Person-Directed Care and Elder Empowerment with Jill Vitale-Aussem

Join Kosta and his guest: Jill Vitale-Aussem, President and CEO of Christian Living Communities, a Colorado-based not-for-profit serving more than 1,000 older adults and their families.

Jill is a licensed nursing home administrator, LeadingAge Leadership Academy Fellow, Reframing Aging facilitator, and author of Disrupting the Status Quo of Senior Living: A Mindshift.

Today we’re talking about Person-Directed Care and Elder Empowerment.

Find out more about Jill Vitale-Aussem and Christian Living Communities: 
https://www.jillvitaleaussem.com/
https://www.christianlivingcommunities.org/

Jill's Book, Disrupting the Status Quo of Senior Living: A Mindshift:
https://www.amazon.com/Disrupting-Status-Quo-Senior-Living/dp/1938870824

Find out more about Kosta Yepifantsev:
http://kostayepifantsev.com/

Transcript

Jill Vitale-Aussem: 0:04

so often look at family members or paid team members as caregivers. And what that really implies is that I'm, I'm here to take care of you. And I don't you don't have anything to give back to me. Right. And that's very disempowering for people. It's very paternalistic. And so that concept of care partners, we are all in this together family members, paid team members, volunteers, people that work in the community. We're all in this together and and the elder

Caroline Moore: 0:36

Welcome to Now or Never Long-Term Care Strategy themselves. with Kosta Yepifantsev a podcast for all those seeking answers and solutions in the long term care space. This podcast is designed to create resources, start conversations and bring awareness to the industry that will inevitably impact all Americans. Here's your host Kosta Yepifantsev.

Kosta Yepifantsev: 0:59

Hey, y'all, this is Kosta. And today I'm here with my guest, Jill Vitale-Aussem, President and CEO of Christian living communities, a Colorado based not for profit serving more than 1000 older adults and families through its nine owned and managed communities, including homecare spanning the entire state of Colorado jealous a licensed nursing home administrator, leading age Leadership Academy fellow reframing aging facilitator and author of disrupting the status quo of senior living a mind shift. Today we're talking about person directed care and elder empowerment. So Jill, before we get into the episode, I want to talk about your book disrupting the status quo of senior living. For anyone that isn't familiar, this book is based around the crisis we're facing in 2023. And the looming reality that we must evolve Senior Living, what can readers expect from this work?

Jill Vitale-Aussem: 1:56

Well, the book was actually published in 2019. You know, and it was, it's interesting at the time, you know, I was concerned like, Is this too much to be saying that senior living needs to change? And what happened, as we all know, is through the COVID pandemic, it's really trying to light that on the fact that yes, yes, things do need to change. So it really I think, is, is perfect. For this time, a lot more people are talking about disrupting the status quo, the status quo, so people can expect is it you know, it's really a book about the evolution I think of, of senior living models. And what I've heard from people that they really like is it's a lot of stories about, I will just say the dumb things that I did before I knew better when I was in nursing home administrator, and then Executive Director, right. And so it's, it's really about, you know, really changing our own mindsets and, and what we can accomplish when we start thinking about aging differently. And when we start thinking about aging services in a different way. So I think people have found it very readable, and a lot of good examples. And then at the end of every chapter, there are discussion questions. So there are communities and organizations that are using it for book clubs. So it's really, it's really, really been fun to see it sparked more change in our field.

Kosta Yepifantsev: 3:21

And when you talk about the evolution of care, alright, so you're obviously a hands on person. When I read that article that you had an ARP, it said that you actually became like a patient for 24 hours to try and see what it was like to be on the other side of things. When you talk about the evolution. Why is that important to you?

