In June 2008, the Trustees of the John A. Hartford Foundation approved one grant totaling $1.7 million for a project to increase the nation’s capacity to provide effective and affordable health care to its rapidly increasing older population.  The grant is described below.

Enhancing the Quality of Medical Home Services
Johns Hopkins University
Baltimore, MD
Charles E. Boult, MD, MPH, MBA
$1,729,690
Three Years

The John A. Hartford Foundation has made a grant to Johns Hopkins University to develop and distribute educational resources and technical assistance to primary care practices participating in a new $400 million Medicare Medical Home Demonstration project.  The Demonstration will test whether reimbursement for improved primary care management of elderly patients with multiple chronic conditions will lead to improved health and reduced health care costs.  Health care spending for those with four or more chronic conditions such as diabetes and hypertension accounts for 80 percent of Medicare expenditures, $402 billion in 2006 alone.  Complex older patients with those conditions are likely to suffer negative health outcomes without good primary care management.  Through prior grants to Johns Hopkins Medical Center totaling nearly $2 million, the John A. Hartford Foundation has supported the development of the successful Guided Care model, an evidence-based approach to the Medical Home with proven success managing chronic disease in primary care practice. 

Funding for the project will be used to develop and disseminate technical assistance and Web-based resources built on the Guided Care model, tailored to primary care physicians and nurses participating in the Medicare Medical Home Demonstration project.  The technical assistance will be provided in partnership with the major primary care physician organizations including the American College of Physicians and the American Academy of Family Physicians. 

The Medicare Medical Home Demonstration project, which was authorized by Congress in 2006, will provide incentive payments to primary care practices in up to eight states for chronic condition care management that is comprehensive, evidence-based, and uses health information technology while supporting patients’ management of their own conditions.  Guided Care, which utilizes a trained nurse to personalize care and teach patients and their families how to manage chronic conditions, is a model for the Medical Home that will serve as a valuable resource to the demonstration project participants. 

The John A. Hartford Foundation, in partnership with the National Institute on Aging and the Agency for Healthcare Research and Quality, has supported the development of the Guided Care model since 2005 as part of its strategy to improve and integrate health care services for the rapidly increasing population of older adults. 

For more information on the Guided Care model developed at Johns Hopkins University, please visit http://www.guidedcare.org.  For more information on the Medicare Medical Home Demonstration project, please visit http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD.

In March 2008, the Trustees of the John A. Hartford Foundation approved six grants totaling $5 million for projects to increase the nation’s capacity to provide effective and affordable health care to its rapidly increasing older population.  The grants are described below.

Geriatric Nursing Leadership Academy Implementation
Sigma Theta Tau International Honor Society of Nursing
Indianapolis, IN
Mary Rita Hurley, RN, MPA
$1,666,413
Forty-four Months

The John A. Hartford Foundation has made a grant to Sigma Theta Tau, the honor society for nursing, to implement the Geriatric Nursing Leadership Academy program, which will increase the organization’s capacity to meet the needs of an aging population and will prepare and position nurses in leadership roles within health care delivery settings to improve the quality of care for older patients and their families.  Older adults constitute a majority within the health care delivery system as consumers of services and recipients of care, and nurses are in unique positions to manage, coordinate, and facilitate decision-making among health care delivery teams to ensure that geriatric best practices are utilized.  This effort builds on a prior one-year planning grant to develop the academy curriculum and a national mentorship structure for academy participants.

Funding to Sigma Theta Tau, the honor society of nursing representing 130,000 members, will be used to enhance geriatric knowledge among Sigma Theta Tau members through biennial meetings, a geriatric interest group, and dissemination of evidence-based geriatric practice guidelines.  Funding will also be used to implement the Geriatric Nursing Leadership Academy model, which is based in part on their successful leadership academy for maternal child nurses.  The 18-month training academy will develop the leadership and management skills of 20 competitively chosen nurse leaders across the country, who will implement geriatric care delivery improvement projects in their hospitals, nursing homes and other settings, improving care for tens of thousands of older patients.  A national network of prominent nurse mentors will be used to provide expertise to the academy participants. 

Older adults have a higher frequency of primary care visits, receive 50 percent of all hospital care, use more than 80 percent of home care services, and occupy 90 percent of all nursing home beds in the United States.  Nurses play critical roles in all of these settings and are often in the best position to initiate changes to improve the care of geriatric patients.  However, nurses receive little or no training to prepare them for the leadership roles they are often thrust into early in their careers.  The need for leadership development and mentoring has been identified as critical by many employers of nurses, and the Geriatric Nursing Leadership Academy will prepare a cadre of nurse leaders able to create significant change to improve the health care of older adults.

For more information on Sigma Theta Tau and the Geriatric Nursing Leadership Academy, please visit http://www.nursingsociety.org/LeadershipInstitute/GeriatricAcademy/.

Centers of Excellence in Geriatric Psychiatry
$1,500,000
Five Years

University of California, San Diego
La Jolla, CA
Dilip Jeste, MD
$750,000, Five Years 

University of Pittsburgh
Pittsburgh, PA
Charles Reynolds III, MD
$750,000, Five Years

To increase the number and quality of geriatric psychiatry faculty members who will teach future psychiatrists to provide good mental health care to older adults, the John A. Hartford Foundation is renewing support for two Centers of Excellence in Geriatric Psychiatry at the University of California, San Diego and the University of Pittsburgh.  Funding will support the training of at least 25 faculty scholars as educators, researchers, and leaders in the field of geriatric mental health.  The number of older people with significant psychiatric problems is expected to climb to 15 million by 2030, and their unique needs will best be met by mental health providers trained by specialists in geriatric psychiatry.  The two awardees, first funded in 2005, are part of a network of 27 Hartford Centers of Excellence in Geriatric Medicine and Training at academic medical institutions across the country.

Funding to the Centers of Excellence in Geriatric Psychiatry supports the recruitment and development of future faculty in geriatric psychiatry and is used for financial support, mentoring, research opportunities, and leadership experiences.  In addition to attracting and retaining academic geriatric psychiatrists, the centers contribute greatly to the growth and dissemination of knowledge about geriatric mental health to other psychiatrists and the larger medical community.  Since 1997, the John A. Hartford Foundation has awarded over $38 million to create Centers of Excellence in Geriatric Medicine and Training throughout the nation.

The rapidly growing number of older adults, the increased risk of mental health problems due to increased life expectancy, the higher prevalence of certain mental health problems in baby boomers than in prior cohorts, and the current lack of geriatric psychiatrists requires an increased capacity in geriatric mental health training and education.  Eighteen to twenty-eight percent of older Americans have significant psychiatric symptoms, and that number is expected to rise.  Specialized training and research in geriatric psychiatry is needed to address the unique needs of older patients including age-related changes in brain structure and function, the co-existence of multiple medical problems, the use of multiple medications, cognitive impairment, and difficulties in long-term follow-up.  There are over 39,000 psychiatrists in the United States, but only 1,596 of them are certified in geriatric psychiatry.

