Friday, October 23, 2020
Ever find yourself saying, "what was their name again? It's on the tip of my tongue." Then do you worry that you have dementia because you can't remember the word? The Washington Post tackled this in a recent article, Dementia is more than occasionally forgetting a name or a word.
First, it is important to know that dementia cannot be diagnosed from afar or by someone who is not a doctor. A person needs a detailed doctor’s exam for a diagnosis. Sometimes, brain imaging is required.
And, forgetting an occasional word — or even where you put your keys — does not mean a person has dementia. There are different types of memory loss and they can have different causes, such as other medical conditions, falls or even medication, including herbals, supplements and anything over-the-counter.
There is normal age-related memory loss, and the article emphasizes that such memory loss is normal! Let’s distinguish from memory loss that is not normal---“forgetting the name of someone you see every day; forgetting how to get to a place you visit frequently; or having problems with your activities of daily living, like eating, dressing and hygiene….When you have troubles with memory — but they don’t interfere with your daily activities — this is called mild cognitive impairment. Your primary care doctor can diagnose it. But sometimes it gets worse, so your doctor should follow you closely if you have mild cognitive impairment.”
The article offers the CDC's quick bullet-point list of warning signs for specific domains when forgetfulness is more than just normal age-related memory loss:
- Reasoning, judgment and problem solving.
- Visual perception beyond typical age-related changes in vision.
Although Alzheimer’s is the dementia that most often comes to mind, the article reminds us that there are several types of dementia. The article provides a good overview of the issues that arise from dementia and concludes with this thought-provoking observation:
But even more frightening is unrecognized or unacknowledged dementia. You must, openly and honestly, discuss changes you notice in your memory or thinking with your doctor. It’s the first step toward figuring out what is happening and making sure your health is the best it can be.
And, as with any disease or disease group, dementia is not a “character flaw,” and the term should not be used to criticize a person. Dementia is a serious medical diagnosis — ask those who have it, the loved ones who care for them or any of us who treat them.
Tuesday, October 20, 2020
The Washington Post recently published an article examining the future of long term care facilities around the world, As covid-19 cases surge, global study paints grim picture for elder-care homes.
There are few easy lessons. In many countries, the trend is hard to escape: The larger the coronavirus outbreak in an area, the more deaths elder-care facilities there can expect to see, according to the results of an ongoing transnational research project, which published new data this week.
Across 26 countries, elder-care home residents have accounted for an average of 47 percent of recorded coronavirus deaths, according to data collected by the International Long-Term Care Policy Network, a global collaboration between academics and policymakers.
With the cases rising again, will the death toll in facilities rise as well? We know that residents of SNFs are more frail, but what causes such a high death rate is the subject of ongoing research according to the article. Because of the lack of or variations in data with various countries, "[t]he only true metric for understanding the impact of covid-19 on elder-care homes is to look at the total number of deaths among residents and compare the change over previous years, but that data is rarely published...."
Countries tried various approaches, some with success, some without. But what works? "[I]t can be hard to isolate tactics that work. In some facilities in Spain and Britain, having staff live on site and submit to frequent testing appears to have helped keep the virus out. In the United States, rapid response teams that isolate patients and take them to hospitals have been helpful in limiting the virus’s spread." Tactics don't come without tradeoffs, however. For example, restricting visitation may protect residents but the isolation has a negative impact.
Will there be significant and long-lasting changes to the way we provide long-term care? "Elder-care facilities may see significant changes — and not just in the short term. The International Long-Term Care Policy Network predicts higher costs and lower demand for elder-care services may not be a blip but could last for 'many years to come.'"
Friday, October 16, 2020
The Consumer Financial Protection Bureau and the National Alliance for Caregiving are offering a free webinar on Tuesday, October 20 at 2 p.m. eastern on Tools for Financial Caregivers of Older Adults.
The Consumer Financial Protection Bureau (CFPB) and the National Alliance for Caregiving (NAC) will provide a free webinar on Tuesday, October 20, 2020 from 2-3 pm ET. NAC will share findings from its joint study with AARP on caregiving, including ways financial strain can affect caregivers and older adults. The CFPB will share free resources for financial caregivers of older adults, with an emphasis on tips and tools that can be used during the Pandemic to manage someone else’s money.
Gabriela Prudencio – National Alliance for Caregiving
Lisa Weintraub Schifferle – CFPB, Office for Older Americans
Kate Kramer – CFPB, Office for Older Americans
Friday, October 2, 2020
The National Guardianship Association (NGA) has released a September 21, 2020 FAQ for guardians about the pandemic. Frequently Asked Questions by Guardians About the COVID-19 Pandemic.
