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The Life-Changing Experience of Visiting the Elderly<p>​​<img src="/Topics/Guest-Columns/PublishingImages/2022/OliviaSavoie.jpg" alt="Olivia Savoie" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />The first time I entered an assisted living community, I was five years old. My first-grade class and I went equipped with gifts of bananas and carefully copied Bible verses on colorful handmade cards. We passed our offerings to residents situated in a circle of wheelchairs. A tape of instrumental Cajun music played softly in the background.</p><p>My peers were mostly uncomfortable, hanging back in groups or huddling by our teacher. I was an exception to that discomfort. I eagerly handed out cards, said hello, and made friendly conversation.</p><p>I vividly remember encountering one man leaning back in his wheelchair with his head unnaturally cocked toward the ceiling and drool dripping down his chin. My mother, who volunteered to join us that day, asked me to take special care telling him hello. She said that his name was Mr. Nathan; he was the dad of one of my dad's friends and had been the district attorney a long time ago. I didn't know what all that meant, but I happily told him hello and gave him my favorite card—one with a big rainbow on it—even though he didn't seem to hear me and failed to acknowledge the slip of paper I left on his lap. Something inside me knew there was more to him than the shell before me.</p><p>As I went down the line of residents, I met some women who clutched baby dolls to their chests. On the bus-ride home, Mom explained this was because they had held so many babies of their own in their younger years that now they felt safe and relaxed holding a baby again. My cohorts were confused; to me, it made sense.&#160;</p><p>I was seven the next time I went into an assisted living community. Prompt Succor was located in a rural town north of Lafayette, Louisiana, where I lived. Mom took me there to see my granny, who worked there as a beautician. (Years later I learned that in the wake of her own mother's death, my granny found great comfort in serving other people's mothers. I thought that was overwhelmingly beautiful.)</p><p>The day I first visited Prompt Succor, I wore a green velvet dress. I remember it well because several ladies wished to touch it. That day as I walked to meet Granny, a beautiful woman named Dorothy not only said hello to me, but asked me how old I was, where I went to school, and what my favorite color was. I told her and then countered with the same questions. She answered them—91, Opelousas High School, purple. I carried on a conversation with her just like I would have with any child I met on the playground—with any friend.</p><p>I was nine years old when my mom, older sister, and I started carting our harp to assisted living communities a few times a year. My sister and I would each play three or four songs. The room would fill with oohs and aahs and offbeat claps. There would be humming and singing. Whether the words were right or wrong didn't matter—there was joy. Even at nine years old, I recognized it. It was the same joy I felt on Christmas morning when I unwrapped a new baby doll, the same joy I felt when my baby sister came home from the hospital, the same joy I felt when I raced into the ocean on the first day of summer vacation. Joy was joy—rather it was experienced by someone 90 or nine, it was the same—and I knew it.</p><p>As I grew older, the practice of visiting assisted living communities didn't subside. It blossomed. Once I had my own car, I made weekly trips to Maison de Lafayette, a community near my home. Over the years, I made a plethora of friends there.</p><p>I visited Mrs. Nettie, who put together more puzzles than I thought humanly possible. Once upon a time she had owned a flower shop, and she showed me album after album of her floral creations.</p><p>I visited Mrs. Opal, who loved to decorate her room for every holiday. If she didn't know which one came next, as she took down one's decorations, she would ask a nurse. When they responded with “Mardi Gras&quot; or “Halloween&quot; or “4th of July,&quot; she would excitedly pull décor from a plastic tub under her bed. Twice I happened by and helped her decorate.</p><p>I visited Mr. Al, an Italian man who reminded me of my grandfather. He always wore blue, button-down pajamas, no matter the hour of the day.</p><p>I visited Mrs. Virginia, who seemed to always be sitting on the side of her bed, an empty bag clasped in her lap, as she waited to catch the train. She would inform me over and over again that she was about to travel up north to meet her fiancé's parents. She would ask where I was traveling to. At first, I was confused. Eventually, I'd smile and sit beside her and tell her I was heading north, too, and that we could make the journey together.