AARP Pennsylvania, Drexel University's College of Nursing & Health Professions Issue Report Entitled 'Disrupting Disparities in Pennsylvania – Retooling for Geographic, Racial and Ethnic Growth'
* * *
Executive Summary
Currently, most older Pennsylvanians live in rural areas, are primarily White and low income, and reside in areas with a high dependency index./1
However, in a short 20 years, there will be a dramatic demographic shift in the state with exponential growth in the aging population, particularly in the southeastern portion of the state. This region, anchored by
While an aging population brings important opportunities, it also ushers in critical challenges. The key challenge facing
This first report on Disrupting Disparities in
The report is divided into three major sections: Setting the Stage: Understanding Health Disparities in
SECTION I
Setting the Stage: Understanding Health Disparities in
This section has two parts. The first part, Aging in
The second part, Historical Disparities are Exacerbated by COVID-19 in the 50+ in
SECTION II
Retooling for an Aging Pennsylvania
This section has three parts. First, in Addressing Disparities through Telehealth, the report examines the emergence of the use of telehealth with COVID-19, its benefits and challenges, and existing inequities that prevent its widespread availability and integration into health care delivery systems.
Second, in Expanding and Diversifying the Health Care Workforce, the report examines new and emerging competencies needed for assuring culturally competent and evidence-based care is provided throughout the state of
Third, in Supporting Direct Care Workers--The Backbone of Services for Older Adults, particular attention is given to the role of direct care workers who serve a critical role in caring for older adults in long-term care settings.
SECTION III
Key Actionable Recommendations
This report urges immediate actions be taken in five key areas.
1. Continuously monitor health and geographic and racial/ethnic disparities:
* There is a need to assure continued monitoring of population health within counties from which to identify needs and then assure access to needed prevention programs and disease management of chronic conditions. This is particularly important for those most vulnerable throughout the state to ensure equitable access to healthcare and programs that are culturally relevant. The Healthy People/2 initiative can serve as a model to establish the key metrics counties and the state should routinely obtain to evaluate the success of programs designed to aid in the prevention and management of chronic conditions.
2. Provide broadband access across the state along with technology literacy and expanded telehealth:
* Internet access is not available equitably across the state, necessitating immediate attention to expanding broadband infrastructure in rural areas to ensure reliable high-speed internet is available in homes. Access to the internet is a social determinant of health/3 requiring immediate action to assure access to smartphones for those with limited income.
* Along with internet access is the need to address computer literacy and offer programs that instruct in using technology to access critical health information, reduce social isolation, and receive medical care. Intergenerational programs to teach the 50+ population computer literacy skills could be a creative solution.
* To expand access and utilization of telehealth, the state can build upon telehealth flexibilities extended during the COVID-19 pandemic. The state could require private insurance plans and Medicaid to cover telehealth services on similar terms as in-person services. State telehealth law could also be improved to allow for telehealth to be performed by additional types of providers, using additional modalities, and without limitation on originating location. With expanded access to telehealth, patients will also need increased information and outreach on how to use telehealth and about which providers allow telehealth as an option.
* Critical evaluation is needed of the outcomes of using telehealth in rural and urban settings and for specialty care, as well as primary health care and behavioral health care. Evaluative data can inform reforms to the continuation and expansion of delivery of telehealth practices into the future.
3. Prepare a health care workforce in telehealth, provide culturally competent care in prevention and chronic disease management:
* Creation of a statewide workforce database of licensed health professionals, needs to be developed and updated as licenses are renewed. Standard data elements should be collected for all licensed health professionals including age, race/ ethnicity, place of employment, specialty area, etc.
* While health care providers quickly pivoted to telehealth during the pandemic, many did so for the first time and without formal training. The health care workforce needs to be adequately trained in the delivery of telehealth care. Medical, nursing, and health profession pre-licensure programs should develop and incorporate competences for delivering care via telehealth.
* There is an immediate need to infuse geriatric training across the health professions curriculum. With the increase in aging population in
* To address workforce issues, the state can draw upon the 15 recommendations from the 2008
* Implement loan forgiveness programs to promote the training of a geriatric workforce.
* Develop a
* Nurse practitioners need full practice authority in
4. Support direct care workers in all care settings:
* Require nursing homes to develop effective recruitment and retention strategies to attract and retain direct care workers to ensure adequate staffing including increased wages and non-wage benefits (childcare, housing, transportation assistance, and food supports).
* Many direct care workers are "unaffiliated" with a health system as they work in homecare. Concerted efforts are needed to ensure these direct care workers have access to COVID-19 vaccinations across the state.
* Ensure eligible direct care workers have access to health care benefits, as many receive wages at the poverty level.
* Develop training programs to support continual skill development of direct care workers.
* Create career pathways for direct care workers, including support for continuing education and other educational opportunities.
5. Implement strategies statewide for COVID-19 testing and vaccination distribution:
* Many rural counties do not have hospitals, pharmacies, or drug stores. A variety of settings need to be utilized to distribute the COVID-19 vaccination across the state. Distribution of COVID-19 vaccine in resource-limited communities should consider a variety of settings including ambulatory care facilities (e.g., kidney dialysis centers), in addition to pharmacies and hospitals.
* As reasons for vaccine hesitancy are complex, developing strategies targeting different populations is needed. Recent surveys suggest that Blacks have a higher vaccine hesitancy rate. An important call to action is to use multicomponent strategies including tailoring messages to 50+ communities across the state to vaccinate when their turn comes. At the same time, this is a teachable moment to educate on other vaccines and preventive measures to promote health.
