For These Seniors, The Doctor Is In

The city of Orange partners with St. Barnabas to bring primary care to a residence for elders.

In the Orange Health and Wellness Alliance exam room at Oakwood Towers, a senior apartment complex in Orange, Dr. Robert Clarke sees patient and building resident Mary Ore.
Photo by Andy Foster.

Cecee Holland has numbness in one of the fingers on her right hand. As she sits in the community room in Oakwood Towers at 400 Oakwood Avenue, a privately owned, 236-unit senior residence in Orange, her sweater decorated with Obama buttons, she’s not complaining or in pain. In fact, she has positioned her motorized wheelchair in front of the television so she can yell numbers at The Price Is Right. To travel to the doctor, 76-year-old Holland would have to arrange her own transportation, since she doesn’t drive and some buses cannot accommodate her wheelchair. And because all she feels is a little numbness, she normally would not bother making the trip.

But today, without leaving the building or missing her morning shows, she’s seeing her new doctor. Luckily for Holland, 400 Oakwood is the pilot building for the Orange Health and Wellness Alliance (OHWA), a partnership between the city and St. Barnabas Health Care System. “When Orange Memorial Hospital closed [in 2004], it created a void in the city,” says Orange mayor Eldridge Hawkins Jr., as he explains the concept. It’s simple: Bring a doctor into the building once a week to provide primary care, draw blood, take urine samples, do blood-pressure screenings and EKGs—and catch the little things before they become big things.

Magically, OHWA costs the city nothing. “We’re building on relationships,” says Hawkins. “I had a pre-existing relationship with St. Barnabas, and they’ve taken up the charge. When you’re trying to do the right thing, it doesn’t take a whole lot of arm twisting.”

St. Barnabas chose Newark Beth Israel Medical Center (one of ten hospitals in the St. Barnabas network) as the partner for 400 Oakwood. Newark Beth Israel outfitted the exam room, helped find a doctor for the program among its staff, and provides a medical assistant and an on-site coordinator. The building’s management is also on board. It provides the space for the OHWA outpost.

The benefits of the program are shared by all. Newark Beth Israel will likely get the referrals when patients need to see a specialist, have a mammogram, or get a hip replaced. The involvement of building management creates good will among the residents. The mayor fulfills a campaign promise by bringing primary care to seniors who are liable to go without it. The doctor sees and bills patients just as he would from his office. (Most of the charges are covered by Medicare.) And best of all, the residents get the care they need.

At 400 Oakwood, behind a door that still reads “T.V. ROOM,” Dr. Robert Clarke greets his patients. With his kindly demeanor and charming Jamaican accent, Clarke is perfectly suited for this gig, which requires both the gentleness to get skeptical seniors to trust him and the firmness to convince them to go get that colonoscopy. He talks about how he sees his mother, who died at Orange Memorial, in every patient.

Now, some of the residents get their blood pressure checked just to chat him up. And they can get more than just a checkup (or a chat): OHWA provides same-day prescription refills (and a pharmacist to consult about medications), flu shots, wellness seminars, scheduling and transport to specialist appointments or physical therapy, and more. When Clarke arrives each week, an announcement plays in every unit reminding residents that it’s time to come down if they would like to see the doctor. If someone is too sick or immobile, Clarke will go to them.

It was not long after OHWA opened at 400 Oakwood in April that seniors from other buildings began calling to ask when the alliance was coming to them. OHWA is poised to open its next branch at 340 Thomas Boulevard and hopes to open in all seven major senior residences in the city, which has a large senior population. Newark Beth Israel is also pairing with the city of Newark for an OHWA-like project. With the growing emphasis on preventive care and aging-in-place initiatives, OHWA’s timing seems propitious.

There is good reason for this movement: Seniors value their independence, but when they will not or cannot leave home for care, conditions worsen, diagnoses get more serious, many have to be institutionalized, and costs soar. Could the OHWA model be part of the next wave in senior care?

“Developing a ‘medical home’ for primary-care services is a key component to health care reform,” says Dr. John Brennan, executive director of Newark Beth Israel. “For instance, well-treated diabetic patients will have less ischemic heart disease, less congestive heart failure, and less peripheral vascular disease. And so you decrease acute trips to the hospital.”

Theresa Edelstein, vice president of continuing-care services at the New Jersey Hospital Association, agrees. “It’s a very natural partnership for hospitals. They already have experience providing primary care through their clinics, and they would prefer to not have elderly people come through their emergency departments for that care,” Edelstein says. “This really speaks to the overall public policy goal of keeping people out of institutionalized environments. If you can keep them healthier longer in the communities they’re used to being in, that’s a win for everyone.”

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