Geriatric program doctors pay calls at elderly residences

Many patients were once homeless

Photos by Pat Greenhouse/Globe StaffDr. Diane McMullin visited patient Lucille Bland, 82, a resident in the Ruggles Affordable Assisted Living Community in Boston. Below, Dr. Irene Crofton (left) and McMullin examined William Manton, who is 75 and blind, at the facility. (Photos by Pat Greenhouse/Globe Staff)

Lucille Bland, 82, leans forward in her green upholstered rocking chair and breathes deeply. Dr. Diane McMullin, a Harvard geriatric medical fellow, comes around behind her and places a stethoscope on Bland's back, listening to her breathing while Dr. Irene Crofton observes and takes notes.

"Before I came here, I had one stroke and two heart attacks, and here, I've been OK," Bland says a few minutes later, talking about the care she has received since moving to the Ruggles Affordable Assisted Living Community in Roxbury last October. "I had five doctors I had to see before, and I find this better - you don't have to get ready for them and sit in the waiting room: they're ready for you."

Bland's doctors on this recent day are part of a program through the Beth Israel Deaconess Medical Center - and funded by a three-year federal grant worth about $1.8 million - that places doctors in residences primarily populated by the formerly homeless elderly. Now entering its second year, the Harvard Geriatrics Fellowship Program brings doctors, psychiatrists, and dentists into residences run by Hearth and other organizations dedicated to providing housing and healthcare for the elderly.

McMullin is the first of six medical fellows who will rotate through the Ruggles center in six-week shifts over the course of the next year. Her psychiatric and dental colleagues will join Ruggles in September, while also serving patients on the Cambridge Health Alliance Campus and at the Hebrew Rehabilitation Center.

"It's really nice to see what doctors in the community do," McMullin said. "And to be involved in that is really great."

The program provides an unusual learning opportunity for the fellows, who collaborate to provide comprehensive care for their patients, said Dr. Alan Abrams, the program's director. "It's a unique curriculum that is geared toward the fellows learning in an interdisciplinary way and also to have more in-depth experience with underserved populations," he said. "Also, the Hearth residents that we are involved in helping evaluate get a comprehensive interdisciplinary geriatric evaluation."

The fellows, all of whom recently completed their medical residencies, have become invaluable assets to an organization that serves at-risk patients - many of whom have chronic mental illness and substance abuse problems, and few of whom have had comprehensive healthcare. They make their rounds twice a month at the Ruggles Street building, under the guidance of Harvard faculty such as Crofton, also a staff physician with the Urban Medical Group, and rotate through other facilities throughout the city.

"They add an extra element of support that wasn't there before," said Dawn Matchett, the social worker at Ruggles. For a population prone to mental illness, and a community in which psychiatric services are rare, the psychiatric fellow has become particularly important, she said.

Most of the residents' mental illnesses have gone undiagnosed through years of sporadic care, said Deborah Cutler, Hearth's director of behavioral health, and many are wary of mental health professionals.

"It can be very frightening [to be screened for mental illness], and is something people can be very reluctant to do - they may have had bad experiences in the past, or are fearful of the results," she said. "For some people for whom seeing a psychiatrist seems very overwhelming, having someone come into your home can be very helpful."

Dr. Jason Strauss made those house calls until he finished his fellowship in July; he is returning to the program in a supervisory role. "It's important to work with people with numerous strikes against them - they're homeless for a number of years, many are substance abusers, they are older," he said. "Often, they can just fall through the cracks."

To help keep residents from falling out of the healthcare system, new medical fellows like McMullin and her incoming dental and psychiatric colleagues will collaborate on comprehensive care plans for their patients, providing a complete picture of their ailments.

"It really benefits the residents [because] someone is giving them individual attention, and listening to their medical problems, and then conferring" with the other doctors, said Ethel Fowkes, Hearth's director of health services. As the Ruggles program nurse at the time the fellowship was created last year, Fowkes said she saw very real benefits for her residents - and for the doctors.

"Normally, they only see their patients in hospitals," she said, "but you need to see where they live to truly understand what is going on - why they don't take their medication, what they are struggling with," and how to help them.