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Preparing Family Caregivers to Provide High-Quality Care for People with Dementia

Jan 22, 2015, 9:00 AM

Tatiana Sadak, PhD, PMHNP, is an assistant professor at the University of Washington School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013-2016). She is working to promote “dementia caregiver activation,” a process of preparing caregivers to become ready to manage the multiple needs of loved ones with dementia while caring for themselves.

Tatiana Sadak
Aging in America

The well-documented personal and societal burdens of dementia are the central focus of the National Alzheimer’s Plan, which calls for extensive reforms in the delivery of health care for patients with dementia and their family caregivers. RWJF answered this national call to action by funding several innovative dementia health services research projects and nurturing the careers of junior dementia researchers.

I was fortunate to receive RWJF Nurse Faculty Scholars funding. It will make it possible for me to focus a majority of my time on improving health services for people living with dementia and for their family care partners—or ‘caregivers.’

Dementia patients suffer brain failure that leads to progressive loss of autonomy and the inability to understand and meet personal health care needs. Clinicians conduct health assessments, create care plans, and treat symptoms, but it is dementia family caregivers who deliver the day-to-day care and health management these patients need. There is, however, considerable variation in their capacity to assist care recipients in making health care decisions, for providing daily care, and for navigating health care systems.

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Nurses and the Future of Long-Term Services and Supports

Jan 20, 2015, 12:00 PM, Posted by Maryjoan Ladden

Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation (RWJF).

Maryjoan Ladden / RWJF

By 2050, as many as 84 million Americans will be 65 or older, and most of them will need some sort of help in maintaining their health and well-being. For them, and for the millions of younger Americans who will need similar assistance, it’s essential that we come to grips with the challenge of providing effective and affordable long-term services and supports (LTSS).

As it stands right now, we’ve got a long way to go. But the effort is under way, and nurses are at the forefront. At more than 3 million strong, the nursing workforce will be central to meeting growing demand for LTSS. In addition to providing clinical care, nurses can assess the long-term health prospects of individuals with physical and cognitive impairments, develop customized care plans, monitor individuals’ responses to care, coordinate care across providers and settings, and oversee the quality of the assistance older adults receive.

Aging in America

The latest issue of RWJF’s Charting Nursing’s Future policy brief series highlights a number of trailblazing LTSS efforts in which nurses play a key role. Among them:

  • Transitional Care. The Central New Jersey Care Transitions Program (CNJCTP) is one of a number of sites taking part in the Affordable Care Act-funded Community-Based Care Transitions Program. Six hospitals in the CNJCTP region work with registered nurses (RNs) and social workers, who together act as health coaches to teach self-care strategies to high-risk, chronically ill Medicare beneficiaries. Registered nurses (RNs) focus on beneficiaries’ symptoms and health care needs, including medication management, while social workers attend to socioeconomic needs that may lead beneficiaries to return to the hospital. Coaches visit patients in their homes within three days of discharge, facilitate a follow-up visit with a primary care provider, and follow up by phone for a month after discharge.

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Open Health Data: How To Go for the Gold?

Jan 16, 2015, 1:25 PM, Posted by Susan Dentzer

Dr. Eric Topol Eric J. Topol, M.D.

In his new book, The Patient Will See You Now, Eric Topol, MD, invokes the famed Arabian folk tale One Thousand and One Nights, in which the poor woodcutter Ali Baba utters "Open Sesame" to unseal the cave where thieves have a treasure of gold coins. Topol asks "whether we, like Ali Baba, can breech the gate that keeps us from [health and health care] data, to a new world of openness and transparency."

It's worth remembering that, in the folk tale, Ali Baba does get rich — but after fighting over the gold, almost everybody else ends up dead.

So how do we ensure that the story of increasingly open health data has a more universally happy ending?

It won’t be easy, and Topol acknowledges the quandaries of dealing with the "gold" — the enormous flow of health data already under way.

Among the issues:

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‘I Can’t Breathe’: Racial Injustice as a Determinant of Health Disparities

Jan 15, 2015, 12:00 PM, Posted by Amani M. Nuru-Jeter

Amani M. Nuru-Jeter

Eric Garner’s death and the failure to indict NYPD Officer Daniel Pantaleo have had a profound effect on communities throughout the United States. But it’s not just Eric Garner. This, and similar cases including Michael Brown, Tamir Rice, Trayvon Martin, and Oscar Grant, have put race relations front and center in the national debate.

I’m tired of it, this stops today...every time you see me you want to harass me, you want to stop me...please just leave me alone” –Eric Garner

These last words from Eric Garner are not that different from what we hear in our work with African American women in the San Francisco Bay area:

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So Much Data! How to Share the Wealth for Healthier Communities

Jan 14, 2015, 5:15 PM, Posted by Alonzo L. Plough

What Counts: Harnessing Data for America's Communities

The world of research and evaluation is experiencing a dramatic increase in the quantity and type of available data for analysis. Estimates are that an astonishing 90 percent of the world’s data has been generated in just the past two years. This flood of facts, figures, and measurements brings with it an urgent need for innovative ways to collect and harness the data to provide relevant information to inform policy and advance social change. “Not long ago, we had a problem of insufficient data,” says Kathryn Pettit, a senior research associate at the Urban Institute. “Today we have more data than ever before, but we still need to build capacity to use it in meaningful ways.”

