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The geriatric one-day hospital of the university centrum in Liège, Belgium

The geriatric one-day hospital of the university centrum in Liège, Belgium. Dr Sophie Gillain, MD in charge of clinical activities in the geriatric daily clinic Christel Menozzi, Senior Head Nurse. Working plan. Legislative aspects of geriatric care (GC) in Belgium

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The geriatric one-day hospital of the university centrum in Liège, Belgium

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  1. The geriatric one-day hospital of the university centrum in Liège, Belgium Dr Sophie Gillain, MD in charge of clinical activities in the geriatric daily clinic Christel Menozzi, Senior Head Nurse

  2. Working plan • Legislative aspects of geriatric care (GC) in Belgium • Financial aspects of the geriatric one-day hospital • Every day organisation • Our activity • Guided visit and questions

  3. Working plan • Legislative aspects of geriatric care (GC) in Belgium • Financial aspects of the geriatric one-day hospital • Every day organisation • Our activity • Guided visit and questions

  4. Legislative aspects of geriatric care in Belgium • Sincejanuary 2007, Geriatric plan of care (GPC) • Eachgeneralhospital must have a GPC • Or beassociatedwith an otherhospitalincludingthese plan

  5. Legislative aspects of geriatric care in Belgium • People > 75 yearsold • At risk of frailty • At risk of polymedication • At riskof non typicalclinicalpresentation of the disease • At riskof modification of drugsmetabolism • At riskof functionaldeclin • At riskof malnutrition • At risk to present psycho-social disorders

  6. Legislative aspects of geriatric care in Belgium • Each people ≥ 75 yearsold, hospitalized have to beassess to theserisk •  role of the geriatric mobile team • Olderassessed as at risk have to benefit of the GPC

  7. Legislative aspects of geriatric care in Belgium • Main goals of GPC • Adapted care • Best way to preventfunctionaldecline • Best way to carry out rehabilitation as higheris possible • Best plan of care afterleavinggeriatricdepartment • Follow up • Discussion and plan withothercaregivers • GP, Familymembers, Nursing homes, …

  8. Legislative aspects of geriatric care in Belgium • Main tools to do that • Acute geriatric ward • Geriatric consultation • Mobile geriatric team in the hospital • Mobile geriatric team beyong the hospital • Relation with GP, Nursing homes, Neuropsychiatric center • Geriatric one-day hospital 6. Multidisciplinary approach by organise by caregivers

  9. Specificity in university centrum

  10. Legislative aspects of geriatric care in Belgium • Caregivers of the multidisciplinaryapproach • Geriatrician (6 years more thangeneralmedicine) • Geriatric nurse • Physiotherapist • Psychologist • Ergotherapist • Nutritionist • Speech therapist • Social worker

  11. Legislative aspects of geriatric care in Belgium • Obligation concerning organisation • Assume all differentfunctions • Acute geriatriccare unit, one dayhospital, mobile team • Information transmission • To otherspecialists, GP, patients and families • Multidisciplinary meeting / week / function • Find a adpated consensus for each patient

  12. Legislative aspects of geriatric care in Belgium Obligation concerning specialized caregivers in the different functions of the GPC

  13. Acute geriatric care unit (/ 24 beds) • 1 Geriatrician • Recommandations by SBGG and EUMS • 14.13 Full-Time Equivalent (FTE) dividedinto • 1 FTE Head nurse with a geriatricspecialization • Minimum 4 FTE nurse with a geriatricspecialization • Minimum 5 FTE nurse • 1,33 FTE paramedical staff • Neuropsychologist, Occupationaltherapist, Speech therapist

  14. Mobile geriatric team • Concerningpatients ≥ 75 yearshospitalizedoutsidegeritric care unit and assess as at risk • Since 2007, fundedas a pilot project: 4 FTE • 1.7 FTE nurse and 2.3 FTE paramedicalcaregivers • Since 2014, structural financing: 5.75 FTE • Free distribution intodifferentcaregivers

  15. Geriatric One-day hospital • Pilot project • Funded: 3 FTE • 2 FTE Nurse • 1 FTE Paramedicalcaregiver Obligations to have: occupationaltherapist, physiotherapist, neuropsychologist

  16. Legislative aspects of geriatric care in Belgium Obligation concerningcontinued training • Geriatrician: • Ethical, Economical and Medical aspects • 20 points / year • 2 obligatory meetings / year • Nurses with a geriatricspecialization 60 h/ 4 years

  17. Working plan • Legislative aspects of geriatric care (GC) in Belgium • Financial aspects of the geriatric one-day hospital • Every day organisation • Our activity • Guided visit and questions

  18. Financial aspects of the one-day hospital • Since 2007, financialgrantsallowed by the government • Architectural obligations • Medical and multidisciplinary care obligations • Diagnosis and care • Rehabilitation • Onlyduring the day • Obligation to have geriatrician, nurse, neuropsychologist, occupationaltherapistand physiotherapist • Possibility to consult: nutritionist, social worker, speech therapist • Annual report of activities

  19. Financial aspects of the one-day hsopital • Our classical financial support is related to • Only two multisciplinary assessment per year • For two differents reasons • All visit as a medical consultation • Some administrative tasks • Ask the reimbursement of specific drugs • Our special financial support is calculated on the number of multidisciplinary assessment done

