scholarly journals INTEGRATING SOCIAL NEEDS CARE INTO THE DELIVERY OF HEALTH CARE TO IMPROVE THE NATION’S HEALTH FOR OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S496-S497
Author(s):  
Tamara J Cadet ◽  
Robyn Golden ◽  
Keegan Warren-Clem
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Outcomes ◽  
Social Workers ◽  
Delivery Of Health Care ◽  
Social Needs ◽  
Determinants Of Health ◽  
Care Providers ◽  
Community Based ◽  
Term Care

Abstract An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine examined the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes and to address major challenges facing the U.S. health care system. These challenges, include persisting disparities in health outcomes among vulnerable subpopulations, often defined by a number of factors including age. Presenters will discuss and provide recommendations in the following areas: 1. evidence of impact of social needs care on patient and caregiver/family health and wellbeing, patient activation, health care utilization, cost savings, and patient and provider satisfaction; 2. opportunities and barriers to expanding historical roles and leadership of social workers in providing health-related social needs care and evidence-based care models that incorporate social workers and/or other social needs care providers in interprofessional care teams across the care continuum (e.g., acute, ambulatory, community-based, long-term care, hospice care, public health, care planning) and in delivery system reform efforts (e.g., enhancing prevention and functional status, care management, and transitional care; improving end-of-life care; integration of behavioral, mental, and physical health services); and 3. realized and potential contributions of social needs care to make health care delivery systems more community based, person- and family/caregiver-centered, and responsive to social and structural determinants of health, particularly for vulnerable populations and communities, such as older adults and low-income families. Examples for each of the three areas will also be presented.

scholarly journals MEETING SOCIAL NEEDS TO IMPROVE HEALTH OUTCOMES: PARTNERSHIPS BETWEEN COMMUNITY-BASED ORGS AND HEALTH CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S499-S500
Author(s):  
Traci L Wilson ◽  
Suzanne R Kunkel ◽  
Jane Straker ◽  
Marisa Scala-Foley ◽  
Elizabeth Blair
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Social Services ◽  
Health Care Providers ◽  
Health Care Use ◽  
Social Needs ◽  
Care Providers ◽  
Community Based ◽  
Cross Sectional ◽  
Improve Health

Abstract Unmet social needs negatively affect individual and population health, and better integration of community-based supports and health systems is a promising approach to improve health outcomes and avoid unnecessary health care use. Community-based organizations (CBOs) such as Area Agencies on Aging (AAAs) and Centers for Independent Living (CILs), as providers and coordinators of social services, are well-positioned within their communities to coordinate care and provide for unmet social needs. Partnerships between CBOs and health care entities have clear potential to improve health care outcomes while also reducing expenditures. This paper will present a cross-sectional analysis of a national survey of AAAs, CILS, and other CBOs at two time points (2017: n=593; 2018: n=763) to understand the extent, type, and evolution of CBO engagement with health care providers. In addition, longitudinal analysis (n=374) shows movement at the organization level: 33% of organizations who did not have a contract at T1 but were pursuing one had achieved a contract by T2. This presentation will: describe details of the services delivered, contracting arrangements, and populations served under CBO/health care contracts, as well as challenges experienced by CBOs; examine differences by state and organizational structure; and discuss the implications of state policy on integrated care and contracting.

scholarly journals Evidence for the Effectiveness of Health and Social Services Partnerships

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 225-226
Author(s):  
Traci Wilson ◽  
Suzanne Kunkel ◽  
Amanda Brewster ◽  
Jane Straker ◽  
Elizabeth Blair ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Outcomes ◽  
Social Services ◽  
Independent Living ◽  
Social Needs ◽  
Care Utilization ◽  
Community Based ◽  
Health And Social Services ◽  
Community Based Organizations

Abstract Integration of health and social services is touted as a key method to address social needs and improve population health. We will share the latest evidence on how Area Agency on Aging (AAA) partnerships with health care entities and other organizations improve health outcomes for older adults, while reducing health care costs. AAAs are community leaders in cross-sectoral partnerships that effectively address social determinants of health for older adults, who account for a substantial share of overall health care spending. Results of a longitudinal study (2008 – 2016) which links data from four waves of the National Surveys of AAAs to data on county-level health outcomes show that AAA–health care partnerships and programs reduced health care utilization and costs. AAA partnerships with hospitals reduced Medicare spending by $136 per beneficiary. AAA involvement in evidence-based health promotion programs decreased potentially avoidable nursing home use by nearly one percentage point (representing a change of 6.5%). Finally, we will describe the prevalence and nature of contracting relationships between community-based organizations and health care entities, based on data from the 2020 CBOs and Health Care Contracting Request for Information, the third national RFI of AAAs, Centers for Independent Living, and other aging and disability community-based organizations.

