The Dignity Digest is information compiled weekly by Dignity Alliance Massachusetts concerning long-term services, support, and care. We provide direct links to featured articles below. Each digest contains many more articles on key topics including Nursing Homes, Assisted Living, Home and Community, Housing, Behavioral Health, and Covid-19 than are highlighted below.

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Older Digests are found on the Digest 2020-2021 page.

Issue #73 – Week of January 21, 2022

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Issue #72 – Week of January 14, 2022

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Covid-19 Cases Surge at Nursing Homes

Report in the *Wall Street Journal, January 11, 2022

Cases among staff climb to a new high, while the tally among residents is near the record, according to CDC data. . .

The Covid-19 surge fueled by the Omicron variant is hitting nursing homes hard, with the highest number of cases ever documented among staffers and a near-record tally of residents also testing positive, according to new federal data.

The increases among staff are posing an operational challenge for facilities that have been struggling with worker shortages for months, while a surge in patient cases threatens a return of serious illness and death among residents.

In the week ending Jan. 9, there were 32,061 new confirmed Covid-19 cases among nursing-home residents, up from 18,186 a week earlier and 6,406 the week before that, according to new Centers for Disease Control and Prevention data.

The recent week’s total was close to the highest documented weekly level, which surpassed 34,000 in December 2020. The CDC data only go back to late May 2020.

Cases among staffers are rising even more sharply. In the most recent week of CDC data, there were 57,243 Covid-19 cases among nursing-home staffers, 36% higher than the previous week’s total and nearly double the peak the CDC documented in December 2020. . .

The swelling Covid-19 case numbers in nursing homes are also feeding worries that the facilities could see another wave of serious illness and mortality among their frail occupants, who routinely accounted for a third or more of Covid-19 deaths in the U.S. during early periods of the pandemic. . .

About 87% of nursing-home residents are vaccinated, and about 62% of those people have received a booster dose, recent CDC data show. The rate of Covid-19 cases is much lower among those who have gotten a third vaccine shot, a CDC spokeswoman said. . .

Webster at Rye, in New Hampshire, had no Covid-19 cases among residents until an outbreak in November 2021, when 32 were infected with the virus and six died. Residents were all vaccinated and had been scheduled to receive their booster shots when the outbreak happened.

‘Magic’ Multigenerational Housing Aims to Alleviate Social Isolation

Report in the *Wall Street Journal, January 10, 2022

Two co-living communities set to break ground this year seek to address loneliness, as well as the caregiving and affordable-housing shortages, in the U.S. . .

The U.S. is facing an aging population, a shortage of caregivers, a dearth of affordable housing and an increase in social isolation that threatens well-being. Some think what we really need is Magic.

That is, multi-ability, multigenerational, inclusive co-living, or communities where young and old, families and singles, live side by side, supported by inclusive design, technology, and neighbors. Rethinking community in this way could reshape how and where older adults and people with disabilities live and receive care, while building symbiotic relationships between people of all ages, supporters say.

Magic is the brainchild of geriatrician William Thomas, who spent decades working to improve long-term care. Spurred by a belief that segregating older adults, as well as people with special needs, negatively impacts their well-being, Dr. Thomas co-founded Kallimos Communities to develop neighborhoods based on Magic principles. Groundbreaking is expected to begin in the second half of 2022 on two neighboring 7.5-acre communities in Colorado—the first of what he hopes will be many across the country. . .

Intentional intergenerational models exist in small pockets around the country, where preschools operate in assisted living facilities, and on a grand scale in Singapore, he says, where the government is spending $2.4 billion to build three-generation flats and housing developments that have space for both elder care and child care.

Creating new communities, rather than offering services in existing ones, faces special challenges, including startup costs and getting people to move into them. About 70% of adults 50 and older want to “age in place,” remaining in their homes for the long term, according to a 2021 AARP survey of nearly 3,000 U.S. adults.

Issue #71 – Week of January 7, 2022

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Nursing homes at a tipping point: Many are forced to freeze admissions, stranding patients in hospitals for weeks

News Article in the Boston Globe *, January 5, 2022

Already crowded hospitals across Massachusetts are being forced to keep patients on their wards for weeks after they would otherwise be discharged for rehabilitation or long-term care because there are so few available spaces at nursing homes struggling to stay open amid the Omicron surge. . .

Nursing home industry leaders say they are verging on a crisis. Acutely short-staffed even before the surge, they are facing growing numbers of workers sidelined by infections, spot shortages of rapid test kits, and a state rule many say is outdated that forces them to intermittently freeze admissions. As a result, hospitals across the state, slammed with record numbers of severely ill patients sick with COVID and other conditions, are facing critical bottlenecks at a time when their capacity is at peak levels.

