Jennie Chin Hansen and Dr. Bill Thomas: A Conversation

Picker Award winners for long-term care Jennie Chin Hansen, left, and Dr. Bill Thomas, and Karen Schoeneman, right, with Picker Institute Executive Director Lucile Hanscom.

Jennie Chin Hansen and Dr. Bill Thomas are among the most powerful and best-known advocates for changing the culture of aging and long-term care. The Picker Award for Excellence® in Advancing Patient-Centered Care in Long-Term Care Settings was awarded to Dr. Thomas in 2009 and to Ms. Hansen in 2011.

At the recent Pioneer Network conference in St. Charles, Mo., Dr. Thomas, founder of the Eden Alternative® and the Green House Project®, and Ms. Hansen, CEO of the American Geriatrics Society, discussed a number of topics related to elderhood. One of them was the changes in the long-term care picture following passage of healthcare reform legislation in March 2010.

BT: We're here discuss what we both care about deeply: the well-being of older people.  What's the real story about what has changed over the past year?

JCH: We've seen a flurry of activity following the legislation, including a real recognition that the systems—if you want to call them that—that were intended  to help people may need to re-energize and innovate. Focusing on people with chronic conditions and needing many services, who make up a large percentage of our long-term care population, gives us a new look at how the systems have operated and how they could be redesigned.

There's a real opportunity in the legislation that creates an Innovation Center at the Centers for Medicare and Medicaid Services to identify innovative care and payment models that will reduce costs while improving health and healthcare. This has allowed people who wanted to do the right thing but who weren't in reality that successful to take off the blinders and use this as an opportunity to rethink, take risks, be held accountable and measure—to try something different in small ways over the past year.

BT: For me it goes back to one of the core elements that drives care in this area: great people, fabulous people— terrible system! The number-one obstruction in advancing change  has always been the status quo.  I  think the status quo has taken a real knock over the past year, and that people who want to see change are in a stronger position than they were a year ago.

JCH: There's an irony too, because as much as we dislike worrying about the changes to the underpinnings of Medicare and Medicaid, the uncertainty causes us to think a little bit differently. It's exciting to hear that hospitals are reaching out to senior centers and other places that they never would have in the past, taking an interest in what happens after the patient leaves the hospital.
 
BT: One of the reasons we have such an expensive healthcare system is that it's so compartmentalized—the hospital is compartmentalized from the rest of the community it serves, and it's tightly compartmentalized inside the hospital as well. The legislation is going to help break that down. This is especially important for older people because compartments are very difficult to contend with, so a system where a hospital is in close cooperation with a senior center is a better system.

JCH: Right. And that moves us to think about what happens to the person and not just what the service is. When I've talked at nursing schools over the past few years, I've said that it's not good enough to have a four-square facility where we do everything technically right if patients are left on their own once they're gone out through those glass doors. That is not person-centered care at all! This is the kind of thing that hospitals are now starting to think about:  that just because a person is out the door doesn't mean they're gone. The focus on transitional care has been a new development in the continuum of what happens from point to point, and it brings us a lot closer to what happens to the person.

BT: I applaud what is happening to transitions, but I see this as a transitional phase itself. Helping people navigate a wacky, crazy system that's not built for them is better than not helping them. But even better is to build a system of care where you don't need transitions, counseling and other kinds of health assistance because the system was built around you.

When people ask me to define culture change, I tell them that in conventional care the person adapts to the need of the institution. In culture change we endeavor  to create a system that adjusts to meet the needs of the individual. Those are two very different views of the world. Certainly we're not perfect about meeting the  needs of the individual, but now we see people start to pay attention to transitions, and that's the difference.

JCH: I couldn't agree more. I think it's a good idea to help people segue more smoothly from one point of care to another and to have caregivers care about what happens to patients when they are no longer under their care.

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