Jill Vitale-Aussem: 3:44

Yeah, you know that when I first became a nursing home administrator, as my nephew always says, back in the 1900s, right, like it was back in the time covered wagons. But when I first became a nursing home administrator, I had no idea what it was like to experience life as a resident in a nursing home. And so I had the team admit me as a resident, and it was an awesome community. It was like one of the best communities but I really was very distressed by what my experience was. Not because people weren't doing their jobs, but because they were doing their jobs according to the practices and the policies and the procedures that were in place. So waking. I mean, waking me up every two hours to check my vitals being woken up in the middle of the night to have my skin checked, being woken up at like 530 in the morning for breakfast. That was at seven. And just I was so depressed when I left after 24 hours. And like, you know, just really wonky because I was sleep overwhelmed. Yeah. And I just went I remember going home and just crying like this is what elders live with. And so that really sparked things for me. I'm kind of a weirdo. I've done that, like four other times throughout my career. Got it stayed overnight. And it's it every time. It's a huge eye opener, I really recommend it to anybody who works in this field to experience what life is like. And it really just showed me that the institutional practices are what causes so much distress for people. It's not team members not doing their jobs or going rogue, it's people doing exactly what we tell them to do and ask them to do. Yeah, it's, it's powerful.

Kosta Yepifantsev: 5:27

We're gonna get into the, the issues as to why the system's built this way. But first, let's talk a little bit about the solutions that you've identified. One solution to the care crisis we face is something you've helped to pioneer and turn into a viable care option. Will you explain what person directed care is? And how does it differ from traditional care models and senior living communities?

Jill Vitale-Aussem: 5:52

Yeah, you know, so person, the whole concept of person centered care, and now the evolution to person directed care. It's been around for, you know, at least 20 some years, right? Dr. Bill Thomas of the Eden alternative was the pioneer, one of the pioneers in this work. And what the institutional framework does is it sees people as a task, it sees people as numbers, it sees people as diagnosis. And it sees the people that work in our field as task doers, right. And what happens is, people end up as the Eden alternative says, Being lonely and helpless and bored. And that is, you know, what, when you go into a traditional nursing home, or assisted living, and it also happens in places with residential living, and seeing people slumped over, you know, the most of the time, it's not their physical issues that are causing that, it's because it's like, the death of the human spirit is really what it's about. And so what what person directed care is really all about is, is creating a human habitat, as the Eden alternative says, creating a place where I'm a whole person, where I have I have autonomy in my life, right? I have, as a human alternative, it's the domains of well being. So I have my own identity, I have, I have saved a feeling of safety, I have meaningful growth still in my life, I have purpose in my life, connectedness with other people, and you know, joy, yes, you can have joy, living in long term care. And, you know, what, what Christian living communities, my organization, we take it a step further. And what to what we call our citizenship approach, which is really all about if I live in a community with other people, then I have not just what I need for me, but right, how do I make sure Costa is having a great day, and it's people working together to make their community stronger and better. And that is incredibly powerful.

Kosta Yepifantsev: 8:11

And purpose, you know, if you don't have a sense of purpose, or if you're not learning something new, at least, you know, every few weeks, or, you know, a month or so, like, you don't really have like you said that will, right, because life does get bored. Pretty quickly. If you don't have those elements around.

Jill Vitale-Aussem: 8:31

It's very true. And if there's one thing that the pandemic taught us, it's what it's like to not have freedom, autonomy, meaningful purpose in our lives, not to have connectedness, like we had this shared experience of what it's like to be institutionalized. And we hated it. Oh, yeah. Did we not?

Kosta Yepifantsev: 8:53

I mean, we like we almost went to civil war.

Jill Vitale-Aussem: 8:57

ever there was a lesson to be learned it is it is, it is through that. And I think we need to talk about it more and pick it apart more and figure out what we learned.

Kosta Yepifantsev: 9:09

I mean, you've been doing this for a while, how did we get to this point? Because, like, if you go back to like 70s and 80s, and you had the Nursing Home Reform Act, and you had this increased level of compliance. Was this always the way the system was designed? Did we create the system to operate this way? How did we get to this point?

