Category Archives: Interviews with experts

Guest interviews help readers figure out how to solve care dilemmas.

Some Medical Insights for Caregivers – Conversations with Dr. Roy Hamilton

Since my mom got sick, my sister and I have done tons of research to find the most effective ways of caring for her. During the period when her symptoms emerged, we were all living in a city with expert physicians and State of the Art centers for treating memory loss. But after moving my mom to a rural place with a slower, more calming quality of life, I realized that there are many American towns and cities where access to expert care is very limited.

To provide all readers with more information on the latest developments in dementia treatment, I interviewed Dr. Roy Hamilton from Penn’s Memory Center in Philadelphia. Dr. Hamilton is a Harvard-trained physician who serves as Co-Director of Penn’s Laboratory for Cognition and Neural Stimulation. Our conversation yielded enough ideas to turn this into a two, or even three-part, info session for caregivers.

We started our talk by discussing how families should approach the issue of diagnosis. Since there are not many effective treatments for the disease, many people are willing to accept a probable diagnosis of Alzheimer’s when they may actually have a different form of dementia. I asked Dr. Hamilton whether it makes much difference to get a more precise diagnosis. His view is that “a better diagnosis has greater prognostic value. It gives caregivers a better idea of the course of the disease they will be dealing with.” He reminded me that, “Symptoms vary between the different types of dementia. Frontal Temporal Dementia patients typically have more behavioral symptoms than memory issues. Patients with Lewy’s bodies have more motor symptoms and hallucinations and caregivers need to be prepared for that.” Accurate diagnosis is also important because symptoms experienced by some patients are more treatable. Dr. Hamilton believes that, “It is better for caregivers to know if they are observing a condition that could be arrested or reversed. Examples of modifiable medical conditions that may contribute to cognitive decline include Vitamin B deficiency and hypothyroidism. These can be treated effectively and doing so could lessen their impact on the patient.”

Dementia can be a very puzzling disease, so I asked Dr. Hamilton how caregivers and family members can help physicians come up with the most accurate diagnosis and treatment plans. He advised family members to, “Be honest reporters of the family member’s symptoms. Try to be accurate even if it is painful to recognize what is happening. If the patient is present, it may be hard to talk about, but it’s important for the doctor to know. You may want to try to convey information to the doctor privately. You need to be able to describe to patient’s history of decline and be a good documentarian of treatment that has already occurred. The patient often will not remember the evaluation information that has already been collected.” He also mentioned that since the law limits access to medical records, some information may not be available to a patient’s new doctor. In that situation, “The physician may have to chase down bits and pieces of the story from other sources. Family members can help a lot by collecting results from previous doctor visits. The process of coming up with a complete diagnosis may require a long course of investigation. By providing complete information, families can help to shorten that process.”

Getting Mom treated at Penn’s Memory Center has given our family access to other services that have helped us improve her care. I asked Dr. Hamilton to describe some of the ways that the Memory Center adds value to the treatment of dementia patients. He pointed out that the center gives families access to a patient educator who is a trained social worker.  She links families with information and resources that can help them adapt to the demands of the disease. The Center has a psychologist who offers counseling when families need help to deal with difficult situations. The psychologist also holds patient and caregiver training sessions. In addition, the Center has a multi-disciplinary team of physicians. Their broad spectrum of expertise enhances physicians’ ability to address patients’ complex problems. Specialized centers like Penn’s also qualify to participate in research studies and clinical trials so families can get speedy access to the latest treatments.

Because readers of this site are located all across the country, I asked Dr. Hamilton to mention a few other places where people might find treatment centers offering similar services. He suggested that families check out centers operating at the University of California at San Francisco, the Mayo Clinic, and at Harvard (Massachusetts General Hospital) and Washington University in St. Louis.

The Important Role of Nurses in Elder Care Services — An Interview with Kevin Hook

When we think about how to manage the health of elderly family members, there is a tendency to look at the question from a medical angle. Insurance regulations force us to think about doctors, hospitals, and medications. But there are some elder care programs that deliver geriatric health care by promoting wellness — rather than treating old age as an illness. Health promotion is an idea that’s been embraced by the staff at the LIFE Center in Philadelphia. This philosophy guided the program’s founders who were educators from the University of Pennsylvania’s School of Nursing.

Enrolling a family member  in a “wellness” oriented healthcare program can change the way you look at the entire process of aging. People in the LIFE Center get all of their healthcare through the program. They can attend adult day services during the week and have access to a team of LPN’s, nurse practitioners, social workers, and caregivers who are on duty at LIFE Center every day. If an elder needs physical or occupational therapy, they can get that at the center, too. There is even a geriatric dentist available. The design of the LIFE Center is based on the PACE (Program of All-Inclusive Care for the Elderly) program — which was originally developed in San Francisco in the 1970’s. Today there are 75 PACE programs in 29 states. Many programs have multiple sites within a city. You can find out whether there is a program near you by clicking on this PACE link and typing in your zip code.

In a recent interview with Kevin Hook, the Chief Nursing Officer for Penn’s LIFE Center in West Philadelphia, I learned about the process elders must go through to qualify for these comprehensive services. Mr. Hook explained that elders must be certified as being income eligible for both Medicare and Medicaid. If you live in Philadelphia, you obtain this income certification through the Philadelphia Corporation on Aging. In other states or counties, you can contact the Area Agency on Aging.

The process takes some time and you have to answer a lot of questions, but once you are certified, the benefits of this kind of program are significant. For each new elder, the program’s care team completes a social needs assessment and a nursing assessment. They use this information to create a care plan that will help keep elders living safely in their own homes for as long as possible. Staff members work with the elder and their family members to put together a transportation plan as well as system of other supports. The one care issue that may annoy some elders is the fact that you must get all care from the program’s physicians and nurse practitioners. People who feel loyal to a long-time doctor may not want to switch. But the comprehensive nature of the program offers good reasons to do so.

One reason for the success of PACE programs is that they are economically advantageous. All care is delivered through one system and emergency visits are minimized. Penn’s LIFE center also relies heavily on nurse practitioners. A nurse practitioner is an advanced practice nurse with advanced education that has prepared them to diagnose and treat common illnesses. The roles and responsibilities of nurse practitioners vary in each state because their duties are regulated at the state level. In many states, nurse practitioners can prescribe a wide range of medications when they are needed. This reduces the patient’s number of more costly visits to doctors or hospitals. Because elders at the LIFE Center receive care from an entire team, they also get attention faster when a problem develops. Many of the program’s caregivers have close relationships with the patients and they can convey information to the nurse practitioners if they notice a sudden change in their condition. The Penn program also has the capacity to work with elders who have developed symptoms of dementia. Their day program has a special unit for these patients and a set of onsite protocols to ensure they are safe.

Although we don’t have a program like this near us, it seems like a great option for families who have access to one. Team of caregivers+lower costs+more contact with elders = better sleep for everyone.