The Hartford Foundation’s Centers of Excellence in Geriatric Medicine and Training program was founded in 1988 to meet the need for physician-faculty trained to prepare physicians in the health care needs of older adults.  The 27 centers across the country have proven successful in increasing the number of academically-oriented physicians trained in geriatrics. 

Advancing Aging and Health Policy Understanding
National Health Policy Forum
Washington, DC
Judith Miller Jones
$940,896
Three Years

The John A. Hartford Foundation has renewed funding to the non-partisan National Health Policy Forum to provide congressional and regulatory staff with information and materials to better craft policies and programs that meet the health care needs of older adults.  As the over-65 population dramatically increases, issues such as steadily rising health care costs and a fragmented medical system that performs poorly for many older patients are taking a front seat in policy debates.  The Forum will help bridge the gap between academic and industry experts and Washington policy makers, utilizing a variety of meeting formats and written products aimed at new and senior staff members.  The Foundation has supported the aging-related health policy work of the Forum since 1997.

Funding will be used to create at least four events or reports each year of the grant, targeting senior-level policy makers as well as more mid-level and junior staff members who need background and basic information.  Because federal reimbursement and regulatory policies shape much of the nation’s health care, over the next few years health services for older persons will be subject, among other potential measures, to cost containment efforts, attempts to realign the health care workforce, and possibly mandates for preventive care and chronic disease management.  The Forum’s programming, which will address these topics and others, is designed by expert staff with the help of an advisory board composed of recently retired senior congressional staff members. 

For more information, please visit http://www.nhpf.org

Evaluating the Hartford Geriatric Nursing Initiative
Research Foundation of the City University of New York/Baruch College
New York, NY
Shoshanna Sofaer, DrPH
$806,913
Four Years

The John A. Hartford Foundation has awarded a grant to support the external evaluation of its Hartford Geriatric Nursing Initiative projects.  An efficient, objective assessment of the Foundation’s funding in geriatric nursing is needed to manage grant projects and guide future programming, as well as to document the impact of the initiative on the field of nursing overall. Since 1996, the John A. Hartford Foundation has invested over $68 million in geriatric nursing initiatives to improve the health care of older adults.

The evaluation will be conducted by a team housed at the School of Public Affairs of Baruch College, New York, with vast experience conducting multi-project evaluations and effectively communicating research findings to a variety of audiences.  The evaluation will consist of a Web-based system for routinely collecting data on key metrics for specific projects, the identification and collection of longitudinal data to assess the state of geriatric nursing nationally to determine the overall impact of the Hartford Geriatric Nursing Initiative, and the development of a series of reports to highlight achievements and the need for ongoing work to prepare nurses to be competent in caring for older adults.

Creating a National Alliance on Improving Care for Older Americans
The Meridian Institute
Washington, DC
Timothy J. Mealy
$86,683
Nine Months

The John A. Hartford Foundation has awarded a grant to The Meridian Institute to facilitate the formation of a national coalition that will advance the recommendations of the Institute of Medicine consensus report on the health care workforce needs for an aging society and support policy changes to improve the care of older adults.  The prestigious Institute of Medicine is charged with advising the nation on health care issues, and their report will make several policy recommendations requiring broad support and advocacy to be enacted.  This project is co-funded by The Atlantic Philanthropies, who along with nine other funders supported the Institute of Medicine study.

Funding to The Meridian Institute, a national non-profit organization dedicated to facilitating dialogue and coalitions in the public interest, will be used to identify health professional associations, consumer groups, and industry stakeholders to form a National Alliance on Improving Care for Older Americans, which will advance the policy recommendations of the Institute of Medicine.  The Meridian Institute will conduct interviews with top leaders from these groups, convene national meetings to establish the coalition, and assist the coalition in developing governance structure and membership policies for effective decision-making and future growth over the three to five years typically required to enact major national policy changes. 

The Institute of Medicine report on the health care needs of an aging society was commissioned because of the pressing need for health care reform as the population of older adults dramatically increases over the next few decades.  While older adults already constitute half of hospital occupants and a disproportionate share of most medical services, neither educational systems nor payment polices prioritize geriatrics within health professions; quality of care suffers as a result.  The congressionally chartered and highly esteemed Institute of Medicine has previously issued important reports on topics such as quality of care in nursing homes that ultimately led to landmark reform legislation.  The essential tool for turning the report into action was a coordinated coalition of stakeholders who jointly advocated for change.  The same strategy will be applied to the report on workforce needs for an aging society, with the goal of producing policy changes to improve the care of older adults.

For more information on the Institute of Medicine report, please visit http://www.iom.edu/CMS/3809/40113.aspx.

In December 2007, the Trustees of the John A. Hartford Foundation approved three grants totaling $1.35 million dollars for new Centers of Excellence in Geriatric Medicine and Training.  The grants are described below.

Centers of Excellence in Geriatric Medicine and Training
$1,350,000
Three Years

Brown University/Rhode Island Hospital
Providence, RI
Richard W. Besdine, MD
$450,000, Three Years 

University of Wisconsin
Madison, WI
Sanjay Asthana, MD
$450,000, Three Years 

Wake Forest University
Winston-Salem, NC
Jeff D. Williamson, MD, MHS
$450,000, Three Years

To increase the number of physician faculty dedicated to geriatrics, The John A. Hartford Foundation awarded grants for three new Centers of Excellence in Geriatric Medicine and Training.  The new Centers are at Brown University, the University of Wisconsin, and Wake Forest University.  This funding will support the training of at least 30 advanced fellows and junior faculty members to prepare them for careers in aging research and teaching.  These three new awardees join 24 other Hartford Centers of Excellence in Geriatric Medicine and Training across the country.

Funding to the Centers of Excellence supports the recruitment and development of future faculty in geriatrics and is used variously for direct salary support, pilot research, developing service venues for research, tuition and support for additional training, or hiring necessary research support personnel.  In addition to attracting and retaining academic geriatricians, the Centers of Excellence contribute greatly to the growth and dissemination of knowledge about geriatric medicine to other physicians and the larger medical community.  Since 1997, the John A. Hartford Foundation has awarded over $38 million to create 24 Centers of Excellence in Geriatric Medicine and Training.

