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| <back Long Term Care Advances Quarterly Topics in Research, Training, Service & Policy Vol. 10, No. 1, Fall 1998 Duke University Center for the Study of Aging and Human Development Long Term Care Resources Program Box 2920, DUMC, Durham, NC 27710 (919) 660-7542 The Leadership in an Aging Society Program in 1998: Interdisciplinary, Intergenerataional, Interinstitutional Kathryn Downer, Ed.D. Issue Editor
The Leadership in an Aging Society Program in 1998 Overall, the Leadership in an Aging Society Program during its first six years has served 81 interns and 8 senior leaders with another 28 young researchers receiving career development awards. The past eighteen months have been particularly significant in the evolution of the Leadership Program. Highlights include an exceptional pool of student applicants participating in a diverse range of internship opportunities; increased sources of financial support for students; and a successful new Senior Leadership Program. High Caliber Applicant Pool Characteristics of the 1998 pool of student applicants included 46% Duke Students, 50% belonging to at least one college level honor society, and 21% members of Phi Beta Kappa. Of graduate student applicants, 62% graduated with honors, half of those, summa cum laude. Their interests in aging were evidenced not only by course work completed, but also by volunteer work (in hospitals; Alzheimer's research labs; adult day care programs; retirement homes and communities; and councils on aging) and leadership indicators (student board member for the Association of Gerontology in Higher Education; state level gerontological student award; and participation in leadership programs sponsored by their universities). Increased Diversity in Student Internship Experience. Internship experiences encompassed a wide range of issue exploration including investigation of dimensions of psycho/socio/spiritual aging in relation to coping with chronic disease; analysis of research methodologies and related impact to data validity and reliability; the analysis and development of policy. Internship experiences were also geographically diverse with placements in North Carolina, Maine, the United Kingdom and the Washington D.C. area.
Positive Reception to the Senior Leadership Enhancement Initiative In March of 1997, the Leadership in an Aging Society Program announced the first group of participants in the Senior Leadership Enhancement Initiative. The initiative is designed to assist older adults with emerging leadership potential, to enhance their leadership skills to work more effectively within an aging society. Pilot Year Senior Leader Outcomes. The first group of participants has demonstrably made an impact on their communities and at the state and, in one instance, the national level. One Senior Leader, Bob White, has been the catalyst for the submission of two successful grant proposals which secured funds to organize volunteers to serve the frail elderly in his county. He has also been tireless in his work to develop cooperative relationships between the community, a local college, and university on aging issues resulting in a successful bid for a state level conference; the 1999 Summer Symposium on Aging to be hosted in Fayetteville, N.C. July 21st - 23rd, 1999. Another Senior Leader, Pat Capehart, has become a leader in the state on the issue of recruiting and retaining an adequate frontline workforce to care for frail older adults, including organizing focus and workgroups at the local level, with a special emphasis on "listening" to the issues raised by workers and employers. A third Senior Leader, Sarah Wray, has received recognition for her work in organizing volunteers to help older adults live independently. Four of the eight Senior Leaders are delegates to North Carolina's Senior Tar Heel Legislature, including the current speaker of that assembly, Ben Douglas.
The Interns On November 5, a Leadership Convocation was held to recognize the contributions of the Leadership Mentors, Interns and Glaxo Wellcome Awardees. Susan Goldenson, MPP, research associate at the Urban Institute's Health Policy Center in Washington, D.C., was the Convocation Speaker. The vignettes that follow highlight the experiences of the 1998 Leadership Program interns. Heather K. Altman, Graduate Student, Public Health/Health Behavior Education UNC - Chapel Hill Mentor: Brenda Porter The Setting: Alamance ElderCare The Experience: My internship was with Alamance ElderCare, a non-profit organization dedicated to providing a range of services to seniors in Alamance County, North Carolina. The primary purpose of my internship was to work with Alamance ElderCare and the Community Careways team, an interdisciplinary team of health professionals and community members, to develop a program to address the complex needs associated with seniors' access to medications. In designing this program, the Community Careways team decided to embark on an innovative process called "critical pathways." Critical pathways have historically been used by hospitals and home care companies to manage care for their patients. Critical pathways outlines a set of services, a "roadmap" of care, that should be provided to ensure coordinated and efficient care. The Community Careways team decided to design their own roadmap but this time based on need, not diagnosis, and based in the community, not the hospital. My primary activities involved assisting in the various stages of the planning process: specifically understanding the barriers that seniors face in appropriately accessing their medications; identifying existing local resources that address these barriers; and creating a description of how services can best be provided to seniors. One of my major projects included creating resource guides that detail the services that local agencies and pharmacies provide for seniors in regards to medication access. In addition, I helped to develop a training program for Alamance ElderCare volunteers that will expand the number of clients that can be served utilizing pharmaceutical companies' drug assistance programs. Lastly, I co-wrote an article with my mentor, Brenda Porter, Alamance ElderCare's Program Director, that describes the work of the community Careways team. The article was published in "Senior Advantage," a newsletter that is distributed to over 4,500 Seniors in Alamance County,as well as on the Internet, on Duke Long Term Care Resources Program's web-site. During my internship I developed an in-depth understanding of a variety of issues affecting seniors and their caregivers, especially in relation to medication access. In addition, I gained insight and experience in the complexities of coordinating a team of individuals that have come together for a common goal. This internship experience deepened my commitment to establishing a career in the aging and long-term care field. Cory K. Chen, Undergraduate Student Psychology/Public Policy, Duke University Mentor: George L.. Maddox, Ph.D. The Setting: Forest at Duke Continuing Care Retirement Community; Oxford University, UK, and Rochester, NY. The Experience: Phase I: May 25 - June 25, 1998, The Forest at Duke - Durham, NC (observed operations of a CCRC including their Special Care Unit for individuals with dementia; Mentor: Leslie Jarema) Phase II: July 4 - August 15, 1998, Oxford University - Oxford, UK (spoke to various people about long-term care in the United Kingdom; Mentors: Sir John Grimley Evans, Jacqui Mansfield) Phase III: August 17 - August 27, 1998, Monroe County - Rochester, NY (looked at the broader spectrum of care available for individuals with dementia; Mentors: Emily J. Hawley, Carter Williams) [Ed. Note: Cory Chen did an iterative internship across several sites in the United States and the United Kingdom with Dr. George Maddox as his overall mentor. His statement includes reflections on the needs of older adults with Alzheimer's disease and the programs that serve them which was the central theme of his internship.] The facilities that had the most success with individuals who have dementia were those whose staff really knew the residents whom they worked with. In the United Kingdom one facility, before admitting an individual into their home, would send the staff member who was to be in charge of that individual's care on a visit to that individual's home. The rationale being that it's a chance to see how it is that that individual lives, what they do for leisure, the type of art they like, the music they enjoy. Getting to know the individual with dementia is the key to successfully caring for them by gaining insight that will help us understand the actions and concerns of that individual. I believe that the key to caring for this population in the future is variety and flexibility. Some of these individuals may do better in a special care unit specifically designed for an individual with dementia, others may do better in a mainstreamed setting. Further development of the household system used in the Fairport Baptist Home in Rochester, NY, may provide the variety necessary to successfully care for this population. The household system divides a nursing facility into a number of different "households" (in the case of the Fairport Baptist Home, there were 20 house-holds within the facility). Each household consists of between nine to twelve residents and two to three staff members. Each household is, in a sense, an independent unit with doors separating it from the other households and often a small hallway between. With such a set-up a facility could potentially have a number of different combinations of residents, therapy programs used, and the "style" of each household could be varied. An individual with Alzheimer's could try out a number of households until they found the one that worked best for them. As we continue to grow older and at the same time live longer, the future of care for individuals with dementia becomes increasingly important. I hope to contribute in the effort to find the best ways of caring for those affected by dementia. I plan on continuing my studies in psychology, hopefully pursuing a graduate degree in clinical psychology in the hopes of better understanding how best to provide effective therapy to an individual with dementia. I would also like to pursue my studies in health policy so that ultimately I might be able to bring my clinical experiences to policy design. Katherine Fiori, Undergraduate Student Developmental Psychology/Human Development Duke University Mentor: Deborah Gold, Ph.D. The Setting: Duke Center for Aging and Human Development The Experience: My internship was a bounded independent research project. My mentor, Dr. Deborah T. Gold, is a Duke University Associate Research Professor in the Department of Psychology and Behavioral Sciences. She helped guide me as I explored the area of spirituality, aging and chronic illness. The end product of my research was an annotated bibliography on this fascinating topic. I learned how religion and spirituality can act as coping resources for the elderly suffering from chronic illnesses. The sick elderly must deal with the pain of disease, the functional disabilities involved with disease, loss of roles and social support, and the imminence of death. In terms of overall well-being for this elderly population, the psychosocial benefits of religious involvement and spiritual support may far outweigh the physical benefits of modern medical procedures. As gerontologists urge the medical field to focus on adding life to years rather than adding years to life, research in areas such as religion and spirituality is becoming more and more pertinent to the lives of the sick elderly. Thus, studying the relationship between spirituality and coping with chronic disease has become an important task for researchers today. My compassion for the elderly suffering from chronic illnesses and my understanding for spirituality as a coping resource has been enhanced not only by my direct contact with an "Elder Neighbor" (whom I first met through the volunteer portion of a class I took with Dr. Gold), but also through my research concerning the benefits of spirituality and religion among the elderly. I found my internship very interesting, and my experience has confirmed my goals to continue studying human development with a focus on aging. Patricia Gessner, Graduate Student City Planning, UNC - Chapel Hill Mentor: Peter Skillern The Setting: Durham Affordable Housing Coalition The Experience: I spent the summer as an intern for the Durham Affordable Housing Coalition. My primary responsibility was surveying new multi-family housing complexes for compliance with the handicap accessibility requirements of the Fair Housing Amendments Act of 1988. The availability of accessible housing will make it easier for people with physical disabilities to live independently in any apartments or condominium complexes built after 1991. The demand for accessible housing will increase in the coming years as the baby boomers age and begin to experience age-related impairments. The survey results and my analysis have been delivered to the City of Durham's Department of Human Relations. The Human Relations Commission is the local entity that has the power to enforce Fair Housing laws and require building owners to correct any existing violations. As an additional result of my project, handicap accessibility information was added to the Coalition's affordable housing guide. One final aspect of my position this summer was to work with members of an outside task force that is reviewing and updating the housing strategies of Keeping in Step, a 1991 document that examined the services available to older residents and their caregivers in Durham County. My work with this group will continue through my internship during the coming school year. My experience this summer introduced me to some of the more specialized areas of housing and housing needs. I have learned a great deal about the needs and requirements of special populations and some of the legal steps that have been taken to address these issues. My survey also revealed a need for advocacy to ensure that housing laws are being enforced.
