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Improving the Health Care of America


Improving the Health Care of America s Older Adults Through Social Work The John A. Hartford Foundation Corinne H. Rieder Executive Director and Treasurer – PowerPoint PPT presentation

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Title: Improving the Health Care of America

Improving the Health Care of Americas Older
Adults ThroughSocial Work The John A. Hartford
FoundationCorinne H. RiederExecutive Director
and Treasurer National Association of Deans
and Directors of Social WorkSpring 2009
ConferenceScottsdale, ArizonaMarch 16, 2009
  1. What are key problems in meeting the health care
    needs of our rapidly aging population?
  2. The Hartford Foundation What is it? Why Aging?
    Why is this important to Social Work?
  3. What was the state of geriatric social work in
    1999 when Hartford began its grantmaking what
    has been accomplished?
  4. Observations opportunities for promoting aging
    in social work.

I. Key Problems in Meeting the Health Care Needs
of our Rapidly Aging Population
  • Work Force Shortages
  • There are too few geriatrics specialists,
    including academics, in social work, nursing
  • Deficiencies in Health Care Delivery Quality
  • Quality of care is often unacceptable
  • Systems of care may be inefficient not well
  • Patients families not active partners in care

A. Work Force Shortages
  • Social Work
  • NIA estimated the need for 70,000 geriatric
    social workers by 2020.
  • Currently only 4 of students specialize in
    geriatrics despite the fact that 73 work with
    older adults between 8 10 of social workers
    are employed in long-term care.

A. Work Force Shortages
  • Social Work (Continued)
  • The number of programs is also decreasing. In
    the 1980s, 50 of MSW programs offered an aging
    specialization by the early 1990s this had
    dropped to 33, as of 2003, only 29 offered an
    aging specialization.
  • Of the 2000 doctorates awarded nationally since
    1995, only 289 (14) focused on aging topics.

A. Work Force Shortages
  • Medicine Psychiatry
  • In medicine, certified geriatricians have
    declined from 8,000 in 1998 to 7,000 in 2004, or
    1 geriatrician for every 2,500 older Americans.
  • Assuming current growth rates, by 2030 there will
    be only 7,750 geriatricians or 1 for every 4,250
    older people despite a projected need for 30,000

A. Workforce Shortages
  • Medicine Psychiatry (Continued)
  • Currently there are less than 1,600 certified
    geriatric psychiatrists. At the present
    graduation rate, there will be only 1,700
    geriatric psychiatrists in 2030, or 1 per 5,700
    older Americans with a psychiatric disorder.

A. Work Force Shortages
  • Nurses
  • The most recent projections of the nursing
    shortage range from 340,000 to 1 million nurses.
  • Of the 240,000 advanced practice nurses only
    3,500 are geriatric nurse practitioners.

B. Deficiencies in Health Care Delivery to
Older Adults
  • The quality of care is often unacceptable
  • The health care workforce receives very little
    geriatric training.
  • The health care needs of older adults are
    frequently neither comprehensively addressed nor
  • Too little attention is paid to providing
    preventive services coordinating the treatment
    of chronic acute care conditions.

B. Deficiencies in Health Care Delivery to Older
Adults (Continued)
  • Services are often not provided efficiently.
  • Providers need to be trained to work in
    interdisciplinary teams financing delivery
    systems need to support these teams.
  • Care coordination is essential patient
    transitions need to be facilitated across various
    delivery sites. All providers need access to
    patient information.
  • A number of new cost-effective models have been
    developed tested which improve patient
    outcomes, which should be widely adopted

B. Deficiencies in Health Care Delivery to Older
Adults (Continued)
  • Patients their families are too often not
    active partners in patient care or supported.
  • These partnerships need to include the adoption
    of healthy lifestyles, self-management of chronic
    conditions increased participation of patients
    their families in decision making.
  • The 33 million caregivers providing help to
    adults over 50 need support and training.

