For elderly, homebound or immobile patients, access to medical care can be challenging. A new, innovative service, founded by a Mississippi University for Women assistant professor of nursing, is bringing health care into the home.
Working as a complement to a patient’s primary care physician, the Golden Triangle Geriatric Collaborative, developed by MUW’s Mary Atkinson Smith, delivers in-home health care services by a staff of board-certified nurse practitioners. Patients are referred by hospitals, nursing homes, case managers, insurance companies, family members, and a variety of other sources.
A Louisville native and MUW graduate who earned a doctorate of nursing at the University of Alabama, Smith said she saw a need in the Golden Triangle.
“I watched the decline of my own grandparents, and I saw there are gaps especially for elderly, high-maintenance patients,” she explained. “I wanted to do something to help.”
She spent nearly nine months developing a business plan and protocols that includes affiliation with a collaborating physician — something required by law. Patients with Medicaid, Medicare or other insurance qualify for assistance.
GTGC, now about three months old, was formally approved by the Board of Nursing and the Board of Medicine. Clinical staff members include Smith and five nurse practitioners, four of whom are on faculty at MUW. The group recently also has added a registered dietician. “Diet plays a huge role in chronic illness,” Smith explained.
“We work closely with primary care providers to provide increased access to health care for their homebound elderly patients,” Smith said. But care can start even earlier, when a patient is hospitalized.
“We are able to work with hospitals to provide transitional care to patients prior to their discharge and follow the patient into their post-discharge setting to ensure continuity of care and encourage compliance,” Smith said.
In patients’ homes, she added, “We can offer home safety evaluations, routine lab work, assistance with renewal of medications, administering annual flu shots, and other procedures.” The program also sees patients who are receiving services from home health and hospice agencies, and patients residing in nursing homes, in addition to assisted living facilities.
Honey Johnson, 88, a longtime Starkville resident, now lives in Trinity Place Retirement Community in Columbus. “When I ran into Mary and learned about this program, it seemed like an answer to a prayer,” said the very active octogenarian, who’s an avid reader and boasts a Facebook account.
“I’m reaching an age when I can’t drive anymore, and this is an old-fashioned house call that is desperately needed. You need people you can count on, and this allows health care to be brought to me.”
One of the key areas of emphasis, Smith said, is patient education. “We work with patients to ensure they take the appropriate medications and the appropriate dosage. Often, we find they’re confused if a medication changes or if there’s a generic name for the medication.”
Even though the model is brand new, Smith said already she has had interest from nurse practitioners in Meridian, Greenwood and other Delta locations. And she hopes that continues. “In five years, I’d really like to see this become a program for other nurse practitioners to utilize around the state.”
For more information, go to Geriatric Collaborative