scholarly journals Impacting Quadruple Aim Through Sustainable Clinical-Community Partnerships: Best Practices From a Community-Based Organization Perspective

2020 ◽  
Vol 14 (5) ◽  
pp. 524-531
Author(s):  
Marc Rosen
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Financial Risk ◽  
Community Setting ◽  
Community Partnerships ◽  
Social Needs ◽  
Care Providers ◽  
Community Based ◽  
Community Based Organizations ◽  
Payment Models

Health reform initiatives have caused disruptive change throughout the US health care system. A key driver of change is the adoption of alternative payment models that apply financial risk on physicians and hospital systems. Success in these value-based payment models requires health care provider and payor organizations to continue developing population-based approaches, including partnerships with community-based organizations that provide services within a community setting. Community-based organizations are positioned to serve as an extension of the care continuum because they provide desired access points to upstream services that address nonclinical factors. Yet many health care providers fail to enter into sustainable contracts with community organizations. This limits their ability to treat patients’ social needs and widens the clinic-to-community gap, both of which must be addressed for success in value-based contracts. Future cross-sector collaboration will require stakeholders to abandon transactional partnership arrangements primarily concerned with referral systems in favor of transformational arrangements that better align partnership aims and more equally distribute ownership in solving for capacity building, evaluation, and sustainability. The following practices are based on the experience of local YMCAs and YMCA of the USA in establishing clinic-to-community partnerships throughout the country that can influence clinical cost and quality measures.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 705-705
Author(s):  
Yuchi Young ◽  
Ye-Mei Chen ◽  
Kuo-Piao Chung ◽  
Patrick Schumacher ◽  
Hsiu-Hsi Chen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Healthy Aging ◽  
International Comparisons ◽  
Holistic Health ◽  
Social Needs ◽  
Care Providers ◽  
Term Care ◽  
Healthcare Settings ◽  
Assessment Plans

Abstract The concept of person-centered health care (PCHC) shifts from the individual’s diagnosis to the holistic health and individual social needs. PCHC is defined by WHO as “empowering people to take charge of their own health rather than being passive recipients of services.” This care strategy is based on the belief that if an individual is an equal partner in care planning and care decision making process, and that his/her view, input, and experiences can help improve overall health outcomes. PCHC requires a reconfiguration of the health care system. A vertical or/and horizontal integration of a variety of healthcare settings is necessary. A proposed 5-year PCHC pilot study in Taiwan’s Changhua county aims to reduce unnecessary hospitalizations by 15% in 4 years. Year one will focus on alignment of health care providers, baseline data collection, and assessment plans development. PCHC intervention will start in years two to five. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.

scholarly journals ‘The Open Typology’: Towards Socially Sustainable Architectural and Care Types

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Davide Landi
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Open System ◽  
Care Delivery ◽  
Well Being ◽  
Care Providers ◽  
Contemporary Culture ◽  
Term Care ◽  
High Dependency

One aspect that characterises the twenty-first century is its accomplishments such as better health-care systems, improved economies, a reduction in infant mortality and a growing number of adults living longer. However, these accomplishments can have a downside. For example, people are living longer while at the same time dementia rates are increasing significantly. With the increase in demand for high-dependency-related services, while at the same time costs are spiralling possibly out of control of societal budgets, there is a need for a shift in the care model. Additionally, difficulties in defining a clear dividing line between normal ageing and pathological ageing have led to a stigmatisation of older adults as a social and economic burden. This type of segregation and stigmatisation must be addressed to ensure future care delivery is inclusive. The positive benefits of an inclusive care system are both social and economic, and at an individual level it can positively impact upon an older adult’s mental and physical well-being. Taking this into consideration, the aim of this paper is to describe and empirically explore Humanitas© in Deventer, the Netherlands, a nursing home with a population of 50 older adults with dementia, 80 people with severe physical suffering, 20 people with social difficulties, 10 people in short stay for recovery and 6 university students. This analysis will be adopted as a ‘tool’ for the definition of a new way of conceiving architectural types in contemporary culture, based on the concept of an ‘open system’ described by Richard Sennett. In this study, an open system is able to promote a new paradigm of care built upon inclusive collaboration and teamwork between different categories of health-care providers, volunteers, residents and their families. This will allow an alternative paradigm of older adults’ long-term care and its architectural correlate to ‘normalise’ ageing and its related mental and physical impairments, rather than to ‘medicalise’ and stigmatise.

