This month’s issue of The Gerontologist includes a supplement on culture change and transforming nursing homes. The issue features the work of long-time friends of the John A. Hartford Foundation and experts in the field like Deb Saliba, Phil Sloane, Claudia Beverly, Cornelia Beck, and Robyn Stone.
Because nursing homes are an important part of the continuum of care for older adults and not something likely to disappear, we at the Foundation think getting this part of long-term care right is very important (and why we support grantees like PHI—see Amy Berman’s post last week). The papers in the supplement grew out of a conference funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services and convened by RAND to understand what is known and where the gaps are in our understanding of culture change.
Culture change requires modification in both the training and deployment of the health care workforce. It calls for more skillful workers in more effective teams focused on the unique needs and preferences of the individual resident/patient. This long-term care population is necessarily frail and uses a great deal of medical services, along with the supportive services provided by the facilities. .
Steven Dawson of PHI addresses the briefing on direct care workers held recently by Philanthropy New York.
The health of any given community is fragile and complex. It is greater than the sum of individual health outcomes or access to care. The health of a community rests upon an infrastructure that meets the changing demands and needs of its people within constrained resources. Increasingly, our infrastructure needs to address employment, economic stability, and rising health care costs.
This is especially true given the sea change occurring, with 10,000 people turning age 65 each day in the United States. The maturing of the boomers is fundamentally shifting our view of what a healthy community looks like.
HPPAE is a practicum model for training second-year master’s level social work students in geriatric competencies. The model also includes providing students with a varied experience in several agencies serving older adults in their year-long internship program. Many of the agencies subsequently seek to hire their interns who are educated and expertly trained in providing care to their older clients. We are pleased to share a recent report describing the impact of the model.
What could be better than embarking on a path to a fulfilling career and along the way finding your life partner? I recently met Michael and Alyssa Aguirre who were eager to tell me their story and to thank the Hartford Foundation for funding the Hartford Partnership Program in Aging Education, which helped bring these two social workers together. Here is what they shared:
Our story begins at the University of Michigan School of Social Work in Ann Arbor, where we were both students in the Geriatric Scholarship Program, originally funded by the John A. Hartford Foundation. The unique opportunities offered to Geriatric Scholars drew us to the master’s social work program at Michigan. Being a part of this small cohort, we quickly met at a scholars’ event and got to know each other through several classes during the first nine months of graduate school.
Being a Geriatric Scholar also required that students complete an internship in Detroit, and we decided to carpool together over the summer after finding out that our internships were nearby. As the weeks went on, we realized how much we looked forward to our conversations during our long drives together. We discovered that we were both passionate about the outdoors, our faith, music, biking and of course, older adults. These shared interests bonded us together as we started dating and fell in love.
We believe very strongly that interprofessional teams provide the best care, especially for older people with serious multiple chronic conditions. In direct care as a geriatric social worker, I worked very closely with physicians, psychiatrists, nurses, physical therapists, as well as home health aides and family caregivers. It never occurred to me that my colleagues in other disciplines might not know what a social worker contributes to the team.
As the Grants Manager at the Foundation, my access to grantees is mostly limited to the reports they periodically send to us and the occasional evaluation site visit I attend. So, my focus is usally on the numbers: how grantees spend the money we awarded them and whether they are up to date on their requirements. But these numbers giveonly half the story of what we, as a Foundation, fund and how those funds contribute to improving the health of older adults.
Last week, along with many of my Foundation colleagues, I attended an event at the Weill Cornell Medical College featuring the exciting “end products” of one of our projects, the Medical Student Training in Aging Research Program (or MSTAR). The program enables medical students from across the country to learn about geriatric medicine and conduct research projects that aim to improve the care of older adults.
Shown in the picture are seven of the students and their mentors who participated in the program at the Cornell Division of Geriatric Medicine in New York (also a Hartford Center of Excellence in Geriatric Medicine). Their work showed me the wide range of problems that can befall an elderly patient and the solutions that can improve their care and produce better health outcomes.
As many of our readers know by now, our 2011 Annual Report features our work to address the mental health needs of older Americans. You can view the report online here, and we have begun running blog stories and associated videos that try to capture the experience of older people with mental illness who have benefited from foundation-sponsored programs. I am very proud of this work and the report.
