Volume 2, Issue 5
June 30, 2006

In This Issue

1. New Grants Awarded by Hartford Trustees (June 2006)
2. Wall Street Journal Features Hospital at Home
3. New Social Work Certification in Aging from NASW
4. Eleven Beeson Scholars Chosen for 2006 Cohort
5. Twenty-five Nursing Scholars Selected
6. 2006 Social Work Scholars and Fellows Announced
7. Two Elected to Hartford Board of Trustees
8. Communications Tip: Storytelling for Greater Impact

1. The trustees of the JAHF recently approved the following ten grants.

Paul B. Beeson Career Development Awards in Aging Research Partnership
American Federation for Aging Research (AFAR), Inc.
New York, NY
Odette van der Willik
$7,232,192 Seven Years

Summary

The John A. Hartford Foundation will support the career development of 30 leaders in the field of aging science in conjunction with the National Institute on Aging through a grant to the American Federation for Aging Research for the prestigious Beeson fellowship program.  The highly competitive program provides funding for research, advanced training, mentoring, and networking opportunities for medical school junior faculty.  Since 1994, the Hartford Foundation, in collaboration with other funders, has supported 115 Beeson scholars with $28.2 million contributed to the $60 million program.

Additional Information

The Beeson award provides protected time to limit clinical and administrative responsibilities and allows the scholars to develop expansive, scientifically important research agendas on topics such as the biology of aging, maintenance of health and independence in old age, diseases and disabilities of old age, and systems of care for the elderly.  With the help of national research mentors and by participating in annual scientific and networking meetings, Beeson Scholars are primed to be researchers, teachers, and leaders in research and medical education.

In the next few decades, the number of older adults will double and it is imperative that the nation has the ability to provide high quality medical care and that new scientific knowledge is developed relevant to aging and clinical care. However, medical schools nationwide have less than one-fourth the number of academic physician-scientists presently needed to train current and future doctors in the principles of geriatrics.  The Beeson program identifies academic leaders and provides funds at the most vulnerable stage of their career development to cross that critical juncture to mid-career, independent faculty status.

Current funding partners for the program include the National Institute on Aging, The Atlantic Philanthropies, and The Starr Foundation, among others.

Centers of Excellence (CoEs) in Geriatric Medicine and Training Renewal Grants
$4,500,000 Five Years

Duke University 
Raleigh Durham, NC
Harvey Cohen, MD
$750,000, five years 

Harvard/Beth Israel Deaconess Medical Center
Boston, MA
Lewis A. Lipsitz, MD
$750,000, five years 

Mount Sinai Medical Center 
New York, NY
Roseanne M. Leipzig, MD, PhD
$750,000, five years

University of California, Los Angeles 
Los Angeles, CA
David B. Reuben, MD
$749,717, five years

University of California, San Francisco 
San Francisco, CA
C. Seth Landefeld, MD
$750,000, five years 

University of Michigan
Ann Arbor, MI
Jeffrey B. Halter, MD
$750,000, five years

Summary

The John A. Hartford Foundation renewed grants for five centers of excellence in geriatric medicine and training at Duke University, Harvard/ Beth Israel Deaconess Medical Center, Mount Sinai Medical Center, University of California at Los Angeles, University of California at San Francisco and University of Michigan to continue their efforts to increase the number of physician faculty dedicated to geriatrics. This funding will support the training of at least 100 advanced fellows to prepare them for careers in aging research and teaching geriatric medicine.

Additional Information

Funding to the centers of excellence supports the recruitment and development of larger numbers of future faculty in geriatrics more rapidly than would otherwise be possible and is used variously for direct salary support, pilot research, developing service venues for research, tuition or other additional training expenses, or hiring necessary research support personnel.  In addition to attracting and retaining academic geriatricians, the centers of excellence contribute greatly to the growth and dissemination of knowledge about geriatric medicine to other physicians and the larger medical community. Since 1987, the John A. Hartford Foundation has helped address this problem by awarding $25.1 million to create 24 centers of excellence in geriatric medicine and training.

