In this issue A Publication of the Fall/Winter 2024 Oregon Health Care Association OHCA Policy Priorities | Q&A with Rep. Nguyen | Mindfulness Benefits and EAPs Recreation with Intention: Mindfulness and Wellness in Long Term Care
FALL/WINTER 2024 © 2024. The contents of this publication may not be reproduced or distributed electronically or mechanically, either in whole or in part, without the express written consent of the Oregon Health Care Association. The advertisers assume complete responsibility to use any or all brand names, trademarks, guarantees, and statements which appear in their advertisements. CONTENTS FEATURE 24 28 20 pg6 Recreation with Intention: In this article, we profile two long term care providers who are prioritizing mindfulness and wellness as a key facet of their activities planning. 04 LETTER FROM THE CEO 06 RECREATION WITH INTENTION: MINDFULNESS & WELLNESS IN LONG TERM CARE 11 DATA & RESEARCH Mindfulness to Support Resident Well-being in Long Term Care Settings 14 QUALITY Mindfulness Ideas for Long Term Care Providers 16 LEGAL & REGULATORY Supporting Employee Well-being with EAPs 17 PUBLIC POLICY 2025: New Year, New Legislature 19 SPONSORED CONTENT Can Choice Architecture Influence Resident Well-being? Nurse Mindfulness and Well-being The Intersection of Mental Health and Privacy: Updates to 42 CFR Part 2 24 PROFILES Michelle Marasigan (RN, Holly Residential Care Center) Representative Hoa Nguyen (D-District 48) 28 2024 OHCA ANNUAL CONVENTION 32 UPCOMING EVENTS
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 4 Our focus in this issue of The Oregon Caregiver is to illustrate the importance of care planning and life enrichment directing that is holistic and well-rounded. While a resident’s physical state is always a priority, their overall well-being extends beyond this. Through interviews with providers and long term care leaders from across Oregon, this issue of The Oregon Caregiver showcases specific examples of activities that are being incorporated into residents’ daily lives that focus on mindfulness and wellness, leading to improved mental and physical health for all. In our feature article, we profile two care providers who are making resident mindfulness and wellness a priority in their activity planning. These long term care professionals provide examples of wellness-based activities, as well as the positive health outcomes that these activities have had on both the residents and staff. Walt Dawson shares evidence that highlights the positive outcomes of mindfulness- based activities in our data and research article. In our quality article, Nicolette Reilly provides examples of mindfulness-based activities that are easily implemented into long term care settings and how they lead to improved health outcomes. OHCA general counsel Eugenia Liu highlights Employee Assistance Programs (EAPs), a tool gaining popularity in the long term care community that supports employee mental and emotional well-being. Libby Batlan provides a glimpse into OHCA policy priorities in the upcoming 2025 legislative session. Three OHCA business partners share how their work contributes to improved well-being for Oregon long term care residents. In our policy maker profile, Representative Hoa Nguyen discusses how her background in education has shaped her legislative priorities. Michelle Marasigan of Holly Residential Care Center exemplifies the importance of strong nurse leadership within community-based care settings in our leader profile. Review highlights from the 2024 OHCA Annual Convention in Portland and save the dates of important in-person and online events and trainings coming up in 2025. You can read this magazine and all past editions of The Oregon Caregiver on our website, www.ohca.com. A Holistic Approach to Resident Well-being 11740 SW 68th Pkwy, Ste 250, Portland, OR 97223 Phone: (503) 726-5260 www.ohca.com OHCA STAFF Libby Batlan • Senior VP of Government Relations Philip Bentley, JD • President & CEO James A. Carlson • Advisor Mary Dakin • Workforce Development Manager Cheryl Durant • CRM Administrator/Accountant Amy Ferguson • Executive Administrative Assistant Melodie King, CMP • Director of Education Eugenia Liu • Senior VP & General Counsel Brenda Michael • Assistant Controller Lori Mueller • CFO Nicolette Reilly • Senior VP Quality Services Maggie Walter • Communications Coordinator Rosie Ward • Senior VP of Strategy BOARD OF DIRECTORS CHAIR Steve Fogg, Marquis Companies, Inc. IMMEDIATE PAST CHAIR Kathy LeVee, Generations, LLC VICE CHAIR Mark Remley, Aidan Health Services, Inc. TREASURER Andy Becker, Sapphire Health Services MULTI-FACILITY REPRESENTATIVE Zach Fogg, Marquis Companies, Inc. MULTI-FACILITY REPRESENTATIVE Dr. Elizabeth Burns, MD, Avamere Health Services BUSINESS PARTNER MEMBER REPRESENTATIVE Gabriela Sanchez, Lane Powell, LLC ALF REPRESENTATIVE Mauro Hernandez, Hearth & Truss INDEPENDENT NURSING FACILITY REPRESENTATIVE Kelly Odegaard, Westcare Management BUSINESS PARTNER MEMBER REPRESENTATIVE Marcy Boyd, Moss Adams, LLP AT LARGE REPRESENTATIVE Brenda Connelly, The Springs Living IN-HOME/SENIOR HOUSING REPRESENTATIVE Jonathan Mack, Home Instead Senior Care of Central Oregon RCF REPRESENTATIVE Mark Kinkade, Gateway/McKenzie Living ALF/RCF REPRESENTATIVE Matt Dunham, Mosaic Management ALF/RCF REPRESENTATIVE Matt Hilty, Ohana Ventures NEW/FUTURE LEADER REPRESENTATIVE Hunter McLane, PACS Group, Inc. OC EDITORS Maggie Walter • [email protected] Rosie Ward • [email protected] OC PUBLISHER Big Red M • www.bigredm.com Advertising Sales • Ronnie Jacko (503) 445-2234 • [email protected] Design & Layout • Shelby Bigelow Phil Bentley President and CEO Oregon Health Care Association LETTER FROM THE CEO Stay connected with OHCA! Contact Maggie Walter, [email protected], to be added to our email lists. Improving lives by advancing quality care in Oregon since 1950
