<![CDATA[HillHouse Assisted Living - Blog]]>Sun, 25 Jan 2026 22:27:32 -0500Weebly<![CDATA[Solo Aging and Social Networks]]>Sat, 03 Jan 2026 18:09:57 GMThttps://www.hillhouseassistedliving.com/blog/solo-aging-and-social-networksOlder adults living alone and without immediately available family networks and support have historically been called "elder orphans" or "unbefriended elder" -- phrases that are ageist in their negative associations. More recently, however, social scientists are using the term "solo agers", which is inclusive, neutral, and can reflect both the challenges and the benefits of living alone in later life.

Our increased longevity, reduced family size, geographic distance from adult children and other relatives, and aging of rural communities have all contributed to increased numbers of older people aging solo. In a 2024 report, the Mather Institute estimated that as of 2021, as many as 28% of older adults are aging alone. Maine's Health Aging Data Report confirms that over 28% of adults 65+ are living alone and in some Maine communities, that percentage is as much as 65% (Farmingdale) or 57% (Blue Hill).

A recent study by the University of Maine Center on Aging involved talking with 34 solo agers in Maine, discussing both the challenges and the benefits of living alone in late life. Many solo agers - particularly older women who had raised a family - found living alone liberating from the demands and emotional labor of family life. Others said they felt more resilient and innovative as they figured out work-arounds for getting things done safely by themselves. 

More often, however, solo agers talked about their worries, including having an adequate social network to help with personal care if and when they might need it; to help with transportation to medical appointments; to help with healthcare and financial decisions including future housing or long-term care needs; and to arrange for affairs at or after death. Many solo agers who had lived alone for a long time had established networks, but those who were newly solo or who lived in very rural communities, were more challenged to create a reliable network. Several expressed a desire to connect with other solo agers - an indication that more can be done in Maine communities to help connect solo agers.
For a full report and for a comprehensive list of solo aging resources, visit the project website at https://www.soloagingresourcecenter.org/]]><![CDATA[Nursing Home & Assisted Living Staffing Challenges]]>Mon, 29 Sep 2025 11:56:02 GMThttps://www.hillhouseassistedliving.com/blog/nursing-home-assisted-living-staffing-challengesA recent Maine Monitor article highlights the closures of birthing units and nursing homes, health care organizations at each end of the life course. The reasons for these closures are a complex mix of public policy, demographic shifts, and long-standing system and institutional factors that marginalize women and older people. 

The public policy factors include low Medicaid reimbursement and pressures to increase staffing requirements. Medicaid (in Maine it is called MaineCare) pays for approximately two-thirds of Maine's nursing residents. This means that nursing home operators rely primarily on the established amount that the State of Maine reimburses for operational costs -- and this amount is inadequate to fully cover actual costs and pay staff a living wage. While Maine enacted legislation to increase the reimbursement for direct care labor to 125% of the state minimum wage, the Maine Center for Economic Policy determined this was insufficient to compete with other business sectors. Direct care work is physically and emotionally challenging compared to other work that is compensated at similar rates or higher. Many staff leave long-term care work and take jobs in less demanding sectors. 
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The demographic shifts have been playing out for decades. We are living longer, the baby boomers are aging into needing long-term care, and the birth rates have been dropping steadily. In addition, Maine's population growth was flat from 2011 through 2019. While the pandemic generated in-migration into the state, the lack of affordable housing has put downward pressure on additional growth. 

The primary reason that Maine - and national - nursing homes and assisted living homes resisted staffing increases proposed by the federal Centers for Medicare & Medicaid Services (CMS) and Maine's Office of Aging and Disability Services (OADS) was because operators are unable to fill current staffing needs, nevermind mandated increases in staffing. And increasing pay, as noted above, cannot be the answer. Many private pay assisted living organizations, like HillHouse, are unable to continue raising rates to cover increased wages without experiencing declines in prospective residents who can afford higher rates. It is a difficult, no-win situation, that the public often fails to completely understand given the policy complexity and the opaque complexity of the U.S. healthcare system.

Finally, the long-term care system in this country was founded on a medical model that deprived residents of choice and autonomy in favor of institutional practices with established times for daily care and daily activities. It reinforced stereotypes that older people are frail, dependent, and do not need or want person-centered choices. Over the past two decades, the long-term care sector has worked hard to implement more person-centered practices, though these efforts are often hampered by staff shortages and high operational costs such as wages, health insurance benefits, and rising food costs. Our deeply ageist society has overlooked the needs and preferences of people living in nursing homes and assisted living communities. We have failed to deliver a long-term care system that is adequately funded so that operators are able to provide the quality of care that most of us desperately want to provide. Middle class families that do not qualify for Medicaid-funding nursing home care but are insufficiently wealthy to pay privately for care (upwards of $10,000 per month) are left to fend for themselves as they near end of life and their physical and cognitive abilities change. This places an inordinate burden on family caregivers. 

