UNC Geriatrics at Eastowne
Fellows UNC Geriatric Fellows clinical rotations spend two half-days per week in UNC Geriatrics outpatient clinic at Eastowne, which is both a consultative and primary care clinic. The clinic serves a very diverse patient population. This group includes residents of area assisted living facilities and memory care units and local retirees. Some patients even travel from hours (and even states) away for geriatric care. Furthermore, the clinic has been rated consistently among the top clinics at UNC for patient satisfaction.
The Fellows’ clinic is supported by an interprofessional team including our geriatric pharmacist, Dr. Jena Burkhart, and our clinic social worker, Bryan Godfrey. Fellows also have the ability to consult Dr. Ana Felix, a neurologist, and Dr. Julia Lunsford, a geriatric psychiatrist, who each see consult visits at the clinic. Our interprofessional team assesses new patients in a 90-minute initial appointment. Then, Fellows see follow-up visits for 45 minutes with the ability to consult the interprofessional team as needed. Also, Fellows inherit a panel of patients from an outgoing fellow, and see one new patient per clinic session.
Skilled Nursing Facility
Fellows spend one half-day per week at the skilled nursing facility at one of two local Continuing Care Retirement Communities: either Carol Woods or the Cedars of Chapel Hill. The fellows perform sub-acute care admissions, see regulatory visits, and make acute care visits.
Fellows work with Drs. Margaret Helton, Ben Blomberg and Marvin McBride at the skilled nursing facilities. While on site, they receive mentorship in the management of patients in long-term care. Mentorship areas include advanced care planning, avoiding hospitalizations, staff education, and billing and documentation in skilled nursing facilities. In addition, fellows work closely with social workers, physical therapists, and nursing staff to provide individualized, goal-oriented, appropriate care for residents.
Inpatient Geriatrics/Med A
Fellows spend two 4-week blocks on the Geriatric Inpatient Service, known as Med A. Med A is housed at UNC Hillsborough, located about 10 miles from Chapel Hill. The Med A team consists of a Geriatrics attending, John Gotelli, our Geriatric Nurse Practitioner, Ronald Davis, our inpatient pharmacist. There is also an Internal Medicine resident, two interns, and students from the School of Medicine and the School of Pharmacy.
The nursing and therapy staff have been trained in geriatric principles, and dementia-friendly care, and the unit emphasizes the importance of delirium prevention, early mobility, and safe transitions of care. The Fellows’ responsibilities include resident and student education in inpatient geriatric principles. In particular, they engage in functional and cognitive assessments, as well as performing comprehensive geriatric evaluations on new patients with the nurse practitioner. Fellows often lead goals of care discussions with patients and families.
Parkview Health and Rehabilitation Center
Fellows in the UNC Geriatric Fellows clinical rotations spend a total of two months during the year at a long-term care facility, Parkview Health and Rehabilitation Center. The Chapel Hill-based skilled nursing facility has long-term care patients as well as sub-acute rehabilitation patients. Fellows admit patients to sub-acute rehabilitation after often complex hospital discharges. They also see patients for regulatory visits and sick visits. During these ineractions, Fellows get a better understanding of community-based subacute rehabilitation and long-term care. During their time at Parkview, fellows also work with Dr. Claire Larson on their journal club presentations.
Program of All-Inclusive Care of the Elderly (PACE)
Fellows spend one 4-week block at two nearby PACE sites, Pittsboro and Burlington. The PACE program is a model program for care of frail elderly patients who are dual recipients of Medicare and Medicaid benefits. The program is designed to keep nursing home eligible patients at home. The PACE sites have large day programs with busy on-site clinics managing chronic diseases. PACE also deals with acute issues like volume overload, infections, and wound care. PACE also has rehabilitation services, nutrition services, pharmacy services, and recreation services on site.
The program has a collaborative and focused interprofessional staff. Fellows spend time in the clinic, make home visits with PACE nursing and therapy staff, and get to perform evaluations on new patients. They also participate in daily IDT meetings. Also, the attend more focused individualized care plan meetings for patients they care for in clinic. By the end of the rotation they are encouraged to develop and assess patient goals for the individualized care plan meetings.
Fellows spend one 4-week block with the Department of Physical Medicine and Rehabilitation. Fellows split their time between seeing patients in a local sub-acute care facility after medical or surgical hospitalizations and experiencing a variety of outpatient activities. These outpatient experiences include neuropsychiatric assessment and testing, driving assessment, pelvic rehabilitation, prosthetics and orthotics clinic, physical therapy, occupational therapy, cardiac and pulmonary rehabilitation, home safety evaluations and wheelchair evaluations. The goals of this rotation are for fellows to understand the services and equipment available to their patients to help maintain or regain function.
Inpatient Palliative Care Consultation/Inpatient Hospice
Also in the UNC Geriatric Fellows clinical rotations, Fellows spend a 2-week block with the palliative care consult service. During that time, they see inpatient consults from a variety of medical and surgical services at UNC Chapel Hill for end-stage symptom management and goals of care discussions. The service sees a variety of patients with cancer, heart failure, liver disease, dementia, trauma, and other complex diseases. This is an opportunity for fellows to participate in and lead intense and often complex family meetings, understand the planning for outpatient management of terminally ill patients, and to gain skills in symptom management at the end of life.
On top of that, Fellows also spend a 2-week block on inpatient hospice at the SECU Jim and Betsy Bryan Hospice Home of UNC Health Care. During this rotation, fellows work closely with palliative care attendings at the hospice home. Specifically they focus on advanced symptom management and care planning for patients at the end of life. In addition, they participate in family meetings. Fellows also make home hospice visits with members of the hospice team during this rotation as well.
Fellows spend two four-week blocks rotating through a variety of outpatient clinics. In addition, the have an orientation and introduction to Geriatrics month. The orientation month includes a chance to become more familiarized with UNC Geriatrics outpatient clinic as well as with the area services for older adults. This includes visits to the Area Agency on Aging, local Senior Centers, Adult Day Care Centers, and meeting with Orange County EMS, who provide interesting and innovative services to area seniors.
Other clinic experiences include the Wound Care Clinic with Vascular Surgery, Urogynecology Clinic, Rheumatology Clinic, the Sleep Disorders Clinic, and Heart Failure Clinic.
During these blocks fellows also make home visits, teach residents and students, and have discretionary time to work on their quality improvement project and other educational or research pursuits.
Fellows also have two elective months and three weeks of vacation yearly.