Caring for the Aging Veteran: Age-Friendly Health Systems at the Veterans Health Administration (VHA)

00:00:00:10 - 00:00:36:09
Tom Haederle
The Age-Friendly health systems movement began in the United States in response to our growing aging population and the need to improve health care for older adults. The basic idea to care approach is to ask older adults a simple but critically important question: what matters to you? Participation in the Age-Friendly model has grown dramatically, with the U.S. Department of Veterans Affairs aiming to become the biggest and most influential member of all.

00:00:36:11 - 00:01:05:27
Tom Haederle
Welcome to Advancing Health, the podcast of the American Hospital Association. I'm Tom Haederle with AHA communications. Nine million military veterans receive their health care through the Veterans Health Administration. Nearly half of them are 65 or older. In this podcast hosted by the AHA's Raahat Ansari, senior program manager for Population Health with the AHA Center for Health Innovation, we hear how the VA is weaving the four foundational Age-Friendly principles into its care for veterans nationwide.

00:01:06:00 - 00:01:14:05
Tom Haederle
Our guest is Kimberly Wozneak, national lead for Age-Friendly Health Systems with the U.S. Department of Veterans Affairs. And now, here's Raahat.

00:01:14:07 - 00:01:24:12
Raahat Ansari
Thank you so much, Kim, for joining us and taking time out of your day to be here with us today. Let's just jump right in. How did your Age-Friendly journey begin within the VA?

00:01:24:14 - 00:01:54:16
Kimberly Wozneak
Well, thank you, Raahat, for having me join today's podcast. My Age-Friendly journey began in 2020. I was a Presidential Management Fellow with the Department of Veterans Affairs (VA), and I joined the Office of Geriatrics and Extended Care (GEC) in January of 2020. My very first week with the office included a strategic planning meeting where we set up what we called the Geriatrics and Extended Care Transformation Plan.

00:01:54:18 - 00:02:25:04
Kimberly Wozneak
This is a plan to improve how we provide care to older veterans, really looking at expanding our services so that we can honor veterans preferences to age in place in their homes and in their communities. And really, what we're talking about is what matters most to many older adults - staying independent. And so we saw this really fantastic synergy between our goals nationally and the Age-Friendly Health Systems movement.

00:02:25:06 - 00:02:38:08
Kimberly Wozneak
So following that strategic planning meeting, I met with the Institute for Health Care Improvement (IHI) and we set the aim for VA to become the largest integrated, Age-Friendly Health System in the US.

00:02:38:15 - 00:02:40:04
Raahat Ansari
That is no small feat.

00:02:40:06 - 00:02:58:19
Kimberly Wozneak
Yeah, I know, we've been doing this work now for over four and a half years, and the movement is so critical now for VA more than ever, because we have 9 million enrolled veterans that receive their health care through VA, and nearly half of those veterans are age 65 and older.

00:02:58:22 - 00:03:06:02
Raahat Ansari
That is a huge number and such an opportunity. So that's amazing that you're trying to, you know, incorporate that population into your strategy.

00:03:06:09 - 00:03:27:20
Kimberly Wozneak
Yeah. And you know, by 2035, veterans age 85 and older are expected to increase by 73%. Since 2020, we now have over 400 VA teams that have created a plan to implement the 4Ms. And they've earned recognition as an Age-Friendly Health Systems participant from the Institute for Healthcare Improvement.

00:03:27:22 - 00:03:47:05
Raahat Ansari
That is amazing progress in such a small amount of time, and I think that just is a huge testament to the work that is being done and to the drive that folks have when they're when they're being brought this opportunity. That's amazing. And one thing that I loved hearing you talk about was aging in place and aging at home

00:03:47:07 - 00:04:06:14
Raahat Ansari
and how that up almost always is a huge part of what matters to each older adult. So I love that you're highlighting that and how that typically is something that older adults are hoping is a part of their goal and their plan, but also really important for us to ask that what matters questions so we can understand is this actually your goal as well?

00:04:06:14 - 00:04:20:20
Raahat Ansari
And do you have additional things that you wanted to add to what matters most to you? Can you talk a little bit about what strategies, some of your top strategies that you implemented to see the success in spreading this to all of the VA sites in VA?

