Since 1982, The John A. Hartford Foundation has been a national leader in raising awareness and improving health care for older adults. In this conversation, Rani Snyder, vice president, Program at The John A. Hartford Foundation, discusses the importance of Action Communities in age-friendly care, and why health organizations should use the tools they provide to build exceptional care frameworks.

Tom Haederle

Tom Haederle

Raahat Ansari

Thank you so much for being here with us today, Rani, and having worked with you and the John A. Hartford Foundation for many years, I would love for you to tell our listeners today a little bit about the vision and how this work got started.

Rani E. Snyder

Rani E. Snyder

Our current president, Terry Fulmer, came in about nine years ago. She brought me in shortly thereafter as the vice president for program, and she was really charged to move the needle. We built all this expertise, all these fantastic innovations, and they weren't spreading the way we really wanted to see them spread for the growing number of older adults in our country.

Raahat Ansari

Interesting. We know there's a lot of work that needs to be done, but not enough happening to make it move.

Rani E. Snyder

That's exactly right. So there was sort of a frustration on our part, because we had been in the field for all those years. You know, we celebrate longevity apparently also in our funding. There's a frustration with that know-do gap that exists when it comes to the best possible care for older people. So, we understood at that point that we needed to determine how to go big.

Rani E. Snyder

We understood that the way to do that is to build on collaboration and partnerships. And so we partnered with the Institute for Health Care Improvement. We partnered with the American Hospital Association and health systems themselves, in addition to the creators, the real leaders, of creating those evidence-based models and innovations to come up with what we now call age-friendly health systems.

Raahat Ansari

Thank you. That is so amazing to hear, and it's always rejuvenating to hear how this work started and the importance of it, because we all know that this work is just so important. And, you know, one little anecdote that I'll just share is hearing from people participating in our action communities. Everybody knows someone who's getting older. Everyone cares about someone who's getting older and is getting older themselves.

Raahat Ansari

So I think that's one other really big driver of this work that people will find a real connection to it. So, with that being said, the AHA has an Action Community coming up in September, and we're looking for folks to join us in that seven-month-long virtual Action Community. But I'd love to hear from you. Tell us, what's the selling point?

Raahat Ansari

Why should an organization participate in the Action Community? What's the opportunity for them there?

Rani E. Snyder

Absolutely. And I'm going to start by stepping a little, a half step back to say what an Action Community is. So, an Action Community is a seven-month process by which a health system can learn how to implement age-friendly health systems care in their system, in any given site of care, whether it's a hospital or clinic or a nursing home.

Rani E. Snyder

So, we sometimes get a laugh out of the fact that it's free. The Action Community is free to join the community, but guess what? It's not really free.

Raahat Ansari

That's so true.

Rani E. Snyder

It's underwritten by the John A. Hartford Foundation, because we feel so passionately that this kind of care that is best care, best evidence-based care for older adults at any site of care, from the kitchen table to anywhere they go for their care and then back home again, wherever home may be, that we are willing to underwrite the cost.

Rani E. Snyder

So, I would say to any health system that is considering the increasing number of older adults and some of the difficulties that come with best care for people who have oftentimes multiple and chronic complex needs. Don't leave that money on the table. We're putting it up, so they should really take advantage of this opportunity. And that's just one of the reasons; there are a whole host of reasons.

Rani E. Snyder

Some of the others include the fact that there's really powerful peer-to-peer learning in the action communities, because there are teams from other sites of care and other health systems all across the country that sign up for an Action Community. There often are over 100 different individual units, team units, that are doing this work, and that's really cool.

Rani E. Snyder

Also, there are a variety of other things that come with it. So, for example, there's coaching support along the way from, in this case, the American Hospital Association. But there are also Action Communities that are put on by the Institute for Health Care Improvement.

Raahat Ansari

That's right.

Rani E. Snyder

And others.

Raahat Ansari

State-based ones.

Rani E. Snyder

Absolutely. So, there are a lot of ways to go about it. And we, the John A. Hartford Foundation, don't particularly care where you join as long as you do. It's just that the AHA Action Community that's coming up is perfect timing.

Raahat Ansari

Exactly. It's all about the timing.

Rani E. Snyder

Absolutely, absolutely. The upcoming Action Community for AHA starts in September. So, the other thing I want to reference, though, with regard to why would you want to join an Action Community, why would you want to participate in age-friendly health care and the movement that it has become? It really comes down to outcomes, and this is what is really important to so many hospitals.

Rani E. Snyder

So, I'm going to speak across the board instead of citing a particular either site of care or health system.

Raahat Ansari

I'm sure that's impossible to do because there's so many hospitals that have such good outcomes. But yes, we'd love to hear a general, a general sense.

