Category Archives: Health Policy

Using Big Data to Improve Care for Older Adults


Click on image above to view or download a PDF of the Dartmouth Atlas Project report.

To fulfill our mission of improving the care of older adults, it is critical to know what is working—and what is not—when it comes to health care for the nation’s growing number of older people. That is why The John A. Hartford Foundation supported a new report from the Dartmouth Atlas Project titled Our Parents, Ourselves: Health Care for an Aging Population.

“This report is really about success,” says Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “Life expectancy has almost doubled since the 1900s, from 40 years to 80 years today. The number of adults over age 65 also is projected to almost double in the coming decades, from 43.1 million in 2012 to 83.7 million by 2050. This is truly remarkable and something to celebrate. However, we now need to achieve the same level of success in meeting the care needs of this growing aging population.”

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Join the Effort to Ensure That Medicare Covers Skilled Nursing Care for Those Who Need It

CMA_logo_400pGlenda Jimmo is a name you should know.

Mrs. Jimmo, who is blind and had her leg amputated due to diabetes, was the lead plaintiff in a lawsuit brought against the Centers for Medicare and Medicaid Services (CMS) in 2011 by the Center for Medicare Advocacy on behalf of beneficiaries and seven national organizations representing people with chronic conditions. Mrs. Jimmo requires a wheelchair and needs weekly home health services for her complex conditions. However, she was denied Medicare coverage for services on the grounds that she was unlikely to improve.

This rule of thumb—that Medicare services for skilled nursing or therapy should be discontinued when a patient “plateaus” or will no longer improve—is wrong.

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A Trifecta of Good News for Supporters of Elder Justice

older_Americans_400pFor those of us who have long advocated for a national agenda to prevent, detect, treat and report the mistreatment of older adults, developments over the summer have sparked some measure of hope and optimism.

The cause of elder justice hit the trifecta, with good news coming from all three branches of the federal government. First, the U.S. Supreme Court decision upholding the Affordable Care Act represented a victory for the Elder Justice Act as well. Enacted by Congress as part of the ACA, the Elder Justice Act targets the widespread issue of elder abuse in communities and long-term care facilities.

Then, at last month’s White House Conference on Aging, President Obama announced that a new rule to be issued by the end of 2015 will clarify that, among other approved uses, assistance funds from the Victims of Crime Act may be used to aid elder victims of abuse, financial exploitation, fraud, and neglect.

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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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White House Conference on Aging Shines Spotlight on Issues That Matter

whcoa_select_400pThe White House Conference on Aging offers a special, once-a-decade opportunity to focus national attention on issues that the John A. Hartford Foundation has been working on every day for more than three decades. So I am honored and excited to be among those invited to attend this year’s gathering on July 13 with President Obama, national leaders, colleagues in the field, and people participating virtually across the country who will all join in a national conversation about our aging nation.

At the John A. Hartford Foundation, our focus is on better care for older Americans. We believe that improving the quality of care and the way it is delivered will result in better health for older adults and lower health care costs for the nation as a whole. “Healthy Aging,” one of four policy briefs drafted for the conference, addresses issues that are integral to the Foundation’s current grantmaking strategies, including managing chronic conditions, and prevention and treatment for diseases and behavioral health conditions.

I fervently hope that the national dialogue sparked by the conference will lead to more widespread recognition of the critical role to be played by health professionals with specific expertise in aging, and will support efforts to develop, test, and widely spread evidence-based models of care for older adults that achieve better health outcomes at lower costs.

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Using Storytelling to Drive Change

Caregiving_Walk_400pDid 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.

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IOM Study Offers Hope for Solutions to Challenges Facing Family Caregivers of Older Adults

Gary Epstein-Lubow, MD

Gary Epstein-Lubow, MD

The first place I worked after completing my geriatric psychiatry training was an outpatient neurology clinic devoted to memory disorders. I soon realized that most patient encounters included other people who, in my opinion, could benefit from my attention: family caregivers—spouses, adult children, close friends, significant others, and occasionally parents—who usually accompanied my patients on their visits and had needs that were not being addressed.

I solved this dilemma of how to work with family caregivers through two action items. First, I honed my personal style to allow multiple opportunities for the patient and family members or friends to report concerns and ask questions. Second, I provided reliable avenues for a designated family caregiver to contact me after the patient visit.

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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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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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