- Written by Nour Elkhattaby Strauch, Age-Friendly Program Manager
In October of last year, LifePath launched the Age- and Dementia-Friendly Communities project in Franklin County and the North Quabbin, a community-led effort that aims to bring about policy and systems-level change to make the region more liveable for people of all ages, especially older adults. This 3 to 5 year project has been implemented in hundreds of communities worldwide, including almost 70 municipalities in Massachusetts. Successful projects from across our state have begun various measures to make it easier to age in place, including changes to the built environment and zoning laws, and training local businesses and service providers to be more aware of the needs of older people and those who live with dementia.
Based on WHO/AARP’s 8 domain model, the project starts with collaborating with local select boards to enroll in the Age-Friendly Communities Network, then moves on to a needs assessment phase, an action planning phase, and finally an implementation phase. But prior to any of these phases, the project really starts with ensuring that the community knows about and takes the lead in shaping the process.
During these first few months, our work was focused on doing community outreach to promote and gain support for the Age- and Dementia-Friendly project, and to recruit key community stakeholders as drivers and leaders of these efforts. By design, the project requires strong community participation and leadership so that our efforts are reflecting and responding to the most relevant needs.
To date, we have directly engaged over 100 regional stakeholders including local officials, healthcare and mental health professionals, staff and directors of senior centers and councils on aging, Village Neighbors members, LGBTQIA+ elder advocates, regional planners, transportation and housing professionals, the interfaith community, non-profit staff and leadership, and other civic-minded community members.
Many of these individuals had heard about age-friendly communities in other parts of the state or the country and expressed a lot of enthusiasm about bringing this initiative to Franklin County and the North Quabbin; and even the people who had not heard about the project before were very supportive of this work, recognizing how important it is create systems that can help us live in dignity and continue contributing to the success of our communities as we age.
Through these interactions and the follow-ups thereafter, we have formed a regional steering committee made up of 13 stakeholders who come from different parts of the region and who are active in all of the 8 age-friendly domains. This team will be meeting regularly to coordinate the project’s efforts and to ensure that its priorities reflect those of older adults in our area.
Having established our steering committee, the Age-Friendly project will continue to work with the larger community to promote age- and dementia-friendly practices. More specifically, we have two main objectives for the coming period: working towards enrollment in AARP’s network, and offering age- and dementia-related training programs.
Please reach out to us if you would like your selectboard to host a presentation in the coming weeks, or if you would like to learn more about bringing this project to your town.
As part of the enrollment process into AARP’s Network of Age-Friendly States and Communities, we need to work with area selectboards to issue Letters of Commitment requesting entry into the network and affirming our intention to make Franklin County and the North Quabbin a more age- and dementia-friendly region. The support of our elected officials is highly important in a project that aims to work on policy and systems change. Please reach out to us if you would like your selectboard to host a presentation in the coming weeks, or if you would like to learn more about bringing this project to your town.
At the same time that we are engaging local elected officials, we will be working with other sectors of the community through age- and dementia-friendly trainings. We will offer and promote training sessions for the general public, as well as some sector-specific trainings for first responders, customer service staff, transportation workers, and others. Allies of the Age- and Dementia-Friendly project such as the Alzheimer’s Association and the Massachusetts Healthy Aging Collaborative will bring their vast experience to many of these opportunities.
Despite the challenges one might expect to successful community engagement during this time of social distancing, the Age- and Dementia-Friendly project has been met with a lot of excitement, support, and belief in our region’s potential to be a better place to grow older.
- Written by Janis Merrell
2020 was a very difficult year for nursing home and rest home residents. COVID-19 hit this community of vulnerable individuals particularly hard. That’s why Trevor Boeding, MPH, Long-Term Care Ombudsman Program Director at LifePath, decided to bring joy to as many residents as possible by collecting cards for people living in one of the seven nursing homes and rest homes in the LifePath service area. Cards could be handmade or store-bought, had to be gender neutral, and could not refer to any religious holiday.
