Geriatric Workforce Enhancement Program Research Articles

COMMUNITY PARTNERSHIPS: A MODEL FOR LIFELONG DISABILITIES AND DEMENTIA CARE

In 2015 the Rhode Island Geriatric Education Center (RIGEC) was one of 44 organizations funded by HRSA to implement the Geriatrics Workforce Enhancement Program (GWEP). A primary objective was to develop and deliver Alzheimer’s Disease and Related Dementias (ADRD) education to patients, families, caregivers, and health professionals, with a focus on special populations. Concurrently, Seven Hills Rhode Island, a nonprofit agency that serves people with disabilities, received a grant from the Administration for Community Living (ACL) to provide education and resources to health professionals and caregivers of people with I/DD. As goals for both projects aligned closely, they worked together, fostering a strong partnership, amplifying the opportunity to offer high-quality educational programs and reach target audiences. Lessons learned from this networked approach are critical to informing sustained improvements to the I/DD and health care systems in subsequent GWEP projects.

ASSESSING AT-RISK OLDER ADULTS THROUGH THE RAPID GERIATRIC ASSESSMENT

With the need to increase gerontological competency among all health/social service professions, the Rapid Geriatric Assessment (RGA) (Morley, 2017) is a tool that can be used in most healthcare settings. Designed as a rapid screening, the validated RGA assesses frailty, sarcopenia, anorexia, cognitive function, and advance care planning. Developed in 2015 through the Geriatric Workforce Enhancement Program (GWEP), 3,489 students and 5,643 faculty and practitioners have been trained in its use and have completed 10,881 RGAs in case-finding, screening, nursing home, PACE, and hospital and residential settings. Non-population-based findings show higher-then-national prevalence in all four health condition areas across settings: frailty (n=3,140; 30%), sarcopenia (n=4,458; 42.1%), weight loss risk (n=3,012; 28.4%), and cognitive impairment (n=2,509; 23.7%). Only 34.8% of the total sample had completed advance care plans. Data comparing results by gender, age, race/ethnicity, and setting will be presented along with strategies for curricular and practice integration.

GERIATRIC WORKFORCE ENHANCEMENT PROGRAM: EDUCATIONAL OUTCOMES OF DEMENTIA CAREGIVER CONFERENCES IN RURAL UTAH

The University of Utah was awarded federal funds to establish a Geriatrics Workforce Enhancement Program (GWEP) focused on integrating geriatric training into 20 long-term care centers across the state of Utah. One specific objective of the GWEP was to: Provide community-based dementia education to 500 community participants from four geographically diverse urban and rural locations. In year four of the project, an interdisciplinary academic and community-based team planned and implemented dementia caregiver conferences in two rural areas in Utah that included American Indian (AI) tribal communities. Educational topics included an overview of dementia, engaging in goals of care discussions, managing caregiver stress, and finding local resources. Demographic surveys and pre-post modified 15-item version of the Alzheimer’s Disease Knowledge Scale (ADKS; Carpenter et al., 2009) were administered. A total of 148 participants attended the conferences. Participants were primarily female (76.6%), white (84.2%), and self-identified as family/informal caregivers (35.0%). Of the participants, 17.8% self-identified as AI. Overall, there were no significant differences on the pre- and post ADKS scores (mean scores of 12.45 and 12.5 out of 15 possible points, respectively). However, AI ADKS mean scores were lower (10.2 and 10.5, respectively; range 9-13) than white participants (12.7 for both, respectively; range 12-13) reflecting a greater need for ADRD education in AI tribal communities. The conferences were well-received with 82.5% of attendees said that the conference met their educational needs and 83.9% reported that the information would improve the type of care they provide to someone with dementia.

