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Keeping care visible for elders

by Isabel Fawcett, SPHR

The private marketplace is quietly offering more competitive healthcare management options to consumers. That is great news. There is also an element of danger involved, particularly in the world of eldercare, where continuity of care is vital if there are multiple chronic health issues involved.

Health Clinics Abound

Health clinics are sprouting everywhere. That is good for the economy and good for consumers, right? Local supermarkets, pharmacies and retail clinics in shopping plazas, or store-front locations, offer consumers everything from flu shots (year-round, now?) to cholesterol screenings, ask-a-nurse services, and more. These smaller-scale healthcare ventures are a blessing in terms of greater accessibility and affordability of healthcare to the masses. How in the world could that ever be a bad thing?

Even I've been enticed to have my cholesterol and A1c diabetes testing for $29.99, at a supermarket. I thought about it for 2 seconds before coming to my senses. It helped that the cashier mentioned that she was "learning" to get over her phobia of needles in order to do her job as a pharmacy clerk/cashier/newly-designated diabetes (cholesterol, and, who knows what else) tester.

Continuity of Medical Care for Elders

On a positive note, more than a decade ago, my then seventy-something Mom thoroughly enjoyed her flu-shot walk-in visit to a supermarket-based nurse clinician. Of course she would! There is no chronic medical history baggage to be dealt with by an elder in such walk-in clinic settings.

In fact, going to a walk-in clinic is probably many elders' dreams come true. Consider how commonplace elder refusals to go to their regular physicians are in your world of care, and you'll understand. "What a nice nurse!" He sure was, Mom. The supermarket-based nurse clinician didn't need to see Mom again, unlike Mom's long-time physicians, though he welcomed her back any time, he said. His nurse clinician's user-photo should be in the elders' dictionary definition of 'nice.'

Lest anyone throw out the elder with the bath water, there is good reason to ensure medical continuity of care for chronically ill elders. Perfect case in point is my own eldercare story.

H1N1 and Flu Season 2009 Memories

For years, as I have been a caregiver to an elder, I got my own flu shot sometime between October and November. Mom's clockwork flu shot became my annual tickler to take an added step as her then on-again, off-again caregiver.

One day, I experienced a severe case of the flu. A doctor informed me that some Texas residents "take the flu shot too early," because the "real" flu season in Texas does not start until late December, or thereabouts. I was further enlightened by the physician that the flu shot's effectiveness lasts approximately 3 months only. Nice to know in my caregiver's role.

Had my flu shots been administered in one place only over the years, this regional flu information might have come to me sooner, rather than later. I always can count on my own doctors, and Mom's doctors, for superior patient education regardless of the ailments that may lead us to their respective offices.

I'd been living in a fragmented patient care and caregiving universe for years with flu shots. Mercifully, I was wiser long before the onset of the H1N1 flu epidemic (2009.)

Lessons Learned

Although flu shots are widely available through pharmacies, supermarket clinics, on-site hospital flu clinics and other venues, including elders-only clinics, communicating and coordinating with primary care physicians in charge of an elder's treatment is in an elder's best medical interests. I wholeheartedly embrace the published statement of position by the American Academy of Family Physicians, (2007, 2010) that retail clinics tend to fragment medical care, more so where there are chronic medical issues involved.

My personal eldercare advocacy practice is that flu clinics of choice are those offered by Mom's primary care physician's office, her pulmonologist's office, and for me, my primary care doctor's office. By choosing physicians who have a solid overview of elders' medical histories, there is greater continuity of care.

Should Mom take a pneumonia shot or not based on her medical history? Her pulmonologist and primary care physicians base their answers on Mom's chronic health issues, including respiratory medical health.

For years, I took my flu shots whenever flu clinics were offered by my then-employers. At the time, Mom was a volunteer. The organization where she volunteered offered flu clinics for the general public, their volunteers and paid staff.

She volunteered at annual flu events and got her flu shot sometime when she could take a break. Not once did she ever think of coordinating with her pulmonologist, nor did I. Caregivers and their elders need to assume greater responsibility for proper and timely coordination of care, including full integration of unscheduled emergency department and EMS records of intervention, such as may occur in between regularly scheduled doctors' appointments.


Things Happen

Years ago, while residing elsewhere, Mom had a severe reaction to a flu shot she received at a clinic. The day after the flu shot, Mom was unable to walk. Things happen.

  • Guillian-Barré Syndrome patients are often instructed by their physicians to avoid taking flu shots altogether due to the risk of potentially serious health complications. Even if an elder has not had a recurrence of Guillian-Barré Syndrome or symptoms in years, it still may not be medically advisable for the elder to ever get a flu shot. Always check with your elder's doctors.
  • If there are medical specialists such as oncologists and pulmonologists involved, in addition to your elder's primary care physician, it is best to coordinate across medical teams and specialties to ensure all bases are covered. Medical specialists who treat chronic diseases offer critical input that may be inadvertently overlooked by a primary care physician.
  • Medically necessary prescriptions, including injections, are known to elevate diabetics' blood sugar. Prednisone comes to mind. Diabetic elders and their caregivers need to remain vigilant of blood glucose testing and drug interactions with diabetes treatment.

Tag, You're It, Eldercare Advocate

Your elder's continuity of care is only as strong as your eldercare advocacy and communication with treating physicians, subject to prior authorization by your elder. Take nothing for granted in eldercare, especially in our brave new world of healthcare, where continuity of care is more important than ever.

Sources

American Academy of Family Practitioners (AAFP)

Healthline.com's Cholesterol Health Video, Copyright 2005-2009.

National Institute of of Neurological Disorders and Stroke,Guillian-Barré Fact Sheet, Last updated December 18, 2009.

Mayo Clinic.com