Health AGEnda

Reflections on a Summer at the Hartford Foundation

Before starting my internship with the John A. Hartford Foundation, the notion of improving health outcomes while decreasing costs appeared implausible. Securing strong patient-centered care for a loved one had to come at an extra expense—a large price tag for both the individual, his family, and the institution administering the care. After all, my family recently hired a home health aide to assist and advocate for my grandfather during his stay in the hospital and then during hospice, what is supposed to be one of the most patient-centered forms of care. My family believed that a consistent, if costly, presence and support system would serve him well during employee shifts and other downtime between caregivers.

And it made a difference. Our aide, Abdulai (last name withheld), served as my family’s lifeline, the person my grandfather could rely on for personalized and direct care, the person my mother could trust in clarifying medications and complicated procedures.

Author Caitlin Brookner (back, left) with her cousins and grandfather.

Author Caitlin Brookner (back, left) with her cousins and grandfather, Leonard Weisberg.

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Stunning New IOM Report Reframes How We View Cancer

IOM_Report250The Institute of Medicine (IOM) is swinging for the fences with the release of a new report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.

The report makes recommendations in six areas critical to the delivery of quality cancer care:

  1. Engaged patients
  2. An adequately staffed, trained, and coordinated workforce
  3. Evidence-based care
  4. Learning health care information technology (IT)
  5. Translation of evidence into clinical practice, quality measurement, and performance improvement
  6. Accessible and affordable care.

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Analyze This: Misleading Federal Spending Stats Pit Children vs. Older Adults

KleinTweetCapture300Ezra Klein, a prominent Washington Post blogger whose work I generally respect and enjoy, recently put up a post (Feds spend $7 on elderly for every $1 on kids) on federal spending on young versus older Americans. His post was a reanalysis and interpretation of a recent Urban Institute report on spending on kids, funded by the Annie E. Casey Foundation, that analyzed spending on children in a post American Recovery and Reinvestment Act and budget reduction world.

The Urban Institute report had very little invidious comparison between kids and older adults, but Klein has highlighted what little there was and added new factoids of his own. And I just don’t get it.

I’m sure that Mr. Klein means to be advocating for increased spending on children so as to help create the future we all want to have in our country. For example, in addition to tweeting the inflammatory title of this piece, he also tweets that spending on children will soon be less than interest payments on the debt—another rhetorical comparison intended to show that we need to invest more in kids than we currently do.

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Ten Years After: Poll Shows Depression Care Still Lacking

Ten years ago this month, the initial results of a $10 million depression treatment project funded by the Hartford Foundation (with co-funding from the California HealthCare, Hogg, and Robert Johnson Foundations) were published in the Journal of the American Medical Association.

In what remains the largest multi-site randomized trial of its kind, the project—called IMPACT—showed that it is possible to double the benefits of the usual treatment of older adults for depression in primary care practices. And it demonstrated what changes are needed in the process of depression care to ensure that more patients get better.

So how much progress has our nation made in providing better mental health care for older adults, a decade later? To find out, we commissioned our second national poll, with help from Strategic Communications and Planning, called “Silver and Blue: The Unfinished Business of Mental Health Care for Older Adults.”

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Ensuring Quality Care for Older Adults

If we had to pick a theme for 2012, it might be Measuring Quality of Care Year. Our annual report discussed the lack of quality mental health care for older adults, recently illustrated by the callous dismissal of annual report writer Lynne Christensen’s mother’s post-surgical depression as “to be expected.” Our April poll, “How Does It Feel? The Older Adult Health Care Experience,” also concentrated on this theme. The poll showed that although the vast majority of older adults are satisfied with their care, that care lags badly behind recommended care for older adults on numerous measures.

While the poll was a new experience for us, writing about the sorry state of care for older adults isn’t. To help you better understand this important and frustrating issue, we’ve gathered a collection of Health AGEnda posts that address some of the problems—and solutions—we’ve identified.

Supporting the results of our poll was “The Good, the Bad, and the Ugly,” in which I discussed how far we need to go to improve care for older adults. Although there are some good programs improving geriatrics training for physicians, not all of them are producing robust results. For example, raising falls screening from a dismal 11 percent to a still-mediocre 34 percent is nowhere near good enough, and I believe there needs to be a greater sense of urgency in solving the problem.