Fixing Massachusetts’ nursing homes is a complex problem; here are some of the ways lawmakers are trying to do it

News Article in the Berkshire Eagle, January 5, 2022

Better wages for workers, improved reimbursements for facilities and increased support for nursing home alternatives are all pieces of the complicated puzzle that is nursing home reform

Massachusetts needed nursing home reform even before the pandemic, people say. Now, the stakes are higher.

State Sen. Patricia Jehlen, a Somerville Democrat who co-chairs the Joint Committee on Elder Affairs, said she believes the pandemic has moved legislative leaders to pursue changes.

Even so, addressing long-term care problems in Berkshire County — and across the state — demands different solutions.

Better wages for workers, improved reimbursements for facilities and increased support for nursing home alternatives are all on the table, Jehlen said. . .

The elder affairs committee is weighing the association’s testimony along with the support that the Dignity Alliance and its member organizations have provided for the bill, said state Rep. Thomas Stanley, D-Waltham, who co-chairs the committee with Jehlen. . .

A “nursing home quality jobs initiative” would require MassHealth to fund a “living wage rate add-on” for care workers, and another bill seeks to stabilize nursing facilities’ finances.

Former state Sen. Richard Moore, who serves as Dignity Alliance’s legislative chair, said the coalition has reviewed those proposals and declined to support them due to the potential for “cost-shifting” that would increase profits for facility operators.

“If MassHealth picked up the cost, are the savings going to be passed on as a profit to the owners?” Moore asked. “We’ve been working with some folks from the SEIU that represent some of the workers in nursing homes, and I think they tend to have the interests of the workers in mind more than management does.”. . .

Even before the pandemic, Massachusetts residents had been showing greater interest in alternatives to nursing homes.

More older adults are choosing to “age in community” or “age in place” rather than seek institutional care in nursing homes, the Executive Office of Health and Human Services reported in 2019. One in six nursing homes in the state, it found, had low occupancy, defined as filling below 80 percent of available beds.

Still, some regulations and restrictions prevent people who may not need nursing care from accessing more independent alternatives, Jehlen said.

“There are people in nursing homes who don’t need to be there if we strengthen the rest of the continuum,” she said. “In order to pay adequate rates for people who need that care, we need to strengthen the less expensive and less restrictive services.”

Coronavirus is renewing a call to abolish nursing homes

Essay in Quartz, June 25, 2020

“There’s been a very interesting divide between disability rights groups and, for want of a better expression, elder rights groups, because the elder rights groups seem to be okay with some form of institutionalization,” said Gerard Quinn, an Irish legal scholar who helped draft a landmark United Nations convention on disability rights, and who has recently argued for the gradual abolition of nursing homes.

But since Covid-19, Quinn added, “a lot of the elders rights groups now are turning completely around and beginning to understand the importance of living well in the community with adequate supports.”

In the US, such ambitions have run up against the challenges of remaking the nursing home industry, largely funded by billions of dollars in federal Medicare and Medicaid payouts. . .

[T]he stakes of reform, advocates agree, are high — and have only become clearer during the current pandemic. “We have, since Covid began, received a lot of calls from people desperate to leave facilities,” said Dooha. Through calls from residents and staff, she added, her organization has “learned that conditions in facilities are utterly deplorable.” Those conditions, Dooha says, should cause more people to question a system that, in the US alone, houses around 1.3 million people. . .

A major 2018 survey from AARP, the aging-advocacy organization, reported that close to four in five Americans aged 50 and above prefer to age at home. “Most older people are anxious about the prospect of moving into a nursing home,” a recent analysis of studies in high-income countries reported, and studies consistently show high rates of depression in facilities. . .

For years before Covid-19, researchers have warned that norovirus, influenza, and other infections can spread rapidly in nursing facilities. Those risks have increased in recent years, as nursing homes take in more short-term residents who are getting rehabilitation after hospital visits, and who potentially bring infections into the building with them. . .

Advocates say that these and other problems have only intensified as large companies began buying and consolidating nursing home franchises. Around 70% of nursing homes in the US are under for-profit ownership, and, since the 2000s, private equity firms have purchased many facilities, hoping to cut costs and increase profits. One recent analysis, published by the New York University Stern School of Business, found “robust evidence” that private equity buyouts were linked to “declines in patient health and compliance with care standards.” . . .

What a new system may look like is unclear, and some advocates argue that the structural problems that plague nursing homes won’t be solved by increased regulation or funding. “You can’t throw any more money into this institutional model.” . . .

And experts and advocates agree that obstacles to deinstitutionalizing elder care abound. Cameron, the Adapt organizer, points out that it would be difficult to close nursing homes without offering more affordable housing options in the community. Another limiting factor is labor. Transition to home-based care would require more home health care workers—many of whom work for lower pay, and with fewer labor protections, than their counterparts in facilities. In some places, there are already too few people willing to fill those roles.