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The Road to Well Being

Author: Karen Hart
June, 2012 Issue

Living well may be the best revenge, but living longest is pretty sweet, too.

 
“Thoroughly unprepared, we take the step into the afternoon of life. Worse still, we take this step with the false presupposition that our truths and our ideals will serve us as hitherto. But we cannot live the afternoon of life according to the program of life’s morning, for what was great in the morning will be little at evening and what in the morning was true, at evening will become a lie.” —Carl Jung


The oldest baby boomers turned 65 last year, and every day for the next 19 years, about 10,000 more will cross that threshold. By 2030, when all baby boomers will have turned 65, fully 18 percent of the nation’s population will be at least that age, according to the Pew Research Center population projections.

North Bay medical professionals have noticed a dramatic shift in the way people today are aging and moving into the afternoon of life. “We’ve seen dramatic changes in the way people age in the United States from the 1970s until now,” says Brad Stuart, M.D., chief medical officer of Sutter Care at Home, which offers a range of services in the North Bay. “Traditional retirement is still 65, but people are living 10 to 20 years longer [on average]. Now they’re playing tennis in their nineties, they’re starting new careers instead of going into retirement and aging in place. The fastest growing cohort in the United States are people who are living to be more than 100 years old.”

Part of living longer, however, can also mean living with a chronic illness such as diabetes or heart disease. Or, it may be about learning to cope with hearing loss, vision issues or a hip or knee replacement.

“Today’s seniors are more active, more engaged and more involved, but there’s still work to do to ensure that we’re focusing not only on prevention but also supporting those living with chronic conditions so they can function at the highest level possible,” says Dana Codron, executive director of community outreach at Queen of the Valley Medical Center in Napa.

The changing face of health care

“We’re just beginning to realize that the health care system we grew and nurtured in the 20th century isn’t built to handle seniors with chronic illness, many of whom have several chronic illnesses,” says Dr. Stuart. “What they need is a reorganization of our health care system to provide for what they need and what they want. And what these people want, especially when their chronic illness becomes advanced, is not to be patients.”

“Many health insurance plans cover care only when someone becomes ill,” says Codron. “We’re working to shift the paradigm of health care from an illness model to include a wellness model.”

“Patients want to be seen for who they are; they don’t want to be a patient ‘number.’ For this reason, people want to be more involved and play a greater role in their health care planning—so they can get back on the tennis court or on the ground, playing with their grandchildren,” says Yve Duran, a licensed clinical social worker in the outpatient social work department in chronic conditions management at Kaiser Permanente in Santa Rosa.

As a result, North Bay hospitals are revamping their programs to offer services that fit the needs of seniors today and are focusing their efforts on health, wellness, prevention and a different kind of care for advanced illness.

Focusing on health and wellness

“As people live longer—often considerably past retirement—and their health is better, different issues arise: Where am I going to live? Are there financial constraints? How do I work with my changing body? Suddenly, meaning becomes more important in the second half of their lives, and it’s a time to reinvent themselves,” says Joseph Cutler, behavioral medicine consultant at Kaiser Permanente in Santa Rosa. “The goal is to be as vital and alive as you can be.”

As a result, Kaiser offers a variety of classes to help seniors navigate the afternoon of life.  Senior Hot Topics, established by MSW Diana Gruhl, is a weekly drop-in discussion group for seniors who’ve retired or are planning to retire. It explores a variety of issues, such as relationships, intimacy, health, finances, loss of friends and other family transitions that relate to retirement.  Senior Hot Topics is more of an informal support group, and topics are by request.

Participants might steer discussion into a variety of areas, says Cutler, such as how to work through moving from their home to a smaller space, how to cope with depression that often accompanies a chronic illness or loneliness when a spouse dies. Currently, one of the hot topics in the class is seniors looking for a multi-generational place to live. “Some participants don’t want living situations that are restricted to only retired people,’” says Cutler.

