Geriatric Health Care

Matthew J. Narrett, M.D. (Courtesy of Erickson Retirement Communities)

Matthew J. Narrett, M.D., chief medical officer for Erickson Retirement Communities, was online Tuesday, April 18, at 2 p.m. ET to field questions and comments about geriatric health care, examining the Erickson model.

Narrett is responsible for directing the provision of medical care at all Erickson communities. Prior to his current position, Narrett served as Erickson's Vice President and Regional Medical Director, as well as Medical Director for Charlestown. Before joining Erickson, he was on staff at Derry Hampstead Internal Medicine Associates in New Hampshire.

From The Post:

An Abundance of Care (Post, April 18)

The transcript follows.

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Matthew J. Narrett, M.D.: Welcome to the Washington Post guest forum.

My name is Matt Narrett and I am the chief medical officer for Erickson Communities, a continuing care retirement community company which offers an unparalleled lifestyle at unmatched value to individuals age 62+. We are committed to Successful Aging and have developed a comprehensive healthcare system Erickson Health to address the needs of the residents at our Communities and answer some of the healthcare challenges faced by our nation today. I am a Board certified Geriatrician with over 20 years experience and I welcome your questions.

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Sterling, Va.: I am sure this is not an unusual scenario, but I am at a cross roads with my dad. He's 84, and seems to be getting more and more confused.

I speak to him every day, and see him as often as I can, but my work load and the distance to see him are becoming more problematic. I live and work in Virginia, and he's in Bethesda, which does not seem like a big distance but when I factor in my work schedule (min 6 days/week, 10+ hours a day) it is impossible for me to see him during the week and still have any sort of home life.

In December I was able to get him to look at, and agree to move, to the assisted living facility in Reston. I selected this facility because I believe dad would be happy there if he gave it a chance, and it is very convenient for me to stop by after work. But the day after he visited (and said he would try it for a month) he changed his mind and refused to move.

When I talk to him each day he complains about how lonely he is - but if I mention that he could have lots of people around if he moved to an elder facility, he will immediately tell me that he has lots of friends and is 'very active'. Is this dementia, or senility? Don't know, don't care. What I do know, and do care about, is the no-win situation I am in.

The 10 Commandments tell us to 'Honor thy Father and Mother' - not 'Honor thy Father and Mother until they are difficult, then treat them any way you want'.

How do I convince someone like dad to move?

Matthew J. Narrett, M.D.: Thank you for your question.

You are absolutely right.

This is a common scenario and a challenge that many sons and daughters face across the nation.

There is no simple answer to getting your Dad to move.

Family discussion and the need to take the time to hear out his questions and concerns and fears and provide solutions which he can believe in are vital to the process.

Your sense that he will do better in a less socially isolated environment is right on. Social isolation and depression are common themes among Seniors and an active lifestyle with social engagement will often do much to alleviate this malady. While challenging to get Dad to agree to the move, it is important to try to achieve this soon as the more impaired he becomes the more challenging the adjustment will be.

He is not far from our Communities in Silver Spring, MD and Springfield, VA. Please don't hesitate to contact these Communities or visit the Erickson Web site for more information erickson.com.

Thanks again for your question and good luck,

Matt Narrett M.D.

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Mt. Clemens, Mich.: Any chance to recognize the value of comprehensive geriatric assessment and get some reimbursement for this type of service?

Matthew J. Narrett, M.D.: Thank you for your question.

For years, geriatricians have been attempting to receive compensation for an extensive evaluation provided by a multidisciplinary team which addresses the many issues and concerns which Seniors and their families often face. To date, these efforts to achieve adequate reimbursement for this type of evaluation have been largely unsuccessful but the good news is there are ways to review many of the elements in a comprehensive geriatric assessment with a caring and qualified physician and his or her team. Caring for seniors just like caring for any age group requires a holistic approach covering issues and concerns ranging from psychosocial concerns, to social support systems to diet, exercise and financial concerns over and above a list of diagnoses and the medicines prescribed for them. This evaluation while not done as quickly as is the case with a 3 hour assessment can be equally effective and sometimes more gratifying.

Thanks again for your question

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Silver Spring, Md.: I find your model to be very reasonable, but I think it depends on residents coming into the system healthier than they actually may.

I've observed that disabling conditions arise from years of poor health habits -strokes from uncontrolled blood pressure, joint issues from inactivity and weight problems- that a model like this can not control.

I think this problem plagues traditional assisted living facilities - they were originally designed for healthier residents, but nobody will go there until they are failing.

The article talks about downsizing facilities to avoid that institutional feeling, but doesn't a facility have to be pretty big to support a staff of medical professionals? How many residents are needed to support a medical staff?

I like the staff model because I've observed that finding a doctor for a nursing home resident is nearly impossible if they can't get to the doctors' office.

