“I remember there was a woman. Elderly, blind woman sitting in a wheelchair tied down with what they call a Posey or vest. And she said to me, ‘What did I do wrong that I am punished this way?’ And it was the first time somebody actually talked to me about their feelings. I’ll never forget her.” – Vera Mayer, former DC Long Term Care Coordinator and Founder
Vera Mayer is just over 5 foot 3. She is 84 years of age. And, for more than five decades, she has been one of the District’s fiercest advocates for older adults and people with disabilities as a lawyer, mediator, ombudsman, and eventually founder of the DC Long Term Care Coalition (LTC Coalition).
To understand the LTC Coalition and its 20-year history, mission, and goals is to understand Vera’s journey in the District – the people she met; the connections she made; and the unheard voices that kept her on track.
“To begin with the beginning…”
A lawyer by profession — Vera earned her degree from the George Washington University Law School in 1966 — her journey as a senior advocate began in 1956, when Vera served as a staff member on the Senate Subcommittee on Anti-Trust and Monopoly. From there, she worked with public interest groups on the minimum wage, migrant farm labor, and Medicare.
Though on paper these positions seem like distant stops on her career path, in fact, they represented a deep passion for government, legal structure, and economics. “I wasn’t interested in health issues,” Vera says. “I was interested in economic issues because I grew up in the depression era in New York, and I remember seeing the tents of the homeless people on the lawn of the Hudson River.”
It was this passion for legal structure and economic equality that furthered Vera’s career, eventually leading her to serve as Executive Director for the Physicians Committee for Health Care through Social Security (1962-1964), Mediator for the DC Superior Court Citizens Complaint Center (1981-1984), and – a pivotal moment in LTC’s history — Northwest DC Long Term Care Ombudsman (1987-1995), a federal program offered through Iona Senior Services, one of the District’s senior service agencies and a respected direct-service provider in the community.
As an ombudsman in nursing homes and other residential settings, Vera worked and collaborated with residents, families, and facility administrators to resolve disputes. In the process, however, she also became more aware of the many people living in nursing homes who did not have to be there. “It was observation really,” Vera says. “The people I interviewed, they were saying, ‘Oh, I don’t want to live here. I don’t have to live here. I can live in my home.’”
Though, at the time, Vera had limited experience and know-how when it came to the structure of long term care, hospitals, or Medicaid – she now jokes, “What did I know? I was a lawyer” — she did know something needed to change.
The solution? DC Long Term Care Coalition.
“Instead of saying cheese, we said, ‘Medicaid Waiver’”
Motivated by her observations and the individuals she met, in 1995, Vera turned to Elizabeth Fox, who was at the time Iona Senior Services’ Executive Director. “Vera reported in our regular staff meetings on what was going on,” says Elizabeth. “She reported to me where she was having success and where she needed support.” Expanding the ombudsman program became a clear priority.
“In the course of what Vera experienced, she felt that while the ombudsman program was important, it was limited,” Elizabeth continues. “Some stronger efforts were needed to actually improve the operations of nursing homes so that they did respond to resident and family complaints and needs. We discussed a Coalition quite a lot, and I was certainly in favor of it. I committed to helping to raise funds to establish a separate program that would have its own staff.”
With Iona’s support, Vera began reaching out to other like-minded people, government members, organizations, and nursing home administrators to see if they had an interest in advocating for people to return to their homes, as opposed to transfer from hospitals to nursing homes or other residential facilities. Forming the group proved an easy task. “People already respected the work of Iona and Vera,” says Elizabeth. “The issues were dire. Vera was clearly effective. And Iona was behind it.”
Another vital resource in the beginning was the Iona Citizen’s Advisory Council (CAC). “It was the eyes and ears on the outside of Iona,” says Elizabeth. “The Citizen’s Advisory Council had become aware on their own that these long-term care issues really needed attention. Several of the members worked closely with Vera during that formation stage.”
In fact, the then chair of the CAC, Norene Martin, even agreed to chair the newly formed DC Coalition on Long Term Care. Charles Miller, Sue Whitman, and Mary Gardner Jones, all members of the CAC, also played vital roles in the work of the Coalition.
The Medicaid Waiver
And so, with more than ten organizations, individuals, and Iona staff members in tow, the newly-founded Coalition swiftly began to tackle its first project: To put together a Medicaid program for low-income older adults and people with disabilities that would enable them to stay in their homes. The services provided included medical and nursing care, personal care, and home adaptations. The District had a large population of retired government workers with chronic care needs and incomes higher than the usual low Medicaid level. However, their incomes were insufficient to cover care in the community, causing them to go to nursing homes.
