s cool to be here because we’re going to treat you right.’

“We’re going to have our issues,” she went on. “We might get some pushback from an 88-year-old who says, ‘God says that’s a sin.’ It’s going to happen. And we’re going to learn how to manage that.”

Not Just Seniors

Senior-living facilities aren’t the only ones recognizing opportunities to boost cultural competency among their staffs. For example, Cooley Dickinson Hospital has been recognized as a 2019 Leader in LGBTQ Healthcare Equality by the Human Rights Commission (HRC), the country’s largest LGBTQ civil-rights organization. CDH is the only hospital in Western Mass. and one of only seven hospitals in the Commonwealth to earn this designation.

Among its efforts, Cooley Dickinson has recruited and trained clinicians who specialize in the care of LGBTQ people; implemented changes to electronic medical records that facilitate the use of the patient’s preferred gender, name, and pronouns; and collaborated with local gender-diverse community members, the Fenway Institute, and researchers from Harvard Medical School on the PATH (Plan and Act for Transgender Health) Project, a study that will inform the expansion of gender-affirming health services in Western Mass.

“This designation affirms Cooley Dickinson’s commitment to providing equitable, inclusive, and affirming care for LGBTQQ patients and their families,” said Cooley Dickinson Health Care President and CEO Joanne Marqusee. “We are proud to receive — for the third consecutive year — this honor and to continue our efforts to ensure that our local LGBTQ community has access to respectful, appropriate care.”

Sure, it’s easier for Northampton-based facilities like Cooley Dickinson and Christopher Heights to make these efforts, which are likely to meet with resistance in less progressive areas of the country. But it’s a start.

“We realize it’s going to be an ongoing process, but we as a company are committed to it,” Taylor said.

Weybrew said Christopher Heights is a corporate sponsor of the Out! for Reel film festival, which focuses on LGBTQ-themed films and recently kicked off its season. “I had a chance to get up and speak. The word is getting out that this is going to be a welcoming place, and it starts with us internally asking, how do we make it that place every day? How do we make people feel comfortable?”

The answer is an evolving one — and begins with asking the right questions of those who have felt marginalized for too long.

Joseph Bednar can be reached at [email protected]