Matthew J. Narrett, M.D.: Thank you for your question.

All your points are well taken.

Your absolutely correct finding a Doctor who is willing to come to a nursing home and assisted living facility is often very difficult and getting more so each and every year.

We are committed to providing comprehensive health care and this is why we have a medical group at all our campuses who will see residents in the Medical center or in the assisted living or nursing home facility. One of our fundamental goals is successful aging for seniors and part of achieving this is providing high quality medical care on site. We start with a physician on day One of opening a new Community and we have no expectations about residents being healthier than they actually may be.

We review with each prospective resident health issues they may have but our Model is built to be successful for seniors with chronic conditions and limitations. In fact we do all we can to enhance quality of life and very often see improvement in this regard in residents when they come to Erickson.

Thank you for your question.

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Richmond, Va.: My mother-in-law's assisted living facility does not make suggestions about screenings that she should have. We have to coordinate her care among her seven doctors. Are there facilities that will help with this kind of service? What should consumers look for?

Matthew J. Narrett, M.D.: Thank you for your question.

Ideally suggestions about screening tests for your mother-in-law should come from a primary care geriatrician or internist. Coordinating care among 7 different physicians is an extremely challenging task. I would discuss with one of her current Doctors who you have much confidence in as to who he or she would recommend to be your mother-in-law's primary physician. You might also ask the staff at the assisted living facility as to who they would recommend. They often know the best geriatricians in the area.

Good luck,

Matt Narrett M.D.

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Baltimore, Md.: What is Erickson Health?

washingtonpost.com: An Abundance of Care (Post, April 18)

Matthew J. Narrett, M.D.: Thank you for your question.

EricksonHealth is our comprehensive healthcare system which we provide at all of the Erickson Communities across the nation. We are committed to Successful Aging and to achieve this we provide an active social environment along with robust Prevention and Wellness services and Medical care on site. We have a full service medical center with full time physicians on site in addition to a fitness center, rehab services, home health services, emergency response services, mental health, social workers and more. At our mature communities we also have an assisted living facility and a nursing home. We have an electronic medical record which is safe and secure and our offices are now entirely paperless. Additionally within this past year we now offer a medical insurance product, Erickson Advantage which is the first of its kind for a continuing care retirement community.

Thank you for your question,

Matt Narrett M.D.

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Columbia, Md.: If my parents were to move into an Erickson Communities in what ways would Erickson Health model benefit them?

Matthew J. Narrett, M.D.: Thank you for your question.

Please refer to my response to the prior question on Erickson Health.

Our Model is built to provide a comprehensive response to each and every individual's needs who enters our Communities.

We are committed to wellness and prevention and best practices in Senior Healthcare and Lifestyle.

This past year we immunized over 90% of Community residents enrolled in Erickson Advantage against the flu, a percentage which is well above the national average.

Please check the Web site for more information on Erickson Health.

thanks for your question

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Fairfax, Va.: Matt: As someone who is looking for a care provider for a parent, I've been hearing a lot about person-centered care. The PBS documentary "Almost Home" explores how a "culture change" can occur in how we care for our elderly. How is Erickson addressing this "culture change" and meeting the expectations that people have when moving into an Erickson Community?

Matthew J. Narrett, M.D.: Great question.

We are committed to a person centered culture and have one of the national experts on this subject, Judah Ronch, leading this initiative at Erickson. We like to believe we are part of leading this national culture change by emphasizing a wellness and prevention model and a model based upon an individual's strengths instead of the classic model of "sick care".

We are currently building out a number of programs at Erickson which emphasize fitness and wellness from fall prevention to osteoporosis screening and prevention to memory enhancement to name a few.

We are committed to creating a home environment for every resident of Erickson whether they reside in independent living, assisted living or long term care.

Thanks for the question.

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Washington, D.C.: My mother is a senior and does not have much money. Are there options for free screenings such an colonoscopies and echocardiograms? Are there any free prescription medication programs you may know about?

Matthew J. Narrett, M.D.: Thank you for your question.

With regard to testing and screening for Mom, I would start with a review with her Doctor and see what she in fact needs to have done and what is available in your area in terms of free screenings. Local hospitals will also often offer free programs.

On the medicine side, virtually all of the drug companies offer free medicine to individuals who meet financial criteria. With some research and help from your physician, you should be able to access low cost or free medicine for your Mom.

Also the Part D benefit is an opportunity to receive a pharmacy benefit which can be a significant cost saver.

Thank you for your question.

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Fairfax County, Va.: Dr. Narrett, I read the article about Erickson and since I'm in my 50's I have a few years before I could move into one of your communities. Right now we are seeing the electronic records revolution taking place - anyone who is not getting on board will soon be left behind. What can we expect to be the next big breakthrough in geriatric health care in the next 10-20 years?

Matthew J. Narrett, M.D.: This is another great question that we could spend an hour on.

