Special COVID-19 Episode with Peter Illig

Todd Schlosser:            So I’d like to start off with just asking, what does the NCCAP do for the aging population?

Peter Illig:                    So the National Certification Council for Activity Professionals, or NCCAP, it’s been around since 1986. It was created specifically to provide the qualification for individuals to be the activity director in a skilled nursing facility. So you’re the person overseeing the team that provides the social model of care, originally just in a nursing home setting, but now it’s spreading to adult day at home, across the life care span, to ensure you’re delivering the social model of care.

Todd Schlosser:            Okay. Did you help found it in 1986 or did you enter in a CEO later?

Peter Illig:                    Yeah, I was just brought on three years ago. Yeah. So my background is law, and I’ve always worked for nonprofits, specifically mission-driven nonprofits. I’ve been a human rights lawyer, I’ve created philanthropic foundations, spent a lot of time doing international development work, still a registered consultant with the World Health Organization. I was brought in to reorganize, restructure NCCAP, because of their desire to be at the table with the medical model of care. So really what we’re seeing is this interface between the social and the medical models of care.

Todd Schlosser:            Yeah, and what I’d like to do, if we can, because we’re sort of focusing a lot on the coronavirus or the COVID-19 virus, is talk to you specifically about what NCCAP is doing to sort of help this aging population that is so susceptible to this virus. What are you guys doing to help in this fight against it?

Peter Illig:                    So given the COVID-19 crisis, there’s two big priorities that have come up for the residents in skilled nursing facilities in longterm care. They’re a vulnerable population. We see the restrictions. If you’re over 70, over 60, stay home, don’t get exposed.

Todd Schlosser:            Absolutely.

Peter Illig:                    Those two elements are the infection control, which we’re trying treat if you catch it or we’re trying to prevent you from getting it through the social isolation and distancing, but that social isolation is the other thing, because it leads to depression or faster decline of your cognitive skills if you’re not being stimulated cognitively or physically during the day.

Todd Schlosser:            Yeah. I have heard in other studies that we’ve sort of touched on here on Checking the Vitals that isolation and loneliness, especially in the aging population, can be as bad for you as smoking seven cigarettes a day. So it does have a direct impact on your health, which, when I heard that … I didn’t go to med school or anything, I was blown away by that. So what are some things you can do when they’re isolated to sort of stem that isolated feeling?

Peter Illig:                    Well, it’s still driven a lot by the regulations. There’s specific requirements that a skilled nursing facility or nursing home or care home [inaudible] you’re supposed to have an individualized, person-centered care plan for that person. If you look at the language of the regulation, it says you’re supposed to have staff to provide services to the residents who attain or maintain the highest practicable, physical, mental and psychosocial wellbeing of each resident. So that’s the bar, and it’s pretty high.

Todd Schlosser:            That is pretty high.

Peter Illig:                    That word “practicable” is really, you’re out because of the time and the costs and the staffing requirements to meet that. Just like everybody in a nursing home gets a care plan for their medical conditions, whether that’s a medical intervention or a pharmaceutical intervention, they’re supposed to have that social intervention. So the activity professional is part of what’s called the integrative care team and care plan.

Todd Schlosser:            So does NCCAP have a sort of recommendation for what people should be doing who operate these facilities to help with that isolated feeling and stuff like that?

Peter Illig:                    Right. Yeah. So that’s all part of end cap certification. A person going through our 360 hour certification curriculum comes out with the skills, the knowledge, possesses the competencies to engage an individual, determine what it is that they like, what they’re interested in. It’s individualized. It’s preferences. There’s cultural sensitivities. You have to take into consideration what their physical state is, what their cognitive state is, and you’ve got to come up with activities to engage them and maximize or optimize their physical and cognitive health.

Todd Schlosser:            So I’d imagine that that is changing quite a bit with this COVID-19 outbreak. So what are some ways that, I guess, nursing home or day facilities are pivoting with this? I’d imagine that in a nursing home, that’s sort of a closed off setting, you could close it off, but those workers have to go home, and they’ve got to come back and help work. So what are some things that they can do to maintain their safety, but also maintain this high level that they’ve set?

