Cal Jahf 2010 Strategic Plan Update
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A brief update of the John A. Hartford Foundation\'s strategic plan for program presented to the board of trustees September 2010
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Cal Jahf 2010 Strategic Plan Update
- 1. Aging and Health Program Strategic Plan Update September 2010
- 2. Goals for Today • Quick review of grantmaking approach • Review program strategies, grants, and spending • Update on progress on target indicators • A modest proposal and future directions Aging and Health Program: Strategic Plan Update // 2
- 3. Grantmaking Approach • Only national funder focused on aging and health mission • Highly strategy driven • Expert staff, engaged in the field • Creating change, not grants alone Aging and Health Program: Strategic Plan Update // 3 24.2 20.2 18.7 19.2 19.6 0 5 10 15 20 25 30 2010 2011 2012 2013 2014 Projected Payout ($ millions)
- 4. Aging and Health Program: Overview Aging and Health Program: Strategic Plan Update // 4 Better Health of Older Adults
- 5. Aging and Health Program: Strategic Plan Update // 5 Health Care Delivery Redesigned for Older Adults Model Development and Testing AARP –Caregiver Support Guided Care Sigma Theta Tau – Leadership Academy Practice Change Fellows Dissemination of Proven Ideas Agents of Change OHSU – Care Management + Partners in Care – Medication Mgmt. U. of Washington – IMPACT VNSNY – CHAMP U. Colorado – Care Transitions Mount Sinai – Palliative Care SHM – BOOST Care Transitions PHI – Coaching Supervision Integrating & Improving Services: Portfolio
- 6. Aging and Health Program: Strategic Plan Update // 6 $3,862,303 $623,134 $692,129 Dissemination Change Agents Model Development Integrating & Improving Services: Outstanding Commitments
- 7. Aging and Health Program: Strategic Plan Update // 7 Integrating & Improving Services: Grant Outputs • Models Adopted in 50 States • 3,764 Clinical Sites • 5,372 Providers Trained
- 8. Aging and Health Program: Strategic Plan Update // 8 Goal: Two new models of care demonstrate clinical benefit and feasibility. In Progress • Guided Care • AARP Caregiver Support • PHI Coaching Supervision Integrating & Improving Services: Indicators of Impact Goal: Four models in dissemination become self sustaining in their spread. In Progress • Care Management + • Care Transitions • VNSNY-CHAMP • Meds Management •Palliative Care • IMPACT • SHM BOOST
- 9. Aging and Health Program: Strategic Plan Update // 9 Social Work: Portfolio Social Workers Competent to Care for Older Adults Faculty Development GSA – Doctoral Fellows Leadership Academy Curricular Change Pre-Dissertation Awards NYAM – HPPAE CSWE – Gero-Ed Center GSA – Faculty Scholars
- 10. Aging and Health Program: Strategic Plan Update // 10 Social Work: Outstanding Commitments $8,232,622 $2,182,275 Faculty Development Curricular Change
- 11. Aging and Health Program: Strategic Plan Update // 11 Social Work: Indicators of Impact MSW Programs Having >2 Faculty Specializing in Geriatrics MSW Programs with* Coursework in Aging MSW Programs Adopting Hartford Practicum Model for Training 0% 20% 40% 60% 80% 100% Goal Current *Represents % programs with coursework available, not requiring coursework, which remains our goal.
