Letters to the Editor: The Long-Term Care Team of the Future

"The Long-Term Care Team of the Future"

I read with interest the excellent article titled “The Long-Term Care Team of the Future” in the April 2016 issue of Annals of Long-Term Care: Clinical Care and Aging, authored by Dr Richard Stefanacci and Dr Corey Cusack.¹

Despite my appreciation of the article, I think an opportunity was missed to include the roles of community health workers (CHWs) and spiritual care specialists (chaplains) in any idealized long-term care team.

CHWs, now increasingly certified by professional boards, are lay persons from the community or population of special interest, who serve as cultural bridges between patients (community residents) and licensed health care professionals such as physicians, nurses, and social workers. Given America’s growing diversity of patients and care providers, as well as issues of linguistic and cultural competency and health literacy, CHWs are invaluable members of primary care medical, dental, and behavioral health teams and are beginning to develop important roles on palliative care teams and in specialty outreach and health promotion programs (eg, chronic disease self-management, “high-utilizer” support, etc). I worked with CHWs in my practice as a family physician and hospice/palliative care specialist for almost 30 years—a great privilege and a terrific opportunity to appreciate their unique work close up.

Spiritual care specialists such as hospital and hospice chaplains have been known for many years to add special value, both for patients and fellow care providers, even in altogether secular settings. I was surprised to find their role omitted from the ideal longterm care team in a nursing home or skilled nursing facility.

Tina Castañares, MD

Reference

1. Stefanacci RG, Cusack CL. The long-term care team of the future. Annals of Long-Term Care. 2016;24(4):17-20.

A response from the author:

The letter from Dr Tina Castañares is exactly what we want. As we stated in the note, our article was meant to open a dialogue on what a comprehensive long-term care (LTC) team should include. To this end, we asked for your thoughts on additional roles and responsibilities that others consider critical to a facility’s LTC team. While this should include community health workers and spiritual care specialists (chaplains), we are certain there are other valuable team members that should be recognized, so we continue to encourage thoughts on missing members of the long-term care team. More to add, we hope...

Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD

Reference

1. Buffum MD, Sands L, Miaskowski C, Brod M, Washburn A. A clinical trial of the effectiveness of regularly scheduled versus as-needed administration of acetaminophen in the management of discomfort in older adults with dementia. JAGS. 2004;52:1093-1097.