Kathleen Hill, Graduate Student Health Behavior & Education, UNC at Chapel Hill Mentor: David Moser The Setting: Triangle J Area Agency on Aging The Experience: My project consisted of evaluating contributing factors and developing an intervention that would result in increased involvement on the part of the Community Advisory Committee members who work with the Triangle J Regional Ombudsmen. In addition to this particular project, I shadowed Sharon Wilder and Jill Al-Hafez, both Region J Ombudsmen, in their work as advocates for residents of long-term care and their families. I participated in several trainings for both general staff and for certified nursing assistants. In order to explain other aspects of advocacy, I also sat in on legislative committee meetings of the Friends of Residents in Long Term Care, working with Marlene Chasson, Executive Director. I learned of the increasing need for advocacy on behalf of the elderly and of the politics of the long-term care field, in particular, the impact that the industry itself wields politically. Strong, vocal, organized leadership is needed to speak for those who cannot, or will not speak for themselves. The internship has helped me to solidify my future plans regarding my strong interest in policy analysis and development, and its impact on the individual. Jacob Laubach, Undergraduate Student Medicine/Public Policy, Duke University School of Medicine and Sanford Institute Mentor: Larry Branch, Ph.D. The Setting: Duke Center for Aging and Human Development/National Center for Health Promotion and Disease Prevention The Experience: I was assigned two projects during the ten-week internship. As part of the first project, I worked with data from a randomized telephone survey performed in Massachusetts in 1995 and 1996. The data concerned prostate cancer screening and treatment practices among men over 50. I was asked to complete a report on the results of the study for the Massachusetts Department of Public Health. The report included back-round information on prostate cancer screening obtained through literature review, a summary of the methods used in our study, a presentation of the results of our analysis, and a discussion of the significance of the study. The second project was performed as a report for the Centers for Disease Control and Prevention. It also focused upon prostate cancer screening and treatment practices among men over age 50. The CDC wanted an answer to the following question: Can a telephone survey method be used instead of medical record review at individual medical sites to obtain annual information about prostate cancer screening and treatment? This technique is much cheaper and less invasive than either face to face surveys or medical record review at the offices of medical providers. However, to be effective the telephone survey method must be accurate as well. It involved 432 individuals from the Commonwealth of Massachusetts who completed the prostate cancer questionnaire and also consented to a review of their medical records. Using SAS software, I created a data set that allowed us to compare information from these individuals' medical records with that obtained through telephone administration of the prostate cancer questionnaire. I know that I have benefited tremendously from my work under Dr. Branch at the National Center for Health Promotion. It has given me an opportunity to apply many of the skills learned during the one year of study at the Sanford Institute of Public Policy, most notably statistical analysis and analytic writing. The internship gave me a chance to work closely with individuals who specialize in the fields of survey research and health policy analysis. It gave me new insights into ways that my future work as a physician may be combined with work as a researcher in the field of health policy. Finally, the internship demonstrated to me how quantitative, analytic research can be used to address the challenging questions and problems raised by an aging society. Susan Lee, Undergraduate Student Biological Anthropology & Anatomy/Music Duke University Mentor: Paul Lee, M.D. The Setting: Duke Eye Center The Experience: I have been examining the impact of visual impairment on the physical fitness of the elderly with Dr. Paul Lee at the Duke Eye Center. In order to zero in on the problematic areas and to determine possible approaches for the research, many studies and statistics on the greater elderly population were reviewed. This research generally hypothesized that the visually impaired elderly is at a higher risk of facing adverse physical alteration (i.e. under-/overweight) than the general non- visually impaired elderly population. The degree of physical change is measured through the Body Mass Index (BMI) using an age-modified BMI table. An ophthalmology clinician/research investigator, Dr. De La Paz at the Duke Eye Center, has been collecting the necessary data for BMI calculation among the age- related macular degeneration (ARMD) patients and showed an interest in the study. Thus, the initial data for 150 cases have been entered and calculated, and we are currently waiting for the statistical analysis results. This research project will be continued through the fall semester. A small research grant for student researchers from the Eye Center may also be available for us to conduct this research during that time. The research internship I was fortunate enough to participate in truly exposed me not only to the problems in the aging society in general, but also more importantly, to how to approach problems and to break ground for change-translating intention into reality. Dr. Lee has been a wonderful and enthusiastic guide and supporter for my research topic. As I worked with Dr. Lee this summer, I realized how a comprehensive strategic view of leadership is needed at this point in time. Our present crisis in the care of the elderly clearly calls out for leadership at every level of society and in all organizations that compose it. I am quite excited and challenged by the issues concerning the elderly ophthalmic patients that I came to know closely this summer. My experience this summer reaffirmed my interest in pursuing medicine and clinical research in the field of ophthalmology. Patrick Liedtka, Graduate Student Public Administration/Social Work UNC at Chapel Hill Mentor: Christina Jacob The Setting: Orange County Dept. of Aging The Experience: I will have the good fortune to build upon what I started, by continuing with the Orange County Department on Aging (DOA) in my role as volunteer coordinator for the Friend to Friend in-home assistance program. The goal of the program is to match volunteers with older adults in Orange County who have non-medical care needs. Volunteers will spend a minimum of four hours a month with frail, disabled, or isolated elders, and will act as companions, provide help with grocery shopping, read mail, and transport participants to medical appointments, among other activities. The idea for the program arose when my mentor Christina Jacob with the DOA, sought a solution to the growing waiting list for Orange County's in-home services. My summer was spent researching similar assistance programs throughout the state, examining liability issues, writing a policies and procedures manual, developing promotional materials, and devising a training session. Though less satisfying than seeing the program