November 2025

GERIATRICS

FACULTY SPOTLIGHT: SARA M. BRADLEY, MD

Featuring Sara M. Bradley, MD
In this Q&A, Sara M. Bradley, MD, of Northwestern Medicine Geriatrics, underscores the critical role of geriatric education within medical training, particularly through immersive experiences in senior living environments. She highlights how clinical exposure to independent living, assisted living and skilled nursing facilities equips trainees with nuanced understanding of care transitions, interdisciplinary collaboration and the structural complexities of elder care delivery. 
What unique clinical insights do medical students gain from learning about the services provided to older adults in a senior living facility setting?

- As our students rotate through their clinical clerkships on services such as internal medicine, neurology  and surgery, they are admitting and discharging patients from many types of facilities. Often though, trainees don’t understand the difference in services and support provided by independent living, assisted living and skilled nursing facilities. This experience helps students have a better understanding of where the patients are coming from on admission or going to after discharge and whether that is appropriate and how they can advise patients and families.

How does the interdisciplinary nature of care in a senior living community enhance residents’ understanding of team-based geriatric care?

- As we are living longer and healthier lives, there will be more older adults and more people who would benefit from more supportive living environments because of mobility limitations and/or cognitive impairment or other issues. This may mean having an aid to help with activities of daily living or a nurse to assist with medication management. Having physical therapy or occupational therapy on site can also make a big difference in terms of improving physical deconditioning and maintaining function.

In what ways does this curriculum expose medical students to clinical experiences that they might not encounter in a traditional hospital setting?

-Trainees are so busy in the inpatient setting that they may not be thinking about what happens to their patient after discharge. Hopefully it highlights issues around transitions of care related to patient safety when patents are going back and forth to skilled nursing or assisted living facilities. When will the patient be seen by a provider? Is the discharge summary clear? Many older adults experience multiple transitions of care and are vulnerable to adverse events if medication changes or follow up tests are missed.

What specific skills and competencies would you like medical students to develop from this experience and why are these critical for future physicians?

-Beyond understanding the differences between sites of care and some of the other things I have already mentioned above, it is also critical for trainees to understand how this care is and is not paid for. For example, when their patient is discharged from the hospital to subacute rehab, this is generally paid for by Medicare Part A for the first 21 days; then the patient must pay a co-pay up to day 100, and after that the patient has to pay out of pocket for skilled nursing care unless they quality for Medicaid. Independent and assisted living costs are almost always paid out of pocket as well. This is often a surprise to trainees (as well as patients and families) that these are not covered by traditional insurance. Similarly, to get an aid in the home, patients who don’t have Medicaid must pay out of pocket. It can be really challenging for our older adult patients to get the care that they need.
 
Given that fewer than half of U.S. medical schools require a geriatrics rotation, why do you believe this experience should be universal for all residency candidates?
​-As I mentioned above, our population is aging and a higher proportion of patients admitted to the hospital are over 65. A better understanding of senior living and skilled nursing facilities can help residents realize the limits of what care can and cannot be provided at those sites and improve the safety of transitions of care.
​Sara M Bradley, MD is an associate professor of Geriatrics and Medical Education.

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