or organizations whose bread and butter market is senior citizens, the prospect of an enormous baby boomer population hitting modern maturity promises to be the best thing since early bird specials. For Wesley Woods and Emory, the graying of America presents a different kind of opportunity - one in which we can lead the way to help people age gracefully and more independently, preferably at home in familiar surroundings. The goal is to provide better care for our older people without bankrupting them or our health care system. But it will take more than retirement communities and nursing homes to help people age in healthy, affordable, and ethical ways, says Larry Minnix, CEO of Wesley Woods Center at Emory. Wesley Woods and Emory are blending their missions and cultures to pioneer new ways to care for the elderly and to be more supportive of the people who take care of them. And the two partners believe that today's efforts will not only leverage our programs and facilities to build market strength but also benefit future generations. Besides merger talks with Emory, Minnix recently led an Emory Healthcare strategic plan "reactor" group charged with developing recommendations on how to grow a distinctive chronic care network for special populations. Before submitting its recommendations, that task force examined many aspects of inpatient and outpatient services, long-term care, and the development of new care and treatment - in essence, what it will take to provide affordable care 365 days a year. Many of the concepts under discussion have a familiar ring: emphasize prevention, reduce costs, and improve access to services, whether that means extending physician office hours or providing services in outlying areas closer to where patients live. For example, most older people do not need to be in a nursing home or hospital, says Minnix. "For those with chronic illness, we simply need to reduce the risk of further disability. We need to make sure that they get their medications, that their bathroom is safe so they don't fall and break a hip, that they have a suitable place to live and a balanced diet. They need transportation so they can get to their doctor, and they need visiting nurses or social workers who can help them with daily living." He recalls a recent case of an elderly woman with fleas - literally thousands of them. When social workers from a Wesley Woods affiliate intervened, she was suffering from major skin breakdown and had not washed her hair in two years. She lived alone - except for her cats. In times past, she might have been placed in a nursing home - a $36,000-a-year solution. Instead, thanks to the intervention of a social worker and primary care physician, she spent a few days in the hospital. After visits by an exterminator, nurses, and Meals on Wheels, she's managing better now in her own home - at an annual cost of about $3,000. Working together, Emory and Wesley Woods hope to implement more solutions of this kind. "With the growing population of elderly, we can't afford to build enough nursing homes fast enough to care for them. We have to come up with much better alternatives," Minnix emphasizes. "Together, Emory and Wesley Woods have got to pioneer locally based care networks to respond to elderly and chronically ill people. However, nobody's done that successfully yet on a large scale."

he Wesley Woods-Emory alliance is a natural. Emory's expertise in dealing with complex cases fits well with Wesley Woods' geriatrics specialties and its housing and acute and long-term care services. The Emory presence at Wesley Woods includes medical leadership as well as a force of 150 clinicians, researchers, residents, dietitians, and chaplains. Emory leaders serve on Wesley Woods' Board of Trustees, and Minnix sits on the executive committee of Emory Healthcare. This collaborative relationship recently helped attract a nursing home partner to open a 150-bed nursing home on the Wesley Woods campus. "We needed a new nursing home, but didn't have the capital," Minnix says. "A. G. Rhodes wanted to build a nursing home in Atlanta but didn't have approval to build more beds. So we put up the beds, and they put up the money. Rhodes wanted to be on campus because of the Emory-Wesley Woods expertise. Wesley Woods manages the medical care, and Rhodes, which has a century-old reputation in Atlanta, manages the home." One advantage of the Emory-Wesley Woods partnership is cost reduction by combining services, such as marketing. Articles about aging now appear in every issue of Healthnotes, an Emory publication that reaches more than 200,000 consumers. "We couldn't afford that kind of exposure on our own," Minnix says. Wesley Woods and Emory also share technology, information systems, and consolidated labs. In addition, Wesley Woods serves as a lower-cost alternative for some Emory patients. "If Emory neurosurgeons or oncologists, for example, know that Emory internists can follow their patients at Wesley Woods, they feel good about transferring them to our facility at considerably less cost than keeping them in Emory Hospital. Or we can send referrals to our other facilities in Georgia closer to where patients might live." (continued below)

Larry Minnix, CEO Wesley Woods Center at Emory University

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	mory's ties to Wesley Woods date back to the late 1950s when leaders from the North Georgia Conference of the United Methodist Church and Emory proposed building a retirement home in North Georgia. In 1954, the Methodists and Emory formalized Wesley Woods, which today offers comprehensive services to the elderly and serves as a training and research site to address problems in aging. Wesley Woods now has 12 facilities and programs in Atlanta, Athens, Augusta, Blairsville, Newnan, and Thomson. The 72-acre Clifton Road campus offers a wide range of services.
	1965 Residential services: With 201 apartments, including 20 assisted living units, Wesley Woods Towers was the first structure on the Wesley Woods campus and the first residential retirement facility in the area. Emory provided food services, purchasing, and human resources functions.
	1966 Outpatient care: Wesley Woods Health Center houses The Emory Clinic at Wesley Woods (anesthesiology, medicine, neurology, pathology, psychiatry, and rehab medicine). Faculty treat age-related conditions, such as depression, dementia, stroke, and sleep and movement disorders.
	1972 Long-term care: Budd Terrace was built to nursing home standards, but with a residential atmosphere. The 250-bed facility provides three levels of intermediate care, including an Alzheimer's special care unit.
	1987 Acute care: Wesley Woods Geriatric Hospital is the geriatric teaching and research arm of Emory. Patients at the 100-bed hospital receive short- and long-term acute care, as well as rehabilitation, and treatment of psychiatric and neuropsychiatric disorders.
	1997 Skilled nursing: The newest arrival to the Clifton Road campus of Wesley Woods is the A.G. Rhodes Home, which opened its doors last summer. Emory provides medical direction at the 150-bed nursing home.

