America's Aging Innovations

One topic I have found especially interesting this semester is the state of long-term care in America. Last week I explored what another country is doing. For this week, I wanted to see what innovations were happening in America. When it comes to taking care of our elderly population, there have been some recent innovations that represent a move towards patient-centered care. Once people saw the horrors of nursing homes that did not treat their residents like dignified people, they set out to change the status quo. Out of the darkness has come innovations like The Green House Project or the concept of aging in place that are designed to return autonomy and comfort back to our older Americans. Aging in place is defined by the US Centers for Disease Control and Prevention as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” An AARP report found that 90 percent of adults over age 65 would prefer to stay in their home. How can we make this possible though when there are safety concerns? Partners for Livable Communities and the National Association of Area Agencies on Aging are at the forefront of working to make Aging in Place a lifestyle for as many people as possible. As technology improves, so does our ability to make this a reality. There are assistive technologies, like home safety and security systems and telemedicine, that can be incorporated to make independent living possible. Policies and laws can be enacted that support working towards this goal. Far down the road, there are entire smart houses that can be made to address many of the common issues elders who live alone face. The concept of Aging in Place is great because there is room to tailor the experience to each individual and their needs.
    The Green House Project is on a mission to create meaningful lives. They are a national brand, run on an evidence-based model proven study after study to work. Green House homes are staffed with healthcare teams and made with the help of expert consultants. They are working to transform long-term care with a focus on caring, living and thriving. The concept starts with actually changing the physical environment typical of long-term care. These houses are set up like actual homes. They feature an open kitchen, living room, access to outside and private rooms and bathrooms. There are only 10-12 people per house. The set up fosters building community. These facilities still meet federal and state licensing requirements. Not only is the living environment different, there is also a focus on caring. The Green Houses focus on changing the typical institutional organizational chart and enabling deep relationships between the residents and caregivers. There is a culture of nurturing care and a family experience through common dinners. Family and guests are welcome to visit. The residents are given flexibility in their preferences and personal routines. They are encouraged to pursue what they are passionate about and continue personal growth. With both of these concepts comes the question of how to pay for them. The frustrating thing about these places is they are only available to wealthier individuals. They are rather expensive and only accept a small number of people. I hope that eventually we can reach this style and level of care for all individuals, without money as a barrier.

A Global View

This semester I have found an interest in long-term care. As discussed in older posts, there are many flaws in how we approach taking care of our elderly population. Because of this, I looked at comparison of the United States to the rest of the world. In the global world, America is unfortunately not a leader in taking care of our elderly population. What this means is there is plenty of opportunity to observe and learn from other countries with better spending rates and health outcomes. One country that does particularly well in treating their aging population is Switzerland, which was ranked #1 overall by Global AgeWatch in 2015 in their global index. Before beginning this discussion, I would like to point out that I am aware that just because an intervention or strategy has success in one place, does not mean it will work in another location. This is important to keep in mind when looking into other countries, but there is still value in referencing and adapting tactics to best fit our population. Switzerland provides a lesson in being proactive in dealing with their growing population of elderly and associated health and wellbeing concerns. The Swiss canton, an administrative subdivision, has placed a focus on active aging. This means they have developed programs on a local and regional level that focus on the mobility of the elderly population. These policies promote intergenerational solidarity. Switzerland does this well. In 2015, they had the highest proportion in the world of older people with “high physical functioning” at 79 percent. They also have a large, and growing population of older people suffering from dementia. Currently there are more than 110,000 citizens with dementia, that number is expected to rise to 300,000 by 2050. At the end of 2013, the Swiss took action to address this burden. They made a national dementia strategy with the goal of promoting a better understanding of dementia for specialists and their citizens (AgeWatch, 2015). This kind of policy would also be valuable in America. This is a general concept, that when applied to America’s own population could be successful. Using our own data and statistics, we should also promote understanding of dementia and how to best care for it here.

