In a blog entry months ago, I wrote about how Baby Boomer women–and creating a new “careforce”–are critical for healthcare reform to succeed. And I promised back then to put out some ideas the following week for creative ways to grow that innovative workforce. Okay, I got sidetracked on other topics and missed my own deadline. But as the President must surely be rehearsing his State of the Union address for tomorrow–that will probably include lots of talk about “jobs creation”–I think it’s high time to revisit those questions and ideas. Many opponents of healthcare reform keep telling the President to drop his “healthcare agenda” in favor of a “jobs agenda,” but to me, those two agendas are deeply intertwined.
So here are the questions I posed some time ago. What are we doing in healthcare reform to support, sustain, and enhance the abilities of the often invisible, informal careforce–especially women, who as wives, daughters, daughters-in-law, friends, and neighbors, serve on the front lines of care–to deliver better quality care at reduced financial and emotional costs? How can we further offload the expensive, institutional care settings and professionals by training and skill-shifting to families, friends, and patients themselves who have to become trusted partners on care coordination teams? How are we retraining medical professionals to use new technologies and to build new relationships with this informal careforce to achieve better outcomes for more patients? Who will make up the careforce of the 21st century that anticipates the age wave and caregiving crisis we face?
Here are five ideas that begin to address these big questions:
1) Proactive Patients: We as patients have to become more knowledgeable, responsible, empowered, and proactive about our own healthcare. We cannot sustain our current passive, entitled patient paradigm–what I think of as the Humpty Dumpty syndrome–where we wait until we’re sick or injured and then run to the clinic or hospital to be put back together again by the experts with the expectation of “any means necessary” and “every test available” and “any cost required” to make us better again. We need to catalyze an industry of self-care technologies and services that put some of the onus of health back on patients, to grow the use of Personal Health Records (PHRs) and wellness applications that help people achieve their goals, and to push for cost transparency of tests and procedures so that we as consumers can know the ROI and outcomes of what we’re putting our bodies (and health plans) through. We need to majorly rethink and revamp those dreaded junior high school health classes to make them useful in instilling a foundation of good habits for healthy living while we are young. Health literacy, like all languages, is probably best learned at a young age…so let’s figure out the curriculum to mint hundreds of thousands proactive patients who become an important, unpaid part of the careforce of the future.
2) More Nurses and Doctors: Frankly, we need more physicians and nurses to meet the needs of the age wave, especially those trained in geriatric medicine and primary care. There have been numerous Congressional hearings on this topic, and the problem is well understood, but the solutions have not been forthcoming. First, we need to strive to retain the people who are already working in the healthcare industry. We are burning out our workforce of clinicians with bureaucracy and paperwork and somehow have to get trained medical professionals focused on bedside care and patient needs again. Healthcare reform needs to drive Care Flexibility, where we diversify the locations and models of care to allow physicians and nurses the flexibility to engage with patients in the clinic, in the home, and virtually via electronic means, depending on the need and their best professional judgment. Second, we need to accelerate new students going into healthcare fields. If healthcare reform is able to achieve a “quality over quantity” payment paradigm, this will help pull more folks back into healthcare fields, who have been reluctant to join–or have left–because of today’s “factory line” care paradigm that leaves no one–neither patients nor clinicians–satisfied. Congress needs to implement many of the student loan and debt relief programs for medical and nursing school programs they have reviewed over the years. Perhaps it is time to create “AmeriCorps for Care” or the “Care Corps” for incentivizing new students to go into these fields with service to their country in “trouble spots” or “gap areas” of healthcare to pay back their medical school debts.
3) Empowered Informal Caregivers: Informal caregivers–the family and friends who do the lion’s share of care in America–are key to developing a sustainable, quality healthcare system for all. No matter how proactive we make patients themselves, no matter how much preventive care we do, no matter how many new doctors and nurses we train, it is not likely we can “catch up” with the age wave. We have to train, sustain, and reward informal caregivers to be fundamental participants on Care Coordination teams going forward. Too often today, the medical mainframe treats the family and friends as a “nuisance” who have to be “dealt with” instead of a “resource” who should be “empowered” to offload the formal healthcare system. We need to explore tax credits or other kinds of financial assistance for people who are delivering significant informal care today. We need to explore special mechanisms whereby family caregivers can maintain affordable health insurance for themselves, if they are focused to go part-time or quit their job to care for a loved one. We must develop community health and other kinds of education programs for informal caregivers that explicitly skill-shift some of the chronic care duties that nurses do to these friends and family members who will be on the front lines of care–at the bedside at home–more than anyone else.
