| Policy Studies and Applied Research | ||||||||||||||||||||
| General Publications and Research Topics | The Occasional Long Term Care Policy Paper Series | LTC Advances Newsletter | ||||||||||||||||||
| <back Long Term Care Advances Topics in Research, Training, Service & Policy Vol. 9, No. 1, Fall 1997 Duke University Center for the Study of Aging and Human Development Long Term Care Resources Program, Box 2920, DUMC, Durham, NC 27710 (919) 660-7542 The Leadership in an Aging Society Program in 1997: Implementing a New Initiative and Building on Established Strengths George L. Maddox, PhD, and Sandra Crawford Leak, MHA, Issue Editors
The Leadership in an Aging Society Program in 1997 In its fifth year, the Leadership in an Aging Society Program created a new initiative and built on established strengths. A program of the Duke Long Term Care Resources Program, the Leadership Program's goal is to facilitate development opportunities across the lifespan, particularly opportunities related to aging and long term care policy. Implementing a New Initiative: 1997 is the pilot year for the implementation of the Senior Leadership Enhancement Initiative. This new initiative was developed to provide a more structured approach for serving older adult leaders in North Carolina. Since its inception, Duke LTC has been pleased to work with older adult leadership in North Carolina. Many of those opportunities included the supporting the participation of older adult leaders in events held around the state like the North Carolina White House Conference on Aging. The Senior Leadership Enhancement Initiative builds on those experiences to offer a year-long opportunity or 3 to 5 participants. Building on Established Strengths: The Senior Leadership Enhancement Initiative has formalized an intergenerational approach to leadership development which been a strength of the cornerstone student programs: the Leadership Internship Program and the Glaxo Wellcome LTC Career Development Awards Program for young researchers. Highlights of those programs in 1997 include: Development Awards Program for young researchers. Highlights of those programs in 1997 include:
THE MENTORING RELATIONSHIP REVISITED The guest leadership consultants for the 1997 Leadership Seminar in March were former United States Senator and Duke University President Emeritus, Terry Sanford, and Mick Smyer, PhD, Dean of the Graduate School at Boston College. Senator Sanford had been his mentor when Dr. Smyer was at Duke and first becoming interested in the world of publicpolicy and aging. Together, they reflected on the importance of the mentoring relationship.
The Interns On November 6, a Leadership Convocation was held to recognize the contributions of the Leadership Mentors, Interns and Glaxo Wellcome Awardees. Robert Applebaum, PhD, from the Scripps Gerontology Program at Miami University of Ohio was the guest speaker. The vignettes that follow highlight the experiences of the 1997 Leadership Program interns. Katherine Bridges, Graduate Student, Gerontological Studies, Miami University of Ohio Mentor: Elise Bolda, Ph.D. The Setting: The Emund S. Muskie School of Public Service The Experience: My internship experience at the Muskie Institute provided an opportunity to expand my knowledge and experience in gerontology. Through this internship, I obtained practical experience in applied long term care research and program evaluation. Prior to this experience, I was unaware of how valuable research is to the development and implementation of public policy. As an intern, I participated in many facets of the research process, including: data preparation and file construction; data collection (telephone and in-person interviewing); survey instrument design, piloting, and interviewer training; reviewing literature for publications; survey sample recruitment and project design. The internship at the Muskie School reconfirmed my desire to continue in the field of gerontology. Furthermore, it helped me define my area of interest within the field. I found the long term care policy evaluation studies to be particularly interesting. These studies serve as a vehicle for consumers' voices to be heard, as there are many individuals and families that are affected by residential long term care policy changes. Additionally, I determined that mental health issues, specifically depression among nursing home residents, is another area of interest to me. This interest and exposure to the issues through the Muskie School has enabled me to decide that my professional development focus will likely be in mental health and aging. I believe that in many long term care settings the mental health needs and emotional well-being of older adults are being overshadowed by the pursuit of physical wellness. By concentrating in this area of gerontology, it is my hope to promote greater awareness of this problem and to provide some relief through direct service to this population. Timothy Cahill, Graduate Student, Public Policy, Duke University Mentors: Joseph Alston The Setting: Durham-Duke Office of Community Affairs, Durham, NC The Experience: I started my internship at the Office of Community Affairs on May 19 with the understanding that I would design an evaluation system(s) for the various Duke-Durham collaborative projects