What is User-Friendly Healthcare for the Elderly?, by Garland G. Fritts

Like many persons who have experienced the latter years of the aging process with loved ones, I find myself strongly committed to improving the process, especially with respect to healthcare. Healthcare for the elderly leaves a lot to be desired. This article 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 information 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 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. Nursing staff and physicians were unbearably demanding that we violate my father's wishes. In spite of specific legal documents, 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.

Healthcare Provider "Blindness"

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 as small as 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.*

In summary, I am 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.

*Garland G. Fritts has authored a far more comprehensive article is available that responds to these issues and challenges. Contact Speakers@Speaking.com for more information.

Copyright Garland G. Fritts. All Rights Reserved.

Mr. Fritts facilitates the evolution of geriatric services for hospitals, integrated healthcare delivery systems, long-term care facilities and large physician groups. His focus is on increasing market share for providers while improving healthcare services to the aging population. His speaking engagements have included the ACHE Congress, ACHE Leadership Forums, AMA Academy for Health Services Marketing, and numerous state hospital associations.