To the Class of 2022: Age boldly, enjoy your journey

Published in RINewsToday on May 16, 2022

According to Research.com, this year commencement speakers at colleges and universities in Rhode Island will impart their “pearls of wisdom“ to 19,782 graduating college seniors and their families. The usual commencement speech, traditionally about 10 minutes in length, offers simple tips and observations that, if taken, just might offer the young graduates a more rewarding personal and professional life ahead. Social media platforms and websites will quickly disseminate this sage advice given by well-known lawmakers, judges, television personalities and CEOs, to millions across the globe.

Globe columnist Dan McGowan gives his readers in the Rhode Map, the paper’s free newsletter about Rhode Island, a who’s who list of well-known commencement speakers that will gather at Rhode Island’s 12 Colleges and Universities to give the Class of 2022 advice on making their new journey in the world amidst the continuing COVID-19 pandemic causing sweeping societal changes in the workplace, health care, and social activity. 

McGowan’s detailed listing of “marquee names” delivering commencement speeches at Rhode Island’s colleagues and universities are:  

House Speaker Nancy Pelosi at Brown University; Emmy Award-winning actor and director Henry Winkler at  New England Institute of Technology; Human Resource Guru William J. Conaty at Bryant College; Rhode Island Governor Dan McKee at CCRI; Big East Commissioner Val Ackerman at Providence College;  Entrepreneur and Author Bruce Poon Tip, Founder of G Adventures; Miriam Hospital President Maria Ducharme at Rhode Island College, Deep Sea Explorer Robert Ballard noted for his work in undersea archeology at URI; Graphic designer, educator and Author Cheryl D. Miller at RISD; Navyn Salem, who founded the nonprofit Edesia, Inc. whose mission is to treat and prevent global malnutrition at Salve Regina; and Dr. Anthony Fauci, Chief Medical adviser to the president at Roger Williams University.

This year’s commencement speakers are very well-deserving of their honor to address Rhode Island’s graduating college seniors.  But if I had an opportunity to speak before the graduating class of 2022, here are my thoughts and tips I would give, centered on the importance of aging gracefully and boldly over your accumulating years, and they will accumulate faster than anyone could imagine.

Aging can be viewed as a life-long, unpredictable journey.  A slang phrase in Wikipedia sums up “a simple existential observation that life is full of unpredictable events. Over the years, you might have heard the phrase, “Shit Happens.” Many people choose to hold on to their fading youth, not wanting to look in the mirror to see wrinkles, sagging stomachs, and even gray hair.  They hold fiercely to their memories of the 1963 Pepsi Generation commercial that celebrated youth and active people.   

It’s so easy to say, accept and embrace your aging.  

You will be tempted to chase after prestige, power, the perfect relationship, or a high paying job.  I say being healthy is your most important possession you can have in your lifetime. Cherish it. Work towards it. URI Gerontologist Phil Clark once told me, “Use it or lose it. Stay as physically active as you can.”  “If you rest, you rust,” he says, noting that physical exercise elevates our mood and benefits our cardiovascular system, too. This conversation took place over 25 years ago, and I still remember this advice.  

Before the COVID-19 pandemic, a North Attleboro couple, Mark and Nancy Shorrock began dining daily, seven days a week, if their schedules permitted, at Spumoni’s Restaurant in Pawtucket.  Over the years, they developed personal relationships with around 30 couples who frequented the informal restaurant and bar. While not a support system, that informal group who knew each other innately, benefited the Shorrocks, and I would think all of the people who kept coming back as regularly as they did. 

The importance of being around others is documented in a 2017 national report. The Global Council on Brain Health (GCBH) report, released by AARP, cites strong scientific evidence that behavior changes and lifestyle habits can positively impact one’s brain health. It’s not uncommon for social networks to shrink as we age. “Research tells us that larger social networks may positively impact your health, well-being, even your cognitive functioning,” said Sarah Lock, AARP Senior vice president for Policy and GCBH Executive Director. 

So, as the decades fly by, work to maintain your social network of family and friends to maintain good cognitive functioning. And while you may build your on-line networks, do not overlook the greater importance of the in-person kind, those you break bread with, share what your children may be doing, or call just to hear a voice who knows a whole lot about you, without your even having to say it.      

Research also tells us that you can also reduce your risk of cognitive decline by exercising your brain. Take time in your busy day to read newspapers, magazines, and books, or even play a challenging crossword puzzle, build your vocabulary, learn a new skill, even play chess.

