TOWNSHEND — Susanne Shapiro's nursing career toured through multiple areas of medicine, but the field of elder care has always held her professional heart.
And that heart was evident as Shapiro said goodbye to Valley Cares after eight years as executive director of the organization, which provides affordable elder housing and supportive services known as West River Valley Senior Housing.
In its two facilities, Valley Cares offers three types of housing options with varying degrees of support services for tenants.
“It's been exciting. It's been the best part of my career, this job; there's no doubt about that,” said Shapiro, describing her resignation as “bittersweet.”
“That's the essence and why it's also hard to leave,” she said.
Shapiro said her decision has come after at least a year of thought and evaluating her personal and her family's needs.
“So I want to have a better home-life balance for me and my family,” she said. “That's really what I need right now.”
Shapiro said COVID-19 is not the reason she's leaving, but one factor in her decision is her own exhaustion.
Along with her executive director duties, Shapiro, a registered nurse who also holds a management degree, has filled in to provide nursing when the organization has been short-staffed.
She feels that has been a “setup for burnout” but observed that the shortage of nurses means that professionals can be picky about which jobs they take.
“I don't have a new job,” she said. “I don't know what's that's going to be yet. There are many things I could be interested in but, first of all, I want to take a little break.”
Path to Vermont
Shapiro grew up in Denmark on the Danish-German border. In the 1990s, she and her husband moved to New Jersey where she worked as a nurse. Eventually, they moved back to Denmark before returning to the United States where, in 2012, the family settled in Vermont.
They chose Vermont because Shapiro's husband's family had a second home in Marlboro. During her years in New Jersey, Shapiro traveled to the state for vacations.
“I think the moving is something I've done a lot of and I hope to not have to do again,” she said. “We're happy to be in Vermont.”
Before joining Valley Cares, she was the administrator for Bradley House, now part of Garden Path Elder Living, in Brattleboro. During her time there, she collaborated with Valley Care's founder, Bob Crego, on Bradley House's expansion. As she worked with him, she became familiar with Valley Cares and interested in the director job.
Shapiro has worked as an open-heart nurse, as a critical care nurse, and as an oncology nurse. She has worked in trauma care, burn care, and even software development.
“And somehow, I always thought that I would end up doing this sort of work,” she said.
Her interest in elder care started in high school after she spent a summer in England with a friend of the family who ran a nursing home. Shapiro was fascinated and inspired by the way she worked with the residents there.
Building a community to call home
Shapiro spent most of her interview talking about the Valley Cares residents, its staff, and the community of residents of the three living options.
Residents of the 25 independent living apartments can receive services through the SASH program (Support and Services at Home). The assisted living facility is licensed for 42 residents who receive services such as meals, cleaning assistance, and medical oversight. The supportive housing program blends the independent and assisted-living options.
“I've always valued having a personal relationship with the residents, with their family members, with the providers that they see,” she said.
She has set out to create a home-like environment for the residents. The smell of home-cooked food meets people when they first enter the assisted- and supportive-living facility. Fresh flowers are placed in the common areas, and residents are allowed to hang personal art outside their doors.
Yet providing elder care in a rural area such as Townshend has its challenges.
Accessing services can be difficult, for example. Also, a facility like Valley Cares is not for everyone.
“It's a huge decision for people to decide to come to a facility,” she said. “It's life altering, and that's something we're very mindful of in the admissions process here, of course. It can be quite traumatizing, really, for people.”
Shapiro worries specifically about elders with dementia, which she says is on the rise. According to the Alzheimer's Association, the number of Vermonters afflicted with the disease is estimated to increase almost 31 percent between 2018 and 2025.
In her opinion, not enough facilities exist to serve their needs. She noted that people who are physically fit and can manage daily living - like dressing and eating - are often disqualified for Medicaid. Yet, people with dementia are often physically fit but still can't care for themselves, she said.
She feels the state needs to address this need and has reached out to state agencies and legislators.
Staffing: a big challenge
Staffing is another challenge, she said. VTDigger reported in 2018 a survey showing that Vermont would have approximately 4,000 nursing vacancies by this year. This estimate, of course, had not figured in the COVID-19 pandemic, but illustrates the need to educate more potential registered nurses by lowering barriers such as program costs.
“There's no simple answer here,” she said.
Valley Cares has struggled to hire nurses, especially during the last 18 months. Last year, the organization lost a seasoned nurse manager who had been with the organization since 2012. It took a whole year to find a successor.
“So it was a hard year, a very, very busy time,” she said.
In recent months, Shapiro said, things have changed. Suddenly, Valley Cares has received multiple applications from nurses. She is not sure if that's directly due to the pandemic or to more people moving to the area.
“So, maybe the pool of RNs has grown bigger,” she said. “I hope so, because it's absolutely key for us here to have enough RNs to take care of residents, which is what we do.”
On a recent fall day, Shapiro was busy training registered nurses recently hired by the organization. She said it felt good to get to know them and to feel that the residents “will be in good hands.”
Keeping elders safe in a pandemic
Since March, Valley Cares' assisted and supportive living facility has been on lockdown. From March to May, the residents stayed most of their time in their apartments.
The group dining room was closed, and meals were delivered. Most group activities were also cancelled. Family and friends were not allowed to visit, except for hospice care.
Residents were not allowed to leave the grounds except for specific reasons, such as doctors' appointments. The organization stopped admitting new residents.
The pandemic has placed new pressures on staff, Shapiro said.
