Discussing issues of aging in America, and the impact of both health reform and innovations supporting the health and well-being of our elders.

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Mark Masselli: This is conversations on healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Margaret, last week, we had a great opportunity to hear
from Senator Chris Dodd.

Margaret Flinter: He was really articulate on the broad issues of reform
and on the value of having a public option as a component of any health
reform bill.

Mark Masselli: You are right and the return of the public option to the
healthcare reform e ! ort should help bring the debate back to lowering
cost for consumers. I am missing element lately in the larger
conversation.

Margaret Flinter: Yeah. And Senator Dodd also reminded us that we
already have a public option in the United States in a lot of ways through
Medicaid, Medicare, VA and the Tricare programs for the military.

Mark Masselli: He is right, but the reform debate has taken another step
forward as the Speaker of the House Nancy Pelosi who was our show last
month unveiled the House’s plan for a compromise on healthcare
legislation. She says the bill would o ! er new insurance for tens of
millions of Americans and lower cost for those who already have
coverage.

Margaret Flinter: We have read the new version of the bill and we will be
keeping a close eye on it over the next few weeks.

Mark Masselli: That we will.

Margaret Flinter: Last week, we also learned a lot from Jon Kingsdale,
Executive Director of Massachusetts independent Health Insurance
Connector Authority. They have gotten a right in Massachusetts when it
comes to covering the uninsured and they are pretty close to goal, only
2.6% of residents remain uninsured today.

Mark Masselli: Margaret you are right, how far Massachusetts has come
in such a short time. I only wish the national reform bill would move as
fast, but it won’t be until 2019 before the bill reaches that percentage.

Margaret Flinter: Well that seems like a long time, Mark. But today I am
looking forward to hearing the perspective of our guest Jennie Chin
Hansen of San Francisco, currently serving as the President of AARP
Member Association with 40 million members over age 50.

Mark Masselli: There is a lot more in the health reform debate than just
coverage and I am sure we will hear about the concerns and hopes AARP
has for all Americans.

Margaret Flinter: I am sure we will. You know along with her time at
AARP, Jennie Chin Hansen has had a long career providing very
innovative, integrated and comprehensive primary and long-term care
services in the community for elders.

Mark Masselli: But first we would like to share a comment that we got
from one of last week’s listeners. We heard from the folks from San
Mateo County, California, they seem to be having problems with
forwarding our podcast to friends.

Margaret Flinter: We are sorry, you had a problem, but we have a
solution, we have added a website for the show and it can be found at
www.chcradio.com , click to hear all of our shows and you can just
forward that link to your friends.

Mark Masselli: Sounds like party time.

Margaret Flinter: I don’t know if I’d go that far.

Mark Masselli: And just in case, you weren’t hanging onto our every
word, we now have transcripts of each show as well as some interesting
links to our featured guest.

Margaret Flinter: And hopefully soon also a blog, so we can continue this
dialogue o ! the air.

Mark Masselli: And if you have feedback on our show, e-mail us at
[email protected] .

Margaret Flinter: And one more thing, we want to thank our initial
producer Lucy Nalpathanchil, Lucy helped us get conversations o ! the
ground and we wish her well in her future projects.

Mark Masselli: Thank you Lucy. Now let’s get an update on healthcare
headlines.

Margaret Flinter: This week House of Speaker Nancy Pelosi and Majority
Leader Steny Hoyer released House Bill H.R. 3962, the A ! ordable
Healthcare for America Act. Speaker Pelosi held the rally on the west
front of the Capitol flanked by her committee chair people.

Nancy Pelosi: Today we are about to deliver on the promise of making
a ! ordable quality healthcare available for all Americans and we are
putting it online for all Americans to see.

