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| <back Long Term Care Advances Topics in Research, Training, Service & Policy Vol. 11, No. 1, Fall 1999 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 Duke Leadership in an Aging Society Program in 1999: The Policy Arena Begins to Take Note
Highlights from the 1999 Leadership in an Aging Society Program In 1999, the Duke Leadership Program continued to develop as an intergenerational, interinstitutional, and interdisciplinary program. Highlights include:
SENIOR LEADERS EXPLORE DIVERSE ISSUES ACROSS NC The Senior Leadership Enhancement Initiative began its third year by celebrating the diverse impact alumni are having across North Carolina. The June 1999 ceremony was dedicated to the memory of Mary Little. Karen Gottovi, Director of the NC Division of Aging was the featured speaker. The second year graduates spoke about their year of development and exploration as senior leaders. The accomplishments of this group lend evidence to the difference they are making in the policy arena across NC:
In March of 1999, six older North Carolinians were announced by the Duke Leadership in an Aging Society Program as the most recent "Senior Leaders" to be chosen to participate in the Senior Leadership Enhancement Initiative. The Initiative is designed to assist older adults with distinctive leadership potential to enhance their leadership skills to address the issues facing an aging society. All six Senior Leaders for 1999 have distinguished records of involvement in civic and charitable activities. Highlights of their backgrounds include: Everett Daniels, Southern Pines, is retired from an international career that included work with British Intelligence and the Overseas Division of General Motors. He graduated from the New York University School of Commerce. His civic contributions have included service as a United Way director in Caracas, Venezuela, and in the International Executive Service Corps. In Southern Pines, he has been president of Sandhills Meals on Wheels and RSVP. Rachel Deal, Crossnore, is retired from 38 years of public relations work in the Charlotte and Beech Mountain areas. Her volunteer service includes work with numerous aging and long term care organizations in Avery County including Sloop Care Center, the Geriatrics Services Council, the Alzheimer's Support Group, the Council on Aging, SHIIP, the Nursing/Domiciliary Home Community Advisory Council, and as Senior Tar Heel Legislature representative. Her awards include Avery County Woman of the Year, the Governor's Award for Volunteer Service and the Region D Council of Governments Outstanding Citizen Award. Max Fenson, Wilmington, is retired from American Airlines as the managing director for corporate affairs. Leading to retirement, he became executive director of the First Flight Centennial Foundation based in Raleigh. He has an undergraduate degree from Binghamton University and an LLB from Albany Law School. His civic and professional affiliations include the New York Sate Bar, North Carolina First Flight Commission, Greater Raleigh Chamber of Commerce, and the Senior Tar Heel Legislature, alternate for New Hanover County. Richard Hatch, Long Beach, is retired from the field of journalism. He received an undergraduate degree from the University of Georgia and was based in Atlanta for part of his career, working for United Press (later UPI), the Dekalb NewEra, and the Atlanta Journal. He was also the executive producer and script writer on the international television series, GLOBEWATCH, and the director of news and public affairs for the UNC Center for Public Television. Currently, he is chair of the State Legislative Committee for AARP. Thelma Lennon, Raleigh, is a retired educator with experience at high school and college levels, as well as with the state level department of public instruction in NC. She has an undergraduate degree from NC Central University and a master's degree form Boston University. Currently, she is state president of AARP for NC and chair of the Wake Health Services Community Health Center Board and serves on the Governor's Advisory Council on Aging and the Beneficiary Liaison Committee of Medical Review of NC. Lewis Mokrasch, Winston-Salem, is retired from a distinguished career as a professor of biochemistry at LSU Medical Center in New Orleans. The author of numerous professional publications, his teaching and research focused on medical and dental care. He did his undergraduate work at the College of St. Thomas and his doctoral studies at the University of Wisconsin. Since retirement, his community interests include nursing home reform, local council on aging activities, computer skill technology training for older adults, and hospice care. PRESENTING THE 1999 INTERNS Stefanie Berman, Senior Public Policy, Sanford Institute Duke University, Mentor: Maryanne Keenan Site: Federal Affairs, AARP My internship was with the Federal Affairs Department of AARP which is responsible for representing the interests of Older Americans on legislation introduced on Capital Hill. While Medicare reform and prescription drug coverage for seniors were the hot topics of the hot DC summer, I primarily worked on a topic that has remained quieter, but nonetheless important: long term care. Although long term care was not in the spotlight, there were still several bills introduced on the topic. In addition, many people continued to meet to discuss solutions to the daunting problem of how to care for the chronic needs of an aging population. My work on this topic was a combination of research, legislative tracking, and lobbying visits with my mentor. The long term care topics that I worked on were numerous: long term care insurance, caregiver support, therapy and home health services, nursing home quality, and post-acute services under Medicare. President Clinton kicked off 1999 with a long term care plan that included a tax credit for caregivers and recipients of long term care. Many bills on this theme were subsequently introduced. Additionally, the federal government appeared poised, at the passage of a bill permitting such services, to offer long term care insurance to their employees. The Aging Subcommittee of the Senate concluded their hearings on nursing home quality. These investigations revealed several glaring shortcomings in assuring quality of nursing facilities that are currently being addressed. In addition, as a subsidiary to the overall Medicare Reform discussions, investigations continued as to whether changes mandated by the Balanced Budget Act of 1997 have resulted in rationing of care to the elderly in need of post-acute care and therapy. The summer internship, however, was not only about being exposed to the issues that America needs to address to better care for its aging population. It was also about working with several leaders in the field, people who care intensely about the issues and are constantly forging new paths to achieve their end goals. The people I worked with at AARP, and those I met at various meetings, demonstrated the many approaches that can be taken in order to push the same issues. Their styles of leadership proved to me that success can be gained by many different strategies. They taught me that the most fundamental key to pushing public policy is to assure that your topic never gets pushed from the radar screen, that it remains a salient issue even if it is not a primary one. Hopefully, in this fashion, long term care will soon be more fully addressed and a financially viable, politically feasible, and socially responsible solution will be found. Overall, the summer internship at AARP exceeded even my highest hopes for what I could learn in this program. I was introduced to the workings and barriers to work that are encountered in the federal government. I learned about the players that operate in the aging policy field. I discovered how a team of people can together produce great results and shape the direction of future policy. Mary Jane Davis, Joint degree student: Graduate degree: Sanford Institute, Duke Law: Vanderbilt University Law School Mentors: Michael McCann, Steve Freedman, Phyllis Stewart, and Ann DeMaine Site: North Carolina Division of Aging My summer at the NC Division of Aging (DoA), was filled with a variety of experiences that have given me a great insight into aging policy from many perspectives. In addition to working in two different sections of the DoA, I attended many meetings and symposiums and met many people at all levels of the aging network. I was also fortunate enough to attend a debate of the Judiciary Committee, NC General Assembly, with DoA Director, Karen