Health AGEnda

End of Life and Serious Illness:
A John A. Hartford Foundation Change AGEnts Issue Brief

This is the third in a series of seven issue briefs.

This is the third in a series of seven issue briefs.

The John A. Hartford Foundation Change AGEnts Initiative accelerates sustained practice change that improves the care of older adults. It does this by harnessing the collective power of The John A. Hartford Foundation’s interprofessional community of scholars, clinicians, and health system leaders.

In December 2015, nearly 100 John A. Hartford Foundation Change AGEnts gathered in Philadelphia, PA to identify challenges and opportunities for improving care of older adults in several care settings and issue areas. Each group worked toward identifying actionable areas for John A. Hartford Foundation Change AGEnts, the Foundation, and colleagues in the field to pursue. The brief below represents the summary of the End of Life and Serious Illness group’s proceedings and should inform future work to create widespread and systemic changes in the care of older adults.The other issue briefs will be published on Health AGEnda over the following weeks. 

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Making the Voices of Older Americans Heard in Health Policy

This is the last in a series of six Health AGEnda posts on the 2014 Annual Report.

This is the last in a series of six Health AGEnda posts on the 2014 Annual Report.

Editor’s Note: The John A. Hartford Foundation’s 2014 Annual Report features five profiles of Hartford Change AGEnts whose work is representative of the kinds of practice and policy change the initiative is making. Read Harnessing the Power of Hartford Change AGEnts for more on the Change AGEnts Initiative. Today, we meet Renée Markus Hodin, Carol Regan, and Gregg Warshaw, MD, of Community Catalyst, who are working to bring the perspectives of older adults and aging-expert health professionals to efforts to improve care for the vulnerable population eligible for both Medicare and Medicaid. The John A. Hartford Foundation Board of Trustees recently approved a three-year, $1.5 million renewal grant to expand Community Catalyst’s work. This post concludes our special Health AGEnda series spotlighting the stories and videos of Hartford Change AGEnts profiled in the Annual Report.

As a geriatrician, Gregg Warshaw, MD, has watched with mounting frustration as older adults are bounced back and forth between nursing homes and hospitals—decisions often driven by the different financial models used by Medicare and Medicaid.

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Focusing on the Health Goals of Older Adults

Missed_Target_400pThis week we offer a poignant story of one physician’s struggle to understand what he could do to help his aging and ailing new patient. Written by Dr. Mitch Kaminski, and originally posted on Pulse, a leading narrative medicine website, this true tale makes the point that if we don’t understand a person’s own personal health goal, we are unlikely to achieve it.

We are unlikely to help them.

The John A. Hartford Foundation is deeply committed to aligning care by all health care providers to address the goals of older patients. As people age and become much more medically complex and frail, well-intended treatments may not help with pain or function. The treatment may create new problems and burdens.

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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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Breast Cancer: Are We Making Strides?

Amy Berman, left, and her daughter Stephanie at the American Cancer Society's Making Strides event in New York's Central Park.

Amy Berman, left, and her daughter Stephanie at the American Cancer Society’s Making Strides event in New York’s Central Park.

Maggie Mahar is an influential blogger on topics from health care reform to the economy. Maggie and I agree that we are not making sufficient strides in the war on breast cancer. We disagree that I chose life over longevity. I chose life and longevity.

In honor of breast cancer awareness month, Maggie has allowed us to repost a blog she featured in HealthBeat on Oct. 11th. I am grateful that she uses her potent prose to draw attention to the needs of older adults. Cancer is, after all, primarily a disease of aging. Two-thirds of those living with cancer are age 65 or older.

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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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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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Geriatrics Expertise Saves the Day—and a Life


Dr. William Dale, author of “Geriatrics Saved His Life!” The story took top prize in this year’s John A. Hartford Foundation Heroes of Geriatric Care Story Contest.

Too often when older adults enter the health care system, we hear stories about them not receiving recommended care, such as medications reviews, fall prevention assessments, and depression screenings. Older adults also experience too many adverse events in the hospital, poor handoffs between care settings, and preventable hospital readmissions.  

And too many times, they enter this system lacking the advocates who can expertly provide or coordinate their often complex care.

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What If Health Care Has It All Wrong?

BermanHCLDR_400On June 4, I was fortunate enough to be the special guest on a record-breaking Health Care Leadership Twitter Chat (#HCLDR ) that reached more than 2 million people on Twitter and was the number one trending topic in the twittersphere.

As the guest, I was charged with designing the chat, choosing the topic and questions, and contributing a blog to be referenced on the Health Care Leadership homepage. What was the topic that had the social media hive buzzing? We explored the issues surrounding person-centered care and patient activation, and talked about the role of people supporting their health within the context of health care delivery.

BermanTweet1_350So many of us spend our lives dedicated to improving health care. As a senior program officer working for The John A. Hartford Foundation in NYC, I peruse endless data quantifying the problems, poor quality care, and needless harm to our nation’s frail and vulnerable older adults. For example, 20 percent of our nations’ older adults return to the hospital within 30 days after being discharged. The cost for this debacle is estimated at more than $17 billion dollars per year in avoidable readmissions. If this were a car dealership—and the rate of repaired cars returning needlessly to the shop—they would go out of business.

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