But it Doesnt Have to be this Way! I Can
Envision a Time When
  • Older adults receive quality health care from
    sufficient numbers of well-trained health
  • Care for older adults is comprehensive,
    patient-centered coordinated.
  • Health professionals are trained to work in
    interdisciplinary teams, our countrys
    financing delivery systems support them.
  • Our health care system takes account of the
    increasing social, demographic geographic
    diversity of older adults.
  • Health care is seamless across various delivery
    sites all clinicians have immediate access to
    patients health information communicate with
    one another.
  • Older people their families are active partners
    in their care where there is greater attention
    to financing of disease prevention, the
    adoption of healthy life styles the
    preservation of function.

II. The Hartford Foundation
  • 80 year old, 434 million foundation
  • 30 year history in improving the health of older
  • Narrow consistent focus is unique for a
    foundation our size peers multiple foci
    shorter term commitments less than 2
    philanthropic dollars go to aging
  • Places importance on partnering 2 major partners
    spending down (Atlantic and Reynolds)
  • National in scope put a premium on projects that
    can be sustained have a multiplier effect,
    while avoiding duplicating the efforts of others
  • Strategic in grantmaking rarely fund proposals
    that come over the transom
  • Committed 400 million to 200 organizations over
    the past 30 years

The Impact of the Current Recession on the
Hartford Foundation
  • Independent foundations like Hartford rarely have
    new money coming. Depend solely on the growth of
  • Nor, obviously, do they have a stream of tuition
    or research monies or grateful alums.
  • In October 2007, Hartford was a 78 year old
    Foundation with an endowment of 750 million
    instead of 434 million.
  • With a 320 million decrease in its endowment,
    the Foundation has been forced to cut not only
    many future grants, but also current grantees.
    Something that has been very painful for us to
  • Despite the recession Hartford will maintain our
    commitment to improving the health care of older
    people will increase its efforts when the stock
    market recovers the endowment again grows.

Hartfords Strategies
  • The Foundation pursues 3 strategies
  • Education training
  • Improved service delivery
  • And, drawing excellent scholars into aging RD to
    advance knowledge and improve practice.

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  • The bequest from John A. Hartford, which
    established the Foundation, directed future
    Hartford trustees
  • to do the greatest good for the greatest
  • Andto carve from the whole vast spectrum of
    human needs one small band that the heart and
    mind together tell you is the area in which you
    can make your best contribution.

The Foundations Choice Its Importance to
Social Work to You
  • Given Mr. Hartfords wishes, what led the
    Foundation to choose improving the health care of
    older adults as its goal?
  • 1. Respect for Mr. Hartfords desire to focus on
    a limited area to achieve maximum impact to
    stay within health, his major area of interest.
  • 2. The demographics.
  • 3. No other foundation had that area as a major

Why are the Demographics Important?
  • The growth of older Americans is dramatic.
  • It is widespread across the country.
  • The increase in the number of people over 85
    100 years of age is especially large.
  • Chronic diseases increase with age as do the use
    of health care services their costs.

Growth in the Number of Older Adults
  • Those over 65 years of age will double between
    2000 2030, growing from 35 million to over 70
  • Much of the growth is attributed to the baby
    boom generation born between 1946 1964.
  • 85 the most rapidly growing group, going from
    1.5 in 2000 to 5 of population in 2050.
  • 100 projected to grow from 50,000 to 800,000
    over the same time period.

