Tell us a little about your background and what brought you to the Health and Aging Policy Fellows Program.
Thank you. What a great opportunity to reflect. My story really starts with supportive mentors at California State University, Long Beach in Social Work and Gerontology. I was encouraged by both departments to pursue my interest in macro practice in support of older adults. I eventually took on a role as geriatric education specialist within the Department of Veterans Affairs (VA) in the Greater Los Angeles Geriatric Research Education and Clinical Centers (GRECC), through VA’s Office of Academic Affiliations (OAA)
In VA, I have had multiple opportunities to develop programs that support older Veterans, but also across their lifespan. Early on in GRECC I immersed in geriatric interprofessional team-based teaching, learning and clinical care supporting Veterans and their families. I focused on healthcare system gaps and became fascinated with the potential of health technology to bring care into someone’s home when it was challenging for the patient to get into the healthcare system. My role was expanded into special populations at a regional level as I worked with VA’s national Office of Connected Care (then Office of Care Coordination and Telehealth) and I became more engaged with system issues at a national level. I became acutely aware of the needs and challenges of family caregivers and had an opportunity through VA’s national Office of Social Work to develop one of VA’s first regional caregiver support programs, serving California and Nevada. Later, I had the opportunity to transition to a new demonstration project and Centers of Excellence in Primary Care Education and work nationally with interprofessional champions in Medicine, Nursing, Pharmacy, Psychology, Psychiatry, Physical Therapy, Evaluation and Health Administration. This project was unique in that we really had an opportunity to build a nationally recognized clinical education infrastructure and clinic-based team model that included staff and clinical trainees from these and other health professions. This unique national planning team and the local teams at each participating site were tasked with better linking clinical and actual practice to each patient’s needs, developing and teaching cross profession clinical curriculum, communication strategies and clinical practice strategies to next generation professionals at the site of clinical care. The outcomes of this work won’t be fully evident until many years into the future! At project sunset, I had a unique opportunity to return to VA’s national Caregiver Support Program.
I was drawn to the Health and Aging Policy Fellows (HAPF) Program because I felt a little stuck professionally and wanted to be able to learn how to tell a better story about flagship strategies and those ideas and practices that have big potential but are caught in a myriad of improvement initiatives each competing for attention and resources. When I was teaching graduate and undergraduate social workers public policy coursework, I also always felt like I was shorting them in this area. So I am looking for opportunities to develop relationships and outreach strategies, be part of discussions that lead to and accelerate the improvement in healthcare, identify and understand existing policy and practice and the impact on older adults and the families and others who care for them. I also felt that the HAPF program would contribute to my ability to tackle ideas around advocacy and policy support and sustainment from a very different angle. HAPF is doing that and more!
Why are you interested in working with EWA?
In the federal government, I have worked on various healthcare demonstration projects where top-down approaches drive organizational mission and Veteran care. However, the programming and momentum for cultural evolution really has to begin at the point of care and learning. This is where transformation begins. A team is engaged, each member ideally with unique expertise, training and professional perspective contributing towards common goal, the outcome improvement. Incredibly important next steps include: Packaging and communicating stories, successful messages and targeted outcomes that meet the needs of multiple categories of stakeholders is required for larger scale adaption and adoption of innovation and new policy and practice. EWA, with key partners across the states immerse in this kind of deliberation and targeted advocacy. The organization works collectively to translate, prioritize and push critical change initiatives and strategies at a very different level than the work that I have done. EWA has a primary focus on the needs and qualifications of the eldercare workforce and those requirements that are central to achieving optimal care for older adults. I am focusing on frameworks to advance healthcare social change through advocacy and want to better understand models that link interactions between the micro point of care and the macro system and legislative process and the areas in between that tie both together. These activities help improve my understanding of the legislative, fiscal and decision-making processes that make up the overall delivery system. EWA collaborates across organizations to build momentum and contribute to sustained success. This is important to me.
What projects will you be working on at EWA?
I am excited about the opportunity to take a deep dive into the National Academy of Science 2019 Report “Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health” ; the 2016 report Families Caring for an Aging America; and potentially the February 2020 Report Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The first report revolves around social risk factors and how those factors can impact health outcomes in individuals. The second report is built upon principles of Crossing the Quality Chasm: A New Health System for the 21st Century and tackling the role critical role of caregivers, the impact on older adults as well as the challenges of caregivers. The third report focuses on the impact of isolation on the health of older adults as related to evidence around chronic disease and increased mortality. EWA has developed a cross-organization workgroup of leading stakeholders to identify and policy priorities, advocacy opportunities, roles, and activities and identify the intersections that support a high functioning eldercare workforce and improved quality of life for older adults, their families and other caregivers.
