Improving%20the%20Health%20Care%20of%20America

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Improving the Health Care of Americas Older
Adults ThroughSocial Work The John A. Hartford
FoundationCorinne H. RiederExecutive Director
and Treasurer National Association of Deans
and Directors of Social WorkSpring 2009
ConferenceScottsdale, ArizonaMarch 16, 2009
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Overview

1. What are key problems in meeting the health care
   needs of our rapidly aging population?
2. The Hartford Foundation What is it? Why Aging?
   Why is this important to Social Work?
3. What was the state of geriatric social work in
   1999 when Hartford began its grantmaking what
   has been accomplished?
4. Observations opportunities for promoting aging
   in social work.

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I. Key Problems in Meeting the Health Care Needs
of our Rapidly Aging Population

• Work Force Shortages
• There are too few geriatrics specialists,
  including academics, in social work, nursing
  medicine
• Deficiencies in Health Care Delivery Quality
• Quality of care is often unacceptable
• Systems of care may be inefficient not well
  coordinated.
• Patients families not active partners in care
  provision

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A. Work Force Shortages

• Social Work
• NIA estimated the need for 70,000 geriatric
  social workers by 2020.
• Currently only 4 of students specialize in
  geriatrics despite the fact that 73 work with
  older adults between 8 10 of social workers
  are employed in long-term care.

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A. Work Force Shortages

• Social Work (Continued)
• The number of programs is also decreasing. In
  the 1980s, 50 of MSW programs offered an aging
  specialization by the early 1990s this had
  dropped to 33, as of 2003, only 29 offered an
  aging specialization.
• Of the 2000 doctorates awarded nationally since
  1995, only 289 (14) focused on aging topics.

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A. Work Force Shortages

• Medicine Psychiatry
• In medicine, certified geriatricians have
  declined from 8,000 in 1998 to 7,000 in 2004, or
  1 geriatrician for every 2,500 older Americans.
• Assuming current growth rates, by 2030 there will
  be only 7,750 geriatricians or 1 for every 4,250
  older people despite a projected need for 30,000
  geriatricians.

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A. Workforce Shortages

• Medicine Psychiatry (Continued)
• Currently there are less than 1,600 certified
  geriatric psychiatrists. At the present
  graduation rate, there will be only 1,700
  geriatric psychiatrists in 2030, or 1 per 5,700
  older Americans with a psychiatric disorder.

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A. Work Force Shortages

• Nurses
• The most recent projections of the nursing
  shortage range from 340,000 to 1 million nurses.
• Of the 240,000 advanced practice nurses only
  3,500 are geriatric nurse practitioners.

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B. Deficiencies in Health Care Delivery to
Older Adults

• The quality of care is often unacceptable
• The health care workforce receives very little
  geriatric training.
• The health care needs of older adults are
  frequently neither comprehensively addressed nor
  patient-centered.
• Too little attention is paid to providing
  preventive services coordinating the treatment
  of chronic acute care conditions.

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B. Deficiencies in Health Care Delivery to Older
Adults (Continued)

• Services are often not provided efficiently.
• Providers need to be trained to work in
  interdisciplinary teams financing delivery
  systems need to support these teams.
• Care coordination is essential patient
  transitions need to be facilitated across various
  delivery sites. All providers need access to
  patient information.
• A number of new cost-effective models have been
  developed tested which improve patient
  outcomes, which should be widely adopted
  adapted.

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B. Deficiencies in Health Care Delivery to Older
Adults (Continued)

• Patients their families are too often not
  active partners in patient care or supported.
• These partnerships need to include the adoption
  of healthy lifestyles, self-management of chronic
  conditions increased participation of patients
  their families in decision making.
• The 33 million caregivers providing help to
  adults over 50 need support and training.

