Support for patients with a neurological condition

Support for patients with a neurological condition

If you or a loved one are having trouble navigating the challenges of living with a neurological diagnosis, the Neurologists of Cape Cod in Hyannis and Sandwich has a way to help. They offer a support program designed to assist patients and their families with managing their diagnosis, while linking them to community resources and support services that can improve their quality of life.

"We connect our families to support groups, financial services, Elder Services of Cape Cod and the Islands, home care agencies, skilled nursing and assisted living facilities, and hospice services, if they meet the criteria," said Laurie Knight Kjoller, EdD, LICSW, neurology clinical social worker.

The Beginning of the Program

"Before I came 3 ½ years ago, Dr. (Sean) Horrigan had identified the need to have a social worker in the neurology clinic because patients and their families were coming into the office for care and they had many more needs outside the realm of the clinic," said Kjoller. "Patients and their families had psychosocial needs beyond what the neurology clinic could help with."

Initially, Kjoller was hired to be the Alzheimer's and dementia social worker with a focus on supporting and counseling patients with a diagnosis of dementia or other neurocognitive disorders. Since then, the focus has evolved to include additional neurological diagnoses, including Parkinson's disease and multiple sclerosis.  

Caryn Thornton, MSW, LICSW, a neurology clinic social worker, transitioned from the Cape Cod Healthcare Partial Hospitalization Program to join Kjoller at the neurology clinic program a couple of months ago.

"The social work team works closely with the neurology providers and nurses on our clinic to ensure continuity of care," said Kjoller.

The communication between the neurology team is ongoing and open, in order to provide the highest level of care to patients, she added. She said that she and Thornton agree the program offers a "holistic approach to care for patients and their families."

How the Program Works

Thornton outlined the process of the support program:

• A neurologist or triage nurse will message Kjoller or Thornton with a referral about a patient.
• They review the patient's medical chart to gather information before they speak with the patient.
• They will talk with the patient and/or the caregiver to ask questions geared toward gathering more information when necessary.
• Once they have all the information, they make calls to connect the patient with community services.

"Oftentimes, Caryn and I have the opportunity to meet our patients and their families when they are at the neurology clinic for their appointments with the provider," Kjoller said. "It is the ideal time to begin to build trust and develop a successful helping relationship."

Support Programs

In addition to providing community services connections, Kjoller and Thornton lead two support groups for women with mild cognitive impairment or early-stage dementia, and a similar men's group. They also offer a Parkinson's education series on a quarterly basis.

In the fall, the social work team plans to expand their services to patients with other diagnoses within the clinic. These services will include support for Parkinson's patients. Support groups for post-stroke patients and individuals with multiple sclerosis are planned for 2027.

Kjoller explained that the social work team is part of Neurologists of Cape Cod. In addition, she and Thornton are assisting with the caregiver needs of families who seek help from Cape Cod Healthcare's Dementia and Alzheimer's Caretaker Support Program. All calls and inquiries to the program are directed to the social work team. Appropriate referrals are made, and community resources are provided as needed. Assistance is offered to families even if their family member is not a patient of the neurology clinic. Kjoller and Thornton currently facilitate a caregiver support group in Hyannis, as well.