Here are the top takeaways
• Contact with My Client or Loved One – Maintaining contact is essential, whether remotely or in person.
• Special Considerations for Nursing Home Residents – New federal guidance provides ways you can safely visit a resident in person. While there still may be some restrictions on in person visits, you have a responsibility to maintain contact and monitor well-being through remote access.
• Special Considerations for Residential Groups Settings and Hospitals – While there may be restrictions on in-person visits, you have a responsibility to maintain contact and monitor well-being through remote access.
• Protections and Services for My Client or Loved One in the Community – Maintain contact with your client or loved one in the community, and make sure he or she gets services and supports to maintain health and well-being.
• Access to Courts – Each state determines its own procedures during the pandemic. Courts have made many changes, including implementing or expanding remote hearings, and there may be changes in requirements for timelines, notices, and submission of reports.
• Protecting the Rights and Well-Being of My Client or Loved One – The rights of your client or loved one have not changed, but the pandemic makes it more difficult to exercise certain rights. Take actions to ensure the person receives fair health care treatment, facilities follow safety protocols, and support the individual during this difficult time.
• Protecting the Medical Decisions for My Client or Loved One – Work with health care
providers to ensure that the health care choices and values of your client or loved one are
• Protecting the Finances of My Client or Loved One – As guardian of the estate or conservator,
ensure that your client receives all COVID-19 and other benefits for which he or she is eligible; develop and implement a financial plan that is flexible enough to accommodate demands due to COVID-19; and manage investments and financial affairs with increased vigilance during the pandemic.
• Safety Precautions – Take steps to make sure you are not exposed to or transmitting illness, and to respond if your client or loved one is exposed to COVID-10, shows symptoms, or is hospitalized. Be alert to COVID-19 frauds or scams.
The 20 page FAQ with detailed explanations is available here.
October 2, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)
Thursday, October 1, 2020
We encourage the use of these best practice tips to aid your communication efforts:
• When anticipating a need to hire a new role on your team, screen for bilingual or multilingual candidates.
• Identify members among your team who speak other languages who you know can assist with outreach when connecting with people who speak different languages.
• Establish a list of translated basic phrases, such as “Do you speak English?”.
• If someone is contacting you by phone and has reception issues (Are they trying to reach you from somewhere remote or out of the country?), try to obtain as much information as possible to contact the person back, in the hopes of establishing a clearer second communication attempt.
• For people requesting information with language barriers or who may be hard-of-hearing, slow down your speaking pace, pronounce words clearly, and repeat phrases when necessary.
The full list of tips is available here.
Wednesday, September 30, 2020
There have been lots of discussions about the impact of isolation necessitated by COVID, especially on elders. We have previously written about robot pets, and now the New York Times has examined the role of these robots in lessening the impact of isolation during the pandemic: In Isolating Times, Can Robo-Pets Provide Comfort?
Such devices first appeared in American nursing homes and residences for seniors several years ago. A Japanese company began distributing an animatronic baby seal called PARO in 2009, and Hasbro started marketing robotic cats in 2015.
But the isolation caused by the coronavirus, not only in facilities but also among seniors living alone in their homes, has intensified interest in these products and increased sales, company executives said. It has also led to more public money being used to purchase them.
The article discusses the adoption of the robots by various facilities, and then the interest individuals have shown in having the robots as their companions.
Of particular interest is the Joy for All brand sold by Ageless Innovation, a spinoff of Hasbro, and available from retailers like Walmart and Best Buy for about $120.
One of the largest studies, underwritten by United HealthCare and AARP, distributed free Joy for All robots to 271 seniors living independently.
All the seniors suffered from loneliness, according to a screening questionnaire. At 30 and 60 days, “there was improvement in their mental well-being, in sense of purpose and optimism,” said [the] chief medical officer of AARP’s business subsidiary and a study co-author. The study also found “a reduction in loneliness,” ... although the questionnaires showed that participants remained lonely.
Armed with such findings, Ageless Innovation has been offering discounted robots to state agencies working with seniors. (Both Joy for All and PARO robots can be sanitized to prevent viral transmission, the companies said.)
One Medicare Advantage plan covers them and Ageless Innovation is working to get other MA plans to also cover them. The article also discusses the views of fans and critics of the use of these robot pets. Of course, nothing beats human interaction! What do you think?
Tuesday, September 29, 2020
Mark your calendars now for a free webinar on ABLE accounts on Tuesday October 13 at 2 eastern.
