Caring for seniors: Providers adapting to serve aging population

Recent medical and scientific advances have progressed to the point where people are living longer, healthier, and hopefully happier lives — far longer and far healthier than generations ago. This, of course, also means that the population is aging, especially with the baby boom generation entering the 65-years-old-and-over club last year.

According to the Hartford Institute for Geriatric Nursing at New York University’s (NYU) College of Nursing, the senior population is expected to grow from 39 million in 2008 to 72 million in 2030 — nearly double. This explosive growth will place great demands on our health care system, according to the institute’s website.

Being aware of the population trend for some time, organizations around the country have been designing programs to serve senior citizens.

And even though we are living longer, it doesn’t mean our lives are free of health complications. In fact, many elderly people have several different chronic health problems that need to be addressed concurrently — such as hypertension, diabetes, heart disease, and dementia, just to name a few — in addition to the normal issues that develop with age.

One program that is very aware of these concerns is the Nurses Improving Care for Health System Elders (NICHE) program, which was developed out of the Hartford Institute for Geriatric Nursing and is celebrating its 20th year of operation in 2012.

“The American Association of Geriatrics recognized 25 years ago that the baby boomers are turning 65 and never before have we had this large volume of folks 65 years and older. Basically, the population is aging and doing so exponentially, so a group of nurses at NYU put together NICHE,” said Diana LaBumbard, who is the coordinator of the NICHE program at three Detroit Medical Center (DMC) hospitals — Huron Valley-Sinai in Commerce Township, Sinai-Grace, and Detroit Receiving.

According to the program’s website, the goal of NICHE is “to achieve systematic nursing change that will benefit older hospitalized patients” with a vision “for all patients 65 and over to be given sensitive and exemplary care.”

Overall, the mission of NICHE is “to provide the principles and tools necessary to achieve patient-centered care for older adults.”

In the lakes area, both DMC Huron Valley-Sinai and Henry Ford West Bloomfield hospitals are a part of the NICHE program.

“All three of our (DMC) hospital programs work together as a system to build in quality improvement measures for the geriatric population,” said LaBumbard, whose hospitals have been a part of the program for a decade and continue to get redesignated every year in order to deliver the highest quality care to the aging population.

As part of the NICHE program, the nurses at these hospitals are trained to look for signs of health issues that are common in the elderly.

“Embedded into our daily assessments that we do for all patients is a special assessment called ‘SPICES,’ which targets areas that geriatric patients are at a higher risk of having problems with. They go through this assessment at admission, and it’s an ongoing assessment while they are admitted,” LaBumbard said.

SPICES is an acronym developed at the NYU College of Nursing and stands for the prevalent problems experienced by older adults: sleep disorders; problems with eating or feeding; incontinence; confusion; evidence of falls; and skin breakdown.

“We have specially-trained nurses that understand if the patient has some of these issues found in the geriatric assessment, then we need to come up with special interventions for their care,” LaBumbard said. “That’s something the NICHE team comes up with. And all interventions are evidence-based.”

The NICHE team consists of professionals from various disciplines, such as primary care physicians, geriatric nurses, physical therapists, dietitians, pharmacists, and occupational therapists, among many others.

This interdisciplinary approach is a key component of the NICHE program to ensure that patients receive the best care.

And so far, the program has led to higher patient and family satisfaction, according to LaBumbard.

“The program has multiple benefits. One of the biggest, of course, is the improvement in high quality care,” she said. “But the utmost is really in patient safety. I know (recently) they just had this thing on the national news on how patients still aren’t safe in the hospital. We still have all these medical errors. Well, by going that one step further and adding that 6-point assessment, it highlights this patient population’s risk for problems. We can basically prevent problems like falls and pressure ulcers that can increase the length of stay for patients (in the hospital). It’s really about keeping patients safe.”

Part of keeping patients safe is making sure they have the proper at-home care, which in some cases is preferable to hospital stays.

It may be a counterintuitive notion, but rarely is there rest for those patients staying in a hospital. Constant interruptions from doctors and nurses, orderlies and phlebotomists, visitors and other patients all prevent patients from getting the rest they need to heal.

Sometimes after getting the necessary treatment, the best place to recuperate is at home.

“It’s more relaxing for the patient in a familiar environment, and research shows that patients recover better at home and are less susceptible to infection at their places of residence,” said Mike Ellis with Henry Ford Hospital’s Henry Ford at Home program.

Henry Ford at Home is a program designed to offer patients all the products and services they could need in their home from one location.

It offers Medicare-certified home health care, which includes nursing, physical therapy, occupational therapy, speech therapy, medical social services, home health aides, and dietitians.

Health products are offered, as well, and include oxygen and respiratory services, mobility devices such as walkers and wheelchairs, wound care supplies, and other necessary equipment to take care of someone at home, including hospital beds.

Home infusion services are also available.

“If a patient needs (intravenous) antibiotics or medications in the home, we can provide that,” Ellis said. “We also have e-home care that is a division which uses technology such as personal emergency response system medical dispensers. We use tele-health equipment in patients at home to keep them safe while they are in their own residence.”

The whole point of the program is to keep patients comfortable in their home while still continuing to receive the exemplary care that they would expect at the hospital.

“The service you come to expect from Henry Ford hospitals, we want to extend that service into the home and the community,” Ellis said. “We want to keep patients safe and independent in (their) place of residence. Seniors want to stay out of the hospital as much as possible and live as independently and as securely as they can. Independence is a major issue for the senior population. And the expertise of not only our clinical but technical and equipment team can keep them safe and independent in their homes for longer periods of time.”

