March 2020

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Conversations with Ginny

"Diligence is the mother of good luck." -  Benjamin Franklin

The coronavirus is on everyone’s mind now, particularly since LeadingAge Georgia members serve older adults -- the population at greatest risk from the virus.  I’ve reached out to a number of members and asked what their pulse is and all have said we are buckling down on our infection control measures like we do for flu season. Our members are stepping up on preparedness and remaining calm.  

LeadingAge national is providing great information on infection control measures for our members.  Click HERE to stay on top of the latest information. National prepared recommendations specifically for HUD communities. Click HERE for information.

I reached out to Linda Kluge, executive director of Alliant Quality QIN-QIO, one of the best minds in the country for quality improvement in long-term care.  I asked Linda if our members need to be doing anything different than what they do for flu season.  She said they need to be diligent about their infection control practices like they are for flu season.   She said the information that the CDC and WHO is providing on prevention measures for the coronavirus is excellent and we should follow their recommendations.  

Click HERE for the CDC strategies to prevent the spread of COVID19 in long-term care facilities. The World Health Organization recommends visiting the following their WEBSITE regularly to keep up with their latest recommendations for preventing the spread of the virus. Our members are also advised to keep abreast of the recommendations from our state and local public health departments. See the article in the newsletter for more information on prevention measures.

As you probably heard, CMS announced they are suspending non-emergency survey inspections across the country so inspectors can focus on the most serious health and safety threats like infectious diseases and abuse.  CMS has provided guidelines for preventing the spread of the coronavirus in nursing homes.  Click HERE to ensure your community is following the latest CMS guidelines.

AMDA, the Society for Post-Acute and Long-term Care Medicine has provided recommendations of when staff should use surgical masks and eye protection and how to prioritize use of masks when supplies are limited. AMDA also recommends that if an individual meets the CDC definition of a suspected case, facilities should place the individual in a single room with a closed door pending consultation with their local health department. Click HERE to read all of their recommendations. The AMDA website is also a great source of information so we recommend you keep up with information on their website.

The LeadingAge Georgia/South Carolina conference is two weeks away and we are planning to go ahead with the conference unless the situation with the coronavirus worsens.  Keeping our members safe is important to us.  We are in conversations with the hotel for infection control measures.  We are adding a session on prevention and containment of COVID-19.  We’ll be sharing best practices from experts and some members are making their preparedness plans available so we can learn from each other.

The legislative session is in full-swing.  We’re working on the assisted living bill and it has passed the House and is in the Senate.  We testified before the House Health and Human Services committee and asked that they incorporate a quality improvement component to surveys rather than have a focus on fines.  Oregon has this type of initiative and my counterpart for LeadingAge Oregon reports it is improving care. Click HERE for the latest version of the assisted living bill.

We continue to work with the legislature on our request for funding for behavioral health coaches in HUD communities.  The funding will expand a pilot project started by our partner, the Atlanta Regional Commission. We’ll keep you informed as we move along in the legislative session.

We are hearing conversations that indicate we are in an environment on both the state and federal level that is focused on enforcement and fines.  LeadingAge Georgia will continue to work to promote a quality improvement approach rather than a punitive one and we will work on this with legislators and the Department of Community Health. We will work with our national office on the national level as well. We will also focus on providing on-going education that helps ensure quality care and well-being of residents and staff.  At the Southeast Finance Conference sponsored by Dixon Hughes and Goodman, keynote speaker Larry Minnix said “we are under invested in education.”  I continue to think that our members are the best of the best and fare well with surveys. We will be diligent about providing education and sharing best practices to address issues on which your community/organization is measured.

There is still time for LeadingAge Georgia members and your board members to join our Leadership as Governance series.  Contact me if you are interested in registering.

The newsletter has some great information from experts like the new studies by Mather Institute and highlights from the Dixon Hughes Goodman Southeast Finance Conference. I found the information very interesting and hope you do too.

Thank you for all you do to improve the lives of older adults and the staff who serve them.


