OHCA The Oregon Caregiver Fall Winter 2023

A Publication of the Fall/Winter 2023 Oregon Health Care Association Government Relations Update | Q&A with Rep. Elmer | 2023 Annual Convention Highlights The Resilience and Impact of Women in Long Term Care Facilities

FALL/WINTER 2023 © 2023. 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 26 24 28 pg6 The Resilience and Impact of Women in Long Term Care Facilities In this article, we profile remarkable women leaders from several long term care organizations in Oregon and highlight their experiences, challenges, and opportunities. 04 LETTER FROM THE CEO 06 THE RESILIENCE AND IMPACT OF WOMEN IN LONG TERM CARE FACILITIES 12 QUALITY Elevating a Woman’s Role in Long Term Care 14 LEGAL & REGULATORY Living Longer Means Women Need to Plan Ahead to Promote Quality of Life and Care 15 PUBLIC POLICY Government Relations Between Legislative Sessions 16 DATA & RESEARCH Women’s Impact in Long Term Care Unveiled 17 SPONSORED CONTENT Interview with Denise Reddick, President of Brisk Coffee Roasters Interview with the Women Leaders of Lane Powell 22 PROFILES Amanda Gray (Regional Director, Sapphire Health Services) Donna Sherr (Resident, Oregon Veterans’ Home) Representive Lucetta Elmer (R-District 24) 28 2023 ANNUAL CONVENTION HIGHLIGHTS 30 2023 OHCA AWARD RECIPIENTS 32 UPCOMING EVENTS

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 4 Our focus in this issue of Oregon Caregiver is the remarkable contributions that women make to long term care. Some industries tend to attract one gender over another— a majority of construction workers are men for example—while the nursing and caregiving profession is predominately female. While no statistic tells the whole story, and so many men are excellent professional (and family) caregivers, the data shows that women are the key pillar of caregiving in long term care. Women constitute the vast majority of the caregiving workforce in Oregon, and they are frequently caring for other women as women frequently live longer than men. Women often serve as the nurturing backbone of the sector, providing both professional expertise and emotional support to residents and their families. Women leaders drive innovation, foster inclusive environments, and advocate for vulnerable populations. It’s crucial that we recognize and celebrate the indispensable role of women in long term care. In our feature article, we profile remarkable women leaders from several long term care organizations in Oregon and highlight their experiences, challenges, and opportunities. In our quality article, Nicolette Reilly underlines the tangible impact and benefits of hiring women leaders in long term care. OHCA general counsel Eugenia Liu reviews considerations for care and future planning that can be sometimes overlooked. Libby Batlan reviews what the legislative team has been working on since session ended this summer and previews the 2024 Oregon legislative short session and how it will impact the long term care sector. Walt Dawson unpacks the data behind the implications of women’s health and the importance of considering gender-specific needs in caregiving policies and programs as the aging population grows. Two OHCA business partners share their roles in providing quality services to long term care providers. Incite Strategic Partners, OHCA’s member purchasing partner, spotlights a female leader in the food and beverage industry, while Lane Powell highlights some of its women leaders and how they navigate the male-dominated legal system. In our policymaker profile, Representative Lucetta Elmer discusses her passions and legislative priorities. Hear from Donna Sherr, a resident from the Oregon Veterans’ Home in The Dalles, who shares her incredible life experiences and her advice for young women. Review highlights from the 2023 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 2023 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.  Empowering Women: A Pillar of Long Term 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 • Senior VP Quality Services Rosie Ward • Senior VP of Strategy BOARD OF DIRECTORS CHAIR Steve Fogg, Marquis Companies, Inc. IMMEDIATE PAST CHAIR Kathy LeVee, Generations, LLC VICE CHAIR Mark Remley, Aidan Health Services, Inc. TREASURER Andy Becker, Sapphire Health Services NON-PROPRIETARY REPRESENTATIVE JoAnn Vance, Providence Child Center MULTI-FACILITY REPRESENTATIVE Ryan Delamarter, Prestige Care, Inc. MULTI-FACILITY REPRESENTATIVE Rick Dillon, Avamere Health Services 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 Brenda Connelly, The Springs Living 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 Matt Hilty, Ohana Ventures OC EDITORS Rosie Ward • rward@ohca.com OC PUBLISHER LLM Publications • www.llmpubs.com Advertising Sales • Ronnie Jacko (503) 445-2234 • ronnie@llmpubs.com Design & Layout • Shelby Bigelow Phil Bentley President and CEO Oregon Health Care Association LETTER FROM THE CEO Stay connected with OHCA! Contact Rosie Ward, rward@ohca.com, to be added to our email lists.  Improving lives by advancing quality care in Oregon since 1950

