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OHCA The Oregon Caregiver Fall Winter 2022

The Power of Animal Therapy in Senior Care A Publication of the Fall/Winter 2022 Oregon Health Care Association Benefits of Animal Therapy | Unpacking the Evidence of Animal- Assisted Interventions | Q&A with Rep. Lisa Reynolds

FALL/WINTER 2022 © 2022. The contents of this publication may not be reproduced or distributed electronically or mechanically, either in whole or in part, without the express written consent of the Oregon Health Care Association. The advertisers assume complete responsibility to use any or all brand names, trademarks, guarantees, and statements which appear in their advertisements. CONTENTS FEATURE 22 24 28 pg6 The Power of Animal Therapy in Senior Care In this article, several long term care providers, who have incorporated animals into their buildings, share the many ways animals have healed and uplifted their residents and staff. 04 LETTER FROM THE CEO 06 THE POWER OF ANIMAL THERAPY IN SENIOR CARE 14 QUALITY Specif ic Medical Benef its of Therapy Animals 16 LEGAL & REGULATORY Legal Considerations of Pets, Emotional Support Animals, and Service Animals 18 DATA & RESEARCH Animal-Assited Interventions in Long Term Care Communites: What is the Evidence? 20 PUBLIC POLICY 2023 Session Preview 22 SPONSORED CONTENT Who Let the Dogs in? 24 PROFILES Representative Lisa Reynolds (D-West Portland) Jack Tincknell (Willamette Lutheran Retirement Community) 28 2022 ANNUAL CONVENTION AND TRADE SHOW HIGHLIGHTS 30 OHCA AWARD RECIPIENTS 32 UPCOMING EVENTS

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 4 When it comes to uplifting spirits, there’s no better combination than friendly animals and seniors. Nowmore than ever, making connections and embracing happy moments is a priority. For both staff and residents, animals in long term care settings can enrich lives and provide a unique kind of therapy. In this issue of Oregon Caregiver, we explore how Oregon providers are embracing animals in senior living spaces. In our feature article, we highlight long term care providers who have incorporated animals into their buildings and the many ways animals have healed and uplifted long term care residents and staff. In our quality article, Nicolette Reilly shares the medical and physiological advantages that seniors may receive from pet therapy that they may be missing from traditional medication. OHCA general counsel Eugenia Liu explains the differences between service and emotional support animals and how communities can comply with the regulations to provide accommodations relating to animals in licensed long term care settings. Libby Batlan, OHCA’s SVP of government relations, previews the 2023 Oregon Legislative session and highlights key issues that will impact our sector. The human-animal bond is an established connection, and the benefits are supported by scientific research. Walt Dawson breaks down the data. Incite Strategic Partners, OHCA’s member purchasing partner, highlights creative ways to incorporate pet therapy and animals into long term care communities. In our policymaker profile, Representative Lisa Reynolds shares how her medical background and knowledge is woven into many of her decisions and policies for Oregon. Hear from Jack Tincknell, a resident of Willamette Lutheran Retirement Community, who shares his unique connection with the animals that live onsite and how they’ve impacted his life. Review highlights from the 2022 Annual Convention in Portland and save the dates of important in-person and online events and trainings coming up next year. We also honor all our 2022 OHCA Award recipients who demonstrate a commitment to providing quality care to their residents and clients. You can read this magazine and all past editions of the Oregon Caregiver on our website, www.ohca.com.  Animal Therapy in Senior Care 11740 SW 68th Pkwy, Ste 250, Portland, OR 97223 Phone: (503) 726-5260 www.ohca.com OHCA STAFF Conner Allen • Member & Administrative Services Coordinator Libby Batlan • Senior VP of Government Relations Philip Bentley, JD • President & CEO James A. Carlson • Advisor Cheryl Durant • CRM Administrator/Accountant Melodie King, CMP • Director of Education Eugenia Liu • Senior VP & General Counsel Brenda Michael • Assistant Controller Lori Mueller • CFO Nicolette Reilly, LNHA • Senior VP Quality Services Catherine Van • Communications Specialist Rosie Ward • Senior VP of Strategy BOARD OF DIRECTORS CHAIR Kathy LeVee, Generations, LLC IMMEDIATE PAST CHAIR Steve Fogg, Marquis Companies, Inc. VICE CHAIR Rick Miller, Avamere Health Services TREASURER Mark Remley, Gateway/McKenzie Living NON-PROPRIETARY REPRESENTATIVE JoAnn Vance, Providence Child Center MULTI-FACILITY REPRESENTATIVE Ryan Delamarter, Prestige Care, Inc. MULTI-FACILITY REPRESENTATIVE Jonathan Allred, EmpRes Healthcare Management, LLC BUSINESS PARTNER MEMBER REPRESENTATIVE Gabriela Sanchez, Lane Powell, LLC ALF REPRESENTATIVE Mauro Hernandez, PhD, Hearth & Truss; ITA Partners, LLC INDEPENDENT NURSING FACILITY REPRESENTATIVE Kelly Odegaard, Westcare Management BUSINESS PARTNER MEMBER REPRESENTATIVE Marcy Boyd, Moss Adams, LLP AT LARGE REPRESENTATIVE Andy Becker, Sapphire Health Services IN-HOME/SENIOR HOUSING REPRESENTATIVE Jonathan Mack, Home Instead Senior Care of Central Oregon RCF REPRESENTATIVE Mark Kinkade, Gateway/McKenzie Living ALF/RCF REPRESENTATIVE Lisa Maynard, The Springs Living ALF/RCF REPRESENTATIVE Charles Bloom, Latitude Healthcare Properties OC EDITORS Catherine Van • cvan@ohca.com Rosie Ward • rward@ohca.com OC PUBLISHER LLM Publications • www.llmpubs.com Advertising Sales • Ronnie Jacko (503) 445-2234 • ronnie@llmpubs.com Design & Layout • Hope Sudol Phil Bentley President and CEO Oregon Health Care Association LETTER FROM THE CEO Stay connected with OHCA! Contact Catherine Van, cvan@ohca.com, to be added to our email lists.  Improving lives by advancing quality care in Oregon since 1950

