Problem: As "Baby Boomers" begin to retire, the population of older Americans is set to surge. Yet there are not enough geriatric specialists in the health care workforce to provide knowledgeable care for older people, who often experience multiple chronic conditions, take reams of medications and receive less than optimal quality care in a fragmented, uncoordinated system. As a whole, providers, policy-makers, researchers and educators aren’t paying enough attention to the looming crisis.
Background: A nurse, a gerontologist, an advocate and a visionary, Jennie Chin Hansen, R.N., M.S., F.A.A.N., knows as well as anyone the joys and the sorrows of growing old.
The CEO of the American Geriatrics Society and the past president of both AARP and the American Society on Aging, she’s spent the last four decades building and leading a movement around improving the quality of life—and death—of older Americans.
She recently spent six years as a federal commissioner of the Medicare Payment Advisory Commission (MedPAC), is a board member of the Institute for Healthcare Improvement, and is a member of an American Hospital Association committee working to close health disparities.
In addition, she was a member of the study committee supported by the Robert Wood Johnson Foundation (RWJF) that drafted the groundbreaking report last year on the future of the nursing profession, and she was a member for a decade of the National Advisory Committee for the RWJF Executive Nurse Fellows program.
She is, as one publication called her, the “Marion Wright Edelman of the over-80 set.”
Chin Hansen’s interest in older people dates to her days as a young woman. A budding nurse researcher in the 1970s, she began tracking aging demographics and cultural practices of nearly a dozen ethnicities while at the University of California at San Diego.
She then witnessed the experience of aging in America when she became a caregiver for her parents. She grew dismayed with a culture that she felt was disrespectful of the elderly and determined to change what she saw as a fragmented, uncoordinated system that to her trained eye left too many elders living out overmedicated and underappreciated lives, often in sterile, unfamiliar institutions.
When her own parents became ill, Chin Hansen opened her apartment in San Francisco to her mother, who suffered from severe heart disease, and her father, who had experienced two debilitating strokes. Then a widow and single mother (Chin Hansen’s first husband died of a brain tumor when he was 28 and their son was young), Chin Hansen found herself running a three-generation household.
“I really saw and felt as a daughter caregiver how difficult it is when a parent suddenly becomes vulnerable,” she says. “I know it’s possible to have people in this very difficult part of their lives maintain their dignity.”
To help manage the caregiving burden, Chin Hansen enrolled her father in the community health program for frail elders where she had taken a job as a research nurse, assessing health, function, cognition and costs of a comparison group of elders in the community and nursing homes to those receiving the “invention” of the On Lok program.
On Lok (Cantonese for happy, peaceful home) lived up to its name; Chin Hansen’s father spent his days at the center, enjoying hot meals, participating in activities like painting and debate, and receiving the full complement of health care and social support services. In the evenings, he spent time with his wife and family at Chin Hansen’s home.
On Lok became a happy, peaceful home away from home for Chin Hansen, too. Within three years, she had risen to the position of director, and then executive director, and oversaw the center as it grew from a unique facility to a renowned model that has since been replicated nationwide.
On Lok eventually became the model for the Program of All-Inclusive Care for the Elderly (PACE). It is a federally legislated program in which interdisciplinary teams of clinicians and providers give frail elders coordinated health, medical and social support services at a one-stop location and help participants to continue living in their own homes. The program is reimbursed by a fixed monthly payment from Medicare and Medicaid for each patient it serves.
The model has been replicated around the country and is expected to grow as the national population ages (the fastest growing subset of elders are those who are 85 years old and older). “A powerful demographic shift is occurring,” Chin Hansen says. The first ‘Baby Boomers’ reached retirement age this year and are moving into old age, she says. By 2030, people 65 years or older will comprise 19 percent of the population, according to the Department of Health and Human Services. In 2009, the same population represented 13 percent of the population.
Long life is certainly a blessing, but Chin Hansen warns of an attendant concern: The nation’s health care system is not adequately prepared to care for a crush of elderly patients who are living longer, but often sicker. There are not enough health providers who either specialize in geriatric care or possess the necessary competency of geriatrics knowledge in their practice.
Many clinical providers, she notes, say, “I care for older people, so I know how already.” But Chin Hansen and others say that many of these clinicians don’t always take into account the broader context of aging in America. Many older adults have multiple clinical and/or medical issues, often take many medications at a time, often have memory problems, and often cannot take proper care of themselves on their own.
Health providers, policy-makers, researchers and educators, she says, need to pay special attention to this combination of factors that often complicates care for the elderly.
Solution: It’s a problem Chin Hansen has been paying attention to her entire adult life. In her current position as CEO of the interprofessional American Geriatrics Society, she is working with the organization’s current president (and fellow nurse), Barbara Resnick, Ph.D., C.R.N.P., F.A.A.N., to implement and advocate for geriatric-centered patient care, research, professional and public education and public policy for its members, who are primarily physicians.
The work builds on her accomplishments at AARP and at the American Society on Aging, where she served as president. Assuming the helm of AARP in 2008, she advocated for enhanced medication safety protocols, education about how to prevent falls—a major source of injury for older Americans—and for family conversations about end-of-life planning.
She also has sharpened her focus on nursing in her work with the committee that drafted the Institute of Medicine’s (IOM’s) nursing report—The Future of Nursing: Leading Change, Advancing Health. It calls for a radical transformation of the nursing profession to improve health and health care, and many of its recommendations will benefit aging Americans, Chin Hansen says.
She was a strong supporter, for example, of the report’s call for nurses to practice to the full extent of their training and abilities; that more nurses obtain higher degrees so that they have more specialized skills; and that nurses take on more leadership roles in health organizations and in society. Society, she says, should shape how care is designed so that it is safe and accessible. “We must pay attention to what is happening in the needs of care and work out our ‘tribal matters,’” she says, so that people can stay healthy and receive competent, affordable care.
She is optimistic that the RWJF-backed campaign to implement the report’s recommendations will change the system for the better, and for older Americans in particular.
And the recently enacted health care reform law, she adds, will help because it will fund innovative models of care that will advance approaches, incentives and practices to improve the quality of care and contribute to cost savings.
“The system is beginning to have a greater effective focus on older people,” she says. But if it does not change fast enough, she warns, health care costs will surge and access will narrow. And that, she says, could turn health care, particularly for lower-income older Americans, into a game of musical chairs—or musical beds, so to speak. “The reality is we still have a ways to go.”
RWJF Perspective: The Foundation is committed to improving health and health care of older Americans. To do that, it is supporting The Future of Nursing: Campaign for Action, a collaborative effort to implement the recommendations of the IOM report to improve quality and transform the way Americans receive health care.
The Foundation also supports various programs that promote research into innovative ways to improve health care for older Americans. Participants of the Foundation-supported Interdisciplinary Nursing Quality Research Initiative, for example, recently created a tool to prevent patient falls, and an RWJF Nurse Faculty Scholar is studying the effects of Tai Chi and Western exercise on older adults.