By the year 2030, there will be a 50% increase in demand for geriatric experts, while the number of geriatricians in the workforce is expected to decrease. Although the number of geriatric fellows has remained about the same, it is not enough to fill the projected demand (American Geriatrics Society, 2023).
Ensuring patient access to geriatricians or geriatric-trained healthcare professionals is crucial for the expanding population of older adults in hospitals, long-term care facilities and the community. Furthermore, as the overall United States population ages, the number of nursing home residents age 85 and older continues to rise (Lee & Sumaya, 2013). These patients often have complex medical, psychosocial and functional needs associated with high cost, presenting unique challenges for physicians who care for them.
What are Nursing Homes?
Nursing homes, also called skilled nursing facilities (SNFs), typically have populations of older or elderly patients needing permanent assistance with some or all activities of daily living (ADLs). We see many patients in SNF living with complex chronic conditions such as stroke, heart failure or emphysema, in addition to underlying dementia or other cognitive impairment.
To support aging in place and patient-directed care in the nursing home, we work with a team of social workers and administrative, therapy, dietary, nursing and activities professionals. We also cooperate with other physicians or advanced practice providers (APPs) from palliative medicine, wound care or psychiatry, to name a few specialties.
The team always involves patients’ families or guardians in decisions, from the smallest medication change to intensive goals of care conversations. These interdisciplinary teams in the nursing home are not only responsible for the medical care of patients, but the overall well-being and rights of each patient as an individual. Therefore, it is very important that physicians serving these patients are familiar with geriatric-specific challenges and best practices.
Wellstar Post-Acute Model of Care
Our post-acute services department is comprised of SNFs in a contract agreement with Wellstar. These agreements provide a full-time APP on-site five days a week at each facility, along with a Wellstar-designated medical director.
This strategy aims to improve continuity of care since Wellstar providers have access to all patient records within the system. For example, we can cross-reference medication lists on a new patient admission, review accuracy of follow-up appointments and communicate directly with other providers on the patient’s care team. We also collaborate closely with the SNF clinical and administrative management to continuously evaluate diverse metrics (such as re-hospitalizations or infections) that can significantly impact patients’ quality of life and overall cost of care.
Advancing Quality Geriatric Education
In 2018, the Wellstar Family Medicine (FM) Residency program began its inaugural year. As program director, Dr. Vikoria Nurpeisov engaged a new strategy to place FM residents in the nursing home setting to address gaps in geriatric education and training.
Historically, FM residency programs have mandatory geriatric rotations beginning in the second year. However, in the Wellstar FM program, residents are introduced to the nursing home during their first year. They complete a month-long geriatric rotation in the second year and continue to see patients during the third year (or they can select an additional nursing home rotation as an elective). This immersive experience in the SNF allows FM residents to see real-time application of concepts and establishes a unique structure unlike other family medicine residency programs.
The nursing home geriatric rotation during the second year of residency supplements standard didactic content on aging and dementia. For example, education on geriatric syndromes such as weight loss and pressure injury are enhanced by exposure to on-site wound care and at-risk patient rounds.
To prepare residents for this experience, Brette Svensson provides a lecture on the SNF model during family medicine grand rounds each year. This lecture lays the foundation for first-year residents so when they arrive for the geriatric rotation in year two, the experience builds upon that knowledge. Residents see firsthand the processes of care transition between the hospital, community and nursing home by collaborating with the on-site APP and facility team.
Residents on inpatient and emergency room rotations are in a distinctive position to affect the quality of care for geriatric patients transferring to or from the SNF and hospital. When an SNF patient is sent to the emergency room, we notify the inpatient team or FM hospitalist so the patient may be placed on FM service.
There are many instances in which an FM resident has met a patient at the SNF, later sees them in the emergency room or during inpatient rounds, and then eventually discharges the patient back to us. This relationship fosters robust communication between our entire team and has a positive impact on the Wellstar and SNF partnership, and ultimately the patient’s overall care. Thus, residents gain a much deeper understanding and appreciation of the components of geriatric medicine as a specialty.
As we look to the future of geriatric education, we believe that engaging FM residents in this unique SNF model of care provides them with a strong foundation in geriatric principles, increasing the number of geriatric-trained physicians in the workforce no matter where their career paths lead them.
References
Lee & Sumaya, 2013. Geriatric workforce capacity: a pending crisis for nursing home residents. Frontiers in Public Health.
Dr. Viktoria Nurpeisov
Dr. Nurpeisov earned her bachelor’s degree from Georgia State University and her medical degree from the Medical College of Georgia. She completed her residency at Atlanta Medical Center and her geriatric medicine fellowship at Emory. Dr. Nurpeisovis a board-certified geriatrician and certified medical director of Cobb A.G. Rhodes Nursing Home. She is in practice at Wellstar GME Family Medicine Clinic and serves as the program director of the Wellstar Kennestone Family Medicine Residency Program.
Dr. Brette Svensson
Dr. Svensson is a nurse practitioner and the medical director of the Wellstar post-acute services department. She has been working in nursing home care for over 10 years. She received her BSN and MSN from Emory University and completed her Doctor of Nursing Practice at Georgia State University. Her passions also include volunteering with nurse practitioner organizations to promote nursing leadership and geriatric education.
