WELCOME GRN’s !!! The GRN Program this year will be live at times and pre-recorded at other times. We will be “toggling” between the two at times. We ask for your patience. If you have questions during any pre- recorded presentations, please write them down so you can type them into the “chat” box during the live part of the presentation that will follow all pre-recorded sessions! Thank you! 1

WELCOME!!! To all community nurse participants 2

Thank you To all the presenters who are contributing so much time, passion, and energy to make this an excellent training series. To all the participants, who care deeply about the older persons living in their communities. 3

Geriatric Resource Nurse Training for Community Nurses Sponsored by the Penn State Site of the Geriatric Education Center of Pennsylvania Consortium (GEC/PA) (Penn State University, University of Pittsburgh, & UPMC) in collaboration with the Penn State College of Medicine and the Pennsylvania Behavioral Health and Aging Coalition Principal Investigator: Melissa Hardy, PhD Project Coordinator: Carol Hancock Gold, PhD in the Center for Healthy Aging at Penn State 4

Project Support “This project is supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number # UB4HP “Geriatric Education Center of Pennsylvania”. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS, or the U.S. Government.” 5

Presenters in this Training Series Noel Ballentine, MD Jordan Bicher, DPT Kimberly Keefer, Pharm.D. Lynne Nessel, MSW, LCSW Nicole Osevala, MD Linda Shumaker, RN - BC, MA 6

Responsibilities of Participants You must participate in all 8 trainings in the series. Partial credits cannot be awarded. You have been asked to complete a survey of Demographic information prior to your participation in the first training. This is to meet one of the requirements of our funder for this project. You have been ed a copy of the “Informed Consent Form for Social Science Research”. Please make sure you read this information in regards to your participation in this project. 7

Responsibilities of Participants (cont.) You will be ed the PowerPoint presentation and case on the Wednesday prior to each training date. You will be ed a link to the post-test after each training has concluded. Within that link will be an attestation of having attended the complete webinar for that day you will need to complete with your RN license #. This link will also include an evaluation of that session which also must be completed. These must be completed no later than midnight the Wednesday after each training. 8

Responsibilities of Participants (cont.) You will not be awarded your PSNA certificate unless you complete all of the requirements for the webinars: Demographic Form Attestation after each webinar Post-test after each webinar Evaluation of each webinar 9

Introduction to Geriatric Resource Nurse Training Series for Community Nurses Linda Shumaker, RN-BC, MA Outreach Coordinator Pennsylvania Behavioral Health and Aging Coalition 10

Aging of America…  Those 65 and older represent the fastest growing age group in America.  Growth will be from 12% to 21% of the population by 2030 –estimated 70.1 million.  Rapid growth is expected to occur among the oldest & frailest population groups.  More diverse racially and ethnically  Will live longer  Will have multiple complex health problems  Need for the inter-professional team model!!! 11

Aging of Pennsylvania  Fifth highest aging population in the country  One of the highest population of rural aged  The number of rural elderly is increasing faster than in the urban areas.  By 2020 the elderly population in PA is expected to be approximately 3 million – more than one in four Pennsylvanians will be classified as elderly an increased of more than 50 percent.  The number of oldest old is projected to continue rising in PA more than in the nation as whole.

Aging of America  Supply of healthcare workers does not address current demand and will fall short of the expected increase of demand.  The vast majority of health professionals have little geriatric training:  4% of social workers  Less than 1% of physician assistants  Less than 1% of registered nurses  Less that 1% of pharmacists  Dramatic increases in the number of geriatric specialists are needed in ALL health professions.

Aging of America Institute of Medicine concludes that “the nation faces an impending healthcare crisis as the number of older patients with more complex health needs increasingly outpaces the number of healthcare providers with the knowledge and skills to adequately care for them.”

“All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.” IOM 2003 Report – Health Professions: A Bridge to Quality

 In today’s health care system, services for elderly patients are often delivered by many different providers with little or no coordination among the various professions represented at the patient’s side.  While health professionals are expected to work in inter-professional teams, they are trained in the silos of their respective schools and programs.

Barriers to Care!

Patient / Family Barriers  Isolation  Ageism – belief that depression, confusion are normal conditions of aging  Preference of primary care  Focus on somatic complaints  Stigma  Reluctance to discuss psychological symptoms  Lack of / misinformation

Provider Barriers  Ageism – “normal aging” stereotypes  Training barriers – silos of professional disciplines  Focus on “medical issues”  Lack of awareness of “geriatric-specific” clinical symptoms  Complexity of health problems & treatment issues  Reluctance to inform patients of diagnosis  Lack of access to behavioral health care  Lack of information / misinformation

System Barriers  Fragmentation  Inter-system boundaries  e.g. Exclusion of dementia from many community mental health programs  Time constraints  Lack of access to geriatric specific services/ treatment  Reimbursement issues – including a mismatch between covered services and a changing system of long-term and community-based care  Cultural diversity needs

Geriatric Resource Nurse: Key Position  Provides and communicates standards for best, evidence-based care for older adults  Assists with strategies for identifying older adults at risk of decline  Assists with assessing the development of symptoms related to geriatric issues  Coordinates team-based techniques for care across health professions  Connects service providers and links community services 21

Geriatric Resource Nurse: Key Position (cont.)  Team Leaders in their communities with the knowledge and skills to address the multiple needs of older people  Leaders of community-based Inter- professionals in delivering care to community- residing older adults  Educators across all levels of the community  Professionals  Service providers  Family members  Older adults  The “Community” itself

Addressing Physical and Behavioral Health Needs of Older Adults  Inter-professional approach  Consumer input  Stakeholder-generated principles – CSP/CASSP  Culturally competent  All levels of interagency collaboration  Work toward the aim of dispelling stigma  Integration at the community level  Continuum of care from prevention to treatment SAMHSA Strategic plan Substance Abuse and Mental Health Issues facing Older Adults

Need for Inter-professional Approach  The challenges associated with aging, physical illness, increasing infirmity, dependency and limited financial resources place the older adult at high risk for behavioral health issues.  Proactively addressing these issues requires that we attempt to intervene at the community level, in order to prevent the older adult from having to be hospitalized or transferred to a nursing home for extended care. 24

Need for Inter-professional Approach (cont.)  No single service agency has the skills and resources to effectively address all areas of need.  Successful intervention requires a comprehensive and coordinated system of care! 25

Need for Inter-professional Approach (cont.)  Effective and adequate treatment requires a inter-disciplinary approach that will address the multiple needs of persons as they age and decline in physical, cognitive, and emotional ways.  More emphasis needs to be placed on the importance of cooperation and mutual respect among the professional and lay care- givers, and integration of the various levels and types of care.

Roles of Geriatric Resource Nurse: Key Points  Assess individual needs for community resources  Explore options with client and family  Take a multi-faceted approach  Foster partnerships between agencies  Give support and information to providers throughout referral process  Ensure follow-up across systems  Build inter-professional linkages in the community!

Each week, links of the presentations, instructions for joining the webinar, and the post test will all be posted to the same website: Please check that site each Friday for the instructions to join the webinar and each Monday after the webinar for a link to the posttest. A link to this site will also be ed each Friday and Monday.