Category Archives: Health Policy

Caregiving: ‘A Gift and a Privilege’

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.

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.

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Family Caregiving: ‘A Progression of Life’

Rosemary Rawlins, right, and her mother in "The Bistro."

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.

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Dementia Caregiving: Returning to the Village

The Amjad Family "village" in 2014.

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.”

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Prize Winners in ‘Better Caregiving, Better Lives’
Story Contest Answer the Challenge

Rosemary Rawlins, whose story "Gratitude for End of Life Lessons" tied for second prize in the contest, sits in "the Bistro" with her mother.

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.”

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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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Hartford Change AGEnts Action Awardees: A Super Team Bound to Bowl You Over

While most people will be watching the Super Bowl Sunday, Rachael Watman is rooting for another team: the latest Hartford Change AGEnts Action Awards winners.

While most people will be watching the Super Bowl Sunday, Rachael Watman is rooting for another team: the latest Hartford Change AGEnts Action Awards winners.

I am not going to win many fans here: I don’t watch the Super Bowl nor do I really like football.

My husband just confirmed my suspicion that the Seattle team and somebody from New England are playing Sunday; he then schooled me on the details regarding “Deflategate.”

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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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Opening the Window of Opportunity to Needed Health Policy Change

Health_Affairs_Jan2015_300pPolicy 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.

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Tools You Can Use: The Quality Care Through a Quality Workforce Toolkit

megaphone_illustration_300pWe 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.

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Grappling with the Tough Questions of How We Live—and Die

SeniorsRoses_400pI 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.

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