Coronavirus Resources for LeadingAge Georgia Members

According to the CDC, it’s likely that person-to-person spread of the coronavirus will continue to occur, and it’s likely that at some point, widespread transmission will occur in the United States.    

LeadingAge national and the CDC have provided information that is specifically aimed to help prevent the spread of the coronavirus in long-term care settings.

LeadingAge recommends that you:

•Develop an internal message to proactively acknowledge the current situation, share accurate and relevant information about the coronavirus, and assure community members that you are taking all necessary steps to promote their health and safety.

•Refresh emergency contact lists for staff and residents, including contacts for family, caregivers, and health care providers.

•Ask your residents and responsible parties to ensure you have their most up-to-date POA and Advance Directive information

•Review your community’s protocol for protected health information of residents.

For suggestions for working with local hospitals, other providers and further guidance from LeadingAge click HERE. If you haven’t already, the CDC suggests that you post signs at the entrances of your community instructing visitors not to visit if they have symptoms of respiratory infection. The CDC guidelines for preventing the introduction of respiratory germs into your community click HERE.

The CDC indicated that persons with fever and lower respiratory illness with symptoms of a fever, cough, and shortness of breath could be considered a “COVID-2019 patient under investigation.” They suggest that long-term care facilities concerned that a resident, visitor, or employee may be a COVID-2019 patient under investigation should contact their local or state health department immediately for consultation and guidance. Click HERE for contact information on your local health department.

Cracking the Nut on Middle Markets

There’s a good bit of buzz about the expanding need for middle-market housing for older adults. We know that there is a growing number of older adults who make too much to qualify for affordable housing but not enough to afford most independent living housing options.

At the Southeast Finance Conference presented by Dixon Hughes Goodman, there was a panel discussion on the middle market. Someone asked who will be building middle market housing. Larry Minnix said it will be those who realize their mission is to serve older adults and they step up to meet the needs of those who need middle market housing.  
The panelists, Lisa Legeer of GlynnDevins, Lynn Daly of BB&T Capital Markets and David Ratchford of WellPointe Advisors, LLC reminded attendees that if we don’t build the middle market, the for-profit organizations will build them. The panel said we should not be afraid of the financial risks associated with the middle market. They reminded attendees that when building middle market housing there is typically a 5% development fee, a 5% management fee and the building value. Tax credit funding is being used for the development of the middle market communities.

The key to feasibility for the middle market according to the panel, is to buy the land cheap (sometimes churches have excess land), building no less than 120 units, smaller residences like 500 to 700 square feet for a one-bedroom unit, limited dining, shared services and shared spaces. Ideas for shared spaces include use of a swimming pool on a college campus or a nearby YMCA.

So far there are a limited number of mission-based organizations building middle market housing for older adults. National Church Residences is one of the early pioneers for this market. The panel suggested viewing a video about Givens Gerber Park to get more knowledgeable about the middle market. Check out this virtual tour to learn more about Givens Gerber Park:

Experts in housing and financing like Dixon Hughes Goodman, Ziegler, BB&T and HJ Sims are important partners for ensuring successful ventures into the middle market.

New Findings from “The Age Well Study” by the Mather Institute

More than 125 life plan communities located across more than 30 states are participating in the five-year Age Well Study. Mather Institute surveyed over 5,000 residents between January to May 2018 and then compared their findings to responses from a sample of 1,000 community-at-large older adults.  

The report shows that compared to community-at-large adults, life plan community participants have greater emotional, social, physical, intellectual and vocational wellness but lower spiritual wellness.

The report references the Lawton & Nahemow finding that “aging posits that it is the unique combination of competence and environment that determines an individual’s optimal function.” They point out that life plan communities offer opportunities for volunteering or joining a club and that these opportunities help replace the fulfillment a person experienced through professional roles. They also point out that these opportunities are more challenging to identify in the larger community.

