Hospitals across the country are working toward creating a culture that provides better quality care to aging Americans, with the aid of The John A. Hartford Foundation (JAHF), a nonprofit, nonpartisan organization. The initiative began about two and a half years ago when JAHF President Terry Fulmer, PhD, RN, FAAN, and her colleagues began looking at ways to improve care transitions and the way episodes of care are addressed for an aging population.
“We know that 10,000 turn 65 every day in this country, and we think there will be a demand for care that will rise more than 200% in the next decade,” she says. “We spend about a trillion dollars in hospital costs every year, and a lot of that is Medicare. That confluence of incredibly expensive care and elder people means that we need to be thinking about how to create a system that creates value and continuity across systems.”
JAHF offers multiple resources online at: www.johnahartford.org, and is working with the Institute for Healthcare Improvement in Cambridge, MA, to develop strategies for better quality of care.
JAHF has partnered with five health systems that provide care in 40 states. That work, begun in January, has identified the following four key elements that can be applied to any hospital or health system:
- What matters to the patient. “If what matters to the patient is living long enough to see a grandson’s wedding, you’re going to take one strategy, but if what matters to the patient is something different, you’re going to provide a different kind of care,” Fulmer says.
- Mentation, or mental activity. This includes confusion, delirium, and mood.
“Those four elements are the basis for a prototype to improve care for older people across all healthcare systems,” Fulmer says.
In addition, JAHF offers the following expectations for an age-friendly healthcare system:
- leadership committed to addressing ageism;
- a geriatric care prototype specific to older adults;
- clinical staff who are specifically trained and expert in the care of older adults;
- care teams that are high performing and can show measurable results for care of older adults;
- a systematic approach for coordinating care with organizations beyond their walls;
- a strategy to identify, coordinate with, and support family caregivers;
- a clear process for eliciting patient goals and preferences so as to define a plan of concordant care;
- expected outcomes;
- care that is concordant with the person’s goals;
- promotes physical function and independence;
- prevents polypharmacy (too many medications, inappropriate medication, or the wrong dosage of medication for older adults);
- addresses common geriatric syndromes like falls, delirium, and incontinence;
- manages pain and symptoms;
- recognizes and supports the needs of family caregivers;
- in the community, recognizes increased risk and prevents needless decline;
- in the hospital, restores health;
- in transitions, proactively arranges for the necessary supports and services;
- seamlessly provides coordination between settings and providers.
- Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation, New York City. Telephone: (212) 832-7788.