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

Institute Talk: A Conversation With Iora Health CEO Rushika Fernandopulle

Iora Health Chief Executive Rushika Fernandopulle, left, and Gerontology Institute Director Len Fishman

Rushika Fernandopulle came to the United States from Sri Lanka as a young boy and later became a doctor after graduating from Harvard Medical School. He grew dissatisfied with standard systems of care, convinced alternatives that focused on primary care could work better. Fernandopulle eventually became the co-founder and chief executive of Iora Health, a Boston company building a national medical practice to do just that.

Today, Iora cares for nearly 30,000 patients at 35 practices, about 70 percent of whom are covered by Medicare. For many of its patients, IORA employs a “risk-based care” concept, accepting fixed annual payments to care for patients rather than billing for individual services. Gerontology Institute Director Len Fishman spoke with Fernandopulle recently about his ideas on improving medical care. The following is an edited version of their conversation.

Len Fishman: How did you initially become interested in pursuing a different approach to care?

Rushika Fernandopulle: I’m a primary care doctor who trained at Mass. General. I realized that the model we had for primary care was not optimal. It was fragmented and reactive. Patients weren’t getting better and they were unsatisfied with their doctors. I realized that the core of what we were doing was turning health care into a series of transactions. Document, code, bill. All the things we were trying to do to fix health care were just making the problem worse. The simple insight I had was that maybe what we need to do is start from scratch and rebuild the system from the ground up, starting with relationships and not transactions. And that required changing everything — the payment model, the process, the technology, the space. Continue reading

Institute Talk: A Conversation with Penny Shaw, Activist and Long-Time Nursing Home Resident

Len Fishman and Penny Shaw

Gerontology Institue Director Len Fishman and Penny Shaw in Braintree, Mass.

The word that might best describe Penny Shaw is “indefatigable.” A long-time activist for persons with disabilities, Shaw is a visible and vocal presence on national, state and community issues. She is known for her sharp opinions and blunt talk as an advocate. Shaw sits on more than a dozen committees, including an advisory panel to the state Executive Office of Elder Affairs. She is a prolific writer on disability issues whose work has appeared in a wide range of journals and other publications.

 Shaw has also been a nursing home resident for nearly 16 years. A teacher with a PhD in French literature, she became disabled in 2001 with Guillain-Barre Syndrome, a rare neuromuscular condition, and was not expected to live. After a year in a rehab hospital, Shaw was transferred to a nursing facility in Braintree, Mass., specializing in neurorehabilitation care, where she now lives. Gerontology Institute Director Len Fishman recently met with Shaw to talk about nursing homes from a resident’s perspective. The following is an edited transcript of their conversation.

LEN FISHMAN: You’ve been living in a nursing home for many years now. What was it like at the very beginning?

PENNY SHAW: First of all, I was intubated for five years with a feeding tube. I arrived [at what is now called Braintree Manor Healthcare] on December the 26, 2002, but I was not decannulated until August 2006. So I was basically bed-bound. Continue reading

Institute Talk: A Conversation with Benchmark Senior Living Founder Tom Grape

The Branches in North Attleboro

The Branches, an assisted living community in North Attleboro, offers “companion-living” accommodations exclusively.

 

Assisted living has been an extraordinary successful model for combining housing and personal care. But the cost often puts assisted living out of the reach of many middle- and almost all lower-income elders and their families. Benchmark Senior Living, a leading provider of senior living services in the Northeast, recently opened a new community in North Attleboro, Mass., that found a way to lower costs by rethinking space and the way residents live.

Gerontology Institute Director Len Fishman recently met with Tom Grape, the founder and chief executive of Benchmark Senior Living, to talk about the economics of assisted living, the ideas behind The Branches community in North Attleboro and other issues that affect the cost of senior living services. This is an edited transcript of their conversation.

Len Fishman


Len Fishman: There are a lot of variables in calculating the cost of assisted living, from the size and type of accommodations to the services required for residents. But, roughly speaking,  what does it cost to reside at a Benchmark community today?

 

 Tom Grape: Compared to other alternatives, assisted living remains far more affordable unless you’re going to qualify for Medicaid. In Massachusetts, market-rate assisted living can range from a studio apartment starting at $2,500 to $3,000 a month, including typically three meals a day, housekeeping, laundry, transportation, activities, and some modest amount of personal care. And then a studio might be $3500 a month at the higher end with that same basic level of services. A one bedroom might range from $3000 to $4000 roughly, and then a two bedroom might go from $4000 to $6000. Those are starting points. Continue reading