Category Archives: Health Services

Vitalize360 Launching This Week — Meet and Greet Friday in the Game Room

This is the week that our Vitalize 360 program gets its real launch and sign-up opportunity.  A project of Kendal, it provides us Collington residents the opportunity to get a “life coach,” who will help us bring together whatever resources and help to decide what they want to achieve next in our lives.  If one of us does not yet know what this is, our new staffer Kim Rivers will help us figure that out too.  Once a goal is identified, Kim will help pull together the Collington resources, staff and residents, to support the process.

Often this is thought of in traditional medical terms, such as achieving a particular “vital sign” milestone, or getting physically strong enough to, for example, get on a plan to visit grandchildren.

But many of us feel that the most exciting engagements that this makes possible are more intellectual, political, academic, etc.  Dianna Cox, who runs the project, and was here for a great presentation yesterday, gave an example of a man who had decided to challenge his golf club’s men only policy, and did so successfully.  (Other more transformative possibilities might come to mind.)

Tomorrow, Friday March 9 at 10:30 in the Game Room, there will be a meet and greet to get to know  Kim and learn more about the project.

Here is the PowerPoint that Nancy Cox presented.

Here is a short video:

It is important to note that Vitalize 360 is a key pat of our strategic plan, both as a specific element, and as something that will help build culture-transformative energy.

Indeed, a recent article in the Journal of Aging Research and Healthcare, here, concludes:

In this project, COLLAGE [Vilalize at one location] 360, a comprehensive assessment system and wellness coaching program that focuses on prevention and wellness was implemented in one continuing care retirement community. Following completion of two assessment tools through directed conversations with a wellness coach, older adults developed an individualized vitality plan that outlined life goals, supporting goals and action plans for goal achievement. Results from this program suggest engagement in the assessment and wellness coaching process via the COLLAGE 360 program translated into sample older adults sensing that they live in a more supportive environment when compared with elders not receiving any wellness coaching. In addition, the older adults had positive responses in the areas of mood and life satisfaction. Strategies to improve health and well being need an extended focus beyond the older adult‘s medical conditions and consider psychological, spiritual and social needs with personal preferences being paramount. These issues are foundational to a person- centered, health promotion approach needed among older adults.

Do not miss the opportunity.


The Coming Decline of Hospitals and Implications for Our Strategic Plan

An important article in the New York Times highlights the the ongoing reduction of hospital admissions.

Consider this: What year saw the maximum number of hospitalizations in the United States? The answer is 1981.

That might surprise you. That year, there were over 39 million hospitalizations — 171 admissions per 1,000 Americans. Thirty-five years later, the population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent. There is now a lower rate of hospitalizations than in 1946. As a result, the number of hospitals has declined to 5,534 this year from 6,933 in 1981.

In addition to the impact of increasing infection risks:

The number of hospitals is also declining because more complex care can safely and effectively be provided elsewhere, and that’s good news.

When [the writer] was training to become an oncologist, most chemotherapy was administered in the hospital. Now much better anti-nausea medications and more tolerable oral instead of intravenous treatments have made a hospital admission for chemotherapy unusual. Similarly, hip and knee replacements once required days in the hospital; many can now be done overnight in ambulatory surgical centers. Births outside of hospitals are also increasing, as more women have babies at home or at birthing centers.

Studies have shown that patients with heart failure, pneumonia and some serious infections can be given intravenous antibiotics and other hospital-level treatments at home by visiting nurses. These “hospital at home” programs usually lead to more rapid recoveries, at a lower cost.

This has huge implications for the system as a whole.

As these trends accelerate, many of today’s hospitals will downsize, merge or close. Others will convert to doctors’ offices or outpatient clinics. Those that remain will be devoted to emergency rooms, high-tech services for premature babies, patients requiring brain surgery and organ transplants, and the like. Meanwhile, the nearly one billion annual visits to physicians’ offices, imaging facilities, surgical centers, urgent-care centers and “doc in the box” clinics will grow.

