Q. I am currently a paramedic working for a private ambulance service which is contracted to several nursing homes. I have been seeing a lot of geriatric patients who never leave the nursing home, some very ambulatory and have basically their full mental capacity and some not.. of varying degrees. I have been thinking of starting some sort of business that could go into nursing homes, assisted living centers and private residences that assist people with their homemaking duties if at home, and if in the nursing homes take them for visits to the mall, to the movies, to social events--sort of a sensory stimulation.

I was wondering what your opinion of this type service might be. I would provide nonmedical staff that are CPR and first aid certified but not the emergency medical capability. I just wonder if people were to get out into the fresh air, go for a drive, mix with others of their age group, if that would not be an improvement with their quality of life. Also would it be beneficial to the homebound patient with muscular dystrophy, hydroencephalopathic disorders etc. or the traumatic or stroke brain injured patients?

A. Sounds like a great idea to me--though I don't find much in the research literature on the effects of such interventions. There are a few articles you may want to see, though. One study by Abrahams et al (Journal of the American Geriatric Society, May 1979) utilized high school students in a program of psychosocial rehabilitation for nursing home residents. This involved remotivation and socialization techniques. The study found that this approach led to increased social interaction, reduction in daytime sleeping, and an increase in mobility for participants.

Also see the article by Miller and Barry in the February 1976 issue of Gerontologist, entitled, "The relationship of off premises activities to the quality of life of nursing home patients." I do think you would need to be careful about selecting individuals for various activities--making sure that their doctors approve, for example, and providing for emergency assistance (e.g., having a defibrillator on hand) for some patients. There are, in other words, some medico-legal risks to be considered. But on the whole, it sounds like a project well-worth pursuing. You might want to contact the Gerontological Society of America (www.geron.org), the Institute on Aging (www.med.upenn.edu/aging) and similar organizations, in order to solicit their advice on setting up such a service.

January, 2001

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