scholarly journals PALLIATIVE AND END-OF-LIFE CARE TO THE LGBT COMMUNITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S623-S623
Author(s):  
Gary L Stein ◽  
Cathy Berkman
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Providers ◽  
Term Care ◽  
The Us ◽  
Lgbt Community ◽  
And Gender

Abstract The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care – across cultures and countries. Health care providers may fail to recognize, acknowledge or address disparities in care. Providers and institutions may be uncomfortable with gender and sexuality issues, and often fail to inquire about sexual orientation and gender identity. It is estimated that there are approximately 2.7 million LGBT adults in the U.S. age 50 and older and approximately 1.1 million age 65 and older. In the UK, an estimated 5-7% of the population identify as LGBT; there are between 600,000 and 840,000 LGBT adults aged 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even greater numbers of LGBT older adults, and their families, will require palliative and end-of-life in the coming years. Researchers in the US and UK have found that LGBT older adults living in the community and in long-term care facilities experience inadequate, disrespectful, and abusive care due to their sexual orientation and gender identity status. They fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. This symposium will describe the experiences of LGBT individuals and their family members, and compare commonalities and differences faced by LGBT communities in the US and UK in accessing palliative and end-of-life care.

Health and Psychosocial Needs of Older Adults Who Are Experiencing Homelessness Following Hospital Discharge

2019 ◽  
Vol 60 (4) ◽  
pp. 715-724 ◽  
Author(s):  
Sarah L Canham ◽  
Karen Custodio ◽  
Celine Mauboules ◽  
Chloe Good ◽  
Harvey Bosma
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Hospital Discharge ◽  
Health Care Providers ◽  
Social Needs ◽  
Care Providers ◽  
Psychosocial Needs ◽  
Structured Interviews ◽  
Common Location ◽  
Housing Options

Abstract Introduction Though hospitals are a common location where older adults experiencing homelessness receive health care, an understanding of the types of supports needed upon hospital discharge is limited. We examined the unique characteristics of older homeless adults and the health and psychosocial supports required upon hospital discharge. Design and Methods Guided by principles of community-based participatory research (CBPR), we conducted 20 in-depth, semi-structured interviews with shelter/housing and health care providers in Metro Vancouver. Results Thematic analyses revealed 6 themes: (a) older people experiencing homelessness have unique vulnerabilities upon hospital discharge; (b) following hospital discharge, general population shelters are inappropriate for older adults; (c) shelter/housing options for older adults who have complex health and social needs are limited; (d) shelter/housing for older adults who require medical stabilization and convalescence after hospital discharge is needed; (e) a range of senior-specific shelter/housing options are needed; and (f) unique community supports are needed for older adults upon hospital discharge. Discussion and Implications As the population of older adults increases across North America, there is a parallel trend in the increased numbers of older adults who are experiencing homelessness. Not only is there often a need for ongoing medical care and respite, but there is a need for both shelter and housing options that can appropriately support individual needs.

Improving the ascertainment of refugee-background people in health datasets and health services

2018 ◽  
Vol 42 (2) ◽  
pp. 130 ◽  
Author(s):  
Jane Yelland ◽  
Elisha Riggs ◽  
Josef Szwarc ◽  
Dannielle Vanpraag ◽  
Wendy Dawson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Outcomes ◽  
Delivery Of Health Care ◽  
Clinical Encounter ◽  
Service Planning ◽  
Poor Health ◽  
Care Providers ◽  
Childhood Health ◽  
Early Childhood Health

Ascertainment of vulnerable populations in health datasets is critical to monitoring disparities in health outcomes, enables service planning and guides the delivery of health care. There is emerging evidence that people of refugee backgrounds in Australia experience poor health outcomes and barriers to accessing services, yet a clear picture of these disparities is limited by what is routinely collected in health datasets. There are challenges to improving the accuracy of ascertainment of refugee background, with sensitivities for both consumers and providers about the way questions are asked. Initial testing of four data items in maternity and early childhood health services (maternal country of birth, year of arrival in Australia, requirement for an interpreter and women’s preferred language) suggests that these are straightforward items to collect and acceptable to service administrators, care providers and to women. In addition to the four data items, a set of questions has been developed as a guide for clinicians to use in consultations. These new approaches to ascertainment of refugee background are essential for addressing the risk of poor health outcomes for those who are forced to leave their countries of origin because of persecution and violence. What is known about the topic? Relatively little attention has been given to identifying refugee-background populations in health datasets and health services. What does the paper add? Four routinely collected data items will provide an indication of refugee background to better understand health disparities and guide service planning and the delivery of health care. What are the implications for practice? The data items, together with a set of questions for practitioners to use in the clinical encounter, are essentials to the provision of culturally competent health care.

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