Speaker 1: Hello everybody. Welcome to health chatter and today's show, it's an interesting title. Healthcare as we age. So it what what really involves is the health itself, but then, you know, places that we would that people go to as they age. We've got a great guest with us. All our guests are great, but this one is illustrious. How's that? And thanks to to Barry Bane for making the uh the connection with our guest. We have a great crew that always does our background research for us, also our um production and also our um our marketing as well. Maddie Levine-Wolf. And we have Erin Collins, Deondre Howard, Matthew Campbell, Sheridan Nygard, and of course we have Clarence Jones who's uh co-host on this show along with me and then Barry Bane is our is our medical advisor uh par excellent. So, thank you to all of you. You're you're wonderful, wonderful colleagues. Humad partnership is our sponsor. You can check them out. It's a great community health organization. Check them out at Humad partnership.org. Check us out at healthchatterpodcast.com. All our shows are on there, our background research is on there. You have an opportunity to to pose questions that we can get back to you on. Check us out at healthchatterpodcast.com. So today, healthcare as we age. We have a wonderful guest with us. Dr. Abby Hout is a board certified internist and geriatrician, graduated from the University of Minnesota Medical School in 2004 and a residency at Johns Hopkins in Baltimore.
Speaker 2: Good city.
Speaker 1: Maryland. I was just out in in Bethesda, close by. Yeah, city, exactly. She worked in a program for all inclusive care for the elderly in Chicago before returning to Minneapolis. This is interesting. She worked in a senior care division at Heppen County Medical Center where she developed a develop and ran a physician health call service for low income homebound seniors in Heppen County. Thank you for for for for doing that. I mean, I it it's it's a missed care service for sure. Since 2019, she served as a medical director for ambulatory services at the Minnesota Department of Human Services and maintains a small private geriatrics house call practice, wrap around house calls, which I'm sure she can allude to. This was great though. I noticed this in her in her bio. She said, when not working as a physician, which could be a full-time thing for sure, serves as a chauffeur, private chef and entertainment director for her four children. For those of us who are our our grandparents or have kids or grandkids, we know. So thank you for for being with us today. It's a it's a pleasure having you.
Speaker 2: Yeah, nice to meet you all.
Speaker 1: So, all right.
Speaker 3: Where to start Where to start on this?
Speaker 1: Go ahead, player.
Speaker 3: Yeah, let me let me start with this because Dr. Abby, I I I I looked at your and looked at the information that you're here. How did you get your start? Where what what was your epithemy for this field? Because I think that that that it's always important for people to understand why you why are you so passionate about this particular topic.
Speaker 2: Yeah, you know, I think, I've thought a lot about that. I think part of it was my relationships with my grandparents growing up. I spent a lot of time with my grandparents. Um, spent a lot of time with my grandma Marion in particular, um when I was young and just had very close relationships with them all through, uh, all through my life through college and medical school. Um, when I was starting to explore uh, areas to get involved in in medicine, I kind of gravitated toward what we call primary care. So, family medicine, internal medicine, pediatrics because I really liked the longitudinal relationships with patients. I liked getting to know people, you know, over years and years. I liked seeing them in sickness and in health. Um, and within that field, um, I started to kind of explore what I might do with that. I had some opportunities during medical school to get some mentorship from Dr. Larry Kiner at Heppen County Medical Center, uh, who provided me with some opportunities to I after my second year of medical school went out for a summer Institute in Geriatrics in Boston, had an opportunity to meet other people who are in the field of geriatric medicine and you know, it's it's funny because you every specialty has a little bit of a flavor to it. And and I went and I met all of these other geriatricians and all of these other medical students who were interested in geriatrics and I just thought, these are my people. These are the people who sort of think the same way I do and approach things the same way I do and it just really was a was a good fit for me. So, when I was choosing a residency, I chose to interview at residencies where geriatrics was a priority, where they had big geriatrics programs and I felt like I would get a really good education steeped in geriatrics principles. One of those was Johns Hopkins and I went out to interview there thinking, boy, I don't know. This is, you know, this is a big impressive place. I don't know if there's a place for me here and I match there and it was really one of the best experiences of my life and really set me on this trajectory specifically of uh doing home visits and community-based care. They have a big elder house call program. I learned how to go into somebody's home and provide them the same kinds of services that we would provide them in the clinic and that was really, you know, sort of all she wrote for me. then that's all I wanted to do after that.
