An important goal of the UVA Geriatric Fellowship Program is to provide geriatric medicine fellows with an exceptionally diverse clinical experience, one that emphasizes systems of care delivery along with Practice-Based Learning and Improvement and Systems-Based Practice. All facilities used by the program give fellows the opportunity to assume meaningful patient responsibility in a diversity of clinical settings, with a highly disparate group of elderly patients. Working closely with faculty, fellows are exposed to broad ethnic and socioeconomic patient backgrounds; the population is comprised of elderly patients of both sexes, with a variety of chronic illnesses, and spans the spectrum from acute care to long-term care, and from preventive health and screening to care of terminal illness. In every setting, fellows are closely supervised and taught by faculty physicians. Specific facilities and resources of the Geriatric Subspecialty Program include:
The University of Virginia Hospital is a 618-bed teaching hospital in Charlottesville, Virginia. It is an integral component of the UVA Geriatric Fellowship Program. UVA Hospital has a full range of acute care services, including emergency medicine, operating rooms, intensive care units, diagnostic laboratory and imaging services and a pathology department. The hospital also includes an in-patient palliative care unit. UVA Hospital is consistently ranked among “America’s 100 Top Hospitals.”
The geriatric inpatient consult service serves all specialties in the hospital and the geriatric fellows are an integral and active part of the consult service.
Long-Term Care Institutions
Geriatric fellows receive a broad exposure to long-term care institutions throughout their geriatric subspecialty year, affording them a comprehensive educational experience. A diversity of facilities ensures ample exposure to subacute care and rehabilitation care. Our fellows work closely with key faculty members in an acute inpatient rehabilitation hospital, as well as in several skilled nursing facilities, in order to appreciate the scope and intensity of medical illnesses and as well as the scope and intensity of available medical services across the continuum of care. In each of these settings, geriatric fellows are actively involved as members of interdisciplinary teams. All of these institutions are approved by state licensing agencies and all of the facilities meet the standards promulgated by the Joint Commission on the Accreditation of Healthcare Organization (JCAHO) or other applicable organizations such as the American Health Care Association.
UVA Health South Hospital
UVA Health South Hospital is a JCAHO approved 63-bed Inpatient Rehabilitation Hospital in Charlottesville, Virginia. Patients receive high-intensity rehabilitative services and 24-hour inpatient care. Diagnostic laboratory and imaging services are available on-site. In addition to rehabilitative medicine, physician services also include Geriatrics, Psychiatry, Orthopedics, and Pulmonary.
The Colonnades is a UVA-affiliated integrated retirement community in Charlottesville. The Colonnades campus includes apartments for independent living, an assisted living facility, and a 54-bed nursing facility that provides both skilled and intermediate care. The Geriatric program includes an on-site ambulatory care clinic at The Colonnades (UVA Colonnades Clinic) to allow geriatric fellows to provide continuity of primary care across the continuum of care. Dr. Diane Snustad, a geriatrician and key faculty member, is medical director of The Colonnades and directly supervises geriatric fellows providing care in all sites at The Colonnades.
Martha Jefferson House
Martha Jefferson House is a retirement community in Charlottesville. It comprises apartments or cottages for independent living, an assisted living facility and a 25-bed nursing facility which provides intermediate and long term care. Dr. Balogun is the medical director and is also the geriatrician/primary physician for most of the residents at the facility, providing care at all sites including long term care in the infirmary, as well as home visits for appropriate patients in assisted living and independent living. She also directly supervises geriatric fellows at this site.
Long-Term Non-institutional Care
Jefferson Area Board for Aging (JABA) Senior Center
JABA offers a wide range of services to older individuals from Charlottesville and the surrounding region. JABA has a senior center that provides activities, meals, transportation, peer counseling, advocacy services, social services, nursing care, and health education programs. JABA operates a number of community service projects in addition to on-site adult day care programs and a home care program. A long-term care ombudsman program is located at JABA. In the same building, the UVA Geriatric Fellowship Program operates an ambulatory geriatric clinic. Our fellows have a primary care continuity clinic at JABA under the direct supervision of Drs. Balogun, Simmers, Williams and Green. The Geriatric Orthopedic Preoperative Assessment Clinic is currently housed at JABA as well. Fellows interact with JABA staff and clients throughout their diverse programs.
