nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 1
Innovating, Educating, & Caring for Older Adults: What the World Expects of Nurses!EILEEN M. SULLIVAN-MARX
DEAN & ERLINE PERKINS MCGRIFF PROFESSOR
1990 ANA Jessie M. Scott
Lecture Awardo Global
o Humanity & Health
o Caring
o Nurses owning
Profession/Practice
o Covenant with Society
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 2
1990 2015
Trajectory
o 1990
o Media Campaign for Nursing
o Outcomes based Nursing Research
o Evidence Based Practice
o Standardizing Education
o Diversity
o Address Nursing Shortage
o Anticipating New Settings
Futuristic Nursing Look
o What is attracting nurses to the profession and field?
o How do we continue to integrate the three major foci of our profession?
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 3
American Academy of Nursing
Edge Runners
Edge Runners
American Academy of Nursing
Aging in Place Initiative
RN care coordination saved $483 per month
Arkansas Aging Initiative
90% of seniors now have geriatric care within 60 miles
Living Independently For Elders
24 hours nurse led team care saves 15 cents per dollar
Making Transitional Care More Effective
Shorter hospital stays and less rehospitalization
Senior ASSIST
96% physician satisfaction; 46% decrease in ER visits
NICHE is in over 620 healthcare
organizations in 46 states, Canada,
Bermuda, and Singapore.
The NICHE Model
• Evidence Based
• Collaborative
• Promotes Innovation
• Measurable Impact
• Financially Sustainable
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 4
Nursing & ACA
Bundled Payment
Coordination of Care
Integrated Care
E Technology
Meaningful Use
Community Health Centers
Dual Eligibles
Increase Enrollees in Insurance
Who are the Dual Eligibles?
9.2 million individuals (2008) that are eligible for both
Medicare and Medicaid.
More likely to have mental illness, have limitations in
activities of daily living and multiple chronic conditions.
Few are served by coordinated care models and even
fewer are in integrated models that align Medicare and
Medicaid.
121 Based on 2006 data.
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 5
Our Current Health System
Wellness
Primary care
Home care
Long-term care
Acute care
Flip Pyramid to Transform
Health
Acute care
Long-term care
Home care
Management of chronic illness and care coordination
Health promotion; wellness; primary care
AAMC, 2010
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 6
Four Key Messages
#1) Nurses should be able to practice to full
extent of their education and training
• Remove scope-of-practice barriers
• Implement nurse residency programs
Recommendations:
Four Key Messages
#2) Nurses should achieve higher levels of education and training through an improved education system that
promotes seamless academic progression
• Increase proportion of nurses with BSN degree to 80% by 2020
•Double the number of nurses with a doctorate by 2020
•Ensure that nurses engage in lifelong learning
Recommendations:
Four Key Messages
#3) Nurses should be full partners with physicians
and others in redesigning U.S. health care
• Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
• Prepare and enable nurses to lead change to advance health
Recommendations:
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 7
Four Key Messages
#4) Effective workforce planning and policy-making require better data collection and an
information infrastructure
• Build an improved infrastructure to collect and analyze health care workforce data
Recommendations:
U. S. Registered Nurses
3,063,163 RNs; 5.3% increase from 2004
884 per 100,000 persons
Most employed in hospitals
8% with advanced degrees
51% with BSN
88.4% white, 94.3% women
Projected rate of employment
change by major occupationalgroup, 2012‐22
Health care support occupations will
grow by 28% - top category in growth
Health care practitioners and
technical occupations will grow by
21.5% - second category in growth
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 8
What We Can’t Ignore?
Nursing is the Most Trusted Profession
US Bureau of Labor Statistics
2012-2022 Projected Job Openings
Home Health Aide (48% growth)
Less than high school, short OTJ training
Registered Nurses (19.4%)
Associate degree, no OTJ training
Why NICHE is so relevant?
Can address the gap between nurses
care at the top level and entry level at
the point of care delivery
It is embraced by healthsystem
executives and managers who are
responsible for care and stymied by
the need to have advanced nurses
and front line excellent care providers
nicheprogram.org • 2015 Annual NICHE Conference • Innovation Through Leadership 9
Conclusion/Challenge
Elder Care Across Transitional Settings
Meaningful Use
Complex Chronicity – Function – Time
Individualized Care v. Big Data