Retooling: Moving to Action

Christopher A. Langston, Ph.D.

Program Director, The John A. Hartford Foundation Inc.

November 2011

Christopher.Langston@jhartfound.org

(212) 832-7788

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Adviser to the Nation to Improve Health

Notable Reports• To Err is Human

• Crossing the Quality Chasm– Lots of follow-up activity, awareness, and even

change – but not without lots of work

• Front-of-Package Nutrition Rating

Systems and Symbols: Promoting

Healthier Choices?

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Three-Pronged Approach to

Building Capacity• Enhance geriatric competence of

general workforce in common problems

• Increase recruitment and retention of geriatric specialists and caregivers

• Implement innovative models of care

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Enhancing Competence

• Professionals – Doctors, nurses, social workers,

pharmacists, etc.• Direct-Care Workers

– Nurse aides, home health aides, personal and home care aides

• Informal Caregivers– Families and friends

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Expanding Individual Roles (3.3)

Expand the roles of individuals beyond the traditional scope of practice, such as through job delegation.

• Development of an evidence base• Measurement of additional competence• Greater professional recognition and

salary

You’ll never plow a field by turning it over in your mind

-Irish Proverb

An Example• IOM commissioned by congress in 1982 to

review conditions in nursing homes

• With time, compelling stories, RELENTLESS ADVOCACY, & CONGRESSIONAL CHAMPIONS ->

• OBRA 1987 – legislation for restraint reduction, quality reporting, and quality improvement in nursing homes

Funded by:

The Members

The John A. Hartford Foundation

and

The Atlantic Philanthropies

Process of Change

Public Policy? Private Policy?• Awareness• Discussion• Consensus

• Action• Counter Action

• Resolution• Repeat

Funding, Regulation

Self-Regulation, Competencies

Legislative Vehicles

• Caring for an Aging America Act of 2008– S2708 (Boxer-Collins) – Loan forgiveness and incentives for specialists in MD, RN, SW,

Psych, CNAs

• Geriatric Assessment and Chronic Care Coordination Act of 2007 –S1340/HR2244 (Lincoln)

• Geriatricians Loan Forgiveness Act of 2007-HR2502 (Delauro)

• Positive Aging Act of 2007 S982/HR1669

None had any chance of passage in 110th Congress

Legislation as Marker

Senator Kohl, Chair, Special Aging Committee – S. 3730

All aspects of

IOM report, barring loan

forgiveness

Still no chance of passage in 110th

Congress

H. R. 3590 One Hundred Eleventh Congress of the United States of America

AT THE SECOND SESSIONBegun and held at the City of Washington on Tuesday, the fifth day of January, two thousand and ten

An ActEntitled The Patient Protection and Affordable Care Act.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.(a) SHORT TITLE.—This Act may be cited as the ‘‘Patient Protection and Affordable Care Act’’.

H.R. 3590 signed into Public Law 111-148 March 23, 2010

15It’s not about us or our issues

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PPACA• Title I – Insurance Regulation, Coverage• Title II – Public programs, Coverage (Medicaid)• Title III – Quality**• Title IV – Prevention• Title V – Workforce**• Title VI – Reporting, Transparency, Fraud• Title VII – Biologics/Medicines• Title VIII – CLASS ACT (long-term Care

Insurance)• Title IX – Taxes and Revenue• Title X – Amendments & Additions

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Geriatric Specific WorkforceTITLE V—HEALTH CARE WORKFORCE

• Geriatric Workforce Development – 24 new Geriatric Education Centers, expanded focus $10.8M, 5 years (Sec. 5305)

• Geriatric Career Incentive Awards – non MD awards program (teaching or practice) $10M, 3 years (Sec. 5305)

• Training Opportunities for Direct Care Workers – grants program for long-term care workers $10M, 3 years (Sec. 5302)

• Healthcare Workforce Center/Analysis/Commission -national and state level look at workforce $39M, 4 years (Secs. 5103, 5101)

Process of Change

Public Policy? Private Policy?

• Awareness• Discussion• Consensus

• Action• Counter Action

• Resolution• RepeatFunding,

Regulation Self-Regulation, Competencies

Health Professions Self Regulation

• AAMC – “Don’t kill Granny” Medical Student Geriatric Competencies

• AGS/ABMS – Convening April 2009–MOC & CME

• CSWE – Geriatric Competencies

Health ProfessionsSelf Regulation 2008

Health Professions Self Regulation 2011

• AAMC – “Don’t kill Granny” Medical Student Geriatric Competencies

• AGS/ABMS – Convening April 2009–MOC & CME

• AACN – Geriatric Nursing Competencies

• CSWE – Geriatric Competencies

REMEMBER STONE SOUP