The fastest growing segment of the American population is adults over the age of 85 and the number of people aged 65 or older is projected to double over the next 15 years. Not only is the elderly population increasing steadily, they are spending more and more time in the hospital for treatment of chronic diseases like stroke, heart disease, and cancer.
According to the Centers for Disease Control and Prevention (CDC), two out of three older Americans have more than one chronic condition and treatment for these conditions accounts for nearly two-thirds of the country's healthcare spending. Not only is it expensive to treat chronic conditions in the elderly, the current hospital-focused method is inefficient.
Now, doctors are beginning to rediscover that in-home health care and treatment for the elderly can reduce hospitalizations and improve the management of chronic diseases.
The Return of House Calls in the United States
In-home medical care was once a staple of American life. It was common practice for doctors to visit patients in their homes for both preventive care and medical treatment. In fact, up until the 1940s, about 40% of doctor visits were completed in the home. After World War II, however, physicians began to take their practice out of the home and into the office – it was simply no longer financially advantageous to visit patients in their homes.
Though medical house calls largely fell out of practice, they are once again on the rise. According to Medicare data collected by the American Board of Family Medicine, the number of home visits made by physicians doubled between 2000 and 2006. Regarding elderly patients, a study published in Health Affairs revealed that over 5,000 primary care providers across the country completed more than 1.7 million house calls to beneficiaries of Medicare in 2013 alone, and some physicians make more than a thousand house calls per year.
The Pitfalls of Fee-for-Service Care
Many hospitals and clinicians advertise a patient-centered attitude, but the current model for healthcare in the United States is very provider-centric. The existing fee-for-service model that reimburses physicians for each individual service they perform encourages over-testing and superfluous treatment. It also dictates what care services patients should receive, as well as when and where they should receive them. It is all about what is convenient for the physician, not necessarily for the patient. In-home medical care is the opposite – the patient is the priority.
What Do Medical Home Visits Look Like?
One of the primary advantages of home health care is that it can be customized according to the patient’s needs. Medical home visits can be used to provide everything from preventive medicine to management of complex chronic conditions, and it can be executed by a wide range of medical professionals, including primary care physicians, physical therapists, occupational therapists, speech therapists, and more.
Medical house calls can provide a wide range of services, including the following:
- Primary care
- Routine follow-ups
- Specialist consultations
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech therapy
- Palliative care
- Dementia care
- Medication management
- Transitional care
- Diabetic counseling
- Health and nutrition counseling
- Wound care
In-home doctor visits can be customized according to the patient’s need and may include any combination of the services listed above. By providing in-home health care, house call doctors are able to provide better continuity of care for patients who might not otherwise have access to regular or reliable healthcare services.
Who Qualifies for In-Home Healthcare?
Adults over the age of 85 are the fastest-growing segment of the American population, as well as some of the most common beneficiaries of in-home doctor visits. In-home health care is an excellent option for the elderly, but other patients can also benefit. In order to qualify for in-home doctor visits, a patient must have a valid reason for being unable to visit the doctor’s office. There are a wide variety of potential reasons, but some of the most common include the following:
- Mobility problems such as disability or injury
- Lack of transportation (or access to transportation)
- Vision problems that make driving or traveling dangerous
- Mental health problems or memory problems (such as Alzheimer’s)
- Multiple chronic conditions with complex management
In addition to these general qualifications, there may be specific qualification requirements if you hope to have your medical home visits covered by Medicare. To qualify for home health coverage, you must meet the following criteria:
- Considered “homebound” by the Centers for Medicare & Medicaid (CMS) criteria
- Require skilled care on an intermittent or part-time basis to improve, manage, prevent, or slow a current health condition
- Be under the care of a doctor who completes and documents an in-person visit either 3 months before starting home health care or within one month after starting it
The Centers for Medicare and Medicaid definition of homebound requires that the patient needs the help of another person or medical equipment such as a walker, crutches, or wheelchair to leave the home, or if the patient’s doctor believes that leaving the home could worsen the patient’s health or condition. It is also a requirement that the patient considers it difficult to leave their home.
The Benefits of In-Home Medical Care for the Elderly
The main benefit of in-home medical care for the elderly is that it helps keep patients out of hospitals, emergency rooms, and nursing homes. According to the American Association of Retired Persons (AARP), more than one million older Americans are completely homebound and another 2-3 million are sufficiently disabled that they cannot go to the doctor's office. Even elderly adults who are not completely homebound are likely to put off visiting their primary care doctor because it is simply too much of an ordeal. As a result, their conditions worsen and treatment becomes more expensive.
In addition to reducing the frequency of hospitalizations and ER visits, in-home care is more personalized than the care most patients receive in a doctor's office or hospital. Many physicians see 20 or more patients per day and each visit is very brief. By bringing care directly to the patient, it becomes far more personalized; treatment is customized to each patient's individual medical needs. It can also give both patients and their loved ones peace of mind knowing they are being cared for in the comfort of their own home.
In-home medical care for the elderly also enables patients who live a significant distance from any hospital or medical office the opportunity to receive routine care. According to Nengliang Yao, assistant professor of public health at the University of Virginia School of Medicine, most elderly homebound patients live 30 miles or more away from their medical provider. Increasing the availability of house calls would increase the availability of care for those patients.
Does Elderly Home Care Really Work?
The benefits of house calls for the elderly are more than just theory – various programs have proven that this model of patient-centered care actually works. For example, the Independence at Home Act released in 2012 revealed that home-based care saved Medicare beneficiaries $32 million over two years. For each beneficiary, annual savings averaged $3,000 for the first year and more than $1,000 for the second. Statistical data also showed a decline in hospital readmissions as well as a decrease in emergency room visits and inpatient hospitalizations during the testing period.
The Future Looks Bright
The state of healthcare in the United States is constantly changing; however, increasing availability of house calls for the elderly is promising and is indicative of a trend toward more patient-centered care in the future.
How to Become a House Call Patient
Located in Idaho? The first step to becoming a house call patient with Keystone is to complete the New Patient Form and either fax it or upload it through our secure, HIPAA-compliant form. Click below to get started.