Supporting and Sustaining the Current and Future Workforce to Care for People with Serious Illness: Proceedings of a Workshop (2023)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Supporting and Sustaining the Current and Future Workforce to Care for People with Serious Illness Laurene Graig and Joe Alper, Rapporteurs Roundtable on Quality Care for People with Serious Illness Board on Health Care Services Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs Proceedings of a Workshop 

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by the American Academy of Hospice and Palliative Care, American Geriatrics Society, Ascension Health, Association of Professional Chaplains, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, CSU Shiley Haynes Institute for Palliative Care, Cambia Health Foundation, Catholic Health Association, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, National Association of Social Workers, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, New York Academy of Medicine, Patient- Centered Outcomes Research Institute (PCORI), and the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number – 13: 978-0-309-xxxxx-x International Standard Book Number – 10: 0-309-xxxxx-x Digital Object Identifier: https://doi.org/10.17226/27328. This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Supporting and sustaining the current and future workforce to care for people with serious illness: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27328. PREPUBLICATION COPY—Uncorrected Proofs 

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institu- tion to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineer- ing to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs 

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports ­typically include findings, conclusions, and recommendations based on information ­gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not ­endorsed by other participants, the planning committee, or the National ­Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions ­contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs 

PLANNING COMMITTEE FOR A WORKSHOP ON SUPPORTING AND SUSTAINING THE CURRENT AND FUTURE WORKFORCE TO CARE FOR PEOPLE WITH SERIOUS ILLNESSES1 JOANNE REIFSNYDER (Co-Chair), Professor of Health Services Leadership and Management, University of Maryland School of Nursing BRYNN BOWMAN (Co-Chair), Chief Executive Officer, Center to Advance Palliative Care, and Assistant Professor, Icahn School of Medicine at Mount Sinai JENNIFER MOORE BALLENTINE, Executive Director, CSU Shiley Haynes Institute for Palliative Care (through December 2022) AMY BERMAN, Senior Program Officer, The John A. Hartford Foundation ROBERT ESPINOZA, Executive Vice President of Policy, PHI ERNEST J. GRANT, Immediate Past President, American Nurses Association DIANE MEIER, Founder, Director Emerita, and Strategic Medical Advisor, Center to Advance Palliative Care; Codirector, Patty and Jay Baker National Palliative Care Center; and Professor, Icahn School of Medicine at Mount Sinai AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care ARIKA PATNEAUDE, Director, Bioethics & Palliative Care, Seattle Children’s Hospital CAROL PEDEN, Executive Director for Clinical Quality, Blue Cross Blue Shield Association JOSEPH ROTELLA, Chief Medical Officer, American Academy of Hospice and Palliative Medicine JOSEPH SHEGA, Executive Vice President and Chief Medical Officer, VITAS Healthcare 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speak- ers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs 

Staff LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness SHARYL NASS, Director, Board on Health Care Services EMMA ROONEY, Research Assistant ISAAC SUH, Research Associate Consultants JOE ALPER, Consulting Writer vi PREPUBLICATION COPY—Uncorrected Proofs 

ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1 PEGGY MAGUIRE (Co-Chair), President and Board Chair, Cambria Health Foundation PHILLIP RODGERS (Co-Chair), Professor of Family Medicine and Internal Medicine, The George A. Dean M.D. Professor and Chair, Department of Family Medicine, University of Michigan Medical School JORI BOGETZ, Attending Pediatric Palliative Care Program Faculty, Palliative Care and Resilience Research Program Faculty, Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute BRYNN BOWMAN, Chief Executive Officer, Center to Advance Palliative Care KAREN BULLOCK, Ahearn Endowed Professor, Boston College School of Social Work; Representing the National Association of Social Workers JANE CARMODY, Senior Program Officer, The John A. Hartford Foundation STEVE CLAUSER, Program Director, Improving Healthcare Systems Research Program, Patient-Centered Outcomes Research Institute RORY FARRAND, Vice President, Palliative and Advanced Care, National Hospice and Palliative Care Organization LORI FRANK, Senior Vice President for Research, New York Academy of Medicine MATTHEW GONZALES, Associate Vice President, Chief Medical and Operations Officer, Providence Institute for Human Caring; Representing the Catholic Health Association ANNA GOSLINE, Senior Director Strategic Initiatives, Blue Cross Blue Shield of Massachusetts, Executive Director, Massachusetts Coalition for Serious Illness Care MICHELLE GROMAN, President and Chief Executive Officer, The Greenwall Foundation 1 The National Academies of Sciences, Engineering, and Medicine’s forums and round- tables do not issue, review, or approve individual documents. The responsibility for the pub- lished Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs 