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 6 FEATURE RECREATION WITH INTENTION: MINDFULNESS & WELLNESS IN LONG TERM CARE By Maggie Walter, Oregon Health Care Association “We embrace a really holistic approach to well-being that not only focuses on just the physical and mental aspects of it, but the eight different dimensions of wellness: emotional, vocational, spiritual, environmental, physical, social, intellectual, and financial.” – Lilly Hillyer, The Springs at Happy Valley The idea of ‘well-being’ extends beyond just physical health. Of course, a resident’s physical state is a paramount concern, but how are long term care professionals ensuring that their care is well-rounded, holistic, and providing stimulation for their residents? Incorporating activities that revolve around the concept of residents’ mindfulness and wellness is a growing trend in long term care. Studies have shown that these activities improve a resident’s mental health and also their physical state. In this article, we interviewed two care providers who are making mindfulness and wellness an integral facet of their life enrichment programming to see how these activities impact the residents, as well as the staff who are facilitating them. When a resident enters long term care, at the forefront of their family’s mind is their well-being. Will the transition go smoothly? Will their loved one receive the care that they need? Will they be happy? These concerns are also top of mind for those working within these communities.
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 7 FEATURE Residents of The Watermark at The Pearl have access to a fully equipped gym, allowing them to engage in physical activity whenever they desire. Mindfulness and Wellness in Activities Planning “Mindfulness and wellness are absolutely at the core of what we do,” says Lilly Hillyer, assistant life enrichment director at The Springs at Happy Valley. “At The Springs, we embrace a really holistic approach to well-being that not only focuses on just the physical and mental aspects of it, but the eight different dimensions of wellness: emotional, vocational, spiritual, environmental, physical, social, intellectual, and financial.” Incorporating these different dimensions of wellness into life enrichment programming gives residents a more well-rounded experience within their community. This goes beyond table games, such as dice or cards. Residents require stimulation on various levels that contributes to improving their overall well-being. “These dimensions are interconnected— by addressing each dimension and personalizing our schedules and programs, we ensure that our residents experience a fulfilling lifestyle,” says Hillyer. From aqua fitness to armchair travel to brain games to attending local shows, there are wellness-based activities that cater to all interests at The Springs at Happy Valley. Ella Moretti-Aceves, executive director for The Watermark at The Pearl, approaches life enrichment programming with a similar mindset regarding holistic well-being. “At The Watermark at The Pearl, wellness and mindfulness are foundational to our communities. We believe that promoting physical, mental, and emotional well- being contributes to a more balanced and fulfilling lifestyle for our residents,” says Moretti-Aceves. Examples of wellness-based activities at The Watermark at The Pearl include meditation and breathwork sessions in the green spaces, aromatherapy workshops and spa experiences, and mindful art creation, among many others. “Our activities planning emphasizes wellness as a priority,” says Moretti- Aceves, and she emphasizes that wellness- based activities can be implemented into various aspects of residents’ daily lives. Positive Outcomes in Resident Health and Well-Being Mindfulness and wellness activities can lead to various positive outcomes, both physical and mental. These types of activities have been shown to reduce stress, increase focus and concentration, and help with pain management. At The Watermark at The Pearl, Moretti- Aceves believes that prioritizing these activities has resulted in tremendous positive impacts. “Our residents not only express greater satisfaction with their daily routines, but also display improvements in mental clarity and emotional resilience,” she explains. “One specific example is a resident who struggled with anxiety and joined our weekly meditation class. After CONTINUES »
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 8 FEATURE Hillyer has worked at The Springs at Happy Valley since it opened two years ago. consistently participating, the resident says she’s experienced significant improvements in managing her anxiety and feels more present and engaged in daily life.” These are simple additions to a residents’ daily routine that can lead to improved health outcomes, despite minimal intervention. Another aspect of well-being that is important to nourish is social connection. At The Springs at Happy Valley, Hillyer hosts ‘Lilly’s Kitchen,’ a twice-weekly cooking demonstration that she leads for residents. “It has become a gathering space for residents who feel at home in their kitchen. It’s not only just a place for them to have tasty snacks, but to build those social connections, and bond over recipes. It might just seem like normal programming, but it goes a little bit deeper to where we can have this space that our residents feel very safe, supported, and heard, even if it’s just a cooking demonstration.” It is imperative to offer a wide range of wellness-related activities for residents to choose from, so they have the agency to participate in ones that best fulfill them and suit their needs. From meditation to cooking demonstrations, Moretti-Aceves and Hillyer are incorporating engaging ways to get residents excited about activities geared towards improving their overall well-being. Incorporating Accommodations When people think about mindfulness and wellness, they typically picture yoga, taking a walk, or stretching. In a long term care community, those types of activities may not be feasible for certain residents who have mobility restrictions. Creativity is required by the staff to come up with alternative solutions that achieve similar health outcomes as taking a walk or yoga. “We are committed to ensuring all of our residents, regardless of their physical ability, have access to wellness-based experiences,” Moretti-Aceves says. “For those unable to participate in traditional movement-based activities, we offer alternative programs that focus on mental and emotional well-being.” These activities can include guided meditation sessions, mindfulness discussions, and music therapy. The Watermark at The Pearl has even incorporated virtual reality-based experiences for those with mobility restrictions! The Springs at Happy Valley shares this sentiment that a resident’s level of mobility should not be a barrier to participating in these activities. “This belief is why we designed programming that spans across all eight dimensions of wellness, offering alternatives to meet different needs. For those who can’t take part in traditional physical activities, we offer chair yoga and balloon badminton. At Footsteps, we offer hand massages. Those with any sort of physical condition can still get an aspect of physical wellness,” says Hillyer. “Emotional and social wellness are fostered through programs like Mindful Mandalas » FEATURE, CONT. “Residents are more likely to engage with a program if they feel it speaks to their personal preferences and passions.” – Lilly Hillyer, The Springs at Happy Valley
