Institute Talk: A Conversation with Lisa Gurgone on Supporting Area Agencies That Provide Elder Services

Lisa Gurgone is the executive director of Mass Home Care, the trade association representing the Commonwealth’s network of 28 Aging Services Access Points (ASAPs) and Area Agencies on Aging (AAAs). This single, statewide network of coordinated care delivers home and community based services to over 60,000 individuals per month, providing over $600 million per year in services.

Gerontology Institute Director Len Fishman spoke with Gurgone recently about home care services and how the COVID-19 pandemic has affected both consumers and workers providing care. The following transcript has been edited for length and clarity.

Len FishmanLen Fishman: What would a composite profile of a consumer you serve look like?

 

 

 

Lisa GurgoneLisa Gurgone: The typical age is 82 and about one in five are 90 or older. About 55 percent live alone. We have a lot of women with basic homecare needs, someone to help with shopping and food prep. They may need some bathing assistance or have trouble getting dressed in the morning. People sometimes stay in our system for a very long time and may need additional services as they age. We might sub-contract with a visiting nurses association to provide more skilled care. It runs the gamut but the goal is to help these people stay in the community as long as they want. Continue reading

Institute Talk: A Conversation with Bill Reichman on Elder Care Technology and Innovation in the COVID-19 Pandemic and Beyond

William ReichmanWilliam E. Reichman is a physician and chief executive of Baycrest, a leading non-profit elder care organization comprising health care and housing facilities, outpatient services and a research center on one campus in Toronto. His organization operates a 300-bed rehab hospital, a 472-bed skilled nursing facility, 200 assisted living units and 125 independent-living apartments. (Note: In characterizing the facilities, we have used terminology familiar to U.S. readers.)

 Baycrest, affiliated with the University of Toronto, is also home to one of the world’s largest research institutes focused on brain aging and an innovation accelerator focused on elder well-being. Its tele-education program delivers education content and training to 42 countries around the world. 

 Gerontology Institute Director Len Fishman recently spoke with Reichman about ways Baycrest has deployed technology to manage the impact of the COVID-19 pandemic and how those innovations can permanently influence elder care practice. Fishman is also a board director at Baycrest. The follow transcript has been edited for length.

Len FishmanLen Fishman: A recent Washington Post article reported that 81 percent of COVID-19 deaths in Canada are nursing home residents. How has Baycrest been affected?

 

 

 

William Reichman headshotWilliam Reichman: Baycrest has had some sporadic cases of COVID-19, both in residents and patients, as well as staff members who likely brought the virus to the campus inadvertently. I think all told, we’ve had six cases among our 1,100 beds. There have been other senior care organizations in Canada which tragically have had 40 percent or more of their residents test positive for the virus and 25 percent or more actually die from infection. So it’s been catastrophic in Canada. Continue reading

Institute Talk: A Conversation with Hospice Physician Joanne Lynn About Nursing Homes Dealing with COVID-19


Joanne Lynn is a nationally recognized expert on issues related to palliative and end-of-life care. A geriatrician and hospice physician, she is the author of hundreds of journal articles and many books on issues concerning long-term services and supports. Very recently, she has written articles offering detailed advice for nursing homes dealing with the coronavirus pandemic and an overview of policy priorities for upcoming COVID-19 related deaths out of hospitals.

Gerontology Institute Director Len Fishman spoke with Lynn on April 3 about the daunting health challenges facing nursing homes and the best ways facilities can respond to them. The following transcript has been edited for length and clarity.

Len Fishman: Let’s start by explaining the particular risk COVID-19 poses to residents of nursing homes and other facilities like assisted living?

 

 

Joanne Lynn: The people who live in nursing homes and other residential facilities tend to be not only in the age group that has high risk but also to have multiple complicating conditions that make it very difficult to survive a serious bout of COVID-19. Still, many people get a mild case and sail through or have very mild flu symptoms and feel sick for a few days but do okay. But a substantial proportion will have a serious illness. And it looks like something on the order of around 20 percent will die from COVID-19 in these conditions. Continue reading

Institute Talk: A Conversation with Dan Reingold on Leading a Nursing Home in America’s Worst COVID-19 Hot Spot

Dan Reingold is the chief executive of RiverSpring Health and a prominent national figure in the field of aging services. RiverSpring includes The Hebrew Home at Riverdale, a 750-bed nursing home in the Bronx, N.Y.

