Editor’s Note: Health AGEnda recently spoke with Dr. Joseph Gaugler, professor at the University of Minnesota School of Nursing and co-editor (along with Robert Kane, MD) of the new book Family Caregiving in the New Normal. This unique work addresses challenges and offers cost-effective solutions via a comprehensive “roadmap” for family caregivers, clinicians, and policymakers. It also includes chapters from members of the Hartford Change AGEnts Dementia Caregiving Network, a multi-sector, interdisciplinary team of leaders with expertise in practice, policy, and research related to caregiving and dementia whose mission is to achieve improvements in services, supports, and care for those with dementia and their family caregivers.
Making systemic, large-scale practice change is the idea behind the John A. Hartford Foundation Change AGEnts Initiative, which is featured in our 2014 annual report. We approach our annual reports a bit differently than many other organizations. Rather than just recounting our grants and financial statements for the past year, we prefer to focus on one facet of our work and explore it in-depth.
Mrs. Jimmo, who is blind and had her leg amputated due to diabetes, was the lead plaintiff in a lawsuit brought against the Centers for Medicare and Medicaid Services (CMS) in 2011 by the Center for Medicare Advocacy on behalf of beneficiaries and seven national organizations representing people with chronic conditions. Mrs. Jimmo requires a wheelchair and needs weekly home health services for her complex conditions. However, she was denied Medicare coverage for services on the grounds that she was unlikely to improve.
This rule of thumb—that Medicare services for skilled nursing or therapy should be discontinued when a patient “plateaus” or will no longer improve—is wrong.
Dr. Suzanne Landis has devoted her life to improving care for older adults.
Suzanne Landis, MD, MPH, drives an older, sensible car. She is an understated person often found standing in the back row of group photos. But don’t let her modest demeanor fool you.
She is one of the most giving and effective people I know. Dr. Landis, who practices geriatrics in rural Western North Carolina, leads the Center for Healthy Aging at the Mountain Area Health Education Center.
Chris Langston, right, with his “Faraway” grandmother Nancy Imber, circa late 1970s. Joining them are his mother Adair and younger sister Anne.
When I was a child, I had two grandmothers. A nearby grandmother (Gammy) and a faraway grandmother, known forever after just as “Faraway.” I know she found it rather odd to be looked right in the face and addressed as “Faraway,” but as it was all I ever knew, it seemed just right to me.
In her last years, after the death of her second husband and the usual pile-up of chronic conditions, my Faraway grandmother came to live with her daughter, my mother. But the active and interested woman we had known was gone. She had lost most interest and pleasure in activities that had previously occupied her and seemed unwilling to try new things.
The White House Conference on Aging offers a special, once-a-decade opportunity to focus national attention on issues that the John A. Hartford Foundation has been working on every day for more than three decades. So I am honored and excited to be among those invited to attend this year’s gathering on July 13 with President Obama, national leaders, colleagues in the field, and people participating virtually across the country who will all join in a national conversation about our aging nation.
At the John A. Hartford Foundation, our focus is on better care for older Americans. We believe that improving the quality of care and the way it is delivered will result in better health for older adults and lower health care costs for the nation as a whole. “Healthy Aging,” one of four policy briefs drafted for the conference, addresses issues that are integral to the Foundation’s current grantmaking strategies, including managing chronic conditions, and prevention and treatment for diseases and behavioral health conditions.
I fervently hope that the national dialogue sparked by the conference will lead to more widespread recognition of the critical role to be played by health professionals with specific expertise in aging, and will support efforts to develop, test, and widely spread evidence-based models of care for older adults that achieve better health outcomes at lower costs.
The John A. Hartford Foundation was one of just four new awardees chosen in 2012 to serve as an intermediary between SIF and subgrantees implementing innovative care models. As a result, a $3 million federal grant has been matched by $3 million from the John A. Hartford Foundation, with additional matching grants from the subgrantees, to spread the IMPACT/Collaborative Care model in Washington, Wyoming, Alaska, Montana, and Idaho.
Surrounded by five distinct mountain ranges, Missoula, Montana has been dubbed the Garden City, attracting vacationers and newcomers lured by its natural beauty. It also is considered a hub for services for the surrounding rural and frontier counties.
From left, Terry Fulmer, James D. Farley, and Mathey Mezey at the opening of the Hartford Institute for Geriatric Nusing at NYU in 1997.
All of us at the John A. Hartford Foundation feel a profound sense of loss at the passing of one of the guiding lights of our mission to improve the health of older Americans: James D. Farley, Chair Emeritus of the Board of Trustees.
Jim Farley, who died peacefully at home in Hobe Sound, Florida, on June 17, served as a Trustee for 25 years, from 1977-2002, and was Chair for his last 13 years on the board. He was an astute and principled leader, a man of integrity and the highest standards who was always willing to speak his mind.
From right, JAHF’s Amy Berman and Terry Fulmer, Jon Broyles of C-TAC, and Bud Hammes of Respecting Choices engage in the convening.
Imagine Shirley, an 84-year-old woman with end stage renal failure. Her clinician has proposed continuing a daily dialysis treatment that will extend her life, but that is exhausting and uncomfortable. Overwhelmed by her condition, Shirley has little ability to articulate that she may want something different from her care, and her family is similarly unprepared to help her seek out or weigh any available alternatives—for example, medication and homecare.
What would it take to ensure that Shirley and the millions like her at the end of their lives each year receive the high-quality care that meets their unique needs? To help answer this question, the John A. Hartford Foundation (JAHF) recently convened a meeting at its offices in New York City focused on “End of Life and Serious Illness,” gathering leading innovators in the field and funders with deep interest in this area.
It was the first board meeting under the direction of our new President, Terry Fulmer, PhD, RN, FAAN, and it was the last board meeting for our long-time board chair, Norman H. Volk, who is succeeded by Margaret Wolff. Demonstrating the John A. Hartford Foundation’s commitment to our current strategies to create widespread and systemic practice change in health care, the Trustees approved $10.3 million in six new grants to improve the health of older adults, our largest authorization in many years.
The new grants add muscle to four of our five funding areas comprising the Foundation’s current strategic plan. And our fifth strategy, Interprofessional Leadership in Action, is certainly validated by these projects, most of which are the culmination of several years—sometimes decades—of work by leaders in the field of aging and health who we have helped develop and support.