Peter Illig:                    Well, yeah, there’s a lot of different things being tried right now. So how do you engage someone if they’re quarantined in their room? You’ve still got to go in and provide the medicines or the therapies that are required, and you’ve got to have special protective gear, which we know is in short supply at this time, and you’re supposed to be delivering these social activities. So here’s some examples. A number, many skilled nursing facilities have an internal television broadcast system, and a number of our activity folks have been working with the IT department to plug in and deliver through Zoom, just like we are using, into the rooms of all the residents. So instead of coming together, because they can’t come together into the activity room, the recreation room, the social room to sing songs, play bingo or whatever happens, they’re delivering these activities virtually into the room.

Todd Schlosser:            So literally from down the hall, they’re doing a Zoom call in and leading an exercise program or stuff like that. That’s awesome.

Peter Illig:                    Right. There’s great stories where the workers, the staff are running up and down the halls when the bingo numbers are being called and they’re yelling from their rooms. There’s stories of one side of the hall residents singing one round of a song when the others sing back on the other side, and there’s reports of these residents saying this is the most fun they’ve had in months, if not years.

Todd Schlosser:            Hopefully with the social isolation that’s going on, this will sort of stem the tide of COVID and they can continue these sorts of fun activities, but it is very ingenuitive of them to use Zoom or things like that to keep those programs going, because it can have such an impact on one’s mental state.

Peter Illig:                    Yeah. Let me give you another example. One of our activity directors who was using this virtual system that broadcast into the room shared this information with the family, and this particular resident has a family who was out of state. So not only do they not get in very often, but now they can’t come in. They can’t travel to see this person. So they were able to Zoom from their home out of state into the room of their parents and communicate with them. What was interesting about this scenario was the individual was not in a highly functional cognitive state, but they said they were able two see, through Zoom, because of the voice of the family coming in, they could see a physical reaction, the eyes opening, the expression on the face. So it was a legitimate means, and there was the evidence that there was a response for engaging this resident.

Todd Schlosser:            Yeah. So I’d imagine that … Not that being far away from the nursing home is a benefit, but because they have probably thought through these kinds of solutions before because of the distance factor. Now with the virus being a factor, sort of everyone’s adopting that new lifestyle, for lack of a better term. Are there provisions in place for people that want to go see their loved ones in nursing homes or is it just a, “Sorry, you can’t right now,” and everyone’s just sort of understanding of that?

Peter Illig:                    Yeah, well, they’re understanding it to the degree that they have to comply with it. It’s the law. There’s been stories of quarantine and law enforcement and families simply not being allowed access into the facilities. Security’s increased. You just cannot come in.

Todd Schlosser:            Yeah, and I know that that can be hard for a lot of people. Family is very, very important, and I think the best way to look at it is, it is for their best interest, because they are such a highly susceptible population, and you could be just a carrier and never know that you ever had the virus. So I’ve seen a lot of people posting on Instagram or Facebook pictures of them outside their loved ones window in a nursing home, and they’re taking photos together, and that’s, I think, sort of a heartwarming way to do that. Is there any chance of them infecting them through that? As long as the window was closed, obviously, but is that a safe way of going about it, or is that something that you may now want to make a medical determination on?

Peter Illig:                    Well, yeah, and again, I’m not a medical practitioner, I run that certification body, but I think the requirements for social isolation and social distancing are in place, and if that wasn’t safe, they wouldn’t be allowing that to happen.

Todd Schlosser:            Yeah. Okay. You mentioned that security is tighter at these facilities now. What is security normally like, and then what is it now? Do you know the difference there?

Peter Illig:                    Well, yeah, I’ve been in and out of quite a few a skilled nursing facilities, and they’re vast, there’s large, there small, there’s for-profit, there’s nonprofit. [inaudible] reflects a lot of the socioeconomic realities of our society, which is very diverse. A lot of these skilled nursing facilities have a very diverse population. So the diversity of the skilled nursing home population is extreme, and they function as the home of the resident who’s in there.

Peter Illig:                    So you’ll get a lot of family members coming in, and there’s always a controlled entrance, there is a place to sign in for staff and visitors. Lots of controls, especially now if you’re getting individuals with memory care issues, with various forms of dementia or decreased cognitive state, you can’t have them wandering around, so there’s often a lot of controls in there. Now it’s been heightened where they’re limiting not just professionals, but if there’s a family member that needs to come in to drop something off, they can’t have access, they’re checking IDs, they’re limiting the numbers that come in, whether it’s deliveries or workers. So there’s a lot tighter restrictions on entering and exiting to limit infection.