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 6 FEATURE THE POWER OF ANIMAL THERAPY IN SENIOR CARE By Catherine Van, Oregon Health Care Association Staff and residents at a Marquis building enjoyed a visit from Napoleon the alpaca.

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 7 FEATURE Every morning as the sun rises, Jack Tincknell makes his way to the goat pens at his retirement community. At the pens, he is greeted by three enthusiastic Nigerian dwarf goats that have given his life a new meaning. “I feel love because they love me and I love them,” said Tincknell. The 90-year-old resident feeds the goats, takes them for long walks to the lake, and even cleans their pens—daily rituals that he says bring him joy. “Sometimes, I can kind of feel sorry for myself, but when I get with the animals, everything goes away,” he said. Sitting on 42 acres of the north Keizer bluff, Willamette Lutheran Retirement Community, is where Jack and a myriad of animals call home. From goats and chickens to dogs and cats, this community understands the indescribable bond between animals and humans. “I think the residents get a feeling of self-worth. We all worked hard to get the animals here and then we all name them. They’re not my goats. They’re our goats. I think the residents have that ingrained need to nurture something. It’s having the feeling of contentment to have a warm, living thing next to you that is soaking up your attention,” said Raeann McDonald, the executive director of Willamette Retirement Community. For the past 22 years, McDonald has taken a resident-driven approach to operating her community. So, when her residents insisted on having more pets in the community four years ago, she started a fundraiser to get three Nigerian dwarf goats to the community. What started as one resident’s idea became a community-wide project. Every resident was involved, from building the shelter and obtaining the feed and toys, to naming the goats. “The buy-in for everybody is to feel like it’s their project, their choice, their desire. It’s something they want and they’re the driving force,” she said. “We took a van full of residents and we went out to a farm to see the baby goats. They got to hold them and pet them, call them by their new names, and spend time with them. Everybody couldn’t stop talking about them; they had so much fun.” While the community had always allowed standard pets, like dogs, cats, birds, and fish, McDonald wanted to bring more variety to the community, including Taco the rooster. It wasn’t long until her staff members started bringing their own pets, and soon two more roosters were added to the mix, along with two dogs. Ranger, a golden retriever, holds a special place in McDonald’s heart. She understands first-hand the healing powers of an animal’s love. Her son passed away two years ago, and Ranger has filled that void in her life by staying by her side at home and at work. CONTINUES » “Ranger loved me when my heart was broken, and he let me love him,” she said. “I started bringing him to work with me when he was a puppy and people couldn’t believe his demeanor that he was so gentle. He’s healed so much more than me.” Ranger helped her get through one of the most difficult times in her life, while also providing comfort to the residents along the way. He became a representation of the dog in their childhood that greeted them after school, and the best friend they took on family trips. He became a staple at the community during some of the most challenging times. During the COVID-19 pandemic when seniors around the world had to isolate to stay safe, Ranger and the other animals at Willamette Lutheran provided solace and companionship to its residents. McDonald noticed that even the residents who normally weren’t as Willamette Lutheran’s administrator, Raeann McDonald, brings her dog Ranger, to the community every day.

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 8 FEATURE “I have a resident who is blind. His world is pretty small, so for him to be able to hold a little dog and feel connected to something, that’s huge. I can only imagine how losing your sight makes you feel so unconnected. Even something as simple as petting the dog makes him feel part of everything,” McDonald said. “If you loved animals before you came to a community like this, you never stop loving them. If you have a connection with them, if they give you a sense of comfort, that’s still real. You have an animal that you’re able to stroke and talk to and they give you unconditional love.” It’s the love from animals that brought so many residents joy and additional companionship during the difficult days of the COVID-19 pandemic, when visitors were restricted at long term care communities in Oregon for over half a year. At Marquis Companies, engaging residents was more important than ever during the pandemic. The pressure put a strain on many life enrichment professionals, forcing them to think outside the box. “Activity directors had to get really creative about engagement with animals and creating that feeling of being connected to them. We did all kinds of wonderful things, such as streaming dog shows and live zoo cams from around the world. They would put those up on big screens when they were able to bring residents together in groups,” said Lynne Jensen, the recreational activities consultant at Marquis Companies. As the point person for activity directors company-wide, Jensen saw a variety of » FEATURE, CONT. social and rarely left their rooms, went out to see the goats or took the dogs out for walks. “I think the residents have that ingrained need to nurture something. It’s having the feeling of contentment to have a warm, living thing next to you, that is soaking up your attention.” –Raeann McDonald, Executive Director, Willamette Retirement Community Tuffy, the dog, works his magic at Willamette Lutheran. A miniature pony brought smiles to staff and residents at a Plaza Regency building in Las Vegas.

