IT TAKES A TEAM:
What we will need to meet needs of older adults and their family caregivers.
Capitol Hill Briefing October 30, 2014
#EWABriefing #ItTakesATeam
Panelists
Moderated by: Michèle Saunders, DMD, MS, MPH Lenise A. Cummings-Vaughn, MD
Tara Cortes, PhD, RN, FAAN Andrew Heck, Psy.D., ABPP Carmen Morano, PhD
Arnetta Whittaker
Karen Marshall, JD
The Eldercare Workforce Alliance
• 30 national organizations
• Consumers
• Family Members
• Direct Care Workers
• Health Care Professionals
• Addressing the immediate and future workforce crisis in caring for an aging America
• Advancing Recommendations in 2008 IOM Report:
“ Re-Tooling for an Aging America: Building the Health Care Workforce ”
• 2012 IOM Report “The Mental Health and Substance Use Workforce for Older Adults:
In Whose Hands?”
EWA Member Organizations
• AARP
• Alzheimer's Association
• Alzheimer's Foundation of America
• AMDA – The Society for Post-Acute and Long-Term Care Medicine
• American Academy of Nursing
• American Association for Geriatric Psychiatry
• American Geriatrics Society **
• American Health Care Association and National Center for Assisted Living
• American Nurses Association
• American Physical Therapy Association
• American Psychological Association
• American Society of Consultant Pharmacists
• American Society on Aging
• Caring Across Generations Federal Liaisons
• US Department of Veterans Affairs
• Administration for Community Living
• Coalition of Geriatric Nursing Organizations
• Community Catalyst
• Council on Social Work Education
• Direct Care Alliance
• Family Caregiver Alliance
• Gerontological Society of America**
• LeadingAge
• National Alliance for Caregiving
• National Association for Geriatric Education
• National Association of Social Workers
• National Consumer Voice for Quality Long-Term Care
• National Cooperative Bank
• National Council on Aging
• National Hispanic Council on Aging
• NCB Capital Impact/THE GREEN HOUSE® Project
• PHI - Quality Care through Quality Jobs
• SEIU Healthcare
• Social Work Leadership Institute
** Alliance Co-conveners
EWA Supporters
Persons
• IOM (2008) 3 strategies
• Increase recruitment and retention of geriatric specialists and caregivers
• Geriatric Training Program for Physicians, Dentists, and Behavioral and Mental Health Professions (GTPD)
• Enhance geriatric competence of general workforce in common problems
• Comprehensive Geriatric Education Program (CGEP)
• Geriatric Academic Career Awards (GACA)
• Geriatric Education Centers (GEC)
• Implement innovative models of care
Training in Geriatrics
• Less than 3% of students in medical schools choose to take geriatrics electives.
• Only 4% of social workers report receiving geriatrics training.
• Less than 1% of all registered nurses are certified as gerontological.
• Only 4% of psychologists are trained to work as specialists with older adults (i.e., geropsychologists).
• Less than 1% of practicing physical therapists are certified as geriatric clinical specialists.
• Less than half of pharmacy schools have a distinct course in geriatrics
despite the fact that per capita prescription drug use by people 65 and older is triple that of younger individuals.
• Less than one-fifth of schools training oral-health workers, including dentists
and dental hygienists, offer a course in geriatrics practice.
National Family Caregiver Support Ratio
Source: AARP Public Policy Institute, The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers. August 2013.
In 2010: ratio was 7.2 to 1
In 2030: ratio is
projected to decline to 4.1 to 1
By 2050: ratio is
expected to decline to
2.9 to 1
Title VII Program: Geriatric Education Centers (GEC)
• Train health professions faculty, students, and practitioners in the diagnosis treatment, prevention of disease, disability, and other health problems of the elderly.
• Provide services to and foster collaborative relationships among health professions educators
• Provide quality interdisciplinary geriatric education and
training to the health professions workforce, including geriatric specialists and non-specialists.
• GECs, in the academic year of 2009-2010, provided
interdisciplinary geriatric education and training to 54,167
health profession students and to 20,791 interdisciplinary
teams.
LENISE A. CUMMINGS- VAUGHN, MD
Assistant Professor, Washington University in Saint Louis, Division of Geriatrics and
Nutritional Science
#EWABriefing #ItTakesATeam
Percentage of Population with Chronic Conditions
Source: Robert Wood Johnson Foundation. Chronic Conditions: Making the Case for Ongoing Care. February 2010.
Source: Langston, Chris. “Decline in Geriatric Fellows Defies Pay Boost: +10% = -10%.” John A.
Hartford Foundation, Health AGEnda. December 20, 2012.
Title VII Program: Geriatric Academic Career Awards (GACA)
• Promotes the development of academic clinician educators in geriatrics.
• Focus on interdisciplinary curriculum
development and integrating geriatrics into health professions curricula.
• Provides training in clinical geriatrics for interdisciplinary teams.
• Led to interdisciplinary training of ~60,000
health professionals and led to care to over
525,000 underserved and uninsured patients.