Todd Schlosser:            Yeah. Are there any tighter restrictions on staff, because these people have to go out into the world and then come back. So are there extra precautions for staff members?

Peter Illig:                    Yes. There’s a lot of infection control practices that are standard, and they’re supposed to be standard, and now they’re really being taken seriously. In addition to the things that have always existed, like hand sanitizer, and now a number of facilities have run out of that, but there’s still soap and hot water, so you make do with what you can. At the same time, I think the thing we’re seeing in the news is the limitations on the personal protective equipment, or PPE, masks and people getting fitted for masks and being test fitted to make sure there’s no leakage. So there’s a big rush, again, to limit the infection rate. Our people still go in and, to the degree that they’re able to, deliver those activities in a way that keeps both the caregiver and the care recipient safe.

Todd Schlosser:            Okay. That’s honestly very impressive, because in a time like now, it’s got to be, I’ll say even a little scary to do that. As a professional who’s going in, I would be a little nervous that I may have something and I don’t know I have it, so I understand that they are probably taking the utmost importance on making sure that they’re protecting themselves and other people. I’ve seen some nurses walking around the grocery store, and they’re wearing their masks all the time, because they’re afraid they may get it.

Peter Illig:                    Or have it.

Todd Schlosser:            Or have it. Exactly. Yeah. So I’d imagine a lot of that similar activity is going on in those facilities.

Peter Illig:                    I think why we consider the activity professional or the life enrichment professional to be part of that essential personnel is because of the importance of the physical and mental and psychosocial wellbeing that’s achieved through the social model of care. There’s plenty of statistics, and this is the direction things are going in. It’s very much why NCCAP has been restructuring and reorganizing to demonstrate the data, the evidence that the social model of care has specific positive outcomes to health and longevity, because as you pointed out, if a person gets socially isolated, it leads to depression and diminished activity and diminished health.

Peter Illig:                    So this is really the importance, that there’s plenty of evidence that show if you have the right engagement, where it gets excited … Think about what songs … Go back to high school, back to grammar school. What songs just take you right back to one of your favorite memories or get you up and you want to start dancing? Those types of triggers can keep a person motivated, active, and it stimulates health, reduces falls, reduces the need for medication, increases how quickly you recover from infections. All this evidence, these outcomes that are associated with the social model of care.

Todd Schlosser:            Yeah. I do know you have a section on your website for people to go to look at some of these things, and I would like to talk about that, but do you address new types of activities? Does it go into even how to use Zoom and connect to every patient’s room? Maybe not patient, but residents room. So does it go into all of that on your site?

Peter Illig:                    Yes. Yes. We have a section in there, how to use Zoom. You could use Skype or go to anything … What is that interactive virtual communication … Video conference. So that’s a section. We’ve got links to all sorts of resources that are publicly available through YouTube. Movies, music, activities, puzzles, games. There’s a lot of specific in-room activities. We’ve got a list of 101 activities you can do in-room, one on one with somebody, whether it’s virtually or from a distance.

Todd Schlosser:            Yeah, I’d imagine that those in-room activities could become an over Zoom or over Skype activity very, very easily. It’s just a little piece of technology to connect you to the room and keep you at a safe distance.

Peter Illig:                    Yeah. This is the reality. We’re being forced to use it, and we’re being forced to track how it performs. We’re learning a lot during the crisis.

Todd Schlosser:            Yeah. Do you guys keep track of that data as to how significant someone reacts in person versus on a Zoom or a Skype call?

Peter Illig:                    Yeah, that’s really important to track that data to see, and it usually falls into metrics like resident satisfaction, to the degree that the resident’s able to report on that. The observation of the caregiver, whether they’re on the clinical medical side or the activities social side. The family is really important, however you defined family, whether that’s blood or emotional relationship. Whoever has that close relationship with that resident can give you feedback regarding the state of that person’s mentality, optimism, depression. So we are tracking those types of things.