According to Boeding, “Residents [at long-term care facilities] have experienced disproportionate burdens of disruption, illness, and death related to COVID-19. Stringent visitation curtailment has led to increased levels of social isolation and physical estrangement from family, friends, and loved ones. In addition, many residents have experienced a great deal of upheaval in their physical surroundings and changes in staffing and routines.”
“I hope that residents get the sense that there are many people in the community who are thinking of them and sending them well-wishes and support.”
Due to the Commonwealth's visitation restrictions, the Ombudsman program has not been able to visit with residents in person on a weekly basis. The program was able to successfully shift to connecting with residents virtually, but this type of connection has posed difficulties and has its own shortcomings.
Boeding was inspired to create the card shower project by a meme his wife sent him that encouraged focusing on love instead of focusing on worry, self-doubt, guilt, and anxiety. “Several hours after I looked at the meme, it just came to me—focus on love. I asked myself how to convey this message of love to residents, and the idea of showering them with cards came to me,” Boeding explained.
People could mail the cards to Boeding, or drop them off at a card donation box left outside LifePath’s offices. According to Boeding, the outpouring of support was “amazing,” with a final tally of 427 cards and 100 hand-folded origami cranes which, according to the website JapaneseSalon.nl, represent good fortune and longevity in Japanese, Chinese, and Korean culture.
Cards were contributed by LifePath staff and volunteers, and by the community at large. While most of the support came from the Western Massachusetts area, cards were received from across the Commonwealth and from as far away as Oregon. Gill Elementary School submitted a number of handmade cards created by students. The Erving Senior Center contributed close to 50 cards.
Enough cards and origami cranes were received for almost each and every resident living in a long-term care facility in the LifePath service area. Cards and cranes were delivered by Wednesday, December 23, to social work and activities staff for distribution at Applewood Home for Elders and Quabbin Valley Healthcare in Athol, Farren Care Center in Turners Falls, and LaBelle's Rest Home in Shelburne Falls. In Greenfield, Charlene Manor Extended Care Facility, Buckley Healthcare Center, and Poet's Seat Health Care Center received cards.
“The Ombudsman program at LifePath sends a great big ‘Thank you!’ to each and every one who contributed to this effort: LifePath senior management, staff and volunteers, community members, and the staff at the local long-term care facilities who facilitated the distribution of the cards and cranes,” said Boeding.
“I hope that the card shower brought some light and hope into the lives of the residents who received them. I hope that residents get the sense that there are many people in the community who are thinking of them and sending them well-wishes and support. I hope the cards also serve as a reminder that, although their Ombudsman has not been allowed to make weekly visits, the program at LifePath is very much alive and well. The card shower may remind residents that the Ombudsman program still cares about the quality of their care and the quality of their lives and is still very much available for advocacy with regard to specific concerns.”
- Written by Janis Merrell
Vaccinations offer hope in ending the pandemic
The end of 2020 ushered in hope, first with the announcement that COVID-19 vaccinations had been approved, and then with the start of administration of the vaccine across the country, including in Massachusetts. We are currently in Phase 1 of a three phase vaccination plan. COVID-19 vaccinations continue for COVID-facing health care workers, and as of December 28, residents and staff of long-term care facilities began receiving vaccinations.
Vaccines have very high safety standards, and the vaccines in development to prevent COVID-19 are no exception.
