We Are All Living in a Medical Neighborhood (Part 1)
The Medical Neighborhood is an emerging concept meant to address all the care needs of an individual. The Medical Neighborhood – a group of providers in, literally, the geographic area of the patient and the patient’s family – will identify and coordinate all medical and non medical resources available to manage issues which impact a patient’s health. The aim is to improve clinical outcomes, provide a more satisfying experience of care for both patients and providers, and reduce care costs.
What does the Medical Neighborhood mean for older persons and how will it improve the experience of care they receive from their Medicare providers? Actually, it is part of a larger concept called The Patient-Centered Medical Home that the U.S. Centers for Medicare & Medicaid Services is promoting as a future model for the delivery of care to people on Medicare.
In a Patient-Centered Medical Home, a Primary Care Provider (PCP) is responsible for providing “whole person care.” Under this model, the medical provider is challenged to engage an individual in managing more of his or her own care, to make shared decisions about care with that individual, and integrate with non-medical service providers to support the individual’s efforts. The individual is challenged with knowing how to manage optimum health between office visits and staying out of the hospital.
The Medical Neighborhood includes medical specialists, pharmacies, behavioral health, residential care facilities, non-medical home care providers, and other community resources. Working together, this group will educate and guide the individual in the direction of getting all their care needs met. To ensure that the individual receives optimal care, the Medical Neighborhood strives to meet psychosocial needs, address social and environmental factors that impact the individual’s health and well-being, and address financial and legal aspects that enhance or create barriers to care.
As an essential member of the Medical Neighborhood, the Elder-Centered Law Practice should have a presence early in an individual’s care plan. Within the Medical Neighborhood itself, an Elder-Centered Law Practice is regarded as a specialty: a team of nurses, social workers, licensed therapists, public benefits specialists and attorneys, under one roof, experienced in helping individuals find, get and pay for quality care.
Here is an example of a common situation many older adults and their families face. Frank, 87, is a frail man who has been diagnosed with Alzheimer’s disease. Living by himself at home, Frank is functionally dependent upon his overwhelmed son, Paul, to bring him his groceries, take him to the doctor, pay his bills, and get his medicine.
Is Frank living in a Medical Neighborhood? Where Frank lives – that is, whether or not he lives in a Medical Neighborhood – affects how successfully he and his son Paul will manage his care. That is the subject of our next issue of Elder Law FAX.