Rani E. Snyder

You are 100% right. 100% right. So, some of the kinds of outcomes we are hearing about are decreased length of stay. Do these sound like things that hospitals care about, decreased readmissions?

Raahat Ansari

Right.

Rani E. Snyder

The other one that's really interesting, and this is a little more anecdotal than some of the studies I've seen in individual sites, is we keep hearing of increased workforce satisfaction.

Raahat Ansari

That's amazing because it's so important right now to the field in terms of retention and safety and just being healthy, and especially with Covid and the long hours. That is amazing.

Rani E. Snyder

That's a winner right there. And we know it's something that hospitals and health systems everywhere are really aware of, really conscious and working on. And then there's this one really cool example of a health system that studied as a part of determining what the outcomes have been of their age-friendly health systems work, studied time given back to patients and families, in not having to go to extra appointments and not having to go for the readmissions, those kinds of things.

Raahat Ansari

Oh, that is so powerful. And that just gets back to the “what matters” of this, right? As a part of one of the 4Ms, how do you want to spend your time and what matters to you and that that is so huge that you've got some time back to do the things that you love.

Rani E. Snyder

Exactly. And to speak in sort of hospital parlance, you know, it's back to patient satisfaction. And that also matters very much to the, maybe not the bottom line; well, maybe the bottom line, but certainly to the reputational and other sort of assets of any health system organization.

Raahat Ansari

That's right. That's amazing. So, with the age-friendly health systems work, we at the AHA have been doing this for a little while now. And the AHA has released a new initiative called the Patient Safety Initiative. And as a part of that, we're learning that we can expand this, and we can bring in folks from all levels of the hospital leadership.

Raahat Ansari

And so, the one new area that we're looking into is including the board members. And how are you bringing them into the conversation? How are you leveraging their expertise and what they bring to the table? How are you leveraging that to advance the work of age-friendly within your organization? So, I know that you, congratulations, have recently become a committee member of the Mid Coast Hospital, which is part of MaineHealth, the elder and home care committee.

Raahat Ansari

So, I know that you've been recently appointed to that. Can you tell us a little bit about what your plan is and what you would recommend other trustees to do to ensure that their hospital and health system is bringing age-friendly care to their organization?

Rani E. Snyder

Absolutely. So, this is a hospital in my hometown, in my home state in Maine, Brunswick, Maine. And so I've joined this committee. And I think that it's really important as we're thinking about the numbers of older adults and the ways that we are serving them to ask the questions that both speak to the needs of a hospital or a health system.

Rani E. Snyder

And that comes down again to things like lowering costs, improving safety, improving quality and that also serve the patients. So, I'm actually feel really fortunate because the committee I just joined, the elder and home care committee, has even before I came, decided to take on age-friendly, health-systems-based care for their nursing home, and they were in the process of doing that work.

Raahat Ansari

Perfect timing. All about timing, right?

Rani E. Snyder

Exactly, exactly. So, I don't even have to push it. But I can ask the kinds of questions that raise these issues so that hospitals and health systems and fellow board members are aware that these resources are out there. I mean, if we're talking about hospitals, we're talking about age-friendly health systems, as well as some of the other initiatives that our foundation supports and that are very complementary and integrated with age-friendly health systems like geriatric ED care.

Rani E. Snyder

So, through the American College of Emergency Physicians and their accreditation for geriatrics EDs, or the American College of Surgeons Geriatric Surgery verification, which is another hospital-based program. So, if you're asking the kinds of questions that indicate that you're both looking at the bottom line, looking out for the hospital, but quite frankly aware of and understanding and pushing the importance of caring for the older people in that health system, you're basically it's a win-win or a win-win-win, It's a lot of wins.

Raahat Ansari

Right, everybody wins. And I think that's a fantastic answer. And in that answer, I actually think I heard a little bit about the last point that I want to take to make sure that we touch on. And again, we've been working together for many years now. And when we started this work, we were really focused on the inpatient setting, which made sense, and we had a lot of impact there.

Raahat Ansari

And I would just love for you to talk a little bit about how far we've come and the work that we still have left to do.

Rani E. Snyder

Absolutely. And I really want to give credit here to our president, Terry Fulmer. This is very much her baby. I will say I was there at the very first meeting, but I am not the driver on this one. It's been so exciting to see that the ways that this work has taken off, the fact that the 4Ms of best evidence-based care for older adults is something that really has a lot of traction with both clinicians and the public.

Rani E. Snyder

People understand what it means to ask, assess and track what matters to older people, to pay attention to medications, to focus on mobility as a measure of essentially function.