Current projections suggest that by 2020, the nation needs to triple its production of faculty in geriatric medicine to adequately train the physicians needed to care for a rapidly growing aging population.  However, most fellowship programs in geriatric medicine produce physicians who go into practice, rather than research or teaching.  And the infrastructure to create and sustain faculty members in geriatric medicine, or to attract faculty from other areas of medicine, is under-resourced relative to the need.  Federal funding is typically not available for second, third, or fourth years of advanced training, when physicians complete substantive research projects, further develop a research or medical education niche, expand their curriculum vitae, or prepare manuscripts for publication—all important steps in an academic career.  The Centers of Excellence provide opportunities and financial support for this critical time.

In September 2007, the Trustees of the John A. Hartford Foundation approved eight grants totaling $10.6 million dollars.  Each grant is described below.

Centers of Geriatric Nursing Excellence
$4,000,000
Five Years

The John A. Hartford Foundation has funded four new Centers of Geriatric Nursing Excellence to prepare over 500 nursing faculty members with expertise in geriatrics.  This program expansion was developed in response to the critical shortage of nursing faculty with the skills in geriatrics needed to educate future generations of nurses who will be caring for a rapidly increasing older population.  These new centers will work closely with the five existing Centers of Geriatric Nursing Excellence, funded since 2000, which advance academic geriatric nursing through education, research, practice, and policy activities.

The schools of nursing at Arizona State University, Pennsylvania State University, and the Universities of Minnesota and Utah have each designed new centers to recruit, retain, and retrain academic geriatric nursing faculty.  By the end of the grant period, 178 new doctoral and master’s trained geriatric nursing faculty members will be prepared to educate nursing students.  At least 340 existing nursing faculty will receive geriatrics training to help them better educate nursing students in the care of older adults.  Three of the centers will create regional consortia to expand their geographic reach and train nurses serving elderly populations most in need.

While the existing Centers of Geriatric Nursing Excellence and nursing efforts of the John A. Hartford Foundation have significantly advanced the preparation of nurses to care for older adults, much work remains.  Only 42 percent of schools of nursing employ full-time faculty specializing in geriatrics and less than one percent of all registered nurses are certified in geriatric nursing, despite the growing population of older people needing nursing care.  Additionally, there is an overall shortage in the field of nursing, due in part to a lack of nursing faculty, which resulted in the rejection of more than 147,000 qualified nursing school applicants at all levels in 2005.  

The Centers of Geriatric Nursing Excellence are part of the Foundation’s Building Academic Geriatric Nursing Capacity Initiative, organized by a coordinating center at the American Academy of Nursing.  This initiative was created in 2000 in response to the critical shortage of nursing faculty with the geriatric skills needed to educate future generations of nurses and the paucity of geriatric nursing curricula and research.  Since 1996, the Trustees of the John A. Hartford Foundation have invested over $67 million in nursing initiatives to improve the care of older adults.

The following four institutions received grants to develop Centers of Geriatric Nursing Excellence:

Arizona State University  
Phoenix, AZ 
Colleen Keller, PhD
$1,000,000 for 5 years

Pennsylvania State University
University Park, PA
Ann Kolanowski, PhD, RN
$1,000,000 for 5 years

University of Minnesota
Minneapolis, MN
Jean F. Wyman, PhD, APRN, BC
$1,000,000 for 5 years

University of Utah
Salt Lake City, UT
Ginette A. Pepper, PhD, RN, FAAN
$1,000,000 for 5 years

For more information on the John A. Hartford Foundation’s Building Academic Geriatric Nursing Capacity Initiative and the Centers of Geriatric Nursing Excellence, please visit http://www.geriatricnursing.org.

Hartford Doctoral Fellows in Geriatric Social Work Program Renewal
Gerontological Society of America
Washington, DC
James Lubben, DSW, MPH
Linda Harootyan, MSW
$5,000,000
Five Years

The John A. Hartford Foundation has awarded the Gerontological Society of America a renewal grant to recruit and prepare up to 99 talented doctoral students for academic careers in geriatric social work, with awards of up to $50,000 per student to complete their dissertation research. 

The Doctoral Fellows program will support the high-quality dissertation research and career development of 39 doctoral students committed to geriatric research topics with fellowship stipends, research training, and mentorship.  An additional 60 doctoral students will receive a pre-dissertation travel award to attend scientific meetings, connect with leading researchers from across the country, and participate in workshops on dissertation proposal and grant writing.  The program has a strong track record; for example, of the eight doctoral fellows funded in the first year of the program, all currently hold tenure-track appointments in top social work programs.

In American universities, doctorally prepared professors are charged with creating new knowledge in a field, teaching future practitioners, and recruiting students in their specialty—however, a historical lack of funding and emphasis on geriatric social work led to a dearth of tenure-track faculty focused on the care of older adults, despite the increasing need as America’s older population expands.  The Hartford Doctoral Fellows in Geriatric Social Work program, funded since 2000, has helped reverse this trend and has increased the number of faculty leaders in geriatric social work. 

Since 1998 the Foundation has authorized $60 million for programs to nurture faculty and researchers, develop appropriate curricula, train instructors, and create field training models that prepare social work students for the aging population.  Since September 2000, 54 doctoral fellows have been competitively selected for awards to support research and training in geriatric social work.  The program has seeded social work research in aging and health and launched its graduates to faculty appointments at major universities.

For more information on the Hartford Doctoral Fellows in Geriatric Social Work, please visit http://www.geron.org/Hartford/docfellows.htm.

Development and Dissemination of a Curriculum in Geriatric Cardiology
American College of Cardiology Foundation/Society of Geriatric Cardiology
Washington, DC
Susan Zieman, MD, PhD
$303,524
Two Years

The John A. Hartford Foundation has made a grant to increase the geriatrics expertise of cardiologists through the development and dissemination of a geriatrics curriculum for physicians training to specialize in cardiology.  Cardiovascular disease remains the number one cause of death and the second leading cause of illness in older adults, and as the number of Americans over the age of 65 dramatically increases, cardiologists will need to be properly trained to ensure appropriate care for these older patients.  This project builds on an earlier Hartford-sponsored Geriatrics Educational Retreat for cardiologists, and will be developed through collaboration between the American College of Cardiology, the Society of Geriatric Cardiology, and Duke University medical educators. 

This grant will support the design, development, and dissemination of a flexible curriculum on geriatric cardiology, which will be targeted to the 187 cardiology fellowship training directors in the United States.  The curricular materials will offer systematic topic reviews, discussions of practical patient care issues, and overviews of ethical and clinical decision-making challenges relevant to older patients.  In addition to reaching up to 3,500 cardiologists in fellowship training, the project expects to reach additional fellows and practicing cardiologists through the American College of Cardiology’s well-developed, online training portal.