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 9 FEATURE ways staff at Marquis Companies used animals to engage with seniors. At the Marquis Forest Grove campus, a local farm brought horses, goats, and sheep to visit each resident’s window around the entire community. Other communities organized pet parades in the courtyard with staff and their pets. Scenic drives to horse ranches and alpaca, llama, and goat farms allowed residents to admire animals while distanced and were popular during the pandemic. With government grant funding, Marquis Companies was able to acquire iPads for residents to use to communicate with family members when visitation was limited and to also access virtual experiences to enrichen life within communities. From watching bears catching fish to eagles nesting, residents were able to personalize their virtual experiences. At Marquis Plum Ridge Post Acute Rehab in Klamath Falls, the activities and life enrichment staff put together extensive virtual presentations that featured fun facts about different animals that they would air on their own television channel every week. Jensen says she sees the most positive impact from animal activities and CONTINUES » interactions in her residents with dementia. “It’s a very nonthreatening way to provide that socialization and interaction. Residents will just start talking to the pet, but the folks with dementia just really seem to grasp onto that and talk to it like a small child. It is nurturing to them and can really reduce behavioral issues. It’s often a very familiar thing for them because they’ve had pets over their lives that gave them unconditional love,” said Jensen. Animals were very much part of the residents lives prior to the pandemic. Some communities would bring in K9 units from local police stations to do demonstrations or local certified pet therapy animals to interact with residents. Residents at Marquis Marion Estate in Sublimity made dog treats for the dogs that would come and visit. They also donated treats to the local animal shelter. Some residents would even volunteer as petters at the shelter to give the animals the love and attention they normally don’t receive. “These residents can lose so much when they come into a facility. They lose a lot Columbia Care Basin resident, Laura, holds P2, the dog. “Residents will just start talking to the pet, but the folks with dementia just really seem to grasp onto that and talk to it like a small child. It is nurturing to them and can really reduce behavioral issues. It’s often a very familiar thing for them because they’ve had pets over their lives that gave them unconditional love.” – Lynne Jensen, Recreational Activities Consultant, Marquis Companies

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 10 FEATURE of their independence. They’re no longer driving and now they often share a room with another person. A lot of them lose their pets. So, having pet visits can kind of bring back that joy and connection with an animal that they just truly have » FEATURE, CONT. missed by leaving their independent setting,” said Jensen. At Columbia Basin Care, it’s not unusual to see four or five animals throughout the facility at any given time. Melodie Davis, the marketing director of Columbia Basin Care, was adamant about bringing the animal program back to the community during the pandemic. Before the pandemic, the local Humane Society would bring in dogs and cats to interact with residents. With the lack of volunteers and restrictions from the pandemic, the program was put on hold. Davis took it upon herself to bring animals of her own. Before diving into the long term care profession, Davis worked as a vet technician and manager of an animal clinic. With six pets of her own, she is naturally comfortable around all types of animals. “Animals can really help keep you engaged and lift your spirits. I feel that CONTINUES » Residents enjoy hanging out with the onsite animals at Willamette Lutheran. A resident takes one of the onsite goats on a walk through Willamette Lutheran’s campus. Jack Tincknell, a resident at Willamette Lutheran feeds the onsite goats. Residents and staff at Columbia Basin Care Facility love getting visits from furry friends.

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The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 12 FEATURE » FEATURE, CONT. for myself. It’s really nice for the residents to do something else and be able to focus on something that you can take care of in a way,” said Davis. Her colleagues have joined in on the fun by bringing their own pets to the community. At least twice a day, Davis walks through hallways with different dog breeds that range in age and size, popping into residents’ rooms to add some joy and interaction to their day. “This one resident who was telling me about how, when he was growing up, he had a mastiff, and he said the dog was big enough to ride. He was just so happy,” said Davis. For the most part, Davis says the residents gradually warm up to the dogs even if they’re hesitant at first. She has residents who would, at the beginning, only pet the dogs, but after a few weeks, they started holding and kissing them. As she continues to revamp the animal program at Columbia Basin Care, she’s hoping for more involvement from outside of the community. She’s looking for volunteers who have extra time to visit with good-natured, calm, and obedient animals that can respond to basic commands to start building relationships with the seniors. “It’s more like an escape for the residents. If kids or dogs visit, it’s just more jovial, more lighthearted because no one’s asking you how things are going or what treatments or rehab you’re under; it’s just an easy time to be happy together,” said Davis. “It feels special if it’s just the dog that comes to visit, because then you feel like, ‘oh, this dog came to see me because they like me.’ Whatever you can do to find happiness, however fleeting it is, I think is worth it.” The happiness of the residents and staff stems from unconditional love, nostalgia, physical touch, and a daily routine. Animals can bring a lot of value to long term care settings. Whether it’s the warm nuzzle of a furry friend or a fond memory of a beloved pet, the power of animal therapy can reach beyond any regulation or rule, healing and lifting spirits one pet at a time. “You are improving the residents’ quality of life by putting an animal in their lives,” said McDonald. “There’s nothing better.”

