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Health and Wellness- Background The implementation of policies and programs that promote elder health and wellness is increasingly important. A principal theme of this plan addresses a proactive shift toward promoting healthy aging, creating healthy environments, and increasing access to high-quality health care for everyone. Each objective and its strategies must take a multi-disciplinary approach to achieve health equity - regardless of an individual s age, sex, race, ethnicity, income, education, ability level, geographic location or sexual orientation. Early intervention and prevention are keys that can minimize the incidence of people suffering adverse health conditions. Chronic diseases such as heart disease, cancer and diabetes are among the most prevalent, costly and preventable of all health problems. Chronic diseases often have a long course of illness. They rarely resolve spontaneously, and they are generally not cured by medication or prevented by vaccine. Chronic diseases are the leading cause of death and disability in Florida and the nation. However, consideration of deaths alone severely understates the burden of chronic disease. The prolonged course of illness and disability from chronic diseases such as heart disease, stroke, diabetes and arthritis results in extended pain and suffering as well as in decreased quality of life for thousands of Floridians. Early intervention and prevention can greatly reduce the number of people who must endure these health consequences. Obesity is another health issue that has widespread concern. This concern is inclusive of elders. In Fall 2003, former Governor Bush formed the Governor s Task Force on the Obesity Epidemic to make recommendations regarding the problem of overweight and obesity in Florida. The Governor appointed a 16-member task force. Executive Order 03-196, creating the task force noted that 14.2 percent of high school students are at risk of becoming overweight, and an additional 10.4 percent are overweight. Fiftyseven percent of adults are overweight or obese, a 63 percent increase since 1986. Physical inactivity and poor nutrition comprise the second leading causes of death. In 2002, 26.4 53
percent of Florida adults were physically inactive and only 25.7 percent of Florida adults ate the recommended five daily servings of fruits and vegetables. The shortage in medical staff, particularly among geriatric and primary care physicians, remains another issue facing elders as the baby boomer generation grows older. According to the American Geriatrics Society, it is estimated that, by 2030, there will be only one geriatrician for every 7,665 older adults in the United States. Further, in December 2005, Congress eliminated the $31.5 million Title VII funding for geriatrics. It is anticipated that these recent cuts will have a significant impact on the shortage crisis. Therefore, major steps are needed to recruit and train staff in the aging field. Mental health is still another issue often affecting elders. Elders face many situations that can lead to depression and sometimes even suicide during the aging process. These factors can include loneliness attributed to the loss of a loved one, social isolation, loss of independence or retirement. Substance abuse and alcohol is another major issue that affects elders. Only 11 percent of the population is elderly, but 35 percent of all prescription and nonprescription drugs is used by people aged 65 and older. Elders are the segment of the population with the highest use of over-the-counter (OTC) and prescription drugs (40 percent use at least one OTC drug daily, while 80 percent use a prescription drug daily [Abrams, 1987]). This level of drug use, particularly when combined with even moderate alcohol use, contributes to drug use problems among elders. Further, the problems are sufficiently different from those experienced by other segments of the population that they often go undetected or unrecognized. Florida seniors are a hardy group that includes individuals who have survived the Depression, two World Wars and a world that has changed many times over. This independent, resilient group has been an infrequent user of social services and is generally unaccustomed to obtaining assistance from state agencies. A closer look at the health and social system has revealed that, despite the myriad of state-funded services available to seniors, the reality is that there is little coordination between the service entities. 54
When an individual seeks assistance, an assessment specifically geared to that service may be conducted. Persons seeking multiple services may result in their receiving treatment or assistance in a fragmented manner by multiple entities. A larger need which may not be as easily addressed can go overlooked. To improve care, individual physical, mental and spiritual concerns must be addressed within a system broad enough to resolve problems while remaining flexible enough to accommodate individual need. Adopting a whole-person focus will require a basic shift in how services are developed, structured and funded. Therefore, services become personcentered rather than symptom-centered. An individual might need only one service, or they may have a constellation of needs. For more information on health and wellness trends, please see Appendix A. Health and Wellness- Inventory of Services: Health and wellness programs in most state agencies are centered on prevention and education. The Department of Health currently serves as the primary agency for health and wellness promotion. Programs currently include cancer awareness, osteoporosis prevention, arthritis prevention, heart disease and stroke awareness, chronic disease, and substance abuse program. The agency also encourages physical fitness through its Step Up, Florida campaign and Healthy Communities, Healthy People initiative. The Department of Elder Affairs has similar programs, with prevention and promotion programs in areas such as osteoporosis and mental health screening. The department s Florida Injury Prevention Program for Seniors (FLIPS) program is another service aimed at preventing injuries from falls. Other general services are administered through Older Americans Act (OAA) funds that contribute to elder health and well-being, including nutritional services. 55