    In Switzerland, one of their efforts to support their aging population is a research study called “UrbAging: planning and designing the urban space for an aging population.” This project done in 2007 and 2008 looked into their older populations perspective on the use of public spaces (AgeWatch, 2015). Geneva has worked with the World Health Organization to develop “Age-friendly cities” for their residents. The US could do similar studies. Obviously, we would have different results but shaping them to our population would be valuable. There are also groups like Pro Senectute who work to improve the living conditions for the elderly. One of their projects, “Wohnen fur Hilfe” (Housing for Help) helps match older people with unused rooms in their house with a student who needs a place to live. In return for a place to stay, the student provides help and services. There is also a program in canton Valais called “Domino” where older people can co-rent an apartment with someone who is also their age. Then in 2012, Bern instituted a “Swiss network of age-friendly cities” with the goal of making strategies to help deal with the results of an aging population (AgeWatch, 2015). Programs like this could work in the United States. We could adapt them to fit the needs of the communities they would be instituted in. Using Switzerland’s spirit of community-building, the United States could benefit from better integration of the older population into our younger society. The Swiss work to urban plan for their older population. They created TRACY, which is a policy centering around transport needs of the older population. Their urban planning focuses not only on transportation for the elderly, but also making pedestrian areas safe (AgeWatch, 2015). This kind of policy would also be beneficial in the United States. We need to study our transportation systems and pedestrian areas and see if they meet the needs of a growing, older population. The U.S. needs to learn from Switzerland’s efforts to plan ahead and deal with the effects of an aging population before they become massive issues!

Link to AgeWatch:

AgeWatch Report Card: Switzerland. (2015). Retrieved November 9, 2017, from http://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Switzerland

Leading the Charge

As another semester winds to a close, another year of the Resident Assistant (RA) hiring process begins. As a current RA, our hall staff was asked to go around and suggest qualities that we thought made up good student leaders. Afterwards, we were asked to pick what quality we thought was most important and what residents we thought possessed these qualities. What struck me was how varied all of our answers were. We clearly all have different priorities when it comes to leadership. This sentiment is not unique to our staff. I feel like I am always seeing books or speeches on what makes a good leader. All of these various forms of publication often have different messages and focuses. At some points, it can feel overwhelming. There are so many good ideas out there, but what to focus on? Luckily, I stumbled upon an article by the New England Journal of Medicine Catalyst Insights Council that helped bring some focus to my research. This article, “Five Changes Great Leaders Make to Develop an Improvement Culture” presents five behavioral dimensions that a leader must have to create a culture of constant improvement. The healthcare industry is rapidly changing and focusing on these five areas can lead to improved health system performance. The five focus areas are willingness, humility, curiosity, perseverance, and self-discipline. These qualities are not something attained overnight. It is about changing oneself and continuously improving to set the tone for continuous improvement in rest of the organization. I liked how the researchers described that many of the CEO’s they worked with needed to practice and “act their way into thinking.” This reassured me that I will not have to be perfect right away. If these experienced healthcare executives still need to role-play situations and adjust their thinking, then I have plenty of room to do the same. One important takeaway I got from reading this article, besides the qualities to try to develop in myself, is that there is no glass ceiling when it comes to personal improvement. Even when you reach the top of the chain of command, there are always new ways to approach situations and more learning to be done. No one has all the answers and asking fellow colleagues is a great way to figure out innovative solutions. I’ll end this reflection with a common theme the researchers found in their group of CEO’s that inspires what I hope to do in my future, “Above all, they continuously build on their learning and dare to experiment.”

A link to the article:

https://catalyst.nejm.org/five-changes-great-leaders-improvement-culture/

Being the Difference

Last weekend I was fortunate to be able to attend the 2017 Conference for the National Collegiate Honors Council. Taking place in Atlanta, Georgia, this conference was an awesome opportunity to hear from both professionals and students. One session I attended was about how to show honors programs are a valuable addition to a university and how different schools approach that. One program director from Western Kentucky University discussed how his philosophy is to focus on expectations and not bribing. Instead of just listing off the added benefits that being an honors program might give a student, he asks them questions. He asks students questions like whether they would want the experience or not, if they could go into the program with an open mind, and if they would want the chance to develop themselves. This is what he called the expectation approach. He wants students focused on the developmental outcomes, and not just the benefits like a nicer dorm or early class registration time. As I was listening to him speak, I think this could be applied to management. As someone who could be a hiring manager one day, I would want employees with loyalty beyond just their benefits. Although benefits are an important component of being a competitive employer, I also want employees who are committed to bettering themselves and the organization. It is important that employees look to fit the culture and mission, vision and values of their employer. These qualities will help to make hire employees who are not only a good fit for the current state of the organization, but will create growth and progress in the organization.

