A few years ago, a well-known Texas family physician said, "You know, 50 percent of my patients could be taken care of by a good grandmother!" Think about it, grandparents are who their children call for minor illnesses such as colds, fever or sore throats. We told you last month that there was a third idea for addressing the physician and nurse shortages in Texas (in addition to including patients as part of the work force and paying physicians differently). This "secret weapon" is grandparents.
We have created a program called Grand-Aides. We originally called it the "Grandparent Corps" (in the Houston Chronicle) until we were told at a White House meeting that requiring someone to be a grandparent was illegal and discriminatory against people who don't have grandchildren! Therefore, being a grandparent is not required, but having "the right stuff" is, including the wisdom and respect we often associate with being a grandparent. A grand-aide is a member of the local community who is an extender for a nurse, nurse practitioner or physician. Grand-aides help to provide care for adults and children using telephone protocols and home visits with Skype portable telemedicine. A grand-aide is trained to be certified by the state either as a certified nurse aide, certified medical assistant or certified community health worker, and then is taught the well-defined Grand-Aides curriculum for an additional 180 hours. Grand-aides do not make decisions on care, but are the "eyes and ears" of their supervisors, carrying out their instructions.
The purposes of the Grand-Aides program are: 1. to "decongest" emergency departments, clinics and hospitals of people who could be cared for at home, leading to a 25 percent to 50 percent reduction in unneeded emergency-department and primary-care visits, and a 25 percent to 50 percent reduction in hospital readmissions for those with chronic conditions; 2. to achieve access to appropriate health care, freeing up professionals to do what only they can do; 3. to educate patients in preventive and self-care; 4. to "bend the cost curve" with more affordable care; and, 5. to create paying jobs and enhance the lives of mature adults who want to give back to their communities.
In pilot studies: a) in the Legacy pediatric clinic in Houston, 62 percent of visits and b) in an emergency department in rural Virginia, 74 percent of visits by Medicaid patients could have been initially cared for with a primary care grand-aide and nurse supervisor, potentially saving hundreds of dollars per visit. Thanks to a great deal of work by Texas state Reps. John Zerwas and Jim Pitts and the office of Lt. Gov. David Dewhurst, Texas has placed grand-aides into the Medicaid program by law and has appropriated $1.25 million for an initial pilot that is starting at the Harris County Hospital District with more than 10,000 patients.
Transitional/Chronic Care grand-aides accompany the patient home the day of discharge and make daily visits as needed for those with chronic diseases, like congestive heart failure. Grand-aides help patients remember their medications using Skype to communicate with their supervisory nurse on every visit. The expected outcome is a 25 percent to 50 percent reduction in 30-day readmission. Public and private hospitals around the country have adopted the Grand-Aides program.
As the country struggles to get it right with health care reform, it is clear that we must do things differently. Maybe some of "doing things differently" is remembering "to do some things the same" and using respected members of the community, whether grandparents or not, to do what they have been doing for centuries.
Grandparents changing the health care system in Texas? You betcha.