Margaret Flinter: And what did Americans who went online to read HR
3962 see? A 1900-page document that reflects many of the debates and
discussions held since the release of the earlier versions of the bill. It
creates a new marketplace, the National Health Insurance Exchange with
an option for states that agree to meet federal standards to run their own
exchange. It establishes a public health insurance option that public
option available with the exchange ensuring choice, competition, and
accountability. The bill says that the public option has to survive on its
own premiums and it won’t be eligible for a federal bailout. The option
will have to negotiate rates with providers and participation, both by
consumers and providers is completely voluntary. Speaker Pelosi said
“The bill is fiscally sound, it will not add a dime to the deficit as it
expands coverage, implements key insurance reforms and promotes
prevention and wellness across the health system.” It will cover 96% of all
Americans. What happens next? HR 3962 has now gone to the House
Rules Committee for review and is expected to be released for Florida Bay
possibly as early as this week. Meanwhile Senate Majority Leader Reid
has sent the merged finance and health bills to the Congressional Budget
O " ce for scoring. One thing seems clear, we are no longer in the general
and often emotionally charged phase of this process. We are onto the
greater details with specific areas of contention well understood. We will
be keeping you apprised of the details over the coming weeks.

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Margaret Flinter: This week we are exploring the Intersection of aging
health reform and innovations. With more than a quarter of all Americans

over the age of 50, it’s a critical topic for all of us. And there is perhaps
no better vantage point for considering the issues of both health reform
and innovation than from that of seniors in America. One thing nobody
debates, it’s in everybody’s interest to look for cost e ! ective and
innovative ways to help seniors remain vital and healthy. We want seniors
to manage their chronic illnesses, stay out of the hospital and be at home
for as long as possible. Today, we will be talking with Jennie Chin
Hansen, President of AARP. First some background on AARP. With 40
million members, it’s an influential and organized voice for senior
citizens. Ironically, it can chase its genesis back to a very current issue,
Trouble Finding Health Insurance. In 1958 retired high school Principal
Dr. Ethel Percy Andrus was in search of a source of health insurance for
retired school teachers and couldn’t find any. She went on to form AARP.
The organization’s founding principals haven’t changed, promoting
independence and dignity for older persons, enhancing quality of life and
encouraging older people to serve, not be served. But the world that
members live in has changed a lot and so have the priorities for health
reform and for innovation. Now the AARP priorities in the health reform
debate according the Barry Rand AARP’s CEO, are closing the doughnut
hole as the gap in Medicare prescription coverage is known and
preventing readmissions to hospitals through new support services,
that’s another, ensuring that nothing comes between the patient and the
doctor. But part of the original vision of Dr. Andrus was that one of
productivity and healthy aging. The CDC reports that life expectancy for
Americans has reached new levels. On average, we can expect to live till
78 and researchers confirmed the positive impact of activity, social
engagement and sustained mental activity. One community based
innovation to support productive and healthy aging is in rural Northern
Colorado, it’s called Aging Well and it was started by the region’s visiting
nurse association. Sue Birch is the CEO of the Northwest Colorado
Visiting Nursing Agency and its Aging Well program.

Sue Birch: Aging Well is a program of Northwest Colorado VNA and our
newly formed federally qualified health center. We are redefining health
of elderly people 50 and up and we are taking our health services Aging
Well programming into social gathering places of the people that we
serve here in Northwest Colorado. So we are in co ! ee houses and
community centers, American Legion Post assisted living centers, nursing
home, so we are going into very non-traditional settings and doing a lot
of work around wellness and prevention.

Margaret Flinter: Sue, tell us about the interventions that Aging Well
uses?

Sue Birch: We are doing things like evidence based and best practice
physical activity programs. We are really transforming the community
into a culture shift around embracing health and wellness and healthy
aging and being vibrant.

Margaret Flinter: Senator Mark Udall who is the Senate Committee on
Aging is impressed with the program and especially with the results.

Senator Mark Udall: The Aging Well program that’s been getting results.
It focuses on prevention and it connects rural Coloradons over age 50
with services and information to help them remain active, healthy, in their
homes and out of the hospital. Aging Well has been a great success.
Listing of these numbers from a recent survey, 98% of participants
reported improved fitness, 60% visited their doctor less often and 18%
had reduced their medication needs. This saves dollars and improves
lives.

