Health AGEnda

On Each Other’s Team: What We Can Learn By Listening to Older Adults

poll_satisfaction350If our work at the John A. Hartford Foundation has taught us one thing, it’s this: In the quest to transform primary care for older adults, a huge part of the answer is deploying more geriatrically expert primary care teams that can coordinate and deliver care designed around the patient’s needs. You could call this the low-hanging fruit of health care reform, because, if there is a population in which we have the biggest opportunity to see improvements in both cost and quality of care outcomes, it is older Americans.

The debate on how best to deliver effective primary care has gone on a long time, sometimes frustratingly so, but it has almost never included a crucial constituency: older adults. Today we are pleased to help change that.

We believe that listening to older adults is essential if we are ever going to transform our primary care system so it can and does deliver well-coordinated, comprehensive, accessible care centered on their needs and goals. This belief has already led the Hartford Foundation to conduct two previous public opinion polls, focused exclusively on adults 65 and older, examining serious gaps in geriatric primary care and mental health care.

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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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CoE Pilot Grants Help Illuminate Hartford Change AGEnts Initiative

TS_150878885ChangeAGEntsFor 20 years, the Hartford Centers of Excellence (CoE) in Geriatric Medicine have been supporting the development of geriatrician faculty at schools of medicine across the country. These scholars have become researchers, educators, and clinicians, helping transform academic medicine to better prepare the next generation of physicians to care for older adults.

As we forge ahead with our new strategic plan to rapidly change health care practice to improve the health of older adults, our funding for the Centers is winding down. We are now intent on helping current CoE scholars and alumni, in addition to our academic superstars in nursing and social work, utilize their geriatrics expertise to change health care delivery for the benefit of older adults. We believe this is best achieved by helping them to connect and collaborate.

We are pleased that many of our existing grants are aiding in this transition. Funds within the CoE program, administered by our grantee the American Federation for Aging Research (AFAR), have been repurposed to bring together CoE Scholars and support their work to improve care for older adults. In doing so, we are offering five $40,000 grants to fund collaborative pilot projects.

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Beyond the Boardroom: Interview with Dr. Bruce Chernof

The_SCAN_Foundation_-_Logo300In the world of philanthropy, there are only a handful of foundations focusing on aging and even fewer on aging and health issues.

Five years ago, The SCAN Foundation—an independent private foundation created by, but independent of, The SCAN Health Plan in Long Beach, Calif.,—was born. Over the years, they have been excellent colleagues, co-leaders in Grantmakers in Aging (GIA) and occasional partners on projects. In 2013, the John A. Hartford Foundation  and The SCAN Foundation together cofunded an $800,000 grant to the National Committee for Quality Assurance (NCQA) to take on a major challenge: to help develop measures of quality of care for frail and disadvantaged elders that would be based on personalized goals of care and preferences.

In December 2013, Bruce Chernof, MD, president and CEO of The SCAN Foundation, spoke to the Hartford Foundation board about SCAN’s new five-year strategic plan, long-term care reform, and our deepening partnership. We look forward to working with Dr. Chernof and our other colleagues at SCAN over the next five years and beyond.

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Boxing Day Brings Glad Tidings for Geriatrics Field

TS_122567399_BoxDay_200Happy Boxing Day! This holiday season we got an unexpected gift in geriatric medicine.

One of the most easily counted indicators of the success of geriatrics in medical education is the number of graduating resident physicians choosing additional training in geriatric fellowship programs. Each year, the Journal of the American Medical Association compiles the number of trainees in residency and fellowship programs, and the past two years, I’ve graphed the trends and stirred the tea leaves to try to divine the future of the field. (Read Decline in geriatric fellows defies pay boost: +10% = -10% from 2012  and Falling Leaves, Falling Numbers from 2011.)

Last year, I was concerned and puzzled by what looked like continuing and consistent declines in first-year geriatric fellows in Internal Medicine (IM) and Family Medicine (FM) based programs, despite improving financial incentives. This year, there is an abrupt improvement, with first-year fellows in IM and FM rising by almost 20 percent.

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What’s Next for the Change AGEnts Initiative?

agents_launch_sign_300Ok. We did it. We collectively put Chris Langston’s “What-if-we-have-a-party-and nobody-shows” fears to bed.

We had hoped for 200 attendees at our launch of the Change AGEnts Initiative at the Gerontological Society of America’s (GSA) annual meeting last month. Huzzah! Close to 400 Change AGEnts showed and actively participated in the interactive activities designed to inspire conversation and connections.

In case the launch or the AGEnts initiative has been off your radar:

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New Grants Lighting a Path to Better Care for Older Adults

TS_155483657_light300In health care for older adults (and for everyone really), we know where we want to end up.

It gets articulated in different ways, but generally speaking I think we can all agree we want care for our older loved ones that is coordinated, comprehensive, continuous, and geriatrically expert.

But the path that gets us to that destination is often unclear. To help guide us—the John A. Hartford Foundation and all other stakeholders in the business of health care—we have just funded three grant projects that we hope will shine a light on the way forward.

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Tools You Can Use: A Non-pharmacologic Toolkit for Addressing Behavioral and Psychological Symptoms of Dementia

Toolkit_Capture300As part of our Tools You Can Use series, we like to feature new products and resources that improve the health of older Americans. In this installment, two researchers share a free toolkit that provides evidence-based resources for staff in senior living communities promoting non-pharmacologic strategies to address behavioral and psychological symptoms of dementia.

The toolkit, presented by Ann Kolanowski, PhD, RN, the Elouise Ross Eberly Professor and director of the Hartford Center of Geriatric Nursing Excellence, College of Nursing, Penn State, and Kimberly Van Haitsma, Ph.D., a Clinical Health Psychologist with a specialization in geriatrics at the Polisher Research Institute, addresses a huge problem.

More than 5 million Americans are living with Alzheimer’s disease, with the direct costs of their care in 2012 totaling $200 billion, including $140 billion in costs to Medicare and Medicaid, according to the Alzheimer’s Association. The burden of care to family and formal caregivers is equally troubling: 90 percent of people with dementia will hit, scream, become verbally abusive, or resist care at some point.

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Beyond the Boardroom: Interview with Dr. Amy S. Kelley

Dr. Amy S. Kelley

Dr. Amy S. Kelley

In recent weeks on Health AGEnda, we have presented our five new program strategies: Leadership in Action, Linking Education to Practice, Developing and Disseminating Models of Care, Tools and Measures for Quality Care, and—last but not least—Public Policy and Communications. Paired with each strategy description, we have also presented an interview with a John A. Hartford Foundation grantee who is already doing the work, showing the potential value of the strategy.

If our shift in strategy moves our focus from “upstream” academic capacity building to a “downstream” emphasis on the determinants of practice, these vanguard leaders are shooting the rapids and teaching us what can be done with geriatric expertise.

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Helping Older Adults Live Safely and Independently: An Interview with Aanand Naik, MD

Dr. Aanand Naik

Dr. Aanand Naik

Over the past several weeks, we’ve been introducing the John A. Hartford Foundation’s  new funding areas and we’ve been highlighting examples of people and projects that exemplify the work we want to support under each strategy. Last week, Wally Patawaran discussed our Tools and Measures program area, which will support the improvement and advancement of quality measurement and information technology that can drive improvements in clinical practice and patient outcomes.

Today, we are sharing an interview with Dr. Aanand Naik, a geriatrician and a health services investigator at the DeBakey VA Medical Center in Houston and associate professor of medicine at Baylor College of Medicine. Dr. Naik was a Hartford Health Outcomes Research Scholar and affiliated with our Center of Excellence in Geriatric Medicine at Baylor.

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