Geriatrics is a fast-growing area of medicine. Sometimes referred to as the “silver tsunami”, America has a rapidly growing elderly population. It is our responsibility as healthcare providers to assure access, utilization and delivery of high-quality care. As of today, the US population 65 years and older is now over 50 million individuals and this statistic is projected to increase more than 70 million in the next 25 years. The reason for this surge is due to the aging of the baby boomer population and due to people living longer in general. The increase in longevity stems from increased prevention efforts, earlier detection of disease processes and therefore advanced treatments sooner. For this reason, Geriatrics is the forefront of where medicine is going and a plan to deliver quality care to an advanced age population must be addressed.
A major consideration for now and the future is what an elderly individual will do when they no longer can care for themselves due to a disability or advanced age. How can we measure scientifically whether or not someone is “safe” to provide their own needs? The answers to these questions change and adapt on a regular basis. Currently, healthcare providers use activities of daily living (ADLs) to evaluate someone’s capability of living independently and caring for themselves. This term helps to determine one’s functional status. Common ADLs include dressing, bathing, feeding, grooming and more. When someone can no longer complete these tasks, they must consider a center or someone that can provide the needed assistance. Usually, help comes in the form of a “homemaker”, home health nurse, assisted living or skilled nursing facility. Each of these examples provides different individual services as well as a variation in the level of assistance.
The first-tier level in terms of services offered but not parallel to the financial cost is homemaker and home health nurse services. A home health nurse is usually a health insurance covered option where a nurse comes into the patients home one to two times weekly to help monitor blood levels, clinical status and/ or medication administration. A homemaker service is usually an out-of-pocket expense where an agency or person is hired to render services including cleaning, cooking and even helping the elderly patient with bathing and dressing in some cases. These at-home services provide the least amount of assistance to the individual but do keep the geriatric patient in their home.
If the “first tier” services are not enough support for the patient, the next option would consist of an assisted living facility. These facilities sometimes can have some coverage from insurance, but the majority of these expenses tend to be out-of-pocket. Assisted living centers usually have certified nursing assistants on site twenty-four hours a day, as well as a nurse for a portion of each day. These buildings provide cooked meals, leisure activities, transportation to appointments and even physical therapy in select buildings. The assisted living facility is a place geriatric patient can live and still have a sense of independence. It offers some autonomy to its residents while still providing staff to monitor and help with ADLs.
The highest level of care, tier three, consists on skilled nursing facilities. These centers offer the greatest nursing supervision and medical care. Skilled facilities are usually covered by health insurance for a certain number of days according to the individuals plan. There can be residents in these skilled nursing facilities long term if proven to be necessary. Skilled nursing facilities have twenty-four-hour nurse supervision with a registered nurse available all-day or a portion of each day. Skilled facilities provide IV therapy, G-tube services, nutritionist support, physical therapy, occupational therapy, cooked meals, leisure activities and physician support. A physician must see a patient every 60 days and usually a mid-level sees that same patient in-between for follow-up and acute visits. These facilities offer the most assistance and supervision for the geriatric patient, but still come at a cost.
Overall, the US as a country is in need for more assistive programs for the elderly. Due to such a large population requiring these services, there has been much more federal scrutiny, as is expected. Healthcare providers in the geriatric field have the duty to sort through each patient’s abilities to better determine their needs and the accurate environment for their safety. It is also of the utmost importance to be available and to monitor the care of geriatric patients to ensure quality and that healthcare is moving forward in a positive direction. The advanced age population will only continue to grow in the years to come. We as healthcare professionals are responsible for building the foundation of future geriatric care.