by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)

Dr. Margaret Kaiser, M.D. Internal Medicine and Geriatric Medicine affiliated with the University of Maryland Medical Center

With tears in her eyes, Dr. Margaret A. Kaiser says, “I love my patients.”  She is an internist and gerontologist that is not about words, but action.  She chooses her battles, but is known in the professional community for doing her “Kaiser thing.”  Other physicians know that she can get things done for the patients she loves.  This one little woman living in the mountains of Western Maryland has no idea how much she impacts the lives of the people she cares about most.  She is the voice for the elderly.  She navigates the insanity of the insurance systems to be sure that her patients are served.  She does not charge for her time and mounds of paperwork that she has processed for her patients and families.  She travels distances daily to nursing homes all over the tri-state area. She created, directed, and maintains the only five-star facility for rehabilitation in Western Maryland, called Garrett County Subacute. Recently closing her private practice and dedicating all of her time to nursing care, Dr. Kaiser in one word is extraordinary.

In March of 1991, Dr. Kaiser was featured in People Magazine.  The article, She Does House Calls, is a short synopsis of her life that she has dedicated to treating, helping, serving, advocating and tearing down barriers of discriminating against the elderly.

 
More than anything, growing up in poverty has shaped the way Margaret Kaiser practices medicine.  Her experiences in Portland, Oregon, as one of four children of a single mother, left her with a personal understanding of what the poor must endure to get the treatment others take for granted.  "I still remember the clinic at the University of Oregon Health Sciences Center," says Kaiser, 46, who practices internal medicine out of her private office in the rural town of Oakland, Md., in the Appalachian Mountains.  "It had hard wooden benches, and you waited for hours and hours." 
 

 
Going about her rounds in Garrett County, 140 miles northwest of Washington, D.C., near the West Virginia border, Kaiser, who specializes in geriatrics, is often the only source of health care her patients can count on.  Not only does she make house calls for those too ill to get to her office, sometimes driving 45 minutes to see a single patient, but she also goes out of her way to  do the paperwork they may need to enroll in programs allowing them to receive free medicine from drug companies.


In general, Kaiser lets patients pay what they can, though she still grosses about $130,000, which she considers more than adequate.  "I grew up on welfare, so for me to have anything is enough," says Kaiser, whose husband, respiratory therapist Eric Tribbey, 47, heads the cardiopulmonary department at Garrett County Memorial Hospital. 

Kaiser tries not to be too critical of doctors who don't share her approach.  "Most people go into the field because they want to help people, but that's very easy to lose during your training," she says sadly.  "You don't get a lot of rewards for being a caring, feeling person."

Fast forward 25 years and Dr. Kaiser is even more passionate about dealing with the problems of long-term care.  She is a strong believer in the need for more personalized care.  In a lengthy interview on January 29, 2016, Dr. Kaiser began by saying, “Everyone feels better when the sun shines.”  She explains that places like assisted living need more gardens and emphasizes that nature can improve attitudes.  She talked about how she is not a morning person and if someone tried to wake her up at 5 in the morning or 6 in the morning that it would be unbearable.  She laughed and explained that even 7 a.m. or 9 a.m. is early for her.  Shaking her head back and forth, her body language said that there would be no way she could stand someone bothering her in the morning.  The concern she expressed is that of other people who are not morning types, yet expected to follow the procedure of the facility.  Another issue that obviously is a demonstration of lack of personal care is showering just twice a week.  With an impish look on her face, she asked, “What if I don’t want to shower on my day, or I don’t feel well?”  She continued to explain that if I do not shower on my time and day, then I only get one shower a week in these places.