- 12. Aging and Health Program: Strategic Plan Update // 12 Nursing: Portfolio All Nurses Competent to Care for Older Adults Faculty Development BAGNC Scholarship & Fellowships CGNES Gero Psych Collaborative Curricular Change Gero Nurse Ed. Consortium Associate Degree Programs Adult Advanced Practice Nursing
- 13. Aging and Health Program: Strategic Plan Update // 13 Nursing: Outstanding Commitments $2,710,304 $1,421,398 $8,702,304 Faculty Development Centers of Excellence Curricular ChangeScholars Programs
- 14. Aging and Health Program: Strategic Plan Update // 14 Nursing: Indicators of Impact Bachelors Nursing Schools Adopting AACN Geriatric Competencies Masters Programs Adopting AACN Geriatric Competencies Bachelors Programs with >1 Geriatrics Faculty Member(s) 0% 20% 40% 60% 80% 100% Goal Current
- 15. Aging and Health Program: Strategic Plan Update // 15 Medicine: Portfolio All Physicians Competent to Care for Older Adults Faculty Development Centers of Excellence ADGAP – Leadership Surgeons Initiative Reynolds Foundation Programs Curricular Change MSTAR Beeson Williams Jahnigen Scholars Programs InternalMedicine SpecialistInitiative ADGAP – Chief Residents
- 16. Aging and Health Program: Strategic Plan Update // 16 Medicine: Outstanding Commitments $8,220,619 $9,378,676 $3,673,786 Curricular Change Centers of Excellence Scholars Programs Faculty Development
- 17. Aging and Health Program: Strategic Plan Update // 17 Medicine: Indicators of Impact* % Aca. Medical Centers with Divisions of Geriatrics Average MD faculty = 16 % Medical Schools with geriatric requirements % IM Residencies with some geriatrics requirements 0% 20% 40% 60% 80% 100% Goal Current *Original Indicators of Impact: Faculty in Divisions of Geriatric Medicine Grow by 20% Medical Schools Adopting AAMC Geriatric Competencies Residencies, Specialties, & Subspecialties Adopting Geriatric Training Standards
- 18. Aging and Health Program: Strategic Plan Update// 18
- 19. Aging and Health Program: Strategic Plan Update // 19 Aging and Health Program: Allocation of Funds Commitments Area Plan Actual Proposed Medicine 40% 41% 36%* Nursing 24% 25% 24% Social Work 16% 20% 20%* Services 20% 10% 20%
- 20. Future Directions • 2010 – CGNE & PHI renewals • 2011 – Strategic planning – Rebalance faculty development vs. curriculum – Continuing education • 2012 – Finish making deferred payments – Make new grants to spend ~$7M unallocated in 2013 Aging and Health Program: Strategic Plan Update // 20
- 21. Aging and Health Program: Strategic Plan Update Questions & Discussion
- 22. Aging and Health Program: Strategic Plan Update // 21 Aging and Health Commitments: 2003 - 2010 (in thousands) Outcomes (in dollars) 2003 2004 2005 2006 2007 2008 2009** 2010 Grand Totals ('03 - '09) Medicine 7,221 12,986 1,518 19,787 17,972 3,400 14,815 1,812 77,699 Nursing 3,050 4,267 18,587 591 8,173 8,181 1,331 1,780 44,180 Social Work 3,449 9,185 5,383 9,195 14,425 0 4,607 0 46,244 IIS 328 6,606 2,376 4,800 6,824 5,215 1,199 400 27,348 Aging & Health Other 0 135 2,340 1,264 74 2,403 400 0 6,616 Totals By Year (in current $s): 14,048 33,179 30,204 35,637 47,468 19,199 22,352 3,992 202,087 Cumulative Total (Current $s): 14,048 47,227 77,431 113,068 160,536 179,735 202,087 206,079 Totals By Year (in constant $s):* 14,048 32,318 28,456 32,526 42,124 16,408 19,170 3,376 185,051 Cumulative Total (Constant $s): 14,048 46,366 74,823 107,349 149,473 165,880 185,051 188,426 Outcomes (percentages) 2003 2004 2005 2006 2007 2008 2009 2010 Grand Totals ('03 - '09) Medicine 51.4% 39.1% 5.0% 55.5% 37.9% 17.7% 66.3% 45.4% 38.4% Nursing 21.7% 12.9% 61.5% 1.7% 17.2% 42.6% 6.0% 44.6% 21.9% Social Work 24.6% 27.7% 17.8% 25.8% 30.4% 0.0% 20.6% 0.0% 22.9% IIS 2.3% 19.9% 7.9% 13.5% 14.4% 27.2% 5.4% 10.0% 13.5% Aging & Health Other 0.0% 0.4% 7.7% 3.5% 0.2% 12.5% 1.8% 0.0% 3.3% Totals: 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Includes Projected Commitments through December 2010 *2003 Consumer Price Index Base ** Includes AFAR CoE National Program Office Grant ($8.4 million)
- 23. Aging and Health Program: Strategic Plan Update // 22 Medicine 38% Nursing 22% Social Work 23% IIS 14% Aging & Health Other 3% Medicine Nursing Social Work IIS Aging & Health Other Medicine: $77,699 Nursing: 44,180 Social Work: 46,244 IIS: 27,348 Aging & Health Other: 6,616 Total: $202,087 Aging & Health Grants Committed: 2003-2009
