The pandemic has exposed ageism and ableism

The Pandemic is Exposing Ageism and Ableism — and that’s a good thing

The COVID-19 pandemic has disproportionately affected the nation’s older population. In the process, it has also brought ageism and ableism — discrimination on the basis of physical and cognitive function — into the spotlight. Writer and activist Ashton Applewhite, the author of This Chair Rocks: A Manifesto Against Ageism, argues that this presents us with a unique opportunity to educate people about these two intertwined forms of bias, and to mobilize against them. 

Media coverage of anything aging-related has long been characterized by alarmist hand-wringing, the most egregious example being the gray tsunami metaphor. Coverage of the pandemic is no exception, given that some three quarters of COVID19-related deaths are of people over age 65, many occurring in nursing homes where the virus has run largely unchecked. Typical headlines read, “Ageism on the rise” and “Pandemic making ageism worse!” Don’t make the same mistake.

The pandemic isn’t generating more prejudice, it’s glaringly exposing the ageism and ableism that have been all around us all along. Because ageism is so unexamined, the pandemic is bringing it to many people’s attention for the first time. It’s not ageist and ableist attitudes and behaviors that are on the rise, it’s public awareness and outrage about this type of stigma and discrimination. That’s what’s new and here’s what makes it so exciting: we have a historic opportunity to build on that awareness.

Yes, there’s been awfulness, but there’s also been swift, fierce pushback: against the Telegraph journalist who suggested the virus could benefit the economy by “culling” older Britons; against the Boomer Remover nickname, the handiwork of clueless trolls; against the Texas Lieutenant Governor’s grotesque proposal that grandparents sacrifice themselves for the good of the economy. Supporting this kind of grassroots activism means framing the pandemic, in all its terror and uncertainty, as an unprecedented opportunity to join forces across age, race, and class and create a more equitable post-pandemic society.

The author of This Chair Rocks: A Manifesto Against Ageism, Ashton Applewhite is a leading spokesperson for the emerging movement to raise awareness of ageism and to dismantle it. Ashton has been recognized by the New York Times, the New Yorker, National Public Radio, and the American Society on Aging as an expert on ageism. She blogs at This Chair Rocks and is the voice of Yo, Is This Ageist?  Ashton speaks widely at venues that have ranged from the United Nations to the TED mainstage, has written for Harper’s, the Guardian, and the New York Times, and is a co-founder of the Old School Anti-Ageism Clearinghouse.

This post first appeared on Ashton’s This Chair Rocks blog. 

David Grabowski presents a podcast on rethinking long-term care

Grabowski Spotlighted on Disrupt Podcast: Rethinking Long-Term Care in the US

The nation’s infrastructure has become a hot topic, as the Biden administration lays out its infrastructure plan. Long-term care for the growing senior population is one of the areas for proposed investment, which may be a surprise to some, but not to those in the industry. Rethinking long-term care for our nation’s rapidly aging population is an urgent problem, but addressing it effectively is a complex one.

David Grabowski, Professor of Health Care Policy at Harvard Medical School and a Nexus Insights Fellow, was interviewed recently on his thoughts and recommendations for the reformation of long-term care in the United States. Grabowski is a key figure in the research, policy and media world, with expertise in the economics of aging, Medicare, and the integration and coordination of care for dually-eligible beneficiaries. He’s a member of the Medicare Payment Advisory Commission (MEDPAC), a well-known expert in the post-acute care services realm and a leading speaker on industry publications and newscasts around the world. 

Grabowski’s recommendations range from a unified post-acute payment system to changing up the traditional nursing home model and investing more heavily in home-based care. He compares the United States to other developed countries for home and community-based services spending, considers why investment in nursing homes and home care services is not an either-or proposition, and explores the future of SNF-at-home programs.

Listen to Grabowski’s Interview: A part of the Home Health Care News podcast series Disrupt. 

Bob Kramer and Anne Tumlinson discuss HCBS

Foresight TV: Bob Kramer & Anne Tumlinson – What Does HCBS Mean For LTC?

With the federal government considering an investment in the country’s infrastructure, a new light has been shed on the importance of infrastructure. And from the resulting discussion, a broader understanding of what is vital infrastructure is emerging. That infrastructure necessarily includes a system of long-term care for the nation’s aging population and a trained workforce to deliver that care.

