Dr. Allen Dennison, medical director at Evergreen House Health Center in East Providence, was recently named Physician of the Year for Life Care’s Northeast division. A graduate of Columbia University’s College of Physicians and Surgeons, he is an assistant professor at Brown University’s Warren Alpert Medical School and is affiliated with Rhode Island Hospital. Dr. Dennision shared his thoughts on the changing field of geriatric care.
PBN: What do you like most about caring for older people?
DENNISON:The greatest pleasure is talking to older people and their families in our facility. Even though we nursing home doctors may not be the family doctor, people almost instantly accept us and trust us with intimate details of their lives and, of course, their lives. I love to ask people what they used to do for a living. Some are neither disabled nor retired and bristle, “Whaddya mean?? I’m still working and I am breaking outta this joint.” We love to hear that spunk the best, whether it will happen or not. One of the best things about Evergreen is working with the nurses. We have grown to know and trust one another over a period of years. Our contract is simple. They listen to my silly jokes and I listen to them advocate for the patient they know like no other nurse.
PBN: How has geriatric health care changed since you began practicing medicine?
DENNISON: Geriatric health care now includes distinct venues: the Independent Living Facility, the Assisted Living Facility, and the Skilled Nursing Facility. The latter usually incorporates a unit for rehabilitation as we do at Evergreen. Since the 1980s our hospitals are paid by Medicare a flat fee based on diagnosis. For financial and just space motivations, hospitals discharge patients as early as possible with average length of stays moving from 10 days when I was in intern down to under 4 days. So our first floor is full of acute patients who used to be in the hospital. Paying homage to Yogi Berra, working in Long Term Care is just like the hospital, only different. We have to talk to families and patients about their goals in life which are different patient to patient and change with time even under our noses. Our nurses learn not to make assumptions.
PBN: What does your job as medical director of Evergreen House Health Center entail, ie., what do you do most days?
DENNISON: I always have to explain that I do not own the facility. I am a team member with the nurses, certified nursing assistants, social workers, physical therapists, kitchen workers, activity personnel. We call it the Inter Disciplinary Team. I do not lead the team. The Director of Nurses Tina Correia or the Executive Director Bob Noonan does that. I guide discussions pertaining to medical and infection control issues. I talk to the State Inspectors about issues. They are very sharp and come for three days and watch our work in real time, not just to review charts and documents. We received a “Deficiency Free Survey” in 2013. It was not easy and every member of our team grinned at one another as if we were the Red Sox and had a party. I supervise a very able Nurse Practitioner Jennie Cellar, RNP. She evaluates patients when they first arrive reconciling their many medications with previous lists and speaking with families about wishes for end of life care.
PBN: Are you more optimistic today, or less so, about the quality of care being provided to older Americans?
DENNISON: I am optimistic about the care being provided to older Americans, especially in long-term care. So many innovations are now available to families like the Medicare website for nursing facilities (www.medicare.gov/nursinghomecompare?).These evaluations are based on inspection data and daily data input form the Minimum Data Set (MDS). We have a full time nurse entering this data on patient and facility performance every day. Every facility in the country has been doing this now for 20 years. It is a big burden but the MDS determines our payments, focuses state and federal inspections and enlightens the public about relative strengths and weaknesses of facilities.
This is a huge commitment countrywide to assure good care and help to improve it. When the advocates for small government are someday parked in a nursing home bed they will be slower to fault “big government” for this innovation. In my view, it is good stewardship of the Medicare/Medicaid dollar. From a professional standpoint we have the American Medical Directors Association (amda.com) which provides a growing body of educational materials and meetings. Our president Jonathan Evans, MD is a real nursing home doctor in Charlottesville, Virginia but has the capacity to communicate to all his colleagues improvements in practice. My employer, Lifecare Centers of America flies us to attend meetings of four days twice each year to help us to run the very best facilities. I look forward to the meetings which are professionally enriching and I make a rule to bring home three ideas which our nurse practitioner and staff can implement within two months.
PBN: As the Baby Boom generation ages, what do you see as the biggest challenge facing health care providers who serve this population?
DENNISON: The demographics of the Baby Boom generation frightens actuaries, nurses, government officials and geriatricians alike. Dr. Richard Besdine, is Chief of Geriatrics at Brown. He periodically gives a lecture at the hospitals about geriatric manpower. He refers to the Boomers as the “silver tsunami” and all the doctors grimly nod. Dr. Besdine’s post-doctorate Fellowship in Geriatrics produces three board certified geriatricians per year, woefully insufficient todeal with this tidal wave. He has been innovative in inserting geriatric topics into the curriculum of every course taught at Brown’s Alpert School of Medicine. Every doctor, save the pediatrician perhaps, must be in part a geriatrician. My employer, Lifecare Centers of America, based in Cleveland, Tennessee owns more than 230 facilities nationwide. They have adopted a plan called “Vision of Care” which involves hiring and training a physician for full time staffing of most of their facilities. Community physicians nationwide are so stretched thin with the arrival of universal health insurance, that we can no longer rely on them to follow their patients in LTC facilities. Evergreen will always welcome community physicians to be credentialed to see their own patients but they are becoming less common. I have the exciting opportunity to hire and mentor the right physician to work with us full time to continue our ground-breaking work.
If you know one, send him or her our way at 401-438-3250.