00:04:20:21 - 00:04:48:09
Kimberly Wozneak
VA is really focused on the people side of change, where anyone can become an Age-Friendly champion. When we talk about Age-Friendly care, we are talking about the 4Ms that are driven by the what matters M's. And so the 4M's are what matters, medication, mentation and mobility. And so when we're joining or, you know, a national movement, an initiative or doing anything that feels new, it can be kind of overwhelming.

00:04:48:11 - 00:05:17:06
Kimberly Wozneak
And so we encourage teams to start with small tests of change, particularly around about what matters M. And so if that just means asking one "what matters"? question to one veteran today, and that could be as simple as "what matters most to you?" And from there learning, scaling up and spreading so that we're incorporating these what matters questions into our daily practice to reach more and more veterans over time.

00:05:17:09 - 00:05:25:25
Kimberly Wozneak
I think it's also really helped that we have very active and visible leaders in the movement, communicating at all levels.

00:05:25:28 - 00:05:39:08
Raahat Ansari
That's so important. And one thing that we do hear from our participants quite regularly is it is so key and so impactful to have our leaders engaged in this work. So I love that you're highlighting that for our listeners.

00:05:39:10 - 00:06:01:15
Kimberly Wozneak
Yeah. These messages about the importance of the Age-Friendly Health Systems movement, helping us provide the soonest and best care possible to veterans have come from Dr. Elena Hall, our undersecretary for health, who gave opening remarks at our 2023 Age-Friendly summit, as well as a virtual event that we hosted over the summer that we call the state of Age-Friendly Health Systems in VA.

00:06:01:16 - 00:06:36:22
Kimberly Wozneak
This is really a forum of celebration to celebrate our accomplishments over the last year. So having those messages come from leadership as well as folks who are champions themselves. We have an incredible coalition of champions, people who I can turn to at any time to join me on a national call to share their Age-Friendly story. And I mention those national calls because I think frequent communication about what the purpose of this movement is, how it aligns with our goals for VA is really important.

00:06:36:25 - 00:06:53:08
Kimberly Wozneak
Over the last year, our team presented on over 50 national calls, conferences, presentations to over 9,500 attendees. So we are getting the message about Age-Friendly Health Systems out to anyone who will listen to us.

00:06:53:11 - 00:07:16:03
Raahat Ansari
That is fantastic impact. And one thing that I really liked hearing was about the small test of change, and something that we also teach in our action communities - the seven month long Virtual Learning collaborative. That is one of the ways that most teams engage in this work of implementation. So this is one thing that we teach is you don't have to do and implement all 4M's tomorrow.

00:07:16:06 - 00:07:41:02
Raahat Ansari
Start small, start doing one thing every day. Start doing consistently and you're driving that home by sharing. You know, you can ask one what matters question to one veteran one day, every day. And that will be get enough to get you started on your journey. So love, love hearing that. And the other thing that I wanted to just share was how impactful it is and how you mentioned there are so many champions.

00:07:41:04 - 00:08:04:03
Raahat Ansari
Anybody can have a connection to this work, and I love that you have identified so many champions and so much support that you've got. So moving on. I know you talked a lot about the amazing spread that you've had, and what I want to take a moment to speak about is how you handled any resistance to this change as you implemented it and what you might suggest as ways to overcome those challenges.

00:08:04:06 - 00:08:32:13
Kimberly Wozneak
Yeah, I sometimes hear a lack of time to just start something new and also competing priorities, right? Our clinicians are asked to do a lot. And so what we try to do is reinforce that the 4M's aren't adding work. They're actually streamlining and improving our processes and building on the fantastic evidence-based practices that we already have in place in VA.

00:08:32:14 - 00:09:16:03
Kimberly Wozneak
Right. And we're not adding staff to teams. We're leveraging existing resources and there's no cost to participate in the movement, right? Recognition from the Institute for Health Care Improvement is free. So we should celebrate the great work that we're providing and doing in VA. I mentioned, you know, communicating often. So storytelling has been incredibly impactful for getting those maybe slightly resistant teams on board by hearing from someone else working in a similar care area about their journey and how Age-Friendly care and the 4M's have been valuable to veterans, their families, and caregivers.

00:09:16:06 - 00:09:37:16
Raahat Ansari
That is really helpful and great points to share. And the one thing actually that really stuck with me was about how this all is free and want to highlight that and share that. Definitely, this is something that folks should be taking advantage of. And one thing hearing Dr. Terry Fullmer speak firsthand about this, that really stuck with me

00:09:37:16 - 00:09:57:12
Raahat Ansari
as I as I share about this opportunity, she was laughing. When folks say that this is free? Because the Johnny A. Hartford Foundation is underwriting all of this. And so, you know, it does take the IHI and your team and the AHA team time and money and staff, time to have all this programing up and running.

