Understanding complexities of our patients

Dr. Gary E. Eddey

By Gary E. Eddey, MD

Matheny has a long tradition of serving as a teaching site for professional students. Our facility offers the state of New Jersey a campus where professional students can learn to care effectively and efficiently for one of the most complex patient populations in the world.

Our role as an educational campus for medical students, nursing students and interns in social work and therapeutic disciplines is directly attributable to our status as a special hospital. That status has attracted affiliations with the New Jersey Medical School and with teaching institutions throughout the United States. The primary purpose of our training programs is to ensure that students entering the healthcare fields of medicine, nursing, physical therapy, occupational therapy, speech and language, social work, psychology, recreation, chaplaincy and music therapy are prepared to understand and meet the special healthcare needs of people with complex disabilities. Matheny funds these programs because the more professionals Matheny can train to treat the developmentally disabled population, the more cost-effective and efficient treatment will become.

The training programs we provide have been the focus of several articles in professional journals, have been presented in conferences and have served as models for national healthcare training programs. Our training philosophy was also featured in a national webinar conducted by the Centers for Disease Control and Prevention. This wide exposure results in our programs contributing to the cost-effectiveness of healthcare for persons with disabilities, not only in New Jersey, but nationally as well.

(Fifth in a series of articles by Gary E. Eddey, MD, Vice President and Chief Medical Officer, on the habilitative healthcare model).

Dr. Gary E. Eddey.

By Gary E. Eddey, M.D.

For individuals with complex developmental disabilities, who are totally dependent on care with a lifetime ahead of them, an inpatient habilitation healthcare model may be the most appropriate healthcare approach.

What distinguishes this individual from someone who can be adequately cared for in the community? Here are four determining factors for recommending inpatient habilitation care:

• The chronic neurologic disabling condition is accompanied by many other healthcare disorders.

• Significant musculoskeletal conditions impact mobility.

• The patient is totally dependent for care.

• Social/family supports are unable to keep the patient from improving or even maintaining function.

The above issues significantly increase the care-load burden of the patient. These patients require much closer monitoring throughout the day than those who can live in the community because they have multiple associated clinical conditions requiring the most complex medical, physical, therapeutic and nursing care needs.

At Matheny, 100% of inpatients are complex and ambulatory-dependent. Almost all have 15 to 20 accompanying diagnoses in addition to their primary underlying chronic neurologic disability. The Matheny inpatient habilitation healthcare model is the essential standard of care for all those with significant developmental disabilities and should be the standard of care for all persons with developmental disabilities who are medically  complex.

(Second in a series of articles by Gary E. Eddey, MD, Vice President and Chief Medical Officer at Matheny, on the habilitative healthcare model).

By Gary E. Eddey, MD

The term “habilitation” refers to an approach to healthcare services for individuals with developmental disabilities. It includes comprehensive medical, nursing, therapeutic and educational care, is designed for children and adults and can be provided in either a community or inpatient setting. Habilitation services are essential for those with congenital disabilities, or disabilities acquired early in life, and are often best provided in a community setting for the majority of individuals with developmental disabilities.

Habilitation focuses on the individual, improving his/her functioning and overall health in a supportive environment. It takes into consideration needs in a wide variety of areas including social services, psychology, psychiatry, recreation, therapies, integrated medical and nursing services and, depending on age, educational services. Research confirms the two-way relationship between a full and active lifestyle and physical health for persons with disabilities.

A successful habilitative model must maximize potential at all points along the lifespan continuum. With its emphasis on an integrated approach to care and services, the habilitative model reverses or impedes a decline in health among this at-risk population.

The goal of habilitation is to normalize the life of the individual with developmental disabilities as well as his/her family. Families are a critical element in the care and support of people with disabilities. They are advocates and guardians in most instances. However, the abilities and needs of families must continually be assessed throughout the life cycle. Frequently families can and do provide care when the individual with disabilities is young. This becomes more difficult and, impossible for some, as the individual with disabilities ages.

(The first of several articles by Gary E. Eddey, MD, Vice President and Chief Medical Officer at Matheny, on the habilitative healthcare model).

Do people with disabilities receive the same quality of healthcare as people without disabilities? The answer is “no,” says Kenneth Robey, Ph.D., director of the Matheny Institute for Research.

The reason, says Dr. Robey, at left, is simply lack of training. “Programs at medical schools, nursing schools, dental schools and pharmacy schools have done very little to prepare primary care professionals to serve people with disabilities,” he explains.

Third-year medical students at UMDNJ-New Jersey Medical School currently rotate through Matheny in an attempt to educate future doctors about how to provide this care. But Matheny realizes this isn’t enough. In 2007, Dr. Robey and Gary E. Eddey, M.D., Matheny’s chief medical officer, began exploring what else was being done around the country. That eventually resulted in the formation of the Alliance for Disability in Health Care Education, which has already raised visibility about this issue.

A major goal of the organization, according to Dr. Robey, who served as president in 2010 and 2011, is to develop “a list of things that healthcare professionals need to know or be able to do that works across all disciplines and disabilities.” A long-term goal, which Dr. Robey admits is a stretch, “is to ensure that every medical school, nursing school and medical training program in the United States has some component to address disability-specific issues.”

For more information on this subject, log onto www.matheny.org, click on “All News” and look for “Preparing Healthcare Professionals to Better Serve People with Disabilities.”