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 9 FEATURE CONTINUES » “We believe that when our staff embraces wellness, it enhances the overall atmosphere of the community, contributing to an environment where everyone thrives.” – Ella Moretti-Aceves, The Watermark at The Pearl and creative writing workshops where residents can express themselves and connect with others[…]. We ensure that each resident has an opportunity to engage with the wellness programming in a way that works for them, regardless of physical limitations.” Encouraging Participation and Engagement Getting residents interested in and excited about activities they may not know much about or aren’t used to can often prove challenging. However, this should not deter life enrichment professionals from incorporating these activities into their planning. Hillyer says the best way to increase interest from residents is personalization: tailoring programs to meet specific interests and needs. Hillyer explains, “Residents are more likely to engage with a program if they feel it speaks to their personal preferences and passions.” Creating resident interest surveys and making the activity planning feel ‘community driven’ allows residents to feel they have a voice and that their preferences are being heard. It is very difficult to make anyone do something they have no interest in. This approach allows the voices of those benefiting the most from these activities to be recognized. Hillyer continues, “It can seem daunting at first to integrate elements of fun and creativity and personal interest, but we have seen higher participation and enthusiasm from residents. This not only increases engagement but also gives them a sense of ownership and pride in the community, as well.” Moretti-Aceves says that the key to resident engagement is making activities accessible, enjoyable, and adaptable: “Engaging residents starts with listening to their interests and introducing wellness in creative, low-pressure ways. For example, you can integrate mindfulness into everyday activities, like a creative art session that encourages focusing on the process rather than the outcome.” Proven by Hillyer and Moretti-Aceves, tailoring your wellness-based programming to suit specific interests and passions can greatly increase resident participation and enjoyment, contributing to the overall feeling of improved well-being. Staff Outcomes Incorporating wellness-based activities has positive impacts for the staff working in these communities, as well. Moretti-Aceves says that, at The Watermark at The Pearl, staff have shown great Hillyer combines recreation with wellness with her ‘Lilly’s Kitchen’ cooking demonstrations, providing residents with a space to foster their social connections with other residents and staff. Hillyer was recognized at the 2024 OHCA Annual Convention Awards Luncheon for her achievements in life enrichment and activities planning.
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 10 FEATURE » FEATURE, CONT. enjoyment from the implementation of wellness-based activities. “Many [staff members] participate in mindfulness sessions and fitness activities, which have helped create a stronger sense of community among our team. This has led to improved well-being, greater job satisfaction, and a deeper connection with the residents they care for,” she says. Additionally, Hillyer believes that these activities have shaped the overall atmosphere of The Springs at Happy Valley. “I fully and wholeheartedly believe that our staff has benefitted from the connection and purpose that comes with either leading these wellness programs or just being an active part of the community and engaging with residents… Leading activities like Mixed Media Marvels or Paint and Sip sessions allows staff to see residents in a new light beyond their roles as care recipients. It creates a rewarding experience for staff, as they feel they are making a real difference in residents’ lives,” says Hillyer. Within these communities, these activities have helped foster the relationships between residents and their fellow residents, residents and staff, and staff with their colleagues. Hillyer continues, “Although life enrichment programming is geared towards the resident, I feel like it contributes to the overall progression and uplifting of the community around it, too.” Moretti-Aceves attests to this feeling, as well. She says, “We believe that when our staff embraces wellness, it enhances the overall atmosphere of the community, contributing to an environment where everyone thrives.” From exercise to virtual reality, The Watermark at the Pearl has accommodations for all residents to participate in wellnessbased activities. “I fully and wholeheartedly believe that our staff has benefitted from the connection and purpose that comes with either leading these wellness programs or just being an active part of the community and engaging with residents… Leading activities like Mixed Media Marvels or Paint and Sip sessions allows staff to see residents in a new light beyond their roles as care recipients. It creates a rewarding experience for staff, as they feel they are making a real difference in residents’ lives.” – Lilly Hillyer, The Springs at Happy Valley