Current projections suggest that by 2020 the nation should triple its production of faculty in geriatric medicine to adequately train the physicians needed to care for a rapidly growing aging population, yet most fellowship programs in geriatric medicine produce physicians who go into practice, rather than research or training. The infrastructure to create and sustain faculty members in geriatric medicine, or to attract faculty from other areas of medicine, is small and under resourced relative to the need. Additionally, federal funding is not available for second, third, or fourth years of advanced training when physicians complete substantive research projects, further develop a research or medical education niche, expand their curriculum vitae or prepare manuscripts for publication - all important steps in an academic career.  The centers of excellence provide opportunities and financial support for this critical time.

The six Centers of Excellence receiving renewal funding have been operating since 1997 and have received $6.5 million in prior grant awards.  The Centers of Excellence fall within the John A. Hartford Foundation’s overall support of advanced training in geriatrics, to which the foundation has awarded $36.4 million since 1987.

The Nurse as Supervisor of Direct-Care Staff
Paraprofessional Healthcare Institute
Bronx, New York
Sara Joffe, MEd
$2,350,000 Four Years

Summary

The John A. Hartford Foundation, in partnership with Atlantic Philanthropies, has awarded a grant to the Paraprofessional Healthcare Institute to test and then disseminate a model program in 42 agencies where nurses who oversee paraprofessional staff are trained to be better supervisors to reduce home health aide turnover. Annual turnover rates among home health aides range from 50 to 300 percent, having a major negative impact on the quality of care for elderly patients.

Additional Information

The Paraprofessional Healthcare Institute, a national, non-profit organization focused on increasing the quality of care provided to older and disabled patients, will use funding to expand its staff capacity and teaching tools in order to rigorously test a previously designed nurse coaching model in an expanded range of sites. The project will formalize a curriculum on nurse coaching, create tools to help agency managers implement supervision training, implement management training at home health care agencies, evaluate the results of the program and develop partnerships with three nursing schools for dissemination of effective outcomes.

High turnover rates among home health aides force elderly and disabled consumers to endure a constant churn of strangers who provide care that is at best rushed and impersonal, and at worst isolating, disorienting, and at times even dangerous.  The cycle of instability related to high turnover and its impact on the care of homebound elders will only worsen if left unaddressed as the population ages and more people choose to remain living at home.  To keep the current workforce engaged and to attract other potential workers to the field, systemic changes need to be implemented, and one potential fulcrum to achieve better care for elderly patients is to enhance nurses’ supervisory abilities.

The funded project is part of the Hartford Foundation’s grantmaking to support a limited number of efforts to improve and integrate the “system” of services needed by older adults.  Since 1982, Hartford Foundation Trustees have authorized $71 million in model development projects such as this to integrate and improve health services for the elderly.

Preventing Medication Errors: Evidence-Based Medications Management Intervention
Partners in Care Foundation, Inc.
San Fernando, CA
June Simmons, CEO
$1,699,845 Four Years

Summary

The John A. Hartford Foundation has awarded a grant to the Partners in Care Foundation to test and demonstrate the feasibility of an evidence-based medications management program targeting frail and poor older adults who live in their own homes and receive services from Medicaid waiver care managers. Poor, elderly patients face a high risk of dangerous medications errors, which are usually simple to identify and correct.  This project builds on the work of a prior $1.2 million grant and subsequent dissemination of a medications review model for home patients with private insurance coverage. 

Additional Information

The Partners in Care Foundation will use funding to conduct a formal study in eight home care agencies in three states using Medicaid waiver care managers to conduct in-home medications reviews with elderly patients.  Utilizing a newly developed software program and data that will be reviewed by a consulting pharmacist, the review will target high-risk problems such as drug duplication, cardiovascular medication problems, and inappropriate use of mood altering drugs.  In the final year of the grant, up to 15 home care agencies will participate in an online workshop to deliver the materials and technical assistance needed to disseminate the program widely.

Adults aged 70 and older take more medications than any other group but the likelihood of medication-related problems increases as the medicines potentially interact with each other or as an aging body metabolizes drugs more slowly than expected.  For patients choosing to receive care in their own home, there is no coordinated system for reviewing drug regimens. A recent report found that nearly one-fifth of the 32 million older Americans living at home used potentially inappropriate prescription drugs and nearly 1 million older adults used medications that should always be avoided because of their side effects, costing an estimated $85 billion annually in extra medical care while worsening or creating health problems.

