Chemical Pathology Professor Gershwin Davis, Ph.D., from The University of the West Indies in Trinidad, took a sabbatical this summer with the Long-term Care Administration (LTCA) program.
Davis contacted Donna Alexander, associate lecturer and LTCA program coordinator, after discovering Kent State's post baccalaureate Nursing Home Administration Program. He wanted to learn about long-term care in the United States so he can better inform the Trinidadian government and determine how best to serve the country's growing aging population.
Alexander partnered Davis with United Church Homes, where he took up residence and observed how long-term care services are provided at their facility in Canal Fulton, Ohio.
The College of EHHS asked Gershwin a few questions related to his experiences with the LTCA program and United Church Homes.
Why did you enroll in EHHS’ Long-Term Care Administration program, and what do you hope to learn?
Trinidad and Tobago have one of the highest rates of dementia in the Caribbean, and in the world. Dementia currently has no cure. In the latter stages it may result in the individual being unable to recognize friends and family and being totally dependent on caregivers. The duration of the disease process can last as much as ten years or longer. Therefore, long-term care may be a big part of caring for dementia patients. The aging population in Trinidad and Tobago, and the consequent change in the population demographic, also means an increasing number of elder individuals requiring some form of care or assistance from the younger “sandwich” generation. The changing dependency ratio puts the focus on the increasing caregiving role these individuals would be called upon to play. The EHHS’ Long-Term Care Administration program is one of 15 nationally accredited programs in the U.S., which upon successful completion, would allow individuals to apply for the examinations to become licensed as a long-term care administrator. I see Kent State's program as a vehicle to enhance the skill set of individuals wishing to contribute to, and assist in, addressing this emerging issue of caring for an increasing number of elderly people. I personally wanted to see and experience firsthand how long-term care facilities operate. I hope to gain insight on how to effectively organize and manage long-term care in all its forms, including independent living, assisted living, fast tract rehabilitation, skilled nursing, and in memory care unit settings.
What strategies will you take back to Trinidad to better serve the growing aging population?
Like in many parts of the world, Trinidad and Tobago has an ageing population with an increasing demand on the family resources to provide care for the elderly. This demand may be in terms of the time commitment needed by individuals to care for their elderly relatives or on the resources/savings of the household. There could also be a loss of income for those individuals who may have to give up their gainful employment to provide unpaid care services for their family members. Most caregivers in Trinidad are the patients’ children and spouses. Over 80% of caregivers are female. The patient being male and belonging to a minority ethnic group are associated with a greater degree of caregiver burden. (Minority ethnic groups in Trinidad and Tobago refer to persons who are not of African or East Indian descent and include Chinese, Syrian, Caucasian and mixed ethnicities.) While circumstances differ in various countries /regions, it may be worth looking into some formulation where there is a stronger role for post-acute care in the local setting. This would bring the benefit of freeing up some acute care hospital beds while at the same time facilitating and ensuring that individuals receive supervised care for a period long enough to ensure their full recovery. General education on care options that exist for the elderly locally and internationally may be at the root of a strategy to make individuals and families aware of what is possible and available. This would enable them to make better informed decisions about their elderly relative's care. Stakeholders may even wish to acquire the necessary skill set to create and manage a particular type of facility that does not exist locally, if appropriate stakeholder consultation concludes that this may be a viable option.
What have you learned about long-term care services from your time spent at United Church Homes?
Time spent at United Church Homes (UCH) gave me an overview of what is involved in long-term care, while at the same time allowing me to see it in action. The LTC services at the UCH at Chapel Hill came across as if being delivered on an elder care campus. While care service is provided for the elderly in general, facilities exist that are tailored to the individual's needs during the aging process. The LTC services are thus provided for the needs of individuals along the spectrum of aging from independent living to hospice care. Included here are the needs of those who would benefit from a secure memory unit. I have learned that care service should accommodate for an individual’s unique characteristics and preferences in the context of their support system while also providing space for couples. It could be a 360-degree holistic care with coverage, including the medical, social, physical, cognitive and spiritual needs of the individual while at the same time allowing for their independence. It should exist in a committed, safe, caring, service-driven environment within a regulatory framework that allows for resident involvement. Care service should be animated in part through detailed patient care plans with appropriate therapy. It's important to include a therapeutic activity schedule, dietitian-guided nutrition, and assistance with feeding by appropriate staff, if necessary, with available spiritual care and support at a community and individual level. Long-term care should be under medical and nursing supervision and supported by beauty and barber services on site and outsourced, or on-site laboratory and pharmacy services.
What did you like best about your sabbatical?
The opportunity to interact with the elderly population and hear their concerns and their life experiences, especially in a facility that afforded them the opportunity to move from one type of long-term accommodation to another as their life journey demanded.
Can you recap some statistics about the growth rate for dementia in Trinidad?
Latin America and the Caribbean, along with the developing world in general, have a higher prevalence of dementia than the more developed nations. A Trinidad survey published in 2018 compares the dementia prevalence by age group compared to Latin America and North America. Dementia prevalence from a Trinidad survey compared with those from other countries for identical age groups was observed to be higher in all age groups than those in all or most other countries (Cuba, the Dominican Republic, urban and rural Peru, Venezuela, urban and rural Mexico, urban and rural China, urban and rural India, and Puerto Rico). The only exception being similar or slightly higher prevalence in the 90+ years age range in urban and rural Mexico.
Do you see a long-term relationship forming between Trinidad and Kent State? If so, how would you like to see that evolve?
While the opportunity may exist for exploring a long-term relationship forming between Trinidad and Kent State, the key element here would be awareness. For engagement to occur one must first recognize a need in the local setting and see how, if possible, aspects of another health care configuration could be uniquely integrated to fulfill the universal need of wholesome eldercare. At a local level, a current situation and a gap analysis may be informative of where investment in human resources and capital would be most beneficial. Then, conversations among like-minded individuals or institutions with common goals would go a long way to facilitate mutual benefit.
My interest in dementia epidemiology and chronic disease brought into focus the burden of care for the elderly individuals so affected. I inquired about how care needs were being met and became interested in, and wanted to learn more about, long-term care. I did an online search and came across EHHS’ Long-Term Care Administration program at Kent state, which was aligned with my needs. I wanted an opportunity to gain knowledge and hands-on experience in this expanding field. Fortunately, I was based at United Church Homes in the Chapel Hill community in Canal Fulton, a facility that was ideal for me. At that location, I had the opportunity to see the spectrum of long-term care in action. I thank the staff for their kindness in supporting me during my internship.