April 1, 2020: Lynne Giacobbe on community-based services during a pandemic
April 2, 2020: Dennis Adams on serving low-income housing residents and protecting staff
April 3, 2020: Frank Soltys on FMLA and serving residents living with dementia during the pandemic
April 4, 2020: Aric Martin on legal liability for providers coping with the pandemic
April 4, 2020: Dave Gehm on serving COVID-19-positive residents, building trust, and testing
April 5, 2020: James Bernardo on lack of PPE, stress on staff, and communicating with families
April 6, 2020: Carla Rafferty on Coronavirus policies for assisted living, independent living, and skilled nursing
April 7, 2020: David Smart on how COVID-19 affects older adult housing, plus supporting staff
April 8, 2020: Elizabeth Weingast on coping with a large number of COVID-19-positive residents
April 10, 2020: Roger Myers on COVID-19-positive residents, philosophies driving crisis response, and protecting housing residents
April 13, 2020: Will Blackwell and Teresa Forney on their experiences with state surveys done remotely
April 14, 2020: David Hood on emergency preparedness plans and working with local and state emergency agencies
April 15, 2020: Dr. Samira Beckwith on PACE and hospice programs during the pandemic
April 16, 2020: Toby Halliday of HUD on guidance for housing providers coping with COVID-19
April 17, 2020: Dr. Danielle Doberman on advance care planning and coronavirus
April 18, 2020: Nesa Joseph on how hospice and other community-based services have adjusted to COVID-19
April 19, 2020: Michelle Norris on pandemic stresses for a multistate provider, plus planning and lessons learned for the future
April 20, 2020: Dave Isay on StoryCorps and its new partnership with LeadingAge
April 21, 2020: Carrie Chiusano on how the pandemic affects care for those living with dementia
April 22, 2020: Carol Silver-Elliott with a positive message for LeadingAge members
April 23, 2020: Dr. Nicole Lurie Offers Facts and Cautions About COVID-19 Testing
April 24, 2020: Carrie Hays McElroy on Adapting a PACE to Pandemic Restrictions
April 25, 2020: Ginny Helms on How Georgia is Opening Up and How it Affects Providers
April 26, 2020: Pat Tursi on Operating a Center for Medically Complex Children in the Age of Coronavirus
April 27, 2020: Justin Hinker on Planning for COVID-19 Cases in a Retirement Community
April 28, 2020: Jack Rollins on Issues of Concern to State Medicaid Programs
April 29, 2020: Karolee Alexander and Sue LaGrange on Emergency Staffing
April 30, 2020: Sharon Wilson-Geno on How VOA Pivots to Cope With COVID-19
May 1, 2020: Nancie-Ann Bodell on the Rural Housing Service at USDA
May 4, 2020: Dr. Paul Katz on Containing Outbreaks, Testing, and Workforce Challenges
May 5, 2020: Nick Yablon on Creating Time Capsules During the Pandemic
May 6, 2020: Andrea Lazarek-LaQuay on Helping Counties “Find the Virus”
May 7, 2020: Dr. Nimalie Stone on the Role of CDC and Difficulties That Face Aging Services Providers
May 8, 2020: Deborah Royster on Reconfiguring Services for Community-Based Customers
May 11, 2020: Neal Buddensiek, M.D., on a Multi-State Provider’s Pandemic Preparation, and Concerns About Testing
May 12, 2020: Michelle Just on Communication, Opening Up, and Handling Mixed Messages
May 12, 2020: Nick Uehlecke on How HHS Views Provider Relief Funds
May 13, 2020: Karen Hatfield on Hospice Services, Grief, and Help for Mental Health
May 14, 2020: Rob Lahammer on Tough Media Environment, Staff Engagement, and Opening Up
May 15, 2020: Carol Silver-Elliott on Fighting COVID-19 in the New Jersey Hotspot
May 18, 2020: Beth Kilgore-Robinson and Karina Barragan on the Mental Health of Residents and Staff
May 19, 2020: Robert Espinoza on Disparities in Communities of Color and Why We Must Better Support Low-Income Workers
May 20, 2020: Dr. Tom Frieden on the CDC and Thoughts on Reopening
May 21, 2020: Marvell Adams on Staff Stress, Scheduling, and Self-Care
May 22, 2020: Howard Gleckman on How COVID-19 Changes the Future of Long-Term Services and Supports
May 26, 2020: Kate Shepard on Recovered Residents, Maintaining Positivity, and Testing
May 27, 2020: Lee Ann Hubanks on Challenges Facing Her Affordable Housing Organization
May 28, 2020: Ami Schnauber on the Nightmare of Coronavirus in New York
May 29, 2020: Minnesota Testing Spotlight with Sharon Zehe, Karen Martin, and Diane Rydrych
June 1, 2020: Maureen Carland on Handling a Large Outbreak of COVID-19, and Why Planning for it is so Hard
June 2, 2020: Ralph Gaines on Affordable Housing in Pandemic, Thoughts on HUD Expectations
June 3, 2020: Lori McLaughlin on Overcoming Staff Fears and Poor Service from Public Health Services
June 4, 2020: Keith Knapp on COVID-19 in Kentucky and Positive State Responses
June 5, 2020: Karyne Jones on Overcoming Fear of Discussing Race in Aging Services
June 8, 2020: Jess Maurer on COVID in a Rural State With an Aged Population
June 9, 2020: Mario LeMay on Serving COVID-10-Positive Residents and Overcoming Staff Fear
June 10, 2020: Gus Keach-Longo on Testing, Tracing, and a “Soft Opening” in Elder Housing
June 11, 2020: Stuart Hartman on Protecting Residents and Staff in a Large National Organization
June 12, 2020: Nick Uehlecke of HHS on Provider Relief Funds
June 12, 2020: Col. Brian Kuhn on FEMA PPE Supplies
June 15, 2020: Rebekah Levit on Quickly Responding to an Early Outbreak, and Preparing to Reopen
June 16, 2020: Karen Sturchio on Preparing for Ending of Restrictions and Difficulties of a Rural Provider
June 17, 2020: Tina Sandri on Coping With COVID-19 Early, Plus Workforce and Testing Difficulties
June 18, 2020: Kristi Strawser and Kara Allread on how a Long-Standing Provider Partnership Faced the Pandemic
June 19, 2020: Capt. Joselito Ignacio of FEMA on Quality and Decontamination of PPE
June 22, 2020: Walter Ramos on Finishing Construction and Doing Move-Ins During the Pandemic
June 23, 2020: Michael Soccio on the Economics and Benefits of a Large Home Care/Hospice Program
June 24, 2020: Julie Thorson and Carol Silver Elliott on Leadership in a Time of Crisis
June 25, 2020: Kim Brooks on How HSL is Thinking Through Reopening
June 26, 2020: Mary Stompe on Keeping Housing Residents Engaged While Preparing for Reopening and Another Surge
June 29, 2020: Peter Sullivan on Protecting Residents in a Tourist-Heavy Town, Plus a Visitation Pilot Program
June 30, 2020: Katrina Gray on Procuring and Managing PPE
July 1, 2020: Deke Cateau on Morale, Testing, and Reopening
July 2, 2020: Phil Jacob on Transparency, His Own COVID-19 Infection, and Preparing for a Surge
July 6, 2020: Nancy Evans on How a Large Housing Provider Copes and Thinks About Reopening
July 7, 2020: Kassie South on Surging Cases in SC, Visitation Concerns, and PPE
July 8, 2020: Josh Bowman on Scavenging PPE, Visitation Plans, and Positive Media Coverage
July 9, 2020: Rola O'Meally on Shutting Down—and Then Reinventing—Adult Day Programs
July 10, 2020: Allison Salopeck on PPE, Testing, and Managing Outdoor Visitations
July 13, 2020: Bruce Dmytrow on the Insurance Market and the Effects of COVID-19
July 14, 2020: Dan Stewart on LGBTQ Elders, COVID-19, and How Aging Services Can Become More Inclusive
July 15, 2020: Marki Flannery on HCBS Services Hit Hard by COVID in NYC
July 16, 2020: Dorothy Davis on PPE, Testing, Telehealth Issues in HCBS
July 17, 2020: Steve Fleming on PACE and the Pandemic, Re-opening Adult Day and Dining, and Boosting Pay
July 20, 2020: Lisa Balster on Grief, Hospice in a Pandemic, and Ways Hospice Can Help Staff and Other Providers
July 21, 2020: Manny Ocasio on a “Just Culture” in a Large Multi-state Organization, Plus Testing Challenges
July 22, 2020: Don Blose on Preparing for Pandemics, Keeping Staff and Residents Busy and Loved
July 23, 2020: Dr. Noah Marco on Letting Residents Decide Their Own Risk Tolerance; Plus Testing
July 24, 2020: Hank Lovvorn on In-Person Advocacy with HHS Deputy Secretary
July 27, 2020: Sondra Norder on Taking in Residents Displaced by Fire, and St. Paul’s New Documentary
July 28, 2020: Andrew Banoff on Getting Through the Worst of the Crisis, Plus Good Interaction with Lawmakers
July 29, 2020: Colleen Frankenfield on Early Problems, Motivating and Supporting Staff and Residents
July 30, 2020: Shelly Griffith on the Pandemic, PPE, and Community Support in a Rural County
July 31, 2020: Terri Cunliffe on Multi-State Rapid Hiring Process & Re-Opening
August 3, 2020: Dr. Ashish Jha on Testing and Likely Length of the Pandemic
August 5, 2020: Dave Sanford on White House Supply Chain Task Force and PPE Shipments
August 5, 2020: Derrick DeWitt on Baltimore NH with Zero COVID-19, Health Disparities for POC
August 10, 2020: Dawn Barker on Helping Staff With Stress, Childcare
August 12, 2020: Stacey Johnson on Quality Control and Communication
August 17, 2020: Dr. David Grabowski on Supporting Staff, Public Policy re PPE, and Testing
August 19, 2020: Mitzi Epperson on Visiting With Dr. Deborah Birx
August 24, 2020: Dr. Monica Gandhi on Infectiousness of the Coronavirus, Mask Wearing, and Testing
August 26, 2020: Brian King on Managing Weekly Testing for All
August 31, 2020: Catherine Evans and Meghan Rose on Dangers of California Wildfire Crisis on Top of COVID-19
Sept. 2, 2020: Danny Williams on Serving African American Residents, Health Disparities, and Building Trust
Sept. 9, 2020: Natalie Dattilo on Recognizing Grief and Other Negative Emotions, and Creating Connections to Reduce Isolation
Sept. 14, 2020: Sean Beloud on the Painful Process of Closing a Nursing Home
Sept. 16, 2020: Lisa McCracken on Interesting Data from Ziegler CFO Hotline Reports
Sept. 21, 2020: Evan Shulman on CMS Guidance on Visitation and Testing
Sept. 23, 2020: Daniel Larremore on Computer Modeling, Testing, and Prioritization of Vaccines
Sept. 30, 2020: Rachael Piltch-Loeb on Principles of Good Crisis and Risk Communication
Oct. 5, 2020: Adm. Brett Giroir of HHS on Testing
Oct. 5, 2020: Jeannee Parker Martin and Eric Dowdy of LeadingAge California on the Coronavirus Commission on Nursing Homes
Oct. 7, 2020: Leslie Reynolds of NASS on Voting in the Age of COVID-19
Oct. 12, 2020: Cathy Neece-Brown of J.L. West Ctr for Dementia Care on Protecting Residents Living With Dementia
Oct. 14, 2020: Mary McMullin of Covia on Making Diversity and Inclusion a Guiding Principle
Oct. 19, 2020: Dr. Nimalie Stone of CDC on Vaccines for COVID-19 and Influenza
Oct. 21, 2020: Dr. Ken Mead of NIOSH on Air Purification, Filtering, and COVID-19
Oct. 26, 2020: David Trost on How St. John's United Launched Its Own PCR Testing Lab
Oct. 28, 2020: Jerry Nevins of Rose Blumkin Jewish Home on Working With Surveyors
Nov. 2, 2020: Nick Uehlecke of HHS on Provider Relief Funds
Nov. 2, 2020: Anne Levesque of Wake Robin on Innovative Ways to Support Staff
Nov. 30, 2020: Keith Swartzentruber of Snyder Village on Managing COVID-19 Cases, Financial Impact, and Testing
Dec. 2, 2020: Joshua Weitz of Georgia Institute of Technology on Community Spread and Risk
Dec. 7, 2020: Dr. Ruth Link-Gelles on Vaccines and the Pharmacy Partnership Program
Dec. 7, 2020: Karyne Jones on the COVID-19 Vaccine Education and Equity Project
Dec. 9, 2020: Michael Hebb on Conversation, Support, and Resources About Death and Grief
Dec. 14, 2020: Dr. Joshua Sharfstein Answers Many Questions About the Vaccine
Dec. 16, 2020: Jim Love, Beth Coryea, and Ryan Jeannerette of CVS/Omnicare on the Onsite COVID-19 Vaccine Program
Dec. 21, 2020: Dr. Martha Dawson of NBNA on Outreach to the African American Community on Vaccination
Dec. 23, 2020: Dr. Ali Mokdad of IHME on Using Models to Analyze a Surge
Dec. 28, 2020: 4 LeadingAge Members Share Vaccine Clinic Insights
Dec. 30, 2020: Laura Hoffman of LeadingAge Washington on Rapid Response Staff Teams
Jan. 4, 2021: US Surgeon General Dr. Jerome Adams on COVID-19 Vaccines, Plus CVS Program Updates
Jan. 6, 2021: Robin Jump on Responding to Fears About Vaccination
Jan. 7, 2021: R. Tamara Konetzka of the University of Chicago on Research re Quality vs. Risk of Bad COVID-19 Outcomes.
Jan. 11, 2021: Dr. Larry Corey on Development of Vaccine, Side Effects, and Distribution
Jan. 13, 2021: Jack Rollins on Priorities for State Medicaid Agencies During 2021
Jan. 14, 2021: Dr. Ruth Faden on “Justified Distrust,” Better Communication, and Overcoming Fear of Vaccination
Jan. 28, 2021: Dr. Nimalie Stone on Vaccine Acceptance and Post-Vaccine Side Effects
Feb. 1, 2021: Dr. Alice Bonner on Project ECHO
Feb. 8, 2021: Scott Crabtree and Jeré Hales on Making Vaccination Mandatory for Staff
Feb. 11, 2021: Evan Shulman on Post-Vaccine Visitation Guidance and Survey Practices
Feb. 18, 2021: Dr. Ruth Link-Gelles on the Retail Pharmacy Program and Tricia Neuman on Vaccine Data Difficulties
Feb. 22, 2021: Dr. Bill Mansbach on Psychological Burdens Carried by Providers, Residents, and Families
Feb. 24, 2021: Monica Gandhi, MD, Brings Good News About Life After COVID-19 Vaccination
March 3, 2021: Alycia Bayne on Resources and Supports for Older Adults and Caregivers
March 4, 2021: Miles Lee and Tina Sandri on Vaccine Encouragement in Their Organization
March 8, 2021: Sigal Barsade on Promoting/Encouraging Vaccine Acceptance
March 17, 2021: Carol Silver Elliott and Katie Smith Sloan on Things Learned from the Pandemic Experience.
March 18, 2021: Dr. Simon Mittal on Understanding and Overcoming Vaccine Hesitancy.
March 24, 2021: Dr. Sara Oliver on J&J, Astra Zeneca, and Other Vaccines
March 29, 2021: Dr. Reed Tuckson on Vaccine Hesitancy and Reaching the Hard-to-Convince
March 31, 2021: Dave Wilkinson on the Protect Nursing Homes Tool for Tracing the Risks of Shared Staffing
April 1, 2021: Ashvin Gandhi on Research Into Staff Turnover in Nursing Homes
April 8, 2021: Stuart Butler on Pandemic’s Effect on Attitudes re Workforce and LTSS
April 12, 2021: Dr. Tom Cornwell on Home-Based Primary Care—House Calls
April 15, 2021: Dr. Joshua Sharfstein on the J&J Pause, and Dr. Ashley Kirzinger on Mental Health in Health Workers
April 29, 2021: Dr. Kara Slifka-Jacobs on April 27 Infection Prevention and Control Recommendations from CDC
May 3, 2021: Bob Kramer on the Challenges of Rethinking Nursing Homes and Financing Change
May 5, 2021: Vish Viswanath on Convincing the Most Hesitant Staff to Get Vaccinated
May 10, 2021: Dr. Monica Gandhi on Herd Immunity and Light at the End of the Tunnel
May 12, 2021: Mary Good on CDC Guidance for Independent Living Providers
May 13, 2021: Helen Lamont, Michael Smith, and Maley Hunt on COVID-19 Impact on People Living With Dementia
May 17, 2021: Dr. Ali Mokdad on His Concerns About Another Surge in the Fall
June 10, 2021: Fran Casey on Attracting and Retaining Talent in a Difficult Time
June 21, 2021: Mark McInerney on Workforce Statistics and Demographics as the Economy Opens Up
June 28, 2021: Lori Porter on What to Do About Workforce Problems Plus Vaccine Hesitancy
April 1, 2020: Lynne Giacobbe, executive director, Kendal at Home
Topics: The challenges of community-based clients who are unwilling to allow caregivers into their homes; supporting staff and minimizing caseloads; how telehealth has improved for some members; keeping clients socially connected; and praise for staff resilience. Length: 12:04.
April 2, 2020: Dennis Adams, CEO, Christopher Homes
Topics: How visitor restrictions are working in affordable housing, including residents who resist the restrictions; challenges in screening essential visitors for an organization without clinical staff; increasing employee compensation and challenges faced by staff; dealing with multiple COVID-19-positive residents; how to help residents buy supplies when they can’t leave home. Length: 14:53.
April 3, 2020: Frank Soltys, president & CEO, Felician Village
Topics: Felician Village’s process for deciding which positions to exempt from FMLA provisions, and evaluating how policies affect staff; and infection control processes and contingency planning for COVID-19 cases in memory care units. Length: 8:25.
April 4, 2020: Aric Martin, managing partner, Rolf Goffman Martin Lang LLC
Topics: Intro by Cory Kallheim of LeadingAge, on seeking clarity on PREP Act provisions for immunity for liability for providers. Aric Martin on: providers acting as “quasi-governmental agents,” and deserving immunity; the danger of legal battles down the road, even if providers have strong defenses; PREP act coverage for testing or treatment choices; why all-encompassing federal immunity, or strong state immunity, are necessary; situation in various states—why are some practitioners given protection while those in other states are not; and why LeadingAge should form coalitions with other entities. Length: 18:44.
April 4, 2020: Dave Gehm, president and CEO, Wellspring Lutheran Services
Topics: How to serve residents living with dementia who are COVID-19-positive; on communication with staff, and dealing with staff fear; offering testing to all residents and staff, and how it builds trust and confidence; making a new type of decisions in the face of legal and regulatory liability; and why leaders must ask the right questions and be transparent to empower people with knowledge. Length: 16:12.
April 5, 2020: James Bernardo, president and CEO, Presbyterian Senior Living
Topics: Coping with a lack of PPE; proactive policies by state of Pennsylvania; stress on staff, and supporting them; and helping family understand the severity of the problem in the early days. Length: 13:41.
April 6, 2020: Carla Rafferty, administrator, assisted living, Asbury Place Maryville
Topics: The challenge of setting guidelines for independent living residents who are free to come and go; why the organization is implementing the same rules in assisted living that are used in skilled nursing, to maintain consistency; challenges of guidance on masks and physical distancing for memory care residents who may not comply; an assisted living resident’s creation of customized cloth masks; contingencies for handling a COVID-19-positive resident in assisted living. Length: 13:18.
April 7, 2020: David Smart, president and CEO, Eaton Senior Communities
Topics: How the jobs of service coordinators and wellness coordinators have changed; creating new procedures to remain within guidelines; why it’s especially important for people to move into older adult housing during the pandemic; how emergency preparedness has helped; using operating funds for purchase of PPE; incentives to staff during the pandemic—reduced hours but full-time pay, plus bonuses to exempt staff; and the best way to get in an argument (talk about masks). Length: 12:51.