 The New York State Department of Health reported on March 30 that more than 1,000 residents of state nursing homes, including nearly 700 in New York City, had been sickened by the coronavirus pandemic. Officials said nursing home residents accounted for nearly 15 percent of the state’s 1,218 coronavirus-related deaths at that time.

 Gerontology Institute Director Len Fishman talked with Reingold on March 30 about the challenges of managing a nursing home in an area experiencing the nation’s largest COVID-19 outbreak. The following transcript has been edited for space and clarity.

Len Fishman: Talk a bit about how it feels to be responsible for leading a large nursing home in such a dangerous time and place.

 

 

Dan Reingold: A colleague used the expression that we’re in a whiteout. It feels like that – when you can’t see further out then the length of your hand and you put one foot in front of the other, get your footing secure, and then move the next foot forward. It’s really been quite staggering in terms of the magnitude. We don’t have the right equipment, we’re improvising, and so there’s a little bit of a feeling that we’re fighting a war without all the right ammunition. Continue reading

Institute Talk: A Conversation with Home Care Executive Kevin Smith on Service in the Age of COVID-19

Home care agencies and their employees are performing critical services that help clients continue to live independently, work that has become even more challenging and dangerous in the coronavirus pandemic.

Kevin Smith is the chief executive of Best of Care, an agency headquartered in Quincy, Mass., that serves clients in greater Boston and many other areas of Massachusetts. Smith is also president of the Home Care Aide Council, Inc., a trade association of 70 agencies providing home care services in Massachusetts.

Gerontology Institute Director Len Fishman spoke with Smith on March 23 about home health agencies and their workers during the COVID-19 crisis. The following transcript was edited for length and clarity.

Len Fishman: Tell us briefly who your agency serves.

 

 

Kevin Smith: We are serving about 1,500 people. They are typically over age 60 and actually skew toward their 80s. It’s fair to say many depend on the care of our aides to remain independent and out of facility-based care. Continue reading

Institute Talk: A Conversation With Vince Mor on Alzheimer’s Care and the State of Nursing Homes

Len Fishman and Vince Mor

Len Fishman, left, and Vince Mor

Vincent Mor is a leading academic expert on eldercare issues and a national authority on research related to nursing homes. The Brown University professor has been principal investigator in more than 40 grants funded by the National Institutes of Health that focus on the use of health services and the outcomes experienced by frail and chronically ill persons.

Mor and Susan Mitchell of Hebrew SeniorLife are leading an ambitious new collaborative research incubator for “pragmatic clinical trials” that test and evaluate interventions for Alzheimer’s disease and related dementias. Last month, they received a grant from the National Institute on Aging expected to total $53.4 million to fund that work over the next five years. It was one of the largest federal grants ever awarded for Alzheimer’s care.

Gerontology Institute Director Len Fishman recently spoke with Mor to talk about his new project and discuss the state of the struggling nursing home industry. The following is an edited version of their conversation. Continue reading

Institute Talk: A Conversation with Carl V. Hill on the NIA and Health Disparity Research

Carl V. Hill is director of the Office of Special Populations at the National Institute on Aging, which leads the federal government in conducting and supporting research on aging and the health and well-being of older people. Hill recently visited the UMass Boston campus, where he was the featured speaker at the first annual Gerontology Institute Fellows Dinner. Earlier that day, Hill talked with Institute Director Len Fishman about his career, how he promotes funding for health disparity research and current priorities for the institute’s $3.1 billion research budget. The following is an edited version of their conversation.

Len Fishman: How did you first become interested in a career in public health and health disparity research in particular?

Carl V. Hill: I was in the first class of the Masters of Public Health program at the Morehouse School of Medicine. The founder of that program was Dr. Bill Jenkins, who passed away this year. He was one of the first whistle-blowers on the Tuskegee Syphilis Study. He was also a mentor to many African-Americans in public health and he started this program that allowed many of us to have a start. Later, I had a chance to study for my PhD at the University of Michigan. I worked with people like Woody Neighbors and James S. Jackson, who both worked on the Survey of American Life. They also worked on the Survey on Black Americans, the first data collection on the lives and health of African-Americans in this country. Continue reading

Institute Talk: A Conversation About Retirement Insecurity with Katherine Newman

Katherine Newman, the interim chancellor of the University of Massachusetts Boston, has devoted much of her career to documenting conditions facing poor and working-class Americans. Her new book, Downhill From Here, Retirement Insecurity in the Age of Inequality, examines the perilous state of retirement in the United States. Gerontology Institute Director Len Fishman recently talked with Newman about the dangers facing the pension system, Social Security and other forms of economic support for Americans as they grow older. The following is an edited version of their conversation.