</p><p>I visited Mr. Larry and Mrs. Margie, an inseparable couple who moved into the community after Mr. Larry's many falls. Although Mrs. Margie was healthy and capable of staying at their ranch outside of town, she refused to part ways with him. They would do crossword puzzles together and ask for my “young brain&quot; help when they got stuck. Mrs. Margie once opened her locket to show me a picture of her beloved rat terrier, which wasn't allowed to join them at the facility and had to live with their niece instead.</p><p>And then there was Miss Lola. One day, I headed to the side door at Maison de Lafayette and discovered her sitting outside smoking a cigarette. As I passed her with a polite smile, she stopped me to ask if I smoked. I told her I was only 16 and that I did not. She told me, “Good, these damn things will kill you&quot; and took another drag. I liked her already. I sat down beside her. This was the beginning of our friendship.</p><p>What ensued was rating the male nurses on a cuteness scale from 1 to 10, sharing snacks, and my reading scripture—the Psalms were her favorite—aloud to her, since she could not read the small print in her Bible. I eventually bought her a large-print Bible, which she treasured. What ensued was advice about my high school boyfriends, consolation through my break-ups, and approval of my prom dresses. She told me sad stories about her childhood, outlandish stories about her ex-husband, funny stories about raising her children, brave stories about going to nursing school as a single mother. And then, one day, when I was 20 and newly married, I went to visit like I always did and found her room bare. A nurse informed me that she had passed away three days earlier.</p><p>My husband and I moved to Florida when I was 22. There, I hosted writing workshops in the assisted living communities near us. I visited dozens of facilities and met hundreds of people.</p><p>Mrs. Jan sticks out in my memory. She prided herself in being the resident ambassador at Oakmonte Assisted Living. She wore a name tag and greeted guests with a warm handshake and smile.</p><p>And I'll never forget the two women whose names I didn't get, who, during a workshop, both fell silent and became teary-eyed when prompted to recall memories of World War II. One of them, in a heavy German accent, said that her husband had been killed in the war. The other, a native Floridian, burst into tears, saying her husband, too, had been killed in the war. Both got up, hugged, and cried together.<br></p><p>Over the years, I experienced a multitude of other names, faces, and interactions. I played the harp. I helped with writing memories. I listened. I learned.</p><p>After graduating from college, I began writing life stories for people 65 to 105 years old—for veterans and doctors and stay-at-home mothers and entrepreneurs and educators and everyone in-between. I wrote them for the sole purpose of sharing cherished memories with family members. In the process, I fell in love with many of my subjects' spirits. I gleaned grandfatherly or grandmotherly advice. Some women shared secret family recipes; some men shared gut-wrenching heartaches. I have carried burdens and wept; I have laughed until I cried.</p><p>When I look back, I can trace the lines of my passion for my profession and my affection for the people I work with back to a certain field trip—back to a five-year-old handing a colorful card to Mr. Nathan. I can trace it to what I recognize now as a realization that inside what looked like an idle old man was actually 100 other versions of himself—a curious child, a bold young man, a loving father, a brilliant attorney. And with it came the realization that behind every mask that appeared aged and perhaps less productive than it once had been lived a vibrant young person waiting to be heard, to be seen, to be known, to be befriended.</p><p>Olivia Savoie is co-founder of Raconteur Life Story Writing, a family heirloom biography writing and publishing company based in Louisiana. She can be reached at&#160;<a href="mailto&#58;Olivia@RaconteurWriting.com" target="_blank">Olivia@RaconteurWriting.com</a>.​<br><br></p>2022-11-22T05:00:00Z<img alt="" src="/Topics/Guest-Columns/PublishingImages/2022/OliviaSavoie.jpg" style="BORDER&#58;0px solid;" />Caregiving;Assisted LivingOlivia SavoieOver the years, I experienced a multitude of other names, faces, and interactions. I played the harp. I helped with writing memories. I listened. I learned.