US Population Pyramids
Increases in the Oldest Old
U.S. Population Aged 85 (in millions)
Sources of data U.S. Census Bureau, 65 in the
United States 2005, December 2005 U.S. Census
Bureau, U.S. Interim Projections by Age, Sex,
Race, and Hispanic Origin, 2004.
The Prevalence of Chronic Diseases Increases with
Age Data from 2003-2005
The Use of Health Services Also Increases with Age
  • Older adults represent 13 of the population, yet
    account for
  • 46 of patients in critical care
  • 50 of hospital days
  • 50 of specialty ambulatory care visits
  • 70 of home health services
  • 90 of residents in nursing facilities

What Other Challenges does our Nation Face in
Providing Quality Health Care Social Services
to Older Adults?
  • Health Care Discrimination Ageism
  • The Growing Cost of Health Care the Political,
    Financial Ethical Issues Associated with that
    Growth the need for, difficulty in, achieving
    fundamental reforms to health care delivery

Why are these important to you theSocial
Workers that you educate?
  • 1. Discrimination ageism negatively impact
  • a. Quality of care that older people
  • b. Recruitment of students into geriatric
    health professions.
  • c. Educational training environment,
    i.e., poor care becomes standard care.
  • d. And, students need to be prepared to
    identify treat older adults that have been
    abused /or suffer from self-neglect.

Why are these Important to You?(Continued)
  • The growing cost of health care the difficulty
    in achieving fundamental reforms to health care
  • Annual Medicare costs are over 400 billion.
  • Growing concern about the mismatch between
    projected Medicare entitlements the ability of
    the economy to pay for them.
  • Complex divisive ideological ethical issues
    are also at stake.

There are also Remarkable Opportunities to Make a
Difference in Geriatric Social Work
  • Geriatric Social Work
  • Is the key discipline for coordinating health
    care long term care services for older adults
    their families.
  • Has primary responsibility for supporting
    families informal caregivers.
  • Takes the lead in promoting healthy life styles,
    reducing the incidence of chronic diseases
    eliminating health disparities among different
    segments of the population.
  • Actively helps older adults maintain their
    psychological cognitive health, including the
    promotion of social interaction.
  • Is increasingly attractive to philanthropy,
    business governmental leaders.

III. How is Hartfords Grantmaking in Social
Work Meeting these Challenges? Are they
  1. What was the state of geriatric social work in
    1999 when Hartford began its grantmaking in
    social work?
  2. What has been accomplished through these efforts?

Where was Gerontological Social Work in 1999 when
we began our efforts?
  1. No national aging curriculum models.
  2. No focused national recruiting into geriatric
    social work.
  3. No articulation of competencies in aging to guide
    curriculum training.
  4. No national training projects to prepare faculty
    to teach geriatrics.
  5. Minimal resources to train staff or improve the
    overall care of older people.
  6. No nationwide social work initiatives to improve
    care to older clients.

Where Were We By the Numbers?
  • Overall, less than 3 of social work graduates
    enrolled in geriatric courses.
  • 2. 95 of students took less than 2 courses
    on aging in their social work programs.
  • 3. 73 of social work students report working
    with older adults.

Hartfords Social Work Objectives
  • 1. Prepare a geriatrically competent
  • 2. Incorporate geriatrics in the education
    training programs of all social work schools in
    the country.
  • 3. Ensure that there are sufficient geriatric
    social work faculty members.
  • Develop, test and disseminate innovative,
    cost-effective models of training care that
    improve social work services to older adults.
  • Draw national attention to the importance of
    social works role in improving the health care
    of older people.
  • 6. Communicate the idea that older adults are
    a core business of health care of social

Hartford Financial Commitments to Social Work to
Achieve these Objectives
  • 1999-2008
  • 70 Million authorized
  • (64.5 million in education 5.5 million
  • research and new models)
  • 47 Million paid out
  • 34 Major grants approved

Hartfords Leveraging 2001-2007
  • Total Funding Brought to Geriatric
  • Social Work 163 million

  • The Archstone Foundation
  • The Atlantic Philanthropies
  • The Hearst Foundations
  • The Jacob and Valeria Langeloth Foundation
  • The Helen Bader Foundation
  • Veterans Administration
  • National Institutes of Health
  • National Association of Social Workers
  • AARP Andrus Foundation
  • The Louis and Samuel Silberman Fund
  • The Administration on Aging
  • The Centers for Disease Control
  • Werner and Elaine Dannheisser Trust
  • Plus approximately 50 local funders