Kaiser offers a variety of other classes that help people learn how to prevent illness and disease and take charge of their health. All About Memory, for example, is a one-session class that teaches participants about common memory disorders such as Alzheimer’s disease and dementia and provides lifestyle practices to help keep memory sharp. Fall Prevention is another single-session class that teaches participants skills to reduce their risk of falling.

To keep seniors healthy and moving, Kaiser also offers a restorative yoga class and hypermobility exercise class. There’s also a class for those who need help coping with hearing loss, and a class for those with osteoporosis or who are at risk for developing it. Cholesterol and Your Heart is a class aimed at showing participants how exercise and a heart-healthy diet can lower cholesterol levels.

“At Kaiser, we’ll notice a need and try to create a class or a specific service around it,” says Barbara Carlson, director of health education at Kaiser Permanente. “We’re all about supporting people to thrive and be engaged in what’s helpful and meaningful to them.”

Some of the classes are fee-based or part of the Kaiser member benefit, but many are open to the community. For more information, visit www.kp.org/santarosa.

Tailoring health care to life

A new kind of care is evolving for seniors at Sutter Health in the North Bay, especially for patients coping with advanced illness. Sutter’s Advanced Illness Management (AIM) program helps people tailor their health care needs so they keep living the life they want. Clinicians through Sutter Health’s home health care division⎯Sutter Care at Home⎯help implement the AIM program.

AIM is directed at people who are coping with an increasingly severe chronic illness, such as heart disease, cancer or advanced diabetes. Dr. Stuart founded the AIM program in 1998 because he was tired of patients refusing hospice services, and he realized a different kind of care was needed for this new breed of seniors.

AIM isn’t about what kind of care you want, but what kind of life you want, says Dr. Stuart. “Someone may say, ‘I just want to be able to stand up and walk to the dinner table with my family,’ and our team will say, ‘We can put together a care plan for you that can help you do that.’”  The plan may involve physical therapy, medication or a dietary regimen designed to meet the individual needs of that person.

“We find their personal goals, and we make sure those goals drive their care,” says Dr. Stuart. “It’s all about focusing on their comfort, safety and dignity,” he adds. Sutter Health is finding that focusing on these areas eliminates the kind of care that patients don’t want, which results in care that is more cost-effective. If you look at Medicare spending, it turns out that about half of it is spent on only 5 percent of the people who are over age 65,” he explains.

And while AIM wasn’t designed to save money, they’re finding that the program happens to do just that. “This new breed of seniors benefit from care based at home. It helps them live the lives they choose, and it helps save money because it helps eliminate unwanted care,” says Dr. Stuart. “Trying to guess ahead of time what care might be unnecessary is very difficult and very controversial.” For example, many patients with heart disease can better understand their disease through AIM and learn how to manage their own symptoms such as pain and shortness of breath. By taking a more proactive approach, many patients are able to avoid a trip to the emergency room.

According to Dr. Stuart, care that’s focused on how the patient wants to live rather than on the illness itself is a win-win situation. “There’s a lot more to chronic illness than the medical problems,” he says. “When you’re chronically ill, your health is determined more by social, family, psychological and community factors than by clinical issues. AIM offers a personalized approach to the care of chronic illness. We want to make this care a part of regular medicine,” he says. “And it’s going to take a long time and a lot of blood, sweat and tears to make this happen.”

Regaining and maintaining wellness

The emphasis at Queen of the Valley Medical Center is to help seniors get healthy and stay healthy—physically, mentally and spiritually.” We want to help people establish a strong foundation of health,” says Larry Hazen, manager of outpatient rehabilitation services and wellness integration at the Queen. As a result, the Queen promotes prevention education, overall fitness and management of chronic conditions through its Wellness Center.

The Queen opened the Wellness Center in 2006 to help keep people in the Napa community fit and healthy. Many of its members are seniors coping with chronic conditions, but the Wellness Center is open to all ages. For seniors with a new or chronic condition, the Wellness Center can become their one-stop shop.

