March 2015

Based on a community health needs assessment conducted by Middlesex Hospital, a higher than average, rapidly aging, adult population in Middlesex County was identified, along with high Emergency Department use by older adults for health conditions that could instead be addressed in the outpatient setting. This data helped the Hospital develop community benefit goals to address access and care coordination among Middlesex County’s older adult population. A multidisciplinary Geriatrics Sub-Committee and Geriatrics Steering Committee were formed and several Hospital departments decided to collaborate with the UConn School of Nursing on ways to test an in-home geriatric assessment and support those interested in careers in the specialty of geriatrics.

In 2014, UConn applied for a grant from the Health Resources and Services Administration (HRSA) under the U.S. Department of Health and Human Services, with Middlesex Hospital as a sub-recipient. A three-year, $1.4 million grant was received and launched this January.

Geriatric Outreach and Training with Care (GOT Care!) is an interprofessional collaboration that intends: 1) to provide nursing leadership in the development and execution of an interprofessional team; 2) to increase workforce expertise in geriatrics by providing a learning experience for UConn students in the fields of nursing, physical therapy, social work, pharmacy, and dental medicine, as well as Middlesex Hospital Family Medicine residents, and 3) to improve care for Middlesex Hospital’s vulnerable older adult population by conducting in-home comprehensive geriatric assessments and linking patients to needed services through care navigation.

Middlesex Hospital is a key partner in the GOT Care! Initiative and is providing support from Community Benefit, Homecare and the Family Medicine Residency Program. For the next three years, each semester, students will accompany their respective UConn faculty members, a Middlesex Hospital Homecare nurse navigator and a Middlesex Hospital Family Medicine Residency faculty member into the home of patients who agree to the service. Each discipline will conduct a comprehensive assessment, which is then compiled and reviewed in an interprofessional, team-based meeting. A care plan is then developed and the nurse navigator helps to execute the plan along with the Family Medicine Residency faculty member who will work closely with the patient’s primary care physician. The goal is to improve the health outcomes for those receiving the service through improved assessment, continuity of care, linkages to appropriate services and follow-up.

According to Millicent Malcolm, DNP, GNP-BC, APRN, from Middlesex Hospital Primary Care, who is also an assistant clinical professor for the UConn School of Nursing and the project’s principal investigator, “The expert interprofessional faculty for this GOT Care! Project are very excited to have the opportunity to better prepare our emerging health care workforce with special knowledge and skills for the care of the rapidly growing population of older persons. Students will learn from and practice with these interprofessional leaders in geriatric care, setting the stage for improved health outcomes for older persons, well into the future.”

The information contained within is not meant to substitute for the advice of your physician.