Because the whole point of a crisis is to learn new things, right?

Reflecting on lessons learned, best practices now adopted, and yes, even improvements in how we support older adults, it is clear this past year-plus has highlighted in even greater relief the importance of our core responsibilities to support and execute person-centered care and promote the long-term health and well-being of our residents. When COVID-19 hit, those foundational blocks became more critical, but at the same time, many of the tried-and-true methods of supporting elders were no longer available. Instead, our entire industry had to figure out how to continue to provide services and connect with people in brand new ways.

Consider the following. Most of us spent the first few months of 2020 adapting our services, programs and amenities exclusively to the new and largely unfamiliar online world. Fitness classes moved to Zoom. Social events, book clubs and musical performances became remote. Entire food and beverage departments were upended as communal dining ceased.

Through all the difficulty of figuring out how to do this, and real grief and sadness about the lack of face-to-face gathering and connection, surprising bright spots emerged with the shift to virtual programming. Online fitness classes made it possible for residents with mobility challenges or temporary medical conditions to remain connected with their friends, neighbors and family members. In fact, many of Rose Villa’s residents who had previously never attended a group fitness class began working out in their homes, finding security in the privacy of their personal space!

In addition, resident groups were empowered to take technology into their own hands, and, at Rose Villa, residents created the Rose Villa Today Show — an online hosted talk show that had existed sporadically pre-pandemic but took off like crazy during the past year. The volume and thoughtfulness of resident and staff email interaction went through the roof. Explicit gratitude — made manifest through hope chains, banners, virtual shout outs and lots and lots of cookies — cemented the deep relationship of trust, faith and love between residents and staff members.

The Rose Villa community came together as powerfully as I have ever seen it. Residents sewed enough masks for every staff person to have one. Laundry workers washed hundreds (and hundreds, and hundreds) of masks every day to keep the supply clean and sanitized. No complaints from unending disinfecting and cleaning. Food & Beverage got creative in delivering food, drinks and meals outside so that there was some connection, even though distanced. (Rover the Roving Bar Cart, our LeadingAge Oregon award-winning resident program, is one innovation that isn’t going to go away anytime soon.)

In short, the Rose Villa community stepped up. As annoying as it may sound, you don’t build muscle or discover strength when everything is going your way, when it’s easy or routine. Adversity shapes our character and our future and defines what community can look like.

The pandemic was simply a catalyst that challenged us to continue to innovate, to build on our strengths and our interdependence. Think of everything we are doing now — and doing well — that we did not do at all 18 months ago. It’s a lot! Do we really need to have a global pandemic to rethink how we connect, how we do business, how we thrive as a community of choice for elders and staff?

It is our responsibility to take what we’ve learned about how to change and keep leaning in. It’s the only constant on the road ahead. Calling forth that deep spring of creativity and vitality will ensure a rich — and sometimes unexpected — continuing partnership with everyone involved in senior living, resident and staff member alike.

Our best idea is to segregate an entire group of people simply because they share the same disease? In other areas of life, such as education, we have retreated from this idea, recognizing that segregation hides those whom mainstream society find difficult or upsetting to deal with, rather than improve their lives.

At this point, even if separation as treatment initially was an attempt to improve lives, it has become an overwhelmingly profitable business — with little outcomes-based clinical research to support it. It is a tempting business model for any community, particularly as its near-ubiquitous acceptance brings the echo of received wisdom with it.

That alone should give us pause.

Rose Villa’s approach to supporting older adults to live the lives of their own choosing often has separated us from other continuing care retirement communities. Not offering memory care in a separate, locked unit is a good example.

It’s not an easy path to take; sometimes it takes more time and may appear to take more money to approach support in an individualized, person-centered manner. Often, however, it results in decreased “behaviors” when we cater our approach to the individual person — which in the end saves time and money.

The benefits far outweigh the effort needed — and we’ve learned some lessons along the way.

Lesson 1: Dementia-friendly activities and programming and person-centered architecture and design that appeal to residents living with Alzheimer’s disease appeal to all people.

No matter the diagnoses, aging adults share many of the same conditions that affect people living with dementia. It’s more difficult to hear and see, it’s more difficult to focus, noise becomes a bigger concern, and large groups can be alarming and stressful. The principles of one-on-one attention and focused activities benefit everyone living (and working) in 24-hour care and further encourage interaction and socialization in quieter, smaller circles.

The Opening Minds through Art program at Rose Villa is an excellent example of this lesson. OMA is an intergenerational art program designed to create positive bonds between people living with dementia and community volunteers. Year-over-year, this program has grown and expanded to include the greater community, staff, independent living and 24-hour care residents.

Architecture and design features customized to those with Alzheimer’s also appeal to all people, regardless of diagnoses. The right lighting, careful carpet selections and circular hallways reassure all people that they are in a safe, comforting and familiar space.

