Caring for the Rural Oldest Old

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Caring for the Rural Oldest Old

• A Program Funded by the Claude Worthington
  Benedum Foundation and Based at Lincoln Primary
  Care Center

Michael Grome, PA and Robert B. Walker,
MD Lincoln Primary Care Center Hamlin, WV
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Caring for the Rural Oldest Old
Need West Virginia is one of the nations oldest
populations. The cost of long term care is
ultimately borne by the state (Medicaid). With a
steady increase in elders and an increasingly
higher percentage of West Virginians living to
advanced age, the impending costs of providing
long term care are frightening and threatening
the states economic viability.
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Caring for the Rural Oldest Old
Other Key Factors Increasing households with
two incomes Increasing costs of long term
care Costs of concurrent in-hospital
care Increased prevalence of progressive
dementia
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Caring for the Rural Oldest Old
Goal To improve the independence and quality of
life in the rural oldest old of rural West
Virginia.
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Caring for the Rural Oldest Old
Key Program Elements Primary Care
Team Detailed Geriatrics Assessment Home-Based
Electronic Communication Increased Access to
Care Best Clinical practices Early
Intervention Cost-Based Reimbursement
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Caring for the Rural Oldest Old
Geriatric Team Geriatrician/Primary Care
Physician Geriatric Physician Assistant Nurses
(3) Social Worker Behavioral Specialist Technic
al assistants (2)
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Caring for the Rural Oldest Old
Geriatrics Assessment Instrument Validated in
Rural Populations Administered by Technical
Staff (2 hours) Embedded Clinical
Instruments Guides Care Monitors Clinical Course
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Caring for the Rural Oldest Old
Home-Based Electronic Communication Health
Buddies Telephone Based AM Monitoring Adaptable
to Chronic Conditions Expensive
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Caring for the Rural Oldest Old
Increased Access In-House Relationships Urgent
Call System (nights, weekends,
holidays) Home-Based Electronic
Surveillance
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Caring for the Rural Oldest Old
Best Practices Clinical Care based on Harvard
Geriatric Symposium Care Guided by Geriatrics
Assessment Instrument Care Guided by Elders
Personal Values
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Caring for the Rural Oldest Old
Early Intervention Shallow Physiologic
Reserve Anticipate Needs Assessment
instrument Urgent Call System In-House
Advocates
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Caring for the Rural Oldest Old
The Rural Community Health System Cost-Based
Reimbursement Regional Distribution Staffing Co
mmunity Service Vision
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Caring for the Rural Oldest Old
Clinical Emphases Mental Status Change (Early
Cognitive Dysfunction) Prevention Systolic
Hypertension Chronic Disease
Management Close Medication Management Activit
ies of Daily Living Resource Surveillance Card
iovascular Health Incontinence Pain Physical
Activity
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Caring for the Rural Oldest Old
Message Unless West Virginia must find a way to
prevent or delay unwanted or unnecessary long
term care for its elders. Message Methods exist
for achieving this which are locally affordable
using models that are in place.