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Business of Aging

Peace of Mind

By Mark Morris

 

Heidi Cornwell says families looking for a senior-living community should consider its continuum of care.

Heidi Cornwell says families looking for a senior-living community should consider its continuum of care.

Between now and 2030, 10,000 Americans each day, on average, will reach age 65. That type of growth affects all the industries that serve the senior population — and, not surprisingly, senior living is one industry paying close attention to this trend.

Kimball Farms Life Care provides independent and assisted living as well as dedicated memory-care services. In 2020, the Lenox facility received more inquiries about its residential offering than in any year prior. Heidi Cornwell, marketing and sales director for Kimball Farms, said potential residents are doing more online research to educate themselves about senior community living.

“Many people are ‘shopping around’ earlier because they saw their own parents ill-prepared for this part of their life journey,” Cornwell said. She also noted that, as people live longer, they are moving into senior at a later age.

As a continuing-care retirement community (CCRC), Kimball Farms offers increasing levels of care for those who need it. Residents can easily move from independent living to assisted living, giving the individual and their families greater peace of mind.

For residents who develop dementia or Alzheimer’s disease, Kimball Farms offers memory-care services through its Life Enrichment Program (LEP). Cornwell explained that the program is centered around a philosophy know as habilitation, which increasingly emphasizes a person’s remaining skills instead of the skills they have lost.

For example, if a sandwich is placed in front of a person with dementia, they may not be able to process what to do with it. “However, if someone sits across from them with a sandwich, picks it up, and takes a bite, that is the only queuing they need to understand what to do,” Cornwell said, adding that they can then enjoy their lunch without any further assistance.

“We are so grateful to our residents and their families because they worked with us to find creative and innovative ways to stay engaged and informed, while at the same time keeping everyone healthy.”

Singing is another good example of emphasizing a remaining skill. “The individual may not sing along to a song by themselves, but if an activities person or nurse sings with them, they can sing with pride and remember every word.”

The LEP puts its focus on maximizing quality of life for each resident. Regular routines and programs built around the interests of the individual keep them busy all day and into the evening. As a result, the residents thrive, Cornwell said, noting that the stimulation helps residents with dementia maintain the abilities they still have for as long as possible.

“We place no expectations on them, but encourage them to be the best person they can be,” she said. “We celebrate the good days, bolster self-esteem, and we treat them with the utmost dignity and respect.”

 

Safe Spaces

As research on dementia has evolved, caregivers have increased their understanding on how to manage the condition. Embracing the skills that remain for those with dementia can encourage feelings of acceptance and personal success. That’s important, Cornwell said, because, even though the disease can have an effect on a person’s ability to communicate or recall recent events, they still have a sense of the quality of life they desire.

Or, as she put it, “although they may no longer be able to dance, they still enjoy the music.”

Kimball Farms social worker Jackie Trippico leads what is known as Reminisce Group. This weekly activity begins with staff presenting a specific topic and asking residents to recall a significant memory related to that theme. Cornwell said one popular reminiscence involved talking about a trip to an ice-cream parlor.

Providing comfortable spaces is also part of the program. Kimball Farms’ memory-care neighborhood is a secure, self-contained community. Private apartments are modeled after a typical home with an open floor plan, while residents also have access to a secure outdoor courtyard so they can garden, see visitors, or take part in other activities. The staff ratio is higher than traditional assisted living, and they have all been trained in specialized dementia care.

When COVID-19 hit last year, families could no longer make in-person visits to residents in LEP. Cornwell said the activities professionals and nursing team quickly adapted to using tablets to arrange virtual visits or phone calls so families could stay informed on the care and well-being of their loved ones. Celebrating special occasions simply became virtual events.

“Zoom birthday and anniversary parties, as well as Skype holiday festivities, became our new normal,” she explained.

As COVID vaccine levels rise, Kimball Farms is able to welcome families to visit by appointment. Cornwell reported that residents and their families have been thrilled to resume the personal visits.

“We are so grateful to our residents and their families because they worked with us to find creative and innovative ways to stay engaged and informed, while at the same time keeping everyone healthy.”

As more Americans reach their senior years and live longer than previous generations, the demand for memory-care facilities to treat dementia and Alzheimer’s disease will continue to increase.

According to Seniors Housing Business magazine, from 2013 through 2018 (the latest figures available), the number of new memory-care units increased by 55%.