in action, this has afforded me the opportunity to learn from creative professionals in aging who are engaged in crafting local solutions to meet the needs of their communities. In addition to developing this program, I did case management work with a small number of clients, which involved: completing assessments of their home situation; connecting them to appropriate local services; and bringing resources into their homes to help them maintain their independence. I will spend Mondays and Wednesdays through April 1999 working with the Orange County DOA while finishing my dual MPA/MSW degrees at UNC. My primary goals are to train and place at least 25 volunteers, and to secure the continuity of the program, either through writing a grant or influencing the county to make Friend to Friend a permanent piece of Orange County's aging services. I want to thank the people of the Long Term Care Resources Program for supporting my work. This summer's valuable experiences confirm for me that leading community programs for the aging is where I belong. Alexa Murray, Graduate Student Gerontological Studies; Miami University of Ohio Mentor: Kathryn Magruder, Ph.D. The Setting: National Institute of Mental Health, Division of Services and Intervention Research The Experience: Because of my ongoing interest in the field of psychology and aging, I have tried to tailor my undergraduate and graduate curriculum so that I would learn as much as possible about the current status of mental health research and services for older adults. Interning at the National Institute of Mental Health (NIMH) was the logical choice as a master's practicum placement for me, especially since I desire to someday work for an institution or agency that conducts intramural and/or extramural research in geriatric mental health. The tasks I completed at NIMH are quite congruent with my personal desire to work as a researcher or in a research-related profession (such as a grant specialist) within the mental health and aging arena. During my ten week stay at NIMH, I did the following: learned about the grant management process and witnessed grant review procedures; edited grant summary statements; wrote a report on future research directions in psychology and aging; evaluated abstracts for a September conference on the economics of mental health; conducted divisional interviews; performed extensive literature searches on services pertaining to both adults and children; and attended numerous meetings and conferences. The actual value of these meetings and conferences should not be underestimated, for they opened my eyes to the multi-faceted nature of geriatric mental health. For example, I was made aware of the emerging field known as developmental epidemiology and the study of comorbidity; I was exposed to models of treatment for older patients in the primary care setting; I was introduced to the powerful influence of inter-organizational collaboration on service planning across the aging network and mental health system; and lastly, I learned about the structure and role of NIMH as a research institution. Overall, my internship experience was highly informative and truly fascinating. It was a great opportunity to meet premier researchers and clinicians and to learn about important mental health issues, especially in the context of aging. The fact that I was able to interact with distinguished psychologists, physicians, economists, statisticians, and educators, etc., exposed me to the numerous and highly complex dimensions of mental illness and service delivery. More specifically, the services research focus on comorbidity and mental health care in the primary care sector made me more aware of how complex designing and implementing services can be, especially in regards to mentally ill individuals at the opposite ends of the aging spectrum -- i.e. the very young and the very old. Additionally, the mere fact that I was in the Washington D.C. area opened up a broad spectrum of opportunity for me in and of itself NIMH's size, mission, prominence, and large constituency created an atmosphere in which meeting people from varying backgrounds, disciplines, and affiliations was the norm. In essence, NIMH granted me the flexibility to actively shape my internship in accordance with my professional needs and desires; consequently, I was able to take the initiative and play a role in a diverse range of tasks and activities. Interning at NIMH was truly a "global" experience I would not have had any place else. Kim Mooney Murray, Graduate Student Public Policy/Management, Muskie School University of Southern Maine Mentor: Elise Bolda, Ph.D. The Setting: Muskie School of Public Service The Experience: My work during the summer involved behavior problems in older adults, specifically how these problems can best be measured and factored into the determination of eligibility for Medicaid-funded skilled nursing level of care. My two major tasks involved a literature review of behavior problems and analysis of 739 individuals with behavior problems, assessed for long-term care services in 1997 with the state's uniform assessment form. (The data analysis, which is ongoing, provided the opportunity to become more familiar with SAS software, statistical tools, and research methodologies.) The study I have been involved with over the past three months addresses how best to identify people with behavior problems. We are evaluating the utility of a behavior screen currently implemented to measure behavior, using existing literature on problem behaviors and data analysis of individuals with a minimum number of behavior problems who were assessed for nursing home eligibility in fiscal year 1997. What I've learned is that problem behaviors found in older adults can pose a major problem for those expressing them as well as their caretakers and others around them, affecting their quality of life and increasing the likelihood of nursing home admission. These behaviors may include forms of verbal or physical aggression such as cursing, threatening, hitting, kicking, and biting. Other behaviors may include nonaggressive acts such as pacing or wandering, restlessness, and constant requests for attention. Behavior problems may lead to situations that endanger the elderly individual such as wandering or engaging in physically aggressive acts or they may create a disruptive environment that limits their living arrangement and choice of living companions. The internship experience strengthened my interest in long term care research. It provided me the opportunity to become educated on behavior problems in older adults, particularly on the construct of behavior problems and the need for more research in this area. I am grateful for the time and knowledge shared by my mentor, Elise Bolda, Ph.D., and research analyst manager, Robert Keith, Ph.D. Christina Neill, Graduate Student Psychology, James Madison University Mentors: Eleanor Cain and Marianne Lucia The Setting: Delaware Health and Social Services Division of Services for Aging and Adults with Physical Disabilities The Experience: My experience at the Delaware Health and Social Services Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) enabled me to understand