Speaker 3: Thank you for sharing.
Speaker 1: You know, I'll tell you, it it's it's interesting. Um, as you grow up, um, you know, obviously with your parents and everything, you really don't think about this this aging stuff until all of a sudden as adult children, then you're looking at your older parents and you realize, whoa, um, you know, we have to be connected, we as kids, their kids have to be connected to their care.
Speaker 2: That's right.
Speaker 1: Going going forward. And um, you know, speaking from from experience, that's that's difficult because all of a sudden you're kind of thrust into it. Um, and it it affects not only the delivery of care, which, you know, Abby for sure, you you can you can speak to, but also, um, living arrangements that are safe, um, and and actually compliment if need be their care. So, um, we're getting older, I mean, at least theoretically and hopefully. Um,
Speaker 2: As my grandpa says it beats the alternative.
Speaker 1: Yeah, correct. You know, um, you know, you know, it's like my dad used to say, you know, how are you doing? And he used to say, well, I'm vertical when I want to be and I'm horizontal when I want to be, so it's a good day. So those those types of things. But um, as we age, um, perhaps and maybe you can speak to this, we're taking on different kinds of medical issues, um, that maybe we're around all the time, but we're taking them on uh more and more. And so maybe we should start with that and then maybe we can talk about um, living arrangements for for people and how that compliments their care.
Speaker 2: Sure, and I might make one more comment before I get to that stand, which is um, in addition to being involved in our parents's care, it does change the dynamic a bit of our relationship with our parents.
Speaker 1: Absolutely. Absolutely.
Speaker 2: Which also happens with spouses when you have one spouse who has a serious medical illness and the other spouse becomes a caregiver rather than a husband or a wife. It really does change the dynamic. And so that can be a difficult thing to navigate as well is, you know, wanting your parents to continue to have as much autonomy as they are able to safely have while still helping them navigate the system.
Speaker 1: Yeah. Or when when parent passes away and then all of a sudden you realize, okay, the kids have to kind of realize, okay, how do we take care of dad or mom now? Um, going forward and make sure that they're taking care of.
Speaker 2: Sure. And we see that a lot and we see that couples who have lived together for decades have figured out each other's strengths and weaknesses and where to compensate for one another. And so what you sometimes find is it appears that after dad dies, mom really goes downhill quickly, but that may not necessarily be the case. It may just be that dad had certain roles in the household and mom had certain roles and mom never learned how to do dad's roles and so things kind of fall apart a little bit. And so it's always a bit of figuring out, is this something mom really can't learn how to do and we need to bring some supports in around her or is this just something mom's never done? And we can help her learn how to do this. So that's another piece of it.
Speaker 1: And things can happen quickly. Um, you know, with with you know, let's just say older parents, you know, all of a sudden somebody, you know, a parent has a um a stroke out of nowhere or a heart attack or falls down. Um, these things happen in an acute way. Um, and the aftermath of it is chronic or can be chronic. So,
Speaker 2: And so back to your original question or your original statement, yes, we are dealing with more medical issues as we age and the cumulative effects of chronic medical issues. So, you know, you may have been diagnosed with diabetes in your 40s or 50s, but there are consequences to living with chronic diseases over decades that that start to catch up with you at some point. So that has effects on your heart or on your kidneys or on your brain. Um, then there are um, issues that really seem most of the time connected with aging. Um, that we learn a little bit more about. So you mentioned that I did an internal medicine residency and then a geriatric medicine fellowship. What we learn in geriatric medicine fellowship are a little bit more in depth about issues that tend to be tied to aging or or people are more at risk for as they age. So I'm thinking about things like dementia is a big one. Um, delirium, osteoporosis, urinary incontinence, what we call polypharmacy, which is being on a number of different medications all at the same time. So there are the, you know, the end result of chronic illnesses as we age, there are acute medical illnesses, like the example you gave Stan, and then there are illnesses that, you know, with some exceptions tend to be more tied to older adults. And those are the kinds of things that in geriatric medicine we focus on.
Speaker 1: You know, I was struck by um, home care, home care delivery that that you do. I remember as as a kid, um, my pediatrician making house calls. Mm. You know, I said walk into your house, you know, with a little black bag and and um and take care of you. Um, and as the years went by that that disappeared. Um, so I'm really struck by the fact that that you're you're embracing that. So I wonder if you might want to chat about that a little bit.
