Gayle Kvenvold is retiring from LeadingAge Minnesota at the end of the year after 40 years with the association, 32 of them as president and CEO. She recently spoke with McKnight’s Senior Living about the past, present and future of her professional life and the industry.
Looking back, what would you say are the big changes that have occurred in long-term care overall during your career?
You know, I think sometimes we get frustrated with the pace of change in our field, and sometimes it feels maybe more incremental than we would like it to feel. But some pretty sweeping changes have taken place.
I started this journey of mine as a nursing assistant way back in 1969. So in one form or another, I have been working in the field for even longer than my 40 years with LeadingAge Minnesota.
I can recall when nursing homes were the only option for seniors who needed any level of care and support. It wasn’t even a question of whether or not one needed 24-hour care and support; it was if you needed any level of care and support and you didn’t have family to do that for you and/or you didn’t have resources. Actually, you couldn’t really even buy those services very effectively four or five decades ago.
So what stands out to me is the concept of an array of care. It’s much more about the right service at the right time. That in itself is a significant change over the period of time that I’ve been doing this wonderful work.
We had the term rebalancing to describe seeking home- and community-based options and having our investment in those options be at least equal to or greater than the investment in nursing home care. The emergence of elderly waivers to help make that happen, and waiver programs under Medicaid. The entire concept of home- and community-based services and all of the varying services within that broad description. The emergence of assisted living. The emergence of concepts like hospital at home, the whole role of home care, adult day, the concept of person-centered care, which I like to think of as the customer experience or the consumer experience. All of that has emerged in the last four decades.
Senior living didn’t really even exist, or perhaps was its infancy, when you started.
That’s right. There was affordable senior housing. The [Housing and Urban Development] program was underway. But, really, in terms of residential options for seniors, it came down to the nursing home with its varying levels of care.
When I was a nursing assistant and a nursing home social worker after that, we had, of course, the concept of board and care and intermediate care and skilled care. And we’ve seen this incredible shift in the whole continuum; the individuals who were in those boarding care or intermediate care settings today are at home or in assisted living, and they don’t even touch the skilled nursing part of the array of services we have today. That’s an enormous change.
Looking back, you can see it. On a day-to-day basis, sometimes, I think we lose sight of that.
What drew you to nursing and long-term care originally?
Well, I would like to say that it was a very deliberate plan, but the truth of the matter is, I graduated from high school in need of a summer job. There was an opportunity to sign on as a nursing assistant at my local community nursing home. I went in and applied, and the next day, they said, ‘Come to work.’
There was no nursing assistant training, per se. It was all on-the-job learning. I found that I really loved work with older persons, and I felt a calling to work in that field. Nursing home social work was my first expression of that, and over the course of that work — I was about a decade as a nursing home social worker — I became really interested in why things were the way they were and whether or not there was an opportunity to shape policy, not as an elected official but as someone working with elected officials and state agency personnel around how we deliver services to seniors.
That led me to the association, that idea of coming together as a provider community and working with consumers and others to make change. If you look at the mission of LeadingAge Minnesota, it is that we are driven to enhance and transform the experience of aging. That’s been a lifelong calling to me.
What are the accomplishments you’re most proud of, trying to meet that mission?
It’s all about the partnerships that have been forged across four decades of work and what that has led to in terms of change. If I look at the most significant changes in the way an older person experiences long-term services and supports, if you peel everything back, at the heart of that is some type of collaboration or partnership, either among providers or with providers and consumers working together, or with policymakers. So I would say that that of which I am most proud is that I have been part of a spirit of community with a common vision to enhance the experience of aging for seniors.
No doubt COVID-19 was the first and only pandemic during your career. How do you think it will change the industry?
We’re still in it, so we don’t have quite yet the wisdom of hindsight, but I would say in terms of the unique threat to the population whom we serve, the demands on our workforce, the speed with which we’ve had to adapt and adopt new learnings and new practices, the teamwork that the pandemic has called on us to have — at least in my experience, we haven’t experienced a challenge quite like this.
Let’s hope that there are things that we’ve learned that are going to be new practices in our field, new ways of thinking about service delivery or teamwork or resilience. A CEO in long-term care told me, ‘I hate COVID, but I love what it did for my team.’ And, you know, that’s thinking about this profound sense of purpose that I think all of us working these last months have felt. Nimbleness, inspiration. We’ve learned we can sprint. We’ve learned about grace — that we do the best we can on any given day in any given moment, and then we give ourselves grace for what we weren’t able to get done, and we come back and bring our best again the next day.