TARA CORTES, PHD, RN, FAAN
Executive Director, The Hartford Institute for Geriatric Nursing
Professor, New York University College of Nursing
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Geriatric Workforce Policy Studies (2009)
6.8K 6.3K 6K 5.4K 5.4K
19M
23M
34M
45M
49M
2010 2020 2030 2040 2050
Geriatricians (in Thousands) Population 75+ years (in Millions)
• Nurse practitioners are the future of primary care in this country
• Provide accessible quality care regardless of ability to pay
• There are > 55,000 Family Nurse Practitioners
• There are > 25,000 Adult Nurse Practitioners
• There are < 5,000 Geriatric Nurse Practitioners
• We need to increase the capacity of NPs to deliver age sensitive care to this growing number of
older adults
Nurses
• There are nearly three million nurses
• Less than 1% are certified in geriatrics
• 63% of newly licensed nurses report that 2/3 of their practice is older adults
• Only 33% of baccalaureate programs and 20% of
associate programs offer geriatrics as a free standing course
• Surveys show that nurses are not comfortable caring for
older adults
Education Program, HRSA Grant Program
• This program funded the Hartford Institute at NYU College of Nursing to develop online resources to help Primary Care
Providers (NPs, MDs and PAs) provide age sensitive care to older adults.
• Person focused
• Interprofessional
• Evidence based
• Age specific
• Enhance the capacity of the workforce to provide the care
necessary to maintain older adults at their highest level of function
• Supports the development and dissemination of curricula relating to geriatric care and training of faculty in geriatrics.
• Provides continuing education for nurses
practicing in geriatrics.
Survey of Primary care providers
• 64% of respondents said that adults over the age of 65 years made up 50% or more of their practice
• 96% felt that it would be helpful to have more knowledge about older adults
• 75% did not have a certification in geriatrics
• Most participants ranked interactive e-learning modules as preferred method of
receiving content on care of older
patients
ANDREW HECK, PSY.D., ABPP
President, Council of Professional Geropsychology Training Program
Clinical Director, Piedmont Geriatric Hospital
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Title VII Program: Geriatric Training Program for Physicians, Dentists, and Behavioral and Mental Health Professions (GTPD)
• Increase the supply of culturally competent clinical faculty in geriatrics
• 1-year retraining program for mid-career faculty and a 2-year geriatric fellowship training
• Led to geriatric care for more than 20,000
older adults across the care continuum
Title VII Program: Graduate Psychology Education Program (GPE)
• Currently supports 40 grants to accredited psychology doctoral, internship and postdoctoral training programs to support the interprofessional training of psychology graduate students and interns.
• GPE geropsychology grants have provided supervised mental and behavioral health services to underserved older adult populations in integrated care settings
including primary medical care, social services, and
comprehensive older adult day health care.
CARMEN MORANO, PHD
Associate Professor, Silberman School of Social Work at Hunter College
Director, Hartford Silberman Center of Excellence in Aging and Diversity
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Social Work
0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000
Workforce 2008-2018
2008
2018
• More than 70% of social workers report working with an older adults
• Approximately 5 % receive training for working with older adults
• Only 25% of Bachelors of Social Work programs offer geriatrics certificate
• Projected workforce shortage = 70,000
Support For Social Work
• John A. Hartford Foundation
• More than $55 Million Invested since 2000
• 94 Doctoral Fellows
• 80 Pre-Dissertation Awardees
• 71 Field Practicum Programs with over 1,200 students in the HPPAE Program
• 5 Cohorts of Deans and Directors in Social Work Leadership Program
• Title VII Programs
• Mental and Behavioral Health Training Grant Program
• Loan Forgiveness Programs
• Provide important contextual/environmental information to facilitate appropriate transitions of care
• Provide assessment of Social and Behavioral Determinates of Health
• Provide assessment of individual & family preferences
• Intersection of Values-Beliefs-Resources and Care Options
• Provide information on family caregiver needs
• education, support services, respite, crisis intervention
• Provide assessment of capacity of social networks to
provide assistance, important given the decreasing
size of family
Social Work and Long-Term Care
• Vital link to facilitate effective transitional care
• From Medical to Social Systems of care
• Within social existing social systems of care
• Care coordinator of community-based programs and services
• Vital to maintaining Health and Well-being
• Monitoring of instrumental activities of daily living
• Entitlement Assistance
• Advocate for individuals, families and programs
Selection
General Education, Often with some emphasis
on the basic content required for
specialization
Certification of Competence
Pre-Service Specialized Education
Practice Induction 3,000 hours
Continuing Education
Older Americans Act Family Caregivers Programs
• Family Caregiver Support Services: Provides a range of support services to family and informal caregivers including counseling, respite care, training, and assistance with locating services to keep individuals at home for as long as possible.
• Native American Caregiver Support: Provides a range of
services to Native American caregivers, including information and outreach, access assistance, individual counseling, support groups and training, respite care and other supplemental
services.
• Alzheimer’s Disease Support Services: Supports evidence- based interventions and expands the dementia-capable home and community-based services, enabling older adults to live in their residence of choice.
• Lifespan Respite Care: Improves the quality of
and access to respite care for family caregivers
of children or adults of any age with special needs.
ARNETTA WHITTAKER
Stand-By Aide, Home Care Partners
#EWABriefing #ItTakesATeam
KAREN MARSHALL, JD
Family Caregiver
Executive Director, Kadamba Tree Foundation
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Person-and-Family-Centered Care
2004 2014
Caring for You, Caring for Me | A program of the Rosalynn Carter Institute for Caregiving presented by Kadamba Tree Foundation