Speaker 2: I'd be happy to. I love, I love house calls. I think it's a really interesting and valuable way to get to know people. You know, we can make the best laid plan in a clinic visit, but if you can't practically carry it out at home, it really doesn't matter. You know, other things that we can see in a home visit that we might not get in a clinic visit is we can see the family dynamics. We can understand who's in the house and who's able to do what. We can do things like really get to the bottom of your medication. So for people who are on a lot of medication, sometimes that is just enlightening. You know, somebody's been to the hospital and gotten four prescriptions when they left there and they've got their prescriptions from their primary doctor and they've got their prescriptions from their cardiologist and you go look at their cabinet and it's just a pharmacy.
Speaker 1: Right, right.
Speaker 2: And to, you know, that's a a look that you really can't get in that way in a clinic setting. Um, we can look at things like a refrigerator, you know, do they have adequate food? Do they have food that's not expired? Um, we can look at um how is their bathroom set up? Are there, you know, ways that we can make it less likely that they're going to have a fall? Do they have throw rugs all over that they're going to trip over. So there are a lot of things that you can really learn from a home visit that you just can't in the clinic. It's also speaking of changing dynamics, a really interesting way to be the foreigner, so to speak, you know, when patients come into our clinic, they're anxious, they're in our space, it's sterile, we're in charge, we're setting the agenda. Um, you know, they've got a lot of different people coming in and out poking and prodding at them. When when you go into somebody's home, you're the guest. I ask where I can sit. I ask what they want me. I ask where they want to start. I ask who they want involved. So it's a real flip of of who's in charge here, which I is I think really good for developing a relationship with a patient.
Speaker 1: I think it I think it's it's absolutely wonderful that you're you're doing this. Clarence, go ahead.
Speaker 3: Uh, I'm agreeing with you. Thank you very much for this conversation. Uh, is there a list? I mean we we're talking about seniors getting older.
Speaker 2: Yeah.
Speaker 3: And we're talking we're talking about caregivers. Is there some kind of list that we should be that we should have? I mean, to help to prep us? I mean, I know I know you can't cover everything, but is there a a list of things that we should be at least considering, you know, as we get to this point of healthcare as we age.
Speaker 2: Um, so a few things off off the top of my head. Um, there's there's I mean it would be a it would be more a novel than a list, I think if we thought about all of the things. Um, one of the things that we really focus on in geriatric medicine is functioning. And so we're really looking for ways in which somebody's functioning is changing. So you may look for things like is somebody going out less often? Is somebody self limiting where they're driving? Um, is somebody, you know, using their furniture to navigate around the house, um instead of, you know, walking freely or having more difficulty getting out of a chair. Those are things that start to indicate to us that there's something going on either with your physical or your cognitive functioning. So, um, along with the other things that I just spoke about that we look at in the home are are things that you can look at in your parents's home. Look at their fridge, look at their medicine cabinet, look at their bathroom. Um, you know, is their bathroom clean or is there urine on the floor that might indicate they're having difficulty getting to the bathroom in time. These are all little clues that we look at to indicate something's wrong and maybe we need to go talk with the doctor and and check that out. Um, other things that I think are super important for everybody, but particularly as we get older and should be thinking about, one would be healthcare directives, advanced directives, you know, what are your wishes for your healthcare as you get older, What aren't your wishes for your healthcare as you get older? And even more important than that, who do you trust to make decisions on your behalf at such a time that you aren't able to articulate your own wishes. So those, you know, are even important for younger people because as you know, Stan, you know, you never know, something can happen very quickly. Um, so it's important for people like me with young children too to have those those things articulated, but particularly as we get older, making sure that we've had really good conversations with people that we trust about what our values are and what's important to us. And I try when I talk with patients about healthcare directives, not to get too into the weeds about medical specifics, um, but really focus more on what are your goals, what are your things that are important to you and I can help you make whatever medical decisions are consistent with where you're trying to get as opposed to asking somebody who has no medical background, do you want this or do you not want this? Because that's a really hard question to answer when you don't understand all of the implications that are being asked.
Speaker 1: It's like Barry has something to add here. Yeah, Barry, go.
