This year’s tumultuous campaign season has been riveting. However, Election Day will soon come and go, and our attention will turn from debates and proposals to the actual policy actions of our newly elected executive and legislative leaders.
Health care, which will likely soon approach nearly 20 percent of gross domestic product, will undoubtedly be among the top policy concerns for our new administration and Congress. The critical question will be how our leaders understand this complex topic and prioritize the directions our country should take. The question is relevant for all of us—health systems leaders, clinicians, advocates, consumers, and philanthropy.
Will we, for example, acknowledge and prepare for the 10,000 baby boomers who turn 65 every day and who are living longer than ever before? (A tremendous success story for humanity, by the way.) Will we focus attention in the right way on the 5 percent of people whose care accounts for 50 percent of costs because of their complex health and social needs?
Terry Fulmer, PhD, RN, FAAN, started as the John A. Hartford Foundation’s new President this week.
As I begin an exciting new chapter of a career deeply embedded in geriatrics, I am thrilled by the opportunity to serve as the new President of the John A. Hartford Foundation and bring all of my experience, expertise, and energy to the challenging task of creating transformative change in the way health care is delivered to older Americans.
Many of you already know me, but for those of you who don’t, let me briefly introduce myself: Most recently, I was University Distinguished Professor and Dean of the Bouvé College of Health Sciences at Northeastern University. Before that, I was the Erline Perkins McGriff Professor of Nursing and founding Dean of the New York University (NYU) College of Nursing. For 15 years, I also served as co-director of the Hartford Institute for Geriatric Nursing at NYU, and have held faculty appointments at Boston College, Columbia University, Yale University and the Harvard Division on Aging. I also am an elected member of the Institute of Medicine, and have held leadership positions at the American Geriatrics Society and the Gerontological Society of America, among others. My passion for improving the care of older adults has been central in all of these roles.
Did you hear the story about the New York woman who fought tooth and nail to honor her father’s wish to die at home, only to have the health care system bounce him from facility to facility? He died in a hospital hospice unit with deep pressure ulcers and a million dollars in costs for care that was unwanted.
Or how about the piano teacher dying from cancer who Atul Gawande wrote about? Through a conversation about her priorities, she returned to teaching his daughter and other students, all during home hospice care over the last six weeks of her life. She focused not on having a good death, but on having the best days possible right until the end.
These are stories that stuck with me. They hit a chord. They struck a nerve. However you describe it, they changed the way I was thinking and compelled me to share them—to get others outraged or to give them hope.
Over 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.
Antonio Z. Zuniga, a first-generation Mexican American, who gave inspirational and spiritual lectures in the U.S. and around the world. Here, at the Cliffs of Moher, Ireland, one of the many countries where he once spoke.
After a long career writing primarily for newspapers and magazines, Marielena Zuniga took early retirement with the idea that she would finally be able to accomplish a goal shared by many writers: to get a book published.
She managed to self-publish Loreen On The Lam: A Tennessee Mystery, and also focused on creative inspirational and spiritual writing. But Zuniga soon found herself in a new and unexpected role: as a fulltime caregiver for her father after he suffered a stroke.
Rosemary Rawlins, right, and her mother in “The Bistro.”
For much of the past 13 years, Rosemary Rawlins has found herself thrust into the role of family caregiver in a series of very different scenarios.
First, her husband, Hugh, suffered a severe traumatic brain injury (TBI) after being hit by a car while riding a bike in 2002 and underwent two years of arduous rehabilitation. Then, a year after her husband made a recovery bordering on the miraculous, Rawlins became a caregiver to her parents, as described in her prize-winning story below. And most recently, she helped her husband take care of his father through Parkinson’s disease until he passed away last September, and is preparing to have her mother-in-law move in this spring.
The Amjad Family “village” in 2014.
At the age of 4, Halima Amjad was already telling people she wanted to be a doctor. And not just any doctor.
“I used to say that I want to be Mommy and Daddy’s doctor,” says Amjad, MD, MPH, a clinical and research fellow in geriatric medicine at Johns Hopkins University School of Medicine and winner of the 2014-15 John A. Hartford Foundation Story Contest. “I don’t think I actually meant anything by that, but it ultimately ended up coming true that I chose geriatrics as my parents were getting older.”
Rosemary Rawlins, whose story “Gratitude for End of Life Lessons” tied for second prize in the contest, sits in “the Bistro” with her mother.
“Every time my Mother has a stroke, she wakes up a completely different person. This is okay because, as my Dad once observed, we’ve liked every person she’s been.”
“In the past few months, my sister has stopped talking. She’ll want to say something, realize she can’t, throw up her arms and roar.”
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.