Margaret Flinter: The first such nursing home was built in Tupelo,
Mississippi by Mississippi Methodist Senior Services. The brand new
houses have driveways, barbecue grills and green lawn just like any
housing community, but they are nursing homes with just 10 people in
each house, residents sleep in private bedrooms, share family-styled
meals and have more freedom of movement than in traditional nursing
homes where the sta ! usually decides most aspects of the residence
schedule. We spoke with Greg Warnick, Executive Director of the Green
House Project in Tupelo.

Greg Warnick: You know that care be elder-centered that those that the
elder be given choice in autonomy and freedom and to reduce the three
plays of loneliness, helplessness, and boredom and the elders having
choice in saying what they want and don’t want and you know those that
are closest to the elders having more freedom and autonomy in that as
well.

Margaret Flinter: Fifty homes have opened in 12 states and 130 more are
under development. 42 senior care organizations are building the
houses with technical assistance from NCB Capital Impact, a nonprofit
group. And a study commissioned by the Robert Wood Johnson
Foundation, found significantly higher ratings for their residents on
measures like happiness and contentedness than for their more
traditional counterparts. All of this is an exciting area and we are looking
forward to learning more about it today.

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Margaret Flinter: This week Conversation on Healthcare turns its
attention to innovations and health reform as it relates to aging. It’s an
area of great interest to all of us who love and respect our elders and hey,
we will all belong to that group, known as seniors one day, if we are
lucky.

Mark Masselli: Margaret, I don’t know if you have checked your mailbox
but I think there are lots of us who have already gotten that invitation to
join AARP.

Margaret Flinter: Okay, so it’s not they, it’s we. Regardless, today we are
going to hear from one of the America’s leading experts on aging, Jennie
Chin Hansen. Ms. Hansen was a young registered nurse when she took
her insights into the need for very broad services for the elderly and
created On Lok, a San Francisco organization that provides a wide range
of social, medical and supportive services, all geared to helping seniors
stay healthy and independent and vibrantly connected to life in their
community.

Mark Masselli: Last year, she was elected to a two-year term as President
of AARP. Her On Lok program becomes the prototype for a program
known as PACE, the Program for All-Inclusive Care for the Elderly which
replicated the On Lok model in communities across the country.

Margaret Flinter: There are many ‘firsts’ for her as AARP’s President,
among them she is the first person to hold that position who was a
nurse, the first baby-boomer and she is also a gerontologist.

Mark Masselli: Jennie welcome to Conversations on Healthcare. AARP
has not taken a position on the current health reform legislation but
instead they have a list of key issues of concern, tell us about those.

Jennie Chin Hansen: Sure, Mark. Well you know our membership which
is nearly 40 million people is comprised of people who start at the age of
50 and on up, but as a result about half of our members are younger
than Medicare age that is between 50 and 64 which poses one set of
concern and then the people who are age 65 and older so when I bring
up the comments, it’s in relative to these two large groups of our
members. We have actually distilled them down at this stage that I will
do a headline first and then speak to them, one especially for people who

are between 50 and 64, many of whom have also lost jobs during this
particular economic period. The whole aspect of getting access to
coverage that is a ! ordable and also it doesn’t preclude them from buying
insurance because they have preexisting condition, so especially that
a ! ordability and the access and the ability not to be rated at such a high
dollar amount that it really precludes their participation in any kind of
healthcare coverage. The second group of people who are age 65 and
above have you know the opportunity to have many of their medications
covered under Medicare with the Part D program that passed, but we
knew that program was less than optimum when it passed because there
is a coverage gap for our people. From that group of our members, we
recognized that the ability to what “filled the doughnut hole” as they say
is absolutely important because what we do find is so many people who
drop that hole, end up either not taking their medications, is splitting
their medication just because of cost and that in itself all the times
caused people to end up using more medical services. So between the
two groups what we have find coming up very strong are these two areas.
And then also to appoint that, I mean if you know and our listeners know,
the ability to have an environment that you can age in place with in a
more community based way which is kind of a cross-cutting aspect that’s
cross generational. So those are some three areas, but specific to that is
you know the whole ability to have medications be a ! ordable and that
still is for both the under 65 as well as the above 65. And preserving the
best of what traditional Medicare benefits are about for the people who
are over 65, so these are things that are important for them.

