Almost every physician and hospital administrator wants to help the elderly with their healthcare needs, but the task is difficult. Seniors have far greater comorbidities, and their special needs generally require a greater investment of time and personnel. Reimbursement rates are terribly inadequate. Moreover, the elderly and their families usually do not seek care until the need is extreme.
The situation is no different in my community of Greenwich, Conn. With approximately 11,000 people over the age of 64 in this town of 61,000, fewer than 2,000 seniors consider themselves limited with respect to their mobility or ability to care for themselves, a recent study found.
These and other factors contributed to the ongoing losses that Greenwich Hospital experienced trying to be more user-friendly to the aging population. Six years ago under the direction of the hospital's chief executive officer, Frank Corvino, we moved to enhance services for seniors. The hospital established a unit designed to make it easier and more effective for the elderly, caregivers and their families to obtain healthcare.
Older patients with multiple diseases liked the unit because they received a lot of personalized attention. The community-service organizations liked it because it helped form a comprehensive continuum of care. Physicians liked it because they could order a geriatric assessment of each patient, which resulted in a care plan that saved everyone time and effort. And hospital executives liked it because it provided another level of quality care to our patients while helping to generate positive publicity and potentially reducing exposure to litigation.
In an effort to be professional and to the point, the unit was named the Geriatric Health and Resource Center of Greenwich Hospital. Use of the facility grew during the ensuing years. By fiscal 2002, approximately 50 physicians, some not even on the hospital staff, referred patients to it for more than 175 geriatric assessments and 350 psychiatric assessments.
The center in turn referred 150 patients to 20 other hospital units. In the same year, the center's 10 staffers (mostly assigned part time to it) made 180 public appearances promoting healthcare for the aging population. In the past several years, we published 11 issues of Generations, our publication sent to more than 4,000 people.
Yet the bottom line for the hospital was not always good. Physicians reported that many patients who would benefit from center services were reluctant to go, complaining, "I am not geriatric!"
With the help of our consultant, we completely made over the unit earlier this year, starting with a name change that eliminated the offending word. It became the Center for Healthy Aging, with a tag line, "Smart choices for better living." The target market for aging services has been broadened to include everyone over age 50. Not only do baby boomers care about their own health and appearance, they also are beginning to confront the healthcare challenges of their parents. Our new emphasis is on aging rather than the aged.
Health plans are recognizing the value of preventive care. Additionally, many seniors are willing to pay personally for preventive healthcare services. All of which helps them-and our bottom line. It helps physicians because our promotion of services brings patients to us and then to the physician of choice for continuing care. Often a visit would not have been made until a serious problem existed. It also has reduced visits to our emergency room.
Significantly, we have tied in the separate units that provide senior-oriented services throughout the hospital. The units do not necessarily come under our umbrella, but we are promoting together and have become far more cohesive. Our service line begins with a self-administered healthy aging profile that identifies health risk factors related to access to care, disease state, lifestyle, medications and nutrition. Optional add-ons to this profile include review of current prescriptions and routinely used over-the-counter medications, herbals and supplements; memory screening; measurement and recording of blood pressure, cholesterol, glucose, prostate health and triglycerides; and consultation with a physician/nurse practitioner.
Following the profile is the comprehensive aging assessment, which includes an assessment of cognitive status; a complete history and physical exam; counseling; an evaluation of functional, medical, psychological and social needs; medication profile; a mobility assessment; and development and delivery to the referring physician of a plan for care.
The care plan may make use of a range of hospital services to provide balance and movement assessments; custom case management in the home; diabetes resources; massage therapy; monitored aerobic and strength training; nutrition counseling; physical medicine and rehabilitation; stress-reduction programs; and wellness and prevention programs.
We are looking at additional ways of providing coordinated care for our community's older residents. High on our priority list is attending to the special needs of inpatient seniors. We also want to evaluate the effect the Center for Healthy Aging has on keeping patients and physicians closer to hospital services in contrast with freestanding physician centers, which would have difficulty matching this range of services.
In the meantime, we are working hard to build a hospital-community team to keep the aging population of Greenwich healthy, in the community and in their homes.
Stephen Jones, a physician, is director of the Center for Healthy Aging at Greenwich (Conn.) Hospital.