Ten Things Every Geriatrician Should Know About House Calls

Mia Yang, MD; Jantira Thomas, DO; Rachel Zimmer, DNP, NP-C; Maryjo Cleveland, MD; Jennifer L. Hayashi, MD; Jessica L. Colburn, MD

Disclosures

J Am Geriatr Soc. 2019;67(1):139-144. 

In This Article

Abstract and Introduction

Abstract

Home-based primary care (HBPC) is experiencing a reemergence to meet the needs of homebound older adults. This brief review based on existing literature and expert opinion discusses 10 key facts about HBPC that every geriatrician should know: (1) the team-based nature of HBPC is key to its success; (2) preparations and after-hour access for house calls are required; (3) home safety for the clinician and patient must be considered; (4) being homebound is an independent mortality risk factor with a high symptom burden; (5) home care medicine presents unique benefits and challenges; (6) a systems-based approach to care is essential; (7) HBPC is a sustainable model within value-based care proven by the Department of Veterans Affairs and the Independence at Home Medicare Demonstration Project; (8) HBPC has an educational mission; (9) national organizations for HBPC include American Academy of Home Care Medicine and Home Centered Care Institute; and (10) practicing HBPC is a privilege. HBPC is a dynamic and unique practice model that will continue to grow in the future.

Introduction

House call is a term that can evoke surprise and nostalgia in people who remember a family doctor visiting them at home in a bygone era. Scientific advances over the past several decades have prolonged life expectancy and added to a growing population of older adults with complex multiple morbidities, functional impairment, and significant challenges accessing office-based medical care. These patients, some of whom are younger adults with complex medical needs, have become effectively homebound, with a high symptom burden,[1] and they are at high risk for poor health outcomes and extraordinary healthcare costs. Meanwhile, the American healthcare system has become more difficult to navigate. The healthcare needs of many of these homebound patients can be met by interdisciplinary teams (IDTs) practicing home-based primary care (HBPC). HBPC is longitudinal medical care provided by clinicians in patients' homes who may collaborate with home care agencies (that provide skilled services and home aides). It is not home health but is a distinct model focused on primary medical care. For the purposes of this article, the terms home-based primary care and house calls are interchangeable, but other types of house calls types include transitional care visits after hospitalization, Hospital at Home, home-based palliative care, and concierge home visits. This brief review of key concepts is intended to provide geriatricians, advanced practice providers, and teams with the practical knowledge needed to include HBPC in routine practice. The concepts were selected from a combination of literature reviews and expert consensus opinion.

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