According to the Mather study, regulation of one’s emotions is an important ability in maintaining wellness. The study showed that life plan community residents had better scores on six emotional wellness outcomes than older adults residing in the community at large and a less favorable score on one outcome. As compared to older residents in the community, residents of life plan communities scored higher for satisfaction with life and resilience, lower levels of depression but more depressive symptoms, more positive mood, moderately low levels of hopelessness, moderately positive attitudes toward aging, high levels of optimism, lower levels of pessimism, fairly low levels of stress, similar levels of perceived control and similar perceptions of subjective age.

The Age Well Study says that social connections and support have important implications for an individual’s physical and mental health. It also states that greater feelings of neighborhood cohesion are associated with enhanced mental well-being. The surveys showed that 69% of residents reported that moving to a life plan community somewhat or greatly improved their social wellness. Life plan community participants feel a strong sense of belonging to their communities, lower levels of loneliness compared to older adults from the community and more frequent social contact with friends.

The Age Well Study defines physical wellness as, engaging in physical activity, maintaining a healthy diet, appropriate utilization of health care as well as engaging in healthy behaviors like getting enough sleep and maintaining personal safety. Their report indicates that residents of life plan communities engage in vigorous, moderate, and mild levels of physical activity more than adults in the community at large. They also have better self-reported health and fewer chronic health conditions than older adults in the community as large.

According to the report, spiritual wellness includes seeking meaning and purpose, demonstrating values through behaviors such as meditation, prayer, contemplation of life/death, as well as appreciating beauty, nature and life. The report indicates that as a whole, life plan community participants have moderate levels of spirituality, lower than older adults in the community; however, life plan community participants in the Midwest and South are more spiritual than those in the West.

Intellectual wellness, according to The Age Well Study involves expanding knowledge and skills through a variety of resources as well as through stimulating and creative activities. They point out that intellectual programs were often related to improved cognitive health outcomes. The study reported that self-reported memory is higher for life plan community participants than older adults in the community at large. It also showed that life plan community participants engage more often in intellectual activities more than older adults in the community at large. They engage more in reading, doing word games, playing cards or games, writing letters or stories and significantly more in attending education or training.

According to The Age Well Study, vocational wellness refers to finding and pursing one’s calling in life. That can include personal and occupational interests through meaningful activities, volunteering and developing new interests or hobbies. According to the report, participants from life plan communities have greater sense of purpose in life than older adults in the community at large. They both report being moderately to very satisfied with their retirement satisfaction. Life plan community participants conduct volunteer work more often than older adults in the community according to the report but the two groups do not differ significantly in volunteer or charity work with children or young people.

The Age Well Study reported that respondents indicated that their social, intellectual, physical and, to a lesser extent emotional wellness have improved since moving to a life plan community. The study reported that spiritual wellness scores were higher for older adults in the community at large and recommended that life plan community staff may wish to reexamine opportunities in their community for spiritual wellness to ensure resident needs are met. Click HERE to access the Mather Institute website to read the entire report.

Register Now for Mental Health First Aid

Mental Health First Aid is an 8-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis. The evidence behind the program demonstrates that it does build mental health literacy, helping the public identify, understand, and respond to signs of mental illness.

Click HERE to register.

Want to Help Shape the New HUD Inspection Process?

As you may know, HUD has been working on an overhaul of their Real Estate Assessment Center’s physical housing inspection process.  According to HUD, the new National Standards for the Physical Inspection of Real Estate (NSPIRE) model aims to prioritize health and safety over appearance.  

HUD indicated that NSPIRE will focus on the areas that impact residents directly and aim to have more objective standards with scoring elements that are more defensible and less complex.

HUD is seeking participation in the demonstration of their new inspection model.  Feedback from participants will help shape the new inspection model.

If you choose to participate in the demonstration project, you will have the opportunity to participate in focus groups, listening sessions, conference calls and training sessions on policies and procedures.  You will also have a direct line to HUD.  

To learn more about the opportunity to participate in the demonstration, click HERE.

To read the Get NSPIREd newsletter click HERE.

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