Click photo to watch the Community Catalyst video.
You would think having both Medicare and Medicaid would mean getting more of the benefits and services you need.
But for the 10 million people who receive health care coverage under both systems—who are poor and mostly older adults with complex health and social needs—it’s far too easy to fall between the cracks of these good programs. They are structured differently, have different rules, and often lead to a complicated maze of services and providers.
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”—Margaret Mead
Our mission at the John A. Hartford Foundation is to change the health of older Americans for the better. And despite the national investment in health care and the excitement of research, I don’t think we are alone in seeing this as a long, slow road.
Elena O. Siegel, an assistant professor at the Betty Irene Moore School of Nursing at University of California-Davis and a 2011 Robert Wood Johnson Foundation Nurse Faculty Scholar, is a fine example of the kind of nurse leaders the new fellowship hopes to create. Siegel is a former Claire M. Fagin Postdoctoral Fellow, funded by the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity program and Atlantic Philanthropies.
With the memory of the greeting card and chocolate-fueled Valentine’s Day in our rear view mirror, we would like to honor the part of the holiday that focuses on relationships by announcing a new partnership.
Change doesn’t just happen. It requires bold leadership, innovative thinking, resourcefulness, and an unwavering determination to swim against the tide when necessary.
So where will we find the leaders we so desperately need to bring change to our unwieldy and dysfunctional health care system? Practice Change Leaders for Aging and Health, a new national program co-funded by the John A. Hartford Foundation and The Atlantic Philanthropies, represents a significant step toward answering that question.
Starting on Jan. 1, 2013, the Practice Change Leaders Program will choose 10 health care leaders per year for three years through a rigorous, competitive application process. Those selected will receive one year of funding to complete innovative projects and expand their effectiveness as organizational leaders.
We’ve all seen the data. The number of older adults is on the rise. They bear a disproportionate burden of our dysfunctional health care system, both in terms of poor quality and higher spending. And while there are serious pockets of innovation addressing care of older adults, all too often leaders in health care settings lack the skills to implement and spread these important advances. In response to this national gap in leadership, The Atlantic Philanthropies—in partnership with the John A. Hartford Foundation—funded the Practice Change Fellows Program.
Five years and 38 fellows later, the Altarum Institute released a report that highlights the Practice Change Fellows Program’s successful efforts to develop change leaders who spread innovations that improve the health of older adults. The impacts are nothing short of astounding. The two-year Fellows program was the brainchild of Eric Coleman, MD, MPH, University of Colorado, and Nancy Whitelaw, PhD, from the National Council on Aging. The program aims to expand the number of health care leaders from medicine, nursing, and social work who can effectively promote high-quality care for older adults to a wide range of health and health care organizations. Fellows learned key skills to support spreading innovations, such as how to make the business case to the “C-suite” (CEO, CFO, etc…), and were mentored by leading experts in the field of aging.
The Practice Change Fellows report gives example after example of successful innovation and diffusion, including cutting edge approaches for dementia care, patient-centered health homes, care transitions, rural congestive heart failure management, delirium, and more.
Leadership, as featured in our 2008 Hartford Annual Report, is defined by four key elements: Formal Training, Mentoring, Peer Networking, and Answering the Call. Leaders rarely rise spontaneously from within the ranks of health professionals and often need special training, nurturing, and support. Even though leadership often seems to emerge from nowhere, it is almost always the product of years of work.
Consistent with this, our Building Academic Geriatric Nursing Initiative (BAGNC), now over 200 scholars and fellows strong, is designed to grow gero-expert nurse leaders who can prepare all nurses to be competent to care for older adults.
It’s been a little more than a year since the Patient Protection and Affordable Care Act passed – a drama that is still unfolding in battles around its implementation and funding. Back when health reform was just a gleam in then Senator Obama’s eye, the Hartford Foundation worked with its long-time friends and allies to form the Eldercare Workforce Alliance, a broad coalition of parties representing consumer and family organizations, direct care worker interests, health professional associations, and health care delivery organizations with the mission of implementing the recommendations of the April 2008 Institute of Medicine report, Retooling for an Aging America: Building the Health Care Workforce.
