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New Home-Visit Program Aids Seniors, Widens Student Horizons

New Home-Visit Program Aids Seniors, Widens Student Horizons

In 1900 only four out of every hundred Americans lived to be 65 and older. Today that age group has more than tripled, accounting for 14.5 percent of the U.S. population and projected to maintain its growth momentum for decades. Big numbers like this could foretell heavy pressure on the nation’s health care system, commanding action now.

February 13, 2017

The School of Medicine, with the Frances Payne Bolton School of Nursing, has responded by introducing Aging in Place, an elective interprofessional program to enhance the health of seniors and provide students with extra experience beyond the formal curriculum in attending to older adults. Under a just-launched pilot developed with Jewish Family Service Association, teams of three, first-year students (medicine, master’s-level nursing, and physician assistant—based in the SOM) carry out twice-monthly home visits to older adults. The students learn to conduct and document medical histories, strengthen oral presentation skills, and synthesize the often complex medical and social issues affecting older clients. They also gain insights by encountering clients in natural, non-clinical settings—directly observing physical conditions and social determinants of health.

A cross-disciplinary team of faculty members guides the learners in the 12-week initiative.

“There is so much knowledge that our students must learn and it continues to grow in density,” said Susan Wentz, MD, MS, director of the Area Health Education Center and a shaper of the new program. “But that’s not enough. Sometimes, the demands of training mute the human dimensions of care. With Aging in Place, we hope to nourish students’ humanity from the early stages of their education.”

Through the program, the School of Medicine is helping address the nation’s longstanding personnel shortfall in geriatric care. Today there are about 7,500 certified geriatricians in the US, only 44 percent of the total that the American Geriatrics Society says are needed to properly care for the 12 million Americans aged 65 and over who need specialized geriatric services (out of a total of 46 million older US adults). As the baby boomers continue to hit retirement in full stride—the last ones turn 65 in 2030—the need will only expand.

“We don’t expect every medical student in the program to become a geriatrician,” said Patricia Thomas, MD, FACP, vice dean for medical education. “Those who don’t will nevertheless be treating older patients throughout their careers. Care needs, and ways of addressing them, are different for 80-year olds than for 40-year olds. Aging in Place will convey an appreciation of the richness and depth of older adults’ life experiences, including the capacity to remain vital contributors to society. We think the implications for sensitively-delivered senior care are profound.”

Themes and Goals

The program has several themes:

  • establishing a life-long, empathetic framework for addressing seniors’ needs
  • recognizing the importance of effective communication (speaking and listening) with both clients and colleagues
  • supplying team-based care that emphasizes cooperative learning and doing
  • shifting from a hospital-oriented perspective to home-centeredness

“As the population ages and life expectancy grows, programs such as Aging in Place will become more critical,” said Dr. Wentz. “By emphasizing preventive, at-home care and giving students early collaborative experiences, we are building a model that meets today’s and tomorrow’s needs. And increasing the students’ level of comfort in providing care will benefit all patients, not just seniors.”

A total of 24 students are taking part in the pilot, which is funded in part by a grant from the Abington Foundation. From time to time the eight teams will be accompanied to clients’ homes by Jewish Family Service Association social workers.

A small planning project took place this past summer with a group of three students. The participants—Stephen Smilowitz (medicine), Monica Tenjarla (physician assistant) and Rebecca Arko (nursing)—were so enthusiastic about their experience that in a letter to Dean Thomas, they wrote: “Aging in Place [enables us to] meet patients where they are most comfortable, witness their daily trials and triumphs, and cultivate practical skills. [It] offers students the opportunity to witness for themselves that active and resilient older adults are not an exception to the rule, but a normal outcome. Early student exposure to this experience will inevitably change attitudes.” They concluded by calling the program “the ideal real-world laboratory for health care students to develop their most essential skills: communication and empathy.”

How it Works
To prepare for the home visits, students take part in small-group and seminar sessions. Then, as three-person teams, they develop general plans for each person’s roles and responsibilities. After every visit the students:

  • carry out a “group reflection moment” to identify strengths and opportunities for improvement
  • submit a field note describing the visit
  • prepare written self-reflections assessing their experiences
  • take part in small-group learning sessions with faculty preceptors.

“By collaborating with learners from other disciplines as well as with experienced clinicians, Aging in Place students will gain early familiarity with the benefits, both to their patients and themselves, of team-delivered care,” said Dr. Wentz. “They will come to see the important contributions collaborative care makes in fostering physical and mental health in older adults.
These lessons will last a professional life time.”

 

Photo credit: Credit: Jose Luis Pelaez, Inc./Blend Images/Corbis