IT TAKES A TEAM: What we will need to meet needs of older adults and their family caregivers. Capitol Hill Briefing.

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2 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

3 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

4 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?

5 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

6 EWA Supporters

7 Training Health Professionals to Care for Older 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

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10 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.

11 National Family Caregiver Support Ratio 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 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.

12 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 , provided interdisciplinary geriatric education and training to 54,167 health profession students and to 20,791 interdisciplinary teams.

13 LENISE A. CUMMINGS- VAUGHN, MD Assistant Professor, Washington University in Saint Louis, Division of Geriatrics and Nutritional Science #EWABriefing #ItTakesATeam

14 Percentage of Population with Chronic Conditions Source: Robert Wood Johnson Foundation. Chronic Conditions: Making the Case for Ongoing Care. February 2010.

15 Source: Langston, Chris. Decline in Geriatric Fellows Defies Pay Boost: +10% = -10%. John A. Hartford Foundation, Health AGEnda. December 20, 2012.

16 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.

17 TARA CORTES, PHD, RN, FAAN Executive Director, The Hartford Institute for Geriatric Nursing Professor, New York University College of Nursing #EWABriefing #ItTakesATeam

18 Projection of Geriatricians Geriatric Workforce Policy Studies (2009) Geriatricians (in Thousands) Population 75+ years (in Millions) 45M 49M 34M 19M 23M 6.8K 6.3K 6K 5.4K 5.4K

19 Nurse Practitioners 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

20 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

21 Title VIII: Comprehensive Geriatric 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.

22 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

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24 ANDREW HECK, PSY.D., ABPP President, Council of Professional Geropsychology Training Program Clinical Director, Piedmont Geriatric Hospital #EWABriefing #ItTakesATeam

25 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

26 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.

27 CARMEN MORANO, PHD Associate Professor, Silberman School of Social Work at Hunter College Director, Hartford Silberman Center of Excellence in Aging and Diversity #EWABriefing #ItTakesATeam

28 Social Work Workforce , , , , , , , ,

29 The Current Workforce 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

30 Support For Social Work John A. Hartford Foundation More than $55 Million Invested since 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

31 Social Work and Interdisciplinary Teams 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

32 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

33 Support for Lifelong Learning Selection Certification of Competence General Education, Often with some emphasis on the basic content required for specialization Pre-Service Specialized Education Practice Induction 3,000 hours Continuing Education

34 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 evidencebased 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.

35 ARNETTA WHITTAKER Stand-By Aide, Home Care Partners #EWABriefing #ItTakesATeam

36 KAREN MARSHALL, JD Family Caregiver Executive Director, Kadamba Tree Foundation #EWABriefing #ItTakesATeam

37 Person-and-Family-Centered Care

38 Creating an Effective Care Team Building Cooperative Relationships Care Receiver Studies have found professional and family caregivers need: information about their roles; support from peers; and linkage to other caregivers. Professional Caregiver Family Caregiver Caring for You, Caring for Me A program of the Rosalynn Carter Institute for Caregiving presented by Kadamba Tree Foundation

39 Interdisciplinary Care Case Study Family: Two children One lives in state the other lives across the country Both have full-time jobs Both have two children one in high school one in college Hank 91: Living in two-story family home Congestive Heart Failure Macular Degeneration Wears hearing aids Cannot drive Has symptoms of depression Wants to stay home and despite therapists recommendation to be moved to a nursing home Is the primary caretaker for his wife Louisa 89: Living in two-story family home Advanced Dementia History of UTIs Hypertension

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41 Thank you If you have any questions, please visit our website Caitlin Connolly, Project Director Katy Barnett, Policy and Communications Manager