GWEPs & Community-Based Programs: Improving the Quality of Care for Older Adults

One of my passions is finding new ways to develop a health care workforce that is better prepared to care for older adults.  That is why I was delighted to be part of the session at the recent American Society on Aging (ASA) Conference  that focused on the Geriatric Workforce Enhancement Program and Area Agencies on Aging collaborating to improve care.

One of the great success stories of our time is the story of human longevity. At the same time, the growing number of older adults accounts for a disproportionate (though expected) share of healthcare services and the supply of health professionals trained in geriatric care falls short of the need. In 2015, the Health Resources and Services Administration (HRSA) established the Geriatric Workforce Enhancement Program (GWEP) to develop a health care workforce that maximizes patient and family engagement and improves health outcomes for older adults by integrating geriatrics with primary care. HRSA awarded 44 organizations in 29 states more than $35 million to train and educate health professionals, direct care workers and family caregivers. Of these 44 organizations, 25 have chosen to work directly with Area Agencies on Aging (AAAs). This cooperative agreement program also places special emphasis on creating and delivering community-based programs that will provide patients, families and caregivers with the knowledge and skills to improve health outcomes and the quality of care for older adults.

The John A. Hartford Foundation supports these efforts in a number of ways.  First, we provide support to the GWEP National Coordinating Center, led by the American Geriatrics Society in conjunction with HRSA.  The Coordinating Center is designed to facilitate collaborative learning, offer resources on geriatric education, provide mentoring with geriatrics experts and conduct a national process evaluation to inform future federal programming.

Second, we support the Aging and Disability Business Institute, housed at the National Association of Area Agencies on Aging (n4a).  The mission of the Business Institute is to build and strengthen partnerships between aging and disability community-based organizations and health care organizations.

I believe the true power comes from bringing these two initiatives together, as demonstrated by this ASA workshop. AAAs are natural GWEP partners and can begin to frame themselves as key contributors to primary care transformation.  As the health care delivery system adapts to contemporary needs, we’ve begun to expand our definition of “primary care.”  As a nurse, I’ve long held that care should be team-based and include health and social services.

As president of The John A. Hartford Foundation, I have worked with our trustees and staff in order to set strategic priorities and one of our top priorities is devoted to creating age-friendly health systems. The GWEP and AAA collaborations discussed during the workshop at ASA represent vital elements of an age-friendly system. For example, the partnership between the Johns Hopkins GWEP and the Maryland-Maintaining Active Citizens (MAC), the AAA on the lower Eastern Shore of Maryland, reflects exciting new collaborations. They have been able to offer evidence-based chronic disease self-management programs for older adults on diabetes, hypertension, falls prevention, cancer survival, and depression.  MAC’s affiliation with Johns Hopkins has enabled them to partner with three health systems across the state to increase leaders and programs.

In Texas, there has been a great deal of progress on creating a dementia-capable, integrated system of care for Medicare/Medicaid dual-eligible individuals with Alzheimer’s disease or related disorders and their caregivers. The WE HAIL HRSA GWEP  housed at the University of North Texas is enhancing the University of North Texas Health Science Center and JPS Health Network Family Medicine Residency programs. Through their partnership with the AAA and other community-based organizations, the curriculum now includes experiential modules of community evidence-based programs for fall prevention, dementia care and chronic disease self-management. For example, family medicine residents participate in The Virtual Dementia Tour®, a simulation scientifically proven to build sensitivity and awareness in individuals who care for people with Alzheimer’s disease and other forms of dementia.

“[The training] helped me to understand the need to give written instructions and to involve the family in the care of the patient.” – Feedback from health professional who received WE HAIL HRSA GWEP training

The Texas example also highlights how AAA involvement builds health care champions. The United Way AAA of Tarrant County’s involvement with UNT Health Science Center has strengthened the relationship with those health care providers and allowed them to expand dementia-capable services and supports to unserved and underserved people with, or having a high risk of, developing dementia and their caregivers. Funded by the Administration on Community Living, the AAA is expanding services to high-risk target populations: 1) people living alone, 2) people with Intellectual and Development Disabilities and caregivers, and 3) Hispanic and African American communities.

These are just two examples of GWEP/AAA collaborations. We know that many other innovative and exciting projects are taking place across the country. But as a long-time academic, I also know that publishing this great progress is essential.  We often say that “if it isn’t published so it can be found in the literature, it didn’t happen”.  So I urge all of you community-based organizations out there doing amazing work – document it!  Publishing your results is critical to moving the needle, and changing attitudes. Your knowledge and opinions matter and others need to learn from you!

As you work in your communities to improve the health of older adults, and work with health care entities to understand the importance of home and community-based services, take the time and resources to invest in the analytics and research.  Collect your data, analyze it, or work with your local university and have them conduct the analyses with you. The Institute for Healthcare Improvement has the “Open School” as a wonderful learning collaboratory with rapid cycle quality improvement approaches that might fit your work. Thank you for all you do each day to improve the care of older adults.

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