that are part of Duke's Community Initiative. Joe Alston, Director of Special Projects in the Office of Community Affairs, was my direct supervisor/mentor. I worked on several projects for the Office of Community Affairs. First I designed a report card to measure the progress of Duke's involvement in two neighborhoods, the West- end and Crest Street. Second, I organized a needs assessment for five of Duke's seven partner schools to determine how Duke should concentrate its efforts in those schools. Third, I attended two organizational meetings of the Retired Volunteer Corps and communicated the progress back to the Community Affairs office staff. Fourth, I wrote an evaluation strategy memo that Sandy Ogburn, Director of Community Affairs, and her staff could refer to when evaluating projects in the future. Fifth, I drafted evaluations to assist a youth intern mentoring program that is in the planning stages. Lastly, I interviewed members of Duke's Community Relations Planning Committee to provide Sandy Ogburn with input as to what direction the community initiative should take and what the Duke faculty and staff think of the initiative to date. I am confident that I provided the Community Affairs staff with valuable information regarding the progress of the initiative up to this point and how to assess it in the future. In the process, I learned a great deal about the university and the city and the important relationship they share. I also had the good fortune to meet several individuals in Durham and at Duke who are leaders in their field and in their communities. Sarah Boyce Fasick, M.S. Public Health, UNC, Chapel Hill Mentor: Tork Wade The Setting: North Carolina Foundation for Alternative Health Programs and the North Carolina Office of Rural Health. The Experience: My ten-week internship was busy, stimulating, and educational. I worked on a project called SAIL that plans to implement home- and community-based care services primarily for elderly Medicaid recipients. I wrote drafts of several working documents, including guidelines on the development of a health care provider network, a piece on the use of care management in a community-based long term care environment, a program evaluation, and educational brochures for consumers and health care providers. I worked with a variety of interesting and experienced individuals both at the North Carolina Foundation for Alternative Health Programs and also at the NC Division of Medical Assistance (Medicaid). The experience has piqued my interest in a public sector career, and I plan to pursue this interest in more depth. The exposure to state-level politics will help me to be a better leader on aging issues in the future. I learned about how important it is to gain input from all participants and to then delegate tasks in an efficient manner to move a project towards its goals. It is very important that individuals feel ownership over a particular task and understand clearly how their particular task fits into the big picture. I believe the SAIL project will have a very positive impact on the communities it will affect, and I am pleased that I had the opportunity to participate in its design this summer.
Andrew Florence, Undergraduate, Public Policy, Duke University Mentor: William Scanlon and Phyllis Thornburn The Setting: US General Accounting Office The Experience: I completed my internship at the General Accounting Office on July 30 with our research project well underway. Our final product will be a letter report to the Senate Budget Committee answering questions and providing information about consumer directed services for the elderly and disabled. The research we did specifically focused on finding out which states have programs to provide cash or vouchers for personal care and attendance and other in-home services We also tried to find out what services the programs covered, what populations were eligible and how the program was structured. One thing we found out is that almost every program was structured a little bit differently. This made it difficult to make any sweeping generalizations about consumer-directed care programs. There also is a four year research study, however, sponsored by the Robert Wood Johnson Foundation and the University of Maryland Department of Aging to evaluate a "cash and counseling" program. This study involves four states: Florida, New York, New Jersey, and Florida. These four states will have distinct proposals for their various programs but they will all focus on providing cash payment benefits directly to disabled persons while also providing information, advice, and training to allow consumers to make informed choices and manage their money appropriately for their needs. Our primary goal is to inform the Senate Budget Committee about this research program and about the other state Medicaid programs that are focused on consumer- directed care. Towards the end of my internship I compiled lists of each state that had such programs and outlined what the programs consisted of. I enjoyed comparing the various programs in each state and seeing how they were similar and how they differed. Through this work, I definitely gained an appreciation for effective policy making concerning this population. The Senate Budget Committee was also concerned with