- 24. Aging and Health Program: Strategic Plan Update // 23 0 5,000 10,000 15,000 20,000 25,000 2003 2004 2005 2006 2007 2008 2009 Dollars(InThousands) Year of Trustee Authorization Aging & Health Grants Committed: 2003 - 2009 Medicine Nursing Social Work IIS Aging & Health Other
- 25. Aging and Health Program: Strategic Plan Update // 24 Aging and Health Grant Payouts: 2003 - 2010 (in thousands) Outcomes (in dollars) 2003 2004 2005 2006 2007 2008 2009 2010 Grand Totals ('03 - '09) Medicine 8,118 9,492 9,630 6,029 9,165 7,564 8,480 6,231 58,478 Nursing 7,044 6,424 6,567 5,550 6,407 4,952 6,441 3,802 43,385 Social Work 2,655 3,906 5,265 3,650 6,830 6,142 4,458 3,406 32,906 IIS 4,132 2,577 3,191 1,777 5,042 4,195 5,077 3,088 25,991 Aging & Health Other 451 429 813 1,070 1,142 832 666 620 5,403 Totals By Year (in current $s): 22,400 22,828 25,466 18,076 28,586 23,685 25,122 17,147 166,163 Cumulative Total (Current $s): 22,400 45,228 70,694 88,770 117,356 141,041 166,163 183,310 Totals By Year (in constant $s):* 22,400 22,236 23,993 16,498 25,368 20,241 21,546 2,361 152,282 Cumulative Total (Constant $s): 22,400 44,636 68,628 85,126 110,494 130,736 152,282 154,643 Outcomes (percentages) 2003 2004 2005 2006 2007 2008 2009 2010 Grand Totals ('03 - '09) Medicine 36.2% 41.6% 37.8% 33.4% 32.1% 31.9% 33.8% 36.3% 35.2% Nursing 31.4% 28.1% 25.8% 30.7% 22.4% 20.9% 25.6% 22.2% 26.1% Social Work 11.9% 17.1% 20.7% 20.2% 23.9% 25.9% 17.7% 19.9% 19.8% IIS 18.4% 11.3% 12.5% 9.8% 17.6% 17.7% 20.2% 18.0% 15.6% Aging & Health Other 2.0% 1.9% 3.2% 5.9% 4.0% 3.5% 2.7% 3.6% 3.3% Totals: 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Payments Made Through August 31, 2010 *2003 Consumer Price Index Base
- 26. Aging and Health Program: Strategic Plan Update // 25 Medicine 35% Nursing 26% Social Work 20% IIS 16% Aging & Health Other 3% Aging & Health Grants Paid: 2003 - 2009 Medicine Nursing Social Work IIS Aging & Health Other Medicine: $58,478 Nursing: 43,385 Social Work: 32,906 IIS: 25,991 Aging & Health Other: 5,403 NOTE: ALL DOLLAR FIGURES EXPRESSED IN
- 27. Aging and Health Program: Strategic Plan Update // 26 0 2,000 4,000 6,000 8,000 10,000 12,000 2003 2004 2005 2006 2007 2008 2009 Dollars(InThousands) Aging & Health Grant Payouts: 2003 - 2009 Medicine Nursing Social Work IIS Aging & Health Other
- 28. Aging and Health Program: Strategic Plan Update // 27 AACN – American Association of Colleges of Nursing AAMC – Association of American Medical Colleges ADGAP – Association of Directors of Geriatric Academic Programs BAGNC – Building Academic Geriatric Nursing Capacity BOOST – Better Outcomes for Older adults through Safe Transitions CGNEs – Centers of Geriatric Nursing Excellence GSA – Gerontological Society of America HPPAE – Hartford Partnership Program in Aging Education IM – Internal Medicine MSTAR – Medical Student Training in Aging Research MSW – Master’s in Social Work NYAM – New York Academy of Medicine OHSU – Oregon Health & Science University PHI – Paraprofessional Healthcare Institute SHM – Society of Hospital Medicine VNSNY – Visiting Nurse Service of New York Acronyms
Notas del editor
- Thank you We spent 2007 giving an in depth presentation on each of the areas where we work, Medicne, nursing, social work and services. Then in 2008 I tried to present to you how it all fits together and set out some benchmarks against which we could measure our progress on the program side. Last year, I gave a very brief update focused primarily on how we were responding to our financial circumstances. Then in March and June we were occupied with health reform. So today, we finally have a little more time to talk about our strategies for improving the health of older adults, and to present some sense of how we are doing, in moving towards the goals that we outlined as our progress indicators for our 5-10 year plans back in 2008. I’ll give you the bottom line up front - overall I am very positive, things continue to go well and we feel like we are not only doing this right for the most part but also doing the right things needed to improve health care for older people. You will see that we have made progress, sometimes more than we thought. Time is on our side, and with each passing year we seem to get a larger number of people interested in improving geriatric care, although the base is still very small and our work is by no means done.