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 6 FEATURE THE RESILIENCE AND IMPACT OF WOMEN IN LONG TERM CARE FACILITIES By Catherine Van, Oregon Health Care Association In an increasingly aging society, long term care settings have become crucial support systems for the senior population, providing them with the care, attention, and companionship they need in their golden years. Sara Silva is the president of Arete Living. Looking behind the scenes of these settings, it is clear that women play a pivotal role in ensuring the well-being of the residents. This article shares the stories, challenges, and triumphs of some of the women who dedicate their lives to working in long term care. For some people, working in long term care started as a part time job, for others, it’s a calling. Sara Silva’s first experience with the long term care sector was in high school when she was 17 years old. Her school had a program that let students go through a certified nursing assistant (CNA) program for high school credit. Once they turned 18, they could test to receive their CNA certificate. A preceptorship in nursing health in skilled nursing was part of the program. A career unbeknownst to Silva at the time became her lifelong passion, and she has never turned away from it. Over the course of 20 years working in the long term care sector, Silva has steadily climbed the professional ladder. Her journey began as a CNA, and from there, she assumed various roles, including caregiver, medical technician (med. tech.), resident care coordinator, business office manager, memory care administrator, executive director, regional director, and now, the president at Arete Living. She has taken on key leadership roles within the National Center of Assisted Living (NCAL), where she serves as the secretary/treasurer on the board of directors and chairs the NCAL Quality Committee. She also actively participates in numerous committees at both state and national levels, having previously served as the NCAL State Leader for Oregon and earned recognition as a 2015 AHCA/NCAL Future Leader. This year, she was selected as an honoree of the Jan Thayer Pioneer Award. This award recognizes individuals who have moved the senior care profession forward, positively affecting the lives of those served and those who serve. She was honored at the 2023 AHCA/NCAL Convention and Expo in Denver in October. Even through all her achievements, Silva says the biggest barrier throughout her journey was herself. “I joke that I’ve done every job that an introvert can do,” she said. “It never would have crossed my mind to even consider the administrative path or executive director path until I had somebody say ‘Hey, consider this job to grow into,’ and that’s that. My motivation was

www.ohca.com FALL/WINTER 2023 The Oregon Caregiver 7 FEATURE CONTINUES » someone who took the time to stop me and say, ‘would you consider this?’ or ‘I think that you’re capable.’ Without somebody taking the time to do that, I can’t tell you that I would still be in this profession.” As president of Arete Living, Silva oversees operations and manages 26 senior living properties in six states. Her day-to-day consists of a variety of working with the home office team members to support the communities, working on strategic planning, and future planning. “My leadership style is whatever the team or the team member that I’m working with needs from me. The team that I’ve worked with in the past would probably say consistently that I am very transparent. I believe in prompt communication, and I think that any conflict or problem can be resolved by sitting down and having a face-to-face conversation,” said Silva. “At the end of the day, the best teams believe that the other person is doing the best they can at any given time.” Silva says she has been fortunate enough to work with mentors and leaders who are women for a majority of her career. In the times that this hasn’t been true, she describes the primary difference as the acceptance of processing emotion. “We all have a lot to offer. It comes back to whether people are willing to take that time and put that investment in,” she said. “We are passionate individuals. We are here to serve a purpose. We are here to serve a resident. We feel very deeply, and that’s okay and that’s actually a strength.” Silva’s goal is to get more women in leadership roles. “I do think leaders should always reflect who they lead and who they represent. The more female leaders that you see in the industry, then the more those caregivers and CNAs and LPNs and RNs can see themselves in those roles and understand the path for advancement for themselves,” she said. “Our goal essentially as a leader, should be for our people to outgrow us. When that happens, we’ve done our job and now we become the cheerleader for that person. If you measure your success as a leader in the advancement of your team, even if that means that your team members reach a point that they then leave you, that means you succeeded. It’s not something that should ever be a frustration.” As a self-declared introvert, Silva says she found her confidence from surrounding herself with a team that had a great deal of trust and respect for one another. For young women especially who want to be leaders in long term care, Silva’s advice is to invest in themselves and take the time to learn about leadership. That tenacity may be the one step that will differentiate someone from others. “The game changer in your life as a female leader, as a leader in general, are your mentors, your cheerleaders, and the people who’ve helped you along the way. If you don’t have those people, it’s okay to ask someone to be that person. It’s okay to go to somebody that you admire and tell them that you admire them and ask for advice,” said Silva. It’s the cheerleaders in Tara Pray’s life that have led her down an unconventional path to long term care. Fresh out of college with a degree in nutrition and dietetics, pray joined the Oregon Veterans’ Home in The Dalles as a dietician aide, not yet certified as a registered dietitian. It was her first job, and she quickly embraced the opportunity. Pray’s passion for helping others and the supportive environment of her workplace encouraged her to pursue her certification. Over the years, pray evolved within the organization, moving from the kitchen to the clinical team. Thanks to the encouragement of her mentor, Cheryl Maitland, she was able to see her potential. Now, 16 years later, Pray is the current administrator for the same place she started her career. “I’m never afraid to make a mistake; it’s very growth-oriented. I’ve never been afraid of making a decision and not feeling supported in it and I’ve never been afraid of saying, ‘hey, I messed up on this,’” said Pray. “It speaks to the culture that we have here and that I love so much. There’s so much opportunity for career advancement that we’ve seen almost all of our senior leadership grow in-house.” In a facility run by women, serving mostly men, there is an interesting dynamic. Still, the Oregon Veterans’ Home in The Dalles has become a second home to Pray. Unlike clinic-based or short term healthcare environments, long term care allows staff to form deep connections with residents and their families. Pray believes this connection is what sets the industry apart, making it a fulfilling and distinct aspect of healthcare. “We’re a family. If you’re having a hard day, you go talk to a resident and it just “I do think leaders should always reflect who they lead and who they represent. The more female leaders that you see in the industry, then the more those caregivers and CNAs and LPNs and RNs can see themselves in those roles and understand the path for advancement for themselves.” – Sara Silva, President, Arete Living

