Sunday, January 11, 2021 9:30 p.m. - It has been an eventful few weeks since Christmas, both at HillHouse and politically. On January 4th we began biweekly covid testing for all staff and that will continueuntil DHHS guidance changes. HillHouse expects to hear from Guardian LTC Pharmacy this week about our covid vaccine clinic date, which we so hope will be this week or next. We understand from news reporting that the vaccines are in the state, but the roll-out has been slower than expected. This Sun Journal article today is informative.
We currently have half of our 90 staff who have agreed to get the vaccine. Of course, we would like this number to be higher, but it is consistent with what has been seen across health care settings nationwide. Vaccine confidence is low as public health messaging targeted specifically to direct care workers has been lacking. We have encouraged family members to send letters of support to our staff and convey the sense of urgency that truly exists for families.
Covid is still rising around Maine and as a result residents must still refrain from all group activities. All staff continue to try and spend extra time with residents for socializing, but quiet days coupled with cold winter weather is challenging. We urge families and community members to reach out with cards and letters.
Thursday, December 24, 2020 8:30 p.m. - We are all working hard to maintain a tricky balance between being excited and energetic for the holiday and pressing the urgency to staff of being extra cautious at Christmas family gatherings. In the interests of keeping HillHouse safe from covid, we have asked staff to refrain from gathering with people outside their households or if they do gather, to be as careful as possible keeping masks on, maintaining physical distance, and practicing good hand hygiene. We have posted family cards and emails urging caution and expressing gratitude for staff efforts.Our HillHouse Heroes #SaveOurResidents campaign is underway and we have hung these posters throughout the building. We have heard from Guardian Long Term Care Pharmacy that skilled nursing facilities will be vaccinated before assisted living, so HillHouse will likely be scheduled for the covid vaccine clinic in mid-January. This depends, of course, on the supply of vaccine to Maine. As of this writing, supplies are less than requested and expected and there is uncertainty about how this will impact administration of the vaccine around Maine’s long term care facilities.
In the meantime, however, we are urging staff to read about vaccine safety and we have posted information and provided links to the CDC website. Many staff are concerned; despite the scientific community’s evidence of vaccine safety, there is so much disinformation on social media that people are easily caught up in it. We will continue to seek out ‘trusted others’ who can convincingly convey the message of vaccine safety for direct care workers. This fascinating podcast from MedPage highlights the troubling efforts that the anti-vax community has made to undermine confidence in the convid vaccine. mlc
Sunday, December 6, 2020 8:30 p.m. - It seems best to reinstate the Pandemic Blog now that covid cases are rising sharply throughout Maine and here in Sagadahoc County. Based on the current 28-day rates, Maine DHHS guidance requires long term care providers to again suspend all visits (except for window visits, including those in our sealed foyer), suspend group activities, and non-essential medical appointments. We are still allowed communal dining as long as residents are seated 6’ apart, as we have done all year. In addition, HillHouse staff are required to wear eye protection at all times when around residents, so we have offered staff a few options for safety glasses and face shields.
We are anxiously awaiting further news on vaccine distribution. There is mixed news this weekend out of Washington. The Trump Administration has said vaccine distribution for long term care settings will begin in late December or certainly by mid-January. The incoming Biden Administration sounds less hopeful and has expressed concern about the lack of a comprehensive vaccine distribution plan. While each state has submitted an Interim Vaccine Distribution Plan (click here for Maine’s), states are relying on the federal government’s procurement of the vaccine supply from the manufacturers and distributors once the FDA has approved them for emergency use. We are partnering with Guardian Pharmacy - our pharmaceutical supplier - to administer the vaccine. If Guardian is unable to do so, then Walgreens Pharmacy is the back-up provider.
This coming week we will prepare our internal covid vaccine administration plan modeled on the steps HillHouse has taken each year when CHANS administers the seasonal flu vaccine. We will poll the staff and encourage each of them to get the covid vaccine as soon as it is available so that residents are protected. We are searching for ways to persuade staff who may be hesitant and mistrusting of the speed in which the covid vaccine was developed.
The good news is that resident life is proceeding as normally as possible and the Social Services staff are rising to the occasion with 1:1 activities and hallway activities to keep the mood festive during this holiday season. Santa will be visiting at lunch on December 18th and handing out presents for all residents. Until then there will be lots of festive music, special holiday treats, and plenty of decorations. The staff are still doing short drives in town with just one resident at a time to see the holiday lights.
This is a good time for all family members and friends to send cards and letters -- they are good for the soul AND they provide another opportunity for staff to pay a visit to a resident! mlc
Many HillHouse family members know that I have been posting to this Pandemic Blog since the covid pandemic began in mid-March 2020. I will continue through the Fall and Winter, as we are seeing upticks in Maine cases, particularly in York County. This puts us all on higher alert.
Daily life at HillHouse, for the most, continues in a lovely rhythm of the changing seasons, though everything we do is tinged with unavoidable worry and sadness. We continue in our efforts to clean up and clean out exterior and interior spaces; work that was unattended in the frantic early months of the pandemic. We are very excited about our North Wing Garden project that is well underway and we are reviving the planned renovation of rooms G1 and G2 into a small suite that would be suitable for one resident who wanted more room space or a couple who wanted a separate bedroom and sitting area. Stay tuned.