It also has huge implications for our already well-advanced planning for implementation of our strategic goals with respect to health care at Collington.  For example:

It will become possible for more and more of us to be treated for more contiditions as outpatients.

Our skilled nursing units will have new uses as lower levels of care during treatment are appropriate.

Potential medical system partners will become even more interested in Collington as “off-site partners.”

The need for focused research on the impact of these changes will be greater, making the appeal of a research friendly partner even greater.

Integration of our holistic services with broader service networks will become crucial and practical.

In other words, we are moving toward “modern gerontology” at just the point that other systems will need our partnership.

Stay tuned.

A History of African American Hospitals in the U.S.

By Dr. Bud Gardiner

Join resident Dr. Bud Gardiner on February 15th at 2 pm in the Auditorium for this fascinating program.  Sponsored by the Health Services Committee.


The health of African slaves was an issue concerning slave-holders but there was no organized attention paid to this issue.  In 1832, the Georgia General Assembly established a hospital “for the relief and protection of afflicted and aged Africans”.  Thus, the Georgia Infirmary was built south of Savannah. Over the years approximately 200 hospitals were established for black citizens under the auspices of governments, a variety of charitable organizations and groups of African American citizens and physicians. They were often tied to medical and nursing education. The bulk of them, of course, was in the southern states and had varying lengths of survival. With the impact of economic and social influences, (especially racial integration) only one such hospital remains. Their history provides a fascinating glimpse of an oppressed but resourceful segment of our population.


Preparing for Dementia — An Individual and Collective Responsibility at Collington

As we move forward with operationalising our Strategic Plan, a recent New York Times article on dementia specific advance directives may be useful. Specifically:

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, had spent three years working with specialists in geriatrics, neurology, palliative care and psychiatry to come up with a five-page document that he calls a dementia-specific advance directive.

In simple language, it maps out the effects of mild, moderate and severe dementia, and asks patients to specify which medical interventions they would want — and not want — at each phase of the illness.

“Patients stumble into the advanced stage of dementia before anyone identifies it and talks to them about what’s happening,” Dr. Gaster told me. “At what point, if ever, would they not want medical interventions to keep them alive longer? A lot of people have strong opinions about this, but it’s hard to figure out how to let them express them as the disease progresses.”

As a community with a commitment to individual autonomy, I think the document will speak to many of our concerns, and perhaps most specifically the fear of wanting to reject additional treatment, but no longer having the capacity to communicate that.  As the article elaborates:

For each stage of dementia, the patient can choose among four options. “Full efforts to prolong my life” and “comfort-oriented care only, focused on relieving suffering” represent two ends of the spectrum.

Patients can also opt for lifesaving treatments — except when their hearts stop or they can’t breathe on their own, precluding resuscitation or ventilators.

Or they can opt to receive care where they live but avoid hospitalization. “For someone who doesn’t understand what’s happening, going to an E.R. or being hospitalized can be really traumatic,” Dr. Gaster said. The experience can lead to delirium and other setbacks.

There is debate about whether there should be a separate dementia advance directive, but the idea of specific focus on the issue has great value.  (I personally find the Maryland MOLST utterly incomprehensible, and do achieve that this document does within the MOLST would be a great feat of editing.).

In any event, our commitment to the value of the individual challenges us, in my opinion, to do what we can to make sure that those who wish have thought through these issues, and that our entire system support people in these choices, which certainly reflect only current law, and do not represent any change from that law.

There was at one point talk to Collington working to improve the MOLST.  Maybe now is the time, reflecting the leadership goal in our strategic plan.  Surely these issue have great implications for staffing, training, staff-resident relationships, and culture building.

Thanks, Collington, for being a place where these things are as much on the table as they are on our minds.

Health Services Support Groups now listed

The five support groups meeting monthly at Collington are now listed with their resident leaders on the Health Services Page – click here.