Health AGEnda

Fellowship Offers Opportunity to Hone Policymaking Skills

Health-and-Aging-Policy_300“The Health and Aging Policy Fellowship gave me access to national health policy leaders that I continue to work with to make a greater impact in promoting the health of vulnerable older adults.”

This is what Adriana Perez, one of the 2012 Health and Aging Policy Fellows (HAPF), recently told me regarding her Fellowship at the Centers for Disease Control.

Adriana, an alumna of our Hartford geriatric nursing post-doc fellowship, told me that among the numerous benefits she derived from the program, “I also had the opportunity to build my own interprofessional network with diverse fellows at all stages of career trajectories—who are all passionate about gerontological health.”

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A Little Bit Louder Now: How The John A. Hartford Foundation Is Learning to Speak Up for (and with) Older Adults

GIH_AM_2014_WEBWe know that to some people, foundations simply seem like large ATM machines. If you have the right card and the right code, then voila, the money for a project or organization is dispensed and you’re done. But we, and many of our funder colleagues, strive to be more than this. We hope that we can add value to the work of grantees, supporting them in ways that go beyond the grant check.

I was invited to write an essay for the annual meeting of Grantmakers in Health, a membership organization for foundations like ours working to improve health and health care. The theme was “The Power of Voice,” and we were asked to share how we use the Foundation’s position and influence to advance our mission and how we amplify the voices of our grantees and stakeholders (for us, older adults). We wanted to share this essay about the Foundation’s communications and “noise-making” efforts and you can read other health foundations’ perspectives here.

We hope this provides some insight into our thinking and motivation for you to join us in raising your voice for better health of older adults.

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Wanted: Hartford Change AGEnts with Red Pens

TS_176889370_red_pen300When I was first hired at the John A. Hartford Foundation, I gave one of the then-Senior Program Officers a giant cup filled with new red pens. It seemed to me at the time that the program staff spent a lot of time editing (aka “making stronger”) all sorts of documents—evaluations, grant proposals, drafts of annual reports, etc.

At the Hartford Foundation we strive to be thought partners with our grantees and, thus, like to share feedback. We share loads of feedback among our staff. In fact, we have been trained on how to receive feedback: Simply nod, say “Thank you,” reflect on the input, and incorporate what is helpful.

Now, for the benefit of the Hartford Change AGEnts initiative, we are seeking your feedback. Here is your virtual cup of red pens. We are in the process of creating documents that define the AGEnts Initiative and we need you.

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Content of Care and Patient Population Are Crucial in Evaluating Patient-Centered Medical Homes

TS_83405698_doctor300This week, a RAND research team published a report in the Journal of the American Medical Association (JAMA) on a three-year evaluation of Patient-Centered Medical Homes in Pennsylvania, funded by the Commonwealth Fund and Aetna. Since, like almost everyone else, we believe in the potential benefits of enhanced primary care, this is an important paper.

However, its implications are very complicated. I believe the results confirm concerns I had from the beginning that this kind of project wouldn’t work. Why? Because it wasn’t focused enough on the complexly ill and it didn’t incorporate enough special expertise in their care.

The evaluation was led by Mark Friedberg, MD, and used a pre-post, matched practice/patient design where 32 practices worked to become medical homes. The outcomes of the practices and the patients were tracked over three years. A non-random comparison group was created by looking at other practices and patients followed over the same time period to serve as a contrast group not implementing medical home elements.

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New Guidelines Show What a Geriatric Emergency Department Should Look Like

TS_emergency_300A hospital emergency department can be a chaotic and dangerous place for older adults, resulting in poor outcomes, distress, and dissatisfaction for them and their families.

We’ve had several posts on Health AGEnda related to emergency department (ED) care of older adults (See Building a Better Emergency Department for Older People, Collaboration Across Departments and Foundations Leads to Improved Emergency Care  , and Can EMTs Improve Outcomes for Older Adults Leaving ER?). Older people use emergency rooms in greater numbers than younger adults, and once admitted are more likely to have an emergent or urgent condition, be hospitalized, and be admitted to a critical care unit.

Fortunately, there’s a growing cadre of passionate emergency medicine physicians with geriatrics expertise who are trying to improve emergency care for older people. This is happening in part through the American Geriatrics Society’s Geriatrics for Specialists Initiative and the Jahnigen Scholars program, which we’ve funded for years. The Atlantic Philanthropies and others have supported the Jahnigen Scholars as well as work in specialty nursing care, reaching out to emergency nurses to build their geriatrics expertise.

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Two Decades In, Evidence Still Mixed on Culture Change in Nursing Homes

Geron_Suppl_Cover300This 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. .

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The Direct Care Workforce: Fundamental to the Health of Communities

Steven Dawson of PHI addresses the briefing on direct care workers held recently by Philanthropy New York.

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.

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Valentines for the Hartford Change AGEnts (and my Dziadzia)

From left, Dziadzia, Rachael Watman, and Rachael's grandmother in 1971.

From left, Dziadzia, Rachael Watman, and Rachael’s grandmother in 1971.

My grandfather, Albert Chura, was born on Valentine’s Day in 1907, on a boat en route to the United States from Poland. His family wanted to make a better life in America. And after a lifetime of doing so, at the age of 83, he died on my birthday.

Valentine’s Day always makes me think of Dziadzia (Polish for Grandfather and oddly pronounced Judgie—“Mom, that can’t be how you spell it!”)

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