Spring 2014
Geriatric care that never grows old

Angelina Rende is among the scores of seniors who rely on the care provided by Bridgeport Hospital’s geriatrics team.

They are frail and elderly. They frequently face multiple medical issues treated by a host of specialists who prescribe an alphabet of medications. They are also usually women – patients like Angelina Rende, age 85, and Barbara Moore, 93 – whose lifeline to health care is the geriatrics team at Bridgeport Hospital.

“They give you the best care,” said Angelina, a Bridgeport resident who entered the geriatrics program about four years ago. That care includes a board-certified geriatrician and geriatric nurse practitioner who see her regularly, part of the Geriatric Home Visit Group.

“They come every few months and give me a complete physical,” noted Angelina. “When I was coughing, they even sent in a portable X-ray machine.”

The geriatrician-nurse team also reviews her medications – prescription and over-the-counter – and adjusts them when necessary. “They write down everything, which helps me to remember what I have to take,” she added. “They’re very caring and on top of everything.”

“You can call them any time, which is very convenient,” added Barbara, who lives in a Shelton assisted living community visited by one of the hospital’s board-certified geriatricians. “So, I have a regular primary care doctor.” And if that care requires a specialist, as it did when Barbara required hip replacement surgery, it too is coordinated with the hospital’s geriatric team.

GEMS for geriatric patients
Still another benefit for patients like Barbara and Angelina is the Geriatric Emergency Medicine Service (GEMS), which provides specialized care for patients age 65 and older who are brought to the hospital’s Emergency Department (ED). “Last year I fell and needed stiches on my face and chin,” recalled Barbara. Being part of the hospital’s geriatrics program meant a geriatric nurse practitioner in the ED would help expedite her visit and ensure a thorough exam for other injuries.

Assisted living facilities like Middlebrook Farms in Trumbull, one of six assisted living and 11 extended care facilities in the hospital’s geriatrics program network, make a point of telling new residents about GEMS. “When we talk about the GEMS program, families get excited and they select Bridgeport as their hospital of choice because of it,” said Gale Mayeran, the facility’s executive director.

Gale explained that elderly patients often resist going to an ED from fear of what they’ll experience there and afterward. But when Gale tells them about Bridgeport Hospital’s GEMS program, they’re much more inclined to go.

“Our residents know that they are going to be treated by staff trained in geriatric care and spoken to like adults. That’s not always the case elsewhere.”

The skilled care they receive also means Middlebrook residents will not be placed in another facility to recover. “We trust the program at Bridgeport Hospital,” said Gale. “They understand the needs of the elderly and I know my residents are going to come back home. That’s what our facility is – their home.”

A decade-plus in the making
This trust results from the comprehensive program initiated by Beata Skudlarska, MD, executive director for Geriatrics, and Palliative Care, when she joined Bridgeport Hospital in 2000. What began with a Geriatric Assessment program grew to include the Home Visit Group and GEMS, key elements of the hospital’s geriatrics program, an in-hospital geriatric psychiatry unit and the new Palliative Care/GEMS program (Pall-GEMS), for critically ill patients and those with advanced chronic or terminal illnesses.

The geriatrics program’s annual recognition by U.S. News & World Report since 2011 as a leader in Fairfield County confirms the quality of care provided by Dr. Skudlarska and her experienced staff, along with the strength of the program’s founding principle. “Our program is based on a co-management model,” she explained. “We’re not a direct competitor to primary care physicians. We are respectful of the relationship a patient has with their primary care and community providers, and we work with them to coordinate care for their patients.”

While other area hospitals may offer a similar program, “Ours is more comprehensive,” she added. “What distinguishes our program is that we are the only one in the area that offers such a wide variety of services,” explained Dr. Skudlarska.

“It is seamless care,” added Dori Rogers, RN, manager of Geriatric Services and business development. The communication lines extend from the patient, family member or nurse at an assisted living facility to the geriatric coordinator nurse to the patient’s primary care physician. “It is an entire concert of people with the patient and family at the center,” she added. Patients like Angelina, Barbara and hundreds of others who rely on this care. “We’re their safety net,” noted Rogers.

