The Register Citizen (Torrington, CT)
Doctor making rounds to older patients’ homes
STONINGTON >> For 87-yearold Bob Livermore and 88-year-old Malcolm Wheeler, having “Dr. Mike” come to their apartments in the StoneRidge Retirement Community has made the infirmities of old age easier to bear.
“The last thing you want to do when you’re sick is get out of bed and get in a car and go to a doctor’s office,” said Livermore, as he settled in his favorite living room chair one recent afternoon for a checkup. “When Mike came along, it was perfect. It was a blessing.”
A retired engineer, Livermore signed on with Dr. Michael Feltes’ geriatric practice over a year ago, after his wife, Anne, who has since passed away, became ill and wanted to spend her last days in their apartment rather than a nursing home. Since then, Feltes and his nurse practitioner, Karen Terwilliger, have cared for Livermore after surgery for a cancerous leg tumor and a recent bout with pneumonia.
“I love the guy,” said Livermore.
For Wheeler, who uses a walker, Feltes’ regular visits keep him from becoming isolated, enabling him to stay active in the Stoneridge choir and enjoy meals in the community dining room with his friends.
“I can live very comfortably with a little help,” said Wheeler, a retired IBM executive. “I’ve been in the hospital a lot, but the ease of getting back to independent living has improved a lot because of having the nurse and doctor available to me. When I have to go out and go to the doctor, it’s a big deal. Now, when I have an emergency, Karen is here. For $150 a month, it’s a bargain.”
That’s the fee Feltes charges the 120 patients — most of them in their 80s and 90s — who’ve signed up thus far for the “concierge” medical services he’s been providing in their homes for the last 18 months. His concierge patients get aroundthe-clock access to him and Terwilliger for house calls for routine and emergency medical services, with Medicare and private insurance covering most of the cost of the care but the $150 fee paid out-of-pocket. The fee pays for itself, Feltes and his patients believe, in avoiding costly emergency room visits and hospital stays.
“When an 86-year-old woman falls in her apartment, I can come to her that day and evaluate her and do an assessment that’s a good predictor of whether she has a broken bone,” said Feltes, who has provided medical care at local nursing homes for the last 20 years. “I can call mobile X-ray and ultrasound services and even do IVs in the home. This is a creative new practice design.”
The kind of care Livermore and Wheeler are receiving is something the region needs more of, according to a group of local residents including Feltes — one of the region’s few geriatricians — who incorporated as the Mystic Geriatrics Institute a year ago, six months after beginning informal discussions. Last month, the group obtained its nonprofit status and will host its first major event May 6, a “Seniors Strong Summit 2017” at the Mystic Marriott.
“It will focus on how the community can foster a better quality of life for our seniors,” said Mary Kay Riley, a retired work-life consultant who is president of the group’s Board of Trustees. “We want this region to be a center of excellence for geriatric care and research.”
Improving medical care for the elderly is just one of the goals of the institute. Board members Fran Hoffman of Stonington and Americo Petrocelli, a StoneRidge resident and former commissioner of higher education for Rhode Island, first conceived of the idea as a means of building on the town’s growing population of elderly and services for them because of StoneRidge, the neighboring Masonicare at Mystic senior community and a geriatric medical facility proposed for the nearby Perkins Farm property.
“From a health of the community standpoint, I saw that there was a rapidly growing older age cohort in town,” Hoffman said. “I was really concerned about the economic viability of the area. With people wanting to retire here, I saw a wonderful opportunity to develop a model of excellence for our aging population.”
Petrocelli, 86, said that after moving to StoneRidge three years ago, “it became apparent to me that there’s just something missing in the way medical treatment is delivered to seniors.”
Most primary care doctors, he said, schedule office appointments every 15 minutes, “and it takes me 15 minutes just to get my coat off.”
Mary Jo Riley, supervisor of the Groton Senior Center, said that while the idea of house calls from a doctor may seem like a throwback, it makes a lot of sense for the frail elderly.
“It’s generally the transportation that holds people back,” she said, adding that it can still be an obstacle even with van service for seniors available in many towns. “And sometimes, they’re just too sick to go to the doctor.”
Petrocelli believes that if more elderly had access to house calls from geriatricians, who are specially trained in the complex multiple medical conditions that come with aging, it would benefit not just the patients but their families and their families’ employers, helping the region’s economy. Fewer employees would miss work to care for aging parents, and families would save money by avoiding nursing home costs, Petrocelli said.
For now, Feltes’ practice, called Mystic Geriatrics LLC, is operating independently of the institute, but in the future could be folded into the nonprofit and help seed the start of similar practices. Feltes, who recently added the part-time services of Dr. Paqui Motyl to his practice, is hoping to serve up to 500 concierge patients, and to waive the concierge fee for 10 percent of patients who are impoverished.
Another board member, retired internist and geriatrician Dr. Christoper Morren, envisions the geriatrics institute evolving into a “think tank” for geriatric research, bringing in medical students from Brown, Yale and the University of Connecticut. It would also “be the beacon at the center” of the patchwork of existing senior services providers, creating a network for senior centers, visiting nurse and home care agencies, nursing homes, retirement communities, medical equipment suppliers and others to come together.
Stonington First Selectman Rob Simmons noted that the town’s population is graying. By 2020, about 27 percent of its 18,000 residents will be 65 years and older. The town’s plan of conservation recognizes this trend, he said, calling for future development projects to consider the needs of seniors.
While the geriatrics institute is based in Stonington, however, its mission extends to all of southeastern Connecticut. Riley, the Groton senior center director, said the institute is a welcome addition to the region, especially as the baby boom population ages and the need for services and education about the legal, medical and social issues of aging continues to increase.
To Mary Lenzini, president of the Visiting Nurse Association of Southeastern Connecticut, the institute’s emphasis on home care for seniors makes sense, given the realities of the growing population of those over 80 years old staying in their homes.
“People who end up in the emergency room a few days after getting out of the hospital are usually those who couldn’t get to that first doctor’s visit five to seven days after they got out,” she said.
Doctors and nurses who see patients in their homes, she said, can assess “the whole person,” including their social supports, safety and cleanliness of their environment, whether they have nutritious food in the refrigerator and whether their medications are organized. Patients are also more honest about how they’re feeling when they’re at home, she said.
“We’re seeing so many more people staying at home, with one or two chronic illnesses,” she said. “In the doctor’s office, people can sit there and tell you they’re eating a nutritious diet, but is there anything to eat when you open the refrigerator? A person is different in their home than they are in the office.”
Both hospital networks that serve southeastern Connecticut are planning to add home-based services in this region.
For now, though, Feltes is the region’s only geriatrician providing house calls, meaning his Toyota Land Cruiser is essentially his mobile office as he travels from patients at StoneRidge to those in private homes in New London, Westerly, Norwich “and everything in between,” he said.
Spending 45 minutes to an hour with each patient, getting to know about their lives, assessing their mental as well as physical well-being, he said, is a much more satisfying and ultimately effective way to practice geriatrics than the high-pressure pace of most office practices, he said. When he gets an emergency call from a patient, he said, he gets a mental picture of that person in their home.
“Early on in my career,” he said, “I saw that geriatric care was something that brought me a lot of joy. It’s not sexy, but the science is complex. It’s very demanding, because the patients don’t have just hypertension, they also have depression, and skin issues and memory dysfunction. But I don’t have that pressure to see more and more patients. The concierge practice is a pleasure for me and a quality boost for them.”