Caring for the Aging Adult: Insights from a Geriatric Nurse Care Coordinator

Posted by Donna Mae Scheib on September 15, 2017

Caring for the Aging Adult: Insights from a Geriatric Nurse Care Coordinator

Dana Van Scoy has worked at Nebraska Medicine for the past 25 years as a registered nurse. She received her BSN from Clarkson College located in Omaha, Nebraska, and recently served as a nurse care coordinator for the Internal Medicine Geriatric Clinic at the Home Instead Center for Successful Aging at the University of Nebraska Medical Center. This clinic comprises 10 internal medicine doctors that specialize in geriatrics, from the healthy 65-and-older adult to the most advanced Alzheimer’s dementia patient. Senior Living Link was able to talk with this nurse care coordinator to highlight details of a geriatric clinic visit.

Senior Living Link: What is your role as a nurse care coordinator at a geriatric clinic?

Dana Van Scoy, RN, BSN: I coordinate care of patients in between their clinic visits. For example, medication refills, coordinating home care for patients for physical therapy, occupational therapy, home health skill nursing, bath aides. Also, I help them to find durable medical equipment that they need for their homes such as walkers, wheelchairs, lifts, etc. I help caregivers with their stress and help them fill out family medical leave act paperwork. I fill out long term care insurance so patients can get the maximum use of their benefits. I listen, because some patients do not have anyone else to talk to about their problems or even about their life. I participate in clinic office visits and discharge patients with their clinic visits for instructions from the provider so patients understand medications and how to take them, when to take them, and when not to take them.

Senior Living Link: What is the most common reason patients come to your clinic?

Dana Van Scoy, RN, BSN: Our clinic is specialized in aging adults, including patients that have more complex issues. There is a certain understanding as a geriatric clinic of the comorbidity that is associated with advanced age. Our clinic has the ability in specializations to further understand patient’s needs, whether it is their medical needs, safety needs, or economical needs. We are also able to take more time with patients.

Senior Living Link: What is a typical initial visit like?

Dana Van Scoy, RN, BSN: Initial visits are typically a 90-minute scheduled visit. The first 30 minutes is with the nurse where measurements are taken for height and weight as well as a sitting and standing blood pressure. The sitting and standing blood pressure is important for aging adults because the resting blood pressure is normally a significant difference from physical activity, such as when they walk back from the waiting room to an exam room.

Then, typically a functional screen is taken for a new patient that consists of a small eye check, hearing assessment, and a mini cognition exam. The mini cognition consists of a series of instructions to see if further assessment is needed for cognitive ability. For example, we will have patients repeat three words that we list and have them repeat it back a few minutes later to see what they can remember. While they are waiting to repeat the words, patients will be instructed to draw a face of the clock where we have them put all of the numbers in it and ask them to draw in a set time. We are looking for all of the numbers to line up, so that they are horizontal (so the 12, 6, 3, and 9 line up) and that the short and the long hand are distinctly different. Depending on what they are able to remember for the words and draw for the clock, further assessment may be used, and we typically use the Montreal Cognitive Assessment (MoCA). This assessment looks at visual, spacial, naming of things, memory, attention testing, language, abstraction, delayed recall, and orientation.

Then, the doctor comes in for the remaining 60 minutes of the visit. They will go over the history of present illness, past medical history, review medications, conduct a range of systems assessments (from head to toe), and formulate a patient plan for any further testing. In the geriatric clinic, a big focus is on polypharmacy. A goal is to try to reduce any unnecessary medications for patients. There are also social workers available during the visit for the needs of the caregivers or patients in a social or economic situation.

Other types of visits in a geriatric clinic include the following:

• Geriatric Assessment Clinic: A couple of days a week in our clinic there is an option for a four-hour appointment through our geriatric assessment clinic. This type of clinic follows a national model in geriatric care. This is considered a consult visit so the patient may be there on a self-referral or from another medical doctor requesting further testing. The patient will see a clinical psychologist, a geriatric psychiatrist, pharmacy, and the geriatrician. There is normally a follow up visit a couple of weeks later where it is encouraged that the patient, the caregivers, and the family members are all present so that everyone is on board with the results.

• Follow Up Clinic Visit: These are visits after the initial visit where continuing care of the patient is implemented with review of medications and patient status. These are typically 30 minutes long. For the aging adult, focusing on a longer time allowance for a visit is very helpful so the patient does not feel rushed and they are able to think and ask questions as well as process the doctor’s answers.

• Yearly Wellness Visit: Medicare will pay for a yearly initial wellness visit which is 60 minutes in length and the visit goes through basic preventative medicine review. There is also the option for a subsequent wellness visit for 30 minutes.

Senior Living Link: What do you like about geriatric medicine?

Dana Van Scoy, RN, BSN: I have always loved geriatrics because they have the best stories. They have lived. Is it hard to care for dementia patients? You really have to put yourself in their place. It’s a disease that right now cannot be cured. There are medications that help you have more good days than bad days, but these people can’t help it nor can they control it. I have multiple phone calls a day with the same people but it’s their reassurance.

Senior Living Link: Do you have any advice for caregivers struggling with taking care of an aged loved one?

Dana Van Scoy RN,BSN: Try not to get angry or provoke a stressful situation. If you are frustrated, step away and ask for help. Safety is the biggest concern in the home environment for an Alzheimer’s dementia patient.