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mory brings expertise, reputation, and resources to the marriage, and Wesley Woods, among other things, brings access to patients. The latter's extended family goes beyond Clifton Road through Atlanta Senior Care, which draws from 13 organizations in the Atlanta metropolitan area. Atlanta Senior Care is implementing a pilot project for Medicaid called SOURCE (Service Options Using Resources in Community Environments) to create a statewide continuing care network for at-risk elderly who need medical attention and personal care but prefer to stay in their own homes and communities. Consider the case of another elderly patient - "an accident waiting to happen," says Minnix. When SOURCE case workers were called in, she was taking more than 52 medicines and 12 inhalers, several contraindicated. But thanks to a social worker and a primary care physician at The Emory Clinic at Wesley Woods, she now takes only one pill a day for her lung problem. And Atlanta Senior Care has coordinated community agencies which make it possible for her to remain living at home. Primary geriatric care provided through The Emory Clinic at Wesley Woods is reinforced by home health care from the Visiting Nurses Association, meals from DeKalb County's Senior Connections or Fulton County's Jewish Family Services, and adult day care from the Weinstein Center. Arbor Company supplies an assisted-living network, while the A.G. Rhodes Home and Fountainview Alzheimer's Center specialize in nursing home care. Other services include in-home support, nonemergency medical transportation, and cleaning. Geriatric nurse case managers coordinate all care. Collaboration between Emory and Wesley Woods also promises to enhance access to patients by increasing our bargaining leverage and credibility with payers. Managed care companies are talking with Wesley Woods about contracting for care of patients with chronic illness, for example. And the balanced budget act of 1997 laid the groundwork for creation of provider-sponsored organizations, which would allow Medicare to contract directly with providers such as Wesley Woods and Emory to care for Medicare patients in this region, eliminating middleman costs.

ne of the major challenges of providing geriatric and chronic care as one health care system is inevitable tension between the service culture ingrained in Wesley Woods' 850 employees and the academic culture of the 150 Emory physicians and staff on the Wesley Woods campus. "We'd like for doctors to maximize clinical productivity, but we recognize that some need time for teaching and research. We must begin to act more like a system and conform our schedules to be more patient and family friendly," Minnix says. He notes that Michael Johns, director of the Woodruff Health Sciences Center, has made it clear that clinical services, research, and teaching continue to be co-equal missions at Emory. "All of us will have to generate income to support the system so these co-equal missions will be financially viable. We must work smarter together to create a better outcome of care at less cost," Minnix says, noting that the single biggest barrier to change is people's attitudes. "This isn't about protecting turfs or departments, or capitalizing on a booming senior market. This is about designing care that provides life- and health-preserving sustenance to the aging and chronically ill." --Marlene Goldman

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fter a 30-year courtship, Emory and Wesley Woods may be ready to tie the knot. When they do, Emory will be closer than ever to building a comprehensive health care system that treats patients from birth to old age.

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With the blessings of their governing boards, both organizations are now negotiating possible integration of the Clifton Road components of Wesley Woods into Emory healthcare. The move follows more than a year of discussions between Wesley Woods' CEO Larry Minnix and Michael Johns, director of the Woodruff Health Sciences Center. The new entity would be called The Wesley Woods Center of Emory University, Inc. It would become an operating unit of Emory Healthcare, similar to The Emory Clinic, Emory University Hospital, Crawford Long Hospital, and the Emory Children's Center. Emory Healthcare and Wesley Woods would have overlapping board members, and the current management of Wesley Woods, Inc. would become the senior management of the new operating company. The agreement would formalize a long-standing collaborative relationship in which Emory physicians have enjoyed a major presence on the Clifton Road campus of Wesley Woods. Besides clinical support, dozens of medical and allied health students, residents, and interns train at Wesley Woods each year. Wesley Woods and Emory School of Medicine faculty and employees are involved in numerous research projects related to aging. The existing parent corporation, Wesley Woods, Inc., is also the holding company for other facilities throughout the region, including Wesley Homes, Wesley Woods of Newnan-Peachtree City, Wesley Woods of Athens, and the Foundation of Wesley Woods, Inc. They would remain under the old structure, which would continue as a separate corporation but would continue to be run by senior management of the new Emory company. The proposed marriage offers immense benefits to both institutions - and, most important, to older people served throughout Atlanta and the region. Besides providing Emory Healthcare with an established aging and chronic care component, Wesley Woods would gain a strong partner in fulfilling its mission. For the public, the new organization promises to improve quality and convenience for elderly and chronically ill patients and reduce overall costs of health care delivery. At Emory, the proposal comes on the heels of creating the Emory Children's Center, the largest pediatric multispecialty group practice in Georgia. Negotiation and planning is expected to be completed sometime this year. The final plan would need approval from the Wesley Woods Board of Directors, the North Georgia Annual Conference of the United Methodist Church, and the Emory Trustees. The plan could be effective by July 1998.