Margaret Flinter: And Jennie, I heard you mentioned expanding care to
the home setting and that’s been an area of the health reform bill that we
have been following with a lot of interest, because we haven’t heard a lot
said about it that whole class section of the current health reform bills,
could you tell people a little bit about that?

Jennie Chin Hansen: Right, well I think there are di ! erent dimensions of
this idea that as we age and we may need more care, most people have a
preference I think 9 out of 10 people have told us that they prefer staying
in their own home setting. So one is just the flexibility of having that
even though you might end up needing more complex care that
traditionally people might have thought of nursing home, so the
flexibility that the country might have in the states in particular to
enhance that ability. Secondly, we have never really prepared as a
country for this whole aspect of this chronicity or long-term care as we
call it. And there is at this point some coverage of plan through what’s
called the CLASS Act in order to have a beginning way of saving money

from your payroll for say up to 60 months and after which time you
would then be qualified to make use of a daily amount if necessary for
this kind of chronic long-term care and if you wanted to stay in the
community. So one is more of a planned insurance program, people
would optionally contribute it to and the other one is developing the
structure in state that people could have more community services.

Mark Masselli: We are speaking with Jennie Chin Hansen, President of
AARP. Jennie, you have been recognized early in your career that social
connections was key to maintaining health and vitality and in On Lok,
certainly you achieve that, but you also recognized that it takes a team, a
big team from van drivers to physical therapists, nutritionists, doctors,
nurses and family members to keep particularly the frail elderly in the
community. The PACE programs are modeled on that, but they just
aren’t that widespread, what’s prevented more rapid in broad
development of these Program of All Inclusive Care for the Elderly?

Jennie Chin Hansen: Well thanks for asking about that Mark, I think this
is a very typical and understandable question we get asked all the time.
You know this program really was actually, if I could really specify, was
targeted to the population that would normally go to a nursing home. So
this is not really your geared for your healthier person who has maybe
one or two chronic conditions. And because of the shared nature of the
population that we serve, average age is 82, has about 9 to 10 medical
conditions and takes probably equal amount of medications. The care
coordination piece that you would be hearing in healthcare reform has
been always a tough thing to do and to get say drivers to convey
information to physicians who would understand and listen to that on
behalf of the care. So it’s a Care Delivery Transformation System.
Whenever we talk about Care Delivery Transformation, it’s very hard to
do, that’s one thing. Second thing that makes it tough to do is that we
have probably changed the funding system of the way care is usually
done piecemeal way, it's called “P for Service” as you know. Every time
you see a care provider, there is a payment involved, so it’s a piece-by-
piece approach. When you put the funding all together in a blended way,
it’s a very di ! erent way to do it. So it's a hard model on the one hand to
replicate, but the irony is it makes simple for the elder and their families
to not have to negotiate many pieces of paperwork and requirements; it’s
a simple one-door system.

Margaret Flinter: Thank you Jennie. The Wall Street Journal recently
reported that seniors are the largest growing population using Facebook
and e-mail and we all know, there is quite a few grandparents out there

Skyping with their far-flung grandchildren. Beyond those social things
though there has been some innovative projects that use technology for
remote monitoring of conditions like heart failure or even for daily virtual
visits with nursing for check-in and monitoring. It seems like technology
has a lot to o ! er to seniors in their quest to remain independent and in
their homes, what are you saying that’s exciting you around the country
in that area?

Jennie Chin Hansen: Well I am extremely excited about this, I think there
are two examples that you brought up about people with you know
chronic heart conditions who often times would have to _______19.33 to
see their doctor, can now do that at home, sometimes through tools that
are specially designed for their telephones or something that plugs into
their telephone. I am excited about these kinds of things that allow
people to live their life normally, but take tools right now that are being
developed for everybody, but how we can make sure that they are used
for home. For example, even medication reminder systems that are now
automated rather than having somebody always come in to check on you.
The ability to make sure that you can have this be a simple phone
reminder or something like this would be able to have the chance to do
this in an automated way, so that you don’t forget taking your
medications which actually then maintains your heart condition, your
diabetes much more evenly. So these things are great, they are trying to
make it simple so that it’s not about complexity and then it allows us to
live our life more naturally at home.

