San Diego, California - Reams of medical books and guidelines exist on how to manage a patient’s diabetes, but much of that goes out the window when your patient is a 70-year-old homeless man eating out of a trashcan.
“There’s no point in simply giving this patient insulin and telling him to get on a restricted diet,” said Dr. Diane Chau, associate professor of medicine at UC San Diego School of Medicine and a physician at Veteran Affairs San Diego Healthcare System. “We need to intervene in a broader, more comprehensive way.”
For the homeless man with diabetes, that means helping establish a safe living situation, connecting him with social service meal delivery programs and services and ensuring regular treatment at a community health clinic.
Such interventions may seem out-of-the ordinary, but for Chau this comprehensive real-world approach is exactly what’s needed to better care for homeless seniors as well as older Americans from medically underserved populations.
A board-certified geriatric specialist, Chau heads the new Geriatric Scholars program in the Division of Geriatrics, part of the Department of Medicine. The program will help train health workers in San Diego County how to care for the elderly, with a particular emphasis on homeless seniors, older Latinos in economically disadvantaged areas and seniors in rural communities.
Geriatric Scholars is funded by a $2.5 million grant from the U.S. Department of Health and Human Services and is part of a $35.7 million national Geriatrics Workforce Enhancement Program, which seeks to improve the quality of health care for older Americans.
“In this age of quick fixes, we don’t have a quick fix for some of the problems of the elderly,” said Chau. “It takes more than the typical 15-minute doctor’s office visit. Many of their issues are social problems—fixed income, isolation, inability to drive—that inhibit their ability to get care.”
The UC San Diego Geriatric Scholars program, launched in July, will educate 12 trainees per year, producing a total of 36 graduates over the three-year grant period. After that, a continuing education program being developed under the grant will be used to train additional health professionals regionally and nationally, said Chau, who is also medical director of the Community Living Center, the San Diego VA hospital’s skilled nursing facility.
Chau said the interdisciplinary program will teach doctors, nurses, social workers and other allied health professionals about how to handle the special needs and challenges of the elderly, keeping in mind economic, cultural or logistical barriers to health care. The program will also include a geriatrics pharmacy component through a fellowship recently established through a collaboration with Jonathan Watanabe, an assistant professor of clinical pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences.
Geriatric scholars will be encouraged to look at the “big picture” and connect seniors with community resources to help them overcome obstacles to care, Chau said. For example, she recalled a recent patient, an older, near-homeless woman living alone with her dog. “She has an infected wound that she got from a flea bite. The dog has fleas, the carpet has fleas. The wound isn’t healing properly. It’s not enough to just give her an antibiotic. You’ve got to link her with social services that can help her solve the housing problem, the flea problem and the various related issues affecting her health.”
Ultimately, Chau said, this broader out-of-the-box approach will be less costly to society and better for the patient, noting that without help such individuals may end up seeking more expensive care such as emergency rooms or hospitals.
Another aspect of the geriatric program will be educating trainees about cultural differences that can affect patient care. “Some older Latinos in border communities may not speak English or they may not clearly understand their diagnosis due to cultural differences,” said Chau. She said scholars will be taught awareness and culturally sensitive approaches for communicating health information.
Graduates will be required to complete 120 hours of continuing education courses, including lectures, workshops and substantial patient interactions in medical clinics run by three institutional partners: San Ysidro Health Care and St. Paul’s Chula Vista Program for All-Inclusive Care for the Elderly (PACE), which serve many older Latinos, and the VA San Diego Healthcare System, which serves a number of homeless veterans and people in rural areas.
For rural areas, trainees will use Internet-based telemedicine technologies to see elderly patients in their homes or in medical clinics. “A nurse can bring a laptop into an elderly person’s home, which allows us to speak directly with, examine and assess the patient,” said Chau. The program also will incorporate innovative technologies to enhance distance treatment, such as wound care, which is being assisted by Dr. Kevin Broder, a plastic surgeon and wound care specialist at the San Diego VA Hospital.
