Alison Lloyd

Ohio State University

2017

“This was a great opportunity for networking and discussing various approaches to challenges in helping older adults navigate health care and living full lives with emphasis on remaining in their homes.”

Ohio State Plan on Aging links to Ohio Scholars in Aging by providing policy level information to practitioners who are working in their practicum. My practicum was a combination of experiences within the Wexner Medical Center Emergency Department (ED), Ohio State Employee Assistance Program, and Camden Coalition of Healthcare Providers. One policy that I explored during my placement was that of a required social worker visit when patients presented to the Emergency Department (ED) in area hospitals. This would allow the social worker to assess for and address any unmet needs of the older adults during their ED visit.

In this setting, one method of screening for cognitive impairment that I used is the Mini Mental Status Exam (MMSE). This screening can be performed by the ED social worker when examining the needs of the older adult during their visit. For example, when the patient presents with a fracture from a fall, screening for cognitive impairment could help decrease the rate of recidivism to the ED because the patient could be linked with other needed resources at discharge. “An emergency department visit for a fall should be seen as an opportunity to address unmet patient care needs” (https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/geriatric-falls).

With consideration given for the presentation of the patient, there are several resources that could help the patient remain in their home. These resources could include an option of Adult Day Programs within the area if indicated. Fast paced ED environments leave little room for lengthy contemplation about skilled nursing facility placement and home care. Perhaps integrating choices of adult day programs into discharge planning could be one opportunity to address unmet patient needs.

One case stands out, that of Howard*. Howard had fallen and presented to the Wexner Medical Center ED with a wrist fracture from a fall in his home, diabetes, and mild cognitive impairment. Upon further evaluation, it was discovered that Howard resided in the basement of friend’s home and had 20+ stairs to navigate plus a turn, to get into his home. Based on the results of the physical exam and MMSE, the attending ED physician determined that Howard would need to transition to inpatient for further monitoring while his housing needs were further explored. This was optimal timing to explore the possibility of Adult Day Programs for Howard. Enrolling in these programs could help Howard reduce his likelihood of another fall, and therefore reduce his possibility of readmission. “Older adults with falls are a higher risk population that could benefit from early interventions to reduce their need for recurrent emergency care” (https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/geriatric-falls).

As part of my practicum, I was also responsible for helping patients utilize an online program for depression and anxiety called Beating the Blues. This program was based on Cognitive Behavioral Therapy (CBT) as a strategy for managing symptoms of depression and anxiety. The online CBT program is offered to all Ohio State University faculty, staff and family members who are members of the OSU Health Plan. My role was that of clinical helper. In this role, I guided members through the eight modules of the online program to the extent that they wanted help.

I also shadowed the Columbus Worthington Fire and EMS crews as they completed their daily ambulance runs. This was a great way to learn experientially about the presentation of patients from the beginning of their trauma. This shadowing experience allowed me to see the patient through the entire trauma, from the first call to 911, transportation to the ED, testing, examinations, waiting times, and eventually discharge from the ED to home. This allowed for a complete picture of what the patient experiences when faced with a medical emergency. I was also a team member as part of Camden Coalition’s annual program that trained interdisciplinary teams of professional students from schools around the country to learn to work with complex medical and social needs using a patient-centered approach. “Every hospital has patients with complex care needs who struggle to navigate the equally complex system. These patients, often referred to as high-utilizers or “super-utilizers,” typically have medical and social barriers that keep them from getting the quality care they need” (http://hotspotting.camdenhealth.org/). As a team member, in collaboration with medical students and pharmacists from the Wexner Medical Center College of Medicine, we monitored Luann, a 68 year old female, over the course of 6 months. This included visiting the patient while she was inpatient, in skilled nursing facilities, and at home. The goal was to provide interdisciplinary team care with the ultimate goal of reducing hospital readmissions. The care plan and results were shared at the national conference in Philadelphia, Pennsylvania in January 2017.

The Ohio Scholars in Aging program was a unique opportunity to meet other students from around the entire state of Ohio. This was a great opportunity for networking and discussing various approaches to challenges in helping older adults navigate health care and living full lives with emphasis on remaining in their homes.

*Name changed for privacy