“There needs to be dementia floors in assisted living.”  Dr. Kaiser stressed that assisted living facilities are going to need to do a better job of screening who can live in assisted living.  Any patient can walk right out of the facility and no one would know it for hours.  Assisted living facilities are not locked down.  According to Dr. Kaiser, there needs to be a floor dedicated to dementia type patients where they can be safe and staff can be sure of their whereabouts.  Additionally, families need to know that dementia patients should never have family heirlooms or treasured items with them because other dementia patients just walk off with anything they see or like.  The staff need to be trained to handle the wide range of special problems that the elderly bring to long-term care.  Dr. Kaiser talked about how staff can do a better job of getting through their work day and being more efficient, but noted that understaffing is an unfortunate way that management of long-term care saves money.  In her reflective moments during the conversation, it was obvious that this Baby Boomer who broke all the barriers as a young girl and excelled in a field of science is more determined than ever to right the wrongs of a complicated eldercare business.

Questions for Consideration:

1.  What about protecting the elderly from their own family?  Mr. David Cravey wrote on February 16, 2016, about his experiences in the Hospice industry that span the last ten years.  “I spoke with a couple yesterday who were worried about keeping their mother in good facilities when their funds run out.  Unlike another man I had spoken with who was complaining that he wished his mother would die and quit spending his inheritance, this couple expressed love for their mother but the son was totally self-centered.  I see the scenarios all the time on almost a daily basis as I work with patients and families.  I have even seen several incidences where family members have a patient under Medicaid care and have kept the patient artificially alive so that they don’t lose their check.”

2.  Do nursing aides need social work skills?  Yes!  Ms. Julie Bunnell, GNA/CNA also Med Tech during January 2016, related the story of the man who brought his mother to assisted living by telling her that he was taking her out for ice cream.  He left her at the facility and without any ice cream.  As it turned out, the mother had very kind words for the nursing aides who consoled her, but not for her own son.

3.  Why is there a need to regulate ratios of nursing aides to patients?  Ms. Pamela Hagerman, Director of Aging in Western Maryland, during the fall of 2015 talked about changing careers at age forty and becoming a nursing aide.  She was expected to get twenty total care patients out of bed in the morning, clean them up, dress them, feed them, and perform a host of other activities of daily living that are required for each individual patient.  She said it was impossible and quit the job.  Ms. Dawn Buskirk, CNA, June 2014, wrote about refusing to work with anyone but her own sister who was also a licensed CNA.  Between the two of them, they were expected to perform the same tasks for sixty people in the morning which is a ratio of 1 to 30. 

4.  What are activities of daily living?  What are the needs?  The activities of daily living are usually the same thing that everyone needs to go through during the day and that is toilet when they get up in the morning, during the day, and also before retiringfor the evening.  Brushing teeth, assistance with dentures, combing hair, deodorant, skin treatment, fingernails, toenails, shaving, dressing, organizing the room, helping with mail, vaporizers, fish tanks, repositioning in a chair or a bed, covering up or removing covers and folding them, helping with incontinence problems and changing pull-ups or depends, also changing sheets.  Aides take residents to programs, church services, hair salon appointments, ice cream socials in the building and assist families with meals when they are visiting a family member.  Nursing aides plunge toilets, and fix lights, repair ceilings and leaks, do laundry, and serve meals.  They administer treatments and medications, interface with registered nurses or LPNs and physicians.  Nursing aides also apprise the family of any falls or changes in the condition of their loved one.  This is not a complete list by any means, but the good ones do most of this kind of work with a smile on their face and attempt to make the day better for the people who reside in long-term care.  In short, the frontline nursing aides are responsible for providing personalized care to each and every patient in their section.

5.  What about quality of life at the end stage?  On February 16, 2016, Mr. Dave Berry commented about the aging process.  The words that came to my mind as I read that poem Look Closer: See Me featured in the blog post Look Closer were, "A quest for dignity … What you see is not who I am.”  It is the nursing aide who sees the spirit of the person even when the body is failing.  Nursing aides in long-term care facilities are the hand holders at the end of life.  They find themselves in the role of clergy and grief counselors answering questions from family members who are struggling with losing their loved one.  As a group, nursing aides show profound respect for the end-of-life and hurry to the bedsides of those in most need of critical care.  After the death of a loved one, they attend funerals and console family.  However, as Dr. Margaret A. Kaiser says sadly, “You don’t get a lot of rewards for being a caring, feeling person.”

July, 2019