Geriatrics Models of Care

Michael L. Malone, MD is the Medical Director of Aurora Health Care's Senior Services program and Aurora at Home. He is a Clinical Adjunct Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. He serves as the Section Head of Geriatrics at Aurora Sinai Medical Center in Milwaukee, WI as well as Aurora's Geriatrics Fellowship Director. Dr. Malone is the Section Editor for Models of Geriatric Care, Quality Improvement, and Program Dissemination for the Journal of the American Geriatrics Society. He serves as the Chairman of the Public Policy committee at the American Geriatrics Society.Marie Boltz, PhD, GNP-BC, FGSA, FAAN is the Elouise Ross Eberly and Robert Eberly Endowed Professor at the Ross and Carol Nese College of Nursing, Penn State.Jonny Macias Tejada, MD, AGSF is the Medical Director of Acute Care for Elders at Aurora St. Lukes Medical Center, Medical Director Hospital Elder Life Program Aurora Health Care, and Clinical Adjunct Associate Professor of Medicine at the University of Wisconsin School of Medicine and Public Health.Heidi White, MD, MHS, MEd is a Professor of Medicine Geriatrics Division at Duke University Department of Medicine.

• Part 1. Hospital Based Models of Care.- Acute Care for Elders Unit.- AGS Co-Care HELP Program.- Acute Care for Elders Mobile Consult Program.- The NICHE program.- Palliative Care as a Consultation Program.- AGS Co-Care Ortho Program.- Geriatric Surgery Verification Program.- The VA STRIDE program to promote in hospital ambulation.- Part 2. Models to Address the Needs of Older Adults in Transition from Hospital to Home.- Care Transitions Intervention and BRIDGE and other non- Nursing Home Care Transitions Models.-Project BOOST.- C-TraC model.- Connect Home model to improve the care transitions from Skilled Nursing Facility to Home.- Part 3. Outpatient Care Models 113 pages.- The GRACE Model.- Guided Care.- Stanford Chronic Disease Self- Management Models.- Patient Centered Medical Home/ Home-Based Primary Care.- Collaborative Care with Primary Care & Behavioral Health 7 pages.- Hospital at Home.- HOME MEDS.- Independence at Home and the Veterans Affairs Home-Based Primary Care.- Outpatient Geriatric Evaluation and Management.- Stepping On- A Community-Based Falls Prevention Program.- The VA Gerofit program.- STRIDE falls prevention.- Geriatrics In Primary Care Demonstration.- Geriatrics in Nephrology Clinics Duke.- CAPABLE.- The Senior PharmAssist Program.- Part 4. Emergency Department Models.- Geriatric Emergency Department.- EQUiPPED.- Improving Care Transitions from the ED to Home- Community Paramedics Program.- Part 5. Long Term Care Models.- OPTIMISTIC: A Program to Improve Nursing Home care and Reduce Avoidable Hospitalizations.- The INTERACT Program.- The Program of All-Inclusive Care (PACE) model.- Eden Alternative/ Greenhouse Model.- DICE Approach.- Part 6. Models which address the needs of Unique Patient Populations.- The UCLA Dementia Care Co-management Program.- The Indiana Aging Brain Center.- Wisconsin Alzheimer’s Institute Model.- The COACH program from Durham VA.- The Tele-dementia Clinic for Older Veterans.- Texas Elder Abuse and Mistreatment Institute Forensic Assessment Center Network TEAM- FACN.- Patient Priorities Care for older adults with multiple chronic conditions.- The Interdisciplinary Home Visit Program for Individuals with Advanced Parkinson’s Disease.- The Geriatrics Day Hospital.- The Surgery Wellness Program at UCSF.- The Duke Peri-operative Optimization of Senior Health (POSH) Program.- VA Telemedicine Consult Models of Care.