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But it Doesnt Have to be this Way! I Can
Envision a Time When

• Older adults receive quality health care from
  sufficient numbers of well-trained health
  professionals.
• Care for older adults is comprehensive,
  patient-centered coordinated.
• Health professionals are trained to work in
  interdisciplinary teams, our countrys
  financing delivery systems support them.
• Our health care system takes account of the
  increasing social, demographic geographic
  diversity of older adults.
• Health care is seamless across various delivery
  sites all clinicians have immediate access to
  patients health information communicate with
  one another.
• Older people their families are active partners
  in their care where there is greater attention
  to financing of disease prevention, the
  adoption of healthy life styles the
  preservation of function.

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II. The Hartford Foundation

• 80 year old, 434 million foundation
• 30 year history in improving the health of older
  people
• Narrow consistent focus is unique for a
  foundation our size peers multiple foci
  shorter term commitments less than 2
  philanthropic dollars go to aging
• Places importance on partnering 2 major partners
  spending down (Atlantic and Reynolds)
• National in scope put a premium on projects that
  can be sustained have a multiplier effect,
  while avoiding duplicating the efforts of others
• Strategic in grantmaking rarely fund proposals
  that come over the transom
• Committed 400 million to 200 organizations over
  the past 30 years

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The Impact of the Current Recession on the
Hartford Foundation

• Independent foundations like Hartford rarely have
  new money coming. Depend solely on the growth of
  investments.
• Nor, obviously, do they have a stream of tuition
  or research monies or grateful alums.
• In October 2007, Hartford was a 78 year old
  Foundation with an endowment of 750 million
  instead of 434 million.
• With a 320 million decrease in its endowment,
  the Foundation has been forced to cut not only
  many future grants, but also current grantees.
  Something that has been very painful for us to
  do.
• Despite the recession Hartford will maintain our
  commitment to improving the health care of older
  people will increase its efforts when the stock
  market recovers the endowment again grows.

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Hartfords Strategies

• The Foundation pursues 3 strategies
• Education training
• Improved service delivery
• And, drawing excellent scholars into aging RD to
  advance knowledge and improve practice.

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• The bequest from John A. Hartford, which
  established the Foundation, directed future
  Hartford trustees
• to do the greatest good for the greatest
  number.
• Andto carve from the whole vast spectrum of
  human needs one small band that the heart and
  mind together tell you is the area in which you
  can make your best contribution.

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The Foundations Choice Its Importance to
Social Work to You

• Given Mr. Hartfords wishes, what led the
  Foundation to choose improving the health care of
  older adults as its goal?
• 1. Respect for Mr. Hartfords desire to focus on
  a limited area to achieve maximum impact to
  stay within health, his major area of interest.
• 2. The demographics.
• 3. No other foundation had that area as a major
  focus.

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Why are the Demographics Important?

• The growth of older Americans is dramatic.
• It is widespread across the country.
• The increase in the number of people over 85
  100 years of age is especially large.
• Chronic diseases increase with age as do the use
  of health care services their costs.

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Growth in the Number of Older Adults

• Those over 65 years of age will double between
  2000 2030, growing from 35 million to over 70
  million.
• Much of the growth is attributed to the baby
  boom generation born between 1946 1964.
• 85 the most rapidly growing group, going from
  1.5 in 2000 to 5 of population in 2050.
• 100 projected to grow from 50,000 to 800,000
  over the same time period.

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US Population Pyramids
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Increases in the Oldest Old
U.S. Population Aged 85 (in millions)
Sources of data U.S. Census Bureau, 65 in the
United States 2005, December 2005 U.S. Census
Bureau, U.S. Interim Projections by Age, Sex,
Race, and Hispanic Origin, 2004.
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The Prevalence of Chronic Diseases Increases with
Age Data from 2003-2005
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The Use of Health Services Also Increases with Age

• Older adults represent 13 of the population, yet
  account for
• 46 of patients in critical care
• 50 of hospital days
• 50 of specialty ambulatory care visits
• 70 of home health services
• 90 of residents in nursing facilities

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What Other Challenges does our Nation Face in
Providing Quality Health Care Social Services
to Older Adults?

