Summit County nursing homes should consider working with the community to improve the work culture of their caregivers, providing residents with technology and hiring immigrants and refugees to address staffing shortages.
These are among the recommendations included in a final report issued Thursday by the Summit County Nursing Homes and Facilities Task Force, a group that's been examining the condition of long-term care in the county for more than a year and advocating for change.
The 21-page PowerPoint released by the task force Thursday was intentionally brief.
"When we started out, our concern was that we wanted the task force to be able to have some positive impact as we go forward,” said Summit County Council District 4 representative Jeff Wilhite, who chairs the task force. “It was decided that we would not put together a two, three, four hundred-page document that would be handed out, sit on a shelf, collect dust and nobody do anything. We wanted to have a rubber-meets-the-road approach going forward.”
Summit County Council approved creating the task force in August 2019. The idea for the group came about after a report listed a Copley facility that subsequently closed in the summer of 2019, Fairlawn Rehab and Nursing Center, among the worst in the nation.
The report includes immediate, intermediate and long-term recommendations focused on four priority areas — staffing, legislation, operations and visitation of facilities — that are meant to improve conditions and experiences in long-term care facilities for residents, families and facility operators in Summit County.
The 29-member task force planned to release the report in November, but the pandemic delayed it.
Wilhite and Summit County Executive Ilene Shapiro said that when the task force process started, some people questioned what it could accomplish, as the county only regulates food service in the facilities. The state, including the Ohio Department of Health, has primary authority.
“This is an exercise in proving some of the naysayers wrong because there are always things that can be done,” Shapiro said. “It's just a question of bringing the right people together and thinking in new and different ways, identifying issues and then thinking about how we can...do the things that we need to do to put in place better behaviors, better outcomes that, who knows, might lead to some changes in our ability to govern.”
Summit County has 43 nursing homes with 4,179 licensed beds, 44 assisted living/residential care facilities with 4,327 licensed beds and 13 memory care/dementia care units.
Wilhite said the task force didn’t want to duplicate efforts already happening, so Direction Home Akron Canton Area Agency on Aging & Disabilities is taking the lead on several initiatives, including establishing a residents and family work group; highlighting volunteer advocacy opportunities, like guardianship and ombudsman programs; and addressing ageism and aging in place through a collaboration with Summit County Age Friendly and Age Friendly Akron.
“I realize that this is a nursing home task force, but...it's important to recognize the importance of providing resources and supports for people to age in place and to do that through age-friendly communities. Dorothy in ‘The Wizard of Oz’ had it right: there's no place like home,” said Susan Sigmon, senior vice president of long-term services and supports for Direction Home.
The residents and family work group would identify critical times, like shift changes, and the scope of the problem, and research best practices and possible solutions. Sam McCoy, senior vice president of elder rights at Direction Home, said it would allow for “working kind of from the inside out” and gather information directly from residents and families.
“They know best certainly on their experience within a long-term care facility, and I think it's essential that we as a task force or others don't impose changes upon them and make assumptions that are inaccurate,” he said.
Direction Home also is involved in expanding access to technology in long-term care facilities through its technology program, which provides devices and internet access to facilities for virtual visits with family and health care professionals. The program was funded with federal Coronavirus Aid, Relief and Economic Security (CARES) Act money the county received.
“The isolation and the withdrawal that many of our residents have encountered here in the last nine months is just heartbreaking, and we think this is really an essential part of reconnecting to the community,” McCoy said.
Direction Home Chief Operating Officer Abigail Morgan said she believes all 43 nursing homes in the county are involved with the program.
“We know how much and how hard staff are working to use their own devices, phones or iPads, to try and make phone calls during the visitation limitations during COVID, and so really kind of building on that goodwill, that intent of the nursing facility staff to increase access through technology,” Morgan said.
Expanded technology has also helped Summit County Probate Court access its clients and maintain communication.
"It's allowed us to actually continue to do our job” after previously having to conduct business through windows, said Summit County Probate Court Judge Elinore Marsh Stormer.
Other focus areas include state tested nursing assistant (STNA) education, which will include working with Stark State College; reviewing the role of accessible transportation as a barrier to employment; and initiating change in the STNA work culture.
To address the shortage of nursing assistants, Dr. Mary Dee from Asian Services in Action, Inc. suggested working with the College and Career Academies at Akron’s North High School and the University of Akron ARI-AHEC (Akron-Region Interprofessional Area Health Education Center).