4) Retirees and Volunteers: We have an enormous opportunity to build new volunteer programs that help trained volunteers deliver care support for complete strangers who live in their neighborhoods–or even thousands of miles away via telehealth technologies. Imagine tapping into the national pool of retirees who are already trained in healthcare, either as retired doctors or nurses, who are a largely untapped resource in America. Many of these professionals would like to go back to work part-time, especially if they could work out of their homes and/or have flexible hours. We have the technological capability to put many of those retirees back to work, either as volunteers or part-time employees, to meet care needs in the community. And we need new ideas and programs that instruct and empower retirees who have no formal medical training to learn enough of chronic care management to help frail seniors and other co-morbid patients to thrive in their own homes. Again, I like the idea of a “Care Corps” to help train these volunteers to provide in-home and virtual care for others. Think of this as “Neighborhood Watch” with some telehealth technologies combined with Facebook and Google Maps where you can volunteer–and get a tax deduction for your time–to use a PHR dashboard to help care remotely for 10 seniors who live in your neighborhood. Or I am reminded of the great exploratory program that Dr. Arthur Garson, Provost of the University of Virginia, is doing to train “grandparent” age citizens to do basic chronic care management for other seniors in their community. My point is that there are probably millions of retiring Baby Boomers who are ready to “give back” in whatever ways they can; we need to tap into this disruptive demography with disruptive technologies that provide them innovative ways to do that kind of volunteer work.
5) New Kinds of Virtual Care Providers: We cannot achieve universal coverage and quality care for all Americans if we continue to make an in-clinic or in-hospital visit the default care location for every kind of health encounter. There are enormous opportunities to use telehealth technologies to shift the locus of care–perhaps even as much as 50% of the care that is done in institutions today–to the home and community. But to achieve such an audacious goal, we have to invent some entirely new categories of healthcare workers that we may not have even conceptualized yet. We need new curriculums, new credentialing mechanisms, and new national licensure rules to formally train a workforce of telehealth nurses and telehealth physicians who know how to deliver great quality virtual care for a wide range of care needs. But we also need to invent some entirely new kinds of non-clinical jobs, think of these as “Care Coaches,” who are trained in a mix of social work, clinical informatics, IT (information technologies), and nursing skills to offload clinical staff with the many quality-of-life and non-urgent needs and services that seniors and other chronic patients have on a daily basis. Today we’re stuck in a “clinical mentality” that tries to preserve power and authority in highly trained (and sometimes but not always highly paid) professionals; we need to open up our thinking about the new care models that are occur in the home and community and then figure out what staffing paradigms and training can deliver upon those models.
It’s unclear to me whether or not the federal government can even generate new jobs quickly without just hiring more people to work in government (see Time’s article that makes this point quite well). I suspect government’s role in job creation is in longer term stimulation–in creating the conditions in which new innovations and industries in the private sector can thrive. But it is clear to me that the President and Congress need to tackle Global Aging–our other inconvenient truth–and “careforce creation” initiatives with the same focus and intensity that they have brought to Global Warming and “green jobs” initiatives. If done right, healthcare reform ought to generate new industries and jobs, especially when we add millions of formerly uninsured people to the system.
I well realize that change can be frightening, that skill-shifting aspects of care from physicians to nurses to family members can be threatening to many people. Yes, we’ve seen many battles over the years between doctors and nurses on who gets to prescribe medications…or conflicts between nurses and CNAs about who can provide which level of patient care in which care setting. Yes, there are risks anytime we change best practices, retrain staff, or bring novices onto the care coordination team. Yes, there is some danger that we will create rare cases of fraud and abuse as we shift care to the home and community. But the bigger threats are that we fail to prepare a careforce to meet the needs of 21st century healthcare…and that we miss the opportunity to grow new jobs and industries that put America at the forefront of a new healthcare paradigm needed not just here at home but across the world.