April 8, 2020: Elizabeth Weingast, vice president, clinical excellence, The New Jewish Home
Topics: Going from one COVID-19-positive residents to more than 140; why advance directives must be a part of planning for coronavirus cases; the variety of symptoms among positive people; why cluster units are necessary; the most typical grouping of symptoms; planning for inevitable illness among staff, typically 10-14 days in duration; financial incentives for staff; dealing with backups at mortuaries; why the organization hired a nurse practitioner to serve staff who are out sick; who to contact re testing options; educating new staff; and why you should never allow communication and transparency to diminish. Length: 22:19.
April 10, 2020: Roger Myers, president and CEO, Presbyterian Villages of Michigan
Topics: How PVM is doing (32 confirmed positive residents, 14 deaths; 14 confirmed positive staff, 1 death as of 4/10/2020); why it’s important to “live the mission,” and project calm, confidence, and reassurance; why PVM prioritizes factual information, capturing positive stories, and looking for innovation opportunities; how technology department is using its 3-D printer to make 150 face shields per day; coping with COVID in affordable housing; and things PVM wishes it had known earlier—importance of PPE, need to rethink some contingency plans; and policies put in place to keep virus out of affordable housing while allowing critical services to come in. Length: 18:13.
April 13, 2020: Will Blackwell, VP of health services, Westminster Canterbury Richmond, and Teresa Forney, executive director, Thornwald Home
Topics: Both members’ experiences with recent surveys, performed by phone; how advance planning for the pandemic was time well-spent; value of ongoing recording of changes as they occur for future reference and future surveys; importance of daily meetings; and questions about PPE fit tests. Length: 14:17.
April 14, 2020: David Hood, Principal and Director of Operations–Healthcare, RPA
Topics: Adapting existing emergency preparedness plans for a pandemic; why all providers must engage with their local offices of emergency management, which can be very helpful in supporting providers; why staffing issues are one of the biggest problems for providers during this episode; a review of some “staff reduction mitigation options” and resources he has observed. Length: 16:49.
April 15, 2020: Dr. Samira Beckwith, president and CEO, Hope Healthcare
Topics: Operating a PACE when the PACE center must be closed, and finding ways to visit clients one-on-one using the PACE buses; reassigning staff; offering more education for family caregivers; launching virtual classes and activities for clients; connecting clients with technology; using consistent staffing; why we need to continue to enroll new hospice patients; possibilities for virtual or socially distanced hospice visits; consistent information for staff re PPE use and other issues related to COVID-19 and their work; how Hope Healthcare works with nursing homes; and how we can be an “and.” Length: 15:58.
April 16, 2020: Toby Halliday, Director of HUD Multifamily Housing’s Office of Asset Management and Portfolio Oversight
Topics: How to find guidance re treatment of stimulus payments under the CARES Act; guidance re rights and responsibilities for tenants, including re eviction moratoriums; guidance re forbearance for owners; service coordination funds; HUD deferring to public health officials re handling COVID-19-positive residents; guidance on move-ins/move-outs; and guidance for owners re COVID-19-related expenses. Length: 15:30.
April 17, 2020: Dr. Danielle Doberman, Assistant Professor, Johns Hopkins School of Medicine, and Medical Director of Palliative Medicine at Johns Hopkins Hospital
Topics: Definition of advance care planning (ACP); why people at any stage of life should be planning; how independent living elders can access resources and create advance directives; how COVID-19 affects ACP, and why we must do direct education; do-not-transport options; what should be re-assessed in the light of COVID-19; and trying to envision the illness process in the case of COVID-19. Link to Dr. Doberman’s presentation. Link to Serious Illness Communication and ACP Resources on LeadingAge.org. Length: 15:54.
April 18, 2020: Nesa Joseph, president & CEO, Visiting Nurse Association of Greater St. Louis
Topics: Anxiety from clients and family members re hospice workers and Advanced Illness Management (AIM) workers in their homes; safety measures instituted to help reduce anxiety from clients and staff—“getting used to doing business as unusual”; no staff layoffs so far, despite business down 15-20%; and a new telehealth initiative involving Tapcloud, rolled out just before the lockdowns began. Length: 17:59.
April 19, 2020: Michelle Norris, executive vice president, National Church Residences
Topics: Effects of COVID-19 in a 25-state organization; preparing for reopening in stages, and keeping clients and staff safe; managing norms in different states; strategic concerns on many levels for the future; supporting frontline staff holistically; the PARRT regional testing program for SNF or assisted living communities; testing and PPE lacking in all senior living communities; adding service coordinators to buildings without them; how LTC is the overlooked player in the health care system; and lessons learned for future crises (weakness of paper-based systems, telework, ways to keep staff in many states up to date, and the bigger the crisis, the bigger the heart—great response from employees and volunteers). Length: 25:30.
April 20, 2020: Dave Isay, founder and president, StoryCorps
Topics: The history of StoryCorps; the launch of StoryCorps Connect using a digital platform; now is a critical moment of urgency to connect with a loved one; how it can help prevent social isolation; why a partnership with LeadingAge is a natural opportunity; website is storycorpsconnect.org; and information about a simple toolkit for LeadingAge members. Length: 15:41.
April 21, 2020: Carrie Chiusano, executive director, Dementia Care Center for Excellence, Presbyterian SeniorCare Network
Topics: Keeping up with teams in multiple sites; making it a priority to keep residents and family members in contact; residents with advanced dementia respond to video calls; ways to emphasize resident engagement while maintaining distancing; ways to communicate about COVID-19, and altering body language, with residents; families going to great lengths to interact with loved ones; offering more support to family caregivers; and memory cafes becoming virtual. Length: 15:25.
April 22, 2020: Carol Silver-Elliott, president and CEO, The Jewish Home Family
Topics: A message from the LeadingAge Chair on celebrating our successes; counteracting the inaccurate, negative picture that the media paints of our field; and the importance of staying focused, positive, and together. Length: 2:45.
April 23, 2020: Dr. Nicole Lurie, COVID incident management team leader, Coalition for Epidemic Preparedness Initiatives (CEPI)
Topics: Facts about tests to detect current infections; the limitations of day-to-day fever screening; why tests do not tell us as much as we might expect; facts about tests to detect antibodies; why many of the available antibody tests are questionable; and the effects of poor leadership, and of good leadership. Read this article on LeadingAge.org, based on Dr. Lurie’s presentation. Length: 23:54.
April 24, 2020: Carrie Hays McElroy, VP, clinical operations/CNO, Trinity Health PACE
Topics: Outline of how a PACE (Program of All-Inclusive Care for the Elderly) works; revising care plans to deal with closure of the PACE center; reassigning employees to offer support in clients’ homes; how family support has increased, allowing reduced workloads for staff; weekly staff meetings for PACE employees in multiple states; organized prayer calls; activity packets delivered to clients’ homes; daily check-in phone calls; PPE supplies (adequate due to affiliation with health system), and conservation strategies; serving the few COVID-19-positive clients; confidentiality issues in remote interactions with clients; and challenges for staff who go into clients’ homes. Length: 18:54.
April 25, 2020: Ginny Helms, president and CEO, LeadingAge Georgia
Topics: Experience of Georgia’s phased reopening; how reopening makes providers hypervigilant; members investigating infection control systems; independent living residents are pushing for reopening in many places; life plan communities not doing move-ins, but planning for how to balance quality of life and safety in the future; how adult day providers are adapting, and preparing for limited reopening; and need for funding of adult day providers. Length: 17:47.
April 26, 2020: Pat Tursi, CEO, Elizabeth Seton Children's Center, and Resident Stephanie Gabaud
Topics: Aggressive infection control has kept COVID-19 out; protecting kids who had to go to hospitals; 5% of staff tested positive, most have returned to work; dealing with staff concerns; sharing information and stories with community and media; how to tell families they could not visit with their children; heartbreaking stories of small children whose parents aren’t allowed to visit; comments from Stephanie Gabaud, long-time resident; and the importance of smiling and having fun. Length: 22:16.
April 27, 2020: Justin Hinker, administrator, Avera Prince of Peace Retirement Community
Topics: Avera’s experience with COVID-19 positive residents; connection to Avera health system helps with planning and PPE; creating a COVID-19 wing in anticipation of May peak; financial help to staff, including covering health insurance; creating a “virtual town hall” for family members and planning to keep doing it indefinitely. Length: 16:58.
April 28, 2020: Jack Rollins, program director for federal policy, National Assn. of Medicaid Directors
Topics: Dramatic increase in telemedicine, occurring much more quickly than we thought possible; lots of modifications to reimbursement policy; NAMD wants more state involvement in distributing provider relief funds; Medicaid providers not being prioritized; wants more granular provider-specific funding award information to make better decisions on how to help providers at state level; concerned about “financially fragile” providers (in many fields) that may not be able to remain open, including those who provide non-COVID related care; creation of COVID-19-specific LTC facilities; some states doing higher rates for COVID-19 services; a lot of newly unemployed people likely to end up on Medicaid, and ways to prepare for that, including a higher match rate; and how good data is what policymakers need most to better understand pressure on LTSS providers. Length: 18:12.
April 29, 2020: Karolee Alexander, director of reimbursement and clinical consulting, and Sue LaGrange, education director, Pathway Health
Topics: Providers need to have emergency staffing policies, preferably with addendums re COVID, with focus on different phases; planning for leadership backup; accounting for factors outside of work life that affect staff; fear caused by staff who have frail relatives at home; consider reducing medications management workloads for staff; why memory care units are sites of high transmissibility; good acuity-based staffing tools don’t exist, but PBJ numbers could be a source of data; communicating altered standards of care; trying to reduce non-direct care subtasks from nurses and CNAs by training other staff; hiring new staff; delegation to volunteers; finding ways for staff to build camaraderie; sources of new staff—including hospital nurses, nursing students, and idled cafeteria workers; and a toolkit for emergency staffing and policies. Length: 20:42.
April 30, 2020: Sharon Wilson-Geno, EVP, chief operating officer national services, VOA
Topics: Why VOA staff stays on-site in housing communities; keeping residents active and engaged; operating in multiple states, and dealing with outbreaks in 3 states; how state governments’ views on the virus differ; coping with different reopening plans and communicating with residents; testing—if you look for it, you will find the virus; the validity of tests; why housing and health care, and their funding streams, need to be thought of together; thinking about the people we don’t serve; and how to determine what staff must be tested, and how. Length: 19:04.
May 1, 2020: Nancie-Ann Bodell, deputy administrator for multi-family housing with the Rural Housing Service at USDA
Topics: Intro to USDA multi-family housing; 68% of Section 515 USDA affordable multi-family housing are elderly or disabled; 14,000 units total, 13,000 of them Section 515 rural rental housing; USDA to begin including service coordination within the Sec. 515 portfolio; have heard anecdotes about COVID-19-positive residents, and deferring to CDC and health department recommendations; seeing many interim recertifications due to wage loss; interim certifications being provided to adjust income even for non-wage earners, which may include elderly; what’s unique about rural needs; and impactful job losses. Length: 15:22.
May 4, 2020: Paul Katz, M.D., Chair, Dept. of Geriatrics, Florida State U. College of Medicine
Topics: Difficulty of containing a small outbreak in a nursing home or assisted living; does the acute-care sector understand what skilled nursing faces? Thoughts on mandatory testing and contact tracing for all residents and staff; why hospitals should test everyone who comes in; the acute-care sector misunderstands the LTC workforce; will changes in physician staffing be required in LTC? Comments on team care and telehealth. Length: 19:28.
May 5, 2020: Nick Yablon, associate professor of history, University of Iowa
Topics: An introduction to time capsules; the value of creating time capsules during a difficult time such as this pandemic; how senior living communities can make their mark with time capsules; advice for providers wanting to do time capsules for their residents and staff (and why they should not be buried). Length: 14:35.
May 6, 2020: Andrea Lazarek-LaQuay, Chief Clinical Officer, Nascentia Health
Topics: Home health clients choosing to reduce face-to-face visits; increasing use of telehealth units as a substitute; working with different counties, each with its own emergency management system; connecting with a federally qualified health center (FQHC) in Syracuse, NY; how Nascentia worked with counties to go and “find the virus” in individuals’ homes; Nascentia staff visiting “hotspots” in senior living communities in Onondaga County to do testing; working with providers to allow entry into their facilities; over 1,200 people tested; how to leverage resources in your own community; identifying a limited number of staff as a “target team” to deal with COVID-19 cases; why nasal pharyngeal swabs are still the most effective tests; why this would work in affordable housing. Length: 15:56.
May 7, 2020: Dr. Nimalie Stone, medical epidemiologist, CDC
Topics: How CDC supports providers and health departments; praise for how LTC providers have performed; how providers are vilified; roles of CDC and CMS and how they differ; a snapshot of differences between state agencies—survey agencies vs. health departments; facts about NHSN, and streamlining of reporting during the pandemic; concerns about difficulties with duplicative reporting; and CDC recommendations re masking. Length: 31:31.
May 8, 2020: Deborah Royster, CEO, Seabury Resources for Aging
Topics: Changing services to serve elders sheltering in place; dramatically boosting meal deliveries; great stories of staff going the extra mile to serve; racial disparities in effects of COVID-19; underscoring the importance of protocols and emphasizing it to customers; preparing for Mother’s Day—giving out roses and chocolates, a special meal, window visits, remote family connections; and bringing remote activities, classes, and religious services to residents. Length: 18:19.
May 11, 2020: Neal Buddensiek, M.D., chief medical officer, Benedictine
Topics: A grant 2 years ago allowed creation of an infection tracking system and infection documentation in EMR system as part of our pandemic preparation; a large COVID-19 task force has met every day across the organization; how Benedictine’s “virtual strike team” helps walk individual communities through COVID-19-positive cases, using data; a system that allows us to track infections and data across states; how a system that operates in 5 states can work across all; possibility of turning some COVID-19 units into hospice units; concerns about the logistics and consequences of mass testing of staff and residents. Length: 23:23.
May 12, 2020: Michelle Just, president and CEO, Beatitudes Campus
Topics: Quick adjustments by staff to lockdown of campus; keeping residents engaged—a daily theme for education and resident contact; daily updates for residents by CEO or senior VP; ways to encourage resident questions and comments; thoughts about opening up; how Beatitudes handles marketing, sales, and move-ins; and reminding staff of duty for safety while the state opens up. Length: 14:01.
May 12, 2020: Nick Uehlecke, advisor, HHS
Topics: HHS wants better data on who’s providing care and what it looks like; encourages members to submit to the portal for funding; working to make sure rural and Indian tribe providers get funding; HHS wants to identify individual communities that haven’t received any funding; working on a SNF tranche (including those that are 100% Medicaid) and concerned about relief re PPE as well; advice re how to track spending to come; HHS wants questions to be sent in (via LeadingAge or directly); advice re a multi-continuum provider using funds in various levels of care; question re using donated funds vs. provider relief funds; and questions about deadlines. Length: 19:54.
May 13, 2020: Karen Hatfield, team leader for counseling services, Hospice of the Western Reserve
Topics: None of the team is personally visiting patients; having to pay attention to all losses people experience, and how that affects grief; trying to figure out contingencies for future services the rest of the year; why staff sometimes feel their grief is disenfranchised; why we encourage staff to acknowledge their own grief; grief doesn’t always look like what you expect; the need to recognize delayed grief and validate grief; how we might have to alter services; where to go for counseling and support; we’re now reaching people who didn’t have access to us pre-COVID; new practices that might last beyond the pandemic—some virtual services, etc.; and working with visitor restrictions at LTC providers. Length: 22:31.
May 14, 2020: Rob Lahammer, VP of engagement and advocacy, Presbyterian Homes & Services
Topics: No part of the organization that hasn’t been impacted; value of early lockdown; the transitional care business dropped but we were able to reassign staff; 16 COVID-19 deaths so far; how to maintain a strong communications process; a centrally stored PPE supply; value of transparency; how one standalone transitional care site was converted into a COVID-19 site; in Minnesota, 81% of deaths were in LTC—press has been very hard on providers; difficulties with testing; unengaged employees are leaving, but others sticking, and employee engagement actually going up; dealing with a variety of resident attitudes in independent living; small drop in census; initial plans re relaxing restrictions; and difficulty recruiting new staff. Length: 20:20.
May 15, 2020: Carol Silver-Elliott, president and CEO, The Jewish Home Family
Topics: COVID-19 experiences in the center of a hotspot; turning management staff into dining assistants; this part of NJ was hit hard early on and local hospitals were overwhelmed early; decision to keep COVID-19-positives in-house; how JHF adopted hospital practices, and pushed physicians to be more aggressive; importance of turning and repositioning teams, hydration teams, and high-flow oxygen; praise for staff and others who supported the work; “parking lot guy” and many others that have helped get PPE; JHF has reopened to admissions, including some people in recovery; “You cannot let down your guard even though things are stable”; making full PPE a requirement to any family coming in; testing all new admissions 48 hours before entry; testing mandated in NJ for residents and staff, and how JHF has begun implementing; issues involving payment for testing and sequencing; why leaders and managers must always be positive even in bad situations; and why we hold celebrations for residents who recover. Length: 23:32.
May 18, 2020: Beth Kilgore-Robinson, member services coordinator, Goodwin House, and Karina Barragan, director of resident services programs, TELACU
Topics: Acknowledging grief; finding ways to look for the positive; incorporating mindfulness; organizing virtual services to keep residents and clients engaged; fighting isolation among affordable housing residents; dealing with PTSD, alcohol abuse, noncompliance with stay at home orders, reduced family connections, and hoarding; staff responding well to frequent policy changes; daily checks on resident well-being; and recognizing the need to focus on mental health. Length: 21:08.
May 19, 2020: Robert Espinoza, VP of policy, PHI
Topics: Coronavirus’ more negative effects on communities of color—highly overrepresented; direct care workers especially unable to weather the crisis and having greater difficulty with childcare and health access; why providers should be surveying communities of color re needs; tools to help develop a racial equity lens in our work; for home and community-based workers, why compensation must be improved; things employers can do to support these workers; policy wishes—improving compensation, sick leave, childcare, health coverage, provider compensation, pipelines for more workers into the HCBS sector; precarious lives of these workers creates impossible choices; getting technology to underserved communities; need for better training creates opportunities for both workers and employers; and value of connecting workers to community resources to support them. Length: 19:54.
May 20, 2020: Dr. Tom Frieden, president and CEO, Resolve to Save Lives, and former director, U.S. Centers for Disease Control
Topics: Role of the CDC, and optimism about beating the virus; what will a “new normal” look like; different risk levels for different areas; testing situation improving but does not meet needs yet; how providers should approach reopening; 2 false dichotomies (open vs. closed) and (health vs. economy); and 2 sites of interest (preventepidemics.org and covidexitstrategy.org). Length: 15:00.
May 21, 2020: Marvell Adams, COO, The Kendal Corporation
Topics: Understanding and alleviating stress on staff, both at work and in personal life; encouraging staff to use vacation, and have “staycations”; staff embracing mass testing; switching to 12-hr. shifts; keeping staff in consistent, separate teams, and general benefits of that model; simplifying menu plans to deal with diminished dining staff; encouraging staff to practice self-care; and lessons learned from a children’s book. Length: 16:13.
May 22, 2020: Howard Gleckman, Senior Fellow, Urban Institute
Topics: Disappointing absence of guidance on testing for providers; pandemic was a tragedy waiting to happen; broad recognition of an unsustainable LTC system; why paying for value can be a useful concept going forward; LTC becoming even less attractive to low-wage workers; labor and capital costs will go up; danger of focusing only on infection control; question of where will the money come from; providers understand delivery reform better than anyone; why the goal should be to build a system from scratch; financing LTC through Medicaid is unsustainable; benefits of a public insurance program; the biggest stumbling block is the money; can a shift toward better LTSS really reduce health spending? Length: 21:08.
