The University of Nebraska Medical Center College of Nursing announced today that it has launched a unique mobile clinic to address Nebraska’s rural shortage of those who specialize in the care of older adults.
A $300,000 federal stimulus grant is funding the Mobile Nurse Managed Clinic — a 38-foot, custom-built vehicle and one-of-a-kind mobile clinic. The clinic will fill a critical need for comprehensive geriatric assessments for fragile older adults in rural areas whose physical or mental conditions impair their functioning. The college is working with primary care physicians in communities that have identified a need for the service.
Starting in May, the mobile clinic, which will be staffed by three geriatric nurse practitioners, will rotate service in Norfolk and Neligh initially. The clinic will operate six days a month then ultimately eight days a month. The college hopes to expand to other locations in the future.
It also will provide clinical training for 25 students enrolled in the college’s geriatric nurse practitioner program. There are few rural sites in which to train students who will be practicing in rural areas.
Three geriatric nurse practitioners, Claudia Chaperon, Ph.D., project director of the grant, Sara Wolfson, and another soon to be hired, will provide comprehensive geriatric assessments. Geriatric nurse practitioners specialize in the care of older adults, particularly those with complex health issues. Linda Sather, Ed.D., is co-project director of the grant.
“This is an innovative and collaborative primary health care model that reaches out with a critically needed service to help vulnerable older Nebraskans in rural areas,” said Dr. Chaperon, UNMC assistant professor of nursing. “The goal is to help improve function in older adults so they can maintain or regain their independence and do the things they like doing.”
The project is funded by the American Recovery and Reinvestment Act (stimulus funding) through the U.S. Department of Health and Human Services’ Health Resources and Services Administration. Other grant funding also supports the project.
Comprehensive geriatric assessments are thorough medical evaluations that can include laboratory and other diagnostic screening tests to assess a patient’s physical, mental, social, environmental issues, including memory problems, depression, incontinence, hearing and vision, malnutrition or weight loss, falls, or an unsafe living environment.
Typically, geriatric assessments aren’t available to older adults living in rural areas. There are few physicians who are geriatricians and less than 10 nurse practitioners are certified and licensed as geriatric nurse practitioners to conduct the specialized service.
The mobile clinic’s coordinator will act as a liaison to the community, schedule appointments, coordinate services with physicians and other health care providers, and provide case management for patients and their families. Services will be billed through Medicare, Medicaid and health insurance.
After completing comprehensive geriatric assessments, Dr. Chaperon and her team will develop a care plan that includes a course of treatment or recommendations to resolve the patient’s issues.
“If we find, for example, that a nutritionist is needed, we would refer the patient to a nutritionist in their community,” Dr. Chaperon said. “If the resources aren’t available in the community, we will consult with specialists in regional health centers nearby or at UNMC’s Home Instead Center for Successful Aging in Omaha.”
Charles Harper, Jr., M.D., internal medicine physician at Faith Regional Physician Services in Norfolk, is a partner with the college’s mobile clinic. He said the service is of value to primary care physicians like himself. “It’s difficult for my patients to get to Omaha for comprehensive geriatric assessments,” Dr. Harper said. “It will be of great help to have a multidisciplinary team that can look at the whole picture and come up with better treatment options. I think this is going to benefit patients, families and primary care physicians.”
Janice Cunningham, a student enrolled in UNMC’s geriatric nurse practitioner program, said the Mobile Nurse-Managed Clinic will benefit her. Cunningham is a nurse who lives in Beaver Crossing and is a certified hospice and palliative care nurse in rural Nebraska.
“I have seen a great need for geriatric comprehensive care in my nursing practice,” Cunningham said. “We have many wonderful family practice doctors in Nebraska who do an excellent job with our elders. But many are swamped in their clinical practice and have limited time to spend with very complex geriatric patients who require extra time to perform comprehensive assessments.”
The mobile clinic has two exam rooms, a wheelchair lift, laboratory testing equipment, and EKG machines. It’s also equipped with high definition video capability which can be used as a tool for a live telehealth connection to the patient’s care providers or to specialists for consultation anywhere in the state.
The College of Nursing has operated a mobile nursing center since 1993 which provided health screening services in several rural and urban underserved areas.
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