Selected Podcast
Improving Geriatric Patient Outcomes with Home Care Program
There are currently more than 50 million people over the age of 65 in the United States and according the U.S. Census Bureau that number is expected to grow to 78 million by 2035. Northwestern Medicine's Dwayne Dobschuetz, APRN is taking using an old concept in medicine – the house call – to solve new challenges presented with a rapidly aging population. In this episode he shares how Northwestern Medicine's Home Care Program is improving patient outcomes and allowing more seniors to age in place.
Featured Speaker:
Dwayne Dobschuetz, APRN
Dwayne Dobschuetz, APRN is a Geriatric Nurse Practitioner. Transcription:
Improving Geriatric Patient Outcomes with Home Care Program
Melanie Cole (Host): There are currently more than 50 million people over the age of 65 in the United States, and according to the US Census bureau, that number’s expected to grow to 78 million by 2035. Dwayne Dobschuetz, geriatric nurse practitioner at Northwestern Medicine, is using an old concept in medicine, the house call, to solve new challenges presented with this rapidly aging population. Today, he’s joining me to share more about the Northwestern Medicine HomeCare Program. Dwayne, what a pleasure to have you with us today, and while house calls are not a new concept in medicine, Northwestern Medicine’s HomeCare Program is very unique. Tell us more about this program and how it got started.
Dwayne Dobschuetz, APRN (Guest): Well, it started as an outgrowth of a special project from Medicare in our emergency department at Northwestern, and it was called the Geriatric Emergency Department Innovations Project, and we worked with three other hospitals and did a number of assessments on seniors coming through the emergency department to see if there was a way that they’d not always could be admitted to the hospital. If you show up in the hospital, and you’re 85 or 90, and you present a multiplicity of complaints, more than likely, you’re going to be admitted to the hospital, whether you really need to be or not, and so what the goal was to train a number of nurses to assess the patients that came in to see if we could send them home safely, and I was one of the ER nurses that was selected to receive some specialized geriatric training and then to participate in these assessments of seniors, which took about 20 minutes per senior as we were—saw them during the day.
Host: Wow. What an interesting program. So, why is homecare particularly important for geriatric patients? As you’ve said, you know, making sure they can go home safely. What types of conditions do you treat and tell us a little bit about why this is so important?
Dwayne: Well, the thing that happens when someone comes in is the emergency department physician and the staff know very little about the patient, other than what’s presented and then maybe a little bit of their history, but then if they have fallen, are they safe to go home, and that’s what we began to see, you know, would they be safe? I can remember the day the attending physician looked at me, and he said, “Dwayne, is this lady safe to go home?” and I turned to look around behind me to see who he was talking to and realized he was asking my opinion, and in my assessment, I felt she was safe to go home, but then I added, “If she’s not safe, I’m calling her in two days, in 10 days to see if she’s doing ok; if she’s made an appointment; if she’s scheduled her physical therapy; if they’ve called her.” You know, all the different things that would make her successfully not a candidate to come back to the emergency room.
Host: Wow. What an amazing program and what a great story. Tell us what kind of outcomes you’re seeing with this program. Are you seeing reduced hospitalization? Are you catching problems earlier? Tell us about your outcomes.
Dwayne: The outcomes we have seen by documentation over these three sites that if we did the intervention, that, more than a 30% chance that these seniors would not be admitted to the hospital, but now what I have seen as I have seen patients at home, there are many times that the only alternative a family has is bringing them to the emergency department. I have had the opportunity to many times avert an admission to the hospital by simply seeing them at home and ordering what was appropriate. I’ve even ordered an X ray in the home and been able to treat beginning pneumonia without them having to come to the hospital or just the reassurance that this problem can be addressed at home rather than coming into the hospital.
Host: Well, that’s so important, and as we talk about what you do, Dwayne, the logistics of providing primary care in the home can be a little bit daunting. In addition to seeing patients for their healthcare needs, you spend time assessing their home and making suggestions to help making their home safe. Can you share some of the things that you look for?