May 26, 2020: Kate Shepard, executive director, Reformed Church Home
Topics: Things improving somewhat; thinking about opening up, and offering outdoor activities; update on testing challenges; positive media coverage re 2 residents in their 90s who have recovered from COVID-19; details about a separate unit for residents who have tested positive; using live TV system for communication and engagement; creating an employee appreciation fund; frequency and costs of testing for staff; and pay incentives for all staff, and for staff on the COVID-19 wing. Length: 18:47.
May 27, 2020: Lee Ann Hubanks, president, Plano Community Home
Topics: Service coordinators doing excellent work; no coronavirus cases so far; unable to get tests so far; weekly memos to all stakeholders with updates; revenue losses due to lack of move-ins; PPE costs and additional payroll costs; still reluctant to begin opening up; securing a PPP loan; move-in logistics; and struggles to find PPE. Length: 13:22.
May 28, 2020: Ami Schnauber, VP, advocacy and public policy, LeadingAge New York
Topics: Members have significant challenges with decreased census, partially due to lack of post-acute rehab; hazard pay and testing costs created a huge financial hole; state changing rules and issuing frequent survey questions; tremendous unaffordable costs involved in state-mandated staff testing—total estimate for members at $44 million per week; lab capacity inadequate; how NY State makes the pandemic more difficult for providers; no clear communication from DOH re resident testing, and suddenly changing rules; DOH staff doing testing are not themselves tested, and training is spotty; we want testing, but the volume required is unworkable, unaffordable, and threatens livelihoods of staff; rules for testing of staff who work at multiple communities; and how testing rules may create new staffing shortages. Length: 25:09.
May 29, 2020: Minnesota Testing Spotlight: Sharon Zehe, Mayo Clinic, and Karen Martin and Diane Rydrych, MN Dept. of Health
Topics: the “Minnesota Moonshot”; huge financial, legal, and cultural challenges of doing comprehensive testing; problems of unreimbursed costs; legal issues where facilities do not have medical directors; how mass protests and riots will effect disease statistics and first responders; who pays—insurance companies with state as a backup; additional issues raised by a testing program; identifying asymptomatic workers; reasons for early hesitance by providers; why testing must be an ongoing process; role of Mayo Clinic Labs; working to make home-testing workable in the short term; still questions re infectiousness of asymptomatics; situation of highest-risk residents or staff; and comments re payment for testing. Length: 27:43.
June 1, 2020: Maureen Carland, administrator, Maine Veterans' Homes
Topics: Despite detailed preparation for coronavirus, the first case occurred in an unexpected way; ultimately 34 residents tested positive, 17 passed away, 14 of them directly from COVID-19; why you’re not prepared even if you think you are; why attention to the minutia of infection control is so important; half of staff assigned to that unit also got coronavirus; scheduled Zoom calls with families and staff; delivering meals to sick staff’s homes; many staff lived in a nearby hotel; social workers and chaplains doing regular staff support calls; dealing with social isolation, esp. on the COVID-19 unit; wandering minstrels, bikers, and antique cars coming to visit outside the building; setting up BBQs outside to produce smells for residents (also popcorn, other comfort foods); if doing it again, review how people enter the unit and creating a clean zone; being careful of the language you use; attention to detail in using PPE; thinking about ways to honor residents who die; determining what constitutes “recovered”; and criteria for doing universal testing, and lack of a plan in Maine. Length: 21:49.
June 2, 2020: Ralph Gaines, CEO, Embrace Living
Topics: Challenging environment in EL housing communities, but organization has had only 15 total cases, including employees; some difficulty with PPE supply, but was able to secure sanitizer from distilleries and masks; resident interactions and activities; importance of Wi-Fi access in affordable housing; workforce motivation ideas—staying in close contact in any way possible, a flexible telework policy, “appreciation bags” for employees; and this former HUD employee’s view on how this affects housing policy. Length: 20:37.
June 3, 2020: Lori McLaughlin, managing member, WestShore LLC
Topics: Dealing with panic from nurses when the first positive case occurred; reassuring residents and staff facing fear; used large amounts of PPE; still don’t know what costs will be; state-provided strike teams inadequate; poor response from public health departments; and logistics of testing employees. Length: 15:36.
June 4, 2020: Keith Knapp, senior advisor on adult programs, State of Kentucky
Topics: KY Long-Term Care Advisory Task Force—a group to advise state government re COVID-19 and long-term care; working on protocols on big-picture issues and smaller operational issues; state issued “guidances,” not “directives,” re admission of COVID-19 cases; KY moving away from traditional approach to surveys, has been collaborative and people have been surprised about how good the outcomes have been; KY has been early adapter in universal staff testing, now halfway through; KY has orchestrated wraparound services re different contingencies in testing; creating staff strike teams for bad situations; KY has contracted with a lab and is paying for all testing. Lessons learned: Hope it is the end of semiprivate rooms; hopeful we can pay staff more permanently; we must think through the imposition of isolation, hard issues involved; value of a call center. Length: 22:00.
June 5, 2020: Karyne Jones, CEO, The National Caucus and Center on Black Aged
Topics: Introduction to NCBA; learning about racial denial; disparities in pandemic’s impact on people of color; how social determinants affect health; aging services is segregated; bringing POC into leadership of aging services organizations; LeadingAge needs to do more; a shared responsibility for people of all races; learning to be comfortable talking about race, and stop being afraid of each other; culturally appropriate activities in multiracial communities; actively bringing POC into leadership-track career opportunities in our field; reaching out to POC in marketing for all LeadingAge communities. Length: 30:29.
June 8, 2020: Jess Maurer, executive director, Maine Council on Aging
Topics: Maine is oldest and most rural state, already struggling with a direct care workforce shortage; coronavirus exacerbated the problems; most volunteers are elders who dropped out; coping with the problem—member and partner conversations, direct advocacy; have gotten a lot of help from legislators and others; good ad-hoc partnerships; getting insurers to pay for home-delivered meals; concern about the likely failure of small nonprofits in northern New England; and helping service coordinators cope with pandemic demands. Length: 22:14.
June 9, 2020: Mario LeMay, director, organizational effectiveness, San Francisco Campus for Jewish Living
Topics: SF came through COVID-19 relatively well; preparing to serve coronavirus-positive patients, logistically and otherwise; preparing staff and dealing with employees’ fear; unit was never more than half full; how LeadingAge Leadership Academy experience helped him work through the crisis; and experience of baseline testing for residents and staff and dealing with resistance. Length: 16:59.
June 10, 2020: Gus Keach-Longo, CEO, The Towers at Tower Lane
Topics: Interesting story of the origin of The Towers; “fluid” levels of care offered to residents; 8 coronavirus cases, all contracted outside the building; testing program for all residents and staff, as a pilot; leadership took their tests on camera and broadcast throughout building; doing contact tracing for residents who may have had contact; closed to visitors but not service providers—and how those visitors are tested and screened; overcoming resident/family anger over restrictions; keeping community regularly informed; trying to figure out a “soft open” strategy because isolation is so dangerous; and how expenses of testing and meals are covered. Length: 24:21.
June 11, 2020: Stuart Hartman, SVP of operations, acquisitions, and development, Retirement Housing Foundation
Topics: Limiting interactions between residents and staff and the outside world; 80% of the corporate workforce working at home, and furloughed some staff; nationwide, 122 COVID-19 positives in 35 communities, 66 recovered, and 20 deaths; most facilities had zero cases; lessons learned from initial Washington state nursing home cases—especially involving staff working multiple jobs; enabling those employees to stop working multiple jobs; how RHF is planning ahead for the fall; distinguishing between cases of COVID-19 and influenza; scenarios for staff returning to work in various settings; and policies re vacationing staff. Length: 19:00.
June 12, 2020: Nick Uehlecke, Advisor, Office of U.S. Secretary of HHS
Topics: Questions re Provider Relief Funds—those who bill Medicaid managed care plans are eligible; providers, such as adult day, who had to close their physical space, are eligible; clarification of deadline for applications, will be July 20; status of payments to Medicaid-only SNFs; status of guidance on reporting; policy on “paying to the upper TIN”; what’s next for remaining funds; how provider relief funds affect PACE providers; and eligibility of LPCs, guidance to come. Length: 18:12.
June 12, 2020: Col. Brian Kuhn, White House Supply Chain Task Force, FEMA
Topics: Description of task forces re PPE; Hanes cloth facemasks—not designed for medical settings, intended for visitors; FEMA packages, 2 rounds with a 1-week supply each time; the “blue tarps”—level 3 nonsurgical isolation gowns; details re the next shipment; explaining the tracking and reporting system; “Project America Strong” is the Hanes facemask shipments; how to deal with defective materials; and AL eligibility. Length: 19:03.
June 15, 2020: Rebekah Levit, executive director, Rogerson House
Topics: An assisted living dedicated exclusively to residents living with dementia, plus a social day program; had one of the first COVID-19 deaths in the state; needed to put systems in place immediately; eliminating staff crossover within the neighborhoods; figuring out how to quarantine residents safely; paying close attention to all symptoms; changing the closed day program into the “COVID floor”; continuing to serve residents who cannot socially distance; responding to Governor’s recent announcement that visitation could resume (outdoors only); details about how these visits are managed; which type of visits residents and families like the most; and dealing with PPE needs. Length: 16:44.
June 16, 2020: Karen Sturchio, CEO, Kansas Christian Home
Topics: Reopening guidance in Kansas; alarmed that nursing homes to be opened without restriction in late June; managers wear a lot of hats; state not requiring baseline testing; testing was difficult but getting easier; if county lets emergency declaration expire, we can’t get FEMA reimbursement funds and it would cost about $750K over a year; managing balance between safety and social isolation; sustaining budgeting for a provider with a lot of Medicaid, lose money on every Medicaid resident; and operating on a tight budget and with no margin for error. Length: 25:01.
June 17, 2020: Tina Sandri, CEO, Forest Hills of DC
Topics: The logistics of testing at her previous employer, early in the pandemic; staff challenges early on; at Forest Hills, lining up additional staffing before testing; testing done by public health lab nurses; still a challenge to get staff tested weekly; tremendous cost of testing; majority of cases found have been asymptomatic; covering workforce holes with staff out; dept. of health survey results; and questions re workforce policies. Length: 14:33.
June 18, 2020: Kristi Strawser, executive director, State of the Heart Care, and Kara Allread, SVP, Brethren Retirement Community
Topics: The 40-year partnership between Brethren Retirement and State of the Heart Care (hospice provider); how the partnership helped in coping with the pandemic; some staff work for both organizations; how established good communications helped in working through risks and exposures, without eliminating the hospice’s access; aspects of good partnerships—not becoming complacent, keeping regular contact between leadership and clinical teams; encouraging staff to make “caring choices”; working with LeadingAge Ohio to create a “travel and social gathering risk mitigation tool”; daily alerts using OnShift to remind staff about careful choices made at work and outside; recognizing COVID fatigue; cooperating in staff recognition and support; and policies re staff who work for both organizations. Length: 19:05.
June 19, 2020: Capt. Joselito Ignacio, lead, Supply Preservation Support Team, FEMA
Topics: Quality of PPE, including fraudulent PPE; evaluating unsolicited offers of PPE and respirators; PPE preservation; reducing, reusing, and repurposing PPE; using barrier controls, when possible, to limit using PPE; extended use of PPE; and decontamination systems in hospitals being used on PPE. Length: 20:05.
June 22, 2020: Walter Ramos, president and CEO, Rogerson Communities
Topics: Boston area hit early by the pandemic, had to learn fast; completing a construction project during pandemic; new residents hesitant to move into the new community; move-ins have picked up in recent weeks; setting up many safety protocols for move-ins; great communication and transparency helped the process; no residents have objected to move-ins, and how trust was built among residents; thinking about how to get our residents first in line for getting a vaccine if one is found; financial impact of residents delaying their move-in to the new community; and move-ins to be a challenge going forward as well. Length: 18:21.
June 23, 2020: Michael Soccio, VP of clinical operations, Trinity Health At Home
Topics: Up to 1,500 home care + hospice patients per day in census; “Home Care Connect” program, created to lower costs, reduce in-home visits, and monitor people 24 hrs. per day; clients can launch remote visits at any time, round the clock; many calls after midnight involve anxiety and isolation; many clients in their late 90s who do really well with the technology; “Getting Better and Getting Different” is the mantra—always looking to meet the triple aim; heavily invested in remote monitoring platform; saw during COVID-19 that many patients had no insurance, so we decided to place the technology with all patients who tested positive or who we suspected having it; monitoring remotely is a way to conserve PPE and also reduce exposure of staff; had about 250 COVID-19-positive patients on monitor, and could create a COVID-19 pathway in the Home Care Connect product so device would gather vital signs every 4 hours, with slight changes recorded and assessed; our virtual care center becomes a call center during overnight hours; interesting story about a client with a clogged PIC line; why ER nurses are such experts at triage; why remote monitoring should be 24/7; a business case built on reducing expenses by reducing home visits; patients give positive feedback about the telehealth helping them feel less isolated; thoughts about getting signed orders for services from physicians; and comments about Vivify technology. Length: 25:46.
June 24, 2020: Julie Thorson, president and CEO, Friendship Haven, and Carol Silver Elliott, president and CEO, Jewish Home Family
Topics: Leaders that recognize their strengths; giving each other the grace when someone is “having a day”; relationships that sustain us; the anxiety caused by uncertainty, and learning to put it aside; staying positive despite difficulties; how a closed employee Facebook group has helped; how the Leadership Academy helped; creating a list to prepare for a second wave; and continuing ongoing communication with families. Length: 25:52.
June 25, 2020: Kim Brooks, COO for Senior Living, Hebrew SeniorLife
Topics: Hit hard at 2 sites early, despite being very aggressive in taking steps to protect residents; a “guiding principles document” for reopening planning; residents created educational video for other residents; purposely using different language than the state’s phasing language; risk assessment and mitigation planning tools; home care services picking up lately; trying to get baseline and surveillance testing in independent living; how contact tracing might work well among HSL residents; a relatively unrestricted approach to visitation in independent living; building trust and transparency with all groups; things we’ll keep after COVID—virtual programming opportunities, fitness via TV; and thinking through the return of volunteers. Length: 21:31.
June 26, 2020: Mary Stompe, executive director, PEP Housing
Topics: Starting to open up community rooms to small groups with masks; keeping resident managers and service coordinators working remotely; have had only 1 case; most volunteers are residents, so prevented vulnerable ones from participating, and used staff to take over food delivery and expand the program; the only positions hard to fill were in lower paid jobs like maintenance staff; appreciation pay; reduced hours in summer; flexibility re remote work; “Project Sunshine”—lots of communication with residents, cards, worked with Covia on “Happy Mail” program, bringing music to the properties; managing repairs and inspections; and thorny issues with testing of staff. Length: 20:38.
June 29, 2020: Peter Sullivan, executive director, Birch Bay
Topics: Protecting residents of a rural community with a lot of summer visitors—over 1 million per summer; effects of sheltering in place on residents, esp. those with dementia; “touching” and social supports decreased due to pandemic; pilot project in residential neighborhood, to allow visitation from loved ones with negative swab tests; pilot may extend to assisted living in the future; and staff showing support for the pilot. Length: 22:12.
June 30, 2020: Katrina Gray, compliance officer, Buckner Retirement Communities
Topics: Phased reopening of life plan communities’ independent living residents, have pulled back a little due to Texas surge; testing and isolation from residents coming in from outside; difficulties in procuring PPE; building up an emergency stock of PPE; paying up front for unknown quantity and quality of PPE; designating a “PPE Czar”; using Microsoft Teams to connect staff; planning stockpiles of PPE for the future; LeadingAge Texas sending out useful PPE alerts; and useful help from state and local health departments. Length: 20:54.
July 1, 2020: Deke Cateau, CEO, A.G. Rhodes
Topics: Previous emergence preparedness programs put us in a good place to deal with COVID-19; had 57 resident cases and 38 staff cases, and 9 resident deaths; went to zero cases by June 1 and now have 9 cases again; families misunderstood the governor’s opening order and thought they could visit; outdoor visits opened last week. Lessons learned from pandemic: COO and myself took over ordering supplies ourselves; put vendors on net zero payment terms, or pay in advance as needed; we delivered supplies to the homes ourselves; have strong supply vendors; required administrative staff to come into the workplace, for morale reasons, and it was successful; focused on resident testing early, but have been aggressive about employee testing; “business as unusual”—how to apply person-directed care to the pandemic; COVID-19 will set back the culture change movement; had to re-install barriers such as plexiglass walls at nursing stations after taking them down in the past; 14-day quarantines for new admissions, but tracing is still very difficult; hiring staff for person-directed care involves interviewing for “fit” by asking questions about scenarios; census has dropped to 70% occupancy; new admits push back against 14-day quarantines; finding labs to provide testing; and A.G. Rhodes has purchased 3 testing machines of its own. Length: 19:43.
July 2, 2020: Phil Jacob, associate executive director, The Buckingham
Topics: COVID came along just as a major expansion was completed; shut down admissions when first positive case came along; some staff tested as “positive” for 70 days or more; instituted frequent testing early in the pandemic; many difficult decisions re testing, staffing, etc., early on; transparency required to deal with frequent policy changes forced by the course of the pandemic; making questions asked of staff and new admits intelligible; what happened when I learned I was positive and continued working from home through the disease, and a bad 3 weeks followed by 5 more weeks before coming back to work; how the organization handled the financial hits of the pandemic; Houston undergoing a surge in cases in early July; and handling intra-level of care visits, resident-to-resident, only via remote technology. Length: 20:56.
July 6, 2020: Nancy Evans, CEO, CSI Support and Development
Topics: CSI has a unique cooperative management system for 60 apartment buildings with 6,300+ units in 4 states; coop model conflicts with the need for residents to shelter in place, so shifting our focus is the challenge; 76 confirmed positives in just a few properties in Massachusetts and Michigan, and 20 fatalities, probably have many more positives we don’t know about; going property-by-property to determine reopening strategies; some local health departments have been helpful in doing testing; results of testing are mainly negative, and lots of asymptomatic positives; our communication has never been better and we believe we have a much better handle on what’s going on; working remotely has worked out extremely well; coops are purchasing iPads for council members; stopped all move-ins, and have staff now doing most of the admissions work that was formerly done by member committees; properties are absorbing costs of unoccupied units, but maintenance costs have dropped as well; thoughts about how to handle repairs as things gradually open up; and sanitizing practices for repair jobs. Length: 17:19.
July 7, 2020: Kassie South, senior director of health services, Franke at Seaside
Topics: Huge increase in hospitalizations in Charleston, SC; having to manage downstream effects of hospitals being overwhelmed; increasing cases among staff; quarantine and testing policies for staff who go on vacation; changing staff scheduling to cope with staff shortages and to minimize the number of staff working in resident areas; anxiety re visitation changes, state requirements; floods of tourists coming into Charleston area; converted a 2-bedroom apartment as the PPE stockpile, access limited to only a few staff and stock closely tracked; strange and inadequate collection of PPE from FEMA; value of the Leadership Academy network in getting through the crisis; and concerns about outdoor visitations in hot weather. Length: 20:10.
July 8, 2020: Josh Bowman, administrator, Bethel Manor
Topics: Have not had any resident cases so far, and one asymptomatic staff member; ramping up PPE supplies in an unconventional ways; scavenging N95s from farm stores and paint stores; why I used my pop-up camper to live on-campus during the pandemic; doubled activities staff to boost resident engagement; added an app for family members to follow what their family members is doing during the day; window visitation; made a plexiglass structure outdoors for visitation; started indoor visitation this week, with restrictions; how we got positive local media coverage; advertising all of our infection control precautions; and what to preserve in the future—family connections and preparing for future emergencies. Length: 17:39.
July 9, 2020: Rola O'Meally, director for adult day services, St. Ann's Community
Topics: Adapting to the early closure of adult day programs; assessing the risk levels and needs of participants, then quickly finding ways to help the most high-risk individuals; remote activities, helping coordinate care, wellness, and medical appointments; adding a bilingual (Spanish) wellness coordinator for large number of Hispanic clients; telehealth is here to stay in adult day services; success in keeping hospitalizations down; funding—used some grant funding to help pay for adapted services; and meals and help with medical appointments were the most-requested. Length: 16:34.
