Sonari Glinton:
Hello, I'm Sonari Glinton. I've been thinking a lot about this conversation I listened in on recently. Meet Lauren Wright and her father, Willie Wright.
Lauren Wright:
I'm 33, daddy. I'm 33. I am getting older and I'm having to do adult things like talk to my father about him getting older and being his... What's it called, daddy? I'm your power of attorney.
Willie Wright:
Yes. And that's all you, everything is you.
Lauren Wright:
I know.
Willie Wright:
That's the reality of living as it were. We have to be prepared to live, we also have to prepare to die.
Sonari Glinton:
Listen, I know this sounds like a dark way to start a show, but let's face it. We're a year plus into a pandemic that has been deadly for elderly folks. And we're all thinking about how we ourselves will spend our senior years. And if we're lucky, we're having conversations just like this with love, humor and a bit of frankness.
Lauren Wright:
I already told you, you can't die.
Willie Wright:
Yeah. I can and I will.
Sonari Glinton:
This is a weekly conversation for Lauren and Willie Wright. It's a conversation that feels more urgent because of the pandemic. Right now, Willie loves living in Cleveland, God bless him, where he's a program manager for the National Caucus and Center on Black Aging. But he's getting older and he lives alone far from Lauren and he has diabetes. He thinks about his future every single day.
Willie Wright:
I don't want to be in anybody's nursing home thing. That's just not my style.
Lauren Wright:
It's also not an option, and you're also not 90.
Willie Wright:
But eventually, I will be 90, God willing.
Lauren Wright:
Yeah.
Willie Wright:
But what does that look like for me? What does 75, what does 80 look like for me?
Sonari Glinton:
What does that look like for me? Well baby boomers like Willie Wright are redefining what the golden years can look like, or at least they're trying. They're going to live longer. That could also mean they're living with more health complications like dementia. The pandemic has forced us to reckon with how we treat and value our elders and the people who care for them. So how can we make that care better? If we tackle that now, what could 75, 80, or fingers crossed, 90 look like for Willie Wright, for our parents, or even for us?
Iris Yafuso Toguchi:
It's just a beacon of light when you have that program.
Rudy Sukna:
Yeah. And like I said, I'm very hopeful and I know that we can get through this.
Sylvia Mendoza:
Hallelujah. I can finally get her in a place that has a private room where she does have some dignity and respect.
Sonari Glinton:
I'm Sonari Glinton, and this is Now, What's Next?, an original podcast from Morgan Stanley. Now, let's get started.
Iris Yafuso Toguchi:
Okay. So this is a picture of my mom. We got awarded this award when we closed the bakery from the state saying it was a-
Sonari Glinton:
Iris Yafuso Toguchi is showing me some of her family photos.
Iris Yafuso Toguchi:
This is all of us with the representative of our city.
Sonari Glinton:
Her father opened the Larry's Bakery, a Honolulu institution, in 1957. Her mother, Irene Yafuso, ran it for decades after he died.
Iris Yafuso Toguchi:
She would get up 2:30 in the morning, go to work, get the bakery all set up. And at seven o'clock, she would come home and pick me up and then bring me back to the bakery and feed me my favorite pastry, which was a butterhorn, fresh cup of orange juice, which I had every day for at least 15 years of my life, and that's why I look the way I look now, but she did that. And then after I ate-
Sonari Glinton:
Iris' mom blended two full-time jobs into one. Single mother and business owner.
Iris Yafuso Toguchi:
And at two o'clock, do it all over again.
Sonari Glinton:
You don't get a sense that any flour landed on her.
Iris Yafuso Toguchi:
No! I mean... right?
Sonari Glinton:
What you just described is moving all day long.
Iris Yafuso Toguchi:
Right, right. Exactly.
Sonari Glinton:
But a few years ago, things changed. Iris remembers the day she realized the tables had turned.
Iris Yafuso Toguchi:
She had cut her foot at the bakery site, so I took her to the ER. And I found out she didn't have insurance, health insurance. It was last three, four months back because she forgot to pay for it. That is when I found out something was wrong. Checks galore to publishers, clearing house, Ginsu knives, gave money to the dolphins, the whales, the whatever, and no money. It was all gone.
