Have you noticed the proliferation of independent living, assisted living, skilled nursing and memory care complexes sprouting up throughout SE Michigan? In northern Oakland County where I live, it seems that most new habitational buildings serve some type of elderly population. On the one hand, it’s wonderful to see that so many people who raised their families here will be able to grow old in their own communities; yet at the same time, it saddens me to think that these same long-time area residents, at least those in skilled nursing facilities and memory care, will likely have to give up their primary care physicians at a time when they need continuing, comprehensive, community-based care the most.
I grew up in the 313 – more specifically, the 48212 – where primary care physicians were within walking distance of our neighborhood, and a first sign of semi-serious illness or injury – even in an older person, was likely followed by a quick bus or taxi ride to the doctor’s office. Not so today. When my father was in respite care in a well-known independent care facility in recent years, I observed how far too many health issues were met by an immediate call to 911. The ambulance took the place of the physician or mid-level provider.
Why? Why do we terminate long-term physician/patient relationships, often without a warm hand-off, simply because the patient has changed their residence? Why is it not recognized that handing over a large stack of paper medical records (or an electronic record file) without the PCP’s explanation and input on the health care status of the patient is unacceptable and a barrier to setting up positive new physician/patient relationships? Why is the healthcare system for those in senior care facilities impersonal and lacking in the kind of comprehensive care that community-based care affords?
The Patient Centered Medical Home Neighborhood (PCMH-N) was designed to link primary care practices with the community, including extended services, hospitals, pharmacies, social service agencies, and yes – senior living complexes. Now that they are mushrooming in our neighborhoods, shouldn’t we link them in? Or were we just talking before when we vowed our allegiance to the PCMH-N concept?
Physician Organizations were formed in large part as a response to managed care, with a pool of physicians willing to take on the financial and quality of care risk of serving managed care patient populations. Perhaps we are at that stage again. Can the PCPs from Michigan’s numerous POs be part of the solution that brings primary care into senior care housing? Can we partner with these establishments to provide patient and relationship-centric primary care, care management and a collaborative team of health care specialists such as dietitians, exercise specialists, behavioral health, pharmacists and social workers – some of whom these patients may already know?
Let’s not lose the neighborhood in the Patient Centered Medical Home as we seek to treat our rapidly growing senior population. Let’s commit to being good neighbors.