The Healthcare Paradox of Seniors: Greatest Need but Least Access to Physicians

Our seniors are caught in a healthcare paradox.  They have enormous healthcare challenges, and yet many have the least access to physicians because they have so much trouble getting to them.  By 2030 seniors will represent 20% of our population, and they are the largest subgroup of our citizens.  It would be logical to believe that they would be a major focus of attention of the medical community, but this is not happening.  As a result, our seniors are underserved, overprescribed, and under-represented in healthcare delivery and research.

There are intriguing new developments in electronic access to healthcare, but most seniors don’t or can’t use electronic gizmos and are therefore left behind (

Physician medical practices seem to spring up everywhere, but the physicians themselves maintain their traditional business model and force seniors to either come to them for their care or do without.  Too often our cumbersome medical system causes seniors to delay needed healthcare until it’s too late, resulting in an ER visit or hospitalization.  And when they are discharged from the hospital, seniors are given a ream of paperwork with myriad vague and often conflicting instructions which they are then forced to try to disentangle and assimilate, all while they are still weakened and recovering from their illness.

Seniors have the highest number of chronic medical conditions, are the highest consumers of our healthcare dollars, and yet are at the point in their lives where they are least able to financially contribute to the cost of their healthcare.  And yet approaching senior healthcare in the traditional manner does nothing to reduce their overall healthcare costs.

So, what is the solution?  Well, there is no single solution that will solve this paradox, and looking for a magic bullet that doesn’t exist might explain why there has been such little progress in this arena.  And it blinds us to creative approaches that can be identified that can have real and immediate, tangible benefits.  If we make it our goal to “bite off a little chunk” of this problem rather than the impossible task of conquering the entire monstrosity, and if we get creative, we can make a difference in the lives of our seniors NOW…not a year from now, not 5 or 10 years from now, but NOW!

Here’s an example of a “new” and deceptively simple approach.  A “House Call.”  A simple, old fashioned House Call.  A physician bringing full primary care to the home of a senior.   This opens up a world unseen and unknown by most physicians, because what happens in a patient’s home is often VERY DIFFERENT from what the physician imagines from his remote perspective in the hospital or his office.  And here’s the best part of this approach and where the benefit really lies:  once the physician is in the senior’s home, this allows on-site, realistic physician leadership and management of the senior’s healthcare, where the physician sees things the way they really occur and not just the way he imagines they occur.

There are only a few working models of House Calls across the United States, and among the most successful are those providing care in Retirement Communities (Independent and Assisted Living) which are a popular alternative for many aging seniors.  It is here where physicians can schedule a group of patients to be seen in a ½ day clinic, most closely imitating a ½ day in the doctor’s office.

But this approach needs the partnership and mutual support of both the physician and the Retirement Community.  When this occurs, the benefits of an on-site House Call are just what you’d expect them to be:  more appropriate care directed to the reality an individual patient faces at home, healthcare that is actually provided rather than avoided due to the difficulty or impossibility of accessing a physician, and adjusted expectations of achievable results resulting from a better knowledge of the patient and his preferences.  Applied on a broad scale, the House Call would almost certainly contribute to reducing overall healthcare costs.

We must encourage and foster creative approaches to improving the healthcare of seniors.  Everyone who interacts with seniors is a stakeholder.  So I encourage you to think outside of the traditional healthcare box, think creatively, and then innovate by picking just a small “chunk” of this issue and applying your contribution TODAY!

Why Doctors Don’t Go To Retirement Communities…Unless…

Not one single Retirement Community in Idaho (Independent or Assisted Living) has regularly scheduled on-site doctor services offered to all their residents…not one!  Despite the potential value of these services, not only to the residents but also to the Communities, until now there has been no focused dialogue between doctors and Community administrators to try to bridge this gap.

I’d like to explain, from the doctor’s point of view, why this service does not happen.  I will then point to a solution that works for EVERYONE with the hope that we will all work together in partnership to help the elderly who need us.

The short answer?  Going to Retirement Communities contradicts the doctor’s current business model.  Even though many might desire to extend their practice to include these Communities, they simply can’t because doing so is 180 degrees in opposition to their business model and therefore prevents them from running a profitable medical practice.

Here’s the doctor’s perspective:

  • I can either remain in my office with my entire support staff who has arranged a full afternoon schedule of patients waiting in exam rooms to see me, or
  • I can spend the entire afternoon traveling to a Retirement Community where I have no support staff, have to hunt down my 1 or 2 low reimbursement Medicare patients wandering around the Community somewhere, find some place to examine them, and then somehow arrange follow-up testing and appointments.

Everyone simply accepts that if you need a doctor, you go to the doctor’s office, to a clinic, or to the hospital.  The doctor does NOT come to you.

