Health AGEnda

Of Knights, Knaves, and Pawns: Physician Disillusionment and the Need to Realign Our Health Priorities

Doctored_Book_Cover_300pEver 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.

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Welcome to the New Cohort of Health and Aging Policy Fellows

Health-and-Aging-Policy_300While 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.

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Report Sheds Light on Difficulties of Family Members Caring for People with ‘Challenging Behaviors’

Caregivers_Report_Cover_300pI 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.”

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Public Reporting Alone Will Not Fix Nursing Home Problems

NYT_Capture_NursingHomes400Yesterday, the New York Times had an interesting piece looking at the star rating system that Medicare has been using to evaluate long-term care facilities.

Coincidentally, I was moved to learn that a family friend, my “Aunt Betsy,” has been in an institution for going on 10 years, exceeding almost every expectation for longevity in advanced dementia.

The Times writer, Katie Thomas, observes that much of the data that drives this public reporting system, Nursing Home Compare,  of “hotel-like,” 1- to 5-star ratings comes from institutional self-report and seems susceptible to gaming—including staffing up for the critical two weeks that are the basis of reporting for the year’s rating, and then letting the staff go immediately afterward. Sort of the way that television shows pump up their ratings with guest stars during sweeps week and then fall back to meh afterwards.

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Remembering Jessie Gruman

Editor’s Note: This post was originally published  Aug. 15 on the Health Affairs Blog.

Jessie Gruman: "an elegant, gracious, yet fierce warrior advocate."

Jessie Gruman: “an elegant, gracious, yet fierce warrior advocate.”

Jessie Gruman, founding president of the Center for Advancing Health, died on July 14 after a fifth bout with cancer. Jessie was a hero to patients, families, and health care providers for her selfless work to help people better understand their role and responsibilities in supporting their own health.

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MSTAR Students Already Making Important Contributions to Geriatrics Research

Daniella Schocken, a student at the Icahn School, presents on her research on a Mount Sinai emergency department program that deploys EMTs to help older adults transition home after hospitalization.

Daniella Schocken, a student at the Icahn School, presents on her research on a Mount Sinai emergency department program that deploys EMTs to help older adults transition home after hospitalization.

What did you do for summer vacation? While many of us head to the beach or elsewhere to relax and get away from it all for a while, 149 enterprising students across the country instead devoted the break between their first and second year of medical school to learning about geriatrics and aging research.

Through the Medical Student Training in Aging Research (MSTAR) program, these future physicians engaged in geriatrics training and a mentored research experience at medical schools with outstanding geriatrics programs.

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Hartford Change AGEnts Action Awards: Round 1 & Round 2 (Hot Dog!)

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Recently, while spending some time with my sister and her kids, I had the pleasure of overhearing a conversation between my eight-year-old son, Westley, and his six-year-old cousin, Beckett.

It went like this:

Westley: [Exasperated] Beckett, you knoooow I can’t read minds.
Beckett: Times up! [Dramatic pause] I was thinking about hot dog stands.

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Reflections on a Summer at the Hartford Foundation

Before starting my internship with the John A. Hartford Foundation, the notion of improving health outcomes while decreasing costs appeared implausible. Securing strong patient-centered care for a loved one had to come at an extra expense—a large price tag for both the individual, his family, and the institution administering the care. After all, my family recently hired a home health aide to assist and advocate for my grandfather during his stay in the hospital and then during hospice, what is supposed to be one of the most patient-centered forms of care. My family believed that a consistent, if costly, presence and support system would serve him well during employee shifts and other downtime between caregivers.

And it made a difference. Our aide, Abdulai (last name withheld), served as my family’s lifeline, the person my grandfather could rely on for personalized and direct care, the person my mother could trust in clarifying medications and complicated procedures.

Author Caitlin Brookner (back, left) with her cousins and grandfather.

Author Caitlin Brookner (back, left) with her cousins and grandfather, Leonard Weisberg.

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Tools You Can Use:
The Essentials of Cardiovascular Care in Older Adults

ACC_seal_blue_dark300The most potent risk factor for heart disease is aging, according to the American College of Cardiology (ACC). Given how rapidly our population is aging, that’s sobering news indeed, especially when you consider that clinical practice guidelines rarely apply to older adults with multiple chronic conditions.

That means regardless of how experienced and skilled a cardiologist or other clinician may be in treating cardiovascular disease, they may not have received adequate training in how best to treat cardiovascular disease in older adults.

Fortunately, the American College of Cardiology has released the Essentials of Cardiovascular Care in Older Adults (ECCOA), a free, online self-assessment curriculum designed for cardiovascular specialists and other clinicians who care for older patients with cardiovascular disease. (Continuing education credits are available for physicians and nurses). The curriculum was developed with funding from a John A. Hartford Foundation grant.

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