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 11 DATA & RESEARCH We tend to go about our lives preoccupied with all the many things we need to do— meeting deadlines for work, running errands, making plans for the upcoming weekend. We also spend considerable time thinking about the past. While this might include reminiscing about fond memories, we often focus on the mundane, such as a purchase on a recent trip to the grocery store or last week’s staff meeting. As a result, we miss out on the present moment. These factors have all sorts of effects on our daily lives, many of which can negatively influence mental health and well-being. Enter the practice of mindfulness. While mindfulness has been practiced for thousands of years, a flurry of research in recent decades has propelled mindfulness into everyday life. So, what is mindfulness? According to the American Psychological Association (APA), mindfulness is an awareness of one’s internal states and surroundings (APA, 2024). In other words, mindfulness is being attuned to one’s thoughts, feelings, body, senses, and what is happening around us right now. Mindfulness helps remind us to focus on what is happening in the present moment rather than all the other stuff—past and future—vying for our attention. Mindfulness, however, is much more than being present in the moment; it also has real impacts on our mental health and well-being. According to multiple studies, mindfulness may be a good way to reduce anxiety or depression (Hoffmann and Gómez, 2017). Mindfulness may also be beneficial to our physical health. Multiple studies suggest that practicing mindfulness may specifically support cardiovascular health (Loucks et al., 2015), including controlling one’s blood pressure (Loucks et al., 2019; Nardi et al., 2020). Other studies appear to show that mindfulness may help to reduce chronic pain (Zeidan et al., 2015). Based on these few examples of the benefits of mindfulness, it’s no wonder that the practice is so popular. So, what about the use of mindfulness in long term care settings? There is a clear need to support resident mental health and well-being. Mindfulnessbased interventions (MBIs) are a way to meet this need. MBIs include mindfulness-based stress reduction (MBSR), which was first developed as an intervention in 1979 and has been studied extensively since then (KabatZinn, 1982; Gu et al., 2015). A few recent studies have looked at using MBIs within long-term care settings and the impacts on residents, including on physical as well as mental well-being (Chen et al., 2020; Hsiung et al., 2023; Terry et al., 2021). Chen et al (2020) found that residents living with type 2 diabetes experienced improvements in their HbA1c (glycemic) levels following participation in a nine-week mindfulness-based Mindfulness to Support Resident Well-being in Long Term Care Settings By Walt Dawson, D. Phil program that include meditation, education, and exercise. Another study found that residents’ mental health improved including a substantial decrease in anxiety and fewer depressive symptoms after completing an eightweek, group-based MBI that included lectures on awareness and yoga (Hsiung et al., 2023). The use of MBIs can also benefit direct care staff who work in these care settings. There is ample evidence that Mindfulness-Based Stress Reduction (MSBR) is a helpful approach for reducing anxiety, depression, and stress among health care professionals (Kriakous et al., 2021). One small study found that certified nursing assistants who participated in an online MBI reported reduced depressive symptoms following their participation (Young et al., 2022). More research is needed to clearly demonstrate how the positive impacts of mindfulness on residents and staff in long term care settings can be optimized. We also need to think about the barriers that may limit resident and staff participation in MBIs. For instance, Mindfulness is being attuned to one’s thoughts, feelings, body, senses, and what is happening around us right now. Mindfulness helps remind us to focus on what is happening in the present moment rather than all the other stuff—past and future—vying for our attention. CONTINUES »
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 12 DATA & RESEARCH many MBIs that have been studied in long term care settings are group-based. But this format may not always work well given resident needs. Implementing programs that can be carried out by someone on their own time and in their own space (an app-based mindfulness education program, for example) or encouraging individuals to practice mindfulness more generally rather than through a formal program may help expand access and participation across care settings. In short, promoting the practice of mindfulness can be a great way to support the health and well-being of residents and staff. Mindfulness should not be intended to replace any treatment; rather it can be used to complement existing treatments, practices, and care routines. Additional research, especially larger studies that include more participants, is needed to better show how the potential benefits of MBIs (and how these interventions exactly provide those benefits) can support residents in long term care settings. But one of the most powerful aspects of mindfulness is that it can be practiced almost anytime, anywhere. Walt Dawson is OHCA’s research consultant as well as an assistant professor at Oregon Health & Science University and a senior Atlantic fellow with the Global Brain Health Institute. References: 1. American Psychological Association (APA) (2024). Mindfulness. https://www.apa.org/topics/mindfulness 2. Chen, S. M., Lin, H. S., Atherton, J. J., MacIsaac, R. J., & Wu, C. J. (2020). Effect of a mindfulness programme for long-term care residents with type 2 diabetes: A cluster randomised controlled trial measuring outcomes of glycaemic control, relocation stress and depression. International Journal of Older People Nursing, 15(3), e12312. https://doi.org/10.1111/opn.12312 3. Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulnessbased stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006 4. Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-Based Interventions for Anxiety and Depression. The Psychiatric Clinics of North America, 40(4), 739–749. https://doi. org/10.1016/j.psc.2017.08.008 5. Hsiung, Y., Chen, Y. H., Lin, L. C., & Wang, Y. H. (2023). Effects of Mindfulness-Based Elder Care (MBEC) on symptoms of depression and anxiety and spiritual well-being of institutionalized seniors with disabilities: a randomized controlled trial. BMC Geriatrics, 23(1), 497. https://doi.org/10.1186/s12877-023-04220-6 6. Kabat-Zinn J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47. https://doi.org/10.1016/0163-8343(82)90026-3 7. Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness, 12(1), 1–28. https://doi.org/10.1007/s12671-020-01500-9 8. Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J. A., & Fulwiler, C. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current Cardiology Reports, 17(12), 112. https://doi.org/10.1007/s11886-015-0668-7 9. Loucks, E. B., Nardi, W. R., Gutman, R., Kronish, I. M., Saadeh, F. B., Li, Y., Wentz, A. E., Webb, J., Vago, D. R., Harrison, A., & Britton, W. B. (2019). Mindfulness-Based Blood Pressure Reduction (MB-BP): Stage 1 single-arm clinical trial. PloS One, 14(11), e0223095. https://doi. org/10.1371/journal.pone.0223095 10. Nardi, W. R., Harrison, A., Saadeh, F. B., Webb, J., Wentz, A. E., & Loucks, E. B. (2020). Mindfulness and cardiovascular health: Qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study. PloS One, 15(9), e0239533. https://doi.org/10.1371/ journal.pone.0239533 11. Terry, C., Penland, M., Garland, D., Wang, W., Burton, T., & Dark-Freudeman, A. (2021). Adapting Mindfulness-Based Interventions for Residents of Long-Term Care Facilities. Gerontology & Geriatric Medicine, 7, 23337214211057703. https://doi.org/10.1177/23337214211057703 12. Young, C. C., Kesler, S., Walker, V. G., Johnson, A., & Harrison, T. C. (2023). An Online Mindfulness-based Intervention for Certified Nursing Assistants in Long-term Care. Journal of Holistic Nursing, 41(2), 130–141. https:// doi.org/10.1177/08980101221105709 » DATA & RESEARCH, CONT.
