Matthew Lefferman – Mobile Medical Care and Telehealth Serving Older Adults

Dr. Matthew Lefferman is a pioneer in the field of geriatric mobile medical care. His unique care model has been providing quality mobile care for the geriatric community in greater Los Angeles for over a decade. 

Dr. Lefferman has an undergraduate degree from John Hopkins University, and received his medical degree as a D.O. from Midwestern University. From his experiences in residency, and close connections to his grandparents, he discovered his passion for working in the field of geriatrics, and his unique ability to connect with seniors. As a practicing physician he quickly realized the need for a new approach for this rapidly growing population, and their multiple chronic medical conditions such as chronic pain, ambulatory dysfunction and memory loss, which make traveling to a physician very cumbersome.

As a respected physician in the Los Angeles area, Dr. Lefferman is a regular speaker for facilities, senior groups, and medical conferences on the range of geriatric topics. He also works with several healthcare technology companies as an advisor, helping them gain valuable insight on how they can best serve the geriatric population.

Outside of medicine, Dr. Lefferman enjoys spending time with his wife, three children, and labradoodle, Lucky. He is also active athletically, especially on the soccer field. Dr. Lefferman was a member of Team USA in soccer that won a bronze medal at the 2015 Pan American Maccabi Games in Santiago, Chile. Dr. Lefferman is also active in community service, serving on several local boards, including his kids’ school and the Westside JCC.

Topics:

• Mobile Medicine
• Geriatric Care
• Alternative Medicine
• Nutrition & Health
• Dementia and Cannabis
• Pandemic Related Lockdown Decline
• Telemedicine
• COVID-19

Hanh Brown: [00:00:00] Today, and the program we have Dr. Matthew Lefferman. Who will be talking to us about geriatric mobile medical care, alternative care methods, like mobile care and tele-health are becoming more and more prevalent these days. So I’m very excited to learn more from dr. Lieberman. And thank you so much for being with us today to share your expertise around geriatric, mobile medical care.

Matthew Lefferman: [00:01:36] Thank you. It’s a pleasure to be here. I appreciate the opportunity to talk and to share.

Hanh Brown: [00:01:40] Thank you. What originally got you interested in geriatric care.

Matthew Lefferman: [00:01:46] I always had very good relationships with my grandparents and actually my wife’s grandparents as well. And when I was going through the medical school and residency process just felt connected to that population.

[00:01:59] And the more I learned, the more I saw that there was a gap as far as a quality of care, not being provided to, to seniors. And they really felt the charge then to connect with that population. It’s not glamorous medicine all the time. It’s not like doing heart surgery. It’s a lot of social work. It’s a lot of psychology psychiatry.

[00:02:21] It’s end of life care. It really runs the gamut. But for myself personally, it suits my personality.

Hanh Brown: [00:02:29] I think we need more folks like you physicians. And technologies to help the aging population, especially when now we have 10,000 plus turning 65 plus years old from now until gosh, 2030. So thank you. Thank you for doing this.

[00:02:46] So I know that your expertise is at least partially in geriatric, mobile medical care. Can you start by giving us a brief overview of what this is?

Matthew Lefferman: [00:02:58] My practice is focused on care of patients in assisted living communities. I also go to patients, private homes, and I also go to a nursing homes. But I would say that the one area in particular, that I saw a gap when I was starting, my practice was the assisted living community.

[00:03:19] And you had the residents who were paying many thousands of dollars to reside and were expecting some modicum of medical care. And you had nurses on site. But not necessarily engaged as far as affecting positive health in their residence. So by myself being onsite, being able to connect with the team, being able to prevent residents from having to go out to the doctor, it really it’s been extremely beneficial for the patients and facilities that I serve as far as proactively managing their medical care.

[00:03:54] As far as getting labs testing. In the community and really, as far as preventing hospitalization, which more and more as a buzz word in the medical world is keeping patients out of the hospital. And I like to think that we’re aggressively managing a frail elderly population and keeping them out of the hospital.

