At the John A. Hartford Foundation, we are well on the path to implementing our new strategic plan focused on putting geriatrics expertise to work in health care delivery and practice change.
As I described in last week’s post introducing one of our new strategic funding areas – Leadership in Action – one of our primary strategies will be to engage the community of experts in geriatric social work, medicine, and nursing that we have supported for more than 20 years. We will now support them to join forces in inter-professional teams to implement evidence-based best practices, change policy that will drive improvements in health care delivery, and take other actions to improve the health of older adults. We will accomplish this in part through one of the Leadership in Action's primary grant programs, the Change AGEnts initiative, which was just approved by our Trustees.
While this may be perceived as a departure from our previous, academic-focused work, including our support of aging researchers, many of those whom we have funded already exemplify what we want to support in the future.
Three such academic superstars in nursing, medicine, and social work who are engaged in changing health care delivery recently spoke to our Board of Trustees. We took the opportunity to interview them for our Beyond the Boardroom blog series. Today, we start with Sarah Szanton, PhD, CRNP, from the Johns Hopkins University School of Nursing. Szanton, who received a 2005-07 BAGNC pre-doctoral scholarship award and a Claire M. Fagin 2009-11 post-doctoral fellowship, is conducting a research project, called CAPABLE, to help older adults remain in their homes.
Her work has drawn increasing national attention, including recent articles in Forbes and by the Associated Press. Here is a video clip of my talk with Sarah and an edited transcript of the interview follows.
Sarah, could you tell us a little bit about what got you interested in working with older adults and how the Hartford Foundation has influenced your development as a leader in the field of aging?
I grew up with my grandmother living with us. She had Parkinson’s and depression, and she and I were often alone together at home after school before my parents came home from work, which was very hard for both of us. Then my first job as a nurse practitioner was doing house calls with low-income older adults, where I saw conditions of their housing that were clearly related to their health, and I thought we really need to do something about their housing as well as their health care. We wouldn’t know we needed to do that if we saw them only in clinics.
In terms of how the Hartford Foundation has helped me, I’ve been funded twice, both when I was given my doctoral degree and as a junior faculty, and during that time was funded to develop a pilot that I’ve been testing since. I also learned a lot from the Hartford-supported leadership conferences in a community of scholars and mentors and mentees.
Tell us about your work to improve the health of older adults, and whether this includes collaboration with an interdisciplinary team?
Yes, I think that collaboration is vital in terms of the overall health of older adults. The work that I do is trying to help older adults age in place instead of in institutions, to avoid hospitalization and nursing home care. So we are testing an innovative, but very common-sense, approach to helping older people stay at home, and it’s based on their functional goals. Do they want to get to church? Do they want to be able to cook dinner? What do they want to be able to do? In working toward that, we have a nurse, an occupational therapist, and a handyman who changes their physical environment based on what the occupational therapist orders. So it’s extremely interdisciplinary with all three of those components meeting every week.
Can you tell us a story about someone who has benefited from your research project?
Well, many of the people in our project have benefited, but there’s a particular one I wanted to tell you about, who was one of the most frail that we've had. She was 82, she was taking 26 medications, and on the first visit the nurse came to me afterwards and said, “I don’t think we can help this person. She’s confused, she’s extremely weak. I’m not sure what we’re going to do.” The occupational therapist came after her first visit and said essentially the same thing. But I encouraged them to focus on what the person wanted to be able to do, and to start by looking at the medications.
The nurse realized that the participant was taking all of her medications at once, in the morning, even though some of them were meant to be taken later in the day, and they were pain medications. So the nurse made this wonderful chart where she drew pictures of when they were supposed to be taken throughout the day, and the patient started taking them correctly. Now, she wasn't confused anymore, she was much more alert, and that made the rest of the intervention start to work.
Then the occupational therapist brainstormed with her about what some of her goals were. On the first visit, it took her 30 minutes to walk from her bedroom to the bathroom and, consequently, she never used the bathroom. In her bedroom was a bed that she couldn't get up from herself and a commode chair, for when she needed to use the bathroom, and she sat on the lid of that all day long except for when she needed to use it.
With the occupational therapist, they had the idea of putting chairs along the hallway so that she could rest on the way to the bathroom. For you and I, going to the bathroom is a simple task, but for her, it was herculean, and to be able to break it up started to make all the difference. She started to use her legs and didn't have as much deconditioning. She also started to use some of the capable exercises we have that are based on tai chi and otago, which anyone can do, even if you’re essentially bed bound.
Since she was more alert, we worked on her leg strength through walking, which we made safer by putting a chair at the top of her stairs for resting and stairwell railings she could use for support.
Before we started, she hadn't been downstairs in months. Now she goes down almost every day, and she’s not sitting on top of her commode chair all day. We put risers underneath her bed and made it a little bit more firm with a board, and now she can actually get up out of the bed herself. Her husband had to get her out of bed for years. And he’s thrilled, she’s thrilled, and they told us recently that they’re going to go to Atlantic City on vacation. This is a woman who hadn't been outside in months before we came. So that’s a story that’s just really touched us.
That’s tremendous. So, Sarah, given the strategic shift in the direction of the Hartford Foundation to support efforts like yours that focus on the practice environment, what can we do to offer other leaders this opportunity going forward?
There’s so much to be done. It’s such an exciting time in health care. I think that your strategic shift is coming right at that exactly perfect moment. We’re all trying to learn how to get our models of care into a new system that allegedly will be more about value and less about procedures. I think that all of us who have been developing models of care with Hartford’s support have shown value in terms of quality of care, but what many of us haven’t yet shown is value in terms of cost. I think the Hartford Foundation could really help all of us learn better how to do that, maybe connect us with health economists, or with people who can help us write policy statements. As the world shifts toward capitation arrangements, help us make bridges to the accountable care organizations that might be interested in our models.
I also think that, in the world of medicine, we tend to think of interdisciplinary care as being doctors and nurses, and the Hartford Foundation has been a leader in also including social workers. But we also need to think about occupational therapists, physical therapists, nutritionists, and other disciplines like economists, handymen. It really is going to take a village to help improve the quality of health care and health for older adults.
Thank you for joining us today, Sarah, and for all you do to improve the health of older adults.