According to mass.gov, during Phase 1, which will last until February, vaccinations will be administered to individuals in the following order of priority:
- Clinical and non-clinical health care workers doing direct and COVID-facing care (including COVID-19 testers; COVID-19 vaccinators, and support staff for a COVID vaccination clinic; Medical Reserve Corps who are called up to vaccinate or other COVID-facing direct care work; COVID-facing hospice/palliative care professionals; COVID-facing laboratorians; COVID-facing imaging professions; and emergent employees manufacturing COVID vaccine)
- Long-term care facilities, rest homes, and assisted living facilities
- Emergency medical services, police, and fire (including all interfacility transport workers and MedFlight staff)
- Congregate care settings (including corrections and shelters)
- Home-based health care workers (including PT/OT/SLP therapists who work with medically complex home students)
- Health care workers doing non-COVID-facing care (including dentists/dental students, medical students, physical therapists, interpreters who work in hospitals, behavioral health clinicians not already covered in congregate care or direct care, laboratorians, blood donation workers, organ donation procurement workers, hospice/palliative care professionals, imaging professionals, dialysis center workers and patients, audiologists and speech and language pathologists, and podiatrists)
Phase 2 will begin in February 2021 and will last until March 2021. Vaccinations will be administered in the following order of priority:
- Individuals with 2+ co-morbid conditions which put them at high risk for COVID-19 complications (including individuals with cancer, chronic kidney disease, chronic obstructive pulmonary disease, heart conditions, a weakened immune system from solid organ transplant, obesity, severe obesity, sickle cell disease, diabetes, people who smoke, and women who are pregnant)
- Other workers (including early education; K-12; transit; grocery; utility; food and agriculture; restaurant and cafe workers; employees across the food, beverages, agriculture, consumer goods, retail, and food service sectors; meatpackers; sanitation, public works and public health workers; vaccine development workers; food pantry workers; Uber/Lyft/rideshare services/pharmacy delivery drivers, workers in the passenger ground transportation industry; convenience store workers; and water and wastewater utility staff)
- Adults 65+
- Individuals with one co-morbid condition (examples listed above)
Phase 3 will begin in April 2021, when the vaccine is expected to be available to the general public.
The National Institutes of Health (nih.gov) says vaccines have very high safety standards, and the vaccines in development to prevent COVID-19 are no exception. Vaccines are approved by the FDA for use only if they have proven safe and effective in a large group of people.
Although the search for and development of the COVID-19 vaccines is happening very quickly, the FDA has made the safety standards and approval process even tougher than usual. The FDA set minimum requirements for the effectiveness of products to approve only those vaccines that could offer immunity to the majority of the population.
According to the Centers for Disease Control and Prevention (cdc.gov), a COVID-19 vaccination will help protect you from getting COVID-19. Two doses are needed. Depending on the specific vaccine you get, a second shot 3-4 weeks after your first shot is needed to get the most protection the vaccine has to offer against this serious disease.
While you may have some side effects after being vaccinated, this is a normal sign that your body is building protection. The side effects from COVID-19 vaccination may feel like flu and might even affect your ability to do daily activities, but they should go away in a few days.
Also, cost is not an obstacle to getting vaccinated against COVID-19. Vaccine doses purchased with U.S. taxpayer dollars will be given to the American people at no cost. However, vaccination providers may be able to charge administration fees for giving the shot. Vaccination providers can get this fee reimbursed by the patient’s public or private insurance company or, for uninsured patients, by the Health Resources and Services Administration’s Provider Relief Fund.
While COVID-19 vaccines are one of many important tools to help us stop this pandemic, according to the CDC, it’s also important for everyone to continue using all the tools available as we learn more about how COVID-19 vaccines work in real-world conditions. This means that even once we receive both doses of the vaccine, we will still need to cover our mouths and noses with a mask when around others, stay at least 6 feet away from others, avoid crowds, and wash our hands often.
Older adults are playing a critical role in ending the COVID-19 pandemic through their choice to get vaccinated. If you have additional questions about receiving the vaccine, your healthcare provider can help.
- Written by Attorney Seunghee Cha; Bulkley, Richardson and Gelinas, LLP; Hadley, MA; 413-256-0002
Medicare turned fifty-five years old this year. The national health insurance program, which covers Social Security recipients 65 years old or older and certain individuals with permanent disability, among others, is credited for playing a significant role in reducing poverty. Over the years, the program has expanded to include benefits such as home health care, durable medical equipment, and hospice.
Health care providers tend to misconstrue the law, believing that improvement is a requirement for coverage for skilled care.
Among Medicare’s benefits is skilled care for nursing home care, outpatient therapies, and home health care. The rules governing coverage vary depending on the care setting. For example, skilled care under Part A requires at least 3 days of inpatient hospitalization and a maximum coverage of 100 days in a benefit period. Skilled care as part of home health services under Part B is available to people who are homebound, without the institutional requirement or a 100-day limit.