Gottovi. It was particularly interesting to me, as someone studying law and public policy, to see the legislative process in action. During the first two weeks of my internship, I worked in the Elder Rights Section of the DoA, under the guidance of Michael McCann, attorney for DoA. Several of the projects I worked on with him included reviewing written materials designed to inform and educate the aging public, as well as professionals in the aging network. Some of the topics of these materials were issues related to grandparents raising grandchildren such as legal guardianship and adoption; end of life issues such as advanced directives, living wills, and Do Not Resuscitate orders; consumer fraud issues for seniors; and information on Medicaid for the disabled and eldery. Another part of my work in the Elder Rights Section was to review the DoA's new Service Standards for the Administrative Procedure Act process. I reviewed the new standards for Information & Assistance and Senior Centers to prepare them for the APA rule-making process. The main project I worked on for the DoA was a policy evaluation of its Service Cost-Sharing policy. This project was for the Service Operations Section of the DoA, with Steve Freedman, Phyllis Stewart, and Ann DeMaine as mentors. The policy issue that was presented to me was: "What should the North Carolina DoA do regarding it's Service Cost-Sharing policy, given the changes that have been proposed for the Older American's Act?" This question was the basis of my evaluation and will also be the topic of my Master's Memo for my degree in Public Policy from the Sanford Institute. Much of the evaluation consisted of analyzing the current policy as it is written and being implemented. I surveyed Area Agencies on Aging and state level DSS staff. I also conducted a survey of a sample of NC aging services providers. In addition to collecting data from the provider level, I also visited Senior Centers and Congregate Nutrition sites to discuss the issue with service recipients and interviewed leaders of professional provider organizations and leaders of advocacy organizations for seniors. A final part of my analysis has been to monitor the bills in Congress which propose to change the voluntary contribution aspect of the Older American's Act. These bills, if passed, would permit states to have mandatory cost-sharing for aging services funded under the OAA. I would recommend the DoA as an internship site to anyone interested in learning about aging policy. The DoA staff are very open and receptive to interns. They included the interns in everything and provided us with opportunities to be exposed to all aspects of the aging network and aging policy process. Shawn Davis, Graduate Student, Gerontological Studies, Scripps Gerontology Program, Miami University of Ohio Mentor: Ken Wilson Site: Council on Aging of Southwestern Ohio As part of my internship experience this summer, I had the opportunity to help the Council on Aging of Southwestern Ohio (COA) develop performance measures. Performance management required the Council to adopt a specific point of view about the nature of aging programs and the role of the Council in the aging network. Adopting performance-based management in the public sector is not easy. There are many forces which hamper or limit true performance management. The Council's reliance on public funding and the presence of political considerations alter the way performance-based management can be used to shape policy making, resource allocation, contracting, monitoring, problem resolution, taking corrective action, and much more. Increasingly, however, political leaders are becoming more results and accountability oriented. The State legislature and the county commissioners want more information on the results attributable to the programs they fund. They want to see evidence that the Council's programs are well managed. The executive branch, at all levels, is now continuously trying to harness the complexity of public programs through new management initiatives, reorganization and reinvention of public services. In this complex and competitive environment, how can the Council demonstrate its management capacities? These are some of things I learned from my internship: Leadership is critical in designing and deploying effective performance measurement and management systems. At COA, the chief executive officer, Robert Logan, not only personally articulates the mission, vision, and goals to various levels within the organization, but he is also involved in the dissemination of both performance expectations and results throughout COA. A conceptual framework is needed for the performance measurement and management system. COA is in the process of creating a performance measurement framework that is clear and concise and that is understood by all levels of the organization and that supports objectives and the collection of results. Effective internal and external communications are the keys to successful performance measurement. It is the customers and stakeholders of COA, who will ultimately judge how well the Council has achieved its goals and objectives. And it is those within COA who are entrusted with and expected to achieve performance goals and targets who must clearly understand how success is defined and what their role is in achieving that success. Accountability for results must be clearly assigned and well-understood. COA is in the process of identifying what it takes to determine success and make sure that all managers and employees understand what they are responsible for achieving organizational goals. Compensation, rewards, and recognition should be linked to performance measurements. COA tries to link performance evaluations and rewards to specific measures of success; the Director of Human Resources, Danny Bosley, is in the process of developing a system that ties financial and nonfinancial incentives directly to performance. Such a linkage sends a clear and unambiguous message to the Council as to what's important. Results and progress toward program commitments should be openly shared with employees, customers, and stakeholders. COA maintains information on their performance objectives and specific progress toward these objectives manually. The agency would like to eventually move the information to their Internet and intranet site for real-time access by various levels of management, teams, and sometimes individuals. The Director of Communications, Lou Etheridge, is in the process of creating reports, newsletters, electronic broadcasts, or other visual media to set forth their COA's objectives and accomplishments. Elizabeth Devore, Senior, Chemistry Health Policy Certificate, Duke University Mentor: Judith Riggs Site: Alzheimer's Association, Washington Policy Office My summer at the Alzheimer's Association Washington Policy Office was an invaluable experience. From tracking one of the hottest topics of the summer on Capitol Hill to researching aging-related issues at the state level, the activity centered around health care and aging issues never slowed down in Washington. Since my office brought together federal and state policy specialists, I had the opportunity not only to work on a variety of issues at the national and state levels, but also to see how the two levels of policymaking and advocacy interconnect and complement each other. As a pre-medical student aspiring to become a physician, I gained experience that helped me to understand better how public policy is determined. Further, I began to understand how physicians and advocates can help shape these policies to meet the needs of the people they serve. My work this summer was focused on three major research projects. At the national level, I followed the Medicare prescription drug debate and compiled an analysis of all the prescription drug proposals introduced this year. Of course, in the midst of political positioning for the upcoming election year and President Clinton's Medicare reform proposal, there was much discussion in advocacy circles, as well as on Capitol Hill, surrounding the issue of prescription drug coverage for seniors. President Clinton's prescription drug proposal drew much attention, and along with the Breaux-Thomas proposal (released by the Medicare Commission) served as the benchmark for discussion of the prescription drug issue. In general, the proposals introduced this summer fell into three broad categories of benefits: universal coverage, price controls, and insurance options. While there was some speculation that Washington politicians were serious about a prescription drug benefit for seniors this