Sonari Glinton:
Now, that's a moment. All of her mom's savings were gone. Now, that discovery led to Irene's Alzheimer's diagnosis. And in 2017, Iris and her brother decided to close down the bakery so Iris could become her mom's full-time caregiver and keep her at home. Now, the benefits of aging at home are huge. I mean it's home, it's familiar. You can be independent, but close to loved ones. Not to mention, there's less of a chance of catching viruses. Overall, people live better when they age in place. So why is it so hard to do? First of all, it may be cheaper than a nursing home, but aging in place comes with a cost, a cost that's usually carried by women like Iris.
Iris Yafuso Toguchi:
In the beginning, people are like, "Be careful, the caregiver burnout. I've been there." And I'm like, "Caregiver burnout, I'll never get to that. No, no, I'll never let that happen." Well that thing is real, man. I'm at caregiver burnout for real.
Sonari Glinton:
And then Iris got some help. In 2018, Hawaii launched the groundbreaking Kupuna Caregivers Program. It gives working family caregivers money, financial support up to $70 a day towards services that help keep an elderly person at home. And that could mean hiring a visiting care worker, someone to help with cleaning or cooking, or sending a loved one to daycare.
Speaker 7:
Who's winning?
Irene Yafuso Toguchi:
She's winning!
Sonari Glinton:
Now, Iris finds a bit of relief by sending her mom to a senior daycare center. You can hear Irene playing a game with a small child of a daycare worker.
Irene Yafuso Toguchi:
Come on, open your mouth.
Sonari Glinton:
Now, Iris was nervous about taking her. But day one went a lot better than expected.
Iris Yafuso Toguchi:
She's like, "Hey, there's my friend." She went right in. She started coloring with a friend and that was it. And I tell you, it was like I won the megabucks.
Sonari Glinton:
Iris' mother loves it, but daycare also costs megabucks, bucks Iris and her family didn't have. Social security checks barely cover the cost of medicine, diapers and personal items. Iris was dipping into her own dwindling savings. Now, unpaid family caregivers can expect to spend nearly 20% of their overall income looking after a loved one. And they may need to also bring in home care aids, install safety equipment. And if they don't have family leave, they may lose or give up their own jobs and deplete their own retirement funds. Figuring out how to pay for all of it takes time and a lot of energy. Now, without Kupuna Care, Iris doesn't know how she would cope.
Iris Yafuso Toguchi:
The time that I already don't have I would not have. I would need an eighth day in the week. It's just a beacon of light when you have that program.
Sonari Glinton:
Like any program, Kupuna Care is not perfect. There are waiting lists and the program itself is subject to state budgets and yearly renewal, but it points to a shift to support values that are a part of Hawaiian culture, values we could all embrace. In Hawaiian, kupuna translates roughly to grandparent or ancestor, but it comes from two words that put together mean the source of our existence. And in Hawaii, there are a lot of kupuna.
Iris Yafuso Toguchi:
In Hawaii, they call it the silver wave. Our silver wave is huge. Some of them still drive, still exercise, still teaching the young ones language, or ukulele. They're just so amazing.
Sonari Glinton:
While Hawaii's experiencing the silver wave, the whole world is preparing for a silver tsunami. There are currently 750 million seniors in the world. By 2030, there will be over a billion. And more and more of them want to stay in their homes or with their families. By giving caregivers money to support that desire, the Kupuna Care Program actually saves the government in health care and nursing home costs. I asked Iris, given all the stress and exhaustion, if she'd ever consider putting her mother in a nursing home.
Iris Yafuso Toguchi:
Oh, hell no. No. I want to keep her home safe, especially with coronavirus, but I want to keep her here as long as I can so she's happy and I'm happy. I'm happy. When she's gone, I will have no regrets. And when she's gone, I can sleep all I want, work all I want. I'll probably be old, but I’ll travel. But for right now, this is what's important to me in my life.
Sonari Glinton:
I mean she did make you those pastries when you were a kid.
Iris Yafuso Toguchi:
Mm-hmm. And she did a lot more than just that. She did so much for all of us. So that's the best thing I can do. I mean yes, that's the best thing I can do.