Over 70 percent of those who die of cardiovascular diseases, including heart attacks, heart failure, stroke, and arrhythmia, are older than 65.  Age-associated changes in physiology, and the high likelihood of more than one illness at a time, contribute to the vulnerability of older adults and explain much of the discrepancy in outcomes between younger and older patients.  Medical education oversight and credentialing organizations now mandate exposure to content on managing geriatric patients with cardiovascular disease.  However, there have been few formal curricular and training materials available to meet this need.

Since 1998, the Trustees of the John A. Hartford Foundation have invested over $108 million in programs to strengthen academic geriatrics and training in medicine.  

For more information on the Society of Geriatric Cardiology, please visit http://www.sgcard.org.  For more information on the American College of Cardiology, please visit http://www.acc.org.

The John A. Hartford Foundation Geropsychiatric Nursing Collaborative
American Academy of Nursing
Washington, DC
Patricia A. Ford-Roegner, RN, MSW, FAAN
$1,200,000
Four Years

The John A. Hartford Foundation has made a grant to support the creation and dissemination of standard competencies and curricula in geropsychiatric nursing to improve the nursing care of older adults and better serve their mental health needs.  About one in five older adults (7.5 million) currently have a diagnosable mental disorder and this number is expected to reach 15 million by 2030; yet most nurses, who represent the largest group of professionals caring for older adults, lack skills and knowledge about mental health.  This project, designed to help improve the training of nurses in the care of older adults’ mental health needs, will be led by geropsychiatric nursing leaders from three of the John A. Hartford Foundation Centers of Geriatric Nursing Excellence, with coordination being provided by the American Academy of Nursing.

This grant will support the establishment of a core set of geropsychiatric nursing competencies for all levels of nursing education that will articulate the essential knowledge and skills required by nurses to assure that high-quality mental health care is provided to older adults.  These competencies, established by a working group representing major national nursing organizations, will be disseminated to all nursing schools nationwide.  Building upon the competencies, curricula will be developed for basic, graduate, post-graduate, and continuing education nursing programs.  Additionally, a Web site will be designed to make public the competencies and curricular materials, and two regional workshops will be convened to disseminate geropsychiatric curricular content to graduate nursing programs.

The alarming numbers of older adults with mental disorders compelled the Surgeon General and a Presidential Commission to identify mental health of older adults as a critical public health issue for the 21st century.  Studies indicate that older adults receive fewer mental health services than do persons in other age groups, due in part to underdiagnosis, which results in disability and increased costs of care.  However, nurses, who provide the bulk of health care for older adults in hospitals, homes, and long-term care settings, receive little training in mental health, and even less in geriatric mental health.  Among psychiatric nurses, only 16 percent are prepared in the geropsychiatric subspecialty and only 20 percent of geriatric nurse practitioner programs include any geropsychiatric content. 

Since 1996, the Trustees of the John A. Hartford Foundation have invested over $67 million in nursing initiatives to improve the care of older adults. 

For more information on the John A. Hartford Building Academic Geriatric Nursing Capacity Initiative housed at the American Academy of Nursing, please visit http://www.geriatricnursing.org.

Kensington-Hartford Travel Award in Geriatrics
American Federation for Aging Research
New York, NY
Stephanie Lederman
$73,867
Three Years

The John A. Hartford Foundation has made a grant to support travel scholarships for doctoral students, fellows, and junior faculty in Georgia to attend major national conferences to support their pursuit of academic careers in geriatric social work, nursing, and medicine. 

The Kensington-Hartford Travel Award in Geriatrics is designed as a career building opportunity for up to 30 future professors from six Georgia universities (Georgia State, University of Georgia, Medical College of Georgia, Clark Atlanta University, the Medical Center of Central Georgia, and Emory University).  Through a competitive process, students in the fields of social work, nursing, and medicine who demonstrate a commitment to faculty careers in geriatrics will attend the annual meeting of either the Gerontological Society of America or the American Geriatrics Society in order to learn about the range of research and academic careers available in aging.  

Funding for the program was provided via a terminal contribution to the Hartford Foundation from the Kensington Foundation, which closed its operations in 2005.

The southeast affiliate of the American Federation for Aging Research (AFAR) will administer the program.  For more information on AFAR, please visit http://www.afar.org.

In June 2007, the Trustees of the John A. Hartford Foundation approved six grants totaling $11.1 million dollars.  Each grant is described below.

Professional Partners Supporting Family Caregiving
AARP Foundation
Washington, DC
Susan C. Reinhard, PhD, RN
$511,874
One Year

The John A. Hartford Foundation has awarded a grant to the AARP Foundation to collaborate with the American Journal of Nursing, the Council on Social Work Education, and the Family Caregiver Alliance to convene a State of the Science symposium on family caregiving, and publish findings and resources to improve the care of older adults living at home.  Research suggests that over 33 million family members provide care such as overseeing dietary regimens and managing medications for someone aged 50 or over.  Caregivers, often unprepared for their caregiving role, are more prone to disease and depression, which if not addressed, can result in unnecessary institutionalization of older adults.  Professional caregivers such as nurses and social workers need to be expert in supporting families that provide caregiving.

Funding will support a rigorous review of current best practices across disciplines that promote and support family caregiving.  A series of focus groups will be conducted with family caregivers, nursing and social work experts to identify gaps between current practice and the real day to day needs.  The information gathered will provide the basis for the State of the Science symposium, which will focus on practice, education, research, and policy with representatives from nursing, social work, medicine, health care administration, consumer organizations, the federal government and others.  Findings and resources from the symposium will be published in national journals to key organizations representing the nation’s social workers, nurses, caregivers and older adults.

Chief Resident Immersion Training in the Care of Older Adults
Association of Directors of Geriatric Academic Programs
New York, NY
Sharon A. Levine, MD
$2,095,059
Four Years

The John A. Hartford Foundation has awarded a grant to the Association of Directors of Geriatric Academic Programs (ADGAP) in collaboration with Boston University to replicate the successful Chief Resident Immersion Training (CRIT) Program in the Care of Older Adults at 13 medical schools. The CRIT national demonstration will train up to 400 Chief Residents, who will in turn help transfer geriatric medicine skills to over 18,000 residents and medical students.  These advanced-level residents, who have been assigned administrative and teaching responsibilities at academic medical centers, play a variety of key roles in delivering quality patient care, such as medical student and resident training; mediating between faculty, nursing staff, and residents; and communicating with patients and families.  Chief Residents have great potential to create institutional change to improve the quality of care older adults receive in hospital settings.  
 
