Donna Goodaker

More Options than Ever Exist for Senior Patients

With the implementation of the Tennessee Long Term Care Community Choices Act of 2008, services to seniors broadened. While the law fundamentally restructured the way TennCare was allowed to deliver services to the elderly and those with physical disabilities, it also opened up new options to those outside the Medicaid umbrella.

Today, the state is seeing a significant expansion in home- and community-based services that are being accessed by private pay and self pay patients, as well.

While skilled nursing facilities are still an integral part of the continuum of care, the expansion of services has created a middle ground between living completely independently and residing in a nursing home. By having more options to access assistance at lower levels of acuity, many seniors are able to stay in their own homes longer.

Progress Inc., which was founded in 1971 to assist adults with intellectual disabilities, added senior services when the TennCare waiver was expanded under the 2008 law. Executive Director Donna Goodaker said what her organization realized was that the supports they had already put in place to fill the gaps in services for their core market closely mirrored the types of non-clinical services needed for seniors to age in place. “Philosophically, we’re very committed to people being as independent as possible,” she said, adding that the expansion of services was also made available to those who have suffered traumatic brain injury.

Under the TennCare waiver, individuals have to qualify financially and then have a set of services authorized by the assigned care coordinator through one of the state MCOs. Often, Goodaker said, it is “those very basic things that make the difference in being able to stay in your home or not” —assistance with daily activities including house cleaning, grocery shopping, laundry, making sure prescriptions are filled, bathing and dressing.

“Our job is to keep the people we support happy, healthy and safe. If there is a way to do that to allow people to hold onto the highest level of independence without institutionalization, that’s such a good thing,” she continued. “You ought to be able to stay in your home whether you’ve gotten old or not.”

Goodaker was quick to add nursing homes play an important role in the delivery of care but noted it is equally important for seniors and those with disabilities to have other options, too. “It is so good for Tennessee to have a continuum of services and to continue to broaden those.”

Often these additional services are available to residents of assisted living, as well. The added support might allow an individual to stay at the lowest … and typically least costly … level on the assisted living spectrum or keep spouses with varying needs together.

The good news is a broad range of service providers have been established or, like Progress Inc., have expanded offerings to meet the rising demands of an aging population. However, while more options now exist, knowing what is available and what is appropriate is often overwhelming for family members and caretakers. It’s one of the key reasons Stephen J. D’Amico, MD, CMD, FACGS, formally launched the Center for Older Adult Healthcare (www.cfoac.net) in September.

Through his Franklin-based practice, Cornerstone Medical Group, it became apparent to D’Amico, who is board certified in internal medicine and a Fellow of the College of Geriatric Specialists, that family members of his patients often didn’t fully understand the ramifications of a diagnosis. Through conversation, he said, “I would find the caregiver didn’t have enough information about the disease process.”

Through the Center for Older Adult Healthcare, D’Amico continued, “We’re trying to make it a true geriatric assessment and planning for the families.” Currently, he noted, a range of services exist but are often piecemealed making it difficult for an individual to know all the options available to seniors. The goal of the center is to provide a coordinated team approach that is individualized to a patient’s specific needs and situation.

D’Amico serves as the center’s medical director. His wife, psychologist Annita Kerr-D’Amico, EdD, is executive director, and Lynetta Thomas is the administrator and care coordinator. However, the core team has partnered with a network of specialists ranging from home health experts and hospice providers to attorneys and pharmacists to equip caregivers and family members with the information necessary to allow an elderly patient to age with grace and the right level of care.

Following a physical and cognitive assessment, the center’s team approach could help families and individuals with residential options, disease education, multiple medication management, in-home service options, living wills and advance directives, geriatric care management, Alzheimer’s care and planning, and counseling services for the caregiver and/or aging adult.

“We’re family centered,” said D’Amico. “We’re really helping the caregiver navigate the system to the best advantage of their loved one.” He was quick to say this service is not designed to supplant the primary care physician but to support the medical team already in place. “As the healthcare dollars shrink, the time frame of how long you can spend with patients is going to shrink, too,” he noted. D’Amico added the Center’s team members and community network have the luxury of spending that extra time explaining options and then preparing a report for the primary care physician. 

As Tennessee continues to expand the continuum of care for seniors, more options for aging gracefully are sure to follow. Considering estimates from the U.S. Department of Health and Human Services Commission on Aging anticipate the number of adults over the age of 65 will double by the year 2030, caring for our oldest citizens will require an ‘all hands on deck’ approach in the coming years.

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