Q: How long have you been a GSA member?
A: Five years.
Q: How specifically has membership in GSA benefitted you?
A: As an advocate for older adults, people with disabilities and their caregivers, I’ve found GSA to be an excellent resource for my efforts to oppose the effects of ageism in all it’s forms, but especially in efforts to champion improvement of long-term living and care. I believe that membership in GSA, or any organization, works two ways – benefits received AND benefits one can contribute to others. Consequently, I’ve authored some articles through the GSA Connect Open Forum to share my advocacy efforts with others as well as learn from others in GSA.
Q: How did you get interested in the field of aging?
A: As one who is fortunate enough to be among the aging, I am naturally interested in the field. Like many older adults, I have personally experienced the effects of ageism. However, the experience of COVID-19, clearly focused my attention by the outsized impact of the pandemic on older adults, especially those in nursing homes. I was angered by the failure of most nursing homes in caring for their residents and the failure of government to provide sufficient oversight. This failure led me to write an opinion piece in GSA that was also published in local media. The public reaction that the op-ed received, put me in touch with other like-mined aging professionals and resulted in my co-founding Dignity Alliance Massachusetts and, later, to being elected to the Leadership Council of the National Consumer Voice for Quality Long-Term Care. GSA has become one of my primary resources for policy and advocacy.
Q: What projects are you working on in your current position?
A: Probably my top priority projects are 1) co-leading a campaign to raise the personal needs allowance for nursing home residents which we’ve called, “A Raise for Mom,” 2) supporting efforts to increase nursing home staff, and 3) urging government to do its job of providing oversight of long-term care.
The Personal Needs Allowance (PNA), which is the amount money nursing home residents are permitted to keep to spend on personal care and dignity, needs not addressed by nursing homes. The federal minimum allowance of $30/month hasn’t been increased since the nursing home reform act of 1987, and the limits that states can supplement that amount have also been capped at $200/month. Inflation has vastly curtailed the spending power of the PNA as evidenced in a recent journal article in JAMA by Professors Paul Shafer and Monica Answani.
Nursing home staffing issues are fundamentally the failure of nursing homes to address low pay and high workload that led to insufficient staff as required by law, resulting in poor care and, even, elder abuse. For the most part, it’s less a matter of low government reimbursements and more a matter of profits over residents since the long-term care industry has proven profitable for private equity investors. Recent analysis by the Long-Term Community Care Coalition of New York reveals that a whopping 90% of the nation’s nursing homes fail to meet minimum staffing regulations.
Government oversight of long-term care is a critical issue as well. The Inspector General of the U.S. Department of Health and Human Services has found that more than half of the states “repeatedly failed to meet requirements for conducting nursing home surveys.” Most states failed at least one nursing home performance measure in the four-year period (the total number of nursing home measures ranged from 11 in FY 2017 to eight in FY 2018) and 28 states missed the same performance measure over three or four consecutive years, including 13 states that missed multiple measures in three or four consecutive years. The most common performance measure that states failed was the timeliness of nursing home surveys, with 41% of state failures related to two timeliness measures:
• 23% of timeliness failures reflected failure to survey high-priority complaints within 10 days; 17 states failed this performance measure in all four years.
• 18% of timeliness failures reflected failure to conduct standard surveys at least every 15 months (with a statewide average of 12 months between standard surveys); six states failed this performance measure in all four years.
CMS and states agree that shortages of surveyors and other staff “were root causes for many of the performance problems and that CMS has few options to address these problems.”
My efforts have documented similar failures of oversight in my home state that are among my top projects that I’m working to address through my advocacy.
Q: What do you love most about your line of work?
A: I find that my advocacy at the state and national levels, despite many obstacles, including lack of awareness from policy-makers and the effects of ageism, is making a difference in the lives of older adults. It gives me a definite sense of purpose – something we all need to feel self-worth!
Q: What was the best piece of advice you got early on in your career you’d like to pass on to emerging gerontologists?
A: Even experts don’t know everything they need to know. Learning is a lifelong adventure, and we must constantly be open to new evidence-based information.