Aging in Place Gets a Strong Advocate in Kathy Greenlee: Assistant secretary of aging presents her agenda at Denver conference
By Susan Hindman, September 28, 2009, Published on SilverPlanet.com (http://www.silverplanet.com)
Introduction
Sometimes it’s the simplest of moments that prove to be the most poignant, and Kathy Greenlee, who likes to tell stories, tells one that was pivotal in her life. As Kansas secretary of aging at the time, she was to present a plaque to a nursing home that had turned itself around—morphing from a facility that was so bad its parking lot was cited for being dangerous, into one that was receiving an award as one of the state’s top facilities. She went to the home for the ceremony as well as to see it firsthand and to talk with the residents there, who that particular day were discussing redesigning a bathroom on one wing. Among the ideas tossed out was one by a woman who caught Greenlee’s attention: she specifically wanted green and white towels in this new bathroom. A simple request.
But later, when Greenlee found herself sitting next to this woman and talking with her, “I had one of those moments when you can see yourself in someone else,” she said. “I was in one of the best facilities in the state. And I looked at her and thought, I don’t want this to happen to me. . . . Everybody here lost their health. It doesn’t matter what age they were, they lost their health. . . . This woman needs to be in her own house, designing her own bathroom, not here.”
And so, aging in place—helping seniors stay in their homes and communities, rather than in assisted living facilities or nursing homes—gained a powerful ally in Greenlee (right), who was appointed assistant secretary for aging in the U.S. Department of Health and Human Services (HHS) in June. She oversees an annual budget of $1.5 billion that finds its way to thousands of service organizations, which in turn disperse money to those who provide more specific services for seniors. She answers to HHS Secretary Kathleen Sebelius, with whom she worked in Kansas, and confers with a member of President Obama’s staff who is specifically focused on aging issues.
On September 23, Greenlee gave the closing address at the 25th National Home and Community Based Services Conference in Denver, a four-day gathering that brought together service agency leaders and staff from around the country. In her speech, and in an interview following her speech, she discussed her agenda, which is threefold: working on “culture change” in nursing homes—something “I feel very passionate about”—supporting and expanding home- and community-based services, and encouraging seniors to support their own health.
Culture Change
There are currently 1.5 million seniors living in American nursing homes, and the need for that high level of care will not go away. So the culture change Greenlee talks about is how to make these facilities more “holistic in their approach,” one that acknowledges the uniqueness of the individual. “Nursing homes started with the medical model, more like a really long-term hospital stay, very sterile and not as personal,” she said in an interview. “And that’s not what seniors need for long-term housing.”
In her speech, she said, “I will help establish a national agenda on nursing homes because I believe so much in culture change in nursing homes.” Changing the way nursing homes work “is very difficult because you disrupt every single system in the facility when you make a change. But every person regardless of their age needs to live in a facility where they’re recognized as being unique and supported as individuals and given care that supports their quality of life as well as their quality of care.”
The other issue related to nursing homes is how to keep them from being the first, and sometimes only, stop when seniors lose their health. In Kansas, she said, “Fifty percent of people on Medicaid came to nursing homes straight from the hospital.” Early intervention is essential to keep someone from being discharged from a hospital directly into a nursing home.
“One of the things nursing homes have going for them is that they are open 24/7,” she continued. “We have to be as responsive. We have to have case management on call 24 hours a day” as well as service providers who would show up right away.
Getting the Information Out
Community-based services that support aging at home are “what seniors want; it’s what they deserve,” Greenlee said. These services are much less expensive than care in facilities and need to be made more accessible, not only to those who are poor but also to those who have the money yet don’t know who to call to even get the services.
“This is such a different world,” she said. “How do you get through the maze of all these different systems and supports to even learn that we could send someone from an area agency to someone’s home to do an assessment of what they need?” An assessment might involve looking at the home to figure out how to reduce the risk of falls, or determining if someone needs to come in every day to help with bathing.
She pointed to the Aging and Disability Resource Centers (ADRC) as the model for connecting seniors with information and access to services. There are 175 ADRC sites across the country, covering all but five states. But the model won’t work, she said, “if there aren’t sufficient partners with these other initiatives like housing and transportation.”
Transportation is an issue that troubles Greenlee. “My goodness, what a huge problem,” she said. “Everywhere, the need for public services—to get people to the doctor, to church, to the grocery store—is critical. . . . We can’t buy enough vans to service the need.”
Partnerships, she said, from the community level to the federal level, are essential, especially in light of budget cuts that are ravaging state agencies.
The Medicaid Component
Medicaid is another crucial partner, in relation to not only the services it pays for but also the conversation on change it is part of. “Medicaid is such a core protective service for people who have no other alternative, so it is the safety net,” Greenlee said, but “people want something before they get to that point.”
The “nursing home entitlement piece” of Medicaid is a focal point. “There is a federal law within Medicaid that has a presumption that if someone needs long-term care and they’re on Medicaid, then they will be served in the nursing home,” she said. Waivers allow seniors to be served in the community instead, and many states are treating community services the same as nursing home services in terms of the entitlement, although “that’s not what the federal law is,” she said. “But even at the federal level, policymakers understand that community services are what people want and are less expensive.”
It is that legal entitlement to nursing homes that could be called a stumbling block, when people would rather be somewhere else. “That entitlement doesn’t keep states or the federal government from investing in community services, so it’s not in the way, but it’s there,” she said.
A Full Plate
Greenlee will have a role in the reauthorization of the Older Americans Act, which comes up in 2011. Passed in 1965, the act is the major vehicle for the organization and delivery of care services to older Americans. The act is reauthorized every five years, which she says offers Congress the opportunity to rewrite and update the law. She will be part of the effort to look for changes or improvements to recommend.
Greenlee will be doing a lot of talking over the next year, meeting with the Administration on Aging staff and peers within HHS, talking with nursing home providers as well as national groups representing seniors, visiting communities, and working with the states and their associations to learn about their needs as well as their strengths and weaknesses, “so that I can be in a position to make recommendations to the secretary or to the president.” And there will be conversations with those working in different fields, whose needs may intersect with seniors, such as groups serving those with disabilities or mental illness.
The list of issues, projects, and topics just goes on:
Even the flu didn’t go without mention. Greenlee, who got a flu shot while in Denver, said “I’m very concerned that the H1N1 conversation will eclipse the conversation about seasonal flu,” which is far more deadly to seniors.
It was only last year that Greenlee sat in the audience of one of these conferences, listening to former Assistant Secretary for Aging Josefina Carbonell speak, and thinking to herself, “Now that job looks kind of interesting.” She calls her appointment a “tremendous honor.”
“Above all, I look forward to being able to continue to do (this) work,” she told the audience, and “to do as much as I can to help all of us raise the profile of our work and the importance of what we’re doing.”
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