Speaker 4: Um, yeah, actually uh, you were, you know, saying a lot of the things that that that I would say as well. Um, but I did want to go back to that focus of the home environment and um, you know, a very famous philosopher Yogi Berra said, you can see a lot just by looking. And I I think this um, is something that's important not only for, you know, in in Abby's case doing those house calls, but as as children of aging parents or or friends of aging parents. And again, you know, we always uh have a public health outlook on this show more or less and and talking about community. Um, and oftentimes it's the social group who can help identify some of these things. Uh the point I was going to make was not about advanced advanced care planning and advanced directives, um but sort of as a followup on the kind of things to look at. And one of the overarching things are, well, what can we prevent? And one of them are is the safety things. Uh where falls in particular, um, the the hazards that that can be in a in a home are uh really um there's a lot of them. It can be like a minefield going through uh sometimes your your home. And that uh the idea of falls which for people as they age, so you have osteoporosis, so you don't want to fall. I mean that's what I say. I'm very careful. I don't want to fall because when you're older and you fall, you break. Um, and that usually causes a downward spiral for that ability, not only to function physically, but also then impair impair cognition as people go down, go down that path. So, uh I think one of the the pieces again is to reinforce this idea of uh, you know, look, observe and actually see what you're what you're looking at. Um, the thing that I would like to to pose here is when these things are identified, is there a uh uh like a an easy script that family and friends can use when they identify something that might be a danger to, you know, my mom or my uncle or or whatever. Uh that people can uh understand how to broach that because everybody doesn't want to, you don't want to take away the autonomy and the independence, uh but you want to keep people safe so that they can be independent for a longer period of time. So I'm just wondering in your experience if there has been a particular counsel that you've given families uh for how to approach those things when they the yellow flags or red flags go up.
Speaker 2: Yeah, I I think in a in a way you answered your own question a little bit, which is to say, you know, I'm concerned about your safety. This is something that I've identified that I think is a safety concern. I want you to be able to stay here in your home where you want to stay. So if we're going to be able to do that safely, these are the things that I think we need to address. So you keep bringing it back to their goal. Their goal, their goal, their goal. So this isn't, this isn't about me, this isn't in furtherance of my intruding in your life. This is I'm noticing this. I think it doesn't meet, you know, in the same way that I was talking about advanced directives, I think this isn't consistent with where you want to get to. So can we address this problem so that you can remain here safely because I really want that for you because I know you want that for you. I think that's the best way to approach it is always focusing on the end game of where that person wants to be.
Speaker 1: So, you know, um, let me let me tell you a personal story. So my mother who is now passed away, um, she was living by herself in her home and she came down with a urinary tract infection and boom, fell down in the house, you know, um, and obviously nobody was there. Um, and the only way that my sister and I were able to determine that was we haven't heard from mom. Right. We better go over and and check and low and behold. So, um, those are kind of the kick into place situations where again, it happened. Um, you know, urinary tract infections can cause confusion and disorientation, etcetera and and boom, in this case she she um, she fell down. Um, it eventually led to us looking and say and and you know, having, excuse me, the conversation, okay, with mom, right? The infamous, you know, there's there's kind of typical conversations. There's housing conversations, taking away the keys to the car conversations, those kinds of things, but it led to that, okay? And then we had to discuss with her options. And maybe maybe you can talk about that as far as living options, maybe not in an immediate situation like I'm talking about, but in general, what are we talking about for for people as they age?
Speaker 2: Yeah, I mean there's there's a wide variety of of options for living environments and for care in any of those environments. And so, you know, fortunately and unfortunately, a lot of it depends on the resources you have available to you. Um, you know, I certainly have people who um are entirely bedbound and have been for prolonged periods of time, entirely dependent for their care and are able to remain at home because they have family who has the means to hire in home care around the clock or to supplement the family's care with in home care around the clock. And so, you know, it depends on what you're able to cobble together and what you're able to afford. Some people really are able to remain in their homes even when they're pretty functionally or cognitively impaired. Then there are a wide variety of more structured living environments that people can consider. So there's sort of what you might think about as um independent living, maybe some people call it senior housing where there is, you know, an apartment complex, you have your own space, you do your own things. Many of them then have the um option or ability to add on services as function declines in sort of a a cart piecemeal fashion depending on what it is that you need. Assisted living facilities, um, operate in much the same way. So assisted living facilities, usually you are paying a monthly rate for your room in the facility, which is usually, you know, an apartment that's all yours. Excuse me. Plus maybe some light cleaning services and then things that you need on top of that, like I need help with my shower a couple of times a week or I need my medication set up for me once a week or I need my medications actually delivered to me twice a day. Depending on what you need, there'll be additional add-on charges every month on top of that, you know, rent that you're paying. After that you move into more of a skilled nursing facility kind of um environment where there are nurses there around the clock, you know, they're pretty much providing you all of the medical care you need. So there's not a lot of opportunity to be doing things like taking medications independently. So you're really where you're going to look to live depends on what your needs are and what level of oversight you might need. There are also what some would call continuous care retirement communities where um you're able to sort of escalate care in place over over the time that you're there depending on how your health changes.