what safeguards are in place to ensure that the money granted by Medicaid in these consumer- directed services, such as cash and counseling, is spent for specified services. I enjoyed the opportunities this internship gave me to learn about Medicaid policies from several view points. I was able to learn about the federal waiver requirements, review state programs, witness testimonies before congress and do research on effective state spending on the elderly and disabled. My career plan is to go to medical school. This summer's experience and my exposure to aging issues have had an impact on me and I know that it is a important area of medicine and policy. I think that my policy background will be useful as I pursue a career in medicine because many times the medical experts and policy experts my be coming from different directions and I can add a balanced perspective. Elizabeth Gobble, Graduate Student, Gerontology, Appalachian State University Mentor: Richard Gottlieb and Elaine Handley The Setting: Senior Services, Inc. The Experience: Senior Services, Inc. is a not for profit organization which provides creative, high quality services to facilitate the independent living of frail, elderly people in Forsyth County. Richard Gottlieb, President, and Elaine Handley, Vice-President of Senior Services were my mentors. My internship activities at Senior Services, Inc. focused on Senior Services assuming the operations of the Senior Lunch Program, congregate meal program in Forsyth County. My responsibilities included learning the Title III regulations and the North Carolina policies and procedures for congregate meal programs; developing an understanding of how congregate meal programs operate; and assisting Elaine Handley, with the assumption of the Senior Lunch program. Specifically, I developed job descriptions for all staff and volunteers of the Senior Lunch Program; assisted with the development of the seven site contracts; coordinated the monthly activity calendars for the sites; developed an emergency plan and a quality assurance check list for the sites; assisted with the coordination of a three-day training seminar for the staff; and assisted with the daily operation of the sites. My experience has enabled me to develop contacts within the aging field throughout Forsyth County and begin a career in gerontology. This internship has provided me with a personal guidance and allowed me to gain leadership experience in the field of aging. (Editors' Note: Beth Gobble is expected to receive an MA in Gerontology from Appalachian State, where she is a graduate teaching assistant in the Gerontology Department, this December. In the meantime, she has also been hired as Senior Lunch Program Director by Senior Services. Jennifer Hansen, Undergraduate, Public Policy, Duke University Mentor: Judy Riggs and Susan Goldenson The Setting: Alzheimer's Association, Washington, DC, Policy Office The Experience: I worked at the Alzheimer's Association Public Policy Office in Washington, DC. The Alzheimer's Association is a non-profit organization, based in Chicago, IL, dedicated to helping people with Alzheimer's disease. The Public Policy Office is responsible for both federal and state legislation that affects people with Alzheimer's disease. My intern duties were quite diverse. At the state policy level, I helped publish a review of 1997 state legislation related to Alzheimer's disease, I notified local chapters of new state regulatory legislation, and I revised the Association's Medicaid primer. My largest project was writing a memo on drug formularies that will help guide state advocates and a national work group formed by the Association. I also attended a variety of hearings and advocacy meetings on Capitol Hill. My internship gave me great insight into the federal government and advocacy groups. Through my work I was able to see how effective meetings and hearings are run and what are the best methods for giving presentations. I also learned what it is like to work on Capitol Hill. Patrick Liedtka, Graduate Student, Social Work, University of North Carolina at Chapel Hill Mentor: Ginger Young and Tom Kelley The Setting: Bridges Program, Center for Documentary Studies, Duke University, Durham, NC The Experience: The Bridges Programs connect communities, students, and volunteers in educational and community-building projects through Documentary. Photography, creative writing, oral history, narrative, biography, and video are employed as tools for educational enrichment, reflection and dialogue. My internship has combined direct group work, community outreach, and research to explore ways to improve the quality and substance of Bridges Programs offered to elders in various Durham communities. My interest in documentary led me to start three groups which used photography, oral history, and writing, to record and reflect upon the past and present experiences of the participants. In one location, elders were given cameras to document important aspects of their current lives. These photographs, along with spoken reflections, were turned into an exhibit which is being shown both at a senior center and at other community event. The resources I developed to facilitate groups will be used by Bridges volunteers who continue to work with area seniors. I