Being a volunteer can also be a protective buffer from the curve balls that life may throw at us as we age. “Volunteering can be medicine for the soul. It allows you to connect with other people, explore and remedy emerging community issues, make a difference as a caregiver or mentor and change lives. Volunteering is powerful and can define and redirect your life’s journey,” says Vincent Marzullo, who for 31 years served as RI’s National Service Director and still volunteers weekly at Hasbro Children’s Hospital.

When you require help, don’t be afraid to ask your family, friends or even professional colleagues for support and assistance. People will always go up the ladder of their careers, even down, too.  Take the opportunity to be there for not only people you know, but also strangers when they need a helping hand to jump-start their faltering personal relationships or professional careers. 

Time really does fly after you graduate college.  Don’t be afraid to pivot in your career – you may have spent 4 years or 8 years or many more studying and becoming an expert in a particular subject, but find your passion calls you to another career-path. Don’t be afraid to take the path that calls out the loudest for you. As you move into your middle or later years, view your life as a meaningful journey, living in the present, not tied to past experiences, nor possible future events. It’s the journey, not the end result, that you should focus on.

Amma, a well-known Hindu spiritual teacher, tells her millions of followers to view their life as a ‘canceled check.’ Let go of those past regrets, forgive yourself for those mistakes especially made in childhood and teenage years, more important those you made as you move into your middle or later years. Don’t regret passing up personal or professional opportunities, for others will follow, she says. Use your time on earth wisely; don’t waste it carrying the burdens of past guilt or personal grudges. Think about that.

View your life as being back in high school, learning from each positive and negative experience you encounter. When you confront life’s health, financial, and personal and professional challenges, keep a positive attitude. Don’t be overwhelmed by negative thoughts. Each day you will make daily choices as to how you will react to your problems. In these situations, you can either see the proverbial glass as either being “half-full” or “half-empty.” A positive attitude allows you to see a “half-full” glass, thus allowing you to successfully overcome the adversity.

As we grow older, we sometimes put too much energy into reflecting on our personal and professional defeats, being depressed on the “bad hands” we were dealt. Savor your victories, but always forgive yourself for your shortcomings and failures. Learning from your shortcomings and defeats will build a strong bridge to future successes.

Also, forgive others who have hurt you personally and professionally. You cannot live or reconcile your life peacefully if you are still holding onto grudges, anger, and bitterness, all tied to past relationships or negative employment experiences.

Writer Simon Kent tells us a powerful story about forgiveness in an article penned in 2013 on the Toronto Sun’s website. When Nelson Mandela’s National African party won the election that would end apartheid in South Africa, he forgave his white political foes, says Kent, noting that the power of forgiveness kept the black majority ruling party from seeking revenge.

According to Kent, at his 1994 inauguration, Prisoner 46664 — Nelson Mandela — had kept a seat set aside for a very special guest he wanted to witness his swearing-in as President, the highest office in the land. This person, one of his former jailers from Robben Island, where he was held for 18 years of hard labor. 

Why do we continue to hold anger, bitterness, and grudges against others? If Mandela can easily forgive his former jailor and a white society that kept his black brothers and sisters enslaved for centuries, why can’t you forgive others, too? 

Pass on your hard-earned wisdom. As you begin to accumulate more of life’s professional and personal experiences, share your story with others, especially those younger than you. By the time you reach your twilight years, you will have accumulated a huge reservoir of untapped wisdom gained from your life’s journey from making both good and bad decisions.  When taking on the new role of parent or grandparent, always continue to share your insights and lessons you have learned to your children and grandchildren.  The generations following you will lose out if you remain silent and keep your knowledge and history from them.

Get off the treadmill of life. Learn to slow down and enjoy the simple moments of your life. In her books and lectures, nationally-acclaimed author Connie Goldman, has stated that the simple act of watching a beautiful sunrise or sunset or even puttering around your garden can be as stimulating as a jam-packed calendar of activities.  

My final thought – nothing is guaranteed in life except death, taxes, and even, hopefully, growing old. So, Class of 2022, I urge you to make the most of your life that is just beginning to unfold before you. Don’t focus on the end result. Focus on the journey. Sometimes it is not the big things that you do that count, rather the simple daily acts of loving kindness you give to all those around you.  

Enjoy your new journey. Age boldly.