Sonari Glinton:
We all need to figure out the best thing we can do. But what if there were more programs like Kupuna Care to give us better options? As much as we might like the idea of aging at home, it's not going to work out for everyone. For some of us, a nursing home may be our final destination. Over the last year, the prospect became a lot less appealing to a lot of people. So what can we do to make these facilities safer and more inviting?
Rudy Sukna:
So I'm Rudy Sukna. I live in New Rochelle, New York, and I work as a registered nurse at the Hebrew Home for the Aged.
Sonari Glinton:
It's one of the biggest nursing homes in New York City. And despite the unprecedented challenges of the last year, Rudy gets into the elevator at work every day and pumps himself up so that when the doors open on his floor, he's got his game face on.
Rudy Sukna:
And I'm there with skates ready to go. So they give me a report letting me know what's going on. The floor's on quarantine, somebody's started IV, we're getting blood cultures, if they've got to get swabs. So yeah, it's exciting at the same time. And I'm pumped, ready to go. You've got to be because I can't go in there feeling depressed and feeling, "Oh my God, how am I going to do this?" I go in there with enthusiasm every day, trying to do the best I can do.
Sonari Glinton:
Even in the middle of a pandemic.
Rudy Sukna:
Even in the middle of the pandemic. Yeah.
Sonari Glinton:
And this pandemic has been pretty brutal for Rudy. In early spring last year, he caught COVID from one of his residents, one of the 50 residents in his care at any one time.
Rudy Sukna:
I just had a face mask on. And when I gave her the medication, she spit it back out onto my face and I could feel it going into my eyes. And I was scared at the time and went and washed it out. They sent her out, she died at the hospital. A couple of days later, I normally don't get sick, I started literally getting a 103 fever. I had chills. I was bed ridden for three days. And it was hard for me to breathe too. My mom also got sick, she works in the healthcare field, and she was sick for maybe three months. I was there trying to help her out with different things. My uncle contracted it. He died.
Sonari Glinton:
I'm sorry for your loss.
Rudy Sukna:
Yeah. And then my patients also.... I developed relationships. I had at least 10 I can remember that passed away. So I've been working there for over 24 years. Well yeah, it's going to be 24 years.
Sonari Glinton:
Now, I'm able to look at you. You don't look like you've been working anywhere for 20 years. Can I ask how old are you?
Rudy Sukna:
Yeah, I'm 40. I'm going to be 41 in the next week.
Sonari Glinton:
He's seen a lot in those 24 years. And you might think with all he's seen in this past year alone, Rudy wouldn't want his own loved ones in a nursing home. Well think again, his mother and his aunts care for his grandmother and he's watched the toll it's taken on them.
Rudy Sukna:
And it's very typical. But with the nursing home, you have a lot of different resources. So you have the doctors there, you have the nurses there, you have the aids there, you have physical therapy, there's food there, there's dieticians, there's a lot of different services that we provide for our residents. And it takes the burden off the families. So I don't see a nursing home as a bad thing, I see it as a community.
Sonari Glinton:
But Rudy often struggled, especially over the pandemic, to give his community of seniors the care he felt they deserved.
Rudy Sukna:
Even pre-COVID, it would happen every so often that you'll be having one nurse for 50 patients. I'm telling you that's a mess. So during this time right now, recently, last week, three or four days I was working by myself with 50 patients with four CNAs. And it's difficult.
Sonari Glinton:
Let that sink in. How much can one registered nurse and four certified nursing assistants, or CNAs, do for 50 patients?
Rudy Sukna:
We're crying out that we need more staff because if we have more hands on deck, we're able to tackle this hard situation.
Sonari Glinton:
Here's one thing that could make it easier. This past spring, the New York State Legislature passed the safe staffing bill. It requires homes to have enough staff to make sure each resident gets at least three and a half hours of one-on-one care each day. Plus, the state cap the profits for nursing homes, which means they'll have to spend at least 70% of their revenue on caring for residents and 40% of that on staffing. It's hope that these changes will improve the quality of care for residents and working conditions for caregivers like Rudy. But these changes won't solve the problems of low wages or shortage of workers. A recent study found that nearly three quarters of homes had difficulty finding enough staff to cover shifts, but Rudy is more committed than he's ever been.