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 14 Mindfulness Ideas for Long Term Care Providers By Nicolette Reilly, Oregon Health Care Association As Walt outlined in his article, mindfulness is a valuable and important state of being that can be cultivated in everyday life to help seniors maintain a healthy physical, mental, and emotional well-being. It can help individuals achieve a relaxed state of mind by increasing awareness of their present thoughts, emotions, and feelings. There are numerous benefits of meditation and mindfulness. Here are a few that are particularly relevant for seniors: • Improved focus and concentration: Mindfulness helps seniors stay focused on the present, which can improve memory and cognitive function. This can be particularly beneficial for seniors dealing with cognitive decline or dementia. • Reduced stress and anxiety: Regular meditation can help reduce symptoms of stress and anxiety. This can lead to improved mental health and a better quality of life. • Better sleep: Mindfulness meditations for sleep can help seniors establish healthier sleep patterns. Good sleep is essential for overall health and wellbeing. • Pain management: Mindfulness meditation for pain has been shown to help manage chronic pain in seniors. It can be a useful complement to traditional pain management strategies. • Increased emotional well-being: Mindfulness and meditation can lead to an improved sense of well-being, general mood, and overall happiness. They can help seniors navigate the emotional challenges of aging, fostering resilience, and positivity. • Decreased loneliness and depression: A study from Mindfulness NY reported that mindfulness-based interventions were associated with significant declines in loneliness and depression among seniors. Mindfulness meditation for seniors is a vital part of maintaining mental health and overall well-being. Incorporating mindfulness and meditation into a daily routine doesn’t have to be complicated. Here are some mindfulness activities that seniors can try: • Breathing exercises: Require sitting, focusing on regulating your breath, and being in the moment. Box breathing is a popular exercise that can help lower heart rate and calm the body. Simply focusing on the breath, in and out, can help bring about a sense of calm and focus. It’s a simple practice that can be done anywhere, anytime. • Yoga: Encourages seniors to focus on their bodies, minds, and environments. Regular practice can improve mood, relieve anxiety, and lower the risk of depression. • Mindful eating: Paying attention to the taste, texture, and smell of food can turn a regular meal into a practice of mindfulness. It’s about savoring each bite and being fully present in the experience of eating. • Walking meditation: Also known as mindful walking. Taking a slow, mindful walk, paying attention to each step and the feeling of movement, can be a form of meditation. It’s a way to connect with the body and the surrounding environment. • Body scan: A simple exercise that helps seniors connect to their physical self and notice any sensations without judgment. • Guided sleep meditation: Involves following along with a recorded voice that prompts relaxation techniques and visualizations to help seniors fall into a deep sleep. Incorporating mindfulness meditation into communities’ current activities and person-centered service plans, with flexible, creative programs, can improve the quality of life not only for our residents, but also for your team members. Nicolette Reilly is the SVP of Quality at OHCA. QUALITY
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The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 16 LEGAL & REGULATORY Supporting Employee Well-being with EAPs By Eugenia Liu, J.D., Oregon Health Care Association Senior living providers cannot serve their residents and clients without their valued staff. It is the staff, from the direct care workers, to nurses, to department heads, who play a vital role in delivering quality care each and every day to older adults and individuals with disabilities in these communities. While residents are at the heart of everything that senior living providers do, equal attention should be paid to supporting the health and well-being of staff. Employee Assistance Programs (EAPs) are a tool that more and more employers are adopting to support employee well-being, including mental and emotional health. EAPs are often offered as a part of an employer’s benefits plans and provide employees with access to a wide range of services to support their personal needs, such as confidential counseling to assist with family problems, substance abuse or mental health issues, help with managing or overcoming stress, as well as referrals to manage financial or legal problems. EAPs can be effective tools in recruiting and retaining employees. Studies have shown that non-traditional benefits hold more value for younger workers, including support for mental health and work-related burnout. The benefits of an EAP program can also be utilized as a part of a provider’s critical incident or crisis management process to help employees cope with a work-related or emergency response event. To maximize the benefits of an EAP, providers should take steps to ensure the programs are easily accessible to employees and well-communicated. Reports show that oftentimes, employees did not take advantage of an EAP because they were either not aware of the program or did not think of utilizing it. Periodic reminders and education on an EAP will therefore help employees tap into this resource when needed. To best support our residents, we need to support the staff who serve them, and EAPs offer providers one avenue to do so. Eugenia Liu is the SVP and General Counsel at OHCA.