“We have an outdated, crumbling infrastructure in nursing homes. We have non-existent infrastructure in home and community-based services (HCBS). And we have millions of older adults living longer, many of whom will need services and supports,” said Bob Kramer, Founder and Fellow for Nexus Insights, and Co-Founder and Strategic Advisor for the National Investment Center for Seniors Housing & Care (NIC).

Kramer recently interviewed long-term care expert Anne Tumlinson about the importance of long-term care and changes needed in how it’s delivered and how it’s paid for. Tumlinson, the Founder and CEO of ATI Advisory, and Founder of daughterhood.org, offered recommendations for the policy changes needed to make long-term care financially viable for more seniors and their families. Her recommendations also addressed the critical need for a living wage for the shrinking pool of caregivers who work in long-term care, and the important role of HCBS in helping seniors thrive.

“We don’t have a system; instead, every single family has to create their own system, over and over again. What is out there that could help me? How do I find it, set it up, coordinate it? There is currently no system or function in our society to handle that,“ said Tumlinson.

The interview was hosted by Senior Living Foresight. View the entire discussion.

LTSS caregiver and patient

ATI Advisory Issues Recommendations for Expanding Access to Home and Community-Based Services

Long-term services and supports (LTSS) when provided in the community as home and community-based services (HCBS) can be a lifeline to help a person live safely at home and age with dignity. In a position paper on HCBS, A Blueprint for Reforming Medicaid Long-Term Services and Supports and Creating Good Caregiving Jobs, ATI Advisory CEO, and Nexus Fellow, Anne Tumlinson offered three recommendations for legislators and regulators to expand access to home-based care services sustainably and equitably. 

1 – Providing states with better financial support, assurances and predictability

Medicaid accounts for 29% of total state spending across all funding sources, and LTSS is a substantial portion of this spend. This creates financial pressures, resulting in cuts to the Medicaid program during times of budget pressure, and reluctance to provide or expand services that are optional, such as HCBS LTSS. 

IMMEDIATE RECOMMENDATIONS: Several policy and financing approaches (e.g., enhanced federal match for HCBS, state education on HCBS financial controls) increase access to HCBS by increasing funding and alleviating immediate state financial concerns.

LONGER-TERM RECOMMENDATIONS: Financing reform could include federalizing some portion of LTSS or creating a shared risk model between states and the federal government. 

Read the full recommendation

2 – Modernizing long-standing Medicaid eligibility policies

Long-standing Medicaid eligibility policy creates a bias toward institutional care, making it difficult for individuals to remain in their home or the community when they have LTSS needs. 

IMMEDIATE RECOMMENDATIONS: Several eligibility regulatory changes would increase access to HCBS and help ensure individuals have access to LTSS in the most appropriate setting of care. 

LONGER-TERM RECOMMENDATIONS: National minimum eligibility standards applied across states would reduce inequity and improve access.

Read the full recommendation

3 – Investing in the direct care workforce delivering HCBS

Immediate and longer-term recommendations for increasing access to home and community-based services (HCBS), reducing institutional bias in Medicaid long-term services and supports (LTSS), and creating good caregiving jobs: 

ISSUE: Direct care worker pay is relatively low and the work is demanding. Policymakers should take a comprehensive approach to fairly compensate; elevate; and retain, engage, and develop workers. 

SHORT-TERM RECOMMENDATIONS: Increase the minimum wage, create a high-level HCBS and Direct Care Workforce coordinating office, make targeted investments in training, and launch a public service campaign to help address key workforce issues. 

LONGER-TERM RECOMMENDATIONS: Improve jobs by enacting policies to support affordable childcare, healthcare, and paid sick leave; modernize training; and create a permanent federal Center for Direct Care Excellence. 

Read the full recommendation

 

See the full Position paper

 

Sarah Thomas joins Sentrics Advisory Council

Nexus Insights Fellow Sarah Thomas joins Sentrics Advisory Council

Sentrics, an emerging technology leader in the senior living industry, has welcomed Sarah Thomas, CEO of Delight by Design and Nexus Insights Fellow, to its Advisory Council. Thomas is an accomplished leader and innovator, with nearly 20 years of experience as a global aging expert, advising startups, large corporations and investors. Her technology perspective is shaped by her experience helping some of the largest senior living companies develop and implement strategic change management initiatives and innovative human potential products.

“Sarah Thomas has consistently intersected technology and aging to transform the aging experience,” said Darin LeGrange, CEO of Sentrics. “Her first-hand knowledge launching solutions that are more purpose-driven will help us address the ongoing need for usability, portability, simplicity and the ultimate engagement of the resident, family and healthcare ecosystem.”