Todd Schlosser:            Yeah, I actually wondered this, and I’m not sure if you’ll be the right person to ask, but I have been doing things like this with my family more. Not necessarily in-home facilities, but I have a mom that lives in Asheville and I have a sister that lives in Washington DC, so like we’ve been doing these sorts of things a lot more, and I wondered if maybe the contact from the family on the outside to the family person on the inside has gone up in this time of crisis?

Peter Illig:                    Well, I think that’s absolutely what’s happening, partly because we’re limited in what we can do ourselves. My dad is in his nineties and I’ve got a couple of sisters, and we check on him a couple of times a day. We still live independently down in a retirement community in Florida, but we’re like, “Are you doing okay?” “I’m fine. Nothing’s changed, everything’s fine.” Yeah, there is a consistent increase in how we’re reaching out, and I think it’s a legitimate concern.

Todd Schlosser:            I think it is.

Peter Illig:                    But what it’s emphasizing is the social, emotional, the social emotional needs that often get neglected because our healthcare system, particularly for aging, is always focused on that medical intervention, the pharmaceutical intervention, treating the illness, as opposed to that psychosocial, emotional intelligence that’s needed to be able to engage to keep that person’s physical and cognitive psychosocial wellbeing maximized.

Todd Schlosser:            I do think, now more than ever, with the world sort of feeling a little doom and gloomy because of this virus going around and everyone being isolated and no one can really be in each other’s presence, morale in an in-home facility or a care facility would be lower, and it sounds like you guys have ab approach to sort of raise it up to where it was before or even higher.

Peter Illig:                    Well, certainly we’ve got evidence of that. We get that kind of feedback. We’ve also got some really hard cases where some of our certified professionals, our activity staff, our activity directors, are limited, are locked down in their facility because there are cases of the virus infection and they can’t afford to have these people go home in case they’re infected. They’ve got to make sure they’ve got staff and workers there to care for it. So there are some real hardship cases.

Todd Schlosser:            So they’re actually living there as well, just to make sure that they don’t bring in the virus? That’s amazing.

Peter Illig:                    Or take it out.

Todd Schlosser:            Well, sure. Yeah. That’s amazing. So we’ve talked a lot about what kind of activities can be done through Zoom and through Skype, but why are they so important that they even be done in the first place?

Peter Illig:                    That’s a great question. It’s really important. CMS had the foresight to include it in the regulations early on. Unfortunately, the medical model of care, with the clinical and therapeutic and pharmaceutical interventions, they get a lot of attention primarily because the economics around that and the reimbursement around that. The social model of care, it’s always been required, but not mandated to the same degree. So we’ve got a bit of a challenge to demonstrate that value.

Peter Illig:                    Now the values of social model of care really are because it’s the interface between the social and the medical, and you look at the total person, you can’t really separate them, even if our healthcare system has. You get reimbursement for those medical interventions, but you don’t for the psychosocial, mental, cognitive stimulation and therapies, yet they all produce outcomes for health and longevity. So the activity professional, the knowledge, the skills, the competencies they possess are essential to health, and that’s really what NCCAP is making the case for.

Todd Schlosser:            Excellent. It sounds like you guys are focused on treating the whole person and not the medical side of the person.

Peter Illig:                    Yeah. Yeah. It’s related. They’re integrated. There’s a concept out there that’s been used in Europe for at least over a dozen years, if not 15, if not more, of frailty, looking at the whole person. What are their physical needs? What are their psychosocial, mental needs? Treating the whole person, because when a person is depressed, sure, you could give them a pharmaceutical to try to adjust that, but is it that they miss their family? They can’t remember? Would therapy with music or art or socialization improve that? Music is amazing,, and it produces outcomes close to pharmaceutical when it’s used right. So there’s a lot on the social side of care that can produce impact.

Todd Schlosser:            So Mr. Illig, thank you so much for taking the time to sort of walk us through all of this today and sort of explain exactly what’s going on with these sort of adult living facilities.

Peter Illig:                    Well, it’s a pleasure. I think the outcome is going to be very interesting to see how this impacts our society, not just here in our own community, but across the world, and I think it’s going to cause us to look at our lifespan and our health span in a way where we’ve got to observe what happens at the end.

Todd Schlosser:            Excellent. Thank you so much.