  20. Working plan • Legislative aspects of geriatric care (GC) in Belgium • Financial aspects of the geriatric one-day hospital • Every day organisation • Our activity • Guided visit and questions

  21. Every day organisation • Our location • Brull, outpatientsmedical center of CHU of Liège • All medicalcompetencesavailable • Close to the memory clinic and neurologist • Laboratory on the highestfloor • Imagery center on the first floor • Main limitations • Not close to the acute hospital • Caregiversphysicalyseparatedfrom the rest of the team • Restrictedaccess and parking • Misunderstanding for patients

  22. Every day organisation • Caregivers • 2 Geriatricians • Pr Petermans, head of geriatricdepartment • Dr Gillain, MD • Team of nurses • 2 one-dayspecific nurses • 4 additional nurses from the acute care unit • 2 nurses in training • Able to assume all functions of the GPC • One-dayhospital, acute geriatricward, geriatric mobile team • Allowing training and replacement

  23. Every day organisation • Caregivers • Neuropsychologist • Alternatingevery 3 months • Occupationaltherapist • Alternatingevery 3 months • Physiotherapist • Team of two

  24. Reason to come to • From the GPs • Cognitive disorders • Falls • Functionaldecline • Loss of appetit and weight • From the hospital • Frailtydetectduring hospitalisation by the mobile geriatric team • Emergencies department, medical or surgericalwards • Follow up asked by the geriatricianafter hospitalisation in the geraitricwardbecause of need to beevaluatedwithout acute illness • Delirium duringinfectiousdisease

  25. Typical assessment • First consultation with the geriatrician • Carry out the multisciplinaryapproach • Second visit to benefit to the completeassessment • Complete multidisciplinaryassessment • Design care and/or rehabilitation • First follow up after 3 months • Follow up / 6 month or / year • In the same line with the GPs • We are the second line

  26. Every day organisation • Role of geriatrician: First consultation • Anamnesis and physical exam • Heteroanamnesiswithfamily or neighbours • Sometimestools to detectfrailty • MMSE, Clockdrawing test, Gait test (dual task) • Design the multidisciplinaryevaluation • Organic tests: imagery, bloodanalysis… • Need of neuropsychologicalevaluation • Need of occupationalevaluation • Need of physiotherapist • Need to evaluateability to drive • Write a report to the GP

  27. Every day organisation • Role of geriatrician: Second consultation • After the completemultidisciplinaryevaluationdesigned • Summaryevaluations and physicaltesting • Inform to the diagnosis • Suggestspecifictreatment and care • Specificdrugs • Specificrehabilitation programme • General advicesconcerning nutrition, physicalactivities, social activites • Review of drugs and preventpolypharmacy and sideeffects • Suggestadaptinghelper (Social workers) • Answer the questions of patient and family • Write a report to the GP • Including the completemultidiciplinaryassessment and suggestions

  28. Every day organisation • Role of nurses • Plan the muldisciplinaryassessment • Parameters • blood pression, cardiacfrequency, weight • Geriatricscale • MNA, ADL, IADL, NPI, Water Test by Di Pipo, • If needed, • bloodsamples, ECG • If needed, • Heteroanamnesiswithfamily but without the patient • Inform the geriatrician of new data unknown • Write a specific report for the geriatrician

  29. Every day organisation • Role of Occupationaltherapist • Evaluate the daily-life environment • Test vision and hearcapacities • Givesomeadviceconcerning • Needs of help in IADL or ADL • Needs of help concerninghouseworks • Needs of specificdevice to maintainautonomy • Pill-box: explaininterest and check correct use • Stringer socks • Personalalarm • Needs to adaptenvironment • Carpets, furniture, …

  30. Every day organisation • Role of neuropsychologist • Essentialyneuropsychological test asked by the geriatrician • MMSE, MOCA, Mattis • Clockdrawing test, TrailMaking test, Stroop • Grober 16 or 64 items, CVLT • Fluency tests • Attentionnal tests • Specific tests to assessneuropsychologicalability to drive • Lessoften: moral support • To the patient and/or to the close relation • Write a report for the geriatrician

  31. Every day organisation • Role of physiotherapist • Gait and balance test • Grip strength and Gait speed • Tinetti • Timedup and go prescription rehabilitation • Time chair stand test • Assessfear and risk of falling and postural reaction • Assessabilty to fallwithout danger and abillity to get up • Check shoes and use of the walking stick • Givespecificadvices • Write a report for the geriatrician • Specificrehabilitation (2/ week) • Fallers / Parkinsonian / Dementedperson

  32. Typical day • Geriatrician • 4-5 new patients in the morning • First consultation • 6 patients in the afternoon • First multidisciplinary assessment • Follow-up • Other caregivers • Specific assessment asked by geriatrician and planed by the nurse • In mean 6-8 assessments/day • Physiotherapists (2) • 8-10 mobility assessments (new patients or follow up) • 10-16 patients in rehabilitation

  33. Working plan • Legislative aspects of geriatric care (GC) in Belgium • Financial aspects of the geriatric one-day hospital • Every day organisation • Our activity • Guided visit and questions

  34. Our activity • For patients and families • Onlytwodays • Limitations to the staff • Becausegenerallack of caregivers in Belgium • Different places in charge of geriatric care in CHU • For administrative works • One day more • Planning assessment • Papersconcerningreimbursement of drugs • 500 patients / an

  35. Thanks for coming and Please feel free to ask your questions !

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