Since February, when Kent County Memorial Hospital’s Acute Care for Elders unit opened, the 10-bed section has been full of patients age 75 and older nearly every day.
The unit is part of Care New England Health System’s push to accommodate a growing number of older patients in preparation for an expected influx from the aging baby-boom generation.
Care New England’s preparation extends back to 2014, when Dr. Ana Tuya Fulton, the health system’s executive chief of geriatrics and palliative care, created a geriatrics program to establish a continuum of care for older people, from those who are healthy to the seriously ill.
The elder-focused program is among many that the state’s largest health care systems are implementing. In fact, numbers of senior patients are already swelling, state health specialists say.
“Rhode Island is among the top 10 states for older adult [population], so it’s really an imperative for us,” Fulton said. “We have seen increases in the number of skilled nursing facility patients at Kent; on any given day in our 10-bed unit the average age is 87 to 89.”
Between 80 and 90 unique patients are cared for in the unit monthly, she added.
Kent Hospital recently earned an age-friendly designation after joining an effort led by The John A. Hartford Foundation and The Institute for Healthcare Improvement to see 20% of the country’s hospitals and health systems become age-friendly by next year.
“I would say we are prepared [for a wave of aging patients]. We have worked very hard to get where we are now,” Fulton said.
‘One of the things that we really lack in Rhode Island … is greater care in people’s homes.’
DR. PETER HOLLMANN, Brown Medicine chief medical officer
At Lifespan Corp., a trial program initiated in 2018 that focuses on wrap-around care for older people treated for falls in the Rhode Island Hospital and The Miriam Hospital emergency departments recently received additional funding from the National Institutes of Health.
As part of the study, which enrolled 125 patients since its inception in 2018, older people who’ve been injured from a fall are matched with a physical therapist and a pharmacist who help with rehabilitation and potential drug interactions.
The intent is to prevent further injuries and complications, said the intervention’s creator, Dr. Elizabeth Goldberg, an emergency medicine physician and associate professor of emergency medicine and health services policy and practice at Brown University.
Pharmacists may make safety recommendations after examining patients’ medications for effectiveness and side effects that may contribute to falls, and physical therapists make bedside visits.
“I think that’s really important because when an older person comes in after an injury, they may not know if they can continue to walk up the stairs or continue to lift things,” Goldberg said. “Physical therapists take the person through exercises they would have to be able to do in order to live on their own. … We catch the problems that they’re going to recognize at home before they have to face them.”
Special care continues through the discharge process, which involves caregivers when possible.
“It’s recognizing that older adults need more support after they leave the emergency department, that their risk of falling again in the next few months is 30% higher,” Goldberg said.
A $1.1 million NIH grant will continue to fund the program, as well as further geriatrics training for Goldberg.
One service for seniors that’s still being established in Rhode Island is home health care, said Dr. Peter Hollmann, chief medical officer at Brown Medicine, which is setting up such a network.
“I think one of the things that we really lack in Rhode Island and that you’re starting to see in the rest of the country is greater care in people’s homes. We’re unusually weak for a relatively urban area,” Hollmann said, referencing well-established home care programs in cities such as Boston and Washington, D.C.
He envisions a group of physicians, nurse practitioners, nurses and pharmacists who provide care ranging from hospital services to labs in people’s homes.
“That’s something that I think is good for patients. It saves some money, but it’s especially good for people,” Hollmann said.
Care New England has begun to set up its own version of home care by providing visits to “frail elders” through Integra Community Care’s complex care and hospital-at-home programs, Fulton said.
The health system’s recently opened ambulatory practice dedicated to older patients will also offer home visits to people who need or request them.
As Lifespan prepares for higher numbers of older patients, doctors and residents are undergoing specific training to enforce a comprehensive approach.
“You really need to have a geriatrician or geriatric training; you really have to be thinking about the whole person,” said Dr. John Murphy, a geriatrician and executive vice president for physician affairs at Lifespan. “The average older person has multiple medical issues. They don’t care about the names of what’s wrong – they care about how they function. You need to move from measuring the blood pressure or the kidney function to measuring how the person is functioning overall on a daily basis.”
Elizabeth Graham is a PBN staff writer. Contact her at Graham@PBN.com.
