Category Archives: Grantees

Geriatric Emergency Medicine: The Time to Act is Now
Part Two

Teresita Hogan, MD

One of this blog post’s authors, Teresita Hogan, MD, speaks on care transitions during the Geriatric EM Boot Camp in Milwaukee.

Editor’s Note: In our Feb. 19 Health AGEnda post, the team we’re informally calling the Hartford Geri EM Champions shared information about the first two Geriatric Emergency Medicine Boot Camps and a meeting hosted by the John A. Hartford Foundation in late January to discuss new opportunities to improve acute care of older adults. Today, in the second of two parts, our EM experts discuss why our current system is failing older Americans, and share their vision for better emergency department care that can both serve the needs of older adults and contribute to a more efficient and value-based health care system.

The acute care provided to older adults in emergency departments (ED) across the country, and world, is often inadequate and sometimes dangerous.

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Geriatric Emergency Medicine: The Time to Act is Now

Drs. Kevin Biese and Jan Busby-Whitehead

One of this blog’s authors, Dr. Kevin Biese, right, and Dr. Jan Busby-Whitehead lead a collaborative project at UNC-Chapel Hill to develop a unique model of a geriatric emergency department (ED) focused on improving care transitions.

Editor’s Note: This is the first of two parts.

“Geriatric Emergency Medicine”—As health professionals in Emergency Medicine (EM) who have chosen to focus on the geriatric population, we wish we could claim the topic brings a sense of excitement and opportunity to EM physicians worldwide.

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Focusing on the Health Goals of Older Adults

Missed_Target_400pThis week we offer a poignant story of one physician’s struggle to understand what he could do to help his aging and ailing new patient. Written by Dr. Mitch Kaminski, and originally posted on Pulse, a leading narrative medicine website, this true tale makes the point that if we don’t understand a person’s own personal health goal, we are unlikely to achieve it.

We are unlikely to help them.

The John A. Hartford Foundation is deeply committed to aligning care by all health care providers to address the goals of older patients. As people age and become much more medically complex and frail, well-intended treatments may not help with pain or function. The treatment may create new problems and burdens.

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Aging and Disability Services Need—and Deserve—Support

The Administration for Community Living, aging, disabilityThroughout my career in aging, I have worked for and with community-based agencies. I know how essential these agencies are in helping older people remain well and in their homes by providing and coordinating needed supportive services.

These critical services for older people who have difficulty with daily tasks or younger people with disabilities include home delivered meals, shopping, cooking, bathing, bill paying and/or emotional support, as well as support for their caregivers. In-home assessments determine exactly what is needed for each individual and their family.

The agencies providing these services have always operated on slim budgets funded by federal block grants and philanthropy. Due to funding limits, there are months-long waiting lists for older people who are desperately trying to remain as independent as possible for as long as possible in their own homes.

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Tools You Can Use: An Online Educational Series Focusing on Dementia in Older Adults

Caregiving_DementiaAbout 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.

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

ChangeAGEntsCrowdHands_400

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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A Positive Step Toward Dealing with Postoperative Confusion

postoperative_delirium_cover_300pIn 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.

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Hartford Foundation and CMMI Work Together to Spread Hospital at Home Model

Caregiving_400pFor two decades, the John A. Hartford Foundation has invested in the development and spread of the Hospital at Home model of care, which provides safe, high-quality, hospital-level care to older adults with select conditions in the comfort of their own home.

Over those years, studies have consistently shown that the model delivers improved care and outcomes at lower costs. But adoption has been limited, leading us to conclude that Hospital at Home was ahead of its time.

Now, its time has come. The Center for Medicare and Medicaid Innovation (CMMI), part of the Centers for Medicare and Medicaid Services (CMS), awarded a $9.6 million Health Care Innovation Award to the Icahn School of Medicine at Mount Sinai—in consultation with Johns Hopkins University—to test a version of Hospital at Home called the Mobile Acute Care Team (MACT).

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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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Health Services Research Needs Good Theory to Turn into Better Practice

HospitalOlderWoman_400pLast week, the Journal of the American Medical Association (JAMA) published a large and well-designed study of a post-hospital readmission reduction program called the “virtual ward,” which grew up in the UK and was tested by our cousins to the north in Toronto.

The model partakes of some elements of other evidence-based work done by John A. Hartford Foundation grantees, including Mary Naylor’s Transitional Care Model, the Society of Hospital Medicine’s Project BOOST, and Eric Coleman’s Care Transitions Intervention.

A press release and JAMA Report video are available for those who don’t subscribe to JAMA.

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