Health Care Home Delivery Treats Patients, Providers Where They Live

Article excerpt

Every five minutes, between bites of home-cooked food and friendly conversation, Shari Nalick fed her body doses of toxic drugs. No one at the dinner party ever suspected that Nalick sat at the table undergoing chemotherapy for breast cancer.

The liquid medication poured from a small reservoir belted to Nalick's waist on a fanny pack. On cue, a miniature computer released drugs that flowed through a pencil-thin tube to a vein in Nalick's chest.

The surgeon deliberately inserted the tube just below Nalick's collarbone, carefully calculating that her dress neckline would neatly conceal a bandage the size of a postage stamp.

Just five years ago, Nalick would have sent regrets to the host because she had to be hospitalized for chemotherapy. Today, Nalick and other cancer patients get chemotherapy at home and the chance to keep up their lifestyle.

Everyday, health care gets delivered to the home address of more and more patients throughout the metro area who once were hospitalized for the same treatments.

This year, St. John's Mercy Medical Center alone will deliver home health care to an estimated 62,000 patients in the city of St. Louis and seven surrounding counties in Missouri. That is double the patients they served five years ago.

Throughout Missouri, 200 or so more home health agencies find business just as brisk. Last year, they visited 2.1 million patients, or about 400,000 more than they did in 1985. That increase equals the population of the city of St. Louis.

Why the push to provide health care at home instead of the medical center? Hospitals, insurance companies and the federal government want to save money. The math is simple. It costs less to deliver health care to the patient's front door than to keep the patient in a hospital.

For example, a nurse from an area hospital got paid $125 for each visit she made to Nalick's home in Chesterfield. State health officials recently calculated a typical hospital stay costs $1,510 a day. That adds up to a $62,325 savings based on Nalick's nine chemotherapy treatments that each lasted five days.

Nalick calculates that the home treatment also cut disruption to her everyday life. With her fanny pack strapped around her waist, Nalick slept in her own bed, saw friends at social events, cooked her family meals and went to PTO meetings. When the treatment left her hungry and thirsty, she opened the refrigerator and pantry for her favorite snacks.

In the hospital, Nalick would have faced intravenous treatments that left her veins collapsed.

Through home health care, Nalick avoided hospitalization again. After the chemotherapy, a home health nurse helped her use the same tube to take medication that drastically cut nausea.

Even patients who do go to a hospital stay fewer days. A 21-year old college student stayed at St. John's Mercy Hospital in Washington for five days while doctors treated a leg infection. Back home, he spent two more weeks on intravenous treatment to combat infection, time he would have once spent in the hospital.

Other patients arrive back in their own bedroom with respiratory machines, feeding equipment and medical paraphernalia that lets them inhale drugs or send drugs through their veins.

"People are coming out of the hospital quicker but they are sicker," said Mary Schantz, who directs the Missouri Alliance for Home Care. …