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The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 14 SECTION Specific Medical Benefits of Therapy Animals By Nicolette Reilly, Oregon Health Care Association Many common, age-related life transitions, like moving out of homes, losing a spouse or loved one, restricted driving and other mobilities, or losing the independence that comes with activities of daily living, can cause residents residing in long term care communities to experience depression. In addition, residents may experience an additional decrease in the quality of life due to illness, stress, mental illnesses, and loneliness. More and more, commitments to further enhance residents’ social, behavioral, and emotional needs—especially in relational therapies, which are considered vital to the overall quality of life for seniors—are strengthening in long term care settings. One way to address these needs is animal therapy. Pet therapy has proven to decrease depression, encourage communication, increase social and cognitive stimulation, reduce boredom, and decrease cortical in the body, which results in lower anxiety and stress levels. With pet therapy, the reliance on medications can decrease, showing a resident’s health and wellbeing may be improved by contact with animals. Although dogs are the most common animal used in pet therapy, cats, birds, llamas, rabbits, goats, and other pets have shown to be just as effective. The pet therapy experience can be nostalgic for residents, reminding them of pets they’ve had in the past and the positive associations they may have had with those animals. Certified pet therapy dogs can respond to commands, such as “jump on” and “snuggle,” offering support and physical comfort to those in need. Therapy dogs are also trained to assist with ambulatory needs for high-energy residents who may need a walking companion. In addition to these effects, a study in Acta Biomed March 2017 shows that individuals with an elevated level of voluntary contact with pets can improve the quality of life for seniors experiencing loss and loneliness as well as physical ailments. This form of therapy has been known to decrease blood pressure, improve cardiovascular health, and The pet therapy experience can be nostalgic for residents, reminding them of pets they’ve had in the past and the positive associations they may have had with those animals. QUALITY

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 15 SECTION release chemicals like endorphins such as oxytocin, prolactin, phenylacetic acid, and dopamine, which can decrease pain and have a calming effect on the body. These natural hormones also reduce restlessness, disorientation, and aggressive behavior, and they can improve short-term memory, communication skills, and even eating habits. While long term care residents who own their pets can have a significant quality of life, the responsibility of caring for these pets often fall upon the resident, family members, community staff, or other outside resources. Many long term care communities require that a resident be able to independently care for their pets. While some residents aren’t able to take the responsibility of owning a pet, there are many innovative ways they can still reap the benefits from pet therapy and the bond between human and animal. Long term care facilities often employ third-party animal therapy visits. However, there may also be times when therapy animal visits are impractical, due to geographic distance or health issues that prevent in-person meetings. In these situations, pet therapy companies offer the healing power of the human-to-animal bond through virtual therapy animal visits. In recent years, some senior living facilities have added an innovative twist to the pet therapy concept: robotic pets. These animatronic animals are lifelike, imitating dogs, cats, and other pets that have brought comfort and meaningful connections to residents. As providers in long term care, we have an opportunity to enhance the lives of our seniors by offering animal therapy programs that have the potential to enhance not only the lives of seniors, but also the health and wellbeing of our staff and visitors.  QUALITY

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 16 LEGAL & REGULATORY Legal Considerations of Pets, Emotional Support Animals, and Service Animals By Eugenia Liu, J.D., Oregon Health Care Association Almost any animal can be a pet that brings companionship, comfort, unconditional love, and joy to a person. However, only some animals qualify as emotional support animals and an even smaller population qualify as service animals. While all are animals, service and assistance animals are not considered “pets” and they are not treated the same under the law. Understanding the difference between a pet, an emotional support animal, and a service animal can help residents and communities better manage their rights and responsibilities. Pets vs. Service Animals vs. Emotional Support Animals Pet policies vary widely across different senior living communities. Some communities have a “no pet” policy while others allow pets, but place restrictions on the size and breed of the animal and/or require the animal to be domesticated and a common household pet. In “pet-friendly” communities, residents must comply with pet policies and rules. For example, communities may require the pet to be up-to-date on vaccinations, licensed, and housetrained. Communities also commonly charge a pet fee and require residents to be able to care for the pet themselves. In addition, communities may restrict where a pet can go within the community, such as the dining area or other areas where food is served. However, service animals and emotional support animals are not “pets,” and they are not subject to “no pet” or even traditional “pet policies.” When a dog is trained to do work or perform a specific task on behalf of an individual with a disability, the dog is no longer a pet but a service animal under the Americans with Disabilities Act (ADA), which prohibits discrimination based on a disability in public places. An animal that provides assistance, including emotional support, to an individual is also no longer a pet but an assistance or emotional support animal under the Fair Housing Act (FHA), which protects individuals with disabilities from discrimination in obtaining housing or accessing housing services. The definition of “assistance animal” under the FHA is broader than “service animal” and can include birds, rabbits, cats, and hamsters as well as dogs. For instance, a dog whose sole function is to provide comfort or emotional support does not qualify as a service animal under the ADA, but it does qualify as an assistance animal under the FHA. Compliance and Responsibility for Pets and Service/Assistance Animals To comply with the ADA and FHA, a “no pet” community must allow for service or assistance animals and ensure their “no pet” policy is modified to accommodate the service or assistance animal. Even communities that allow pets must ensure their pet policies reasonably accommodate service or assistance animals. When it comes to service or assistance animals, a community cannot charge pet fees. Similarly, breed and size restrictions generally do not apply. Under the ADA, a service animal may accompany a resident into the dining area or other areas where pets are generally not allowed. While a community must adjust pet policies as appropriate to comply with the ADA and FHA, these laws do not relieve a resident of the responsibility for the service or assistance animal. Residents remain responsible for the care When a dog is trained to do work or perform a specific task on behalf of an individual with a disability, the dog is no longer a pet but a service animal under the Americans with Disabilities Act (ADA), which prohibits discrimination based on a disability in public places.

