Retooling: Moving to Action
Christopher A. Langston, Ph.D.
Program Director, The John A. Hartford Foundation Inc.
November 2011
(212) 832-7788
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
Adviser to the Nation to Improve Health
Notable Reports• To Err is Human
• Crossing the Quality Chasm– Lots of follow-up activity, awareness, and even
change – but not without lots of work
• Front-of-Package Nutrition Rating
Systems and Symbols: Promoting
Healthier Choices?
5
Three-Pronged Approach to
Building Capacity• Enhance geriatric competence of
general workforce in common problems
• Increase recruitment and retention of geriatric specialists and caregivers
• Implement innovative models of care
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Enhancing Competence
• Professionals – Doctors, nurses, social workers,
pharmacists, etc.• Direct-Care Workers
– Nurse aides, home health aides, personal and home care aides
• Informal Caregivers– Families and friends
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Expanding Individual Roles (3.3)
Expand the roles of individuals beyond the traditional scope of practice, such as through job delegation.
• Development of an evidence base• Measurement of additional competence• Greater professional recognition and
salary
You’ll never plow a field by turning it over in your mind
-Irish Proverb
An Example• IOM commissioned by congress in 1982 to
review conditions in nursing homes
• With time, compelling stories, RELENTLESS ADVOCACY, & CONGRESSIONAL CHAMPIONS ->
• OBRA 1987 – legislation for restraint reduction, quality reporting, and quality improvement in nursing homes
Funded by:
The Members
The John A. Hartford Foundation
and
The Atlantic Philanthropies
Process of Change
Public Policy? Private Policy?• Awareness• Discussion• Consensus
• Action• Counter Action
• Resolution• Repeat
Funding, Regulation
Self-Regulation, Competencies
Legislative Vehicles
• Caring for an Aging America Act of 2008– S2708 (Boxer-Collins) – Loan forgiveness and incentives for specialists in MD, RN, SW,
Psych, CNAs
• Geriatric Assessment and Chronic Care Coordination Act of 2007 –S1340/HR2244 (Lincoln)
• Geriatricians Loan Forgiveness Act of 2007-HR2502 (Delauro)
• Positive Aging Act of 2007 S982/HR1669
None had any chance of passage in 110th Congress
Legislation as Marker
Senator Kohl, Chair, Special Aging Committee – S. 3730
All aspects of
IOM report, barring loan
forgiveness
Still no chance of passage in 110th
Congress
H. R. 3590 One Hundred Eleventh Congress of the United States of America
AT THE SECOND SESSIONBegun and held at the City of Washington on Tuesday, the fifth day of January, two thousand and ten
An ActEntitled The Patient Protection and Affordable Care Act.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.(a) SHORT TITLE.—This Act may be cited as the ‘‘Patient Protection and Affordable Care Act’’.
H.R. 3590 signed into Public Law 111-148 March 23, 2010
15It’s not about us or our issues
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PPACA• Title I – Insurance Regulation, Coverage• Title II – Public programs, Coverage (Medicaid)• Title III – Quality**• Title IV – Prevention• Title V – Workforce**• Title VI – Reporting, Transparency, Fraud• Title VII – Biologics/Medicines• Title VIII – CLASS ACT (long-term Care
Insurance)• Title IX – Taxes and Revenue• Title X – Amendments & Additions
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Geriatric Specific WorkforceTITLE V—HEALTH CARE WORKFORCE
• Geriatric Workforce Development – 24 new Geriatric Education Centers, expanded focus $10.8M, 5 years (Sec. 5305)
• Geriatric Career Incentive Awards – non MD awards program (teaching or practice) $10M, 3 years (Sec. 5305)
• Training Opportunities for Direct Care Workers – grants program for long-term care workers $10M, 3 years (Sec. 5302)
• Healthcare Workforce Center/Analysis/Commission -national and state level look at workforce $39M, 4 years (Secs. 5103, 5101)
Process of Change
Public Policy? Private Policy?
• Awareness• Discussion• Consensus
• Action• Counter Action
• Resolution• RepeatFunding,
Regulation Self-Regulation, Competencies
Health Professions Self Regulation
• AAMC – “Don’t kill Granny” Medical Student Geriatric Competencies
• AGS/ABMS – Convening April 2009–MOC & CME
• CSWE – Geriatric Competencies
Health ProfessionsSelf Regulation 2008
Health Professions Self Regulation 2011
• AAMC – “Don’t kill Granny” Medical Student Geriatric Competencies
• AGS/ABMS – Convening April 2009–MOC & CME
• AACN – Geriatric Nursing Competencies
• CSWE – Geriatric Competencies
REMEMBER STONE SOUP
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