New Outpatient Palliative Care Clinic Opens at Mount Sinai Morningside
Due largely to transformational public health advances such as clean drinking water and vaccinations, people are living longer than in previous generations. As people age, many develop one or more chronic conditions that, although manageable, will impede the quality of life for themselves and their families and caregivers. Mount Sinai offers outpatient palliative care by an interdisciplinary team of specialists who treat symptoms, pain, and related stress, including anxiety and depression, felt by patients facing a serious illness.
In July, Mount Sinai opened a third outpatient palliative care clinic, at Mount Sinai Morningside, to provide medical, psychological, social, and spiritual support for patients of all ages and all stages of their illness, regardless of their prognosis. Doctors, nurses, a social worker, a nutritionist, and a chaplain are available to see patients. The goal is to offer care and services that will improve the quality of life for seriously ill patients.
“Our job is to try to reduce the burdens of symptom distress, the burden of feeling like your body has betrayed you, and we focus on supporting family caregivers because they have a very hard job to do,” says Diane E. Meier, MD, Professor of Geriatrics and Palliative Medicine and the
founder of the Lilian and Benjamin Hertzberg Palliative Care Institute at the Icahn School of Medicine at Mount Sinai. “We help people understand what to expect and be prepared for the future as their illness evolves.”
The palliative care team works closely with a patient’s other doctors, such as their oncologist, neurologist, or cardiologist, to coordinate treatment. “The oncologist
it as easy as possible for patients to get palliative care and to make it convenient.
“What I really find inspiring is watching the relationships develop between the doctors and patients and their families, because these are long-term relationships,” says Dr. Meier. “It’s not like hospital care where people are in and out … these patients come back over a very long period of time. You get to see how that human connection actually affects healing.”
treats the disease, and we treat the whole person and the people around them,” Dr. Meier explains.
Until the new clinic opened in July, patients seeking outpatient palliative care visited The Mount Sinai Hospital or Mount Sinai Union Square. However, with a sprawling health system serving people in different parts of the city, the objective was to make
Patients are referred to the palliative care clinic by one of their treating physicians. Palliative care services are covered by many insurance plans, including Medicare and Medicaid. The Mount Sinai Morningside palliative care clinic is located at 1111 Amsterdam Avenue, at 114th Street, just west of Morningside Park. For further information or to make an appointment, please call 212-659-8552.
BROOKDALE DEPARTMENT OF GERIATRICS AND PALLIATIVE MEDICINE
Expanding and Advancing Palliative Medicine Education
The Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai has transformed medical education and created a national model for palliative medicine training that is emulated by other institutions across the United States.
The robust fellowship program trains 32 fellows across seven Mount Sinai hospitals. The Brookdale Department is the largest geriatrics and palliative medicine training program in the United States, and it has trained one in five such specialists across the country. The Brookdale Department offers eight different fellowship training programs to address a national shortage of palliative care specialists created by the exponential growth in the aging population.
One groundbreaking innovation in medical training has been to introduce geriatrics and palliative medicine to medical students as early as possible. “One of the things we’ve tried to do is to influence medical school curriculum from day one to make sure that we are integrating principles of both geriatrics and palliative care earlier in the curriculum,” says Helen M. Fernandez, MD, MPH, Vice Chair of Education and Professor of Geriatrics. “It’s not that everyone will go into palliative care, but they’ll carry these skills and this approach into whatever specialty they enter.”
On the other side of the career continuum, Mount Sinai recently introduced a Mid-Career Hospice and Palliative Care Medical Fellowship for board certified physicians in internal, emergency, or family medicine who want additional training in palliative care to complement their skills.
In 2019, Mount Sinai piloted an integrated residency fellowship program for doctors training in internal family medicine who have a clinical interest in geriatrics. They begin rotations with geriatrics mentors from the outset of their residency training. “We’re always
looking for different ways to train leaders, and this combined program, which we’re helping to disseminate to other health systems, is an innovative model that brings more doctors into the fold who will reach more patients,” says Dr. Fernandez.
The Brookdale Department has expanded its training programs to go beyond the hospital setting and to create clinical models of care that meet patients where they are, rather than requiring patients to visit doctors. Physicians are trained in diverse environments, including ambulatory clinics, nursing homes, and in patients’ homes, perhaps through telehealth visits or the Mount Sinai Visiting Doctors program.
The Brookdale Department’s approach to training has shifted from strictly clinical training to fellowships that focus on leadership skills. The goal is to make an impact by changing the health care system to be more responsive to the needs of older adults and seriously ill persons. In addition to medical training, fellows receive training in areas not typically taught in medical school, including management, accounting, and leadership skills that they will need as they assume leadership positions.
“We are creating the next generation of leaders in this field,” says Rosanne M. Leipzig, MD, PhD, Vice Chair Emeritx and Professor of Geriatrics and Palliative Medicine.