00:09:57:14 - 00:10:15:05
Raahat Ansari
And it is it is a very generous of the John A. Hartford Foundation to be providing us those funds to see this work forward. So that is money that we don't want to leave on the table, and we don't want any organizations to leave on the table, which is all the more reason to participate. And, you know, leverage that support that is being given.

00:10:15:08 - 00:10:23:05
Raahat Ansari
So, moving on. Do you want to talk a little bit about how have you been able to maintain that level of engagement?

00:10:23:07 - 00:11:02:19
Kimberly Wozneak
We also talk in VA about being on the journey to become a high reliability organization. And we know that high reliability organizations, HRO's, experience fewer events of harm despite operating in highly complex environments. And care for older adults is often complex. Something that I've learned from the Institute for Health Care Improvement and participating in past action communities with the American Hospital Association is taking this all teach, all learn approach that is built on a just culture. And in a just culture

00:11:02:21 - 00:11:27:11
Kimberly Wozneak
people are empowered to share safety stories so that we can learn from them. So the example that I want to give is actually from, you know, our VA action community, as we are now getting ready to launch our third national VAH friendly action communities. And we have those monthly webinars that take us into a deep dive where we learn about the 4M's followed by monthly coaching calls.

00:11:27:13 - 00:11:53:06
Kimberly Wozneak
And these are a forum for teams to bring those safety stories, share them with other teams, share challenges, barriers, but also successes. And ask these questions freely because we all have the opportunity to learn from one another and continuously improve as we improve how we document 4M's care in the electronic health record, how we leverage data through national dashboards.

00:11:53:08 - 00:11:56:28
Kimberly Wozneak
It's all for this continuous process improvement.

00:11:57:00 - 00:12:05:04
Raahat Ansari
And that is so amazing to hear. I love how you're collecting all of that data and those stories. I wonder if you have a story that you'd like to share for our listeners today.

00:12:05:06 - 00:12:37:10
Kimberly Wozneak
Well, I've heard this story from several teams now, but in particular our VA community living centers. These are our VA nursing homes, and we have great interprofessional teams in VA. And we found that the 4M's provide a really nice framework for those interprofessional team meetings and huddles, so that when we have different members of the team incorporating what matters questions as part of their practice, they can bring that information back to the team.

00:12:37:14 - 00:13:02:19
Kimberly Wozneak
And we've actually learned that depending who ask the what matters question, the response from the veteran might be a little bit different depending on if it's the, social worker or their physical therapist who's asking. And so, a story I'll share from one team is that when they joined the movement, they realized that they thought they were doing a really good job asking what matters.

00:13:02:19 - 00:13:30:08
Kimberly Wozneak
And what they found was that they were often documenting what they thought mattered to the veteran, and they saw this incredible shift, so that when they joined the movement, they actually started documenting what matters in as close to the veterans own words as possible. Bringing that information back to the team and having all team members contribute to the care plan to make it really focused and aligned with what matters to the veteran.

00:13:30:10 - 00:13:53:13
Raahat Ansari
That is incredibly interesting to hear, and I have heard one other time that what matters question and that answer changes based on who is asking the question. That is an amazing tidbit to understand and learn about, is that it matters who asks the question and where it's coming from. And with that, we're just about to wrap up, so I'll just pause here and ask if you have any last thoughts that you want to share with our listeners today.

00:13:53:15 - 00:14:19:17
Kimberly Wozneak
Really, anyone can be an Age-Friendly champion and do this incredible work in their hospital or health system. I highly encourage you to consider enrolling in a future action community. There is one coming up this spring with the Institute for Health Care Improvement. I love the structure that action communities provide and I love hearing from all the different hospitals and health systems that are doing this work.

00:14:19:19 - 00:14:29:02
Kimberly Wozneak
The Institute for Health Care Improvement has now recognized more than 4,500 participants in the movement, which is really incredible. So get started on your journey today.

00:14:29:07 - 00:14:33:22
Raahat Ansari
That's fantastic. Thank you so much for joining us today, Kim. It was a pleasure.

00:14:33:25 - 00:14:36:01
Kimberly Wozneak
Thank you for having me.

00:14:36:03 - 00:14:44:13
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.