Seeing the Light: Caring for Elder Patients

Travis Eckard readily admits he had little understanding of how older adults were cared for at his very own medical center.

“You know the biggest surprise?” asks Eckard, a physical therapist. “The lack of attention they got. Our capacity to serve this population was very small.”

That was five years ago.

Since then, Kern Medical in Bakersfield has made great strides after 18 of its clinicians were trained in the unique needs of older adults at the UCLA-based California Geriatric Education Center. Spanning disciplines from nursing to social work and geriatric psychiatry, the program’s success depends on a team approach that extends far beyond simple medical testing. The Center is headquartered at UCLA’s Multicampus Program in Gerontology and Geriatrics.

“It’s not just about the doctor but about the pharmacist, the nurse and physical therapist (working together) to keep the patient out of the hospital,” says Eckard, who coordinated UCLA’s training efforts with Kern. “With these complex patients, the more communication that happens the better.”

Kern Medical (formerly Kern Medical Center) is a safety net for Kern County which, like everywhere in California, is facing a huge growth spurt in its older adult population. The number of seniors grew a full 1% between 2010 and 2014 and are now 10% of the county’s population. This number will likely swell to nearly 20% by 2025.

So when UCLA came calling, they made Kern an offer they couldn’t refuse. One of the state’s three geriatric centers of excellence, UCLA had funding from the federal Health Resources and Services Administation to train clinicians at Kern Medical, a 188-bed teaching hospital.

Over the next few years, Kern employees traveled to Los Angeles and studied at home (with additional support from nearby California State University Bakersfield) for nearly 200 hours of training in various topics: the shocking overuse of pharmaceutical drugs among older adults; the spiraling deterioration after falling; mental health woes; and the intricate interplay between social services and health.

“Clinicians don’t see the geriatric population as any different, when (in fact) they have very different needs,” says Eckard. “I didn’t understand the whole breadth of it until I went through the training.”

Hands on experience was often the most powerful teacher.

“The (UCLA) scholars program really put us in the shoes of our patient,” says Dr. Warren Wisnoff, an internist at Kern. “They’d have us wrapping our knees so they didn’t bend so well, then put cotton in our shoes so we’d feel the pain of neuropathy.”

A critical part of the program’s success was including all disciplines, including social work, to connect elder patients with needed services in the community.

“Social work is a huge component that often gets left in the dust of the conversation,” says Eckard.

Eckard says the team approach often puts a physical therapist like himself at the center of care: screening for balance, visual impairments, even drug interactions which can cause gait problems and falls.

If there’s a problem?

“We do further digging,” he says. “While we had that knowledge (in the past) it wasn’t as cohesive as it is now.”

Suffering from a series of health problems including diabetes and shortness of breath, former farm worker Madline Tello was a frequent visitor to the Kern emergency room — often weekly.

“When I went to the emergency room they’d say ‘Are you here again?’” recalls Tello, who was born in the center 64 years ago when it was called Kern General Hospital.

Since the UCLA training — and the installment of new CEO Russell Judd in 2013 — Tello has noticed a vast improvement in both care and cleanliness. Instead of bad attitudes and unkempt facilities — she remembers “toilet paper everywhere” — Tello heralds a highly responsive staff that is friendly and pro-active as it steers her away from the emergency department to needed specialists the same day she calls with health concerns.

“I feel special because I know they don’t just call me, they call all their patients,” says Tello. “It shows they care.”

Kern cares, yet the center also knows that once they admit a patient who returns to the hospital within 30 days, under the Affordable Care Act the facility is now responsible for the cost of these readmissions.

Throughout California – and the country – healthcare providers are fusing behavioral and physical health.

It’s a key component to the state’s Coordinated Care Inititiative, which hopes to place most of the state’s 1.1 million so-called “dual eligibles” into managed care.

At Kern, that meant big surprises for many of its clinicans, who were shocked to find the prevalence of late life depression, psychosis and schizophrenia, not to mention substance abuse – particularly opiods for back pain.

The UCLA training has spurred radical collaboration, says Dr. Rossano Bangasan, a geriatric psychiatrist and medical director for Kern County’s Mental Health Department.

Once considered separate, every issue in a patient’s life is now viewed as interconnected: from the drugs they take to medical test results, cognitive skills and social life.

“It’s now becoming more of a collaborative effort between the treatment teams from different disciplines, with one comman goal,” says Bangasan, who also sees patients at the medical center. “For (the) patient to feel better both in their physical and mental health.”

Kern has seen overall health improvement as well as a reduction in emergency room visits among its older adult population.

“We set some pretty lofty goals when we started and basically checked them off the list,” says Eckard, including “senior sensitivity training” and improvements in geriatric trauma, palliative care, podiatry, mobility, incontinence, fall prevention, and a host of other topics crucial to older adult health.

Although Kern doesn’t yet have a designated clinic for geriatric medicine, that goal is on the horizon. In fact, last year Kern opened its REACH clinic – based on the one-stop shopping philosophy of a “medical home” – that serves as the inspiration for this future development.

Eckard says the UCLA training occurred just in time.

“Geriatrics was underdeveloped in Kern County and Kern Medical,” says Eckard. “This population is not going away.”

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