Hanh Brown: [00:04:14] And nowadays that is a huge savior. Thank you. I’m sure. During the midst of the pandemic, you have been a great saver to many families and older adults. Are the seniors that you’re seeing with your mobile medical care. Are they mostly seniors living in their own homes or are they at senior care facilities?

Matthew Lefferman: [00:04:35] I probably have about a third of my patients who are in private homes. And the closer about two thirds who are in assisted living and in communities in the greater Los Angeles area, there are a couple of different types of assisted living. There’s a board and care, which are like smaller home group homes, which that can have up to six residents and then the larger assisted living.

[00:04:55] So I do a combination of both. It’s hard to have a Medicare practice. That’s going home to home, but by going to assisted living is I can see more patients at one time and it makes it more feasible.

Hanh Brown: [00:05:10] Opportunities. Does the option of mobile medical care give to the seniors? Like what specific groups of seniors are most benefited from the mobile medical care?

Matthew Lefferman: [00:05:22] You know, with, you mentioned the reason COVID pandemic, which yes, has been tragic and has affected the, our patients and facilities. To a significant degree. So with the pandemic. There’s been a rise in demand for, for onsite care, because you have patients who don’t want to go out to sit in a waiting room.

[00:05:42] They don’t want to go to the hospital and get tests and procedures. We’re seeing more and more demand from patients who previously would’ve been happy to go sit in the waiting room, watch Ellen on TV. Like that was our outing, but more and more, they don’t want to go out, but. I would say the, the sweet spot, so to speak.

[00:06:00] Are the residents in assisted living communities who have a harder time getting out to the doctor or maybe they have mobility issues or there are cognitive issues and it frequently takes not just a driver to get them. To where they want to go frequently requires a caregiver or a CNA to go with them.

[00:06:20] And so there’s a lot of time and resources that are involved, especially those patients with cognitive decline. And in particular, those who residing in memory care of assisted livings, it’s particularly hard.

Hanh Brown: [00:06:32] Tele-health has also been on the rise recently due to the pandemic. Can you share with us how this has impact the demand for your services?

Matthew Lefferman: [00:06:42] Sure. We never really did a video. Chad. So we’ve done a lot of telephone triage over the years, but one of the positive responses of the federal government has been the changes regarding telemedicine. Think of it as approximately middle of March as a COVID pandemic was heating up. They made some changes, which allowed for telemedicine for Medicare patients, not just in rural areas, but in urban areas.

[00:07:10] And also it did not require a HIPAA secure platform. We do have a HIPAA-secure platform, which we like to use, but we have found that most patients prefer using, using FaceTime. And that’s generally the easiest from our perspective, it takes. A person on the other end of the line because frequently our patients or unable to navigate technology.

[00:07:35] So that has certainly been a challenge as far as making sure there’s someone on the other line, turning on the iPad or the phone and connecting with us. We like to connect with nurses. I’ve had one building that. Because their driver hasn’t been transporting their residents to doctor’s appointments. The driver has been the one who’s been taking the iPad around and it does make it challenging for myself as a physician.

[00:08:01] Obviously it has limited information to get from the driver as he’s taking me around. But I would say that we’ve been able to meet our productivity that we were at before COVID through telemedicine. And that was through March, up until about a month ago. And in the past month, we’ve been back out in community as we were previously.
[00:08:24] And the adjunct of telemedicine in addition to face-to-face visits is extremely helpful for those urgent visits. And for patients who are in outlying areas that it’s difficult for us to get to them.

Hanh Brown: [00:08:35] Thank you. Wow. That’s great of your dedication and your service now, do you see, let’s say. In which circumstances would you recommend mobile medical care, Instead of tele-health ?

Matthew Lefferman: [00:08:51] I’ve found that there was, as I was doing more and more telemedicine visits, there was a certain amount of fatigue on the part of the communities that I was going to. I would say that it’s not as much one over the other. I think it’s hard to do just one or Jessie, other. I think the challenge now is blending the two together.