SCOTT D. HALPERN, John M. Eisenberg Professor of Medicine, Epidemiology, and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania SHARON B. HAMILL, Interim Executive Director, CSU Shirley Haynes Institute for Palliative Care (from January 2023) JOHN R. HENDRIX, Director, Ascension St. John Palliative Care Program, Ascension Health (through September 2023) DENISE HESS, Representing the Association of Professional Chaplains REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation TOM KOUTSOUMPAS, Co-Founder, Coalition to Transform Advanced Care DIANE E. MEIER, Founder, Director Emerita, and Strategic Medical Advisor, Center to Advance Palliative Care; Codirector, Patty and Jay Baker National Palliative Care Center; and Professor, Icahn School of Medicine at Mount Sinai AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care (through October 2023) R. SEAN MORRISON, Ellen and Howard C. Katz Professor and Chair, Brookdale Department of Geriatrics and Palliative Medicine; Director, National Palliative Care Research Center, Icahn School of Medicine at Mount Sinai CAROL PEDEN, Executive Director for Clinical Quality, Blue Cross Blue Shield Association (through May 2023) THOMAS M. PRISELAC, President and CEO, Cedars-Sinai Health System JOANNE REIFSNYDER, Professor of Health Services Leadership and Management, University of Maryland School of Nursing; Representing the Hospice and Palliative Nurses Association JOE ROTELLA, Chief Medical Officer, American Academy of Hospice and Palliative Medicine LEONARD D. SCHAEFFER, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California (through October 2023) JOSEPH W. SHEGA, Executive Vice President and Chief Medical Officer, VITAS Healthcare; Representing the American Geriatrics Society CARDINALE B. SMITH, Chief Medical Officer, Tisch Cancer Hospital, The Mount Sinai Hospital, VP, Cancer Clinical Services at the Mount Sinai Health System viii PREPUBLICATION COPY—Uncorrected Proofs 

SUSAN ELIZABETH WANG, Regional Chief, Geriatrics & Palliative Medicine, SCPMG, Regional Medical Director, LCP & Serious Illness Care, SCPMG, National Executive Leader, Dignified Journeys & Palliative Care, The Permanente Federation Roundtable on Quality Care for People with Serious Illness Staff LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness SHARYL NASS, Senior Director, Board on Health Care Services EMMA ROONEY, Research Assistant ISAAC SUH, Research Associate JULIE WILTSHIRE, Senior Finance Business Partner, Board on Health Care Services ix PREPUBLICATION COPY—Uncorrected Proofs 

PREPUBLICATION COPY—Uncorrected Proofs 

Reviewers This Proceedings of a Workshop was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, ­objectivity, evi- dence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: KEZIA SCALES, PHI MICHELLE WEBB, Duke University School of Nursing AL SIU, Icahn School of Medicine at Mt. Sinai SARAH E. HETUE HILL, CHRISTUS Santa Rosa Health System & The Children’sHospital of San Antonio Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRUCE N. CALONGE. He was respon- sible for making certain that an independent examination of this proceed- ings was carried out in accordance with standards of the National Academies xi PREPUBLICATION COPY—Uncorrected Proofs 

xii REVIEWERS and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. PREPUBLICATION COPY—Uncorrected Proofs 

Acknowledgments The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Cochairs JoAnne ­Reifsnyder and Brynn Bowman for their valuable contributions to the development and orchestration of this workshop. The Roundtable also wishes to thank all the members of the planning committee who col- laborated to ensure a workshop complete with informative presentations and rich discussions. Finally, we want to thank the speakers and modera- tors, who generously shared their expertise and their time with workshop participants. Support from the many annual sponsors of the Roundtable on Quality Care for People with Serious Illness is critical to the roundtable’s work. The sponsors of the Roundtable on Quality Care for People with Serious I­ llness include: American Academy of Hospice and Palliative Care, American Geriatrics Society, Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, CSU Shiley Haynes Institute for Palliative Care, Cambia Health Foundation, Catholic Health Association, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, National Association of Social Workers, National Coalition for xiii PREPUBLICATION COPY—Uncorrected Proofs 

xiv ACKNOWLEDGMENTS Hospice and Palliative Care, National Hospice and Palliative Care Organi- zation, National Palliative Care Research Center, National Patient Advocate Foundation, New York Academy of Medicine, Patient-Centered Outcomes Research Institute (PCORI), and the Leonard D. Schaeffer ­Center for Health Policy & Economics at the University of Southern California. PREPUBLICATION COPY—Uncorrected Proofs 