- But first to review our goals for today – Approach I will get us started with an overview our grantmaking approach and of the program overall and how it all comes together. Review Then each of the program officers will with their three slides review the strategies within their areas, show how grants connect to these strategies, and look at how currently approved funds are going to be spent over the next few years. Each will also report on the progress we are making towards our indicators. We will not be talking about individual grants, but rather trying to look up to how the effects of the individual grants add up to broader change. We have taken great pains to try to present a relatively simple model of what we are doing, using only three slides each - So if you think something is missing it probably is, but we are trying very hard to create a model that clarifies more than it confuses, one that stimulates thought. As you know measuring progress in our work is actually remarkably difficult. It is easy to measure and track the outputs of our grants, how many scholars, how many sites, and so on. However, it is harder and much more expensive to find out if those pieces are really adding up to change in whole fields of education and practice the way we want. So this summer we used pretty much all the available time of our summer intern as well as some of Marcus’ time and the program officers to do some detective work, and measure some things that we thought would tell us something about how geriatrics is positioned in the field. Our intern, Steve Strickland, did most of this work on-line reviewing faculty rosters for medical nursing and social work schools. Reading on-line course catalogs and requirements. For the most part this is new information, only a few weeks old and is different from most other information in the field which is based on voluntary and often relatively low rates of response to surveys. Of course this approach is highly dependent upon the dedication with which schools keep their websites up to date. No data is perfect and throughout this work, we have tried to have the attitude: let’s measure something and see what we can learn. Finally we do want to propose to you a minor adjustment in the allocation among sub areas of the program, that would be used to guide future grantmaking in 2012 as we start to regrow our program once again. We will leave plenty of time for questions and comments.
- Grant spending ’10 - $24.2 ’11 - $20.2 ’12 - $18.7 ’13 - $19.2 ’14 - $19.6 We are highly strategic, internally directed (as opposed to reactive) funders. We make relatively large long-term grants to large accademic, professional, and practice organizations with the intent of making large scale national change. We have a bit over 100 grants and falling as we try to live within our means and we close the individual Centers of Excellence award. Our median grant size is almost $900k over 4-5 years and yet our grants represent relatively small proportion of our grantees’ budgets given their size. We have an expert program staff who are each deeply engaged in their areas and as such we are all committed to making change using all the tools available to us, not limiting ourselves to making grants alone. This includes developing partnerships, communicating to a variety of audiences, and providing non-financial support to grantees as you’ve heard in yesterday’s updates. In the panel of the right, you see the resource bottom line we are working with. Although the effects of the fall in the endowment were cushioned by the change in payout to the three year average, we are still in the declining payout phase, with a further reduction to our payout targets of 20% expected next year before we hit bottom in 2012 and then begin to rise up again.