Working closely with staff from the then Southeast Community Hospital, a real pioneer in long term care, according to Vera, members of the Coalition developed the Medicaid Waiver Program, which ultimately provided more services in the home to older adults 65 and older, and adults with disabilities. “It was really revolutionary for the city because we had no program of the sort to begin with,” says Vera. “So, that was our first big project. And it was a very big project. And it took us years to accomplish.”
Wages, Health Benefits, and Other Issues
Working on the Medicaid Waiver, of course, revealed many other obstacles, particularly wages and benefits for those working in long term care. Says Vera, “We had the Medicaid Waiver, but we didn’t have applicants to do this work because the wages were too low.”
So, the Living Wage Law became the next LTC Coalition priority. Over the course of many years, the Coalition successfully advocated for an increase in Medicaid wages through the DC Council’s Committee on Health Care. Together with other DC organizations, the Coalition worked to enact the Living Wage Law, which helped resolve the wage issue for some employees who worked for companies that contracted with the DC government. Still, it took many years before the wage program was administered.
In addition to developing regulations for home care, the LTC Coalition has also been a strong advocate for those in residential care, even helping the District to develop its own Assisted Living Regulations, which was a unique process. Typically, legislation is written, passed by the Council, signed by the Mayor, and then referred to a DC government agency to develop regulations. In this case, however, the Coalition went to Linda Cropp, then chairperson of the DC Council, and offered help. “We went to Linda and said we would like to work with you on assisted living,” says Vera. “And she said, ‘Fine. You develop the regulations, and I’ll get them passed.’”
That’s exactly what the Coalition did.
Joined by experts in assisted living laws and regulations, for countless months, LTC Coalition members convened at lunch, snacking on cheese and French bread — and Vera’s homemade lentil soup — and worked out a detailed assisted living regulatory model, which included medication administration by nursing assistants trained in a program developed by the DC Board of Nursing. The draft was reviewed by the DC Council lawyers, and eventually introduced by Linda. With re-writes from the Executive Director of the Board of Nursing, the Assisted Living Residency Act was passed in 2000.
From there, projects continued to snowball. Through working on the Living Wage, the Coalition began to look at the regulations and training of nursing assistants, collaborating with the Board of Nursing. It worked on restraint reduction, developing the regulations for the use of bedrails in hospitals and even evaluating the threshold for what is considered a restraint. More recently, the Coalition has reached out to public schools to consider offering career training for high school students so that upon graduation they can become nursing assistants. As the District works to implement its Age-Friendly DC Initiative, the Coalition also continues to look at housing and accessibility, particularly when it comes to helping older adults transition from a hospital or other facility back into their home.
Notably, through all the ups and downs, the collaboration between the Coalition and Iona remains strong. “To have this Coalition be so strong for 20 years, be a part of Iona’s 40 years, and come from an agency with a broader mission is quite special,” says Elizabeth. She cites their symbiotic relationship as being crucial to the many years. For example, the LTC Coalition has greatly benefited from Iona’s social workers sharing experiences and frustrations with current long-term care issues. Additionally, Iona has many connections with DC government officials. For Iona, the organization “can be a part of social change, in addition to a superb social service provider,” says Elizabeth. “Iona really has a responsibility to look at how to make things better beyond the help they are giving to the people in the community,” she continues. “If it’s a structural problem, they should try to understand it and help to change it. It seemed apparent that that was the responsible thing to do, and I was so grateful there were other people charging ahead and showing us how to do it — like Vera.”
“It’s got a very heavy agenda!”
In 2010, Vera retired as the Coordinator of the LTC Coalition, leaving an impressive legacy. Five years later, the Coalition continues to take on new challenges and celebrate successes with Judy Levy at the helm.
In its 20-year history, the Coalition has tackled and improved so much. Nonetheless, as Vera notes, challenges continue to evolve. “All the problems we have today, they’re going to go on in the future,” she says. “We have an aging population. We also have an increased disability population.”
For the Coalition – and the District – these growing populations mean new infrastructure like additional sidewalks and ramps; technological advances for hospitals, nursing homes, and even the home; additional training for care providers; increased preventative services; and of course, the proper procedures, regulations, administration, and implementation.
So, yes, progress may be stubbornly slow, but the Coalition’s ambitions remain ever-high, advocating for the very best for DC residents.