a medical school, or has a letter of agreement with a medical school to serve as a teaching facility for health and allied health professions.

SECTION 8: FUNDING LEVELS

Beginning in FY 79, the AoA proposes to use resources under Title IV-E of the Older Americans Act to support the development and establishment of Long Term Care Gerontology Centers focused on building and studying a continuum of community based services for the chronically disabled elderly. The process leading to the establishment of such centers involves two distinct phases:

1. The Development phase. This includes the preparation of grant applications(May 1979 July 1979) during which period applicants will assess their interest, capability and commitment to realizing center program objectives and then the initiation of the actual development of such centers. Approximately 16-24 awards ranging from $60,000 to $100,000 for the one-year developmental period will be made. In approximately the sixth month of the developmental year guidelines for the preparation of grant applications for full scale centers will be released. Applicants will be notified in the ninth month of the developmental year regarding the funding (or not) of their application. The remaining three months of the developmental year will be used for the transition to a full scale center for successful applicants.

2. The Implementation phase. This will involve the full scale operation of Long Term Care Gerontology Centers. It is expected that a minimum of ten (10) awards, in the form of cooperative agreements, will be made, ranging in amounts from $200,000 per year for the first year to $400,000 for each of two (2) subsequent years. Before completing the initial Phase II project period, the Centers will be given the opportunity to compete for an additional two (2) years of Title IV-E support. The Title IV-E awards are intended to support the core activities of the centers with substantial additional funding coming from sources such as DHUD, NIMH, Title XIX waivers, collaborative arrangements with the Veterans Administration, and grants under AoA's discretionary funding and special long term care demonstrations.

The present guidelines are a call for developmental grant applications from qualified applicants, related to the development phase of the process for establishing the Long Term Care Gerontology Centers.

Guidelines for the submission of applications for the support of full-scale Long Term Care Gerontology Centers, related to the implementation phase of this process, will be issued subsequently during the course of the development grant period.

SECTION 9: LENGTH OF PROJECTS

The developmental phase of Long Term Care Gerontology Centers is expected to be one year in length. For those centers chosen to receive implementation Phase II funding, the length of project support is expected to be three (3) years depending upon performance and the availability of funding. It is expected that the Centers will be given the opportunity to compete for an additional two (2) years of Title IV-E support. It should be recognized that a full scale center is expected to seek funding from many sources, and that it is quite possible that funding distributed under the Title IV-E authority would be of decreasing importance to the continuation of a given center.

SECTION 10: SUBMISSION DATE

The closing date for receipt of applications under the Long Term Care Gerontology Center Program is August 27, 1979. Applications may be mailed or hand delivered. Hand delivered applications will be accepted from 9:00 a.m. to 5:30 p.m. daily, except Saturdays, Sundays, and Federal holidays, through August 27, 1979. Mailed applications received after the closing date will be accepted only if they show a U.S. Postal Service postmark or a U.S. Postal Service mail receipt of no later than August 27, 1979.

With rare exception, undergraduate and postgraduate training of today's primary care physicians does not include exposure to and competence in the growing body of knowledge concerning clinical and case management problems that occur frequently with older patients. While medical schools and professional organizations have shown increased interest and attention to this matter during the past few years, the fact remains that there is a critical need to develop medical school faculty, trained and experienced in geriatric medicine, who will serve as educators and leaders in the training of current and future physicians and other health care providers.

There are a few new efforts across the country, to interest future health professionals in geriatric medicine. The Veterans' Administration through both its GRECC program and its Geriatric Fellowships Program is beginning to train geriatric practitioners. However, there remains a need for faculty who have a knowledgeable orientation and an interest in geriatric medicine and who will influence up-coming students and current professionals in this field of research, practice and teaching. In an effort to improve the quality of medical care and to encourage new professionals to enter the field of geriatric medicine, the Administration on Aging will support a selected number of geriatric fellowships which will offer future medical professionals exposure to the special body of knowledge related to geriatric medicine, to the special ethical issues related to the care of older persons, to the social, economic and psychological problems which interact with health problems, and to new approaches to long term care in the community and/or institutions. These geriatric physicians will then become members of medical school faculties for the purpose of training geriatric physicians, exposing medical students to geriatric issues, and supervising and encouraging research and practical experiences related to geriatric care.

SECTION 2 PROGRAM OBJECTIVES

During FY 1979, the Administration on Aging will award up to five grants to support the development of multiyear programs to train physicians for faculty leadership roles in geriatric medicine. The focus of the program is to provide recent graduate physicians in Internal Medicine, Family Practice, or Psychiatry with the additional clinical and teaching experience necessary and appropriate to qualify them to serve on the faculty of existing medical school geriatric programs or to provide leadership in the development of new academic geriatric programs.

It is anticipated that this Geriatric Fellowship Program will assist in the development of a cadre of physicians with the knowledge, attitudes and skills appropriate to ensure excellence in geriatric patient care. In order to accomplish this, the Administration on Aging feels that, at a minimum each physician should at the completion of the three year period:

- continue to provide leadership, education, and training to
medical students in the field of geriatric medicine.

- be knowledgeable about the organization and delivery of

health services to older persons at the community level,
and the public policy issues affecting the availability
and acceptability of such services.

possess the appropriate knowledge and skills necessary to
meet the diagnostic, therapeutic, and care management
problems confronting patients in later years.

recognize the special physical, psychological and social
needs of older persons and design treatment accordingly.

have had extensive experience in working with older persons
in a variety of settings including ambulatory and institutional
care (both acute and chronic) as well as community based care
and facilities (such as home care, day care and outreach
programs).

possess the necessary knowledge, skills and experience to
approach, on a multidisciplinary basis, the mobilization
of appropriate medical, social and related professional and
program resources required to meet the short and long term
needs of the older patient.

SCOPE OF PROJECT ACTIVITIES

Each award will be for a period of approximately six years, during which time it is expected that three (3) physicians will have completed, at a minimum, the following three year sequence; one year of specialized residency training in geriatrics and a two year faculty appointment during which the physician will assume full time geriatric teaching and clinical responsibilities. Candidates to be selected by the medical school for participation in this program should have completed the second or third of their post graduate years in their speciality prior to receiving consideration for inclusion in the AoA supported program. It is expected that the AoA supported 12 month geriatric residency will constitute post graduate year 3 or 4, depending upon the applicant's program and the individual candidates selected.

It is anticipated that the timetable for each award will follow the following sequence. It is possible that an individual school may be prepared to recruit and begin training a geriatric resident in their first year of the grant award. This would shorten the time line by approximately one year.

Year One

Organize program components

and recruit first fellow.

Year Two Train first geriatric resident, recruit second fellow.

Year Three Faculty appointment for first fellow, first year of
geriatric residency for second fellow, recruit third
fellow.