In addition to EWA, you are also working with ACL and the RAISE Family Caregiver Advisory Panel. What drew you to this fellowship?
Caregiver support has been a long-time personal and professional interest of mine fueled by the influence of Kathleen Kelly, Family Caregiver Alliance. In my roles within special populations in VA (particularly within geriatrics, telehealth and rural health), I met with, worked with and assessed Veterans their families and other caregivers experiencing challenges around the provision of care. At that same time I conducted a study of VA social workers across the country related to their perceptions of caregiver health system gaps. Later when I had an opportunity to propose a demonstration site through VA’s National Office of Social Work, the California Caregiver Resource Centers (CRC’s) model significantly influenced the development of that proposal. I worked closely with my mentor and Co-PI and the Southern CRC to build the VA California Offices on Caregiving in supporting Veteran caregivers in 3 states. During that time, Kathleen also suggested that we explore a VA/Stanford collaboration based in Stanford’s Chronic Disease Self-Management Model. Ultimately that suggestion led to the development and pilot of Building Better Caregivers (BBC) an online workshop intended to enhance caregiver skillset and reduce stress and burden. Later, I had the opportunity to work with the national social work team and others to contribute to VA’s first national iteration of caregiver support prior to the historical 2010 legislation under the Obama Administration. (PL111-163).
When the opportunity arose to work with ACL and the National Family Caregiver Support Program and the Advisory Panel it intuitively seemed a good match. As a federal partner myself, I am interested in how other federal agencies expand and collaborate on critical programming to develop a national plan. Greg Link of ACL has been working closely with me to develop my role as a federal liaison, and I am working with the Advisory Panel and RAISE Federal Partners to develop an Inventory of federally funded caregiver resources per the RAISE ACT Public Law 115-119. This project has potential to help us better understand caregiver system gaps, but also to expand the knowledge base of resources available to caregivers. This partnership is also a good match for my detail within VA’s Caregiver Program Office. The program has grown and continues to grow tremendously, and I feel honored to be a part of some of that. As the VA is working feverishly to support and expand programming for the Program of General Caregiver Support and the Program of Comprehensive Assistance under the VA Mission Act of 2018, I trust that knowledge exchange and resource sharing will be useful for both organizations.
Many times, we learn as much from our fellows as they learn from us. What experiences in your personal and professional life have helped inform your work in this fellowship?
My personal lessons revolve around the following thoughts:
On Culture Change and Transformation
Change is hard
Change isn’t about ownership….we are all in this together.
Caregivers (both professional and family or informal) will benefit from support, education and/or guidance. In fact, these things are essential.
Without support the patient and the caregiver will suffer and the health system will be negatively impacted.
Caregivers can and should be perceived as essential members of the healthcare team.
On Interprofessional Teams
A single profession can’t know everything. Each team member brings unique perspective and expertise.
Team members must understand each other’s roles, scope and potential.
Impactful collaboration and communication takes time, trust, resources and hard work.
On the Big Picture
The story is much deeper than the data.
Rules are made to be questioned, disruption embraced.
There is never enough time or resources.
Laural (“Laurie”) is a macro social worker with career focus on healthcare disparities, equity, interventions, resources and policies with impact on older adults, their families and other caregivers. Laurie is employed by Department of Veterans Affairs in VA’s national Office of Academic Affiliations (OAA), the largest provider of health professions education in the United States. She is additionally working on the expansion of VA’s Caregiver Support Program in the national Care Management and Social Work office. Laurie has served in national roles to develop geriatric education, primary care and mental health integration, women’s health, palliative care, rural health, telehealth, care coordination and in the development of interprofessional teaching and learning strategies. Laurie taught public policy coursework at California State University, Long Beach to graduate and undergraduate social work students. She has master’s degree in social work, a gerontology certificate and bachelors in psychology from California State University, Long Beach. Ms. Traylor was selected as a fellow for the Health and Aging Policy Fellowship Program, serving a dual placement with Eldercare Workforce Alliance and the United States Department of Health and Human Services in the Administration for Community Living. Laurie was recently awarded title as distinguished public policy fellow in the National Academies of Practice 2020.