There are no easy solutions. I offer this post as a way to better understand the external pressures on long-term care organizations. They are working within a larger, very constrained system that does not often allow for delivering the care that we all would want as we age. ]]><![CDATA[Do you use elderspeak? It is time to stop.]]>Thu, 11 Apr 2024 12:43:38 GMThttps://www.hillhouseassistedliving.com/blog/do-you-use-elderspeak-it-is-time-to-stopThe term “elderspeak” has been around for 40 years and while many of us use it frequently in our interactions with older adults, very few of us realize we are using it and even fewer know how harmful and dehumanizing it feels to older people.

Elderspeak is defined as simplified speech used with older adults and sounds like baby talk. Elderspeak also includes non-verbal gestures and actions, such as patting and excessive or inappropriate smiling.

The most common and recognizable features of elderspeak are: 1) using terms such as “honey” or “sweetie” instead of the person’s actual name; 2) using the collective pronoun “we”, instead of “you” (for example, “how are we today?”); 3) using a high-pitched or unnecessarily loud voice; 4) using exaggerated intonation; 5) standing or sitting too close; 6) using exaggerated praise (for example, “great job!”) or 7) using reflective speech patterns that request the older person to take action for someone else (for example, “would you stand up for me, please?” or “lift your arm for Dr. Jones”). These are all patterns of speech and actions that we typically use with infants and children, except that older people – even those with cognitive changes – are not children and we do not like being treated as children.

Studies show that 75% of elderspeak directed at nursing home resident could not be distinguished from babytalk directed at two-year-olds. And worse yet, nearly 97% of interactions between care staff in a hospital and patients with dementia had elements of elderspeak.

Studies also show that elderspeak results in a 50% increase in resistance to care in older adults with dementia and it causes older adults to feel frustrated, embarrassed, and incompetent, and it leads to loss of independence. It also reflects unprofessionalism in care staff.

Even though elderspeak-users do not intend harm; in fact, elderspeak is an attempt to convey care, it does cause harm. It denies older people of their adult identity – an identity that still resides within us, despite any physical or cognitive changes occurring in our bodies and minds.

When engaging with older people, we might ask ourselves from now on: is this how I would talk or engage with a 45-year-old? And older people, when it feels safe to do so let’s speak up when people talk to us in child-like ways.]]><![CDATA[The Moving Forward Coalition - a National Movement to Improve Nursing Home Quality]]>Sat, 10 Feb 2024 19:23:11 GMThttps://www.hillhouseassistedliving.com/blog/the-moving-forward-coalition-a-national-movement-to-improve-nursing-home-qualityIn April 2022, the National Academies of Science, Engineering, and Medicine (NASEM) issued a bracing report of nursing home quality in the wake of the disproportionate number of COVID-19 related deaths in nursing homes and assisted living communities during the pandemic. The 600-page report offered an array of recommendations for improved quality. Shortly thereafter, The John A. Hartford Foundation funded efforts to convene experts across sectors and disciplines - including nursing home residents - to work together to address the NASEM recommendations and entrusted this effort to LeadingAge, a non-profit long-term care advocacy organization. The resulting Moving Forward Coalition (MFC), is now in its second year and closing in on starting to test a variety of improvements in nursing homes across the country.

The Coalition's work was originally divided up among seven committees reflecting the seven goals outlined in the NASEM report. Over the first year of the Coalition's work, as individual committees created action plans to structure and organize the work ahead of them, it became clear that there was overlap among the committees. As a result, the nine formal Action Plans laid out on the MFC website, reflect deep study and collaboration to generate as much positive change in nursing home care as possible in the short term. Longer term efforts are also needed and the Coalition is laying the ground work for federal and state policy and culture change that is long overdue. 

As one example of change, Goal Committee One has focused on developing a guidebook that will help nursing home leaders and managers deepen the conversations with residents and family members around each resident's preferences and priorities for daily care. Too often care staff make decisions on behalf of residents that, while well-meaning, may not truly reflect what is important or meaningful for that particular resident. The guidebook will support nursing homes with training content, assessment forms, and templates that encourage including residents and their family members in care conversations in ways that are better aligned with individual sensitivities, personality, temperment, capacity, and identity, with the goal of identifying and delivering care that is truly person-centered.

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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. 
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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.

]]><![CDATA[Pandemic Blog]]>Fri, 25 Dec 2020 02:02:00 GMThttps://www.hillhouseassistedliving.com/blog/pandemic-blog6023860Picture
 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
]]><![CDATA[Pandemic Blog]]>Sun, 06 Dec 2020 05:00:00 GMThttps://www.hillhouseassistedliving.com/blog/pandemic-blog6020711Sunday, 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. 
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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   ]]><![CDATA[Pandemic Blog]]>Sat, 26 Sep 2020 12:37:58 GMThttps://www.hillhouseassistedliving.com/blog/pandemic-blogMany 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. 
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]]><![CDATA[Tips for Interacting with Older People]]>Thu, 27 Feb 2020 16:43:17 GMThttps://www.hillhouseassistedliving.com/blog/engaging-with-older-people-best-practicesThere 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.
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