Jill Vitale-Aussem: 9:33

You know, so so much I think what I always to hear and ever write about is that you know, nursing home nursing home design came from like hospitals, right? And so this model of efficiency and and you know, the regulations like the obrah 87 for nursing homes that was really intended to to create quality of life. What I think I think there's a couple of problems, I think that we all have very ageist beliefs in our own heads right about what it means to be old about what it means to be old and living with frailty and living with dementia. And we have very limiting beliefs, right? And we think are in paternalistic beliefs. And our job is to keep you safe. And, you know, if you're safe, then job well done. And that's not that's not true. And so I think a lot of what happens is our own inaccurate beliefs about what this is really all about. And then the other thing is that, that regulations are going to create quality of life. If that was the case, then we would, I mean, we get more regulations all the time, and it doesn't make anything better. So it because I think what happens is a lot of times it ends up being check the box, I check this box, and I did this and that means I'm meeting. Yeah. So I it's a it's a bear this whole complex situation,

Kosta Yepifantsev: 11:02

you know, and we're going to, I'll ask, I'll ask that same question in a different way later in the episode, but I think we can leave it in terms of when you talk about the evolution of the industry in the care process. I think that compliance leads to the opposite of that, the punitive measures, and also the fact that all of our all of the people that pay for long term care in one capacity or another are from the federal government, or insurance companies, they're very risk averse, and they're vague, and they don't believe or understand the conversation that we're having right now. Or they may just not really, it might may not matter to them to the capacity that it does to us. But we're gonna get into that a little bit later. Right now, I want to talk more about person directed care, how can we ensure that the needs and details of specific care for each individual are respected and met in a person directed care model?

Jill Vitale-Aussem: 12:00

You know, the first thing that really has to happen, and the Eden alternative teaches this is, is to drive change, you have to have three types of transformation happen, right, and the very first is personal transformation. And so if we, as people that work in this field, don't change the way that we think about aging, if we don't challenge what all of the the institutional things we've been taught and the ageist things we've been taught, since we were toddlers, nothing's going to change, right. And, and so it, it's really about about getting everybody in your organization, and this is whether it's residential, living, assisted living, nursing homes, whatever it is, to go through this process of personal transformation, leaders have to start first. And then when people go through that personal transformation, if you don't start changing your, your, your organizational side of things, right, if I'm, and I've seen this happen way too many times where people get training, and they're like, oh, my gosh, this is the way things should be. Yet we still have human resources, policies that are ridiculous. And we still have very limiting processes. Like, if you don't get everybody up by six in the morning, you're not doing your job, and things like that, then nothing will change. And so what what I have found is that it is that it's that personal transformation, it's people understanding that it can be different. It's changing your organization, and your operational practices to support that. And, you know, eventually the ideal situation is you change the physical environment also, right and make it more not home, like home. And what happens is, in those, when you do that work, you're going to be held accountable by everybody. Right? If I'm like, and I've had this happen, I start doing something that's institutional, then I've got all these empowered people, resident team members, family members who are like, ah, what what's going on here, you're this is institutional. And so it creates this environment where everybody's holding each other accountable. And it's tough, but it's good, but institutional practices creep back in. They're very sneaky. And so you have to have that shared accountability to keep moving things forward.

Kosta Yepifantsev: 14:27

Well, and also we're talking about families and caregivers, what role do they play? And how do they change the way that they provide care in a person directed model? And also, you know, as you're going through this transition, what do you think they should prepare for?

