New Masonicare Medical Director Orchestrates Well-Being For Elderly Patients

By Nancy K. Crevier

Dr Yvette Fernandez’s face lights up when she talks about her specialty, geriatric medicine. Dr Fernandez is the new medical director for short-term and long-term rehabilitation at Masonicare at Newtown, as well as for the assisted living facility associated with it, Lockwood Lodge. A graduate of Albert Einstein College of Medicine in New York City, she completed her residency at Montefiore Hospital in the Bronx, and spent six years as an attending physician at Metropolitan Hospital in New York City, and at Mt Sinai Hospital in Queens.

She came to Masonicare at Newtown in July 2010, following two years in private practice in Waterbury.

Five of her six years as an attending physician, Dr Fernandez served in the geriatric outpatient clinic at Mount Sinai Hospital, and it was that experience that prompted her to pursue a geriatric fellowship.

“The relationship that a doctor establishes with an older patient harkens back to an old-fashioned doctor/patient relationship, and I think that is what attracted me,” said Dr Fernandez. “The trust and the gratitude expressed by these older patients is so satisfying.”

The older patient can get lost in an internist visit these days, and feel rushed, said Dr Fernandez. “That can lead to poor care, because the patient has ten minutes to see the doctor and may not remember to ask the questions that they have. [Elderly patients] are a more compliant population. By establishing a trust, and taking time to know the older patient, though,” she said, “a [geriatric specialist] can have more impact on their quality of life.”

At Masonicare at Newtown, Dr Fernandez feels she is able to build that element of trust into the relationship she has with the nearly 200 patients under her care. “They feel like I am a proponent for the population. I see how they get shuffled through the system, and it breaks my heart to see these older people, who have given so much in their lifetimes, especially the veterans, unable to get the health care that they need. Their rights are compromised in a lot of ways,” she said.

As a full-time doctor at Masonicare at Newtown, Dr Fernandez is available five days of the week, as well as being on-call many weekends. She relies on the assistance of Masonicare nurse practitioner John Lujanac to split the workload. “I could never care for this number of patients all on my own,” she said. “John and I are in constant communication, so this works very well.”

Her steady presence is reassuring to patients, and allows her to utilize a holistic approach to care, optimizing treatment and understanding the individual patient’s needs. “Geriatric medicine as a specialty allows me to spend more time with a patient. You have to look at them as a whole: What is their access to care? Do they need a caregiver? Is the family involved in planning? How do you approach care if they become chronically ill? There is a lot to consider,” said Dr Fernandez. “We try to optimize the baseline function in spite of overwhelming illnesses and an array of medications they may be taking. It’s not easy,” she said, “to strike a balance.”

Masonicare at Newtown is a perfect example of the continuum of care for the elderly, she said, and one of the things that she likes about the facility. “You have short-term care available to help bring a patient back to that balanced baseline. The assisted living facility provides supported independence, including specially supervised care for the memory impaired. And then we have the long-term care as that balance is tipped away from optimum health,” said Dr Fernandez.

There are special challenges that face older patients, and part of her job is to help them assess and overcome these difficulties. “The number one challenge I would say, for older patients, are financial obstacles, even for those who are not very ill,” she said. Even one or two common diagnoses can mean prescriptions that are quite costly, for example.

The next challenge for the elderly is how accessible quality health care is for them. “The third thing, is that we have an ever-growing population with Alzheimer’s. We’re better at detecting it now, and we also have an increasing population over the age of 80,” said Dr Fernandez.

Many of her patients come to her concerned about memory issues, she said, and that is the subject of a Lunch and Learn talk Dr Fernandez gave February 24 at the Fairfield Masonic Lodge in Fairfield. “People assume that memory issues are inevitable with age. I try to help people identify what is normal and what is not. Absentmindedness does not mean a patient necessarily has Alzheimer’s,” she said. Sometimes, it is overmedication, or a bad interaction between the many medications an older patient may take, that creates memory issues she said, or depression and anxiety can impair concentration. As a geriatric specialist, she is able to monitor and reassure the patients in her care.

Dr Fernandez, who lives in Ridgefield with her husband, John Clements, and their two small children, has settled into her role at Masonicare at Newtown in just six months, and has already developed an idea of short- and long-term goals she would like to achieve as medical director of the facility.

“One of my immediate goals is for the community to be aware that Masonicare at Newtown is a resource for acute and long-term care, especially for patients already diagnosed with dementia. I want to let people know that we are aligned with Masonicare to provide quality care to the elderly. I am here full-time. I do not have a private practice, and that is one of the things that makes Masonicare different from other nursing home facilities. We have full-time, in-house doctors,” she said.

That kind of personalized care means that long-term care patients become “like family,” said Dr Fernandez. “When you go out on the wards, there is not a sterile, clinical feel. Patients think of us as family members,” she said.

She is also anticipating an increase in the number of younger, as well as older patients, at the outpatient rehabilitation facility on site, for physical therapy, a service that has been available to community members since this past summer. “We have also added nine new private rooms for inpatient rehabilitation patients, that can be prebooked when someone has surgery, like hip or knee replacement. I think that will draw patients who want that privacy,” she said.

Further out, Dr Fernandez would like to implement a geriatric assessment program for outpatients. “Patients from the community could come in with geriatric syndromes, whether it is Alzheimer’s or just failure to thrive. I would then go through all of their chronic illnesses with them, and use my geriatric skills to come up with an assessment of his or her health, and then a comprehensive, individualized treatment plan. I do that a little, already, with some of my Lockwood Lodge patients. This would be an outpatient service, though,” explained Dr Fernandez.

As much as she enjoys her interaction with residents of Masonicare at Newtown, for Dr Fernandez the best part of her job is being able to return a patient to the level of health that allows them to return home. “Seeing a very ill patient come in, sometimes hanging by a thread, who is wondering if they will ever go back home again, and then helping that to happen is very satisfying,” she said.

“I grew up in New York City, and I come from an Hispanic culture, where you revere the older people,” said Dr Fernandez. “As a geriatric specialist, I see the older people as the most grateful group of patients. But,” she said, “I learn from them, as much as they learn from me.”