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 17 PUBLIC POLICY 2025: New Year, New Legislature By Libby Batlan, Oregon Health Care Association January is a time for beginnings; a new year brings a fresh perspective and a recommitment to goals. For some, this means the perennial task of upholding new year’s resolutions, but for Oregon Health Care Association’s (OHCA) government relations team, the start of 2025 means one thing: Oregon legislature will be in session soon. After another general election that resulted in Democrats retaining legislative control, lawmakers will convene in Salem for a “long” session. They will have six months to complete their work, including the consideration of thousands of bills and finalizing the state’s budget for another two years. OHCA Priorities OHCA will center its legislative agenda on three pillars: 1. Protecting and enhancing Medicaid reimbursement rates for nursing facilities, community-based care facilities, and in-home care agencies. 2. Defending against harmful policies that drive up costs to deliver care and reduce access to care. 3. Supporting workforce initiatives that funnel more nursing staff to postacute and community-based care settings. Understanding the upcoming session is directly tied to understanding the state’s current budget climate. Unlike the federal government, Oregon’s legislature must begin and end each biennium with a balanced budget, just like any other business. This means that when the economy is strong, lawmakers can spend more on important services or start new programs. But when money gets tight, they are forced to make hard choices and prioritize where to spend Oregonians’ tax dollars. Despite volatility over the last five years with the pandemic and record-high inflation, Oregon’s economy has experienced significant growth, buoyed by massive influxes of one-time federal funds flowing to state coffers. But that is changing, and a more constrained budget climate will have a significant impact on state funding for services next session. Budget Shortfall The cause of the potential budget shortfall is complicated. The basis for Oregon’s budget is the state economist’s quarterly revenue forecast, which provides the Governor and legislators projections about the funds that will be available to pay for state services. The latest forecast, released in September 2024, showed that despite growth in short-term revenue, the longer-term outlook is bleaker, and it is expected that General Fund revenue will experience a sharp decline. If there are insufficient revenues during the 2025–2027 budget years to meet the predicted needs for services, this could mean cuts depending upon how deeply the legislature wants to dip into their budget reserves. The other problem is the legislature needs more money than ever before to keep all its programs afloat. The state’s overall budget has grown from just under CONTINUES »
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 18 $20 billion in 2017–19 to just over $31 billion in 2023–25. Underlying this budget growth is the fact that the legislature recently approved new programs that have not yet been fully paid for. Other factors effecting the budget include: • Medicaid caseloads are high, • Devastating wildfires have ravaged the region summer after summer causing large spikes in prevention and recovery costs, • Housing and homelessness remains a major concern, • Oregon’s public schools are underperforming, and • The legislature must fund another transportation package in 2025 to keep up with the maintenance of roads, bridges, and other infrastructure. To make matters even more complex, it is assured that Oregon’s unique “kicker” tax law will again be triggered, siphoning off about $1 billion of General Fund monies back to taxpayers that would otherwise be used to fund program and service requirements. Long Term Care Impact With all this in mind, the biggest budget risk for long term care next session is the potential risk of cuts to Medicaid reimbursement rates from policymakers looking to reduce spending or reallocate funding to other priorities. We know that reducing or maintaining Medicaid rates, and not increasing them to keep up with inflationary care costs, reduces access to care for low-income Oregon seniors, and so OHCA will be focused on ensuring that is not the outcome. Through our advocacy program, OHCA has been able to translate strong budget years into historic, double-digit Medicaid rate increases for the sector. These increases came at a time when labor and medical supply costs were soaring and enabled many of our members to continue to operate and provide care during this challenging economic time. In the 2025 session, we will make the case that funding for Medicaid long term services and supports is a core service delivery area for the state, and that any cuts will result in tragic impacts for low and middle-income seniors that need care in their homes or in a licensed setting. Workforce Standards Board Beyond the budget, OHCA will be focused on defending against legislation that would create a home and community-based services workforce standards board in Oregon, which would likely be harmful to the sector’s ability to provide affordable care depending on how it was structured and the authorities it is provided under the law. Workforce standards boards have emerged in other states in recent years, but only three states have adopted them specifically for care-related workers and in different capacities than what the Oregon bill is pushing for. These boards are empowered by the legislature to set and enforce workplace standards— including wages, benefits, training, and safety—that cover all workers in a particular sector regardless of individual operator’s specific circumstances, locations, Medicaid mix, and other important factors that affect operators and organization budgets. OHCA has and will always support raising caregiver wages, improving workforce challenges in the long term care sector, and enhancing care outcomes for older adults. While we understand a workforce standards board is an idea some advocacy groups believe is best to address workforce shortages, OHCA is concerned about potential catastrophic, unintended consequences for consumers, providers, and the state, primarily care affordability and access to care in certain parts of the state. As always, we will call on our members to help us advocate effectively next session. The support and engagement of providers is central to our success, and we look forward to working with you once again as we can on both the opportunities and challenges of the next legislative session. Libby Batlan is the SVP of Government Relations at OHCA. »PUBLIC POLICY, CONT. PUBLIC POLICY OHCA has and will always support raising caregiver wages, improving workforce challenges in the long term care sector, and enhancing care outcomes for older adults.