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 17 LEGAL & REGULATORY and maintenance of their animals and community staff are not required to provide care for or supervise animals, unless pet or animal care is a service offered by the community. Likewise, residents remain responsible for any damage or injury caused by their animals and communities may charge for those damages. Communities may also ask for the removal of an animal, including a service or assistance animal, if it is out of control, not housebroken, or poses a direct threat to the health or safety of others, such as biting or displays of aggressive behaviors towards others. However, when it comes to service or assistance animals, communities may not exclude them based on general fears, assumptions, or stereotypes about the breed. Similarly, communities cannot automatically bar a service or assistance animal because another resident is allergic to the animal. The community will need to engage in an interactive process with each resident to see if it can reasonably accommodate both residents, such as agreed-upon dog-free zones. As with any interactive process, this is a fact-specific balancing requirement that may have differing results based on the situation at hand. Regardless of whether the animal is a pet, an emotional support animal, or a service animal, it is important for residents to ask themselves whether they can independently care for and maintain their animal and consider what will happen to the animal if its resident owner can no longer care for it. To avoid a situation where a beloved animal may be deemed abandoned or neglected and sent to a shelter, residents may want to designate a loved one or a friend to pick up and care for the animal when the resident is transferred, discharged, or no longer in a position to care for the animal. Communities may also want to manage expectations on their end by proactively asking the resident to designate a person at the time of move-in and outline in the residency agreement or pet/animal policies that the community may board the animal and charge for any costs incurred if the designated person does not remove or care for the animal. Clearly communicating the resident and community’s respective rights and responsibilities prior to move-in, upon move-in, and throughout the residency will help ensure residents and their best friends have a safe, enjoyable stay at the community. 

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 18 DATA & RESEARCH The human-animal bond is a longestablished connection. Pets—be it a dog, cat, bird, or other animal companion—are an ever-increasingly important part of our lives and our families. In recent years, there has been a growing interest in the potential impacts on the wellbeing of intentional interactions between animals and people who may be living with conditions as varied as autism spectrum disorder in children, people of all ages living with post-traumatic stress disorder (PTSD), or older adults living with dementia. While many areas of research on the potential benefits of many of human-animal interactions are still in the nascent stages of development, some interactions are better understood than others. Older adults are a well-studied group to assess the positive benefits of animal-assisted interventions (AAIs). Older adults living in long term care communities may particularly benefit from AAIs. A few key definitions are helpful to understand what is and is not a therapeutic intervention involving an animal versus something that may be more focused on providing life enrichment. Take, for example, the term, AAIs, which includes a variety of ways animals may intentionally engage with humans in a supportive or comforting manner. Emotional support animals and service animals are likely some of the most familiar examples of AAIs. Service animals are highly trained and work with professionals when engaging with older adults. However, the many forms of AAIs are far more wide-ranging and may also include more clearly therapeutic approaches to human-animal interactions. Animal-assisted therapy (AAT) is a form of an AAI with the goal of supporting people with the expressed purpose of improving their social, emotional, physical, and/or cognitive wellbeing. An example of an AAT might be a scheduled visit to a long term care community by a certified animal that is part of a therapy team that also includes a therapist trained in working with the animal. Animals might be incorporated into a conventional therapeutic session or may be an addition (or complement) to other existing therapies a resident might receive. Given the strong bonds that exist between dogs and humans, it is unsurprising that AAIs most often include dogs. Yet, other animals can be a part of AAIs such as guinea pigs or horses (e.g., equine therapy), depending on the specific needs of the person supported through this approach. Indeed, there is evidence to suggest the therapeutic involvement of animals in long term care settings can be beneficial to residents as well as caregivers. Further research is needed to move beyond anecdotal stories of success to better Animal-Assisted Interventions in Long Term Care Communities: What is the Evidence? By Walt Dawson, D.Phil clarify how and why these interventions can be beneficial and what types of interventions may be the most appropriate and in what context; however, the existing evidence is promising. Some of the most interesting impacts of AAT involve anxiety and depression, which are commonly experienced issues amongst residents in long term care settings. Further, there is increasing awareness of the negative effects of social isolation and loneliness amongst older adults. The multiple impacts of the COVID-19 pandemic, in particular, on older adults living in long term care settings has brought this awareness into sharper focus. Non-pharmacological approaches to mitigate these issues are of particular salience given fewer possible risks (i.e., side effects) and lower costs when compared to more conventional treatments and interventions. Some studies1 appear to show reductions in loneliness and anxiety from various animal-based interventions amongst participating older adults including a recently published systematic review and meta-analysis in JAMA Network Open Animal-assisted therapy (AAT) is a form of an AAI with the goal of supporting people with the expressed purpose of improving their social, emotional, physical, and/or cognitive wellbeing.