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RWJF Executive Nurse Fellow Brings Nursing Perspective to Bioethics

Jan 14, 2015, 9:00 AM

Cynda Rushton, PhD, RN, FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics and a professor of nursing and pediatrics at Johns Hopkins University. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2006-2009). In 2014, she was named a Hastings Center Fellow for her work in bioethics.

Cynda Rushton

Human Capital Blog: Congratulations on being named a 2014 Hastings Center Fellow. What does this fellowship mean for you and your career?

Cynda Rushton: It’s a wonderful honor to be included in this interprofessional group of scholars of bioethics. It’s a terrific opportunity to cross-pollinate with great thinkers and leaders and to think about some of the most vexing ethical issues in health care. It’s going to be a rich container for dialogue, learning, and leadership.

HCB: How will the fellowship work?

Rushton: Fellows have the opportunity to help guide the direction of the Hastings Center, which is an independent, non-partisan and nonprofit bioethics research institute in New York. The center’s mission is to address fundamental ethical issues in the areas of health, medicine, and the environment, and we’ll be bringing up issues that we think deserve more in-depth scholarship and research. This summer, we’re having a retreat where we will be able to work together around issues of common concern, particularly in the area of bioethics.

HCB: What will you focus on as a fellow?

Rushton: My focus has been on how to create a culture of ethical practice in health care. I’m interested in what is required to create that culture and what kind of individual competencies need to be in place to support people to practice ethically and reduce moral distress.

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What's Next Health: What We Can Achieve By Working Together

Jan 13, 2015, 10:49 AM, Posted by Marjorie Paloma

Nate Garvis Color How can it be charitable to work with a business whose motive is to make more profit? Marjorie Paloma shares thoughts from from Nate Garvis.

As part of our What’s Next Health series, RWJF regularly talks with leading thinkers about the future of health and health care. Recently, we spoke with Nate Garvis, founder and author of Naked Civics, about entrepreneurial thinking and how it can be applied to building a Culture of Health. RWJF Director Marjorie Paloma reflects on Nate's approach.

What would you be willing to do to learn?

This is just one of many provocative questions Nate Garvis of Naked Civics is asking the Foundation as we look to build a Culture of Health.

Many times, we come across people who seem to have all the answers. But Nate doesn’t pretend to. Instead, he uses questions that help us journey through an issue, guiding us toward a new type of discovery process—one that takes us to uncomfortable places and challenges us to work with unlikely bedfellows.

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New Year, New Coverage for Millions

Jan 9, 2015, 2:51 PM, Posted by John R. Lumpkin

Health Care Dot Gov healthcare.gov

The beginning of a new year is a great time to reflect on progress toward longstanding goals. At RWJF, we’ve spent the better part of four decades advancing solutions to help everyone in our nation gain access to affordable, high quality health care—a goal we reaffirmed in 2014 when we announced our vision for a Culture of Health in America.

Happily, our country has made enormous progress toward this goal in 2014. Health coverage rates improved dramatically last year because of robust enrollment through the health insurance marketplaces, Medicaid, and CHIP. As we enter 2015, we continue to see strong coverage gains, with nearly 6.6 million consumers newly enrolled or renewing through HealthCare.gov.

But let’s not forget that more than 40 million people remain uninsured. There is still more work to be done to make sure all those who are eligible can get the coverage they need and deserve.

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The Patient—and Her Data—Will See You Now

Jan 7, 2015, 1:48 PM, Posted by Susan Dentzer

Smartphone Photo by Viktor Hanacek, Picjumbo.com

It’s 2015, the year that Marty McFly, the fictional character in the 1989 hit movie "Back to the Future II," visits by time traveling into the future in a souped-up DeLorean automobile. Predictably, most of the technologies the film foreshadowed haven’t been invented as of the real 2015—not the “hover board” that Marty glides along on, nor the self-lacing sneakers, nor (of course) the time travel.

But plenty else has been invented or discovered in the last 30 years, revolutionizing much of our lives, including our health and health care. If you want to feel as exhilarated, and maybe even as disoriented, as Marty did after fast-forwarding to 2015, read Dr. Eric Topol’s new book, The Patient Will See You Now: The Future of Medicine Is In Your Hands.

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Top 10 Signs We are Building a Culture of Health

Dec 17, 2014, 7:18 PM, Posted by Catherine Arnst

Two daycare teachers play with a group of young children outside.

Last January the Robert Wood Johnson Foundation alerted the world to its new strategy: To build a Culture of Health for all, one that would allow every one of us to make healthy choices wherever we live, work, and play. A big reach, we know, but we are nothing if not optimistic. So, 12 months on, we asked ourselves—How’re we doing? Pretty good, as it turns out. Here are the top 10 signs that America is moving towards a Culture of Health (in no particular order).

10. The evidence is in—kids are beginning to slim down.

Research published in February shows continued signs of progress toward reversing the childhood obesity epidemic: Obesity prevalence among 2 to 5 year olds dropped by approximately 40 percent in eight years, a remarkable turnaround. There is still much work to do in this area, but at least our youngest kids can look forward to a healthier future.

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