Originally written for and appeared on Arizona Daily Star’s Local Opinion: We can do better for your elders
The following is the opinion and analysis of the writer: Dr. Corinne Self
“Anita tried to stab John with a knitting needle,” I remember my mom telling us over the phone when I was a teen.
Aunt Anita was too much for anyone to handle. My uncle moved her into a nursing home, but he worried: Was Anita clean? Was she fed? Why the medications? He brought her home after two days. She died at home a couple of years later — too soon — with her husband, once a decorated veteran, now a worn-out caregiver, by her side.
Several years ago, straight out of my geriatric fellowship, I was promised my dream job. I was to head a new home-based primary care program at a corporate medical center with 38 locations and a reputation for innovation. Home-based care can help older adults with mobility and cognitive issues access care. It also offers an alternative to the most vulnerable patients, who otherwise often land in expensive nursing homes. But, nursing home stays often lead to hospital stays, and hospital stays significantly increase the risk of disability in older adults.
In my new job, I’d help patients by seeing them at home. I would also, I imagined, help them navigate the health care system and avoid hospital stays. Patients wouldn’t be railroaded into decisions they weren’t comfortable with.
But I could not deliver. I wanted patients to be able to call and talk to someone who knew their names, but with bureaucratic restrictions, it wasn’t possible. I had no team and no ability to build relationships with my patients or my community.
Fed up, I finally started my own medical practice.
One day, during a routine visit, I encountered a patient who said she missed the old days of medicine. I was lost. Younger doctors are less paternalistic and better at shared decision making, right? But she said she now lacked a general practitioner she could count on. She was sent to multiple specialists, with no one person or team overseeing things.
That’s when it clicked: Patients needed a single party responsible not just for ailments, but for the whole health care journey. Helping patients by properly coordinating and navigating care is the piece that goes missing, and our making sure care is personalized is what can impact outcomes. When this kind of responsibility is centered, we can not only serve patients better, we can cut the notably high cost of health care in the U.S.
This model of care means visiting patients at home, which can provide a window to what’s really going on. Seeing all of the drugs, vitamins, and supplements a patient is taking (or not taking) can be powerful.
This model means taking time to sit down with a patient to look through specialist records. Is that next cardiology visit actually going to be more beneficial than a relaxing family luncheon or an updo at a hair salon?
This model means admitting what we don’t know. What did medical school leave out about the value of dementia education for families, of music and art therapy, of pet therapy? What do we need to learn about supporting caregivers through crisis?
In short, we need to treat every patient like they were our own parents. We need a model that allows hand-holding, extensive care coordination, and caregiver support. That involves a team of medical providers, clinical social workers, nurses, therapists who truly get to know patients and their families. That allows care teams and their patients the freedom to use non-traditional techniques.
It’s not too expensive to implement this model. What’s too expensive are unnecessary hospital admissions, prolonged nursing home stays, and caregivers that are getting sick themselves from all of the pressure.
And don’t our elders deserve better?