Hartfords Social Work Initiative
  • Broadly speaking, Hartfords Social Work is
  • organized around 3 themes
  • Academic leadership development
  • Faculty Scholars Program
  • Doctoral Fellows Program
  • Pre-dissertation Awards
  • The Leadership Academy in Aging
  • Curriculum for aging
  • GeroEd Center (previously GeroRich, SAGE S/W)
  • Providing real-world training for social work
  • Hartford Partnership Program for Aging Education
    (HPPAE, formerly PPP)

Whats Been Accomplished and Where are We Today?
  1. 81 scholars in 8 cohorts. Of the 81 scholars,
    all who have applied for tenure received tenure.
    These scholars serve on the faculty of 37 schools
    in 28 states they have written 260 book
    chapters, 21 textbooks, the 1st 6 cohorts have
    published 612 articles in top tier journals
    overall these scholars have made 1,605 research
    presentations were awarded 206 grants.

Whats been Accomplished and Where are We Today?
  • 2. 69 doctoral fellows have been selected who
    show promise to become faculty leaders in
    geriatric social work. Of these, 35 former
    doctoral fellows hold full-time faculty status or
    post-doctoral appointments almost half (32) are
    still engaged in dissertation research.
  • 3. 80 Pre-Dissertation Awardees have been
    selected 16 have gone on to become doctoral
    fellows 8 applied for the August selection
    cycle, and 26 more plan to apply this year.

Whats been Accomplished and Where are We Today?
  • Curriculum grants resulted in new aging curricula
    being disseminated adapted by over 180 schools.
  • Gero-Ed is a model for the development of
    additional competencies (CSWE EPAS).
  • 6. Aging-content is being increased in social
    work text books.
  • 7. Geriatric questions have been written for
    social work licensing exams.
  • HPPAE has been adopted in 72 schools in 32

Whats been Accomplished and Where are We Today?
  • 9. In January 2006, The Handbook of Social
    Work in Health and Aging was published, a
    1,000-page reference text edited by Dr. Barbara
    Berkman authored by 33 scholars and 31 program
  • A national leadership development program for
    deans directors has been established to
    strengthen skills promote gerontological social
  • 11. At this meeting, Dr. Nancy Hooyman, is
    unveiling her new book, Transforming Social Work
    The First Decade of the Hartford Geriatric Social
    Work Initiative.

IV. Observations Opportunities for Promoting
Aging in Social Work
  1. Observations
  2. Recommendations for promoting aging in social

8 Observations About Social Work
  1. The general public some health professionals
    are not fully aware of social works real
    potential contributions to improving the health
    care of older people. Nor, do they understand
    the expertise that social workers bring to the
    table. Within the field, there has been
    inadequate attention given to program evaluation
    measuring the cost-effectiveness of social work
    services. These factors contribute to social
    workers being underutilized sometimes feeling
    that their skills are undervalued.

Observations (Continued)
  • 2. Who speaks for social work education
    nationally? The field of social work is
    fragmented by its multiple national associations.
    This situation reduces its impact in a variety
    of ways dilutes the potentially pivotal role
    played by deans directors.

Observations (Continued)
  • 3. Social work is a complex challenging
    profession with a commitment to meet the multiple
    needs of our countrys diverse population. While
    this is a positive, the field can also become so
    fragmented that it overlooks common human needs
    that cut across specific population groups, e.g.
    aging, income inequality.

Observations (Continued)
  1. Is there too much separation between policy
    practice within social work programs? Do social
    works diverse roots in clinical practice
    community organization prevent policy from being
    fully integrated into the fields curriculum,
    clinical practice research efforts?

