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.
We were introduced to Sally and her daughter Edna last year in a video from our grantee Community Catalyst. I learned recently that Sally has since passed away, but I am so grateful that her and her daughter’s story lives on.
It embodies the promise of the Voices for Better Health initiative, which advocates for quality care for low-income older adults and younger disabled people dually enrolled in both Medicare and Medicaid, as Sally was.
And fortunately, as states rapidly move to integrate Medicare and Medicaid financing and care for the “duals” population, advocates from Voices for Better Health and anyone concerned about people like Sally have a new resource.
I think it would be safe to say that most of us have trouble facing our own mortality. The idea that tomorrow isn’t promised fails to get many of us to actually live that way (I know I’m guilty).
Longer term and more connected to the John A. Hartford Foundation’s work, we don’t like to think of ourselves as “old”—let alone dying—and we don’t plan well for futures that will likely include the need for long-term care or services later in life.
Our health care system and policies reflect this short sightedness, as well. That’s why it’s been refreshing to see some provocative writing about these issues over the past few weeks that might help us all think and do more to live our final years in old age the way we would want.
Last week, the Institute of Medicine released a new report titled Dying in America.
The committee that worked on the report included some long-time grantees and friends of the John A. Hartford Foundation, such as June Simmons of the Partners in Care Foundation, Jean Kutner, a Beeson Scholar and faculty member at the University of Colorado, Diane Meier, leader of the Center to Advance Palliative Care, Patricia Bomba of Rochester, NY’s Excellus Blue Cross/Blue Shield, and Joan Teno of the Center of Excellence in Geriatric Medicine at Brown University.
As always, we are proud to be associated with leaders who give their time to explore such urgent issues.
Ever since I began working as a program officer at the John A. Hartford Foundation, I’ve tried to do my best to put myself in the shoes of the health professionals with whom we’ve worked and whose education and training historically has been one of our main concerns.
I’ve often found memoirs and other lightly fictionalized accounts to be the best way to get into the culture and daily experience of these health professionals. I’ve read Samuel Shem’s The House of God, countless memoirs of nurses and physicians, and even a very affecting memoir of a nurse’s aide in a nursing home.
One of the tricks of such reading is that we experience what our imagination and the author’s words together conjure in a special state of willing suspension of disbelief. Psychological research suggests that this process of imagination and purposeful lowering of critical skepticism is, in fact, what makes fiction so persuasive and engenders the feeling that novelists understand a truth about human character that other ways of knowing can’t match.
While many of our legacy grant programs continue to support the development of leaders in the field of aging and health research and education (see this week’s earlier Health AGEnda post about our latest Hartford/VA social work research scholars), new and growing investments under the John A. Hartford Foundation’s current strategic plan are also nurturing leaders in aging and health practice and policy change.
As part of our Leadership in Action funding portfolio, we recently approved a $1.6 million grant to co-fund the Health and Aging Policy Fellows program, in partnership with The Atlantic Philanthropies. The program, which offers fellows the experience and skills necessary to make a positive contribution to the development and implementation of health policies that affect older Americans, has just announced its 2014-15 class and we welcome them to the Hartford family and our community of Change AGEnts.
With representatives from many of our legacy strategy programs, including the Archbold Pre-Doctoral Nursing Scholars, the Social Work Doctoral Fellows and the Jahnigen Scholars in surgical and related medical specialties, we are assured that many of our academic program alumni are right there with us in the shift to our current portfolio of strategies focused on taking geriatrics expertise and evidence and making real and lasting improvements in health care delivery for our aging population.
I bet every reader of Health AGEnda knows someone who is a family caregiver (many see one every day in the mirror). And I bet every family member or friend providing care to an older adult who needs assistance because of chronic disease or frailty has their stories of good and bad days—of feeling incredibly fulfilled and completely overwhelmed.
Caregivers have much in common with each other, and our policies and systems need several overarching improvements to address caregiver needs. That is why the John A. Hartford Foundation is supporting an Institute of Medicine study to lay out the top level policy and practice recommendations (For more information, read New Grants Target Policy and Practice Change.)
However, it is worth noting that not all caregiving is the same. A recent analysis funded by the John A. Hartford Foundation from the AARP Public Policy Institute and the United Hospital Fund points to the especially difficult circumstances of those who care for people with cognitive impairment (such asAlzheimer’s or other dementias) and/or behavioral health conditions (such as depression, anxiety or serious mental illness), referred to in the study together as “challenging behaviors.”
From left, featured experts Peggy O’Kane, Robert Berenson, and Caroline Blaum listen intently.
Like so many stakeholders in health care, we at the John A. Hartford Foundation have many of our hopes pinned on enhanced primary care as a way of improving health outcomes, particularly for older Americans who face multiple chronic conditions.
Primary care providers will need more skills, more teammates, community partners, and, of course, more money, to live up to these hopes. But we believe that better primary care can prevent some of the acute and expensive events such as hospitalizations that they experience, and thereby also lower total costs of health care.
July is an important month in history, with Bastille Day, on July 14, coming just 10 days after our own 4th of July. So what better time to consider issues of justice and equality?
There are lots of different ways to interpret equality: equality of outcomes, equality of opportunity, or perhaps—as an even more complex relative equality—matching of resources to individuals’ needs.
In the context of improving health care delivery to older adults, there are several important examples of these principles of equality in what is called “risk adjustment.” And I find myself with very different reactions to the different kinds.