Health AGEnda

Help Us Spend $100,000,000! (Really Well)

Since the downturn in 2008, we at the Hartford Foundation have had the incredibly frustrating experience of not having money for new grant programs amid what seems like a smorgasbord of opportunities to make an incredible impact on the health of older Americans.

We of course had faith in what we funded back in 2008, so we have been mostly working to pay our prior commitments and build grantee and our capacity for sustainability and impact.  I am really proud of this work: the painful but necessary process of rightsizing our commitments and managing our cash flow, the furious efforts to draw in other funding and build grantee capacity, and the vigorous attempts to be sure that every drop of value from our grantees’ work is included in health reform and workforce considerations. The latter drives our communications efforts, such as the blog itself.

But now, in the absence of any major market changes, by 2013 we will have fulfilled our commitments and will be looking at about $100,000,000 to spend through new grants in the five years 2013-2017.  To do this really, really well, we need all the help we can get.  I want to use this post as an open invitation for our grantees, stakeholders, peers, and older persons themselves to offer suggestions about how we can make the biggest difference in the lives of older adults.  We continue to believe that health professionals (physicians, nurses, and social workers) and service delivery models are important, but we should go back to first principles and think about the actual challenges faced by older adults.  As stewards of the Foundation’s money, holding it in trust for the benefit of society, we are obliged to think carefully about how the money can be best put to use to help the most people.

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Social Workers Are Best for Care Transitions

A recent article by Robert Kane published in the January 19, 2011, issue of the Journal of the American Medical Association (JAMA), “Finding the Right Level of Posthospital Care,” is a must-read for anyone interested in discharge planning issues.  Bob packs a lot of information into this article–a literature review of physicians’ roles in discharge planning, a list of what should be considered in a discharge plan involving long term care, and what a family should know about finding an appropriate discharge planner.  However, I think he missed an important opportunity—pointing out the need for other trained professionals to be involved in the discharge process.  Having started my career in social work as a hospital discharge planner, I feel very strongly that discharge planning belongs in the realm of social work.

I applaud Bob’s suggestion that physicians should play a crucial role in transitions from the hospital to long term care services.  However, it should not fall to them to work out every detail. Instead, social workers can and should be the facilitator and advocate for the patient, allowing the physician to focus on medical necessities.  It is inefficient for physicians to cross-train in areas of social work expertise, such as the ins and outs of long term care services,  financial issues, the patient’s and families’ wishes and ability to pay, etc.

Perhaps the role of discharge planning has changed. Bob states that it seems that hospital discharge planners are concerned only with quick and efficient discharges to save the hospital money.  If this is true, it needs to change.  I believe that physicians should partner with social workers to encourage them to do the job they are trained to do–advocate for the patient; work with the family; keep abreast of the patient’s medical treatment and progress by speaking with the physicians, nurses, and other medical personnel; and keep informed about community services and eligibility requirements as well as all long term care options.  Talking to other social workers and working with social work leaders to develop geriatric social work competencies, we all agree that appropriate and adequate discharge planning is critical for care transitions and preventing or reducing hospital readmissions.  Social workers, who are trained in care coordination, are the right health care professionals to bring all the necessary staff and resources together to create discharge plans that will benefit older persons.

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