Dwayne: Well, almost every senior has 10 throw rugs in their home. So, that’s an immediate fall risk. I then ask them to show me their bathroom, and I walk in the bathroom and see how they try and get up off the toilets. I know that sounds unbelievably simple, but the contortions that they go through and the multiplicity of falls come in the bathroom, so I recommend bars. I recommend handles for the toilet that make them safe to get in and out because that’s where they’re going to fall.
It’s amazing to see what they need to have done at home just to make them safe, and these are simple things. These are not complicated structural things, but simple aids that people don’t think of. Many people say, oh, I don’t need a cane or a walker at home, and then I ask them to walk for me, and I notice what they call—what I call furniture surfing—where they literally touch every piece of furniture to keep from falling, and then I can encourage them to use the right equipment.
Host: So important. What great tips. So, your department is working on an NIH grant centered around making long-term care decisions. How do you incorporate the planyourlifespan.org into your visits?
Dwayne: One example is when you’re admitted to the hospital—when you have to go for say rehab afterwards to a facility, the social worker will come in and say, “Okay, where would you like to go for rehab?” and the patient looks and says, “I don’t know” and the family says, “I don’t know.” What planyourlifespan.org does is help a family and a patient think in advance where they would like to go for rehab, or they can actually investigate it beforehand and have that in their mind when they’re in the hospital. What that does, it saves them at least three days of a hospital stay, which is so critical to get patients out of the hospital as soon as they can, and by making those choices in a planned fashion, through planyourlifespan.org, it really helps to speed up that process.
Host: Well, it certainly does, and these are such important topics and such important points, Dwayne. So, why do you feel it’s important for hospitals to establish programs like yours and the hospital protocol and trainings around caring for geriatric patients? Tell us about that.
Dwayne: The reason that it’s so important is every physician I know has at least one patient they want to fire, and not in a bad sense. It’s that patient has not been to the office to see the physician in say a year, but yet they are continually calling for medication, for help, for advice, for letters, for recommendation for rehab, and at some point, the physician says, “Unless I see you, I can’t prescribe this for you. I can’t help you” and many of these people are limited by physical incapability, mental incapacity, or just they don’t want to come to the hospital and so by me going there, I can be the eyes and the ears of the physician and help make those people safe at home.
Host: Wonderful information. Thank you so much, Dwayne, for joining us today and sharing your expertise. What a great segment, and that wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter. I’m Melanie Cole.
Improving Geriatric Patient Outcomes with Home Care Program
Melanie Cole (Host): There are currently more than 50 million people over the age of 65 in the United States, and according to the US Census bureau, that number’s expected to grow to 78 million by 2035. Dwayne Dobschuetz, geriatric nurse practitioner at Northwestern Medicine, is using an old concept in medicine, the house call, to solve new challenges presented with this rapidly aging population. Today, he’s joining me to share more about the Northwestern Medicine HomeCare Program. Dwayne, what a pleasure to have you with us today, and while house calls are not a new concept in medicine, Northwestern Medicine’s HomeCare Program is very unique. Tell us more about this program and how it got started.
Dwayne Dobschuetz, APRN (Guest): Well, it started as an outgrowth of a special project from Medicare in our emergency department at Northwestern, and it was called the Geriatric Emergency Department Innovations Project, and we worked with three other hospitals and did a number of assessments on seniors coming through the emergency department to see if there was a way that they’d not always could be admitted to the hospital. If you show up in the hospital, and you’re 85 or 90, and you present a multiplicity of complaints, more than likely, you’re going to be admitted to the hospital, whether you really need to be or not, and so what the goal was to train a number of nurses to assess the patients that came in to see if we could send them home safely, and I was one of the ER nurses that was selected to receive some specialized geriatric training and then to participate in these assessments of seniors, which took about 20 minutes per senior as we were—saw them during the day.
Host: Wow. What an interesting program. So, why is homecare particularly important for geriatric patients? As you’ve said, you know, making sure they can go home safely. What types of conditions do you treat and tell us a little bit about why this is so important?
