Raising a Healthcare Workforce in NC to Care for People and - - PowerPoint PPT Presentation

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Raising a Healthcare Workforce in NC to Care for People and - - PowerPoint PPT Presentation

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Raising a Healthcare Workforce in NC to Care for People and Families with Serious Illness Mitchell T. Heflin, MD, MHS Duke Geriatrics April 12, 2019 Duke GWEP https://geriatrichub.nursing.duke.edu/ Overview Needs Who has serious

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Raising a Healthcare Workforce in NC to Care for People and Families with Serious Illness

Mitchell T. Heflin, MD, MHS Duke Geriatrics April 12, 2019

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Overview

  • Needs

– Who has serious illness and who cares for them? – What are the quantitative and qualitative gaps in workforce preparation?

  • Opportunities

– New roles – Resources & funding – Current models

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Aging Population in North Carolina

Reddy S, NC State Aging Profile, December 2017.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Older adults in NC: Health

  • 81% with at least 1 chronic condition; 51% have 2 or

more

  • 160,000 with Alzheimer’s disease
  • 22% report difficulty with mobility

– 29% had at least one fall; 16 % with two or more

  • High rates of poverty, limited education, isolation
  • Average life expectancy at age 65 is 20 years

Reddy S, NC State Aging Profile, December 2017.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Serious Illness in NC: Other populations

  • End stage renal disease
  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Cancer (as a chronic disease?)
  • Neurologic conditions: spinal cord, brain injury, stroke,

dementia

  • Children with medical complexity (CMC) (D. Ming, MD)

– 1% of children; 33% of pediatric health spending – Technological needs and caregiver burden

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Workforce drivers

  • Demand

– Medically and technologically complex care – Care increasingly in ambulatory and community environments – Family caregiver needs

  • Supply

– Newly graduated professionals unlikely to meet demands – Concentrated in large centers in more urban areas – Limited resources for retraining individuals and teams

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NC Community Health Worker Report, May 2018.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

https://nchealthworkforce.unc.edu/

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Duke GWEP https://geriatrichub.nursing.duke.edu/

https://nchealthworkforce.unc.edu/

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Duke GWEP https://geriatrichub.nursing.duke.edu/

https://nchealthworkforce.unc.edu/

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Duke GWEP https://geriatrichub.nursing.duke.edu/

https://nchealthworkforce.unc.edu/

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Workforce Needs in NC

  • Increase health professions serving rural areas
  • Enhance/incent training in ambulatory, long term

care, and community settings

  • Recruit and train a more diverse workforce to reflect

the population served

Erin Fraher, PhD, MPP. Presentation on Program on Health Workforce Research and Policy, March 2, 2018

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Workforce Needs in NC: Curriculum

  • Management of multiple chronic conditions and

medications—ie medical complexity

  • Diagnostic and therapeutic technologies
  • Geriatrics and palliative care
  • Information access and exchange
  • Communication and coordination
  • Community engagement
  • Teamwork
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Duke GWEP https://geriatrichub.nursing.duke.edu/

Interprofessional teams

  • Increased competence in IP collaborative practice
  • Team members functioning at “top of scope of practice”

– E.g. Licensing and supervision of NPs

  • Greater flexibility/variability of roles within and between

professions

  • New roles requiring retraining and new credentials
  • Educators skilled at training in team-based care

– Teaching across professions

  • Clinical practice sites with high functioning teams

Interprofessional Education Collaborative. (2016). Washington, DC.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Interprofessional Education to Enhance Learner Outcomes Interdependent with Collaborative Practice to Enhance Patient Outcomes

Educational Systems

(Accreditation– Institutional Structures)

Professional Systems

(Regulatory and Payment)

Health Professions Learner Outcomes Institutional factors

Leadership- Resources Administrative Processes

Teaching factors

Learning Content Faculty Development

Learner

Organizational factors

Governance Structuring Clinical Care

Interactional factors

Shared Goals Vision Sense of Belonging

Patient Provider & Org. Outcomes

Learner

Educators Educators Educators Educators

Modified from D’Amour & Oandasan, 2005, J. of Interprofessional Care Supplement 1, 8-20

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Changing definitions of workforce

  • Value-based, person-centered care
  • Evolving roles:

– Care coordination

  • Navigators, care managers, case managers, transition specialists

– Practice facilitators

  • Workflow redesign and change managers

– Population-based approaches

  • Population health nurses

– “Boundary spanning” roles

  • Assessing and addressing social drivers of health

– Health information technologists

Fraher E, Ricketts T. NCMJ, 2016.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Evolving role of nursing

  • Care management experts

– Billable services through TCM and CCM

  • Population health specialists

– Health information specialists

  • Health educators

– Group/Centering clinics

  • Practice and system leaders
  • Barriers: Reimbursement, Licensing

Fraher E, Spetz J, LDI Interdisciplinary Nursing Quality Research Initiative, 2015.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Expanded definitions of workforce

  • Advanced Direct Care Worker: (www.eldercareworkforce.org )

– Increased demand for homecare for disabled and dying – DCW as extension of care team – Enhanced training

  • Monitoring for and communicating changes in condition
  • Support adherence to medication, nutrition, activity
  • Disease specific: CHF, Diabetes, Dementia

– Questions regarding supervision and financing

EWA Issue Brief, September 2014.

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Expanded definitions of workforce

  • Community Health Workers: (https://files.nc.gov/ncdhhs/DHHS-CWH-

Report_Web%205-21-18.pdf)

– “Boundary spanning” role with community connection – Focus on social connector function– “last 5 feet” – NC DHHS CHW Initiative final report May 2018 – Roles, curriculum, certification

  • Family Caregivers: (www.eldercareworkforce.org )

– Nearly 18 million in US; one third > 65 years old – 50 % employed with $250B in lost wages – Do “heroic amounts of work daily just to tread water” (D. Ming) – Need training, resources, respite and voice as team member

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Resources/Networks

  • Academic health centers and Community-based

training programs

  • Area Health Education Centers
  • Community Colleges
  • Office of Rural Health
  • Area Agencies on Aging
  • NC Medical Society
  • Other….
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Duke GWEP https://geriatrichub.nursing.duke.edu/

Funding

  • Limited funding for education
  • Debt driven decisions
  • Health Resources and Services Administration (HRSA)
  • Insurers, ACO’s, Health systems
  • Medicare/Medicaid
  • Accountable Care Communities

– http://nciom.org/task-force-on-accountable-care- communities/

  • Low or no tuition/loan repayment
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Duke GWEP https://geriatrichub.nursing.duke.edu/

Summary

  • Future healthcare workforce needs to account for

value-based care

  • Shift focus to rural areas and community-based sites
  • Emphasize team-based care and flexible roles
  • Expand direct care and community health worker

programs

  • Include family caregivers as team members
  • Engage government, health systems, and insurers in

training redesign and finance

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Duke GWEP https://geriatrichub.nursing.duke.edu/

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Duke GWEP https://geriatrichub.nursing.duke.edu/

Geriatric Workforce Enhancement Programs (GWEP)

Establish centers to develop a healthcare workforce that maximizes patient and family engagement and improves health outcomes for

  • lder adults by integrating geriatrics with

primary care.

  • 44 nationwide
  • 3 in North Carolina—including UNC and ECU
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Duke GWEP https://geriatrichub.nursing.duke.edu/

Improved care

  • f older adults

Duke Geriatric Resource Team (GRT) Training Program

Communication: IPCP training workshop Competencies: Upfront training for frontline staff and nurses Monthly webinars, online resources Continuous Improvement: Focused projects Connections: Referrals to ICT, community agencies