Helen M. Fernandez, MD, MPH, alongside Geriatrics and Palliative Medicine trainees.Innovative Fellowship Program Trains Board Certified Physicians to Be Palliative Care Specialists
Anticipating a growing nationwide need for palliative care clinicians as the American population ages, Mount Sinai introduced an innovative fellowship program for doctors already board certified in internal, emergency, or family medicine. The MidCareer Hospice and Palliative Care Medical Fellowship is aimed at physicians who want training in palliative care to complement their skills. Mid-career fellows spend approximately 20 percent of their time in training while simultaneously carrying out clinical and leadership roles and responsibilities.
Mid-career physicians are seen as an important untapped group of future specialists. Mount Sinai, which trains the largest number of geriatricians and
palliative care doctors in the country, is frequently approached by practicing primary care, ICU, or emergency medicine physicians, who realize the importance of palliative care and want additional specialty training.
Since the fellowship is part-time, competency-based and not time-based, the training schedule is flexible and allows physicians to gain specialty training without giving up their ongoing professional responsibilities.
“We are training these doctors while they continue to work in their regular practice, so they learn new skills with our program and
Telemedicine Brings Palliative Care into Patients’ Homes
Telemedicine use among adults in the United States has grown significantly since the beginning of the COVID-19 pandemic. Telehealth, which provides care remotely using technology such as video and phone calls, monitoring devices, phone apps, and patient portals, ensures continuity of care while avoiding the challenges associated with travel to health care visits.
“There was a fivefold increase in the number of older adults who used telemedicine at the beginning of the pandemic,” says Julia L. Frydman, MD, Assistant Professor of Geriatrics and Palliative Medicine, who has studied this topic. “We need to make sure we keep that progress going and expand access to the rest of the population of older and seriously ill adults.”
In a study she conducted, Dr. Frydman found that nearly 24 percent of respondents reported using telemedicine during the pandemic, up from nearly 6 percent before. She noted that, as telemedicine use expands, barriers to access must be addressed. Her research shows
apply these skills in real time,” says Helen M. Fernandez, MD, MPH, Vice Chair of Education and Professor of Geriatrics. “With this training model, we look forward to these attendings becoming leaders in two specialties.”
Jessica Fleischer-Black, MD, an emergency medicine doctor who recently completed her mid-career fellowship, feels reinvigorated by her training.
“I’m full of ideas and coming up with more possible projects every day,” she says.
“While I was in this program, I had things to learn and things to teach, and I’m excited to talk to patients and help them and their families through difficult times.”
that older adults with less education, without a partner or spouse, or living in rural communities were among those who did not use telemedicine.
Dr. Frydman points to initiatives taken by the federal government involving the expansion of broadband internet that will help. “Once we know that someone has broadband and has a device, we need to teach them how to use the technology, and that will probably be done by some combination of health care educators, community health workers, or patient support and education programs that health systems are going to need to develop,” says Dr. Frydman. “My work demonstrates that more must be done to ensure access is universal. Equity must be at the forefront as we assess the long-lasting value of telemedicine.”
Julia L. Frydman, MD Helen M. Fernandez, MD, MPHUsing the Arts to Improve Quality of Life for Palliative Care Patients
Creative expression can play an important role in palliative care. The Brookdale Department of Geriatrics and Palliative Medicine, long recognizing the value of the arts in therapy, sees a new incarnation of this programming for seriously ill patients at The Mount Sinai Hospital.
Under the direction of John Mondanaro, PhD, LCAT, MT-BC, CCLS, Director of Expressive Arts Therapy, the innovative program’s reach is extended through the training of graduate-level students from music, art, dance-movement, or drama therapy programs completing the clinical internship hours required for credentialing at the national level, and licensure within New York State.
According to research reviewed by the National Institutes of Health, music therapy and other forms of integrative therapy can
address a wide range of needs across social, emotional, cognitive, physical, and spiritual domains.
“We work with patients and their families— adults and children—to help navigate illness and treatment together,” says Dr. Mondanaro, who is dually certified in music therapy and child life. “Parents facing existential fear and uncertainty are often prone to shielding their children from the
truth. We help by supporting authentic and developmentally targeted communication with children so they feel included with a sense of mastery rather than isolated and confused.”
Expressive arts therapy is expansive in its therapeutic reach because it includes all of the arts—music, art, dance-movement, and drama. “We try to engage patients and their families in one form or another because that’s where the real therapy occurs—in the shared creative process,” Dr. Mondanaro says. “One time I was working with a patient whose mother and sister were at her bedside and she was ecstatic that they were creating music together. Creating beauty through expressive arts therapies frames the experience of illness and hospitalization differently, and profoundly shapes that moment of time.”
Lilian and Benjamin Hertzberg Palliative Care Institute
Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070 New York, NY 10029 212-241-1446 mountsinai.org/care/palliative-care
@MSHSGeriPalCare
Musical therapy session with John Mondanaro, PhD, LCAT, MT-BC, CCLS