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A Team Approach to Senior Adult Well-being
by Dr. Nasseer Masoodi, ACV Medical Director
Growing old isn’t easy. Caring for an elderly family member with chronic health issues can be a challenge too. Taking your loved one from one specialist to another can be a drain on your time, your pocketbook and your emotions. In the end. your loved one, whether a parent or a spouse, may not be receiving the best care possible. And you may be paying more than you need. Here’s a possible solution. Consider a team-based approach.
While the practice of geriatric medicine includes preventive medicine and the diagnosis and treatment of reversible diseases, it is very much dominated by the challenges of caring for patients with chronic illness. Studies like the one published in 2002 by the Institute of Medicine, Health Professions Education: A Bridge to Quality, found the best way to treat the elderly was through the team approach. Detailed analysis proves that interdisciplinary geriatric teams can provide care that is better suited to the needs of seniors than care from traditional providers. Interdisciplinary teams generally include physicians, nurse practitioners/physician assistants, and social workers, while nutritionists, speech, physical and occupational therapists, psychologists,or other specialists. participate on a case-by-case basis. Not only is team care beneficial, but it is cost-effective as well.
Two decades ago, Advent Christian Village established a team-based approach through our Resident Care Assessment (RCA) team. We have been using this coordinated approach to care ever since. The team meets weekly and is comprised of medical staff, administrators, pastors, social service, and other support services staff, working cooperatively to manage the needs of a resident. The goal is to keep residents as independent as possible by maximizing their functionality, well-being and happiness. The delivery of quality, cost-effective medical services is critical. Accomplishing the team approach requires continuous broad education for every team member. A physician certified in geriatric medicine leads this effort; however, management, expertise, and commitment are required from all other disciplines.
What differentiates ACV’s RCA team from traditional models is the participation of administrators, home care specialists, housing managers, pastoral staff and housekeeping personnel. The RCA team is designed to treat the whole person rather than simply their specific medical condition(s). We are concerned about an individual’s living situation, independent functioning, nutritional status and support system, and the team focuses on promoting wellness and quality of life.
The goal of Resident Care Assessment is to assist the resident and his or her family in receiving care that respects the autonomy and dignity of the senior adult and address any safety issues. The team accomplishes this through the following process:
- Assessing physical, environmental, cognitive, spiritual and functional levels by including nutritional assessments, social interventions, communication about feelings of depression and isolation.
- Home safety visits to prevent falls and other injuries, which can be crucial to overall health. Geriatricians and gerontologists have long recognized that frail elderly need more than medical care to remain independent and possibly prevent disease or injury.
- Identifying Needs/Risks- Residents considered at high risk for hospitalization, or those with deteriorating cognitive status benefit the most from this “targeted patient” technique. Use of RCA team care leads to fewer hospitalizations and emergency room visits.
- Locating and managing the delivery of services, which RCA can coordinate care across different sites. This may include care in the patient’s home, primary and specialty care clinics, nursing facilities and hospitals. Coordination is crucial since the elderly often have complex chronic conditions.
- Monitoring and adjusting the provision of services as required, which is extremely important. Teams routinely monitor medication use to eliminate unnecessary medications, ensure proper use, select alternatives with fewer side effects or alter certain combinations since the interactions could render the drugs ineffective or even harmful.
- Within legal limits, keeping the family informed of the resident’s status changes. Spouses and children are an integral part of the informal care network.
What Are the Benefits of Resident Care Assessment Services?
One Stop Shopping: Service Coordinators know the available services, their cost and quality. This saves family members who live at a distance time and money.
Personalized Services: Service Coordinators address the individual needs of the resident and their family by communicating with everyone involved.
Accessibility: Medical staff and Service Coordinators are available to residents on daily basis; they are accustomed to responding to crisis or emergency situations. Continuity of Care- Service Coordinators can represent the resident and their needs to health care and service providers within and outside the Village in a consistent and reliable manner, saving time and preventing miscommunication.
Quality and Cost Control: The RCA helps prevent inappropriate hospital care and overuse of services. The team matches services to the residents’ needs and thereby contains costs. Through ongoing resident monitoring, Service Coordinators help prevent crises. A team approach helps to deliver high quality care in a safe and effective way.
That is how we provide care at Advent Christian Village. If you have a family member who is facing these issues elsewhere, you may want to look into what kind of team-based approach is available there.
Nasseer A. Masoodi MD, FACP, CMD, CPE
Medical Director Health Services ACV Inc.
Disclaimer: This article is provided for informational purposes only and should not be construed as specific medical advice. Please consult with your physician before making any changes to your medical care.