FLOURISHCARE: HELPING OLDER ADULTS FLOURISH IN RURAL COMMUNITIES

Flourishing represents living within an optimal range of human functioning. To foster older adults flourishing, our FlourishCare model of care coordination was developed as part of a HRSA Geriatric Workforce Enhancement Program (GWEP) to transform PC sites by delivering coordinated services in 6 rural KY counties. FlourishCare is unique in its integration of academic teams, community health teams and mental health specialists within age-friendly primary care health systems.FlourishCare recognizes that many of the largest drivers of health care costs fall outside the clinical care environment. One of the major components of Flourish is the involvement of community health navigators (CHNs), community education coordinators (CECs) and community coalitions working with the health teams to respond to the social determinants of health. For each patient that is referred and agrees to participation in the program, the CHN performs Flourish clinical and home assessments and obtains medical records. A repeated measure designed was used to assess the 60 patients who have baseline assessments results along with at least a 6-month assessment and in some cases a 12-month assessment (n= 20). Patients have demonstrated a significant increase in their flourishing across all determinants of health. There was also a significant improvement the total FI from pre to post-test at 6-month. These outcomes illustrate that it is important to operationalize the outcomes for older adults by evaluating the success as the ability of the older adult to flourish when they can maintain current functioning, access to resources have sufficient support systems in place.

AN ASSESSMENT OF GERIATRIC TTRAINING AND SUPPORT NEEDS FOR CAREGIVERS AND HEALTH CARE PROFESSIONALS IN RURAL TEXAS

Of the 254 counties in Texas, 69% are rural, and three out of every four counties are designated as whole or partial Primary Care Health Professional Shortage Areas. Rural counties in Texas have a higher proportion of older adults compared to metropolitan counties, and rural older adults with Alzheimer’s Disease and their caregivers face unique challenges of limited access to healthcare and lower earnings, resulting in more health-related problems. As part of a HRSA Geriatrics Workforce Enhancement Program, an academic medical center, two Area Agencies on Aging in North Texas, and an Alzheimer’s Association Chapter partnered to expand access to evidence-based programs into surrounding rural counties for older adults and caregivers of persons with Alzheimer’s Disease. An interdisciplinary workgroup developed focus group questionnaires for older adults, caregivers, and health care providers in rural areas to identify perceived needs, barriers to accessing services, and strategic partnerships. The North Central Texas Council of Governments conducted 11 focus groups in late 2018 and early 2019. Of these, seven consisted of family members caring for persons with memory loss. Four consisted of professionals who treat persons with memory loss. Transcription and thematic analysis identified key themes of training needs (both providers’ and laypersons’), resource needs, providers’ best practices, barriers to quality care, and other support needs. Practice implications of the findings include cross-sector partners and integrating telehealth platforms for program delivery. Collaboration between academic and community partners can expand access to evidence-based programs for rural and other underserved communities and address areas of need.

FOSTERING DEMENTIA-FRIENDLY COMMUNITIES AND SUPPORTING CAREGIVERS THROUGH THE GWEP PROGRAMS

As the number of people affected by dementia increases, it is essential that caregivers are provided resources and communities educated on how to engage and support people living with dementia. Supporting caregivers and providing education about dementia-friendly communities are key components of the Geriatric Workforce Enhancement Programs. This symposium will provide examples of GWEP projects which foster dementia-friendly communities and support caregivers. Additionally, recent and current legislation targeting dementia and caregivers will be presented.

CUSTOMIZING STAKEHOLDER ENGAGEMENT TO SUPPORT AGING IN PLACE

Geriatrics infusion and transformation of community-based settings to support “aging in place” is complex. It requires a customized approach that engages multiple stakeholders who are invested in systems redesign and process change. Rowan University School of Osteopathic Medicine’s NJ Geriatrics Workforce Enhancement Program, in partnership with an affordable housing facility operated by Fair Share Housing/Northgate II, and Rutgers University School of Nursing (RSoN), implemented a Resident Health Risk Assessment (RHRA) tool as part of an interprofessional community-based training experience for health professions students. The goal was to identify health risks that impact a resident’s ability to age in place and implement a person-centered intervention plan. Multi-level stakeholder engagement and ongoing rapid cycle quality improvement catalyzed changes in structure and process for all partners. Results included refinement of an interprofessional clinical rotation, introduction of competency attainment into the orientation process, and resource reallocation to support data collection.