July 10, 2020: Allison Salopeck, president and CEO, Jennings
Topics: Lost 10 residents in May; restarting admissions; good success in short-term rehab; AL candidates holding off on move-ins, and many of them have more flexibility than those requiring skilled nursing; we have a tight-knit community of NP senior care providers, and have been able so far to get as many test kits as we’ve asked for; testing turnaround of 24-48 hours for the most part; National Guard has helped with testing; staffing has been one of the biggest struggles; have a number of staff who work in other places as well; tried to convince people to pick just one place to work; stopped job shadowing and went to online interviews, but are trying to get job shadowing back; part-time staff were encouraged to jump onto full time; outdoor visitation for AL and SNFs in Ohio; wanted a way to limit exposure of staff doing testing of visitors; came up with a “car-hop” where visitors stay in their cars and maintain social distancing while visiting relatives. Length: 19:48.
July 13, 2020: Bruce Dmytrow, Senior VP, CNA Insurance
Topics: Insurance market outlook before COVID-19; loss cost pre-COVID was trending at about 11%, and large jury awards were becoming more frequent; the claim severity has converged across all service levels and in all jurisdictions and in both NP and FP settings; beginning to see optimism until COVID-19 hit; in the senior living sector, there’s been a significant moratorium on new business by some of our competitors; pandemic, class action, and other exclusions shifting; have tried to take a measured approach among our long-term customers seeking renewals; most policies exclude business interruption coverage where there is no property damage; affects of federal and state immunity and executive orders; insurance landscape after COVID-19 is hard to predict because of constant change; if indemnity immunity is passed on the federal level things could look better; advice on being prepared for the future; keeping a timeline and documentation of events and challenges managed is a good idea for managing claims; insurability of health care isolation center to attract and care for COVID-positive people can be difficult—important to show how you’re operating from staffing, equipment, and infection control standpoints; “severity” refers to the average indemnity the company pays on claims; more about “timelines.” “Opportunities” presented by COVID-19: it has encouraged greater communication and collaboration among providers and families; new models of care being developed; increased telehealth; utilization of new technologies, including robotics and IoT; emphasis on home health options; more emphasis on social determinants; greater use of data; and greater attention to mental health. Length: 20:30.
July 14, 2020: Dan Stewart, Human Rights Campaign and LEI
Topics: Effects of COVID-19 on LGBTQ elders; greater risk for poor health conditions, chronic disease; higher risk for severe illness from COVID-19; 20% of LGBTQ elders are people of color; “fear of providers”; we’re just starting to learn about LGBTQ aging; a decreased social network LGBTQ elders can rely on; SAGE’s elder hotline 877-360-LGBT; the LEI (Long-Term Care Equality Index) is designed to help us care for LGBTQ elders, work with residential communities to provide tools, best practices, etc.; a “commitment to care pledge”; a self-assessment tool for providers; survey respondents can take a needs-based assessment; start by reviewing your non-discrimination policy; details of the self-assessment; making housing communities more inclusive; and strategies for non-inclusive residents. Length: 28:45.
July 15, 2020: Marki Flannery, President & CEO, VNSNY
Topics: VNSNY is largest nonprofit HCBS health care organization in the country; out business was significantly impacted by pandemic; HH business declined 25% in admissions in March, and 61% decline in April; very slight improvements by May; in hospice, saw increases in month over month volume in hospice; many people in end stage of COVID were served; average hospice length of stay went from 72 days to 19 days by March, predominantly because of lack of elective surgeries; huge impact on staff; biggest challenge was PPE access; for awhile, all PPE supplies were going to hospitals; we felt pressure from hospitals to accept patients with COVID, and we refused because of lack of PPE; they then offered to supply PPE to us and we agreed to take patients; many of our home-based clients were testing positive, and staff was being infected; 12 employees died; we don’t routinely test staff; only staff providing care are those working in nursing homes or AL where the communities require testing; home-care clients were declining care but that is improving; leadership lessons learned—stockpile as much PPE as possible, applied for lots of external funding, create a clinical emergency response team; I spent the majority of my time over-communicating—daily audio messages, written messages, weekly conference calls, regular video communications; and did advocacy to gain reimbursement for telehealth, but no relief has arrived so far. Length: 17:33.
July 16, 2020: Dorothy Davis, CEO, VNHS
Topics: Common theme has been employee safety, how our culture will get us through the crisis; providing PPE has been a priority; hit our high point for COVID-19 in April, seeing steady decline through May, June, and are seeing an increase in the last week; now preparing for our second wave; we now have 90 days of PPE; started testing our employees who had known exposure at work; today, testing a thermal scan as a screening tool, if test positive there, we move to a rapid antibody test, and if positive there, moving to nasal swabs. Have tested almost 3,000 people, most in senior living; have learned that those employees we have tested have had very few positive tests, so we continue to reinforce infection control and proper techniques; spent 6 figures on PPE, did a lot of due diligence to source it; went from 6 gowns a month to 300 gowns a week; we got provider relief funds and invested those dollars into PPE; hospice bereavement team has been available to our employees in wake of staff passing away; and staff surveys gave positive answers about communication, information, and level of transparency; we have not mandated our testing for staff unless they had a workplace exposure and we are requesting a 14-day quarantine; not all staff pleased with that; HH was our biggest revenue decline, partly due to shutdown of elective procedures in hospitals; we saw a growth in hospice revenues, almost 8% in the first 10 weeks; private duty had a revenue decline; our patients and even some staff struggled with telehealth technology; went back to phone calls in many cases; and telehealth did not have the impact we wanted. Length: 23:55.
July 17, 2020: Steve Fleming, president and CEO, The Well-Spring Group
Topics: Have been fortunate re positive cases; 2 positives on one campus in independent living; PACE has been hit due to the pandemic; physician office still open but other center operations shut down in late March; shifted to a home-based program for PACE, which made staff become home health aides and going into homes; 3 PACE participants in skilled nursing passed away; PACE is now open again as of July 1, very limited due to social distancing; averaging about 24 participants per day; families are hurting because the center wasn’t open for 3 months; our traditional adult day program has re-opened, because family caregivers need the help. Dining re-opening has seen about 10% of the population (40 people) coming to the dining room; dining area limited to 75 maximum; there are residents who say they’ll take the risk and really want to dine there; we have a conspicuous green-vested sanitizing person; a no-touch dining experience for residents and wait staff; staff received an early COVID bonus, and later a “longevity bonus”; testing costs about $105 per test; we estimate $250K - $500K in unanticipated expenses; details about no-touch serving; received some PPP money, and the state has continued to pay for PACE participants; have not had to furlough PACE staff; and has increased wages in general, competitive with acute care. Length: 22:33.
July 20, 2020: Lisa Balster, director of care, patient, and family support, Hospice of Dayton
Topics: “Loss of the assumptive world” as the loss of the world we assumed we would live in, and the way our life would be; Hospice of Dayton remains very busy; had to cut back on visitors; in-person visits limited to 2 people per day; bereavement is different under the pandemic—we are well-equipped to deal with it, but waiting for the other shoe to drop, people who don’t cope well with life in general are under even more stress now; how providers can promote healthy grieving; teaching people to not be alone as one small way to cope with grief, and giving them other resources; now there is “COVID stigma”; helping people acknowledge the pain of grief; services available from hospices—the hospice ethic is that every human in the community is our client; CDC website has a great resource list for grief and bereavement; and staying in contact with staff requires multiple layers (team meetings plus one-on-one touch-ins). Length: 17:38.
July 21, 2020: Manny Ocasio, chief HR and compliance officer, Asbury Communities
Topics: No positive cases in many communities, but outbreaks in some others, but as of today, no active COVID-19 cases in any SNFs; a “no regrets” strategy that focuses on trust, on commitment to mission, commitment to those closest to the process, and accountability; “a just culture” as a way to organize our thinking; implementing sophisticated screening device from 986labs.com; expanded a partnership to manage all of our call-outs and help us know where to make adjustments; how “just culture” articulates a principle in trusting and assuming good intentions when staff came to us with unusual requests; managing through a framework of trust and compassion; simple things providers can do to implement something like this; handling wait times for testing results; gave bonuses totaling $600K to providers and may do it later in the year again; and managing communication across a multi-state organization. Length: 21:44.
July 22, 2020: Don Blose, CEO, Spanish Cove Retirement Village
Topics: Blose is former OK state immunization director; surprised by the lack of PPE stockpiles that public health departments had; our incident command team met every day for 4 months—group had an incident commander, different managers for various areas of operations, a scribe, etc.; my background helps me keep my eyes on the big picture; make sure to give everyone something to do, and sometimes doing something is the only cure for anxiety in a crisis; you can manage a pandemic, but can’t manage a panic; our residents also need something to do too, so have to figure out better ways to keep them involved; our residents need a lot from us at a time like this, so we have to “love ‘em more than we ever did before, to make them feel special”—go over the top to help them; breakdown of what happens in daily incident command meetings. Length: 18:40.
July 23, 2020: Dr. Noah Marco, chief medical officer, Los Angeles Jewish Home
Topics: 50 residents tested positive, and there have been 10 deaths; 86 staff positives, and 64 have returned to work; a new patient-centered visitors policy is in the works, to adjust what we do with residents based on their own risk tolerance; belongs to a nationwide Delphi group to come up with ways to do it; need for a national movement to share best practices on this, maybe involving “idle industries”; comments on CMS announcement of testing in nursing homes; concerns about specificity of machines; what we need most is asymptomatic testing; got LA City and County to bring testing to nursing homes; 50% or more of cases are coming from asymptomatic people, so really the only way it can spread in a facility is through asymptomatic people; the other 2 aspects are PPE and infection control; reducing spread of COVID—washing hands, PPE protecting eyes, noses, and mouths, and infection control and testing; staff really devoted to preventing spread and committed to following protocols; and staff buy-in for more visitation requires strong staff relationships and empowerment. Length: 24:08.
July 24, 2020: Hank Lovvorn, COO, Presbyterian Homes
Topics: Moved 58 new residents into a new community in April and May; under the pandemic, you learn a lot about your culture, and our culture is doing well; have had resident cases in 2 communities, 5 cases total, but a lot of employees have tested employees; stories of visit with HHS Deputy Secretary, in an outdoor setting; we shared details about our experience with him; talked about testing costs, quarantine sweeps, PPE, he had specific questions, and we talked about person-centered care, value of nonprofit providers, regulatory matters; I asked him about his priorities, and said he oversees vaccines, priority of therapeutics for treatment, and where the money goes; he said the whole industry is now working on a vaccine and they are working on all of the rollout/distribution logistics in advance; and he found that advocacy is easy if you’re willing to take your opportunities. Length: 18:04.
July 27, 2020: Sondra Norder, president and CEO, St. Paul Elder Services
Topics: For the most part, our COVID experience has been fairly light, only a few positive cases among residents and staff; how St. Paul took in 28 residents from another community that had a fire; how 75 off-duty staff members showed up to help; needed to test everyone weekly and state was helpful in getting that done; those residents will be allowed to stay here through the end of the year; St. Paul’s documentary; we have a nun on staff with video production background, who did the filming; decided to do a deliberate media strategy to get our narrative out there; it was a chance to show our expertise and change the media picture. Length: 14:21.
July 28, 2020: Andrew Banoff, president and CEO, Jewish Senior Services
Topics: Had 92 residents and 62 staff who were COVID-19-positive; 2 intense months early on; staff rose to the occasion; CT dept. of public health has worked really well with providers; I had opportunity to have a Zoom meeting with legislative committees; participated in a 4.5 hour meeting; in my segment I used the LeadingAge 5 Essential Actions as structure; LeadingAge CT was a great help; I told them PPE comes first, the price impact of PPE; talked about testing (which has gotten much better lately); discussions related to safe reopening; our campus is home to other organizations; talked about funding, and what happens going forward; talked about staff recognition, incentive pay, resources, support, staff as heart and soul of the organization; lost $500K per month because of COVID-19—it’s not just a cost problem but also a revenue problem; fundraising—we had truly remarkable response from family members, we haven’t been shy about asking and families, board members, donors, and foundations have been generous. Have had 7 focused infection control surveys by state during the pandemic. Length: 19:09.
July 29, 2020: Colleen Frankenfield, president and CEO, Lutheran Social Ministries of New Jersey
Topics: Have been COVID-free for about 68 days, after having lost over 40% of our residents in SNF and AL due to COVID or complications after COVID cases; 1 nurse passed away, another nurse recovered after being on a ventilator and now has neurological issues. Big challenge was that none of our residents and staff started with the symptoms that we were told to expect; hospitals were sending us people who were probably actively infected but the hospitals had not accurately diagnosed them; motivating staff meant meeting the needs of the individuals; we housed staff in empty units when we could because they were afraid of taking the virus home; others were put up in hotels, others on nearby college campus; provided all meals to all staff; hazard pay and bonuses for staff; biggest need was emotional and psychological support; our chaplains are licensed counselors; doctors and nurses are used to dealing with illness and death, but not so much of it; staff camaraderie was a big factor in keeping everyone on board; my faith and focus on the goal of caring for seniors is what kept me going; organizations without on-board counseling resources should consider employee assistance programs, local churches, etc.; had many staff who refused to work, many were out for a month or 2; some returned and there was some tension between coworkers; bought tablets for residents to help their communication; daily wellness calls for all residents in IL and housing; set up food pantries in all affordable housing buildings; connected with local college radio stations; connected with pen pals; used hospice and bereavement staff to help residents, and extended the service to family members not a part of hospice. Length: 17:19.
July 30, 2020: Shelly Griffith, CEO, Eben Ezer Lutheran Care Center
Topics: Our county was one of hardest-hit in Colorado, a rural area with meat harvesting and milk plants, and a prison system that were hard-hit; many team members shared households with people working there, so we had some cases; we are the largest LTC organization in northeast Colorado; had PPE problems early on; after we had an outbreak we were the first to have access to supplies from local health department, though it was not enough; lots of scrambling to get more supplies; also partner with local hospitals, and we all have plans in place to cooperate, but hospitals were hesitant at first; later hospitals allowed some of their ancillary staff to come work here after being furloughed; we have less access to resources others might have, but the local community did everything they could to help us; the amount of supplies and food and drink showing up was very fulfilling to our team; most amazing thing is that our turnover was lower during the worst time than it normally is; people have that “rural grit and tenacity” to stick with it; one retired nurse came back to work to help with infection control; PRNs stepping up to full time and volunteering for the COVID units; many other great examples; many home care clients opted out of service at that time; “reconnection visits,” for families, contacts go through one individual on our team and she’s doing all scheduling; all visits outdoors; trying to do it M-F because weekends are more challenging because of staffing; we thought we would need additional marketing to re-brand ourselves but we learned that was not the case—community has a lot of faith in us. Question is now how we can handle the number of people who want to come here! Trying to understand how the virus came into the building; might have been from a person admitted in February without symptoms; later tested positive for antibody, so it could have been her who brought it? Length: 21:15.
July 31, 2020: Terri Cunliffe, president and CEO, Covenant Living Communities & Services
Topics: 10 of 17 communities had positive cases; learned a lot about infection control, esp. in housekeeping and facilities; a “staffing up” plan to help cope with the pandemic, with a “quick hire” process that hired 452 people in 10 weeks; 3 recruiting teams, each with 3-4 screeners of prospects; brought people into orientation while doing background checks; created SWAT teams for each site; we do lots of digital recruiting; some home health staff re-deployed in the earlier days, until home health business picked up again; learned that we had not been as diligent in recruiting practices that we should have been before; brought in an infection control physician to point out areas to be improved; had to do a lot of retraining for housekeeping; a new housekeeping training program was created; new “hospitality aide” position—entry-level, non-trained position for a variety of needs like answering call lights, help with cleaning, screenings, delivered meals, packed meals, activities, one-on-one with residents, allowed us to better deploy our certified assistants; did not include them in our PBJ report; almost all of our positives now are staff; created a re-opening guide to give us a structure consistent for every community; phase-to-phase decisions rely on data for SNF and AL, but a little more subjective for independent living; trying to bring services back to IL so they don’t need to go out too much; appreciation bonuses are earned bonuses tied to coming to work for all scheduled shifts; trying to figure out a way to carry that in the future; re-opening guide was useful for residents and families. Length: 22:01.
August 3, 2020: Dr. Ashish Jha, director, Harvard Global Health Institute
Topics: Hoping this is an 18-month pandemic, starting in January 2020—we are still not even halfway through it; aging services providers have faced enormous challenges; always some risk of visitors in a community until there’s a vaccine, but things we can do to dramatically reduce risk; wearing and mask and being outdoors could be quite safe; but nothing is 100% foolproof; there is such a cost to not having visitors, so I’m generally in favor of moving forward in some ways; I’m optimistic we’ll have the testing we’ll need by next June; there are now cheap reliable tests available; antigen tests are coming to NHs; the technology exists if the policy makers will allow it to come to fruition; antigen testing—what we should not care so much about missing people who are infected, but we should really care about missing people who are infectious; these tests work much better on the latter, so false positives are less of a problem; if these tests can be offered on a regular basis, you’ll end up picking up people who are infectious; the majority of people who spread COVID-19 will develop symptoms, but start spreading a day or two before that, those are the people we want to catch; we have to have some kind of testing regime for those people, and the antigen test is pretty good. Advice to senior housing providers: Single biggest thing for everybody is press your government to do a better job in managing the virus; a national mask mandate would be a good idea; no bars, no indoor dining, no gyms, no gatherings above 10; if done in a vast majority of states everything would become easier; paper antigen tests—they are coming but the problem is making enough; federal govt. needs to do more to speed that up; cost profile for antigen tests; false positives—with PCR testing and with antigen tests we don’t see many false positives; false positives are a huge problem in antibody tests; anyone who tests positive on the antigen test should then get a PCR test as a confirmation; with enough $$, how long it would take to get a better testing regime in place. Length: 23:12.
August 5, 2020: Dave Sanford, Brig. Gen., Deputy Director of the White House Supply Chain Task Force
Topics: Status of 2nd PPE shipment to NHs; contents of shipments; recourse if shipments have problems; what can providers do who can’t get the PPE they need; FEMA now buying PPE to support state requests; this fall, leveraging the Defense Production act we should see more of what’s needed this fall; private-pay NHs that are not supported by Medicare/Medicaid not eligible for these shipments, but are eligible to work with their state emergency mgmt. functions. Length: 13:21.
August 5, 2020: Derrick DeWitt, CFO and director, Maryland Baptist Aged Home
Topics: Small 29-bed nursing home in Baltimore, has has no COVID-19 cases; we locked down very early, March 1; eliminated visits from some service visitors; asked staff to take extraordinary care in their free time and limit contact with other people; staff deserves most of the credit; screen tests every day, almost accounting for hour-for-hour activities; asked “are you willing to commit to these measures to keep yourself and the NH safe”; began providing private transportation to limit exposure; brought in extra cleaning personnel, brought in additional activities people; battling staff fatigue, starting to see frustration, but want to be careful that our staff is not relaxing too much; we make sure we have reserve, working with on-call staff, created a plan to give relief to current staff; cross-training to give staff time off; reaching out to displaced workers; 1-800 counseling number for staff; we weren’t sure if help would come when we need it; bought PPE early on, felt that in these depressed areas, POC can get the short end of the stick; for us being a small independent, we are 95% Medicaid, our building is not as nice as others but we pride ourselves on quality of care; we can’t afford the cost of testing; haven’t been able to bring in new residents; some activities ideas we’ve tried; and greatest concern is maintaining our success in having no COVID-19 cases. Length: 24:34.
August 10, 2020: Dawn Barker, VP of HR, RiverWoods Group
Topics: Manchester, NH status had an outbreak and lost 22 residents; 2 other communities had just a few cases, mostly staff; greatest concerns right now are 1) parents dealing with children’s schooling and 2) the number of jobs we have open between our communities; concerned that fear and other factors is keeping people from applying; children staying home increases household expenses for employees; EAP program for employees; “town hall meetings” that staff can attend to talk with other people to overcome isolation; keeping staff engaged; self-care is often a very simple moment of relief; and supporting families of residents with “park & chats,” drive-up programs to allow families to meet residents face to face from their vehicles. Length: 15:33.