The Department of Children and Families works with individuals experiencing severe and persistent mental illness or who are in a mental health crisis. Two recent mental health initiatives target elders. The Department of State also has several health and wellness programs. The Florida Center for Creative Aging promotes successful aging by improving quality of life through arts and humanities. Similarly, the Florida Arts Council is a visioning program that includes health and wellness. The agency is also involved in several partnerships with other state agencies that assist in encouraging the health and well-being of Florida s elders. See Appendix B for details. Health and Wellness- Objectives: Goal: Increase the quality and years of healthy life and eliminate health disparities (Healthy People 2010). Objective 1- Objective 2- Objective 3- Encourage and promote healthy aging through early intervention and prevention programs.* Ensure that seniors are financially secure to meet obligations, purchase necessary medical services and prescription drugs and other vital necessities of life. Support local, state and federal programs that target financial viability of seniors, including Social Security, Medicare, Medicaid, local taxes, public policies, etc. Ensure that Americans have transportation options to retain their mobility and independence.* *Objective is similar to an objective/strategy in other topic areas. 56
Objective 4- Objective 5- Objective 6- Objective 7- Objective 8- Objective 9- Objective 10- Objective 11- Objective 12- Develop a coordinated federal, state and local emergency response plan for seniors in the event of public health emergencies or disasters.* Attain an adequate number of personnel in all health care professions who are skilled, culturally competent and specialized in geriatrics.* Support older adults in making complex health care decisions. Increase the number of service models that offer integrated health and aging services. Decrease the waiting period for older adults that need mental health and substance abuse services. Support improvements in senior nutrition programs. Encourage community designs to promote livable communities that enable aging in place.* Foster innovations that prevent sight and hearing loss and that aid older adults with sight and hearing-loss and other physical and mental disabilities to actively engage in their communities. Promote the development of a comprehensive oral health program to reduce dental diseases, including dental caries, periodontal diseases and oral cancer; and to reduce associated risks of diseases that are showing interrelatedness to periodontitis. *Objective is similar to an objective/strategy in other topic areas. 57
Health and Wellness- Key Implementation Strategies, Roles and Responsibilities: The desired holistic approach to health and wellness issues will involve the Department of Elder Affairs, Department of Health, Department of Children and Families, Department of State, Department of Financial Services and the Department of Transportation, committing themselves to develop and implement a coordinated plan to serve seniors. Although state agencies take the lead in carrying out many of the strategies to support seniors, local community resources are the bedrock of face-to-face services for millions of seniors. Community partnerships, particularly when they reach out to nontraditional partners, can be among the most effective tools for improving health in communities. The following matrix identifies the roles and responsibilities of the state s key players in delivering health services to Florida s older residents. Strategy Develop and implement wellness programs for seniors, accessible at sites such as senior centers, ensuring access for individuals with disabilities (Objective 1,10) Develop and implement fall prevention and balance maintenance programs for seniors (Objective 1,10) Develop tools for families to assist in decisionmaking with regard to health conditions and lifestyle behaviors (Objective 6) Support local outreach efforts through resources such as senior centers, to inform seniors and their family members of programs that aid in understanding health-related issues and treatment options (Objective 1,6) DOEA SERT DCF DOH DFS DOS AHCA DOT Other Local Feds --- --- --- --- --- --- --- --- Legend: Lead Support Partnership --- 58
Strategy Promote regular screening as a standard protocol for early identification for numerous conditions (Objective 1, 7) Attain a higher proportion of older adults who are vaccinated annually against influenza and pneumococcal disease (Objective 1,7) Develop and implement programs that are culturally and linguistically appropriate to reduce health disparities for disease prevention, detection and treatment (Objective 1,7) Encourage public and private health insurers to broadly cover preventive care for disease prevention (Objective 1,2) Promote programs that educate individuals with chronic disease to assuage their disease with proper diet (Objective 1,9) Promote nutritional programs targeted to lowincome older adults (Objective 1,9) Strengthen the link between healthful dietary habits and increased physical activity (Objective 1,9) Support a strong national and state program for basic and applied nutrition research to provide a sound scientific base for dietary recommendations and effective interventions (Objective 1,9) Promote programs that reverse the Westernization of diets (Objective 1,9) Increase physical activity opportunities that enhance a consortium of care and selfmanagement practices (Objective 1,10) Develop and implement obesity reduction programs for seniors (Objective 10) Promote direct deposit for federal beneficiaries to reduce the risk of mail theft (Objective 2) DOEA SERT DCF DOH DFS DOS AHCA DOT Other Local Feds --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- Legend: Lead Support Partnership --- 59