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 19 DATA & RESEARCH from Hoang et al. that includes loneliness among long term care residents. Other studies have also pointed to improved measures of physical health for older adults including reductions in blood pressure among nursing facility residents who interact with therapy dogs (for instance, Handlin et al., 2018). One should take caution in interpreting the findings of these various studies and their effects on AAI participants; further research is needed to better understand these findings.2 The potential benefits of AAIs have also been specifically studied for people living with dementia. Studies appear to show that AAIs may decrease the neuropsychiatric symptoms in dementia or the behavioral and psychological symptoms of dementia (BPSD)3 such as agitation, depression, apathy, hallucinations, or wandering. A 2018 meta-analysis of AAIs and impacts on dementia by Hu et al. found substantial decreases in depression and agitation. Whether or not AAIs may help mitigate all types of BPSD, which more than 97 percent of all people living with dementia experience at some point during the disease, is less clear.4 Once again, the use of non-pharmacological approaches to support people living with dementia is highly important. Something like AAIs that are both fun and relatively low risk, which can also potentially decrease depression and agitation, would be a wonderful addition to the supportive activities and therapies offered in care communities. While the risks of possible side effects may be low as are the costs of AAIs when compared to more conventional therapies, careful considerations are still needed, and other potential risks mitigated. For instance, a fear of certain animals by a resident or allergies may mean other approaches than an AAI should be explored in those situations. There is also a need to ensure both the animal and their human professional are properly trained to work with older adults in long term care settings. These types of considerations, while essential, should not prevent the use of AAIs and AATs when appropriate. Animal assisted interventions may be a fun, cost effective way to better support residents of long term care communities. This appears to be the case for residents living with dementia as well as others who may be experiencing other challenges and conditions such as PTSD. While further research is needed to understand the full range of potential benefits (as well as the limitations) of animal assisted interventions for older adults, there is some evidence to suggest that AAIs may reduce neuropsychiatric symptoms (or BPSD) among people living with dementia. This is good news and something that should be explored further as we continue to work to improve the overall wellbeing of residents and staff in Oregon’s long term care communities.  Walt Dawson is an assistant professor at Oregon Health & Science University and a senior Atlantic fellow with the Global Brain Health Institute. References 1. Hoang P, King JA, Moore S, Moore K, Reich K, Sidhu H, Tan CV, Whaley C, & McMillan J. (2022). Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis. JAMA Network Open, 5(10):e2236676. doi:10.1001/ jamanetworkopen.2022.36676. 2. Handlin L, Nilsson A, Lidfors L, Petersson M, & UvnäsMoberg K. (2018). The Effects of a Therapy Dog on the Blood Pressure and Heart Rate of Older Residents in a Nursing Home, Anthrozoös, 31:5, 567-576. doi:10.1080/089 27936.2018.1505268. 3. Hu M, Zhang P, Leng M, Li C, & Chen L. (2018). Animalassisted intervention for individuals with cognitive impairment: A meta-analysis of randomized controlled trials and quasi-randomized controlled trials. Psychiatry Research, 260, 418–427. https://doi.org/10.1016/ j.psychres.2017.12.016. 4. Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschanz JT, and Cache County Investigators. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23(2): 170–177. https:// doi.org/10.1002/gps.1858.

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 20 PUBLIC POLICY Oregon recently concluded a historic election cycle. It resulted in continued Democratic majorities in the State Legislature and former Speaker of the House Tina Kotek (D) emerging victorious from a threeway contest that was the most expensive in the state’s history. As we move forward from the election, the OHCA government relations team is gearing up for the 2023 legislative session. The 2022 election featured uncharacteristically competitive races because of newly drawn congressional and legislative district lines along with retirements of long-serving elected officials. Additionally, voters were making decisions amid an uncertain political climate with major issues impacting the lives of Oregonians, including record-high inflation, a looming recession, Supreme Court action on a range of issues, and concerns about public safety, affordable housing, and homelessness. The upcoming Oregon legislative is a “long” session. Lawmakers convene in January and will have approximately six months to complete their business. During this session, the state will set its budget for the next two years, including consideration of adjustments to Medicaid reimbursement rates. OHCA will vigorously advocate on behalf of its members with a legislative agenda centered on helping to relieve the current workforce crisis, pushing for Medicaid reimbursement rates to meet the true cost of care, and reducing the fiscal burden placed on providers by temporary staffing agencies. In addition, OHCA will evaluate—and engage in as needed—other legislation or regulatory proposals that may have an impact on long term care providers. Workforce The shortage of trained and qualified direct caregivers, registered nurses, licensed practical nurses, and certified nursing assistants is challenging the long term care sector and limiting equitable access to services and supports for Oregonians in all areas of the state. It is now well-documented that nursing facilities and community-based care settings have experienced a deeper and more sustained labor shortage than other sectors of the health care continuum. Before the pandemic began, employment levels at hospitals and long term care communities were about the same. But by March 2022,1 nursing facility and residential care facility employment levels fell well below that of hospitals and have not recovered to pre-pandemic levels. Moreover, re-employment patterns varied across the health care sectors with long term care faring by far the worst.2 While 54 percent of hospital workers went back to work for their same employer after making an unemployment claim, only 25 percent did so on long term care settings. Additionally, 40 percent of employees who were employed in long term care and filed an unemployment claim during the pandemic left the sector and took a job in a different field. With all this in mind, OHCA will prioritize advancing legislative concepts that provide support to workers in long term care. One such example is subsidizing the cost of childcare for these employees. More than 80 percent of licensed and unlicensed caregivers in senior care facilities are women, and many of those women are caring for children under the age of 18. Childcare in Oregon is expensive, and many workers must choose between staying in their job and staying home with their children. OHCA believes the state could play a role in providing financial support to long term care workers to help pay for childcare costs, which will improve retention and preserve access to long term care for Oregonians who need it. Medicaid Rates For the past two years, the state’s economic and revenue forecast has looked bright despite the economic challenges posed by the pandemic. OHCA has been able to leverage additional state and federal funds and work with the legislature to make critically needed investments in the sector, including temporary and permanent increases to Medicaid reimbursement and funding to improve long term care infrastructure. 2023 Session Preview By Libby Batlan, Oregon Health Care Association OHCA will vigorously advocate on behalf of its members with a legislative agenda centered on helping to relieve the current workforce crisis, pushing for Medicaid reimbursement rates to meet the true cost of care, and reducing the fiscal burden placed on providers by temporary staffing agencies.

