Geriatric Healthcare Services

Geriatricians or other Practitioners in Aging Medicine

Geriatricians are doctors or nurse practitioners who specialize in treating older people. In seeking medical professional help, the elderly or their family should attempt to discover geriatric care specialists in their area. If that is not possible an effort should be made to locate a geriatric clinic in the area.

Geriatric clinics are becoming more popular, and even though the doctors who staff them may not always be geriatric physicians, they are likely to be aware of the problems associated with treating elderly people. Many geriatric clinics include a team of specialists to help older people. Here are some of the specialists who may be available in a geriatric clinic:

• Geriatrician
• Nurse
• Social worker
• Nutritionist
• Physical therapist
• Occupational therapist
• Consultant pharmacist
• Geropsychiatrist

If there are no geriatricians or geriatric clinics in the area, an attempt should be made to find those doctors who specialize in elderly care. This can be done by making phone calls to various doctors' offices or by an online search. It is to the older person's benefit to find a doctor who understands aging and how to treat older people. Proper geriatric health care might even help relieve the amount of care needed for an older person by improving health and reducing disabilities.

There is currently little incentive to encourage established doctors or students in medical school to specialize in geriatric medicine. Even though it is a recognized specialty, according to the American Geriatrics Society, there are only about 9,000 M.D. Geriatricians and several hundred osteopathic physicians (DO) certified in geriatrics, as well as some 2,400 board-certified geropsychiatrists in the United States . (A geropsychiatrists it is a psychiatrist trained to deal with the mental health needs and specific syndromes faced by older adults).

According to Census Bureau there are approximately 770,000 practicing doctors of medicine in the United States. This means there is roughly 1 doctor, including specialists, for every 300 persons in the United States. Based on the numbers above there is only about 1 Geriatrician for every 3,000 elderly persons in this country. Because there are so few of them, it may be impossible to find a physician specializing in geriatric care in some areas of the country.

There are many more family physicians or internists who specialize in treating older people and from experience they have probably learned about many of the issues associated with treating the elderly. Nevertheless, many of these practitioners could probably benefit from more specialized geriatric training if it were available.

Out of 145 medical schools in the United States only five have geriatric care departments. Many more medical schools offer elective courses in geriatrics but only 3% of all medical students ever enroll for such classes.

Helping elderly people who are nearing the end of their lives and who suffer from multiple, incurable and chronic disorders is often not an appealing prospect to family doctors or to young medical students. Besides, geriatric care typically does not produce as much income as other specialties.

Most doctors who treat the elderly are reimbursed either through Medicare or sometimes through Medicaid or sometimes a combination of both. These government programs have become more and more stingy over the years. Many doctors who in the past have accepted Medicare find that they have better paying opportunities treating younger patients and they will no longer accept new Medicare patients. And if those younger patients are available for treatment, few doctors are going to go out of their way to seek out Medicare or Medicaid reimbursement.

There are doctors, geriatric nurse practitioners or physicians' assistants who derive satisfaction from working with older people. And they may be taking a cut in pay by doing this. These practitioners are most likely going to be Geriatricians.

House Call Doctors

Many doctors are returning to the practice of medicine a hundred years ago and are making house calls. Health insurance plans, including Medicare, will now reimburse a doctor and possibly a staff member, if test equipment is involved, to visit homebound patients in their homes.

To qualify for a home visit, the patient must have to experience great difficulty in leaving the home in order meet with the doctor in his or her office. This does not, however, mean the care recipient need be totally disabled. It simply means that transportation requirements or help needed to get to a doctor might be very expensive or difficult to provide or the patient's safety might be jeopardized by leaving the home.

Doctors are willing to visit in the home and provide service because they are paid more money by health insurance providers to compensate them for their time and their loss of efficiency in meeting patients in their offices. Probably the insurance providers reason that the additional cost of meeting with patients at home, before major medical problems evolve, is more cost effective than paying for ambulances and treatment in emergency rooms.

There are also several advantages to using home visits as opposed to office visits. The patient will be more relaxed and cooperative in familiar surroundings. Older people are thrilled that a doctor would take time to visit them in their home. They will be more compliant, more open and as a result receive better treatment as opposed to receiving care in the doctor's office. Typically, the doctor will take more time and be able to establish a better rapport with his patient. The idea of the doctor not having to hurry off to another patient in another room is comforting to an older person.

A very important benefit for house calls is that a physician can see the environment in which his patient is living and have a better understanding of how that environment may affect his patient's health. By seeing it first-hand he can make recommendations for care that would have been impossible in his office. In essence the doctor learns much more about a patient in her home and he can achieve a personal connection that would have been difficult to establish in the office. The ultimate outcome of a house call is that the doctor can provide a greater degree of holistic medicine.

A home visit patient can receive house calls on a periodic or ongoing basis. The patient need not give up other doctors if the reason for being homebound is temporary. Testing equipment in the past few years has become more portable and the doctor can bring an assistant who might provide tests on site. Heart function, lung function and simple blood tests performed on site can give the doctor an immediate feedback on the needs of his patient and allow him to make treatment decisions without the delay of waiting for test results.

Physicians Orders For Life Sustaining Treatment (POLST)

A POLST form is a physician's order that records your wishes for resuscitation, use of antibiotics, artificially administered fluids, and nutrition.

How it works:
Your physician or nurse practitioner records your preferences and signs the POLST form. This becomes your prescription for treatment and is binding legally for your wishes, even if you are mentally unable to communicate when that time comes.
You can change the order at any time. A copy should be kept with your physician as well as a family member and yourself. In the case of a 911 call for an emergency, the form must go with you so they know your wishes. Otherwise, the emergency attendants are required to apply all lifesaving procedures.
You can state the amount of care you want on this form. For example, if you do not want a feeding tube, you can state that, or you may want minimum and temporary use of a feeding tube.
Official POLST forms can be found on the internet under your state's department of health website or may be procured from your physician.

Health Care Advocates

Sometimes it's easier for a person to hire someone to walk through the maze of finding doctors, making sure treatments are appropriate and working with insurance companies. There is a growing industry designed to help people in this area. It is also important to remember that area agencies on aging can provide counseling services for Medicare at no cost. But the services of health-care advocates are typically broader and can save a great deal of time for people who have the money to hire someone to be their advocate.