Developed with Donald W. Reynolds Foundation support by Sharon A. Levine, MD, and others at Boston University Medical Center three years ago, the CRIT Program in the Care of Older Adults uses intensive geriatrics education retreats to teach Chief Residents the basics of geriatric syndromes and the care of complex older patients.  In addition, they learn leadership and management skills, and how to improve communication and collaboration between specialties involved in the care of older patients.  Chief Residents and their mentors also create a one-year project focused on geriatric clinical care or education.  Funding will be used to support the development of the program at 13 competitively chosen academic medical centers over 4 years. 

To date, the John A. Hartford Foundation has granted over $157 million to support academic geriatrics and training in medicine.

National Center for Gerontological Social Work Education
Council on Social Work Education
Alexandria, VA
Julia M. Watkins, PhD
Nancy Hooyman, PhD
$4,739,983
Five Years

The John A. Hartford Foundation has renewed its support for the Council on Social Work Education to expand the National Center for Gerontological Social Work Education, which will enable at least 130 schools of social work to increase the geriatrics content in their curriculum.   Among the supported programs, faculty teams at each school will be formed to review content about aging in the core courses and support will be provided to launch advanced courses in geriatric social work and recruit students to aging and social work through experiential learning.

Studies from before the creation of the National Center for Gerontological Social Work Education showed that most students were not receiving the training they needed to effectively assist their older clients.  The Foundation’s partnership with the Council on Social Work Education, begun in 1998, provided for the development of curriculum standards and the creation of a clearinghouse for geriatric teaching tools, and to date more than $55 million has been invested by the Foundation in geriatric social work education.

Funding to the Council on Social Work Education will be used to support four core activities that promote the education of social workers, particularly bachelor’s students, in how to best serve older clients: 55 Curriculum Development Institutes, which are multi-year guided workshops on integrating geriatrics into core courses, will be launched; 35 small grants will be awarded to schools of social work to develop majors in gerontological social work; 40 schools will be awarded grants to create and promote innovative experiential learning programs to encourage bachelor’s students’ interest in aging; and online courses about teaching aging will be expanded for faculty that lack the resources to participate in national professional development activities.  The Center will continue its work to institutionalize geriatrics in social work education through annual meetings, by providing resources to textbook editors and publishers, by training faculty to write social work licensing questions about aging, by presenting awards to outstanding professors, and by training admissions and career counseling personnel at schools of social work to help guide students into studies and careers in aging.

Due to the rapidly aging population, most practicing social workers will serve older persons, helping them and their families utilize the multiple systems of care that provide health and supportive systems.  The needs of the elderly are often unique and require specialized knowledge and training to be adequately addressed.  Before the creation of the National Center for Gerontological Social Work Education, there was little formalized training in aging at the approximately 600 schools of social work across the country. 

Hartford Geriatrics Health Outcomes Research Scholars
Foundation for Health In Aging, Inc.
New York, NY
Eric A. Coleman, MD, MPH
$2,798,057
Four Years

The John A. Hartford Foundation has awarded a renewal grant to the Foundation for Health in Aging to continue the Hartford Geriatrics Health Outcomes Research Scholars Awards Program, which supports four junior faculty physicians per year who are committed to improving the health care of older adults through research focused on the effects of health care practices and interventions.  The number of older Americans is expected to double in the next 30 years, and there is a great need to both increase scientific knowledge about geriatric health care practices and increase the number of medical faculty who can teach physicians-in-training how to best care for older adults.  The Foundation has established a variety of mechanisms to support geriatrics research and faculty development through its education and training grants, including this award, which was established in 2004 when Pfizer participation in the program ceased. 

Funding to the Foundation for Health in Aging, a part of the American Geriatrics Society, will be used to competitively award $200,000 grants to 12 junior faculty researchers over 4 years to support aging-related health outcomes research—the study of functional status, impairments, perceptions, and health services utilization that are influenced by disease, injury, treatment, intervention, or health policy.  Funding is also used to provide mentoring and networking opportunities for the scholars.

The shortage of geriatrics faculty in all of the health professions remains one of the most important barriers to overcome in preparing the nation to better care for its older citizens.  Obtaining early financial support to begin research projects is critical for junior faculty to compete for larger federal grants, which help launch academic medicine careers.  Besides supporting the development of geriatrics faculty, this grant supports the research that will help improve the health outcomes of older adults.

Hartford Institute for Geriatric Nursing Clinical Resources Expansion
New York University
New York, NY
Mathy Mezey, EdD, RN
$350,000
Three Years

The John A. Hartford Foundation has awarded a grant to expand, enhance, and broadly disseminate the unique clinical resources of the Hartford Institute for Geriatric Nursing, which for the past 10 years has launched pioneering projects to advance geriatric nursing in the areas of education, research, practice, and policy.  The Institute’s clinical resources, considered the “gold standard” in geriatric nursing care, require periodic review and updating and while broadly used, will reach even more practicing nurses through wider dissemination.  This project builds on prior grants totaling nearly $10 million dollars to support the Hartford Institute for Geriatric Nursing at New York University.  

Funding for the project will be used to support four main activities: the updating and expansion of the Institute’s clinical practice protocols and Try This series, used by nurses to assess common geriatric conditions; the enhancement of the Institute’s Web site; the increased dissemination of Institute products through workshops, conferences, and publications; and the establishment of revenue streams and strategic alliances to assure the long-term stability of Institute resources.  These activities over the three-year grant will assure that Institute resources are up-to-date, evidence-based, and reaching the nursing community in the most effective ways possible to ultimately improve nursing care for older adults.

The Hartford Institute for Geriatric Nursing’s clinical resources are highly regarded and used, however, like any evidence-based health care practice tools, they require periodic review and updating to ensure that the best and most current science is incorporated into the materials.  The Institute has established a three-year cycle for reviewing and updating all of their resources.  Most of these resources are available free of charge on the Institute’s Web site, and to reach more nurses in an effective way, the Web site will benefit from a technological upgrade to make it more user friendly and comprehensive.

The Practice Change Fellows: An Interdisciplinary Leadership Program to
Improve Health Care for Older Adults
University of Colorado
Denver, CO
Eric A. Coleman, MD, MPH
$600,000
Four Years

The John A. Hartford Foundation has awarded a grant to support the Practice Change Fellows program to expand the number of health care leaders in medicine, nursing, and social work who can effectively promote high quality care to older adults in a wide range of health care organizations.  Health care professionals who have become leaders in their respective organizations typically do so without formal leadership training, mentoring, or peer support and creating system-wide change to improve geriatric care can be challenging.  Hartford support of 6 Practice Change Fellows complements the funding of 24 additional Fellows by The Atlantic Philanthropies. 