Jill Vitale-Aussem: 14:43

Well, you know, what I think this is really all about is creating community, right in the community like that's why we call it a citizenship approach. You have meaningful purpose. You have autonomy, but you have interdependence with other people. And community is messy and the This work is messy like it isn't you? I'll tell you what, I think changing a nursing home or assisted living is like one of the hardest things you can do. Right? So for people that think we're going on this journey, and all of a sudden, it's going to be fixed tomorrow. That's not the case it is it is step by step and moving things forward. So I think people have to be prepared for messiness. Right, and and oops, that that's not quite where we wanted to go, and how do we continue to evolve. The other thing is the concept of Care Partnership. And that's really important, right? Because we so often look at family members or paid team members as caregivers. And what that really implies is that I, I'm here to take care of you. And I don't, you don't have anything to give back to me. Right. And that's very disempowering for people. It's very paternalistic. And so that concept of care partners, we are all in this together, family members, paid team members, volunteers, people that, you know, work in the community, we're all in this together, and and the elder themselves is part of that that person receiving care. Yeah. Right. So, you know, in and for failing reason, you know, this is tough, too, because, you know, I know this, as you know, as with having a parent, one who passed away a year ago, with kids, adult children can be paternalistic, too. Right. And so, if, if a resident an elder is making decisions that you don't agree with, and they're like, I know that I have diabetes, but I'm going to have my, you know, coconut cake. Every night that I'm with dinner. That's my choice. And, like, you know, we, it's that whole dignity of risk. So there's, there's change, everybody on the care partner team has to have personal growth and start thinking about things differently.

Kosta Yepifantsev: 17:03

And it's, it's so sad. And honestly, it's quite alarming when you encounter family members who want to take away the things that bring people happiness, like, for example, okay, I really like chocolate chip cookies. And even though I exercise every single day, I like to run, but I also like to eat chocolate chip cookies every single day. All right. Tate's specifically, so shout out to dates. If somebody said you can't eat chocolate chip cookies, or if they like you were talking about in the pandemic, if they force some level of institutionalization, like that leads to depression. Yep. Yeah. And it is. You know, what I, when I see this happening a lot of times is when people receive a demo a dementia diagnosis. Yeah. And as it progresses, oh, my gosh, we go down this rabbit hole in it is impossible for people to give any ground to say, Come on, like, there's still this is still a person, you know, we can still provide care, as if you know, as an indie to an individual, right? Yeah.

Jill Vitale-Aussem: 18:14

Yeah. Yeah, I think you're absolutely right. And I think 99% of the time, it comes from love, I want to protect this person. But it's again, I think it's education. And understanding that by taking away autonomy, you are impacting the person's physical health. It taking away purpose. So yeah, it's tough, but it again, it's, it's talking it through and having people think about things differently, but it's tough because we all love, love our loved ones, right? And

Kosta Yepifantsev: 18:50

could you share some success stories or examples of how the person directed care model has improved the quality of life for those receiving elder care?

Jill Vitale-Aussem: 18:59

Sure, I'm gonna give you I'm gonna give you three different examples. Okay. Okay, levels of, of living. So, you know, a really basic example, is in like skilled nursing, and I hope this isn't still happening. But you know, the whole idea of waking people up in the staff having a GET UP list, right? That's

Kosta Yepifantsev: 19:21

crazy. List.

Jill Vitale-Aussem: 19:24

Think about how that sets a person up for their day. Right? Yeah, I'm not going to my days is going to be shot. If somebody comes in and wakes me up when I don't want to be up. It also destroys our team members. Because then I had a nurse tell me this, like, it crushed my soul to be like, I have to go wake people up to do my job and get them out of bed and not at least let them start their day. They work the way they want. So just even that basic change, of promoting sleep and waking up when you want to wake up. And and that has a huge impact. That's really basic. I unfortunately, I think it's it probably is still happening some places where people

Kosta Yepifantsev: 20:11

like it is unfortunate, I'm sorry to inform you that it is still happening often.

Jill Vitale-Aussem: 20:15

Yeah, that's that.

Kosta Yepifantsev: 20:18

That's because, and what's what's unfortunate about it, and I hate to interrupt, but what's unfortunate is the checks that you're talking about, and the medication administration that you're talking about are prescribed by physicians. Yeah, on a schedule. And I'm thinking and I always think to myself, why would a physician think it's a good idea to wake somebody up at two o'clock in the morning to give a specific medication or to check a specific, vital? And I mean, that's how but that's how pervasive this is. It spans across the entire healthcare system.