year, the prospects of gaining a meaningful benefit were still unclear as the summer wrapped-up. My two other projects focused on state issues that were important for Alzheimer's families and aging advocates. I compiled a publication that provided information on tax credits and deductions available in each of the states for caregivers of Alzheimer's patients and elderly dependents. In addition, I prepared information on the allocation of tobacco settlement funds that will begin to be distributed to the states next summer. While many states have already begun to allocate their tobacco money, many of these states have not determined specifically what programs will be funded with the money. Several key states have made large commitments to aging programs, including allocations for prescription drug assistance programs and respite care. These decisions may set a precedent that advocates in other states will use in order to push for aging allocations as well. Overall, my experience this summer was invaluable as an opportunity to understand the inner workings of politics and how this relates directly to issues such as health care and aging policy that affect all of us. Meaningful change can be effected within the context of our political system despite the frustrations and disillusionment that can come from endless debate about health reform. While the summer did not convince me that my career will be entirely devoted to work in the policy arena, it did show me that, as a future physician, I can channel my concerns about the lack of universal, quality health care in a productive way that can help bring about change to benefit those in need of care. Jonathan Etter, Senior, Public Policy, Sanford Institute, Duke University Mentor: Jon Dauphine Site: Long Term Care Campaign I spent this past summer working for the Long Term Care Campaign (LTCC), a coalition of 147 organizations devoted to incorporating long term care (LTC) into national political discourse so that there can be positive steps taken by government to address the issue. Specifically, the Campaign has three legislative principles: (1) LTC services should be available to all that need them; (2) people should have access to a broad range of LTC settings; and (3) costs for LTC should be spread broadly and progressively so no one portion of society is unduly strained. The three main sponsors of the Campaign are the American Association of Retired Persons (AARP), the Alzheimer¹s Association, and the Paralyzed Veterans of America. My central function as an intern for the Campaign was to conduct a research project in which I documented peoples' personal experiences with long term care and long term care insurance. In compiling my collection of case studies, I called individuals who were referred to me by LTCC member organizations. While on the phone, I would ask the individual a series of questions from an interview template that I drafted at the beginning of the summer. During each call, the interview would evolve into an in-depth conversation in which the interviewee would share his/her feelings about long term care and the current health system. The process taught me a great deal about how the need for long term care can effect one's life. Following the interview process, I compiled all information into a computer log of case studies. The Campaign was able to use the case studies to help assess the more pertinent aspects of long term care in America. Also, the Campaign will hopefully use the project as an advocacy tool. In addition to the research project, I was able to help with the everyday function of the Campaign. It was an exciting time to be working for a LTC advocacy group considering the proximity of the upcoming presidential election. Many of my daily functions included helping the LTCC prepare for the Iowa Caucus. I aided in the formulation of advocacy flyers, gathered candidate contact information, and designed the LTCC¹s "Contact the Candidates" web-site. For more information on the Long Term Care Campaign click "here" Perhaps my most enjoyable campaign-related activity was my job of creating an ongoing spreadsheet that documented each candidate¹s public stance towards long term care. It was especially interesting to see some of the candidates' platforms evolve over the course of the summer. In the middle of the summer, my mentor Jon Dauphine let me try my hand at writing a press release for the Campaign. The release concerned recent LTC legislation's tendency to be based on long term care insurance. The piece outlined some of the problems with implementing private insurance as a cure-all and it pressed for a more comprehensive solution. Writing the press release was something that I really enjoyed because I had never attempted that type of writing before. Dauphine greatly enhanced the experience, as he made time to discuss each of my drafts with me. During my internship this past summer I began to understand the depth and complexity of long term care within the United States. A few themes in particular seemed to emerge: First, people of all ages can be in need of long-term care. Prior to working at the Campaign, I thought the issue really only pertained to the elderly. Moreover, it is equally apparent that LTC profoundly effects all races, socioeconomic levels, etc. Second, I realized that it must be very difficult (emotionally, physically, economically) to be a caregiver. While interviewing people, I realized that being a caregiver is a 24-7 occupation. Third, people often do not get get a choice of their care setting. I spoke with many individuals who wished they could get in-home or community-based care but only received coverage for a facility-based setting. This lack of choice was upsetting to most of the people with whom I spoke; they felt that it hampered their independence. Fourth, I have found that many people simply can not afford long term care. In conducting my research it became increasingly evident that long term care is extremely costly. Too often it seemed as if people had to impoverish themselves and their families to cover the costs of care. This is something that should be addressed by our health system before the problem gets more critical with the upcoming surge in elderly. Emily Gamble, Graduate Student, Public Administration, UNC-CH Mentors: Susan Harmuth, Jesse Goodman, and Bonnie Cramer Site: NC Division of Facility Services I spent the summer at the North Carolina Division of Facility Services (DFS), a division of the state Department of Health and Human Services. DFS is charged with the regulation of state facilities, including prisons, mental institutions, hospitals, and nursing homes. The Division's Health Care Personnel Registry (HCPR) Branch oversees the curriculum development and certification for Certified Nursing Assistants (CNA), and maintains the federally mandated Nurse Aide Registry. The branch is also responsible for investigating all allegations of abuse, misappropriation or diversion of property and drugs, and the falsification of work records by CNA staff. Over the summer I had the good fortune to work for two mentors on two very different projects. The first project was developed under the mentorship of Jesse Goodman, head of the HCPR branch, with the direction and cooperation of Jayne Bunn, Manager of the HCPR Abuse Investigators. The Division's investigators are the personnel charged with investigating charges of abuse or other inappropriate conduct by CNA's, who provide the bulk of care to the elderly in nursing facilities. The job is a challenging one and requires special skills and training. In recent years there have been an insufficient number of investigators to handle the reported cases in a timely manner. In order to solve this problem and to insure the best quality care for the state's elderly population, as well as their safety, the state legislature recently approved several new investigator positions for HCPR. Despite the approval for the new positions, and repeated advertising, HCPR was unable to find qualified personnel in the Raleigh area. However, as part of an initiative to improve air quality, reduce traffic in the Triangle area, and improve efficiency, the state has initiated a Telework Pilot Project. This project allows certain selected positions to telework (work from home or another area outside of the central office) for a trial period. Because the bulk of an HCPR Investigator's time is spent out of the office at sites around the state, and because of the lack of qualified applicants responding in the Raleigh area, the branch was an ideal candidate for participation in the Telework project. During my time with HCPR I was charged