• Health Care Discrimination Ageism
• The Growing Cost of Health Care the Political,
  Financial Ethical Issues Associated with that
  Growth the need for, difficulty in, achieving
  fundamental reforms to health care delivery

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Why are these important to you theSocial
Workers that you educate?

• 1. Discrimination ageism negatively impact
• a. Quality of care that older people
  receive.
• b. Recruitment of students into geriatric
  health professions.
• c. Educational training environment,
  i.e., poor care becomes standard care.
• d. And, students need to be prepared to
  identify treat older adults that have been
  abused /or suffer from self-neglect.

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Why are these Important to You?(Continued)

• The growing cost of health care the difficulty
  in achieving fundamental reforms to health care
  delivery
• Annual Medicare costs are over 400 billion.
• Growing concern about the mismatch between
  projected Medicare entitlements the ability of
  the economy to pay for them.
• Complex divisive ideological ethical issues
  are also at stake.

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There are also Remarkable Opportunities to Make a
Difference in Geriatric Social Work

• Geriatric Social Work
• Is the key discipline for coordinating health
  care long term care services for older adults
  their families.
• Has primary responsibility for supporting
  families informal caregivers.
• Takes the lead in promoting healthy life styles,
  reducing the incidence of chronic diseases
  eliminating health disparities among different
  segments of the population.
• Actively helps older adults maintain their
  psychological cognitive health, including the
  promotion of social interaction.
• Is increasingly attractive to philanthropy,
  business governmental leaders.

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III. How is Hartfords Grantmaking in Social
Work Meeting these Challenges? Are they
succeeding?

1. What was the state of geriatric social work in
   1999 when Hartford began its grantmaking in
   social work?
2. What has been accomplished through these efforts?

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Where was Gerontological Social Work in 1999 when
we began our efforts?

1. No national aging curriculum models.
2. No focused national recruiting into geriatric
   social work.
3. No articulation of competencies in aging to guide
   curriculum training.
4. No national training projects to prepare faculty
   to teach geriatrics.
5. Minimal resources to train staff or improve the
   overall care of older people.
6. No nationwide social work initiatives to improve
   care to older clients.

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Where Were We By the Numbers?

• Overall, less than 3 of social work graduates
  enrolled in geriatric courses.
• 2. 95 of students took less than 2 courses
  on aging in their social work programs.
• 3. 73 of social work students report working
  with older adults.

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Hartfords Social Work Objectives

• 1. Prepare a geriatrically competent
  workforce.
• 2. Incorporate geriatrics in the education
  training programs of all social work schools in
  the country.
• 3. Ensure that there are sufficient geriatric
  social work faculty members.
• Develop, test and disseminate innovative,
  cost-effective models of training care that
  improve social work services to older adults.
• Draw national attention to the importance of
  social works role in improving the health care
  of older people.
• 6. Communicate the idea that older adults are
  a core business of health care of social
  work.

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Hartford Financial Commitments to Social Work to
Achieve these Objectives

• 1999-2008
• 70 Million authorized
• (64.5 million in education 5.5 million
  for
• research and new models)
• 47 Million paid out
• 34 Major grants approved

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Hartfords Leveraging 2001-2007

• Total Funding Brought to Geriatric
• Social Work 163 million

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Partnerships

• The Archstone Foundation
• The Atlantic Philanthropies
• The Hearst Foundations
• The Jacob and Valeria Langeloth Foundation
• The Helen Bader Foundation
• Veterans Administration
• National Institutes of Health
• National Association of Social Workers
• AARP Andrus Foundation
• The Louis and Samuel Silberman Fund
• The Administration on Aging
• The Centers for Disease Control
• Werner and Elaine Dannheisser Trust
• Plus approximately 50 local funders

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Hartfords Social Work Initiative

• Broadly speaking, Hartfords Social Work is
• organized around 3 themes
• Academic leadership development
• Faculty Scholars Program
• Doctoral Fellows Program
• Pre-dissertation Awards
• The Leadership Academy in Aging
• Curriculum for aging
• GeroEd Center (previously GeroRich, SAGE S/W)
• Providing real-world training for social work
  students.
• Hartford Partnership Program for Aging Education
  (HPPAE, formerly PPP)

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Whats Been Accomplished and Where are We Today?

