AGS Announcements

No More JAGS for You?
Today is the last day of AGS' 2009 membership renewal grace period! Renew online today to ensure uninterrupted access to the many and varied benefits of AGS membership! These include free subscriptions not only to the Journal of the American Geriatrics Society (JAGS), but also to Annals of Long-Term Care, and Clinical Geriatrics. Other benefits include reduced registration fees for AGS' upcoming Annual Scientific Meeting, discounts on AGS products, and access to the members-only MyAGS site -- home to AGS knowledge resources for the AGS Practice Management Toolkit, AGS Media Toolkit, one-click access to JAGS AGS discussion boards, and the AGS Legislative Toolkit. Among other things, members also benefit from the Society's public policy advocacy work in Washington, and are eligible to join AGS' many committees, sections, and special interest groups, and assume leadership positions in the society.

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What's Up in Washington

AGS Applauds Sens. Boxer and Collins' Introduction of "Caring for An Aging America Act," in Endorsement Letter and Press Release
The American Geriatrics Society hailed Sens. Barbara Boxer (D-CA) and Susan Collins (R-ME) for introducing the "Caring for An Aging America Act of 2009" in the Senate and House yesterday, both writing a letter endorsing the legislation and issuing a nationally distributed press release lauding the bill.

Sens. Boxer and Collins' legislation would help address the serious and growing nationwide shortage of healthcare professionals and direct-care workers trained to meet the unique healthcare needs of older adults.

The "Caring for An Aging America Act of 2009" would allocate $130 million over five years to fund educational loan forgiveness and training and career advancement opportunities for healthcare professionals and direct-care workers who make a commitment to caring for older adults.

"As the Institute of Medicine warned last year in its groundbreaking report on elder healthcare, we have far too few healthcare professionals and direct-care workers with the training necessary to provide the acute and long-term care that the growing ranks of older Americans need," said AGS President-Elect Cheryl Phillips, MD, Chief Medical Officer for On Lok, a nonprofit organization that provides all-inclusive healthcare and chronic care services for older adults in the San Francisco area.

"Sens. Boxer and Collins' legislation will help us meet demand for these workers, and provide employment opportunities for Americans," Dr. Phillips added. "AGS looks forward to working with Sens. Boxer and Collins and other lawmakers to advance this important legislation."

AGS strongly supports provisions in Sens. Boxer and Collins' legislation that would:

• Establish the Geriatric and Gerontology Loan Repayment Program for physicians, physician assistants, pharmacists, advance practice nurses, psychologists, and social workers who complete training in geriatrics or gerontology and agree to provide care for older adults, full-time, for at least two years.
• Expand eligibility for the Nursing Education Loan Repayment Program so it includes registered nurses who complete specialty training and provide nursing services to older people in long-term care settings.
• Expand career advancement opportunities for nursing and direct care workers by offering specialty training in long-term care through the existing Career Ladders Grants Program. According to the IOM's 2008 report, many direct-care workers are inadequately trained and prepared to care for older people.
• Create a "Health and Long-Term Care Workforce Advisory Panel for an Aging America" to examine and advise the Secretary of Health and Humans Services, the Secretary of Labor, and Congress on workforce issues related to healthcare and long-term care for older Americans.

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Congressional Budget Committees Approve Leaner Versions of President's Spending Plan, Full Senate and House Votes Expected This Week; Two Major Insurers Offer to Drop Higher Rates for Some With Histories of Prior Illness; Adoption of HIT in Hospitals Lags Behind Expectations
Voting along party lines last week, the Senate and House budget committees approved trimmed-down versions of President Obama's spending plan. Both chambers "removed Obama's detailed proposal for a 10-year, $634 billion health reserve plan from their budget plans and … approved plans that simply acknowledge the desire to have a health reserve fund that would not increase the deficit," The Washington Post reports. But Administration officials said that this would be sufficient to move healthcare reform forward, and that more specifics from the president's healthcare proposals would "come back into play," once Congress begins drafting more detailed legislation.

