Long-Term Chronic Care Hospital Medical Director Shares His Vision for Geriatric Care

An interview with Kent Bakaev, M.D., Medical Director of LTCH at Hebrew SeniorLife.

What inspired you to become a geriatrician?

Dr. Bakaev: I was raised for the most part by my grandparents because my parents were very busy with their careers, so since my childhood I developed appreciation for the elderly. But I truly became inspired to pursue geriatric medicine in my last year of medical school when I learned how rich the experience of caring for older patients can be. Elderly patients are different in many ways. They are much more patient and wiser than their younger counterparts. Understanding and meeting older patients’ medical needs is a shared process between patient and doctor, and sometimes my patients guide me.

I am drawn to the holistic team-based approach that caring for older patients demands. To tailor care to the older patient requires evidence-based treatments while bringing in empirical analysis. Historically medicine for the last century has had only one major goal – longevity. And we’ve been quite successful given that we have nearly doubled life expectancy since the 19^th century. However in geriatric medicine longevity is limited as a measure for success. We don’t have a cure for old age and death. That’s why geriatricians and their patients focus on goals for care beyond curing a condition or increasing longevity.

One goal might be to maintain functional capacity, which impacts independence. Another goal is quality of life and comfort. Of course, ideally one would want longevity, functionality and quality of life. But practically speaking that is not always possible. So that is why a geriatrician has to look at patients from many different angles. Medical, social, cultural, functional, cognitive, and psychological considerations all come into play; sometimes financial considerations as well. That is why it takes a team of professionals to provide appropriate care to older adults. A physician alone could not achieve much for their patients.
 

What drew you to Hebrew Rehabilitation Center?

Dr. Bakaev: I was a fellow at Hebrew Rehabilitation Center four years ago, and was astonished by all that Hebrew SeniorLife offers to seniors and their families. It’s a one-of-a-kind organization that delivers care at all levels of complexity. HSL provides care within multiple medical domains— hospital-level care on the Medically Acute Care Unit, stepped down care on the Rehabilitative Services Units, long-term chronic care hospital (LTCH), in-home care and outpatient clinics within Hebrew SeniorLife’s living communities, as well as serving seniors in the larger community via housing and adult day care. HSL pretty much covers all domains where geriatric services should be delivered. I personally think the organization has a vision for what geriatric care should look like and how it can be delivered.

I was also impressed by the quality of care that HSL provides. We apply the most advanced evidence-based research to the treatment of our patients. HSL also has a unique ally on its quest to become an unmatched leader in the field of Geriatric care - the Hinda and Arthur Marcus Institute For Aging Research, which is one of the most well-known and advanced aging research institutions in the world.

I also feel that this organization has a very strong connection with the community overall in Boston. It’s very well-known and respected. Three words come to mind when I think about HSL—commitment, culture, and vision

What is your vision for LTCH at Hebrew SeniorLife?

Dr. Bakaev: Hebrew Rehabilitation Center already has a great patient and family-centered culture in place and my goal is to champion that approach by continuing to provide comprehensive and individual level of care delivered in a home-like environment. Under my watch care will continue to be provided by a multi-disciplinary team and tailored to the individual needs of each patient taking into consideration personal medical and non-medical goals. We continue to support patients and their families through our palliative care program and provide innovative nonphmarmacological interventions, for instance music therapy to address emotional issues. 

I would like to maintain and promote further full engagement of all members of medical teams, a superb level of communication and collaboration within the team and other departments, as well as culture of mutual respect and support. I strongly believe enhancement of these essential qualities will help us achieve the big organizational goals we have set for ourselves.   

What would you say to an adult child who is reluctant to place a loved-one in an LTCH?

Dr. Bakaev: LTCH-level care is the right choice when the level of care an individual needs exceeds the level of care they receive. When outpatient resources have been explored and there continue to be concerns about safety and access to timely and adequate medical care of an older person, as well as care giver burnout, it is often beneficial for all parties involved to consider LTCH care. Seniors get appropriate 24-hour care in an environment that offers a variety of beneficial social and physical activities, and their adult children can focus on their lives, and in many cases actually improve their relationships with loved-ones in their final years of life.