Professor Bonica also touched upon this theme in class the other day. He emphasized how when we are looking to get hired for an internship we should focus on what we can do for the organization and how we can solve problems. He mentioned how we should not just look to be a “pocket” addition to the staff that follows someone around but doesn’t make a real difference. This made me think about this concept from the employee side, as opposed to the employer side. One way to set yourself apart is to go above and beyond. In my internship experience, I hope to showcase my leadership skills by being a problem solver. Using my experience of what I have done in the past, I will work to continue being proactive and a valuable addition to my future place of organization. I think this sets a good foundation for wherever my future career takes me!

Compensating Care

In a recent blog post, I discussed the future of long term care in America. In our policy class, we recently started discussing aging in America and the different facets to that face. One issue I was personally struck by was how many people are unpaid caregivers for a family member or loved one. The National Partnership for Women and Families reports that by 2050 the elderly population is expected to be nearly 88 million people, or 20 percent of our population (NPWF, 2015). These people face a large burden of chronic disease and other medical issues. When health problems arise, often times it is close family members who have to step up to take care of their elders. Unfortunately, there is no financial compensation for this work. Many people are forced to leave their jobs or put their own health on the backburner to work as a caregiver and also maintain another job. Across the United States there are at least 43.5 million unpaid family caregivers. Most of these people have paying jobs that are unrelated to caregiving services. Half of all these people still work full time. When an unfortunate medical event happens, these caregivers need time off to properly take care of their family while maintaining their own mental wellbeing (NPWF, 2015). Seven in ten caregivers report that they have to make accommodations at their workplace to take care of their loved ones. When the average caregiver over 50 loses the workforce to care for their parent, they can expect to lose $303, 880 in private pensions, social security and wages. If they are a woman, that number rises to $324,000 (NPWF, 2015). More than the financial burden these caregivers face, common experiences include depression, frustration, stress, higher rates of chronic disease and a diminished immune response (NPWF, 2015).

     The unpaid caregiver conundrum creates a vicious cycle. We need to institute policies that will help relieve the burden of unpaid family caregivers. There needs to be mandated paid family and medical leave for employees. Currently, only 13% of workers have access to this type of leave. In place we have the Family and Medical Leave Act (FMLA) but that only provides access to unpaid, job protected leave for 60 percent of the workforce. There are still 60 million people who do not have protection under the FMLA. This policy should be expanded to cover everyone, but I also think we need to do more. Many Americans, even if they have FMLA protection, cannot take the leave because they cannot afford to take that unpaid break (NPWF, 2015). As a country we need to institute policy that enacts mandatory paid family and medical leave for people when they have to take on the role of an unofficial caregiver. Employers required to offer health insurance should also offer paid family medical leave. As mentioned earlier, being an unpaid family caregiver, leads to costly negative health outcomes like higher rates of chronic disease. Offering paid family medical leave can lower rates of associated negative health outcomes and thus lower costs of insurance. These policies should be available to anyone no matter their career or where they live. Another beneficial policy would be increased access to mental health services for caregivers. This could be tied into insurance policies. The associated rates of stress and depression that caregivers face require attention. It is like the airplane-oxygen analogy, you have to put your own oxygen mask on before you help others with theirs. If the caregivers slip into poor health, they will not be able to provide adequate care to their loved ones. There should be support groups created to help build community and let people know they are not alone. Overall, these policies represent just the beginning of creating a nation where caregivers are given the compensation they deserve and need. At the same time, this is a step in the right direction for more comprehensive policy related to this issue. As healthcare leaders I believe we have a moral responsibility to lobby for issues that relate to the health and wellness of our population. This particular issue is pressing and I am glad it was brought to my attention through my education!

