The Most Vulnerable Patients Can Face Greatest Barriers To Care

While volunteering at an assisted living facility in his community, James Chin learned about the unique challenges that residents of the facility face in the pursuit of continuous, coordinated primary care. Here, he highlights a need for innovation in delivery of care to this vulnerable population.

By James Chin 

During my sophomore and junior years in college, I served as a volunteer companion to elderly residents in an assisted living facility in Waltham, MA. Each Thursday afternoon, I spent time getting to know the residents in the home, occasionally even participating in games of bocce and bingo. That’s how I met “Mary.” She was 97 and loved to tell me stories about growing up in a small town just outside of Boston. In a tender voice, Mary told me stories from her younger days. She once told me about going dancing with her first crush when she was about my age.

But some of her stories aren’t so sunny. Since she moved into the assisted living facility, Mary has had challenges getting coordinated and continuous primary care. Her story reflects a need for innovation in primary care at assisted living facilities nationwide.
 Mary has type 2 diabetes, and she needs a walker to get around. After moving into the assisted living facility about two years ago, Mary’s declining personal mobility and limited transportation options have made it increasingly difficult for her to see her preferred primary care physician. Assisted living, she told me, is not a nursing home. If you need to see a primary care doctor, a podiatrist, dentist, or ophthalmologist, someone has to take you.
 
Moving into assisted living has caused Mary to lose the range of health care provider options she once had. If she can’t get transportation to her own doctors, she must sign up for a consultation with the in-house physician. But because the in-house physician is at the facility infrequently and demand is high, there are long wait times for short appointments with him. And if Mary is taken to the hospital in an ambulance, it won’t be the hospital she might have chosen. It will be the hospital affiliated with the facility.
 
So when Mary fell and was taken to a hospital that she didn’t know and which wasn’t convenient for her children to visit, she was frustrated. Unlike her preferred health care provider network, the health care provider team affiliated with the assisted living facility lacked detailed medical records of her existing conditions. As a result, Mary had to explain her pre-existing medical conditions repeatedly to a new team of health care professionals– a common problem for residents of assisted living facility residents and anyone who doesn’t have an established primary care provider. When Mary was discharged from the hospital, she was relegated to getting follow-up care from the in-house doctor who was always in high demand.
 
Mary was disillusioned, but her experience is hardly unique. An estimated 735,000 people nationwide live in assisted living facilities, and many have limited access to well-coordinated primary care. Although assisted living communities often have a nurse on-call around the clock for acute and urgent issues, in-house physicians may only visit once or twice a week for routine care. Often times, physician visits once or twice a week may be insufficient to adequately address the needs of a typical 11- to 25-bed assisted living facility. In addition, time spent per patient is often limited due to high demand. For this already vulnerable population, access to primary care physicians who not only understand their special needs but also provide adequate and timely care is crucial.

Mary’s story is a reminder that the most vulnerable among us face not only physical health challenges, but also largely unnecessary health system challenges. However, I am hopeful that through focused clinical innovation in the primary care space, Mary and those who share her plight will one day be able to tell vastly different stories of their health care experience.

James Chin is an undergraduate student at Dartmouth College and co-leader at his school’s PCP Chapter. 

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Posted by Sonya Collins on Jan 14, 2014 10:55 AM US/Eastern
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