 Len Fishman: Your book reads in part like a post-mortem of the defined benefit pension system. Defined benefits provide a fixed pre-established benefit for employees at retirement, usually based on length of service and salary. They hit their high-water mark in 1980 and then plummeted. What happened?

Katherine Newman: Union density began to decline sharply at the same point. The defined benefit pension system is very much a creature of the collective bargaining power of unions. That’s why defined benefit systems tended to exist mainly where there were unionized workers. And as union density slipped — in part because of deregulation and industry competition – the strength behind the defined benefits began to shrink. Today, a very small minority of Americans have what we would call true pensions – 401(k) plans are definitely not pensions in terms of security and employer responsibility for investment. Continue reading

Institute Talk: A Conversation with Jim Wessler of the Alzheimer’s Association

Alzheimer's bill signing

Some of the challenges faced by people with Alzheimer’s disease and their families can be found in a doctor’s office or a hospital. Large numbers of people affected are not diagnosed or, in some cases, not told of the diagnosis. Hospitals and their staffs are not always prepared or trained to recognize and help patients with Alzheimer’s. Gerontology Institute Director Len Fishman recently talked with Jim Wessler, chief executive of the Alzheimer’s Association Massachusetts/New Hampshire Chapter, about those challenges and a landmark law passed last year in Massachusetts intended to deal with them. The following is an edited version of their conversation.

Len Fishman: The Alzheimer’s Association reports less than half of Americans with Alzheimer’s disease have been diagnosed and less than half of them have been told of their diagnoses. That means about one in four Americans with Alzheimer’s know they have it. What are the impediments to diagnosis?

Jim Wessler: People with diseases don’t want to hear the bad news so there may be some reluctance to bring it up with their doctor. But in survey data, well over 90 percent of both patients and physicians say a cognitive assessment is important. An overwhelming number of people expect their physician will bring it up. Most don’t go to their doctors and say, “I want to get my blood pressure checked and I want the blood test for cholesterol and while you’re at it, let’s look at my sugar count and all that.” You expect the question as part of their assessment of your health. Right or wrong, consumers expect doctors will do it. Continue reading

Institute Talk: A Conversation with Senior Housing Design Authority Victor Regnier

Victor Regnier is, perhaps, the nation’s leading authority on the design and development of senior housing with service across the LTSS continuum. A joint professor at USC’s School of Architecture and Leonard Davis School of Gerontology, Regnier is the only person to achieve fellowship status in both the American Institute of Architects and the Gerontological Society of America.

As a designer and practicing architect, he has provided consulting advice on more than 400 building projects in 38 states and several foreign countries. As an academic, he has written 10 books or monographs and directed more than 20 research projects. Regnier’s latest book, Housing Design for an Increasingly Older Population, was published in September 2018.

Gerontology Institute Director Len Fishman recently talked with Regnier about  northern European models of senior housing with supportive services and their influence on housing for older adults in the United States. The following is an edited version of their conversation.


Len FishmanLen Fishman:
Your view of housing and services for older adults has been deeply influenced by models from Northern Europe, especially Denmark, Sweden, Finland and the Netherlands. How did this happen?

 

Victor Regnier: I had been working on a research project with the head of geriatric medicine at UCLA in the late ‘80s, early ‘90s. I wanted to examine new housing models and had an upcoming sabbatical. He said I should go to northern Europe. He had been impressed by their attitudes and perspective on creating non-institutional circumstances for older people, especially older frail people. I ended up going to five countries. I asked to see the most non-institutional or residential housing for the frailest individuals and visited 100 buildings.

LF: You were coming from a country where, at that point, there was no assisted living to speak of and the idea of housing with supportive services hadn’t emerged yet. What were your impressions? Continue reading