CATHOLIC HEALTH PARTNERS
Roy Hopkins of Morristown, Tenn., began manifesting signs of vascular dementia at age 66, shortly after open heart surgery in 1995. He started dragging his left foot, developed significant mood swings and experienced memory loss.
When his wife, Martha, realized he couldn't be home alone, she enrolled him in ALPS Adult Day Service in Morristown. "I felt so lucky to find a program like ALPS in town. It was a godsend," she says. But as Hopkins' disease progressed, Morristown, a city of 25,000 located 50 miles east of Knoxville, Tenn., had little else to offer in terms of family support.
Luckily, the Hopkins' daughter and son-in-law lived in Knoxville and were familiar with GAP, a geriatric assessment program. The multidisciplinary, outpatient assessment and treatment program is designed to address the emotional, social and functional health of individuals ages 55 and older. In 2004, when Roy was 75, the couple came to GAP, which is supported in part by Knoxville's Mercy Health Partners Foundation, for a comprehensive evaluation.
There the staff of 15 — which includes a part-time geriatrician, part-time geriatric psychiatrist, nurse practitioner, licensed clinical social workers, nurses and medical assistants — took Roy's complete physical history; screened him for memory loss, depression, anxiety, social and functional status; ordered lab work including brain imaging; and spoke to family members about behaviors and other concerns.
During a follow-up conference, GAP staff discussed Roy's diagnosis and treatment plan — everything from recommending medications to providing caregiver education, behavior management, a home safety evaluation and support group services. After that, the Hopkinses continued as active GAP clients for seven years, seeing their primary care physician but driving to Knoxville every three to six months for consultations until Roy suffered a major heart attack in February at age 82 and entered a nursing home in Morristown.
The Hopkinses are typical of the approximately 2,500 clients GAP serves, says Jill Beason, regional director for community services at Mercy Health Partners.
"More than 50 percent of our case-load includes patients with dementia or Alzheimer's disease, some with a dual diagnosis of dementia with depression or anxiety disorders," she says. "The rest of our population tends to have comorbid psychiatric disease — aging patients with schizophrenia, bipolar disorders, autism, and so on."
GAP traces its beginnings to 1992, says Beason, when Knoxville's Baptist Health System initiated the program with start-up funding of $225,000 as a way to preserve independence and enhance quality of life in an aging population through early detection of dementia and intervention. When Baptist merged in 2008 with St. Mary's Health System to form Mercy Health Partners, leaders considered discontinuing the program due to its high expense.
"GAP had always been a community benefit program, requiring lots of resources to serve a vulnerable population, often on Medicare, Medicaid or without any insurance at all," says Beason.
The Mercy Health Partners Foundation has provided a monthly subsidy for GAP since 2009. That, plus Mercy Health Partners financial support, helps GAP continue to operate on an annual budget of $632,000.
The cost is well worth it, says Dr. Monica Crane, clinical director of dementia care at GAP as well as associate director at the Cole Neuroscience Center at the University of Tennessee Medical Center in Knoxville.
"This is such a unique program because of the heavy social work/nursing component. When you are dealing with chronic, incurable diseases, the best way to provide care is through social support — helping patients and families access services, drug assistance and counseling," she says. "Patients can live with dementia for 20 years, so caregivers need heavy support for long, committed times."
Though Crane admits that the GAP program is far from lucrative, she maintains that it ultimately saves dollars by minimizing expensive health care utilization both for patients, who are able to stay at home — and out of full-time nursing home care — for as long as possible, and for caregivers, who cope better with stress due to social support.
Serving such a vulnerable population also ties into the mission of Mercy Health Partners, says Beason. "Our ministry is to improve the health of our community by focusing on the poor and underserved. This is definitely an underserved clientele," she says.
Just ask Martha Hopkins, who maintains that GAP has functioned like "another family" for her. "They did more than help me to understand Alzheimer's disease. Anytime I needed to talk, the staff was there to listen to my worries and help me manage difficult behaviors," says Martha. "Even now, with Roy in a nursing home, I still keep them up to date with our lives.'