Access builds trust, promotes end-of-life care planning
Lloyd and Carol Allan enjoy the social and recreational opportunities at Felician Village in Manitowoc, Wis. It has three restaurants, movies on Thursdays and a large TV room where they join friends to cheer the Green Bay Packers. But it's another convenience that sets Felician Village apart among continuum-of-care senior living communities — their primary care doctor has an office on the campus.
Dr. Gary Schmidt, medical director of Felician Village, examines Lloyd Allan in his Holy Family Memorial Medical Center office at Felician Village, a senior living, continuum-of-care center in Manitowoc, Wis. The hospital also has primary care offices in two other Manitowoc nursing homes.
"I love the arrangement," said Lloyd, 90. "I wouldn't get in my car, drive 3 miles and get out just to ask some little question about my health. But here, I can go see my doctor any time. And the short walk to his office is good for me."
The Allans, married for 61 years, see Dr. Gary Schmidt in his offices at Felician Village, a sprawling senior living center that offers independent living apartments and multiple levels of care. Holy Family Memorial Medical Center and health network in Manitowoc staffs the family medicine clinic at Felician Village and at two other senior living centers in Manitowoc, a city of about 33,000 people on Lake Michigan about 80 miles north of Milwaukee. Holy Family Memorial is part of Manitowoc-based Franciscan Sisters of Christian Charity Sponsored Ministries; and Felician Village is part of Chicago-based Felician Services.
The Allans moved to Felician Village four years ago. The continuum-of-care campus has 122 independent living units, 48 apartments, 32 assisted living units and 84 beds in its nursing and rehabilitation center. It is in a pleasant residential neighborhood just eight blocks south of the hospital.
Schmidt, a family practitioner and staff member at Holy Family Memorial, has been medical director at Felician Village for three decades. When it expanded about five years ago, he moved his practice into an office near the main entrance.
Schmidt said about 60 percent of his patients at the HFM Family Medicine Clinic at Felician Village live on the campus. The rest make office visits, just as they would if his practice were in a standard commercial building.
A doctor in the house
Schmidt said working on the campus allows him to spend more time with his patients and walk to "house calls." Almost all of Felician Village's buildings are directly connected with enclosed walkways.
He said that close proximity to patients has reduced the need for residents to seek hospital care.
"Ten years ago, if someone fell, I'd take a phone call and give instructions to send the patient to the emergency room," Schmidt said. "Now, somebody will drop by my office to tell me there's been a fall. I can walk straight to the patient's room. I can decide there if an X-ray is appropriate. And we don't need an ER visit."
That's music to the ears of administrators at Holy Family Memorial. Marcia Donlon, its administrative director of primary care, said having doctors' offices at the senior centers has reduced ambulance runs by 63 percent and readmissions of residents by 20 percent.
Donlon said that saves money by cutting the number of emergency room visits. It also reduces overnight stays, she said, and it better positions Holy Family Memorial for changes in federal reimbursements and to avoid penalties for readmissions of Medicare patients for preventable causes.
"Most important, it's good for the patients," Donlon said.
Care coordination across the continuum
Donlon said the hospital leases its clinic space at Felician Village, the Manitowoc Health & Rehabilitation Center and the Shady Lane Nursing Care Center, all in Manitowoc. And it employs Schmidt, other doctors, nurse practitioners and other clinic staff members.
Donlon said the arrangement provides better coordination of care, which helps to resolve what she called "the historical track record of hospitals and nursing homes not working very well together." She said the hospital and senior living communities have clear protocols for better handling chronic and minor health issues.
Donlon said the more collaborative arrangement is consistent with the health system's philosophy of "the right care in the right setting with the right outcomes."
Schmidt said he enjoys the freedom to spend more time with his patients, listen to their life stories and earn their trust. That is vital, he said, in getting senior patients to consider planning for end-of-life care — a major goal of Holy Family Memorial in establishing the offices.
"I get to talk to them informally and, over time, discuss how they want to handle things" related to end-of-life care. There's no crisis forcing things. I can share my faith, they can share theirs. The men can tell me what they did in the war."
Donlon said many families still believe their elders need to be in hospitals for the last days or weeks of their lives. If senior residents have time to make their own plans with empathetic caregivers like Schmidt, more will receive appropriate hospice care.
Donlon and Schmidt said one concern they had at the outset was whether other patients, especially younger ones, would stay away if his office was at a senior living complex. Schmidt's office at Felician Village has direct walk-in access from the parking lot.
"Some of the younger ones weren't so sure until they saw the office," he said. "They'd come in and say, 'I wasn't sure I wanted to come to a nursing home, but this is nice.'"
Donlon said the Holy Family Memorial doctor's office at Manitowoc Health & Rehabilitation Center, a 150-bed nursing home, is just across a highway from Silver Lake College of the Holy Family, which, like Holy Family Memorial, is a member of FSCC Sponsored Ministries. Donlon said students visit the doctor's office there because of the convenience.
She said Holy Family Memorial executives are sufficiently pleased with the results to want to expand into more area nursing homes. "We used to say we were a hospital that owned some clinics," she said. "Now we're a physicians' organization with clinics that happens to own a hospital."
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