Mark Masselli: Jennie you are on the Faculty of the Center for Health
Professionals at the University of California at San Francisco and
influencing the training of the next generation of health professionals.
Thoughts about how we train the next generation to a new model?

Jennie Chin Hansen: Right, well I think there are some exciting places
that are starting this whole idea of starting together at the same time. I
think Je ! erson University in Philadelphia is starting with this ability to
bring some of the di ! erent disciplines together to recognize they are
really often times securing for the same person. So when you start that
way, you are focused on people you are caring about, not only about your
individual profession, because what happens is when we get trained so
separately, you do get very understandably focused on your standards,
your practice and your particular profession. And not that we don’t get
back to focusing on the person or the patient or the consumer, but it’s a
little bit harder to undo that and you know re-read the clause, so to
speak, rather than to take the threads at the very beginning and read it as

a whole piece together focusing on you know the beauty of the fabric that
is our patients and our consumers.

Mark Masselli: Jennie, tell us what you were seeing or reading about
innovations that excite you, what should our listeners be paying attention
to?

Jennie Chin Hansen: Well there are lot of things about you know
healthcare that are quite well covered, you know I think one of the things
you brought in note to me is there something quite exciting and lately
and I just happened to come back a couple of days ago from this meeting
at Stanford University in California where actually there are social
innovators of people who are age 60 and above. And some of them are
doing amazing things in terms of healthcare as well as the ability to
participate in social things, so it's not quite health as you know we might
look at it traditionally, but it’s absolute engagement and the possibility of
Encore live, so to speak, to do things that frankly do have great impact on
our overall well being. And these are energized people who have had
maybe in a previous work-life and they found something that really
touched their heart, touched the need that they found in the community
or something that happened in their life and have really zoomed ahead to
make a real di ! erence and that’s another positive way to think about
health in the future.

Margaret Flinter: Well that is so exciting and Jennie Chin Hansen,
President of AARP, thanks so much for speaking with us today.

Jennie Chin Hansen: Thank you both for having me.

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Mark Masselli: Each week conversations highlight a bright idea about
how to make wellness a part of our community’s and everyday lives?

Margaret Flinter: These week’s bright ideas continues our focus on
healthy aging through voluntarism.

Mark Masselli: Seniors who want to stay healthy are often counseled to
eat right, see their doctor and take their medication, but here is one more
thing that seniors can do to help themselves, they can help others.
Studies have shown that when senior citizens volunteer in their
community, it has a measurable impact on their physical and mental
health. A number of studies have shown that seniors who volunteer

enjoy a longer life expectancy and when seniors with chronic medical
conditions volunteer, they receive benefits beyond what can be achieved
with medical care. Volunteering has even shown an impact in lowering
the incidence of heart disease amongst seniors. It turns out that the key
to getting the health benefits of volunteering is to dedicate a significant
amount of time at least a few hours per week and that means that seniors
should be sure to find activities that they both enjoy and they have
meaning for them. There were number of programs like the Encore
Fellowship, the Senior Corps and Experience Corps to help seniors find
the right kind of volunteering opportunities and there is more recognition
of the impact that senior volunteering can have. An organization called
Civic Ventures chooses 10 seniors every year to receive their purpose
prize which rewards social innovators over the age of 60 who are making
a di ! erence. In last May, President Obama signed into a law the Senator
Edward M. Kennedy Serve America Act which has special benefits targeted
to older Americans who help in their community all of which should help
more seniors find a way to stay active, get back to their community and
improve their own health at the same time, now that’s a bright idea.

(Music)

Margaret Flinter: This is conversations on healthcare I am Margaret
Flinter.

Mark Masselli: And I am Mark Masselli, peace in health.

Conversations on healthcare broadcast from the Campus of Wesleyan
University at WESU streaming live at www.wesufm.org and brought to you
by the Community Health Center.