Sep 1, 2020
Elder Care: Past and Future with Joanne Lynn, MD, MA, MS and Carrie Graham, PhD, MGS
“There needs to be a community anchor in managing eldercare.”— Joanne Lynn, MD, MS, MA (03:21-03:25)
Is it right, ethical, or moral that we have put 1.3 million Americans in solitary confinement for the past six months because of COVID-19? Would we tolerate this for college students? Young adults? Children? Not likely. But we have done this to 1.3 million nursing residents in this country. Why isn’t anyone asking these residents and their families what matters to them?
In this week's episode, Dr. Melissa Batchelor welcomes Drs. Joanne Lynn and Carrie Graham as her guests for this week. We will discuss nursing homes and COVID as well as long-term care financing considerations from her fellowship.
Part One of ‘Elder Care: Past and Future with Joanne Lynn, MD, MA, MS’
Joanne Lynn, MD, MS, MA, is a 2019-2020 Health and Aging Policy Fellow and is the Director of the Program to Improve Eldercare at Altarum Institute. One of the first hospice physicians in the US and an early developer of palliative care, Dr. Lynn is author of 300 peer-reviewed journal articles and 80 books and chapters on geriatrics, palliative care, and end of life care. She has been a tenured professor at the George Washington School of Medicine and Dartmouth Medical School and has worked in quality improvement for CMS, IHI, and the Washington, DC, Department of Health. She has led the team that has developed the MediCaring Communities reform model for eldercare and is working to generate communities capable of improving the performance of their eldercare arrangements. Other current projects include expansion of PACE to serve elders who are not enrolled in Medicaid and enabling better conditions for paid and unpaid caregivers. You can visit her website at Medicaring.org to read her Issue Briefs and comment on What to Do About Nursing Homes.
Carrie Graham, PhD, MGS, a 2018-2019 Health and Aging Policy Fellow, has been working in the field of health policy, gerontology, and evaluation research for 20 years. She holds a doctorate in Medical Sociology from UCSF and a master's degree in Gerontological Studies from the Scripps Gerontology Center at Miami University. She is currently an Associate Adjunct Professor at the UCSF Institute for Health and Aging and holds a joint faculty appointment at UC Berkeley in the School of Public Health. She is the principal investigator of several studies examining the experiences and choices of seniors and people with disabilities who are transitioning to managed care delivery systems. Most recently, she led a multi-campus evaluation of California's dual financial alignment demonstration. She also evaluates consumer-directed organizations that work to promote aging in the community, called Villages.
Dr. Graham specializes in using a participatory evaluation approach that incorporates the perspectives of consumers and stakeholders in all phases of evaluation, from the evaluation design through the interpretation of results. She conducts research with hard to reach populations, including frail seniors, people with disabilities, people with chronic illnesses, and people with no or limited English proficiency. To answer complex policy questions, she often uses mixed methods, incorporating qualitative data from interviews or focus groups, and quantitative survey data.
“COVID-19 showed how little policymakers and leaders know about their aging population.” — Carrie Graham, PhD, MGS (08:04-08:11)
Since COVID-19 has overwhelmed most of our plans, Dr. Lynn ended up spending a great deal of effort trying to keep reporters and others attuned to what was happening to seriously disabled elders. She was initially trying to improve eldercare financing due to large numbers of older adults who, when they need help, have no resources. Communities need to know how they stand and how they're performing. She's involved in developing data for county-level descriptions of how elder care works across the country. If you think about what happens to a person when they become very disabled in old age, so much depends upon their geographic community. Is there a workforce that can help out when the person needs intimate care? Is there a transportation system? Is there housing that's all on one floor and wheelchair accessible? There is not yet a federal guideline that calls on nursing homes to know what their residents want.
If you have ideas of how nursing homes can be improved, you can add your comments to Dr. Lynn’s blog here. (Medicaring.org blog What to Do about Nursing Homes?).
You can also check out Dr. Terry Fulmer’s blog here: Nursing Homes in the Time of COVID-19: We Need Urgent Action Now and a Long-Term Strategy
You can also check out here Issue Briefs here on Elder Abuse; LTSS Financing; Home Care Workforce Shortage; Housing for the Elderly; and Transportation Challenges in Old Age.
Part Two of ‘Elder Care: Past and Future with Joanne Lynn, MD, MA, MS’
It's getting to the point where it is so much more expensive to do nothing than break out and do some of the right things. Before COVID-19, we were already in big trouble with financing eldercare. The large numbers of boomers hit disability; they don't have enough savings. They don't have any insurance. They have relatively small families and are often separated by distance.
The best idea is an insurance scheme where the government picks up the costliest long-term patients, and the individual stays responsible for the upfront costs. Forty percent of us who make it to age 80 will have some form of cognitive impairment. Some people will escape it by having something that kills them abruptly. But most people will live with chronic illness, and even substantial disability for at least a while before dying.
“The most fundamental thing is to know what the patient wants.” — Joanne Lynn, MD, MS, MA (10:14-10:19)
You can't know whether you're going to be the person who has a stroke tomorrow and needs 20 years of around-the-clock supportive services, or whether you're going to be somebody who lives until 86 and dies in her sleep. The hardest part is that no one can predict what you're going to need in the future. Thus, building a system that's reliable enough to trust for 50 years is crucial. We have to get the public to invest in their being, and better ways of dealing with the finances, or we are going to have one heck of a lot of older adults without housing, food, and the very basics.
Thank you for joining us for this special series of This is Getting Old. Sponsored by the Health and Aging Policy Fellows program, Capstone Conversations is brought to you by MelissaBPhD, in collaboration with The George Washington University's Center for Aging, Health, and Humanities.
About Melissa
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.