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Geriatrics Ventures North
A geriatric niche is growing at Keswick

Willie Mae Mitchell often drops in at the Hopkins clinic when she attends Keswick’s adult day-care program next door. Here, she weighs in with Alice Brazier and, from left, Jeremy Barron and Samuel C. Durso.

Shortly after moving here from Los Angeles, Willie Mae Mitchell called Johns Hopkins at Keswick, the North Baltimore outpatient clinic where she’s a regular patient, for a doctor’s note. She wasn’t trying to get out of jury duty or work. She just needed permission, given she’s 93, to take a class in line dancing.

More and more seniors like Mitchell, who are well into their 80s and 90s, are living independently in the community. And yet despite active lifestyles, they often have chronic conditions, like diabetes, heart disease and arthritis, that warrant accessible outpatient care.

That, in part, is why the Division of Geriatric Medicine and Gerontology established a clinic at Keswick Multi-Care Center, a full-service, skilled nursing and long-term care facility on 40th Street near University Parkway, just north of the Homewood campus. Open since 2003, Johns Hopkins at Keswick is still building its patient base, but several initiatives down the road promise growth.

Staffed by geriatric nurse practitioner Alice Brazier and five Hopkins faculty geriatricians, including medical director Jeremy Barron and division clinical director Samuel C. Durso, the clinic draws heavily on the expertise of Hopkins’ Division of Geriatrics to address the complex needs of older adults. Sevil Yasar, for instance, leads a memory clinic where patients are evaluated and managed with drugs, and families come together to make a plan. There’s also an osteoporosis clinic.

The partnership has its genesis in the late 1990s when Keswick administrators approached Johns Hopkins. A few Hopkins physicians already had relationships with Keswick. Psychiatrist Peter Rabins, an Alzheimer’s disease specialist, was a consultant on its dementia unit, for example. “Here were two organizations—both more than 100 years old—with a rich tradition of caring for the elderly,” says Richard Bennett, Johns Hopkins Bayview’s vice president of medical affairs and a leading force behind the arrangement.

Former geriatrics chief John Burton, one of the first to promote the Keswick partnership, believed it would give Hopkins a presence in North Baltimore and potentially draw patients to the East Baltimore or Bayview campuses. (Mitchell is a case in point: she’s had two surgeries at Bayview.) What’s more, an outpatient clinic would provide another venue for clinical rotations. Keswick was banking on the Hopkins name to attract business. For the past three years, U.S. News & World Report has named the Division of Geriatrics No. 2 in the nation. So in May 2001, the two institutions entered into a 10-year affiliation agreement.

Renovating a small section of the facility for the outpatient clinic—at Keswick’s expense—was the first order of business, recalls Bennett, who’s also a Keswick board member. The clinic is located next to Keswick’s adult day-care center and across the street from the Rotunda mall.

Two years since it opened, it draws between 150 and 200 patients a month. Clinical director Durso would like to say Johns Hopkins at Keswick is thriving but acknowledges, “We could be busier.”

Still, several initiatives offer promising returns. Now Keswick’s nursing home patients can be seen at the clinic for specialty care. More outreach efforts are being planned at area churches and senior centers. And Keswick has broken ground on a $16 million addition to provide more sub-acute care and assisted living for those with Alzheimer’s. Discussion is under way for a program called Keswick at Home, a venture that would coordinate a broad range of home care services, as well as the development of a physician house-call program in North Baltimore.

So far, Keswick Multi-Care’s management has given Johns Hopkins at Keswick high marks. “We’ve had a very positive relationship with Hopkins,” says Keswick board chairman Craig Horner. “The Hopkins name, a huge asset, has allowed us to branch out. Yes, we’re in a period of transition, but our sense is it’s going to work out well.”

—Judy Minkove



Johns Hopkins Medicine

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