[00:09:09] So, how do you coordinate doing face-to-face visits and then also doing telemedicine visits and picking the right, but the sweet spot, as far as patients who are appropriate and additionally, From a provider perspective, it’s a matter of how do I coordinate my schedule so that I’m available for those telemedicine visits, because if I’m out in the field, it’s hard to just stop and do a telemedicine visit.

[00:09:34] So I try and schedule them at the end of my day when I’m back, back in my office. But you know, over the years, we’ve tried to coordinate any number of specialists to go to assisted living communities, not just myself as a physician. We like to collaborate with podiatrists, optometrists, physical therapists.

[00:09:51] Psychologists and psychiatrists, I would recommend to all of them to try and balance to balance the two, but it’s all possible through telemedicine.

Hanh Brown: [00:09:59] So basically, do you see them as an either or solution or could it help some seniors to use both together? That’s what it sounds like, is that right?

Matthew Lefferman: [00:10:08] Yes, my recommendation and what I’ve found in best practice that we’re moving forward with is being able to juggle the two because.

[00:10:16] There’s a certain sense of fatigue as far as technology and just using technology. And we had a number of canceled appointments or in, and they’re canceled because the nurses don’t want to make themselves available and they get busy with it. Third day. Plus there’s a senior medicine is very, is very hands-on.

[00:10:37] That connection is really important. And I’ve seen decline in my senior population, even though the residents let’s say, have had connection with their family through FaceTime, there’s still been significant decline because that’s not the same as being there in person feeling, touching someone, smelling someone, utilizing all the senses.

[00:10:58] That’s really important for seniors.

Hanh Brown: [00:11:01] I agree with you. I think technology has been a great savior during this time, right? For obvious reasons to tell you it will never come near sitting next to mom, maybe taking her for a walk, sharing a meal with her because depending on their acuity or where they are, perhaps in, let’s say a dementia, it’s not about words, right?

[00:11:25] Sometimes they may not speak as much. It’s about being present in seeing the overall disposition technology has been great. Wow. It just allows us to do what you and I are doing right now. Make connections, push out a very important message and service of what you’re doing, but I still one-on-one and I’m sure loved ones want to be near their mom or dad.

Matthew Lefferman: [00:11:47] Significant decline from, from COVID in terms of deaths, but we’ve had almost an equal amount of deaths, I would say from.

[00:11:57] That lack of connectivity and from being locked down and I’ve been calling it pandemic related, lockdown decline, but it’s a real thing. And I think that’s going to be a large part of the story five years from now. When we look back at the COVID crisis.

Hanh Brown: [00:12:12] It’s a fine balance, right? Keeping folks safe. And how do you do that?

[00:12:17] To continue to have them continue to thrive and engage for their overall wellbeing. And that’s very important. Okay. I know you also have expertise regarding dementia and cannabis. Can you tell us about the research, what it is saying about the connection between the two.

Matthew Lefferman: [00:12:37] Sure. I recently had a chance to present to the Calla conference, a California assisted living association regarding this topic.

[00:12:46] Somewhat timely because there were several States in the, the election that approved medical marijuana and even Oregon, and just any, when a step further, and it has approved a small amounts of other narcotics. It’s an interesting time as far as the use of marijuana and use of cannabis. And my recommendation is, and my general overview of this topic is that.

[00:13:08] You have to tread lightly because it is still federally illegal. And state-wise, it’s still a gray area as far as using cannabis, but there’s enough evidence that it’s not being prosecuted. And if you’re using it as an alternative to the narcotics, to the benzodiazepine, to the anti-psychotics that have significant side effects, It is a helpful adjunct and you’re using if you’re using it under the guidance of a physician and specifically related to its use dementia, that there are some limited clinical trials.

[00:13:46] Unfortunately, there’ve been very few clinical trials because of cannabis is illegal status. There’s been a lot of bench research research in animals, which has showed a positive correlation between lack of reducing the effects of dementia and patients who are using cannabis. Hopefully that research will improve over time.