Jill Vitale-Aussem: 20:51

So we have to educate physicians to prescribe medications upon wakening right rather than a certain time. So it is it's an they're part of the care partner team, to me that a patient an assisted living example. We have one of our communities that we manage, is has a beautiful pond, right. And it's it's in the mountains at the mountains. And there is a resident there who loves fishing. And he and he's in a wheelchair, and the pond isn't like there's like a dock you can go out on it's like really and marshy around the side of it. And this fishing rod, this man, so much joy, and in an institutional community, the team would have been like he's not safe, that can't work. And instead, the team and the maintenance director, it's not really his job, right quality of life for residents, officially, but it is his job because he's in a community that has done this work. They they figured out how to get him one of those wheelchairs with the tracks on it. Oh, nice. Yeah. Right. And so he drives down there and sits in the weeds and marsh and fishes. And that would not happen. And that's one example of for one individual. But if he didn't have that, like he would give up like that brings him such joy. And so that's a example for one person. But it's that change of seeing somebody has a whole human being and not being so afraid of risk figuring out how do we minimize risk, to have somebody have a life worth living. The other example I'll give is in residential living, and we have several life plan communities, which have all the different levels of living. And this is really so our community, Clermont Park here in the Denver area, I started here as the executive director there. And this is really about that citizenship model, where the residents in that community own that community. Yeah, they have created an inclusive culture. So too many times in, in communities where there's different levels of care, if you live in the nursing home, you have demands out, right, you're cut off, and you're ostracized, and they have created community norms there. And that's where the power comes in, right? policies about bullying. I'm not so big on that. It's those residents, they are true citizens, and they create healthy norms of inclusion for everybody there. And healthy norms of like, what this is what we want to do, and we're gonna make it happen. And the team there is just really there to support the life that the community wants, and people looking out for each other. And you just walk in that place. And you're like, something's different here. Right. And it's we had leading H in Denver, last year, the leading ag annual meeting, and they chose it as one of their tour sites. And people that came to that tour that visit to that community leaders from around the country left, like so I saw so many people with plant with like, crying, because they're like, this is the way it should be because the resident taught them about things, you know what I mean? So it's,

Kosta Yepifantsev: 24:18

and if if I could put a bow on it. So if you think about our entire lives, when we're in school, we're a part of a team, when we're at when we're in at work. We're a part of a team. When we're in a family raising kids, we're a part of a team, the only time that we get isolated to this individual, you know, angst is when we're elderly and and suffer some type of disability and may have to be in an institution or a facility. And what you've been able to create is that team environment that is the Yeah, exactly. It's common. I mean, it's literally how we grew up. It's, you know, and it's rather shocking, but I do We'll also want to touch on the individual that you had that goes fishing and you guys identified that wheelchair that has a track on it. I'm a big proponent of technology. And I've just we've just recently been working towards a pilot with UnitedHealthcare to provide technology few hours a day in some of our homes and remove some of the human element in the care process. Now, we don't have a weight care in a lot of the homes. So it's a it's a good application in our model. What I've have found to be astounding is when we accept technology as a solution, we actually find more solutions because we're open to the idea of technology. But we get so much pushback from the people, the the people that pay for long term care, not necessarily out of pocket, but insurance companies managed care organizations, Medicaid, the primary payers, because they're risk averse. So in your opinion, how can technology be leveraged to support person directed care? And elder empowerment?

Jill Vitale-Aussem: 26:16

Ah, well, you know, when you think about risk, there's a lot more risk relying on human beings than technology.

Kosta Yepifantsev: 26:24

Yes, agreed.