There are efforts underway in many sectors - housing, education, employment, healthcare - to use intergenerational approaches to improve opportunities and outcomes for the several generations that come together to achieve many desired societal goals, such as reducing social isolation, ending ageism, growing the workforce, and improving quality of life.
This mixing of the generations offers enormous benefits for all and it will surely promote open-mindedness, tolerance, and understanding. People who reach the age of 65 now have a life expectancy of 86 years and older people now comprise two+ generations of people from the ages of 65 to 100+. If intergenerational programs and services are to be successful, younger generations must learn a few “rules of the road” for interacting with older people, including the oldest old, those over the age of 85, who may functional or cognitive limitations. Many younger generations have not spent significant amounts of time around older people, particularly those with impairments. What are the correct ways to engage with older people? How do you talk with someone who has forgetfulness or mild or advanced dementia; or someone who is hard of hearing, has poor vision, or has difficulty speaking?
The first “rule of thumb” should always be to inquire of the older person; ask about preferences, likes or dislikes directly and never assume. If the older individual can express a preference or has a specific request, it should be honored. Beyond that, here are a few basic suggestions that can apply to interactions with all older people, no matter their age or no matter the setting.
Tip #1: Use more inclusive, less judgmental language when referring to older people. Use of the term “elderly” or “the elderly” is associated with frailty and decline, which may not be representative of the person or people you are addressing. According to recent research by the FrameWorks Institute, a social change research institute, “older people” is the preferred term because it is inclusive and less associated with frailty and debility. Use of “older” confirms the relative aspect of aging, since we are all aging and there is no threshold-crossing at which time we become “old”, and use of “people” is the most humanizing; it is the lowest common denominator of our humanity.
Tip #2: Older people are not children and they do not want to be spoken to as if they are. This means refraining from calling them “sweetie” or “honey” or referring to their behavior as “cute”. While people may indeed be charmed by the wisdom and humor of some older people, it is our responsibility to recognize that older people have lived long lives, full of experiences and expertise and we should all be treated accordingly. Use of diminutive endearments is particularly common among caregivers; but just because some older people need assistance with some activities of daily life should not diminish their stature as an autonomous person with years of accumulated experience, wisdom, and knowledge.
Tip #3: Speak directly to the older person. In any conversation with mixed ages, speak directly to the older person and do not address questions about the older person to someone else in the room, even if that person has decision-making authority. We often talk over older people, forgetting that they have feelings, opinions, and decision-making autonomy, and that they command the same dignity and respect as everyone else -- perhaps more.
Tip #4: Make older people visible. Older people tend to be invisible in a youth-obsessed culture, so be sure to actually see and acknowledge older people in whatever setting you encounter them. This means greeting them, engaging with them, consulting them, and listening to them when they speak. Older people have much to offer and much to teach us about growing old, and growing very old, in our society. We have been slow to learn these lessons, so we must catch up.
Tip #5: When engaging with someone with any cognitive impairment, enter into their own reality. It is pointless to remind someone with dementia of the correct time, date, place, or surrounding circumstances. Doing so often causes greater confusion and anxiety for that person. If an older person with confusion asks the same question repeatedly, it is best to answer repeatedly without showing frustration or concern. If an older person with dementia thinks it is 1950, it is best to go along with that reality as best you can and as calmly and reassuringly as possible.
There are a few simple guidelines for engaging with older people who have physical impairments of any sort - mobility, vision, or hearing. For those with mobility challenges, ask them directly (if it isn’t obvious) whether and how you can assist them. Most people with support needs can and will ask for the help they need; do not automatically offer help if they seem to be managing fine. The exception would be those courtesies that we would offer anyone, such as opening doors.
For individuals with vision impairments, it is most helpful to describe the immediate environment, if it is relevant to the interaction, and be attuned to those things that must need to be seen in order to understand the situation. For example, if someone walks into the room, it is courteous to say to the person with the impairment, “Ms. ___ has joined us”.
Hearing impairments, like vision impairments, are on a spectrum, but it is usually best to speak clearly and more slowly, facing the person directly, and pausing slightly while talking. Avoid shouting; sometimes speaking in a lower tone of voice is helpful for some. Avoid situations where there is a lot of background noise.
Maine is the oldest state in the nation, by median age and we want to be at the vanguard of consistent, respectful, and dignified interactions with all older people.
Do you wonder if there is a difference between social isolation and loneliness? There is a difference, even though we often use the terms interchangeably.
Click on the image below to read this paper on why the difference matters.
Mary Lou Ciolfi, JD, MS, HillHouse's former Administrator, holds adjunct faculty positions at the University of New England and the University of Massachusetts, Amherst and teaches courses in Health Policy and Aging Politics, Policy & Law. She has particular interests in Ageism, Social Isolation and Loneliness in Older People, and End-of Life Care