The Wellness Center features a medical fitness center called Synergy where senior members often work out. Synergy offers more than 150 weekly classes such as yoga, meditation, cardio, indoor cycling and water aerobics, among others. There’s also a weight room and exercise equipment.

“A lot of people come to Synergy because it’s the same building where they receive clinical services, so they’re already comfortable here,” says Hazen. “And they’re often working out next to fellow patients as well as members of their medical team.” Some of the outpatient services offered include rehabilitation services, cardiac rehabilitation, diabetes wellness, bone density testing and an Institute for Integrative Health, which offers stress-mastery counseling and acupuncture.

The Wellness Center also offers nutrition assessments and classes that focus on nutrition education. Eating for a Healthy Heart, for example, is a one-hour class taught by a dietitian, who discusses the principles of a heart healthy diet, how to read food labels, and what to order when dining out, among other topics. There are also classes on weight loss and enhancing your balance.

The Queen also offers a three-month program for cancer patients. The Cancer Wellness Program is designed to help patients transition to survivorship and emphasize a plan that encompasses optimal health in body, mind and spirit. This program is supported by QVMC Foundation, so there are no fees for the participants.

The Coumadin Clinic is offered for seniors taking blood thinners because they’ve either had a cardiovascular event or are at risk for one. A support group for stroke patients meets routinely and is led by a speech therapist.

In addition, the Queen provides a program called CARE Network, a community-based chronic disease management initiative which helps individuals with chronic conditions better manage their health at home. CARE Network provides RN and social work home visits to low-income persons who have chronic conditions such as diabetes or cardiac issues (at no out-of-pocket expense to the individual). “With the economy and cost of living, many folks are just making ends meet,” says Codron. “Often, even a co-pay can be a barrier to a medical visit or obtaining prescriptions, and this adequate management of diabetes, for example, becomes impossible.”

The CARE Network program provides one-on-one disease management education, ensures routine medical follow-up, helps with medications, insurance benefits and home-safety concerns. The program also helps seniors with basic needs such as food and shelter.

“Our commitment to the community is to ensure access to care and services for all seniors to enable them to enjoy life to the fullest,” says Codron.

Future care for seniors

Just as the baby boomer generation’s sheer size made nationwide impacts on schools and the workforce, it’s sure to influence the future of health care services.  “By 2030, we’ll see the 65-plus population double what it was at the turn of the last century. Between 2000 and 2030, the over-65 population will go from 35 million to 70 million,” says Dr. Stuart.

As this generation enters the realm of aging concerns, its impact on senior health care will call for a redefinition of the industry, prompting changes on all levels from the government to providers and patients.

What’s on the horizon for senior health services?

Most experts in the health care field agree that prevention, rather than crisis care, will emerge as the new focus. “It’s always better to be proactive so you can prevent chronic conditions such as arthritis, diabetes or cancer,” says Hazen.

“I’m hoping for a shift in health care that incentivizes the provision of prevention and wellness services and not just an illness model,” adds Codron.

Moving to more individualized care is another way health care providers are catering to the rush of baby boomers.

“We pin the ‘patient’ label on them, but they don’t want it. 'Person-centered care’ is something doctors and hospitals need to talk more about. It’s important to talk to people about how they want to live,” says Dr. Stuart, who adds that the general trend in health care is moving toward personalized medicine.

“We’re already creating drugs that target individual cancer cells instead of attacking the whole body,” he says. “Pretty soon, as we learn to untangle every person’s genetic code, we’ll see the same targeted approach to many individual illnesses. As it becomes easier and cheaper to decode your own genome, more and more medications will be designed just for you, not anyone else. That ges for care of chronic illness, too.”

“As people live longer with chronic medical conditions, we hope to continue to have conversations with seniors across all phases of their life to best support them in living their lives the way they want to,” says Duran. “So that people can get the type of care and services that meet their specific goals and wishes.”

Meanwhile, as more and more people step into the afternoon of life, North Bay hospitals continue to make changes and add programs that encourage seniors to become more proactive in taking charge of their health.

 

 

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