Preparing Health Professionals for Models of Interdisciplinary Practice in an Aging Society

1. Preparing Health Professionals for Models of Interdisciplinary Practice in an Aging Society JoAnn Damron-Rodriguez, PhD, LCSW School of Public Affairs Department of Social Welfare University of California, Los Angeles Taipei, Taiwan May 17, 2010

2. Worldwide AgingPercent of Population over age 65Both Taiwan and USA in the 8.0 to 12.9 Category

3. Average Life Expectancy in Asian Countries and the U.S.A.

4. OUR AGING WORLD: CHANGING THE SHAPE OF THE AMERICAN POPULATION • THE FUTURE OLDER POPULATION WIIL: • BE MORE EDUCATED AND DIVERSE • BE CHALLENGED TO MANAGE CHRONIC ILLNESS • DEMAND SERVICE CHOICES • HAVE FEWER FAMILY CAREGIVERS

5. OUTLINE • Preparing Competent Health Professionals in the Field of Aging • Interdisciplinary and Cross-Cultural Competence • Evidence-based Models of Interdisciplinary Healthcare

6. SOCIAL WORK RESPONSIBILITIES IN Today’s Delivery System for the Growing Population of Older Persons and Their Families I. • Patient Centered Care • Family Care giving Support • Community Care • Cultural Competence

7. COMPETENCEIS THE STANDARDCouncil on Higher Education Accreditation (CHEA)CBE Now Required 76 Different Professions DefineCompetence • Competence: The state or quality of being adequately or well qualified… a specific range of skill, knowledge or ability • Professional Competence: The achievement and demonstration of core knowledge, values and skills in social work practice • Geriatric Competence: Establishing geriatric competencies shape curricular, field training, and continuing education programs that effectively prepare practitioners to address the need of older adults and their families

8. Elements ofCompetency-Based Education and Evaluation (CBE)for the Field of Aging • Adoption of defined set of competencies as a framework for education • Establishment of student learning goals based on the competencies • Assessment of student skill level using the identified competencies • Integration of classroom and field curricula

9. Hartford Foundation Geriatric Nursing and Social Work Competencies :Cross-Cultural Nursing Competency Social Work Competency Diversity: Attitudes and Values Clarification Recognize one’s own and others’ attitudes, values, and expectations about aging and their impact on care of older adults and their families. Respect diversity among older adult clients, families, and Professionals (e.g., class, race, ethnicity, gender, and sexual orientation). Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, and lifestyle on how families and assistive personnel provide long-term care to older adults. Address the cultural, spiritual, and ethnic values and beliefs of older adults and families. Damron-Rodriguez,J.A. (2008).  State of the science: Developing nurse and social worker competence for professional practice with family caregivers. American Journal of Nursing & Journal of Social Work Education

10. Geriatric Nursing and Social Work Competencies : Family Caregiver Support Family Education Nursing Social Work Involve, educate, and, when appropriate, supervise family, friends, and assistive personnel in implementing best practices for older adults. Use educational strategies to provide older persons and their families with information for wellness and disease management. Interdisciplinary Teamwork Understand the perspective and values of social work in working effectively with other disciplines in geriatric interdisciplinary practice. Recognize the benefits of interdisciplinary team participation in care of older adults.

11. Competencies to Learner Outcomes Professional Competency  Educational Program  Learning Objectives  Learning Activities to Support Objectives  Assessing Competency-based Learner Outcomes

12. TYPES OF CROSS-DISCIPLINARY TEAMS II.

13. Cross-Cultural Practice

14. Distribution by Race and Ethnicity

15. Bangladesh Bhutan Cambodia China Hong Kong India Indonesia Japan Macau Laos Malaysia Maldives Mongolia Myanmar Nepal North Korea Asian Americansrefers to individuals who trace their heritage to the following countries: • Pakistan • Philippines • Singapore • South Korea • Sri Lanka • Taiwan • Thailand • Vietnam

16. PROGRAM APPROPRIATENESS Geriatric Assessment, Level of Care Continuum, Continuity, Coordination, ACCESSIBILITY Information and referral, Healthcare coverage, Location, Accommodate Disability, Intake, Hours, Translation ACCEPTABILITY Outreach, Cultural Diversity, Family Friendly Minority Elders Barriers to LTCNeedUtilization POPULATION Acute, Chronic, Disease Prevalence, Symptom Presentation, SES, Health Insurance, Immigration Status, Neighborhood, Language, Functional Level Ethnicity, Support Systems, Acculturation, STRUCTURAL CULTURAL

17. III. IOM: Redesign models of care broaden provider & patient roles to achieve greater system responsiveness • Needs must be addressed comprehensively • Services must be provided efficiently • Older persons must be active participants in their own care • Increased dissemination of more effective and efficient models is needed • Expanded roles of health care providers

18. OLDER ADULTS AT RISK IN TRANSITION • Why at risk? • Co-morbidity • Disability • Frailty • At risk for? • Incompatibility in treatments • Polypharmacy/adverse drug events • Social Isolation/similarly frail caregivers • Rapid decompensation • Re-hospitalizations, institutionalization, mortality

19. In-Home Services In-Community Services Needs/Circumstances of Clients & Family/Social Network Congregate Housing Services Institutional Services Adults are Most Vulnerable at the Transitions in Care 1997 The Advisory Board Company

20. IOM Recommendation: Care Coordination • PACE • Social HMO • Medicare Coordinated Care Demonstration • Arizona LTC System

21. Community Services Home Services Residential Services Site of Program in Community-Based Care ·Adult day health care ·Congregate meals ·Exercise program ·Information and referral ·Legal ·Money management ·Outpatient mental health ·Protective services ·Public Guardian ·Recreation ·Respite care ·Senior Center ·Support groups ·Transportation ·Emergency response system ·Home-delivered meals ·Home health care ·Home Health Aide ·Homemaker/Companion ·Telephone Reassurance Friendly Visitor ·Hospice ·Home repair ·Assisted living ·Continuing care retirement community ·Nursing Home ·Residential care (Board & Care) ·Senior Citizen Apartments ·Shared Housing

22. Medical Cognitive Affective Environment SocialSupport Functional Status Economic Spirituality IOM Recommendation: Interdisciplinary TeamsFor Geriatric Assessment and Intervention • IMPACT • GRACE

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26. IMPACT Intervention Team FlowDepression Care Specialist (PCP)=Nurse or Social Worker , Primary Care Doctor, Psychiatrist PCP Team Referral Initial visit with DCS Consult with PCP and team psychiatrist Step 1 treatment Consult with team psychiatrist -> adjust Treatment plan Reevaluation Relapse prevention

28. IOM Recommendation: Involvement of Family and Caregiver • AIM • IDEAtel • Family Health Options

30. Primary Care in the Veterans Health Administration Largest integrated health care system in the US Comprehensive electronic medical record >850 sites of Primary Care 152 Medical Centers >700 Community Based Outpatient Clinics (CBOC) 4.8 million primary care patients-each assigned to an individual primary care provider 53% in 12 million encounters/year in CBOCs

31. Patient Centered Primary Care Replaces episodic care based on illness and patient complaints with coordinated care and a long term healing relationship The Primary Care Team Takes collective responsibility for patient care Responsible for providing all the patient’s health care needs Arranges for appropriate care with other specialties as needed  Enhanced Access Enhanced communication between Patients Providers Staff Team-based Care Patient-centered Care Continuous Improvement

32. Pillars of the Medical Home

33. Patient-Centered Perspective

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35. THANK YOU FOR INVITING ME 感謝聆聽 JoAnn Damron-Rodriguez’s e-mail: jdamron@ucla.edu