Jeanna Duerscherl | The Roanoke Times

Dr. Gary Oberlender talks with Del Low at his home in Roanoke County. Oberlender is providing a new service for the elderly in the community by offering holistic medical care.

Dr. Gary Oberlender heard a repeated complaint when he worked as a geriatrician and internist at the Veterans Affairs Medical Center in Salem.

"I like my doctor; he just doesn't have the time."

Or, "I have several doctors, but I just get the feeling that no one is bringing it all together."

When he retired in September 2006, Oberlender decided to create a unique service to respond to senior citizens' needs. He made it even more unusual by basing it exclusively on a venerable medical tradition: the house call.

He started his own practice providing in-home comprehensive geriatric evaluations. He also performs independent medical evaluations for estate planning as well as other medical and legal procedures.

"What has been amazing is the tremendous amount of interest," Oberlender said. "This is a huge need."

As the elderly population has grown, so has the need to care for this group's special medical issues. Many seniors see various specialists to manage a combination of chronic illnesses such as diabetes and dementia. They often take a confusing array of medications and struggle with both physical and psychological ailments.

Despite the need, geriatricians are few and far between.

In the Roanoke Valley there are fewer than a dozen, according to Martha Anderson of Carilion's Center for Healthy Aging. Anderson said the number of doctors who make house calls is probably the same as the number of geriatricians.

"Geriatrics as a field is in its baby stages," Oberlender said, adding that the specialty only became board certified in 1988.

Providing medical care to the elderly offers its own unique challenges and rewards.

Oberlender knows that firsthand after working 21 years at the VA hospital, where he served as both director of the Geriatric Evaluation Unit and medical director of the Extended Care Rehabilitation Center.

Modern medicine's acute-care model has trouble dealing with seniors, he said. The model seeks to find a diagnosis quickly, but seniors often deal with combinations of cognitive and affective disorders that require time to assess.

Oberlender described how primary care doctors are locked into a production model that has them seeing patients for an average of 15 minutes. After that amount of time in his own practice, he said, he's just finished with introductions.

Oberlender said Medicare will reimburse approximately 50 percent of the $1,250 fee for his comprehensive evaluation.

Oberlender emphasizes the need to focus on the caregivers of elderly patients as well. Because he makes house calls, he can see firsthand how patients and caregivers interact. He often makes recommendations on support groups or health care sitters who can come into the home.

Oberlender sees himself as an adjunct to a primary care doctor. He sees one or two patients a month, and before a visit, he asks for the patient's medical history from the past 12 to 18 months. He typically spends two to three hours on his first visit, then writes up the case after he gets home. Then he takes a couple of days to a week to make an assessment.

When he finishes, he gives one report to the caregiver or patient and another one to the doctor.

"I sleep on it. I think about it," Oberlender said. "I'm going to take as long as it takes."

One of Oberlender's patients, Del Low, 87, described what he enjoys about Oberlender's care. "Good, open, clean communication and active interest in my needs unfettered by time constraints," he said.

Oberlender said he enjoys having enough time to really listen to his patients' stories.

It was an interest he developed when he first moved to Southwestern Virginia in his 20s and worked in a rural community for two years, at Bland County Medical Clinic. As the only doctor in a region with 6,000 people, he often got to listen to the stories of older patients.

Later, at the VA hospital, he cared for a 101-year-old man whose parents were both freed slaves. "For me to feel history like that was so amazing," he said.

His parents, Betty and Martin Oberlender, are both Holocaust survivors who had their stories recorded and videotaped for Steven Spielberg's Shoah Foundation.

"I love talking to older people who can give you firsthand accounts of lives years ago."