Cypress Living leaders (from left) Joe Velderman, Vice President of Innovation; Christine Burns, Vice President of Homeand Community-Based Services; and Louisa Cannamela, Vice President of Clinical Services, work together to bring onsite medical care to residents.

Sep 14 2023
Patient-Centered Care

Senior Care Organizations Bring Primary Care to Their Communities

Senior care organizations are implementing onsite primary care services to offer residents a whole-person wellness experience.

Cypress Living used to have a physician lease a space on its campus for residents to receive primary care several days a week. Then, when the COVID-19 pandemic began in 2020, the senior care organization based in Fort Myers, Fla., decided to build out its own medical care practice to connect care teams for a more proactive, predictive approach to residents’ health.

Seamless collaboration is a key reason to offer onsite primary care at a senior living community, says Louisa Cannamela, vice president of clinical services at Cypress Living.

“Primary care is that one area that has to pull everything together,” she says. “It really has to take that holistic approach.” That means coordinating care from multiple specialists, such as cardiologists, nephrologists and gastroenterologists.

Though a majority of older adults want to age in their homes for as long as possible, some senior care organizations with living communities are setting themselves apart by making primary care services for residents easily accessible on campus.

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While assisted living and skilled nursing spaces have been integrating primary care for a long time, independent living communities haven’t always included that aspect. So, when a community does offer onsite services, a team of physicians, organizational staff and more can collaborate to make sure a resident’s wellness encompasses all facets of their daily life.

An interdisciplinary approach incorporating primary care can help ease care transitions and eliminate a source of stress for residents, since older adults are more likely to be managing chronic conditions that require regular health checkups.

“The more organizations can reduce that number of transitions between care providers, the better it is in terms of outcomes for those older adults from a healing perspective and a cognitive integrity perspective,” says Dee Pekruhn, director of Life Plan Communities Services and Policy at LeadingAge.

As more senior care organizations incorporate primary care services into their communities, they’re implementing virtual care to provide the flexibility to manage patients remotely, says Scott Code, vice president of LeadingAge’s Center for Aging Services Technologies. They’re also improving digital access to schedule appointments and set up virtual touchpoints, he adds.

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Cypress Living Offers Complete Approach with Primary Care Clinic

At Cypress Living, independent living residents can visit a physical clinic or see a clinician during a house call. Physicians will typically see residents with chronic conditions every three to six months, while those without chronic conditions may stick to annual visits, says Christine Burns, vice president of home and community-based services.

“We can really provide great insight and collaboration across the board when we’re talking with and caring for our residents, and I think that is truly special,” Burns adds.

The organization uses Microsoft Teams to connect nurses and medical assistants to providers, Cannamela says. The platform also enables physicians to include off-campus family members in residents’ care discussions. “Just having the opportunity to collaborate and really focus on what’s best for our residents and their needs has been something special we can provide,” Burns adds.

Telepresence carts linked to Teams and equipped with Logitech cameras and medical devices such as USB otoscopes give clinical teams mobility.

“You can change the camera input from the Logitech camera to the otoscope while you’re midstream in a Teams meeting, and a caregiver can hold up that otoscope to a person’s ears or nose or throat to get a more in-depth look at what’s going on with somebody,” says Vice President of Innovation Joe Velderman.

The Teams platform has helped supplement the use of electronic health records systems, he says.

“These Teams threads really provide a contextual conversation around caregiving and resident encounters and bridge the gap between our medical care team, our skilled nursing team, and assisted living or memory care teams,” Velderman says. “They also support caregiving continuity between shifts of frontline workers. That’s brought a lot of value to the different service lines we have and the patient-centered focus we want to provide.”

Christine Burns
We can really provide great insight and collaboration across the board when we’re talking with and caring for our residents, and I think that is truly special.”

Christine Burns Vice President of Home and Community-Based Services, Cypress Living

Cypress Living also relies on remote patient monitoring tools to help with respiratory and sleep assessment as needed, he says.

That was critical in detecting atrial fibrillation in a COVID-19 patient who was recuperating at home, Velderman says. “Through coordination and the resources that we have on our campus, we were able to pull an EKG and do a full assessment,” he adds. A cardiologist was brought in to help with care.

Onsite primary care services allow more interaction with patients since clinicians are working right where the patients live, Cannamela says.

“It provides a different opportunity to interact with residents that you don’t get in a traditional outpatient primary care setting,” she says. “You get those little interactions with them throughout the whole time that they’re there. We get to help transition them as they age through our continuum of care.”

A key goal this year for Cypress Living is to offer residents access to patient portals, Velderman adds.

“It’s a difficult endeavor for us because we do run a few different electronic health records systems,” he says. The organization is evaluating a new EHR platform for the care team and expects it to offer more participation for patients, Velderman says.

“It becomes incumbent upon our medical record-keeping teams to maintain that source of truth across different platforms as our residents and patients interact with different service lines,” he adds.

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Primary Care Enables Integrated Approach To Wellness In Senior Living

Farther north, Catonsville, Md.-based Charlestown Senior Living opened its onsite medical center more than 30 years ago, says Dr. Matthew Narrett, chief medical officer at Erickson Senior Living, which manages the community.

“On a daily basis, a resident might have an acute event, whether it be a fall or an urgent or emergent medical need,” Narrett says. “Finding a doctor and getting them needed care to prevent an unnecessary transfer to the hospital was of paramount importance.”

About 20 percent of Charlestown’s medical visits are scheduled the same day, he adds. “Access is so important — waiting for care may result in an unnecessary emergency room trip and hospitalization. Timely intervention is critical in all healthcare, but it’s especially so for seniors.”

Erickson Senior Living also takes an integrative approach to wellness. “We manage everything from high blood pressure to osteoarthritis and emotional well-being. A big part of managing chronic illness is addressing the mental health component,” Narrett says.

Residents have access to patient portals that connect with an EHR, which has integrations with the organization’s continuing care app. Narrett adds that physicians can see medication lists and nursing and rehab progress notes on the EHR platform.

How One Senior Care Organization Integrates Primary Care

Bloomfield, N.J.-based Juniper Communities launched a program that combines onsite primary care with residential services, bridging care silos.

“We realized that if we could integrate some of the ancillary service providers who work most closely with our residents to manage chronic illness, we would provide a better experience and far better outcomes,” says Juniper founder and CEO Lynne Katzmann.

Juniper also looked to build coordination with its rehabilitation provider and pharmacy into its EHR platform.

The program includes a medical concierge, who “serves as an administrator, an auditor of data and communication, and a coach for the individual,” Katzmann says.

The medical concierge bridges Juniper’s chronic care management efforts with primary care. “We believed that if we could integrate primary care into our continuum, provide a single playbook via a common EHR platform and facilitate that with a medical concierge, we would get better outcomes,” Katzmann says.

The goal of the primary care program is to keep residents out of the hospital, which is the most expensive aspect of healthcare, she adds.

Juniper uses an enterprise version of Amazon Alexa for residents to alert the care team to their needs. The organization is also exploring other ways that Alexa can help older adults and protect personal information. It’s part of a technology platform that ensures residents can receive integrated, whole-person care, Katzmann says.

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Photography by Edward Linsmier

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