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Senior Citizen's Guide to Baltimore

Geriatric Care After 60

As Americans, we feel very strongly about our homes. As we grow older, our overwhelming preference is to age “in place,” in our most familiar environment, surrounded by the people and things we love most. Our vision of successful aging is to remain active, healthy, engaged and independent throughout a long and satisfying life.

Home is a concept that provides comfort and peace of mind. It is the one place we know by heart: where the sofa is, how long it takes to toast a piece of bread, where we last left the remote control. So it only makes sense to apply the particulars of “home” to other areas of our lives – including the medical practice we choose.

As we age, we often find ourselves seeking out the care of doctors, nurse practitioners and other medical professionals more and more to both prevent major health crises and to manage those medical problems that inevitably arise. Traditionally, this has meant primary care from a family medicine or internal medicine physician group, with referrals to specialists who offer care for everything from heart disease to diabetes management and skin problems. This may lead to gaps in care from too many doctors, each of whom is responsible for only a piece of the patient’s medical history.

These gaps have led to calls for a return of sorts to the old days, with a modern twist. While the revered country doctor – the one who knows every detail of his patients’ medical histories, no matter how seemingly insignificant – is largely a thing of the past, there has been a new trend toward creating a “medical home” within modern medical practices.

The idea of creating “medical homes” in primary care practices has gained momentum recently through the debate over Health Care Reform. Thanks to discussion and examination of the idea, there is now a definition of the concept that is being applied as more and more practices convert to this new model of care:

In a medical home: 1) Each patient must have their own personal physician or nurse practitioner; 2) The medical home must provide comprehensive care that addresses the whole person and all medical issues that may arise; 3) The care must be coordinated and a part of the larger health system; 4) The care must be accessible, reliable, patient-centered and safe and offer treatments that are sound and proven; 5) The care must use current technology to assist the physician in decision-making and in his or her assessment and evaluation of the patient; and 6) Most importantly, it should be satisfying to both the patients and the physicians.

A patient should feel like a revered guest in the medical home, treated with all the hospitality and generosity he or she would find in visiting the home of a trusted friend. Care should be seamless and coordinated. It should be brought to the patient when he or she is unable to travel for care, as for those who live in a nursing home. And if, at some point, the wish to stay at home until the end becomes difficult to maintain, each personal “patient story” – the medical history and documents that outline living wills and decisions about who will make medical choices if the patient is unable – should follow the patient from home to the hospital, nursing home, assisted living facility or any other care facility.

In today’s health care environment, physicians and nurse practitioners are often called “providers” and patients are called “consumers” of health care. Author Arthur Frank, in his book “The Renewal of Generosity,” suggests that, in the era of the medical home, health care providers should think of themselves rather as “hosts,” welcoming those in need of care as “guests” into their medical homes.

This may sound like an idealized vision for medical care, but it can, and hopefully will, become a reality. A successful medical home will ensure that no patient will figuratively fall through the cracks, that all medicines that are prescribed are safe when taken together, and that all of a patient’s wants and needs are known, recognized and acknowledged. It also ensures that the patient remains, first and foremost, a person, and not the number on his or her medical chart.

For older adults, the essence of successful health care reform is the comfort of knowing that our medical care will be technically expert, coordinated and attentive. Older adults can judge the success of health care reform by whether the door of the medical home is open when needed and whether they are greeted there as honored guests

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