We’d like a do-over, please

By Jeff Jerebker & Rick Gamache

Jeff Jerebker
If there was a way to go back to 1965 and have a do-over on nursing home design in America, we would not create or accept the institutional architecture, the chronic under-reimbursement and dysfunctional regulatory system that are hallmarks of our current reality. We suspect most stakeholders feel the same way.
With the tragedy of the COVID pandemic, we must ask ourselves why we can’t unite to go forward with the painful lessons of the past. Why can’t we drive home a better future for elders and younger disabled residents that need a more comprehensive level of care and support?
We need to reimagine the whole system of long-term care and the very culture that drives it. That includes physical nursing home design, how each person is cared for, the lack of living wages for direct caregivers, and the systems of regulation and reimbursement. The Live Oak Project was born in response to the catastrophe of COVID-driven nursing home deaths to boldly advocate for how and where we age.
We are not naïve to the daunting challenges of this imperative vision. We are totally aware of the limits of the present system and the many stakeholder organizations, each with their own interests and investments. Does this mean we are doomed to, at best, marginal change that won’t significantly reach down to the root of the problems of institutional environments, workforce inequities and shortages, and a culture of care whereby the provider, rather than the resident, is at its center?
Rick Gamache
Some blame nursing home ownership and management. Others lay fault on reimbursement, and some put the blame on regulations. The list goes on and on. The stark reality is that there is no scapegoat; there isn’t a “good guy” versus a “bad guy”. 
The entirety of the system was poorly constructed on quicksand, bound to fail as soon as an earthquake happened. That occurred in 2020 with COVID-19. The system collapsed. The overcrowded, overregulated, under-reimbursed, institutionally designed nursing homes crumbled leaving many dead from the virus or from isolation, an overwhelmed workforce, etc.

What we’ve learned (and knew) about nursing home design

Every person is unique as is every nursing home community. Before us lies the opportunity to truly create a person-directed culture that reflects the richness of the people who live and work there.
We owe it to our elders, our care partners, and all other stakeholders, including investors, to feel the intrinsic rewards of an atmosphere where every individual can thrive.
The pandemic has taught us much, including that underfunding elder care is a policy decision that has contributed mightily to the low salaries of Direct Care Workers and has stifled innovation across the long-term care landscape.
To achieve the level of change necessary, all of us, including government regulators, policymakers, elders, consumers, advocates and providers, need to help shoulder the responsibility of fixing a system that was never properly designed. 
There are a number of forward-thinking, progressive providers around the country that have already implemented successfully reimagined environments, cultures of care, organization and support of staff, and relationships with regulators. Let’s bring that knowledge together and open our hearts and minds to creating a new system that works for the individuals who live and work in long-term care. 
In a world where so much seems broken and dysfunctional, fixing long-term care suddenly seems less formidable, and could provide a template for healing other societal problems.
It has been said that the darkest hour is right before the dawn. The light shines on all of us to create a better future.
The Live Oak Project is a passionate group of experienced long-term care professionals and activists, bound together by the desire to reimagine, reinvent, and transform Long-Term Care Services and Supports.
Jeff Jerebker was the Founder and CEO of Pinon Management, former Treasurer of Pioneer Network, Co-Founder of the Live Oak Project, and Board Member of Kallimos Communities.
Rick Gamache is the CEO of Aldersbridge Communities, a RI-based not-for-profit provider of health care and housing for low-income elders. He is a member of the Live Oak Project Steering Group, and the former board chair of The Eden Alternative.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.