- Our mission is of course better health of older adults and this diagram shows how we think we will get there. Older adults are in the center of course and the broad environment is out here. Clearly this includes a fair amount of general problems in health care quality coupled with some special problems in ignorance and ageism that make are jobs that much harder. In here are the 4 parts of our program, MDs, RNs, MSWs, and Services. The problems of geriatric care are notable in that they demand interdisciplinary care that considers the biological, psychological, and social aspects of aging. Producing better health outcomes for older people requires change in at least these four areas. We therefore need skilled physicians, nurses, and social workers (and others as well). We also need the places where they work to enable them to use their skills, so we need to support redesign of practice. It is only through changes in practice that we can hope to have changes in the health outcomes of people. Finally the thin “other” work hovering overhead, represents important efforts like our communications work, the IOM, and others which serve to push this effort along. So before turning the floor over to Amy – I just want to say again that I think we are doing well, pursuing a critical mission, and that we feel proud and privileged to be able to say that we work at the John A. Hartford Foundation. ******************************************************************* As we all know time is both on our side and one of our biggest problems. Since the start of the aging and health program in 1982, the public and stakeholders have becoming more and more aware of the importance and the defects in care of older americans. I think pretty much every policy makers knows at this point that the majority of health care spending is on those with multiple chronic illnesses, and most realize that those people are older adults. We saw significant attention to aging issues in PPACA, if not as much as we would have liked. We are seeing significant funding in aging being added from both private sources and public ones. While we are all concerned about some of our larger partners like Reynolds and Atlantic spending down, we are still 5 to 10 years away and in both cases they are supporting important parts of the puzzle. We are also seeing many new funders interested in aging or at least in issues like chronic care and hospital readmissions that lead inevitably to aging. Nevertheless, if we are going to have an opportunity to really improve health and health care for older people we need to make progress within the next 10 to 15 years BEFORE the demographic problems become insurmountable and the slow nature of change in the health care workforce and and delivery delay improvements even further.
- The Integrating and Improving Services grants aim to improve health of older adults at the bedside and the kitchen table. They build upon the Foundation’s previous work in Health Care Cost & Quality that led to outcomes such as the development of PACE, the program for all-inclusive care of the elderly, begun at On Lok under the leadership of Jenny Chin Hansen, which continues to be replicated today. Our Services grants aim to redesign services to be effective and affordable, and to meet the needs of older adults. We accomplish the redesign through three main strategies that you see in this slide. 1) First, we develop and test of innovative models of care AND 2) Second, we create Agents of Change within practice settings to implement proven innovations. 3) Together these foster our third strategy, dissemination of the Foundation’s efforts. The Foundation focuses on areas that are truly important to the health of older adults such as medication management and improving care transitions. Our efforts cross a wide range of health care settings from the hospital to primary care to home care. For example, the Center to Advance Palliative Care led by Diane Meier, is expanding the availability of hospital-based palliative care programs. Our CHAMP Program through the Visiting Nurse Service of NY is improving how medications, pain, and other geriatric issues are handled in home care agencies around the country. These efforts are high risk and high reward. And we have achieved significant impact through these investments as I will show you in a moment.
- But first let’s look at how our funds are allocated. These dollar figures represent our outstanding commitments, the balance to be paid on active Services grants. So they are an indicator of our activity looking forward. Currently, the bulk of our funds---- 75% ----support dissemination of our innovations. As Chris discussed in his March presentation on health care reform, our efforts had an impact on health care reform legislation. They are also informing the implementation of health reform. But as our available funding returns we intend to ramp up our investments in new models. So what impacts have we achieved through our investments in Integrating and Improving Services?
- Hartford models are in health care setting in all 50 states including Alaska and Hawaii. Our active grants today have trained more than 5300 physicians, nurses and social workers in new models of care. Over 3700 hospitals, home care agencies and primary care practices have adopted our models. And we have created 68 leaders to serve as change agents in 27 states who are leading geriatric services redesign in practice settings. Next, let’s look at our indicators of impact, what we hope to achieve through these investments. Outputs (AB) Model development, testing & dissemination: Models adopted in 50 states at 3764 sites 5372 providers trained in new models Agents of change: 68 leaders in 27 states trained to lead geriatric services redesign in practice settings ======================== Models in testing phase: Guided Care, AARP Professional Partners Supporting Family Caregivers, SHM BOOST (3) Models in dissemination phase: IMPACT, CTI, CMP, PICF (4) [Resources in dissemination phase: CHAMP, CAPC ] ======================== Somewhat different kinds of indicators. Here we want to develop new ideas and get them spread. Our indicators are taking two models to the point of proven benefit and feasibility and getting four models to the point of self-sustaining spread. In our strategy of model development, we have also refined our strategy. We have specialized more and more in late stage model testing and development, refining and proving benefit in areas where there is already substantial evidence of what can and should be done. While this is still risky work, it is much less risky at this late stage of the development process than at earlier stages. We are also becoming more and more expert in issues of dissemination, as Amy mentioned we will be convening our most accomplished grantees to focus on what is known about this work in December. But we know now how important it is to market and offer training – to actively push (there are no better mouse traps that just fly off the shelf here. We know that business case, marketing, branding, and channels of information are very important. And lastly part of dissemination but also a new strategy that Amy has developed is the recognition that in the process of changing clinical care, human capital is also essential but that the agents of this change are not necessarily academics but may need capacity building to be effective. Our new grant to Sigma Theta Tau to training practicing nurses with administrative roles to lead change within their institutions is a good example of this strategy.