The Partners in Care Foundation is a non-profit, charitable organization that increases access to home-health care for at-risk populations.  Since 2001, Hartford Funding has enabled Partners in Care to disseminate medical management practices to ultimately decrease dangerous medication errors among older patients.

Health Care Workforce Consensus Report for an Aging Society
Institute of Medicine of the National Academies
Washington, DC
Harvey Fineberg, MD, PhD
$400,000 Two Years

Summary

The John A. Hartford Foundation, in partnership with other foundations, has funded an Institute of Medicine report to review the current state of knowledge about geriatrics health care workforce preparation and create a “blueprint” for geriatric care in the 21st century.  In six years, the first of 75 million baby-boomers will reach age 65 yet there has been little comprehensive planning to develop and deploy the health professions workforce to provide high quality care to this burgeoning population. 

Additional Information

Funding for the Institute of Medicine report will be used to develop a national consensus study and report to characterize the optimal health care workforce for an aging America and will be disseminated to a broad audience.  Consistent with a well developed consensus report process, the Institute of Medicine will impanel an ad hoc committee of 15 national experts from a variety of related fields. Their analysis will focus on the optimal deployment of human resources (both professional and non-professional), the best ways to train and retain those health care personnel in care of older persons, and the ways in which government health and education programs can provide incentives to promote the delivery of high quality care to the full health spectrum of the elderly American population. 

In the absence of major changes in health care delivery and workforce preparation, the rapidly growing older population’s health care needs and costs of meeting those needs will precipitate a major national crisis. The basic structure of health care delivery has not changed in over a century, Medicare remains structurally the same since its inception despite changes in patient needs and system capacity, and the geriatric work force is insufficient due to payment inadequacies and insufficient incentives for pursuing geriatric training.  This combines to form a bleak projection for the future of health care for the elderly.

A nonprofit organization specifically created to provide science-based advice on matters of biomedical science, medicine, and health, the Institute of Medicine was chartered in 1970 as a component of the National Academy of Sciences.  The highly respected, non-partisan Institute provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy makers, professionals, leaders in every sector of society, and the public at large.  Since the 1980’s, The John A. Hartford Foundation has been committed to increasing the nation’s capacity to provide effective, affordable health care to America’s older population and views this report from such a highly regarded source as critical to addressing the future challenges of providing quality healthcare for the elderly.

2. Wall Street Journal Features Hospital at Home

The John A. Hartford Foundation-supported Hospital at Home project, led by principal investigator Bruce Leff, MD, at Johns Hopkins University, received front page coverage in the national edition of The Wall Street Journal on April 19, 2006. The story provides a comprehensive look at this innovative “get well at home program,” as the Journal called it, which provides professional, high quality acute care for older adults, and was created and tested with $5.9 million in grants from the Hartford Foundation. Hospital at Home features multiple daily nursing visits, 24/7 availability of doctors, and needed tests like EKGs, X-rays, IVs, or oxygen therapy provided by healthcare professionals at home. A recent study published by Leff and colleagues in the Annals of Internal Medicine found Hospital at Home to be a viable, patient-centered, cost-effective alternative to traditional, hospital-based acute care.

To link to the complete story, “House Calls: Portland Hospital Gives Acutely Ill a Homecare Option,” and find other resources on this program, please visit: www.jhartfound.org/wsj.htm.

The Foundation has also prepared a four-page brief on implementing Hospital at Home, which is available at www.jhartfound.org/ideas/hospitalathome.

3. New Social Work Certification in Aging from NASW

The National Association of Social Workers (NASW) has created three new specialty credentials to increase credibility for social workers in the aging practice area. The credentials address specific areas of knowledge and skill, including assessment of older adults’ needs and functional capability, expertise regarding physical and mental health issues, case and care management, long term care, elder abuse, quality of life issues, and advance care planning. The new aging credentials are:

The creation of these credentials is in line with the Hartford Foundation’s funding for initiatives aimed at increasing the number and capacity of social workers to address the needs of older adults. It also addresses the findings in NASW’s Center for Workforce Studies recent report indicating a rising demand for social workers who specialize in aging practice.