with creating the policies and procedures for the telework investigators that would enable the pilot to run as smoothly as possible. In cooperation with Ken Galuppi, the project manager, and the affected staff in the branch and at DFS, I was able to develop the basic protocols that will hopefully make the transition from an office-based investigation staff to a home-based staff located around the state as simple as possible. My second project was focused more specifically on improving the quality of care for the elderly and populations with disabilities by improving the quality of their caregivers, specifically nurse aides. It is estimated that aide workers provide over 80% of paid long term care. The work of nurse aides is stressful, hard, has no career ladder, and pays low wages with few, if any, benefits. In the last few years, the turnover rate of nurse aides in North Carolina nursing homes has exceeded 100%, and at this time there are as many inactive CNAs on the state's nurse aide registry as there are active CNAs. While the number of CNAs decreases, the need for these paraprofessionals is only expected to increase as the population ages. In reaction to this crisis, DFS, in collaboration with other organizations and associations involved in long term care, has begun to look at how these workers can be effectively recruited and retained. Part of that effort involved looking at how other states are coping with this issue. In collaboration with my second mentor, Susan Harmuth, Health Policy Analyst, I spent the summer researching other states initiatives to retain workers through improved salaries and benefits. We conducted a survey of all 50 states' Units on Aging and Medicaid Offices to determine if those agencies felt Nurse Aide recruitment and retention was an issue, and if so, what, if any, base wages and benefits were offered to attract and hold these workers. In addition, we asked states for information on other initiatives being taken to increase retention. The final results of this survey, combined with statistical data on the nurse aide population, were compiled and analyzed. "Comparing State Efforts to Address the Recruitment and Retention of Nurse Aide and other Paraprofessional Aide Workers," is available on the NC Division of Facility Services website under "For Providers:" http://facility-services.state.nc.us My experiences at DFS introduced me to a whole new view of long term care, that of the nurse aides who provide the bulk of care to the elderly. Because I spent the summer working on two very different projects, one focused on improving the quality of services to a state agency's clients through innovative staffing, and one focusing on policy issues, I also had the opportunity to combine my interest in public policy with my training in public administration. Prior to my summer experience, I had worked extensively in the non-profit sector, but working with DFS allowed me to learn more about how a state government agency operates. I will be continuing with DFS throughout the school year, so I will have the chance to continue to follow each of these projects over the course of the next few months. Patricia Hooker, Doctoral Student Clinical Psychology, UNC-CH Mentor: Elizabeth Mutran, PhD Site: UNC Center on Minority Aging I completed my internship this summer at the UNC Center on Minority Aging (CMA). Over the summer, I worked on the Durham Elders Project (DEP), which is a general health survey of African American elders in Durham. The DEP is an effort to validate existing measures in a population of older African Americans, test mechanisms for recruitment and data collection in the African American community, obtain baseline information on a local population of African American elders, and forge a research partnership with the community. My primary activities consisted of conducting interviewer training, scheduling interviews with participants, assigning interviewer time slots, preparing interview materials, interviewing participants, and entering data from completed surveys. During the summer, we completed 38 interviews at one of the six churches that will be participating in the DEP. I learned a great deal about conducting community-based research during my internship. First, the process of establishing a relationship with the community is extremely important. It is natural for lay individuals, particularly African Americans, to be distrustful of research endeavors. This is not surprising given the infamous examples of unethical treatment of African American subjects in past research. Fortunately, the Center on Minority Aging benefited a great deal from the opportunity to work with area churches in order to recruit subjects. I also learned, however, that attempting to work with an established organization such as a church requires a great deal of persistence on the part of the researcher. The research project is highly unlikely to be a top priority for the organization, and a lot of effort is required to negotiate the needs and considerations of both the researcher(s) and the organization. Overall, however, we were able to make considerable gains toward our goal of developing a research partnership with the Durham community. I also participated in related public policy experiences. I first met with Bonnie Morrell at the NC Division of Mental Health to discuss a project aimed at developing community-based alternatives for geriatric patients who are currently served in state psychiatric hospitals. My second activity was "shadowing" Susan Harmuth from the Division of Facility Services at a work group meeting for a grant-funded project to address paraprofessional and nurse aide recruitment and retention issues. For both these projects, I was invited to attend future meetings during the fall semester. In July, I went to the Fourth Annual North Carolina Summer Symposium on Aging where I attended several sessions that were particularly relevant to my internship. My last outside activity was attending a meeting of leaders from other churches (i.e., churches which were not part of the DEP) who are putting together a project to restore and revitalize the historical district of Durham called Walltown. My internship at the CMA has cultivated my interest in public policy regarding aging issues, and it has been a wonderful opportunity to become educated about the content of these issues in North Carolina. I feel that I've learned two important things that will directly impact my professional future. First, no matter how much research I may do while in school or in my career, research will have no real impact for the elderly unless it can be translated into some type of policy or intervention. Important legislation with regard to older adults is generally implemented on a state level. The internship provided me with the means for becoming familiar with North Carolina policy issues and the mechanisms by which ideas and information are transformed into policy. Second, the relationship between public policy and research is reciprocal. Policy will not be effective unless policy decisions are informed by relevant research, and my internship allowed me to learn about how to conduct this type of research with seniors in the community. As a psychologist in training, the work I did at the CMA is very close to my heart. Research with minority populations is desperately needed to decrease the discrepancy between minority and majority health outcomes. The DEP will serve to establish links with community members and organizations that will facilitate community participation in research and ideally foster research on African American elders that will improve their health and quality of life. My goal for the work that I started at the CMA as a graduate student is that it will lead me to a career program of research, interventions, and policy decisions that will continue to benefit elders in North Carolina. Christopher Kelly, Doctoral Student, Gerontology, Leonard Davis School, University of Southern California Mentor: Eric Anderson Site: General Accounting Office My internship at the General Accounting Office provided me a perspective on the formation and implementation of aging policy for which there is simply no substitute. I had long been fascinated with the political process, and I had developed a particular interest in long term care policy. I had assumed that my first year of study in the Ph.D. program at the Leonard Davis School of Gerontology at USC had conferred upon me some degree of expertise in these areas. I was mistaken. While my previous, studies had established a sound foundation, this summer's experience in Washington was absolutely essential