Healthier People, Healthier Organizations
The “New” Holistic Approach To Elder Care?
by Dr. Barney Spivack, LifeCare Medical Director

The benefits and importance of taking a “fuller view” of older individuals served by health plans has been getting much publicity recently. Complex care management programs—programs in which social workers, nurses, health coaches and other professionals all bring their skills to bear to help individuals better manage their chronic conditions and improve their overall quality of life-are now being widely advocated. These programs attempt to serve “the whole person” to create the best possible outcomes. However, this is not really a new concept. It is the same the approach that has been recommended and utilized by geriatricians for decades.

Geriatricians are family physicians or internists who have advanced training in the care of older adults. The hallmark of the geriatrician is to take an overall view of the patient, incorporating medical, socioeconomic, psychologic, environmental, patient preferences and other factors. The geriatrician's paramount goal is to optimize the patient's day-to-day functioning and independence to create an improved quality of life.

Unfortunately, geriatricians are in short supply, a trend that will only grow worse as our society ages. The American Geriatrics Society (AGS), the foremost professional organization representing this field, predicts that by 2030, when there are expected to be 80 million people over age 65 in the U.S., the nation will need at least 26,000 more geriatricians than are likely to be available. The reasons for this shortage largely relate to inadequate physician reimbursement for the care provided to older adults, especially in comparison to other medical interventions. In fact, the workforce in general that is dedicated to the care of older adults (nurses, social workers, rehabilitation professionals, pharmacists, and many others) also faces a critical shortage.

Given these trends, most older adults will continue to receive much of their care from primary care physicians and other professionals, rather than from board-certified geriatricians. This is one of the chief reasons why LifeCare has been working to build awareness among physicians and other health care professionals about the suitable goals of eldercare. It is why the tools and resources we create are largely multi-disciplinary in nature, addressing the needs of older individuals holistically. Our assessment and risk stratification tools, for example, are based upon the core principles of care for older adults and encompass both recommended and emerging care standards. In this way, we can more favorably impact the care of the older adults we serve and better ensure that the health care professionals who serve them will be guided appropriately, even if they aren’t trained geriatricians.

It's encouraging to see the national media now focusing attention on a multi-disciplinary approach in the care of older adults. Here at LifeCare, this is the focus we have been advocating and practicing for years, and we will continue to refine our approach as the field's knowledge base grows.

As always, I want to address the topics that are most important to you in this column and the best way to do that is with your input! So please feel free to email me with questions, success stories or comments. I look forward to hearing from you.

Dr. Barney Spivack's medical career spans more than 25 years, with a focus on the care of older adults, chronic disease, and long-term care. Prior to joining LifeCare, he was the Director of Medical Services at Waveny Care Network in New Canaan, Connecticut. Before that, he was Director of Geriatric Medicine at Norwalk and Stamford Hospitals. Dr. Spivack also is active in the American Medical Directors Association and is President of the Connecticut Geriatrics Society.