It is just icing on the cake that shortly after the release of our mental health–focused annual report, the Institute of Medicine (IOM) released its examination of related workforce issues, called “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” The report explicitly frames itself as a follow-up to the 2008 Hartford Foundation co-sponsored IOM report, “Retooling for an Aging America: Building the Health Care Workforce.” The new study committee included many friends of the Foundation — including its Chair, Dan Blazer, who served with distinction on our Beeson Advisory Committee for many years; Chris Callahan, an early Beeson scholar and aging research leader at Indiana University (a Center of Excellence); Kitty Buckwalter, the recently retired director of our Center of Geriatric Nursing Excellence at the University of Iowa; and long-time colleagues Fred Blow and Steve Bartels of the University of Michigan and Dartmouth, respectively.
I greatly respect the fellows of the IOM who produced the report and I agree with their recommendations (listed below) — how could I not? The new recommendations are essentially rephrasings of the recommendations of the 2008 Retooling report, focusing on the subset of the geriatric health care workforce serving patients with mental health/substance needs. I hope that this time government and professions leaders will listen. I hope that the workforce provisions of the Affordable Care Act will be funded (and expanded) and I hope that as a society we will make the shift in workforce training and deployment that we need to support the well-being and independence of older adults.
In the next installment of our Beyond the Boardroom series, Senior Program Officer Rachael Watman interviews Kathryn G. Kietzman, PhD, MSW. Dr. Kietzman is a research scientist at the University of California, Los Angeles Center for Health Policy Research, a Hartford Social Work Doctoral Fellow, and a member of the inaugural class of The Atlantic Philanthropies-funded Health and Aging Policy Fellows. She is the project director of the “Helping Older-Adults Maintain Independence” (HOME) Study, which examines how low-income older Californians with long-term care needs develop and sustain a network of care that enables them to remain safely in their own homes.
Dr. Kietzman served as a consultant during our annual review of one of the Foundation’s grant projects, the Eldercare Workforce Alliance (EWA). The EWA is a coalition of 29 national organizations — representing consumers, family caregivers, the direct-care workforce, and healthcare professionals — joined together to address the immediate and future workforce crisis in caring for an aging America. In her interview, she discusses the EWA and its advocacy and policy efforts to expand and strengthen the workforce. She also shares about her own career trajectory, how she came to focus on care of older adults, and her current work on policy changes that will improve the health of our aging population.
Last week, I wrote about serendipitously discovering the work of Primary Care Progress, a grassroots physician advocacy group trying to strengthen primary care. The serendipity continued shortly after I saw their work in cyberspace, when I got a chance to meet some of its leaders in the real world (in Philadelphia). Because of the Foundation’s belief that enhanced primary care is one of the essential pillars for improving the health of older Americans, last Monday I attended a meeting sponsored by the American Board of Internal Medicine Foundation. The topic: returning joy to primary care.
You might wonder how returning joy to physicians and other people working in primary care (although most meeting attendees were MDs) would relate to the Foundation’s mission of improving the health of older Americans. But I think the evidence is clear that people who enjoy their work do it better, stay in their careers, and make the work seem more attractive to others. And, if we are to provide the kind of comprehensive and proactive primary care that older adults need, we certainly need more primary care providers (of all professions) who really want to do it.
At the Foundation, we have invested significantly in research and training to try to discover how primary care can better support healthy aging. Projects like IMPACT, Care Management Plus, Guided Care, and the Practicing Physician Education initiative have all tried to make that happen. Other projects such as Indiana University’s GRACE and the Atlantic Philanthropies-funded ACOVE Prime have also offered important lessons on how to make primary care more aging-friendly. We continue to be very interested in how reinvestment in primary care careers, improved payment, and systems redesign can make this critical part of the health care system better able to serve the older adult population. And, of course, we are very aware of the defects and frustrations of primary care as it often very ineffectively tries to serve older people, as I’ve written about here and here. (In a few weeks the Foundation will be releasing the results of its first-ever poll of the experience of primary care by older adults that we hope will shed some additional light on this topic.)
As you all know, we at the John A. Hartford Foundation have funded multiple programs designed to recruit and retain health care professionals in geriatrics. We are interested in learning what works: What is the best way to instill enthusiasm in students to pursue a career providing care to older adults? Two of our colleagues, Drs. Judith Howe and Robert Maiden, have written a compelling article on what led them into the field of gerontology. The article, “Accidental Tourists: How 2 Gerontologists Found their Field,” was published in The Atlantic on February 9, 2012, and can be found here.
Both Drs. Howe and Maiden stumbled into their careers and are glad they did. Now they are in exciting careers in aging, working with students and wondering how they can “reshape the landscape of gerontology so that it is viewed as an attractive, rewarding and esteemed career.” Judith Howe states she was fortunate to have several mentors who were pioneers in aging. We have found that mentoring is a key component in recruiting and nurturing students and faculty to the field of aging.