RURAL CENTER FOR GERIATRIC EXCELLENCE

COMMUNITY DESCRIPTION

Canby, Minnesota, is approximately 150 miles west of Minneapolis. It is located in Yellow Medicine county, which borders South Dakota on the west. The town’s population is about 2,000 and the county’s 15,000. The entire area is very rural. Nearly one in four residents is over 65, and twice as many older adults live below poverty level than any other age group.

BACKGROUND HISTORY OF THE PROJECT

Many of this area’s senior services are provided by agencies based far from Canby. The Area Agency on Aging (in Appleton) and the state social services office (in Granite Falls) are both 45 miles away, and the five-county public health office (in Benson) is 60 miles. Virtually all services require a long-distance phone call, which means distance and time are factors in most transactions. These logistics often result in a maze of disjointed services that are of little value because they are unknown or inaccessible.

Just over three years ago, the board and staff of Canby Community Health Services (CCHS) created an urban health care delivery model in a rural environment. The Rural Center for Geriatric Excellence was modeled after the Geriatric Health Institute of Sioux Valley Hospital, Sioux Falls, South Dakota. The local group received a $20,000 federal Rural Health Transition grant to hire a program administrator and operate the Center for the first six months. Office space and basic supplies were furnished by the CCHS.

Canby Community Health Services is the governing organization that oversees the town’s health care facilities. It began in 1957 with formation of the hospital district. Today, it includes the hospital (27 beds, with swing beds), a 75-bed nursing home, a 19-unit adult congregate living facility, a medical clinic (three family practice doctors, an internist, and two physician’s assistants) and a home health care agency. The first three structures are located on the same campus, while the latter is several blocks away. A new building on site will physically unite all 200+ employees of CCHS. This organization is affiliated (by lease) with the Sioux Valley Hospital in Sioux Falls, South Dakota.

PROJECT INITIATIVE

“The Rural Center for Geriatric Excellence is a coordinated, comprehensive continuum of services designed to meet the social, psychological, and health needs of an aging population in the rural setting.” This is a holistic health care approach, i.e., one that views the entire person within the environment. Each individual receives a comprehensive interdisciplinary geriatric assessment.

This approach is interdisciplinary. The TEAM includes a physician, geriatric nurse specialist, pharmacist, dietitian, therapist (physical and/or occupational), human services professional, and other health care professionals (e.g., mental health specialist), as needed. Each interviews the client separately. In addition, local family members and close personal friends are queried regarding the client’s health and well being. With this extensive interview process, the assessment may take four hours or more. Afterwards, the TEAM members compile their reports and make specific recommendations. The final report is presented by the full TEAM to the client, family members, and others. Recommendations may include the need for legal services, financial assistance, home health care, podiatry, ophthalmology, audiology services, etc. This comprehensive report helps the individual plan ahead so that their remaining years can be more enjoyable and productive.

Each comprehensive geriatric assessment is composed of: 1) case identification by a family physician, social services, nurse specialist, or self-referral, 2) assessment, recommendations, and planning, 3) coordination and referral, 4) implementation of services, and 5) monitoring, evaluation, and follow-up. Health, social, and community needs are addressed by the TEAM.

The Geriatric Center’s primary goal is to assess each individual’s capacity to maintain an independent life style. The entire CCHS organization actively sponsors community wellness and disease prevention programs that help individuals change their habits early to prevent avoidable disabilities. Finally, the Center works with many local groups, such as the ministerial association, Lutheran Social Services Older Adult Programs, the Yellow Medicine County Senior Advocate, the Area Aging Network, the Sioux Valley Hospital, and the Southwest Minnesota Arts and Humanities Council, to find ways to better meet the needs of the elderly. Many of the team’s recommendations or referrals can be handled quickly and locally.

Referrals may be made by a local physician or self-referral. In either case, a complete written report is given to the client’s family physician.

FUNDING

The small start-up grant was not meant to sustain the program through its formative years. Rather, it was anticipated that assessment charges would cover the cost of staff time with some margin. Initial assessments were priced at $650, and it was believed that Medicare would reimburse this amount. As things evolved, the Geriatric Center was only being reimbursed approximately one-half this amount. However, “now entering the second full year of operation, budgeted expenses still exceed projected revenues. The entire payment framework isn’t there and we’re waiting for payment mechanisms to catch up”. Nevertheless, the administrator hopes it is positioning itself for the managed care environment when it reaches the rural area.

CHALLENGES

Even with assistance from the Sioux Valley Hospital, the biggest challenge was just knowing where to start. Although the Geriatric Center was a part of CCHS, how should it be marketed? Should it have a separate identity or be an integral part of CCHS?

An advisory board was created to assist in the promotion of the Geriatric Center. In a conversation with the contact person, it was stated this body could have been utilized more fully to assist in promoting the concept.

CURRENT STATUS

On May 1, 1997, the Rural Center for Geriatric Excellence, as such, ceased to exist. The primary reason was financial. There were not enough individuals being assessed to cover operating costs. In fact, the program was losing money. In order to break even, roughly two dozen individuals would have had to be screened per year. During the 1996-97 fiscal year, the Center saw fewer than ten.

Nevertheless, the administrator indicated there were several key features of the Rural Center for Geriatric Excellence that made it unique. First, it attempted to consolidate administration of all geriatric services. Second, it provided a comprehensive assessment for each individual, which will still be useful for that individual’s health management and may provide data for comparison with the future health initiatives provide data. Finally, this program should be fairly easy to replicate.