One way the task force has explored addressing critical staffing shortages, especially during the pandemic, is by working with the community’s refugee and immigrant population, including undocumented immigrants.
Task force member May Chen, retired executive director of ASIA Inc., said immigrants and refugees often come from cultures in which older adults are revered and cared for at home by their children and grandchildren in multigenerational households. That makes them well-suited to care for older adults in long-term care facilities.
"Nursing homes are facing difficult challenges that are increasingly evident during the pandemic. Among them is a lack of staff to deliver the necessary and quality services for their residents,” Chen said. “I'm strongly convinced that the newcomers in our community are an untapped resource that can be developed to reduce the shortage of nursing home staff.”
But there are cultural, racial, institutional, educational and systemic barriers to their employment, she said.
Many already have health care experience, having worked in the industry in their home countries. But when they get to the United States, these barriers, especially language, can prevent them from finding employment in the field.
Dee recalled the story of a man she knows who worked as a pediatric surgeon in Africa but in the United States was working night shifts hauling trash for a garbage collection company.
Dee said the task force, working with ASIA Inc., needs to address cultural and language barriers through training.
“There are people who have the skillset to work in the field,” she said. “But we just need to work with them, to help them.”
And it’s not just about the staff. There aren’t typically many immigrant or refugee elders in care facilities, as it clashes with cultural expectations of how to care for older generations. But Chen said that as children who grew up in the U.S. are westernized, they may become more likely to seek outside resources to care for relatives.
Chen recalled meeting a Chinese couple in a facility who were “lacking culturally and linguistically socialization and communication.” She provided them with Chinese language DVDs, which she said they watched “over and over and over again.”
“The question is how prepared are the mainstream nursing homes to provide skilled nursing home services to this viable, linguistically and culturally diverse elder population?” Chen said. “Many of these elders have sacrificed much to come to America, to realize their dreams for their children and families. Now, few joys are left in their lives as they ride towards the sunset. If their remaining days have to be spent in a nursing home, they deserve to be cared for in a culturally respectful way.”
Some recommendations have already been implemented, including the creation of an elder care blog, insidersinsight.org, by task force member Stephanie Chambers, a nursing home administrator. It includes family stories, industry experts and volunteer recruitment and support and provides advice and assistance to residents and families on elder care.
Another program that’s already been implemented is an initiative getting companion pet devices to long-term care facility residents to reduce loneliness. The initiative from Direction Home, Summit County and Summit County Probate Court has included delivering more than 70 cat and dog devices, paid for using money the county received through the CARES Act.
"So many of our people literally are stuck in a room. They cannot leave the room,” Stormer said. “I think it's one of those little small touches where the impact just can't really be understood until you see somebody with one of these little cats, and they talk to it and snuggle with it.”
Wilhite said the group will not stop its work in 2021. Future plans include identifying task groups for action planning in the first quarter, identifying responsibilities and outcomes for action plans in the second quarter, beginning work on tasks and action plans in the third quarter and reporting outcomes and identifying barriers, unmet needs and further action plans for 2022 in the fourth quarter.
Past task force meetings are available to watch on the “Summit County Nursing Homes and Facilities Task Force” Facebook page.
Immediate recommendations include:
—Establish and maintain a personal protective equipment (PPE) dispensary to be prepared for future pandemics (already underway)
—Create an elder care blog (already created)
—Multicultural food and programs
—Rapid response/advocate access (already underway)
—Elder rights customer service (already underway)
—STNA education, training and recruitment
—A Peace Corps-style Elder Corps of volunteers interested in health care who could assist facilities with nonmedical care (already underway)
—Ohio HB 461 (“Esther’s Law”)
—Resident bill of rights
—Pandemic guardianship and communication (already underway).
—Long-term care performance data and selection assistance (already underway)
Intermediate recommendations include:
—Aging in place programs
—Telehealth (already underway)
—Quality therapeutic interventions
—Memory special interventions (already underway)
—Quality of daily living
—Address language barriers
—Codify clearly defined “memory care” standards
—Reinstatement of a minimum staff to resident ratio in assisted living
Long-term recommendations include:
—Pandemic practices, control and prevention
—Pandemic designated facilities (as disease can spread quickly in congregate living settings like long-term care facilities)
—Address negative STNA work culture
—Seamless transition from private pay to Medicaid in assisted living (more Medicaid assisted-living beds)
—Increased reimbursement for assisted-living providers