Whether you’re new to caregiving or a veteran, there are still things to learn about the US healthcare system. This series of videos from Alz Live provides a roadmap. This is part six of an eight part series.
Nurse Practitioners and Physician Assistants, alternatives to doctors, help ensure that patients have timely access to quality health care.
Great Players to Have in Your Court
Like many caregivers, you may regularly interact with a Nurse Practitioner or Physician Assistant on your loved one’s care team, rather than the primary care physician. That can be a good thing.
“Many caregivers are happy to talk to advance practice nurses about issues they aren’t necessarily comfortable talking to the physician about,” says Elizabeth Capezuti, Ph.D., R.N., F.A.A.N.
It’s an observation based on considerable expertise. Capezuti is the William Randolph Hearst Foundation Chair in Gerontology and Professor at the Hunter-Bellevue School of Nursing in New York City. She hears many versions of the same story.
“My mother’s internist didn’t really have time for her and he didn’t take a holistic approach to her Alzheimer’s diagnosis,” said Barbara Glickstein, who helped her mother, then in her late 80s and living in Florida, find a Nurse Practitioner.
It took some time, but they eventually connected with the only registered NP in the area — a 40-minute drive away. “Mom really liked her. She was very available for things that required clinical skills and primary care knowledge and, because of her nursing training, she could also address the psychosocial needs, that may or may not may be medically serious but still a concern to Mom.”
What Are They?
A Nurse Practitioner is a registered nurse (RN) with advanced education and clinical training who provides an array of health care, including the diagnosis and management of common as well as complex medical conditions.
NPs specialize in specific areas of care like gerontology or women’s health and work independently or in collaboration with a physician practice, depending on individual state regulations. With training focused on the medical/nursing model, NPs bring a comprehensive perspective to health care. According to the American Academy of Nurse Practitioners, what sets NPs apart from other health care providers is “their unique emphasis on the health and well-being of the whole person.”
It makes sense for caregivers and those with Alzheimer’s to rely on nurse practitioners for routine care in many situations, Capuzeti says. “We’re talking about the type of patients that need lots of supportive care in terms of how to do the day-to-day, the functional things, as well as the medical primary care.”
Physician Assistants, or PAs, also provide routine care — they perform physical exams, diagnose and treat illnesses, order and interpret labs, imaging and other diagnostic tests, counsel patients about wellness and preventive health care, assist in surgery, and prescribe medications. They follow a medical/physician model of care, focusing mostly on disease diagnosis, treatment and management. PAs practice under physician supervision, although task delegation can be very broad, depending upon specific state regulations.
The influx of people into the health system from the Affordable Care Act, and the wave of aging baby boomers who need geriatric care, mean “physicians are learning new ways to work with patients and caregivers in the office setting,” says said Peter DeGolia, M.D., Professor of Family Medicine at Case Western Reserve School of Medicine in Cleveland, OH. “There are changes occurring on the provider side; many for the better.”
Having an NP or PA in the practice can foster better communication and help make sure little things don’t fall through the cracks because the physician is rushed.
Reasons for the Need
At least 55 million people in the United States live in areas with severe physician shortages, according to the Health Resources and Services Administration.
Nurse Practitioners and Physician Assistants can help to fill that void to ensure that patients have timely access to quality health care. Using the services of an NP or PA for routine care can mean faster appointment scheduling and less time in the waiting room; for those in rural areas, it may help to avoid having to drive long distances to get their loved one quality, routine care. You may also encounter these health professionals in skilled nursing facilities or in home care settings.
“There are people who say, I only want to see my Nurse Practitioner, and there are other people who say, ‘I’m not paying to see a Nurse Practitioner, I want to see a doctor.’ But I think that you should be open to the person that you can have the most useful conversation with,” says patient advocate and author Trisha Torrey. She finds that because of their training, “nurses listen differently.”
Glickstein said her mother’s NP was an excellent all-round communicator. “She worked with me by email long distance. I could ask a question in the morning and I’d get a reply by lunchtime.” More importantly, her mother felt that her physical and psychosocial health care needs were met. “I got the sense that she didn’t feel invisible. It was a whole different experience for her.”
USAgainstAlzheimers, or USA2, is a national organization that engages in “public advocacy, federal relations, grassroots activity and voter relations” on behalf of those with AD and their caregivers. http://www.usagainstalzheimers.org/
New York University’s Fisher Center for Alzheimer’s Research Foundation has a free monthly newsletter at www.alzinfo.org. This NYU site also has a link to “Clinical Stages of Alzheimer’s” — a comprehensive timeline to alert caregivers about what to expect as their loved one declines through the early, moderate, and severe stages of AD.
A website coordinated by Cornell Medical College to help caregivers prepare a safe home environment for someone with Alzheimer’s can be found at www.ThisCaringHome.org.