- Here we want to develop new ideas and get them spread. Our five-year indicators are taking two models to the point of proven benefit and feasibility, and launching four models to the point of self-sustaining spread. I am proud to report that we are on track to meet or exceed these goals. Currently we have three models in the demonstration phase. Models in testing phase: Guided Care, our grant to AARP to improve professional support of family caregivers, and the Paraprofessional Health Institute’s Nurse Coaching Supervision model; We have many more models in the dissemination phase with two currently poised to achieve sustainability…our grants to Diane Meier in Palliative Care and our discharge planning effort known as BOOST Better Outcomes to support Older Adults through Safe Transitions. : IMPACT, CTI, CMP, PICF, CHAMP, CAPC, SHM BOOST Next, Nora will present our efforts in Social Work. ======================== Somewhat different kinds of indicators. WE WANT TO SHOW THAT WE ARE ON COURSE ON BOTH OF THESE INDICATORS. AARP AND GUIDED CARE (?) MAY PROVE BENEFICIAL/FEASIBLE OF THOSE IN DISSEMINATION – ONLY SHM-BOOST IS AT THE END OF GRANT SUPPORT BUT IT AND MANY OF THE OTHERS LOOK LIKE THEY WILL BE VIABLE ONGOING ENTERPRISES – ESPECIALLY CARE TRANSITIONS, CARE MANAGEMENT +, AND IMPACT In our strategy of model development, we have also refined our strategy. We have specialized more and more in late stage model testing and development, refining and proving benefit in areas where there is already substantial evidence of what can and should be done. While this is still risky work, it is much less risky at this late stage of the development process than at earlier stages. We are also becoming more and more expert in issues of dissemination, as Amy mentioned we will be convening our most accomplished grantees to focus on what is known about this work in December. But we know now how important it is to market and offer training – to actively push (there are no better mouse traps that just fly off the shelf here. We know that business case, marketing, branding, and channels of information are very important. And lastly part of dissemination but also a new strategy that Amy has developed is the recognition that in the process of changing clinical care, human capital is also essential but that the agents of this change are not necessarily academics but may need capacity building to be effective. Our new grant to Sigma Theta Tau to training practicing nurses with administrative roles to lead change within their institutions is a good example of this strategy.
- In 1998 the board approved the development of the GSWI based on the successful initiatives of Medicine Nursing. It was recognized that geriatric social workers are important members of the team. They provide expert guidance in bridging services from medical care to community based agencies, mental health interventions, caregiver support and information and referral for entitlements. Similar to geriatric physicians and nurses, there are not enough geriatrically trained and educated social workers to meet the need of our aging population. Less than 3% of the social work students focus on geriatrics, yet over 70% do end up working with older adults and their caregivers. Therefore the goal of the GSWI is to increase the number and quality of social workers competent to care for older adults. In social work you will see the two main strategies we use in our education and training work, Faculty Development and Curricular Change You will see these same Strategies again in nursing and medicine. Social work has always had relatively few, but relatively large grants each with many different components. We believe that using the strategies to (1) Increase the number of faculty in schools of social work who have expertise in geriatrics, and to (2) Increase the amount of curriculum focusing on aging issues in schools of social work. We will better prepare social work students to work with the elderly and their caregivers. As this slide shows, we have grant programs focusing on faculty development: The Pre-dissertation Award, which provides a pipeline to the The Doctoral Fellows Program, which provides a pipeline to the The Faculty Scholars Program: There are now 100 faculty scholars across the country The grants focusing on curriculum development are: The Gero-Ed Center The Hartford Program in Aging Education The Leadership Academy, focuses on deans and directors of schools of social work, and requires them to develop a project on aging in their schools. Each of these grant programs helps to build the others, such as the faculty scholars advocating for more aging curriculum and adopting the HPPAE model, and the deans advocating for faculty scholars.