Lesson 2: Memory illness is a dynamic, changing disease that progresses in different ways for each person who has it.

Locking people up “for their own safety” makes much less sense when you understand that not everyone goes through the same stages as the disease progresses. In addition, whatever behavior they exhibit — such as exit-seeking — also will pass as the illness changes the way they interact with the world around them.

One example of the way we interact with folks who want to walk yet cannot navigate their way around the outside world is to send a staff person with them on their walkabout. (Either you spend the one-on-one time outside enjoying a walk, or inside dealing with a frustrated, high-energy resident who just wants to go outside. You choose.) One gentleman wanted to go on multiple walks every day. When he no longer was able to or interested in getting out and walking, staff members noted how much they missed their daily walks with him.

To say that everyone with dementia should live together and be served in a homogenous, regimented way does not make sense. Some people remain highly verbal and articulate. Some people lose words early on and experience the frustration of being unable to say what they mean. Understanding the stages and nuances means people can be comfortable to express themselves in a way that is accepted and embraced.

Lesson 3: Make your entire campus dementia-friendly, and train all staff in memory illness.

We invest heavily in training. And because we believe that everyone here remains a full member of our community regardless of physical or mental capability, it’s important to train the front desk staff, the drivers, the housekeepers and groundskeepers — everyone — every bit as much as the hands-on caregivers. Every staff member can add to a resident’s enjoyment of life, sense of safety, personal value and love. And each staff member gets those things in return.

Lesson 4: People with Alzheimer’s function at a higher level socially and emotionally for a longer period than they would if they were segregated and only able to interact with people who share the same disease.

People with dementia often become more isolated and depressed as their disease progresses. Some become nonverbal, further shrinking their world.

Recently, one of our more severely affected residents with Alzheimer’s was seated for lunch with a resident who requires 24-hour care for physical reasons. They spent the better part of an hour conversing over lunch. Not only did each consume more food because of the interaction — another benefit to inclusion — conversations and friendships were built that we wouldn’t see otherwise.

Integration keeps everyone’s world larger and richer and emphasizes and builds on everything the resident can still do rather than focusing on loss.

Lesson 5: Removing anyone from the fabric of the community they belong to impoverishes the rest of the community as much as it may underserve the person with the illness. 

Part of our highest calling as humans is to love and support our friends, neighbors and family. Denying us the ability and opportunity to serve each other in those basic, caring ways diminishes our world and robs us of our own healing power.

I observed one example of this in action on a rainy night in Portland after an event in our performing arts center. I saw one of our independent residents walking two women with memory illness back to their rooms in our nursing facility. The three were arm-in-arm, laughing, just friends out for a night on the town. No one had a label; every one of them felt seen, heard and loved.

Frankly, I believe at some point we will look back at the practice of isolating people based their diagnosis as archaic. In the rush to not be left out of a profitable market trend, we have overlooked many fundamentals, such as research, how to best focus on building a memory-supporting environment and care, and how to most effectively train and support staff and families.

How does this affect the communities we have taken such care to nurture? How much more terrifying is it to receive a memory illness diagnosis when you know it means likely removal from your community? How much less rich do our lives together become when we are robbed of the chance to be fully present and walk down life’s road together?

That’s why I was appalled (to put it mildly) to learn they had been told by another community that they would be better off telling people they were sisters. I remember thinking, “I literally can’t believe in this day and age this can happen.”

I was reminded of Pat and Carol’s disappointment and frustration when I read, with the same shocked disbelief, the recent article reporting the Missouri couple who were denied senior housing because of their sexual orientation. At its core, the problem with this verdict is that it takes aim at the heart of senior living, which is about connection, meaning and relationships.

Ultimately, shunning any segment of seniors from senior living has devastating emotional, physical and societal consequences — in this case, forcing openly gay seniors to retreat to a closet many of them literally left decades before. Their fear of rejection or judgment can prevent them seeking the care and assistance they need, risk their health and further isolate them from society and companionship.

The judge’s perspective that fair housing laws don’t protect sexual orientation status completely disregards that this case was 100 percent about sex — about two women who have shared an intimate relationship and the continuing care retirement community’s discomfort with their lifestyle.

This decision misses the mark. We need to take a closer, critical look at the problem and the message this verdict sends – not only to the gay senior population, which numbers 2.4 million older adults, but to the broader population. Excluding an entire group of people based on a single characteristic is wrong.

Decisions such as this one send a devastating message to all gay people that their love isn’t valid. It tells a senior resident with a gay child that their family is not welcome. It tells gay employees to fear the community where they work.

Dozens of states protect employees from being discriminated against in their places of work. Why would we treat retirees seeking senior housing to any less?

The past few years have been some of the most divisive and polarizing our country has seen in recent history. If two people love each other, care for each other and wish to spend their lives together, then why would a judge, or anyone else, prevent this from happening?

It’s time to rethink the fair housing act to be truly inclusive.