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Slow Down and Listen: The 2011 Annual Report Video Series

Recently, you heard from the creative team—our writer, photographers, and videographers—for our award-winning 2011 annual report focused on mental health and older adults. In that blog post, Don Battershall reported that in order to capture the stories of the older adults, caregivers, and health care professionals featured in the annual report, he needed to “really slow down and just listen, let the person talk.”

Today, we are delighted to give you the opportunity to “slow down and listen,” just as Don did, through the first of our collection of 2011 annual report videos.

The first video features Elizabeth, an inspiring older adult who overcame years of depression triggered by the murder of her daughter and subsequent death of her husband. Elizabeth, together with her Depression Care Manager Rita Haverkamp, RN, MNS, CNS, participated in Project IMPACT—a successful, Hartford-funded model to assess and treat depression in a primary care setting.

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Expected Does Not Mean Inevitable

As our dedicated 2012 Hartford Foundation annual report blog series followers know, our August 7 blog featured the creative team behind our award-winning annual report. Intrigued by their stories, we asked our annual report writer, Lynne Christensen, to tell us more about her experience writing about mental health and older adults.

Writing this year’s annual report had personal significance for me that I could not have anticipated when I began the project. About halfway through the writing process, I learned that my 81-year-old mother needed a heart valve replacement, and the surgery couldn’t wait. It was a traumatic surgery for someone her age.

Alice Christensen and her beloved cat, Sugar

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We Won!

We are always proud of how our innovative and entrepreneurial grantees parlay work started with Foundation support into additional resources to improve the health of older adults (for example, in the CMMI Innovation Challenge program). Today, I am very proud to announce that in partnership with our long-time grantees at the University of Washington’s Advancing Integrated Mental Health Solutions (AIMS) center, led by Jurgen Unutzer, we have managed the same trick ourselves, resulting in what should ultimately be almost $11 million in new money to improve older adults’ mental health.

Starting last year, we have been preparing an application to the Corporation for National & Community Service (CNCS) as part of its Social Innovation Fund competition. This competition calls for foundations and non-profit organizations to put forward evidence-based models (like the University of Washington’s IMPACT depression care model) that solve important social problems. It rewards the winners via a three-way award system in which private dollars are matched 1:1 with federal dollars and regranted out to subgrantees who must then obtain another 1:1 match to their awards. Right now, we’ve been awarded $2 million over 2 years. Assuming we do a good job (which we plan to!), we then get another year and another $1 million. Thus, our $3 million over three years should turn into $6 (thanks to the federal match) and then almost $11 million (thanks to the matching funds for the subgrantees).

We are part of a cohort of just four new awardees for 2012 who will be intermediaries between the Social Innovation Fund and subgrantees implementing innovative models. Staff at CNCS and our program officer (writing that feels odd!) tell us that the selection process “was highly competitive and sought proposals that would drive impact and transform lives. Only organizations with a track record of success implementing programs with evidence of effectiveness were eligible. All applicants also needed to have a strong plan for growing program capacity and rigorously evaluating their results.”

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Serendipity

As many of our readers know by now, our 2011 Annual Report features our work to address the mental health needs of older Americans. You can view the report online here, and we have begun running blog stories and associated videos that try to capture the experience of older people with mental illness who have benefited from foundation-sponsored programs. I am very proud of this work and the report.

It is just icing on the cake that shortly after the release of our mental health–focused annual report, the Institute of Medicine (IOM) released its examination of related workforce issues, called “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” The report explicitly frames itself as a follow-up to the 2008 Hartford Foundation co-sponsored IOM report, “Retooling for an Aging America: Building the Health Care Workforce.” The new study committee included many friends of the Foundation — including its Chair, Dan Blazer, who served with distinction on our Beeson Advisory Committee for many years; Chris Callahan, an early Beeson scholar and aging research leader at Indiana University (a Center of Excellence); Kitty Buckwalter, the recently retired director of our Center of Geriatric Nursing Excellence at the University of Iowa; and long-time colleagues Fred Blow and Steve Bartels of the University of Michigan and Dartmouth, respectively.

I greatly respect the fellows of the IOM who produced the report and I agree with their recommendations (listed below) — how could I not? The new recommendations are essentially rephrasings of the recommendations of the 2008 Retooling report, focusing on the subset of the geriatric health care workforce serving patients with mental health/substance needs. I hope that this time government and professions leaders will listen. I hope that the workforce provisions of the Affordable Care Act will be funded (and expanded) and I hope that as a society we will make the shift in workforce training and deployment that we need to support the well-being and independence of older adults.

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