Eldercare Voices, COVID Edition: Gwendolyn Graddy, M.D., F.A.C.P.

Eldercare Voices is an occasional feature of the Center’s monthly newsletter, Health Innovation Highlights, inviting guest commentators directly involved in care delivery to older adults to share their perspectives from the field. This is the first in a special series of interviews on their experiences with older adults during the pandemic.

Interview with Gwendolyn Graddy, M.D., F.A.C.P., Medical Director, PACE Southeast Michigan

Dr. Graddy is currently the Chief Medical Officer for PACE (Program of All-Inclusive Care for the Elderly) Southeast Michigan. Her special interests include Alzheimer’s disease, nursing home care, spirituality, aging and wellness, health disparities and cultural competency and the role of women’s support groups on stress reduction and improvement of work-life balance. She speaks extensively on healthy aging, caregiving and Alzheimer’s dementia, and integrated models of care including the PACE program. She has been invited multiple times to Washington, D.C. to speak on Caregiving and Managing a dual-eligible frail older population.

Center: How are the older adults you work with doing? And, how are you doing?

Dr. Graddy: I have to say that because of our ability to be able to continue to provide care for our participants, there was no break in care, so when the pandemic limited our ability to bring them out to us, we went to them. We just shifted from providing care in the PACE Center, to providing care in the home. For many of them that really is the best place to provide care because some of them are still not comfortable coming out. We can understand why because when we look at the cases of COVID, and we look at the percentage of hospitalizations, and the number of deaths, it was the older adult population at the highest risk. And the largest percentage of the participants that we care for are African American, also at very high risk.

We've still been able to do, to some degree, some socialization because we have tablets, called Grand Pads, that allow them to be able to continue to communicate with their case managers, to play games, communicate with their families and so forth.

As for me, I am doing well. Part of the reason I can honestly say I'm doing well, number one, my family has done well. We've been very fortunate that there have been very few cases of COVID within our family. And I'm blessed to work with a community of people, the staff that I work with at PACE Southeast Michigan, who are committed to the care of these elder adults. They are my true heroes – the frontline staff.

Center: What do you think older adults most need right now?

Dr. Graddy: I think because we’re in the flu season, I'm going to start with something that may be taken for granted, but I think it’s especially important right now. We are really emphasizing the need for flu vaccines and making those available.

Number two, making certain that we’re continuing to educate older adults on the importance of the things that we can do to control the spread of COVID. So, mask-wearing, handwashing and social distancing to the degree that you can. We can't over-emphasize simple things like that.

The next thing is, I think, making certain that we’re providing the resources needed to help them feel safe in their communities. Simple things like fresh fruits and vegetables.

And when we think about social determinants of health, often, we don’t think about something like social isolation as a risk for poor health or poor outcomes, but it is. When one of our participants is used to coming into the center two, three or even five times per week, this limited access and isolation can lead to depression or anxiety.

Center: What are you learning now that signals the direction for care in the future?

Dr. Graddy: What I'm learning now, that I know is going to influence the direction of care in the future, is we are going to have to learn how to provide more care in the home. No matter what that home looks like, by the way, because it’s their home and to quote the Wizard of Oz, “there is no place like home.:

And so that is a whole shift because it starts with having the staff able to provide that care in the home, right? And then, educating the staff to be able to do that while making certain our staff is safe as they provide that home-based care. Also, being able to provide more respite in the home, being able to support caregivers and provide them what they need because when we support the caregiver, the caregiver will be able to complement what we need to do.

Telehealth is definitely also a part of where we’re going for the future of providing health care, especially to an older adult population. I think as we look at telehealth, there are a couple of things. Number one, we need to find a way that telehealth can be financially supported.

Number two, we’re going to have be creative about how we use telehealth. How providers – whether it’s a cardiologist appointment, or it’s a dermatology appointment – how do we actually use that technology to be able to provide the service that’s needed to that participant when they need it and be able to pay for that. CMS and the powers that be are just going to have figure out how we reimburse providers when they do telehealth.

And then, the last part of it is the cultural shift, having people accept telehealth and have them feel like I'm here for them on a remote visit.

Center: What's been most surprising to you about the experience of older adults during this pandemic?

Dr. Graddy: I don't know whether I should call it surprise. It’s more that I’ve been impressed with the resilience of the teams of people that continue to provide care every day. When you have to go into an uncertain environment, and you're not certain yourself about what you're being exposed to, even though you're being provided with the appropriate PPE, that you're still willing to do it. That’s resilience. That’s the reason I call our staff that continue to do that, day in and day out, the true heroes.

And there is the resilience of the older adults we care for. I am amazed at how, even with the fear, they are open to having our staff come into their homes. They ask the staff how they are doing, are concerned about their families. At the same time, there is also a level of fear among older adults about going out. They don’t want to go to an emergency room. They didn’t want to go to the hospital. They didn’t want to go a sub-specialty appointment because they were afraid.

Center: If you could wave a magic wand, what would you wish for to improve the lives of older adults (aside from an effective, safe, widely available vaccine)?

Dr. Graddy: I would wish to improve the lives of those who don’t have the type of support that we are able to provide our participants and their caregivers. I’d like to help those who are often most marginalized, and sometimes really don’t get equitable care. Just by virtue of their age, decisions are made about what should and should not be given. I would want every person who has a need that has not been met to be in a program like PACE – that would be a near-perfect world. America is aging, and we must learn how to care for this increasingly aging population. PACE is one of the models of care that has the capability of doing that. Good care, equitable care, quality care, compassionate care.

Care that would maintain their dignity and make them feel valued. I would want them to feel that somebody cared enough about them to make certain that what they needed was provided when they need it and then, that somebody was willing to talk to them, to explain why we do it this way, or why we are doing something different, so that they would feel like they're being heard.

So that’s what I would want. It’s not even a medical thing. It’s really a philosophical, spiritual wellbeing that I would want for them. Because that’s what I would want for myself as I am aging. That’s what I wanted for my mom and my aging family members.

 

This interview has been lightly edited for length and clarity.