Five Questions With: Jim Nyberg

Jim Nyberg is the director of LeadingAge RI, a Washington, D.C.-based nonprofit that represents nonprofit nursing homes, assisted-living residences, senior housing and adult day centers in Rhode Island.

Prior to that position, 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. 

Nyberg, who has been with LeadingAge RI since 2008, has presided over the organization as the industry worked on several reforms that helped more than 40 facilities in the Providence metropolitan area earn the “Best Nursing Home” honor from the U.S. News & World Report for 2018-2019. Facilities won the accolade by rating as a high-performance facility in either the overall ratings or in the short-stay rating.

Rhode Island is one of four states in the country in which 50 percent of all Medicare/Medicaid nursing homes achieved the top rank this year. Also, two-thirds of LeadingAge RI skilled nursing providers received he “Best Nursing Home” status from the publication.

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Providence Business News asked Nyberg about the efforts nursing homes have been making in self-reform, and about the areas that still need work.

PBN: Rhode Island nursing homes are performing well, according to the U.S. News & World Report’s “Best Nursing Homes” report. Can you put this in context of the industry nationwide?

NYBERG: With hard work and collaboration, our state’s nursing homes have consistently been rated well-above the national average on deficiencies, family/resident satisfaction, and other indicators. We are a compact state that has a close-knit community of providers, state officials and other stakeholders who share information and ideas.

This year, the rating is especially meaningful with the new methodology that U.S. News used, which emphasized staffing, a factor that plays a critical role in quality care. The 2018 ranking is also significant because Rhode Island joined three other states in achieving one distinct honor: 50 percent of our nursing homes that achieved the “Best Nursing Home” honor also accept Medicare and Medicaid patients.

This demonstrates how the industry in Rhode Island is working to meet best-in-class standards, despite impediments, including ongoing budgetary constraints, the [Unified Health Infrastructure Project] imbroglio, workforce challenges, and new federal regulations and oversight processes.

PBN: LeadingAge RI has been working to reform the local nursing home industry through culture change and the Green House model. Please explain these reforms and how they contributed to Rhode Island’s performance in the report.

NYBERG: Rhode Island has been at the forefront of the culture-change movement, which incorporates resident-focused care provided in a home-like environment. This includes the Green House model, for which LeadingAge RI advocated as an important innovation, as well as related models of care to create more of a household setting for residents and staff.

These are important changes because we want nursing homes to be a place where older individuals can enjoy their lives and thrive. Basically, we are returning to home-like settings and self-directed care, which have improved resident, family and employee satisfaction. These innovations definitely played a role in our state’s outstanding ranking in the U.S. News survey.

PBN: What needs to be done to continue improving the system?

NYBERG: We can’t stop evolving. Culture change is an ongoing, dynamic process, requiring sustained commitment by all levels of staff, especially the direct-care workers who are the linchpin of quality care.

The critical component here is the recruitment and retention of committed workers when there is currently a workforce crisis in the industry. Funding is the issue. The majority of nursing home residents are on Medicaid, which unfortunately does not cover the cost of care. Consequently, providers struggle to remain viable while also competing with other industries that can offer workers higher rates of pay.

To correct the situation, we need a sustained governmental commitment to adequately fund nursing homes, so that we can be competitive in recruiting and retaining quality caregivers. Our burgeoning elderly population here in Rhode Island requires that change to avert a crisis.

PBN: Does Rhode Island still lack safe and affordable housing options for older people?

NYBERG: Yes, safe and affordable housing remains a challenge, with many subsidized apartments maintaining a waiting list of a year or more. Moreover, new data shows that about 16 percent of owners and 32 percent of renters ages 80 and older in Rhode Island are “severely cost-burdened,” according to the Joint Center for Housing Studies at Harvard, which means that they spend over 50 percent of their income on housing. This leaves less than 50 percent of their income to pay for critical expenses such as doctors, dental treatments, prescriptions, food and heating, which is obviously a challenging situation for these individuals.

We are hoping that the housing bond passed in 2016 now being allocated will help support the development of new affordable housing for our growing older population. We also need to increase the supply of affordable assisted living, including for individuals on Medicaid. There has been some progress on this front, which will hopefully help address this challenge. But it needs to be an ongoing priority to help keep seniors in their communities.

This pressing housing need presents a great opportunity for people to use their knowledge in industrial design, architecture or health care to collaborate and be change-makers. Rhode Island has a vast number of national and internally recognized innovators. We have a wealth of talent in and out of our colleges and universities. We need people who are passionate about positively impacting people’s lives to focus their efforts on this challenge in our communities.

PBN: Please share an anecdote that illustrates the plight of aging people and how the system has improved the way it serves them.

NYBERG: That is a great question, but it’s hard to give just one anecdote.  LeadingAge RI has embraced the continuum of care and supports policies to ensure that every individual receives the care that they deserve – in the place they call home.

We are responding to the people we care for and serve, and are redefining the word “home” to meet their needs. They are deciding where they want to live and what services they need. If they wish to age in place, our adult day centers or the PACE program can provide the care and social supports to help them remain safely in the community. If they’d like to move to a smaller place, we offer independent living apartments. For those seniors who need assistance with medication administration, cleaning, and food preparation, we offer assisted living. If age or infirmities require more care, we have nursing homes.

No two individuals are alike. No two individuals will age in the same manner or desire the same services as they age. LeadingAge members are adapting, and will continue to adapt, to meet the full range of unique needs for every person we serve.

Rob Borkowski is a PBN staff writer. Email him at