STRENGTHENING A COMMUNITY HEALTHY AGING EDUCATION PROGRAM THROUGH CBO PARTNERSHIPS AND RCQI

The SHARE Network (Supporting Healthy Aging Resources & Education) is a Geriatrics Workforce Enhancement Program serving older adults in a large urban, underserved community. For 4 years, one objective of the SHARE Network has been to increase health literacy while fostering positive change in older adults through “Healthy Aging” presentations. Led by geriatrics subject experts, these presentations cover a wide range of important health topics for older adults at a variety of community-based organization (CBO) partner locations. Rapid Cycle Quality Improvement (RCQI) efforts to enhance this programming include surveying audience members after a presentation, then sharing results with CBO partners at monthly meetings to review popular topics, participant demographics, quality of presentations, suggestions for improvement, etc. These recurring RCQI meetings have proven critical to maintaining a robust healthy aging curriculum and network engagement across a variety of organizations and interests. Analysis of participant survey data demonstrates the strength of QI efforts and includes a qualitative analysis of open-ended responses. To date, 153 presentations have been held with 2,704 attendees and 1,470 respondents, 86.3% of whom planned to make a health change after attending the presentation. Qualitative analysis of these behavior change plans reveals that 82.6% are proactive behaviors versus restrictive behaviors, and that diet, exercise, and lifestyle changes are most common. This program, and its RCQI approach, serves as a successful model for aligning the educational objectives and priorities of network partners, while ensuring relevancy and cultural competency in promoting positive healthy behaviors in the older adult community.

THE RESOURCE EXCHANGE NETWORK: A MODEL FOR TRANSFORMATIVE CHANGE IN GERIATRIC CARE

Transformational efforts to redesign the care system for older adults call for the development of novel partnership models incorporating academic institutions, primary care networks, and community-based organizations. The Rhode Island Geriatric Workforce Enhancement Program (RI-GWEP) has utilized the “resource exchange model” to develop innovative, interdisciplinary, and integrated projects combining educational resources, clinical expertise, programmatic experience, and impact evaluation. With particular emphasis on the challenges of developing interprofessional education spanning the traditional gaps between disciplines and departments, this presentation emphasizes the critical conditions, components, and capacities of such a collaborative network. These include: (1) mission dominance, (2) barter exchange, (3) partnership investment, and (4) interpersonal relationships. RI-GWEP’s experience provides insights into the conceptual foundation of geriatrics networks and specific, concrete examples of projects incorporating these principles. Implications for the development of networks in other settings include consideration of particular: (1) projects, (2) people, (3) places, (4) personalities, and (5) possibilities.

FALL PREVENTION PROGRAMS FOR RURAL COMMUNITY DWELLING OLDER ADULTS RESULTS IN IMPROVED BALANCE

More than one in four older adults (OA) in the US fall each year and 20 to 30% suffer moderate to severe injuries such as head trauma or hip fractures. Falls are both a medical and financial burden that can be significantly reduced by lifestyle interventions. One of the main strategies to help reduce these statistics is evidence-based fall prevention classes which help to build muscle, improve balance, and increase participants’ confidence in fall control. A goal of the Arkansas Geriatric Workforce Enhancement Program (HRSA grant U1QHP28723) is to deliver community-based programs that improve health outcomes and quality of life. Evidence-based preventive health training is a major way to meet this goal. Two of these evidence-based trainings are Tai Chi (TC) and A Matter of Balance (AMOB), multi-week classes that help to improve balance and reduce fall risk. This study took place at scheduled community-based classes, where demographic and balance data were obtained. The aim was to determine the difference in the balance of community-dwelling OA as measured by Balance Tracking System® before and after AMOB and TC courses. Both groups showed positive changes in their mean balance percentage with the AMOB class having a higher Mean ± SD (24.3 ± 21.0) vs. the TC participants (4.0 ± 29.7). The One-Way Analysis of Variance showed statistically significant difference in the AMOB class over those in the TC class, F (1, 32) = 5.280, p < 0.05. The Cohen’s d = 0.789 indicates a large effect between the two groups.

