I was recently invited to participate on a panel for the Age-friendly NYC initiative led by the office of the Mayor, the New York City Council, and the New York Academy of Medicine. Picture my delight when my two co-panelists were both speaking about initiatives that were originally funded by The John A. Hartford Foundation!
I had the great pleasure of listening to Monefa M. Anderson, MPA, RN-BC, Senior Associate Vice President of Nursing and Chief of Staff to the System Chief Nurse Executive at NYC Health + Hospitals. NYC Health + Hospitals is the largest public health care system in the United States. They provide essential inpatient, outpatient, and home-based services to more than one million New Yorkers every year in more than 70 locations across the city’s five boroughs. Imagine that!
And further imagine how excited I was when Monefa presented about her work with Nurses Improving Care for the Health Systems Elders (NICHE), a nurse-driven and hospital-wide approach to improving the care of older adults. The NICHE program is now in all 11 acute care hospitals in their system! This senior-friendly care, as they call it, is designed to meet the special needs of older adults during hospitalization.
In 1992, The John A. Hartford Foundation board approved their first nurse-led grant to me when I was at the Columbia University School of Nursing. The funding was for testing hospital-based nursing programs that included the Geriatric Resource Nurse Model, first conceptualized during the late 1980s when I was at Boston’s Beth Israel Hospital (now, Beth Israel-Deaconess) and then further developed at Yale-New Haven Hospital (now Yale-New Haven Health) in the early 1990s. It is almost magical to me that NICHE is now in over 600 health systems nationally and the Geriatric Resource Nurses who lead practice improvement for older adults every day are moving the bar for what great care must and should be.
The next presenter on the panel was Raji Ayinla, MD, Chief of Medicine at Harlem Hospital, also a part of NYC Health + Hospitals. He spoke passionately about his Acute Care for the Elderly unit (ACE) and presented data that showed how care improves when ACE units are targeted to older adults with special care needs. The model was also conceptualized in the early 80’s through the same John A. Hartford Foundation initiative that gave rise to NICHE.
This all means that NYC Health + Hospitals is truly leading the pack in age-friendly care. My presentation, intimately related to theirs, focused on our current Age-Friendly Health Systems initiative that is being led by the Institute for Healthcare Improvement (IHI) in Boston, MA. Kedar Mate, MD, Leslie Pelton, Catherine Mather, and Kate Hilton, along with a myriad of IHI faculty and staff, are charging ahead with our goal to transform 20 percent of America’s health systems to “age-friendly” status by 2020. I feel certain that under the new NYC Health + Hospitals leadership of Dr. Mitchel Katz, this good work will only accelerate.
What does this all mean? Which model is best? And how do we know when it’s working? Some of the ways we can detect change are when patient satisfaction scores improve and when staff’s satisfaction does the same. We know are making a difference when there are fewer episodes of delirium, fewer falls, fewer medication harms, and when patients and families tell us that their goals are being addressed in a person-centered way.
We have the evidence to make the changes we all want to see. For over 30 years, our Foundation, along with several others, as well as the National Institute on Aging, have developed the science we need to achieve optimal care for older adults.
The issue in front of us is how we can spread and scale our work in a reliable way so older patients get the right care in the right place at the right time. NYC Health + Hospitals has a deep understanding of the need to be an Age-Friendly Health System. They are showing us that spread and scale is indeed possible. We welcome Dr. Katz, and we congratulate Monefa, Raji, and all of the leaders in this system for their commitment to improving care for older adults in an increasingly age-friendly New York City.
Faculty, T. N. P. (1994). Geriatric models of care: Which one's right for your institution? American Journal of Nursing, 94, 21-23.
Mezey, M., Fulmer, T., & Fletcher, K. (2002a). Nurses Improving Care to Healthsytems Elders (NICHE): Using Outcomes and Benchmarks for Evidenced-Based Practice. Geriatric Nurs, 23(3), 1-7.
Mezey, M., Fulmer, T., & Fletcher, K. (2002b). A Perfect NICHE for Gerontology Nurses [Editorial]. Geriatric Nurs, 23(3), 1.