4. Eleven Beeson Scholars Chosen for 2006 Cohort

The Paul B. Beeson Career Development Awards in Aging Research Program has named eleven 2006-2009 recipients. This highly competitive award is granted to up to 12 physician-faculty scholars each year who are laying clinically relevant groundwork in many areas related to aging, including the biology of aging, age-related diseases, and health services and clinical management issues—all with the aim of enhancing the health and quality of life of older adults. With the additional support of the National Institute on Aging (NIA), recipients receive $600,000 to $800,000 for a three- to five-year period.

The 2006-2009 Beeson Scholars are:

Katrin Chua, MD, PhD, Assistant Professor, Stanford University
Regulation of Cellular Senescence and Proliferative Capacity by Mammalian SIRT1

Margaret Fang, MD, MPH, Assistant Adjunct Professor, University of California, San Francisco
Risks of Warfarin for Elders with Atril Fibrillation

Alex Federman, MD, MPH, Assistant Professor, Mount Sinai School of Medicine
Health Insurance Navigators for the Low-Income Elderly

Emily Finlayson, MD, Assistant Professor, University of Michigan
Functional Outcomes After Major Surgery in Nursing Home Residents

Stacy Fischer, MD, Assistant Professor, University of Colorado Health Science Center
Improving Care at the End of Life for Latinos: A Cultural Navigator Intervention

Alfred Fisher, MD, PhD, Assistant Professor, University of Pittsburgh
Dopamine, Tyrosine, and their Metabolites in Aging in Neurodegenerative Disease

Sean Leng, MD, PhD, Assistant Professor, Johns Hopkins University
Vaccine-Induced Immunity against Influenza in Frailty

Ann O'Hare, MD, Assistant Adjunct Professor, University of California, San Francisco
Targeting Nephrology Referral Among Elderly Patients with Chronic Kidney Disease

Caterina Rosano, MD, MPH, Assistant Professor, University of Pittsburgh
Novel Brain Neuroimaging Markers of Age-Related Mobility Impairment

Manish Shah, MD, Assistant Professor, University of Rochester
Screening and Interventions in an Acute Care Setting

Consuelo Wilkins, MD, Assistant Professor, Washington University
Vitamin D in Older Adults: Cognition, Mood and Hippocampal Volume.

5. Twenty-five Nursing Scholars Selected

The Hartford-supported Building Academic Geriatric Nursing Capacity (BAGNC) Scholar Awards Program recently selected a new cohort of pre-doctoral Scholars and post-doctoral Fellows. Beginning this year, BAGNC post-doctoral Fellows will be known as the Claire M. Fagin Fellows, in honor of this outstanding nurse leader, original director of the BAGNC, and Dean and Professor Emerita of the University of Pennsylvania School of Nursing. Scholars each receive up to $100,000 over two years to subsidize their studies. Fellows are awarded up to $120,000 over two years to support research in the field of geriatric nursing. The winners were chosen through a rigorous national competition.

The 2006 Scholars and Fagin Fellows join 106 BAGNC colleagues selected since the program began in 2000. To date, the Hartford Foundation has invested more than $15 million in scholarships for nurses through this program.

The 2006 Pre-doctoral Scholars are:

Lynda Arevalo, MSN, RN,University of Texas Health Science Center at San Antonio
Latino Alzheimer's caregivers perception of caregiver burden

Mary Black, MS, RN, University of Minnesota
Depressive symptoms among Native American caregivers of individuals with Alzheimer's or dementia

Tom Blodgett, RN, BSN, University of Iowa
Leading nurse practice change: Effectiveness of nurse-driven protocol for removal of indwelling urinary catheters in hospitalized older adults

Abraham Brody, RN, University of California, San Francisco
How do palliative care and hospice care models effect the quality of pain and symptom management at the end of life in the long-term care setting?

