He’s a highly respected one. The University of Virginia Medical Center professor of nursing is director of the School of Nursing’s geriatric nurse practitioner program and head of the school’s diversity committee. Wearing academic, administrative and research hats, he’s a kind of medical Renaissance figure, but one whose priorities are clear. "I am an educator first," he says, "whether it’s educating my patients to take their medications properly, educating my students or educating my faculty members on issues that will move the department forward."

Chairman of the school’s Department of Acute and Specialty Care, he also sits on the advisory board of the new Institute for Aging, and focuses on developing a new family-centered geriatric care unit that respects patient autonomy in ways that are rare in these days of high-tech, hierarchical medicine. "Generally, a facility tells an elder when he or she needs to be in his bed or room," Lyder says. "We ask them." With each patient assigned a physician-nurse practitioner pair, the unit also ensures thorough care.

Though long workdays are commonplace for Lyder, he relaxes by reading Toni Morrison or Maya Angelou and hanging out with friends in Charlottesville’s small Trinidadian community. It was in his tropical birthplace of Port of Spain, in fact, that he first conceived of a career in elder care, his beloved grandparents his inspiration.

He moved to Manhattan at 13 and attended prep school in Massachusetts, followed by coursework in biology and psychology. Doctoral studies in gerontological nursing from Chicago’s Rush University College of Nursing prepared him for work with the patients who continue to inspire him. "We see them all the time," he says, "elders who have a sense of themselves, who are able to accept losses in their lives, yet still are able to laugh at life’s experiences, and able to see tomorrow."

Now in his third year at U.Va. after a nine-year tenure at Yale, the well-traveled healer feels that he’s found a truly congenial home. "This is a wonderful community of scholars," he says. "I think we challenge each other in how we perceive reality, and challenge each other to be our best at what we do."

CONSIDERING
LONG-TERM CARE

Deciding that it’s time for a family’s elders to seek long-term care takes tact, truthfulness and guidance, Lyder says. "I’ve been in geriatrics for 15 years and the decision isn’t ever easy," he says. "I’ve never met an older adult who’s said that they’re ready to leave their home."

Yet frequent falls, concern about financial irregularities and memory loss all could point to the fact that an elder is no longer safe in his or her environment. It’s at that point that professional help is available. Lyder recommends that the family first consult with a geriatric nurse practitioner, a geriatrician, or a geriatric social worker, then candidly approach the parent.

"Begin by stating the obvious—that this is an uncomfortable, but necessary, discussion," says Lyder. State some of the behaviors that have caused concern, and then proceed to lay out the options the professional has advised.

ASSESSING FACILITIES

Among the emerging trends in long-term care is the development of assisted-living communities that, Lyder says, "almost look like condominiums" and facilitate for elders the transition from independent living to living in a community. Nursing care is available on site, as are facilities for more serious physical and psychological care when needed.

In assessing nursing homes, Lyder advises that families:  

• Visit the Web site www.medicare.gov and click on "Compare Nursing Homes in Your Area." They will find results of government surveys of every nursing home that receives federal or state funding, including nurse-to-patient ratios and any concerns about the care.

• Visit potential facilities at different times of the day and talk to staff, residents and regular visitors about their experience of the facility.

• Evaluate whether the facility is clean and odor-free and whether the staff seems friendly and respectful.

• Inquire about who provides medical care for the facility and which hospitals the facility uses.

Lyder says that families may find reassuring the fact that all nursing homes participating in Medicare or Medicaid are inspected by federal and state surveyors, who examine both the home and the care provided the residents. Their report is then posted in the nursing home. Reviewing such reports can be critical for families exploring long-term care options.