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 8 FEATURE » FEATURE, CONT. reminds you of why you do what you do. I get to spend a lot of time with our floor staff too, which is another opportunity to make connections. In a small town, there’s so much intertwining of our staff and different personal connections,” said Pray. “Honestly, in some ways, I feel that I have the easiest job in the building because I have so many wonderful team members that I just get to support and love them through their jobs and that makes my job very easy.” Pray’s self-sufficient staff is a testament to her leadership. She was selected as this year’s OHCA Administrator of the Year in a skilled nursing setting. One striking aspect of Pray’s leadership style is her confidence and ability to support her team effectively. She acknowledges the importance of building a strong team, emphasizing strengths, and creating an atmosphere where team members can thrive. “On a day-to-day basis, I’m trying to do a good job just doing the best that I can, but I honestly, for other people to think that I am doing a great job, it’s very humbling and I feel very honored,” she said. “I put a lot of work into getting the right people in the right positions and looking at strengths and playing on those strengths.” The COVID-19 pandemic opened Pray’s eyes to the flexibility of her team. Job descriptions and duties had to morph and staff members had to absorb different positions to keep the facility afloat, which helped Pray identify different strengths in her staff. “I’ve identified people within our organization who were CNAs and I thought, ‘Oh, there’s some potential,’ just like my mentor did to me. I said, ‘we’re going to grow you, and now you’re my business office director,’ or ‘you may be a laundry aid now, but now you’re a recruitment and an onboarding specialist because you have a way with people and you’re so welcoming.’ I like picking and pulling these people that come into the organization and putting them in the right spot,” she said. Tara Pray, administrator at the Oregon Veterans’ Home, with her family. “I tell my female staff, ‘You can do it all. Don’t be intimidated by feeling like you have to make the sacrifices that previous generations have had in order to have a thriving career. You can have both and you don’t have to miss out on either,’” said Pray. “There was a time where I thought I wanted to have another baby, but I was also getting ready to receive this promotion. I didn’t know which to pick, but my mentor said, ‘we’re going to pick both.’ I had the baby, and I took the promotion, and we made it work.” – Tara Pray, Administrator, Oregon Veterans’ Home

www.ohca.com FALL/WINTER 2023 The Oregon Caregiver 9 FEATURE Tara Pray stands with her team at the Oregon Veterans’ Home. Tara Pray is the administrator at the Oregon Veterans’ Home in The Dalles and is OHCA 2023 Administrator of the Year in skilled nursing. Pray’s approach is characterized by her lack of ego and a focus on hiring people she says are smarter than herself. She says she believes that the diversity of skills and knowledge within her team enhances the overall success of the organization. Like Silva, Pray hopes for more female leaders in long term care and believes that this trend is gradually shifting, with more women taking on leadership roles. However, she acknowledges that women still face unique challenges in balancing their careers with family life. She is determined to create an environment where women can excel in leadership without sacrificing their personal lives. “I tell my female staff, ‘You can do it all. Don’t be intimidated by feeling like you have to make the sacrifices that previous generations have had in order to have a thriving career. You can have both and you don’t have to miss out on either,’” said Pray. “There was a time where I thought I wanted to have another baby, but I was also getting ready to receive this promotion. I didn’t know which to pick, but my mentor said, ‘we’re going to pick both.’ I had the baby, and I took the promotion, and we made it work.” Like Pray, Brenda Connelly’s path to leadership was shaped by her experiences and determination. Connelly also started her career in long term care as a teenager. She had been exposed to healthcare from a very early age. Her family consisted of nurses, including her mom, aunts, and many extended relatives. By the second grade, Connelly was pushing wheelchairs in the local nursing home while her mom worked, and she got very comfortable being around older adults, viewing them as her extended grandparents. With aspirations to follow in her mother’s footsteps and pursue a career in nursing, it was only natural for her to begin working at a nursing home at the age of 16. Initially, she started as a water girl, distributing refreshments and snacks, but her dedication and commitment led to a promotion to CNA, the first steppingstone in her career. She continued her education and became a charge nurse at a large nursing facility in Fargo, North Dakota. By the time she was 23 years old, she earned positions in infection control and quality and then as director of nursing. “I’ve always been able to reflect on my prior position or other positions that CONTINUES » preceded that, to really understand what it means to walk a mile in that person’s shoes and how important their role is, and how we truly can’t achieve success in terms of quality of services and care if we don’t listen to those most important people on the front lines,” said Connelly. “There is no one department that’s more important than another.” After spending 12 years working in a skilled nursing setting, she began working on the community-based care side as an executive director with The Springs Living in Whitefish, Montana. As she continued her journey, she became increasingly fascinated by the collaborative and essential aspects of achieving high quality in community performance and service outcomes. She wanted to understand how different departments worked together for the betterment of residents. This curiosity led her to delve deeper into the operational side of healthcare, exploring the