Raahat Ansari

Sure. Isn't it so interesting how it just like, pulls everyone, to get like anybody, like you just said, that a provider or a patient, anybody can just easily latch onto it. It's super simple, I love that. But yes, please continue.

Rani E. Snyder

Absolutely. Well, and the only one left that I haven't mentioned yet, is mentation, which is anything of the mind. You know, if you were a geriatrician, you'd be thinking of the 3Ds: dementia, delirium, depression, right? But really, it's anything cognitive. So, we started out our full group together with IHI and AHA and the others, started out thinking about it as a hospital-based possibility but very quickly realized that that was necessary but insufficient.

Raahat Ansari

Correct. Yeah.

Rani E. Snyder

And that older people get care that either helps or frankly can harm them in a whole host of settings. So, we, a couple of things have changed over the almost nine years, I'd say eight or nine years of this work. First of all, we just started a new expansion of the work that is systemwide. So up until now, through the Action Communities, a particular site of care might join.

Rani E. Snyder

It might be a hospital unit, it might be an ambulatory clinic, it might be a nursing home, as I mentioned. And those sites are a single site. But what we're doing now is working with 30 systems that have volunteered, that have signed up because they see and feel the importance of this and have seen, quite frankly, some of the positive outcomes, to push it across all of the different settings ultimately in their systems. It's super exciting.

Raahat Ansari

Yeah, and that's really interesting. And I think that's like one other key point for those who might not have participated in the age-friendly work to date is that this framework fits in any unit, and even being in a single organization, it could mean something very different based on from one unit to the next. And that's the whole point of this framework, is that it can be tailored to fit the needs of the unit in the organization, whether the type of setting you're in, you know, you had spoken about the hospital that you're working with is a little bit of a rural in a rural area.

Raahat Ansari

You know, we also have critical access hospitals and, you know, within the rural areas, of course, and academic medical centers. So just this is literally tailored. You can tailor this to fit any care setting. So, and I think, you know, you mentioned that it's in the convenient care clinics. The CVS.

Rani E. Snyder

Yes. Absolutely. Well so we're now moving to spread through all parts of the health system. So, we started with age-friendly health systems, with the geri-ED work that I mentioned and the surgery work, the geriatric surgery verification. Well, now we're talking about, as you mentioned, CVS minute clinics, all of the minute clinics in the country have been in the process for several years now of becoming age-friendly, which is super exciting.

Rani E. Snyder

In addition, I mentioned nursing homes and ambulatory care settings. PACE sites. So, for folks who are not familiar with what PACE is, it's an acronym that stands for Programs of All-Inclusive Care of the Elderly. Really, it's everywhere. And in fact, there are crosswalks to some of the community-based organizations that are doing work in partnership

now with health systems as well.

Raahat Ansari

That is so amazing. And we could talk for hours, but I know we're at time. So just wanted to thank you one last time and pause to say if there are any other comments that you wanted to just give to our Action Community, people are thinking about joining or people who are well on their path, anything you additional you might want to share.

Rani E. Snyder

I would love to. There are some other expansion areas that I didn't mention, so that includes things like age-friendly health systems for caregivers. So, caregivers are themselves a twofer, right? Because it's their health impacts not only themselves but also the person they're caring for. So, this is not just about the care recipient, but the person who's doing the work for them.

Rani E. Snyder

And really working that in. The Veterans Administration is doing this work across the country. So, we're very excited about that. And we're really thinking through and implementing age-friendly care in home-based primary care. This is care for people who can't get out of their home to go to a primary care clinician of some sort. Hospital at home.

Rani E. Snyder

So back to the hospital. But really thinking about that kind of hospital-level care at home for those people where it's appropriate, and many, many others are joining the movement. So, the last thing that I guess I'll say is that there are other funders, who have, who are increasingly joining this work as well. So, depending on where a health system is, there may be funders in your community that will help you to not just join an Action Community because we fund those, but to really implement the principles of age-friendly care, to measure the age-friendly care that they're implementing.

Raahat Ansari

That's huge. So that data, right, not only helps the organization itself, it can help other teams that are looking, then thinking about it, to build that case and bring that back to their own organization. So, there's so much data out there. Be sure to look for it on all of our websites.

Rani E. Snyder

You bet. Thank you. We're doing some work with UCSF to be sort of the national clearinghouse of some of that work, and to lead some of the evaluation and outcomes on the age-friendly health systems work. So, we invite everybody to join us. All we want, really, is to make sure that every older adult, everywhere they are, gets the best possible care.

Raahat Ansari

I love that. Thank you. Thanks for being here with us today.

Rani E. Snyder

My pleasure.

Tom Haederle

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