to truly understand the policy process and to clarify my research interests. During my three months of work in the Health, Education and Human Services Division (HEHS) at the GAO, I had the opportunity to work on a number of separate projects related to the issue of nursing home oversight. My primary responsibility was to assist in drafting a response to a request made to the GAO by Senator Charles Grassley, the Chairman of the Senate Special Committee on Aging. Senator Grassley sought to determine the accuracy of a claim made by the American Health Care Association, (AHCA) that both state surveyors and the Health Care Financing Administration (HCFA) are overzealous in citing nursing homes for violations. The nursing home lobbying group provided several examples of state and federal citations that it felt did not represent cases in which nursing home residents experienced actual harm. Senator Grassley asked the GAO to investigate this claim, and the Aging Committee forwarded the materials it had received from AHCA to our project team. The results of our investigation are reflected in the final report, which will be released to the public this fall. In addition to my primary work on this report, I also assisted the nursing home oversight team within HEHS on two related assignments. The first is an ongoing comparative study of HCFA's 10 regional offices and the methodologies and criteria these offices employ to evaluate the performance of the state survey agencies responsible for nursing home regulation. The second assignment was to assist in the preparation of HEHS Director William Scanlon's June 30 testimony before the Senate Special Committee on Aging, in which Dr. Scanlon appraised the performance of HCFA in implementing the President's recent nursing home initiatives. My internship allowed me to work closely with different members of the nursing home oversight team, individuals who approached this common goal from a wide variety of personal backgrounds. I also found the experience of working in Washington rewarding. I have long approached the political process with great interest, but also with a certain amount of skepticism. However, I discovered during my GAO internship a renewed faith in the policy process. I found the Senate Aging Committee refreshingly free of the negative partisanship that often characterizes the political system. I also discovered a healthy relationship between the GAO and the Senate Aging Committee, a vivid example of a government that truly works. I am happy to report that I find myself not only better informed about the policy process, but also less cynical. Hailey Maier, Graduate Student, Health Behavior and Education, UNC-CH School of Public Health Mentors: Dennis Streets and Bill Lamb Site: North Carolina Division of Aging My internship was with the North Carolina Division of Aging in the planning and information section. I worked on a project concerning information and assistance (I&A) services in North Carolina. Working on this issue allowed me to see the process the Division goes through in making changes to policies or systems that impact the elderly. By interacting with policy leaders, local providers and elderly citizens, I gained an understanding of the varied perspectives that individuals and groups at different levels of the aging network bring to aging policy and the challenges of incorporating these perspectives into decision making at the state level. The first part of my internship involved drafting a paper to summarize the proceedings of a Symposium on Information and Assistance (I&A) held by the Governor's Council on Aging. The Council held the meeting to educate themselves and others in the aging network about I&A and to formulate recommendations for the Governor based on this information. After I summarized the proceedings of the meeting, I distributed the draft to several people within the Division, at the Duke LTC Resources program, and finally to the speakers from the symposium. The process of shaping and editing this paper was different from what I had experienced in writing papers for classes or research projects. Since different groups and individuals had strong opinions about some of the issues discussed in the paper, everything had to be phrased in a way that would reflect an understanding of these perspectives, while accurately conveying the message as the speaker intended it. Through this process, I learned who the major stakeholders were in this issue and how they felt I & A systems should be organized. This kind of knowledge is critical in working on a policy and yet I would not have gained this kind of perspective by just researching the topic. "Governor's Advisory Council Symposium on Information and Assistance," is available as part of the Duke LTC Occasional Policy Series at www.geri.duke.edu/ltc/ltc2.html The next portion of my project involved surveying the directors of the Area Agencies on Aging across the state to find out what kind of information systems and programs they are currently using. Conducting this survey increased my understanding of the major challenges in determining appropriate policies for individuals and agencies across the state. Because individuals age in very different ways, older adults are a particularly diverse population. The counties in North Carolina are also quite diverse and have very different needs and capacity to provide services. This makes the task of developing standards and policies that will apply to the whole state extremely challenging. During my internship, I attended several meetings and events that gave me a broader perspective of I&A systems and aging policy in general. In August, I went to the Summer Symposium on Aging in Fayetteville. In addition to the knowledge I gained at the conference, I also enjoyed the opportunity to interact with people who work in aging policy and services. In fact, I made a connection at the conference that led to a part-time job at the N.C. Extension Service. My placement at the Division of Aging taught me a great deal about developing aging policy, and observing day-to-day operations in a state agency was a learning experience in itself. My mentors, Bill Lamb and Dennis Streets, were very supportive and helpful in my projects. By interacting with people from different organizations and areas of North Carolina, I gained a better understanding of a variety of career opportunities in aging and have a more informed idea about the kind of position I would like to pursue after graduation. Kameron Matthews, Senior, Public Policy, Sanford Institute, Duke University Mentor: Powell Lawton, PhD Site: Philadelphia Geriatric Center Working with Philadelphia Geriatric Center (PGC) was a great experience. At the onset of my internship, PGC was comprised of a nursing home, assisted living quarters, an outpatient clinic, and a research department. The home has been serving the Philadelphia Jewish community for more than thirty years. I gained a true perspective into geriatric care through interviews that I performed with nursing home residents. The purpose of the research project of which I was a part was to develop measures and indicators of quality of life in nursing homes. While I only interviewed the residents, the entire project, which was directed by my mentor Dr. Powell Lawton, consisted of a staff/caregiver interview, a family member interview, and several observation sweeps of the nursing home/facility and individual residents room and bath. The importance of this study was two-fold. First, the creation of a measurement of quality of life (QOL) in nursing home allows for a more inclusive set of standards by which a nursing home could be judged. At this point in time, the only measurements available to compare nursing homes are the tangible characteristics: cost, bed-space, nursing staff, etc. The measurements used within these interviews will hopefully shed light on the more subjective realms of QOL. Second, a measurement of QOL could benefit future development and policy in the field of geriatric care. After setting a standard of care, better policy can be created to meet and even surpass that standard. However, without the exact scientific measurement of what is meant by quality of life, such policy cannot be formed. That detail was the focus of this project. As a whole, my experience was very worthwhile. Within our society, so much of our population is neglected, and this research could assist in a reversal of that fact. Residents of nursing homes deserve the same quality of life as those of us who have the ability to live on our own. The measurement and standardization of such quality of life is therefore essential.