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 10 FEATURE » FEATURE, CONT. intricacies of every department and their contribution to the cycle. After about a year and a half, Connelly faced a pivotal moment in her career. The regional nurse had retired, and she was asked if she would be interested in taking on a broader role. This opportunity marked her first step into overseeing multi- campus health services, a significant milestone that set the stage for her future leadership roles. Following that position, Connelly served for six years in operations positions supporting communities and was then the chief quality officer. “I never forgot where success lies, which is enhancing the relationship between the residents and our frontline staff and assuring that we’re doing whatever we can to support the incredible people who work day in and day out to make our residents’ days better,” she said. In 2020, Connelly assumed the role of chief operating officer of The Springs Living during the COVID-19 pandemic. These turbulent times only reinforced the significance of having leaders deeply connected to their organization’s values and mission. Her commitment to providing resources, support, and innovation to the frontline teams became evident during this critical period. Two years later, Connelly became president of the company, overseeing 20 retirement communities across Oregon, Montana, and Washington. Connelly says she is fortunate that The Springs Living invests in future leaders within the company. Without its support, she said she never saw herself advancing to this leadership role. “There was nothing within me that said, ‘I’m going to be president someday; that’s what I aspire to be,’” she said. “However, there have been moments in my career where I looked at opportunities before me and said, ‘You know what? I bet I can add something here.’ When you get into a role, surround yourself with talented, passionate people, do your very best to help move the mission forward and generally good things will come.” Connelly attributes much of her success to the mentorship and guidance she received along her journey. She encourages aspiring leaders, particularly women, not to hesitate in expressing their aspirations. Speaking up and seeking guidance from supervisors, mentors, or trusted colleagues can be instrumental in advancing one’s career. Connelly emphasizes the importance of confidence, empathy, and a willingness to learn from both successes and failures. “Be willing to work harder than anyone else around you. Nothing is going to just be handed to you. Be a lifelong learner, no matter what position you’re in, always show great kindness and empathy, and support your colleagues,” she said. “There’s this saying, that we need to fix each other’s crowns and not knock them off. Success doesn’t need to be a competition. There is more than enough need for future leaders for our profession. The only reason I am here is because I had other people who helped me along the way.” Connelly was honored as one of McKnight’s 2022 Women of Distinction, and currently serves on OHCA’s board of directors. Her path to leadership hasn’t always been easy. She describes often being one of very few women at executive meetings early in her career and learning to build up her confidence over the years to speak up and contribute. She admits to making a lot of mistakes along the way but says showing up authentically will always be better than being perfect. “I think, naturally, women have more of a tendency to step back when we should lean in. I had great mentors along the way that helped me who are also female leaders. Remind yourself that you were invited to the table for a reason, therefore you were invited to contribute, and you must contribute. Every single boardroom, every single meeting needs diversity: diversity of thought, diversity of personality style, gender, cultural background, you name it,” she said. “If you’re nervous, remind yourself that you are representing something bigger than yourself. They need your perspective. Be genuine, listen intently, show both grace and grit, and you will shine.” Connelly made it her duty to show women the pathway to leadership exists. Being a role model is something she takes seriously, recognizing that she is always on stage and that people are watching. However, she doesn’t let that overshadow her day-to-day work. “No one around us expects us to be perfect or have all the answers; that was a lesson that I probably learned too late, where I was really striving for perfection “I think, naturally, women have more of a tendency to step back when we should lean in. I had great mentors along the way that helped me who are also female leaders. Remind yourself that you were invited to the table for a reason, therefore you were invited to contribute, and you must contribute.” – Brenda Connelly, President, The Springs Living