Lisette Bunting-Perry, MScN, University of Pennsylvania
Pain in older adults with Parkinson's disease

Bill Buron, MSN, RNC, APN, University of Arkansas for Medical Sciences
An individualized intervention (designed) to promote personhood among residents living with dementia in the long-term care setting

Elizabeth Caley, RN, BSN, BA, Oregon Health & Science University
Health policies that promote self-care management and health promotion

Judy Campbell, MSN, ARNP, University of Georgia
Change in behaviors in persons with dementia and caregiver appraisals of behaviors when 'CareWatch' system is utilized

Carol Delville, MSN, RN, CNS-AH, CCRN, University of Texas at Austin
Changes resulting from emotional representation of symptoms in adults with heart failure

Carol Enderlin, MNSc, RN, University of Arkansas for Medical Sciences
Restless leg syndrome, sleep, and fatigue in geriatric patients with multiple myeloma

Marcena Gabrielson, RN, MSN, University of Iowa
Long-term care, caregiving, and end-of-life care issues in the older adult gay and lesbian population

Katherine Hostvedt, RN, MSN, University of Pennsylvania
Critical analysis of nursing home management styles and identification of management strategies aimed at producing constructive work cultures

Carol Kemp, BSN, RN, BC, Oregon Health & Science University
Integrative therapies in the management of chronic pain among older adults

Mary Kay McKown, RN, MS, FNP, University of California, San Francisco
The possibility of a "meaningful death": What it means to homebound elders, their caregivers, and nurses

Charlene Ono, APRN-Rx, University of Hawaii, Manoa
Quality of dying: The lived experience

Kathryn Sexson, MS, RN, FNP, ARNP-BC, Oregon Health & Science University
Ethical issues surrounding elders in transition: Perspectives of the elder, family caregiver, and healthcare provider

Rebecca Trotta, MSN, RN, University of Pennsylvania
Improved nursing home care through palliative care

Janet Van Cleave, MSN, AOCN, ACNP-CS, Yale University
Exploration of symptoms and functional status in older adults during cancer treatment


The 2006 Claire M. Fagin Fellows are:

Wan Chen, PhD, RN, University of California, San Francisco
Age and ethnicity effects on symptom experiences of acute myocardial infarction

Nancy Chu, PhD, APRN, BC, University of Oklahoma
Health needs of Vietnamese-American elders

Deborah D'Avolio, PhD, ACNP, ANP, University of Pennsylvania
Factors influencing utilization of the emergency department by inner city older adults

Ann Mayo, RN, DNSc, University of California, San Francisco
Decision-making among older adults with mild cognitive impairment

Suzanne Prevost, RN, PhD, University of Arkansas for Medical Sciences
Improving end-of-life care in long-term care facilities

Hilaire Thompson, PhD, APRN, BC, CNRN, University of Washington
Improving outcomes following traumatic brain injury in hospitalized older adults

Lan Yao, PhD, University of Pennsylvania
Effects of a positive emotion-charged Tai Chi home training program on elders with Alzheimer's disease and their caregivers

The BAGNC is part of the Hartford Geriatric Nursing Initiative (HGNI), a multi-faceted investment aimed at enhancing the care of older adults through innovations in nursing practice, education, research, leadership, and policy. In 2005, the Atlantic Philanthropies joined with Hartford to provide generous support to the BAGNC program and increase funding for post-doctoral fellowships. A third partner, The Mayday Fund, contributes additional monies for those Scholars and Fellows whose research focuses on the study of pain in the elderly.

6. 2006 Social Work Scholars and Fellows Announced

The Gerontological Society of America selected 12 geriatric social work faculty members for the Hartford Faculty Scholars Program, six students for Hartford Doctoral Fellowship program, and 20 students for the Hartford Doctoral Fellows Pre-Dissertation Award program.

The Hartford Faculty Scholars are provided with opportunities for professional development and $100,000 in funding over the next two years. Now in its seventh year, the award aims to improve the well-being of older adults by increasing the number of adequately trained geriatric social workers.