Monique Moultrie, Senior, Religion and Sociology, Duke University Mentor: Joan Pellettier Site: Durham Council for Senior Citizens As an Outreach Assistant for the Durham Council for Senior Citizens, I was introduced to various aspects of aging issues. I expressed an interest in working with minority aging; hence, my internship focused on African-American elderly. Since African-Americans represent the largest percentage of minority elderly in Durham County, my main projects can be used to create an encompassing outreach plan for other minority communities. My projects were quite congruent with my desire to see how minority elderly communities accessed services. Stemming from my general assumptions about minority aging, my outreach plan focused on the specific needs of an African-American elderly community. With the permission of my mentor, Joan Pellettier, the Executive Director of the Council for Senior Citizens, I became the liaison for the Council and the Duke Endowment's Walltown Families and Children Initiative. By working with this initiative, I was able to interview minority elderly and discuss their problems accessing services. I also had the opportunity to interact with minority elderly in the Duke Street Senior Center. Through my daily interactions with the participants of the Center, I gained valuable knowledge about the spirit of minority elderly. These persons answered my survey questions with bluntness and ease. Further, they provided me with more than just an understanding of what kinds of services they wanted, but information that instructed me on why some services weren't being utilized. I found this internship to be a direct match for my future career interests because it provided me with the opportunity to encounter both the administrative as well as the more personal aspects of minority aging. My position at the Council gave me a holistic view of issues and informed me on how services could be better provided or better publicized. All of my projects proved to benefit my goal of reaching out to minority communities. Kimberly Reynolds, Doctoral Student, Health Behavior and Education, UNC-CH School of Public Health Mentors: Judi Lund Person, Michael Dubin, and Laura Hanson, MD Site: NC Coalition to Improve End-of-Life Care I worked this summer as an intern with the NC Coalition to Improve End-of-Life Care, a recently created statewide coalition funded by the Robert Wood Johnson Foundation and based at Hospice for the Carolinas. The goals of the Coalition are to serve as a center for statewide communication and coordination regarding end-of-life care, to develop a directory of end-of-life resources in North Carolina, to train health care professionals in providing better end-of-life care, and to interact with community groups around death and dying issues. During my internship, I participated in organizational functions at Hospice for the Carolinas, and I was involved in organizational and programmatic capacities with several of the subcommittees on the Coalition. I was also able to attend a number of regional and statewide conferences, such as the Eastern area AHEC conference on Death with Dignity and the Hospice for the Carolinas symposium on Spiritual Care of the Dying. My primary duties with the Coalition consisted of working with the Coalition's task force on "Death outside the Hospital Setting." This group is looking at ways to improve end-of- life care for individuals living in nursing homes and other residential settings, such as assisted living facilities. I spent the summer designing training and educational materials relevant to these groups. Products include a training manual for nursing home staff, an advance care planning booklet for nursing home residents and their family members, and a policy analysis of barriers to high- quality end-of-life care for nursing home residents. The internship allowed me to better familiarize myself with the literature on aging, and specifically on death and dying issues. I also developed an appreciation of the joys and challenges of working in coalitions, which can be an important tool for anyone working in the health education field. In addition, I was able to meet and share ideas with others across the state working in the areas of aging and end-of-life care. The opportunity to interact with so many interesting and inspiring individuals was one of the highlights of my summer experience and will be, I believe, a long-term asset. D. Todd Rose, Joint Degree Student, Public Policy, Sanford Institute, and Medicine, Duke University Medical School Mentor: Thomas Vail, MD Site: Duke Division of Orthopedics As a joint degree student in Medicine and Public Policy at Duke, I was interested in an internship experience that would combine my medical research interests with public policy. I applied to the Leadership in an Aging Society Program and was approved for a joint award as an intern and Glaxo Wellcome young researcher in long term care. My internship was with Dr. Thomas Vail at the Duke Divsion of Orthopedics studying the use of patient education interventions to improve outcomes for patients who undergo hip replacements. The project also served as the basis for my public policy memo, which is major paper required for Public Policy graduate students. In addition to Dr. Vail, Dr. Joe Lipscomb, from the Sanford institute, helped me with the initial development of the project. The intervention I studied was a patient education video that had been used to educate a number of patients on what to expect about their hip replacement procedure. For my part of the research project, I collected data from medical records and cost systems to look at outcomes. Data analysts from the hospital's T-1 data system were helpful with data collection, and Don Taylor in the Center for Health Policy, Law and Management worked with me on the actual data analysis. Preliminary results indicate that outcomes were improved, and a paper is being prepared for publication that summarized the results. The internship experience has been a rewarding one for me. The project has good potential for improving health care, particularly for the elderly. Additionally, I enjoyed learning more about the public policy aspects of care for the elderly and interacting with the other interns. Susan Scott, Graduate Student, Health Behavior and Education, UNC-CH School of Public Health Mentor: Betty Wiser, EdD Site: Older Adult Health Program, NC Division of Public Health My internship consisted of program planning, resource development, and public awareness efforts related to prevalent older adult health conditions in North Carolina, particularly osteoporosis and arthritis. My initial assignment was to develop two sections of a federal grant application aimed at building state capacity for implementation of a National Arthritis Action Plan. This project provided excellent experience in gathering data from existing epidemiologic data sets and in analyzing potential system enhancements to support future efforts to reduce the arthritis burden in the state. I also benefited from collaborating with a team of diverse professionals during the grant writing process. My second project was to coordinate an osteoporosis segment for "Inside North Carolina," which airs weekly throughout the state via cable access and residential satellite. I worked with the producers at the NC Agency for Public Telecommunications to confirm panelists and develop basic content for the program. The panel consisted of professionals experienced in the medical, research, policy, and program delivery facets of osteoporosis. The live, call-in format of the program provided an opportunity to address a wide range of concerns regarding prevention, diagnosis, and treatment. It was exciting to witness production of a television program from start to finish. Also, it was gratifying to