The ABLE Act offers the opportunity for 8 million individuals with disabilities to save without affecting means tested benefits. The ABLE Act builds on the Americans with Disabilities Act (ADA), recognizing the extra, significant costs that come with living with a disability. This training will cover how ABLE accounts empower people to save and invest their funds in a tax-advantaged savings vehicle to cover a wide range of qualified disability expenses, providing for a better future and enhanced quality of life.
Presenters will share:
- How an ABLE account can increase financial independence
- ABLE account basics and the interaction with SSI and Medicaid
- Resources and tools
- Miranda Kennedy, Director, ABLE National Resource Center
- Marlene Ulisky, Disability Benefits Expert, ABLE National Resource Center
- Pshon Barrett, Esquire, ADA Group, LLC, Attorneys for Disabled Americans and ABLE account owner and 2020 ABLE NRC Ambassador
Closed captioning will be available on this webcast. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webcast start time.
This training will be presented in a WEBCAST format to accommodate more participants. Due to the high volume of participants, computer audio will be the only option to listen to the presentation. No telephone call-in number will be provided. Please plan accordingly. Thank you.
This webcast will be recorded and available on our website shortly after the presentation. The recording and training materials will also be emailed to all registrants within a few days after the training.
To register, click here
Thursday, September 24, 2020
Not a day goes by, or so it seems, that thee isn't some new article or announcement or data released about SNFs. Here, in no particular order, is some of the recent ones that I've collected in my inbox.
New York Times: Inside a Nursing Home Devoted to Treating Those With Covid-19
Wednesday, September 23, 2020
Prohibiting visitors to SNFs has hopefully helped limit the spread of COVID. But what is the impact of those in isolation? According to the Washington Post article, Pandemic isolation has killed thousands of Alzheimer’s patients while families watch from afar, for some the impact has been profound. According to the Post's research, the article states that
Beyond the staggering U.S. deaths caused directly by the novel coronavirus, more than 134,200 people have died from Alzheimer’s and other forms of dementia since March. That is 13,200 more U.S. deaths caused by dementia than expected, compared with previous years, according to an analysis of federal data....
Overlooked amid America’s war against the coronavirus is this reality: People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them. In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years.
This is an important consideration as states begin to allow visits to residences of LTC facilities. Data is also showing increased deaths not specifically from COVID but "occur from causes such as hypertension or sepsis. But they are occurring at much higher levels than in the past, experts say, in part because of the pandemic’s indirect effects — hospitals being overrun or care being delayed."
The article highlights a number of individuals' stories and compares reopening of SNFs in other countries to that of the US. "Countries like the Netherlands have safely reopened their nursing homes without any increase in coronavirus cases by providing ample protective equipment, testing and rigorous protocols. ... But in the United States, little of the trillions in emergency funding has gone to nursing homes. For months, the Trump administration has talked of getting more testing into nursing homes, but the effort continues to be plagued with problems."
The article includes information about the methodology used for this study. This is a helpful article to use as a basis of class discussion. I'm assigning to my students!
September 23, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink
Friday, September 18, 2020
Here's a cool idea from the National Long-Term Care Ombudsman Resource Center: Ombudsman Safety Bags! As states begin to allow visits for residents of LTC facilities, ombudsmen, among others, need to keep themselves, and others, safe. The safety bags include "an Ombudsman imprinted face mask, hand sanitizer, sanitizer wipes, and resources specifically for Ombudsman programs. The resources include tips for Ombudsman program communication, a tip sheet about self-care, NORS FAQs related to COVID-19, 25 Ombudsman program promotion postcards, and COVID-19 Recovery and Reentry Resources." It seems that these bags would be helpful for any professional who interacts with others, especially in cases where attorneys make home visits to their clients.
I just wanted to share something positive with you, so there you have it!
Wednesday, September 16, 2020
Convene a commission of experts to address safety and quality in nursing homes in relation to the public health emergency. The main purpose of the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) was to solicit lessons learned from the early days of the pandemic and recommendations for future actions to improve infection prevention and control measures, safety procedures, and the quality of life of residents within nursing homes.
The 25 member commission met 9 times and made the following:
27 recommendations and accompanying action steps organized into 10 themes. These themes intersect with the Commission’s four objectives, and reflect responses to:
• Ongoing supply and affordability dilemmas related to testing, screening, and personal
protective equipment (PPE)
• Tension between rigorous infection control measures and quality of life issues that exist
in cohorting and visitation policies
• A call for transparent and accessible communications with residents, their representatives
and loved ones, and the public
• Urgent need to train, support, protect, and respect direct-care providers Outdated infrastructure of many nursing-home facilities
• Opportunities to create and organize guidance to owners and administrators that is more
actionable and to obtain data from nursing homes that is more meaningful for action and
• Insufficient funding for quality nursing home operations, workforce performance, and
The commission did not unanimously adopt the report. The 186 page report is available here. Stay tuned.