August 12, 2020: Stacey Johnson, VP of quality, Trinity Health
Topics: Quality control—what is impact of all these changes in lifestyle on residents, for instance, falls; COVID magnifies all of the traditional wellness and health issues of residents; PPE certainly aligns with quality; had to develop more sophisticated logistics systems to deal with PPE; communication should be a quality metric; PPE training is a quality metric; and as daughter of a parent in a NH with dementia, I understand importance of communication much more than before. Length: 17:07.
August 17, 2020: David Grabowski, PhD, professor of health care policy, Dept. of Health Care Policy, Harvard Medical School
Topics: “A crisis on top of a crisis”; crisis in how we pay for and regulate nursing home services; steps that could be taken to stem the tide—PPE and testing, plus more dollars into hero or hazard pay and benefits; NH caregiving is the most dangerous job in America right now; some critics of NHs don’t pay enough attention to public policy; antigen testing machines are a great development; hope we can get them to every NH in country in near future, plus training; and hope to avoid nickel-and-diming anyone with this. What will the fall look like? Don’t think we can test our way out of this, we need PPE, cohorting, and workforce support; a lot of concern about what happens in the fall; what this crisis will mean for longstanding problems in our field; comments on paper-based saliva tests, lacks accuracy of PCR-based tests but they have real promise; and will nursing homes be “first in line” for vaccines if they appear? How to overturn bad public image of NH; and frustrated about PPE supply, need more federal govt. involvement. Length: 21:45.
August 19, 2020: Mitzi Epperson, associate campus director, Baptist Village at Owasso
Topics: Had 9 staff COVID-positive and 4 residents so far, all recovered; Dr. Deborah Birx visited our campus; had an area of the building where visitors would have not connection with residents; had a great small group of people to meet with her; she was taking careful notes; talked at great length; she promoted mask wearing, even outdoors; antigen testing machines—guidance to come from CMS, with distribution of devices by end of September; Birx is not recommending reopening, because of continued spread; doing whatever we can to keep residents engaged. Length: 15:53.
August 24, 2020: Monica Gandhi, MD, professor of medicine and associate chief in the division of HIV, Infectious Diseases, and Global Medicine at UCSF.
Topics: Masks protect the wearer and others; knowing that it protects yourself is a positive message that gives you control; N95 masks are great but are not feasible for most people to wear around; we suggest one of those surgical masks or a simple cotton cloth mask; after infection, people are most contagious for 7.7 days; working with staff to keep them healthy—the only place not to mask is at home; by wearing mask whenever you’re away from home is effective; you can eat while masked, so social distance at that time; asymptomatic people either have great immune systems, T-cells that help fight infection, or a low dose received; if we can drive up rates of asymptomatic infection, that’s positive; don’t look at antibodies, look at T-cells; over the last 2 weeks, major results have shown even with asymptomatic infection, you get immunity; her thoughts about antigen testing machines—even if it’s not the best test, if it’s fast it’s useful, places like NHs should use frequent testing; wouldn’t use it every day but reasonable once a week; re plasma treatment, we should wait for randomized controlled trials even though she is optimistic about it. Isolation and quarantine are different, the former used to be 14 days and is not 10 days from the beginning of symptoms. Quarantine remains at 14 days. No tests are perfect, in settings with lots of transmission positive tests are likely to be accurate; comments re aerosols vs. droplets; comments about rapid antigen testing along with verification tests; comments about international travel. Length: 21:56.
August 26, 2020: Brian King, director of health and wellness, Deerfield
Topics: 6 resident cases with one fatality; 13 staff cases with one death; grieving his loss remains the greatest challenge for the team; offer pastoral care and a counseling program, but the best thing to do was to talk to each other; servant leadership culture enabled us to cope with this; we are required to do weekly testing; test all staff on Tuesdays, all residents on Wednesdays, we also include contractors that come in; relationship with labs allowed us to improve turnaround time, by using a smaller lab as opposed to a big national lab, and have worked together to improve processes; think the antigen machine will have a role in our testing program when we receive it; we are self-insured so we can make the call to test everyone, but flipside is that it’s a direct cost to us, which is about $100/test, and get a discount with the lab we use; not testing IL staff, focused on health care area; and Deerfield’s system for testing large numbers of staff efficiently. Length: 16:05.
August 31, 2020: Catherine Evans, executive director, Lesley Senior Communities, and Meghan Rose, general counsel and director of housing policy, LeadingAge California
Topics: Dealing with power emergencies, shutdowns, and rolling blackouts in CA; Lesley dealing with some power outages in large buildings; preparing for wildfires; 2 properties affected by fast-moving fires; warned residents to be ready in case of evacuation; left with about 30 residents with nowhere to go; high-risk seniors having to go to an evac center? Had to prepare our own homes, plus plans for all organizational records; fortunately did not have to evacuate yet. LeadingAge CA members dealing with a disaster on top of another; SNFs have MOUs with hospitals and other facilities, but many are no longer in effect because hospitals are restricting transfers; various other problems; tried to ID other LeadingAge members who could help with evacuees; Residential Care Facilities for the Elderly (RCFEs) don’t have to have strong evacuation MOUs, only requires 2 appropriate shelter locations; we’ve learned this is inadequate for the future, and that RCFEs need reciprocal transfer arrangements; LeadingAge CA members were willing to help, though there are liability issues that have to be faced due to COVID-19 precautions; challenges of connecting with the Red Cross; older adults juggling need to leave home because of fires but then go to a place full of other people; lack of good solutions for people with nowhere else to go; why hotels are not an option in many cases. Advice for other members: have way more information than required, and make yourself known to Red Cross; Twitter is the best way to get up to date info about evacuation, and encourage members to keep phone on and loud to deal with emergency calls; purchased 10 washable breathable masks for every resident; and creating relationships with local offices of emergency services BEFORE disasters. Length: 28:38.
Sept. 2, 2020: Danny Williams, president and CEO, Eliza Bryant Village
Topics: Importance of building trust; focus on “what’s happened to this person” rather than “what’s wrong with this person”; understanding explicit and implicit biases; with predominantly African American population, already a lot of health disparities, and COVID-19 preys upon those weaknesses. The work of the Eliza Bryant Village Elder Justice Center: wing of nursing home converted into the center; must keep advocating for vulnerable population with leaders; broadening our definition of who our neighbor is. For elder justice center, victims of crime funds are a source of funding; local foundations are good on this; helping other foundations see the issue, more funding will probably be found. Staffing is predominantly African American, we focus on local hiring, but we’ve also attracted those of other races who care for the mission. Length: 18:43.
Sept. 9, 2020: Natalie Dattilo, Ph.D., director of psychology in the Department of Psychiatry, Brigham & Women's Hospital/Harvard Medical School
Topics: “Toxic positivity” is the idea that we should feel better than we do, it stems from overvaluing positive emotions and undervaluing negative ones; it denies a very real experience that needs to be recognized; we should distinguish between what we feel and what we think—they are related but are different things. “It would be weird if we were feeling OK right now.” Grief is a large part of the discomfort that we feel; it must be recognized for what it is to deal with it in an appropriate way. There is a sense of loss for many of us, and we’ve lived with breathtaking changes, and this sense of loss is not trivial; different stages of grief; we don’t necessarily have good solutions to isolation and disconnection; the feeling of isolation is a subjective thing; making connections is the most important preventive of depression; people can develop a sense of connection within, something that can be cultivated on our own; powerlessness can leave us feeling angry and hopeless, but reclaiming some sense of control, power, and purpose can be individually driven; I can channel this emotional energy into something productive; how managers can lead and support staff in a crisis; it’s not too early to think about how to make the best of the holidays this year; some suggested grief resources. Length: 22:22.
Sept. 14, 2020: Sean Beloud, Executive Director, St. John's Retirement Village
Topics: 67 COVID-19 positive cases in skilled nursing, and 34 positive staff members on campus during April; background of St. John’s decision to close its nursing home; concern after April about census recovering, plus the financial drain; did our deep dive into the financials in June; had to keep the AL residents’ welfare in mind; began to navigate a plan for meeting regulatory requirements and submitted a 28-page plan on July 8, and plan approved on July 17; we met with each resident and family individually to discuss the plan; set up interdisciplinary meetings with residents and families to keep them up to date on each step; met with staff individually; we were able to place almost all staff in new jobs either here or with other organizations; set up a “closing ceremony” on the day the last resident was discharged; need for getting help with the process, and for constant transparent and individualized conversations with residents, families, and staff; dealing with concerns of AL residents; and what comes next. Length: 19:45.
Sept. 16, 2020: Lisa McCracken, Director, Senior Living Research and Development, Ziegler
Topics: Discussion of the CFO Hotline Report; survey covers 6-10 questions of importance to a CFO audience, but topics aren’t all finance-related; audience is NFP senior living CFOs; all reports are accessible at Ziegler site; in September, 19% of respondents said they’re considering closure of skilled nursing sites; seeing some stability among providers; provider relief funds have helped, but experiences vary. Occupancy: Q2 occupancy dropped significantly over Q1; the greatest drop in SNFs; IL is holding pretty steady; pace of decline in occupancy is slowing down in general. Sales and marketing incentives: 70-75% of providers aren’t seeing a need to offer them, 30% offering some kind of discounts, and they usually help; restrictions are what’s keeping residents out, not cost issues. What members are thinking about for the near future: providers are still interested in growing, and HCBS initiatives are gaining interest; COVID has not changed demographics. Staff turnover: 40% said turnover has increased, the remaining hasn’t really changed; there was heavy turnover in the beginning but it’s stabilized a little. Debt: we’re at record lows for borrowing rates now, some borrowers pushing up timelines because the rates are so attractive; investors are bullish on senior living. Length: 21:15.
Sept. 21, 2020: Evan Shulman, Division of Nursing Homes in the Quality, Safety, and Oversight Group, CMS
Topics: New guidance re in-person visitation; learned a lot about COVID-19 spread; if followed, more visitation can be enabled; really no reason not to enable outdoor visitation apart from weather concerns; indoor visitation can still be restricted but we also understand these risks better; there are circumstances where visitation must be allowed to occur; we are ready to approve use of CMP funds to help facilitate more visitation; what to do if state and federal guidance on this conflict. Antigen testing, and false positives/negatives; false positives are a regular part of this kind of testing; CDC website has information about when to do confirmatory tests; guidelines on documenting data; testing guidance for incoming contractors; outbreaks vs. outdoor visits; what to do when lab availability is difficult; indoor visitation vs. testing; leaving the facility vs. quarantine requirements. Length: 23:32.
Sept. 23, 2020: Daniel Larremore, Ph.D., Assistant Professor, Computer Science, UC - Boulder
Topics: Discussion of computer modeling for COVID-19; differences in modeling in different scenarios; this is primarily an airborne disease; understanding the course of the virus and infectious period in people infected; modeling testing; effects of fast turnaround on effectiveness of testing; why asymptomatic testing is critical; more testing is always better, and why an at-home test would be great; to minimize mortality of this disease, we need to prioritize vaccination for older adults first. Length: 12:58.
Sept. 30, 2020: Rachael Piltch-Loeb, Ph.D., Preparedness Fellow, T.H. Chan School of Public Health, Harvard U.
Topics: Elements of risk communication; communication needs to be a feedback loop to make it a 2-way street; 2-way communication shows responsibility and respect for the audience; 6 principles of crisis and risk communication; why having a communications strategy is important for an organization—it offers a reference point for decisions made and ensures you include all the elements that are needed. She recommends the Crisis & Emergency Risk Communication (CERC) website from CDC (link: https://emergency.cdc.gov/cerc/index.asp). Panic is not common when people get timely and accurate information. Distill the rationale for decision making to 3 key, succinct messages. Communicate only 3 distinct points, use less than 27 words, and speak in affirmatives instead of “don’t.” Overcoming demonization of nursing homes; how to deal with rumors among affordable housing residents—goal is focusing on what you’re doing to manage the cases you know about; thoughts about communicating with staff and keeping them motivated; take any opportunity to acknowledge their needs and demonstrate that you’re attempting to be responsive. Length: 24:03.
Oct. 5, 2020: Admiral Brett Giroir, assistant secretary of health, HHS
Topics: Abbott BinaxNOW™ COVID-19 Ag cards; 50 million of the 150 million units will be set aside for vulnerable populations, including nursing homes; cards being sent only to nursing homes in counties with red or yellow by our grading scale; the other 100 million will go to states for use in schools or nursing homes; a lab-based PCR test is the gold standard, but the costs are very high and lab turnaround time is an issue, as is availability. Antigen tests may be less sensitive, but should pick up high viral loads among people who are likely to spread; they are a useful alternative to PCR tests, and are the best of the options that are actually available in some places—a less-sensitive test done frequently, and with a 15-minute turnaround, is better for infection control. What to do re states who prohibit antigen tests; understanding the number of false positives in relatively low-prevalence areas; comments about testing of hospital staff, surveyors, and ombudsmen; access to more tests after the initial rounds; distribution to red and yellow counties will be weekly for Binax cards. Thoughts on the “saliva test”: It’s not a saliva test, it’s a saliva collection method, and must be sent to a PCR lab. Length: 22:19.
Oct. 5, 2020: Jeannee Parker Martin, president and CEO, and Eric Dowdy, chief governmental affairs officer, LeadingAge California
Topics: Discussion of the Coronavirus Commission on Quality and Safety in Nursing Homes (“The Nursing Home Commission”); we were the only voice representing the aging services continuum on the commission, but there were many voices supporting our field; the final report led to a September meeting with Vice President Pence and CMS Administrator Verma at the White House—Martin was allowed to attend; the goals of the commission. Tensions resulted, related to: ongoing supply and affordability; rigorous infection control and quality of life issues; urgent need to train, support, protect, and respect frontline caregivers; outdated infrastructure of many nursing homes, due to antiquated regulations or outdated reimbursement levels; need to coordinate guidance; insufficient funding for nursing homes to implement new activities; the 10 themes that resulted; 27 recommendations came out of it, and there were 100 action steps suggested. Commission recommendations on: testing and screening; additional funding to cover nursing home testing requirements; better training on use of machines; cohorting; improving the “workforce ecosystem”; hazard pay; anticipating hotspots; staffing; professionalizing infection prevention. The commission also discussed liability protection for operators. More information at Mitre.org. Length: 15:22.
Oct. 7, 2020: Leslie Reynolds, Executive Director, National Association of Secretaries of State
Topics: Social media is both a curse and benefit re election information; “canivote.org” website for information and links to local election officials; urging people to go to state and local election officials for most accurate information; voting by mail is safe, many safeguards are in place, and states have been doing mail voting for a long time. In-person voting: Check to be sure polling locations have not changed; there will be social distancing, infection control measures, hand sanitizer, and more; local election officers may not be able to go into facilities to help, as they have before; providers should reach out to local officials as early as possible about how they can assist you; #trustedinfo2020 is about highlighting reliable information on voting from state election officials. Length: 19:06.
Oct. 12, 2020: Cathy Neece-Brown, VP for mission support at the James L. West Center for Dementia Care
Topics: Our certification requires us to have more staff per resident than many other organizations; we serve only those with dementia; building a real pipeline for finding and developing staff; schools at all levels doing clinical rotations here; a dementia education advisory council; teaching dementia in grades 9-12, and training students as CNAs; running a free CNA school. Working with those with dementia during COVID-19: social distancing difficult. Private-pay facility getting provider relief funds; one-time testing is $15,000; costs of PPE have escalated from 400-800%; have found testing opportunities locally; we test twice per week, positivity rate is over 10%. Ways of incentivizing staff; very strong dementia education; suggested dementia training resources—anyone can visit jameslwestlearn.org. Covering cost of testing: private philanthropy, negotiation with private labs; LeadingAge Texas has helped, as has the public health department. Length: 20:55.
Oct. 14, 2020: Mary McMullin, chief strategy & advancement officer, Covia
Topics: Diversity and inclusion as a guiding principle of Covia; principles come to fruition in behavior; it affects governance—who do we seek to have on our boards and as leaders? Not a checklist, but how will they advocate for our mission? Age, racial, religious diversity sought; a robust resident communication policy; directs them to communicate locally first, e.g., to their own executive director; we talk about our conflicts, a process called “Valuing Community”; what we seek is to raise and discuss issues of conflict and come to an understanding of being in community with people who don’t share our views; share statements of principles to new residents before they become residents; resident images from all our programs will be used throughout the website; trust index on feeling welcome regardless of gender orientation or age was in the mid-80% range, but goal is to get into the 90s. Diversity and inclusion training is included in regular training, but leadership team and board members we’ve done focus on unconscious bias—you can’t address what you don’t think is wrong; we use Great Place to Work employee survey, and there is one specifically for senior living, and it gives us actionable insights. Length: 19:38.
Oct. 19, 2020: Dr. Nimalie Stone, medical epidemiologist, CDC
Topics: Many vaccine candidates are under evaluation; public health plus long-term care have 2 important tasks: educating residents and families and health care personnel about the importance of the vaccine, and how to create a protective bubble around older adults we care for; residents’ immune response may not be as robust as other people’s; building on our experience with flu, Stone’s opinion is that frailty and comorbitities can blunt immune responses even with a vaccine; a flu vaccine doesn’t guarantee a resident won’t get flu, but it often reduces their risk of hospitalization or death. The first thing we’re waiting for is guidance from the ACIP, a federal advisory committee that helps identify the way vaccines should be given to a population; I expect the health care workforce to be near the top of the list; states will get allocations based on populations to be prioritized; for LTC residents, a federal pharmacy partnership program will help make that allotment; the best time for older adults to get the flu vaccine is October, well before the virus is circulating—it takes a couple of weeks to get the full protective effect. In general, the LTC workforce has not been as easy to promote flu vaccine to; acute care tends to have much higher workforce vaccine coverage than LTC; one step to start with is having conversation with staff to learn their concerns—listening is important; comments on importance of air quality and purification systems; the heavy respiratory droplets are still the main way COVID-19 spreads; she recommends that providers always keep that in mind and take any steps—technological or otherwise—that can reduce that kind of transmission whenever possible. How to handle people with symptoms that are common to both COVID-19 and flu; testing for both viruses is a good idea; move them to dedicated COVID-19 units only when they are confirmed with that inspection; people who have both infections shouldn’t be housed with those who have only COVID-19. Length: 24:52.
Oct. 21, 2020: Dr. Ken Mead, engineer and industrial hygienist, CDC/NIOSH
Topics: Air filtration/purification systems aren’t a substitute for PPE or other workplace precautions, but are a part of good practice; NIOSH generally does not approve individual products, with the exception of PPE, such as the N95 respirator; search on “certified equipment list” at the CDC website; how to shop for portable and other air filtration systems; HEPA systems are extremely good, including for COVID-19; things that can be done with fewer resources; there is a CDC webpage on ventilation considerations for schools that can be useful (no specific site for LTC); engineering considerations are considered adjunct or auxiliary to good infection control practices; make sure you don’t have any areas of poor air movement; there are air tracer tools that release fog that you can observe to determine air movement; you can test exhaust vents with little pieces of tissue paper; are there special environmental considerations for members doing their own testing? Test outdoors or in an area with directional air flow that leads outdoors. UV units for air cleaning do work, but it might not make sense to put them in air ducts for LTC. The primary application might be in congregate rooms, maybe an upper-room UVGI system, a long-lived technology; the in-duct systems work, but should be reserved for hospitals in areas who have a large number of infectious persons. Questions about needlepoint bipolar ionization: NIOSH thinks of it as an emerging technology without a track record in health care, and does not have a lot of scientific data collected; consumers should really ask tough questions to be sure the device has been tested in an environment similar to yours; electrostatic filters do have value, but the length of protection is debatable; it may perform worse once it loses the electrostatic charge. Length: 21:41.
