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

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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.

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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

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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 # UB4HP19199. “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.”

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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

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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 emailed 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.

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Responsibilities of Participants (cont.)

• You will be emailed the PowerPoint presentation and case on the Wednesday prior to each training date.

• You will be emailed 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.

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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

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Introduction to Geriatric Resource Nurse Training

Series for Community Nurses

Linda Shumaker, RN-BC, MA

Outreach Coordinator

Pennsylvania Behavioral Health and

Aging Coalition

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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

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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

treatmentSAMHSA Strategic plan Substance Abuseand Mental Health Issues facing Older Adults 2001 - 2006

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.

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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!

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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: www.olderpa.org/grnho.

• 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 emailed each Friday and Monday.