www.ohca.com FALL/WINTER 2023 The Oregon Caregiver 11 FEATURE Brenda Connelly is the president of The Springs Living. CONTINUES » and getting really hard on myself when I wasn’t achieving it,” she said. “It’s okay if what you say isn’t right on point, or it’s okay if this idea that you bring up isn’t one that the team gravitates toward. Keep bringing up ideas, keep showing that you are invested in the conversation and good things will come.” Connelly encourages staff, especially female staff, to bring up a position in which they aspire to be. She recommends finding a trusted supervisor and surfacing those aspirations because most of the time, people don’t know if someone is interested. It is also important not to get discouraged if an opportunity doesn’t work out the first time. Ask for feedback on what further experience or growth you might need, work hard at it, and try again. “At this stage in my career, one of my goals is to focus on mentoring others toward leadership roles. At times, this means recognizing potential that the individual themselves may not see. There is something so special about watching young leaders develop and grow in their careers right before my eyes. Sometimes we all need a cheerleader and mentor standing next to us in support with getting to that next stage because we can easily get in our own way,” said Connelly. Connelly makes it a point to be her staff’s cheerleader, being approachable and getting to know all the employees at a building when she visits. She always tells them how important they are and that their work is appreciated. The journeys of Silva, Pray, and Connelly in long term care shed light on some of the many remarkable contributions of women in the long term care sector. Their dedication, confidence, and commitment to empowering their teams and future generations of leaders are truly inspiring. 

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 12 Elevating a Woman’s Role in Long Term Care By Nicolette Reilly, Oregon Health Care Association Successful organizations are focused on recruiting and building strong leaders to create a culture that is aligned with the company’s mission and values. As organizations look to build their leadership teams, the most progressive organizations have gained ground by recognizing the benefits of increasing the representation of women and diversity in senior level positions. Research shows that there are a variety of reasons for this, but one is simply that female leaders tend to be (though of course, not always) better communicators. For a business to thrive, an environment of open, accountable communication and execution is vital. Women, due to their life experiences, typically have more emotional self-awareness, empathy, conflict management, flexibility, and teamwork—all essential skills to being a good leader. Women are more likely to connect with their employees on a personal level and can create a unified, caring team. In a culture where the workforce wants to be heard and understood, women tend to have a stronger ability to listen, empathize, and resolve conflict while talking through the issues and taking a team approach to resolutions. With considering diversity in the workplace, women historically are more collaborative and inclusive in their leadership styles. This is beneficial for the team because it encourages a diverse group of people to work together and share their ideas. Women’s presence on management teams is generally associated with a more participatory leadership style. According to the American Psychological Association, generally, leadership groups with more women exhibited greater equality in conversational turn-taking, further enabling the group members to be responsive to one another and to make the best use of the knowledge and skills of members. For an organization to succeed, diverse perspectives should be brought into every level. Pew Research Center states that women who hold power in leadership positions are also more likely to be aware of gender equality issues and, therefore, will be more willing to offer opportunities for women, as well as for those who have various intersecting identities, such as Black women, women with disabilities, and LGBTQIA2S+ women, who collaborate with them. In recent years, researchers have found that organizations with a higher percentage of women at the top tend to be better at attracting and retaining female talent. “People, especially younger people, are more likely to be attracted by organizations that have a higher percentage of females at the top,” said a study published in the Journal of Business Ethics. “This is because people have positive associations with female leaders.” The study also found that these organizations perceive higher levels of organizational culture commitment and work satisfaction among their employees. Another reason for higher work satisfaction is that women typically focus more on providing mentorship, support, and encouragement to those who are just starting out in their careers. The Journal of Business Ethics states that women who work for organizations with a higher percentage of women at the top are also more likely to be satisfied with their jobs and feel less stressed about balancing work and family life. Ria Jordan, Human Capital Strategist, states that an analysis of women’s impact in organizations shows that their influence leads to greater motivation and better results. This commitment also demonstrates a positive impact on the company culture and increased employee satisfaction. For long term care leaders interested in building and retaining staff at all levels, the research shows that it is critical to hire and support women in leadership positions.  Nicolette Reilly is the SVP of Quality at OHCA. Sources: • Colwill, J. and Townsend, J. (1999), “Women, leadership and information technology : The impact of women leaders in organizations and their role in integrating information technology with corporate strategy”, Journal of Management Development, Vol. 18 No. 3, pp. 207-216 • Jordan, R (2022), “The Impact of Female Leadership”, Human Capital Strategist • Novotney, A (2023), “Psychological research shows Women Leaders improve businesses”, American Psychological Association • “Women and Leadership,” Pew Research, https://www. pewresearch.org/social-trends/2015/01/14/women-andleadership/ QUALITY