Oct. 26, 2020: David Trost, CEO, St. John's United
Topics: St. John’s set up its own PCR testing lab; decided we had to do something to avoid long lab-test delays; lab will open a few days after this presentation; needed to hire a laboratory director and pass stringent certifications; got most standard equipment in hospitals is multifunctional and on long back-orders, so we found a product with a research platform that had an emergency use authorization (EUA) for COVID-19 PCR testing; we are now validating the equipment; hired 2 people—a lab director (a physician) and a laboratory scientist—and will want to hire a second lab scientist in the future; hope to do 400 real-time PCR tests in an 8-hour period; all excess capacity will be prioritized for other senior care facilities; there is no other PCR testing center of this size in Billings; we’ve been sending tests to the state of Montana in Helena (governor is paying for all tests in the state); surveillance testing will be done with the state, and we’ll do our own outbreak testing. Outdoor visitation isn’t possible anymore; we’re defining “compassionate visits” as one visit per resident per month; will have “visitation hosts” who will greet and screen visitors using a self-swab and take samples for rapid testing while waiting in cars, then escort them to and from their visits; we ordered “visitation sheds” from Costco with barriers and heating; trying hard to balance safety and mental well-being. We hope it will be a low-occurrence year for flu within our community; visitor tests for surveillance and screening don’t require an order—those tests are not diagnostic; if visitors test positive we notify the local health department and tell people they must see their doctors; don’t know if we will test for the flu virus; possibility of getting a platform to screen for combination of COVID and flu testing; CARES act funding helped us start up our lab, and we’ve had a lot of support in town as well; 33-50% of the cost is just the little drops of reagent. Length: 18:45.
Oct. 28, 2020: Jerry Nevins, assistant administrator, Rose Blumkin Jewish Home
Topics: No residents have had COVID-19; 20-25 staff have been positive; Omaha health care coalition (180-plus organizations) does training, has stockpiled resources (including some PPE) serving the Omaha area; it was used up quickly; he is a former surveyor; in Nebraska, surveyor/surveyed relationship is seen as a partnership, though in 2014 CMS was saying that this should be an “adversarial relationship”; in NE, the job title was “nursing services health care surveyor/consultant”; even so, we couldn’t really “consult”—could not say “this is what you SHOULD do” in any case, but could talk about what other providers had done; ultimately, residents should be the winners in the process; “documentation will set you free”; his thoughts about COVID-testing surveyors; hospitals in his opinion aren’t doing as much testing as LTC providers; there are still PPE shortages, even in hospitals; working with hospitals and other local health organizations. Length: 27:57.
Nov. 2, 2020: Nick Uehlecke, advisor, Office of U.S. Secretary of HHS
Topics: Status of Phase 2 funds and application process; Phase 3 to come in 2 segments; details about the process; discussion of use of funds, clarifications to come; not really any requirements re the order of uses for funds; future of provider relief funds—announcement to come; deadline for use of CARES funding has been moved to summer 2021; providers can find examples of reporting required for provider relief funds on the FAQ site; questions members ask of LeadingAge do drive the discussions in HHS. Length: 11:48:
Nov. 2, 2020: Anne Levesque, HR director, Wake Robin
Topics: Focus on our organizational culture, which focuses on both resident and staff needs; 2 values that resonate for us this year are community and mutual support; housing, transportation, and childcare cannot be separated from employment issues. Employee loan programs that are easy to navigate, fast, and useful: got a grant that enables us to cover car repairs up to $1,500 for employees that need it; any (small) balance not covered by grant is taken out of employee pay over a 6-month period; the 2nd is a no-questions-asked emergency loan program done in conjunction with a local credit union—applicants sign up for savings account with the CU; the value of the loan (given by the CU, interest rate usually prime + 1) is deposited into the savings account, and no employee has defaulted so far. Working Bridges is a Vermont United Way program that helps staff navigate state and federal programs that they are eligible for; there’s a kit that can be used anywhere in the U.S. to help work with credit unions in this way; many programs you have for residents translate quite well to helping staff too; details of employee meals benefit; programs are tracked and we have 90% retention for those in the CU loan program; anecdotal successes as part of the auto repair program; we describe these programs to job candidates because it speaks to who we want to be as an employer; giving these benefits as early as 3 months into employment as a direct response to the COVID experience. Length: 18:00.
Nov. 30, 2020: Keith Swartzentruber, executive director, Snyder Village
Topics: Had our first resident positives in September, 12 total; required moving non-infected residents; it was a good thing that our census had dipped so that we had the beds available; operated a COVID wing for 1 month; had 2 residents pass away; staff response was excellent, though some new processes were a struggle; used a UV light chamber to help sanitize PPE; were able to close the COVID unit, but in recent weeks we’ve had 4 additional positives, all of them recovering—used “zip doors” on the outsides of those residents’ rooms; financial impact has been significant; have been at only 81% for the last few months (usually at 91%). Got a payroll loan that helped tremendously; received funds from HHS; how he discussed social isolation with his congressman; he did not concretely working with local health department to consider options for visitations, because visits outdoor aren’t possible at this time of year; Illinois public health holds that a positive with any type of test is to be treated as a positive, no matter what; on a weekly testing schedule Mondays and Tuesdays so we get results by Saturday, though things are slowing down. Length: 17:52.
Dec. 2, 2020: Joshua Weitz, Ph.D., director of the Quantitative Biosciences Graduate Program at the Georgia Institute of Technology
Topics: Viruses infect many organisms and ultimately have great effect on societies; connecting tangible events (gatherings) to spread of viruses; wanted to demonstrate this at a county level with an interactive website; gives estimate of the risk that one or more individuals may have COVID-19 in events of different sizes; the risk can get quite high as events grow in size; the percentage risk gives an estimate that one or more individuals may be infected—but does not necessarily mean someone will get COVID at that event. All of the choices you make to mitigate risk drives the risk down; indoor events without masks and poor ventilation is associated with higher risk; in outdoor events with masks and spacing, even with one person in that crowd with COVID-19, the chance of transmission will drop dramatically; an introduced case within a nursing home can accelerate; I try to let people understand the risk of going from one event leading to the transmission to NH residents; one person can lead to multiple places; the vast majority of people remain immunologically naïve. Comments about vaccines: High-effectiveness vaccines are good news, but we can’t let our guard down; it will take months for vaccines to get us to herd immunity; the tool updates daily; using the tool working with public health officials. Length: 20:40.
Dec. 7, 2020: Dr. Ruth Link-Gelles, doctoral epidemiologist, CDC
Topics: We’re looking at continued mask wearing and social distancing for a while to come; LTC pharmacy partnership in individual states could start as soon as Dec. 21; the pharmacy partnership uses the pharmacies’ national size and history in LTC to help make the vaccinations happen; these vaccines have unusual storage requirements and special data tracking requirements; all reporting done by the pharmacies. In the program, the facilities must: get informed consent from residents, families, and staff; and think through the logistics of making the vaccinations go efficiently. Medium or large facilities will mostly require 3 clinics, smaller ones 2; these are all 2-dose vaccines; states are not required to follow ACIP recommendations; some states are having ER personnel vaccinated first; the first priority will be SNFs; the 2nd wave would include AL, HUD 202s, etc.; IL residents in LPCs are not included in the program—decision made to ensure vaccine for the highest-risk individuals first; when vaccine is left over after doing the high-risk residents, the pharmacies can vaccine IL residents, but the latter are not the target of this program; CDC’s definition of health care worker is very broad, interpreted to mean anyone working in a LTC facility; HCBS workers are considered health care workers, but are not part of the pharmacy partnership; watch your states for information about mass vaccination clinics for such workers; HUD 202 provider staff would probably fall under the health care provider definition—check with pharmacy re service coordinators; no decision yet on vaccine for residents who have recovered from documented cases of COVID-19; no decision yet on vaccine for pregnant women; the partnership’s vaccines come from their state’s allocations; cases where facility staff might help administer vaccines. Length: 22:26.
See a written summary of this interview at https://leadingage.org/regulation/whats-latest-vaccine-interview-cdcs-ruth-link-gelles.
Dec. 7, 2020: Karyne Jones, CEO, The National Caucus and Center on Black Aged
Topics: Vaccine Education & Equity Project involves 75 organizations (including LeadingAge) to disseminate accurate education and talk about how vaccines can promote equity and trust; the Project is a network of organizations trying to enhance community awareness around the importance of disseminating the vaccine; trying to build trust to help convince people to agree to vaccination; in African American community, a history of being subject to medical experimentation, and lack of access to health care; building trust in skeptical staff is crucial; https://covidvaccineproject.org/ is our site; also on Facebook, LinkedIn, and Twitter. Length: 16:41.
Dec. 9, 2020: Michael Hebb, partner at RoundGlass and founder of Death Over Dinner
Topics: Author of Let’s Talk About Death Over Dinner; why we don’t talk about death; hard to get into the conversation but it can be very uplifting; it shouldn’t be a matter of “you should do this”; this conversation usually happens when something is terribly wrong; should be done in a more relaxed way; it’s a global movement; been hosting “virtual death dinners”; it’s possibly even more powerful now using teleconferencing; EOL Community (www.eol.community) is a free resource, has a community to support you in creating an end of life plan, advanced care directives, connections to providers, etc.; another resource is www.covidpaper.org, a coalition created the first week of lockdown, we realized people would be dying and grieving differently because of COVID; brought in medical directors, funeral directors, people who work in LTC, to gather resources; material in covidpaper.org should really resonate with people in LTC field; there is no time stamp on rituals—funerals and memorials can be held again later; the common stages of grief model is about getting the grief done, but we know that you live with grief, it makes you a different person; how providers can honor the losses of residents, and help staff get through it; encourage staff to share their feelings about what they did well and what they did not—a way to help deal with “failure.” A new community focused on caretaker well-being is going to be created on the EOL Community; some ritual ideas in the COVID paper; some grief resources. Length: 18:37.
Dec. 14, 2020: Dr. Joshua Sharfstein, vice dean for public health practice and community engagement, Bloomberg School of Public Health, Johns Hopkins University
Topics: Surge is dangerous and could get worse; vaccine may not make a dent for at least a couple of months; Operation Warp Speed has been remarkable, and why it was so unusual; comments about the EUA process and FDA process; discussion of demographics of people in vaccine studies; side effects—sore arms, fevers, joint pains that last a day or two; expect a few side effects to appear in residents and staff right after vaccination day; how we’ll continually learn more about the vaccine as we go along; no reason to believe the vaccine is a risk to future fertility in women; question has come up about currently pregnant women; COVID-19 is also very dangerous for pregnant women; we’ll learn more as we go along; the virus does mutate, but they are small mutations and will not affect effectiveness of the vaccine, which is designed around the virus’ ability to enter human cells; vaccine may not last forever, we still don’t know exactly how long it will last; those who already have had COVID-19 should get vaccinated; hope to someday have a better way to measure how immune a person is; questions about asymptomatic shedding after vaccination; the end of the pandemic is when the rate of infection is very low; the vaccine is not a live vaccine; comments on why some committee members to vote no on the vaccine approval. Length: 31:08.
See a written summary of this interview at https://www.leadingage.org/regulation/vaccines-interview-dr-joshua-sharfstein.
Dec. 16, 2020: Jim Love, Beth Coryea, and Ryan Jeannerette, CVS/Omnicare
Topics: Onsite COVID-19 Vaccine Program; we created a website re COVID vaccination (https://www.omnicare.com/covid-19-vaccine-resource/); Omnicare will have point of contact for each participating organization; 10,000 pharmacists will assist in immunizing residents and staff; this is an attempt to vaccinate all LTC residents and staff in 3-4 months; one concern is people who are unwilling to take the vaccine; resources to help with vaccine acceptance education when needed; those who have not heard from CVS about their enrollment in the program can email email@example.com; turnaround time for answers to emails should be 24-48 hours; process for getting consent—hard copies, verbal, or digital options; timing of the 3 clinics is based on the requirements of the first dose followed by the booster; hope the first clinic will do the majority of residents and staff, the 2nd for the boosters, and the 3rd as “clean-up”; up to each facility as to how they vaccinate the staff; possible staggering of groups of staff—it’s up to the provider facility to decide; what to do about residents who leave the sites after the first vaccination but before the boosters arrive; are Medicare cards required or is the number good enough; standard CVS consent forms may have too many exclusions in the screening questions, adjustments to be made. Re HUD 202 providers: we’ll work with them to support collection of information, and we’ll have to take them case-by-case; no out of pocket costs for anyone being vaccinated, including those without insurance; guidance on educating residents and staff about vaccine (many tools on Omnicare website); life plan community residents not in the scope at this point; staff that work between different levels of care will be eligible; consent forms in Spanish are being created and we’re open to creating forms in other languages; still limited data re effect on pregnant women; consent should be completed by the facility before CVS arrives on site; CVS has a goal of making each vaccination event last only one day; teams will be prepared for reactions to the vaccinations; signing up for the partnership—requests for new facilities would have to go to CDC to be signed up to the partnership program. Also see the LeadingAge COVID-19 Vaccine Information and Resources page. Length: 43:42.
Dec. 21, 2020: Dr. Martha Dawson, president, National Black Nurses Association
Topics: Supports the rollout plan for the vaccine; NBNA town halls on the vaccine; effort to address concerns of POC among health care workers; Black Coalition Against COVID-19 to reach out to the black community; NBNA has chapters in 35 states and DC; dispelling fears of black community based on historical treatment of African Americans by the health care system; gradually seeing reduction of number of people who will not accept the vaccine; why “crucial conversations” need to keep happening; use language—“vaccine knowledge” rather than “vaccine hesitancy.” Blackdoctor.org is tracking data re people changing their minds about vaccination; the Reset Program by NBNA is designed to take care of frontline nurses, access to mental health consultations, go to www.NBNA.org for information about that and for webinars for health workers; NBNA Family Health for the Holidays Toolkit. Length: 24:59.
See a written summary of this interview at https://leadingage.org/regulation/leadingage-interview-dr-martha-dawson-president-national-black-nurses-association.
Dec. 23, 2020: Dr. Ali Mokdad, professor of health metrics sciences at IHME, University of Washington
Topics: Comments on modeling the surge; how models work; our models have been accurate lately; additional indoor time during winter contributes to spread; vaccines are being incorporated into the model with different scenarios; speed is of the essence in vaccination; there was a Thanksgiving surge; we call for mask mandates; discussion of mask usage; Americans react to surges with more mask wearing, and we’re hoping for pre-empting infections; modeling on convergence of COVID-19 and flu; we’re seeing less of a flu season; testing will remain important after the vaccine is out. Length: 17:03.
Dec. 28, 2020: 4 LeadingAge Members Share Vaccine Clinic Insights
Participants: Mary Lynn Spalding, president and CEO, Christian Care Communities; Vassar Byrd, CEO, Rose Villa Senior Living; Sue Dionne Jones, director of nursing, The Cedars; Julia Kyle, director of pharmacy services, Motion Picture & Television Fund, Wasserman Campus. Stories of initial outreach—there were some glitches and communication issues; good idea to talk in advance to the pharmacy team leads; the provider, not the pharmacy, should set the tone for how things work, so be prepared in advance; some communication troubles between county and pharmacies; issues with consents—they are a lot of work and time-intensive; value of an educational Zoom meeting with families; some forms could be pre-populated by our IT dept.; used a “fast-pass” system to allow on-duty staff to come off the store and get through the vaccine line quickly; treated the day as a historical milestone; be sure to give lunch to the pharmacists; thawing process for the vaccine can cause some delays; we provided epi-pens, antihistamines and other things for the observation area; high percentages (90%-plus) of residents got vaccines; somewhat lower numbers of staff. Side effects: some headaches and low temperatures, some arm pain, but nothing serious from any of the organizations; how the observation areas were managed; make copies of Medicare/Medicaid cards ahead of time and keep a copier nearby. Length: 39:07.
See a written summary of this interview at https://leadingage.org/regulation/covid-19-vaccination-clinics-members-insights-week-one.
Dec. 30, 2020: Laura Hoffman, director of clinical and nursing facility regulatory services, LeadingAge Washington
Topics: Rapid Response Teams in Washington state available to help with staffing problems in LTC; teams were created using CARES Act funding, implemented between Nov. 4 and Dec. 5; requirements to qualify for access to help from the teams; teams come at no cost to the organization; surveys now on hold in the state; staff are brought in from across the nation; good collaboration with the state. Length: 12:17.
Jan. 4, 2021: Dr. Jerome Adams, US Surgeon General, Plus CVS Representatives
Topics: For a summary of the conversation, see this LeadingAge article: https://leadingage.org/regulation/interview-dr-jerome-adams-us-surgeon-general. It covers vaccine supplies and pipeline; possibility of a one-dose vaccine; vaccination timeline for less vulnerable people; how to boost vaccine acceptance by staff; course of pandemic in the near future; a children’s vaccine; prospects for “normality”; why people should continue to take precautions. Length: 45:32.
Jan. 6, 2021: Robin Jump, associate professor of medicine, Case Western Reserve University
Topics: Fears and myths that people have about the vaccine, and some factual answers—re the vaccine and pregnancy, side effects, mutations, concerns about MRNA technology (which is not new); trying to create a “no-judgment zone”; peer-to-peer interactions are very valuable; the new strain is more readily spread; vaccine still works on it; infections that come post-infection; incentives for getting the vaccine; concerns about allergic reactions. Length: 22:31.
See a written summary of this interview at https://www.leadingage.org/regulation/addressing-vaccine-reluctance-interview-dr-robin-jump.
Jan. 7, 2021: R. Tamara Konetzka, professor, Dept. of Public Health Sciences, U. of Chicago Biological Sciences
Topics: Analysis of relationship between quality measures and COVID infections and deaths; did a 12-state analysis of the probability of having at least one COVID case by nursing home star ratings; found no meaningful relationship between star ratings and 1) the probability of an outbreak, 2) the size of that outbreak, or 3) the number of deaths. Factors that do better predict nursing home outbreaks are community spread surrounding the home and size of the facility. Has mixed feelings about the star rating system; this is a crisis that affects all nursing homes; the relationship of Medicaid percentage to COVID affects started out weak but has grown a little more significant; what these findings mean for performance incentives and provider relief funds; it might be best to have incentives tied directly to things the nursing homes actually have control over; how does policy research translate into lessons for providers? There is research showing that COVID coming into communities is often led by staff—it underscores the importance of getting staff vaccinated. Length: 18:09.
See a written summary of this interview at https://www.leadingage.org/regulation/quality-medicaid-and-covid-interview-dr-tamara-konetzka.
Jan. 11, 2021: Dr. Larry Corey, professor, Department of Laboratory Medicine & Pathology, University of Washington
Topics: About the COVID-19 Prevention Network, and infrastructure to do clinical trials to validate vaccines; description of principle behind mRNA vaccines; discussion of how to approach resistance to vaccination; with these vaccines, the older you are, the lesser your side effects, and the second dose typically has at least 1/3 more side effects than the first for both Moderna and Pfizer. Can a vaccinated person be a carrier of COVID-19—unclear, and could be the case; this virus is much more infectious than flu; question re first-dose strategy—important thing is getting as much vaccine into people as soon as possible; thoughts about threshholds for allowing in-person visits. Length: 25:39.
See a written summary of this interview at https://www.leadingage.org/regulation/interview-dr-larry-corey-university-washington.
Jan. 13, 2021: Jack Rollins, program director for federal policy, National Assn. of Medicaid Directors
Topics: Helping to prepare state Medicaid agencies for recession—significantly reduced state resources; Congress has enacted continuous enrollment requirements, which has marked a real uptick in Medicaid rolls; Medicaid directors struggling with equity issues; making sure Medicaid is a partner in reaching vulnerable populations with vaccine—esp. HCBS providers; keeping certain types of providers financially viable while revenues are badly diminished; behavioral health providers and telehealth; CARES funding helping states help providers, though not really up to the Medicaid directors in some states; ways to talk to states about low Medicaid rates and how to prop up critically important parts of the health care system—support “an agenda of certainty.” NAMD doing a lot of outreach to providers re vaccines; CMS encouraging states to mirror Medicaid rates, but not every state will; federal administrative actions will probably be all-COVID for the short term. What providers can do to advocate: gather good data and advocate persistently for additional federal investments in Medicaid delivery system infrastructure. Length: 20:18.
