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In response to some of the challenges that have been articlulated about the future of Geriatrics, we describe a more positive view and value proposition for the field. Health professionals with specific training in Geriatrics are a natural fit for a variety of roles in value‐based care (VBC) programs and health systems. These roles include serving as educators for primary care health professionals and specialists in person‐centered care of older adults, serving as consultants on geriatric conditions and syndromes in a co‐management model of care, becoming effective leaders in VBC programs and health systems, and conducting quality improvement initiatives to build on the evidence‐base for the management of common conditions in the older population. We further recommend that VBC programs and systems support Centers of Excellence or Institutes to implement these strategies within and Age‐Friendly, learning system approach. See related articles by Chad Boult, Colenda and Applegate, and Ross et al. in this issue. [ABSTRACT FROM AUTHOR]

Purpose: We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. Design and Methods: We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home surveyors from a midwestern state attending two statewide workshops on the revised guidance. Results: Of 558 attendees, 500 (85%) responded, including 39% of the state's directors of nursing and 57% of state nursing home surveyors. There were striking deficiencies in knowledge regarding urinary incontinence and catheter care, with significant discrepancies by type of respondent, particularly between state surveyors and nursing home staff. Staff cited documentation and staffing levels as the most frequent concerns about implementation. Open-ended responses reflected the divergence of concerns and antagonism among the stakeholders, and staff nurses' feeling that F315 violated residents' rights. Implications: The revised Tag F315 guidance will be unlikely to improve the quality of urinary incontinence care in nursing homes because of significant knowledge and attitudinal discrepancies between nursing home staff and state surveyors, facility staff's focus on documentation and staffing, and reliance on implementation strategies known to be ineffective. Federal, state, and other urinary incontinence guideline efforts should focus on managerial structures and methods to improve quality nursing home care. Research is needed to address how nursing home residents and families define and value "quality" urinary incontinence management and to incorporate these in quality-improvement strategies and measures. (Contains 4 tables.)

Purpose: This study evaluated whether the satisfaction levels of long-term-care residents and their family members concerning incontinence and mobility care were sensitive to an improvement intervention. Design and Methods: A randomized, controlled intervention trial with incontinent long-term-care residents was conducted wherein research staff provided toileting and walking assistance. The frequency of assistance was of sufficient intensity to significantly improve continence and mobility outcomes in the treatment group as a whole. Interviews were conducted with residents and family members at baseline and after 8 weeks of intervention to assess their satisfaction with and preferences for incontinence and mobility care, using two question types: (a) direct satisfaction and (b) a discrepancy index of "met needs" reflecting the difference between perceived and preferred care frequencies. Results: Both residents and family members reported high rates of satisfaction to direct satisfaction questions. Residents' reports were sensitive to care improvements based only on the discrepancy index measure. Few family members were able to answer specific questions about incontinence and mobility care frequencies, and their reports were insensitive to care improvements. Implications: The majority of incontinent long-term-care residents were able to reliably answer questions about their perceived and preferred care frequencies related to incontinence and mobility care. A discrepancy index based on these questions was sensitive to care frequency improvements. Family members' reports were not sensitive to improvements, and direct satisfaction questions were misleading for both residents and family members.