Strategy Promote programs that equip seniors with the tools and resources they need to make informed financial decisions about personal financial issues, including personal savings accounts, long-term care insurance, applying for loans, managing debt, making sound investment choices and saving for retirement (Objective 2) Revise SHINE curriculum to include a resource to refer seniors who request further financial information (Objective 2) Explore the modification of transportation funding to furnish vouchers to clients rather than transportation providers in order to enhance client choice and sharpen competition among providers (Objective 3)* Work with officials to ensure availability of inexpensive transportation for health related appointments and errands (Objective 3) Fund Medicaid to provide transportation to health related appointments and errands, even across county lines (Objective 3) Improve efforts to reach older adults to identify immediate needs (Objective 4) Improve efforts to provide swift assistance in the aftermath of health emergencies or disasters (evacuation, potable water, MREs, etc.) (Objective 4)* Ensure an adequate supply of prescription drugs, eye glasses, and durable medical equipment is available in the event an individual s supply is destroyed or runs out (Objective 4) DOEA SERT DCF DOH DFS DOS AHCA DOT Other Local Feds --- --- --- --- --- Improve the state s tarp program to cover exposed roofs when individual has insufficient funds to make repairs (Objective 4) Legend: Lead Support Partnership --- *Strategy is similar to an objective/strategy in other topic areas. 60
Strategy Prior to transitioning a senior back into their home from a special needs shelter, conduct home inspections to identify potential dangerous or unsanitary conditions, and work with local authorities to locate alternate housing when the home is unsafe (Objective 4) Increase the number of special needs shelters that are appropriately equipped and maintained, and publicly promote the shelters and the need to pre-register (Objective 4)* Allow caregivers to evacuate with their disabled relative to maximize continuity of care and to reduce adverse effects of stress on disabled seniors (Objective 4) Promote programs that encourage individuals to enter the health care field, and increase the ratio of geriatricians serving the age 65+ population from Florida s current 15 per 100,000 to the national rate of 23 per 100,000 (Objective 5) Work with appropriate agencies to increase the number of health professionals, especially those serving seniors with special needs and in long-term care facilities (Objective 5) Expand loan forgiveness programs for professionals working in medically underserved areas (MUAs) and medically underserved populations (MUPs) (Objective 5) Support increasing the capacity of Florida's higher education and vocational training systems to produce more medical and allied professional and paraprofessional personnel, particularly in primary care (Objective 5) Support strategies offered by health literacy advocates to develop a comprehensive program to create easily understandable health information through available state agencies, commissions and the private sector (Objective 6) DOEA SERT DCF DOH DFS DOS AHCA DOT Other Local Feds --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- *Strategy is similar to an objective/strategy in other topic areas. Legend: Lead Support Partnership --- 61
Strategy Improve patient transition from inpatient care to community settings (Objective 7) Reduce the treatment gap for older adults with severe persistent mental illness (SPMI) (Objective 8) Support programs that provide treatment to severely and persistently mentally ill (SPMI) older adults (Objective 8) Ensure that older adults have access to mental health services and substance abuse services (Objective 8) Promote and enhance screening and outreach services to facilitate early identification of substance abuse, depression and suicide risk (Objective 8) Continue to fund or seek external funds for evidence-based models of recruitment and substance abuse prevention for older adults (Objective 1, 8) Continue to expand the Brief Intervention and Treatment for Elders (BRITE) pilot program, an innovative outreach program designed to provide services to older adults that need services in non-traditional settings (e.g., home) (Objective 8) Continue collaboration among state agencies and service providers to build a comprehensive system of care and services for older adults (Objective 8) Develop and implement safe driving programs for seniors (Objective 10)* DOEA SERT DCF DOH DFS DOS AHCA DOT Other Local Feds --- --- --- Legend: Lead Support Partnership --- *Strategy is similar to an objective/strategy in other topic areas. 62
Strategy Support co-location of services for seniors directly adjacent to public transportation routes (Objective 10)* Promote education on prevention of sight and hearing loss and community resources (Objective 11) Provide ongoing access to health care for individuals with sight and hearing disabilities (Objective 11) Remove barriers to physical activity due to sight and hearing loss and other physical and mental disabilities (Objective 11) Provide oral health care targeted to individuals with diseases for which research shows systemic associations to periodontitis: heart disease, diabetes, osteoporosis, respiratory infections, etc. (Objective 12) Increase access to dental care for low-income adults with special needs (Objective 12) Support fluoridation programs in areas with non-fluoridated community water systems (Objective 12) Promote awareness among health care providers and the public about the importance of annual oral cancer exams for seniors who have ever used tobacco products (Objective 1,12) Support emerging programs that increase the oral heath professional workforce and expand the capacity of nursing homes and other longterm care facilities to furnish basic care to individuals in nursing homes (Objective 12) DOEA SERT DCF DOH DFS DOS AHCA DOT Other Local Feds *Strategy is similar to an objective/strategy in other topic areas. Legend: Lead Support Partnership --- 63