At the core of this program is the hospital’s Center for Geriatrics, based at 95 Armory Road, Stratford. Here, four geriatric nurse coordinators work with four physicians, each of whom is responsible for a geriatric practice that involves home visits, care at assisted living facilities and interacting with a variety of community-based agencies. These geriatric nurses are available Monday-Friday and there is always 24/7 provider coverage even when the office is closed.

Beata Skudlarska, MD, (left) and Dori Rogers, RN, are members of Bridgeport Hospital’s team coordinating a geriatrics program that is a leader in Fairfield County.
A dedicated, compassionate staff
Coordinating this multifaceted, patient-centered program with Dr. Skudlarska are individuals like Vivian Argento, MD, clinical director of geriatrics; Gina Calder, administrative director, Geriatric Services and Patient Relations; Susan Ott, practice supervisor; Kristin Edwards, MD, clinical director of Palliative Care; and Rogers. They are responsible for overseeing the nearly 1,000 visits each month to geriatric patients in their homes and at skilled nursing facilities, as well as in-hospital and the ED.

“The staff that makes our geriatrics program such a success is a very unique group,” said Dr. Skudlarska. “They are not only highly accomplished with diverse skills, but also compassionate, which they demonstrate each day through random acts of kindness to their patients.”

Angelina attests to that kindness, recalling how a geriatric nurse practitioner did more than provide medical attention during a visit to the Emergency Department. “She also brought me a sandwich and some fruit.”

“That is the rare combination that enables us to offer a geriatrics program the greater Bridgeport community can take pride in and one we intend to continue expanding,” concluded Dr. Skudlarska. Which is welcome news for patients like Barbara and Angelina.

“It’s a wonderful program,” said Angelina. “I would recommend it to anyone.”

Coordinating patient care at the Geriatrics Center are (l-r) Jacqueline Bostick, RN, geriatric care coordinator, with Arelis Margarito and Sharrie Bullock, registered medical assistants.

About our geriatrics program
Since 2011, Bridgeport Hospital continues to rank as a leader in Fairfield County for geriatrics by U.S. News & World Report. Key reasons include our:

Geriatrics team
Bridgeport Hospital’s geriatric specialty services team includes geriatricians who are board-certified in internal medicine, geriatrics and palliative care – which focuses on preventing or easing pain, stress and suffering during an illness – and certified geriatric nurse practitioners and other experienced staff who provide expert care for patients and support for family members.

Geriatric assessment program
This is often the first step to finding the right care. Tests can reveal the reasons for conditions such as depression, memory loss, behavior problems, frequent falls, dizzy spells, side effects from medication and other problems. An assessment includes a personal and family medical history, physical exam, mental evaluation, medication review and a questionnaire for family members. Psychiatric conditions are treated through Bridgeport Hospital’s Psychiatry department.

Once the cause is determined, staff chart the best solutions and communicate with a patient’s primary care physician regularly to achieve best results.

Geriatric home visit group
The home visit group brings the care housebound older adults need into their home. The group functions like the patient’s primary care physician.

Services include a thorough geriatric assessment and follow- up visits by geriatricians or nurse practitioners, who alternate visits to ensure they both know the patient well. If hospitalization becomes necessary, the Geriatric Emergency Medicine Service (GEMS) expedites admission.

GEMS program
This program provides specialized care for patients age 65 and older who arrive in Bridgeport Hospital’s Emergency Department (ED) between 9 am – 7:30 pm, Monday-Sunday. A specially trained GEMS nurse practitioner explains any testing required, then coordinates treatment with the ED doctors and expedites admission, if necessary.

Services in extended care and assisted living facilities
Geriatric specialists also serve as attending physicians in many area nursing homes and assisted living facilities. The facility’s case management or admissions coordinator can help make arrangements.

Palliative Care-GEMS program
The new Palliative Care/Geriatric Emergency Medicine Services program (Pall-GEMS) is a joint effort of the Medical and Surgical Intensive Care units and Emergency Department. Open to all critically ill patients and those with advanced chronic or terminal illnesses, the program focuses on meeting with families and patients to discuss care goals and to improve the patient’s quality of life and safety.

For more details about Bridgeport Hospital’s geriatrics program, call (203) 384-3388.