CEO of AHCA/NCAL Mark Parkinson on Changing Long Term Care for the Better<p> Mark Parkinson, the president and CEO of the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), recently joined the <a href="https&#58;//ltcheroes.com/" target="_blank">LTC Heroes</a> podcast to discuss the work that he and his team are doing to improve the lives of seniors. </p><p>“We want to create great experiences and a great setting for our residents while they're alive,” he said. He shared with <a href="https&#58;//experience.care/" target="_blank">Experience Care</a>’s Peter Murphy Lewis the innovative measures AHCA has taken to help make care more accessible. Parkinson also told how AHCA is advocating for fairer wages for long term care employees. You can watch the entire interview below&#58;<br><br> </p><center><iframe src="https&#58;//www.youtube.com/embed/4RGLVZNvJSw?enablejsapi=1&amp;origin=https&#58;//www.providermagazine.com" title="&quot;Advocacy for LTC&quot; Mark Parkinson - President &amp; CEO at AHCA" allowfullscreen="" data-gtm-yt-inspected-32388671_20="true" id="772703113" width="560" height="315" frameborder="0"></iframe></center> <br><br>One important step to fulfilling those goals is pushing for reasonable regulations. “We're advocating against negative regulatory proposals, like the idea of requiring 4.1 hours of direct care per resident, whether the money is provided or not,” he said. “At the same time, we're trying to help states so they can continue to receive Medicaid increases by maximizing provider recovery at the state level.”<p></p><p>Still, there is much to be done in terms of filling out long term care teams. That is why Parkinson embraced an innovative idea that came from AHCA’s director of clinical and regulatory services, Pamela Truscott. She proposed developing a temporary nursing aide program in which individuals could be trained in eight to twelve hours. “We put the program together under Pam's leadership, took it to CMS, they approved it, and put the training up on our website for free, even for non-members,” he said. “Over 300,000 people have taken the training and over 200,000 are working in buildings.”</p><p>Lastly, AHCA works hard to ensure that caregivers are compensated fairly. So when the CMS proposed a 2 percent payment cut, Parkinson and his team got to work. “We went to our members and told them that we need to pull together to fight this,” he said. “We submitted 6,920 unique comments and changed their minds.” The result? “They went from a 2 percent cut to starting this October with a 2.7 percent increase. And it’s just a beautiful example of what can happen when we all pull together and get our message out.” It is that sort of collaborative spirit that drives AHCA forward everyday as part of a mission to improve the lives of America’s older adults and those who care for them.<em><br></em></p><p> <em>Cameron Zargar, Ph.D., is the director of content and editor-in-chief of the Experience Care website.</em><br></p>2022-11-16T05:00:00Z<img alt="Mark Parkinson" src="/PublishingImages/Headshots/MarkParkinson.jpg" style="BORDER&#58;0px solid;" />QualityCameron Zargar, Ph.D.Parkinson recently joined the LTC Heroes podcast to discuss the work that he and his team are doing to improve the lives of seniors.
4 Strategies to Bring Population Health to Your Food and Nutrition Services Program<p><img src="/Breaking-News/PublishingImages/headshots/LisaRoberson.jpg" alt="Lisa Roberson" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​It’s not enough to just care for patients inside our facilities. We must think bigger these days—for the good of the patient, community, and our organization. That’s where population health comes in. It has long been a buzzword, but as an industry, we have an opportunity to bring the concept to life. Skilled nursing and long term care facilities can learn from other areas of the health care industry to fully integrate population health programs into their food and nutrition services.</p><p>Population health initiatives are an important factor in caring for an entire community, but they also can have a tangible impact on a long term care or skilled nursing facility’s finances by controlling costs, improving outcomes and increasing patient satisfaction scores. Here are four key points to drive success through integrating population health within food and nutrition services.<br></p><h3>1. Invest in a sustainable supply chain.</h3><p>Where our food comes from matters. It matters from a freshness and taste perspective. It matters from a health perspective. And it certainly matters from a sustainability perspective, which recently came to light during COVID when our supply chains were strained.