Should you see a geriatrician? An Interview with Bryan Godfrey, MSW, UNC Geriatrics
In a University of Minnesota study, patients who had seen a geriatrics team were a quarter less likely to become disabled, half as likely to develop depression, and 40% less likely to require home health services. Does this mean you should change who you see for primary care?
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We know that as one ages, their health care needs change. But does this warrant moving their primary care to a geriatrician? In a University of Minnesota study, patients who had seen a geriatrics team were a quarter less likely to become disabled, half as likely to develop depression, and 40% less likely to require home health services.
We generally serve people 65 and up. On a case-by-case basis, we’ll see younger people if they have conditions common to advanced age, such as dementia, incontinence, or a history of falls.
Our providers are physicians with certifications in internal or family medicine, but they also have specialized training in geriatrics. This means they are especially attuned to the challenges older adults often face and particularly skilled in helping patients and families prepare for the road ahead. For example, while a regular doctor might be quick to prescribe medication for high blood pressure, our providers will carefully consider whether reducing blood pressure is worth the increased risk of a fall, which can have a huge impact on a senior’s life. In addition, our providers are knowledgeable about care options such as home aide care and adult day care, which many regular doctors may not know about. In addition to doctors and nurse practitioners, we have specialists in psychiatry, neurology, pharmacy, and social work—all in the same clinic.
- Assessment and treatment recommendation. We consider the whole person and environment, from past medical history to current living situation. We ask about problems and challenges, but we are also interested in strengths and supports. With the patient’s permission, we involve the whole family in decision-making. We strive to help patients maintain health, happiness, and independence whenever possible.
- De-prescribing. (46% of people over age 70 are taking 5 or more medications.) Many patients come to us with prescriptions from multiple providers that conflict or cause more harm than good. With patient input, we decide what meds are really needed.
- As a social worker, I am particularly concerned with screening for social and mental health problems that have never been properly addressed, or even recognized. Aging is filled with change and loss, and many patients feel incredibly sad, anxious, or lonely. At the same time, many worry they’ll lose their independence if they ask for help. I’m here to build relationships and share resources so we can tackle problems together.
- Home care—We have lists of caregivers and agencies that our patients have recommended. We can help patients not only find the right caregiver, but also learn how to pay for it, or if free or reduced-cost options are available.
- PACE, the “Program for All-inclusive Care for the Elderly,” is a great program for folks with Medicare and full Medicaid. You have access to all kinds of services, from a day program to medical care, transportation and some in-home assistance, for very little cost, if any.
- Personal care service (or PCS). This is for people with full Medicaid who need help with Activities of Daily Living (ADLs). Many patients qualify for up to 80 hours per month (about 2.5 hours per day) of free home care. Patients with multiple, serious limitations might qualify for as much as 130 hours of assistance per month.
- Aid & Attendance. Many veterans find it difficult and intimidating to connect with VA supports, such as pension benefits. With the help of a Veteran’s Support Officer (VSO), patients and even their spouses might receive money to help pay for care.
- Long-term care insurance. Many adult children aren’t aware their parents have a policy, and many patients don’t realize what their policy covers. We can help everyone understand what benefits are available and how they can be activated.
- Transportation. If your doctor tells you that you should no longer drive, it can feel like your life is over. Fortunately, there are several options to help patients maintain independence and get where they need to go. From Chapel Hill’s free door-to-door service EZ Rider to transportation through private companies such as Go Go Grandparent, there’s always an option available.
- There are lots of community supports for patients and their caregivers when memory impairment or dementia is the problem. Whether you prefer individual consultation or a support group, education and assistance is out there. You’re not alone!
- If it’s not safe to stay at home any longer, even with comprehensive assistance, we can help the patient and family explore all their options. These may include a senior day program, a family care home, assisted living, or even a nursing home. Don’t assume you can’t afford these—ask your doctor and social worker for more information!
Rather than hope for the best, we need to have the hard conversations early on. What should we do if there are safety concerns at home, or if living at home is no longer an option? If the patient is unconscious or too sick to think clearly, who should make decisions for them, and what should those decisions look like? Do you want to live no matter what, or does quality of life also matter to you? The answers will be different for different people, and they change over time. We struggle to have difficult conversations, but they’re crucial to ensure that a patient’s rights and wishes are respected—and family doesn’t have to worry about doing the wrong thing.
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