The geriatric one-day hospital of the university centrum in Liège, Belgium

The geriatric one-day hospital of the university centrum in Liège, Belgium Dr Sophie Gillain, MD in charge of clinical activities in the geriatric daily clinic Christel Menozzi, Senior Head Nurse

Working plan • Legislative aspects of geriatric care (GC) in Belgium • Financial aspects of the geriatric one-day hospital • Every day organisation • Our activity • Guided visit and questions

Legislative aspects of geriatric care in Belgium • Sincejanuary 2007, Geriatric plan of care (GPC) • Eachgeneralhospital must have a GPC • Or beassociatedwith an otherhospitalincludingthese plan

Legislative aspects of geriatric care in Belgium • People > 75 yearsold • At risk of frailty • At risk of polymedication • At riskof non typicalclinicalpresentation of the disease • At riskof modification of drugsmetabolism • At riskof functionaldeclin • At riskof malnutrition • At risk to present psycho-social disorders

Legislative aspects of geriatric care in Belgium • Each people ≥ 75 yearsold, hospitalized have to beassess to theserisk •  role of the geriatric mobile team • Olderassessed as at risk have to benefit of the GPC

Legislative aspects of geriatric care in Belgium • Main goals of GPC • Adapted care • Best way to preventfunctionaldecline • Best way to carry out rehabilitation as higheris possible • Best plan of care afterleavinggeriatricdepartment • Follow up • Discussion and plan withothercaregivers • GP, Familymembers, Nursing homes, …

Legislative aspects of geriatric care in Belgium • Main tools to do that • Acute geriatric ward • Geriatric consultation • Mobile geriatric team in the hospital • Mobile geriatric team beyong the hospital • Relation with GP, Nursing homes, Neuropsychiatric center • Geriatric one-day hospital 6. Multidisciplinary approach by organise by caregivers

Specificity in university centrum

Legislative aspects of geriatric care in Belgium • Caregivers of the multidisciplinaryapproach • Geriatrician (6 years more thangeneralmedicine) • Geriatric nurse • Physiotherapist • Psychologist • Ergotherapist • Nutritionist • Speech therapist • Social worker

Legislative aspects of geriatric care in Belgium • Obligation concerning organisation • Assume all differentfunctions • Acute geriatriccare unit, one dayhospital, mobile team • Information transmission • To otherspecialists, GP, patients and families • Multidisciplinary meeting / week / function • Find a adpated consensus for each patient

Legislative aspects of geriatric care in Belgium Obligation concerning specialized caregivers in the different functions of the GPC

Acute geriatric care unit (/ 24 beds) • 1 Geriatrician • Recommandations by SBGG and EUMS • 14.13 Full-Time Equivalent (FTE) dividedinto • 1 FTE Head nurse with a geriatricspecialization • Minimum 4 FTE nurse with a geriatricspecialization • Minimum 5 FTE nurse • 1,33 FTE paramedical staff • Neuropsychologist, Occupationaltherapist, Speech therapist

Mobile geriatric team • Concerningpatients ≥ 75 yearshospitalizedoutsidegeritric care unit and assess as at risk • Since 2007, fundedas a pilot project: 4 FTE • 1.7 FTE nurse and 2.3 FTE paramedicalcaregivers • Since 2014, structural financing: 5.75 FTE • Free distribution intodifferentcaregivers

Geriatric One-day hospital • Pilot project • Funded: 3 FTE • 2 FTE Nurse • 1 FTE Paramedicalcaregiver Obligations to have: occupationaltherapist, physiotherapist, neuropsychologist

Legislative aspects of geriatric care in Belgium Obligation concerningcontinued training • Geriatrician: • Ethical, Economical and Medical aspects • 20 points / year • 2 obligatory meetings / year • Nurses with a geriatricspecialization 60 h/ 4 years

Financial aspects of the one-day hospital • Since 2007, financialgrantsallowed by the government • Architectural obligations • Medical and multidisciplinary care obligations • Diagnosis and care • Rehabilitation • Onlyduring the day • Obligation to have geriatrician, nurse, neuropsychologist, occupationaltherapistand physiotherapist • Possibility to consult: nutritionist, social worker, speech therapist • Annual report of activities

Financial aspects of the one-day hsopital • Our classical financial support is related to • Only two multisciplinary assessment per year • For two differents reasons • All visit as a medical consultation • Some administrative tasks • Ask the reimbursement of specific drugs • Our special financial support is calculated on the number of multidisciplinary assessment done

Every day organisation • Our location • Brull, outpatientsmedical center of CHU of Liège • All medicalcompetencesavailable • Close to the memory clinic and neurologist • Laboratory on the highestfloor • Imagery center on the first floor • Main limitations • Not close to the acute hospital • Caregiversphysicalyseparatedfrom the rest of the team • Restrictedaccess and parking • Misunderstanding for patients