Rudy Sukna:
We're there to take care of these people who've been through their lives already and this is like their sunset of their life. I don't think you can just sometimes abandon ship. I'm a union delegate. So I'm there for my residents and my coworkers.
Sonari Glinton:
Are you hopeful?
Rudy Sukna:
I wouldn't be here if I wasn't hopeful. That's why I'm sticking around. I don't know. Maybe I'm too optimistic or I have too much enthusiasm, but that's how I've lived my whole life anyway.
Sonari Glinton:
If you want to change the sunset years as Rudy likes to call them, then we have to value the people who care for the elderly. They've been essential to getting through this crisis. And while Rudy and his union advocated for better conditions for his residents and coworkers, there's another revolution happening. The nursing home and caregiver industry is beginning a huge rethink of the facilities themselves. Now, if you close your eyes and imagine your standard nursing home, you probably see something that looks like a hospital floor, long hallways, rooms with two or more people in them, a nursing station, medical carts and wheelchairs, IVs. Modern nursing homes resemble hospitals because well they grew out of hospitals. After World War II. The U.S. government shifted funding away from welfare homes for the elderly to facilities that gave medical care to the elderly.
Sonari Glinton:
Now, many of those facilities were built and managed by hospitals. And when Medicare arrived in the U.S. in 1965, seniors with low incomes got money to pay for long-term care homes. Then by the 1970s, the number of U.S. nursing homes had more than doubled. While there have been efforts to tighten regulations and improve the nursing home industry, not much has changed in the last 50 years. That is until a global pandemic encouraged us to look around and see if there's a better way of doing things.
Sonari Glinton:
Hello, Sylvia. How are you doing?
Sylvia Mendoza:
Fine. Thank you, Sonari. How are you today?
Sonari Glinton:
I'm all right. Well first, I have to say I'm sorry for your loss.
Sylvia Mendoza:
Oh, well thank you very much.
Sonari Glinton:
Sylvia's mother, Lupe Mendoza, died in February. She was 91-years-old and survived cancer, had dementia, and diabetes. But Sylvia literally beams when she talks about her mother as a young woman.
Sylvia Mendoza:
She looked like Liz Taylor, but instead of the purple eyes, she had green eyes. She would wear her little glove in the early fifties and sixties. And as she became older, she always had her matching pants suits. In fact, one of the instructions she had for the funeral directors was a little rouge, a little pink lipstick, part my hair to the side so I look like maybe Lana Turner in the early years, sexy like. So that was my mom, always concerned with appearances.
Sonari Glinton:
All right. Now, to be clear, this isn't a story about the death of Lupe Mendoza. This is a story about how her only child, Sylvia, found a nursing home that helped her live out her days as happily as possible. In fact, Sylvia Mendosa was following her mother's own instructions.
Sylvia Mendoza:
My dad became very ill and he was home bound for 10 years. And during that time, she was his primary care provider and I would come in and provide respite. But she then said, "If I ever need help, don't keep me at home because our relationship will be really strange. You're going to hate me at that point in time. Find me a nice nursing home."
Sonari Glinton:
Now, that time came after Sylvia's mom had a bad fall and had to stay in the hospital. The doctors recommended a nursing home with a rehab facility and she stayed there for five months. But Sylvia knew that it was not a good fit.
Sylvia Mendoza:
She was sharing a room with three other people and really was not getting the attention or the care that she deserved and needed. I'd show up to visit with her and she'd be in the same clothes three days in a row. And I'd asked, "Hasn't she been changed?" "Well she doesn't want to."
Sonari Glinton:
Now, Sylvia started looking for alternatives and she didn't like what she saw. I'll spare you the gory details. You've heard about them all before. Sylvia though was on the hunt for something much, much better.
Rosemarie Sperry:
What I was looking for was does the staff treat the people under their care the same way they would treat a family member?
Sonari Glinton:
Sylvia found what she was looking for in a Green House.
Rosemarie Sperry:
Lupe loved Mexican food. And we would host taco night on one of our lovely outdoor patio and just enjoyed the evening and the good company as well. Every year, Sylvia would organize a large party for Lupe's birthday, everything from food and drinks to a live mariachi band, who would come and play for everyone, including our neighbors to enjoy.