aging policy as both dynamic and diverse. The Program and Planning Unit exposed me to a wide variety of issues policy makers face that affect the lives of older adults. The projects I completed include analyzing and writing a report using results of the staff Training Needs Assessment survey for the division; drafting the division's first training policy; assisting in drafting legislation enabling grandparent caregiver's to enroll grandchildren in school and authorize medical treatment; and participating in negotiating a contract with the University of Delaware Health Center to start support groups for seniors. The most valuable insights I gained were through engaging in conversations with individuals about their current and past job responsibilities. I was able to attend a session of the Delaware State Senate with the Delaware Division Director, Eleanor Cain, who provided an excellent commentary on the many nursing home reform bills being considered and was eager to share with me her interest in gerontology. Watching the Senate in session with Eleanor Cain, helped me understand how a bill is introduced and becomes a law. I attended several senior health fairs which expanded my knowledge of community resources. Awareness of such community services is currently proving a valuable asset in my placement in the Jesuit Volunteer Corps as the coordinator of an elderly outreach program in Yakima, Washington. As a future leader on aging issues I will take with me from DSAAPD the excitement of seeing theory put into practice. My experience has solidified my interest in pursuing a career both research and service oriented in order to improve the quality of life for older adults. Katherine Peterson, Undergraduate Student Public Policy/Economics Health Policy Duke University Mentor: Phyllis Thornburn The Setting: General Accounting Office The Experience: I interned this summer at the US General Accounting Office headquarters in Washington, DC. I worked in the Health and Human Resources Department in the Health Financing Issue Area under Dr. Bill Scanlon. This project is one of a series of GAO reports designed to investigate the expansion of Medicaid and Medicare being run under managed care. This specific project is focused on states' programs for Medicaid mental health patients that are in mandatory managed care plans. I did research on HCFA regulations and guidelines for states running mandatory managed care programs for their mental heath Medicaid patients. This research led to a list of HCFA interview questions. This information will be used in the report to explain the role of the federal government (or lack of) in implementing and running a Medicaid managed care mental health carve-out program in individual states. My second responsibility was to investigate the 1997 Balanced Budget Act. I wrote a report on how the BBA will effect states' managed care Medicaid programs and how it will differ for physical and mental health. I also analyzed financial data, especially the mental health block grants from SAMHSA. I examined the trends in the costs to the programs and SAMHSA's formula changes. I learned about US government institutions and procedures for policy change. In looking at a career in health policy, it was important for me to learn the basics of how our political system, including government agencies and advocacy groups, works in reality and not just in theory. In addition, I was able to learn about different "hot" issues being researched at the GAO by attending conferences and Congressional testimonies. Some of these topics include Social Security reform, raising the retirement age, lack of quality in nursing homes, and Medicare. After this summer's internship, I have a more focused idea on my career goals having decided that I definitely want to continue to work in the health field. I am fascinated by the health care system phenomenon of the managed care boom. I would like to continue to look at this change and how it relates or could apply to Medicare. As managed care organizations continue to grow and take over more of the health market, I think that it will be increasingly important to create regulations for quality and access. This is especially important with government run programs like Medicare and Medicaid. If this managed care growth trend continues and as government health care funds become strained (especially with the baby-boomers retirement), it is very possibly that managed care (for better or worse) will take over most, if not all, of Medicare. Obviously, there are many ethical and logistical concerns with these changes that need to be examined and questioned. I would like to work further with these topics, whether it be with the government, a managed care company, or an advocacy group.
Julie Prince, Graduate Student Public Policy/Economics Health Policy Duke University/ UNC at Chapel Hill Mentor: Sandy Crawford Leak, MHA The Setting: Duke Long Term Care Resources Program The Experience: My placement this summer was with the Duke Long Term Care Resources Program under Sandy Crawford Leak. During my internship, I learned about issues involved in North Carolina's long term care system. Since I have had extensive experiences with nursing home care, I wanted to learn more about home and community based alternatives in NC. Thus, my main project was helping monitor the performance of the Aging at Home III sites. - CAP/DA sites in NC receiving funding from the Kate B. Reynolds Charitable Trust to hire additional case managers in order to increase the number of clients served. In the remaining time, I researched assisted living for a paper Duke LTC is writing under contract. Finally, I began to "get out" more into the state, and met various people involved in NC long term care. CAP/DA Program: The Duke Long Term Care Resources Program manages a Kate B. Reynolds Charitable Trust grant to 18 state CAP offices. During my placement, I visited numerous CAP program offices across the state with Sandy Leak, and helped monitor sites' performances under their grant contract. I also communicated with sites regarding new electronic reporting programs. Further, I managed and analyzed all data coming into Duke LTC from the Aging at Home III sites. Finally, I wrote and edited quarterly newsletters for Aging at Home III called "Progress Notes," which relayed information to sites and interested state officials regarding progress, challenges, policy changes, and other related topics. Costs of Assisted Living Care in NC: My second responsibility was to work on a research project that Duke LTC was completing under contract. The data came from the 3rd wave of NC Adult Care Homes Cost Reports (1996-1997). My work focused on data analysis and writing parts of the paper. Meeting other people in NC Long Term Care: Recently, I have had many opportunities to meet people involved in aging and long term care issues across the state: I attended the Senior Leaders Closing Ceremony (Duke Long Term Care) in Raleigh where I met the Senior Leaders and professionals around the state involved with the program; I went to a meeting concerning building information systems in NC for long term care; I was able to observe a penalty review hearing with Marlene Chasson (Director of Friends of Residents in Raleigh) and Kate Hill (Duke LTC intern); I shadowed Karen Gottovi (Director of the Division on Aging) for the day; and I presented at the NC Summer Symposium on Aging in Boone. I have been fortunate to observe many different leadership styles and situations. By working in an office with dedicated and experienced and knowledgeable people, I learned a great deal about what it takes to get things done in North Carolina's long term care policy system. Also, by traveling across the state, and meeting with various professionals in the state's long term care system, I have been able to observe the varying degrees of leadership and the different styles needed to accomplish different tasks in difficult circumstances. You must adapt yourself and your leadership style to the situation at hand, or others will not follow your lead. I now feel that I have a good grasp of the system as well as the challenges and successes North Carolina has with respect to long term care. I have grounded myself with knowledge and experience in alternatives to nursing home placement - including both the benefits and challenges associated with home and community based care in North Carolina. I am sure that this experience will aid me greatly in any policy-related work that I pursue upon graduation. Peter Stuart Reed, Graduate Student Public Health/Health Behavior and Education UNC at Chapel Hill Mentors: Marian Sigmon and Dennis Streets The Setting: Division of Aging, NC Department of Health and Human Services The Experience: My placement at the Division of Aging, NC Dept. of Health and Human Services, for the Duke Leadership in an Aging Society Program provided a wonderful experience. I worked on two major projects, and several other minor projects. In addition, the internship offered me the opportunity to meet many people and attend many of the meetings occurring throughout the aging network. One of the major projects on which I worked was an estimation of the prevalence rates of Alzheimer's disease in all the counties of NC. The first task of this project was to decide on the methods I would use to estimate the number of cases. After a review of professional literature, and through discussion with experts at Duke University, I decided to use standardized rates established by the US General Accounting Office. I created a brochure with summary information and a notebook containing detailed information for each county, which are currently being published by the Division. In addition, I put the information in computer format, which is currently available on the Division of Aging web site. Another major project I undertook this summer was a synthesis of qualitative data from regional forums throughout NC on the impending effect of the baby boom generation on NC's ability to deal with the older population. The Division hosted three regional forums in different parts of the state, which were attended by aging service providers, academicians and community members. The topical areas discussed as relevant included such things as family structure, financial planning, long-term caregiving and available services. Dennis Streets and I created a brochure summarizing this information, which is currently being published. Also, this boomer information is currently available on the Division of Aging web site. One of the most exciting segments of my internship this summer was the meetings that I was able to attend. All of the staff members at the Division were wonderful about including me in the many activities in which they participate throughout NC. I was able to meet many people who are working the field of aging, including academicians, service providers and older people themselves. Also, attending the meetings and listening to the speakers was truly educational. Meetings I attended included: the Governor's Advisory Council on Aging, the Senior Tarheel Legislature, the Kroger Senior Expo, a planning meeting for the NC Association on Aging, a planning meeting for the NC Summer Symposium on Aging, the Division of Aging Management Team Meeting, the NC Summer Symposium on Aging, and a 'National Forum on Social Security' with a teleconference between Rep. David Price and Pres. Bill Clinton. It was wonderful to realize the extent to which there are people working to ensure that the older residents of NC have everything they deserve. Overall, I had a tremendous experience. My match with the NC Division of Aging was better than I could have hoped for, and the mentorship I received was exemplary. I learned a great deal about the substantive areas related to my major projects, and learned a great deal about the state of aging in general through the meetings I attended and the contacts that I made. I am very thankful for the opportunity to participate in the Duke Leadership in an Aging Society Internship Program. Maureen Reindl, Graduate Student Sociology, Duke University Mentor: Deborah Gold, Ph.D. The Setting: Duke Center for Aging and Human Development The Experience: My summer internship consisted of two separate, but related, projects. The majority of my time was spent finishing a research study that I began as an independent study during my senior year. The study resulted in a paper entitled, "The Relationship Between Chronic Illness and Religious Practices in an Elderly Population," and was conducted under the guidance of Dr. deborah Gold and Dr. Linda George. The background work and study design were completed during the school year, and the summer was mostly spent creating statistical models, analyzing and interpreting the data, and writing up the final report. The other component of my internship was an informal study of the Established Populations of Epidemiological Studies of the Elderly (EPESE) research project. The purpose of this activity was to give me a better idea of how a research project worked. I interviewed six people directly involved with the EPESE to gain insight on such topics as the design of the questionnaire, interviewing, data management, data analysis, and individual studies using the data. The people I interviewed were Dr. Gold, Dr. George, Connie Service, Dr. Gerda Fillenbaum, Dr. Judy Hays and Celia Hybels. I asked questions not only about their role in the EPESE but also about how it compared to other studies, what were the best and worst aspects of it, what education and professional background they had, and many other related questions. I also read any literature I could find on the project and the studies that resulted from it. The combination of being personally involved with a study while also having the opportunity to talk to real researchers was an invaluable experience. I not only learned a lot about how research projects and studies are run but I also realized how much more I have to learn. By talking to people in different areas of research, I saw how much goes into a research project and how many different areas of specialization are available. All of these things will be very beneficial to me during and after graduate school. The learning that took place through my research study was more in the form of experience than information. With Dr. Gold leading me step-by-step, I experienced each phase of the research