Building Systemic Health Equity for Geriatric Patients

Oct 13, 2024 | Articles, Doing the Work, Justice, Equity, Diversity & Inclusion, Leadership

“The best thing about living … is the chance to keep on doing it!” — Lena Horne

 By Joleen Lonigan

Health care organizations continue to face challenges to provide quality care in the face of the increasing barriers that many of our patients confront daily.  The barriers continue to emerge since the COVID-19 pandemic, more so for our geriatric patient population and even more so for elderly minorities.  The isolation our geriatric population experienced only highlighted the social and medical fragility of the population. The percentage of the elderly that need a higher level of care continues to rise as well as non-medical visits to the emergency room.  Health care organizations need to ensure health equity for their geriatric patients are embedded in their quality improvement and patient safety structure to promote a systematic versus an episodic approach.  

The initial step to level out health equity is to have an executive leadership that understands their community, the care they require and the health outcomes they have and have not achieved.  Such leadership can lead their organizations to make health equity a priority and sustain any change that is required through transformation efforts.  Such efforts include engaging geriatric clinical expertise in the care delivery team, such as Gerontologists and Geriatric Clinical Nurse Specialists, and developing structures for ongoing training to deliver culturally competent care for the geriatric patient population.  This includes exploring the issues that matter to our geriatric patients such as respect and dignity as well challenges with social justice and access to care.

It is a known fact that older patients are medically and socially frail and therefore, are high utilizers of the health care system for ambulatory and inpatient care as well as skilled nursing facilities.  Data also indicates that patients that receive care from nursing staff with geriatric education  are less likely to be restrained, experience less functional decline, delirium and ultimately, fewer hospital readmissions.  Health care organizations must recognize that the social issues faced by the geriatric population can have a significant impact on their health status as well as their access to care.  More older patients would prefer to age at home but lack resources for assistance at home.  They may be socially frail, lacking any type of family or social support, may not qualify for supplemental health care coverage and/or, simply cannot afford a private caregiver.  In the instances where they may have caregiver support, the caregiver may lack proper training on how to properly care for an elderly person with complex medical and social needs.  Thus, health care organizations may be instrumental in training their nursing and discharge planning staff to assess and identify the needs of the geriatric patient and any need for training their caregivers will require and should be included in the discharge plan.  It will be necessary for discharge planners to close the loop by ensuring the care needs of the patient have been met.  This can be an opportunity for health care leaders to strengthen their partnerships with ambulatory care centers via improved data sharing.

Beginning in 2025, hospitals that participate in Medicare’s Hospital Inpatient Quality Reporting (IQR) Program will be required to report on whether hospitals have protocols in place to: 1) elicit patient health care goals, 2) responsibly manage medications, 3) implement frailty screening and intervention (including for cognition and mobility), 4) assess social vulnerability (e.g. social isolation, caregiver stress, elder abuse) and 5) designate age-friendly leadership. This measure builds upon the 4Ms framework of nursing:  1) what Matters to the geriatric patient (i.e. goals and preferences), 2) Medications, 3) Mentation and 4) Mobility 

As our patient population ages and increases, we should also realize that it will affect our workforce.  It can be emotionally and physically draining to take care of elderly parents/family members when having to balance a career.  Health organization leaders can take steps to retain employees as well lower daily absenteeism by offering benefits such as on-demand caregiving and elder care leave.  Such investments will pay off given the cost of replacing employees.

Health care organizations can make a difference to reduce the health disparities faced by our geriatric patients.   They can designate leaders that prioritize health equity and that can ensure delivery of age-friendly care with adoption of a geriatric care models. This includes promoting education in geriatric care across health disciplines, mitigating and sustaining change in their organizations as well as being cognizant of their own employees’ needs.  By implementing initiatives to reduce health disparities, health care leaders can be a positive influence on both patient and employee satisfaction.

 

Joleen Lonigan, DNP, RN, N.E.-B.C., F.A.C.H.E., is Associate Chief Nursing Officer, Patient Care Services with UC Davis. She is a member of the American Nurses Association, American Organization of Nurse Executives, American College of Healthcare Executives, and California Association of Healthcare Leaders. Joleen was an active board member of CAHL from 2017-2020 and remains a member of the Clinical Leaders Council post her board activity. She was invited to serve on the regional ACHE RAC in 2023-2024.

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