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Mon April 9, 2012
The Golden Years: Aging in Our Region (Part Two)
Three times a week, Dr. Mark Williams visits half a dozen geriatric patients at The Davis Community, a nursing home and rehabilitation center in Porters Neck.
For the second part of WHQR’s series The Golden Years: Aging in Our Region, Michelle Bliss joins Williams on one of his visits to learn how senior care is evolving while the demographic grows and government funding through Medicare and Medicaid could soon shrink.
Before checking in on 85-year-old Donald Medlock, Williams huddles with his third-year medical resident Joshua Dobstaff for a quick update on their patient’s recent fall.
“He said he only fell six inches. I asked him to explain it a little more and he said he slid out of his recliner. On exam, just kind of palpating under the cervical collar—very tender along the clavicle. So, I’m just kind of concerned about that.”
Williams is a geriatric specialist with the South East Area Health Education Center who teaches for the residency program at New Hanover Regional Medical Center. He gives lectures and presentations but prefers to teach in the field.
Patients like Medlock light up when Williams greets them, shaking their hand or gently patting them on the shoulder or knee. During their visit, Williams makes sure to speak loudly and listen carefully over the hum of Medlock’s oxygen machine.
Williams: “What I heard was that you slid down and hurt your area around your collarbone.”
Medlock: “That is correct.”
Williams: “Well, I’m going to gently poke around and you tell me if anything hurts.”
North Carolina’s senior population is projected to jump from 1.2 million to more than 2 million people in the next 20 years. That means Williams is charged with teaching a new generation of doctors during an unprecedented time in human history.
“In the days of the Roman Empire, 2100 years ago, the average life expectancy at birth was 35. Just at the twentieth century, the average life expectancy was 47. So, it took mankind 19 centuries to increase the life expectancy by twelve years, from 35 to 47. And just over the last 100 years, it’s increased from 47 to 80.”
Today’s young doctors do have unprecedented medical technology to treat the chronic and simultaneous symptoms of a geriatric patient…
“But the key is: how is it applied? And how do you feel when you interact with your doctor? Is the healthcare encounter one that’s brilliant, but superficial or sterile? Or is there a real sense of caring where the person opens up and you can really help accomplish whatever the shared goals are?”
Having an open dialogue with patients is critical because the elderly require tailored, preventive care, which isn’t always a priority.
“If somebody falls and breaks a bone, our system is very responsive; care is prompt and very efficient. But as we get older, our diseases become more chronic, and chronic disease management takes time, and time isn’t always as reimbursed as doing an acute procedure.”
One model of preventative care in Wilmington is Elderhaus PACE, the Program of All-inclusive Care for the Elderly, where Julia Devane recently celebrated her 100th birthday.
PACE offers healthcare and adult day care to seniors like Devane who are at risk of being institutionalized and are eligible for Medicare, Medicaid, or both.
Devane still gets to live at home with her daughter Annette Murphy. Together, they describe her secret to a long, healthy life.
Murphy: “She keeps herself busy. Even today, she keeps herself busy. She tells me not to make an invalid out of her.”
Devane: “What it really means is do what you can for yourself. Don’t wait for people to do it for you. So, that’s the way I live.”
The center’s medical director Dr. Marsha Fretwell agrees with that advice, citing a key hallmark of the program: personal responsibility.
“If you go on TV, you know that a motorized wheelchair is something that everybody needs, right? Because Medicare pays for it, okay. Well, when you come into the PACE program, if you did absolutely need one, we would provide it. But, short of that, we’ll get you on your feet walking.”
If a patient feels entitled to a major crutch, like a wheelchair, their muscles grow weak prematurely. When they can no longer stand up or go to the bathroom on their own, Fretwell says they’ve paved their way to a nursing home.
That’s why her patients exercise at least 30 minutes a day.
“You name anything that people associate as the inevitable diseases of aging, and it’s all related to an absence of exercise. It makes dementia better. It makes depression better. It makes constipation better. It makes osteoporosis better. It makes heart disease better.”
Wilmington’s PACE program led the state when it opened four years ago. In two more years, there will be 11 centers across North Carolina.
They each receive a fee per patient per month from Medicare and Medicaid. Having set funding, instead of being reimbursed for each prescription or procedure, is daunting. But it can spark problem-solving.
“When it comes out of your pocket, you think creatively before you spend the money; whereas, in the healthcare system—I say it’s like a sieve. You want it? Okay, Medicare will cover it. You want it? Okay, Medicaid will cover it. And that’s the era that’s over. And that’s going to be a huge cultural shift.”
In the next few months, the center is expanding to double its capacity and serve 160 patients. At the same time, other PACE organizations across the country have seen their Medicaid payments drop. If that happens in North Carolina, Fretwell and her team will continue fine-tuning their creative approach, which has already helped so many of their patients walk, live at home, and celebrate another birthday.