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Introduction Quick Links:
Preface
Aging Population Background
Personal Motivation
Related Examples
A Multitude of Needs
Answers Are Complex
Understanding
and Serving the Needs Of an Aging Population*
Recognizing the need of hospital administrators and physicians to better understand how best to serve the aging population, Garland Fritts,
leader of the Fry Consultants' healthcare practice, has written a document that can be used as a resource in the healthcare field by providers to the elderly, as well as by the elderly themselves and
their caregivers.
The document includes:
- A preface describing the motivation to create this document as well as what users might achieve from its use
- A description of the needs of the elderly, especially healthcare (Chapter I)
- Which of those needs are not being fulfilled for many of the elderly (Chapter II)
- What is happening to the elderly and their caregivers as a result (Chapter III)
- What should be done about the situation, especially by providers, including the use of e-solutions
(Chapter IV)
The complete article is available on this website and in hard copy upon request.
Preface
Like many persons who have experienced the latter years of the aging process with loved ones, we find ourselves strongly committed to improving the
process, especially with respect to healthcare. Healthcare for the elderly leaves a lot to be desired. This document describes many of the needs of the elderly, what is
not being done about them, what is happening as a result, and what should be done.
It is directed to health system chief executive officers, administrators and physician groups. That said, it is also useful from an information
viewpoint for members of the aging population and their caregivers. Since so much of the care of older adults should rely on a systematic continuum of care, there is significant emphasis on the
value of applying electronic solutions (e-solutions) to the healthcare process.
This document will help health system and physician group leaders understand how to use geriatric services to increase market share, broaden
market coverage, develop a business/service line, increase revenues and manage risk.
Concomitantly, the provider will improve the quality of care of its patients and build community relations and acceptance.
Fragmentation of services is a problem throughout healthcare but nowhere is it as serious as with the geriatric
population.
Episodic care for individuals who are frequently dealing with multiple chronic conditions is not the answer. Too many providers still deal with one geriatric healthcare matter at a time. Such treatment, or lack thereof, often leads to further complications, including premature death.
Aging Population Background
As an example, one study has shown that 25 percent of seniors have treatable conditions unknown to their physicians; 17 percent of seniors'
hospital admissions are caused by drug mismanagement. Approximately 40 percent of seniors over 70 years of age are discharged from a hospital with one or more unwanted side effects.
Twenty-seven percent of those seniors are rehospitalized within three months and 15 percent are newly institutionalized.
Responsibility for this state of affairs is shared by a broad spectrum of individuals, including physicians, hospital administrators, other
healthcare professionals, and government agencies. Of course, the primary responsibility lies with the caregivers and the aging persons themselves. The answers vary for each person and are
particularly complex since they are so interlinked with physical, mental, emotional and spiritual considerations.
These matters will become increasingly apparent as the Baby Boomers begin to deal with the problems of their aging parents. They are
not going to like the experience; as a result, one can expect a significant increase in legal actions against hospitals and physicians.
Most of the truly responsible and responsive care of the elderly in this country is provided by those care providers and family members who
have lived through the trauma of seeing a loved one become increasingly frail, develop multiple chronic conditions, begin using a number of different medications, and eventually die.
The fortunate ones did not have to spend a lengthy time in a skilled nursing facility.
As one health system CEO said, "until my father died a few months ago, I had no idea of the problems.
We thought that we had all the advance directives worked out but when I was called out of a meeting, my father had been taken to the closest hospital… and it was not ours. Nursing
staff and physicians were unbearably demanding that we violate my father's wishes. In spite of documents rushed from the nearby safe deposit box, they insisted that they hear the words from his
lips…not once but on several occasions, as he lay dying. It was not the comforting, caring experience that we had wanted for him.
"It just proved to me that in many of our nation's healthcare institutions, the foxes are running the hen
houses. I hope the hospitals in our system aren't like this, but I fear that they are."
The fact remains that the vast majority of persons working with the elderly are caring, conscientious and trying to do the best that they
possibly can. They are trying to deal with family concerns, cope with complex rules and regulations, control costs, and minimize risks of legal actions.
A related challenge is that so many care providers, especially physicians, do not appear to understand that the elderly have just as many
differences from the general population as do children. No one thinks twice about the special educational needs of
physicians to become pediatricians. But there is little concern about the special educational needs of physicians to treat the elderly. One problem is that older adults look like adults. Children at least look different from the general population and, therefore, it is easier for caregivers to recognize that special protocols may make sense.
Too many physicians and healthcare professionals sincerely believe that what is good for one adult is good for all adults.
They do not recognize the physical, mental and emotional differences that exist in the elderly.
