Now What? Evolving Standards of Care


By 2050, the U.S. population ages 65 and older is projected to reach 89 million, more than double the 40.5 million Americans in that age bracket in 2010. The proportion of those who suffer from one or more chronic diseases is increasing just as rapidly. Alzheimer's Disease, Parkinson's Disease, neurological and cardio-vascular conditions are expected to spike. Much of this increase is helped along or accompanied by obesity and/or diabetes.

The demands on the health care system are immense. Add to that the complexity of needs in sectors of the population as people age with intellectual and developmental disabilities, or mental and behavioral health conditions like schizophrenia, bi-polar disorder, depression, and addiction. Consider socio-economic factors within the African-American, Latino-Hispanic, LGBTQA, and immigrant communities. All of these put added pressure on the system, forcing the standards of care to continue to evolve and try to keep pace.  

In order to meet the needs of the population into the middle and late 21st century and beyond, a more comprehensive, collaborative approach is needed.

In this episode of the award-winning Now What? series, host and co-producer Dr. Anna Fisher and her guests discuss current standards of care, how they will need to evolve, and what communities can do in collaboration with policy makers, care providers, and resource agencies. 

Panel of Experts

Dr. Anna Fisher serves as the Hillcrest Health Services health, quality, and nursing services education expert. She is responsible for the implementation of educational and quality improvement programs following the identification of clinical needs, competency exams, and supporting the need for high quality of care for diverse business lines that include assisted living, memory support, adult day services, home health care, palliative, hospice, post-acute, and skilled nursing care. 

Dr. Fisher is also an adjunct professor in the College of Arts and Sciences at Bellevue University and teaches in the Masters-Health Administration Program. She was awarded the prestigious Maenner Award for Professorship of the Year in 2012. In 2015, she received the APEX Award for Excellence in Health & Medical Writing by Nursing 2015, for an article she co-authored entitled, "Best Practices for Engaging Patients with Dementia."

Dr. Fisher is co-producer of the NET Connects series, Now What?, about elder care and dementia. The program series received a 2014 Nebraska Broadcasters Association Silver Award in the Service to Community category and a 2012 Nebraska Broadcasters Association Bronze Award of Excellence in the category of Service to Community.

Dr. Fisher is currently President of the Consortium of Dementia Alternatives and Vice President of the Montessori International School of the Plains. She is a certified dementia practitioner, licensed nurse, and holds an undergraduate degree in human resources, graduate degree in business management, and a doctorate in health administration.


Dr. Natalie Manley, MD, MPH, CMD is an assistant professor in the Division of Geriatrics and Gerontology, Department of Internal Medicine, University of Nebraska Medical Center. Dr. Manley holds a certification in geriatric medicine and medical direction in post-acute and long-term care.  She is medical director for Hillcrest Hospice Care. Dr. Manley’s academic interests include palliative care and hospice, nursing home care, caregiver strain and support, veterans as caregivers and education in community and nursing home care for medical students and residents.

Dr. Manley is a co-investigator on a grant testing a dementia care program that aims to improve the quality of life for persons with dementia and their caregivers. She has published computer-based educational materials and participated in educational video publications. Dr. Manley is a member of the American Association of Hospice and Palliative Medicine, American Medical Directors Association and the American Geriatrics Society.  She received her MD and MPH from the University of Nebraska Medical Center. Dr. Manley completed residency training and geriatric fellowship at the University of Utah, Salt Lake City. She completed an advanced geriatric fellowship at the VA Medical Center, Salt Lake City.


Dr. Thomas Safranek has been the Nebraska State Epidemiologist since 1990. Prior to that he served on the faculty at Creighton University in the Department of Medical Microbiology and Internal Medicine. He did undergraduate work at the University of San Francisco, and attended medical school and completed his Internal Medicine residency training at Georgetown University. Following that, he served as Chief Medical Resident and Infectious Disease Fellow at Creighton University in Omaha, Nebraska. He then participated in the Epidemic Intelligence Service (EIS 1984) at the Centers for Disease Control, where he worked in the Hospital Infections Program.

In his capacity as State Epidemiologist, he oversees epidemiologic investigation and study of a variety of public health problems affecting the state’s population. He has worked in all areas of public health epidemiology, including maternal-child health, chronic disease and injury epidemiology programs. Since 2000, he has devoted substantial efforts to state and national public health informatics initiatives, including National Electronic Disease Surveillance System and Health Alert Network. He has lobbied for enhancement and funding of electronic laboratory reporting and sought to expand the scope of diseases and data tracked through this system. In addition, he has worked with a public health unit responsible for addressing the identification and control of bioterrorism in the state.


Janet Miller received a Master’s degree in Sociology and a Masters Certification in Applied Gerontology from the University of Nebraska at Omaha. Both of her degrees focused on persons with intellectual and developmental disabilities. She is an Affiliated Trainer in a dementia care curriculum offered through the National Task Group, part of the American Academy of Developmental Medicine and Dentistry (AADMD). Janet has been responsible for parent-to-parent support programs, activities for persons with disabilities, supported employment services, respite services and more.

Janet’s professional career has been directed in the field of developmental disabilities since the birth of her daughter, Jennifer, age 41, who has Down syndrome and probable Alzheimer’s disease. Jennifer’s journey into dementia began in her mid-30’s but was not diagnosed until her late 30’s. Her present focus is to bring dementia training opportunities to Nebraska to equip parents and professionals in more effectively caring for this unique population. She is presently employed by the Munroe-Meyer Institute/University of Nebraska Medical Center.