</p><p>Food travels an average of 1,500 miles to get from the farm to your plate. That leaves a significant carbon footprint. In all, food production is responsible for a fourth of the world’s greenhouse gas emissions. That is not sustainable.</p><p>We need to create a cleaner, greener supply chain. That journey starts with sustainability of logistics, produce sourcing, and packaging. By purchasing locally, long term care facilities can source produce that is picked and eaten at the peak of ripeness, which means it is denser in nutrients and, thus, more nutritious. This leads to a sustainable sourcing model as well as a successful business infrastructure in the community. In addition, diversifying suppliers through both number of sources and social backgrounds has proven to be a successful approach to promote sustainability.</p><p>A sustainable supply chain is more than just an environmental initiative or way to promote goodwill in the community. It is a smart business move. It is caring for the population as a whole and creating channels to get the critical resources you need to care for patients.</p><h3>2. Rethink menus.</h3><p>Creating healthier populations from a food and nutrition services perspective starts with our first touchpoint—patient dining. We need to create healthy options that foster wellness. That means no antibiotics or growth hormones, while encouraging fresh produce and low-fat proteins. All this needs to be done while maintaining delicious flavors. Menu creation can be the first step in a population health strategy.</p><p>One area where I’m seeing significant growth is with plant-based diets. Studies have shown the advantages of a diet rich with plant-based food, including lower abdominal fat, cholesterol, blood sugar, and BMI compared to study participants consuming a diet of predominantly animal protein. And 58 percent of consumers say they want to increase their plant-based protein consumption.</p><p>Rethinking our menus and taking particular care to craft dishes focused on fitness can lead to both immediate and long term improvements in patient wellness. It’s about showing them healthier options outside of their current diet. Patient dining is the first opportunity to start that conversation.</p><h3>3. Think beyond the four walls of your facility.</h3><p>We have an opportunity to impact community wellness long past a patient’s stay. That means thinking beyond the four walls of the facility and getting facts about nutrition and its impact on wellbeing to the community. The first step of this is to change patient perceptions about healthy eating, which can have a trickledown effect on others in the household. </p><p>It can be intimidating trying to cook healthy food. Facilities have an opportunity to teach the community about the benefits of healthy eating and how to bring it to life. Setting up a teaching kitchen with your onsite dietitians or culinary staff can provide confidence for in-home cooks and empower them to live healthier lives. Some hospitals have taken this to the digital space with instructional cooking videos that are featured on social media or local news.</p><p>Even armed with the right information, there are barriers to living a healthy lifestyle. Too often underserved communities do not have access to the nutritious food that is critical to establish long term healthy habits. A programmatic approach from the facility can be expensive, but it doesn’t have to entirely come out of your already thin margins. For example, I have seen facilities invest in mobile grocery stores that are funded through grants and community fundraising. These grocery stores-on-wheels provide fresh ingredients to areas that otherwise would not have access to them, helping to eliminate food deserts.</p><h3>4. Create programs to reduce waste.</h3><p>Food waste is everywhere in the U.S. with approximately 40 percent of food produced ultimately being wasted. Health care leaders sit in a prime position to make a quantifiable impact on the industry and community. Controlling food waste makes you a better steward of your resources and helps to manage your business in a sustainable way.</p><p>While we can’t eliminate food waste entirely, we can minimize it and turn waste into community benefit. Many hospitals partner with local organizations to donate excess food. They set up composting sites to better utilize the existing waste and repurpose that waste through gardens that provide produce for patients. Additionally, being mindful of ingredients and how they are prepared impacts waste. I love to see facilities adopt a “root to stem” strategy to use the entirety of their ingredients instead of throwing out large portions of useable produce. </p><p>New technology features can be used to drive waste reduction. Through enhanced analytics, we can better track and record food waste types, amounts, and ultimate destinations (e.g., donation, composting, landfill). Through this data, facilities receive valuable insights to create new strategies to address food waste at the source. Some have been able to decrease their food waste by nearly 50 percent by utilizing technology to make better, more informed decisions.