Healthy Aging from a Local Perspective for L.A. County Seniors

1. June Simmons, CEO Directors Knowledge Fair 8/14/2008 Healthy Aging from a Local Perspective for L.A. County Seniors

2. The Strategic Environment – challenges and opportunities U.S. health care system is in crisis Failings of system are profound and widely acknowledged Pressure is building for transformation

3. High Costs and Poor Outcomes Spend twice any other developed country Ranked 37th in world on health outcomes 40 million uninsured Little prevention/lots of expensive late care Growing role for community and family caregiving and self-care

4. 80% of Health Dollars Spent on Chronic Conditions 31% of Americans are obese Adults are not physically active (28-34% aged 65-74; 35-44% aged 75+) Rates of obesity in children (16-33%) Type II diabetes skyrocketing – 40% increase in ’90s. 6.9% of Americans; 20% among 65+ Ethnic health disparities dramatic

5. The Scope of the Problem • 1.7 million Americans die of a chronic disease each year • Chronic diseases affect the quality of life of 90 million • 87% of persons aged 65 and over have at least one chronic condition; 67% have 2 or more • 99% of Medicare spending is on behalf of beneficiaries with at least one chronic condition.

6. What is a chronic disease? • Arthritis • Chronic lung disease • Diabetes • Heart condition • Cardiovascular disease • Chronic pain • Depression • Cancer • Stroke • Any ongoing health condition Four chronic conditions cause 2/3 of all deaths a year. Heart Disease, Cancer, Stroke and Diabetes

7. Ethnic Health Disparities: Diabetes Among Hispanics Admissions for uncontrolled diabetes without complications per 100,000 population, age 65 and over, by ethnicity, 2004 2006 National Healthcare Disparities Report

8. 40% of Deaths in U.S. Due to Modifiable Risk Factors • Smoking was king • Obesity and lack of physical activity • Chronic conditions result: • Diabetes • Respiratory conditions • Cardiovascular • Arthritis • Cancer

9. Source: Stephen A. Schroeder, MD. We Can Do Better. NEJM 357:12

10. Need to work with whole person, family and community Facing complex and fragmented system Need to integrate personal care and medical care Interdisciplinary team needed Fundamental re-design is required – in large, complex system

11. Building a “Health” system • Healthcare must change • The Aging Network must seize the opportunity to partner with primary care • Josefina Carbonnal has provided the great vision – converting aging services to health-building and health empowerment resources • We have the opportunity to lead

12. The Expanded Chronic Care Model: Integrating Population Health Promotion 

13. New Models of Care are Needed • Reallocation of existing dollars from care to prevention and promoting health • Strengthen community and home care – reduce use of institutions • Reduce fragmentation – increase integration to address chronic diseases

14. Changing American Culture • We are in the service of a great vision • Mainstreaming access to powerful tools for health • Building a platform for better quality of life • Less pain • Less illness • Greater mobility and better function • This is a MISSION, not a PROJECT

15. California Evidence-Based Initiative 2006 • California Departments of Aging and Health awarded 3-year grant from Administration on Aging • Initiative brings evidence- based programming to age-based organizations • Partners in Care is the state program office, California Health Innovation Center

16. Evidence-Based Programs Evidence Based Model Promising Practice Best Practice • Are supported by extensive research and have been proven to work • Clear, detailed description of the program • Have measurable outcomes • Easier to market the program and engage valuable partners • Increases effective use of resources to enhance programming • Increases funding opportunities

17. AoA Evidence-Based Programs • Matter of Balance: Managing Concerns about Falls • Healthier Living: Managing Ongoing Health Conditions • Healthy Moves for Aging Well • Medication Management Improvement System (MMIS)

18. AoA Evidence-Based Programs • Matter of Balance: Managing Concerns about Falls • Healthier Living: Managing Ongoing Health Conditions • Healthy Moves for Aging Well • Medication Management Improvement System (MMIS)

19. Matter of Balance: Managing Concerns about Falls • Designed to reduce fear of falling and increase activity levels of seniors with fall concerns • Consists of eight 2 hour classes led by 2 volunteers • Participants learn: • To view falls and fear of falling as controllable • To set realistic goals for increasing activity • To change environment to reduce fall risk factors • To promote exercise to increase strength & balance

20. A Matter of Balance: Managing Concerns About Falls What Happens During Classes? • Group discussion • Problem-solving • Skill building • Assertiveness training • Exercise training • Videotapes • Sharing practical solutions

21. Participants include anyone who: • is concerned about falls • is interested in improving flexibility, balance and strength • is age 55 or older, ambulatory and able to problem-solve

22. California Evidence-Based Programs • **Healthier Living: Managing Ongoing Health Conditions • Matter of Balance: Managing Concerns about Falls • Healthy Moves for Aging Well • Medication Management Improvement System

23. Healthier Living:Managing Ongoing Health Conditions • Self-management program designed to help people manage chronic illnesses • Consists of six 2½ hour sessions led by 2 leaders • Highly scripted • Groups are small (10-20 people)

24. Target Population • Have at least 1 chronic condition • Diverse seniors in underserved communities • Must have stamina to attend 2 ½ hour class, plus travel time • Must have cognitive function to participate • Must transfer independently or have caregiver to assist

25. Goals of a Self-Management Program • Participant learns how to identify problems • Participant learns how to act on problems • Participant learns problem-solving skills related to chronic conditions • Participant learns how to generate short-term action plans

26. Workshop Overview • Managing symptoms • Dealing with difficult emotions (frustration, anger, pain) • Personalizing a fitness and exercise program • Relaxation techniques • Tips for eating well • Medication "how to's" • Improving communications (family, friends, doctors) • Effective problem-solving • Setting weekly goals

27. Materials- Multiple Language Leader’s Manual • English • Spanish • Chinese • Japanese • Korean • Bengali • Dutch • German Participant Workbook • English • Spanish • Chinese • Japanese • Korean • Hindi • Italian • Norwegian • Somali • Turkish • Vietnamese • Welsh • Arabic Relaxation CD • English • Spanish • Chinese

28. Program Benefits Improvements in Health Status • Decrease in pain • Decrease in depression • Decrease in fatigue • Decrease in shortness of breath • Decrease in health distress • Improvement in role function • Improved quality of life • Greater self-empowerment!!

29. Program Benefits Reductions in Health Care Utilization • Fewer visits to physicians • Fewer emergency department visits • Fewer hospitalizations • Fewer days in hospital

30. Going to Scale • This is challenging work – needs to: • Reach large numbers of people • Maintain fidelity • Be sustainable/cost-effective and consumer-engaging

31. California Collaborative Models • Need partners that can: • Identify & connect participants – e.g. physicians • Provide quality, sustainable platform, e.g. community college adult education • Sponsors and sites, e.g. health plans, senior centers

32. Target Sectors For ADOPTION/ENGAGEMENT

33. Seize the Opportunity • A time of potential transformation • Must rise to the occasion • Going to scale is key • This will take more time than we planned • Need commitment at all levels • It is well worth the journey

34. Questions?? Greg Bailey Program Coordinator Partners in Care gbailey@picf.org 818-837-3775 ext 161

35. GREEN “HANDOUTS” • PLEASE GO TO THE PARTNERS IN CARE WEBSITE TO DOWNLOAD THIS PRESENTATION • WWW.PICF.ORG • Click on Presentations