Practice Change Fellows will be selected annually through a national competition, based on their leadership potential and demonstrated ability to implement and sustain new geriatric services or aging-related programs.  Fellows will attend six national leadership training programs and receive intensive mentorship.  In addition to support of the Fellows’ participation in the program, funding will be used to create and disseminate 12 Practice Change Bulletins, which will showcase the Fellows’ newly implemented aging-related services and programs.  Funding will also be used to evaluate the Practice Change Fellows’ impact in the broader context of health care delivery in this country.

There is often no mechanism for health care professionals in the practice setting to gain the requisite skills and content expertise in critical areas such as management, quality improvement, financial analysis, and leadership to succeed in their positions.  A survey of current geriatric health care leaders conducted by the University of Colorado found that leadership skills evolve haphazardly, if at all, with important gaps in the areas of strategic planning, negotiation, and developing compelling business plans.  Respondents in the survey reported a need for structured mentorship and a cohesive network of colleagues with these skills sets. 

In March 2007, the Trustees of the John A. Hartford Foundation approved 15 grants totaling $24.4 million dollars.  Each grant is described below.

Centers of Excellence (CoEs) in Geriatric Medicine and Training Renewal Grants
$3,750,000
Five Years

Johns Hopkins University
Baltimore, MD
Linda P. Fried, MD, MPH
$750,000, Five Years

University of Hawaii
Honolulu, HI
Patricia L. Blanchette, MD, MPH
$750,000, Five Years

University of Pittsburgh
Pittsburgh, PA
Neil M. Resnick, MD
$750,000, Five Years

University of Rochester
Rochester, NY
William J. Hall, MD
$750,000, Five Years

Yale University
New Haven, CT
Mary E. Tinetti, MD
$750,000, Five Years

The John A. Hartford Foundation renewed grants for five Centers of Excellence in Geriatric Medicine and Training at Johns Hopkins University, University of Hawaii, University of Pittsburgh, University of Rochester, and Yale University to continue their efforts to increase the number of physician faculty dedicated to geriatrics. This funding will support the training of at least 100 advanced fellows and junior faculty members to prepare them for careers in aging research and teaching geriatric medicine.

Funding to the Centers of Excellence supports the recruitment and development of future faculty in geriatrics and is used variously for direct salary support, pilot research, developing service venues for research, tuition and support for additional training, or hiring necessary research support personnel.  In addition to attracting and retaining academic geriatricians, the Centers of Excellence contribute greatly to the growth and dissemination of knowledge about geriatric medicine to other physicians and the larger medical community. Since 1997, the John A. Hartford Foundation has helped address this problem by awarding over $38 million to create 24 Centers of Excellence in Geriatric Medicine and Training.

Current projections suggest that by 2020 the nation should triple its production of faculty in geriatric medicine to adequately train the physicians needed to care for a rapidly growing aging population, yet most fellowship programs in geriatric medicine produce physicians who go into practice, rather than research or training.  The infrastructure to create and sustain faculty members in geriatric medicine, or to attract faculty from other areas of medicine, is small and under-resourced relative to the need.  Additionally, federal funding is not available for second, third, or fourth years of advanced training when physicians complete substantive research projects, further develop a research or medical education niche, expand their curriculum vitae or prepare manuscripts for publication—all important steps in an academic career.  The Centers of Excellence provide opportunities and financial support for this critical time.

Four of the Centers of Excellence receiving renewal funding have been operating since 1997, one since 2001, and in total they have received $4.1 million in prior grant awards.  The Centers of Excellence fall within the John A. Hartford Foundation’s overall support of advanced training in medicine, to which the Foundation has awarded $49 million since 1987.

Geriatrics for Specialty Residents Program Expansion
American Geriatrics Society
New York, NY
Nancy Lundebjerg, MPA
$5,082,481
54 Months

The John A. Hartford Foundation has awarded a grant to the American Geriatrics Society to competitively award funding to 75 medical residency programs to develop curriculum materials for teaching future surgeons and related specialists to better care for older patients.  Adults over the age of 65 are twice as likely to undergo common surgical procedures as persons aged 45-64, they are susceptible to a wider range of complications resulting from surgery and hospitalization, and the medical professionals who perform or prescribe surgery and other advanced procedures are often not adequately trained in the needs of these older persons.  This grant builds on a previously funded component of the Foundation supported Geriatrics for Specialists Initiative of the American Geriatrics Society.

Funding for this project will be used to competitively award 75 grants over three years to surgical and specialty resident programs across the country to create and implement training courses that effectively teach future specialists how to work with older patients.  Each project will be led by a specialty medicine professor partnered with a faculty member from geriatric medicine, receive technical support from former grantees and American Geriatrics Society staff, and be brought together for opportunities to share learning.  Additionally, six alumni of the program will receive funding to support planning for greater dissemination of innovations developed through their projects.

This grant will help better train surgeons and medical specialty doctors who are increasingly required to address the needs of older patients.  At the same time that the number of older Americans is increasing, medical technologies are resulting in more procedures available to geriatric patients, such as knee replacements, cardiac catheterization, and liver transplants.  After surgery, patients and families need guidance in making post-operative decisions to address the risk of complications.  The special needs of older patients require specific training during residency–the multi-year period of hands-on patient care after medical school graduation that is provided at over 1,000 community hospitals and academic health centers.

Hartford Collaborative Research Awards: Paul B. Beeson Career Development
Scholars Program
American Federation for Aging Research, Inc.
New York, NY
Odette van der Willik
$2,392,858
30 Months

The John A. Hartford Foundation has awarded a grant to the American Federation for Aging Research, Inc. (AFAR) to fund interdisciplinary teams of alumni from the prestigious Paul B. Beeson Career Development in Aging Research Program to spur new directions in the understanding and treatment of diseases associated with aging.  Federal funding for interdisciplinary research–the research that is likely to produce breakthroughs in medical knowledge and practice, especially related to aging–has been increasing, however applications require expensive preliminary research and data gathering.  This grant will allow Beeson Scholars, already identified as top investigators in geriatric medicine, to collaborate on research that spans traditional disciplinary boundaries and prepare for larger federal grants.  The Foundation, in partnership with the National Institute on Aging and other partners, has supported the Beeson Program since 1994 with $35.4 million.

To support the development of interdisciplinary research, teams of former Beeson Scholars will be able to apply for grants of up to $400,000 over two years for projects that involve clinical, basic biomedical, biopsychosocial, epidemiological, ethics-related, or health services research relevant to aging and geriatrics.  Cross-disciplinary collaborations could include scenarios such as an expert in patient-provider relationships partnering with a cancer researcher to develop better ways to foster clinical decision making, or experts in depression and heart disease forming a research team to help better understand the interaction of psychological and cardiac problems. The funding would be used to hire staff and expert consultants, purchase supplies and equipment, and meet the other costs of launching investigations such as clinical tests or patient incentives associated with the research project. 