</p><p>Food and nutrition services can drive a new, healthier perspective for the community because it takes more than just a clinical approach to care for a population. The foodservice team plays an important role in supporting and assisting long term care and skilled nursing facilities to establish and expand population health programs that have many far reaching and sustained benefits for patients and communities.<br><br><em>Lisa Roberson, RDN, LD, is national director of wellness &amp; sustainability at Morrison Healthcare. She is a registered dietitian with 20 plus years of experience in nutrition leadership.</em></p>2022-11-15T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/food.jpg" style="BORDER&#58;0px solid;" />Population Health ManagementLisa Roberson, RDNSkilled nursing and long term care facilities can learn from other areas of the health care industry to fully integrate population health programs into their food and nutrition services.
5 Ways to Reduce the Risk of Falling in Your Community<p>​<img src="/Topics/Guest-Columns/PublishingImages/2022/GlenXiong.jpg" alt="Glen Xiong" class="ms-rtePosition-2" style="margin&#58;0px;width&#58;138px;height&#58;138px;" />​Over the last year, senior care providers have faced many new challenges and opportunities. While advances in <a href="https&#58;//www.forbes.com/sites/sarazeffgeber/2022/08/15/covid-brought-a-much-needed-tech-infusion-to-the-lives-of-older-adults-at-home-and-senior-living-communities/?sh=4cbb501368a4" target="_blank">robotics</a>, artificial intelligence, and other technologies are helping provide better care for seniors, new <a href="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/AL-Survey-June2022.pdf" target="_blank">research by the National Center for Assisted Living</a> found that more than half of senior care providers say their overall workforce situation has worsened since January 2022. In fact, the same survey found that 63 percent of assisted living communities are experiencing staffing shortages, and a staggering 98 percent have asked staff to work overtime or extra shifts due to the staffing shortages.</p><p>Without the right support, these issues leave providers with less oversight, which makes it difficult to maintain the same quality of care. For assisted living communities, that unfortunately means more falls are likely to occur.</p><p>According to the Centers for Disease Control and Prevention, <a href="https&#58;//www.cdc.gov/injury/features/older-adult-falls/index.html" target="_blank">a person falls every second</a>, and for those living with dementia—who often need to be cared for in assisted living communities—that number doubles. Falls are truly happening all the time, and they're a source of significant concern for care providers. Even more distressing, older adults with dementia are often unable to describe how they fell, making post-fall response and prevention challenging for caregivers and distressing for family members. I know because as a doctor I've seen this firsthand. However, I have also learned that falls don't have to be inevitable. Here are five ways care providers can reduce the fall risk in their communities.</p><p><strong>1.</strong>&#160;&#160;&#160;&#160; <strong>Keep an eye on medications that increase fall risk.</strong></p><p>One of the first steps caregivers should take to protect residents from falls is understanding their medications. That's because some pain medications—particularly narcotic medications—can cause problems with coordination, making someone more prone to falling. Similarly, psychotropic medications can also increase the risk of falls—especially antipsychotics. Anyone that is taking these kinds of medications, or is caring for someone taking them, should be aware of this heightened fall risk and make changes to their environment accordingly.</p><p><strong>2.</strong>&#160;&#160;&#160;&#160; <strong>Stay consistent with staffing.</strong></p><p>As I mentioned earlier, providers across the US are struggling with staffing, which is likely to increase fall risk at assisted living communities. That's because for people living in a senior care community, staffing patterns can be a source of disruption or one of calmness and stability.