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ENCOURAGING SERVICE THROUGH COLLABORATION

Nurse-managed memory disorder clinic puts the emphasis on respect

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by Ruth M. Tappen

George’s mother, two aunts and, most recently, his brother, developed Alzheimer’s disease (AD). He knew intellectually that an occasional memory lapse was not AD but was unnerved every time it happened. Sarah, on the other hand, was sure nothing was wrong. At least that’s what she told her husband, but he’d noticed she no longer played bridge and had begun forgetting important appointments. Harry kept getting lost. He would go out for bread and coffee and not return for hours. If someone suggested he stop driving alone, he went into a rage and stormed out of the house, car keys in hand. (The preceding names are pseudonyms.)

All three sought help at our new Louis and Anne Green Memory and Wellness Center, part of the Christine E. Lynn College of Nursing on the Florida Atlantic University campus in Boca Raton. George was relieved to find he had no significant memory loss and that his test results could serve as a baseline for future comparison if needed. Sarah had mild AD and enrolled in the Level I (mild impairment) day program, where she played non-score-keeping bridge every afternoon. Harry failed the on-road driving test and reluctantly stopped driving. It took several hours to create an alternative transportation plan to accommodate his active routine.

The Louis and Anne Green Memory and Wellness Center extends a warm personal welcome to those who visit. Bright, airy rooms with natural light and soft colors add to the comfort of clients and families. Consultation and examination suites were designed by the geriatric nurse practitioners (GNPs) that staff the center’s diagnostic clinic. The library offers family members a quiet place for the long waits generated by testing sessions that last two to three hours. The center offers comprehensive diagnostic examinations, older driver evaluation, individual cognitive and psychotherapy sessions, support groups, community education, therapeutic day programs for people with mild to moderate memory problems, and a number of ongoing behavioral and pharmacological research studies.

Geriatric nurse practitioners conduct the initial diagnostic examination and order blood work, scans and other tests as needed. Students from various disciplines participate in the activities, as do a large number of community volunteers. The center is unique in the state of Florida because it is based on a nurse practitioner model, offers both diagnosis and treatment under one roof, and operates within the college’s philosophy of caring, with emphasis on respect for impaired individuals.

Designing and building the center took six years from the time the Green family offered $1.5 million to build an Alzheimer’s care center—a gift matched by state funds—to the time we opened the doors of our new building. Originally referred to as an Alzheimer’s research and care facility, we soon realized that the term “Alzheimer’s disease” frightened people. Memory is a milder, less threatening word to most, and wellness conveys optimism and hope. The donors’ vision for the center is to eventually offer comprehensive care from the time of diagnosis through the end of life, with residential care and a skilled nursing facility on the same site. Our partner, Boca Raton Community Hospital, will provide acute care.

At first, we offered primary care by the center’s geriatric nurse practitioners, but we found that most people were satisfied with their primary care providers and came to us for our expertise in memory problems. Further, local physicians raised a storm of protest over our offering primary care, fearing we would “steal” their patients. One group threatened to drive us out of Palm Beach County entirely.

Despite this backlash, other physicians recognized the value of our services and referred patients to us. Several helped us refocus as a specialty practice. Today, about half of our clients are referred by physicians—some of them neurologists—few of whom conduct driver evaluations. The rest are self-referred. In June 2005, we became the 15th state-designated memory disorder clinic, a major victory for this upstart nurse-managed clinic.

We also learned financial lessons during our start-up phase. The services of a social worker, originally part of the diagnostic team, were not reimbursable under Medicare, and few families were willing to pay for this themselves. Reluctantly, we asked the GNPs and clinical psychologist to assume the social work role and eliminated the position.

Shaped by the caring philosophy of the college, the vision of our donors, characteristics of the community, reimbursement guidelines and, especially, the expressed needs of our clients, the Louis and Anne Green Memory and Wellness Center is an example of what nurses can accomplish if they dream big. RNL

Ruth M. Tappen, RN, EdD, FAAN, the Christine E. Lynn Eminent Scholar and Professor at Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton, Fla., is director of The Louis and Anne Green Memory and Wellness Center.