Advancing understanding of aging processes and treatments—from cellular mechanisms to diseases associated with aging to issues in clinical management to systems of care—requires new approaches and greater interaction across numerous disciplines.  The push for interdisciplinary research has resulted in the National Institutes of Health funding millions of dollars of new grants to understand the complexity of biological systems and disease, create organizational models for team science, and develop research partnerships with patient communities, community-based health care providers, and academic researchers.  A successful application for this new funding requires preliminary results from multi-perspective studies, an expensive proposition unavailable to most laboratories. 

Funding provided through this grant will assist researchers in building collaborative research projects and builds off the tremendous success of the Beeson Program, which has been funded for 13 years by the John A. Hartford Foundation and other partners.  To date, the Beeson Program has supported 126 Scholars at 39 institutions nationwide, creating programs in important basic and clinical aging-related research.

Improving Hospital Care Transitions for Older Adults
Society of Hospital Medicine
Philadelphia, PA
Laurence Wellikson, MD, FACP
$1,452,017
Three Years

The John A. Hartford Foundation has awarded a grant to the Society of Hospital Medicine to develop and disseminate nationally a quality improvement program to make the hospital discharge process safer for older patients, improving the process at over 100 hospitals and affecting over 270,000 discharges each year.  Research has shown that the transition period following hospitalization can be dangerous for elders, but can be improved with proper discharge planning, often directed by hospitalists—physicians whose primary professional focus and expertise is the medical care of hospitalized patients.  This grant continues the work of a previous $400,000 grant to the Society of Hospital Medicine to develop leadership training for hospitalists and test discharge planning models. 

This grant will provide funding to develop a set of interventions to optimize the hospital discharge transition for older adults, building on earlier Foundation-funded discharge planning demonstration projects and other studies and models from the “patient-centered care” movement.  Funding will also be used to create an instruction manual for implementing, evaluating, and sustaining the interventions; leadership training, mentored implementation of interventions, and intensive on-site consultation to improve the capacity of community and academic hospitals to implement and sustain the quality improvement models; and dissemination of the interventions, instruction manual, and project outcomes through professional journal publication and other forums. 

Today there are an estimated 15,000 hospitalists spread among over 2,000 physician groups, who practice in an increasing number of the nation’s hospitals and academic medical centers, including more than half of the nation’s hospitals with more than 100 beds.  These hospitalists are in key positions to help improve the discharge process, which can be stressful and often dangerous for older adults.  Care coordination at the time of hospital discharge often lacks a consistent, coordinated, and safe approach and this grant seeks to address those issues.

A prior grant to the Society of Hospital Medicine in 2004 accomplished the development and dissemination of a set of core competencies for training hospitalists to care for older patients; the publishing and dissemination of a series of articles related to improving care for elders; and the creation of a clinical “toolbox” for geriatric care available on the Society of Hospital Medicine’s Web site.

Developing New Models of Health Care Delivery to Seniors
Preventive Medicine Research Institute
Sausalito, CA
Dean Ornish, MD
$200,000
One Year

The John A. Hartford Foundation has made a grant to the Preventive Medicine Research Institute to plan for expansion of the scientifically proven Program for Reversing Heart Disease to seniors and the health care providers who serve them.  Chronic diseases such as coronary heart disease are the leading causes of death and disability in the United States, yet less than two percent of the nation’s health care spending goes to prevention of these conditions, which are most prevalent in older populations. 

Funding to the Preventive Medicine Research Institute, led by Dean Ornish, MD, will be used to develop a new model of dissemination of the Program for Reversing Heart Disease specifically targeted to older adults.  The Program, consisting of optimal nutrition, moderate exercise, stress management, and social support, has been shown to reverse the progression of coronary heart disease as well as positively impact other chronic conditions, including diabetes, hypertension, hypercholesterolemia, prostate cancer, depression, and obesity.  The federal government has concluded that there is now sufficient scientific evidence to warrant Medicare coverage of the Program and discussions with Medicare officials will continue through this grant project.

Approximately $1.8 trillion was spent last year on health care in this country, and 75 percent of this amount on treating Americans with chronic illnesses.  Tens of billions of dollars are spent each year on cardiology procedures like angioplasties and stents, despite scientific evidence showing that these procedures do not necessarily prolong life or even prevent heart attacks in those with stable coronary artery disease.  And because these approaches only bypass the problem without also addressing the underlying causes, the same problems tend to recur or new problems or side effects develop.  The Foundation, in partnership with the Preventive Medicine Research Institute, seeks to bring more attention to preventive medicine to address these issues.

How to Try This: Geriatric Assessment Nursing Resources
New York University
New York, NY
Mathy D. Mezey, EdD, RN, FAAN
$2,622,560
Three Years

The John A. Hartford Foundation has made a grant to New York University to develop a series of 30 geriatric nursing assessment videos and corresponding articles for use by community college nursing programs to improve the ability of nurses to care for elderly patients.  Sixty-three percent of those entering the nursing workforce are graduates of community college programs, yet there is a lack of faculty, curriculum, and resources to adequately prepare them to care for older adults.  This project builds on prior grants to the New York University Hartford Institute for Geriatric Nursing, which produced the original “Try This” geriatric nursing assessment series.

The three-year grant to New York University, in collaboration with the American Journal of Nursing, will incorporate the “Try This” geriatric nursing assessment series, considered the gold standard for assessing health issues of older adults like dementia and falls, into community college nursing curricula.  Funding will be used to: develop and publish 30 Web-based demonstration videos and 30 complementary articles in the American Journal of Nursing; broadly disseminate the articles and video products to community college nursing faculty, students, and graduates through sessions at key nursing conferences; promote access to the assessments for use in staff development and continuing education of practicing nurses; and evaluate the products and their dissemination.

Training in nursing assessment specific to older adults is important because illness in older people often looks very different than in younger individuals.  For example, the first symptom of a urinary tract infection for an older person is often a fall or sudden confusion, whereas a younger person’s first symptoms would be frequent urination, pain, and a fever.  Tools have been developed to help train nurses in baccalaureate programs how to assess geriatric patients, however, more than 50,000 new nurses graduate each year from community colleges, which have not had access to these tools and resources. 

This grant builds on over 12 years of funding totaling more than $16.6 million by the John A. Hartford Foundation to New York University for the Hartford Institute for Geriatric Nursing.