Cornwell advises those who are looking at senior-living options to consider the continuum of care a community offers. Healthy seniors who may choose independent living in senior housing to downsize from their homes need to think about future needs as well, she said.

“The community they choose should be a place that will provide them with the best quality of life, for the rest of their life, with increasing levels of care when and if they need it.”

COVID-19

Glass Half Full

By Mark Morris

many people with a history of alcohol abuse have relapsed

Edna Rodriguez says many people with a history of alcohol abuse have relapsed during the pandemic due partly to boredom and disconnection.

Each October, as the weather becomes colder and the days get shorter, it’s not unusual to see an increase in demand for substance-abuse services due to seasonal depression. This fall, however, counselors are expecting an even larger spike in the need for their services because of COVID-19.

Since the beginning of the pandemic, treatment centers in Massachusetts have seen an increase in opioid-related overdoses in the patients they treat — a problem exacerbated by the fact that the drugs have become more dangerous, said Steve Winn, president and CEO of Behavioral Health Network (BHN).

Health professionals believe the problem stems from interruptions in the worldwide supply chain of illegal drugs, making it harder to get heroin and synthetic opioids like fentanyl. As a result, what is being sold as pure heroin is often mixed with a more lethal type of fentanyl, causing the increase in overdoses and deaths.

“We don’t know if use is up, but we know the repercussions of use are more serious now than they were a year ago,” Winn told BusinessWest. “In 2018 and 2019, Massachusetts had begun to flatten the curve on opioid overdoses, but now that curve has accelerated up.”

It’s not a regional problem, he added, as the most recent data shows opioid deaths up in every county in the state.

People with substance-use disorders often have a co-occurring mental-health diagnosis, a situation that may increase their COVID-19 risk, said Millie Rivas, clinical supervisor for Outpatient Behavioral Health at Center for Human Development (CHD), adding that several factors can make people with substance-use disorders more vulnerable to coronavirus.

“Patients with a co-occurring diagnosis usually have a history of poor healthcare and poor nutrition,” she noted. “Add substance use to that, and they become a magnet for COVID-19.”

In short, the stress and anxiety caused by the pandemic — and the economic turmoil that has followed in its wake — aren’t the only COVID-related factors making things tougher for those struggling with substance abuse and those striving to help them. Not by a longshot.

 

From a Distance

Even treating people with substance-use issues became more complicated when the pandemic first hit. By following CDC guidelines to keep everyone safe, one-on-one support was severely reduced, resulting in more isolation for vulnerable people who needed help.

While support has largely shifted to virtual appointments, Rivas and her staff have had to provide technical guidance, as well as their normal counsel to their clients.

“We’re doing things we aren’t accustomed to, such as training people how to use Zoom platforms and how to use their phone beyond Facebook so they can reach services and telehealth,” she said.

Working on virtual platforms allows CHD staff to interact in a more normal way with clients and observe their behavior. Rivas noted that meeting one-on-one would require clients to wear masks, making it more difficult to hear them or see their facial expressions. When clients use virtual platforms, they are also able to increase their engagement in the world.

Steven Winn

“We don’t know if use is up, but we know the repercussions of use are more serious now than they were a year ago. In 2018 and 2019, Massachusetts had begun to flatten the curve on opioid overdoses, but now that curve has accelerated up.”

“At times, going virtual has been frustrating for the client, but overall, it’s nice to have them experience an achievement like that,” Rivas said, adding that clients can now more easily connect with healthcare providers as well as family and friends, and hopefully become more engaged and feel less isolated.

While it’s not surprising that those with a history of substance abuse would be more vulnerable during a pandemic, Rivas has observed an increase in substance use among people with no diagnosed substance-use disorders. The myriad factors include health concerns, increased isolation from not going out and socializing, and anxiety about finances. “It’s not unusual for people to manage stress with one too many beers or one too many glasses of wine.”

Winn noted that clinicians at BHN have observed an increase in people coming in to talk about alcohol use and overuse. “They are self-medicating because they feel more stressed, more unhappy, and more isolated.”

Edna Rodriguez, director of Clinical Assessment and Clinical Ambulatory Programs at Providence Behavioral Health Hospital, has noticed a trend during the pandemic of people having relapses and abusing alcohol after years of being clean and sober. She cited one example of a person who relapsed after five years of sobriety. Clients tell her they start drinking again out of boredom and being stuck at home.