Jill Vitale-Aussem: 26:27

My gosh, you know, my, my, my hope. And the way we look at technology here is where technology is never going to completely take the place of human beings in this field, I don't believe but technology that can free people up to be able to do what humans do best, which is be with each other and have those interactions. I think that's got to be the goal. And then the other thing I've been thinking a lot about is, and tell me what to think about this. You know, how do we how do we use technology to support autonomy, and freedom for people living with dementia while keeping people safe? Right. So, you know, like, I love to walk and be outside. And if I have dementia someday, and I'm in in someplace where I can't do that, or if I want to be in an inclusive place of care, right, where I'd have to be locked up someplace. And there's Tech, I mean, you think about your ring, if you have a ring doorbell, right? Like, that's pretty cheap technology. And that can tell you that, you know, Jill is at the front door, and she just picked up a package. So how can we use that technology? And I think that's what you're getting at? Maybe I am

Kosta Yepifantsev: 27:48

I am. And so I'm going to, I'm going to package it all together. So when you talk about specifically people with a dementia disability, there are you're never gonna be able to remove the human element from the care from the care process. And that's okay, because there are specific activities like going on walks that may require in a human being to accompany or support somebody that has dementia. It's but if you can prevent the burnout, that that caregiver experiences and even if it's a family member, the burnout that they experienced as a caregiver, if you can provide some way of incorporating a few hours a day of respite, I mean, states are literally tripping over themselves with respite pilot programs, Florida, Tennessee, Colorado, like everybody's trying to figure out how are we going to provide respite to caregivers that are that are providing trillions of dollars a year and care for free, by the way, and whatever. But the only solution that they look at is how are we going to create a workforce to provide these respite services, but it's we're past that, I mean, we're not living in the age of iRobot, obviously, but we have the technological applications, to be able to give a few hours of respite to caregivers so that they can be there when it matters for those. Yes, yeah. Right. That makes sense. And, and you know, and I'll take it, I'll take it in a different direction. As you can tell, I'm pretty passionate about technology. I'll take it in a different direction, like somebody that, for example, is at risk of falling or has like an unsteady gait. You know, if you've just even put like some, like the, you know, those string lights that people use in the kitchen to have the lighting under their cabinets, if you put those on the floor, and a sensor that's on their bed so that as soon as they get out of bed, those lights come on and light their way to the bathroom in the middle of the night. Like that's a that's a simple DIY application that may cost under, you know, $200 that people can afford and In what you're doing with regards to person directed care and the evolution of care and creating citizenship, like, technology is the direct complement to that. It is. So, you know, well, long, long story short, you don't

Jill Vitale-Aussem: 30:17

have to if if a sensor on your bed can say that somebody is in deep sleep, yeah, you don't need to go in and check on him right and turn on the light, make sure they're okay. And yeah, yeah, it really can. I think you're absolutely right. And

Kosta Yepifantsev: 30:31

early, if you consider like early onset Alzheimer's, before the disease has progressed to, to a significant point, like if you're, if your mom or your dad has early onset Alzheimer's, and there are things that happen, but they don't happen often. But you're still like, worried to death every single day that something bad is gonna happen. If you had a sensor, say, for example, on a bed, and then you, you know, they went to the restroom, and then that sensor didn't show up that they're back in bed. But if you had a sensor on the living room chair, because it's four o'clock in the morning, and they're watching TV, yep. Like that is how we have to start thinking about giving people back their dignity and their autonomy.

Jill Vitale-Aussem: 31:18

So I like that. That makes a lot of sense.

Kosta Yepifantsev: 31:21

All right, so we're about to wrap up. And your opinion, what's the most necessary and impactful mindset shift we can make as Americans to ensure that our elder population is properly cared for, and we build a future of care that is empowering for all people?