[00:14:07] There is more research regarding the. In fact on some of the, the symptoms of dementia beyond just the cognitive effects, trouble sleeping pain, as far as lack of mobility, as far as the anxiety and agitation. And so it is a cannabis is a helpful adjunct in all of those conditions as well.

Hanh Brown: [00:14:30] So a lot of baby boomers grew up being told that cannabis was a dangerous drug and may even hurt the brain.

[00:14:37] So has it been hard to convince them otherwise? And what tactics do you use to convince these seniors to use it as a therapeutic?

Matthew Lefferman: [00:14:45] Sure. I think knowledge is power, and I think that as physicians were trusted for our opinions nurses and. Nurse practitioners and other healthcare providers as well. So I think the more we see healthcare providers taking the time to look at the research to educate themselves, then I think you’ll see more acceptance among the public, but there’s certainly is there’s a lot of noise out there as far as the benefits of cannabis.

[00:15:14] And so patients on their own families on their own are hearing about it and saying, Hey, what do you, what do you think about this? What do you think about this product? I try and proactively recommended myself, but I think it takes a few minutes of education, which not every healthcare provider feels like they have, because it’s complicated.

[00:15:33] You’re not just, it’s not like you can just call the pharmacy and say, I want this blood pressure medication and they’re going to deliver it. There’s so many the options out there. There are different routes of administration and different brands. So it’s hard to just call the pharmacy and say, send over 15 milligrams of cannabis.

[00:15:51] And so it takes. Some research, as far as the family, finding a brand, finding a route of administration that that’s appropriate and as much as anything, the education piece also pertains to the assisted living communities, because there’s still a lot of lack of understanding and a kind of uneasiness. As far as using these products.

[00:16:11] But to me, if, as long as they’re the assisted living communities are storing them, having them in the Mar like they do, there are other medications checking off when they’re administered monitoring for side effects, but then it’s, they can be used safely.

Hanh Brown: [00:16:28] So a lot of monitoring and tread lightly and proceed with caution.

Matthew Lefferman: [00:16:33] Correct. And there’s so many brands. And different options out there. People are learning and hopefully in five years there’ll be a better understanding and it’ll be easier for a doctor to just say, I want to order cannabis and a pharmacy can deliver, let’s say a standard dosing regimen.

Hanh Brown: [00:16:52] That’s new information.

[00:16:53] Thank you for sharing that. That’s on the horizon. Okay. On a personal level. What do you think is your biggest strength that enables you to have on unique, impactful effect on the older adults? I guess something that isn’t well known about you personally.

Matthew Lefferman: [00:17:10] I connected well to, to my grandparents, to my wife’s grandparents, I am a, of the Jewish faith.

[00:17:19] And so I do spend a fair amount of time in synagogue, and that provides for another opportunity. It has over the years, it’s provided opportunities for me to connect with, with the elderly as well, and to see them in a different, in a different setting and have a chance. To interact with them that has helped to enhance my, uh, connection and understanding of seniors.

[00:17:41] And. In COVID having the continued religious connection and faith connection has been grounding for me and continue to allow me to grow. Even though I feel like so many avenues are shut off, although zoom, there are many more. Activities to connect with others, but the synagogue is Elisa and in Los Angeles area have tried to find creative ways to engage their, their memberships.

[00:18:07] I’m having outdoor and services. And as I’ve been able to engage through those, it’s helped me to still feel grounded and connected. And so that has been helpful for me.

Hanh Brown: [00:18:17] Amen to that. I feel the same way. I’m from Michigan. And there has been a few occasions that our church has held outdoor that I’m not sure what’s going to happen when now we’re getting to be 30 degrees in Michigan right now.

[00:18:30] But yeah, I think it’s a great idea at all times, but I think particularly during this time, we need to be grounded, whether it’s spiritually or whatever means it is for people, right.