See a written summary of this interview at https://www.leadingage.org/regulation/interview-jack-rollins-national-association-medicaid-directors
Jan. 14, 2021: Dr. Ruth Faden, professor of biomedical ethics, Johns Hopkins University
Topics: Definition of bioethics; “justified distrust”; public health leaders and clinical leaders have done a poor job of earning trust over the years; shaming is the wrong attitude to take; we must be trusted communicators and we must listen. Should we require vaccination as a condition of employment—and is that the most prudent and ethically best course? Best to pull in trusted communicators and listen; don’t know if 1-on-1 communication is the best strategy; financial incentives work in some cases and not in others; not all hesitancy is due to the same causes—conspiracy theories are involved as well; people have different epistemologies and understanding of truth. Length: 21:50.
See a written summary of this interview at https://www.leadingage.org/regulation/interview-dr-ruth-faden-johns-hopkins-university.
Jan. 28, 2021: Dr. Nimalie Stone, medical epidemiologist, CDC
Topics: Thoughts on vaccine hesitancy; high vaccine acceptance rates for residents, but not for staff; one-on-one conversations seem to be most effective in addressing fears and misinformation; symptoms after receiving the vaccine; caution is advised re new variants of the virus; discouraging premedication with analgesics before getting the vaccine; people in the midst of an active infection should defer vaccine, but once recovered, no minimum delay necessary. Timing advice re vaccine and TB tests. Length: 26:53.
See a written summary of this interview at
Feb. 1, 2021: Dr. Alice Bonner, senior advisor for aging, Institute for Healthcare Improvement
Topics: Project ECHO introduction (website: https://hsc.unm.edu/echo/); 16-week curriculum, almost half of U.S. nursing homes are signed up; content in infection control and supporting staff; sessions include some didactic conversation, case presentations, and then discussion of quality improvement as something integrated into day-to-day processes; participants like being able to talk with other providers; looking for ways to engage CNAs even more—they often have the most helpful comments; there is still time for more nursing homes to sign up, through February; participants in this phase is about $6,000 per nursing home; AHRQ is hopeful funding will continue. Vaccine hesitancy: worked with AMDA on some material; developed a slide deck and a Word document, posted on the IHI website; CDC and LeadingAge also have resources on this; program is strongly geared toward skilled nursing; in the next phase we would like to figure out how to expand to other settings; a consultant who wants to participate should affiliate in some way with a nursing home; an infection preventionist from a small home to sign up and forward the materials to the rest of the staff. Length: 22:41.
Feb. 8, 2021: Scott Crabtree, president and CEO, and Jeré Hales, COO, Lambeth House
Topics: New Orleans area was one of the top few clusters of COVID-19 outbreaks in the U.S. last year; our first case was March 10, 2020, and last case on March 29. Since March 29, 2020, we’ve had only 2 resident positives (independent living). We lost about 60 employees, who quit; from June 1 through this past weekend have had only 6 employee positives; we’ve become a very close-knit group. Decided to make vaccines mandatory; the biggest fight was with the state, which wanted to give vaccine only to the nursing home residents; we convinced them that was a poor public health policy; staff education was in smaller groups and 1-on-1 for those struggling with policy; we felt we had a moral obligation to do anything we could to stop this virus; there was fear among staff, and we talked about fear and courage. Everyone got a day off after the vaccine, and those with side effects got a free day too. We had an internal “Not Here, Not Us” campaign to get people to pledge that we’d do everything we could to mitigate the spread of the virus. At 99.74% vaccinated now; residents will be able to dine, go to a performance in an auditorium, and get their lives back; vaccine hesitancy is real; had a local African American physician who helped counsel staff; we lost 10 employees over this, and told them we’d consider them for re-employment if they get the vaccine; small-group conversations must be led by someone that the employees trust; only hiring new people who agree up front to take the vaccine; we’ll allow more residents to use dining rooms now. None of our social spaces will be open to anyone except residents; require vaccination for contract employees. The impact of requiring vaccination is a short-term challenge, but NOT doing it has much worse long-term, long-lasting impacts. We have to get our older people’s lives back. Length: 30:26.
See a written summary of this interview at https://www.leadingage.org/regulation/interview-scott-crabtree-and-jere-hales-february-8-2021.
Feb. 11, 2021: Evan Shulman, Director for the Division of Nursing Homes in the Quality, Safety, and Oversight Group, CMS
Topics: Revision of post-vaccination CMS guidance on visitation—still too early to change it; don’t yet know if vaccine prevents transmission; still too much not know about variants; until then, keep sticking to the infection control guidelines; issues with “essential caregiver” designations; too early for guidance changes re internal interaction; discussion of collaborative survey approaches—CMS doesn’t support them because surveys must remain objective; advice for providers readying themselves for upcoming surveys; advice on ROPs Phase 3; discussion of NHSN reporting; can an “essential caregiver” be considered “compassionate care”? Inconsistencies in surveyors’ interpretation of regulations and guidance; visitor positive tests do not necessarily trigger an outbreak response. Length: 26:13. (For a short version of this interview, covering only visitation guidance, click here.)
See a written summary of this interview at https://www.leadingage.org/regulation/updates-cms-interview-evan-shulman-%E2%80%93-february-11-2021.
Feb. 18, 2021: Dr. Ruth Link-Gelles, epidemiologist, CDC; and Tricia Neuman, senior VP of the Henry J. Kaiser Family Foundation
Topics: (Ruth Link-Gelles) The Pharmacy Partnership has made great progress; rolling through 3rd clinics in SNFs and finishing up on AL clinics (depending on states) and hope to be finished by the end of March; the Retail Pharmacy Program is spinning up, started last week with a million doses going to retail pharmacies of all sizes; LTC pharmacies will still be able to order vaccines; PACE members, for instance, will be eligible as long as the doses come through LTC pharmacies; most vaccines come through the federal govt. to state health departments; many kinds of clinics are being held as supply ramps up; providers (e.g., a housing community) who don’t work with a LTC pharmacy might be able to work out creative solutions with pharmacies; providers can see on the CDC website which pharmacies are activated state-by-state; adult day centers who can work with an LTC pharmacy they can participate as long as clients fit criteria.
(Tricia Neuman) KFF study of vaccine rates for older adults: 53% of vaccines have gone to older people, but didn’t know what share of older people have had the vaccines; not all states are reporting, and not all had expanded eligibility to those 65 and over; no states have vaccinated majority of those over 65 as of a few weeks ago. WV was doing the best, but PA worst, though Philadelphia isn’t included in PA statistics; also couldn’t tell whether the LTC partnership numbers were included in overall state data; issues with non-uniform reporting; we found no data on vaccination rates by race and ethnicity; the pandemic shows us a lot of problems with public health systems; a national problem handled at a state level; is there more Medicare could do to support the public health infrastructure? We have a “vaccine monitor” with polling information; vaccine hesitancy is diminishing but there are still a lot of people not open to it; state criteria and priorities differ; we tested ways/messages for making people more comfortable; people want to hear from people they know and trust; discussion of KFF polling methods. Length: 30:31.
Feb. 22, 2021: Dr. Bill Mansbach, CEO and president of CounterPoint Health Services
Topics: Data collected on psychological burdens carried by providers, residents, and families through a national survey; focusing on psychological burdens, how organizations cope and support their staff, and attitudes about the vaccines; we have data from last year to compare to it. “Psychological burden” is the collection of symptoms we experience over time, usually anxiety and depression, but there are somatic and cognitive symptoms too; latest survey ends in a few days. Findings from early waves: We knew the pandemic burden would align with the PTSD model; in May, 50% of health care providers in senior living and nursing homes experienced a psychological burden threshold, significant enough to interfere with everyday functioning. 50% is 30 points higher than it would be pre-pandemic. Compare that to families, who were around 50%, and residents, around 40%. In October we had identical data; nothing had changed in 6 months. This time around we might experience a lessening of the psychological burden. As things get better, the workforce might fully experience the weight (and the “wait”) of the last 10 months; for some it might be deepened, and might be associated with providers leaving the field; I think many orgs have gotten better at supporting staff; I hope to see staff members supporting one another. Have worked with LeadingAge on the “Art of the Supportive Check-in” (referenced in the LeadingAge Pandemic Playbook). Also created a series of stress management tools, including some short videos available at CounterPoint Health Services. Re vaccine encouragement: the key is getting good, reliable information out; we are encouraging people to go to https://www.thebcat.com/ and sign up as an education member, and we’ll report our findings to that membership list. There’s a fundamental balance between keeping people safe, but if we don’t give people ways to engage, social distancing kills. If we don’t do something to have meaningful engagement, we’ll add to people’s suffering. Not good to isolate older adults living with dementia. Advice on how staff can alleviate stress projected onto them by families; advice on helping residents cope with anxiety and depression. Length: 24:05.
Feb. 24, 2021: Monica Gandhi, MD, professor of medicine and associate chief in the division of HIV, Infectious Diseases, and Global Medicine at UCSF
Topics: A vaccinated person is 100% safe from death and 99.6% safe from developing severe illness if exposed to COVID-19. She is in favor of opening up once everyone (including visitors) is vaccinated. What if surrounding community isn’t vaccinated? If there are unvaccinated visitors, the visitors should theoretically wear a mask while visiting. It’s inaccurate to say that we don’t know if the vaccines prevent transmission. It’s more accurate to say that the trials are not designed to tell us if a vaccinated person could still harbor the virus and theoretically pass it on. We do have data, in my opinion, to say you can’t pass it on to an unvaccinated person, but the “official” recommendation will be to wear a mask; but I think that will fall away in about 2 weeks. What about staff who aren’t vaccinated? If staff not 100% vaccinated, then any unvaccinated visitor rules of masks and distancing would have to apply. As more of the population gets vaccinated the virus just won’t be around anymore. Re vaccine hesitancy: Herd immunity means that infection rates will slow down dramatically even if some members of a population aren’t vaccinated. Keep an eye on Israel and the UK, who are doing a much better job than anyone else in the world. It’s going to happen, we’ll get out of this pandemic soon. Vaccination of children won’t be necessary. Re variants: She thinks variants are getting overblown; the efficacy of vaccines across variants was equal to the numbers for the main version. T-cell immunity protects us against severe disease, regardless of variants: “Variants Shmariants.” How long will immunity last after vaccine? Antibodies can go down at some point, but T-cell and B-cell immunity lasts for at least 10 years after vaccination; I don’t think it will need yearly booster vaccinations like flu; a vaccinated person in contact with someone who is PCR-positive with COVID-19, the chances of acquiring the infection are vanishingly small, and will not require quarantine. What about people who have recovered from COVID? Data shows that those people are not transmitting. If you had a mild infection, an antibody test might not show it. The best way is to look at T-cells. Length: 22:27.
March 3, 2021: Alycia Bayne, principal research scientist at NORC at the University of Chicago
Topics: A study, “Maintaining Physical and Mental Well-Being of Older Adults and of Their Caregivers During Public Health Emergencies” for CDC Foundation. Tried to understand 1) needs and concerns of older adults and caregivers during the crisis and 2) what kind of supports are available. Found 300 public health programs and services available—for social isolation, managing chronic conditions, etc. The intention was to bring all together in one place so organizations can adapt them for older adults and caregivers. Available at NORC.org. Discusses concerns about being isolated, lonely, fear of vaccine, concerns about getting supplies, food, and health care services. Focused on community-dwelling populations, and people 50-plus; mental health and financial security key concerns among ethnic minority populations; in rural populations, getting access to household supplies was a problem; access to broadband was an issue. Surprising findings: importance of the multi-faceted nature of technology issues, plus ability to use technology; that there was so little knowledge of the resources out there. Re caregivers: concerned about health and safety of their loved ones, and of themselves; they need respite care; importance of self-care. A fifth of Americans 18-plus were caregivers during COVID-19, many aged 18-39. Four main opportunities: we must increase awareness of these resources; we must develop programs to address needs of sub-populations; a chance to focus on technology access, cost, and literacy; ways to help caregivers get respite care during an emergency. Discussion of resources re technology, including for Spanish-speaking people. Trends in sub-populations’ trust in various communication modes and sources. Length: 24:54.
March 4, 2021: Miles Lee, life enrichment coordinator, and Tina Sandri, CEO, Forest Hills Senior Living Community
Topics: Miles Lee: Started his job in Sept. 2020; residents and staff were anxious at the time to know if there would be vaccines; heard from some hesitant co-workers, volunteered to learn more information to help at CDC, GoodRx, various other sources; people were concerned about ingredients, effects on body, etc.; after the first clinic, people compared notes and that brought some people around; now people have seen two rounds of vaccine and people are doing fine; motivated by unnecessary suffering from this disease. Enjoys doing work that helps vulnerable people.
Tina Sandri: We discussed whether to mandate the vaccine, and decided not to. Also compassion and respect are among our values, and want to be sure we show that to staff. We made vaccines optional for staff, but required that all department heads had to become knowledgeable about the vaccine and channel that knowledge out; did not use words, “you should, you must.” Instructed all staff to listen hard to what people were saying. Our success rate has been twice the national avg. for staff, getting close to 70%. We have “eight ways to communicate.” OnShift software, which does our scheduling, has messaging functions; posters, handouts, huddles at change of shifts, positive message board in the lobby; trying to be visible around the clock. We’ve analyzed our data about who hasn’t gotten the vaccine—we are predominantly African American, African, and islander-staffed. In our messaging, we don’t have as many trusted leaders in the African (immigrant) workforce, so we’re finding ways to reach out to them. We told staff that EEOC says we can mandate, but that we’ve not chosen to. Length: 28:45.
March 8, 2021: Sigal Barsade, Ph.D., Bernstein Professor of Mgmt., The Wharton School at University of Pennsylvania
Topics: Report on COVID-19 vaccination uptake project; top behavioral scientists participated; worked to make it practical, easy to use; vaccine hesitancy seen as an attitude rather than a behavior. Five groupings of people based on attitudes: 1) those who have taken vaccine, and we want to empower them as advocates—some are “convert communicators”; the “moveable middle” is 2) make it easy, eliminate structural obstacles; 3) make it easy but also try to influence and boost motivation; 4) more resistant, but goal is to build trust in vaccine safety and the organization. Group 5) is “refusers”; we believe only 2-5% of people will never agree to take the vaccine. Why a “culture of companion and love” in LTC is valuable. Women, Republicans, low-income, and black respondents are more likely to refuse the vaccine; older adults less likely to refuse; no data re regional differences within those groups. If you can point out trends to people, it’s very convincing. Neutralizing negative effects caused by refusers: we suggest respect, a focus on freedom of choice, one-on-one conversations, and avoiding being outright dismissive; it can be time-consuming, but we have to understand that people have choice. Length: 28:24.
March 17, 2021: Carol Silver Elliott, chair, and Katie Smith Sloan, president and CEO, LeadingAge
Topics: When we knew this virus was a crisis; how LeadingAge pivoted away from existing workplans to go all-in on the pandemic; why we had to spend a lot of time educating the media; we have a long way to go but have raised our profile; why it’s time for providers to tell our story aggressively and tell the stories of our successes. How the crisis has changed the way LeadingAge operates; how our bonds with state associations have grown stronger. Are we ready for another pandemic? Comments about why the Pandemic Playbook is so important; for all the awfulness of the year, it’s been a great learning year; we’re proud of the way our teams and members have risen to the occasion. Length: 21:55.
March 18, 2021: Dr. Simon Mittal, chief medical officer, CareChoice Cooperative
Topics: Description of MAGIC (Minnesota Association of Geriatrics Inspired Clinicians), formerly Minnesota Medical Directors Association. Has expanded membership to include other types of medical staff; created to provide a resource to talk about senior issues re health care; toolkits for facilities to help with things live testing, treatment, vaccination, etc. Re vaccine hesitancy in general: It’s not just about “the science”; misinformation, support systems, etc. Have done a lot of Q&A at many homes; many questions about long-term consequences of vaccine; the vaccine development process wasn’t really out of the norm, it just involved less red tape; this part of a long-term trend of parts of the population who are afraid of vaccines; we have to be cautious about overriding people’s belief systems and values; my conversations have involved asking people to explain where they are coming from, and I have avoided adversarial conversations; it’s OK to say you don’t have all the answers; conversations should be continual. Concerns of immigrants: role of community and spiritual leaders and their involvement; importance of empathy; people need to know they are heard and not dismissed for their belief systems; how to address people’s strong belief systems; discussing the MAGIC video on its website and on YouTube. Length: 22:28.
March 24, 2021: Dr. Sara Oliver, lead for the COVID-19 Vaccines ACIP Work Group, CDC
Topics: Johnson & Johnson vaccine: the trials enrolled younger healthier people first, then younger people with medical conditions, then older people without medical conditions; then older adults with medical conditions. Ended up having a shorter follow-up time for the last of those groups. “The differences we saw by age really leveled out later.” “The best vaccine is the one you have access to.” All vaccines had very high efficacy against needing severe hospitalization. Astra Zeneca: When vaccinating millions of people you will see rare events. In the U.S. we are looking at “background rates” for medical conditions like blood clots, and then, within the vaccine group, do blood clot rates match the background rates? Clinical trials are being conducted in the U.S. We anticipate additional “looks” at the data relatively soon. Discussion of process involving ACIP and FDA; we are probably weeks (rather than days) away from approval. There are other vaccines undergoing clinical trials. Will annual COVID shots, or boosters, be likely? Hard to say at this point; the larger question is whether the virus will change to require new vaccines; transmission risk from people who are vaccinated or have had the virus—we are very encouraged that the vaccines will prevent transmission; timeline for vaccines to get full approval instead of EUAs—at least 6 months of data will be needed for full approval, but could occur in summer; we should continue to offer vaccines to people who declined initially. Length: 22:10.
March 29, 2021: Dr. Reed Tuckson, Tuckson Health Solutions and Black Coalition Against COVID-19
Topics: History of Black Coalition Against COVID-19; importance of community organizing against the pandemic; 4 black medical schools brought together with other orgs to promote participation in vaccine trials; appreciation for the risks that health professionals on the front lines (in nursing homes) were taking to save people in need. We’ve seen a large reduction in the number of people of color unwilling to take the vaccine, but also have seen hardening of attitudes among some. Older people much more willing to take vaccine than under-35s. Still frustration about getting vaccines. Strategies to reach the people who can be convinced to take the vaccine, perhaps using celebrities, or finding those who can convene the conversation; what will happen to the last holdouts? Lessons learned about our LTC system; impact of distrust; shame of health policy and care delivery. Younger celebrities who can reach younger people? Challenges re vaccine passports; reaching the kind of people who would make good employees in LTC; problem of “line-jumpers.” Length: 33:50.
March 31, 2021: Dave Wilkinson, executive director of the Yale Tobin Center for Economic Policy
Topics: Shared staffing in nursing homes adds a new source of infections; Tobin Ctr. created a web tool that shows staff interconnectivity between all nursing homes in the USA. Is relevant to other types of infections, e.g., regular flu. Called Protect Nursing Homes, address is https://www.protectnursinghomes.org/. Started as research, then created the web tool, both based on a novel data set. Combined anonymous cell mobility data with GPS data, to show when a cell phone shows up in more than one nursing home. Staff interconnectivity has been a significant driver of COVID-19 in nursing homes; has shown that outbreaks in nursing homes are highly predictive of outbreaks in other ones; a form of “institutional contact tracing.” Data is helpful for outbreak management for COVID and other infections; for helping homes decide when to do “elevated monitoring”; for targeted communications to networks of staff; how to use the information you find at protectnursinghomes.org; we want nursing homes to give us feedback after they use this; staff sharing also occurs in settings other than skilled nursing—we are working to include data on other settings, e.g., hospitals. How data was found—there is anonymized cell phone data widely available for commercial purposes; we only know that people are showing up in nursing homes, but while NHs were closed, it was extremely likely that pings were staff; the data is durable, but we’re refreshing it now; how this data can be used to support advocacy efforts re Medicaid reimbursement rates. Length: 25:08.
