What is geriatric medicine?

What does it mean to be “board-certified”?

What does an initial consultation include?

Does ElderConsult accept Medicare or Supplemental Insurance?

How long does a consultation take?

Can a consultation be done in the patient’s home?

If the consultation is in a private home, will you need any particular equipment or supplies?

Will I offend my primary doctor by having this consultation?

What is “decisionmaking capacity?”

What is geriatric medicine?
Geriatric medicine is the study of all aspects of aging including the physical, emotional and psychological concerns of the elderly. It is the medical complement to gerontology, which is the social study of aging.

What does it mean to be “board-certified”?
In order to be board-certified in the sub-specialty of geriatrics in the United States, a physician must already be certified in internal medicine by the American Board of Internal Medicine and complete at least an additional year of training in geriatric medicine, demonstrate competence in care of patients, meet licensing requirements and pass a rigorous examination.

What does an initial consultation include?
An initial comprehensive geriatric assessment usually takes 1 ½ to 2 hours to complete. For patients who tire easily, it can be broken up into several visits. It includes:

• A review of all available medical records, charts, data and history
• A review of all concerns that the person, their family, the caregivers or facility (if involved) may have
• A discussion regarding what is important in life to this person, goals of care, wishes for resuscitation and other interventions
• A functionality assessment focusing on quality of day-to-day life, including suggested ways for the family or other caregivers to help
• Evaluation of acute, chronic and neuropathic pain and recommendations for management
• Referrals to physical or occupational therapists as necessary
• A review of medications, including over-the-counter products and supplements, to identify drugs, dosages and interactions that may be troublesome to the older person
• A physical examination
• A  mental and emotional examination, including:
• Examination for memory problems, decision making capacity, and dementia, which can be caused by factors as varied as vitamin deficiencies, Alzheimer’s disease or strokes
• Treatment recommendations for agitation and mood problems, including training in techniques for moderating anger or reaction in the demented individual without increasing their confusion
• Diagnosis of depression and recommendations for treatment and behavioral interventions
• Preparation of a report to be delivered to the person evaluated or durable power of attorney, the family physician and, if that person chooses, to  other caregivers or facility
• Communication and collaboration with the primary physician who, in most cases, will continue to manage patient care and emergencies. ElderConsult is also available to provide primary care in some areas. This is especially helpful to those who are housebound or refuse to visit a physician

Does ElderConsult accept Medicare or Supplemental Insurance?
We do not accept Medicare or Supplemental Insurance, nor participate in HMOs. However, we will send a HIPPA bill sheet to your insurance carrier if you have non-HMO, non-Medicare supplemental insurance. We cannot guarantee that your insurer will reimburse you – you should contact them for more information.

How long does a consultation take?
About 1 ½ to 2 ½ hours.

Can a consultation be done in the patient’s home?
Yes, even if “home” is a skilled nursing facility, assisted living facility or some other alternative living arrangement. ElderConsult will also visit those admitted to hospitals to do an evaluation and leave a report for the admitting physician as well as discussing the case with that doctor. ElderConsult doctors will not write orders on hospital patients.

If the consultation is in a private home, will you need any particular equipment or supplies?
No. We will bring any necessary equipment or supplies. If blood tests are needed, we can draw the blood and deliver it to the appropriate lab.

Will I offend my primary doctor by having this consultation?
No. We first attempt to reach the physician prior to the exam. We suggest, not order medication adjustments. We find that most primary physicians welcome the expertise of a trained geriatric physician or nurse practitioner in managing the care of elderly patients. These are often some of the most challenging patients in a physician’s practice. Such patients often require more time and attention to address complex issues than a primary physician often can spare. Your ElderConsult practitioner will collaborate with your primary physician to provide the best possible care. Click here to see a sample of a letter to a primary physician.

What is “decisionmaking capacity?”
In order to have decisionmaking capacity, (“Competence” has an entirely different meaning, and is a legal term), one must demonstrate an ability to understand the risks and benefits of a proposed intervention (either financial or medical) and be able to communicate a choice. The evidence of understanding required for entering into financial agreements is higher since the concepts are abstract and the outcomes can have dramatic effects for the person’s well-being. A lower level of evidence of understanding must be shown for a person to be able to choose their medical durable power of attorney, or health care proxy.

Of course, there are also cases where the person is subject to undue influence and the person that they think is their advocate may not behave as such. These are complicated cases that can require time and teamwork to resolve — often from Adult Protective Services, eldercare attorneys and geriatricians or neuropsychologists.