In Memoriam The Roundtable on Quality Care for People with Serious Illness dedi- cated its April 2023 workshop to honor the life and work of Randy Curtis, who passed away in February 2023. J. Randall Curtis, M.D., M.P.H., was an expert in critical care, p ­ alliative care, and pulmonary medicine. As a palliative care researcher, he received over 25 years of continuous NIH funding. He authored more than 350 peer-reviewed research articles and more than 200 editorials and c­ hapters. Dr. Curtis founded the Cambia Palliative Care Center of ­Excellence at the University of Washington. In 2022, he received a Lifetime Achievement Award and a mentoring award from the American Academy of Hospice and Palliative Medicine. xv PREPUBLICATION COPY—Uncorrected Proofs 

PREPUBLICATION COPY—Uncorrected Proofs 

Contents ACRONYMS AND ABBREVIATIONS xxi INTRODUCTION 1 OPENING REMARKS 8 VOICES FROM A WORKFORCE IN CRISIS 11 Panel Discussion, 15 Audience Q & A, 17 OVERVIEW OF THE CURRENT AND FUTURE STATE OF THE WORKFORCE 18 SYSTEMS LEVEL APPROACHES TO SUPPORTING THE WELL-BEING OF THE HEALTH WORKFORCE 28 Well-Being of the Pediatric Workforce, 29 Well-Being of the Nursing Workforce, 31 Well-Being of the Long-Term Care Workforce, 33 Well-Being of the Clinical Workforce in Rural Areas, 33 Panel Discussion, 35 Audience Q & A, 39 CREATING A COMPASSIONATE, CARING ENVIRONMENT FOR PATIENTS AND CLINICIANS 40 DIRECT CARE WORKERS: INDISPENSABLE, UNDERVALUED, AND IN SHORT SUPPLY 48 Audience Q & A, 54 xvii PREPUBLICATION COPY—Uncorrected Proofs 

xviii CONTENTS ADVANCING DEI IN SERIOUS ILLNESS CARE 55 Panel Discussion, 62 Audience Q & A, 64 DEVELOPING PROMISING MODEL/INNOVATIVE APPROACHES TO WORKFORCE RECRUITMENT, TRAINING, AND RETENTION 65 Programs to Support Direct Care Workers, 66 Midcareer Hospice and Palliative Medicine Fellowship Consortium, 69 Striving for Concordant Care: Teaching Serious Illness Communication Skills, 72 Healing Healthcare Initiative Pilot Program, 76 Panel Discussion, 80 Audience Q & A, 81 THE SERIOUS ILLNESS CARE WORKFORCE: A CALL FOR RADICAL TRANSFORMATION 84 Audience Q & A, 90 VIDEO MONTAGE: VOICES OF THE SERIOUS ILLNESS CARE WORKFORCE 93 Closing Remarks, 94 REFERENCES 97 APPENDIX A: STATEMENT OF TASK 103 APPENDIX B: WORKSHOP AGENDA 105 PREPUBLICATION COPY—Uncorrected Proofs 

Box and Figures BOX 1 Suggestions Made by Individual Workshop Participants to Support and Sustain the Current and Future Workforce to Care for People, 3 FIGURES 1 Demographic makeup of the direct care and physician workforce, 24 2 Number of Medicare Advantage plans offering expanded supplemental benefits, 25 3 Structure of the midcareer fellowship, 70 4 Structure of the Serious Illness Communication Skills Curriculum, 75 xix PREPUBLICATION COPY—Uncorrected Proofs 

PREPUBLICATION COPY—Uncorrected Proofs 

Acronyms and Abbreviations AAHPM American Academy for Hospice and Palliative Medicine ADL activity of daily living ANA American Nurses Association CNA certified nursing assistant HBCU historically Black college and university HPNA Hospice and Palliative Nurses Association IADL instrumental activity of daily living PPE personal protective equipment SWHPN Social Work Hospice and Palliative Care Network xxi PREPUBLICATION COPY—Uncorrected Proofs 

PREPUBLICATION COPY—Uncorrected Proofs