April 1, 2021: Ashvin Gandhi, assistant professor, UCLA Anderson School of Management
Topics: Co-author of new Health Affairs article on turnover rates in nursing homes across the U.S., using PBJ data. Findings: Turnover rates are very high, often 100% annually; paper is part of a larger project for us to change the way we think about NH staff. It’s frustrating that 5-star measures and regulators often think about staff as widgets; for us, this research is the start of rethinking how we think about staffing—employees aren’t interchangeable parts. Turnover is complicated to measure; what enabled this research is the availability of PBJ data to look at daily shifts to precisely measure turnover. We looked at employees who separate from their job, and asked, what percentage of care did you provide during the 90 days before leaving? If that person provided 10% of the hours of care, then their separation count is 10% turnover. This way you don’t over-weight the importance of temp or part time staff that don’t provide a lot of care. It seems that lots of areas with high turnover are areas with low minimum wages and low reimbursement rates; what surprised us is that turnover is high for all staff types, including RNs and LPNs; we would like to learn what’s driving turnover there. Should turnover be included in 5-Star ratings? We need a more thoughtful approach to evaluating what a quality workforce is. Found higher turnover rates in for-profit and chain-owned NHs; his conjectures about why that is the case. Trying to use 2020 data to understand the COVID-era situation. Strong correlation between 5-Star ratings and turnover percentage. Length: 25:42.
April 8, 2021: Stuart Butler, senior fellow in economic studies, The Brookings Institution
Topics: COVID-19 has changed conversations about the workforce, about social isolation, social determinants of health, and more. What he learned from many conversations: Three particular themes: 1) the nursing home population is two—those who need long-term care and those in post-acute care, and maybe we should treat them differently; we need to think about the ideal purpose of a NH, and the ways the payment system drives design. 2) There’s an untapped potential for home care due to technology, potential for rethinking people’s homes, and social capital is developing rapidly—growth of senior villages for example. 3) We really need to refocus on the workforce, think about training, career paths, and the role of teams. What changes to consider, especially concerning nursing homes: First, funding really needs reform; NHs should be smaller; NHs could be kind of a hub for other services, diversifying the business model to give more stability; making the NH better integrated into the community; forming partnerships, etc. We’re missing out on what other roles NH could take on; the more we can mix functions, the better. Many NH residents on Medicaid could be living elsewhere except for money. Medicaid must be more flexible in covering other settings and must fix the rates. We must look more broadly about the range of services covered in health plans, Medicare Advantage, etc. We may be at a point of inflection politically, but done on several tracks instead of one huge reform; value of catastrophic insurance. Thoughts on role of churches and parish nurses; caregiving work must be made into more of a career. Length: 25:53.
April 12, 2021: Dr. Tom Cornwell, senior medical director of village medical at home and executive chairman of the Home Centered Care Institute
Topics: Cornwell has made more than 34,000 house calls in 27 years. With value-based care, this is becoming more mainstream. The Home Centered Care Institute is a nonprofit that helps expand home-based primary care programs via education, consulting, advocacy, and research. There’s a lot of end-of-life care as part of this; 20-25% of our patients pass away every year. Village Medical wants to apply resources to high-risk patients to keep them out of hospitals; we use a lot of data analytics to predict high-risk patients. My partner and I do a lot of hospice care, but it’s a team sport—we need help from other home health providers and others; in AL facilities we have seen an enormous uptick in house calls. Kudos to CMS for “flipping on” telehealth quickly in 2020; it’s only under the public health emergency legislation that you can do telehealth visits; it is not a place of service under federal telehealth law. The question is how much flexibility we will get in the future. Re vaccination: For every nursing home resident there are 2-4 equally at-risk people at home. CDC has protocols for vaccinating the homebound now. For home-based patients the post-shot observation period creates a problem; also, all doses in a vial have to be used within 6 hours; if you have home-bound patients, you need to work with your public health department; some departments do the vaccination themselves. Home visits are more costly because of providers driving around, but nothing reduces hospitalizations and readmissions as well as home-based primary care. We’re at a tipping point—helped along by COVID—for home-based primary care. J&J vaccine was a game-changer for us, and only has 5 doses per vial—really helpful for people visiting multiple people. Data on savings for home care patients are favorable; value-based medicine is helping this kind of primary care. Length: 27:39.
April 15, 2021: Dr. Joshua Sharfstein, vice dean for public health practice and community engagement, Bloomberg School of Public Health, Johns Hopkins University; and Dr. Ashley Kirzinger, associate director of public opinion and survey research, Kaiser Family Foundation
Topics: [Sharfstein] Re pause of the J&J vaccine. Not an unsafe vaccine; a few women had an unusual and dangerous type of blood clots; now in the middle of a review process done out of an abundance of caution. ACIP convened April 14 and expect to meet again in a few days; expect recommendations to come in a few days to 2 weeks; the decision could well be that certain people could be encouraged to take a different vaccine. “It’s a sign of a system that takes safety seriously.” No reason to worry for people who’ve already had the J&J; doesn’t appear after the first 2 weeks; doesn’t appear in older people; this is about as rare as a severe allergic reaction, which is incredibly rare. The federal government is just making a recommendation to pause it, but some states are requiring a pause.
[Kirzinger] Frontline Health Care Workers Survey: More than 1,300 interviews with frontline health care workers (not just LTSS settings); latest one on mental health toll on workers. Findings on vaccine acceptance and intention, data collection finished mid-March: Majorities of doctors and nurses with advanced degrees have already been vaccinated; a lag among direct-care workers in nursing homes or AL facilities, and in home care; their hesitation mirror what we see in the public generally; there are a lot of “wait-and-seers.” There’s also an access issue; only 1/3 of health care workers working in patient homes had been offered a vaccine by their employer; may be unable to take time off work to get vaccinated or recover if there are side effects; more than half of black frontline health care workers were not confident vaccines were properly tested; one-third of Hispanics, and three in 10 whites. We are concerned about how the J&J pause may impact this “movable middle” group. Findings from the mental health report: ¾ of frontline health care workers hopeful about going into work, 2/3 are optimistic about the future; but more than half are burned out too. Self-employed home workers were less likely to have been vaccinated; biggest barrier was lack of time and access. Length: 31:13.
April 29, 2021: Dr. Kara Slifka-Jacobs, medical epidemiologist in the Prevention and Response Branch within CDC's Division of Healthcare Quality Promotion
Topics: Updates from 4/27/2021 re health care infection prevention and control recommendations in response to COVID-19 vaccination: Guidance will be updated going forward. If all present in a room are vaccinated they can go without masks; if someone unvaccinated or unknown comes into the room, recommendation to re-mask everyone and social distance; applies to both staff and residents. Not expecting masks to go on every time someone passes by. Discussion of asking people if they are vaccinated; challenge of ever-changing advice; changes in guidance are based on what we’ve learned, and significant decrease of infections in LTC. What about children under 12—we recommend that masks continue to be used by everyone in the group when they come into facilities (including residents). Outdoor visitation during outbreaks in a community—CMS vs. CDC guidance. Eye protection for nursing home staff: full PPE recommended if you know the person has COVID-19 or is in quarantine; if your facility is in an area of moderate to substantial community transmission (large scale transmission and 5%-plus positive rates in the county), along with the proper facemask, eye protection is to be used during resident care encounters. Masks still recommended for health care personnel when at work; one situation where masks would not need to be used; other situations. Anyplace there are unvaccinated people, wear masks, and full PPE if suspected positive. Guidance re outdoor concerts. Length: 21:59.
May 3, 2021: Bob Kramer, co-founder and strategic advisor, National Investment Center for Seniors Housing & Care (NIC)
Topics: We have a very short window to focus on “fixing nursing homes.” By next year, public attention will probably have moved on. It’s critical that we seize this opportunity to speak with one voice. COVID forced our issues into the public spotlight; it’s an opportunity for us to fix the long-broken system; focusing on what people want; can’t be siloed, with too much focus on HCBS to the neglect of skilled nursing; forced impoverishment of middle-market people is bad for everyone too. Re HCBS vs. NH: we really have no HCBS infrastructure; with NHs, we have an old, outdated, and broken infrastructure, dealing with much higher acuity and significantly challenged population in skilled nursing; we must be moving into the “neighborhood model;” the money can’t all come from the government; time to overhaul the model and also increase design that improve infection control. States are fearful of expanding HCBS services; there will never be enough government dollars, we must bring in private money in some way; our inventory of nursing homes is very old and wasn’t built for future needs. Comments on Green House model and PACE: the challenge is scalability; how to deal with construction costs—must be solved if we can make these things scalable; models based on the assumption of unlimited government support and funding will not succeed. Capital costs of investing in buildings concern me the most; thoughts about the post-acute model and its future; thoughts about “the place we call home.” Thoughts on delivery of services in skilled nursing; people with any choice will choose private rooms; the equation has to be changed away from non-private rooms. Length: 28:02.
May 5, 2021: Vish Viswanath, professor of health communication at the Harvard T.H. Chan School of Public Health and the Dana-Faber Cancer Institute
Topics: Convincing the one-third of staff who are still declining vaccination; this is not a homogenous group, and its members have a variety of reasons; there is a hard-nosed “refuser” group within it; the hesitant one-third includes those distrustful because of historical racism/marginalization, but can be brought around and there is room for a lot of conversation; I would rather address the fear than write them off; find who can convince people—colleagues, clergy, etc. There are 10-15% who are refusers; there are two options: One is institutional, you can mandate vaccines; the individual option is harder and would need to be done one-on-one. J&J pause showed system is working; people who completely refuse might think the virus is not a danger, or think COVID-19 harms fetal cells, or has microchips, and there’s not a lot you can do to convince them. Seasonal flu vaccinations: We should have scripts and tools to help engage people. Encouraging vaccines among those who have had COVID-19. Length: 24:53.
May 10, 2021: Monica Gandhi, MD, professor of medicine and associate chief in the division of HIV, Infectious Diseases, and Global Medicine at UCSF
Topics: Now there’s plenty of vaccine supply, and she believes there is less hesitancy than some reports suggest; staff vaccination is critical for LTSS settings; incentives work but there will be mandates in some places. “I think we worry too much.” Many people will become more confident as we see massive numbers vaccinated and doing well; messaging with compassion instead of shame will always work better; aerosolized transmission is exceedingly rare outdoors. In nursing homes, unvaccinated people should wear double masks indoor; even in those above age 85, your risk of hospitalization or death plummets after vaccination. The aerosolization data means that outside, your safety is guaranteed regardless of your vaccination status. Predicts that outdoor masking will go away soon. Your risk of getting COVID has to do with your own vaccination status, but also the status of those around you if you’re unvaccinated. We’re falling below 30K cases per day in the U.S. With variants: Your protection against severe disease is intact with our vaccines; they don’t break through your immunity if you’re vaccinated. I think we’ll make the 70% first-dose by July 4 goal, and that will get us to herd immunity. Predicts the summer will be good, and cases will be below 10,000 per day by July 4. Third shots aren’t needed—believes we’ll have long-term immunity. Length: 28:56.
May 12, 2021: Mary Good, Community Interventions and Critical Populations Task Force, CDC
Topics: CDC guidance for independent living; what holds back loosening guidelines for IL; additional guidance about choosing safer activities for those fully vaccinated; we want more vaccines in arms before updated guidance. Advice for IL operators on factors to take into consideration: Older adults are more likely to have underlying medical conditions; common spaces might allow transmission; IL residents move around a lot. Some communities could have lower risk factors than their surrounding areas. Longer-term changes to independent senior living: masking during flu seasons; dealing with other kinds of viral spread; making virtual connections a part of daily life. CDC has a risk assessment tool. CDC resources on moving from vaccine hesitance to confidence are available in a number of languages. Showing hesitant people how vaccination can lead to “normality” as a motivating factor. IL residents can be asked about their vaccine status in an IL facility—that does not supply health care services—without necessarily violating HIPAA; guidance re off-campus bus trips for IL residents. Length: 22:21.
May 13, 2021: Helen Lamont, HHS; Michael Smith, president and CEO, and Maley Hunt, COO and residential services administrator, LiveWell Dementia Specialists
Topics: Disproportionate impact of COVID-19 on Medicare beneficiaries with dementia: high rates of COVID infections, high mortality rate, higher infection rate for them in nursing homes; about 1/3 of people with dementia in all settings who got COVID died; perhaps some underlying biological processes occurring in dementia are associated with a greater reaction to COVID; black and Hispanic beneficiaries had higher rates of infection and mortality; dual-eligibles had twice as high a chance of getting COVID, but risk of death wasn’t as great; people with dementia are 1.5 times as likely to get sick and 1.5 times more likely to die, even after controlling for other factors, e.g., age. What can providers take from this report: We expected to see a lot of excess mortality during COVID among people with dementia, and we did not. The mortality rate among these people who did not have COVID was about the same as before the pandemic. Most if not all of the additional deaths were accounted for by COVID. For the future, how can we mitigate the secondary effects among this population? Developing recommendations to focus on staff, better work on disaster preparedness, and addressing behavioral and psychological aspects of dementia. There is a push to do more work to prevent dementia. The National Alzheimer's Project Act (NAPA) Council is soliciting nominations for new non-federal members. Looking for care providers; a health assn. rep; a researcher; a state health dept. rep; a patient advocate; an advocate who is living with dementia; and a caregiver. Send nominations to firstname.lastname@example.org, include a resume or CV for the nominated persons.
Michael Smith and Maley Hunt: Our goal was “Science Plus” in early days of the pandemic: a high degree of infection control, everyone masked and other good practices, had no infections or deaths. Made certain life could go on, residents continued to move around, ate with other people. Our responsibility was to be extraordinary at infection control. We had very few staff cases; gave masks to staff to take home to their families; secured rapid antigen testing, a daily routine; told staff who were even “possibly exposed” to stay home. Tried to care plan for each individual; for some, touch was the right thing and for others, a phone call was the right thing. Lessons learned about the future: Challenge is, how do our noble intentions disempower people who already feel disempowered? It’s incumbent on us to unwrap that, reflect on that, and get back to a sense of well-being, autonomy, and choice. Vaccines are not a condition of employment; we’re at 94% of staff vaccination, with no incentives offered. Length: 33:29.
May 17, 2021: Dr. Ali Mokdad, Institute for Health Metrics and Evaluation (IHME) at the University of Washington
Topics: Believes CDC has moved too soon; haven’t reached an immunity level to justify dropping masks indoors; not enough enforcement; and enough children aren’t vaccinated. We’re going in the right direction, but concerned about next winter; believes vaccines aren’t effective enough against some variants; need to increase preventive efforts and we won’t reach herd immunity before next winter. You’re safe if you’re indoors with all-vaccinated people, but who’s enforcing who’s vaccinated? Recommends children continue to be masked. We report total mortality from COVID-19, including people who die because of missing treatment in wake of COVID-19, projecting 947,000 total COVID mortality deaths by September. Expect a rise in infections but not as much mortality. “Take the vaccine to save your life, not to ditch your mask.” Concerned for young adults who are unvaccinated. Expects a reversal of the CDC guidance in the fall. Unmasking advice from CDC was a big mistake. Best ways to argue in favor of continued masking and social distancing. Our numbers are high because we have “total COVID-19 deaths” that adds people who died of downstream effects such as foregone medical care, suicide, and other issues. Length: 20:43.
June 10, 2021: Fran Casey, chief people officer, Goodwin House
Topics: View the workforce situation as an opportunity to attract and retain the best talent. We do weekly virtual career fairs, and each fair has resulted in at least 2 hires. This is easier than the earlier in-person fairs, and more efficient. We look at what are we doing not just for Goodwin House but what are we doing in the broader area; making connections more than pre-pandemic. Trying to be much more proactive; about to launch a Pathways Program in July: creates an advanced CNA program with a northern Virginia college; these advanced CNAs will be involved in interviewing and onboarding staff and assisting in training of staff. We’re selecting the first cohort of 10 staff who are going for this, we had more applications than slots available. We had lots of staff who didn’t miss a shift in 18 months; we pay staff well, did gift baskets, additional pay. Our CEO wrote letters to all staff and to their family members. Recommend trying for a “top workplace designation” in your area if there is one, it does encourage applicants. We created a float pool, to launch Oct. 1, hiring RNs as full-time, and can be exposed to all parts of organization: hospice, home health, LPCs, then they will get a higher rate for having the expertise to work in different parts of the organization. We’re at 96% of staff fully vaccinated; did it through a campaign of education, provided a diverse group of clinical leaders to answer staff questions; spoke with each one who declined initially, asked them what we could do to change their mind. Some of our best champions were co-workers, who would cheerlead, cajole, endorse as needed. Residents asked staff if they were vaccinated. We have required it of all new hires in the last few months, and as of July 15 all staff are required to get vaccinated. Three have quit, without a religious or medical reason. Ten staff have requested religious or medical exemption. A couple of good resources: “easy texting”; email blasts; My Interview; Calendly. Indeed is very good platform for staff recruitment, along with word of mouth. Referral bonuses, in general: referrer gets half after 3 months and the rest after 6 months. Have a good relationship with local higher ed institutions, we are a clinical site for some of them, we host luncheons for students and swag bags; also have an internship program for students after getting credentials. When reaching out to schools, we usually call the people in charge of the academic programs. Length: 23:48.
June 21, 2021: Mark McInerney, director of the Maine Center for Workforce Research and Information
Topics: About 22.5 million job losses in U.S. in spring of 2020. There has been steady recovery since; we have recovered about 15 million jobs so far; still have a long way to go. Enhanced unemployment benefits is part of the explanation, but not the only one. The pandemic impacted both labor supply and demand at the same time. Concern for personal safety, school closures, day care closures, and travel restrictions affected many workers. There is data illustrating all this: U.S. Census Bureau has found that the two most common factors in people not working are 1) caregiving needs, 20%; and 2) 17% have concerns for their own health and safety. Re aging services: many of the same factors affect your members. Effect of demographic changes dating back well before the pandemic: a large cohort of boomers relative to younger people; we’re getting an imbalanced population structure. Immigration can help. Another factor is that over time, we observe increases in productivity and technology, and fewer workers will be able to achieve a lot more in the future, though I can’t be sure how that will play out in aging services. What should LeadingAge members do to be inviting places to work? This labor market is tight because demand for workers is so high. Employers will have to compete on: wages; schedule flexibility to help them accommodate their challenges; purpose or mission; part-time work options; and career paths. How many boomers might come back to the workforce? With longer life expectancy, some people do “unretire.” Length: 22:54.
June 28, 2021: Lori Porter, CEO, National Assn of Health Care Assistants
Topics: We may struggle with vaccine hesitancy for years to come. Hospitals in Joplin, MO are reopening their ICUs, and more young people in it now. Vaccine refusers are using the same arguments as before, but we need to push harder than ever because with time those arguments are weakening. We use AMDA as our source for info because they’re the most trusted among this group; we’re taking a much stronger voice to our members, e.g., “this can’t go on.” One CCRC operator told me he thinks he’ll lose about 40 employees if he mandates the vaccine. Thoughts on supporting staff: This workforce issue is not the fault of the provider organizations; the focus really needs to be on the toxic relationship between nurses and CNAs. We have an “Enclave Principle” that creates distinct CNA departments with DNAs (directors of nursing assistants). CNA leaders go through training with us and are leaders of their departments. If we don’t repair the workforce cultures inside, it doesn’t matter how good the administrator or DON is, if CNAs are entering a culture of angry, frustrated people. Everyone in our profession has something on top of them that is making what they do miserable. Why can’t CNAs be involved in care plans? The only way to attract people to our field, IMO, is a call to action. People want to be part of a team. Millennials want to make a difference. Two kinds of benefits: logical, which is pay & benefits and we’re weak on that. The second kind is emotional, and we’re very high on that, and that can inspire people. We need a mass recruiting effort and I don’t see how it can be done one state at a time. Reimbursement doesn’t allow us to provide quality care. Enclave model: It’s basically a leadership development model, we have found that CNAs celebrate when their departments succeed, modules can be applicable in almost any setting. If I were an administrator again, I would try to build a culture in which everyone is engaged. I would involve residents and their families more. Length: 25:20.