The New York Times asked the hard question, whether COVID deaths in SNFs were preventable, in a recently published opinion from the editorial board. How Many of These 68,000 Deaths Could Have Been Avoided?
Around 40 percent of all coronavirus-related deaths in the United States have been among the staff and residents of nursing homes and other long-term care facilities — totaling some 68,000 people.
Those deaths were not inevitable. The novel coronavirus is adept at spreading in congregant living facilities, and older people face an increased risk of contracting and dying from it. But most of the nation’s nursing homes had months of warning about the coming threat: One of the first coronavirus outbreaks in the country was in a nursing home near Seattle, making it clear that such facilities ought to prepare.
The opinion discusses steps SNFs could have taken to reduce the chances of spread, the financial model for SNFs in the US. The opinion also discusses the reduction of oversight and notes
Every effort should be made to ensure that the bulk of the money that the government puts into this industry goes to patient care, not providers’ pockets. An investigation started by the House of Representatives into the nation’s largest for-profit homes is a meaningful step in this direction. The Justice Department should follow suit.
The opinion discusses the way SNFs get supplies for their PPEs, etc. as well as staffing shortages. The editors conclude with 3 recommendations
In the near term, lawmakers should provide for hazard pay for nursing home workers in the next relief package and should require all nursing homes to enact non-punitive sick-leave policies so that workers don’t infect colleagues or residents.
In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long-term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long-term care can be reimbursed with Medicare dollars.
Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.
Tuesday, September 15, 2020
The Tampa Bay Times recently reported that the Florida Governor was authorizing visitation of residents in SNFs and ALFs in certain circumstances, DeSantis says yes, but will Florida nursing homes reopen to visitors? The order, which was effective on September 1, still requires that visitors maintain social distance. "The governor’s executive order... end[ed] the five-month ban on visitors at long-term care facilities that he imposed in an effort to protect the state’s most vulnerable residents from the coronavirus. The order will continue to allow visits from those deemed essential or compassionate caregivers, including in facilities that have had recent positive tests." The order is optional and the SNFs and ALFs can choose to not allow visitors.
The final report of the task force appointed by the Florida governor is available here.
Monday, September 14, 2020
Mark your calendars now for a free webinar on How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19. The webinar is set for October 6, 2020 from 2-3:30 p.m. Here's a description of the webinar.
The COVID-19 pandemic has brought to the forefront longstanding racial disparities in our healthcare system, and data show that older adults – especially older adults of color and those in residential congregate settings – are disproportionately impacted by the virus. Aging advocates play a key role in holding health plans and government agencies accountable to meeting the needs of those most at risk during this time. In this webinar, How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19 , we will provide an overview of dual eligibles and the types of health plans that serve them. We will also present specific programmatic recommendations that advocates can push health plans with dual eligible members in their community to adopt. These recommendations are measures that plans can take to center equity in their ongoing response to COVID-19 and ensure they are meeting the needs of older adults of color during this challenging time.
To register, click here.
Friday, September 11, 2020
Computer Weekly recently addressed the legal issues that may occur when using technology for caregiving AI may be a solution to the social care crisis, but what are the legal concerns?, looks at the caregiving situation in the U.K. Building on the story from yesterday about the robot "Pepper" who can carry on conversations, the article highlights some legal issues, such as an individual's privacy.
Consider this-the robot could report concerns about abuse, for example, "the technology might provide a report, supported by video evidence, to family members or those with the legal responsibility of care, such as attorneys or deputies, who can then review such material. It can easily become part of a care home contract to consent to such filming, although it is vital that this is handled in a sensitive manner and regularly deleted to ensure that a resident’s privacy is protected." The article notes concerns about "sensitive personal data." Would residents provide consent? Who would consent if a resident lacks capacity. As the article concludes, "[W]e must never forget who is at the heart of these considerations, and the legal framework needs to catch up with the technology to protect them and for it to have a viable chance of success."
Thanks to Professor Feeley for sending me this article.
Thursday, September 10, 2020
The Guardian recently published an article about the use of robots in long term care facilities to combat loneliness of residents. Robots to be used in UK care homes to help reduce loneliness describes the roll these robots can play in interacting with residents. These are not your "normal" robots, but then I don't know what one would consider a "normal" robot. These robots, on wheels, "called “Pepper”, move independently and gesture with robotic arms and hands and are designed to be “culturally competent”, which means that after some initial programming they learn about the interests and backgrounds of care home residents. This allows them to initiate rudimentary conversations, play residents’ favourite music, teach them languages, and offer practical help including medicine reminders." The researchers not that these robots do not replace human caregivers but instead supplement them. The robots were tested in the U.K. and Japan and researchers found that those residents who spent time with the robots for "18 hours across two weeks had a significant improvement in their mental health. There was a small but positive impact on loneliness severity among users and the system did not increase feelings of loneliness...."