Dissemination of Care Management Plus: Information Technology Tools
for the Care of Seniors
Oregon Health & Science University
Portland, OR
David A. Dorr, MD, MS
$2,477,509
Four Years

The John A. Hartford Foundation has awarded a grant to Oregon Health & Science University to implement the successfully tested Care Management Plus model of health care for elders, which utilizes a care manager and computer technology and should reduce deaths, decrease re-hospitalizations, and improve disease management for thousands of elderly patients in at least 32 primary care clinics.  High quality geriatric care requires the collaborative effort of a wide range of skilled health professionals, as well as patients and their families, in order to address the complex needs of frail elders.  The Care Management Plus model was developed with a prior $1.2 million grant at Intermountain Health Care in Utah as part of the Foundation’s Geriatric Interdisciplinary Teams in Practice Initiative.

Funding through this grant will support implementation of the Care Management Plus model in at least 32 primary care clinics over 4 years, development of reimbursement methodology so that improving care to seniors and those with multiple chronic conditions is encouraged, and creation of a sustainable business plan for the model’s dissemination beyond the funding period.  The Care Management Plus model uses computer technology and a nurse care manager to help patients and caregivers self manage their conditions, prioritize their health care needs, and navigate an increasingly complex health care system.  The unique computer technology includes a care manager tracking database, patient summary sheet, and messaging systems to facilitate communication and best practices among the health care team.

Health care teams working collaboratively can have a profound impact on improving outcomes for older patients.  Without well-functioning teams, the fragmentation of care, which has been a long-standing concern of the Foundation, can result in danger to patients and burdensome costs for the system.  Demand by primary care clinics for the Care Management Plus model has been high, despite significant investments required by the clinics to implement the program. 

Establishing a Framework for Geriatric Home Care Excellence
Visiting Nurse Service of New York
New York, NY
Penny Hollander Feldman, PhD
$835,466
Sixteen Months

The John A. Hartford Foundation has awarded a grant to the Visiting Nurse Service of New York to establish a national framework of geriatric home care practice guidelines that can be used by accrediting agencies, public and private purchasers, and by home care organizations to guide and assess the delivery of home health services to older persons.  The use of home care—the provision of care and supportive services in the home that promote, maintain, or restore health and independence—is a growing field in which nearly 70 percent of those receiving home care are over the age of 65.  Home care patients are living longer and are facing more complex health needs, yet there are no national guidelines or standards for geriatric best practices. 

This grant will provide funding to review the scientific literature on home care, conduct in-depth interviews with key leaders, hold regional focus groups, and publish five topical white papers, ultimately leading to the development of new geriatric practice guidelines and resources for the home care industry.  Stakeholders such as the Joint Commission on Accreditation of Healthcare Organizations, the National Association of Home Care, and leading home care agencies across the country will be involved in the initiative.  This project will lead to the establishment of the first national geriatric special interest group in the home care field.

Geriatric Nursing Leadership Academy
Sigma Theta Tau International Foundation for Nursing
Indianapolis, IN
Mary Rita Hurley, RN, MPA
$529,575
One Year

 The John A. Hartford Foundation has made a grant to Sigma Theta Tau International Foundation for Nursing to plan for the establishment of a geriatric nursing leadership academy, which will prepare and position nurses in leadership roles within health care delivery settings and improve the quality of care to geriatric patients and their families.  Older adults constitute a majority within the health care delivery system as consumers of services and recipients of care and nurses, who provide much of the hands-on care to these older patients, are in unique positions to manage, coordinate, and facilitate decision-making in collaboration with other health professionals in providing good geriatric care.  It is important that nurses have opportunities to develop leadership skills that will enable them to take advantage of their positions and lead change in their health care settings to improve the quality of geriatric care. 

Funding to Sigma Theta Tau, the honor society of nursing representing 130,000 members, will be used to develop the geriatric nursing leadership academy model, which will be based in part on their successful leadership academy for maternal child nurses.  A national network of nurse leader mentors will be established to provide expertise to the participants of the leadership academy.  Funding will also be used to develop additional leadership and scholarship resources including two books on geriatric nursing and an online geriatric nurse community. 

Practicum Partnership Program Adoption Initiative Continuation
New York Academy of Medicine
New York, NY
Patricia J. Volland, MSW, MBA
$4,685,376
Four Years

The John A. Hartford Foundation has renewed a grant to the New York Academy of Medicine to fund 25 additional graduate schools of social work to implement rotational field training with older adults, and to prepare legacy materials that will assist in the future implementation of the training model after Foundation funding has ended.  Social work students greatly benefit from rotational field training that allows them to have experiences spanning the fragmented systems of care in which they will eventually work, while introducing them to older adults of varied ages and levels of functioning and independence.  This renewal grant continues the work of prior funding used to test and implement the training model at over 41 schools of social work.

Funding from this grant will provide $75,000 each to 25 schools of social work to implement the rotational field training model for working with older adults.  Funding will also be used to continue support of a coordinating center, create “starter kits” and other materials that can be used by schools of social work wishing to implement the training model in the future, and for meetings and workshops in support of the program.

Social work students will become the crucial service providers to enable older adults and their families to access the array of health and social services available as part of modern medicine.  In traditional field training at social work schools, students are often placed at one site, often in nursing homes or other venues where they are least independent and healthy.  A rotational model allows social work students to experience a broader array of settings where they will encounter seniors at various levels of functioning and health.   

Establishing PACE as a Community Care Option for Rural Elders
National PACE Association
Alexandria, VA
Peter Fitzgerald
$334,856
21 Months

The John A. Hartford Foundation has awarded a grant to the National PACE (Program for All-inclusive Care for the Elderly) Association to help 15 rural elder care providers apply for up to $17.5 million in federal funds to develop local PACE sites.  Most older Americans prefer to live at home, but may be unable to do so because of the complexity of our current health care system.  The successful PACE program, which provides coordinated services to seniors and allows them to avoid nursing home placement, has been adopted in 19 states, but is lacking in rural areas.  New federal funding is available for rural sites, but the application process is extremely complex and requires technical assistance from experienced staff.  The Foundation has supported the dissemination of PACE sites with two prior grants.

Funding from the grant will support intensive group and one-on-one consulting between the National PACE Association and applicant sites to successfully complete the complex and lengthy application for federal funding.  In the process, the National PACE Association will update and revise its technical assistance materials to meet new federal regulations and be available for future implementation of more PACE sites. 

PACE sites overcome the typical fragmentation of care by utilizing an integrated health care financing model that combines Medicare and Medicaid to provide comprehensive services at a day health center.  In essence, each PACE site becomes both an insurance company and a health and social services provider and uses the best available clinical management knowledge and skills to facilitate operations.  In 1997, PACE was designated as an allowable service provider within the Medicare system, setting the stage for wider adoption. However, development of sites using the PACE care model is limited by regulatory, financial, and organizational hurdles.