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 21 PUBLIC POLICY Approaching the next biennium, federal pandemic funding has slowed or stopped entirely, and the economy continues to experience high inflation and the threat of a recession as soon as next year. How the economy fares will be a critical factor in the extent the legislature has the resources to make new budgetary investments. Nevertheless, ensuring Oregon’s Medicaid system is appropriately reimbursing providers is the most critical component to ensure the long term care system can meet the needs of Oregon’s seniors. As such, it will be the highest budget priority for OHCA in 2023. OHCA will work with lawmakers to ensure rates are increased and the temporary rates are held steady to make sure providers do not experience a rate cut amid the workforce crisis and continued pandemic. Temporary Staffing Agencies Stabilizing costs borne by providers from some temporary staffing agencies was OHCA’s top policy priority in the 2022 session. The legislature passed Senate Bill (SB) 1549 that improved standards and training for temporary staffing agencies and required them to be licensed with the state of Oregon by July 2023. While this is good progress toward improving the temporary staffing agency industry as a whole, more work needs to be done to control the fiscal impact of temporary staff on equitable access to care. SB 1549 called for the Oregon Health Authority (OHA) to produce a policy proposal and recommendation on a process for setting annual maximum rates a temporary staffing agency may charge a provider. OHCA plans to bring legislation in the 2023 session to address market stabilization and encourage staff to seek longer-term, high-quality careers.  References 1. State of Oregon Employment Department, Employment Statistics. Winter 2022. 2. State of Oregon Employment Department, Unemployment Insurance Records. Winter 2022.

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 22 SPONSORED CONTENT Senior living communities attempt to create home-like environments for residents in innovative and heartfelt ways and that includes animal companionship. As you’ve read throughout this magazine, many communities take advantage of therapy animals as a regular part of resident engagement using animal assisted therapy, or AAT. Dogs are the most common animal visitors to senior living, but cats and even birds or guinea pigs can play a role in animal-based therapy. More than just a feel-good enhancement to resident programming, there are real benefits to animal therapy including stress reduction, lower blood pressure, reduced loneliness, and benefits to heart health. Residents receiving AAT have a lower incidence of depression and anxiety. And research suggests that people find strangers more trustworthy when that unknown person is in the company of a dog, which could help residents feel calmer around unknown visitors or staff. For those living with dementia, the soothing presence of a dog to pet or to hug can help calm and quiet harder emotions. Aside from biometric markers of wellbeing, animals may also serve as motivation for hesitant residents to start their day. Knowing there is an AAT visitor coming can serve as an impetus for folks to get up, get dressed, and participate in mealtime in preparation for their visit. While there may be plenty of friendly family pets that come to visit residents or former owners, it’s a good idea to arrange for a certified therapy dog to visit with groups of residents, or residents with whom the dog is not familiar. Certified therapy dogs have been tested in multiple settings to ensure that they react positively to interactions with strangers, and that they aren’t frightened of unusual sounds, movements, or equipment like wheelchairs. Dogs and other animals can make gentle and loving visitors, but what about equine therapy? Is there a place for horse-based interactions with senior living? The answer once again is, yes! A newer idea for assisted living, bringing horses to visit campuses with the right space available, can offer an additional form of animal interaction. Petting, brushing, even riding a horse can bring seniors a sense of calm, purpose, and accomplishment. While it may not suit all the residents’ desires and abilities, a surprising number of folks want to go out and see a visiting equine! Even residents needing wheelchair assistance can enjoy viewing a horse or feeding it a treat. In addition to individual visiting therapy animals, consider out-of-the-box ideas for animal engagement with your residents. • Can your community adopt dogs or cats that live in the building with residents? This might sound far-fetched but communities who have taken the plunge have found no shortage of willing volunteers to schedule and transport facility pets to vet or grooming appointments, help with training, and provide longer walks to dogs when visiting a family member. Working animal care into a staff schedule ensures that all needs are met, while providing consistent animal companionship to residents. • Could a local breed rescue hold an informal “show” in the grassy area of campus? • Can a shelter bring over puppies to help socialize them prior to adoption? • Perhaps a local dog is a show winner whose handler would be willing to give a talk and demonstration of agility or obedience. Who Lets the Dogs in? By Jen Bruning, MS, RDN, LDN, Incite Strategic Partners Residents receiving AAT have a lower incidence of depression and anxiety. And research suggests that people find strangers more trustworthy when that unknown person is in the company of a dog, which could help residents feel calmer around unknown visitors or staff.