- This chart illustrates the current commitment of dollars for the active grants in social work. As you can see, much of the GSWI budget, $8.2 M, is for faculty development, compared to the $2.1 M for curricular change. This is due to the recent rescissions to all the program budgets. However, it was decided not to decrease the monies that were allocated to individuals, such as the faculty scholars and the doctoral fellows, therefore, as this chart illustrates, much of the faculty development monies were preserved. Going forward, we will be working towards a more equitable distribution between the 2 strategies, as we know that work in curriculum development is important and worth the investment. As you will see in the next slide.
- This slide represents the indicators of impact for the two strategies, for the 2nd year of our 5 year strategic plan. In order to obtain these indicators, our intern reviewed the websites of all the 198 CSWE accredited masters level programs in order to identify those schools that indicated the type of curriculum, and specialty faculty they offered. While this is not 100% accurate, it does serve as a usable estimation of indicators. This method was preferred over a survey instrument, due to the questionable self-reporting and the known factor of low percent of return. Overall, as you can see, we are making good progress. First, we see the impact of the faculty development strategy. Goal: to have 2 professors specializing in geriatrics in 60% of the CSWE accredited schools of social work. Accomplishment: currently 48% of the MSW schools have at least 2 professors specializing in geriatrics. Second, for the curricular change, Goal: to have 50% of the schools of social work require course work in aging. Accomplishment: currently 57% of MSW schools offer a course in aging ** however, this percentage represents elective courses, not required which is our goal. Goal: to have 75% of MSW programs adopt the HPPAE model Accomplishment: 36% of MSW schools have adopted the HPPAE model Going Forward - Clearly the GSWI has shown much progress, and yet there is still more to achieve. As our strategic plan evolves, new programs will be developed and existing ones will be remodeled in order to be as effective as possible in increasing the number and quality of social workers competent to care for Older adults.
- In 1996, we made our first grant to advance geriatric nursing based on the need for a skilled nursing workforce to care for our rapidly aging population. Nurses represent the largest health care provider for older adults and yet a serious gap remains between supply and demand. For example, less than 2% of all advanced practice registered nurses are certified in geriatrics—that is, about 3,500 of the 240,000 master’s level nurses. So, on this first slide you can see the goal for our Nursing grants is to ensure that all nurses are competent to care for older adults. To do this, we support efforts focused on two strategies: Faculty Development and Curricular Change. We believe that by having a gero expert faculty in the classroom and by infusing aging broadly throughout the nursing curriculum, we are preparing all nursing students—regardless of their specialization—to be armed with the skills to care for our aging society. Faculty Development is represented thru our BAGNC awards where we have supported over 200 pre & post doctoral gero-focused nursing scholars and thru our 9 CGNEs. Our second strategy--curricular change—defines four of our main projects. These projects that are developing competencies or standards and creating curricular materials tailored all levels of nursing education. For example, our grant to NLN focuses on prelic (AD, BSN) whereas the AACN APRN is for the master’s level nurse.
- As evidenced on this slide, the bulk of our commitments (almost $9 m) falls into our scholarship program. The remaining investments are in curricular efforts and our CGNEs. It is worth mentioning that as our grant making increases in the coming years, we hope to achieve a bit more balance between our faculty development & curricular efforts.
- This final slide shares our two main indicators of impact. That is, our 5-year goals measuring our two main strategies of FD and CC and how they ultimately prepare nurses to be competent to care for older adults. You can see 2 years into this, we are doing quite well in both areas. Allow me to walk you through each. Our first goal focuses on Curricular Change. We want 50% of baccalaureate SON to Adopt AACN Geriatric Competencies. By way of background, the AACN mandates use of their Essentials of Baccalaureate Education competencies for accreditation of their 600 plus baccalaureate nursing programs. This is important because these competencies include a significant emphasis on caring for our aging population. So you can see that we have exceeded this goal. Our next step will be to ensure that the recently developed adult-gero competencies for the master’s level will be adopted by 100% of advanced practice programs by 2015. And we are very much on track for this goal—some Trustees may recall that this project was positively reviewed at Wed’s EC mtg. Our second indicator is focused on Faculty Development. We want 50% of baccalaureate nursing schools have at least one faculty member who specializes in Geriatrics. Because this data is not formally collected on a routine basis, our summer intern sampled 104 accredited baccalaureate programs out of the 600 programs nationally and what he found was that about 72% of the schools surveyed had 1 or more gero faculty. We are very encouraged by this finding, but also know that this is a sample of baccalaureate schools only. This limitation aside, we are now considering adjusting this goal to have 2 or more gero-expert faculty at BSN. This is based on the learnings from a few Hartford-supported nursing projects that confirm that having only one gero faculty member is isolating and often does not result in sustainable change within an institution. According to our sample data, 53% of the 104 schools do have 2 or more gero-expert faculty.