These differences impact everything: metabolic rates, memory, thinking clarity, mobility loss from inactivity, incontinence from catheter use, dizziness from polypharmacy, alcohol and drug use, multiple chronic illnesses, and on and on. Furthermore, there are few networks for tracking and reporting the particular requirements of elderly patients among pharmacies, primary care physicians, specialists, nursing homes, etc.
Personal Motivation
As the leader of Fry Consultants' Healthcare Practice, I have personally experienced unacceptable situations with loved ones who were part
of the aging population and entangled in the healthcare web. It involved both my father and mother on separate occasions.
In 1980 my father suffered from a stroke and then another one a few days later in a Florida hospital.
Within hours, he also was diagnosed as having a rapidly spreading lung cancer. Physicians recommended operating. Only when questioned did they indicate that the invasive surgery, at best, would only extend his life a few days to a week. My mother, brother and I decided against the surgery and my father died peacefully a day later.
My mother's case was more complex and was an even more severe indictment of the care offered to elderly persons.
It was the late '80s and she had been experiencing repetitive TIAs since a major stroke 25 years earlier. My brother and I wanted her to have round the clock care in her Florida home, hundreds of miles from where he and I lived. The local hospital had no home health services for private pay patients and would only give us a list of local home care providers. They refused to recommend one over another and, when we finally engaged one, the hospital refused to coordinate care. This lack of coordination further complicated the care and compromised the results. At times, her doctor ordered unneeded tests late in the day during hospital stays in order to extend her stay in the facility.
At one point late in her life, I finally thought to ask the president of the medical staff of one of my clients about the more than a dozen
medications that she was being given daily. He studied the list and dosages. Not knowing her condition first hand he could not comment on the efficacy of the medications.
But he did indicate that several things were clear about the physician. The physician was likely older (he was) and had not kept up with pharmaceutical changes. The president said that there were newer, more effective products on the market at less cost. Some of the medications, he said, were not compatible with one another and it was probable that the patient was not alert. (He was correct.)
To further complicate matters, my mother's esophagus deteriorated and the doctor urged us to insert a feeding tube into her stomach.
She spent close to the next two years in a nursing home, comatose. The feeding tube should never have been inserted. We know that now.
Related Example
In yet another situation, a client wanted to establish a reimbursement code for special services to the elderly.
Written requests to the intermediary got nowhere. A group of us finally decided that a personal visit to the intermediary was the best chance. The director heard our story, our request and why we thought the service for which we wanted reimbursement was unique. She stopped us almost in mid sentence, told us that she had lost her elderly mother a few months before, and then lauded what we were offering, wished something like that had been available for her mother, and approved our request. Unfortunately, this level of enlightenment is still rare.
A Multitude of Needs
The good news/bad news is that most CEOs' of hospitals and related physicians are still too young to have had personal experiences with their dying
parents. As a result, many CEO's eyes glaze over when one talks about keeping elderly patients at home, thereby reducing hospital admissions. Similarly, but for different
reasons, many physicians, especially those with large practices of elderly patients, just do not understand the special needs of the elderly patient in contrast to younger adults. Typical examples
include failure to modify medication dosages, accepting at face value an older person's answers regarding medications being taken, or failing to establish special geriatric pre-op directions and
guidelines.
Health is not the only trauma facing today's aging population.
Financial concerns rank second with most seniors, but the two are strongly interlinked. Older persons want to be healthy but, even if they are healthy, they worry and fret about having enough money to take care of themselves when the time comes that they are not healthy. No amount of savings seems to satisfy many seniors as they strive to protect themselves from later adversity.
There are other needs, of course, including recreation, exercise, safety, sex, socialization, security, religion and others.
Answers are Complex
In many communities where the population is even 60,000 or less, there are typically 24 to 30 community agencies available to help the
elderly. In addition, there may be as many as a dozen healthcare related organizations. The elderly population (those persons over 65 years of age) in such a community will typically number at
least 7,500 persons.
The challenge is to coordinate all the diverse service organizations and the healthcare providers into a continuum
that is easily accessible by the aging population and their caregivers.
As an example, family members living some distance from an aging parent should be able to access a reliable continuum of care for their parent as easily as it would be to find a realtor to help with locating a new home. In most communities today such assistance is impossible to find because it does not exist.
The daunting challenge is to get the organizations and individuals to collaborate on commonly agreed upon goals, forgoing interagency
competition and turf protectiveness. Section IV of this booklet, "The Ultimate in User-Friendliness for the Aging Population," addresses this challenge and others related to it.
This material then is dedicated to helping all healthcare providers as well as
caregivers and older adults discover how to make the quality of life better for the aging population and their caregivers. It will also help concerned individuals know what services to seek and what questions to ask.
Continue to Chapter 1, "
The Multiplicity of Needs of the Elderly"
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