www.ohca.com FALL/WINTER 2022 The Oregon Caregiver 23 SPONSORED CONTENT • If a community is situated in or near a rural area, ask a local farmer or rancher bringing in a few livestock animals for a parking lot “fair.” Speaking of fairs, many state and county fairs are easily accessible by short car trips and can facilitate animal engagement with a hearty dose of reminiscence to boot. Farm animals from chickens and geese to pigs, cattle, goats, and horses are all on display. There may even be an area designated for petting some animals that seniors can enjoy. If you are worried about accessibility, contact the fair organizers and ask about access for wheelchairs, walkers, or people who can only go short distances on foot. While animal interactions are best kept in-person, there are virtual options that residents can enjoy. From televised national dog shows to a visit with a family pet via video chat, seeing animals on the screen can delight devoted animal lovers from afar. There are many ways to engage residents with animals for improved quality of life, excitement, reminiscence, reduced stressed, and improved mood. With the right animal visitor, those feelings just might extend beyond residents to staff and visitors as well!  There are many ways to engage residents with animals for improved quality of life, excitement, reminiscence, reduced stressed, and improved mood. With the right animal visitor, those feelings just might extend beyond residents to staff and visitors as well! Jen Bruning is the director of nutrition and brand innovation with Incite Strategic Partners, OHCA’s purchasing partner and an OHCA business partner. This article has been sponsored and provided by Incite Strategic Partners. References 1. Yakimicki ML, Edwards NE, Richards E, Beck AM. AnimalAssisted Intervention and Dementia: A Systematic Review. Clinical Nursing Research. 2019;28(1):9-29. doi:10.1177/1054773818756987. 2. Beetz A, Uvnäs-Moberg K, Julius H, Kotrschal K. Psychosocial and psychophysiological effects of humananimal interactions: the possible role of oxytocin. Front Psychol. 2012 Jul 9;3:234. doi: 10.3389/fpsyg.2012.00234. PMID: 22866043; PMCID: PMC3408111. 3. https://www.chicagotribune.com/suburbs/advertising/ primetime/chi-primetime-dogs-081011-story.html. 4. https://www.therapydogs.com/facility-information. 5. https://www.therapydogs.com/how-dogs-can-helpseniors. 6. https://eqliving.com/senior-care-meets-equine-therapy. A disabled senior man in wheelchair indoors playing with a pet dog at home—stock photo. Senior woman drinking morning coffee and talking with dog—stock photo.

The Oregon Caregiver FALL/WINTER 2022 www.ohca.com 24 PROFILE Rep. Lisa Reynolds (D-West Portland) POLICY MAKER Representative Lisa Reynolds (D-West Portland) serves as the Chair of the Committee on Human Services, as well as Vice-Chair of the Committees on Early Childhood and Behavioral Health. Outside of her legislative work, Rep. Reynolds is a pediatrician in Portland. In this interview, she shares how her passion and experience in healthcare influence her policy interests and decisions. What have you learned about Oregon’s long term care sector that you didn’t know before you took office? I’m certainly learning about it as a daughter. My dad is currently in an assisted living facility in Chicago, and I’ve had to navigate the process with my mom. I’ve known for a while that Oregon has been a leader in home-based and community-based care for seniors. I’m just starting to delve into the long term care sector; it’s complicated and it’ll certainly be a big part of my understanding of work next year. What are your policy interests? I’ve had a 25-year career as a pediatrician and I’m still seeing patients. I see what’s working and what’s not working for families, and what really motivated me to run for office was that I felt like there was more I could do for children and parents than what I could accomplish in the exam room. What a lot of it comes down to is: Oregon is juggling a lot. We are in the process of implementing paid family leave and sick leave. We have universal home visits. We’ve done Medicaid expansion and Oregon is one of the few states in the country that covers all kids. I’m really focused on the medical care of prenatal to three years old because I know that what we put into place for families in those years can have very long term implications, even in aging. I think there are some lifelong trajectories we can try to put people on that could have a positive impact in aging. I’m focused on upstream investments. We don’t spend enough resources at the beginning of life, but it really pays itself back in huge dividends. What connections can you make between our early years and our late years? You’ve probably seen the cartoon of a person crawling in the diaper and then walking with the cane and then they’re in a diaper again at the end of life. It is an interesting circle of life. Both times in life require substantial help—people are in vulnerable situations, whether you’re a two-month-old or an aging person who’s having physical and mental decline. A lot of times, kids and older Oregonians can’t often advocate for themselves, and we need to seek out their voices in the policy-making process. I will say that I have a severely mentally ill brother who lives in a nursing home and has for several years in Chicago. I know that for him to have autonomy sometimes means he’s in unsafe situations. Where do we draw that line between giving people autonomy and not just lip service autonomy, but also really making sure that they’re safety side boards in place? I think that’s threading the needle almost at every age of life, but probably really comes to its height in adolescence and then for older Oregonians. As your new role as Chair of the Human Services Committee, what do you hope to tackle in the 2023 session? I’m really inspired by the people who do the work—both in the agency and among advocates—and the people who have lived experiences and are willing to share that with me. I want to really figure out where the pain points are in I’m really inspired by the people who do the work—both in the agency and among advocates—and the people who have lived experiences and are willing to share that with me.

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