Skilled care is nursing and physical, occupational, and speech-language therapy services that can only be performed safely and effectively by or under the supervision of professionals to treat, manage, observe, and evaluate a patient’s conditions and care. (Skilled care should not be confused with custodial care in nursing homes for room and board and assistance with activities of daily living—Medicare does not cover custodial care.)
Under Medicare law, skilled nursing or therapy is provided to patients to improve their condition, maintain current capabilities, or prevent further deterioration. Unfortunately, beneficiaries, particularly those with longer-term or chronic conditions, are often denied skilled care because they are not improving. Health care providers tend to misconstrue the law, believing that improvement is a requirement for coverage for skilled care.
Due to the widespread, wrongful denial of skilled care around the country, in 2011 Medicare advocates filed a class action lawsuit against the Centers for Medicare & Medicaid Services (CMS). The case, Jimmo v. Sebelius, was settled in 2013; as part of the settlement CMS issued a clarification of the law that skilled care coverage includes services to maintain a beneficiary’s current capabilities and to prevent further decline even if the beneficiary does not improve. CMS was also required to conduct an educational campaign to Medicare providers and adjudicators.
Several years after the Jimmo settlement, Medicare beneficiaries still face denial of medically necessary skilled care. The application of the erroneous improvement standard persists, according to a recent national survey of Medicare providers and adjudicators.
If you receive Medicare, or you are an advocate for a Medicare beneficiary, you need to know the right to medically necessary skilled care. These services are crucial to helping people reduce their risk of falls and hospitalization, maintain activities of daily living, regain independence, or effectively adjust to new levels of self-care.
- Written by Barbara Bodzin, Executive Director
Death is an inevitable fact that most people find hard to contemplate and discuss with others. Yet, one of the best inheritances you can give your loved ones is a clear plan of what your choices are. Advanced care planning is about making thoughtful decisions now to ensure others understand your wishes if you’re unable to speak for yourself. Here are five key areas to focus on for having your say in what matters most to you.
One of the best inheritances you can give your loved ones is a clear plan of what your choices are.
End of life care, choosing a representative
The Health Care Proxy is a simple document, legally valid in Massachusetts, which allows you to name someone (an "agent") to make healthcare decisions on your behalf in the event that you are unable to make or communicate those decisions. You therefore need to provide your proxy with clear instructions as to what you do and do not want for end of life care. You can find a Health Care Proxy form and directions at massmed.org.
On the other hand, a MOLST (Medical Orders for Life Sustaining Treatment) form, is a medical document signed by both you and your health care provider, and is effective as soon as it is signed. For patients near the end of life in Massachusetts, MOLST is an official form which lets you discuss and document your choices for "life-sustaining treatments" — based on your own needs, preferences, and what is medically appropriate. It is recommended if you have a MOLST in place to also fill out a Health Care Proxy form to appoint your Health Care Agent.
Legal and financial matters
Bereft loved ones have enough to deal with emotionally and leaving financial matters in disarray puts an undue burden on family and can lead to tensions and disputes. If you pass away without a will, there are laws that may dictate the allocations of your estate. Drawing up a will with an attorney will uphold your wishes for the distribution of your money and possessions. Be sure someone knows where your will and your advance directive documents are located.
Consider donation of your organs to help another person, or help advance medical science. If this is something you want to do, make sure you document your wishes, tell your family, and speak with your primary care provider.
How you would like to be remembered
Are there letters you want to write to loved ones? What would you like people to know before you die? Do you want to finish a family tree, or family album? The time to do this is while you are still able. This is also a perfect opportunity to connect and collaborate with loved ones and pass along family history.
Have you thought about whether you would prefer to be buried or cremated? Perhaps you would like a green funeral rather than a more traditional one. Think about what kind of service you would like, and whether you want more of a celebration of your life rather than a conventional ceremony. What readings or music would you like to have, and who would you like to be there? Write down your preferences and share them with someone you trust, include these choices in your will, or make these arrangements directly with a funeral home.
End of life planning will provide you with peace of mind, knowing those you love will be spared the need to make these hard decisions during their time of grief. This deeply personal process will enable you to embrace the life you have lived and ensure your beliefs, values, and choices are honored.