Matthew Lefferman: [00:18:42] And the chance to engage with family, not just, you know, everyone, it’s quick for the kids to. To be on their, their devices, but to force them to have a time to come together as a family is really important, especially now.

Hanh Brown: [00:18:55] Have you given thought on how you want to experience your own aging journey?

Matthew Lefferman: [00:19:00] Yes. As I have watched my patients age, I have my own practice now about 12 years or so, it has seen a forced me to reconcile what is inevitable and another personal. So my anecdote is that I was diagnosed with type one diabetes two years ago. So it’s, you know, there was a personal journey through, you know, through understanding and changing and better changing my lifestyle and better preparing myself for what would be ahead.

[00:19:30] And for myself, that’s. Involved a lot of time learning about how to eat better, how to exercise better. And I spend a fair amount of time focused on myself, which with kids over many years, my focus very much is my kids, but I’m at a point now where I said I’ve realized I have to focus more on myself. So as far as taking time to exercise, Every day or as many days as possible taking the time to eat, it’s really crucial.

[00:19:56] And so I see the, those patients who really thrive and make into their nineties, hundreds, there’s no, there’s no one solution, but it seems like they’re the ones who are active. They don’t smoke, they don’t drink to excess. And I see as well that they tend to have a strong connection. We talked a little bit about the family connection and religious connection.

[00:20:17] I think that’s really important as well. So creating that healthy balance is, and really dedicating time to myself, I think is really, is it has been my approach.

Hanh Brown: [00:20:26] No, I love it. I think everything you described my husband and I would echo that. I think during the pandemic, it’s very easy to stay down. Cause I feel like the whole world is on mute, but I think it’s very important to.

[00:20:39] Take care of yourself, whether you know you with kids or with, or without kids, because you over a wellbeing, I can’t speak enough if you’re not grounded, physically, mentally, spiritually, you can’t really give much of yourself to your children. Anyhow, I disagree everything that you’re saying. I think it’s great.

[00:20:59] And thank you for sharing that. Do you have anything else that you would like to share with the listeners?

Matthew Lefferman: [00:21:04] No, this has been a great forum. And I would just say that the senior community, he has been heroic for the most part, and that there are instances of tragedy over the past six, seven months with COVID it’s easy to blame, but we should be aware of the acts of the healthcare workers on the frontline.

[00:21:29] I think my feeling in assessing the healthcare, the general health care talk in the general community related to the election is out there still is not enough discussion about seniors. And there still is not enough discussion about how we can help keep seniors active. The tragedy that happened in nursing, you know, with COVID deaths and nursing homes.

[00:21:52] Should not happen again. And I think we, as a, those who care about seniors and involved in senior health care need to keep the pressure on and try and create awareness. And that’s what I’m, hopefully this platform can do that because we need to have our voices heard. Really important that there’s more healthcare being provided.

[00:22:11] And if you look at the affordable care act, there have been 20 million new enrollees, and that’s amazing. But when you look at 50 million seniors over the age of 65 in America, that’s a huge population and they deserve our attention and focus. And hopefully that will be an increasing part of the public discourse.

[00:22:31] And I think we all need to do what we can to let our members. Uh, of Congress now to have discussions and forums like this, to energize people, to increase the awareness of the need for more healthcare, for better healthcare for our senior population.

Hanh Brown: [00:22:47] Amen to that. I could not have said that better myself.

[00:22:49] Thank you very much needed in everything that you describe. This is the driving force behind this forum, because I think there are so many people very impactful like yourself. That wants to positively serve the aging population 10,000 a day, turning 65 plus for the up until 2030, I think we should amplify that message.

[00:23:12] There’s great. Compassionate, empathetic folks serving every day. Thank you so much.

Matthew Lefferman: [00:23:20] Thank you. I really appreciate it. It was nice to connect. Thank you. I appreciate the opportunity.

Matthew’s Links:

LinkedIn: https://www.linkedin.com/in/dr-matthew-lefferman-627a9b8/
Access Healthcare Associates: https://www.accesshealthca.com/