Sonari Glinton:
Rosemarie Sperry is one of the nursing assistants who cared for Sylvia's mom during her last years at the Evergreen Villas, their unique part of Mt. San Antonio Gardens, a large retirement and nursing home facility in Pomona, California. Now, Sylvia was thrilled when her mother moved to the top of their waiting list.
Sylvia Mendoza:
Hallelujah. I can finally get her in a place that has a private room where she does have some dignity and respect.
Sonari Glinton:
The Evergreen Villas are part of the Green House Project, a nonprofit organization dedicated to humanizing the nursing home experience. Now, they do that by making smaller facilities that look and feel like home, no long hallways or nursing stations, private rooms, private showers, a big fireplace and a bright, comfy living room, and a kitchen that everyone can use.
Sylvia Mendoza:
One day when she was a bit lucid, she said, "Is this how a college dorm is like?" And I said, "Yes." You have that atmosphere where everybody is together and you get to enjoy each other's company and you get to interact and do different things. So that's how it's different. It's more family like, almost collegial.
Sonari Glinton:
The Green House staffing model helps with that family feeling. On a day shift, a registered nurse like Rudy would have to take care of no more than 24 residents. He'd have the help of four nursing assistants. Now, those lower ratios make everyone happier and healthier. And during the first four months of the pandemic, 95% of Green House homes reported zero cases of COVID-19 among residents or staff. There are currently around 300 Green Houses around America, but with those numbers, you can certainly expect to see more. Now, this care is not cheap. About 45% of Green House residents qualify for Medicaid, but not Lupe.
Sylvia Mendoza:
Yeah, we did have to refinance our home to help defray some of the costs. So yes, it is expensive. But when you have a loved one who has given so much of their time and love and money to educate you and make sure you have the best in their waning years, you want to make sure that you do something for them as well. And that was her money. And I decided to use it on her.
Sonari Glinton:
Sylvia has no regrets. Not only was she able to keep working at a job she loves.
Sylvia Mendoza:
I was able to maintain the relationship as her daughter versus her care provider.
Sonari Glinton:
In fact, Sylvia's taken out long-term care insurance for herself and started saving money so if she needs it in the future, she can stay at a place like the Evergreen Villas. And seeing her mom happy there meant the world to Sylvia, as did the tribute her mother received from the caregivers the day she died.
Sylvia Mendoza:
They had gotten my mom ready and they put on her blush and her lipstick like she had wanted. And as they were wheeling her out, one of the women turned on her phone and started playing mariachi music. All of the staff came out and lined the driveway and they were singing that she was the [inaudible 00:25:03]. She was the queen of the house here. And they paid tribute to her by playing one of her favorite songs as she left. And we were very touched by that.
Sonari Glinton:
This is what it looks like when we value our elders. Sylvia was able to make the best choice for herself and her mother just like Irene and Iris Yafuso Toguchi made a different, but equally good choice in Hawaii because well... they had good options. Options that were grounded in a positive perspective on old age. The problems facing nursing homes are very complex and we've only looked at a few of the possible ways forward. But after what we've seen and learned through the pandemic, are we ready to start making changes? Will we make solutions like the Green Houses more accessible and affordable? Will we invest in more staff? Will we expand kupuna caregiver support? I'm hoping we answer some of these questions for Willie and Lauren Wright, the father and daughter duo from the beginning of the story.
Willie Wright:
But you know I love you, right?
Lauren Wright:
I know. I love you too.
Willie Wright:
And we'll make the right decisions. We'll make it work.
Lauren Wright:
I know.
Willie Wright:
Yeah. Not going to be the babysitter though.
Lauren Wright:
No, I'm not expecting you to be the babysitter.
Sonari Glinton:
We always find ways of making it work. But here's the thing, can we find ways of making it better? On the next episode, speaking of babysitters, we find out if the pandemic has been enough to create positive change around actual daycare, making it better, more affordable and accessible.
I'm Sonari Glinton, and this has been Now, What's Next?, an original podcast from Morgan Stanley. Thank you for listening.
