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14 months

American Bar Association Fund for Justice and Education*

Naomi Karp, JD
"Healthcare Decision-Making for the Unbefriended Elderly:
Towards Legislative Improvements in New York State"

The aim of this project is to help the many socially isolated and unbefriended elderly obtain someone to make healthcare decisions for them. This topic is particularly important in New York where the laws, developed to protect people's right to determine the course of their own care, have created a number of barriers preventing unauthorized care decisions for an individual. This project will provide clinicians, ethics committees, healthcare administrators and legislators with innovative methods for dealing with these unbefriended patients in order to avoid the necessity for legal intervention.

$100,000 | 36 months
Calvary Fund, Inc.*
Christopher Comfort, MD
"Fostering Competency in Healthcare Proxies"

This project seeks to help healthcare proxies increase their competency as healthcare decision makers. The focus will be on how proxies view their capabilities, needs and deficiencies, with the goal of improving their confidence and effectiveness as healthcare agents. To that end an intervention strategy will be developed based on extensive information gathered from 100 proxies as they navigate the process of making healthcare decisions for patients cognitively unable to do so for themselves. The materials will then be tested for effectiveness with approximately 600 proxies including the original 100. The intervention itself will be conducted by social work staff in small group settings. Pre- and post-tests will measure whether the program helped the proxies feel more secure and competent in acting as healthcare agents. If successful, this intervention will be integrated into the current admissions process at Calvary Hospital.

$18,000 | 12 months
Columbia University
Steven M. Albert, PhD, MSC
"Guide to Dementia Care for Home Health Aides"

This grant supports the revisions, distribution and evaluation of the use of a manual that was developed with funding from The Samuels Foundation (1997-1998). This is a practical guide for home health aides working with homebound dementia patients written in the words of the aides themselves. In addition to its distribution, it is hoped that the guide will be incorporated into mandatory training for home health aides.

$432,000 | 24 Months
Cornell University - Weill Medical College

Alvin Mushlin
“Establishing a Faculty Associates Program in Medical Ethics”
This grant would fund the second and third years (the Foundation funded the first year) of a 3-year program that seeks to bridge the gap between ethical theory and clinical practice by providing part time support for an "internship" for practicing physicians to be more formally trained in medical bio-ethics in order to build the capacity of the Division of Medical Ethics to better serve the patients of NYPresbyterian Healthcare System.
Project Start Date: October 2002 Project End Date: October 2004

$15,000 | 12 months
Cornell University - Weill Medical College
Joseph J. Fins, MD
"Support for Communication/Dissemination Initiative for 'Contract to Covenant' Project"

This grant would provide funds for the development of a 24-page supplement to the Hastings Center Report for the "From Contract to Covenant in Advance Care Planning" project funded by the Samuels Foundation (see 2000 grants). Upon successful completion of the peer review process, the funds for this grant would be used to print the supplement.

$200,000 | 18 months
Cornell University - Weill Medical College*
Joseph J. Fins, MD
"Fidelity, Wisdom and Love: Interactive Patient and Proxy Materials"

During the first round of the Healthcare Agency Initiative, Dr. Fins' project, "From Contract to Covenant in Advance Care Planning," developed a mechanism to describe clearly the complex, personal aspects of the patient-proxy relationship. This project takes that work to the next stage by creating a practical, educational tool to help patients and their proxies better understand and prepare for their roles and mutual responsibilities, and to enhance the likelihood that patients' preferences will be understood and followed. The product of the grant will be an educational kit, including an introductory video describing the patient-proxy relationship, educational workbooks, a leader's guide and supporting materials, such as proxy forms and questionnaires geared toward a lay audience.

$55,500 | 12 months
Elders Share the Arts, Inc.
Anne Basting, PhD
"Dissemination of a Creative Story-Telling Activity for Dementia Patients: TimeSlips"

The goal of this project is to train approximately 50 staff people from ten long term care programs (day care programs, nursing homes, etc.) in New York City to use the TimeSlips method of story telling. TimeSlips is a low cost activity to help to improve the quality of life of people with dementia and those who care for them. The training includes a one-hour per week storytelling session led by a certified TimeSlips storytelling facilitator. Over the course of the 10 weeks, staff will move from observers to facilitators. The project also includes ten education presentations on TimeSlips to encourage other facilities to implement the method.