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 19 SPONSORED CONTENT The concept of choice architecture has illustrated new ways of enhancing the well-being of diners in restaurants, corporate cafes, schools and hospitals. Is there a role for choice architecture in senior living dining programs? The short answer is YES. Helping residents choose the best options at mealtimes is part of our job as senior living professionals, and choice architecture can help us with this. What is Choice Architecture? Choice architecture refers to the deliberate crafting of decision-making environments.1 In the dining experience, using choice architecture might mean presenting different foods in different ways, using certain verbiage on menus, or offering foods in a certain order, all for the sake of influencing the way a decision is made about what to eat. In senior living, we can use these principles to help residents choose foods in line with their health goals, eat more foods that will help them maintain weight, eat more of their meal overall, and drink more fluids to support better hydration. Two important aspects of choice architecture are menu engineering and behavioral nudges. Menu Engineering Menu engineering can take many forms. The way we name our dishes can have a huge impact on the perception of those foods.2 Ask residents how they would describe their favorite dishes, then consider adding those words to accurately name dishes on your menu. Using appealing words like “crisp,” “creamy,” “luscious,” or “rich” can impact the way your residents choose various foods, which may help them with their health Can Choice Architecture Influence Resident Well-being? By Jen Bruning, MS, RDN, LDN, Incite Strategic Partners goals. Incorporate high-quality photos of foods on the menu to give folks a better idea of what to expect on their plate. Upgrade your posted or hand-held menus to better serve your clientele and add distinction to your dining program. Consider using symbols to mark choices on a menu that support various health conditions. This strategy has been shown to be particularly effective when used on Baby Boomers. Indicating which items are lower sodium or fat, a good source of fiber or are considered part of the Mediterranean diet could all help diners make smart choices at mealtimes. Behavioral Nudges Behavior “Nudges” refer to small influential shifts to the environment to foster healthier decision-making. In senior living, we can nudge residents in several ways: • Make hydration stations more visually appealing and easier to get to, nudging folks to stay better hydrated. • List a healthier meal option earlier on a menu allowing folks to make the better choice for themselves before being overwhelmed by more menu options. • Consider colorful table settings. Different color schemes may influence residents’ PO intake. For example, red colored plates can help enhance appetite, whereas yellow sustains attention. Used more often for people living with dementia, these colorful options may also increase intake among residents without dementia as well. While many of these ideas are used in the general population to reduce caloric intake, rarely is that the goal among seniors. “Healthy” is defined by what is best for the individual, which might mean weight gain or maintenance, and often includes a focus on enjoyment. Get creative and have fun using these theories to enhance the well-being of residents in new and innovative ways. Jen Bruning is the director of nutrition and brand innovation with Incite Strategic Partners, OHCA’s purchasing partner and an OHCA business partner. This article has been sponsored and provided by Incite Strategic Partners. References: 1. https://thedecisionlab.com/reference-guide/psychology/ choice-architecture 2. https://www.sciencedirect.com/science/article/abs/pii/ S0278431924002354 Consider using symbols to mark choices on a menu that support various health conditions. This strategy has been shown to be particularly effective when used on Baby Boomers.