Founded in 2016 and headquartered in Dallas, Texas, Sentrics helps senior living communities nationwide transform into more sophisticated, clinically oriented, risk-management businesses. Its Sentrics360 suite creates a 360-degree view—physical, medical, social and behavioral—of the wellbeing of each resident. Sentrics systems collect vital data, while machine learning and AI analyze and interpret the data, empowering families, senior living communities, and healthcare providers to make the best care decisions and optimize their operations. 

“The best way to support an age-inclusive experience is to integrate technology and the human touch,” said Thomas. “Sentrics is pushing senior living forward by acquiring and developing technology that puts the residents at the center of everything it does. This human-centric, purpose-driven design makes technology more accessible and adoptable.”

See the full press release

reform in nursing homes affects residents and caregivers

Seize the moment: Bob Kramer lays out path for meaningful reform in nursing homes in new Health Affairs blog

“The American long-term care system, particularly in skilled nursing facilities, has been exposed as deeply flawed, chronically underfunded, and in need of reform.” This bold statement is from Robert Kramer, Founder and Fellow of Nexus Insights, and Co-Founder and Strategic Advisor for NIC. It’s the opening line of his recent blog in Health Affairs.

Kramer delves deeply into the urgent problems facing nursing homes that have been spotlighted on the national stage by the pandemic and its tragic death toll among nursing home residents and staff. Kramer predicts the likely responses we can expect to see from nursing home operators, federal and state regulators and policy makers, and seniors and their families. But he urges, instead, a more thoughtful, complex and multi-faceted approach to solving the challenges of long-term care in nursing homes that involves dispensing with out-of-date assumptions, acknowledging the problems, and aligning the different stakeholders involved.

The problems he sees stem from undervaluing and undercompensating the work of caregivers, and the too-narrow focus of regulatory metrics on physical care needs, rather than the personal goals and aspirations of the residents themselves, and their quality of life. Other challenging problems include the long-term shortage of caregivers for a rapidly growing population of seniors, the lack of financial transparency, inadequate reimbursement models that incentivize the wrong behaviors, the age of nursing home infrastructure, and the financial impact of the COVID-19-related lawsuits that are certain to hit the beleaguered industry as the pandemic winds down.

“Every stakeholder must understand that this is a disruptive moment.” – Bob Kramer

The solutions Kramer proposes will require thoughtful cooperation and coordination among all the players in the industry, including industry providers, organized labor, consumer advocates, investors, and regulators. And it won’t be easy. But as Kramer points out, “Every stakeholder must understand that this is a disruptive moment. SNFs and long-term care are, for a moment, center stage. Those of us who care about this sector, and the millions of Americans it serves, must seize this moment.”

Link to full blog

 

Jody Holtzman interview

Trends, Challenges and Opportunities in the Longevity and Aging Industry – A Jody Holtzman Interview

COVID-19 has been a tremendous challenge for everyone, but it has shone an especially bright spotlight on how underserved our aging population really is. We sat down with Nexus Fellow and Senior Managing Partner at Longevity Venture Advisers, Jody Holtzman, to discuss trends, challenges and opportunities in the longevity and aging industry in this new world.

Jody is a well known leader in the aging and longevity world, having spent the past 15+ years in the field, preceded by a career in strategy consulting. His work in aging includes a 12 year stint at AARP where he ran research and was senior vice president of thought leadership and market innovation. 

 

NEXUS INSIGHTS – You have spoken about Baby Boomers and their lack of interest in traditional long-term care communities, especially assisted living. Tell us more about that.

JH – First, it is hard to generalize when you are talking about a population of just over 70 million people, which is the current Boomer population in the US. That’s more people than in the UK, France, or Italy. So, let’s just establish that one size does not fit all and there will always be a segment of Boomers for whom traditional long-term care settings are attractive. However, even before the pandemic, occupancy rates across independent and assisted living already were at a low, while the age of new residents continued to climb well into the 80s. And the mental image and mental model of long-term care communities for Boomers was one of nursing homes where people are warehoused to die. Since the pandemic this image has only been deepened as Boomers saw nursing home death rates, as well as experienced such with their own older loved ones.