$104,000 | 18 months
Fordham University*
Irene A. Gutheil, DSW
"Strengthening Healthcare Agency: A Protocol for Use with Hispanic Elders"

During the first round of Healthcare Agency grants, the project directors developed the "Start Talking Early and Plan: A Program to Increase Communication Between Elders and Their Healthcare Agents Program" (STEP), an intervention to improve the process of healthcare decision making. This project will build upon that work to create a similar intervention for the Hispanic community. A culturally sensitive, bilingual protocol will be developed and tested among elderly Hispanics receiving home care from the Jewish Home and Hospital Long Term Home Healthcare Program in the Bronx. The goal of the protocol will be to increase and improve communication between the proxy and the person they will eventually represent, rather than focus simply on completing forms. An extensive communications strategy, piggy backing on the current efforts of the STEP program, will target all healthcare and social work agencies in New York City that serve the Hispanic elderly.

$7,500 | 2 months
Grantmakers in Health
Lauren LeRoy, PhD
"Annual Meeting: Strengthening the Future of Health and Philanthropy"
This grant is to support the annual meeting to be held in New York City from February 27 through March 1, 2002.

$120,000 | 12 months
New York City Health and Hospitals Corporation/Jacobi Medical Center*
Steven R. Hahn, MC
"How Long Does It Take to Plan Ahead: Getting Advance Planning into HHC Hospitals"

The goal of this project is to demonstrate to the management of the HHC, the public hospital system in NYC, that it is feasible to adopt a policy requiring all primary care physicians to discuss advance directives and selection of a healthcare proxy with their patients. The project will determine if necessary information about the need to have a healthcare agent can be conveyed to patients in discussions varying from 5 to 15 minutes. The effect of the duration of the discussion will be measured by a count of the number of patients who complete a healthcare proxy statement. They will also assess the degree to which the named agent, or proxy, seems to understand the patient's wishes. One of the major outcomes will be the determination of the most effective and efficient time frame for the initial discussion. In other words, does it make a difference if the doctors discussed the issue for 5 minutes, as compared with 10 or 15, or not at all? The results will lay the groundwork to persuade practitioners that it is possible to incorporate advance directive discussions into their everyday practice.

$190,000 | 24 months
New York University*
Mathy Mezey, EdD, FAAN, and Gloria Ramsey, RN, JD
"Working with the African American Church Community to Encourage
End of Life Planning and Proxy Form Completion"

This project seeks to establish an ongoing program of educational activities in the Convent Avenue Baptist Church aimed at encouraging African Americans to complete advance directives and appoint healthcare agents. A simple evaluation will measure whether people actually complete the forms as a result of the intervention.

$160,000 | 18 months
New York University Downtown Hospital*
Lester W. Blair, MD
"Burden, Support and Educational Needs of Chinese-American Healthcare Agents"

This project builds on a highly successful intervention to increase the number of Chinese-American New Yorkers appointing healthcare agents that was funded in the first round of the Healthcare Agency initiative. This new project, rather than simply trying to increase the numbers of proxies completed, approaches the issue from the perspective of the culturally specific challenges facing the Chinese-American agent and seeks to provide information, support and help in performing the task of making healthcare decisions for someone else. Employing the Peer Advocate model that worked so well in the first intervention, the project directors will interview Chinese-American agents to learn about their experiences and needs and develop an intervention to address these findings. The final product of the grant will be culturally relevant materials for the Chinese-American community that address the complex issues of healthcare agency from the agent's point of view. In addition, a trained cadre of Peer Advocates will be ready to help Chinese Americans deal with advance care planning and the process of substituted healthcare decision making.

$380,000 | 18 months
Partnership for Caring (PfC)
Karen Orloff Kaplan, MPH, ScD

"Coordinating Center: Continued Management of the Healthcare Agency
and Palliative Care Initiatives"

PfC operates a Coordinating Center for two program initiatives for the Samuels Foundation: 1) to strengthen the process of healthcare agency; and 2) to enhance palliative care for those with severe chronic illness. This grant extends the funding for a second round of grant making in each program area.

$290,000 | 30 months
Research Foundation of City University of New York
Roberta K. Graziano, DSW
"Support for a Second Cohort of Students for the Social Work Program
to Better Serve the Health Needs of the Elderly"

The Foundation previously funded the development of an MSW curriculum with specific content in aging and geriatric health. The Foundation supported the implementation of this program's first cohort of students (see 2000 grants). This grant supports the continued implementation with a second cohort of students and the evaluation of this work-study curriculum. The program has been designed to enable employees of community agencies serving the elderly in New York City to attain an MSW Degree with a specific course of study entitled "Aging in Health," while continuing to work.

* Notes projects funded as a result of the RFP (request for proposals) program administered by Partnership for Caring for the Foundation's Healthcare Agency Initiative.

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