I believe in the next 10 - 20 years we will see a cost shifting in healthcare from "sick care" to well care. For instance, let's prevent the hip fracture from ever occurring by doing fall prevention programs, osteoporosis screening and diet and exercise education. Hip fractures are associated with substantial morbidity, mortality and very high cost. It is much more satisfying and much much cheaper to prevent illness rather than just react to it.

We will also see quality initiatives take hold in medicine and finally I believe we will see fewer and fewer Seniors moving to Nursing Homes as we find technology answers and better ways to provide care in the home setting.

At Erickson and with Erickson Advantage, our medical insurance product, we are working to make this vision of wellness and fitness a reality.

Thank you for your question

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Springfield, Va.: What is Erickson doing to address fall prevention amongst your residents?

Matthew J. Narrett, M.D.: Thank you for your great question,

At Erickson,we are committed to fall prevention and fracture prevention as well.

As described in prior answers we emphasize wellness and fall prevention is a high priority. We have a fall prevention questionnaire which identifies risk and also makes recommendations. This tool has been successful in preventing falls and we couple it with osteoporosis screening to cover bone health as well.

The good news is that all the recommendations we make for fall prevention are available on campus. From a referral to the medical center to review medicines to a referral to a therapist for a home safety evaluation we can address risk factors without you ever having to leave your residence.

Thanks for a great question.

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Man, W.Va.: If you were of middle to low income and at the age of retirement, would you sign up for Medicare Part D? What cautions do you have for those who must decide in the next few weeks?

Matthew J. Narrett, M.D.: Thank you for a very timely question.

I would certainly sign up for the part D benefit as it will result in savings for you if you are on prescription medication. While there has been some confusion over this benefit, the bottom line is that any part D plan you sign up for will be better than no benefit at all.

Check out the Medicare web site and make a selection which is convenient for you and which covers your medications satisfactorily.

Thanks for your question.

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Woodbridge, Va.: Not quite a geriatric question -- Do you know of any books or guides on strength training for middle age? The trainer at my fitness center has helped me put together a routine that sort of works but seems more appropriate for someone about 25 than about 50. I am no longer interested in "continually challenging myself" I simply want to reach and then maintain a reasonable level of fitness. Right now everything seems to working from the chest down but my arms are always sore and my shoulders often have sharp knife like pains. If this is fitness, I would rather be out of shape.

Matthew J. Narrett, M.D.: Thank you for your question.

It is difficult to make individual recommendations in this regard but in general I would find an exercise regime which does not result in significant pain at the time of or following the exercise program.

Perhaps consulting with your physician would be a good place to start.

Thanks again for your question.

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Kansas City, Mo.: How do you residents pay for the medical services if they are not yet 65?

Matthew J. Narrett, M.D.: Thank you for your question.

We accept medical insurance for individuals who have not yet reached Medicare eligible age.

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Takoma Park, Md.: Thank you for commenting on my experience with my mother. My 86-year-old mother passed away in February 2005. She was diagnosed with congestive heart failure about 4 years ago. In January of 2005 she was so weak she could not get out of bed. She was taken to the emergency room where they did a battery of tests and found her heart was not the problem but her sodium levels were way off with fluid in her lungs. They released her after a few days to a nursing home to recuperate. After a few days there she went into what seemed like a catatonic state. The nurses said they thought she was going downhill and to call all the family. One member of my family asked that they take a urine sample and sure enough she had a raging urinary tract infection. They started her on antibiotics and she immediately became herself again. 10 days later the same thing happened, catatonic state (meaning she was awake but would not respond to anything, would not look you in the eyes, etc.). The nurses thought she was overly tired and said she just needed to rest. My sister insisted an ambulance take her to the hospital where they took another urine sample that came out "looking like cottage cheese". Her urinary infection turned septic, the infection traveled to her heart and she died 36 hours later. Afterwards we found out that even with her initial raging urinary tract infection the nursing home only had her on a low dose antibiotic for only 5 days, not the usual 10. Also, she needed help in getting to the bathroom so a nurses aide would have been there, and, if paying attention, would have seen changes in her urine consistency and output but nothing was noted. We were all devastated. We knew she wasn't going to be around for more than a few more years, but we thought at least we could get her home again. What could we have done differently? We felt we were very vigilant with the staff and also felt that the nurses aides (who probably make no more than minimum wage) were very caring but very overworked and understaffed.

Matthew J. Narrett, M.D.: Thank you for your question. It is very difficult to provide an answer. What I can share with you is that urinary tract infections are often treated for five days and also that urinary infections can be life threatening especially at the age of 86 in someone as weak as your Mom was. Take care. It certainly sounds like you and the Staff did all that was possible for your Mom.

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washingtonpost.com: This concludes the discussion with Matthew J. Narrett, M.D. Thank you for your questions.

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