“In my opinion, since COVID hit, we’ve seen an increase in the glorifying of alcohol use,” Rodriguez said, noting social-media memes about people day drinking and taking Zoom calls with a drink in hand. While meant to be humorous, she explained, these messages are dangerous for people with substance-use disorders, especially when so many are feeling less connected to the community.

“Distractions that were healthy, like going to the gym, going to church, or programs that encourage people to live healthy lifestyles, have all been reduced or eliminated,” she said. “We’re in a moment of depleted connections.”

Because the pandemic creates uncertainty for everyone, Winn encourages anyone who has a question about their substance use to reach out to BHN or one of the other local agencies.

“If you’re struggling with something, reach out and ask for help. We’re all doing telehealth, so it’s safe in terms of social distancing.”

 

Heal Thyself

Providers face a dilemma of trying to help people while at the same time feeling their own stress and uncertainty about the coronavirus. Rodriguez said many of her colleagues are experiencing ‘pandemic fatigue.’

“I wish there was a book on my shelf titled ‘How to Treat Substance Use Disorders During a Pandemic,’ but we don’t have that book; we’re all new to this, and we’re still learning.”

Rodriguez and her colleagues are supporting each other by having conversations about how to stay grounded. She mentioned a ‘comfort cart’ that goes around to staff with bottles of water, soda, and treats like chocolate and candy.

“It’s a way of recognizing that everyone is stressed and needs something to comfort themselves,” she said. “The more we take care of each other, the better resource we’re going to be for our patients.”

Rivas said she often reminds her staff about the importance of self-care.

“It’s easy to forget about yourself when you’re trying to take care of someone else,” she noted, adding that, among other changes since COVID-19, staff can no longer use their offices for one-on-one meetings because they are too small to accommodate proper social distancing.

As everyone is still trying to figure out how to stay safe from a virus that just won’t fade away, Rodriguez said her normal work process now includes thinking about how to take care of herself as a provider.

Yet, she remains hopeful the scientific and therapeutic communities will use their creativity to develop new ways for everyone to deal with coronavirus. “These times are calling for an honest and humble review of how we administer treatment, how we approach our patients, and how we approach ourselves as providers.”

Senior Planning

Some Questions and Answers About Home-care Services

By Tania Spear

What is home care?

Home-care services are delivered to clients wherever they call home. There is a wide variety of assistance available, including everything from occasional help with housekeeping, meal preparation, companionship, and errands to skilled services such as nursing, physical therapy, occupational therapy, speech therapy, and hospice care. The goal is to support clients who prefer to remain at home, but need care that cannot easily or effectively be provided by family or friends.

Who provides home care?

Home-care services can be provided by an agency or an individual. Support can be provided from one hour to up to 24 hours a day, 365 days per year. There are many reputable agencies in the area. Your physician, area Council on Aging, hospital-discharge planner, or geriatric-care manager will be able to refer you to a home-care provider most appropriate to assist you.

“The goal is to support clients who prefer to remain at home, but need care that cannot easily or effectively be provided by family or friends.”

How do I pay for home-care services?

Government and private insurance may pay for services under specific circumstances such as after a recent hospitalization when skilled nursing or therapy services are needed. Ongoing assistance with activities of daily living (bathing, dressing, feeding, etc.) and housekeeping are generally not covered by insurance and are often private pay. It would be best to contact your provider for more information.

Are there benefits to using an agency?

While you may pay more using an agency caregiver, there are some advantages. An agency will offer pre-screening of workers, liability protection, workers’ compensation, and backup care in the event a particular caregiver isn’t available. An agency handles scheduling, payroll, and taxes, resulting in less paperwork.

How do I evaluate a home-care agency?

You will want to know if the agency works with you to develop a written plan of care and/or service contract and, if so, how often it is updated. How does the agency screen and evaluate employees? Are caregivers and supervisors available 24/7/365? How does the agency resolve concerns or complaints? Can the agency provide a list of local references?

What about COVID-19?

While accepting help at home from an agency may cause some fear during the pandemic, there are some things to consider that may help make you feel more confident in your decision to refuse or accept care as well as minimize risks. First, you want to assess the need for care. For many, care is essential, and refusing assistance in not an option. If you’ve determined help is necessary, check with the agency to determine what infection-control protocols are in place and if the agency has enough personal protective equipment (PPE) available. In addition to following CDC guidelines, you may want significant details related to how the agency is protecting staff and clients.