Speaker 1: So for um, a son or a daughter that's trying to take care of their their parent. What do you recommend for them? Okay, so it's like, you know, it's one thing dealing with an immediate situation, it's another thing being proactively prepared. Yeah. So what do you what do you recommend or what do you see?
Speaker 2: So in in some ways it's a little difficult to be too proactively prepared because you want to make your decisions based on the actual care needs. But what I do always always recommend is to go places. There is nothing like actually walking through a place, meeting with people, getting a feel like I was saying when when I was, you know, going through medical school and residency and meeting people and got just got this sense, this is this is where I belong. There's different flavors if you want to put it that way to different living environments and um finding one that feels right is really important and there's no way to do that other than visiting. So I really recommend visiting several places. You know, you obviously people need to take other considerations into account. Is this close to my kids? Is this close to my church? Is this close to my doctors? Um, some facilities have um have doctors and nurse practitioners who come right in and provide the care. Is that something I'm interested in or is it important to me to continue going out to the doctors as long as I can. So there's all sorts of different things to consider.
Speaker 1: Yeah. Not easy.
Speaker 2: It's not easy. It's not easy and it's not a I think one of the things that makes it difficult is it's not a one size fits all.
Speaker 1: Correct. Correct. You know, I remember and Clarence I'll get to you in just a sec. I remember when we were dealing with this with my mother, um, she went into an independent living situation, okay? But if she needed to up that, the assisted living, she could remain in her place and all you had to do is basically flip a switch and you know, they lock, they lock the medicine cabinets and then somebody comes into her place. So it's less disruptive for in this case my mother, so she wouldn't have to move again. Right. Okay, which is which is advantageous. Go ahead, Clarence.
Speaker 3: So we've talked a lot about parents, uh, I mean uh children taking care of their parents with this issue. What about for me? What are the things that I should be thinking about? What what list is there for me to to be considered of as we're as we as I'm thinking about becoming more seasoned.
Speaker 2: I I mean, I think it's I think it's very similar Clarence. I think it's ensuring that you've identified people who um you trust to either help articulate what you want or to help navigate the system so that the arrangements that you want are put into place. I think it's really giving some thought to what's important to you, um, where it's important for you to be, who it's important for you to be around because that will dictate a lot of these decisions about what's on the table and what's not on the table for you in terms of where you might be living as you age. Um, in terms of, you know, where do people get in trouble early. Um, well, people get in trouble early with things that are complex tasks to navigate. So I think about when I'm thinking about early places where people get in trouble with potentially high consequences. I'm thinking about things like driving, I'm thinking about things like medication management, I'm thinking about things like financial management. And so those are areas where you want to be thinking about, um, let me just say it this way. You want to be thinking. Am I have Am I having more difficulty driving at night? Am I feeling more anxious when I'm driving places that I'm not familiar with? You know, is it time to start limiting to where I'm feeling comfortable. Those are the kinds of things that you want to be thinking about. And those are the places, like I said, we call them, we call it executive functioning, you know, multi-step complex tasks that have to be done in a certain order while you're taking in lots of information from the world around you. Those are the places where people can get in trouble early on and the places where to just be paying attention for any little slips and bolstering yourself if you're starting to see them. Oops, I paid, I paid my electric bill twice last month. That's not like me.
Speaker 3: Yeah, yeah. I think it's, I think this is a very interesting conversation because I think, I believe that we just, we want to stay in control for so long that if we, you know, if we start, you know, start slipping, you know, like paying your bill twice a month. I just say, oh, I'm just getting old. But I don't think that it's enough for me to take action. And so I think we have to be, we have to be a little bit more, I don't want to say mature. We just have to be a little bit more realistic, I think in terms of really asking for help, you know, when we get to this point. That's just me thinking right now. I don't know if a situation came up, I don't know if I'd do it or not, but I'm just saying, it just seems like
Speaker 2: No, it's It's hard and you know, and to the point about the bills. I mean everybody makes mistakes, right? So, you know, you're not, you're not gonna pull the trigger on somebody else needs to do this for me because I've made one mistake necessarily, but it's just a a thing to pay attention to and if it becomes a pattern, then we want to start looking for, not not necessarily even ways to take that away from you, but ways to put safeties in or checks and balances in so that you can continue to do as much as you can for yourself without having any bad outcomes from them.