1. 81 scholars in 8 cohorts. Of the 81 scholars,
   all who have applied for tenure received tenure.
   These scholars serve on the faculty of 37 schools
   in 28 states they have written 260 book
   chapters, 21 textbooks, the 1st 6 cohorts have
   published 612 articles in top tier journals
   overall these scholars have made 1,605 research
   presentations were awarded 206 grants.

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Whats been Accomplished and Where are We Today?
(Continued)

• 2. 69 doctoral fellows have been selected who
  show promise to become faculty leaders in
  geriatric social work. Of these, 35 former
  doctoral fellows hold full-time faculty status or
  post-doctoral appointments almost half (32) are
  still engaged in dissertation research.
• 3. 80 Pre-Dissertation Awardees have been
  selected 16 have gone on to become doctoral
  fellows 8 applied for the August selection
  cycle, and 26 more plan to apply this year.
  

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Whats been Accomplished and Where are We Today?
(Continued)

• Curriculum grants resulted in new aging curricula
  being disseminated adapted by over 180 schools.
• Gero-Ed is a model for the development of
  additional competencies (CSWE EPAS).
• 6. Aging-content is being increased in social
  work text books.
• 7. Geriatric questions have been written for
  social work licensing exams.
• HPPAE has been adopted in 72 schools in 32
  states.

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Whats been Accomplished and Where are We Today?
(Continued)

• 9. In January 2006, The Handbook of Social
  Work in Health and Aging was published, a
  1,000-page reference text edited by Dr. Barbara
  Berkman authored by 33 scholars and 31 program
  mentors.
• A national leadership development program for
  deans directors has been established to
  strengthen skills promote gerontological social
  work.
• 11. At this meeting, Dr. Nancy Hooyman, is
  unveiling her new book, Transforming Social Work
  The First Decade of the Hartford Geriatric Social
  Work Initiative.

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IV. Observations Opportunities for Promoting
Aging in Social Work

1. Observations
2. Recommendations for promoting aging in social
   work

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8 Observations About Social Work

1. The general public some health professionals
   are not fully aware of social works real
   potential contributions to improving the health
   care of older people. Nor, do they understand
   the expertise that social workers bring to the
   table. Within the field, there has been
   inadequate attention given to program evaluation
   measuring the cost-effectiveness of social work
   services. These factors contribute to social
   workers being underutilized sometimes feeling
   that their skills are undervalued.

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Observations (Continued)

• 2. Who speaks for social work education
  nationally? The field of social work is
  fragmented by its multiple national associations.
  This situation reduces its impact in a variety
  of ways dilutes the potentially pivotal role
  played by deans directors.

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Observations (Continued)

• 3. Social work is a complex challenging
  profession with a commitment to meet the multiple
  needs of our countrys diverse population. While
  this is a positive, the field can also become so
  fragmented that it overlooks common human needs
  that cut across specific population groups, e.g.
  aging, income inequality.

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Observations (Continued)

1. Is there too much separation between policy
   practice within social work programs? Do social
   works diverse roots in clinical practice
   community organization prevent policy from being
   fully integrated into the fields curriculum,
   clinical practice research efforts?

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Observations (Continued)

• 5. Improving the health care of older people is
  an interdisciplinary effort in practice, policy
  RD. How well connected are you and your
  schools faculty with counterparts in medicine,
  nursing other health professions? Are there
  silos or turf battles that need to be addressed
  in your institution? How much have you exploited
  the resources of other professions to advance
  social work?