Are there any other things I should consider before receiving home care?

If a client or family hasn’t ever had help at home in the past, it can create some distress. The loss of independence and privacy can be factors. Oftentimes, if a competent caregiver with the right skills is placed, even the most seemingly resistant client may begin to look forward to the caregiver visits. Establishing expectations based on an appropriate plan of care and a goal for each visit is important for both the client and caregiver. With the right blend of care and compassion, a bit of support can make a world of difference in allowing someone who wishes to remain home to stay safe and healthy.

Tania Spear, MSN, MBA, RN is the owner and administrator of Silver Linings Home Care, LLC. She is a registered nurse and an Elms College graduate with a master of science degree in nursing and health services management and an MBA in healthcare leadership; (413) 363-2575; [email protected]

Opinion

Opinion

By Christine Palmieri

September is National Recovery Month. ‘Recovery’ is a word that gets used a lot in the world of mental health and addiction services, sometimes so much so that I think we can easily lose sight of what it represents. In my role with the Mental Health Assoc. (MHA), I often have the opportunity to talk to newly hired staff about the idea of recovery. We discuss what it means and what it can look like in the context of working with people who have experienced trauma, homelessness, psychiatric diagnosis, and substance problems.

When I ask new staff the question, “what does it mean to recover?” I frequently hear things like “getting better” or “getting back to where you were” or “having a better quality of life.” Although I tell staff there are no wrong answers to this question, secretly I think there are. They’re common and easy, but insufficient.

As with many things, I think it’s easier to talk about what recovery is by defining what it isn’t. For me, recovery isn’t a cure. It isn’t a finish line or a place people get to. It isn’t a goal that can be neatly summarized in a treatment plan. I believe recovery is a process that is unique and intimately personal to the individual going through it. Ultimately, though, I think the answer to the question “what does it mean to recover?” should be “it isn’t for me to say.”

I believe recovery is a process that is unique and intimately personal to the individual going through it.

As providers of services, or as loved ones, community members, and policy makers, I don’t believe it’s up to us to define what recovery means or looks like for people going through it. Each person needs to examine and define what it means to them. For the rest of us, I think the more important question is “what makes recovery possible?” When the question is posed this way, we are able to engage this idea of recovery in a much different and more productive way. This question offers the opportunity to share the responsibility and partner with those we support.

The analogy of a seedling is often used when describing this process of recovery, and one I use when I talk to our new hires about their roles and responsibilities as providers of service. Seeds are remarkable little things. For me, they represent unlimited potential. A seed no bigger than a grain of rice contains within it everything it needs to grow into a giant sequoia. But no seed can grow without the right environmental conditions. No amount of force or assertion of control can make a seed grow. It needs the right soil, the right amount of water, and the right amount of light.

In the same way, within each person who has experienced trauma, homelessness, psychiatric diagnosis, or problems with substances, I believe there lies unlimited potential for growth, and each person needs the right environment for the process of recovery to take place. As providers, loved ones, community members, and policy makers, we very often control that environment. Metaphorically, we provide the soil, the water and the light.

Soil is the place where recovery begins. It offers a place for the seed to grow roots, to gather strength, security, and safety. Soil is what keeps trees rooted tightly to the ground through storms. It is our responsibility to offer environments where people in recovery feel safe and secure, to try out new ways of coping and new ways of managing the difficulties and challenges that life presents to all of us.

Water provides a seedling with essential nourishment. We need to find ways to support people in recovery to discover what truly nourishes them. The work of recovery is hard. It requires taking risks and feeling uncomfortable. We cannot do the work of recovery for anyone else, but we can and should work to help people in recovery find the supportive relationships, meaningful roles, and reasons to do that hard work.

Light provides the energy necessary for growth. In recovery, I believe light is offered through the hope and understanding that every person has within them the potential to live a full and active life in the community, whatever that means for them. As providers, loved ones, community members, and policy makers, it is our role to shine the light of hope for people who have experienced discrimination, loss of power and control, and in many cases a loss of their identity. We hold this hope and offer this light because we know, without question, that recovery, however it is defined, is not only possible, but is happening, right now, all around us.

Christine Palmieri is vice president of the Division of Recovery and Housing at MHA.

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