If you’ve visited one of our PACE Centers in California, Colorado or New Mexico, you’ve probably seen a furry friend roaming the halls greeting participants in their path. This is likely one of our service animals or therapy dogs.
It shouldn’t come as a surprise that animals (service, therapy or companionship) have been known to provide physical and mental health benefits to those around them. Studies show animal companionship can greatly affect the quality of our lives. Below are some of the theorized advantages:
Physical Health Benefits
Lower blood pressure
Regulated heart rate
Lower risk of heart disease
Lower levels of stress
Fewer doctor visits
Fewer sick days off from work
Mental Health Benefits
Sense of responsibility
Lower rates of depression
Increased participation in social and physical activities
Service vs. therapy vs. companionship
Service animals must be individually trained to perform tasks related to a participant’s disabilities while therapy animals belong to a therapist or psychiatric personnel and must be accompanied by them at all times.
Service animals are trained to behave flawlessly in public and will even tuck themselves under tables so as not to be an inconvenience to those around them. Therapy animals often provide comfort and companionship to others by listening to them read or accompanying them during appointments.
Companionship animals are virtually indistinguishable from the family pet and may not behave perfectly in public. For this reason, companionship animals are not allowed in most public places and must remain at home.
Take two aspirin and call me in the morning is outdated medical advice. Thanks to the new clinical exercise program at the InnovAge Denver center, it’s more like do 20 reps and call me in the morning.
The popular new clinical exercise program at the Denver PACE (Program of All-inclusive Care for the Elderly) center helps participants get stronger, which improves their ability to perform activities of daily living. Which, in turn, keeps them living independently.
The clinical exercise program is designed to systematically reduce the risk of serious health problems among the highest-risk participants, says Steven Jones, the clinical exercise physiologist at the Denver Center. Steven, who has a degree in exercise physiology, owned a personal training business in Atlanta for six years before coming to Colorado.
The clinical exercise program is literally prescribed by the center’s physicians. The first set of participants they’ve referred are those diagnosed with metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke and diabetes.
“Participants are getting stronger, which improves their ability to perform activities of daily living, which keeps them living independently,” Steven says. “This is exactly what PACE is all about.”
Steven tailors a plan for each program participant based on specific exercise protocols developed by the American College of Sports Medicine and the Centers for Disease Control and Prevention. Participants use several pieces of new equipment InnovAge bought for the program, including a leg press, cardiac rehab treadmills and recumbent bicycles. Steven monitors each participant’s heart rate, blood pressure and oxygen saturation to make sure they are reaching their goal threshold, safely.
“Exercise is highly effective for dropping these numbers,” says Steven. “It just makes sense.”
The math is easy. The numbers of older adults in the United States continues to increase, while the number of physicians entering training programs for geriatric fellowships is decreasing.
Our traditional reimbursement model, which values procedures and acute care over management of multiple chronic conditions, is a major contributor to the decrease in new geriatricians.
In the U.S., 10,000 people turn 65 years old every day. In just 14 years, approximately 20% of the population will be 65 years or older; that’s 72 million people in the U.S. alone. The amount of 65-84 years old will reach approximately 63 million. Growing older also means an opportunity to accumulate a greater number of comorbidities, ranging from chronic arthritis and heart failure, to debilitating dementias.
By 2050, it’s estimated there will be 1.5 geriatricians for every 10,000 people 75 years old and older, a decrease of 3.2 geriatricians for every 10,000 people from 2000, according to the American Geriatrics Society.
The work of a geriatrician may not be considered exciting or glamorous, but it is important, invariably interesting, rewarding and cost-effective.
Geriatricians and the geriatric patient do not easily fit into our current healthcare system. In a productivity-based clinic environment, a new patients is expected to be seen every 15 minutes, however it can take 15 minutes to get an elderly patient back to the room, obtain vital signs and ready for an exam.
Geriatricians and the work they do may not fit in a value-based reimbursement model either.
Due to their advanced age and multiple co-morbidities, elderly patients do not easily fit into typical quality metrics for the management of many chronic conditions, including diabetes control and cancer screening. Geriatric care is at its core comprehensive, patient-centered and coordinated care—it is time-consuming and intensive and is not likely be replicated by telephonic case management.
For all the challenges in real-life and the high jinx on television—like the HBO show “Getting On”—there are success stories, for the geriatrician and older patients, in the real world.
One such success is the Program of All-inclusive Care for the Elderly (PACE).
PACE is a great answer for those geriatricians committed to their craft and their patients.
A Medicare and Medicaid care model designed to improve care coordination and outcomes for underserved older adults, PACE takes place in a single facility housing medical, dental, occupational and rehabilitation therapy, adult day, pharmacy and more. The care coordination afforded participants typically leads to improved outcomes for participants.
PACE is an interdisciplinary team model where the patient, the care delivery system and the payment system are aligned. The primary care physician and the interdisciplinary team have the opportunity to make a positive impact on the lives of many older adults while not having to worry about the many reimbursement issues.
As PACE programs expand nationwide, more opportunities for board-certified geriatricians and primary-care physicians with interest and expertise in caring for seniors become available. Primary care delivery in PACE programs varies from employed physicians to contracted providers. Some programs may use a physician or a nurse practitioner to provide care. In general, PACE work is full-time employment, so physicians must have a passion for the work.
In addition, PACE programs benefit geriatricians because it is not a production-based model so it allows the physicians to spend time with each participant without needing to worry about pushing the patient through the system quickly. Collaborating with the interdisciplinary team allows for greater support and more comprehensive care, as well.
For geriatricians, this creates an atmosphere conducive to spending the necessary amount of time with patients. While there’s no single answer to handle the coming influx of older adults and falling numbers of geriatricians, PACE can be a refuge for those physicians looking to continue providing hands-on, high-quality care to older adults.
Lisa Price, MD is chief medical officer at Denver-based InnovAge, a provider of health and wellness services for older adults in California, Colorado and New Mexico. Price was a private practice geriatrician for 11 years, and then attended on the Acute Care of the Elderly (ACE) service and taught quality improvement at the University of Colorado. She is board certified in internal medicine and geriatrics, and has expertise in managed care, electronic health records and quality improvement. http://MyInnovAge.org.
This article originally appeared in Medical Economics.