The pandemic also really laid bare the depth of our workforce challenge. And in particular, it really called out what those of us working in long-term services and supports have long known about the societal standing of caregiving careers. It’s not where it needs to be. We talk about caregiving aspirationally as an honored and sought-after career, and it’s going to be incumbent on us, as we come out of this pandemic, to really make good on that. My own opinion is that while wages are only a part of the picture, they’re a huge part. We need to ensure that you can support a family as a caregiver. As providers, we’re going to be called to partner in new ways in the lives of our workers, whether that is housing or day care — which we’ve heard so much about during the pandemic — or healthcare or psychosocial supports that our workers are going to need. That’s an area I would be very interested in working on, that we can somehow recognize the complexity of these roles in caregiving, the unique combination of people skills and empathy and judgment that we need for those individuals, and value them as we ought to be valuing them.
What do you think the future holds for senior living?
We’ve just talked about the challenges of the pandemic, but I think the future is really bright. When you look at the number of people who are going to need some form of service and support and/or healthcare over the course of their aging, we are going to be so needed and so called upon to rise to the demographic that is before us.
And there are things we’ve learned through the pandemic that are going to guide us forward. The ways in which technology became part of our everyday experience, whether that was for healthcare purposes like telemedicine, or whether that was for connectedness. I don’t think we will return to a time when technology is not a part of how we deliver services and how we interact with one another. In fact, I think we’ve just scratched the surface there.
I also believe that we’ve learned so much in a hard way about the social determinants of health and the importance of community and connection. And so I’m pretty bullish on congregate living. I think we’ve learned a lot about our need for human connection and the role that that plays in our overall health and well-being. And I think we’ve only scratched the surface on ways in which we can configure housing and services.
And then the other thing, which has been a bit of a soap box for me for a long time, is long-term care financing reform. I think we were beginning to see a little bit of momentum before the pandemic in some thinking about leadership that states could do on this front. But I hope that we really, really can embrace this in the years we have ahead and leverage the public will to be able to find a way to pay for these services across our populations in new ways that leverage private investment but also public support. That’s a quest that I believe lies ahead for us.
Do you think the arrival of the baby boomers to long-term care will bring more urgency to the issue of long-term care financing?
I absolutely do. I love the metaphor of our demographics being like a jet plane that’s taking off, that we’re just now gaining altitude, and then the reality will hit us when we oldest boomers begin to turn 85 and 2031, which isn’t very far away. I think that will bring a sense of urgency that perhaps has been lacking, even though the wisest among us have been seeing for a long time, ‘We need to act now to prepare for the future.’
I’ve had many mentors over the years, but I had a mentor who talked about the blast furnace of change, that we change most fundamentally when our backs are against the wall, when we’re in the heat of the furnace, and I think that the demographics before us will create that sense of urgency that can bring real action. Fortunately, all the work that’s been done, it’s not for naught. The great work that’s been done by LeadingAge in their Center on Aging and UMass Boston and the SCAN Foundation — a lot of good minds have been thinking about this challenge, and I think maybe the boomers provide some of that critical mass. All generations will benefit from that when it does happen.
And what’s next for you?
As I’ve been saying to friends and family, I’m going to stand still for a little while, maybe 30 days or so. But I see myself still involved in some way in the field of aging. I’m passionate about governance. I’ve been blessed all of these years to work for and with an outstanding board of directors, and our mission-driven members work with those community stakeholders in their communities. I think it is also a wonderful calling to be a part of a governing community of an organization.
I’m also really keenly interested in combating ageism, to be honest. I will turn 70 before this year is out, and I’ve experienced ageism on a personal level, like being handed a magnifying glass along with a menu in a restaurant.
One of the troubling things that I see coming out of the pandemic is that we rarely refer to the senior population that we serve in our settings anymore without using the word vulnerable to describe them. COVID-19 poses a unique threat to an older person, but still, we’ve used that term vulnerable over and over and over to describe seniors in the last 16 months or so. I think that has implications for our willingness as a society to have informed risk as part of our reality as we grow older. I think it has implications for our agency in our seventh and eighth and ninth decades of life.
I feel myself somewhat called to that as well. Is there an opportunity to underscore that, as we grow older, a key part of our engagement in life is our ability to make our decisions? I think there’s work to be done on that front, and in some small way, I could see myself contributing there, I hope.
An abbreviated version of this interview appears as “A Few Minutes With…” in the August 2021 issue of McKnight’s Senior Living magazine.