Every day organisation • Caregivers • 2 Geriatricians • Pr Petermans, head of geriatricdepartment • Dr Gillain, MD • Team of nurses • 2 one-dayspecific nurses • 4 additional nurses from the acute care unit • 2 nurses in training • Able to assume all functions of the GPC • One-dayhospital, acute geriatricward, geriatric mobile team • Allowing training and replacement

Every day organisation • Caregivers • Neuropsychologist • Alternatingevery 3 months • Occupationaltherapist • Alternatingevery 3 months • Physiotherapist • Team of two

Reason to come to • From the GPs • Cognitive disorders • Falls • Functionaldecline • Loss of appetit and weight • From the hospital • Frailtydetectduring hospitalisation by the mobile geriatric team • Emergencies department, medical or surgericalwards • Follow up asked by the geriatricianafter hospitalisation in the geraitricwardbecause of need to beevaluatedwithout acute illness • Delirium duringinfectiousdisease

Typical assessment • First consultation with the geriatrician • Carry out the multisciplinaryapproach • Second visit to benefit to the completeassessment • Complete multidisciplinaryassessment • Design care and/or rehabilitation • First follow up after 3 months • Follow up / 6 month or / year • In the same line with the GPs • We are the second line

Every day organisation • Role of geriatrician: First consultation • Anamnesis and physical exam • Heteroanamnesiswithfamily or neighbours • Sometimestools to detectfrailty • MMSE, Clockdrawing test, Gait test (dual task) • Design the multidisciplinaryevaluation • Organic tests: imagery, bloodanalysis… • Need of neuropsychologicalevaluation • Need of occupationalevaluation • Need of physiotherapist • Need to evaluateability to drive • Write a report to the GP

Every day organisation • Role of geriatrician: Second consultation • After the completemultidisciplinaryevaluationdesigned • Summaryevaluations and physicaltesting • Inform to the diagnosis • Suggestspecifictreatment and care • Specificdrugs • Specificrehabilitation programme • General advicesconcerning nutrition, physicalactivities, social activites • Review of drugs and preventpolypharmacy and sideeffects • Suggestadaptinghelper (Social workers) • Answer the questions of patient and family • Write a report to the GP • Including the completemultidiciplinaryassessment and suggestions

Every day organisation • Role of nurses • Plan the muldisciplinaryassessment • Parameters • blood pression, cardiacfrequency, weight • Geriatricscale • MNA, ADL, IADL, NPI, Water Test by Di Pipo, • If needed, • bloodsamples, ECG • If needed, • Heteroanamnesiswithfamily but without the patient • Inform the geriatrician of new data unknown • Write a specific report for the geriatrician

Every day organisation • Role of Occupationaltherapist • Evaluate the daily-life environment • Test vision and hearcapacities • Givesomeadviceconcerning • Needs of help in IADL or ADL • Needs of help concerninghouseworks • Needs of specificdevice to maintainautonomy • Pill-box: explaininterest and check correct use • Stringer socks • Personalalarm • Needs to adaptenvironment • Carpets, furniture, …

Every day organisation • Role of neuropsychologist • Essentialyneuropsychological test asked by the geriatrician • MMSE, MOCA, Mattis • Clockdrawing test, TrailMaking test, Stroop • Grober 16 or 64 items, CVLT • Fluency tests • Attentionnal tests • Specific tests to assessneuropsychologicalability to drive • Lessoften: moral support • To the patient and/or to the close relation • Write a report for the geriatrician

Every day organisation • Role of physiotherapist • Gait and balance test • Grip strength and Gait speed • Tinetti • Timedup and go prescription rehabilitation • Time chair stand test • Assessfear and risk of falling and postural reaction • Assessabilty to fallwithout danger and abillity to get up • Check shoes and use of the walking stick • Givespecificadvices • Write a report for the geriatrician • Specificrehabilitation (2/ week) • Fallers / Parkinsonian / Dementedperson

Typical day • Geriatrician • 4-5 new patients in the morning • First consultation • 6 patients in the afternoon • First multidisciplinary assessment • Follow-up • Other caregivers • Specific assessment asked by geriatrician and planed by the nurse • In mean 6-8 assessments/day • Physiotherapists (2) • 8-10 mobility assessments (new patients or follow up) • 10-16 patients in rehabilitation

Our activity • For patients and families • Onlytwodays • Limitations to the staff • Becausegenerallack of caregivers in Belgium • Different places in charge of geriatric care in CHU • For administrative works • One day more • Planning assessment • Papersconcerningreimbursement of drugs • 500 patients / an

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The geriatric one-day hospital of the university centrum in Liège, Belgium