UofL geriatrician hopes to influence policy, redefine aging experience

Christian Davis Furman recently was accepted into the Health and Aging Policy Fellows (HAPF) Program in Washington D.C. Furman, the medical director of the UofL Trager Institute/Republic Bank Foundation Optimal Aging Clinic, will spend a year in Washington as part of the interdisciplinary fellowship's residential track, networking and learning how to influence policy.

HAPF is a year-long program designed to prepare leaders who will work to improve health and aging policy relative to health care for older adults. Applicants to the program must demonstrate a commitment to the health and aging issues of older Americans, as well as the potential to be health policy leaders. 

According to Trager Institute Executive Director Anna Faul, the fellowship will allow Furman to introduce the institute and its mission to people who have the power to change the field of geriatrics, not only to address the needs of older adults but to redefine the aging experience.

UofL News asked Furman about what drew her to the fellowship and what she expects to gain and learn during her year in D.C.

UofL News: How did you hear about this fellowship and what interested you about applying for it?

Christian D. Furman: I first heard about the Health and Aging Policy Fellowship when I was an innovation advisor for the Center for Medicare and Medicaid Innovation (CMMI) about ten years ago. While I was a CMMI innovation advisor, they encouraged us to apply for the fellowship. As I teach geriatrics, I always discuss policy issues that need to be corrected. I thought now was the time to change these policies. Instead of just talking about it, now was the time to do something. 

ULN: What are your expectations going into the fellowship?

Furman: I expect to learn how state and federal policies are made. I expect to learn who makes these policies. I expect to make a network of professionals who I can work with in the future to advocate for policy changes to improve the lives of older adults.

ULN: What excites you the most about being part of this fellowship? 

Furman: I chose the residential track and will be relocating to Washington during this one-year fellowship. I am excited to be in an environment where I will meet people daily who can change policies to improve the lives of older adults!

ULN: Do you have any specific goals you want to accomplish while in Washington? 

Furman: My goal during the fellowship is to change the Hospice Medicare Benefit to include room and board at the nursing home. When I was chief of hospice and palliative care at the VA, I would discharge dying patients to the nursing home with Hospice so they could have a peaceful death in a home-like setting. A few weeks later, they would arrive back at the VA emergency room (ER) actively dying. The ER is not the best environment to die.

The reason this occurred is when the patient arrived at the nursing home, the nursing home said that if the patient wanted to use their Hospice Medicare Benefit, they needed to pay room and board (about $250/day) or they could stay at the nursing home at no-charge and use their Skilled Medicare Benefit. Most patients choose free services, so they used their Skilled Medicare Benefit and not their Hospice Medicare Benefit. Therefore, when they start to actively die, there is no specialized care team that knows what to do (Hospice), so the patient is sent back to the ER. While these dying patients are receiving Skilled Medicare Services, they are forced to do physical therapy and walk up and down the halls when they are very weak and would rather stay in bed. I have seen this same scenario play out again and again over my past 22 years as a geriatrician. Now is the time for me to try to change this policy. This fellowship will give me the skills necessary to advocate for this change. 

ULN: You’ll continue your role as the medical director at the Trager Institute/Republic Bank Foundation Optimal Aging Clinic while you’re doing this fellowship. How do you plan to stay connected with the Trager Institute during your absence? 

Furman: I am very grateful for the support from Toni Ganzel, dean of the UofL School of Medicine and Anna Faul, executive director of Trager Institute, in allowing me to pursue this fellowship. I will retain the Smock Endowed Chair and be able teach advocacy and policy to our learners at Trager during the fellowship. I will join Trager meetings and conferences virtually and speak daily to our practice manager. The other geriatricians and our nurse practitioner will care for my patients during this time. I am extremely blessed that we have a wonderful team!

Interview by Samantha Adams.