2. Cheryl Miller

3. To increase awareness of the real needs of older Americans, to reduce ageism, and to explore proposed policy initiatives aimed at improving health care and reducing the prevalence of chronic disease.

4.  Encourage discussion among health care professionals  Provide information related to current legislation, and policy initiatives designed to promote safe and effective care  Promote critical thinking related to improved nursing practices for the elderly

5.  Society will witness a rapid growth rate of persons 65 years and older (National Institutes of Health & U. S. Census Bureau, 2006).  Chronic medical conditions account for more than half of all health care spending (Kovner & Knickman, 2008).  Health care workers devoted to caring for the aging is in short supply (ANA, 2009).  The Health Resources and Services Administration (ANA, 2009) predict that the nursing shortage will grow to 36 % by the year 2020.

6.  Current medical model is focused on acute care needs, rather than preventative care or the chronic illness needs (Kovner & Knickman, 2008).  Only 1% of all physicians are certified in geriatrics, and less than 1% of all nurses are certified as gerontological nurses (Institute of Medicine, 2008).  Medicare, is expected to be exhausted by the year 2019 unless health care inflation is reduced or tax funding is sharply increased (Social Security and Medicare Board of Trustees, 2008)

7.  Ten million people 65 years and older are in need of long term care services and that number is expected to double by 2040 (Johnson, Toohey, & Weiner 2007).  Medicare coverage is limited and designed to cover long term care expenses related to medical needs only.  Currently, few insurance plans offer long term care coverage.  As a result, many clients and their families are not prepared to meet the financial and social burden of caring for the elderly.

8.  Thus, providing quality and effective health care for the aging population is of paramount importance.

9.  Helps healthy people to maintain their health status, helps to cure acute illness, and enables people with chronic illness to live as long as possible, while also maintaining their optimum health status (Bodenheimer & Grumbach, 2009).

10.  Healthy People 2020 developed by the U. S. Public Health System (HHS, 2010).  Bill S.245 (2010) Re-tooling the Health Care Workforce for an Aging America Act of 2009 sponsored by Senator Herbert Kohl January 14, 2009.  Improving Health Care for Health System Elders (NICHE) (2010) endorsed by The Hartford Institute for Geriatric Nursing.

11. Overarching Goals  Health equity, eliminate disparities and improve health for all groups  Eliminate preventable disease, disability, injury and premature death  Social and physical environments that promote good health for all  Healthy development and healthy behaviors across every stage of life (HHS, 2010)

12.  Amends Public Health Service Act  Advocates for an analysis of the health of the long-term care workforce  Amends Workforce Investment Act of 1998 (S. 245, 2010)

13.  Amends the Older American Act of 1965 to require the Assistant Secretary for Aging to:  Establish a National Resource Center  Develop family caregiver training guides  Develop guidelines and referral processes for caregivers of Medicare recipients (S. 245, 2010)

14.  Amends Title XIX of the Social Security Act to:  Assessments of family caregiver support needs  Funding for future research studies  Retention of nurses and home health aides  Promote spending by the National Institute of Health on chronic illnesses (S. 245, 2010)

15.  John A. Hartford Foundation Institute for Geriatric Nursing at New York University in 1992  Nationwide initiative  Resources devoted to elder care  Provides tools for hospitals to evaluate care practices  Implemented at Munson Medical Center in February 2010 (NICHE, 2010)

16.  Goal- Systematic nursing change that will benefit hospitalized older adults  Vision-Geriatric sensitive and exemplary care to all hospitalized adults over 65 years and over  Mission- Principles and tools to stimulate change in the culture of health care (NICHE, 2010)

17.  Vision & culture to specialize in care for the elderly.  Improve nursing satisfaction & improve patient care including reductions in: *Falls & fall related injuries *Hospital acquired pressure ulcers *Catheter associated urinary tract infections *Restraint Use *Functional decline *Length of stay & re-admission rates (D. Halleck, R.N., B.S.N., Manager B4 Personal Communication, March 2, 2010)

18.  Driving force of health care reform  Designate older adults as a priority population.  Raise awareness of ageism.  Eliminate social barriers.  Promote research to advance care practices.  Encourage dialogue & promote discovery of new technology.

19.  Bill S. 245(2010)-National, state, and local legislators, the education consortium, health care organizations, and health care consumers  Healthy People 2020 (2010)-National, state, and local legislators, professional nursing organizations, organizational and community leaders  NICHE (2010)-Hospital Administrators, nurses, physicians, patients, and the general public at large

20.  This student wholeheartedly supports these three policy initiatives.  The overall goals of these policy initiatives:  Reduce ageism  Promoting education and research  Development of specialized care practices devoted to elder care

21.  Community wide education programs or special events  Brainstorm or share ideas with fellow colleagues  Partnership with professional nursing organizations

22.  Changing the U. S. health care system into one that is more responsive to the needs of its older citizens is of paramount importance.  This effort will require collaboration of policy makers, health care providers, insurers, consumers, and family caregivers alike.  It will likely be a slow process and one that requires commitment, innovative thinking, and a critical analysis of our past failures.

23. American Nurses Association (2009). National Nursing Shortage Facts. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/ State/StateLegislativeAgenda/NursingWorkforce_1/2007FactSheet.aspx Bodenheimer, R., & Grumbach, K. (2009). Understanding health policy: A clinical approach (5th ed.). New York, NY: The McGraw-Hill Companies, Inc. Coalition of Michigan Organization of Nursing (2010). Retrieved from http://micomon.org/ De la Rue, M., (2003). Preventing Ageism in Nursing Students: An action theory approach. Australian Journal of Advanced Nursing, 20(4), 8-14. GovTrack (2010). Re-Tooling the Health Care Workforce for an Aging America Act of 2009. Read the Bill: S.245. Retrieved from http://www.govtrack.us/congress/billtext.xpd?bill=s111-245 Johnson, R., Toohey, D., & Weiner, J., 2007. Meeting the Long Term Care Needs of the Baby Boomers How Changing Families Will Affect Paid Helpers and Institutions. Retrieved from http://www.urban.org/publications/311451.html Kovner, A. R., & Knickman, J. R. (2008). Jonas & Kovner’s : Health care delivery in the United States (9th ed.). New York, NY: Springer Publishing Company NICHE (2010). Nurses Improving Care for Health System Elders. Retrieved from http://hartfordign.org/Resources/NICHE/

24. Social Security and Medicare Board of Trustees, 2008. Retrieved from http://www.socialsecurity.gov/OACT/TR/TR08/ The National Institutes of Health and U.S. Census Bureau. (2006). Dramatic changes in U. S. Highlighted in New Census NIH Report: Impact of baby boomers anticipated. Retrieved from http://www.nia.nih.gov/NewsAndEvents/PressReleases/ PR2006030965PlusReport.htm U. S. Department of Health & Human Resources (2010). Healthy People 2020. Proposed Objectives on Educational and Community Based Programs. Retrieved from http://www.healthypeople.gov/hp2020/Objectives/ viewProposedObjectives.aspx?id=19&TopicArea=Educational+and+Community- Based+Programs U. S. Department of Health & Human Resources (2006). News Release. Over 38 Million People with Medicare Now Receiving Prescription Drug coverage. Retrieved from http://www.hhs.gov/news/press/2006pres/20060614.html U. S. Senate Special Committee on Aging (2008). Kohl Bill to Address Severe Impending Shortage in Health Care Workforce. Retrieved from http://aging/senate.gov/record.cfm?id=305719