Embed Size (px)
Citation preview
Perspectives on the Age Wave: Key Issues, Solutions, and Opportunities
Robyn Golden, LCSW Director of Older Adult ProgramsRush University Medical Center
Age Wave: Why Does it Matter?
• Growing older adult population will increase demands on health care systems– Greater volumes of people living longer lives with more chronic conditions
• Factors that make older adults vulnerable necessitate quick, informed evidence-based intervention by a professional well trained in aging issues, programs, and policies– To ensure quality of care and efficiency– To address complex issues affecting all aspects of a persons’ life: physical,
social, emotional, financial, etc.– To reduce over utilization that results in high costs– To facilitate advanced care planning for future needs– To maximize family caregivers’ well-being and productivity– To deliver culturally competent or culturally appropriate care
© Rush University Medical Center, 2011
Issues in Care
• Discharging “sicker and quicker”• Inefficient health care system and lack of care
coordination• Difficult medication schedules • Sophisticated technology• Locating and accessing quality paid help• Dealing with “information overload” and
choices• Juggling competing demands of work and
caregiving• More long-distance caregiving
© Rush University Medical Center, 2011
Hospital Usage
• Over 13.2 million people over 65 were discharged from a short hospital stay in 2003– More than three times the rate for people
of all ages • 5.8 day average length of stay
– Decreased by 5 days since 1980
© Rush University Medical Center, 2011
Other Medical Trends
• More doctor visits per year than general population– 3.8 for people 45-64 – 5.9 for people 65-74– 7.5 for people over 75
• 96% report having a usual place for medical care
• 2.6% report failing to obtain medical help due to financial barriers
© Rush University Medical Center, 2011
Health Care Expenditures
• Population over 65– $3,899 out-of-pocket health care expenditures– Increase of 46% since 1993– 12.5% of total expenditures spent on health
• Average health costs for population over 65– $2,142 (55%) for insurance– $920 (24%) for drugs– $678 (17%) for medical services– $158 (4%) for medical supplies
© Rush University Medical Center, 2011
How Do Geriatric Social Workers Help?
• Geriatric social workers couple profession’s person-in-environment perspective and commitment to social justice with advanced training in aging– Promote the mental and psychosocial well-being of older adults and
their family caregivers
– Provide care coordination, interventions to empower older clients and modify their environment, and advocacy for policy-level changes to optimize quality of care
– Assess elders’ physical, psychological, social, familial, economic, cultural, and environmental circumstances as a basis for planning and evaluating interventions
– Navigate and expedite resources to assist older adults and their families and reduce future cost
Hooyman N, Unützer J. A Perilous Arc of Supply and Demand: How Can America Meet the Multiplying Mental Health Care Needs of an Aging Populace? Generations. 2010;34(4):36-42.
A Model for Care Coordination
• Rush Enhanced Discharge Planning Program (EDPP) is an example of how these needs can be addressed across transition– Short-term telephonic care coordination– Provided by Master’s-prepared social workers– From a biopsychosocial perspective– For older adults at risk for adverse events after an
inpatient hospitalization
© Rush University Medical Center, 2009
Rush EDPP: Primary Goals
EDPP operates with several guiding tasks to reach the goal of preventing avoidable adverse events post-discharge:1. Ensuring patients understand and have the ability to follow
through on the discharge plan of care 2. Connecting patients to their healthcare providers and
community based services and facilitating communication between providers
3. Tracking system problems for corrective action or change4. Feeding information back into the Rush system to help guide
future care© Rush University Medical Center, 2009
Process
© Rush University Medical Center, 2009
Referral Pre-Assessment Assessment Intervention
EDPP model has four distinct phases
• Intervention group – Less likely to have 30-day mortality– More likely to communicate with physician, make an MD
appointment, keep and MD appointment, as well as make and keep the MD appointment
• Among EDPP program participants, over time– Decrease in caregiver stress– Increase in knowledge of medications over time
• At 30-day follow-up a substantial majority reported satisfaction with the EDPP program– 81% reporting it should be offered to discharged patients– 77% reporting that all their needs had been met
Findings
© Rush University Medical Center, 2009
EDPP and Medical Homes
• EDPP model able to address transitional care aspects of Patient-Centered Medical Home– PCMH pilot initiated at Rush in Summer 2010– Working to standardize process, integrate social work
based transitional care into PCMH
© Rush University Medical Center, 2009
Rush PCMH Pilot
• APN students serve as care coordinators for at-risk patients at 7 primary care practices involved in pilot– Social work care coordination and self-management
education available through Rush Older Adult Programs social workers
• Assists in meeting NCQA standards for access, care management, self-management, continuity of care, others
– EDPP available as transitional care component of PCMH• Inpatients from PCMH practices identified through daily risk list• EDPP social worker emails PCP about potential for post-discharge
intervention, identify issues for consideration in intervention• EDPP provided as usual with handoff to Older Adult Programs for
long term coordination© Rush University Medical Center, 2009
To Thrive Under Reform
• Engaging patients• Prevention and wellness• Not transactions but a journey• Transparency of performance• Focus on burden of treatment, not illness• Cost and quality in the same breath
© Rush University Medical Center, 2009
