1. Perspectives on the Age Wave: Key Issues, Solutions, and Opportunities Robyn Golden, LCSW Director of Older Adult Programs Rush University Medical Center

2. Age Wave: Why Does it Matter? Growing older adult population will increase demands on health care systems – Greater volumes of people living longer lives with more chronic conditions Factors that make older adults vulnerable necessitate quick, informed evidence-based intervention by a professional well trained in aging issues, programs, and policies – To ensure quality of care and efficiency – To address complex issues affecting all aspects of a persons’ life: physical, social, emotional, financial, etc. – To reduce over utilization that results in high costs – To facilitate advanced care planning for future needs – To maximize family caregivers’ well-being and productivity – To deliver culturally competent or culturally appropriate care © Rush University Medical Center, 2011

3. Issues in Care Discharging “sicker and quicker” Inefficient health care system and lack of care coordination Difficult medication schedules Sophisticated technology Locating and accessing quality paid help Dealing with “information overload” and choices Juggling competing demands of work and caregiving More long-distance caregiving © Rush University Medical Center, 2011

4. Hospital Usage Over 13.2 million people over 65 were discharged from a short hospital stay in 2003 – More than three times the rate for people of all ages 5.8 day average length of stay – Decreased by 5 days since 1980 © Rush University Medical Center, 2011

5. Other Medical Trends More doctor visits per year than general population – 3.8 for people 45-64 – 5.9 for people 65-74 – 7.5 for people over 75 96% report having a usual place for medical care 2.6% report failing to obtain medical help due to financial barriers © Rush University Medical Center, 2011

6. Health Care Expenditures Population over 65 – $3,899 out-of-pocket health care expenditures – Increase of 46% since 1993 – 12.5% of total expenditures spent on health Average health costs for population over 65 – $2,142 (55%) for insurance – $920 (24%) for drugs – $678 (17%) for medical services – $158 (4%) for medical supplies © Rush University Medical Center, 2011

7. How Do Geriatric Social Workers Help? Geriatric social workers couple profession’s person-in- environment perspective and commitment to social justice with advanced training in aging – Promote the mental and psychosocial well-being of older adults and their family caregivers – Provide care coordination, interventions to empower older clients and modify their environment, and advocacy for policy- level changes to optimize quality of care – Assess elders’ physical, psychological, social, familial, economic, cultural, and environmental circumstances as a basis for planning and evaluating interventions – Navigate and expedite resources to assist older adults and their families and reduce future cost Hooyman N, Unützer J. A Perilous Arc of Supply and Demand: How Can America Meet the Multiplying Mental Health Care Needs of an Aging Populace? Generations. 2010;34(4):36-42.

8. A Model for Care Coordination Rush Enhanced Discharge Planning Program (EDPP) is an example of how these needs can be addressed across transition – Short-term telephonic care coordination – Provided by Master’s-prepared social workers – From a biopsychosocial perspective – For older adults at risk for adverse events after an inpatient hospitalization © Rush University Medical Center, 2009

9. Rush EDPP: Primary Goals EDPP operates with several guiding tasks to reach the goal of preventing avoidable adverse events post- discharge : 1.Ensuring patients understand and have the ability to follow through on the discharge plan of care 2.Connecting patients to their healthcare providers and community based services and facilitating communication between providers 3.Tracking system problems for corrective action or change 4.Feeding information back into the Rush system to help guide future care © Rush University Medical Center, 2009

10. Process © Rush University Medical Center, 2009 Referral Pre- Assessment AssessmentIntervention EDPP model has four distinct phases

11. Intervention group – Less likely to have 30-day mortality – More likely to communicate with physician, make an MD appointment, keep and MD appointment, as well as make and keep the MD appointment Among EDPP program participants, over time – Decrease in caregiver stress – Increase in knowledge of medications over time At 30-day follow-up a substantial majority reported satisfaction with the EDPP program – 81% reporting it should be offered to discharged patients – 77% reporting that all their needs had been met Findings © Rush University Medical Center, 2009

12. EDPP and Medical Homes EDPP model able to address transitional care aspects of Patient-Centered Medical Home – PCMH pilot initiated at Rush in Summer 2010 – Working to standardize process, integrate social work based transitional care into PCMH © Rush University Medical Center, 2009

13. Rush PCMH Pilot APN students serve as care coordinators for at-risk patients at 7 primary care practices involved in pilot – Social work care coordination and self-management education available through Rush Older Adult Programs social workers Assists in meeting NCQA standards for access, care management, self-management, continuity of care, others – EDPP available as transitional care component of PCMH Inpatients from PCMH practices identified through daily risk list EDPP social worker emails PCP about potential for post-discharge intervention, identify issues for consideration in intervention EDPP provided as usual with handoff to Older Adult Programs for long term coordination © Rush University Medical Center, 2009

14. To Thrive Under Reform Engaging patients Prevention and wellness Not transactions but a journey Transparency of performance Focus on burden of treatment, not illness Cost and quality in the same breath © Rush University Medical Center, 2009

15. Questions? Contact: Robyn Golden Robyn_L_Golden@rush.edu © Rush University Medical Center, 2009