NEW MODELS OF CARING W. Daniel Hale, Ph.D. Professor of Psychology, Stetson University Adjunct Associate Professor of Medicine Johns Hopkins School of Medicine Special Advisor Office of the President Johns Hopkins Bayview Medical Center (starting June 27, 2011)

The Future of Health Care Health care challenges that need to be addressed. Aging society/chronic conditions Health disparities Access

Demographic Imperative United States Population 65 years of age or older – 13 % – 20 % (projection)

Demographic Imperative Volusia County 1992 Population – 375, years of age or older – >20%

Increase In Chronic Conditions 87% of 65+ have at least one chronic condition 67% of 65+ have two or more chronic conditions Chronic Conditions: Making the Case for Ongoing Care Partnership for Solutions Johns Hopkins University and the Robert Wood Johnson Foundation

Chronic Diseases More than 133 million Americans live with at least one chronic condition Approximately half of these have multiple chronic conditions 160 million by million by 2030 Anderson 2007

People with chronic conditions account for … 90 percent of all prescription drugs used 80 percent of all inpatient hospital stays 75 percent of all visits to physicians 85 percent of all health care expenditures Anderson 2007 Chronic diseases are the leading cause of mortality, accounting for seven out of every ten deaths. Partnership to Fight Chronic Disease 2008

Health Care for Chronic Conditions Where is most health care provided? Who delivers most health care? Examples: Glaucoma Diabetes Mellitus

The data … suggest that care provided in the current acute, episodic model is not cost-effective and often leads to poor outcomes for patients with chronic conditions. … chronic conditions require continuous care and coordination across health care settings and providers. Chronic Conditions: Making the Case for Ongoing Care Partnership for Solutions Johns Hopkins University and the Robert Wood Johnson Foundation

We can find solutions by developing better connections between supportive and clinical care delivery systems. … we can find solutions by encouraging and supporting patient self-management and family caregiving. Chronic Conditions: Making the Case for Ongoing Care Partnership for Solutions Johns Hopkins University and the Robert Wood Johnson Foundation

Partner with religious congregations … “ Faith communities in which people worship together are arguably the single most important repository of social capital in America. ” Bowling Alone: The Collapse and Revival of American Community Robert Putnam, Ph.D.

Partner with religious congregations … “ In one survey of twenty-two different types of voluntary associations, from hobby groups to professional associations to veterans groups to self-help groups to sports clubs to service clubs, it was membership in religious groups that was most closely associated with other forms of civic involvement, like voting, jury service, community projects, talking with neighbors, and giving to charity. ” Bowling Alone: The Collapse and Revival of American Community Robert Putnam, Ph.D.

Partner with religious congregations … “… religiously involved people seem simply to know more people. One intriguing survey … found that religious attendance was the most powerful predictor of the number of one ’ s daily personal encounters. Regular church attendees reported talking with 40 percent more people in the course of the day. ” Bowling Alone: The Collapse and Revival of American Community Robert Putnam, Ph.D.

14 The Gerontologist, Vol. 37, No Hospital and physician leaders supported program. Clergy championed congregation-based health education. Committed and energetic lay leaders could be identified and trained. Self-sustaining programs were established.

The Plan Train 12 “ Lay Health Educators ” (expect attrition, so start with 20 – 25) Recruit these volunteers from religious congregations Medical professionals would provide instruction and materials Lay health educators and medical professionals would conduct programs

Started recruiting – 22 were in our first set of classes Classes held at Halifax Medical Center in Daytona Beach Ended with 25 ( “ reverse attrition ” ) Two more sets of classes were offered Total of 59 volunteers trained as lay health educators

The Gerontologist, Vol. 43, No. 6, Showed that a national sample of clergy and laity would be amenable to partnering. Identified areas of most interest: Health-related classes Screenings Preventive interventions, e.g., vaccinations

SURVEY OF LAITY Sample = 524 2/3 ’ s of sample from 5 denominations –Baptist (19%) –Methodist (17%) –Presbyterian (12%) –Catholic (11%) –Lutheran (10%) Hale & Bennett, 2003 The Gerontologist

SURVEY OF LAITY Would you like to have health programs in your congregation? Yes = 85% Are there individuals who would assist? Yes = 84% Would you be willing to assist? Yes = 45%

SURVEY OF LAITY Stress management – 56% Alzheimer ’ s disease – 53% Cancer – 51% Heart disease – 48% Depression – 48% CPR – 47% Advance directives – 45% Arthritis – 40% Diabetes – 38%

SURVEY OF LAITY Health screenings (e.g., blood pressure) Yes = 78% Preventive measures ( e.g., flu vaccinations ) Yes = 74% Exercise programs Yes = 80% Support groups Yes = 82%

“This book literally has the potential to save lives.” Book and Media Reviews. JAMA 2009; 302:1911

JHBMC Healthy Community Partnership P romotes community health. Engages community leaders. Addresses health disparity. Improves health and lives of our neighbors. 23

Dr. Burton was right!