One of this blog’s authors, Dr. Kevin Biese, right, and Dr. Jan Busby-Whitehead lead a collaborative project at UNC-Chapel Hill to develop a unique model of a geriatric emergency department (ED) focused on improving care transitions.
Editor’s Note: This is the first of two parts.
“Geriatric Emergency Medicine”—As health professionals in Emergency Medicine (EM) who have chosen to focus on the geriatric population, we wish we could claim the topic brings a sense of excitement and opportunity to EM physicians worldwide.
This week we offer a poignant story of one physician’s struggle to understand what he could do to help his aging and ailing new patient. Written by Dr. Mitch Kaminski, and originally posted on Pulse, a leading narrative medicine website, this true tale makes the point that if we don’t understand a person’s own personal health goal, we are unlikely to achieve it.
We are unlikely to help them.
The John A. Hartford Foundation is deeply committed to aligning care by all health care providers to address the goals of older patients. As people age and become much more medically complex and frail, well-intended treatments may not help with pain or function. The treatment may create new problems and burdens.
Throughout 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.
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.
Todd Shurn and his mother, Alice, in 2013. Todd became a fulltime caregiver when his mother could no longer live on her own due to dementia. Photo courtesy of Todd Shurn.
Editor’s Note: The Jan. 15 deadline for submissions to the John A. Hartford Foundation’s second annual story contest is fast approaching. This year’s theme is Better Caregiving, Better Lives: Real Life Strategies and Solutions, and we are looking for stories from family caregivers and health care providers that illustrate the strategies and solutions caregivers are using to effectively and gracefully care for older adults. We are especially interested in stories about caring for older adults with dementia/Alzheimer’s disease.
So today, we share a dementia caregiving story written by one of this year’s contest judges, Yanick Rice Lamb, who teaches journalism at Howard University and is co-founder of FierceforBlackWomen.com, which partnered with TheRoot.com on the article. Lamb wrote a special introduction for Health AGEnda discussing how she approached writing the story and what she hoped to accomplish. It is our hope that Yanick’s behind-the-scenes insights into the writing process and her well-written, moving story will inspire others to share their own stories with us, and shine a light on how to “show” a story, not just “tell” it.