Report from the National Partnership for Women & Families: http://www.nationalpartnership.org/research-library/work-family/paid-leave/older-adults-and-caregivers.pdf

Making a Positive Impact

Typical of Professor Bonica’s courses, we are consistently being given opportunities to practice real-world skills in the classroom. This time, we were able to provide both positive and negative feedback to members of our semester-long project group. As I wrote out different feedback for my colleagues, I began to think about what I could say that would really benefit them. I did not want to give generic feedback that would prompt nothing more than skimming over it and a “That’s nice” response. I want my team to feel like I picked up on their unique strengths and provided valuable insight into weaknesses. Considering this will not be the last time I do this, it is a valuable skill to have. With dreams of being an administrator in my future, I foresee many times where I will have to evaluate future employees. I would like to consistently provide feedback that is useful and meaningful. How do I achieve this though? My first thought was the obvious: give people ways to improve upon their weaknesses. Although this is extremely important and could be the topic of a whole other blog post, it is not what I decided to focus on. After reading an article on the topic, I began to really consider how powerful positive feedback can be. Kristi Hedges writes for Forbes about “How to Give Concise Positive Feedback” in the workplace. She outlines her reasoning for why positive feedback is just as important to employee success as constructive criticism.

Many people may think that positive feedback is nothing more than a pat on the back or a way to soften the blow of criticism. This is not true though. Hedges writes “And while it is necessary to provide constructive criticism to help employees better themselves, providing too much can demoralize and create a negative spiral of disengagement. It’s the positive feedback that reminds people what they should be doing more of, and how to bring their strengths to bear” (Hedges, 2015). Positive feedback is a great way to show employees what they are doing well. One of Hedges’ tips is to be specific. By telling the person exactly what they did well in detail, they will have an easier job knowing what to repeat in the future. Another tip I really liked was making sure to keep positive feedback separate from negative feedback. If you try and sandwich the two together, the positive feedback loses it's power because it seems like a consolation prize. That or the message could be completely lost. Also, Hedges discusses how it is valuable to make positive feedback visible to everyone in the organization. Making praise visible allows other coworkers to congratulate each other and see what work is valued in the organization. I have noticed that Professor Bonica will often do this. He shows us exemplary work from our classmates which validates the student on their achievement, but also provides an example of what we should try and work towards. Overall, positive feedback is a great way to build community and make people feel good about the work they are doing. When balanced with constructive criticism when needed, positive feedback is a valuable tool in the workplace!

Link to Hedges’ article:

https://www.forbes.com/sites/work-in-progress/2015/10/07/how-to-give-concise-positive-feedback/3/#7f448fe732ba

Bridging the Gap

Going to the doctor’s office for a non-emergency related cause is fairly stress free for me. Sure, I might be bothered by whatever cold or ailment I think I’ve caught, but I am able to easily drive there. Filling out forms and billing information is easy when I know that I’ll have coverage. When I meet the doctor, we easily communicate because we both speak the same language. I am able to understand what they are saying and ask questions when I need to. These are all things that seem simple and I often take for granted. I was reminded how this is not the case for a lot of people in America after hearing a local executive speak. In our Management class we recently heard from the CEO of a Federally Qualified Health Center. This CEO discussed how his facilities serve very diverse populations. Over 60% of his patients at one facility do not speak English as a first language. This makes it critical to have interpreters and care that focuses on being culturally competent. His facilities also provide care no matter if the person can pay or not. You could clearly see this CEO was truly passionate about the work he does serving the communities that need it most. After listening to this CEO speak I was interested in looking into the benefits of culturally competent care and what role it plays within an organization. The Commonwealth Fund did research into the importance of culturally competent care and found that not only does it decrease disparities in care, but that it can also improve quality of care across an organization. The article quotes an Administrator for the U.S. Department of Health and Human services who said, “What we’re talking about in terms of cultural competency...is providing quality care to individuals who in the past have not received it...and when I think of quality care, that’s what we're looking for for all Americans”’ Cultural competence is a key part to improving the quality of care in an organization. Although it may not be as easy to measure as reimbursement rates or patient encounters, it is invaluable when it comes to providing patient-first care. I hope to continue learning more about cultural competency and how to implement best practices into an organization.

Link to The Commonwealth Fund’s Report:

http://www.commonwealthfund.org/usr_doc/betancourt_culturalcompetence_576.pdf