« The Dual Agenda: February 24, 2016 Issue

Eldercare Voices

Sharing Geriatrics Best Practices with Nurses and Other Community Providers

Martha Rounds-Watson, MS, APRN, GCNS-BC

Over the past two years, my role as a geriatric provider advocate in Rhode Island working with Community Catalyst to improve care for older adults has afforded me many new and horizon-expanding experiences. I’ve had opportunities both to learn and to teach that wouldn’t otherwise have been available to me, all focused on improving care for older adults in my state. Working with Rhode Island consumer and health policy advocates with whom I was partnered by Community Catalyst has really been an eye-opener – that as an Advanced Practice Nurse - a Clinical Nurse Specialist in geriatrics, I could contribute to effecting policy change in my state during this exciting time that our dual eligible demonstration project has been under development. That has been enlightening, empowering and very satisfying, on the learning side.

On the teaching side, this innovative partnership opened up new doors for me to share my expertise in geriatrics in a new sphere. While I have long been involved in nursing education both in academic and hospital settings, last year I had my first opportunity to provide training in geriatric-competent concepts to providers who help coordinate care for low-income older adults in the community setting. In collaborating with Maureen Maigret of The Senior Agenda Coalition of Rhode Island – a Community Catalyst state partner organization – a connection was made with Neighborhood Health Plan of Rhode Island (NHPRI) to jointly develop a set of brief trainings in key geriatrics concepts for nurses and other providers on their staff. NHPRI is a non-profit plan that began providing care in 2013 to dually eligible older adults (those in both Medicare and Medicaid) through its Rhody Health Options plan.

Beginning in the spring of 2015 and continuing through fall, I had the opportunity to personally present a series of training sessions to a group of nurses, social workers and physical therapists at NHPRI who make regularly scheduled home visits with Rhody Health Options members to conduct detailed assessments in order to identify gaps in care that an Integrated Care Team can then address using an Interdisciplinary Care Plan. With the chronic shortage of both geriatricians, and geriatrics-specialized nurses, it is absolutely incumbent that our health system gear up to give all frontline providers who care for older adults a core understanding of well-established best practices in dealing with the unique needs of older patients.

The first four trainings covered these core topics: Falls Prevention; Pain Management; Delirium, Depression and Dementia; and Frailty. Each one-hour session was a practice-oriented training focused on the community setting – seeing patients at home, whether in their apartment, an assisted living facility or nursing home. PowerPoint presentations were used as a jumping-off point for an interactive discussion, engaging the participants throughout the session, rather than a one-way lecture. None of the 15-20 nurses and other providers who participated in each session were geriatrics specialists, but they all were very excited to be learning new geriatrics concepts and skills, crucial to their work. They asked excellent questions throughout, demonstrating that they understand how important these issues are for their members, and they were eager for more information. Other key topics envisioned for continued training: Interdisciplinary Team Approach to End of Life Issues- Having the Necessary Discussions; Communication Issues with the Geriatric Population; and Successful Transitions of Care for the Geriatric Population.

In the feedback we received from our participants, there was an overwhelming response that this material was of great value and that this should just be the beginning. Comments such as “very relevant to our work” and “another 30 minutes would have been helpful” were indicative of the interest and desire to dig deeper into these topics.

I feel very fortunate to have been given the opportunity to partner with NHPRI in piloting this educational effort. We think it can represent a model for wide emulation across the country. Few experts expect that medical schools and nursing programs will be able to graduate anywhere near the number of geriatricians and geriatrics-specialized advanced practice nurse practitioners so urgently needed to meet the rapid demographic growth of older adults over the coming decades.

The challenge for all health plans will be to embed this type of geriatrics best practices training into standard orientation regimens, so that everyone coming on board can be exposed to these concepts right from the start of their work with older populations. With the abundance of CME-eligible online training resources already available in geriatrics topics as a starting point, it does not have to take years for states to create pathways for nurses to receive a certification in geriatrics. As a longtime educator in academic nursing, I know well the range of topics that nurses and other frontline providers must stay current on through their continuing education. It is indeed a broad and ever-expanding list of topics. However, working geriatrics firmly into the mix represents the challenge we must rise to if all of us are to expect high-quality geriatric-competent care for our parents, friends and ourselves in the decades ahead. We should expect no less.

Martha Rounds-Watson, MS, APRN, GCNS-BC has been passionate about geriatric health care for over 25 years and is currently responsible for patient care quality outcomes as an Advanced Practice Manager at The Miriam Hospital in Providence, Rhode Island. She has been responsible for a broad range of geriatric initiatives at this Magnet-designated, 247-bed adult acute care hospital. She has been involved in initiatives to manage common hospital-acquired conditions such as falls, pressure ulcers, CAUTI, restraints and delirium. She also has been involved in education of hospital staff in efforts to improve overall geriatric knowledge, especially in delirium management, pain management and palliative care initiatives. Martha holds an MS degree from the University of Rhode Island as an APN Geriatric Clinical Nurse Specialist and also holds a certification from ANCC in Pain Management.

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