Authors: Rebecca K. Slossberg, Rumaysa Sharif, Teffin C. Benedict and Terry Fulmer
WHAT WE'RE LEARNING
Dear Colleagues—
The murder of George Floyd in 2020, along with too many similar horrific incidents, sparked a dialogue about racial justice in this country that was inflamed by clear and unacceptable racial disparities in the impact of COVID-19. Conversations about diversity, equity and inclusion gained new urgency and meaning, including at The John A. Hartford Foundation. We recognize the need for humility, concrete actions and a commitment to ongoing learning and improvement to achieve true change and equitable aging for all.
As one initial activity, we reviewed our grant application guidelines and realized that there was no signaling of the importance of diversity, equity and inclusion as a priority in our grantmaking to improve care for older adults. We revised the guidelines so that funded projects now all intentionally address equity. Since May 2020, we have been learning ways to systematically address racial equity from our grantees and gathering examples of how they are focusing on diversity, equity and inclusion more broadly in their work.
Common Themes of Action
Our grantees are working to develop meaningful and timely care strategies that are culturally appropriate, so that the workforce caring for older adults has the skills needed to better serve diverse communities. They are creating care models and pathways to enhance continuity of care and reduce provider bias. Important work is being done to train organizations that work with family caregivers to be more culturally responsive and to tailor resources to the specific cultural and language preferences of the people being served. Grantees are working on addressing gaps in services by partnering with leaders in underserved communities and leveraging state partnerships to enable peer-to-peer learning. They are embedding equity into resource allocation decisions using tools such as the Social Vulnerability Index that includes socioeconomic determinants, housing composition, race, ethnicity and language as variables. They are also organizing roundtables that include diverse community leaders and designing action plans to address disparities and enhance access to services for those providing dementia care.
Select Examples
The Age-Friendly Public Health Systems initiative, led by Trust for America's Health, urgently worked on access to the COVID-19 vaccine for homebound older adults in 2021 by convening stakeholder organizations and developing guides to innovative practices. Equity became a centerpiece of the policy recommendations to state and local health departments, which included collecting data specifically on communities of color and expanding and diversifying those giving vaccinations to better reach underserved communities. They recommended that health departments should recruit vaccinators that reflect the target population and know their spoken languages and train vaccinators in treating older adults, including people living with dementia and disabilities. Successful models were identified and disseminated, such as those that recruited vaccinator teams made of native language speakers in Santa Clara, CA, and in the Indian Health Service.
In another example, the Milken Institute is strengthening its Alliance to Improve Dementia Care to develop and promote policies that reduce disparities in the prevalence of dementia and increase access to services for populations at highest risk. The Alliance’s work resulted in a consensus-driven approach to develop recommendations to improve continuity of dementia care. In its October 2020 roundtable and report, “Reducing Health and Economic Disparities in Dementia,” the Alliance convened leading experts to develop recommendations to reduce inequitable impacts of dementia on African Americans and Latinos. A summary of the key lessons and recommendations was presented in a recorded panel. The report recommended increased community outreach and engagement to improve brain health awareness. It also addressed the importance of racially and ethnically diverse communities to build a capable and culturally competent workforce through recruitment, retention and increased interdisciplinary training, as well as by developing the core components of collaborative dementia care models. Collaborative care models encourage providers to increase continuity, build trusting relationships and follow through with actions to serve diverse communities.
The Diverse Elders Coalition is addressing unmet family caregiving needs in diverse older communities through its Family Caregiving for Diverse Elders Resource Hub. This initiative addresses the lack of culturally responsive care and appropriate support for family and friend caregivers from different populations. The Coalition first conducted quantitative and qualitative research with Black and African American, American Indian and Alaska Native, Asian American, Hispanic, LGBTQ+ and Southeast Asian American caregivers. The in-depth research, conducted in partnership with the Benjamin Rose Institute on Aging, served as the basis for a curriculum and free trainings to educate healthcare and social service providers who want to better meet the needs of diverse family caregivers. The Coalition provided resources and support to caregivers through a series of listening sessions. Their goal is to educate national and local policymakers about programs and policies that will improve the well-being of diverse caregivers and enhance their ability to provide care. A new phase of work will expand the policy advocacy capacity of the Coalition and its members.
Finally, the Center to Advance Palliative Care (CAPC) is improving access to quality palliative care throughout the nation. CAPC has a special project, “Improving Health Equity for People with Serious Illness,” that focuses on reducing disparities in pain management, effective communication and family caregiver burden as a product of inaccessible palliative care services. The initiative is creating a pathway and tools to ameliorate inequities in palliative care access and quality for Black, Hispanic/LatinX, Indigenous communities, LGBTQ+, rural communities and low-income populations specifically. Key areas of action include addressing gaps and access for underserved patient populations, equipping clinicians to address disparities, using market research to inform awareness strategies and providing a national platform for palliative care leaders of color. CAPC has developed resources including a Health Equity blog series and a curated set of practical tools based on a national scan in its Health Equity in Palliative Care Toolkit.
These are only a few examples of what we are learning from our grantees. We look forward to sharing more valuable insights in the future. We are grateful to our grantee partners for their remarkable work and for all the ways they are moving us toward more equitable, age-friendly care for older adults, their family caregivers and those living with serious illness.
Sincerely,
Terry Fulmer, PhD, RN, FAAN
President
The John A. Hartford Foundation
Share your best practices with us for making the context of aging more equitable.