There also is something else going on when we look at how Boomers view long-term care. And that is, they simply do not see themselves in those settings. It does not jive with their own self-image. This came out in spades to me the first time I spoke to a LeadingAge conference and did this exercise with the audience. I asked everyone to stand if they proudly participate in the management of any type of long-term care community. Three hundred and fifty people jumped up. Smiles all around! Then, I asked them to remain standing “if you are looking forward to the day you live in your own facility.” And the overwhelming majority of the audience sat down. These were people on the front lines of senior living, committed to making life better for older people. But they also, overwhelmingly, were Baby Boomers. And they did not see themselves in senior living. So, something has to change.

There is something else going on when we look at how Boomers view long-term care. And that is, they simply do not see themselves in those settings. – Jody Holtzman

NEXUS INSIGHTS – You talk about how the pandemic has shaped how and where health and healthcare happen. Tell us about the trends that you are seeing.

JH – Trends over the past year, both within and outside senior living, have increasingly confirmed that the home is and will continue to be the focus of health, care, and connected living. The growing consensus across the healthcare community got a boost from the orientation embedded in the concept of social determinants of health (SDOH) which is encapsulated in the view that health is a function of one’s zip code and the conditions of life in a geographic area. Health is now, officially, “beyond medicine.”

In parallel with the new focus on SDOH over the past year, digital health has exploded. While the health benefits of home-based care were being proven, along comes COVID and people are told to lock down and remain in their homes. Telehealth, telemedicine, and other virtual communications, became the dominant market response in healthcare and society more broadly. All in combination reinforcing the centrality of the Home and further boosting demand for more home and community-based products and services.

 

NEXUS INSIGHTS – You work with a lot of healthcare companies in the aging space. How are they dealing with these new trends and market opportunities?

JH – In response to the pandemic, and to both longstanding needs and those recognized by looking at health through the lens of SDOH, CMS has added a growing list of non-traditional, supplemental benefits that may be reimbursed through Medicare Advantage, but not traditional Medicare. Startups and others have responded with an array of new offerings covered by new reimbursement codes. And MA plans have been increasingly adding them to services already offered in their plans. While payers have had the near-term benefit of attracting new customers through product/service-based competitive differentiation during Open Season, the longer-term health benefits and attendant cost savings have yet to be proven. And this brings us to a dilemma. While the need and availability of a growing list of technology-enabled products and services has been established, customer/patient adoption is still low, and returns on investment have been as well.

For startups, this is concerning because, in many cases, they are being directed by investors and others to build their channel strategies around Medicare Advantage. Even if the deals with payers are all gain-share arrangements without requiring cash outlays by the payers, they still are making an investment in time and dedicated resources, if only to track progress. The question needs to be asked and monitored – how long will MA plans include offerings that garner limited customer uptake? If nothing else, the current terrain calls for a diversified go-to-market strategy that is not solely dependent on Medicare Advantage.

Stop calling them facilities

Why are We Still Dropping the “F-Bomb”?

If you’ve seen the movie A Christmas Story, you likely remember the scene in which 9-year-old Ralphie is helping his dad change a tire on the side of the road on a dark snowy night. Ralphie is so excited to help but he drops the lug nuts and loses them in the snow. In frustration, he yells out “Fuuuuudggge!” Ralphie then explains through narration, “…only I didn’t say fudge. I said THE word. The queen mother of all dirty words – the F-dash-dash-dash word!” Ralphie ends up being punished with a bar of soap in his mouth.

That’s how we should view the word ‘facility’. As the queen mother of all dirty words: the F-bomb.

Do you dream of living in a facility? Of course not! Facilities are cold institutions where humanity and the human spirit wither and die. Why then do we use this awful term to describe the places older people live and receive support? It denigrates residents and team members alike, yet it’s sprinkled generously throughout the narrative of senior living – by government regulators, by leaders in the field, and even by people living and working in communities.

At Christian Living Communities-Cappella Living Solutions, we’re on a mission to ban the F-bomb because, as Dr. Bill Thomas, Founder of the Eden Alternative, has said time and time again, “words make worlds”.

Our words drive our beliefs and behaviors. Call a building a facility and people will act like they live and work in a facility. Call it a community and the seeds of change are planted.

Community is a word filled with promise, with hope, and with citizenship. In a community everyone is valued and has a role to play. This is the type of culture we strive to build in each CLC-Cappella community. Yes, we provide excellent care and services, but we also purposefully create environments where each person has autonomy, a deep sense of belonging, continued growth and meaningful purpose.

It’s time to eradicate “facility” from our vocabulary and start using words that honor elderhood. So, bust out the soap, implement a “swear jar” if you want. Let’s start changing our world through the words we use.