Speaker 1: Barry.
Speaker 4: Yeah, I'd like to uh weigh in on this a little bit, um not only to help Clarence but also uh me and Stan because we're in that uh aging cohort. Um, everyone is familiar with the saying, you know, it takes the whole community to raise a child. Um, I think it also takes a community to uh support healthy aging. And in particular, um, and I'll use the example of I have a group of friends that we've been together for 40 plus years, um and when we talk about aging healthily, the importance of that social connection is is really good on two fronts. Number one, it keeps you uh stimulated mentally, um and that's really uh helpful. Um and also physically as well. So whether it be, you know, some kind of physical activity is is really important. But even beyond that, when you have a group of friends, uh everybody joke at least in my group, we joke about how we're getting older and some of the things that we wind up doing that we didn't used to do. Uh but you also get uh in a very non-threatening way, uh everybody has their way of of compensating for some of those things and it doesn't mean that you're, you know, totally losing it, but it's something to be expected as you get older and having uh a group to share that with in a non-threatening way can also give you some ideas for for how to adapt and compensate for those kind of things. Because one of the other things uh that we didn't talk about is, you know, demographically what's happened in this country in general, uh when I grew up and my grandmother became frail and couldn't live at her apartment, she moved in with us. And so you had a lot of multigenerational caregiving that was built in place. But now people live all over the country and it's, it's a lot more difficult uh to be there. Although again, things like Zoom has have really helped to keep people connected, you know, perhaps a little bit more. But that's why I think there's been more reliance on that community um of friends and uh neighbors and things like that to sort of uh the glue that sort of keeps things together. And and then again, when you can combine it with a medical provider that gets linked in in some way, I think the the likelihood of better outcomes um probably goes up and and Abby, you probably are more familiar with some of the research that hopefully would support my hypothesis about uh what seems to make things work a little bit a little bit better. So
Speaker 2: No, I I think there's very good, there's very good research around um the importance particularly to cognitive functioning of remaining socially active and socially engaged.
Speaker 1: You know, our, our research team, um put together some interesting information, tips for healthy agent and I was and I'm wondering if you might um comment on this. So, one is being as as you age, being aware of nutrition, your activity level, um your mental functioning which we just touched on a little bit, your social wellbeing, which Barry alluded to, um emotional wellbeing, injury prevention and healthcare routine. Um, so I wonder if you might, does that make sense in you know, that list?
Speaker 2: I mean, it makes sense, but if you think about it, it makes sense for all of us.
Speaker 1: Correct. Good point. Very good point. Very good point. Um, you know, I think nutrition is important for a number of reasons, um for muscle strength, for bone health, for cognition, um all sorts of reasons. Physical activity, the same way. In fact, physical activity is just as important for your cognitive health and your mental health as it is for your physical health. So all all of those recommendations make good sense for older adults and younger adults.
Speaker 1: You know, it was it was interesting. I, you know, I've said on this show before, I volunteer at Methodist Hospital in their orthopedic unit and see uh knee patients after they've come out of knee surgery. And you know, many of them are in their their 70s, 80s. And it was interesting just yesterday, I saw a woman, she was 73 years old, her daughter was there. Um, and the daughter asked me, she said, okay, mom now has had her knee replaced, what should I expect going forward, okay? So it was it was interesting. So in other words, you know, the mother obviously is going through this, but the her her daughter was saying, hmm, you know, my mom is basically, you know, older, are there things that I need to be aware of now? Um, I thought that was a very insightful question for sure. Another point I want to bring up is this. Um, for anybody living alone, um, who's frankly again, you know, to your point Abby is it I think it's important for everybody. Um, who's your safety call? Okay, if if something happens, who is your safety call? Like is it a neighbor? Is it, you know, a family member? Um, who is it that you can call in the immediacy of a situation if you need help? Um, do you, do you deal with that with with some of the patients that you see?