Observations (Continued)
  • 5. Improving the health care of older people is
    an interdisciplinary effort in practice, policy
    RD. How well connected are you and your
    schools faculty with counterparts in medicine,
    nursing other health professions? Are there
    silos or turf battles that need to be addressed
    in your institution? How much have you exploited
    the resources of other professions to advance
    social work?

Observations (Continued)
  • 6. Social work needs more research focused on
    a) better understanding improving service
    delivery, b) the assessment teaching of
    required competencies that need to be exercised
    in specific care environments, and c) evaluation
    cost-benefit studies of different
    interventions. Private funders ask Where in
    social work is the health services research that
    we see in medicine and nursing?

Observations (Continued)
  • 7. Some colleges and universities seem
    unwilling to assume a responsibility for meeting
    national work force needs. While this tendency
    may be less in social work, it still takes its
    toll on school departmental resource allocation
    decisions pressure to bring in research funding
    in research intensive universities. How is this
    viewed in your institution? Does it impact your

  • 8. Some in leadership positions argue that social
    work is not sufficiently proactive, future
    oriented strategic. They attribute this to it
    being a helping profession the fields
    clinical orientation, thus focusing on reacting
    to specific here now health social
    problems. Are deans directors, in your view,
    honing their strategic skills to think plan for
    the future?

One Recommendation
  • Incorporate Geriatrics into your
  • Schools Program

11 Ways to Incorporate Geriatrics into your
Schools Program
  • Infuse geriatrics across the curriculum in
    existing non-geriatric courses increase
    stand-alone courses. Exercise your leadership to
    include geriatric competencies content in state
    licensing exams. To assist you, access the
    extensive teaching curricular resources through
  • Exert your influence to ensure that the new EPAS
    emphasis on context, e.g. demographics, is
    applied in reaffirmation/accreditation processes.
    The Gero-Ed and HPPAE programs have the best
    developed geriatric social work competencies now

Incorporating Geriatrics (Continued)
  • Increase the number, quality variety of
    clinical experiences that students experience
    with older people the institutions that serve
    them. Also, educate social workers to measurably
    improve the health outcomes of family caregivers.
    Again, HPPAE is an excellent model to adopt.
  • 4. Increase the number of social workers
    focused on geriatrics at all levels of social
    work including health, substance use mental
    health specializations (Gero-Ed Center Masters
    Advanced Curriculum ProjectMAC).

Incorporating Geriatrics (Continued)
  • Hire more faculty members with expertise in
    gerontology. Help faculty re-train in geriatrics
    when possible.
  • Increase efforts to obtain government, corporate
    philanthropic support to expand aging social
    work programs, especially important are monies
    for financial assistance to masters doctoral
    level students. Given social work salaries
    relative to those of other health professionals,
    it is critical that deans directors advocate
    for speak up on state federal legislation
    providing student financial assistance, including
    proposals for loan forgiveness.

Incorporating Geriatrics (Continued)
  • Deans directors are eager that faculty members
    apply for receive Hartford other funding, but
    they also need to support faculty with sufficient
    in-kind resources additional funding beyond
    that which foundations provide.
  • 8. Support the adoption adaptation of
    existing evidence-based social worker models,
    such as the Hartford Partnership Program in Aging
    Education (HPPAE), that improve the education of
    trainees and the delivery of health care services
    to older patients.

Incorporating Geriatrics (Continued)
  • 9. Initiate interdisciplinary teaching programs
    so graduates are better able to work in
    interdisciplinary teams, especially serving frail
    older adults.
  • 10. Have your school take a leadership role in
    critical geriatric areas where there is
    insufficient attention, strategies, models
    creativity. Among those that stand out are 1)
    prevention public health, 2) mental health,
    both diseases and social isolation.

Incorporating Geriatrics (Continued)
  • 11. Increase educational, research practice
    relationships with non-social work schools in
    your institution to better prepare social workers
    to assume managerial, policy leadership roles
    within outside social work programs academic
    health centers. Social work leaders also need to
    strengthen their partnerships with community
    leaders to provide better services to older

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