Program Weaves Single Web of Care for Elderly Patients

By Lewin, Tamar | THE JOURNAL RECORD, February 16, 1994 | Go to article overview

Program Weaves Single Web of Care for Elderly Patients


Lewin, Tamar, THE JOURNAL RECORD


COLUMBIA, S.C. _ After Rosa Alston had her second leg amputated, her surgeon began making arrangements for her to go to a nursing home.

But Alston, a 73-year-old widow who lives alone, would have none of it. Instead, she signed up for Palmetto Senior Care, a comprehensive-care program for frail elderly people based on a San Francisco model that is winning support among health policy makers nationwide.

Palmetto social workers helped Alston find and move to an apartment that she could navigate in her wheelchair. On Mondays and Fridays, Palmetto sends an aide to clean the apartment and to help her bathe. On Tuesdays and Thursdays, the Palmetto van takes Alston to the program's day center, where she plays Bingo, makes crafts, eats lunch, leads a Bible discussion group and is monitored for her diabetes and other health problems.

When necessary, Palmetto doctors make house calls. And when Alston's dog, Skippy, got fleas, Palmetto paid to remove them.

The program, which requires participants to sign over their Medicaid and Medicare policies, is free of charge for Alston, as long as she uses its doctors and nurses. And for Medicaid and Medicare, which pay its costs, the program is less expensive than care in a nursing home.

Palmetto and the eight similar programs across the country are an ambitious effort to weave medical care, home care, social services and case management into a single web of care. They are modeled on the 20-year-old On Lok center for frail elderly residents of San Francisco's Chinatown.

Unlike most other health plans for frail elderly Americans, these programs assign participants to a day center, where a team of doctors, nurses, social workers, therapists, nutritionists and pharmacists decide what services each person needs. The centers are small, allowing for individual attention. Palmetto's day centers _ one in a strip shopping center, one in an office building and one, for people with dementia, in a converted home _ serve a total of 200 people.

"This is what medicine is supposed to be like," said Dr. Paul Eleazer, the medical director of Palmetto, which is affiliated with Richland Memorial Hospital here. "It's taking care of people without worrying about funding sources, or malpractice, or inpatient-outpatient. All you have to think about is whether this is the best way to care for this patient."

The On Lok model, whose name comes from the Chinese words for "peaceful" and "happy," may be expanded to statewide use in both Massachusetts, where it has started in East Boston, and New York, where programs exist in the Bronx and Rochester. …

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