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