know that the program provided an immediate, free, and authoritative source of information for people with wide-ranging levels of knowledge about osteoporosis. Bone mineral density testing (BMD) is the definitive method of osteoporosis diagnosis. Access to statewide, up-to-date information on providers of this medical service is a high priority for the Older Adult Health Program. I collected and compiled provider data for use by Program staff in addressing telephone inquiries from consumers. As my major project, I wrote a guide on using the Internet for older adult health research and consumer education, which was jointly published by the Division of Public Health and the Division of Aging. The guide is being distributed to professionals in local health departments, social service agencies, local aging service providers, and cooperative extension offices throughout North Carolina. In gathering content for the guide, I consulted with numerous researchers and technical professionals in the Raleigh- Durham-Chapel Hill area. This experience encouraged me to stay informed about rapidly developing roles for the Internet in promoting older adult health. "Using the Internet for Older Adult Health Education and Research," may be found on the Older Adult Health Program Website at www.communityhealth.dhhs.state.nc.us/ under Chronic Care. My internship with the Leadership in an Aging Society Program was extremely positive. My mentor, Betty Wiser, provided excellent guidance and continually shared her knowledge of policy-making and health promotion initiatives. The insights I gained about the factors that are shaping health policy for aging people will be invaluable in my future health promotion endeavors. Sarah Sutro, Graduate Student, Gerontology, Leonard Davis School, University of Southern California Mentor: Kirsten Sloan Site: Federal Affairs, AARP As an intern in AARP's Department of Federal Affairs, I gained exposure to both the federal legislative process, as well as federal health policy and reform issues relative to Medicare. My work focused on the underlying issues associated with Medicare, primarily Medicare reform and the repercussions of the Balanced Budget Act of 1997. Upon arrival, I was assigned to work with Kirsten Sloan, AARP's federal legislative representative specializing in Medicare. With the impending onslaught of baby boomers entering retirement age, feared insolvency of Medicare's Trust Fund, and increasing focus on the projected budget surplus, Medicare has been the focus of much debate in the federal legislative arena. After the dissolution of the Bipartisan Commission on the Future of Medicare in April 1999, the Senate Finance Committee held a series of hearings to discuss the current Medicare program and what options reside for its reform. Initially, I was assigned to track Medicare reform and attend all Medicare-related hearings. I assisted Ms. Sloan in following reform and briefing the AARP legislative team on the policy, process, and various alternatives presented. By the close of summer, the President and Senator Breaux had presented plans for the reform of Medicare. Among other projects, I drafted a matrix outlining the plans, comparing and contrasting the specifics of each. In addition to attending the Medicare hearings, I also accompanied Ms. Sloan to Hill office visits in which AARP's position on Medicare was relayed, and information was provided to the Congressional staff. Additionally, I attended a conference on the repercussions of the Balanced Budget Act of 1997 on hospitals, at which time I met representatives of the health policy arena. Tracking the legislative process introduced me to the many complexities associated with healthcare reform and the difficulties of reaching consensus in order to move forward. I was curious about how this interest group, representing 37 million Americans aged 50 and over (of which 40% are Republican, 40% are Democrat and 20% are Independent), could successfully advocate on behalf all members. What I came to learn was that AARP approaches change in a gradual fashion. In order to assess what is best for its membership, AARP legislative representatives often will reserve judgement on an issue until more questions are answered and issues are discussed within AARP and the greater policy arena. I became familiar with many aspects of Medicare and health policy. I was assigned to a number of other issues, such as Veteran's Medicare contracting and the Medicare appeals process. I worked with AARP health team members and outside health care advocates to analyze policy including briefing Tricia Smith, the health team director, and assisting in developing a document outlining the various alternatives for reforming Fee-for-Service Medicare. Aside from learning about AARP's role in the broader policy arena and the intricacies of health care policy, I was exposed to the inner-workings of AARP's Federal Affairs department, including the organizational culture and the leadership style. The director of the Federal Affairs health team portrayed tremendous interpersonal skills, motivating the team members through the example she set. She also revealed an ability to anticipate problems. The opportunities provided by the Duke University Leadership in an Aging Society internship were fantastic. Not only am I thrilled to have had the opportunity to work inside the "DC Beltway", but I am also grateful for becoming acquainted with a new network of peers involved in the aging arena. Godwin Unanka, PhD, Graduate Student, Scripps Gerontology Program, Miami University of Ohio Mentor: Professor Gary Andrews Site: Program on Aging, United Nations On my arrival at the UN office my mission and work assignments were spelt out to include: (i) preparing background papers for the UN Interregional Expert Group Meeting on "Developing a Framework for Policies for a Society for All Ages" scheduled for June 10-15 in Seoul, Korea; (ii) making presentations at plenary sessions, being involved in discussions, and contributing to writing the final report of that meeting; (iii) participating in research; and (iv) contributing to the development of the report of the "Expert Consultative Meeting on a Research Agenda on Aging for the 21st Century" held in Vienna, February, 1999. I engaged in library searches at the statistical library of the Department of Economic and Social Affairs (DESA) and the main UN library- the Dag Hammarksjold Library Thus, I reviewed various UN mandate documents and reference publications leading to the concept of a Society for All Ages. I developed and wrote a support background paper - "Developing a Policy Framework for a Society for All Ages From Developing Countries' Perspectives." At the close of the Regional Congress, I moved to the Institute of Foreign Affairs and National Security, Seoul - the venue for the UN Interregional Group Expert Meeting for Developing a Policy Framework for a Society for All Ages. I presented my background paper at the plenary session. I also served as the rapporteur for Group 1 (Developing Nations). Back at the UN, I participated in a meeting of the Program on Aging unit on June 23 to discuss the format of the report to be submitted for the Secretary-General's Report. Later in the summer, I traveled to Nigeria to complete the last phase of my work assignment - research and project development. While in Nigeria, I successfully recruited and trained 20 research assistants and completed a pilot (survey) study via in-person interviews with 75 older persons in Imo State Nigeria. Following discussions with my supervisor and colleagues at the UN Program on Aging, I also embarked on the project of establishing a Longevity Center for All Ages in Nigeria. To facilitate this, I engaged in activities to raise awareness on the issues of longevity and the society for all ages. It is interesting