Written by: Jill Vitale-Aussem, President and CEO of CLC-Cappella Living Solutions and Nexus Insights Fellow

Originally posted in Christian Living Communities.

Sarah Thomas and Bob Kramer

Let’s Quit Talking to Ourselves: Sarah Thomas and Bob Kramer on the Future of Senior Living

“They’re coming for our space,” said Sarah Thomas, CEO of Delight by Design, and a Nexus Insights Fellow. Thomas is an accomplished leader of innovation and a global aging expert, advising startups, large corporations and investors.Those of us in senior living and senior care need to lift our heads to see what’s coming. We need to see how we can be part of creating what’s ahead of us.” 

Thomas recently joined Bob Kramer, Founder & Fellow at Nexus Insights and Co-founder and Strategic Advisor for NIC, for a conversation on Senior Living Foresight TV, entitled “Let’s Quit Talking to Ourselves: Moving the Conversation Outside Senior Living.”

The two discussed the increasing presence of investors and large corporations in the aging industry. Kramer and Thomas agreed that outside companies can be perceived as threats. But a wiser approach, they advise, is to see opportunities for productive partnerships.

“We must elevate our voice to be heard beyond our own walls,” said Thomas. “If we don’t want to partner with them, we may be replaced. So we need to look at what is not our domain expertise, and to identify gaps and consumer expectations that we’re not meeting.” Kramer agreed, observing that larger companies have greater logistical support, and greater expertise in certain domains. The key is to look for partners who can help close those gaps.

“We must elevate our voice to be heard beyond our own walls.” – Sarah Thomas

Thomas and Kramer discussed the importance of ageism, which is everywhere, and impacts everyone, and not just the older demographic. Thomas’s consulting work includes helping investors understand the marketplace, and to see the true needs and not the perceived needs “that are often misperceived,” and based on ageist ideas and stigmas. The two agreed that communities need to know their own value proposition, and to know how to communicate it, if they want to have a bigger seat at the table.

The discussion also touched on the value of universal design. “If we’re designing for all instead of designing for old, then we have beautiful designs that are also functional,” Thomas explained. Her experience includes work with the integration of robotics and fashion. The lesson for the aging industry, she suggested, is that beautiful designs help accelerate the adoption of new ideas, a philosophy that should be applied to senior living and senior care.

The two also talked out the potentially lasting impact of the pandemic on the industry. “The pandemic reinforced the idea that senior living is all about care,” Kramer said. “Ultimately we have to offer an experience that is aspirational, that is about a sense of belonging, about the joy of being alive, and not just making it through the day.”

See the whole conversation:

Bob Kramer speaks on senior living post-covid at Living Well

Bob Kramer Speaks on Aging and Senior Living Post-COVID-19 at Living Well

“We’ve all learned lessons, painfully, during this pandemic,” said Bob Kramer, Founder & Fellow for Nexus Insights, and Co-founder and Strategic Advisor at NIC. “Let’s seize the opportunity from the crisis so we can say we learned from it, and we won’t be here a year or two from now saying that nothing is different.”

Kramer was speaking as part of a panel at Living Well, a forum to advance important aging-related issues that is hosted annually by A.G. Rhodes. This year’s event, which was held virtually for the first time, addressed the topic Aging and Senior Living Post-COVID-19. A.G. Rhodes is a top nursing home provider of senior rehab services and long-term care in Atlanta and Marietta, and one of Atlanta’s oldest nonprofit organizations.

Kramer was joined on the panel by Becky Kurtz, Director of the Atlanta Area Agency on Aging, Elise Eplan, Founder & Principal of The Eplan Group, and Deke Cateau, CEO of A.G. Rhodes. The panel was moderated by Jocelyn Dorsey, Former WSB-TV Broadcast Manager and Member of the A.G. Rhodes Board of Directors.

The discussion addressed a number of important issues facing senior living administrators today, including the role of leaders in managing the crisis, response to issues of safety and social isolation and how to balance the two, the challenges of aging infrastructure for infection prevention in skilled nursing facilities, as well as the importance of transparency in addressing problems spotlighted by the pandemic.

The discussion also highlighted some of the silver linings from the pandemic, such as the impact of vaccines, and the new spotlight on the issue of loneliness. “One benefit of this horrible pandemic is that it has brought empathy to the issue of social isolation and loneliness for older adults. I can now talk to any college student and they will get it, because they too miss getting together with their friends,” Kramer observed.

View the discussion: