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

Solutions

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