Hero Next Door: DO revamping geriatric medicine in northwest Pa.

After James Lin, DO, finished medical school, he was hoping his internal medicine residency would lead to a career specializing in gastroenterology, cardiology or critical care.

But during his intern year, his father fell ill and was diagnosed with metastatic liver cancer. Dr. Lin flew to Taiwan and spent six months at his father’s bedside. While guiding his dad through his end-of-life care, Dr. Lin began to see health care delivery from a different perspective, and he had a lot of time to think about it.

“I realized that people who are elderly or have terminal illnesses tend to get marginalized in the health system,” he says. “It’s just the nature of how physicians are trained. If someone has a terminal illness, we often think there’s nothing more we can do. I thought we could do better.”

Dr. Lin left Taiwan with a new appreciation for patient advocacy after helping his father avoid unnecessary medications and procedures.

“As physicians, we have to be advocates for our patients—especially the elderly,” he says. “When our patients are in their 80s and 90s and they’ve worked all their lives, they certainly deserve the best care when they get sick.”

At the time, Dr. Lin had no idea that his insights were about to be put to good use—that he would eventually become one of the leading geriatricians in the field and usher in a new era of geriatric care at Millcreek Health System, the parent corporation of the Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania, and its teaching hospital, Millcreek Community Hospital.

Rethinking geriatric medicine

When Dr. Lin was finishing his residency at Millcreek Community Hospital, he learned that Millcreek Health System was looking for a physician to spearhead the overhaul of its approach to elder care.

“The health system approached me to do geriatric medicine, and I just thought, ‘That’s perfect and must be a sign because I was thinking about that the whole six months I was in Asia taking care of my dad,’ ” he says.

After taking the position, Dr. Lin established a geriatric medicine fellowship at Millcreek Community Hospital.

Danielle M. Hansen, DO, was the first fellow in the new program. She says she relished the opportunity to learn more about geriatric medicine and appreciated the fellowship’s focus on functional needs and quality of life. She describes Dr. Lin as a firm, solutions-based leader.

“Dr. Lin very much wants you to come to the table with not just a problem, but also what you think the proposed solution should be,” says Dr. Hansen, who is now the vice president of acute care services and quality at the hospital. “He then will discuss that option as well as any other options and help lead you down the right path.”

At first, fellows worked at nursing homes and other senior services centers to get the experience they needed. Dr. Lin then helped found LECOM’s Institute for Successful Aging, which eventually provided fellows with training in acute care and subacute rehabilitation for seniors.

“Now we have the most robust geriatric fellowship program in the country because of all the services and the continuum of care that we offer,” says Dr. Lin, the institute’s vice president of senior services and adult living.

Within the Institute for Successful Aging, Dr. Lin established an elderly acute care unit as well as a subacute rehabilitation unit at Millcreek Community Hospital.

“A lot of our community elderly individuals who had an acute illness didn’t want to go to a nursing home to do their rehab,” he says. “They want a transitional unit where we can help get them back to their home after an acute illness. There was a need for an intermediate unit where we could do subacute rehab within the hospital, and we had the space.”

The health system now offers outpatient services, acute surgical medical units, rehabilitation and subacute rehabilitation units, and a skilled nursing facility on one campus.

“We want to make the LECOM Institute for Successful Aging a one-stop shop for seniors in our region,” Dr. Lin says. “Pennsylvania has the fourth largest percentage of people over the age of 65.”

With all these services in one place, patients should receive more coordinated care. Physicians can use the campus-wide electronic health records system to quickly learn a patient’s history and medications, which are particularly important for elderly patients, who may suffer from dementia or have trouble remembering their medications.

Dr. Lin’s efforts to bolster geriatric care at Millcreek Health System have led to a raising of the bar for geriatric care in the greater Erie area and in northwest Pennsylvania, Dr. Hansen says.

“We have patients come to see us even from New York and Ohio and from several hours away in Pennsylvania because there is no other care that compares to what we’re providing,” she says. “And our competitors—other nursing homes and patient hospitals—are really trying to match the kind of work that we do.”

Dr. Lin also wanted to raise the bar for training LECOM’s medical students and residents in geriatric care.

“As the baby boomers go up in number, the future doctors, pharmacists and dental students training at LECOM are going to be taking care of many people over the age of 65 in their careers,” he says. “And not everybody’s going to go into geriatric medicine because it’s just not a sexy specialty. Everybody wants to be an orthopedic surgeon or a cardiologist. But whether you’re an orthopedic surgeon or a cardiologist, you’re going to need to learn how to take care of the elderly.”