Speaker 2: I think that's I think it's important in that direction, who can I call if I'm having difficulty, but I also think in the opposite direction, who's going to call me and check in on me? You know, so is there is there a plan? You know, we've all heard some of these horrific stories about, well, I mean, look at the Jean Hackman story just recently of, you know, somebody was down for several days before somebody figured it out and could the outcome have been different had someone known. And so, you know, it's not just if I'm in a crisis, who can I call, but who's going to be regularly checking in to make sure I'm doing okay and if, and if they can't get a hold of me for a day, have a plan for a welfare check or or something like that, have somebody else who has a set of keys to the house who can go check in. So I think the plan, the plan in both directions is important.
Speaker 1: Yeah, yeah. Yeah, you make a very, very good point. It's good for all of us. I mean, you know, it doesn't necessarily have to be when you're older. So I want to talk about your your your service basically that that you you provide this in home um care. Um, how does somebody connect with that?
Speaker 2: Um, so we have a website, a phone number that people can call to connect with it. Um, you know, what I'll say about physician house calls and one reason why there isn't more of that happening like there used to be is that it's frankly a pretty inefficient way to take care of people. Um you know, I can't see 10 or 12 patients in their own homes in a morning, the way I can if I'm sitting in a clinic and everybody's coming to me and the nurse is putting them in the room and I'm just walking, you know, room to room back and forth. Um, and our healthcare environment, our our reimbursement environment is really set up to support volume of patients seen and procedures. And so when you're spending a lot of time with one person, um, and not doing any procedures, it's it's a pretty um inefficient and not very profitable way to take care of people. So I'll just I'll I'll start with that about why there isn't more of that. I think as we move into hopefully, we've been talking about this for two decades now or something, but more um uh outcomes based models of care, um that maybe there'll be some more value placed on this kind of delivery because it is the right way to care for certain types of people. So it's not a great way to care for somebody who has every ability to get into a doctor's office. But for some people where it's really um difficult to get in, it's the best way to care for them because otherwise they're just going to wait until they're in an emergency in a crisis and end up in an emergency room rather than dealing with a problem before it comes to that level of critical. Um, so that's that's, you know, kind of my my spiel about house calls in general. Um, so I go out into the home and I see people who are homebound for one reason or another. I would say that in my personal practice, um the largest proportion of my patients has been homebound related to advanced dementia and behavioral issues related to their dementia. Um, you know, so maybe it's very frightening for them to get into the car and be sitting in a clinic with a bunch of strangers in a strange environment, um, or maybe their dementia has progressed to the point where they're bedbound and it's difficult for them to get out. Some of this has been attenuated a little bit over the past few years really in the pandemic with the increasing use of telehealth. So some of those patients have been able to maintain their regular primary care providers via telehealth visits, but that's a little bit on the chopping block with Medicare here. It was supposed to end at the end of this month and now it's just been extended through um September. So we'll see what happens with Medicare being willing to continue to reimburse telehealth services. But otherwise, you know, this is really the best way to care for those homebound folks.
Speaker 1: Go ahead.
Speaker 3: yeah, I just want to thank you for that. I mean for that transparency because I was thinking about the same thing, why don't we have more of these kinds of services because we know that people need that, but I think you very uh very clearly stated why we don't have more. And so thank you. I do thank you for the work that you are doing.
Speaker 2: Sure. And I think there are groups that um, you know, I think it's more common for groups that will go into a facility, right? an assisted living facility or even a residential care home or a group home because you have a, you know, a quorum of people. You can see five or six or 10 or 20 or 30 people. you know, it's essentially moving your clinic into a facility. Um, I think where I saw a real gap or where I came in was in individuals living in their own personal homes where it's just one or maybe a couple who who need the care. Um it it's hard to find somewhere that will go out and do that kind of work. So that's where I um that's where I saw I guess an opportunity for providing a service that I didn't see elsewhere.
Speaker 1: So Abby, are there, you know, with the the type of work you're doing, um, the care that you're providing, is it is it is it specific for instance to the metropolitan area here? Are there other programs like this going on nationally? Um, or are you unique?
Speaker 2: Um, no, there are there are certainly other um physicians nationally who do home visits. Um, there are home visit programs. Uh a lot of them are housed like how I learned how to do house calls in academic medical centers that sort of um absorb the cost of doing that as, you know, uh an outreach program or recognizing that it's important in other ways for training, um for teaching. Um, fewer freestanding programs like that where physicians are going out. That being said, you know, I'm hard pressed to find a physician who hasn't done a house call or a few house calls for a patient that where it was really just the appropriate thing to do at at the time. And so when I was at Heben, one of one of my goals was to and what I did was bring residents out with us to show young trainees even if this isn't going to be how you practice medicine regularly, this is not that scary. This is a thing you can do. You know how to do this work. It's a different environment, but the medicine doesn't change. So, you know, when when you find a scenario where this is really the best or the only way to care for one of your patients to help people feel empowered that they know how to do that, how to see somebody at home.