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Observations (Continued)

• 6. Social work needs more research focused on
  a) better understanding improving service
  delivery, b) the assessment teaching of
  required competencies that need to be exercised
  in specific care environments, and c) evaluation
  cost-benefit studies of different
  interventions. Private funders ask Where in
  social work is the health services research that
  we see in medicine and nursing?

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Observations (Continued)

• 7. Some colleges and universities seem
  unwilling to assume a responsibility for meeting
  national work force needs. While this tendency
  may be less in social work, it still takes its
  toll on school departmental resource allocation
  decisions pressure to bring in research funding
  in research intensive universities. How is this
  viewed in your institution? Does it impact your
  school?

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OBSERVATIONS (Continued)

• 8. Some in leadership positions argue that social
  work is not sufficiently proactive, future
  oriented strategic. They attribute this to it
  being a helping profession the fields
  clinical orientation, thus focusing on reacting
  to specific here now health social
  problems. Are deans directors, in your view,
  honing their strategic skills to think plan for
  the future?

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One Recommendation

• Incorporate Geriatrics into your
• Schools Program

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11 Ways to Incorporate Geriatrics into your
Schools Program

• Infuse geriatrics across the curriculum in
  existing non-geriatric courses increase
  stand-alone courses. Exercise your leadership to
  include geriatric competencies content in state
  licensing exams. To assist you, access the
  extensive teaching curricular resources through
  WWW.Gero-EdCenter.org.
• Exert your influence to ensure that the new EPAS
  emphasis on context, e.g. demographics, is
  applied in reaffirmation/accreditation processes.
  The Gero-Ed and HPPAE programs have the best
  developed geriatric social work competencies now
  available.

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Incorporating Geriatrics (Continued)

• Increase the number, quality variety of
  clinical experiences that students experience
  with older people the institutions that serve
  them. Also, educate social workers to measurably
  improve the health outcomes of family caregivers.
  Again, HPPAE is an excellent model to adopt.
• 4. Increase the number of social workers
  focused on geriatrics at all levels of social
  work including health, substance use mental
  health specializations (Gero-Ed Center Masters
  Advanced Curriculum ProjectMAC).

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Incorporating Geriatrics (Continued)

• Hire more faculty members with expertise in
  gerontology. Help faculty re-train in geriatrics
  when possible.
• Increase efforts to obtain government, corporate
  philanthropic support to expand aging social
  work programs, especially important are monies
  for financial assistance to masters doctoral
  level students. Given social work salaries
  relative to those of other health professionals,
  it is critical that deans directors advocate
  for speak up on state federal legislation
  providing student financial assistance, including
  proposals for loan forgiveness.

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Incorporating Geriatrics (Continued)

• Deans directors are eager that faculty members
  apply for receive Hartford other funding, but
  they also need to support faculty with sufficient
  in-kind resources additional funding beyond
  that which foundations provide.
• 8. Support the adoption adaptation of
  existing evidence-based social worker models,
  such as the Hartford Partnership Program in Aging
  Education (HPPAE), that improve the education of
  trainees and the delivery of health care services
  to older patients.

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Incorporating Geriatrics (Continued)

• 9. Initiate interdisciplinary teaching programs
  so graduates are better able to work in
  interdisciplinary teams, especially serving frail
  older adults.
• 10. Have your school take a leadership role in
  critical geriatric areas where there is
  insufficient attention, strategies, models
  creativity. Among those that stand out are 1)
  prevention public health, 2) mental health,
  both diseases and social isolation.

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Incorporating Geriatrics (Continued)

• 11. Increase educational, research practice
  relationships with non-social work schools in
  your institution to better prepare social workers
  to assume managerial, policy leadership roles
  within outside social work programs academic
  health centers. Social work leaders also need to
  strengthen their partnerships with community
  leaders to provide better services to older
  adults.

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