Emergency Department Geriatric Case Manager Links Seniors to the Appropriate Services

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Finding the time to deal with the complex medical, social and emotional problems of the elderly is one of today’s health-care challenges. Fran Wolfe, the new Geriatric Case Manager in North York General Hospital’s Charlotte & Lewis Steinberg Emergency is determined to help meet that challenge and get seniors connected to the appropriate health-care services.

The position of Geriatric Case Manager in Emergency is a new one, and there are only six similar positions in Ontario. Fran was hired last fall when the Emergency Services Program found that a large percentage of emergency patients were seniors and many were returning with recurring problems and few supports in place.

The benefit of having a geriatric nursing assessment within the department is that the staff can identify those seniors who many benefit from Fran’s expertise and knowledge of geriatric services available in the Hospital and in the community.

“The community served by North York General Hospital has the highest percentage of seniors in the city, and the number of seniors is rising,” says Dr. Tim Rutledge, Emergency Services Medical Program Director. “Having a Geriatric Case Manager in the emergency department means that we can more effectively meet the needs of elderly community members.”

Dr. Rutledge explains that adding a Geriatric Case Manager to their staff continues a long tradition of the Hospital providing support for the health and dignity of seniors by offering a range of coordinated specialized geriatric day and long term care services.

“Emergency is a fast-paced environment with a high volume of patients. Fran is able to provide more comprehensive assessments of our elderly patients and take the time to listen to their concerns. She is then able to draw on various resources as needed to assure optimal care,” he says. “She is a highly valuable addition to our multidisciplinary team.”

Fran conducts a physical and cognitive assessment with geriatric clients, with priority given to those who could potentially be discharged. Through the development of a plan of care, she coordinates the appropriate community resources for the senior client and provides follow up contact when the person returns home. “My role is to advocate for the client and their family, to connect them with what resource is best to meet their needs and to support them in their return to better health. Hopefully, with more of this safety net in place, we can help improve their quality of life and prevent them from having to come back to the emergency department,” says Fran.

With compassion, she goes over test results with the senior, speaks with family members and provides one-on-one health teaching. Her goal is to return the senior to a safer environment and help them maintain their independence by connecting them to services in the community.

Sandra York agrees that having someone focused on looking after the needs of the elderly is a valuable addition. Sandra’s 80-year-old mother, Shirley, recently fell and broke her wrist, and was treated in the emergency department. “I was so pleased that Fran took so much interest in my mother’s overall well-being,” says Sandra. “She asked my mother all the right questions and helped determine what may have caused her to fall. Fran also put a referral in for us so that my mother will get a follow-up appointment for assessment at a falls clinic.”Fran, who started her nursing career 30 years ago, says that her greatest satisfaction is seeing that a person has been well looked after, to the best of her ability. “We always try to have the person return to their current lifestyle and provide them with the right resources to maintain their quality of life,” she says.

A monitoring and evaluating system is presently in place to measure the impact of the Geriatric Case Manager on repeat visits to the emergency, patient satisfaction and to identify specific trends in the geriatric population.

North York General Hospital is a multi-site teaching hospital in north central Toronto, and offers a wide range of clinical services in nine program areas: Emergency Services; Family and Community Medicine; Genetics; Long Term Care; Maternal/Newborn Services; Medical Services; Mental Health; Paediatrics; and Surgical Services.