Happy Birthday to Me! I'm a toddler now!

So, this month, Geriatrics Planning & Solutions, Inc. celebrates it's 2nd birthday. And it's been a pretty busy year with lots of growth and development (as would be expected for a toddler!) . I'm truly grateful to all the patients and families who have entrusted the care of their loved ones to me. I am also thankful to the community of wonderful professionals I have met over the past few years who are addressing the varied and complex care needs of older adults residing in the community. And as I make my way around the sun again with Geriatrics Planning & Solutions, I thought I'd put out an updated "FAQ" based on the questions I've seen the most.

What the hell do you do? (i.e. What services do you provide?)

Some days, I don't even know. Just kidding.

The fundamental thing I do as a geriatrician is provide medical care at home to older adults- house calls. Think Marcus Welby, MD, but instead of a black bag, I use a yellow backpack. And a laptop.

But in simple terms, the following is a list of what I can do clinically-

a) Geriatrics Consultations- help you pull the fragmented & complex world of healthcare together; assess your overall health status (medical, functional, cognitive, emotional, social) and come up with a plan that makes sense for you.

b) Care Coordination- be the person to call your doctors & providers, get the information you need & questions answered, and translate all of that to you so we can figure out what to do going forward.

c) Geriatrics Primary Care- basically put the previous two things together in an ongoing relationship. As one patient described me, I'm his "quarterback." I educate, summarize, coordinate, communicate, translate, & plan for how to move forward. (This is pretty amazing- to be called a quarterback, for someone who was the classic example of a band geek in high school!) I can coordinate labs to be done at home, imaging to be done at home, dental visits at home, audiology/podiatry/therapy at home. I can even connect you with emergency services at home so you can have an "urgent care" level of evaluation and care in your home.

d) Dementia/Cognitive Evaluations, Care, & Management. I can help diagnose dementia and provide guidance to help you & your loved ones navigate the path ahead. This includes pulling in the many resources I've come across in the community to support the care at home or assess the need for transitioning to different living enviroments (e.g. assisted living, nursing home, memory care).

e) Palliative Care/End-of-Life Care & Guidance- I can help prognosticate and provide guidance about how care should look at the end-of-life. Questions about palliative care? Questions about hospice? Questions about Medical Aid in Dying? Questions about DNR? Questions about advance care directives or health care proxies? I can help answer all of them in a non-threatening way that helps you & your loved ones really understand what may make the most sense and how to navigate that path.

f) Medical Decision Making Capacity- for persons who are undergoing cognitive changes that may be impacting their ability to make safe & appropriate decisions for themselves, I can assess their capacity in a relaxed manner in their home. This can be part of a guardianship evaluation or work with an elder law attorney who is trying to help a patient/family organize things as conditions change.

g) Health Advocacy & Education- this goes for all patients, but especially when patients are admitted to hospitals, nursing facilities, or assisted living. I can visit the patients, reach out to the medical & other care teams, and help the patients/families understand what's going on. I can also help communicate the family's questions/concerns to the care teams and facilitate a plan for the best discharge.

Where's your office?

My office is my car. I'm based near Princeton, NJ, but can serve all of NJ & parts of suburban Philadelphia as well. I can also serve NY, but haven't ventured there yet as I'm trying to figure out how best to navigate the distance.

But, the true answer is that because I do 100% house calls, I don't have a traditional office. I go to the patients' homes or where they are.

Do you take insurance?

No.

My services are paid for directly/privately. I cannot submit any claims to insurances, including Medicare. This goes for the patients also- they cannot submit a claim for my visits to insurances, including Medicare.

However- remember, the patient has not opted out of Medicare or health insurance. So, if I order anything (e.g. labs, imaging, therapies, referrals, testing, medications, DME, etc.), they can all be covered through the usual insurance routes. Furthermore, if a patient is seeing specialists for various conditions, all of that can continue as is. I can just help them reach out to the specialists and understand what's going on.

Why not?

Primarily for time.

The main reason I started doing what I'm doing is to allow myself to feel like a geriatrician again- it takes time to sort through the issues that an older adult with chronic medical conditions, potential functional and cognitive changes, and other social challenges faces. I feel my job as a physician/geriatrician is to educate- to help patients & families understand what's going on and what the options are so they can make truly educated decisions for themselves.

Through traditional insurance routes, I would not be able to spend the time I do with patients & families. My initial visits can be up to 2 hours sometimes and follow-up visits can go up to an hour or an hour and a half- again there's no limit. We have the time to sit down, talk, and review things in detail. We get all your questions answered

What's your favorite pizza (these days)?

The Arthur Avenue pizza at Portofino Pizza & Pasta in Wappinger Falls, NY. Yes, it's random, but that combination of sausage, roasted garlic, hot peppers, & "special spices" is to die for...I mean, you've got it all- savory satisfaction with spicy and sweet.

I'll be back...

Do you do public speaking?

Yes- I love educating audiences on topics related to geriatrics and have done numerous presentations over the past few years. So, whether it's the local senior canter, a caregiver support group, or a symposium/panel presentation, bring it on!

Naturally, for some presentations that will require much more detailed preparation, I may need to charge as I do put a lot of time into this endeavor so that every one can benefit.

What kind of topics can you cover for education?

Pretty much any topic related to geriatrics care- I've done a lot on end-of-life care issues, managing goals of care/advance care planning, dementia & cognitive impairment- including caregiver stress, ageism, frailty, and what's considered normal vs abnormal in the aging process.

What's your idea of a perfect evening?

A nice walk on the beach at sunset, being chased by crazed seagulls who are after my Arthur Avenue pizza...(see above re: favorite pizza)

Just kidding- if you want to know more about me/my priorities at this stage- I love spending time with my family & friends, cooking & baking, swimming & working out, and ice cream. You can never have a bad day if you have ice cream.

So- I look forward to navigating the toddler years successfully & emerging into the next stage of this practice. I have really enjoyed meeting all my patients, their families & care partners, new colleagues, and traffic on I-287, and look forward to continuing to develop a successful house call practice serving older adults in our area.