The Alliance had barely received its first check in April of 2009 when health reform started to boil. It was suddenly urgent to advocate for the inclusion of eldercare workforce concerns before history passed us by. That urgency has been unrelenting over the past year, as efforts have shifted to focus on implementation and appropriations. Along with our other external funding partner, The Atlantic Philanthropies, and the 28 contributing member organizations, we are engaged in what will be a long struggle to ensure that the workforce implications of caring for older Americans are adequately addressed in federal programs and regulation. The priorities of the Alliance include: improving the training and compensation of the direct-care workforce; requiring competence in geriatrics from all health professionals as well as increasing the number of those specializing in the field; and supporting the adoption of innovative models of care that will better meet the needs of older people and make better use of current workforce capabilities. Continue reading →
Older Americans are not getting very good quality health care, as findings from many studies and experts show. However, most older adults and their caregivers don’t realize that they are getting substandard care. Given that most people are unfamiliar with the various guidelines for the treatment of chronic conditions and geriatric syndromes (e.g., falls, dementia, incontinence), it is probably unreasonable to think that they will ever be able to judge if their care is meeting evidence-based standards. People tend to mistake easy access to interventions (and particularly specialist physicians) for quality.
When family caregivers need to take on a substantial share of care for their loved ones, the many deficiencies in our system become very apparent to all concerned. This reality is poignantly captured in a first-person story in the April 2010 Atlantic Monthly, “Letting Go of My Father,” by Jonathan Rauch.
As Mr. Rauch struggles with caring for his father in his last year, he identifies many of the issues caregivers face. He writes, “My professional work all but stopped. Finding doctors for him and getting him to appointments and coordinating escalating medical needs swallowed entire days.” As a caregiver he struggles with not only his father’s care needs, and the weaknesses of the care system, but his own lack of preparation for the caregiver role. He writes “The medical infrastructure for elder care is good, very good. But the cultural infrastructure is all but nonexistent. How can it be that so many people like me are so completely unprepared for what is, after all, one of life’s near certainties?”
Health care reform offers an opportunity for those of us who care about health and aging to improve how public policy affects older adults. That’s why programs like the Health and Aging Policy Fellowship, funded by The Atlantic Philanthropies, are so important. The program helps mid-career professionals in health and aging—nurses, doctors, social workers, and others—learn how to translate their clinical expertise into effective public policy that impacts the lives of millions of older Americans.
We are proud that six of the nine 2009-10 fellows are from the John A. Hartford Foundation “family,” as were several fellows from years past. Recipients Chad Boult, Diane Meier, Richard Marottoli, and Heidi Wald are current or former grant recipients, and Steven Counsell and Margaret Wallhagen direct Centers of Excellence in Geriatric Medicine and Nursing, respectively. We congratulate them, as well as the other 2009-10 fellows, and we look forward to working with them at the annual communications workshop that we sponsor. As we wrote in our 2008 Annual Report, we need leaders if we are going to help our health care system and health policies address the needs of the growing number of older adults. Equipping talented individuals who have the desire to lead with the knowledge as well as communication, networking, and organizational skills they need to lead effectively is one of the best ways to ensure that aging issues will gain the prominence they deserve in the public policy arena.
Recently, while I was working on some personal health promotion (i.e., running on the treadmill in the gym), I was listening to a series of podcasts on quality improvement in the US healthcare system from the Institute for Healthcare Improvement (IHI). Don Berwick, MD, the leader of IHI, was describing something of the history and vision of quality improvement. This seemed particularly relevant in light of the recent discussion about the high rate of hospital readmission among Medicare patients.
Dr. Berwick talked about the need to change the framing of quality problems. When IHI first began its work, errors and mistakes in health care were often referred to as “complications.” He argued that this framing undermines any motivation for change, as complications seem uncontrollable, inevitable, and properties of the patient or the disease rather than of the health care process.
Now understood as “errors” and ascribed not to individual practitioners, but to the overall design of the health care process, adverse events have proven very controllable. As the 100,000 Lives campaign and a variety of quality improvement efforts have shown, “complications” such as ventilator acquired pneumonia and central line infection are amenable to significant improvements. In fall 2008, Medicare announced that it would stop paying for 10 “never events,” such as preventable infections, bedsores, and incompatible blood transfusions, among others. More recently, a group calledPublic Private Partnership to Promote Patient Safety, or P5S, launched a bid to convince health industry stakeholders to cooperate in an effort to make medical devices more mistake-proof.