As Orson Welles might have said: “We will evaluate no program before its time.”
One of the first things you learn in “foundation school” is how easy it is to kill even great programs by evaluating them before they are ready.
Nothing innovative starts working on day one as well as it will with practice, adjustment, and refinement. Even more deadly is an evaluation with low-cost methods that doesn’t really provide the information you want and need. One of the painful lessons I’ve learned is to always buy the highest quality and therefore most expensive evaluation you can afford, because it’s cheaper in the long run.
Policy change is hard. Just think about the 2010 Affordable Care Act, its tortuous path toward enactment, and the ongoing debates five years later that swirl around the law and its implementation.
There are many theories for how policy change happens, but one of my favorites is Kingdon’s policy streams model. To simplify a bit, it proposes that a window of opportunity opens when three separate streams come together: a problem gets defined and recognized as such, viable solutions are available, and there is political will to match them up.
Except for the political will part (thank you, partisan gridlock), at first glance this might seem easy. But think about how often your problem is not seen as a problem by others. For years, we faced this challenge when it came to making the case that older adults don’t get the care they should because they have special needs that require specialized, geriatrics-expert knowledge. Because of this challenge and the constantly shifting political landscape, it’s important to have policy solutions at the ready for the time when the problem and politics streams come together.
Todd Shurn and his mother, Alice, in 2013. Todd became a fulltime caregiver when his mother could no longer live on her own due to dementia. Photo courtesy of Todd Shurn.
Editor’s Note: The Jan. 15 deadline for submissions to the John A. Hartford Foundation’s second annual story contest is fast approaching. This year’s theme is Better Caregiving, Better Lives: Real Life Strategies and Solutions, and we are looking for stories from family caregivers and health care providers that illustrate the strategies and solutions caregivers are using to effectively and gracefully care for older adults. We are especially interested in stories about caring for older adults with dementia/Alzheimer’s disease.
So today, we share a dementia caregiving story written by one of this year’s contest judges, Yanick Rice Lamb, who teaches journalism at Howard University and is co-founder of FierceforBlackWomen.com, which partnered with TheRoot.com on the article. Lamb wrote a special introduction for Health AGEnda discussing how she approached writing the story and what she hoped to accomplish. It is our hope that Yanick’s behind-the-scenes insights into the writing process and her well-written, moving story will inspire others to share their own stories with us, and shine a light on how to “show” a story, not just “tell” it.
“Whoever said nothing is impossible obviously hasn’t tried nailing Jell-O to a tree.”—John Candy
As the year comes to a close, there are many lists of the best and worst in almost every imaginable category for 2014. Here at Health AGEnda, we have made an annual practice of reviewing the workforce in training data—specifically, the number of graduating resident physicians choosing additional training in geriatric fellowship programs—published in the Journal of the American Medical Association (JAMA). (Read Boxing Day Brings Glad Tidings for Geriatrics Field from 2013, Decline in Geriatric Fellows Defies Pay Boost: +10% = -10% from 2012 and Falling Leaves, Falling Numbers from 2011.)
I recently saw one of my charts presented (without attribution ) in a Washington briefing session on the workforce available to care for older adults, so I guess I have to keep updating them.
About a year ago, we posted a holiday gift for you—a Tools You Can Use blog that featured a free toolkit with evidence-based resources for staff in senior living communities promoting non-pharmacologic strategies to address behavioral and psychological symptoms of dementia.
We got a lot of response to that post. A lot, like almost 6,000 hits. Clearly, people are hungry for resources that address the needs of older adults with dementia. So in this spirit, we share another recently developed Tools Use Can Use, a continuing education online dementia series focusing on older adults that was created by the Hartford Center of Gerontological Nursing Excellence at Arizona State University (ASU); this work is supported by Virginia G. Piper Charitable Trust.
The series, called Caring for Persons with Alzheimer’s disease and Other Related Dementias and their Families Across the Continuum of Care, features four online, self-paced learning modules focusing on specific stages of dementia. The series aims to increase the knowledge and skills of nursing and other healthcare professionals to provide optimal dementia care and family support during all stages of the illness.
The opening session of the Hartford Change AGEnts Conference in Philadelphia last week.
Last week was the capstone of the first-year rollout of the Hartford Change AGEnts Initiative. This projects aims to engage and support all prior John A. Hartford Foundation health and aging grantees to focus on making systematic, large-scale practice change in the care of older Americans.
More than 160 Change AGEnts converged on Philadelphia for an intensive, day-and-a-half conference that was packed from start to finish with opportunities to learn, share knowledge, and network with others from different parts of the country and different disciplines. It was an energizing experience, not only because it gathered so much of the Hartford Foundation’s most precious assets—its people—in one place, but also because we learned more about the work already underway to improve care. We also saw new relationships and ideas emerge that will advance our mission.
In June 2011, I wrote about my then-80-year-old father’s experiences with post-operative confusion — otherwise known as delirium — following triple bypass surgery. Three-and-a-half years later, that post continues to draw thousands of readers every month, along with comments that express the frustration and heartbreak that is still all too common among families dealing with the issue.
So I’m pleased to share the news that our colleagues at the American Geriatrics Society (AGS) have released a guideline for health care professionals that I hope will greatly reduce the confusion and frustration so many older adults and their families have to endure as a result of failures to prevent, identify, or properly manage delirium after surgery.
The new Clinical Practice Guideline for Postoperative Delirium in Older Adults offers a framework that will enable hospital systems and health care professionals to implement actionable, evidence-based interventions, both nonpharmacologic and drug-based, to improve delirium prevention and treatment.
Best wishes for a happy, healthy Thanksgiving from Health AGEnda and the John A. Hartford Foundation.
And we give thanks for those who have touched our lives and made them better, including our dear colleague Steve Abramovich, who passed away four years ago today.