Caregivers Flying Blind in Providing Complex Medical and Nursing Care

Published in the Woonsocket Call on April 21, 2019

Half of the nation’s 40 million family caregivers are performing intense and complicated medical and nursing tasks, managing multiple health conditions for their family members and friends, says a newly published AARP report.

AARP’s special report, “Home Alone Revisited: Family Caregivers Providing Complex Care,” released April 17, 2019, takes a close look at specific medical and nursing tasks (including giving injections, preparing special diets, managing tube feedings and even handling medical equipment) that family caregivers are currently doing. It’s a follow-up report to AARP’s 2012 Home Alone Study that took the first in-depth look at how caregivers managed providing complex medical and nursing care that was formerly offered by trained professionals.

Changes in the Health Care System Can Support Family Caregivers

“This report shows the extent of complex tasks that millions of family caregivers are providing every day. They are largely alone in learning how to perform these tasks,” said Susan Reinhard, RN, Ph.D., Senior vice president and Director, AARP Policy Institute, in a statement announcing the release of the a 56-page report. “About half of family caregivers are worried about making a mistake. We need to do a lot more across the health care system—with providers and hospitals—to help support these family caregivers,” says Reinhard.

Adds Rani E. Snyder, program director at The John A. Hartford Foundation, “Family caregivers are the linchpin in our health care system, particularly for older adults,” “This study shines new light on the diversity of family caregivers performing complex tasks—from men to millennials to multicultural populations—and is a rallying cry for an all hands-on-deck approach to creating age-friendly health systems that better support and prepare these often forgotten members of the health care team.”

The new statistics in this report shed more light on the demands of family caregiving,” said AARP Rhode Island State Director Kathleen Connell, a former nurse. “These described caregiving responsibilities sound like a task list for a team of home nurses, aides, dieticians, physical therapists and personal drivers who work without weekends off, much less vacations. Is there any question that people worry about making a mistake that compounds existing issues?,” she says.

“The takeaway is quite clear,” Connell added. “Caregiving is stressful and we need to expand efforts to provide assistance. And it’s a very big ‘we’ that I am speaking of. Families need to help out and share more responsibilities as well as offer respite for primary caregivers. Neighbors and extended family also can lend a hand. And we need government to continue to provide assistance through legislation that supports family caregivers. Caregiving responsibilities can be both daunting and exhausting. It’s the new reality. The good news is that as we raise awareness we can work together to improve the lives of caregivers, “ says Connell.

A Sampling of the AARP Report’s Findings

AARP’s Home Alone Revised Report report found that almost half of the caregiver respondents (48 percent) prepare special diets multiple times per day. Preparing these meals often involved taking precise measurements, following specific dietary guidelines, constant monitoring, and the use of special equipment for preparation and feeding.

Thirty percent of the respondents say preparing special diets are hard to manage, this being more challenging to men. Younger caregivers found it more difficult to manage this task than older caregivers.

The caregivers also reported that 54 percent of the survey’s respondents say they manage incontinence multiple times a day. Most say managing incontinence is more difficult than managing medications, helping with assistive devices and performing wound care. Seventy-six percent say they learned how to manage incontinence on their own. More than one in four would appreciate having assistance from another person to help.

According to AARP’s report, 70 percent of these caregivers are dealing with the emotional stress of managing pain relief in the middle of a national opioid crisis. More than four in 10 expressed concerns about giving the optimal dose. About four in 10 faced difficulties in controlling the pain of the care recipient.

Finally, 51 percent of the survey respondents assisted with canes, walkers, and other mobility devices while over a third (37 percent) dealt with wound care.

The researchers conclude that “uncomplicated world of ‘informal’ caregiving” no longer applies” to the nation’s caregivers. “In the current health care environment, it is presumed that every home is a potential hospital and every service that the person needs can be provided by an unpaid family member, with only occasional visits by a primary care provider, nurse or therapist,” say the researchers,” they say.

AARP’s Home Alone Revised Report is a must read for Congress and state lawmakers who can easily address the challenges caregivers face when providing medically complex care by crafting policies and programs that will provide support and resources to the nation’s growing number of caregivers.

This caregiving issue might be a good one for the U.S. Senate Special Committee Aging to study.