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The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 14 LEGAL & REGULATORY Living Longer Means Women Need to Plan Ahead to Promote Quality of Life and Care By Eugenia Liu, J.D., Oregon Health Care Association It is no secret that women have been proven to live longer than men. The Centers for Disease Control and Prevention (CDC) reported that in 2021, the life expectancy for women was 79.1 years while the life expectancy for men was 73.2 years. Furthermore, the gap in life expectancy between men and women grew in 2021 to 5.9 years. When these numbers are viewed through the lens of senior living, this means that more than 70% of the resident population in assisted living and more than 60% of long-stay residents in nursing facilities are female. Yet, women still face barriers to aging, including lower wages or reliance on marriage for retirement or Social Security benefits, that lead to less financial security. For women, wellstructured end of life plans can help empower them to live their best lives as they age by giving them control over decisions around where they want to live, how they want to live, what type of care they want, and who makes decisions for them when they can no longer do so themselves. Health Care Decisions Living longer can certainly have its benefits, but it can also bring about tough questions and answers regarding the type of care, treatment, and services that an individual wants as they age. If an individual outlives their spouse, domestic partner, or significant other, then who makes and honors those decisions when that individual reaches a point where they no longer have the capacity to make those decisions for themselves? Providers often default to family members, but family members may not be the best choice if they have been estranged or hold different values and belief systems. What if there are five children but none of them can agree on a decision that honors that individual’s choice? Perhaps a best friend who has known the individual for years with a deeper understanding of the individual’s values, preferences, and choices would be better suited to step into that individual’s shoes. Planning for health care decisions may include the following: • Advance Directive for Health Care: An advance directive is a legal document that appoints a healthcare representative for an individual and provides instructions on the individual’s treatment goals and care preferences. Choosing a healthcare representative is a critical step to ensuring an individual’s wishes are honored because that representative is obligated to follow the preferences, wishes, and choices of the individual when making decisions on behalf of individual. It is important for an individual to share information about their life, values, wishes, and choices, including care setting preference, such as home, hospice, assisted living/ residential care, or a nursing facility, to help the healthcare representative make the right decisions. • Portable Order for Life-Sustaining Treatment (POLST): Unlike an advance directive, which is a legal document, a POLST is a medical order that outlines an individual’s wishes for treatment near the end of life. A POLST is used when an individual has a serious progressive or advanced disease near the end of their life, and it is completely voluntary. • Death with Dignity: Oregon allows terminally ill individuals to end their lives through the voluntary request for and self-administration of a lethal dose of medication. It is important to note that long term care settings are not required to participate in the death with dignity process and individuals may want to ask facilities about their death with dignity policies. Management of Financial Assets It is equally important to plan for the management of assets while one has the capacity to do so. Designating a trusted individual to make financial decisions can help mitigate the risk of financial abuse, which is typically perpetrated by someone close to the individual including friends, partners, and relatives. Financial power of attorney documents, wills, and trusts are all tools that can help individuals direct how assets should be used and/or distributed, including requests related to payments for care. Funeral and Post-Death Considerations End-of-life planning does not stop at managing health care decisions and assets up until death; there are also post-death considerations. Some wish to donate organs (or even whole bodies), some wish to be cremated, and yet others wish for a green compostable burial. While there are default rules in Oregon around who can make such decisions, such as a spouse, adult child, or parents, those default rules may not reflect an individual’s wishes, preferences, and choices. If an individual has specific wishes about the disposition of their remains, it is important to outline those wishes to make sure they are followed. End-of-life discussions and planning can be difficult and challenging, but a good life plan can promote smooth transitions between care settings and ensure an individual lives their best life on their terms.  Eugenia Liu is the SVP and General Counsel at OHCA.

www.ohca.com FALL/WINTER 2023 The Oregon Caregiver 15 PUBLIC POLICY Government Relations Between Legislative Sessions By Libby Batlan, Oregon Health Care Association The 2023 legislative session adjourned at the end of June after a more than 40-day walkout by Senate Republicans over controversial policy issues related to firearms, abortion, and gender-affirming health care. The OHCA government relations team navigated the political tumult and successfully shepherded major policy and budget improvements for our members through the legislative process. Our successes included the passage of House Bill (HB) 2665, which among other things, requires the Oregon Health Authority (OHA) to establish, on an annual basis, how much temporary staffing agencies can charge long term care facilities and hospitals. The first year a rate cap will go into effect is 2025 and OHCA will be working with OHA and other stakeholders over the next year to ensure HB 2665’s successful implementation. In the meantime, temporary staffing agencies must now be licensed to operate in the state of Oregon—the result of OHCA’s advocacy in a previous legislative session. Licensure status is publicly available via OHA’s Health Licensing Office website, and we hope it will be a useful tool for providers looking to assess which agencies to partner with moving forward. The Legislature also prioritized stability for Medicaid reimbursement rates for skilled nursing and community-based care facilities by approving cost-of- living-adjustments (COLAs) that ensured providers will not experience rate reductions. Since the close of session, OHCA’s focus has been on the implementation of legislation that has a direct impact on long term care providers. One such piece of legislation is HB 3396, which established the Joint Task Force on Hospital Discharge Challenges. The task force, which includes representation from OHCA and long term care providers, is responsible for developing recommendations to address the challenges faced by hospitals in discharging patients to appropriate post-acute care settings, including reducing barriers to work for nurses and nursing assistants in postacute care settings. The task force will meet three times before the end of the year and can make recommendations for legislation in the 2024 and 2025 sessions. Possible policy solutions supported by the long term care sector include streamlining the Medicaid eligibility process for Oregonians, reducing delays in background checks for workers, and improving access to guardianships for patients and residents. Oregon’s next legislative session will begin in February 2024. This will be a short session, only lasting 35 days, and lawmakers will be limited in the number of bills they can introduce. Short sessions, which occur during even- numbered years, were originally created for the Legislature to tackle smaller, technical public policy, or make necessary budget adjustments mid-biennium. Despite the original intent, policymakers tend to bring forward substantive and complex policy issues. In 2024, it is likely a central focus of session will be on addressing the drug addiction crisis in Oregon and the implementation of the Drug Decriminalization and Addiction Treatment Act (Ballot Measure 110). While OHCA’s agenda is still being developed, we anticipate pursuing legislation that reduces delays in background checks to get caregivers to work faster and makes statutory clarifications related to Acuity-Based Staffing Tools in community-based care facilities to support providers and reduce unnecessary administrative burdens. Look for a more detailed overview of OHCA’s 2024 legislative priorities in the next Oregon Caregiver magazine.  Libby Batlan is the SVP of Government Relations at OHCA. Temporary staffing agencies must now be licensed to operate in the state of Oregon—the result of OHCA’s advocacy in a previous legislative session. Licensure status is publicly available via OHA’s Health Licensing Office website, and we hope it will be a useful tool for providers looking to assess which agencies to partner with moving forward.

