The Stanly News and Press (Albemarle, NC)

August 15, 2012

Treatment in long-term care facilities


Wednesday, August 15, 2012 — What used to be called “nursing home care” is now called extended or long-term care. Today, thousands of people are benefiting from a shift in how patients are treated in these facilities that provide a continuum of care for patients who are often hospitalized for an injury, joint replacement, stroke or other condition.

Leading these changes in Stanly County is Dr. Stephen Seltzer, a family medicine physician with more than 35 years of experience in treating all types of medical conditions. In July 2010, Seltzer gave up his traditional “office practice” to become Stanly County’s only full-time long-term care physician. In this role, he visits patients at Stanly Manor, Forrest Oakes, Bethany Woods and the Lutheran Home each weekday.

Today, Seltzer said he wouldn’t trade his kind of person-centered care for anything.

“In the days of my office practice, extended care was not as personal with a lot of patient care done by telephone, faxed reports, and triage,” he said.

“Today, I visit every facility Monday through Friday. Because I am in those facilities so frequently, I get to see for myself how patients are responding to the treatment plans I’ve put in place. This personal attention allows me to address issues before they become serious.”

Many patients who benefit from short-term extended care facilities have undergone such conditions as joint replacement and require close monitoring and rehabilitation. Other patients may have acute conditions such as heart failure or pneumonia and require frequent monitoring by a physician.

“Regardless of the illness or injury,” he said, “patients can access my services through the hospital case manager, a family member or they can even self-refer.”  

Seltzer says that many people still have the image of a long-term facility as being for those with serious chronic issues like dementia or stroke. While only about half of his patients are admitted for strokes and dementia, others are there for treatment so they can return home.

When patients leave a long-term care facility for home or assisted living,  Seltzer encourages reconnection with their primary care provider or establishing themselves with a new one. Seltzer does not see patients outside of the four Albemarle extended care facilities.

“I recently treated a 54-year-old man for pneumonia because he had no one to care for him at home,” said Seltzer.

“He needed close monitoring of his condition and someone there to help ensure the antibiotics were doing their job and that he was responding to treatment.”

Another patient Seltzer recently treated was a woman with emphysema. “She was using home oxygen and became weaker and weaker at home,” he said.

“Her family decided to admit her. I developed a customized treatment plan to stabilize her condition and help improve her capacity to function. After six weeks, she was home working in her garden without oxygen. This is what gives me such incredible gratification.”

Seltzer said, “That his goal is not only to give highly personalized treatment at the bedside, but to reduce the incidence of hospital re-admission.

Reducing hospital re-admission is crucial to reducing healthcare costs for everyone,” said Seltzer, “but it’s most important for the patient’s health and well-being as well as the family’s peace of mind.”

In the two years he has served the area’s long-term care communities on a full-time basis, he says he has been most amazed at the dedication and attention patients are given at these facilities, not just by nurses, but by everyone working at these facilities.

“The saying ‘it takes a village’ is true,” he said.

“I’ve had maintenance workers, dietitians and other non-clinical staff pull me to the side to ask about a patient or to offer an observation on a patient’s condition. For instance, I had someone in the maintenance area tell me he felt a patient was depressed. I welcome this type of input and insight as we all work together as a team to help patients regain the highest level of quality of life they can.”

Many of the long-term care communities have made great strides in developing activities that stimulate a patient.

“Songs, games and other activities are aimed at keeping a patient’s neurological function as strong as it can be.”

Many families, he says, don’t realize they can request his services for a loved one. He encourages anyone who may be considering a joint replacement or other upcoming surgery that may require extended care to arrange a tour of the facilities and to talk with him about his services.