- Again our goal is for all physicians to be competent in the care of older adults. We know that fewer than 7,000 and falling of the roughly 800,000 MDs in the US specialize in geriatrics and traditionally most physicians have little or no exposure to geriatrics in their training. Finally, as in the other professions, geriatric care is not a small issue at the margins, but rather the core business of health care so we need at least basic competence from all if we are to provide high quality care. Since its beginning in 1982, the Foundations work with physicians has used these two main strategies: faculty development and curricular change. You might remember that our very first formal aging and health grant was the Hartford Faculty Scholars program which retrained physician faculty from other disciplines of medicine in geriatrics and which got David Reuben started in his career in geriatric medicine. In faculty development we try to help those interested in geriatrics per se or in the aging aspects of other specialties get off to a good start and position themselves for influence in their careers. Because we still have so many scholars programs in medicine this graphic breaks them out as a separate echelon in the back. Collectively these scholars programs have supported almost 700 people at the faculty level as well as over 1000 medical students of whom several hundred have focused their careers in aging. One of the characteristics of our programs at this point in time, but in medicine especially, is the potential power of their alumni given the large number and time to move into positions of influence they have had. As an example, just last week Harlan Krumholz a 2nd cohort Beeson scholar at Yale was profiled in Forbes as the most important doctor you have never heard about for his comparative effectiveness work in cardiology. In Curricular change, shown here by our ADGAP Chief Resident program, the surgical specialists initiative, and the internal medicine specialists initiative , we try to influence training standards, develop training materials, and have them spread. It is here that we are working for the big win that nursing has already had – a really effective requirement for minimum competency in caring for older adults in medicine. Of course these two strategies work together as faculty do the direct teaching of future practitioners, lead curricular change efforts, and eventually are positioned to support them from positions of leadership. Last, while we have spent more money and have done most of the initial work, because of their size and scope, I also wanted to mention the work in aging and health of the Donald W. Reynolds Foundation. Over the last 10 years they have spent almost $100M on their grants to 40 medical schools and 4 faculty development centers. We understand that they are very likely to award another $10M later this year for geriatric training of surgical specialists and for MDs to be better team members. However, they are very unpredictable in the short term and spending down in the long-term. Atlantic is pretty much off all of these boards with its current focus on public policy and consumer advocacy. They still have some residual monies in all of these games, but it is running out and they are not attending to any of their investments.
- As in the other fields, relatively little money in Curricular change representing our commitment to individuals as we cut our way back and also accidents of timing depending upon what was up for renewal when. This is actually just a bit more exagerated than it was in 2008 Also we have $1.78M outstanding in other representing our NHPF, Communications, EWA, Workforce Studies, and Hurricane grants or 3.5% of our outstanding commitments.
- SO this chart shows some indicators of progress medicine in year 2 of our 5 year plan. Indicators of Impact Geriatrics Divisions Increase Faculty Size by 20% 50% of Medical Schools Adopt New Geriatric Competencies 50% of Residencies, Specialties, & Subspecialties Adopt Specific Geriatric Training Standards (Currently ~ 30%) So down here we would show current measures of our impact - Size of Divisions, % of schools adopting competencies, and % of residencies Faculty growth - Some good news and some bad news Of those institutions with formal geriatrics academic units (divisions or departments) the average number of physician faculty is 16 – however, only 60% of medical schools have a division or better of geriatrics that we could find and when they do not, while they no doubt have some geriatrics faculty, the number is undoubtedly less. 30% of medical schools have explicit geriatric requirements for Medical Students 57% of Internal medicine residencies have some geriatrics requirements in their training programs
- As you know we believe that geriatrics competence among at least these three professions and redesign of how care is delivered across many settings is essential to improving the health or older adults. Many other things are relevant and even important, but these four things are those we have the money, expertise, and staff to address. Looking forward to when we have unallocated money to fund new grants in 2013 we did want to propose a change in the targets we plan for. Moving social work up and medicine by 4%. Having laid off the bulk of our most expensive scholars programs on other funders in Medicine, we are now free with your permission to adjust Medicine down somewhat and to make the transition for social work less abrupt.