The Colonnades is a UVA-affiliated integrated “continuous care” retirement community in Charlottesville. The Colonnades campus includes apartments for independent living, an assisted living facility, and a 54-bed nursing facility that provides both skilled and intermediate care. The Colonnades has a home care program to promote maintenance of function and independence, in order to facilitate “aging in place.” Our fellows provide continuity of primary care to patients across the continuum of care and throughout the entire campus at The Colonnades, under the direct supervision of Dr. Diane Snustad. In addition, fellows coordinate home care services and interact directly with home health agency staff in developing individualized care plans for their patients receiving home care.
Continuum Home Health Care
Continuum Home Health Care is a community home health agency affiliated with UVA. Continuum Home Health provides home health services including personal care, skilled nursing care, physical, occupational, and respiratory therapies, as well as social services, case management, phlebotomy and other laboratory specimen acquisition services, along with parenteral administration of medications. Geriatric fellows coordinate home care services and interact directly with Continuum Home Health staff in developing individualized care plans for their patients receiving home care, under the close supervision of faculty members.
Ambulatory Care Program
The ambulatory care program comprises a minimum of 33% of each geriatric fellow’s time weekly. Each fellow evaluates at least 1 to 3 new geriatric patients and 4 to 8 follow-up geriatric patients each week. This includes at least three-half days per week spent in a continuity of care experience. The experience is designed to provide continuing care in a geriatric clinic to elderly patients who may require the services of multiple medical disciplines, such as neurology, gynecology, urology, psychiatry, podiatry, orthopedics, physical medicine and rehabilitation, dentistry, audiology, otolaryngology, and ophthalmology, as well as nursing, social work, and nutrition. Fellows coordinate the implementation of recommendations from diverse medical specialties and disciplines, while gaining valuable experience in other relevant ambulatory specialty and subspecialty clinics, such as Memory Disorders Clinic, Geriatric Psychiatry, Urology, and Wound Care. Geriatric fellows provide continuity of care functions in the following ambulatory care facilities:
UVA JABA Clinic
The UVA Geriatric Fellowship Program operates an ambulatory Geriatric Medicine primary care clinic at the Jefferson Area Board of Aging Senior Center in Charlottesville (also referred to as University Physicians at JABA). Geriatric fellows provide ongoing care to patients under the direct supervision of Drs. Balogun, Kizer, Williams and Green. A full range of primary care services is available from health maintenance and preventive screening to office procedures and treatment of advanced disease. Fellows also perform comprehensive geriatric assessment and outpatient consultation at the request of physicians in other medical specialties.
Our fellows have direct access to consultation on-site from neurology, psychology, podiatric care, rehabilitative medicine and pain management specialists. Diagnostic laboratory testing is available on site and nursing care is available for such procedures as intravenous administration of medications and fluids. Fellows also make home visits (“house calls”) to home bound and other patients whose care is coordinated from the JABA clinic site. This latter activity is under the direct supervision of Drs. Green and Balogun.
UVA Colonnades Clinic
The UVA Geriatric Subspecialty Program operates an ambulatory Geriatric Medicine primary care clinic at The Colonnades in Charlottesville. Although the clinic itself is located on the campus of The Colonnades, an integrated retirement community, patients receiving ongoing care at the UVA Colonnades Clinic come from throughout the city of Charlottesville and surrounding region. Dr. Diane Snustad, a key faculty member, serves as medical director and supervises fellows at the UVA Colonnades clinic. A full range of primary care services is available from health maintenance and preventive screening to office procedures and treatment of advanced disease.
Fellows have direct access to consultation on-site from geriatric psychiatry. Diagnostic laboratory testing is on site. In addition, nursing care is available for procedures including intravenous administration of medications and fluids. Our fellows also make home visits (“house calls”) to home bound and other patients and visit patients in the Colonnades Assisted Living facility, with care coordinated from the Colonnades clinic site.