Henry Ford currently has 17 locations that offer Henry Ford at Home, and Henry Ford West Bloomfield Hospital is one of them.

According to Ellis, Henry Ford has been in the home health care business for over 30 years and is the largest provider of in-home services in Michigan.

“It’s absolutely beneficial for seniors,” Ellis said. “We have some of the highest clinical ratings in patient satisfaction outcomes in the industry with our home care program. I think it’s because of a combination of all the services we offer. It depends on the patient’s conditions and needs, and by offering all services under one location, we are able to meet and customize towards the patient’s needs.”

For more information on the Henry Ford at Home program in West Bloomfield, call 248-661-7935.

Another person who is familiar with benefits of in-residence care is Dr. Adil Arabbo, the chief of family medicine at DMC Huron Valley-Sinai Hospital.

“I think any time you’re not hospitalizing patients, and they are staying in their own home and a familiar environment, it improves the patient’s quality of life,” Arabbo said.

In addition to seeing seniors in his office, he and his Care with Compassion Physician Group make visits a couple days a week to patients in the comfort of their own homes, provided that they live in an assisted living facility or senior apartment complex.

“We don’t make house calls to individual residences,” he said.

Arabbo and his group work along with Huron Valley-Sinai to coordinate care.

“We work closely with Huron Valley to be able to monitor residents as soon as they get in the hospital so that we can discharge and bring them back to their place of residence as soon as possible.

“When we see residents at their homes, we are looking for things to work on and pay attention to in order to decrease hospitalization, emergency room visits, and to improve the quality of life,” Arabbo said. “The approach is beneficial in that it gets patients back into their own environment quicker. Typically, when you don’t have something in place such as a continuum of community between the hospital and the doctor managing at home, the patient will have continued relapses. The patient will keep going to the emergency room for sometimes unnecessary visits. By visiting patients at their place of residence, we are staying ahead of the curve because we are monitoring and taking care of issues that often result in hospital visits.”

These issues include being vigilant about preventing falls, infections, pneumonia, and inappropriate use of medications.

  According to LaBumbard, some senior citizens average taking between five and 10 different medications a day.

“One of the biggest problems in health care is poly-pharmacy,” LaBumbard said. “Patients are seeing so many different doctors and being prescribed different medications for their different ailments. And sometimes those drugs cause other issues or counteract other drugs the patient may be taking.”

“Sometimes overlaps in medications can compound certain symptoms. Some can even make patients more drowsy and more prone to falls,” Arabbo added.

His group of doctors also works with other health professionals, such as nurses and physical therapists, to alleviate these types of issues and ensure quality care.

“We rely on the other team members, such as those in nursing and home health care to come out and educate patients and their families — for example, providing a well-lit environment at night,” Arabbo said. “If the patient is up and walking at night, we should allow the living space to be less invasive. We are customizing care for every patient. Essentially, we are streamlining the care by looking at who the caregivers are, which physicians the patients are seeing, and making sure the medication and regimens are in place while the patient is at home.”

The end goal of this approach is to help seniors build and maintain their independence.

“We’re trying to make them more independent by being more proactive in their care,” Arabbo said.

And it seems to be working.

“We have been getting accolades from our patients and their families. And at the end of the day that is what you want,” Arabbo said.

He also sees this form of a care as a way to cope with the exponentially growing senior population.

“What will happen with the aging baby boomer population is there will continue to be an overwhelming rise in health care costs,” Arabbo said. “There has to be a way where care is delivered and is more cost-effective and efficient. More importantly, it has to improve the patient’s quality of life. And this model of senior care seems to take care of all these components for us.”

DMC’s LaBumbard said she feels well prepared for the challenges of senior care in the future, as well.

“It’s not rocket science,” she said. “We just have to recognize that there are differences in this patient population. We need to have heightened awareness as health care providers. And I think the biggest thing is to remain opened to an interdisciplinary approach. And we need to continue to do research and then teach our staff how to translate research into care.”

And it’s not just the private sector that offers programs and services catered toward helping senior citizens cope with health-related issues during their golden years.

The Oakland County Department of Health and Human Services also offers services geared toward senior citizens and has a page on the county’s website, oakgov.com/seniors. The department provides public health nursing services to older adults, including telephone and home visits for functional and safety assessments.

Oakland County Senior Citizens Services Coordinator Mary Strobe can be reached at 248-858-0213, and the county also provides a nurse on-call service at 248-858-1406.

Counseling to senior centers, community groups, and housing sites is also provided by the department, as are outreach flu clinics in the fall.

Uninsured and under-insured Oakland County residents can also obtain a free prescription drug discount card that includes benefits such as an average savings of 20 percent, as well as savings on specialty medications.

There are also no enrollment fees and no age requirements with the discount card program, which also provides unlimited use for a whole family and is available at over 57,000 participating pharmacies.

The division also warns that the discount card does not count as insurance and is made possible through a partnership between the Oakland County Board of Commissioners and the National Association of Counties.

For more information on the discount prescription card program, call 1-877-321-2652 or visit naco.advancerx.com.

The Health Division also provides seniors with a discount dental program that is accepted by 90,000 dentists across the country and provides savings of 20 to 50 percent.

An application for the dental discount program can be downloaded at oakgov.com/discountdental/enroll.

A date to mark on the calendar is May 23, when the 2012 North Oakland Caregiver and Senior Expo will be held at the Orion Center in Lake Orion.

There is also a state hotline for seniors seeking assistance with Medicare or Medicaid issues, accessible by calling 1-800-803-7174.