Health Care: Caregivers adjust to aging population

April 30--Editor's note: This article was published in the Record-Eagle's Momentum '18 special publication. For more stories from northern Michigan's economic engine click here to read Momentum in its entirety online.

TRAVERSE CITY -- Northwest Lower Michigan's population is getting older, and local health care providers are bracing for rapidly increasing demand for services.

"One of the challenges we've had at the Pavilions is, from time to time, a wait list," said Deb Allen, executive director at the nursing home.

The number of people on Earth aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050, with most of the increase in developing countries, according to the Global Health and Aging report, presented by the World Health Organization.

The world's health care systems will be stressed as the population ages by the increasing incidence of cancer, dementia, obesity, diabetes and rising number of falls.

The Pavilions is responding to the increasing need for health services by bringing the PACE program, an effort to bring health-related services to elderly people who want to keep living at home, into the area. The Program of All-Inclusive Care for the Elderly will open locally in about a year and will offer a variety of services.

"Our mission is to provide accessible, trusted and compassionate care that enhances quality of life for aging adults," said Kory Hansen, administrator and CEO of the Pavilions. "We see ourselves as advocates for the area's aging population, especially those for whom the cost of care will exceed their resources. No one should be denied care because of an inability to pay."

Baby Boomers are becoming geriatrics at a feverish rate. As a result, chronic conditions that tend to strike the elderly are becoming more widespread. Heart disease, cancer and other chronic conditions are striking an increasingly large portion of the population.

"Over 70 percent of our (cardiology) patients are in the Medicare age group ... over 65," said Dr. Dino Recchia, chairman of the Department of Cardiology at Munson Medical Center. "The number of people in that age group is expected to go up dramatically. It's supposed to go up by at least a third."

"If you look nationally, the number of people over the age of 65 is expected to almost double over the next 30 years," Recchia said. "That's the group of patients that makes up the overwhelming majority of people who have heart disease. So delivering care to that group of patients is a challenge."

Chronic Care Management

Nurse practitioner Julie Hartl started her Chronic Care Management business in 2014 after working for Munson for 14 years.

"We're basically targeting patients that fall through the cracks, people that don't qualify for hospice -- they have chronic illnesses, they tend to frequent the emergency room," she said. "We tend to see patients that are older or disabled. They have issues like cancer, heart disease, heart failure is a big one, lung disease. Dementia is another large population.

"I was trying to find a way to reach out to the community more. The hospital work is great for the patients that need the care acutely," said Hartl. "There's a large population that are in their homes, they're stable but things arise and they don't want to go to the hospital -- they're not quite that ill, or they don't know when to go to the hospital. That population usually ends up getting quite sick, and those things are preventable."

Chronic Care Management sends caregivers to those folks at home, and helps arrange medical visits when required. The company typically bills through insurance companies in much the same way as doctor's offices.

Hartl worked alone in 2014 and had 40 patients. The business now has 650 patients and 25 employees including nurses, office workers, dietitians and a social worker. The business has staff on call 24/7. About 60 percent of Chronic Care's patients are age 70 or older. The business grossed more than $1.1 million in 2017, Hartl said.

Chronic Care Management is growing, she said, because the company targets the growing population of older but healthy people: Boomers who are well enough to live independently, but generally have multiple health issues. Her goal is to keep clients as healthy as possible and to deal with minor issues before they become major.

Attitude adjustment

Medical workers need to adjust their mindset when working with the elderly.

"They're very complex, many have several morbidity factors ... at the same time," said Dawn Halleck, nursing manager on a general medical unit at Munson Medical Center.

She helps run training programs for nurses and nursing assistants designed to help staff more effectively deal with geriatric patients.

"We do a lot on how medication effects are different in the elderly," she said. "They're more sensitive to doses. They might have different side effects."

Munson introduced extra training on working with geriatric patients some time ago.

Part of that focus is making staff more aware of whom they're dealing with. Halleck has used her 104-year-old grandmother as a teaching aid during training sessions. The centenarian lives independently, walks without any aids, rides a bicycle to church, attends exercise classes three times a week and likes to bake. But that wouldn't be obvious if she arrived at the hospital with a temporary problem.

"If you put her in a hospital bed, she would look frail," said Halleck.

Health care workers need to "look past the hospital gown" to see the individual, she said.

Hospitals are admitting patients with more acute conditions than in the past.

"What I see with patients is, they're more sick. They go into the hospital more sick," Hartl said.

Heart disease

Doctors today can treat problems associated with aging in ways that weren't possible just a few years ago.

"We can do things now we never could do before: stents, pacemakers, oblation, less invasive things," said Recchia. "The choice of treatment of cardiovascular disease is amazing."

The availability of more effective treatments has resulted in better outcomes.

"So people live longer, well into the 80s, with leftover problems related to their original the issue," Recchia said.

The older a person gets, the more likely they are to have multiple chronic problems. After one problem is treated, other issues remain.

"We see a lot of heart failure and a lot of atrial fibrillation, rhythm problems."

"The number of people who require services is growing rapidly," said Recchia.

The nation, and Munson, has so far been able to deal with that increasing demand for services by adding nurse practitioners and physician assistants, who can help doctors manage patient treatments. Munson, he said, in the last five years has doubled the number of such advanced practice providers.

"We've gone from the individual model to a team-based model," said Recchia.

Cancer

About 23 percent of people living in Munson's service region are 65 or older, said Kathleen LaRaia, executive director of oncology services for Munson Healthcare. The statewide figure is 17 percent. That means northwest Lower Michigan is likely to see more cancer patients than other parts of the state. And the trend continues.

"That means the incidence for cancer will increase," she said.

The Cowell Family Cancer Center currently hosts about 300 patient visits per day. The facility is accepting 412 new patients per year. Projections suggest it will see more than 2,000 new patients in the next five years, LaRaia said.

Munson also provides cancer-related clinical visits at several of Munson's regional facilities.

Insurance effects

Better health care over the last few decades has resulted in more people living longer -- and with better health -- into what used to be called old age. Longer lives translate into increased health care costs.

"We've got very healthy people in the prime of life, and they're entering Medicare with a vengeance," said Krischa Winright, senior vice president for Senior Health Services.

Like all of society, health care is adjusting to the aging of the Baby Boomer generation.

"We had to build schools for the Boomer generation," Winright said. "They're very used to having society adjust to them."

Our health care system, including insurance companies, must accommodate the growing number of Boomers entering retirement.

"People are living longer, but they're also living longer with chronic disease," said Winright. "Blue Cross Blue Shield of Michigan has not only invested in resources, but in technology to target the aging population."

"All of the best of health care you will see focused on seniors in the coming years. You will see a lot of innovation."

By The Numbers

650

The number of patients currently served by Chronic Care Management's 25 employees. The business started in 2014, when founder Julie Hartl served 40 patients.

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