Many of the John A. Hartford Foundation’s grant projects are working hard to improve the quality of health care for the older adults who are dually enrolled in both Medicare and Medicaid.
As a group, these low-income, older adults have more complex health conditions and a greater need for coordinated, geriatrics-expert care that meets their own individualized health goals.
To improve quality and reduce costs in this population, states are working with the federal government and local managed care health plans to integrate the financing and care delivered through Medicare and Medicaid. Changes are happening fast as states experiment with delivering care to this population of “duals” through these health plans, many of which have never had experience caring for an older adult population with complex conditions.
Since launching our Hartford Change AGEnts initiative late last year, we’ve taken the first steps toward our goal of accelerating sustained practice change that improves the health of older Americans, their families, and communities.
Change AGEnts are connecting through our online community and the first two Change AGEnts Networks—focused on patient-centered medical homes and dementia caregiving—are already hard at work. We’ve funded nine Change AGEnts Action Awards and are currently accepting applications for our second cohort, and we’ve awarded collaborative pilot grants in partnership with the Change AGEnts program for our Centers of Excellence Scholars and for Beeson Scholars.
The initiative’s leadership team and our partners at the Gerontological Society of America (GSA) are working hard to support the Change AGEnts community and are ready and willing to help people engage. Since we get lots of questions about how people can get involved, we thought that addressing them in a Q&A would be helpful and highlight some immediate opportunities.
Ever 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.
While 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.
I 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.”
Yesterday, 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.
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, 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.
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.
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.