This report reveals that the predominant story of aging in
The report shows that one solution will not fit all and there is no one "magic bullet." Rather, a multi-prong approach targeting multiple risks and structural determinants will be necessary, and must be tailored to regional variation in needs to assure that older people age equitably throughout the state. Moreover, understanding county-by-county differences in the aging experience is necessary to develop targeted policies and practices that address differential unmet needs.
* * *
Key Actionable Recommendations
This report urges that immediate actions be taken in five key areas.
1. Continuously monitor health, geographic and racial/ethnic disparities:
* There is a need to assure continued monitoring of population health within counties from which to identify needs and then assure access to needed prevention programs and disease management of chronic conditions. This is particularly important for those most vulnerable throughout the state to ensure equitable access to healthcare and programs that are culturally relevant. The Healthy People/2 initiative can serve as a model to establish the key metrics counties and the state should routinely obtain to evaluate the success of programs designed to aid in the prevention and management of chronic conditions.
2. Provide broadband access across the state along with technology literacy and expanded telehealth:
* Internet access is not available equitably across the state, necessitating immediate attention to expanding broadband infrastructure in rural areas to ensure reliable high-speed internet is available in homes. Access to the internet is a social determinant of health requiring immediate action to assure access to smartphones for those with limited income.
* Along with Internet access is the need to address computer literacy and offer programs that instruct in using technology to access critical health information, reduce social isolation and receive medical care. Intergenerational programs to teach people 50+ computer literacy skills could be a creative solution.
* To expand access and utilization of telehealth, the state can build upon telehealth flexibilities extended during the COVID-19 pandemic. The state could require private insurance plans and Medicaid to cover telehealth services on similar terms as in-person services. State telehealth law could also be improved to allow for telehealth to be performed by additional types of providers, using additional modalities, and without limitation on originating location. With expanded access to telehealth, patients will also need increased information and outreach on how to use telehealth and about which providers allow telehealth as an option./95,/96
* Critical evaluation is needed of the outcomes of using telehealth in rural and urban settings and for specialty care, as well as primary health care and behavioral health care. Evaluative data can inform reforms to the continuation and expansion of delivery of telehealth practices into the future.
3. Prepare a health care workforce in telehealth, and provide culturally competent care in prevention and chronic disease management:
* Creation of a statewide workforce database of licensed health professionals needs to be developed and updated as licenses are renewed. Standard data elements should be collected for all licensed health professionals, including age, race/ ethnicity, place of employment, specialty area, etc.
* While health care providers quickly pivoted to telehealth during the pandemic, many did so for the first time and without formal training. The health care workforce needs to be adequately trained in the delivery of telehealth care. Medical, nursing, and health profession prelicensure programs should develop and incorporate competences for delivering care via telehealth.
* There is an immediate need to infuse geriatric training across the health professions curriculum. With the increase in aging population in
* To address workforce issues, the state can draw upon the 15 recommendations from the 2008
* Implement loan forgiveness programs to promote the training of a geriatric workforce.
* Develop a
* Nurse practitioners need full practice authority in
4. Support direct care workers in all care settings:
* Require nursing homes to develop effective recruitment and retention strategies to attract and retain direct care workers to ensure adequate staffing, including increased wages and non-wage benefits (childcare, housing, transportation assistance, and food supports).
* Many direct care workers are "unaffiliated" with a health system as they work in homecare. Concerted efforts are needed to ensure these direct care workers have access to COVID-19 vaccinations across the state.
* Ensure eligible direct care workers have access to health care benefits as many receive wages at the poverty level.
* Develop training programs to support continual skill development of direct care workers.
* Create career pathways for direct care workers, including support for continuing education and other educational opportunities.
5. Implement strategies statewide for COVID-19 testing and vaccination distribution:
* Many rural counties do not have hospitals, pharmacies, or drug stores. A variety of settings need to be utilized to distribute the COVID-19 vaccination across the state. Distribution of COVID-19 vaccine in resource-limited communities should consider a variety of settings, including ambulatory care facilities (e.g., kidney dialysis centers), in addition to pharmacies and hospitals.
* As reasons for vaccine hesitancy are complex, developing strategies targeting different populations is needed. Recent surveys suggest that Blacks have a higher vaccine hesitancy rate. An important call to action is to use multicomponent strategies (See Box below) including tailoring messages to 50+ communities across the state to vaccinate when their turn comes. At the same time this is a teachable moment to educate on other vaccines and preventive measures to promote health.
This report reveals that the predominant story of aging in
The report shows that one solution will not fit all and that there is no one "magic bullet." Rather, a multi-prong approach targeting multiple risks and structural determinants will be necessary and tailored to regional variation in needs to assure that older people age equitably throughout the state. Moreover, understanding county-by-county differences in the aging experience is necessary in order to develop targeted policies and practices that address differential unmet needs.
Strategies to Promote COVID-19 Vaccination Acceptance
* Make vaccines available to uninsured individuals at no cost for the vaccine or administering the vaccine.
* Make vaccine easily accessible at convenient locations.
* Employ effective outreach strategies including media, (television, radio, social media, mail).
* Ensure outreach strategies that are linguistically and culturally appropriate and targeted to address community concerns and values.
* Share information and conduct community outreach using trusted messengers.
* Emphasize the health and economic benefit of vaccination for individuals, their families, and communities.
* * *
The full report including references can be viewed at: https://aarp-states.brightspotcdn.com/6f/b6/de161f3a4a63a23e811693d90b68/aarp-drexel-pennsylvania-disrupting-disparities-design-0421-final.pdf
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