Dwayne: Well, the thing that happens when someone comes in is the emergency department physician and the staff know very little about the patient, other than what’s presented and then maybe a little bit of their history, but then if they have fallen, are they safe to go home, and that’s what we began to see, you know, would they be safe? I can remember the day the attending physician looked at me, and he said, “Dwayne, is this lady safe to go home?” and I turned to look around behind me to see who he was talking to and realized he was asking my opinion, and in my assessment, I felt she was safe to go home, but then I added, “If she’s not safe, I’m calling her in two days, in 10 days to see if she’s doing ok; if she’s made an appointment; if she’s scheduled her physical therapy; if they’ve called her.” You know, all the different things that would make her successfully not a candidate to come back to the emergency room.
Host: Wow. What an amazing program and what a great story. Tell us what kind of outcomes you’re seeing with this program. Are you seeing reduced hospitalization? Are you catching problems earlier? Tell us about your outcomes.
Dwayne: The outcomes we have seen by documentation over these three sites that if we did the intervention, that, more than a 30% chance that these seniors would not be admitted to the hospital, but now what I have seen as I have seen patients at home, there are many times that the only alternative a family has is bringing them to the emergency department. I have had the opportunity to many times avert an admission to the hospital by simply seeing them at home and ordering what was appropriate. I’ve even ordered an X ray in the home and been able to treat beginning pneumonia without them having to come to the hospital or just the reassurance that this problem can be addressed at home rather than coming into the hospital.
Host: Well, that’s so important, and as we talk about what you do, Dwayne, the logistics of providing primary care in the home can be a little bit daunting. In addition to seeing patients for their healthcare needs, you spend time assessing their home and making suggestions to help making their home safe. Can you share some of the things that you look for?
Dwayne: Well, almost every senior has 10 throw rugs in their home. So, that’s an immediate fall risk. I then ask them to show me their bathroom, and I walk in the bathroom and see how they try and get up off the toilets. I know that sounds unbelievably simple, but the contortions that they go through and the multiplicity of falls come in the bathroom, so I recommend bars. I recommend handles for the toilet that make them safe to get in and out because that’s where they’re going to fall.
It’s amazing to see what they need to have done at home just to make them safe, and these are simple things. These are not complicated structural things, but simple aids that people don’t think of. Many people say, oh, I don’t need a cane or a walker at home, and then I ask them to walk for me, and I notice what they call—what I call furniture surfing—where they literally touch every piece of furniture to keep from falling, and then I can encourage them to use the right equipment.
Host: So important. What great tips. So, your department is working on an NIH grant centered around making long-term care decisions. How do you incorporate the planyourlifespan.org into your visits?
Dwayne: One example is when you’re admitted to the hospital—when you have to go for say rehab afterwards to a facility, the social worker will come in and say, “Okay, where would you like to go for rehab?” and the patient looks and says, “I don’t know” and the family says, “I don’t know.” What planyourlifespan.org does is help a family and a patient think in advance where they would like to go for rehab, or they can actually investigate it beforehand and have that in their mind when they’re in the hospital. What that does, it saves them at least three days of a hospital stay, which is so critical to get patients out of the hospital as soon as they can, and by making those choices in a planned fashion, through planyourlifespan.org, it really helps to speed up that process.
Host: Well, it certainly does, and these are such important topics and such important points, Dwayne. So, why do you feel it’s important for hospitals to establish programs like yours and the hospital protocol and trainings around caring for geriatric patients? Tell us about that.
Dwayne: The reason that it’s so important is every physician I know has at least one patient they want to fire, and not in a bad sense. It’s that patient has not been to the office to see the physician in say a year, but yet they are continually calling for medication, for help, for advice, for letters, for recommendation for rehab, and at some point, the physician says, “Unless I see you, I can’t prescribe this for you. I can’t help you” and many of these people are limited by physical incapability, mental incapacity, or just they don’t want to come to the hospital and so by me going there, I can be the eyes and the ears of the physician and help make those people safe at home.
Host: Wonderful information. Thank you so much, Dwayne, for joining us today and sharing your expertise. What a great segment, and that wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter. I’m Melanie Cole.