Health AGEnda

Geriatric Emergency Medicine: The Time to Act is Now
Part Two

Teresita Hogan, MD

One of this blog post’s authors, Teresita Hogan, MD, speaks on care transitions during the Geriatric EM Boot Camp in Milwaukee.

Editor’s Note: In our Feb. 19 Health AGEnda post, the team we’re informally calling the Hartford Geri EM Champions shared information about the first two Geriatric Emergency Medicine Boot Camps and a meeting hosted by the John A. Hartford Foundation in late January to discuss new opportunities to improve acute care of older adults. Today, in the second of two parts, our EM experts discuss why our current system is failing older Americans, and share their vision for better emergency department care that can both serve the needs of older adults and contribute to a more efficient and value-based health care system.

The acute care provided to older adults in emergency departments (ED) across the country, and world, is often inadequate and sometimes dangerous.

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Aging and Disability Services Need—and Deserve—Support

The Administration for Community Living, aging, disabilityThroughout 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.

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Care Transitions Evaluation Is Premature and Confusing

As Orson Welles might have said: "We will evaluate no program before its time."

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.

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Opening the Window of Opportunity to Needed Health Policy Change

Health_Affairs_Jan2015_300pPolicy 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.

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Dealing With Dementia: How I Wrote the Story

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.

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.

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Happy New Year!

Best Wishes for a Healthy and Happy New Year from Health AGEnda and the John A. Hartford Foundation.

Best Wishes for a Healthy and Happy New Year from Health AGEnda and the John A. Hartford Foundation.

Happy Holidays!

Warm Holiday Wishes from Health AGEnda and the John A. Hartford Foundation.

Warm Holiday Wishes from Health AGEnda and the John A. Hartford Foundation.

Tools You Can Use: An Online Educational Series Focusing on Dementia in Older Adults

Caregiving_DementiaAbout a year ago, we posted a holiday gift for you—a Tools You Can Use blog that featured a free toolkit with evidence-based resources for staff in senior living communities promoting non-pharmacologic strategies to address behavioral and psychological symptoms of dementia.

We got a lot of response to that post. A lot, like almost 6,000 hits. Clearly, people are hungry for resources that address the needs of older adults with dementia. So in this spirit, we share another recently developed Tools Use Can Use, a continuing education online dementia series focusing on older adults that was created by the Hartford Center of Gerontological Nursing Excellence at Arizona State University (ASU); this work is supported by Virginia G. Piper Charitable Trust.

The series, called Caring for Persons with Alzheimer’s disease and Other Related Dementias and their Families Across the Continuum of Care, features four online, self-paced learning modules focusing on specific stages of dementia. The series aims to increase the knowledge and skills of nursing and other healthcare professionals to provide optimal dementia care and family support during all stages of the illness.

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Challenging Change AGEnts to Realize Promise of Improved Care for Older Adults

ChangeAGEntsCrowdHands_400

The opening session of the Hartford Change AGEnts Conference in Philadelphia last week.

Last week was the capstone of the first-year rollout of the Hartford Change AGEnts Initiative. This projects aims to engage and support all prior John A. Hartford Foundation health and aging grantees to focus on making systematic, large-scale practice change in the care of older Americans.

More than 160 Change AGEnts converged on Philadelphia for an intensive, day-and-a-half conference that was packed from start to finish with opportunities to learn, share knowledge, and network with others from different parts of the country and different disciplines. It was an energizing experience, not only because it gathered so much of the Hartford Foundation’s most precious assets—its people—in one place, but also because we learned more about the work already underway to improve care. We also saw new relationships and ideas emerge that will advance our mission.

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Share Your Family Caregiving Story

Caregiving_Walk_400pAre you a family caregiver of an older adult or a health care provider who works with family caregivers? Have you seen the challenges of caregiving up close and discovered ways of overcoming them?

If you said yes, you have an important story to tell and we want you to share it.

Today, we launched our second annual John A. Hartford Foundation story contest, and this year our theme is “Better Caregiving, Better Lives: Real Life Strategies and Solutions.”

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