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 16 DATA & RESEARCH In most countries of the world, women provide most of the care and support for older adults. A similar dynamic exists in Oregon. Additionally, the majority of older adults who receive any care or support, be that within licensed long term care facilities or within the community, are also women. This common intersection of women as both care partner and care recipient create a unique and uncommon workplace dynamic. Diving into the data underlying this dynamic is essential for understanding the best way to support both groups. According to Portland State University’s Institute on Aging, an estimated 68% of all Oregon residential care and assisted living residents are female, while an estimated 72% of Oregon’s memory care residents are female. An estimated 56% of Oregonians who receive care in skilled nursing facilities (SNF) are also female, although the proportion increases with age as 67% of Oregonians accessing SNF care who are 85 years of age and older are female. Care utilization in the community outside of licensed long term care facilities follows a similar pattern as an estimated 60% of all care recipients are female. These differences in care utilization between men and women across care settings highlights the importance of women’s health and wellbeing, in particular women’s brain health. In recent years, brain health and the risk factors for cognitive impairment are increasingly recognized as important factors for the health and wellbeing of women. The Women’s Brain Health Project is a great example of a global collaboration that is leading research on sex and gender in relation to brain health. It is important to note that men as care partners—both paid and unpaid—also provide substantial care and support. Indeed, as highlighted by the AARP Public Policy Institute, 40% of all care partners for an aging spouse, parent, or neighbor are men. This may point to evolving cultural trends and workforce practices just as the population is rapidly aging in the United States. The U.S. Census Bureau estimates that for the first time in history, adults 65 Women’s Impact in Long Term Care Unveiled By Walt Dawson, D.Phil years of age and older will outnumber children as soon as 2034. The aging of our society has many implications for planning for care and support. In most countries, the average life expectancy is longer for women than men. According to the U.S. Centers for Disease Control & Prevention (CDC), the overall U.S. life expectancy at birth is 76 years, while the average woman’s life expectancy is 79 years, and it is 74 years in men—a five-year difference. This is a decline from a 2019 high of 81 and 76 years, respectively, as the average life expectancy in all states fell during the COVID19 pandemic. Oregon maintains a higher-than-average life expectancy than the U.S. as a whole (ranking eighth highest average state in the U.S.), with the life expectancy of men and women following a similar pattern to that of the country overall with an average of 81 years for women and 76 years for men. According to data from Paraprofessional Health Institute (PHI), 81% of Oregon’s paid care partners are women. With any effort that is focused on the improving the supports of care partners—including those provided by families, friends, or neighbors—the specific impacts and needs of women must be central to the design and approach. In Oregon, the CDC estimates that 54% of all care partners for older adults including those who are paid as well as unpaid are women. Shifting cultural dynamics, along with the aging of our society, pose a number of important considerations for employers and policymakers alike. All policies and programs that are implemented in Oregon must be designed in a way to ensure they meaningfully support care partners.  Walt Dawson is OHCA’s research consultant as well as an assistant professor at Oregon Health & Science University and a senior Atlantic fellow with the Global Brain Health Institute.

www.ohca.com FALL/WINTER 2023 The Oregon Caregiver 17 There’s an interesting parallel happening in the food and beverage space. As these two industries work side by side to improve the lives of residents, both are seeing more female leaders emerging in their respective spaces. I spoke with Denise Reddick at Brisk Coffee Roasters to learn more about the ways that being a woman in a leadership role complements business relationships and allows for greater success. “I come from a time where multiple family generations lived under one roof. I saw my grandmothers take care of their parents; I saw my mother take care of her SPONSORED CONTENT Interview with Denise Reddick, President of Brisk Coffee Roasters By Jen Bruning, MS, RDN, LDN, Incite Strategic Partners CONTINUES » parents and now I’m taking care of my parents. Senior care is something that my generation has seen. That is one way that I connect with operators in senior living and female executives who have climbed the ranks,” said Reddick. Brisk is a national coffee roaster that has put particular emphasis on serving the senior living segment. As one of the only female presidents of a national coffee roasting chain, I wondered about the parallels between women in leadership across complementary business segments. I asked Reddick why Brisk has chosen to focus on senior living. Denise Reddick, is the president of Brisk Coffee Roasters.