While staff are a potential vector for bringing the coronavirus into the facility, Shapiro said that it is also tricky for an employer to dictate how staff may spend their free time, such as asking them not to attend large gatherings while off duty.
Shapiro said that the organization has had to nurture its staff as much as its residents.
“The phrase 'COVID fatigue' is true,” she said.
The organization is trying to hire extra staff just so it can keep up with the extra COVID-19-related health protocols.
“There are a lot of extra steps staff have to take, and that's not what they asked for when they took the job,” Shapiro added. “We have some amazing, dedicated staff members who keep stepping up whenever we ask more of them.”
The work that staff members perform is important, emotional, and hard, Shapiro said. She has felt grateful for what staffers do every day for the organization and its residents.
“It's people's livelihood, it's people's destinies that we're a part of, and we have people who have been here longer than I. We've built a very strong culture, and I think when I leave, that culture doesn't leave,” Shapiro said. “For that, I'm really grateful, and that will remain.”
Over the summer, the facility has cautiously reopened on a very limited basis. Family are allowed to visit with residents on the building's porch. Family members must go through a screening process and remain 6 feet from loved ones.
The staff's caution has paid off. So far, Valley Cares has had no documented cases of COVID-19.
The assisted and supportive living facility renewed its admissions process in June.
“They [the state agencies] developed protocols for that for nursing homes and thought that we could follow the same protocols,” she said. “But we're not a nursing home.”
According to these protocols, nursing homes need to test a new resident on the day of admission and for a certain amount of time after. Valley Cares, however, isn't equipped to do its own testing, she said.
Shapiro worked with the state to develop alternative protocols that could work at a place like Valley Cares.
COVID-19 requirements for new residents to Valley Cares include quarantining prior to arriving and then for 14 days after arriving. Shapiro said it's a tough process because the new resident can't explore their new community or meet neighbors.
“So, in the first two weeks, it's an isolation period, so it's hard,” she said.
Shapiro said that during her tenure at Valley Cares, she has always been “heavily involved” in the admissions process.
She also acknowledged that the pandemic has challenged the residents as well. Health is more than one's physical fitness, she said - it is also about people's emotional and mental well-being. The isolation created by the pandemic has been hard on residents.
A couple of residents have moved back in with family because the separation due to the pandemic restrictions was too hard.
“It's so difficult to not have the family involvement for our people, and the staff have worked really hard to fill that void,” she said.
Shapiro is also happy that the residents can now gather in groups smaller than 10 for limited activities.
In September, the dining room opened for small group meals and breakfasts, she said, noting that it's been nice to come through the door and see people eating breakfast.
“We try very hard to make it lively here - it's not just keeping people clean and fed, it's also about keeping them happy,” Shapiro said. “That's especially important right now.”
An early connection
Board interim president Jean Allbee has served on Valley Cares' board since the organization's incorporation in 2004.
As a member of the committee that hired Shapiro, Allbee remembers how her manner and calmness stood out. When Allbee asked Shapiro why she chose to work with elders, Shapiro spoke about her grandmother.
“And that was the reason it was so important to me as well, because of my grandmother, so that was a real connection,” Allbee said. “She just seemed competent and confident to me, and I've never been disappointed.”
Allbee said that in the intervening years, Shapiro has remained steadfast.
The board president added that after a lightning strike caused a four-alarm fire in 2015, Shapiro ensured that any residents that needed to move during repairs liked their new homes.
“When we had the fire, and when the COVID struck, I just think she did such a great job of keeping things together and making the residents feel safe and cared for,” she said.
Instead of simply shifting people displaced by the fire to a new place and leaving them there, Shapiro stayed in touch with the residents, Allbee said, and she worked to find them another place if they were unhappy.
Allbee said the Valley Cares community as a whole has kept the facility COVID-free so far, an achievement she credits to the whole team and to Shapiro's leadership.
“They have been so careful and following every protocol, so I think that is a huge thing,” she said.
“And they worry, too - they all worry about the mental well-being, emotional well-being, of all the residents because they can't see people or get out,” Allbee said. “That's been a hard thing for the staff to try and deal with as well.”
Allbee believes the key to Shapiro's success at Valley Cares is that she is a “very caring person” whose experience as an RN deepened her relationship with the residents and her ability to care for them.
“She always greets them as though they were her grandparents, instead of some old person she is supposed to be responsible for,” Allbee said. “She always looks residents in the eye; she always says good morning.”
Before COVID-19 restricted group activities, Allbee also taught a strong-bones class to residents.
“I think the residents love her,” Allbee said. “The board members all have a tremendous amount of respect for her.”
“She made it what it is for a large part,” she said - and, as a result, “everyone who visits feels like [Valley Cares] is a homey place and not an institution.”
Finding time to relax
After eight years as executive director of the organization's independent and assisted living facilities, Shapiro is looking forward to relaxing. At the same time, she will miss the residents and staff of Valley Cares.
Shapiro officially ended her tenure on Sept. 18, and plans to gradually step away as the new executive director, JoAnne Blanchard, takes the reins.
“Positions like mine need to be done by new people every now and again, I think,” she said, noting that the board had a lot of good candidates to choose from.
Shapiro added that Valley Cares is not alone as it moves forward.
“I've always felt that there is a community holding us” - one that extends beyond the organization and to the residents' families, the professionals assisting the organization, the town of Townshend, and the state, she said.
She described her work and the trust placed in her by the organization and residents as “a privilege.”
“That has been a huge honor and privilege,” she said. “Now I'm going to cry.”