Here’s the dilemma

Healthcare is changing, and this means that doctors and Retirement Communities must adapt to new ways.  In order to reduce overall healthcare costs, there is an increasing focus on delivering as much healthcare as possible OUT of institutions (e.g. hospitals) and in the Community.

Here’s how doctors must change

You must be more creative and develop a business model that encourages you to come out of your office and provide care in our Communities.  There’s a HUGE need and desire for this, and it must be met.  Especially for the elderly for whom scheduling appointments and arranging transportation is so difficult that they will often avoid essential medical care rather than go through all the hassle.

Here’s how Retirement Communities must change

Your market is extremely competitive, and in order to achieve a profitable census Communities must not only attract residents but maintain their loyalty by offering quality services.  When available, on-site healthcare MUST be included.  You must invest in this service just as you would invest in other valuable services you provide.

Here’s a solution

Doctors and Retirement Communities must come together as partners, not competitors.  They must understand that neither is trying to take advantage of the other.  Rather, both are working together, in partnership and to their mutual benefit, to care for the elderly.

Doctors in Boise, Idaho have ‘stepped up to the plate’ and met this challenge by developing a new business model that makes it possible to provide regularly scheduled services to all residents of a Community while maintaining a profitable medical practice.

But this new model requires that Retirement Communities must also ‘step up to the plate’ and invest in a service that their residents want and that will benefit them and make them more profitable by raising their census.

A partnership that includes Retirement Communities, their residents, and doctors, is one in which EVERYBODY WINS!

House Calls Makes Front Page of the Idaho Statesman!

House Calls is proud to be recognized with a front page article in the February 25th issue of the Idaho Statesman.  Seniors are an under-represented population in outpatient healthcare, and we hope to be part of the solution.

Please read about us in the following link.  And when you do, watch out for Molly!

House Calls newest partner – Bonaventure Place!

House Calls is proud to announce its newest partner – Bonaventure Place in Boise, Idaho!  A gorgeous, spacious community combining both Independent and Assisted Living with many wonderful amenities.  And now Bonaventure Place is one of the only Retirement Communities in Idaho who brings the doctor to the residents!  Any resident may choose to have some or all of their full primary healthcare services provided in the comfort and convenience of their own apartment!  No additional cost – just additional care and comfort!

Come to Bonaventure Place in Boise!  Take a tour, talk with the House Calls doctor.  We look forward to being your next home!

When Health Fails in Retirement Communities: a 3 Step Program for Proactive Healthcare Intervention

Health related attrition is a major ongoing challenge to the census of any Retirement Community.  A solution to this challenge is a COMMITTED FOCUS on a program of Proactive Healthcare Intervention.  Such a program is not only easy to implement with common sense ideas, it’s free!

Here’s my suggestion for a simple 3 step program that will be effective and easy to explain to employees.

Figure 1

Under Step 1: Create a position called: Director of Proactive Healthcare (DPH).  Enlist the support of every employee:  housekeepers, bookkeepers, secretaries, maintenance personnel, bus drivers, cooks, activity directors, everyone.  Encourage everyone who interacts with residents to actively observe for any signs of health problems and to report any concerns immediately to the DPH.

Under Step 2:  The Inflection Point (shown in Figure 2) occurs as soon as signs of failing health are noted.  When the Inflection Point has been reached, take immediate action!  “Don’t wait, or it’ll be too late!” can be your motto.

Figure 2

Here are some examples of failing health employees may observe and then report to the DPH:

  • Frequent falls
  • Bruising
  • Limping
  • Moving slower than usual
  • Missing meals or residents requesting meals in their room
  • Problems taking medications appropriately
  • Pills noted on the floor or lying around on countertops in resident’s apartment
  • Worsening depression
  • Less socializing
  • Confusion

Residents exhibiting any of these signs should be put on a “watch list” and monitored by the DPH until they are back to baseline.

Under Step 3:  The most reliable way of getting a timely and appropriate response from a physician is NOT by telephone.  When a concern is raised, the DPH should go personally to the office of the resident’s physician and speak with him face-to-face.  Provide a concise, accurate description of the changes observed with the resident, and request an office visit at the first possible opening.

As you can see, these are 3 very simple and yet effective components of a proactive focus on the healthcare of your residents.  Implementing these suggestions is easy, does not require any additional expense, and will benefit everyone.

If you have any further thoughts or suggestions about the role of physicians in Retirement Communities, I urge you to comment on the House Calls blog.

This is an important topic, and I look forward to continuing this discussion and hearing other points of view.

HealthCare in Retirement Communities: Passive is No Longer an Option.

After reviewing the advertising of my local Retirement Communities, I asked myself:  “What stands out?”

