Under the direction of Chief of Geriatric Medicine, Patricia A. Bloom, M.D., the comprehensive Geriatrics Program at St. Luke's-Roosevelt Hospital Center (SLR) specifically addresses the special health and medical needs of this expanding senior community, including in-patient care, out-patient care, and the needs of people with Alzheimer's Disease. Importantly, SLR staff also assists families in navigating the "how-to's" of home care, and Medicare/Medicaid entitlements. The medical center is also preparing for the future by training its house staff on senior medical care issues.
New Geriatric Psychiatry Unit
Families with elder members suffering with Alzheimer's Disease, psychosis, and schizophrenia can now resource the services of the new 30-bed in-patient Geriatric Psychiatry Unit at the St. Luke's Hospital site on Amsterdam Avenue and 113 Street. In this nurturing and supportive ambiance, the SLR geriatric psychiatry team also treats patients with the disorders of depression, dementia and agitation. "In this model unit," says Dr. Bloom, "we can tailor the best course of treatment for the individual depending on the root cause of complex psychiatric conditions. They may be associated with one of the dementias or memory loss diseases. They can also be associated with such diseases as vascular brain disease, which in turn may be associated with strokes or transient ischemic attacks (TIAs, or "mini-strokes"). But psychiatric conditions in the elderly can also be due to other medical diagnoses, the stress of illness, or improper medication or over-medication." The staff includes geriatric psychiatrists, a geriatric medical consultant, a geriatric nurse practitioner, psychiatric nurses and social workers. The unit also provides music, art and occupational therapy programs, as well as spirituality groups.
* The National Longevity Center, a nonpartisan, nonprofit New York think tank, cites studies indicating that at least 20,000 geriatric physicians are now needed in the U.S., but only 6,784 currently exist, and too few are being trained in the nation's medical schools.
Geriatric Training for In-House Physicians
The Division of Geriatric Medicine includes three full-time attending physicians, two geriatric nurse practitioners and two geriatric fellows in a new Geriatric Fellowship Program. In addition to its patient care activities, the Division is dedicated to the education of physicians in training. "With more elderly utilizing our facility, our mission is to educate the entire house staff on their special needs," says geriatrician Brian C. Scanlan, M.D. In an effort to raise awareness, SLR geriatricians offer specialty consults to colleagues dealing with geriatric cases in other areas of the hospital, along with a full curriculum of lectures and special presentations.
Geriatric Ambulatory Care Facility
St. Luke's-Roosevelt provides an out-patient facility at the St. Luke's site, focusing on coordination of interdisciplinary medical care with access to specialists and emphasis on functional ability. "Our goal is to help the aging to live up to their best potential, at the fullest possible functioning" says Dr. Bloom. "To that end, we provide geriatric assessments to increase physical, cognitive and psychological functioning. We also like to make sure our patients are getting enough sleep, exercising for mobility, preventing de-hydration by drinking enough water, and are using eyeglasses and hearing aids to improve sight and hearing."
Homecare Services
One of the goals of the geriatrics program is to enable members of the SLR community to receive the health care they need to remain in the community and age safely "in place." Underscoring SLR's commitment to the elder community is the medical center's participation as the health care partner in several naturally occurring retirement communities (NORCS). NORCS provide the coordinated social and health care services that empower seniors to remain active and productive. SLR geriatric NORC nurses are based in the community, providing health screenings, ongoing care management, monitoring chronic diseases such as diabetes, and serving as a point of entry to the comprehensive geriatric services that are offered by the medical center.
One such example is the NORC Program partnered with the New York City Housing Authority (NYCHA) at the Amsterdam Houses on Manhattan's west side where SLR geriatric nurses work with Amsterdam Houses elders on identifying primary care physicians, navigating health insurance issues, and recognizing medical symptoms that require attention. They also provide advice on diets and exercise, encourage screenings for such disease risk factors as blood pressure and cholesterol, and arrange for home nursing and physician visits where necessary.
Walk-In Community Center
SLR'S HEAL Center (Health, Education, Advocacy, Learning) is centrally located at St. Luke's Hospital on Amsterdam Avenue to offer assistance on public entitlements, insurance eligibility and claims, managed care plans or heath-related concerns. In addition, counseling staff can answer questions about Medicare, Medicaid and other programs. No appointment is necessary between 9 AM and 5 PM, Monday through Friday.
Special Services for Alzheimer's Patients
St. Luke's-Roosevelt Hospital Center also provides physician support services to neighboring Manhattan assisted living and long term care facilities that serve Alzheimer patients, including The Hearthstone and Isabella Geriatric Center, and an entire network of residential facilities in the Bronx and Westchester.
End-of-Life Care
The SLR Ethics Committee is a group of nurses, doctors, social workers, chaplains, patient representatives and community members, who are committed to assisting patients, family members and the health care team when ethical issues arise during in-patient care. This committee is available to consult with families and the hospital's geriatric specialists to provide the best end-of-life care, including control of pain, relief of suffering, and guidance on appropriate courses of treatment consistent with personal spiritual values. St. Luke's-Roosevelt maintains a partnership with the Jacob Perlow Hospice at Beth Israel Medical Center, which provides both inpatient and home-based hospice care.