2012 ANNUAL REPORT

Ensuring Success of Established Programs

Over the past decade, the Hartford Foundation continued to strengthen its strategies for funding people and programs that help improve health care for older Americans. It made renewal grants for many of its large initiatives. “The Hartford Foundation is distinctive because they make strategic investments for a long enough period of time for programs to achieve a level of impact and at times greatness,” says W. June Simmons, MSW, CEO, Partners in Care Foundation. “The duration and intensity of funding produces lasting results.”

Over this period, the Foundation’s work in improving and integrating services for older adults expanded in new directions and professions, and in collaboration with different partners. This included initiatives focused on family caregivers (AARP Foundation-Professional Partners Supporting Family Care Giving) and direct care workers, such as home health aides (PHI).

In 2006, the Foundation began supporting the relatively new field of palliative care and helped lead a consortium of new funders in support of the Center to Advance Palliative Care (CAPC) directed by Diane E. Meier, MD at Mount Sinai Medical Center. Dr. Meier has been a powerful advocate of and contributor to the rapid growth of palliative care services in hospitals across the country. Identifying and supporting leaders like Dr. Meier, as well as developing future leaders in geriatrics and gerontology, has been an important goal since the inception of the Aging and Health program area. Over the last decade, the Foundation expanded its leadership programs (Geriatric Nursing Leadership Academy, Practice Change Fellows).

Dissemination and diffusion of proven models of education and practice
Over the last decade, the Hartford Foundation has placed greater emphasis on the dissemination of proven models, both in clinical care and in education. The Hartford Foundation built dissemination strategies into grants to articulate the financial impact and benefits of new models of care and to make the case for adoption. When particular models of care prove successful, dedicated dissemination grants support and facilitate widespread uptake. In education, the Foundation partnered with national educational organizations to change training and competency requirements that would then create demand for new training models.

One of the most successful innovative models of care the Foundation has funded is a program to treat late-life depression more effectively in primary care settings (Improving Treatment for Late-life Depression). A Hartford-funded clinical trial demonstrated that this interdisciplinary team care approach doubles the effectiveness of usual depression care at lower costs. With funds from a major dissemination grant and strategic work with a variety of partners, the IMPACT (Improving Mood: Promoting Access to Collaborative Treatment for Late-Life Depression) dissemination project has become institutionalized as the AIMS Center (Advancing Integrated Mental Health Solutions) and its “star product,” the IMPACT model, is now used in over 600 health care practices serving tens of thousands of older adults around the country.

Dissemination grants also helped spread several other geriatric care models. This included the Care Transitions Intervention, a highly effective program that empowers older adults to safely navigate the dangerous transition between health care settings, preventing needless re-hospitalization (Geriatric Interdisciplinary Teams in Practice). A model that brings the technology of the hospital into the homes of older adult patients received funding both to prove it works effectively and to encourage widespread adoption (Hospital at Home). Models that promote interdisciplinary team care (Guided Care and GITp) have also been integrated into many primary care practices because of Hartford-funded dissemination work.

Over the past decade, the Foundation strengthened its academic programs and expanded into new health care service areas, such as palliative care, family caregiving, and the direct care workforce.

Even when grant funding ends, the Hartford Foundation continues to promote the evidence-based models that it funded. “If the Hartford Foundation isn’t actively funding you, they continue to advance the work by introducing other funding opportunities and linking you to resources,” says Ms. Simmons, who directed a project to reduce dangerous medication errors (Preventing Medication Errors).

Building communications capacity to create change
Academic researchers can test a new idea for delivering better care to older adults and prove that it works, but unless they can make themselves understood and influence health system leaders and policy makers, the idea will likely go nowhere. Since 1999, the Hartford Foundation has funded a Communication and Dissemination Initiative to help grantees learn how to create focused, integrated messages about their work and the importance of geriatrics in medicine, nursing, and social work.

In recent years, the Hartford Foundation has raised its own profile in order to bring more attention to its work and gain the notice of potential funding partners and policy makers. In the Foundation’s early years, and even well into the era of the Aging and Health program, the Foundation remained a quiet force supporting the efforts of grantees who represented the public face of the work. With the Communication and Dissemination Initiative, Foundation staff now develop their own communication skills, more actively discuss the Foundation and grantees with the media, and promote use of the Hartford “brand,” which has become associated with excellence in high-quality geriatrics training.
“Our strategy is to put our grantees first and have them involved and engaged in the policy process. Their expertise is leading the way.” Christopher A. Langston, PhD
Program Director
The John A. Hartford Foundation

Creating systems change through policy and advocacy
The Hartford Foundation has also become more active in the health policy arena. In 2006, the Foundation brought together a consortium of partners to fund a report by the Institute of Medicine to document the geriatrics workforce shortage and provide recommendations for the country. The resulting report, Retooling for an Aging America, issued an urgent call to enhance the competence of all health professionals in the delivery of geriatric care, increase the recruitment and retention of geriatric specialists, and redesign models of care.

Based on the recommendations of this report, the Foundation and its long-time partner The Atlantic Philanthropies supported the formation of the Eldercare Workforce Alliance, a coalition of 29 national nonprofit organizations.

The Hartford Foundation is non-partisan, and like other U.S. foundations, it cannot lobby, but it has found other effective means for engaging in the national health care conversation. Grants have funded educational sessions for Congressional and agency staff through the National Health Policy Forum in Washington, DC. Foundation staff members publish articles, make presentations, and sit on national committees that also inform policy makers. The Foundation’s Health AGEnda blog provides a forum for engaging in national dialogue about geriatric care issues.

“We need to have an influence on policy,” says Christopher A. Langston, PhD, Program Director of the Hartford Foundation. “Our strategy is to put our grantees first and have them involved and engaged in the policy process. Their expertise is leading the way.”

To ensure success of its programs, the Foundation has increased its investments in dissemination, communications, and policy activities.

Several Hartford Foundation grantees have been instrumental in developing and passing legislation, and many have worked with federal agencies to implement health care policies that improve care for older adults. Several Foundation grantees, including Dr. Coleman, who directs the Care Transitions Program (GITp), showed that poorly coordinated transitions between health care settings and providers often result in needless hospital readmissions and cost billions of dollars annually. By identifying a critical problem and developing highly effective interventions, Foundation grantees raised the issue of care transitions as a national policy priority.