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Geriatrics and Extended Care

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Geriatric Patient Aligned Care Team (Geri-PACT)

Geriatric Patient Aligned Care Team (Geri-PACT) offers enhanced ambulatory care expertise for managing community-dwelling Veterans whose healthcare needs are particularly challenging due to multiple chronic diseases, coexisting cognitive and functional decline as well as psychosocial factors.  GeriPACT integrates and coordinates traditional ambulatory and institution-based health care services with a variety of community-based services.  In this way, GeriPACT strives to optimize’ independence and quality of life for these particularly vulnerable Veterans in the face of  their multiple interacting cognitive, functional, psychosocial, and medical challenges. GeriPACT marshals the efforts and expertise of primary care providers and interdisciplinary team members who possess advanced training in assessing and addressing the functional dependencies, syndromes and illnesses of vulnerable and elderly Veterans, within the context of those impairments.

“Geriatric Primary Care” programs were locally established at multiple points of VHA care delivery in the 1990s in response to demand for longitudinal, interdisciplinary team-based outpatient care for high-risk, high-utilization, and predominantly (but not exclusively) elderly Veterans.  The demand arose because the multiple chronic diseases, dependencies, and reliance on both VHA and non-VHA support services typical of these patients were inadequately addressed in VHA primary care settings due to time and staff competency constraints.  The transition of primary care in VHA to Patient-Aligned Care Teams has mainstreamed patient-centered, team-based care for Veterans, enhancing access and focusing resources on providing not merely a sequence of care encounters but offering a true continuum of health-related services.  For the majority of VHA patients, these changes represent a substantial enhancement in timely access and both appropriateness and coordination of care.  Yet it is increasingly recognized that a small proportion of the VHA patient population nonetheless continues to require a level of care that is not generally available to them through PACT, owing to time constraints, complexity of patient need, and dependence on particularly focused case coordination and care management activities—and these are the Veterans for whom GeriPACT is intended. 

Criteria for GeriPACT, which is currently offered in about 2/3 of VA medical centers, include:

  • GeriPACT panel size must be no more than 2/3 the size specified for co-located PACTs;
  • GeriPACT teamlets (for 800 patients) consist of 1.0 FTE each of provider (MD, DO, PA, or NP), RN, and LVN; plus 0.5 FTE each of SW and PharmD or Clinical Pharmacy Specialist; plus clerical support; plus access to mental health professional, dietician, and rehabilitation therapists within their extended teams;
  • GeriPACT providers must be boarded or board-eligible in geriatrics; or have undertaken advanced clinical geriatric training; or have demonstrable and significant experience in managing the health needs of medically complex and frail elders;
  • GeriPACT support staff should have advanced clinical training or significant prior experience in care of the frail elderly;
  • Inclusion criteria include multiple complex chronic diseases, functional dependence, dementia or other cognitive decline, geriatric syndromes (e.g., frailty, falls, memory loss, incontinence, polypharmacy, age 85 or older); and
  • Exclusion criteria include untreated substance abuse and referral to address time-limited, administrative needs, such as filling prescriptions ordered by non-VA providers for drugs limited to geriatrics, e.g., Aricept.