have written a concept paper which the program can use as a guide to tailor their outreach to elders for the next several years. The exhibits I put together in conjunction with group participants have spurred some communities to start their own documentary projects. My internship has solidified my desire to make aging an integral part o my plans as a professional. My goal after finishing school is to use my direct service and community outreach experience in an administrative position combining my interests in aging and mental health. Dana Miller, BS Multidisciplinary Perspectives on Health and Illness , Duke University Mentor: Dr. Phoebe Liebig Setting: Andrus Gerontology Center, University of Southern California The Experience: I was placed at the Andrus Gerontology Center for my internship. The center is located on the campus of the University of Southern California in Los Angeles. I was placed as a research associate with Dr. Phoebe Liebig, an Associate Professor here at USC. Primarily I worked on the Home Modifications Actions Project (HMAP). This is a three year project with four parts. The goal of the project is to increase awareness about the need for and the access to home modifications for frail elderly and persons with disability. The project is based on the idea that, with technology today, our society has a large population of people aging with disability, and people aging into disability. The project is gathering information about what home modification (HM) programs are available, setting up a local coalition, setting up a national coalition, and creating a home page for people to go to for information regarding HMs. My part of this project dealt with gathering information about what is already out there in the area of HMs. After researching what information has been asked, and still needs to be asked, I created a survey for each state's Housing Finance Agency and Community Development Agency. These agencies are potential funding sources for HMs. Our survey had three purposes: to find out what each state agency does in the field of HMs, to find out what each agency knows is going on in their state in the field of HMs, and to educate these agencies about what could be going on in the field of HMs. The ultimate goal of the project is to come up with a "model system" of organization and networking. The internship was very valuable to me in many ways. First, the exposure to the complexity of policy in the area of gerontology was eye-opening. It is one thing to study changes people go through as they age, but coming up with solutions to the challenges involves so many different people and interest groups whose needs all must be considered. Also, I learned a lot about the field of research in general. The group working on this project is a tight team. Each team member has his/her part, but everyone coordinates and keeps everyone updated extremely well. The four parts of the project are four very large tasks, and the whole project is moving smoothly and on time due to the unbelievable organization of this group. Finally, this internship was a great way to ease through the transition from classroom to work environment. Dr. Liebig was a perfect mentor this summer. She balanced giving me responsibility and space to make independent decisions with guidance and help when it was needed. The internship was neither overwhelming, nor unchallenging. I think the most important thing about leadership I learned from this internship is to start small and focused and then grow outward. It is hard to tackle the whole country, but if you make a difference in one small part, you can convince others to follow along. I think the local coalition is going to be extremely effective in motivating the rest of the country and Congress to take steps forward in helping frail elderly and persons with disability modify their homes and remain independent and aging at home longer. Julie Prince, Graduate Student, Public Policy, Duke University Mentor: Lori Owen Smetanka and Sarah Greene Burger The Setting: National Citizens' Coalition for Nursing Home Reform The Experience: This summer, I was fortunate to be able to work at the National Citizens' Coalition for Nursing Home Reform. NCCNHR's mission is to protect and improve the care and quality of life all nursing home residents. My first project at NCCNHR involved rewriting fact sheets on Residents' Rights, How to Choose a Nursing Home, and the High Cost of Poor Care. These fact sheets are distributed free of charge to anyone who requests information from NCCNHR. My second project was to complete a Residents' Right Week packet. Lori Owen Smetanka and I worked together to complete this task. Our packet is about 50 pages and contains information to help facilitate communication on residents' rights and to aid in training staff about residents' rights. We included poetry written by residents in Beverly Enterprise homes and form the information for better presentation. The packet distributed to all 50 state ombudsmen at no charge. Third, NCCNHR wanted to broaden its advocacy to a new issue: the large number of malnourished elderly living in nursing homes. Research has shown that up 85% of residents are malnourished, even though the Nursing Home Reform Act would seem to guarantee against this troubling statistic. I