The 2006 Faculty Scholars and the primary topics of their research are:

Kathryn Betts Adams, PhD, Case Western Reserve University
Sub-threshold depression among older adults in congregate housing: Characterization and screening

Harriet L. Cohen, PhD, Texas Christian University
Narratives of forgiveness among older Holocaust survivors

Joy Swanson Ernst, PhD, Hood College
Risk and protective factors for caregiver neglect of older adults: a study of adult protective services case records

Denise Gammonley, PhD, University of Central Florida
Nursing home psychosocial care for older adults with a history of mental health treatment

Daniel S. Gardner, PhD, New York University
An explanatory evaluation of a psychoeducational multi-family group for older adults with advanced cancer and their family caregivers

Marie Liston, PhD, Rutgers University
Meeting the needs of older veterans through the VA System: Voices of users of outpatient health care services

Crystal Dea Moore, PhD, Skidmore College
Health care communication and decision making: The caregiver's role in supporting older patients

Anissa Taun Rogers, PhD, University of Portland
Health disparities among older Latinos: Examining relationships between sociocultural factors, health literacy, and health behaviors

Marie Savundranayagam, PhD, University of Wisconsin-Milwaukee
The impact of psychoeducational programs on spouse caregivers of persons with dementia: Pilot testing an evaluation framework

Fengyan Tang, PhD, University of Pittsburgh
The longitudinal effects of elder service programs on older volunteers' health: The role of individual experience and institutional factors

Cheryl Waites, EdD, North Carolina State University
Promising health promotion strategies and interventions: SW practice with racial and ethnic elders

Bradley Zodikoff, PhD, Adelphi University
Providers' perceptions of barriers to geriatric mental health care

Hartford Doctoral Fellowship recipients will each receive a $50,000 dissertation grant plus $20,000 in matching support from their home institutions, which will enable them to more fully concentrate on their dissertation research projects over the next two years.

Members of the first cohort of the 2006 Hartford Doctoral Fellowship are:

Amy Cohen-Callow
University of Maryland, Baltimore

Bryan K. Ford
University of Alabama

Kathryn G. Kietzman
University of California, Los Angeles

Frances Mills
University of South Carolina

Duy D. Nguyen
Columbia University

Frances E. Wilby
University of Utah

The Hartford Doctoral Fellows Pre-Dissertation Award provides recipients with opportunities for successful careers in gerontological social work. Each receives stipends to attend both GSA's November 2006 Annual Scientific Meeting in Dallas and The Society for Social Work and Research (SSWR) January 2007 Annual Meeting in San Francisco. There recipients will attend workshops designed to develop their research skills.
Applications for the second round of 2006 Doctoral Fellows are due August 1, 2006.

7. Two Elected to Hartford Board of Trustees

John H. Allen and Barbara Paul Robinson were elected to the Board of Trustees of the John A. Hartford Foundation in June.

Mr. Allen is President of International Advisor Services, which works with early stage companies in the field of micro and nanotechnology. From 1989 to 2003, Mr. Allen was Executive Vice President of Finance and Operations of Dent & Company Incorporated and previously worked in investment banking at Bankers Trust and Bank of America. Mr. Allen received a BA in Economics and Latin American Studies at Princeton University, an MBA from Harvard University, and has also studied at the Johns Hopkins School of Advanced International Studies and the Fundacao Getulio Vargas in Rio de Janeiro. Mr. Allen currently focuses his non-profit efforts on SOS Children's Villages, a world wide network of 450 villages housing more than 45,000 orphaned, destitute or troubled children and youth each year.

Ms. Robinson is a partner at Debevoise & Plimpton and served as head of the Trusts and Estates Department. A graduate of Bryn Mawr College and Yale Law School, she serves on a number of nonprofit and foundation boards, including the Foundation for Child Development, Catalyst, Bryn Mawr College, Wave Hill, and the Teagle Foundation. She is a former president of the Association of the Bar of the City of New York and currently a member of the Mayor's Commission on Women's Issues in New York City.

8. Communication Tip: Storytelling for Greater Impact

Many researchers struggle with the task of conveying large amounts of important data to a lay audience. One creative way of doing this is through storytelling. Storytelling, using real stories about people or situations, provides a reader- or audience-friendly format that gets a point across. For example, a story about how Mrs. Thomas’ life changed as a result of your breakthrough treatment may have just as great an impact on your audience, particularly a lay audience, as a welter of jargon and statistics. Many times, the subjects of your real life stories may be willing to speak about your research and provide testimonials, which add further interest for your audience. There are several resources available on the Web that provide guidance on using stories to communicate your message, including www.nancyschwartz.com and www.agoodmanonline.com.

Copyright 2004 The John A. Hartford Foundation