</p><p>When we think of staffing disruptions, it could be anything from shift changes to staff members missing their rounds and disrupting a patient's usual routine. This can leave a patient feeling confused, neglected, or uncomfortable, which are emotional triggers that can easily instigate anxiety, increased movement, and ultimately, falls.</p><p>This is why our current staffing shortages are such a critical issue for assisted living communities; without the right staff, quality of care decreases.</p><p><strong>3.</strong>&#160;&#160;&#160;&#160; <strong>Watch out for sleep disruptions.</strong></p><p>When a person's sleep cycle is disrupted, they have a greater risk of falling. In an assisted living community, it's important for caregivers to ask questions like, “What can we do to manage or fix sleep disruptions?&quot; For instance, something as simple as monitoring the thermostat could prevent someone from waking up and falling on their way to get that extra blanket. Additionally, ensuring that a person is not sleeping excessively during the day and is engaged in meaningful activities will ensure better sleep at night.&#160;</p><p><strong>4.</strong>&#160;&#160;&#160;&#160; <strong>Be aware of the time of day, week, and year.</strong></p><p>Keeping in mind the time of day, week, and year can help prevent falls, because we know some falls happen more often at certain times.</p><p>For instance, “sundowning&quot; is a term we use to characterize the increased confusion or agitation that some aging people experience in the late afternoon or early evening. This can sometimes lead to more anxious and aggressive behavior, including shouting, cursing, and running around. This is a time for extreme risk of falling, and caregivers need to plan accordingly.</p><p>Based on data during the pandemic, most falls happen on Saturday. In fact, the least falls happen on Sunday and then they trend up during the week. We think this happens because of a few factors, including staffing patterns, family visits (with more happening on the weekend), and spiritual engagement (decreasing the number of falls on Sunday).</p><p>Falls occur more often during the spring and summer than during colder months. Some believe cold weather reduces fall risk because residents have slower mobility and might be more stiff. Others believe it's because the colder weather makes people less active as they stay bundled up, reducing their fall risk. Whatever the case, care champions should be aware of how these changes impact fall risk.</p><p><strong>5.</strong>&#160;&#160;&#160;&#160; <strong>Understand patients to understand the cause of cognitive disorientation.</strong></p><p>Anyone with cognitive impairments is at greater risk of falls. Part of the reason for this is because cognitive disorientation often leads to agitation and to difficulties with balance as people get anxious, putting them at greater risk of falling.</p><p>Caregivers can help prevent falls in their patients by getting to know them. Something as simple as knowing their hobbies, family background, and personal history can help caregivers understand what's behind their cognitive disorientation—and thus, help mitigate fall risk because of it.</p><p>For example, I once took care of a mail delivery person with dementia, which meant he was used to large amounts of walking as part of his vocation before he started living in the care facility. With that in mind, he needed to be given plenty of space and time to walk the facility—just as he had walked his mail route—so that his energy was appropriately expended during the day. Then, he would naturally sleep better at night.</p><p>Similarly, it is important to avoid sedating medication during the day that would cause a person to sleep during the day but pace at night. “Agitation&quot; often occurs if this person is not given ample opportunity for physical activity.</p><p>Between fall risks, staffing shortages, and an aging population that's constantly getting bigger, assisted living communities certainly have plenty to worry about. Falls, however, don't have to feel like an unsolvable problem for senior care providers—not when the right steps are taken to help prevent them.</p><p><em>Glen Xiong, MD</em><em>, is chief medical officer at SafelyYou. He is certified by the American Medical Directors Association in Post-Acute and Long-term Care Medicine (2006, 2016). He provides clinical care at the UC Davis Medical Center and in skilled nursing and assisted living facilities.​</em></p>2022-11-07T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/fall_risk.jpg" style="BORDER&#58;0px solid;" />FallsGlen XiongAccording to the CDC, a person falls every second, and for those living with dementia—who often need to be cared for in assisted living communities—that number doubles.