When I was first hired at the John A. Hartford Foundation, I gave one of the then-Senior Program Officers a giant cup filled with new red pens. It seemed to me at the time that the program staff spent a lot of time editing (aka “making stronger”) all sorts of documents—evaluations, grant proposals, drafts of annual reports, etc.
At the Hartford Foundation we strive to be thought partners with our grantees and, thus, like to share feedback. We share loads of feedback among our staff. In fact, we have been trained on how to receive feedback: Simply nod, say “Thank you,” reflect on the input, and incorporate what is helpful.
Now, for the benefit of the Hartford Change AGEnts initiative, we are seeking your feedback. Here is your virtual cup of red pens. We are in the process of creating documents that define the AGEnts Initiative and we need you.
Nora OBrien-Suric makes her presentation at CalSWEC’s Aging Summit.
The Affordable Care Act has opened the door to new opportunities for social workers to apply their knowledge, experience, and skills as part of collaborative teams.
This is great news for those of us who have long advocated for better care coordination as a solution to our nation’s health care crisis. Now, it’s time for social work educators and practitioners to rise to the challenge.
This week, a RAND research team published a report in the Journal of the American Medical Association (JAMA) on a three-year evaluation of Patient-Centered Medical Homes in Pennsylvania, funded by the Commonwealth Fund and Aetna. Since, like almost everyone else, we believe in the potential benefits of enhanced primary care, this is an important paper.
However, its implications are very complicated. I believe the results confirm concerns I had from the beginning that this kind of project wouldn’t work. Why? Because it wasn’t focused enough on the complexly ill and it didn’t incorporate enough special expertise in their care.
The evaluation was led by Mark Friedberg, MD, and used a pre-post, matched practice/patient design where 32 practices worked to become medical homes. The outcomes of the practices and the patients were tracked over three years. A non-random comparison group was created by looking at other practices and patients followed over the same time period to serve as a contrast group not implementing medical home elements.
Fortunately, there’s a growing cadre of passionate emergency medicine physicians with geriatrics expertise who are trying to improve emergency care for older people. This is happening in part through the American Geriatrics Society’s Geriatrics for Specialists Initiative and the Jahnigen Scholars program, which we’ve funded for years. The Atlantic Philanthropies and others have supported the Jahnigen Scholars as well as work in specialty nursing care, reaching out to emergency nurses to build their geriatrics expertise.
This month’s issue of The Gerontologist includes a supplement on culture change and transforming nursing homes. The issue features the work of long-time friends of the John A. Hartford Foundation and experts in the field like Deb Saliba, Phil Sloane, Claudia Beverly, Cornelia Beck, and Robyn Stone.
Because nursing homes are an important part of the continuum of care for older adults and not something likely to disappear, we at the Foundation think getting this part of long-term care right is very important (and why we support grantees like PHI—see Amy Berman’s post last week). The papers in the supplement grew out of a conference funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services and convened by RAND to understand what is known and where the gaps are in our understanding of culture change.
Culture change requires modification in both the training and deployment of the health care workforce. It calls for more skillful workers in more effective teams focused on the unique needs and preferences of the individual resident/patient. This long-term care population is necessarily frail and uses a great deal of medical services, along with the supportive services provided by the facilities. .
Steven Dawson of PHI addresses the briefing on direct care workers held recently by Philanthropy New York.
The health of any given community is fragile and complex. It is greater than the sum of individual health outcomes or access to care. The health of a community rests upon an infrastructure that meets the changing demands and needs of its people within constrained resources. Increasingly, our infrastructure needs to address employment, economic stability, and rising health care costs.
This is especially true given the sea change occurring, with 10,000 people turning age 65 each day in the United States. The maturing of the boomers is fundamentally shifting our view of what a healthy community looks like.
From left, Dziadzia, Rachael Watman, and Rachael’s grandmother in 1971.
My grandfather, Albert Chura, was born on Valentine’s Day in 1907, on a boat en route to the United States from Poland. His family wanted to make a better life in America. And after a lifetime of doing so, at the age of 83, he died on my birthday.
Valentine’s Day always makes me think of Dziadzia (Polish for Grandfather and oddly pronounced Judgie—“Mom, that can’t be how you spell it!”)
Together, along with several other key people, we worked to establish a partnership with the VA to adopt the Hartford Partnership Program in Aging Education (HPPAE), a rotational field model used to train master’s level social work students to work with older adults in a variety of settings.
Over the weekend, Gina Kolata, a New York Times health reporter, wrote a piece on the work of the new Center for Medicare and Medicaid Innovation (CMMI) that was created as part of health reform to test potential improvements in health care organization and delivery.
Interestingly, the slant on the story was on the lack of rigor in the work of CMMI in its failure to use true experimental research designs, those in which participants are randomized to experimental conditions. Using these designs, often referred to as randomized control trials in bio-medicine, yields results that can be interpreted most authoritatively as something about the treatment causing something about the outcome. (Causal inferences.)
Dr. Timothy W. Farrell, right, from the video series depicting a patient undergoing transitions of care across different locations of care.
It happens all too often: Older adults “fall through the cracks” of the health care system. They fall victim to bad transitions of care due to a host of issues, including poor communication, a lack of geriatrics expertise on the part of the health care provider, and a dysfunctional or non-existent team.
As a result, older adults are rehospitalized, frequently move across sites of care, and receive suboptimal and, too often, harmful services.