Care for the Medically Complex Senior

At last weeks National Private Duty Association (soon to be the Homecare Association of American) conference, there were many great presentations and discussions, and we will be highlighting a number of them in upcoming posts.  One that deserves “instant” attention was by Dr. Lee Lindquist, Associate Professor of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University, and Dr. Steven Fox, Medical Director, Wellspring Personal Care.

The title of their session was “Teaching a Workforce to Care for the Medically Complex Senior”.  The workforce referred to is the population of para-professional caregivers employed by home care agencies across the country.  The title highlights what is happening both in medical research and in healthcare and Medicare reform.  The “nutshell” message is that these caregivers (Home Care Aides) need to be trained to see themselves as true healthcare workers and to be able to participate in where geriatric healthcare is going – chronic disease management.

As an example, Dr. Lindquist describes one of her patients, in his 90s, in terms of the conditions he faces:

Alzheimer’s dementia, Gout, Hypertension, High Cholesterol, Hypothyroid, Depression, Congestive Heart Failure, Arthritis, Diet-controlled Diabetes, Benign Prostatic Hypertrophy (BPH)
Dr. Lindquist points out that, while the Home Care Aides are not clinicians, they must be aware of symptoms, medications (including side effects), signs of deterioration, and so forth, and be able to communicate these to the clinical folks working with the patient.
Dr. Fox took the discussion one step further, talking about “Geriatric Syndromes,” which he defines as, “Critical Signs and Symptoms that Greatly Impact Morbidity and Mortality”.  He lists the following:
  • Sleep disorders
  • Problems with Eating
  • Pain
  • Pulmonary
  • Incontinence
  • Confusion
  • Evidence of Falls
  • Skin Breakdown

Dr. Fox and Dr. Lindquist argue that, with seniors, treating individual diseases, in isolation, is a mistake.  One needs to understand the “syndrome,” the complex context of the senior’s condition.  Moreover, the caregiver, because of frequency and duration of contact and observation, is the clinician’s greatest ally in dealing with this complexity.

The bottom line is that the day of the “non-medical” home care agency, supporting ADLs and IADLs and thinking all is good, is over.  The agencies will continue, but they must redefine themselves as a critical link in the continuum of care for geriatric patients.  Part of that redefinition is developing and implementing training programs for their para-professional employees. 

More on that topic in future.  In the meantime, best wishes.  Bert


2 responses to “Care for the Medically Complex Senior

  1. Really that’s great article, these points are very helpful, thanks for sharing with us.


  2. Pingback: Geriatric Syndromes in Action | Support For Home In-Home Care

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