3.3 How could MediCaring Communities encourage elders to use clinicians who provide geriatricized medical care?

MediCaring builds on and ensures primary care for elders who live with advanced, serious, and complex conditions. Primary care for frail elders is not primary care as usual, which is often a doctor who provides routine prevention services, a limited amount of chronic disease self-care education, treatment for minor illnesses and injuries, and coordination of services from specialists. In contrast, geriatric clinical practice is primary care for some of the most complicated patient situations, responsive and responsible in recognizing and assuring that the service array meets the important and interacting physical, psychosocial, and spiritual needs that very complicated elders and their families encounter.[68] But elderly persons and their families do not know this. They believe that any physician is as capable as another, and that there is no reason to consider leaving the physician who served them through mid-life just because they are becoming old and frail. That physician is unlikely to have many of the check-mark characteristics discussed earlier in this chapter, probably has no particular training in geriatric or end-of-life care, and probably is used to having short visits with patients (often 10-15 minutes), which does not allow time for dealing with complex issues.

The MediCaring Community could institute incentives to encourage use of the more skilled and appropriate medical providers. This could take the form of a list of preferred providers, a financial incentive for using them, information as to the merits of various providers, publicity in local media, and word-of-mouth recommendations. The community could also provide feedback to the practitioners as to the quality of their services and could offer ongoing education and tools to encourage appropriate geriatric standards.

The first MediCaring Communities may be developed by expanding certain PACE programs, which is a very appealing first implementation that is described in detail in Chapter 7. In that setting, the PACE program would take on some responsibility to monitor and manage the workforce and other needs in the community.

[68] (Tinetti, Fried and Boyd 2012)