Clinical initiatives at Yale include the Dorothy Adler Geriatric Assessment Center, a special Acute Care for the Elderly Unit at Yale-New Haven Hospital, a innovative co-treatment program in General Surgery at the West Haven VA Hospital, and a number of consultative programs at the VA Hospital. The NEMG-YNH Geriatric Services cares for individuals in life care centers, assisted living facilities, and skilled nursing facilities.
Dorothy Adler Geriatric Assessment Center: Appointments, Cancellations, and Information: (203) 688-6361
Under the direction of Dr. Richard Marottoli the Dorothy Adler Geriatric Assessment Center at Yale New Haven Hospital is an outpatient consultative service that provides comprehensive assessment of older persons. The Adler Center uses a team approach to work with persons who have medical, psychological, cognitive, or social problems impeding function or threatening independent living. The staff at the Adler Center includes geriatricians, geriatric psychiatrists, nurse case managers, patient care assistants, physical therapists, and neuropsychologists. The staff works closely with the patient and the family, the patient's physicians, and other care providers to develop a comprehensive plan to help optimize function, independence and quality of life. The Adler Center helps patients and families by developing linkages with appropriate community services such as home health care agencies, adult day care centers, and volunteer support groups. Moreover, the staff at the Center provides ongoing case management and clinical care as necessary for individual patients, in conjunction with the patient's physician. Finally, the Adler Center serves as an important educational site for interns, residents and fellows in geriatric medicine, as a leading model for other institutions who are developing geriatric programs, and as an important site of patient oriented research in geriatrics.
Yale Acute Care for the Elderly (ACE) Unit
The Acute Care for the Elderly Unit at Yale-New Haven Hospital provides a model of interdisciplinary care for older patients at Yale-New Haven Hospital. It is a major site for teaching resident physicians and medical students about the care of the frail elderly. Two teams are localized on this Unit, the Cooney medical team, which consists of two resident physicians, two interns, and two medical students working with one Geriatric attending physician and a Hospitalist team, in which two physicians and physician associates manage the Hospitalist patients on this Unit. Interdisciplinary Rounds are held twice a week for both of these teams. A team of physicians, nurses, physical and occupational therapists, care coordinator, dietician, and social worker meet to review the goals and status of all the patients on the Unit. The goal of this Unit is to develop clinical interventions which can be implemented throughout the hospital to improve the care of the frail elderly patients. The first initiative on delirium has been implemented throughout the medical units throughout the East Pavilion. The approach on this Unit is focused on the function of older individuals and to review daily the “geriatric vital signs” of mobility, mental status, continence, nutrition, and integrity of the skin. The attending physicians review daily with the resident physicians and nursing staff the goals of care of each individual. This Unit has become a major teaching site for geriatrics for resident physicians in Internal Medicine at the Yale Medical Center.
NEMG-Yale New Haven Geriatric Services
The Yale New Haven Geriatric Services, led by Drs. Leo Cooney and Lisa Walke, provides primary care for residents in four local nursing homes. Yale-New Haven Hospital, in conjunction with the Section of Geriatrics, developed this program in order to fulfill three goals: 1) to provide high quality subacute, transitional care to patients discharged from Yale-New Haven Hospital and other area hospitals; 2) to provide excellent models of care for residents in long-term care; and 3) to create a new environment for teaching medical students, resident physicians, and fellows care of these complex older patients. Physicians on the full-time and part-time faculty, working in conjunction with nurse practitioners and physician assistants, care for 450 short and long-term nursing home residents. Physicians in this practice are working with Yale Geriatric Investigators in studies to improve nursing home care.
In-Patient and Out-Patient Geriatric Consultation
Under the direction of Drs. Terri Fried and Chandrika Kumar, the geriatrics faculty work in coordination with nursing and pharmacy to provide a multidisciplinary approach to the care of older adults. Providers caring for adults 70 years of age or older admitted to the acute surgical, medical, neurologic, or psychiatric services may request geriatrics consultation on behalf of their patients for a variety of services including comprehensive geriatrics assessment, falls evaluation, medication management and disposition planning. Ambulatory patients may be referred to the geriatrics consultation clinic for a wide range of services including pre-operative geriatrics assessment, cognitive assessment, evaluation of driving ability, needs assessment, and suitability of living arrangements. Medication counseling and reconciliation by the geriatrics pharmacy team is incorporated into outpatient visits. Select patients may receive follow-up evaluation in their homes. The consultation service strives to meet the needs of the entire family unit so caregiver burden is assessed and addressed by the geriatrics nurse practitioner. Regardless of the site of care, the geriatrics consultation service works closely with social work and care coordination to optimize care for all older adults.
Home Care and Hospice
Home visits with members of the interdisciplinary home care team (nurses, social worker, pharmacist, and dietician), see patients needing urgent intervention for a diverse array of problems including rehabilitation, disease management for congestive heart failure, diabetes, and other chronic diseases in exacerbation, wound care, and palliative care. The VA Connecticut Advanced Illness Management Team see both inpatient and home hospice patients for evaluations, palliative therapies, and end-of-life decision-making.