New Mexico is a rural state with unique barriers to health service delivery to homebound elderly. The University of New Mexico's Visiting Physicians Program allows these patients to stay in their homes by bringing physicians to them. The physicians use community agencies to provide nursing, lab, X-ray, and physical therapy services. The University of New Mexico has also integrated home visits into the medical students, residents and geriatric fellows' educational programs. By involving medical students, residents and fellows in home care, future physicians who practice in New Mexico will incorporate this valuable service into care far the homebound elderly in their practice communities.
Keywords: elders; geriatrics; home visit; homebound; medical education; New Mexico
New Mexico is a rural state with a population of over 1.9 million (U.S. Census Bureau, 2005). The total number of people in New Mexico is less than a fourth of the population of New York City, and Albuquerque, the biggest city in the state, has a population of 700,000. Dirt roads and desert are encountered 20 minutes drive from Albuquerque, located at the base of the Sandia Mountains. The state is visually beautiful, with sunset hues in reds, pinks, yellows and orange bouncing off the peaks. New Mexico's culture is diverse. New Mexico's Native Americans immigrated 20,000 to 40,000 years ago. There are New Mexicans who can chart their ancestry back to Spain and many back to Mexico. People arrive in the state from many countries, including China and Russia, to work at the various military bases and scientific laboratories. Asians began coming to Albuquerque after WWII when the Japanese left the internment camps. Albuquerque's growing Vietnamese population is a consequence of the state accepting "Boat People" after the war in Vietnam.
New Mexico's geriatric population reflects this diversity. It has the second-largest population of Native American elders. Of people over the age of 65, New Mexico has 28.6% Hispanic and Latino elders, the highest in the United States. These special geriatric populations have distinctive health care needs. For example, among the findings of the New Mexico Elder Health Survey, a prospective study on 2200 Hispanic and non-Hispanic elders conducted between May 1993 to March 1994, is that Hispanics have a lower concentration of vitamin B12, C, and folate than nonHispanic Whites (Lindeman et al., 2000). This finding may correlate with a decline in cognitive function, even after adjusting for depression. Being able to identify and correct health problems can improve Hispanic elders' physical well-being and their quality of life. Unfortunately, barriers to health care also exist in New Mexico. Mrs. Martinez (name changed) illustrates several of the barriers.
Maria Martinez, an 84-year-old Hispanic woman with diabetes, has lived in the same home for over 64 years. She is wheelchairbound consequent to a benign spinal tumor diagnosed about 30 years ago. This does not stop her from making tortillas and tamales for the holidays, shared with a large extended family in the southwest valley of Albuquerque. Unfortunately, during a recent Christmas, she spent too much time in the wheelchair and developed a decubitus ulcer that progressed to osteomyelitis. After several weeks in the hospital, Mrs. Martinez wanted to go home. However, she cannot drive and the nearest clinic is 10 miles away. It is difficult for her to get into her wheelchair because of the location of the decubitus ulcer. She needs assistance with her activities of daily living such as bathing and ambulation. The hospital team caring for her wanted to discharge her to a nursing home, but she insisted on going home and her children and grandchildren wanted to honor her wishes. They agreed to take turns staying with her at her house so that she would enjoy 24/7 care. She was bed bound at that time, and had significant wound care needs in addition to her usual bowel regime and Foley catheter care. …