HUBS OF INNOVATION: GWEP UTILIZATION OF TECHNOLOGY AND INNOVATION FOR TRAINING AND SERVICE DELIVERY

Technology offers powerful tools for meeting the increasing needs of older adults and caregivers. The Geriatric Workforce Enhancement Program recognizes the important role technology will play in service delivery and training by fostering innovation to meet local training and healthcare needs. This symposium will review the innovative models and strategies GWEPs are utilizing to improve care including Project ECHO, remote monitoring, and telehealth. The policy implications of these models will be presented, including current legislative action to support technology and innovation in the care of older adults.

THE DUKE INTERAGENCY CARE TEAM: A BRIDGE TO GERIATRIC COMMUNITY RESOURCES

The Duke Geriatric Workforce Enhancement Program aims to improve linkages between primary care practices (PCP’s) and community-based organizations by developing an interdisciplinary, community-based team to consult with PCPs, identifying resources to help vulnerable older adults. The Inter-agency Care Team (ICT) includes a nurse practitioner, pharmacists, community resource specialists, geriatricians and geriatrics and advanced practice nursing fellows. PCP’s refer older adults with complex care needs through the EHR for virtual consultation by the ICT. Team members review medical records and call participants and caregivers to obtain permission for the consult, gather information on function, social factors, medical problems, and their perceived needs. The ICT meets to review each case and sends written recommendations to the PCP and patient. To date, the ICT performed consultations for 73 older adults with a mean age of 76 years. 69% were female. 71% were black and 26% white. Frequently identified needs included personal/home safety (74%), medication management (64.3%), food security (63.0%), cognition (49.3%), transportation (38.4%) and advance care planning (31.5%). In the 90 days before consultation, 32.9% of patients had ED visits and 21.9% were hospitalized. In the 90 days after, 24.7% had ED visits and 13.7% were hospitalized. (Differences were not statistically significant.) ICT provided virtual consultation for complex older adults with prevalent social needs and high rates of ED visits and hospitalization. The team worked with PCP’s to connect these patients more directly to community resources. Further study is needed to know rates of adherence with recommendations and true impact on health outcomes.

FACTORS FACILITATING COLLABORATION AND ENGAGEMENT: BUILDING AND SUSTAINING STATEWIDE COALITIONS

Sustaining collaboration across multiple community-based organizations (CBOs) creates synergies and economies of scale to support age-friendly communities beyond the provision of direct services any single CBO can achieve. The Carolina Geriatrics Workforce Enhancement Program (CGWEP) created and sustained multiple statewide coalitions focused on geriatrics syndromes. More than 290 CBOs, including Area Health Education Centers, social services programs and nongovernmental organizations, meet quarterly to form linkages, promote education and build infrastructure to support rural and underserved older adults. Shared governance with pooled resources has been achieved because of a long history of partnership, mutually beneficial relationships, flexibility, and frequent communication. The strength of the partnership is evidenced by continued growth in number of CBOs, number of sponsored events, and number of referrals to CBOs. Two coalitions, focused on falls prevention and mental health respectively, have been adopted by partners and sustained beyond grant funding.

BUILDING NETWORKS TO ADDRESS AT-RISK OLDER ADULTS

With the rise of older adults and the number of chronic health issues in this population, comes the need for greater collaboration across organizations and health care settings. Age-friendly health systems offer the benefits of providing the best care possible to individuals and families, connect people to specific community resources, and optimize the best access to services and programs. The Gateway Geriatric Workforce Enhancement Program (GWEP) has combined the efforts of Saint Louis University and a rural, critical access hospital to establish a care network across Missouri. Together, this partnership has created a number of services, initiatives, and projects to help older adults maintain independence and offer families ways to take of their loved ones in more effective ways. In this symposium, presenters from Social Work, Marriage and Family Therapy, Geriatric Medicine, Psychology and Nursing disciplines will introduce several areas of this age-friendly network. The four abstracts for this symposium include: 1.) Assessing At-Risk Older Adults through the Rapid Geriatric Assessment, 2.) Cognitive Stimulation Therapy for Individuals with Memory Loss, 3.) Predictors of Falls in Older Adults Across Partner Settings, and 4.) Development of program initiatives such as the Rapid Geriatric Assessment screening, Cognitive Stimulation Therapy, Falls Assessment in Seniors, and Care for Persons with Dementia in their Environments will be covered in detail. At the end of the four presentations, the presenters will highlight the importance of this collaborative network and ways for audience members to consider building an age-friendly network in their community.

IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

The Geriatric Workforce Enhancement Program: Review of the Coordinating Center and Examples of the GWEP in Practice

The Health Resources and Services Administration created the Geriatric Workforce Enhancement Program (GWEP) in 2015 to address future geriatric workforce challenges and redefine the delivery of care to older adults. The John A. Hartford Foundation subsequently funded the GWEP Coordinating Center (GWEP-CC) to offer centralized, strategic support to these 44 diverse GWEP sites. This article outlines the last 3 years of GWEP work done at the national and local levels to transform geriatric care. Dissemination of the innovative Geriatric Interprofessional Team Transformation in Primary Care program, created by the Dartmouth GWEP, demonstrates how the GWEP-CC can benefit local initiatives and inform national perspectives. The GWEP-CC is a change agent in this way, scaling and distributing information and implementation support across the country. The GWEP-CC also serves as an essential repository of data, continuously determining what is working and what could be improved. This informs activity of the GWEP-CC, funders and other stakeholders, and provides the most up-to-date resources to GWEP sites and their partners. The GWEP-CC achieves its objectives through several key pillars: networking opportunities, education and training, advocacy, and evaluation. Although many advances have been made, opportunities to continue paving the way are plenty, especially with regards to mental health. This article discusses the work accomplished to date and presents some future considerations for mental health and overall healthcare transformation.

UPDATES FROM THE GEAR-UP PROJECT: PERFORMANCE OF MULTIDISCIPLINARY LEARNERS ON LATE LIFE DEPRESSION AND COGNITIVE IMPAIRMENT SIMULATIONS

UPDATES FROM THE GEAR-UP PROJECT: PERFORMANCE OF MULTIDISCIPLINARY LEARNERS ON LATE LIFE DEPRESSION AND COGNITIVE IMPAIRMENT SIMULATIONS

Training for In-Home Supportive Services Caregivers in an Underserved Area.

Despite the complexity of care associated with older adults who have been diagnosed with Alzheimer's disease and related dementias, many in-home paid caregivers receive little to no training in competent care for these older adults. The In-Home Supportive Services program in California provides care for elderly, blind, and disabled people with the goal of ensuring the care recipients may remain safely in their own homes. Yet, these caregivers are not required to receive training in any specific disease or condition prior to providing caregiving services. A Geriatrics Workforce Enhancement Program and the Riverside County Department of Social Services jointly developed and implemented three different interactive, community-based, knowledge and skills-based training courses for IHSS caregivers. Analysis of pre/post course evaluations across all three courses demonstrated statistically significant gains in knowledge and self-rated skills among the participants.

IMPLEMENTING A NURSE RUN ANNUAL WELLNESS VISIT

The Medicare Annual Wellness Visit (AWV) is a free service offered to Medicare Part B beneficiaries annually to promote preventive care and reduce unnecessary utilization of health care services. The Centers for Medicare Services allows registered nurses to conduct the AWV and generate similar revenue to when a physician conducts the visit. Through the Northern New England Geriatric Workforce Enhancement Program (GWEP), we engaged twelve practices to implement the AWV as a nurse run visit. By implementing the nurse run AWV, a practice could increase utilization of AWV, increase employee and patient satisfaction, and increase revenue. One site was able to increase billing (non-facility price) by 212% and Relative Value Units (RVU) by 190% by implementing the Nurse Run AWV.

Dr. Smith Goes to Washington: Society Members Unite Legislators With Issues Aimed at Improving Care

Dr. Smith Goes to Washington: Society Members Unite Legislators With Issues Aimed at Improving Care