Speaker 1: So one last question I have for you is how do you connect with um necessary um types of of of care. For instance, if if you go in and see a patient in their home and you realize, you know what, we need to do some lab tests. So what what do you do in order to get that accomplished for that patient?
Speaker 2: So there are in-hometomy services. Oh okay. There are in- home um radiology services. So the same companies that go out to nursing homes to do x-rays, you can get them to go in a private home. So I'm when I'm seeing a patient at home, I can get, I mean, obviously I can't send them through a CT scanner at home, but if I need a plain x-ray, if I need an ultrasound, if I need an EKG, if I need a lab, um there are companies that we can call to do that and they they will go out there. They will, you know, for the service, they bill the patient's insurance usually Medicare. Um, there's sometimes an extra out of pocket charge for the sort of a convenience fee so to speak for going to the home, but then, you know, the lab itself would be run through insurance. So there are ways to get that done. I would say that it has gotten um over the course of the last few years, it's gotten a little bit more difficult to find in-hometomy services. A lot of um lab draws and things used to be done through long-term care pharmacies and due to, you know, staffing issues everywhere. Um those services have have, you know, disappeared to some extent over the last few years.
Speaker 1: Okay. Clarence, last thoughts.
Speaker 3: You're on mute. Yeah, yeah, no. No. Thank you. I have really um it it has really caused me. this conversation really caused me to think about some things. And so I very much appreciate you for sharing and um definitely appreciate your your journey and also the fact that uh I'm thinking about, you know, quite honestly, I'm thinking about organizations that are uh working with senior populations and how important it might be to talk about what you've been talking about and to see if there can be additional support for our communities. So, thank you.
Speaker 2: Yeah, you're very welcome.
Speaker 1: Barry, last thoughts.
Speaker 4: Um, you know, they say the pop the age of the population that's increasing the most are the Centenarians. That's true. People over over 100 and uh, you know, with people living longer, obviously the effects of aging uh play a role and I'm very appreciative of uh taking a topic that's that's really broad but being able to give a perspective and get it down to some of the more important things that all of us need to hear about, need to attend to uh and should uh, you know, be repeated over and over again uh because things are are forever changing. And I you know, I think some of the priority things that we highlighted here today, um again, it's just the beginning of the questions we need to ask and just be observant of and and pay attention to so that all of us can live as independently and as meaningful lives that we can and uh Abby as you had highlighted the the idea of what are your goals, you got to think about what's what's important to you and that's very different from person to person, but articulating those will really help to create the kind of plan of care that you need as you age to meet your goals as well as you possibly can. And goals do change over time as well. It's not you're not locked into that. um and so we know that, but for the time being, then let's do what we can do. So thank you so much for um being on our show. I appreciate it.
Speaker 1: I'm glad.
Speaker 4: And finally to get to to be with you face to face. Abby and I go back actually a ways but it was always
Speaker 2: We've we've run in the same circles for a long time but it took us a while to to actually be in the same place at the same time, so
Speaker 1: I'm glad health chatter brought you together. Abby, thank you so much. Uh this has been wonderful. If you have any particular information that you think would be useful to put on our website, we would happily share that with with the listening audience in the transcript of the of the show. So feel free to get that get that to us. This was um it was really a learning experience even, you know, for me, I'm older, but you know, I I learned a lot and so thank you. Thank you for for the service that you provide and the insights that you you gave us today. It was great having you on the show.
Speaker 2: Well, you're very welcome. It's very nice to meet you. And I actually, um, I'm giving a talk next week and I put together a handout about, um, sort of early signs of cognitive and functional impairment and and some, um, senior resources. So I'm happy to share that with you as well.
Speaker 1: Yeah, pop it over and we'll we'll get that out on our on our website. So thanks for being with us. For you, the listening audience, thanks for being with us. Today, we have great shows coming up. We have one coming up on quality improvement and quality in assurance in healthcare. And then one that connects with this one, we're going to be doing a show on Alzheimer's coming up as well. So thanks to everybody out in the listening audience, everybody keep health chatting away.