The Oregon Caregiver FALL/WINTER 2023 www.ohca.com 18 » SPONSORED CONTENT, CONT. “About 15 years ago, our parents and our grandparents started entering senior living. As we are visiting our relatives in these communities, we are starting to understand just how critically important coffee is to residents. It’s the first thing they drink in the morning. It’s the first thing they think of, and coffee is a very emotional beverage,” she said. Reflecting on what they were seeing, Brisk made a point to focus on the needs and wants of not only the residents, but the culinary teams that serve them. “We have developed products and programs that are geared toward enhancing the coffee drinking experience for the resident and making the job easier for the operator to execute the program,” said Reddick. “Our business model gets coffee to our clients’ factory direct one or two days outside of the roasting process. We can typically offer better pricing and we offer fresher coffee because it’s not sitting on the shelf. It gets straight to the to the building and so there aren’t substitutions; there aren’t back orders, and we can provide 100% compliance for the healthcare organization.” I asked Reddick whether she feels she has a unique perspective as a woman, serving an industry with so many female leaders and employees. “I started from the bottom, and I worked my way up. I’ve swept floors and I’ve run packing machines. Because of that, I lead with empathy, and I think I gain a little more respect with my colleagues because they know I’ve done the work. I believe the same thing with emerging leaders and senior living. Most of them have been operators; they’re great leaders because they lead with resident care in mind and not just other business marks like finance and marketing. Emerging female leaders are really going to take senior living and senior care to a new level,” Reddick said. Research supports this claim: companies with a better gender mix at corporate leadership levels see gains above and beyond their less-gender-diverse competitors. More women on company boards means fewer financial reporting errors, better transparency, and more contributions to charitable funds. As Reddick verified, women tend to more effectively lead with empathy, striking a balance between ensuring staff feel supported, and seeing results. Leading with empathy is a key component of reducing turnover and burnout, which are two culture-killers in senior living. Not only might more empathy, as modeled by women in leadership, reduce turnover, but it may keep residents safer. High turnover among nursing staff has been shown to increase errors with patient care and treatment. Senior living would grind to a halt without the efforts of women in this workforce, as about 80% of all senior living employees are women. As Reddick points out, many people who choose to work in this sector do so for more than just a paycheck. The sense of purpose that can be found through employment working with residents is not only fulfilling but motivating. For women who wish to explore career advancement, Reddick has a piece of advice. “Be the best one in the room; you have to know what you’re talking about,” she said. “Study everything that you can about the industry that you’re in and the industries that you serve so, when you walk into that room, you know more than anybody else. Knowledge is power, and knowledge gains respect and confidence.”  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. SPONSORED CONTENT

www.ohca.com FALL/WINTER 2023 The Oregon Caregiver 19 Interview with the Women Leaders of Lane Powell Gabi Sanchez, Shareholder and Co-Chair of the Senior Living and Long Term Care Group In addition to co-chairing Lane Powell’s Senior Living and Long Term Care Group, Gabi Sanchez is also on the firm’s board of directors as well as the board of directors for the Oregon Health Care Association. Her favorite role at the firm is practicing law where she assists senior living and long term care providers with all manner of regulatory, compliance, risk management, licensing, and other legal issues. She also serves as outside general counsel for many clients. What do you know now that you wish you knew early on in your career? I wish I had been a better advocate for myself, had more confidence in my abilities and known it was okay to say ‘no’ and to wear better shoes! How can women navigate power structures at work and build confidence over the years? We just have to do it even if it is uncomfortable. Find allies and mentors who will help you work through those systems. Don’t be afraid to ask for what you want. Surround yourself with people who will not only be your advocates but will also help you grow and help you improve even when it’s not easy. Who is your role model and why? I have two role models; the first is my parents. Both my mom and dad immigrated to this country and worked so hard and faced so many prejudices to give my sister and I a better life. I will forever be indebted to my parents. The second is Barb Duffy, the president of our firm. She’s one of the most amazing and selfless leaders I have ever met. She’s definitely a servant leader; she doesn’t shy away from problems, is an incredible advocate, and is tireless. I really admire her. What’s the best advice you’ve ever received? Advocate hard for others but also be an advocate for yourself. Don’t be afraid to take chances even if you’re afraid, and make sure you can stand on your own two feet. Don’t rely on someone else to take care of you. Lane Powell PC is one of Pacific Northwest’s oldest and longest running law firms. The Portland chapter has been a longtime OHCA business partner member and strong supporter. In this interview, three women from the Portland chapter share their backgrounds, leadership styles, and their journeys that propelled them to their current positions of influence. Carin Marney Gabi Sanchez Noelle Cooper CONTINUES » SPONSORED CONTENT