Dr. El

For a fascinating close-up of the impact of policy decisions on individuals and teams, I step onto the nursing home unit. For a fascinating zoom-out of the impact of policy decisions on the healthcare system in general, I follow the Twitter feed of David Grabowski, Ph.D., professor of health policy research at Harvard Medical School.

Dr. Grabowski has studied the economics of aging for decades and, due in large part to the pandemic-related attention thrust upon long-term care, his work has been in the spotlight now more than ever.

His studies early in the pandemic focused on nursing homes’ need for PPE and other assistance. As the months wore on, he detailed the toll of separating residents from their families. His latest articles address the impact of high nursing staff turnover and call for increased financial transparency within the long-term care industry.

He holds researcher superhero status in my mind: He’s writing with scientific authority about things we observe in the field every day, often taking on issues we aren’t in the position to discuss.

Dr. Grabowski and I spoke recently about his research and about developments in the field. I took some time to reflect upon this discussion, lightly edited, below.

EFB: What do you like about this work?

DG: Everything! Everything that is studied in health policy is present in long-term care and more so — the response to payment incentives, quality of care, the need to support the workforce.

Reflections: Even though long-term care isn’t a “sexy” topic to research, or a “sexy” job to be in, those that can get past this barrier find it a vital and exciting field, whether they are researchers, administrators or direct care staff. Vocal enthusiasts can draw other people to the field, as Dr. Grabowski has done.

EFB: It seems like the pandemic has increased the visibility of your work.

DG: Definitely. I’m getting more interest from students and faculty and more people are calling for interviews. I’m very excited that people are interested in it. Once you see how this works, or doesn’t work very well, it makes you see the need to devote more resources to it and to put forward better policies. I do have some fear that we won’t follow through on the work we need to do, that the media will shift focus and people will move on to something else.

Reflections: Of my 20-plus years in the field, this is the closest I’ve seen the country come to recognizing how crucial it is to make substantive changes to better meet the needs of residents, families and staff and to address payment inequities. If the devastation of the pandemic can’t do it, it’s hard to imagine what could. This is our moment.

EFB: Is there anything that people who work in nursing homes can do to foster these changes?

DG: Let their voices be heard. Nobody knows better than the staff what’s happening in these buildings. How is PDPM working? How are the visitation policies going? Staff and family members were testifying in front of Congress — their experience cuts through the researchers, the policy people, the government officials. One staff member said, “We don’t need another pizza party, we need PPE.” This carries a lot of weight.

Reflections: Decisions made without input from the people affected by them are based on incomplete information and therefore aren’t as sound as they could be. Testifying in front of Congress is one way to offer perspective; others include speaking up about observations in team meetings, writing an opinion piece for an industry publication such as McKnight’s or becoming a member of an organization that supports your views.

EFB: Are there any organizations you think people should join to make their voices heard?

DG: It’s important to become part of a group that’s advocating on your behalf. The National Consumer Voice advocates for families and residents, for instance. The National Association of Health Care Assistants is another strong organization.

Reflections: There are a host of valuable national associations in the field, directed towards facilities as a whole (LeadingAge, AHCA), and specific disciplines (ACHCA for health care administrators, NADONA for nursing directors, etc.), as well as many state associations.

Perhaps it’s time, though, for a centralized organization that could act on behalf of LTC workers regardless of discipline, with the goal of establishing reasonable working conditions that stabilize the workforce and thereby improve care for residents.

It will take input from all of us — from superhero researchers to policy makers to LTC leaders to front line staff — to rethink long-term care facilities so that they’re sustainable businesses that provide quality employment and quality care.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at EleanorFeldmanBarbera.com.