began the Initiative by researching the issue extensively; creating an informational file system for the articles; and summarizing three of Jeanie Kayser-Jones' articles for NCCNHR's Board members. I also wrote a grant proposal for $5000 to write an issues paper on malnutrition in nursing homes. After I wrote the grant proposal , I compiled materials on malnutrition for NCCNHR's annual meeting packet. This packet is given to all annual meeting participants (usually around 300 people from across the country). Also, I wrote a fact sheet on Malnutrition in Nursing Home Residents, which has already been distributed. Finally, I presented all of my work to the Board on July 25th, including two resolutions for consideration and a two- year plan for the Nutrition Initiative. During my internship, I was able to attend many meetings, including the Presidential Advisory Committee on Consumer Protection and Quality in the Health Care Industry; the Commerce Subcommittee Mark-up of the Boren Amendment, the American Health Care Association's Congressional Conference; Campaign for Quality for Quality Care meetings; Senate, Special Committee on Aging press conference and hearings, a Consensus Conference hosted by NCCNHR, Medicaid strategy meetings with other citizen groups and Congressional staff interested in Medicaid, and others. NCCNHR did an excellent job of introducing me to the health and aging policy arenas, other groups interested in aging issues, and the way that the "system" works. I could not have asked for a better experience than I received at NCCNHR this summer. My mentors and other NCCNHR staff were extremely dedicated to helping me learn all that I could and making sure that I was getting everything that I wanted out of my internship. They gave me real projects and I never felt like I was "just the intern." Because of this inclusion, I felt like a part of a team at NCCNHR. I was able to observe numerous leadership styles and to learn a great deal about the workings of a non-profit organization. Finally, I have learned how easy it is to dedicate your life to such a wonderful cause as nursing home reform. By watching the staff at NCCNHR, I finally felt like there were other people out there that felt the way I did about elderly. It was very uplifting and encouraging to learn from people doing what I hope to be doing in a few years. ( Editors' Note: The grant proposal Julie Prince wrote for an issue paper on nutrition in nursing homes was successful. She is currently working on that paper which will form the basis for her Master's memo at the Sanford Institute.) Hao Zhou Graduate Student, Department of Economics, Duke University Mentor: Ann McDermed, PhD, and Robert Clark, PhD The Setting: College of Management, NC State University The Experience: My placement for the summer was with Professor Ann McDermed and Professor Robert Clark at the College of Management at NCSU. The main objective is to analyze how an individual's employment choice is affected by the health care and retirement benefits provided their employer. The study also focuses on how the demographic factors and company character affect the employee's satisfaction with these benefits. Except for the last feedback from my supervisors, the main project had ended in late August. Thus, this is an appropriate time to make a final summary report. My first assignment was focused on setting up the Life Stage Survey data file and critiquing the consulting report. Since then, I worked on some detailed statistical analysis of the survey data, which includes summary statistics, data clarification, and recoding of all dummy variables. The final task was to estimate three equation 5 econometric models to explain choice, importance, and satisfaction related to medical insurance. This involved a basic PROBIT estimation and two OLS estimations. Wei Zhu, Graduate Student, Department of Economics, Duke University Mentor: Dr. Alvin Headen, Jr. The Setting: Economics Department, College of Management, NC State University The Experience: The opportunity to be an intern in the Leadership in an Aging Society Program has proven to be one of the most rewarding experiences in my graduate career. I was able to talk frequently with my mentor, Dr. Alvin Headen, about long term care issues, both in general, in terms of research issues and policy concerns, and specifically, about the analysis of the 1994 National Long Term Care Survey. Under the guidance of Dr. Headen, I was able to quickly familiarize myself with the literature and the methodologies used in the related studies and incorporate them in our analysis. From our discussions, and with the help of Dr. Frank Sloan at the Economics Department at Duke, Dr. Headen was able to submit a proposal to the Home Care Research Initiative 1997, sponsored by the Robert Wood Johnson Foundation, on the topic of Targeting Home Care Resources. Attending the workshop given by the Robert Wood Johnson Foundation was an enriching experience. Research efforts paid off in unexpected ways when I found myself incorporating much of what I learned working with Dr. Headen into my dissertation. My interest in the economics of aging has been greatly enhanced and my understanding deepened through the internship opportunity.
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