Fitting the growing geriatric population’s complex and chronic healthcare needs into today’s fragmented health system is like putting a round peg into a square hole, many suggest.
Among those looking for better geriatric care solutions — University of Pennsylvania nurses Mary Naylor, PhD, RN, FAAN, and Nancy A. Hodgson, PhD, RN, FAAN, who chaired a think tank called Assuring High Value Care for Vulnerable Older Adults and their Caregivers: Maximizing the Contributions of Nurses.
An invitation-only list of health system leaders, policymakers, innovators, consumer advocates and scholars gathered at the meeting to recommend ways to improve the U.S. health system for older adults with complex chronic conditions.
The May 2018 meeting spawned actionable recommendations for transforming care delivery for the more than 40% of older Americans living with four or more chronic illnesses. The Gerontologist journal is expected to publish the meeting’s full report this fall.
Hodgson, the Anthony Buividas term chairwoman in gerontology at the University of Pennsylvania School of Nursing (Penn Nursing), shared important points for nurses — not only about the initiative, but also how its recommendations might impact the profession.
“We know that there are models of nursing care that would do well in terms of value to address chronically ill older adults,” Hodgson said.
But many are not yet scaled into routine practice.
This isn’t a nurse-only initiative. In fact, nurses represented only about a handful of those at the meeting, according to Hodgson.
“We were trying to see where nurses could be leveraged in this crisis,” she said. “We recognize that nurses are key members of interdisciplinary teams. But we felt there was a strong role that nurses could provide and, in the future, nurses could be leveraged as leaders because we have the skills to address this crisis. That’s really what we wanted to convene this group to think about.”
Why geriatric care is a key healthcare issue
Aging patients’ increasing healthcare complexity is an important issue, Hodgson said.
“We know that the majority of older adults have at least one chronic condition,” she said. “Up to 40% have four or more chronic conditions, which adds to the complexity of care in the way they present complaints and symptoms. It also indicates that they’re probably on multiple medications and multiple treatment regimens that add to complexity. They’re being cared for increasingly by family members, who do not feel prepared to take on that complex care. And they encounter a very fragmented health system, so there is not communication across care providers. I think nurses are there to pick up the pieces. We’re there at every point of care for older adults.”
Among the geriatric care solutions to emerge from the meeting:
- Creating seamless electronic health record systems that could talk to multiple points of care. Although some health systems are beginning to move in this direction, the experts honed in on more extensive use of EHRs, with hospitals easily communicating to nursing homes and home care.
- Leveraging technologies and innovations that are happening in other industries, with nurses being among the innovators. Technologies that innovators might leverage include wearable technologies that interface with clinicians and using mobile phone apps for easier patient-provider communication. Experts at the meeting suggested that technologies clinicians use to provide care for older adults must be user-friendly.
“Currently, some of these things exist but older adults have a harder time navigating [these technologies],” Hodgson said. “Nurses could be well positioned to help facilitate their interacting with technology and also in working to create new technology that’s more user-friendly.”
The full report will include all the think tank’s recommendations. The report’s themes will address:
- Overcoming barriers for using evidence-based care models in practice.
- How nurses can partner with consumer advocacy movements to advance agendas aimed at helping older adults living with chronic conditions.
- How to position nurses to advance innovations to better geriatric care.
What nurses can do today
Hodgson said it’s important for nurses to be aware of policy changes focused on advancing care for people living with chronic conditions. One is the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, which will go into effect in 2020 and was part of the Budget Act of 2018. The CHRONIC Care Act is specific for Medicare and Medicare Advantage plans and puts more emphasis on telehealth and other creative options for providing coverage for people living with chronic diseases, Hodgson said.
The other is the Caregiver Advise, Record and Enable (CARE) Act, which AARP supports. It recognizes and backs family caregivers’ increasing roles in caring for adults with chronic health conditions. Another, the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act, requires the Secretary of Health and Human Services to develop, maintain and update a strategy to recognize and support family caregivers, according to AARP.com.
“These are some examples of policy shifts that will influence nursing care, as we try to recognize the role of family caregivers, for one, and come up with more creative strategies that Medicare will reimburse to help these older adults with chronic conditions,” Hodgson said.
The aging clock is ticking
The ever-increasing geriatric care population and ill-equipped healthcare system to care for them is a problem that isn’t going away.
The U.S. population’s median age climbed from 35.3 years in 2000 to 37.9 years in 2016. Americans ages 65 and older grew from 35 million in 2000 to 49.2 million in 2016, which is more than 15% of the total population, according to U.S. Census Bureau statistics released in June 2017.
“There is little question that the increase in the number of elderly Americans will continue to pose a steadily growing demand for healthcare and supportive services,” researchers wrote in the study Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration, published in the May-June 2018 issue of the Journal of the American Board of Family Medicine. “Much of the existing United States healthcare system is tightly wedded to a complex infrastructure and the medical expertise trained to leverage those resources to diagnose and treat disease. An uncertain …read more
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