The Senate trimmed roughly $15 billion from the president's original $3.6 trillion budget for non-defense spending and the House, $7 billion, prior to the committee votes. The two plans would create an estimated $1.2 trillion deficit in the coming fiscal year, but would "dramatically narrow the gap between spending and revenue as the economy recovers over the next five years," according to the Post. Republicans contend that the spared down plans would still drive up debt to an unacceptable degree, however. The full House and Senate will consider the plans this week. A key issue on the Hill is whether lawmakers will ultimately opt to use a controversial procedural maneuver called "budget reconciliation" to push the president's healthcare and energy initiatives through without Republican votes.

Among other elements of healthcare reform, Democratic and Republican lawmakers are divided over whether to create a new public health insurance program that would compete with private insurers. Critics argue that private plans won't be able to compete with a public plan and will be driven out of the market. The end result, they predict, will be a single-payer, government run healthcare system.

In an online Town Hall meeting last week, President Obama said that the best approach to providing universal healthcare would be to build on the current system, which relies in part on employer plans - plans that, he noted, have long met the needs of many Americans.

Releasing a report outlining their preferred approach to healthcare reform last week, a coalition of physicians, insurers, hospitals, employers, pharmaceutical firms and consumers also called for building on existing employer-based health coverage

Private insurers are threatened by the prospect of the creation of a public health insurance plan and are advocating for alternatives that don't deviate so significantly from the status quo. Last week, two leading insurers offered - for the first time - to limit their controversial practice of charger higher premiums to certain people with histories of medical problems, the AP reports. The insurers, however, left themselves the option of charging higher premiums based on age and other factors.

In other healthcare policy news:

A Department of Health and Human Services report released Monday underscores the pressing need for comprehensive healthcare reform. According to the report -- a compilation of findings from dozens of studies -- healthcare spending in the U.S. doubled between 1996 and 2006, and is expected to rise from 16% of gross domestic product now, to 25% in 2025, and 49% by 2082 -- unless there are sweeping changes in the system.

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While many medical experts agree that eliminating paper records would help save lives and make healthcare more efficient and less costly, a recent New England Journal of Medicine study finds that the adoption of electronic health records in hospitals isn't as widespread as estimated and is likely to be more expensive and problematic than expected.

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The Obama Administration established new rules for private Medicare Advantage plans this week. Under the new rules, the comprehensive plans -- which cover roughly 10 million beneficiaries -- will face greater scrutiny if they don't cap beneficiaries' annual out-of-pocket costs at $3,400, or if they charge more for dialysis, home health care and other services than traditional Medicare. In those cases, the plans will be asked to reduce their fees. In addition, the plans "won't be allowed to charge sick, low-income patients more than … they would pay under traditional Medicare," The Wall Street Journal reports. Full story

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Things We Like

The Green House Project, Featured on PHI's Website
Robert Jenkens, director of The Green House ® Project, which recently helped launch its eighteenth Green House campus, is looking forward to the further expansion of these revolutionary alternatives to nursing homes. Thanks to a generous 2005 grant from the Robert Wood Johnson Foundation, the organization is in the process of implementing 50 new Green House developments nationwide, and Jenkins sees far more in the future.

"As we go well beyond the grant, we expect the real benefit will be to grow and evolve from what we learn from each other, from our best practices and collective wisdom," Jenkens explains in a recent interview with PHI, a national nonprofit working to improve the quality of eldercare and disability services by supporting quality jobs for direct-care workers. AGS and PHI are the elected co-conveners of the Elder Workforce Alliance (EWA), a coalition of 25 organizations working to address the growing nationwide shortage of healthcare professionals and direct-care workers trained to meet older adults' unique healthcare needs -- a shortage that was the subject of last year's groundbreaking Institute of Medicine report.

Green Houses are small, homelike facilities where a small number of residents get the full range of personal and clinical care services offered in nursing homes. But size isn't the only thing that differentiates Green Houses from nursing homes.