Robots, whether "Pepper" or others, do have limitations--for example, they aren't human. The article reports some of the limitations mentioned, such as their chats with residents were lacking some depth, were impersonal and lacked cultural awareness. Their movements were, shall we say, robotic. But imagine, a robot that can hold a conversation with you. This can be a great tool, to supplement human caregivers!
Thanks to Professor Feeley for sending me the article.
Thursday, August 27, 2020
Mark your calendars for the 2020 Schiller DuCanto & Fleck Family Law Center Virtual Symposium: The Current State of Elder Law. The symposium will be October 12, from 10-5:45 edt. Here's a description about the program
DePaul’s Schiller DuCanto & Fleck Family Law Center is hosting a full day virtual symposium on the area of elder law. Through various panel discussions with experts in the field, panelists and attendees will explore the intersection of family law and elder law, emergency guardianships, advance directives, public benefits, caregivers, choices in end of life matters, protecting your loved ones from financial exploitation, and LGBTQ Seniors. There will also be an elder law case law update that you don't want to miss.
Click here for more info and to register.
Sunday, August 23, 2020
Inevitably ... the virus has found its most ideal conditions in the warehouses storing America’s elderly population. No one knows the current death toll. As of early July, CMS put the number at 33,509, but the count covered only federally regulated nursing homes, not assisted-living communities. The homes, moreover, were not required to report deaths that occurred before May 8, although the agency said it was confident that “the vast majority” did so. One in five nursing homes didn’t bother to report their numbers at all. A New York Times study in late June put the number of deaths in U.S. nursing homes at a staggering 55,000, but even this figure did not necessarily include all of those who became infected in a home but died in a hospital, as was the case for Sharon Mitchell. In some states, the vast majority of COVID-19 deaths were in homes: 64 percent in Massachusetts, 68 percent in Pennsylvania, 77 percent in Minnesota. In New Jersey, one in every ten people housed in nursing homes or assisted-living centers died. This was a helpless population, helpless because so often confined in a state of neglect and squalor. But despite or perhaps because of their conditions, they were worth a lot of money. In effect, they were being harvested for profit.
The article looks at the financial model of long term care facilities in the U.S. It offers a comprehensive history of the development of LTC facilities in the U.S., culminating with a discussion of the ownership of LTC facilities by private equity firms. The article covers the impact of the pandemic and the efforts by the industry to get shield laws to provide them immunity.
As noted by the article, it's not only U.S. facilities that have faced these deaths from the pandemic. It notes one company that made changes early in the pandemic, which resulted in less cases, at least in some facilities. If we are to change the way we provide ltc in this country, in my opinion, this article is important. I'm assigning it to my students.
Friday, August 14, 2020
Earlier this week, the GAO issued a new report, CHILD WELFARE AND AGING PROGRAMS: HHS Could Enhance Support for Grandparents and Other Relative Caregivers.
Here are the highlights
In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials.
Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists.
The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunitiesto help states better support kin caregivers.
GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful.
The full report is available here.
Tuesday, August 11, 2020
I hope everyone knows the story of the Rosie the Riveter, and the difference they made during WWII. One of the Rosie the Riverters is still making a difference, according to a recent story in the Washington Post. 94-year-old ‘Rosie the Riveter’ once made warplanes and red bandannas. Now she makes face masks with the same cloth. features Mae Krier, who has continued to make a difference. "For many years, Krier has paid tribute to her beloved Rosie the Riveters by making red bandannas with white polka dots — a style shown in J. Howard Miller’s iconic Rosie the Riveter “We Can Do It!” poster for Westinghouse Electric. Since the war against the novel coronavirus started, Krier shifted her energy from making Rosie bandannas to Rosie face masks, cut from the same cotton cloth."
The article provides a nice history of the Rosier the Riveters, which is a good read for our students, who may not know the story. Ms. Krier also explains the can do attitude of the Riveters and how she sees it applying to the pandemic. She also expressed to the reporter her reactions to the pandemic and masks:
[S]he is frustrated and disheartened to see how many Americans are fighting safety measures and refusing to wear masks. Nurses, she said, are the new Rosie the Riveters, and hospitals are the new battlefield with coronavirus patients.
“We’re fighting a different kind of war — a terrible virus,” she said. “Where is the ‘We can do it’ spirit?”