Dartmouth-Hitchcock initiative aims to offer better geriatric care

  • Daniel Stadler, Dartmouth-Hitchcock's director of geriatrics, right, speaks during a press conference announcing the establishment of a new $4.5 million geriatric emergency department with a contribution of $3 million from nonprofit West Health at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., Wednesday, Oct. 23, 2019. West Health President and CEO Shelley Lyford, left, and D-H emergency medicine section chief Scott Rodi, middle, also spoke at the event. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. AP — James M. Patterson

Valley News Staff Writer
Published: 10/23/2019 10:08:38 PM
Modified: 10/23/2019 10:08:33 PM

LEBANON — Dartmouth-Hitchcock announced plans on Wednesday to partner with a California-based nonprofit to make visits to the emergency department more helpful for people over age 65 and to reduce the need for subsequent visits.

Through the $4.5 million collaboration with the La Jolla-based West Health, D-H aims to gain accreditation as a geriatric emergency department from the American College of Emergency Physicians by training staff to improve screening of older patients for social as well as medical needs and to connect them with resources to better manage chronic conditions and health at home.

The initiative involves consultations with providers using video technology in the hospital, aka telemedicine.

For frail seniors, trips to the emergency department can be a “double-edged sword,” said Dr. Daniel Stadler, D-H’s director of geriatrics, during a news conference on Wednesday at Dartmouth-Hitchcock Medical Center.

Though such patients are glad to have access to skilled medical providers, when they arrive in the emergency department they may not be thinking clearly and struggle to provide accurate information about their condition, what brought them to the hospital and what their home lives are like, Stadler said. That lack of clarity can lead to lengthy waits and cause providers to order unnecessary tests, which may increase the patients’ agitation, he said.

In contrast, Stadler said he hopes that the geriatric emergency department will help such patients get what they need by improving the way providers assess and address their medical needs in the context of their age, desires and any social challenges they might face such as transportation, housing and home care.

“I am just really excited to be moving forward with this,” Stadler said.

In creating the geriatric emergency department, D-H will join a group of 103 hospitals around the country that have earned such accreditation so far.

D-H, however, aims to be the first rural academic medical center to establish such a program. In this first year of the program, D-H plans to get the geriatric emergency department up and running at DHMC in Lebanon. In the subsequent two years, the organization aims to use telemedicine to expand the program, serving as a hub for rural hospitals to connect with specialists such as geriatric social workers.

Hospital officials said they have not yet determined which critical access hospitals will be the first four to participate in the telemedicine program.

Maine, Vermont and New Hampshire have the highest median ages in the country. In addition, Vermont and Maine have the highest percentages of seniors living in rural areas in the country, according to U.S. Census Bureau data. In Vermont, more than 65% of seniors over 65 live in rural areas, and in Maine nearly 63% do. New Hampshire ranks lower in this category but still has more than 43% of seniors living in rural areas.

West Health, which is focused on reducing health care costs and helping people age well, is contributing $3 million to the project. Led by Chelsea native Shelley Lyford, West Health consists of three related nonprofit organizations that were founded beginning in 2006 by Gary and Mary West after they retired from running West Corp., an Omaha, Neb.-based communication company.

Last January, West Health established its own senior emergency care unit at the University of California, San Diego Health, said Lyford, a 1993 graduate of Chelsea High School. West Health will share lessons it learned with D-H leaders as they go about establishing their own geriatric emergency department.

Overall, the goal is to “connect seniors to the resources in their own communities that are appropriate for their care needs,” Lyford said during the news conference. In doing so, Lyford said hospital admissions and costs can be reduced and beds can be freed up for those who need them most.

State Rep. Polly Campion, D-Etna, a former D-H nurse who now serves on the House Health, Human Services and Elderly Affairs Committee and as chairwoman of the newly formed state Commission on Aging, said she knows from experience the importance of seeing patients’ medical needs in the full context of their lives.

For example, Campion said that while she was working as a community health nurse making home visits, one of her patients was an 88-year-old woman with congestive heart failure. Had the patient gone to an emergency room, she most likely would have been admitted to the hospital. But providers might not have realized that she also was needed at home as the primary caregiver for her 90-year-old husband with Alzheimer’s disease and for her 50-year-old son with Down syndrome, illustrating the complexities the new program hopes to navigate. The woman ended up dying one month after her husband, Campion said.

Campion said she hopes the work of the geriatric emergency department will help “improve care for those individuals.”

D-H CEO Joanne Conroy said the new emergency department is just one element of the work that needs to be done to care for the region’s aging population. Conroy noted that the continuing care community Kendal at Hanover runs an embedded medical clinic staffed by D-H providers, and, as a consequence, residents there don’t need to be admitted to D-H as often as people in other facilities.

“That’s a model that we need to continue to build on,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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