A Final Note…

AARP gathered the study’s data through a nationally representative, population-based, online survey of 2,089 family caregivers. This study employed an oversampling of multicultural groups, taking a closer look at difficult tasks, and putting greater attention on available resources and outcomes. The study’s sampling strategy ensured multicultural representation and investigated generational differences. Additionally, the researchers also explored certain topics in greater depth, including special diets, incontinence, pain, and the impact of social isolation on the caregiver.

The AARP Home Alone Study is a special report from the Founders of the Home Alone Alliance℠ (AARP, United Hospital Fund, Family Caregiver Alliance and UC Davis-Betty Irene Moore School of Nursing). With funding from The John A. Hartford Foundation to the AARP Foundation, the study took an in-depth look at the specific medical/nursing tasks that family caregivers are doing.

To read the full report, go to: https://www.AARP.org/ppi/info-2018/home-alone-family-caregivers-providing-complex-chronic-care.html.

Note: Updated April 22, 2018…

Questions Raised About the State’s New Independent Provider Program

Published in the Woonsocket Call on July 15, 2018

In the waning days of the 2018 legislative session, the Rhode Island General Assembly passed legislation (S 2734 Sub A, H 7803 Sub A) that establishes in the Ocean State the “Independent Provider” (IP) model of at-home care, which allows consumers to hire and manage caregivers of their own choice while the state takes on certain responsibilities, such as setting caregivers’ wages, qualification standards and hours. With Gov. Gina M. Raimondo’s signature, the legislation became law on June 29th.

The enacted legislation is backed by the Rhode Island Campaign for Home Care Independence and Choice, a coalition that includes the Senior Agenda Coalition, RI Working Families Party, RI Organizing Project, District 1199 SEIU New England, RI AFL-CIO, Economic Progress Institute and the RI Chapter of the National Organization of Women (NOW). But, although on the losing side of the legislative debate the Rhode Island Partnership for Home Care continues to express its concern about the impact on the delivery by IPs to seniors and persons with disability.

Overwhelming Support on Smith Hill

The health care legislation, sponsored by Senate Majority Whip Maryellen Goodwin (D-Providence) and Rep. Christopher R. Blazejewski (D-Providence), easily passed both the House and Senate Chambers. The Senate Committee on Labor unanimously passed the measure by a 9-0 vote. By a count of 33-0, the legislation easily passed on the Senate floor. Meanwhile, in the other chamber, the House Committee of Finance put its stamp of approval on the measure by a vote of 13-0, with the legislation ultimately passing of the House floor by a vote of 60-11. But, because the House amended the bill (in committee and on the floor), it had to come back to the Senate for consideration again. The Senate vote on the revised legislation was 28-3.

In a statement announcing the new law, Goodwin and Blazejewski, say “By increasing both availability and quality of at-home care options, the new law’s ultimate goal is to move Rhode Island toward greater use of care in the community rather than in nursing facilities, since at-home care is both more comfortable and satisfying for consumers and less expensive than nursing facilities.”

“Presently, Rhode Island ranks 42nd in the nation in terms of investment in home care. Ninety percent of older Americans prefer home care. Not only is it more comfortable for seniors, it’s more cost-effective, as we’ve seen in states like Massachusetts. High-quality home care is what people want, and it saves money. I’m proud to support this effort to help make excellent home care available to more Rhode Islanders,” said Goodwin.

Adds, Blazejewski, “There is little question that people prefer to stay in their homes as long as possible. Particularly now, as the over-65 population in our state is rapidly expanding, Rhode Island must shift more of our long-term care resources toward supporting home care. Our legislation will help provide more options for home-based services, enhance access to them and establish standards that assure high-quality care.”

Hiring, Finding and Managing a Caregiver

Currently around 77 percent of Medicaid funding for long-term services and supports goes to nursing facility care rather than community-based care. Those who use community-based care generally go through agencies or find, hire and manage a caregiver on their own. This bill would create a third option.

Under the Independent Provider model, which has been in place in Massachusetts since 2008, consumers would still be the direct employer who determines when to hire or fire an employee, but the state would take on responsibilities for maintaining a registry of qualified caregivers, and would set parameters such as rates, qualifications and hours.

While the new law stipulates that they are not employees of the state, it would give home care workers the right to collectively bargain with the state over those parameters. Allowing them to organize would ensure that this otherwise dispersed workforce has a unified voice and a seat at the table to tackle the issues facing Rhode Island’s long term services and supports system, said the sponsors.