study. For example, I learned my way around the Med. Center library doing a literature review, I learned about linear regression models during data analysis, I learned how to interpret p-values, I learned how to write an abstract, and so forth. The majority of my learning probably took place during the actual writing of the paper. Each draft would come back covered in red, only to be discussed, corrected, and returned the next day. After eleven drafts, it was turned in for the last time. We are hoping that it will be accepted by a journal sometime in the future. This internship has strengthened my commitment to attending graduate school in sociology and has confirmed my desire to focus on medical sociology. Since the EPESE involves an elderly sample, I learned a lot about issues of aging. These issues continue to be of interest to me and have raised the possibility of a career in gerontology. Dr. Gold and Dr. George have been very helpful in guiding me through this process and answering all my questions on graduate schools. Amy Shah, Undergraduate Student Public Policy/Biology, Duke University. Mentors: Heidi White, M.D. and Eleanor McConnell, Ph.D. Setting: Methodist Retirement Home and Duke University School of Nursing The Experience: My internship involved working with Dr. Heidi White at the Methodist Retirement Home and with Dr. Eleanor McConnell at the Duke University School of Nursing. At the Methodist Retirement home, I worked with Dr. White on a research project that examined the relationship between weight loss, patient activity level and Alzheimer's disease. The purpose of the experiment is to determine if Alzheimer's patients with increased activity levels lose weight over time. My responsibilities included weighing patients monthly, administering a questionnaire to staff, recording what the patients ate over a two-day period and monitoring patients' activity level using an activity monitor. These tasks enabled me to acquire an understanding of how clinical research is performed and also to gain a sense of the different types of individuals that one has to interact with in a nursing home. Many of the staff members that I worked with were nurses aides. Because these are the individuals with whom residents have the most contact, it is important that they administer care that is of high quality. At the retirement home, I was also given the opportunity to attend both staff and administrative meetings. From these meetings, I gained an understanding of the manner in which a nursing home operates, the different jobs that exist, and the hierarchy that is present. Attending these meetings also enabled me to realize that caring for elderly patients is a complex task and there are many different facets of their lives that need to be considered in order to ensure their well being. Attending these meetings also made me realize the value of communication. Because there are so many different individuals caring for different aspects of a patients life, it is important that they work together and be aware of any problems a patient is facing. If this communication was not present, staff trying to care for a resident would become frustrated and residents would not get the quality of care that they deserve. I worked with Dr. McConnell on a project that she was working on with the Nursing home consortium. It involved creating a web page in order to ensure that nursing homes obtained current information on treatment options for urinary incontinence. Although there are several effective treatments for urinary incontinence, it still persists in many nursing homes today. This, however is not the case. The diffusion of information, I have learned, often takes several years. The web page that I have been working on will hopefully facilitate this diffusion by making treatment options easier to under-stand and apply. My internship provided me with insight into how a nursing home functions, and how residents are taken care of. I have come to realize that many nursing home residents do not receive a high quality of care because they are not able to care for themselves, and, in essence, do not always have a voice themselves. For this reason, it is important that they have both individuals and policies to act as their advocates. Although this internship has given me the sense that the problems faced by nursing homes will be challenging to solve, it is because of these problems that I would consider working in this field in the future. I know that working to help solve the problems faced by the elderly in today's society would be something that I would find both rewarding and fulfilling. Additionally, this program has made me more aware of the exact nature of the problems that are present in this field, and I now believe that I have more of an idea of what kinds of solutions would be most effective in ameliorating the problems that are faced by nursing home residents. Michelle Stevenson, Graduate Student, Human Development and Family Studies UNC at Greensboro Mentor: Kim Dawkins Berry The Setting: Piedmont Triad AAA The Experience: During my internship, I worked with Kim Dawkins Berry at the Piedmont Triad Council of Government's Area Agency on Aging (Region G). The goal of my summer was to examine access to community-based services through information and referral, case assistance, and case management in various North Carolina counties. To achieve this goal, I traveled to seven counties: Alamance, Catawba, Cleveland, Forsyth, Guilford, Mecklenburg, and Wake. Some of these counties were considered to be progressive in their development or implementation of universal access to aging services. I conducted on-site analyses noting similarities and differences in access to services, method of delivery, and general service organization. In addition to my research on the various counties, I also shadowed Kim Dawkins Berry in county planning meetings relative to aging services. I observed the relationships between committee members and was able to watch them interact while achieving a common goal. I was also able to travel to Raleigh with Kim Berry as she advocated for the older population. I was introduced to the structure of aging services funded by the home and community care block grant. I discovered the process necessary to develop a new structure of publicly-funded aging services, as well as relationships with private agencies. I was introduced to interagency interactions, community communication, and "turf wars". The dynamics were interesting, as were the differences from county to county. I was able to investigate rural and urban differences, as well as observe how these areas had overcome obstacles to universal service access. I learned that community cooperation is essential in meeting the needs of older adults. In addition, I learned first hand that strong leaders are necessary to bring about positive change. I observed differences in leadership types and the resulting impact on aging services. I began the internship with very little knowledge about the structure of aging services or the policy implementation process at the local level. I entered the internship as a graduate student not sure of my career plans. As a result of my experiences this