Health AGEnda

Chris Langston

About Chris Langston

Christopher A. Langston, PhD, is the Program Director of the John A. Hartford Foundation, and is responsible for the Foundation’s grantmaking in support of its mission to improve the health of older Americans.

New Grants Totaling $3.28 Million Spur Long-Term Changes in Delivery of Care to Older Adults

OlderCouple_496398699The Trustees of the John A. Hartford Foundation approved three grants totaling more than $3.28 million last week that we believe will lead to fundamental, long-term changes in the way care is delivered to older adults.

We renewed and expanded our work to ensure that the voices of older adults and aging-expert professionals are influencing debates about health care delivery through advocacy; we are supporting the development of quality measures and performance standards that support integrated, patient-centered, goal-based care that helps people to achieve their priority outcomes; and through the collaborative ReFraming Aging Initiative, we will counter the pervasive negative beliefs about aging that are barriers to improving the care of older people.

Under our Policy and Communications portfolio, the Board approved a three-year, $1.5 million renewal grant that will expand the partnership between aging-expert health care professionals and consumer advocates in the Voices for Better Health initiative. This project of Community Catalyst, a nonprofit, Boston-based health care advocacy organization, is working to ensure that integrated health plans for dually eligible Medicare/Medicaid individuals deliver high-quality care to this low-income, vulnerable population.

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Proposed Physician Fee Schedule Change
Brings Christmas in July

Chris Langston, right, with his "Faraway" grandmother Nancy Imber, circa late 1970s. Joining them are his mother Adair and younger sister Anne.

Chris Langston, right, with his “Faraway” grandmother Nancy Imber, circa late 1970s. Joining them are his mother Adair and younger sister Anne.

When I was a child, I had two grandmothers. A nearby grandmother (Gammy) and a faraway grandmother, known forever after just as “Faraway.” I know she found it rather odd to be looked right in the face and addressed as “Faraway,” but as it was all I ever knew, it seemed just right to me.

In her last years, after the death of her second husband and the usual pile-up of chronic conditions, my Faraway grandmother came to live with her daughter, my mother. But the active and interested woman we had known was gone. She had lost most interest and pleasure in activities that had previously occupied her and seemed unwilling to try new things.

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Investing $10.3 Million in Projects to Transform Care for Older Adults

Transforming_Health_Care_SS__400pLast week’s meeting of the John A. Hartford Foundation’s Board of Trustees was an important and exciting time for us all.

It was the first board meeting under the direction of our new President, Terry Fulmer, PhD, RN, FAAN, and it was the last board meeting for our long-time board chair, Norman H. Volk, who is succeeded by Margaret Wolff. Demonstrating the John A. Hartford Foundation’s commitment to our current strategies to create widespread and systemic practice change in health care, the Trustees approved $10.3 million in six new grants to improve the health of older adults, our largest authorization in many years.

The new grants add muscle to four of our five funding areas comprising the Foundation’s current strategic plan. And our fifth strategy, Interprofessional Leadership in Action, is certainly validated by these projects, most of which are the culmination of several years—sometimes decades—of work by leaders in the field of aging and health who we have helped develop and support.

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Hartford Grantees, Friends Shine at AGS Annual Meeting

National_Harbor_400pMost of our John A. Hartford Foundation staff have come to the banks of the Potomac River in National Harbor, MD, this week for the annual scientific meeting of long-time grantee and partner, the American Geriatrics Society (AGS). It’s always a great opportunity to catch up with valued friends and colleagues, learn about the latest advances in aging and health research, and celebrate those who have made important contributions to the field.

This year is no exception. In fact, it is gratifying to see how many of those being honored by AGS this week have been part of the Hartford Foundation community, through grants, scholarships, fellowships, and partnerships.

Steven R. Counsell, MD

Steven R. Counsell, MD

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Making Electronic Health Records Responsive to Needs of Older Adults (Really Meaningful Use)

EHR_shutterstock_150374810_300pI was recently in New Orleans and coincidently listened to an interview with Robert Wachter of the University of California, San Francsico talking about health IT and his new book on where the nation stands regarding electronic health records (EHRs).

Somehow, the temptations of the French Quarter and the problem of EHRs combined in my mind to produce the image of the nation’s health system out on the town, binging on HITECH Act ARRA money, blackout drunk, and waking up married to some very inappropriate electronic health record system.

This isn’t exactly how it happened, but most of the bloom does seem to be off the rose of the electronic medical record and we are in a phase of regret and disillusionment. Physicians have been complaining for years about the hours added to their days by the workflow disruption of digital data entry and the breach in the relationship with patients created by interacting with the computer, rather than the person. At the same time most of the anticipated fabulous features of EHRs are still in the anticipated stage.

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Public Understanding of Aging Built on a House of Cards

HoC_300pOver the weekend, I walked past my wife and kids watching the new season three of Netflix’s House of Cards and was stunned to see the evil President Frank Underwood ranting at his cabinet to get on with designing his jobs program that would be funded by slashing the “entitlements” of Social Security, Medicare, and Medicaid that are “sucking us dry.”

I gave an impromptu lecture to the family on the folly of this policy position—I’m not sure they noticed. And of course, we’ve also written many times about the false narrative of zero-sum intergenerational conflict. (Read Pitting Older Adults Against Children Is a Zero-Sum Game and Analyze This: Misleading Federal Spending Stats Pit Children Vs. Older Adults.)

But what can anyone do when even television writers feel comfortable with this notion that the benefits that older adults earned in their lifetime of work are a dagger to the heart of the nation? While Underwood is certainly a morally compromised character, in this scene he is actually portrayed as the hero, taking decisive action in the face of a roomful of indecisive, equivocating, naysaying bureaucrats.

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Care Transitions Evaluation Is Premature and Confusing

As Orson Welles might have said: "We will evaluate no program before its time."

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.

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When It Comes to Geriatrics Expertise, If You Can’t Change the Numbers, Change the Game

“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.

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Challenging Change AGEnts to Realize Promise of Improved Care for Older Adults


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.

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Hartford Grantees Recognized at GSA

2014_GSA_Meeting_Logo_300pFor almost 20 years, the Gerontological Society of America (GSA) has been one of the John A. Hartford Foundation’s key grantee partners.

The organization served first as the home of the Geriatric Social Work Initiative (GSWI), then as the coordinating center for the National Hartford Center of Gerontological Nursing Excellence (NHCGNE) , and most recently, as the basecamp of the Hartford Change AGEnts Initiative.

So the GSA annual meeting, being held this week in Washington, DC, is a tremendous opportunity to connect with long-standing friends and meet new ones in the field of aging, as well as to check in on long-ago grants and plan new ones.

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