Healthy Aging from a Local Perspective for L.A. County Seniors June Simmons, CEO Directors Knowledge Fair 8/14/2008

The Strategic Environment – challenges and opportunities U.S. health care system is in crisis Failings of system are profound and widely acknowledged Pressure is building for transformation

High Costs and Poor Outcomes Spend twice any other developed country Ranked 37 th in world on health outcomes 40 million uninsured Little prevention/lots of expensive late care Growing role for community and family caregiving and self-care

80% of Health Dollars Spent on Chronic Conditions 31% of Americans are obese Adults are not physically active (28-34% aged 65-74; 35-44% aged 75+) Rates of obesity in children (16-33%) Type II diabetes skyrocketing – 40% increase in ’90s. 6.9% of Americans; 20% among 65+ Ethnic health disparities dramatic

The Scope of the Problem 1.7 million Americans die of a chronic disease each year Chronic diseases affect the quality of life of 90 million 87% of persons aged 65 and over have at least one chronic condition; 67% have 2 or more 99% of Medicare spending is on behalf of beneficiaries with at least one chronic condition.

What is a chronic disease? Arthritis Chronic lung disease Diabetes Heart condition Cardiovascular disease Chronic pain Depression Cancer Stroke Any ongoing health condition Four chronic conditions cause 2/3 of all deaths a year. Heart Disease, Cancer, Stroke and Diabetes

Ethnic Health Disparities: Diabetes Among Hispanics Admissions for uncontrolled diabetes without complications per 100,000 population, age 65 and over, by ethnicity, National Healthcare Disparities Report

40% of Deaths in U.S. Due to Modifiable Risk Factors Smoking was king Obesity and lack of physical activity Chronic conditions result: –Diabetes –Respiratory conditions –Cardiovascular –Arthritis –Cancer

Source: Stephen A. Schroeder, MD. We Can Do Better. NEJM 357:12

Need to work with whole person, family and community Facing complex and fragmented system Need to integrate personal care and medical care Interdisciplinary team needed Fundamental re-design is required – in large, complex system

Building a “Health” system Healthcare must change The Aging Network must seize the opportunity to partner with primary care Josefina Carbonnal has provided the great vision – converting aging services to health-building and health empowerment resources We have the opportunity to lead

The Expanded Chronic Care Model: Integrating Population Health Promotion

New Models of Care are Needed Reallocation of existing dollars from care to prevention and promoting health Strengthen community and home care – reduce use of institutions Reduce fragmentation – increase integration to address chronic diseases

Changing American Culture We are in the service of a great vision –Mainstreaming access to powerful tools for health –Building a platform for better quality of life Less pain Less illness Greater mobility and better function –This is a MISSION, not a PROJECT

California Evidence-Based Initiative 2006 California Departments of Aging and Health awarded 3-year grant from Administration on Aging Initiative brings evidence- based programming to age- based organizations Partners in Care is the state program office, California Health Innovation Center

Evidence-Based Programs Are supported by extensive research and have been proven to work Clear, detailed description of the program Have measurable outcomes Easier to market the program and engage valuable partners Increases effective use of resources to enhance programming Increases funding opportunities Best Practice Promising Practice Evidence Based Model

AoA Evidence-Based Programs Matter of Balance: Managing Concerns about Falls Healthier Living: Managing Ongoing Health Conditions Healthy Moves for Aging Well Medication Management Improvement System (MMIS)

AoA Evidence-Based Programs Matter of Balance: Managing Concerns about Falls Healthier Living: Managing Ongoing Health Conditions Healthy Moves for Aging Well Medication Management Improvement System (MMIS)

Matter of Balance: Managing Concerns about Falls Designed to reduce fear of falling and increase activity levels of seniors with fall concerns Consists of eight 2 hour classes led by 2 volunteers Participants learn: To view falls and fear of falling as controllable To set realistic goals for increasing activity To change environment to reduce fall risk factors To promote exercise to increase strength & balance

A Matter of Balance: Managing Concerns About Falls What Happens During Classes? Group discussion Problem-solving Skill building Assertiveness training Exercise training Videotapes Sharing practical solutions

Participants include anyone who: is concerned about falls is interested in improving flexibility, balance and strength is age 55 or older, ambulatory and able to problem-solve

California Evidence-Based Programs **Healthier Living: Managing Ongoing Health Conditions Matter of Balance: Managing Concerns about Falls Healthy Moves for Aging Well Medication Management Improvement System

Healthier Living: Managing Ongoing Health Conditions Self-management program designed to help people manage chronic illnesses Consists of six 2½ hour sessions led by 2 leaders Highly scripted Groups are small (10-20 people)

Target Population Have at least 1 chronic condition Diverse seniors in underserved communities Must have stamina to attend 2 ½ hour class, plus travel time Must have cognitive function to participate Must transfer independently or have caregiver to assist

Goals of a Self-Management Program –Participant learns how to identify problems –Participant learns how to act on problems –Participant learns problem-solving skills related to chronic conditions –Participant learns how to generate short-term action plans

Workshop Overview  Managing symptoms  Dealing with difficult emotions (frustration, anger, pain)  Personalizing a fitness and exercise program  Relaxation techniques  Tips for eating well  Medication "how to's"  Improving communications (family, friends, doctors)  Effective problem-solving  Setting weekly goals

Materials- Multiple Language Participant Workbook English Spanish Chinese Japanese Korean Relaxation CD English Spanish Chinese Leader’s Manual English Spanish Chinese Japanese Korean Bengali Dutch German Hindi Italian Norwegian Somali Turkish Vietnamese Welsh Arabic

Program Benefits Improvements in Health Status Decrease in pain Decrease in depression Decrease in fatigue Decrease in shortness of breath Decrease in health distress Improvement in role function Improved quality of life Greater self-empowerment!!

Reductions in Health Care Utilization Fewer visits to physicians Fewer emergency department visits Fewer hospitalizations Fewer days in hospital Program Benefits

Going to Scale This is challenging work – needs to: Reach large numbers of people Maintain fidelity Be sustainable/cost-effective and consumer-engaging

California Collaborative Models Need partners that can: Identify & connect participants – e.g. physicians Provide quality, sustainable platform, e.g. community college adult education Sponsors and sites, e.g. health plans, senior centers

Evidence- Based Project Office Public Health Sector Senior Housing Sites Hospitals Health Plans Physician Groups Community Colleges Faith- Based Orgs Mental Health Sector Senior Centers Parks and Rec. Target Sectors For ADOPTION/ENGAGEMENT

Seize the Opportunity A time of potential transformation Must rise to the occasion Going to scale is key This will take more time than we planned Need commitment at all levels It is well worth the journey

Questions?? Greg Bailey Program Coordinator Partners in Care ext 161

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