As New York Gets Older, Hospitals Expand Services

The last couple of years have been a clear turning point in the healthcare industry, with many of the City’s top hospitals putting greater emphasis on the special care senior patients need.

“As we age, our body doesn’t function in the same manner,” said Dr. Nisha Rughwani, professor of geriatrics and palliative medicine at Mount Sinai’s medical school. “Geriatrics care is specialized care.”

Older adults, Rughwani said, need help as they travel along the extended life course and they face increased rates of cancer, greater susceptibility to infections and overall lower immune systems. Geriatrics provides care for those over an abstract age threshold. What the typical patient might not realize, Rughwani said, is that even the simplest doctor-patient transactions—like prescriptions — are affected by age.

Certain medications are never prescribed to older people, she said. As patients blow out more and more candles, there are always factors to worry about, like constipation or especially dizziness.

Back in 1982, Mount Sinai, established the country’s first-ever Department of Geriatrics in New York. It was Ignatz Nascher, the Austrian-born, New York-made Mount Sinai physician that first coined the term, “geriatrics,” in 1909, and is credited with the field’s genesis. New York has since become the home of much of the country’s leading geriatric professionals.

Although American life spans have skyrocketed since the birth of geriatrics, it wasn’t necessarily accompanied by huge advancements in aging care in the medical industry.

“Healthcare is a business,” Rughwani said. “Certain hospitals got rid of [geriatric care units] because geriatrics doesn’t bring in a lot of money.”

But in New York, revenue is coming in from geriatric urban sprawl.

Rughwani said a number of older adults attracted by the many resources here from social to medical are retiring in the City.

Among the lures: Convenient public transportation, a variety of entertainment, densely populated neighborhoods, groceries at every corner, never having to cook a meal, world-class healthcare—all facts Rughwani listed, crafting the perfect paradise for the octogenarian.

“It’s a very easy city to grow old in,” she said. “Anything that anyone wants is in New York.”

But if you look at any big-name hospitals, Rughwani said, the rate of older adults in their care outpaces that of the typical patient. About 60 to 70 percent of their average out-patient census is of geriatric age, she said.

There aren’t enough geriatricians in the world, and some argue it’s the wrong path for future doctors. Rughwani said some don’t agree with investing in this quality of life, because it isn’t optimal.

A ward of “mixed ages,” Rughwani said, calls for a much greater chance of an older adult getting sick—or even sicker.

“The best thing for an older adult, if they’re sick and in a hospital, is to be in a geriatric care unit to get care tailored to them,” she said.

Susan A. Sales, CEO at NYC Health + Hospitals, believes geriatric services need to be promoted and highlighted, as the needs of aging adults continue to grow. Indivdiuals in the 60 and above age group are the most rapidly-growing segment of the population—and the future of their care lies in funding, she said.

“As a nursing home administrator, I have seen many nursing homes close or be purchased by for-profit institutions over the last several years,” she said. “Trying to break even and hire healthcare staff in a competitive market is very challenging.”

Dr. Michael Schuster, NYC Health + Hospital’s chief medical officer, said New York’s aging population growth is exacerbated in communities of color.

“Most of that population will need some form of long term care,” he said. “This population is also a significant portion of the workforce, but shortages of affordable, secure housing impacts their ability to lead productive and fulfilling lives.”

Northwell Lenox Hill Hospital, located at 100 E. 77 Street, opened its doors to more senior citizens with a new medical practice just blocks away from its main campus, specializing in geriatric care.

Dr. Alexander Rimar, the director of geriatrics and palliative medicine at Lenox Hill, said anything that improves quality of life—at any age — is worth investing in.

Lenox Hill, he said, participates in an “age-friendly health system,” which works to elevate the care of the geriatric population.

“It takes a specialized approach to maintain that longevity and independence,” Rimar said.

Rimar said the new practice will cast further importance on a key value of Lenox Hill Geriatrics, to age in place. Aging in place is the idea that an individual can grow older in their own home and community.

“This is more than just the patients. This is about our communities,” he said. “Lenox Hill is located in a very unique community; we just really need to do the best for our patients.”

As life expectancy climbs higher, priorities don’t always take shape. Rimar said it all goes back to Lenox Hill’s commitment to care in the right place and the right time. If more of their patients are blowing out more candles each year, then a new facility is necessary.

“This medical practice is something that was truly needed in Manhattan at this particular time,” he said. “I think that was something that was desperately needed.”