The answer? “Nothing.”  That’s right, nothing.  Absolutely nothing stands out.  Everybody looks the same.

I challenge you:  review the advertising of 10 different Retirement Communities.  Then close your eyes and name 1 single feature that distinguishes any 1 or 2 of the communities from all the others.

Did you have any luck???  If you did, you’re better than I am!  I don’t mean silly things, like “Imagine the excitement of that perfect bridge hand!”  I mean things of substance and real value that seniors will appreciate as a welcome exchange and even motivation when moving to a Retirement Community from the home in which they have lived for so long.

Consider this:  many Retirement Communities spend as much as $5000 – $10,000 per month, EVERY MONTH, on advertising (or even more).  And yet the ONLY thing they accomplish is to make themselves look IDENTICAL to every other Retirement Community.  Same amenities, same verbiage, even many with the same stock photos of the same happy and smiling seniors!

Retirement Communities operate in an incredibly competitive market, and this only promises to intensify with the coming of the Baby Boomers.  So why are Retirement Communities so willing to invest so much money into something that makes them appear so ordinary and average, but are yet so reluctant to invest even 1/10th of that amount in a service (HealthCare) that brings real value and will distinguish them among all their competitors?  The psychology of this observation is hard to understand.

Those who represent Retirement Communities are abundantly aware that HealthCare is one of the TOP CONCERNS of ALL seniors.  This is an opportunity!  So why not take advantage of this opportunity and offer a service that every senior wants and that promises the best chance for not only stabilizing the census but recruiting new residents and growing a community’s census?

In Boise, Idaho, some physicians have stepped up to the challenge and will now provide full primary care in the comfort and convenience of your resident’s rooms.  Yes…it requires a very modest investment to make this happen.  Yes…it requires a community to ACTIVELY participate in the health and wellness of their residents.  But the compelling advantages of this investment FAR outweigh the modest cost.

The Retirement Communities, both Independent and Assisted, who will be thriving in this competitive market 3, 4, or 5 years from now will be those who are prepared to capture the Baby Boomers who bring greater expectations.  The Communities that survive will be those who are proactive NOW and adapt to the changing demands and needs of their residents.  The “passive” approach, when it comes to healthcare, is simply no longer an option.

Physicians MUST partner with Retirement Communities, and here’s why…

Healthcare delivery is changing from a Hospital focus to a community focus.  And with this change, Retirement Communities, operating in a very competitive market, are obliged to be a participant in their residents’ healthcare.

Hospitals, responding to their own set of pressures, are discharging patients earlier and earlier in the course of their patients’ recovery from an illness, transferring the burden and responsibility of coordinating their care during this fragile time to the patients themselves.

  • In 2011 The Centers for Disease Control noted that seniors discharged from hospitals between 1990 and 2010 had a 31-36% shorter length of stay.
  • In 2012 The Agency for Healthcare Research and Quality noted that many discharged patients were home bound and needed either skilled nursing or physical therapy, as there was a 79% increase in patients being discharged to Home Health services during a similar time frame.

This increased demand for community-based healthcare unfortunately has not been accompanied by easier access to primary care physicians.  Although patients were sicker, the only way to see their physician was still to somehow struggle into the physician’s office.  As disagreeable as this was to both patients and physicians, there simply was no alternative to this model.

But now there is an alternative.  House Calls answer is a model that encourages a partnership with physicians, Retirement Communities, and their residents.  Full primary care can now be delivered to residents in the comfort and convenience of their Retirement Community apartment.  Regularly scheduled clinics are put in place where residents may voluntarily see the House Calls physician for either single visits or as their PCP.  And this partnership allows even more benefits:

  • Any new resident to the Retirement Community will automatically be accepted as a patient if requested.
  • Home Health orders will be signed within 24-48 hours of request.
  • Physician directed healthcare coordination, where all who participate in a resident’s healthcare, are now led by a physician and unified as a TEAM rather than acting as separate individual services who don’t communicate with one another.
  • Memory Care residents and their families and staff members are spared the stress and inconvenience of transporting these fragile individuals off-site for routine doctor visits.
  • A Marketing and Promotional advantage that identifies THIS COMMUNITY as a LEADER by offering a service that ALL RESIDENTS WANT, WITHOUT EXCEPTION – easy and convenient access to a physician-led team of healthcare professionals.
  • Stabilization of Community census by reducing health related attrition through pro-active, early, physician-led intervention in a resident’s declining health.
  • Growing of Community census by capturing prospective residents who choose THIS Community because of its unparalleled healthcare support.

EVERYBODY WINS with this partnership.  We intend to meet the challenge of tackling the increasing community healthcare needs by converting our experience into a huge success.  Our communities, not hospitals, will be the focus of healthcare in the future…and we and our partners are ready!