"I WOULD say that the best of times for seniors would be associated with the rapid pace of change in the health care and long-term care settings that is intended to improve quality and help keep people in the community. "
Jim Nyberg is the director of LeadingAge RI, which represents nonprofit nursing homes, assisted living residences, senior housing, and adult day centers in RI. Prior to this, he was the director of elder services at Child & Family Services of Newport County, overseeing home care, case management, information and referral, and other services for elders in the community. He also spent several years doing advocacy and government relations work at the International Longevity Center in New York City, which was an aging research, education, and advocacy think tank. He received his bachelor’s degree from the College of William & Mary and a master’s degree in Public Administration from the Wagner School of Public Service at NYU.
PBN: How did you first become interested in elder care?
NYBERG: Like many people in the field, my interest was born out of a personal experience. My grandfather developed Alzheimer’s and came to live with my family when I was in high school. Our life together remains a positive memory, and a reminder of the need to promote dignity and respect for our older citizens. My interest in this area really solidified when working for Dr. Bob Butler at the International Longevity Center (ILC). He was a world-renowned expert in the field of aging and spent his life working to combat ageism and improve the well-being of older people. I worked on all kinds of projects and advocacy initiatives under his leadership at the ILC, which proved to be an incomparable education. Sadly, Dr. Butler passed away a few years ago, but he remains an inspiration to me.
PBN: What positive changes in the industry have you been proudest to be part of during your career?
NYBERG: I am very proud of how our members and others in the industry have continued to innovate during difficult economic times. They’re developing new programs and services and promoting person-centered care for older people, transforming the experience of aging in our state.
Nursing homes, for example, are a very different place than they used to be. Entire staffs are working together to make changes, big and small, to create more home-like environments and to respond to the individual needs of their residents, a process dubbed “culture change.” They’re moving away from the sterile institutional environments that many people remember from years ago. Of particular note, we helped enact a law that will allow for an entirely new model of nursing home care (called “green houses”) to developed in Rhode Island. This was a very important step in the evolution of care here in Rhode Island.
PBN: In what ways is now the best of times and the worst of times for seniors when it comes to health care in the state of Rhode Island?
NYBERG: I would say that the best of times for seniors would be associated with the rapid pace of change in the health care and long-term care settings that is intended to improve quality and help keep people in the community. Given the size of our growing older population and this era of scarce public resources, everyone knows that the status quo is not sustainable. So in response, new initiatives to test how we pay for and deliver care are popping up all over, and hold promise for improving care and reducing costs. There is a much greater focus on communication, collaboration, and coordination across care settings, from hospitals and doctor’s offices to long-term care settings. I think this is especially important given the geriatric expertise that our long-term care providers have, whether it is nurses, social workers, CNAs, or other staff. On a related note, there is much greater attention to the need to better support individuals in the community for as long as possible. While there will always be a need for quality nursing home care for our most frail and vulnerable, it is also important to better utilize resources in the community, such as assisted living, adult day health services, home care, and other supports.
On the flip side, we remain in very challenging economic times, at the federal and state government levels, at the provider level, and at the consumer level. Given these financial pressures, there is the risk that consumer access to care and quality of care could be affected. Therefore, it will be important for all of us to be vigilant advocates for our older population during these changing times.
PBN: Is there a state, a region, or even a city that leads the way when it comes to providing for health care for its seniors?
NYBERG: That is tricky to answer, as aging services is so different across the states, and some models that might work in one place may not work in another. From a broader perspective, I think a country like the Netherlands is an interesting example of how to provide care for seniors. Their long-term care system is publicly funded (incidentally, that is also the case in the U.S. for the most part, albeit in a very fragmented way), but care is provided by private, largely nonprofit, providers. That helps establish a fairly coordinated funding system but also fosters competition, innovation, and a commitment to quality among providers in order to survive and thrive.
PBN: What is the single most important change that needs to happen in Rhode Island in the area of health and long-term care issues?
NYBERG: I would say it is finding the responsible balance involving both spending and infrastructure for our long-term care system so that it is financially sustainable for payers and consumers. A critical element of this involves safe and affordable senior housing, and coordinating services to these individuals. Unfortunately, numerous public commissions and governmental work groups on senior issues in recent times have come to the same conclusion: Rhode Island lacks safe and affordable housing options for older people. Federal funding for senior housing developments has dried up, so we need to figure out new ways to develop housing. We remain hopeful that “supportive care residences” will soon be established by the Health Department. (These are small group homes for seniors to live in the community while receiving services from a licensed provider.) These residences are one step in the right direction, but much more needs to be done. Collectively, we need to ensure that all people, regardless of their financial means, have the opportunity age in the place they call home – whether it is their own house, an apartment, or a nursing home.
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