Building on The John A. Hartford Foundation’s investment of more than a half billion dollars in aging and health programs over the past three decades, the Foundation’s Board of Trustees approved four new grants totaling $5.5 million to accelerate the move to age-friendly health systems that measurably improve care for older adults while lowering costs.
We are excited about the transformational potential of these grant projects and partnerships.
I recently wrote about our work for Health Affairs with Senior Program Officer Amy Berman. We asked: “How do we move from a model at a time to a set of strategies that transform systems, drive improved health and cost outcomes, efficiently utilize available resources, deploy them strategically to those at greatest risk, and create the least amount of stress on the care delivery system?”
With these grants, we begin to answer those questions. Each of the investments approved by the Trustees draws on the expertise of highly respected national leaders to address gaps in our current health care delivery system that can prevent older adults from getting the care they need and deserve.
Reimagining the 21st Century Health System for Older Adults
Age-Friendly Health Systems is one of the Foundation’s three priority areas, along with Family Caregiving and Serious Illness & End of Life. In this rapidly changing health care environment, as hospitals consolidate into health systems that offer a wide but inconsistent array of services, the Foundation saw the opportunity to make better use of available resources and introduce evidence-based strategies that measurably improve the quality of care for older adults.
After more than a year of planning, our new Age-Friendly Health Systems Initiative is launching with a $3.19 million grant over 42 months. The Foundation has partnered with the Institute for Healthcare Improvement (IHI) and the American Hospital Association (AHA) to develop and test a health systems-wide prototype model of care for older adults, measuring the impact on health systems as compared with those lacking such an approach. The goal is to spread the evidence-based Age-Friendly Health System model to 20 percent of hospitals and health systems in the United States by 2020.
This is a bold and ambitious goal that holds the promise of transforming our health system for all, and especially for the most vulnerable older adults. We are very pleased to work with longtime Foundation grantees Dr. Mary Tinetti, of the Yale School of Public Health; Dr. Bruce Leff, of Johns Hopkins University; and Dr. Al Siu, of Mount Sinai on this important initiative. And we are gratified that four health care systems that together serve older adults across 30 states—Kaiser Permanente, Trinity, Providence St. Joseph, and Anne Arundel—have signed on to co-design and test the model.
Dr. Kedar Mate from IHI will serve as the principal investigator on this grant with Andrea Kabcenell as a key leader. We will be communicating about our progress on our website and in our blogs as this exciting initiative progresses. Special thanks to Derek Feeley, President and CEO of IHI, along with Dr. Don Berwick and Maureen Bisognano, IHI’s presidents emeriti and now IHI Senior Fellows, for all they have done to help us bring our ideas to fruition.
Online Playbook Guides Care of Older Adults with Complex Health and Social Needs
The John A. Hartford Foundation also has continued its partnership with four other foundations—The Commonwealth Fund, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, and The SCAN Foundation—in supporting better care of people with complex needs, many of whom are older adults. Together, as an initial step, the foundations are working with our grant’s principal investigator Dr. Don Goldmann and the IHI team to launch an online resource, or Playbook, for leaders of Accountable Care Organizations and Medicare Advantage plans on improving care for this high-need, high-cost group.
The Playbook, to be launched this month, is intended to demonstrate the challenges facing adults with complex health and social needs, and provide direction on how to meet those needs through a variety of evidence-based resources and tools. The Foundation’s Trustees approved a one-year, $180,838 grant to continue the development and refinement of the Playbook, adding content and functionality to the website based on user feedback and ensuring that the Playbook is integrated into other related initiatives.
The Age-Friendly Health Systems Initiative is expected to directly benefit from having the Playbook as a resource and will also contribute content to the Playbook in the future.
Improving Care and Outcomes for People with Hip Fractures
One of the serious gaps in our current health care system involves fragility hip fractures, which often lead to loss of function and loss of independence, and prove fatal in far too many cases. An estimated 260,000 hip fractures occur each year. Within the first year of hospitalization for a hip fracture, 20 percent of patients die. Hip fractures are the third most costly diagnosis in the United States, totaling more than $18 billion in 2012.
In 2015, The John A. Hartford Foundation awarded a one-year $399,512 planning grant for the American Geriatrics Society (AGS) to develop a viable business strategy and implementation plan for a Geriatrics-Orthopedic Hip-Fracture Co-management Intervention that evidence indicates would greatly improve care and outcomes for older adults hospitalized with hip fractures in a cost-effective way.
As a result of the planning grant, AGS demonstrated a clear need and a viable market for adoption of a co-management model, and also developed a business plan to disseminate the model to academic and community hospitals and health systems nationwide.
A new three-year, $1.399 million grant approved by the Trustees will support AGS’s efforts to disseminate the co-management intervention broadly, under the direction of AGS CEO Nancy Lundebjerg.
We are especially pleased that three of the leading experts in the field will continue to play important roles in this new grant: Dr. Richard W. Besdine will serve as Senior Medical Advisor, and Drs. Daniel A. Mendelson and Lynn McNicoll will serve as Medical Directors.
Developing a Scalable Model to Address Elder Mistreatment
As a nurse who has devoted much of my research career to elder mistreatment, I find it heartbreaking and unacceptable that one of the gaps in our current health care system remains the lack of a scalable model that can identify, assess, intervene, and prevent elder abuse, neglect, and exploitation. An estimated 10 percent of older adults—5 million people—are victims of mistreatment, including physical abuse, psychological or verbal abuse, sexual abuse, financial exploitation, and neglect.
“Safe in the Hospital, Safe at Home: A Planning Proposal for a National Co-Laboratory to Address Elder Mistreatment” represents an important first step toward finally closing that gap. Our Foundation awarded a two-year, $774,984 grant to the Education Development Center to convene leading national experts in four states across the country to develop, test, and evaluate a prototype model of intervention for victims of elder mistreatment.
This intervention will ensure that older people seen in hospital settings, including emergency rooms, will be assessed for potential mistreatment and will receive appropriate treatment and referral. Clearly, no health system can truly be considered “age-friendly” if elder mistreatment goes unchecked.
Leading the project is Rebecca Stoeckle, the Education Development Center’s vice president for health and technology who has decades of experience leading comprehensive health care practice change initiatives, including The John A. Hartford Foundation-supported model known as NICHE, Nurses Improving Care for Healthsystem Elders. The team assembled to develop the prototype model are all leaders in the field of aging with impressive expertise in elder mistreatment. They include: Dr. Carmel Dyer of University of Texas Health; Dr. Alice Bonner, Secretary of the Massachusetts Executive Office of Elder Affairs; Dr. Laura Mosqueda of the Keck School of Medicine at USC; and Dr. Mark Lachs of Weill Cornell Medicine.
Making Our Vision a Reality
The John A. Hartford Foundation is committed to transforming our health care system into one that puts the needs and desires of older adults at the center of decision-making, a system free of unnecessary or unwanted care, and one without preventable harms and deaths from medication errors, falls, pressure ulcers, delirium, and yes, elder mistreatment.
Transformation is never easy. We are so grateful for our all of partners and grantees as we work together toward making our vision of an Age-Friendly Health System a reality.