The Oregon Caregiver FALL/WINTER 2024 www.ohca.com 20 Nursing in community-based care settings, such as assisted living and memory care, can be incredibly rewarding. Ask any nurse what keeps them in this setting, and they will talk about their love and passion for this unique population of residents. But, like all specialties, working in community-based care (CBC) has its own unique set of challenges. Nurses in CBC often work in isolation as the sole nurse for an entire community of residents and staff. Once on the job, nurses must navigate unique and unfamiliar setting- based regulations. Limited opportunities for CBC-specialized training, education, and support can further make nurses feel like an involuntary lone wolf in this field. Some CBC nurses may relate to being an “accidental leader”—someone who didn’t set out to lead, but who possesses the necessary knowledge and skills, and are then given the responsibilities of a leader without sufficient training or support. This unique set of challenges in CBC creates a very real potential for nurse burnout. In a 2022 survey of Oregon nurses, 97% reported a work-related stressor, with the highest reports of stress coming from nurses in long-term care and home health/hospice (Oregon Center for Nursing, 2022). Recognizing this frequency for nurse stress and burnout across settings, in 2023 the Oregon State Board of Nursing made the decision to include nurse wellness in their mission statement. The statement now reads, “The Oregon State Board of Nursing protects the public through regulatory excellence and promoting the wellness of nursing professionals.” It is a small addition that makes a huge statement: nurse wellness IS public safety. Indeed, the well-being of nurses and care workers is paramount to the sector’s quality of care and longevity. Nurse Mindfulness and Well-being By Alayna Amrein, Communications Coordinator, NurseLearn SPONSORED CONTENT Alida Raynor RN, NurseLearn Enhanced Program alumna, poses with her NurseLearn Mentor, July Lumague-Test at the OHCA Annual Convention. From a desire to combat the root causes of stress and burnout specific to CBC settings—nurse isolation, navigating unique regulations, and limited CBC specialized education—an online learning platform for CBC nurses, NurseLearn, was born. Two free learning programs are available through NurseLearn, the Enhanced Program and the Standard Program. The Enhanced Program equips Oregon- licensed nurses with the mentorship, CBC-specialized learning modules, and nurse community support needed to thrive in their role. The NurseLearn modules cover six topic areas vital to the success and well-being of CBC nurses in their role. Through the
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 21 Modules, like the examples above, cover six topic areas that include RN Delegation, Leadership & Management, Medication System, Care Management, Behavioral and Mental Health, and Significant Change of Condition. Nurse wellness IS public safety. Indeed, the well-being of nurses and care workers is paramount to the sector’s quality of care and longevity. modules, nurses acquire tools that help them navigate technical skills, CBC regulations, and interpersonal team dynamics with ease and confidence. One module titled “Self-Care, Resilience, and Wellness” openly and honestly analyzes workplace factors that contribute to burnout and empowers nurses to cultivate an environment of sustainable self-care strategies. “As a regional nurse, I answer CBC nurses’ questions every day,” says Alida Raynor, a CBC nurse of 13 years and an Enhanced Program alumna. “NurseLearn gives me the assurance that I am giving them the right answer.” SPONSORED CONTENT The Enhanced Program is currently accepting applications for the next cohort which begins January 3, 2025. Nurses can apply to the Enhanced Program, and nurses, assisted living and memory care licensed administrators, and student nurses can access the Standard Program, at nurselearn.com/odhs. NurseLearn is an OHCA business partner member. This article has been sponsored and provided by NurseLearn.
www.ohca.com FALL/WINTER 2024 The Oregon Caregiver 23 SPONSORED CONTENT The intersection of mental health and privacy is of paramount importance—particularly in long term care facilities. However, it can be a delicate balance to ensure that sensitive patient information is protected while facilitating efficient and effective treatment for residents. This is particularly true for psychotherapy notes (regulated under HIPAA) and substance use disorder (SUD) records created or maintained by certain federally assisted programs (regulated under 42 CFR Part 2), which have historically presented differing compliance obligations. On February 8, 2024, the Department of Health and Human Services (HHS) released a final rule to align 42 CFR Part 2, which protects certain Part 2 SUD records, with HIPAA and the HITECH Act. This rule specifically aims to enhance care coordination and privacy protections for patients seeking SUD treatment by adopting more consistent and stringent compliance obligations. The rule became effective on April 16, 2024, with a final compliance date of February 16, 2026. These new rules not only impact Part 2 programs, but also lawful holders such as long term care facilities that may receive SUD records from Part 2 programs in the course of providing services to their residents. One key area of impact includes restrictions on certain disclosures of Part 2 SUD records. Under HIPAA, psychotherapy notes are given special protection and must be kept separate from the rest of a patient’s medical records. These psychotherapy notes require separate patient consent for use and disclosure. The new Part 2 rule extends similar protections to SUD counseling session notes, requiring them to be maintained separately and requiring both Part 2 programs and lawful holders to obtain a distinct consent for any use or disclosure. The rule also expands prohibitions on using and The Intersection of Mental Health and Privacy: Updates to 42 CFR Part 2 By Brent Hoard and Emma Trivax, Troutman Pepper disclosing Part 2 records in legal proceedings without patient consent or a court order. The good news is that, excluding SUD counseling notes, Part 2 programs and lawful holders now can obtain a single consent from patients to use and disclose Part 2 records for treatment, payment, and health care operations, when historically a new consent was required for each individual disclosure. There are also some limited circumstances where redisclosures by Part 2 programs and lawful holders are permitted without a new patient consent. This rule update should enhance the coordination care between Part 2 programs and long term care facilities. Overall, the new updates to Part 2’s robust privacy protections for SUD records will encourage patients to obtain SUD treatment, but nonetheless add additional compliance considerations for long-term care facilities that are in receipt of such records. In addition to existing criminal sanctions, the Part 2 rule adds potential civil monetary penalties for violations of confidentiality provisions. Therefore, entities that operate or receive information from Part 2 programs should consider reviewing and updating Part 2 policies and procedures, updating contract templates, and conducting training for relevant members of the workforce. Troutman Pepper is an OHCA business partner member. This article has been sponsored and provided by Troutman Pepper.
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