Physicians working with the elderly need to know whether functional loss is due to simple aging or an underlying problem, Dr. Lin notes. They also must learn how to advise patients on staving off bone density and muscle loss and work with caregivers or family members who manage a patient’s care.

In 2013, fewer than 1% of students graduating from osteopathic medical schools planned to pursue geriatrics, according to self-reported data from the American Association of Colleges of Osteopathic Medicine’s Graduating Senior Survey. One of Millcreek Community Hospital’s internal medicine residents, Jason R. Carlson, DO, says that after working under Dr. Lin, he’s now interested in pursuing geriatrics as his career.

“I was going to go into emergency medicine because I enjoyed taking care of patient problems,” he says. “But one of the things I didn’t enjoy about emergency medicine was the lack of continuity of care. Dr. Lin has helped me to realize that with geriatric medicine, you’ll handle real problems in the intensive care unit and on a day-to-day basis in the geriatric world while also providing continuous care to patients and their families.”

Senior living center

Geriatric care at LECOM is poised to become even more comprehensive next year, when LECOM’s new 138-bed senior living center is scheduled to open. Dr. Lin, who is overseeing the $42-million project, says his team wanted to provide a unique environment and better coordination of care for elderly patients who needed greater hospital access.

“We didn’t want to just build another nursing home,” he says. “These are people’s homes. If you require long-term care in a nursing home, you’re going to live there most likely for the remaining days of your life. We wanted to make the environment more homelike and more comfortable.”

Dr. Lin and his team evaluated trends in senior housing and drew from a few cutting-edge models to design a unique senior residence, he says.

The center will feature four floors of housing, and each patient’s room will have its own bathroom and sitting area. Patient rooms will be grouped into “neighborhoods” of 18, with each neighborhood sharing a full kitchen, dining area, living room and activity space, Dr. Lin says.

“We will create a mini-community within each neighborhood,” he says. “Hopefully the 18 patients in each neighborhood can mingle and do things together.”

Dr. Lin brought his business sense and passion for patient care to the project, Dr. Hansen says, resulting in a building designed to optimize functionality, operations and patient comfort. As an example, she cites the simple decision of where to store supplies.

“A lot of the patient care supplies will actually be housed in the patients’ rooms rather than at a central supply station,” she says. “So it will be much more efficient for staff members, when they go to care for a patient, to have access to everything that they need rather than having to make multiple trips to a central office for supplies.”

But one of the greatest benefits the senior living center will offer its occupants, Dr. Lin notes, is on-site hospital care.

“When most people in nursing homes get acutely sick, staff have to call an ambulance, and the ambulance picks them up and drives a mile to the hospital,” he says. “But when our senior living center patients get acutely sick, there is no need for an ambulance. We have house staff on call 24/7. We have attending physicians. And our Institute for Successful Aging office is right downstairs from them.”

With hospital care on-site, patients won’t have to grapple with the transition of care—which can result in details getting lost between physicians—that can happen at conventional nursing homes, Dr. Lin notes.

Dr. Lin’s success in overseeing the design of the senior living center can partly be attributed to his forward-thinking nature, Dr. Hansen says.

“Dr. Lin has a great ability to foresee what will be marketable and appealing,” she says. “He looks at the big picture and not just at the current moment or the next month. He’s looking 10, 15, 20 years down the road.”

Looking ahead, Dr. Lin says he would like to help establish an Institute for Successful Aging at LECOM’s Bradenton, Florida, campus and possibly a senior living center for that community as well.

‘The most rewarding patients’

Dr. Lin says he has been surprised by how much he enjoys caring for elderly patients. Although he once had other plans for his career, he now realizes that geriatrics is a perfect fit for him. He encourages medical students and residents not to settle on a specialty too quickly.

“As students go through their rotations, they should keep an open mind,” he says. “They may be fixated on being an orthopedic surgeon or a general surgeon or a trauma surgeon, which I certainly was. But other opportunities may come about, which might change your life and lead you to a completely different place than where you thought you’d be.”

Dr. Lin also advises medical students, family physicians and internists to develop competency in treating seniors. One way to do this is to remember to be more understanding with elderly patients, to avoid interrupting them, and to take extra time to get a good history from them, he says.

“As a primary care physician, whether you go into internal medicine or family medicine, up to 50% of your practice may be elderly patients,” he says. “To me, they are the most rewarding patients because they are very appreciative of what you do.”