Our senior loved ones may remember, from their own childhoods, a time when the doctor came to their house to provide medical care and treatment during times of illness in the family.
Perhaps the doctor came at the end to help prepare a loved one who passed away.
It was common to see a doctor in the house.
We may now get the opportunity to visit with a doctor in our own homes, as the trend toward house calls once again begins to increase.
In the 1930s, about 40% of doctor visits were in the home. By 1980 that number had dropped to only 1%. That number is slowly rising, with the expectation that even more in-home visits will become the norm as our population ages and the medical community searches for a new way to provide medical care.
Even though we might all want to be able to get a visit from the doctor to save us from the ‘enjoyment’ of their waiting room, seniors are most likely to be the ones to gain the advantages from a doctor who comes to call.
Doctor House Calls on the Rise
When healthcare shifted to an office or facility-based treatment model that accommodated more than 40 patient visits a day, the number of house calls declined markedly.
Doctors couldn’t sustain their practices seeing fewer patients as insurance reimbursement rates – and thus the compensation for them and their practices – changed.
In recent years, doctors have responded to the needs of their aging patients and begun going back to house calls to seniors. Some doctors have made special trips to the homes of older adults for a few years now in special circumstances, but the number of physicians who are making it a large part of their practice is on the rise.
Some doctor groups specialize in house calls.
According to a recent article in the Washington Post, there are benefits to not only the senior who won’t have to spend their day waiting to get routine medical care or be placed in a facility instead of getting care at home but also to the government in terms of Medicare healthcare savings.
It is estimated that only about 13% of family physicians made regular house calls in 2013 but others made a few each month for seniors in their practices.
Most house call physicians who do ongoing visits are part of a practice primarily treating in-home patients.
House Calls Take Special Skills
Being a doctor that participates in house calls takes a special skill set, different from what is needed to see patients in an office setting.
Fortunately, the ability to practice in a person’s home is made easier with technology and access to devices that can monitor vital signs and health data.
Doctors who provide a house call practice need other team members to help them provide the best care, such as nurse practitioners and social workers who can link seniors to needed resources. Doctors and nurse practitioners come regularly to take senior’s blood pressure, talk about their medications and check other vital signs.
When house calls replace facility placement, it is important that seniors have access to someone who can be available to help 24 hours a day, seven days a week. This requires a team approach.
Benefits of House Calls
There are many benefits that are far reaching when we are able to keep seniors at home and provide them the medical care they require to remain healthy.
- No waiting in waiting rooms, which can expose vulnerable seniors to other illnesses
- No driving to the doctor’s office or paying for non-emergent ambulance service or wheelchair transport; caregivers don’t have to transfer a weak senior in and out of the car or even out of the house
- Individualized, personalized care; senior are more likely to feel someone cares about them and their health
- Doctor’s attention focused on senior, not other distractions in the office
- Doctors can see for themselves that the patients’ homes are in livable condition, appropriate food is available, and seniors are well kept
- Improved quality of life, as seniors are able to remain in their home longer and don’t see themselves as ‘sick’
- Vital signs measured, timely instructions on diet or medications can be given by the doctor
- Many supports also can be done in-home, such as x-rays, blood work, therapy and even home health care
- No missed appointments because the can’t arrange transportation or simply forget
- Decreased need for emergency room visits or hospitalizations
- Improved patient and caregiver satisfaction with the healthcare they are receiving
- Medicare savings
As this list indicates, not only do our senior loved ones benefit, but there are benefits for providers, caregivers and the healthcare system itself.
Medicare Changes with the Affordable Care Act
Many experts worry that Medicare will not be able to meet the healthcare demands of the growing numbers of seniors.
There are programs that many have begun to create to find ways to keep seniors healthy, at home where the cost of care is more manageable compared to facility care and to lower the overall cost of care through reduced hospitalizations and proper medication management.
Studies found that house calls have the potential to save the government billions of dollars. Treating seniors in their homes can save Medicare large amounts of money that would otherwise be spent on inpatient and residential care.
It has been estimated that in-home care can save Medicare an estimated $21 billion to $34 billion over 10 years, according to an analysis by Jen Associates that was commissioned by the American Academy of Home Care Medicine (AAHCM). Without home care this money would be spent on hospitals, short-term nursing homes and other costs.
Independence at Home Act
In 2012, the Independence at Home (IAH) Act, which was started under the Affordable Care Act, works to make more doctor house calls available to seniors across the country.
To help achieve that goal, a three-year pilot program using 17 practices in selected states around the country was begun in 2012. The initial results were promising, so much so that Congress voted to extend it another two years for 14 of the practices.
In the first year of the pilot, Medicare participants saved more than $25 million — an average of $3,070 per beneficiary, according to the Centers for Medicare & Medicaid Services (CMS). Beneficiaries had fewer hospital readmissions and fewer hospital visits.
Unfortunately, in our current medical care model it is easiers for healthcare professionals to discharge a senior to a nursing home than to set up a home-care program. It has been estimated that 2/3 of people in nursing homes probably no longer need to be there because they don’t need 24 hour nursing care.
Doctor house calls can help seniors get back into the community or to prevent new ones from coming into facilities who might not need to.
Here is a graphic that shows which states are currently piloting the Medicare house call program.
House Call Via Technology
Seniors who can benefit from doctor house calls but who may not be in a region of the country where doctors actually make house calls due to distance can still benefit from in-home care when using technology.
Telemedicine can fill the gap for many seniors who have mobility impairments or transportation issues that keep them out of the doctor office for routine care. The lack of this routine care and follow-up treatment for seniors can often lead to serious illness requiring emergency care when a doctor visit could have corrected the medical problem sooner.
Virtual doctor visits and vital signs monitoring using mHealth technology currently readily available would benefit many seniors. You can learn more about telehealth assisting seniors and caregivers in our article.
The future holds many new programs for seniors and family caregivers especially with healthcare and technology innovations.
The more we learn as family caregivers, the better care our senior loved ones can access.