Jill Vitale-Aussem: 31:39

Well, I, so it's thinking about aging differently. And we have got, because when we think about aging, as it's about decline, and you become helpless, and it really impacts the services that we provide. It it impacts, you know, I mean, we don't value older people in this country, we do not value those that care for them. It was evident during the pandemic, when aiming services was at the end of the line, and then just got nothing but blame as compared to the hospital system. So if we don't start shifting the way we think about this field, who's going to want to work in the field, right now, people, as much technology as we have, we still need people. And then the other thing that that is a big concern for me, is this myth, that is everywhere, that everybody can successfully age in place in their own home. We know that is not true. We know that the majority of people live in homes that aren't designed for changing mobility needs, we know people get isolated, which leads to incredible health challenges and problems. And we've got to start getting people thinking about it. So I have a book to recommend to your audience. And that is Ryan, Frederick's book, it's called Right place, right time. And it's really all about every all of us, like at every age, looking at does the place, the place I live matters. Does the place that I live, give me social connection? Does it give me opportunities for meaningful purpose for physical well being? And really looking at that, because we're I'm very concerned that we are setting up a huge percentage of older people. And those of us, you know, as we as we get older, for failure, and worse health outcomes, because they're going to be not living in the right place.

Kosta Yepifantsev: 33:39

There is something that I was thinking about leading up to this episode that I was like, If she starts talking about this, I have to ask her this question. And so you did.

Jill Vitale-Aussem: 33:50

So yeah, I'm just concerning. It really is.

Kosta Yepifantsev: 33:53

So think about it like this. You've got, you know, the baby boomer generation between 1946 and 1964. We talk about this often on the show. So you have an 80% chance of needing long term care at some point after the age of 75. The first baby boomer that was in 2021, turns 75. As the need continues to progress, right, not everybody can age in place. But I read a statistic last week, we are short 6.5 million homes in the United States. How are we going to solve not only the aging problem, but also the housing problem? And do you think that this problem is this like building the transcontinental railroad? Is that how insurmountable this problem is and how much effort and attention it needs?

Jill Vitale-Aussem: 34:52

Um, you know, I think we need to start looking at a growing number of older people not as a problem

Kosta Yepifantsev: 35:00

But as a resource, absolutely right?

Jill Vitale-Aussem: 35:03

And when we start to shift that it doesn't, there. There's so many opportunities as we get older that we can be part of the solution. And the more we're engaged, the more we live amongst other people, the less likely is that we're going to need more higher levels of care, right? Because those things are definitely predictors of your health. So I think that that needs to be a shift, for sure,

Kosta Yepifantsev: 35:30

like a multi like a multi generational adoption. So like, more multi generational families, essentially,

Jill Vitale-Aussem: 35:38

I don't, I don't know about that. I mean, potentially, but I don't know if we're ever gonna go back to that. But I mean, I mean, just because we're older doesn't mean like, like it are. So think about, we've got a staffing crisis. We've got older people living and I'm thinking residential, living and assisted living, people who need meaningful purpose people who can't afford senior living. And so we're gonna we're doing a pilot at one of our communities, with dining, like, if you live in this community, you want to make some extra bucks. We have these positions open, and why don't we do more of that. And if we stop disabling older people, maybe we don't need as many staff

Kosta Yepifantsev: 36:17

absolutely keep costs lower. So we always like to end the show with a call to action. What advice do you have for families, caregivers, and senior living communities who wants to adopt person directed care?

Jill Vitale-Aussem: 36:33

Take the first step. Okay, go to a certified eating associate training, go to eat not.org Sign up for a class there's online training, find books to read, go to the pazza pioneer network and greenhouse there another culture change transformation organization. There's a conference in July in Pittsburgh, take the first step. I think it's really important to you don't have to have everything all figured out but start with that personal transformation education on your own and then keep it going. But take first step

Caroline Moore: 37:07

Thank you for joining us on this episode of Now or Never Long-Term Care Strategy with Kosta Yepifantsev. If you enjoyed listening and you wanna hear more make sure you subscribe on Apple podcast Spotify or wherever you find your Podcasts, leave us a review or better yet share this episode with a friend. Now or Never Long-Term Care Strategy is a Kosta Yepifantsev production. Today’s episode was written and produced by Morgan Franklin. Want to find out more about Kosta? Visit us at kostayepifantsev.com