"Individuals living in Green House homes have rights: they maintain independence, direct their own care, and live with dignity," PHI reports. "In addition to replacing the institutional care model with small homes that accommodate no more than 8 to 10 people, the Green House model offers a new role for the direct-care worker. That role is to protect and nurture those living in the Green House. Together with the residents, direct-care workers run the household; they also provide personal care, cook, and clean. Nurses are on-call to provide clinical care, when needed. "

Each Green House is staffed by a self-managed team of CNAs who get 120 hours of extra training in the Green House approach, and report to administrator who provides support and acts as coordinator, the PHI article explains. Studies find that turnover in Green Houses is far lower than in nursing homes, and staff report greater job satisfaction, mentioning, among other things, that they get to know residents much better in the intimate Green House setting and can, as a result, better care for them.

The first pilot Green House project opened in Tupelo, Mississippi in 2002. There are now 18 campuses nationwide, each including from one to 10 houses. Another 20 campuses are in development. The Green House ® Project is a program of NCB Capital Impact, a Washington, D.C., based non-profit that works to bring innovation to low-income communities and improve the lives of those living there. Established by an act of Congress in the late '70s, the organization works in health care, education, affordable housing, and long-term care.

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Upcoming AGS Deadlines

The Practice Change Fellows Program: Enhancing Leadership in Geriatric Care 2009 Call For Applications (Deadline: April 1, 2009)
The Practice Change Fellows program is now accepting applications for the 2009 award cycle. The program is designed to develop healthcare leaders who can effectively promote high quality care for older adults. Eligible applicants must hold a leadership role in a health organization or institution and have service line or programmatic responsibility for care to older adults. They must be sufficiently senior in their organization to have decision-making authority and be able to effect change. Nurses, physicians, and social workers are eligible to apply. Applications and more details are available at www.practicechangefellows.org. The application deadline for the 2009 award cycle is April 1.

As many as 10 Practice Change Fellows are selected through a national competition for each award cycle. Fellows receive $90,000 over the two-year program and work with accomplished national mentors to design, implement, and evaluate a new project. This project will ideally focus on an innovative aging-related program or geriatric service line. Fellows will participate in tri-annual meetings where they will receive input on their projects from national program mentors and Advisory Board members, join in case-based discussions on how to effect change, and attend interactive presentations led by national experts. Completion of formal leadership training (local or national) is another core component of the program. By the end of the two years, Fellows will be able to articulate a vision of what they hope to accomplish in the upcoming five years and the steps necessary to achieve this.

The Practice Change Fellows program is funded by the Atlantic Philanthropies and the John A. Hartford Foundation, and administered by the Division of Health Care Policy and Research at the University of Colorado at Denver and Health Sciences Center in partnership with the National Council on Aging.

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Health and Aging Policy Fellows 2009-2010 Call For Applications (Deadline: April 15, 2009)
Health and Aging Policy Fellows, a new program supported by the Atlantic Philanthropies and directed by Harold Alan Pincus, MD, Professor of Psychiatry at Columbia University, is now accepting applications for the 2009-2010 fellowship year. The Health and Aging Policy Fellows program aims to advance healthcare professional's knowledge and experience in policy-making that affects older Americans by providing them with experience and skills necessary to make positive contributions to the development and implementation of future health care policies. The Fellows Program offers two different tracks for individual placement: a nine-to-12-month placement in Washington, D.C. or at a state agency (residential track); and a health policy project and brief placement(s) throughout the year at relevant sites (non-residential track) to achieve this goal. The applications deadline for the 2009-2010 award cycle is April 15.

Contact Harold Alan Pincus, M.D., Director of the program, (pincush@pi.cpmc.columbia.edu or 212-543-5400) or Phuong Trang Huynh, Ph.D., Deputy Director of the program (huynhpt@pi.cpmc.columbia.edu or 212-543-6213).

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