summer, I recognized that I would like to pursue a career in academia. The difference is that now I am able to share this information with future students and share my experiences with them. In addition, I have been introduced to the role academicians can play in county and regional planning. I realized that as an academician, I would like to have a strong emphasis in community service, possibly sitting on planning committees or serving as a consultant to aging service providers or planners. This experience has revealed the importance of strong leadership. Publicly funded aging services would remain a fragmented, unapproachable system without strong leaders to advocate for and guide older adults. However, I was able to talk to some of the forerunners who were not only managers, but also effective leaders. These leaders were able to bring people together and inspire them to create positive changes in their community. Because of the Duke internship, I have met wonderful role models and have a clearer vision of the type of leader I want to be. Rebecca Utz, Graduate Student Gerontological Studies, Miami Uni. of Ohio Mentor: Rachelle Cummins and Katharyn Marks Setting: American Association of Retired Persons (AARP) The Experience: Before my internship commenced, I hoped I would acquire practical experience as a researcher in aging issues, as well as gain an understanding of how AARP operates as a powerful advocacy group dedicated to addressing the needs and interests of persons 50 and older. Fortunately, my placement with AARP met and far exceeded my expectations and goals. During my twelve-week placement in the Research Group of AARP, I primarily worked on the State Legislative Issues Team. AARP commissions a member survey every two years to assist the AARP State Legislative Committee (SLC) with planning and implementing AARP's legislative activities in each state. The survey is one of four methods the SLC uses to determine its legislative priorities and which issues are most important to members on which to advocate. The other three methods involve scanning the political landscape, reviewing other data sources, and listening to the opinions of AARP volunteers and AARP chapter members. The SLCs, along with the Research Group, design a short survey that taps into the emerging legislative issues of each state. Health care concerns, independent living issues, consumer protections, and state budget issues are among a few examples of the content areas that the various surveys address. The Research Group analyzes the data, compares it to any related data, and reports the findings to the SLC of the respective states. Working closely with the other team members in all facets of survey design and data analysis, I gained valuable practice using statistical software packages, writing succinct research reports, and presenting the findings to the SLC. All together, I was responsible for the data analysis and report writing of four states: Alabama, Mississippi, Georgia, and Colorado. In addition to my responsibilities to the State Legislative Issues Survey Team, I also was afforded the opportunity to meet and speak with other employees throughout the Association. Through various informational interviews with key staff members, I was able to gain an understanding of the enormous scope and diversity of AARP's programs and activities. My experiences at AARP have been a tremendous learning experience, which will only further my current educational pursuit of a Masters Degree in the field of aging research. From my summer-long internship, I feel I have developed academically, professionally, as well as personally. David Weatherly, Graduate Student Sociology/Gerontology, East Carolina University Mentors: Louisa Cox, Jim Mitchell, Ph.D., and Leigh Phillips. The Setting: Mid-East Commission's Area Agency on Aging (Washington, NC) The Experience: My internship placement with the Area Agency on Aging has provided me with the opportunity to be exposed to the many facets in the aging service environment of Eastern North Carolina. Over the course of the summer I traveled to area senior centers, councils on aging, health departments, and centers on aging. These site visits, allowed me to become better aquatinted with the elder adults, services, and service providers operating within Region Q (Pitt, Martin, Hertford, Beaufort, and Bertie county). Along with traveling, I worked on two independent projects, a follow-up survey and a content analysis. The content analysis focused on the screening instruments used by the area service providers to determine if an elder adult is eligible to receive in-home services. The follow up survey sought to determine user satisfaction levels following a three day computer based Information and referral software training. I also was fortunate enough to attend the Third Annual Summer Symposium On Aging in Boone NC. Two Duke interns and myself were given the opportunity to briefly speak about our internship experiences during the opening plenary session that was conducted by the Duke Leadership in an Aging Society Program. The symposium was an enjoyable experience for me. I was introduced to several of the key players in the North Carolina Aging network and learned more about existing infrastructure that exists in NC. The vast majority of my internship experience was centered on the implementation and refinement of a computer based Information and Referral system. I attended a 3-day training session to learn more about the Information and Referral (I&R) Technology Project. This Project was conceived and put together through the combined efforts of the Duke Long Term Care Resources Program, the UNC Smart Agency, and the Mid- East Commission. My exposure to and subsequent involvement with this I&R project was the defining internship experience that has helped to guide my career path choice. This I&R software program, named IRis, serves the five counties of Region Q and contains a comprehensive database to aid in the coordination of older adult needs with available professional and community services. "IRis" (in conjunction with the automated Duke Services Outcome Screen (SOS)) enables both trained staff and volunteers to obtain the necessary information to refer a client to a needed program (based on their specific needs and geographical location). IRis users can quickly perform extensive searches by program title or agency name, keywords, or service taxonomy. In addition, this program also enables the area service providers to customize caller records for specific program needs as well as enable the agency to create extensive statistical reports based on geographical location, age groups, basic needs, etc. The combination of aging health services and cutting edge computer technology makes this newest form of information and referral quite appealing to me. As a result of the exposure to the I&R project through my summer internship, I have begun to incorporate I&R work into my future career plans. As a result, my fall assistantship with the ECU Center on Aging will allow me to continue my involvement with the expanding information and referral system in place here in eastern North Carolina.
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