JAHF Program Director Rani Snyder also contributed to this post.
With Inauguration Day at hand, all of us have priorities that we would like to see addressed by the new administration. Regardless of political ideology, there are certain truths that require immediate and careful attention. One is the aging of our society and the effects this will have on the care of older adults.
The John A. Hartford Foundation firmly believes that changes in our nation’s health care system must be motivated by the desire to provide older adults the quality of care they need and deserve. Our top three priorities are:
1. Advancement of an age-friendly health system that honors the preferences of older adults and facilitates excellent care.
2. Support for the nation’s family caregivers.
3. Acceleration of the availability and adoption of best practices for end-of-life and palliative care for people with serious illnesses.
Why? It is because in each of these areas, we have the opportunity to transform care and improve the health and well-being of millions of older adults.
Advancement of Age-Friendly Health Systems
With tremendous progress in public health, scientific knowledge, health care practices, and technology over the past century, people are living longer, and there is a growing number of people living well into their 70s and 80s. However, the risk for multiple chronic conditions increases as we age, and requires regular clinical appointments, medications, interventions, and at times, hospitalizations. This care can be poorly coordinated and often results in unintended adverse health consequences.
Older adults too often experience long wait times, redundant services, and a failure of nurses and doctors to even listen to what matters to them, much less focus on their issues. We can and must do better as the population of older adults who are not well-served by our current system continues to grow.
We believe that focused attention from key health system leaders, health care professionals, family caregivers, and patient advocates can identify and change processes of care that result in immediate and dramatic improvements in the quality of care older adults receive. Incentives that propel this work are needed as the Affordable Care Act is repealed, new systems are created, and the potential chaos in the system related to payment threatens to draw attention away from the actual care of older people. Aligning that care with the wishes of older adults and family caregivers while incorporating evidence-based approaches that work across entire health systems should be the paramount goal of any changes. The Medicare, Medicaid, and Social Security programs must be preserved and improved in ways that achieve that goal.
Support for Family Caregivers
There are nearly 18 million people in the United States regularly providing care to an older loved one who needs assistance. These family caregivers frequently perform heroic tasks, but are often invisible in our health care system and receive little preparation and support. Often overwhelmed and unsure of where to get answers and support for the complex care needs of their loved ones, they suffer depression, anxiety, and describe a sense of failure in their efforts. According to AARP, almost half of all family caregivers in America have performed medical/nursing tasks that include managing multiple medications, providing wound care, managing special diets, and operating monitors or other specialized medical equipment.
The CARE Act has been enacted in more than 30 states, providing a new mechanism requiring the identification, notification, and education of family caregivers of individuals who are hospitalized. (For more information, read the AARP Thinking Policy blog post, Stepping Up to Support Caregivers.)
While this is just one step in one setting, we have the chance to help implement this law in the right way and leverage it into broader changes so that family caregivers are recognized and assisted in all parts of the health care system.
Acceleration of End of Life and Palliative Care Best Practices for People with Serious Illnesses
With increasing age comes greater risk for serious illness and the natural progression toward the end of life. Too often, care at this time fails to meet the goals and preferences of older adults and results in harm and burden. Palliative care and other effective, evidenced-based approaches must be more widely available.
Our Senior Program Officer Amy Berman, while addressing the U.S. Senate Special Committee on Aging in Washington, DC, last year, gave us all great direction that we hope the new administration and leaders of both parties in Congress will move forward:
“We need more experts. There are no federal training dollars for palliative care physicians, nurses, and others. We also need training for all those who are involved in the care of seriously ill people to ensure they are competent in palliation and difficult conversations because we will never have enough experts. We need more research dollars. While the percentage of the National Institutes of Health budget spent on palliative care research has doubled from 0.2 percent to 0.4 percent, it still rounds to zero. We need concerted efforts to build public awareness about palliative care and its benefits. And we need community-based palliative care beyond the hospital, the care I receive, to be broadly available.”
We are passionate about creating a social movement that advances all of these ideas—where quality and humane care for older adults is the norm, and everyone knows what that means and can expect the same. Our role as a private philanthropic foundation is to build the momentum to advance the core values of equity, kindness, integrity, and respect for older adults everywhere.