skip to content

Saturday, March 17, 2018

Heller Faculty Notes

A mission to improve health and human services for older adults

Walter Leutz, Ph.D. '81, examines how to work within and restructure a system where long-term care and health care are separate

Thirty years ago, Walter Leutz graduated from the Heller School for Social Policy and Management with a PhD and a personal mission to improve health and human services for older adults. Today, he can still be found at the Heller School making progress towards accomplishing that mission. 

Leutz has spent decades examining the intricacies of better coordinated services for older adults; specifically, how to work within and restructure a system where long-term care and health care are separate. At Heller, Leutz is both an Associate Professor and Associate Dean for Academic Personnel. He currently conducts research sponsored by the Children’s Bureau, the Department of Health and Human Services (DHHS) and the Massachusetts Health Policy Forum.

Q: How did you first become interested in long-term care and aging?

A: It was serendipitous that I found this field. I was a student at the Heller School in the late ‘70s, and there were fellowships being offered at the time where students could study aging. I took one of the fellowships, and luckily I found the area to be very interesting. Not long after graduation, I returned to Heller to do work on managed care, concentrating specifically on how to combine a managed care program with long-term care.

This issue of fragmentation of care is enormously complex. Elders and other persons with chronic illnesses and disabilities often have complicated conditions that span both medical care and supportive services. They need help with both their everyday living and their health care, but the two systems are very separate. People experience their lives as a whole, without a separation between their medical needs and their long-term care needs. Therefore I believe we need to create more holistic services, and for that reason, I have been working on integration of care throughout my career.

Q: What are your proudest achievements?

A: I believe that my greatest achievement was a Brandeis-based program that my colleagues and I initiated and coordinated over the last 25 years called the Social HMO. The program offered a more coordinated approach to health care, and it offered benefits for managed care. The goal was to give people a more integrated health care option, and although it did end just last year, we were able to serve a whole generation of seniors. I consider that a huge success.

Intellectually, the work that I’ve done on integration of care has been used by people who are trying to improve the quality of care people are offered, both in the United States and around the world. That is something I am proud of.

Q: What are your current projects?

A: A major focus right now is a project on healthy aging sponsored by the Heller School’s Massachusetts Health Policy Forum. The healthy aging project is something that my colleagues and I have been working on for two years, and our goal is to promote health in elderly individuals by putting together a healthy aging plan for Massachusetts. It’s important to note that older adults do not necessarily view health as freedom from illness, but as being able to lead a decent, interesting life. Our plan will help them do so in a number of ways.

Our healthy aging model sees the path to healthy aging as the interdependence between empowered elders and their social and physical environments. Even when older adults develop chronic illnesses or disabilities, they generally want to stay involved with activities that have been meaningful to them - their families, their faith community, or physical exercise like walking. But they may need new kinds of supports to stay active - like transportation or safe walking paths. Similarly, we are promoting programs to help older people take charge of their health and their lives. The most prominent program of this type is called Chronic Disease Self-Management, which empowers people with chronic diseases to take responsibility for their health. They become involved in their health care, which has shown to be very effective in terms of cost and improvement of health. The basic idea is that these people work with a small group in which they work out how to deal with their lives, and then, with the support of the group, take action.

On the other end of the spectrum, I’m also working on projects involving children. The first project tests a model of services for children with autism ages four through nine. The project centers around empowerment and autonomy. The model we’re testing involves autistic children from low-income families in Massachusetts who are Medicaid-eligible. The model is parent-directed, which means that the parents can choose what services their children receive. We look at how well these people can manage this system, and also how well these kinds of services can operate in a low-income household.

The other project is an evaluation of a Massachusetts program that enhances services available to new mothers who have used illicit drugs during pregnancy. This program provides peer mentors (mothers who also used drugs while pregnant but who are now in recovery and no longer using) who help women navigate the current system, accessing drug treatment, doing the things that will prevent children from going into foster care, and help finding a job. As with much of my work, the idea is to empower individuals to take steps to become healthy. Also, we are assessing how well the model coordinates services across agencies and professionals.

Q: What message do you wish to communicate about illness and long-term care?

A: The first thing people should keep in mind for situations having to do with chronic illness and long-term care is that it isn’t easy. It’s emotionally challenging, there’s a lot to learn about the process, and the system can be extremely challenging to manage. I always want people to keep that in mind because if they are struggling, it doesn’t mean that they are doing something wrong, or even that the people they are working with are doing something wrong. On the other hand, if people can find allies to help them navigate the system, it is something to be valued.

It also makes sense for people to learn about Medicare and Medicaid. I teach an undergraduate course at Brandeis on disabilities and long-term care, and one of the things I make sure is that the students come out knowing the difference between Medicare and Medicaid and what they do and don't cover for long-term care. It’s important for people to know the distinction between these federal programs as well as what private health insurance covers and doesn’t cover.

Q: Is there anything else you would like people to know?

A: I have spent a long time working at the Heller School, and I have done so because I truly believe it is a great place to be. Researchers here are working on a very wide range of things, but there’s a fundamental agreement that our mission is to use knowledge to advance social justice. The work accomplished at Heller is not only important and meaningful, but also practical. It’s a fantastic experience to work with both faculty and students who have a realistic view of our world and how they can improve it.

Knowledge Advancing Social Justice