The Northwoods of Wisconsin is a serene setting for anyone who loves the great outdoors — clean lakes and streams for fishing and water recreation, dense forests and wildlife, and a lot of peace and quiet. But rural northern Wisconsin has an older population than the state average, and isolation from resources and family is a common theme for its elderly demographic. With age being the leading risk factor for Alzheimer’s disease, the need for dementia support services is great in northern communities.
"Because this is a rural area, patients can live way out in the woods; the nearest neighbor could live a half a mile away," explains Chris Koeppl, MD, an internal medicine doctor with Ascension and the founding memory care specialist of the Northern Wisconsin Memory Diagnostic Clinic in Rhinelander, Wisconsin.
"A lot of people retire up here," adds Joelle Millikin, MD, a geriatrician with Ascension and the Rhinelander clinic's second memory care specialist. "When they get dementia, they have no family nearby to help. It becomes a struggle for them to stay safe in their homes."
For more than two decades, the Northern Wisconsin Memory Diagnostic Clinic has been meeting these challenges head on for people with memory concerns, providing expert dementia support close to home for seniors in northeast Wisconsin. The clinic takes a multidisciplinary and multi-organizational approach to connect patients and families to resources and education.
About the clinic
The Northern Wisconsin Memory Diagnostic Clinic is located in Rhinelander, a city of about 8,000 people in northeastern Wisconsin's Oneida County. The clinic is affiliated with Ascension Medical Group and was established in 1998, the same year it joined the Wisconsin Alzheimer’s Institute (WA)-Affiliated Dementia Diagnostic Clinics Network. The clinic has the distinction of being the first WAI-affiliated rural memory diagnostic clinic in the state.
The clinic serves a large geographical area, including Oneida, Vilas, Forest, Lincoln, and Langlade counties. According to the Wisconsin Department of Health Services, 15.6% of the state population is aged 65 years or older, but in Oneida County, 26% of its population is aged 65 or older, with similar demographics in neighboring counties.
The clinic has two MDs, Dr. Chris Koeppl who sees patients in an outpatient clinic, and Dr. Joelle Millikin, who sees patients in nursing homes and assisted livings. The rest of the multi-disciplinary team includes a nurse, social worker, psychologist, and a patient and family education support specialist who is also employed by the local Alzheimer’s Association. Each doctor sees patients in clinic one afternoon a month.
The memory clinic offers a brief screening for memory issues, provided by a family practice NP and an RN case manager. Referrals are then made to the Memory Diagnostic Clinic for a full team evaluation or directly to a psychologist for testing in less complicated cases.
Together, the Rhinelander memory clinic team see 60 to 80 new patients a year; over the last two decades, clinic staff has served about 1,800 patients.
One of the clinic’s unique approaches to memory care is the way it has embedded its local Alzheimer’s Association community outreach specialist, Julie St. Pierre, into its clinic staff. St. Pierre is present during the clinic’s twice-monthly afternoon clinics, coordinates caregiver support groups, and supports patient families with information about aging services in their communities.
"It's really hard on families to get a diagnosis and not know what to do next. Julie, along with our nurse case manager Jasmine Baker, RN, is an advocate for families and patients and helps them walk down this road after diagnosis," Koeppl says. “The opportunity for patients and families to obtain education and caregiver support immediately after a diagnosis is a huge benefit for patients who may travel over an hour to attend an appointment at the clinic."
The Rhinelander memory clinic is purely consultational and exists in part as a service to its colleagues, offering them a place to refer patients for specialized, expert memory diagnosis. After a diagnosis and consultation, the clinic refers patients back to their primary care providers for follow-up and ongoing care.
Patients and families also find the clinic through referrals, many of them through the Alzheimer’s Association because of its close working relationship with St. Pierre. "Julie has been a good partner," Koeppl says. "She talks us up and invites Dr. Millikin and me to speak at conferences. This all spreads awareness of our services."
And the clinic has proved to be an important service to patients and families throughout the area.
"It takes an hour or two to sit down with a patient and their family and deliver a diagnosis — it's not something you can do in a 15-minute appointment," Koeppl says. "This is not a financially productive clinic, but it’s highly valuable to the people receiving the care and attention."
Evolution of care
Dr. Koeppl has seen many changes in memory care over the last two decades. In the early days as he was working to establish the clinic, he met with administration leaders who challenged him on the need to invest in a memory care clinic.
"They would ask, 'If we don't have a cure or treatments, what’s the point of an early diagnosis?'" Koeppl recalls. But administration took to the idea, Koeppl adds, and they quickly learned the value of educating patients and families early about the disease, and giving them resources to prepare for what is coming down the road. "It's also an opportunity for patients and families to commiserate with one another and let the tears flow. It's valuable," Koeppl says.
Another change is with the general attitude toward dementia and memory loss. "It's not the cloistered diagnosis it once was," he says. "People are more open in talking about the disease, and they want to know more."
The Rhinelander clinic is also involved in training the next generation of dementia care specialists. The clinic participates in the WAI-sponsored summer preceptorships in which medical students get exposure to memory screenings, memory diagnostic clinic team assessments, internal medicine, geriatrics, psychology, psychiatry, hospital-based practice, and specialties such as radiology.
"We value our role in student training and welcome medical students and psychology interns as observers and participants," Millikin says.
The Northern Wisconsin Memory Diagnostic Clinic was one of two clinics recognized as clinics of distinction at the 2019 WAI's 17th Annual Update in Alzheimer's Disease and Related Dementias, held in Madison, Wisconsin, on October 31, 2019.
You can learn more about the WAI-affiliated Dementia Diagnostic Clinics online, including information about clinic locations and how to establish a memory clinic.
Photo caption: Staff from the Northern Wisconsin Memory Diagnostic Clinic in Rhinelander, Wisconsin. Left to right: Kim Radtke, NP, Jasmine Baker, RN, Joelle Millikin, MD, Gerontologist physician; Christopher Koeppl, MD, Gina Koeppl, PhD, Julie St. Pierre.
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