to experience the development of frameworks that would guide the initiation/formulation and implementation of aging policies in the 21st century. Specifically, the experience reinforced my professional interests and goals - - particularly my concern that the aging problems in developing African countries deserve adequate national and international policy and programmatic attention. In fact, my experiences within this period heightened my ambition, suggesting that in our current era of globalization, an interest in cross-national gerontological research and program development are fertile and achievable professional goals. Very importantly, I garnered ideas that motivated me to begin to explore and actually embark on the project of establishing a Longevity Center for All Ages in Nigeria. I am optimistic that with the relevant individual and organizational supports, this center will make significant impact in Nigeria and Africa towards (i) the maximization of the human life-span, (ii) health promotion, and (iii) promotion of home and community-based services for the elderly. Christine Vitt, Doctoral Student Clinical Psychology, Duke University Mentor: Gina Upchurch, RPh, MPH Site: Senior PHARMAssist, Durham, NC Senior PHARMAssist is a charitable nonprofit organization located in downtown Durham. The program's mission is to educate Durham County senior citizens about preventive health measures, consult with seniors and healthcare providers about safe and effective medication use, and provide financial assistance for necessary medications to seniors with low incomes. Since 1994, Senior PHARMAssist has helped over 650 Durham County senior citizens pay for their medications. Funded clients are seen every six to eight months for re-certification and a medication review. This educational component of the program ensures that clients are active participants in their health and pharmaceutical care. An abundance of data is collected from clients of the program. These data include a complete medication review and assessments of medication adherence, health services utilization, functional ability and satisfaction with the program. My internship focused on data management, ensuring our ability to evaluate the important service Senior PHARMAssist provides to the Durham community. In my tenure at Senior PHARMAssist, I was able to address data management issues in several ways, namely data collection, data entry and data analysis. An evaluation of the content of the interviews revealed a need for some revision of the client interview. Certain changes were implemented and new questions were added. This informative and important data set will now be able to answer even more questions about the pharmaceutical and health concerns of Durham's senior citizens, and measure the different ways Senior PHARMAssist helps our clients. In order to evaluate the program, more data needed to be entered into the computer. I organized a system for organized data entry and developed a training manual for volunteers. I was also involved with evaluation of the program. I am co-author on a manuscript that is being submitted to for publication. The article is an evaluation of the program after one year. Changes in medication adherence, knowledge about medications, adverse events, inpatient hospital stays and emergency room visits after one year in the program are tested and discussed. In addition to my duties with data management, I have been able to observe and participate in the daily activities of a non-profit organization. With the recent federal attention toward a Medicare prescription benefit program, programs like Senior PHARMAssist provide a good model for the benefits of combining access and education. We do help clients pay for medications, providing access, but we also ensure that they understand their medication regimen and what steps they need to take to stay healthy. Working at Senior PHARMAssist has also taught me valuable lessons that I will bring to my career as a clinical psychologist. I am more sensitized to the fact that people's medications can have significant side effects which may be impacting their well-being. Also, though nearly 30% of the clients report a diagnosis of depression, very few of our depressed clients are using psychotherapy or other non-pharmaceutical interventions for treatment. This is a population that mental health care professionals must inform about options. Finally, I value the efforts that community programs like Senior PHARMAssist make in providing for the needs of the elderly, particularly those with limited incomes, and am determined to address the needs of this community in my own career.
Duke Leadership in an Aging Society Program presents GLAXO WELLCOME LTC CAREER DEVELOPMENT AWARDS 1999-2000 AWARD RECIPIENTS Scott Lynch, Sociology Time-Varying Effects of SES on Health: Age & Cohort Differences in the Education-Health Relationship. Scott Lynch's dissertation level research will address the temporal dimension of the relationship between SES and health. He will simultaneously model age and cohort differences in the relationship between education and health by employing structural equation modeling techniques and using multiple longitudinal datasets. D. Todd Rose, Medicine/Public Policy Effects of Patient Education Information on Hip Replacement Surgery Outcomes. Outcomes research will examine the effects of an informational videotape on the length of time in hospital, length of time in rehabilitation and inpatient expense following total hip replacement surgery. Suzanne Strulowitz, Sociology Effects of Informal AIDS Caregiving on Caregiver Social Networks and Health. For this dissertation level project, the focus will be on the effects of caregiving for a person with AIDS on the caregiver's health. The study will address the unique aspects of AIDS caregiving, particularly for southeastern caregivers, who, pilot research indicates, are frequently female, over 55 and African American. Christine Vitt, Clinical Psychology Compliance of Type II Diabetes Patients with Preprandial Medication Schedules. This research project will assess factors related to noncompliance to a recently developed oral medication for diabetes and develop an intervention to enhance compliance. The Duke Leadership in an Aging Society Program: A Profile of Student Participants at the End of Six Years During the first six years of the Leadership in an Aging Society Program, 84 students were placed in mentored internships and 30 received Glaxo Wellcome career development awards for young researchers. From a comprehensive survey of alumni in the Summer of 1999 and continuing contacts with them, the following profile emerges:
Pat Capehart, Senior Leader '97 . Capehart, Patricia J. "Recruitment and Retention of Nursing Assistants: Community Perspectives on a National Issue." Duke LTC Occasional Policy Paper Series, July 1999, Paper Number 9. Heather Altman, Intern '98 . Altman, Heather K. "The Rise and Fall of National and North Carolina Policies Addressing Medication Access for Older Adults." North Carolina Medical Journal, July/August 1999, Volume 60, Number 4, 198-202. Julie Prince Bell, Intern '97, '98, . Bell, Julie Prince and Sandy Crawford Leak. "The Aging at Home Program: A successful Partnership in Caring." Duke LTC Occasional Policy Paper Series, July 1999, Paper Number 8. Christina Neill, Intern '98, . Neill, C.M. and A. Kahn. "The Role of Personal spirituality and Religious Social Activity on the Life Satisfaction of Older Widowed women." Sex Roles, 1999, Volume 40, 319-329. Anne Barrett, Young Research '97, '98, and Scott Lynch, Young Research, '97, '99 . Barrett, Anne E. and Scott M. Lynch. "Caregiving Networks of the Elderly: Variation by Martial Status." Forthcoming in The Gerontologist. back to top |
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