robert blancato executive director, national association of nutrition and aging services programs...
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Aging Patients, Nutrition and Caregiving
Robert BlancatoExecutive Director,
National Association of Nutrition and Aging Services Programs (NANASP)
March 29, 2014
Aging in America and the Hispanic population
ACANutrition and health outcomesCaregivingSolutions
Today’s Discussion Includes…
• The Hispanic older population (65+) was 2.7 million in 2008 and is projected to grow to over 17 million by 2050. • In 2008, Hispanic persons made up 6.8 percent of the older population…• But, by 2050, Hispanic persons are projected to account for 19.8 percent of the older population. • By 2019, Hispanic persons are projected to be the largest racial/ethnic minority in this age group.
Key focus on prevention as well as covering the uninsured
All of these are covered for free under the ACA with any insurance plan:◦ Blood pressure screening◦ Cholesterol screening◦ Type 2 diabetes screening◦ Diet counseling◦ Obesity screening and counseling
“Welcome to Medicare” free preventive health screening Lowering hospital readmissions/care transitions Other delivery system reforms/ ACO’s bundled payments Health homes
Affordable Care Act
More than pop culture’s counting of calories and fat grams
It’s about everything we consume – and don’t consume – and the energy it provides
Also about how diseases, conditions, and overall health can be affected by what we eat
In short, “the cornerstone of preventive medicine, the handmaiden of curative medicine, and the responsibility of every physician”
What is Nutrition?
87% of all seniors have diabetes, hypertension, high cholesterol and/or some combination of these
These diseases are costly to our health system and also predispose for nursing home placement
These 3 chronic diseases all can be managed with nutrition interventions and without expensive medical treatment in many cases
Nutrition and Chronic Disease
MALNUTRITION RISK FOR PATIENTS WITH CHF, CANCER, AND COPD IS OVER 40%
MALNUTRITION PREVALENCE INCREASES WITH AGE
MalnutritionRisk
CHF50%
Cancer43.8%
GI Cancer47.5%
COPD58.5%
Colorectal Cancer38.9%
Incr
easi
ng M
alnu
triti
on
• Age > 8034%
• Age 60-7927%
• Age <6025%
Malnutrition is Prevalent Among Older Adults and Those with Chronic Conditions
The Problem Malnutrition not routinely recognized/treated as standard of
medical care Patients often poorly nourished on hospital admission◦ Not provided aggressive nutrition therapy during hospital stay◦ Discharged into community still poorly nourished/at risk for
poor nutrition, without an adequate plan for nutritional care The Result Healthcare systems likely have poorer patient health outcomes &
increased readmissions because of lack of attention to/treatment of malnutrition
Increased Chronic Disease Means More Patients at Risk of Malnutrition
Caregiving and long term care are interrelated and the challenge of the future
Less than 5 percent older adults in nursing homes 4 times as many need long term care services in homes
and community settings Movement away from long term care (institutional
care) to long term services and supports (home and community based care)
Family caregiving in center
Families: Our Nation’s Caregivers
In 2004, families 'donated’ more than a third of the nation’s overall spending on long-term elder care and contributed a significant amount of out-of-pocket funds:◦ In 2004, the total cost of long-term care services for the elderly,
including unpaid or ‘donated’ time, was $211.4 billion ◦ By 2011, some estimates had the total cost of long-term care
services for the elderly exploding to $450 billion dollars annually
Elder Caregiving is Expensive
Info received by family caregivers during patient’s hospitalization documented:
◦ 76%: no information on activities patient could do◦ 70%: no info re: foods patient could eat◦ 75%: no info on when to return to hospital if patient
experienced problems post-discharge◦ 80%: no info on likely complications to watch for
Conclusion: ◦ Family caregivers receive very little info from health
professionals about patient’s care at home
Many Caregivers Are Ill-Equipped to Provide Complex Healthcare
Transition from one source of care to another brings high risk for communication failures, procedural errors, and unimplemented plans 36% of family caregivers perform medical/nursing tasks for care recipients
with multiple chronic physical/cognitive conditions Adults may spend more years caring for their parents than for their
children
Care Transitions Remain Problematic
29% of older adults have a below basic health literacy level Among all ages, more than half of prescription drugs are not
taken properly 41% of Latino adults lack basic health literacy Linguistic and cultural barriers contribute to health disparities Need national effort to:◦ Help patients and caregivers make appropriate health decisions.◦ Become more culturally and linguistically competent. ◦ Create bilingual materials with straightforward messages.◦ Communicate more effectively with patients and their families.◦ Focus on at-risk populations who come in frequent contact with
the healthcare system because of increased rates of chronic diseases.
Health Literacy Solutions
Hospital Standards◦ Include nutrition screening/ therapeutic nutrition
intervention in hospital licensure requirements, hospital rating/comparison measures
◦Develop a “good nutrition” seal of approval programTransitions of Care and Other Care
Models◦ Include nutrition screening/therapeutic nutrition
intervention in state healthcare quality initiatives and care models
Standards and Models Solutions
Employer Caregiver TOOLKIT: Focus on Therapeutic Nutrition
◦New online workplace TOOLKIT to help employers set up successful therapeutic nutrition programs
◦ Provides employers with free, practical & high-quality tools/resources so all industries can find solutions to support working caregivers & mature workers with their therapeutic nutrition needs
◦Available free of charge at: http://familiesandwork.org/nutrition-toolkit
Employer-Based Solutions
In ACA implementation work, place distinct emphasis on including nutrition (i.e., meals, oral nutrition supplements, education, screening) in relevant grants such as care transitions
◦ No future grants should be provided to models without nutrition included
◦ Further advocacy on nutrition screening/therapeutic nutrition intervention in essential benefit language
Place greater emphasis on malnutrition in health policy priorities
Policy Solutions
Nutrition is the largest program in the Act◦ Links between nutrition and health need to be made stronger◦ “Utilize” vs. “solicit” the advice of registered dietitians in Senate bill and newest
House bill Add screening as an element of nutrition education Address complex nutrition needs
◦ Allow states more flexibility to provide therapeutic nutrition oral supplements in addition to, not just as a replacement for, regular meals
Make the Nutrition Resource Center permanent Bolster National Family Caregiver Support program under
OAA◦ Promote stronger education and awareness around health care, malnutrition
and its consequences Formalize link between nutrition, caregiving, and
business through the OAA
Older Americans Act Reauthorization
Invest in better data collection◦ Demonstrate the value of nutrition in saving Medicare and Medicaid
dollars Explore expansion of medical nutrition therapy under
Medicare◦ Evaluate its impact to date
Ensure that all discussions of long term care include nutrition◦ Build long term services and supports around nutrition
Cover nutrition screening and therapeutic nutrition intervention under private long term care insurance
White House Conference on Aging in 2015 with nutrition as a focus
White House Summit on Working Families in June
Other Priorities
Affordable Care Act turned 4 on March 20 Impact still being assessed One enduring feature is focus on prevention, and
improved health outcomes through system reforms Health long term care and social policies of future must
recognize and achieve cultural competency America is aging but America is not aged Recognize we are an intergenerational nation and build
policies and programs accordingly Maintain the role of government to help vulnerable of all
ages
Conclusion