Consumers in states with independent provider models report higher levels of client satisfaction and autonomy, received more stable worker matches, improved medical outcomes, and reduced unmet need with agencies delivering fewer hours of care relative to the needs of the consumer.

In testimony supporting the health care legislation, Director Charles J. Fogarty, of Rhode Island’s Division of Elderly Affairs (DEA), told lawmakers that the health care legislation supports two goals of DEA, first it would enable elderly and disabled Rhode Islanders who are medically able to stay at home and second, it would address Rhode Island’s direct service provider workforce shortage.

Fogarty said it’s critical for older adults and people with disabilities to have access to the quality of care that is right for them. “In some cases, care from an independent provider they know and trust will best meet their needs to remain independent. In other cases, a home care agency will be the right fit. And for some, particularly those with complex medical needs, our quality nursing homes are the right option,” he said.

When quizzed asked about The Rhode Island Health Care Association’s position, Virginia Burke, President and CEO, recognized the value of home care in the state’s long-term care continuum but stressed that residents in the state’s nursing facilities “are too sick or impaired to mange at home.” She said, “Our only concern with this proposal is the suggestion that it could drain Medicaid funding from the frailest and most vulnerable among our elders in order to pay for a new Medicaid service. Surely our elders deserve good quality and compassionate care in all settings.”

Calling for More Education, State Oversight of IPs

While most who testified before the Senate and House panel hearings came to tout the benefits of bringing IP caregivers into the homes of older Rhode Islanders and persons with disabilities, Nicholas A. Oliver, Executive Director of the Rhode Island Partnership for Home Care, sees problems down the road and calls the new policy “duplicative and costly.”

In written testimony, if the legislation is passed Oliver warns that Rhode Island will be authorizing untrained and unsupervised paraprofessionals to deliver healthcare to the state’s most frail seniors without Department of Health oversight, without adherence to national accreditation standards for personal care attendant service delivery and without protections against fraud, waste and abuse.

Furthermore, his testimony expressed concern over the lack of oversight as to the quality of care provided by IPs to their older or disabled clients. Although the legislation called for supervision from the Director of Human Services (DHS), this state agency does not have the mandated legislative authority to investigate IPs to ensure that patient safety is met and the recipients of care are protected against harm in their homes. Nor does it require daily supervision for adherence to the patient’s authorized plan of care, he says, noting that is a requirement for licensed home health and hospice agencies.

Oliver observes that the legislation does not require IPs to receive the same level of intensive training that Certified Nursing Assistances (CNAs) receive from their home health care and hospice agencies. While the state requires all CNAs to complete 120 hours of initial training, pass a written and practical examination, become licensed by the Department of Health and maintain a license by completing a minimum of 12 hours of in-service training annually, the legislation only requires IPs to take three hours of generalized training and no continuing in-service training is required.

CNAs deliver the same personal care attendant services as the IPs but have a specific scope of practices that they must follow as regulated by the Department of Health and their licensure board while IPs do not have these requirements, says Oliver.

Finally, Oliver says that “to ensure quality of care [provided by home care and hospice agencies], CNAs are supervised by a registered nurse (RN) that is actively involved in the field and who is available to respond to both the patient’s and the CNA’s needs on-demand to reduce risk of patient injury, harm or declining health status and to reduce risk of CNA injury, harm or improper delivery of personal care.” IPs do not have this supervision., he says.

Safe guards are put in place by home health and hospice agencies to ensure the safety of patient and direct care staff, says Oliver, noting that these agencies are nationally accredited by The Joint Commission, the Community Health Accreditation Program (CHAP) or the Accreditation Commission for Health Care (ACHC) in partnership with the Department of Health for compliance of state and federal rules and regulations, as well as national clinical standards for personal care attendant service delivery.

With the Rhode Island General Assembly bringing IPs into the state’s health care delivery system, the state’s Executive Office of Health and Human Services, granted authority by the legislation to develop the program, might just consider establishing a Task Force of experts to closely monitor the progress of the new IP program’s implementation to ensure that quality of care is being provided and to make suggestions for legislative fixes next year if operational problems are identified. Unanticipated consequences of implementing new rules and regulations do happen and every effort should be state policy makers that this does will not happen in Rhode Island with the creation of the new IP program.

To watch Oliver talk about the Rhode Island Partnership for Home Care’s opposition to the enactment of IP legislation that would increase state involvement in the home care sector, go to http://m.golocalprov.com/live/nicholas-oliver.