Newspaper article The Tuscaloosa News

IDEAS & ISSUES: 'House Calls' Sensible Option for the Elderly

Newspaper article The Tuscaloosa News

IDEAS & ISSUES: 'House Calls' Sensible Option for the Elderly

Article excerpt

I make house calls. Remember those? When a doctor came to your door with a black bag? You might think of this as a quaint vestige of prewar life or a luxury for the exceptionally wealthy with their concierge doctors. But home care medicine, as it's now called, is extremely efficient and effective in modern America. Indeed, it often makes more medical and financial sense than a trip to the doctor's office.

Picture an older couple: He's 86, she's 82. He's got several health issues: obstructive lung disease, heart failure, diabetes, hypertension, arthritis and early Alzheimer's. She takes care of him, organizes his 14 medications, prepares low-salt meals. They're managing.

But then one Tuesday they notice he's getting more short of breath and his legs are a bit swollen. They cross their fingers and hope this is temporary. They're not stupid; it's a kind of denial. Neither of them drives. They'd have to get a ride from a nearby daughter, but she's got two kids, and they don't want to bother her if they don't have to. So they wait a day. Or two.

By Thursday, it's real. His symptoms are worsening. They call their doctor's office and are told to go straight to the emergency room -- it's too complicated for a quick office visit. They grow used to these intermittent hospitalizations. Like a lot of people, he jokes that he's going in for "a tune-up."

This is how millions of people with chronic conditions get into a cycle where all of their care is emergency care.

According to a recent Brookings Institution report, older people with chronic conditions suffer "repeated cycles of crisis, hospitalization and expensive but ineffective or even counterproductive treatment -- leading to still more of the same." This is one reason our health care system is so expensive. Patients like this who constitute the top 10 percent of Medicare beneficiaries account for 57 percent of Medicare spending.

Home care medicine makes so much sense for these patients, and could cut those costs significantly. Multiple studies have found that even among the ill and elderly, at least 30 percent of hospitalizations are potentially avoidable. Research on home-based care for VA patients found a nearly 14 percent reduction in total health care costs, and a forthcoming study on a Medicare program in Washington suggests savings of around 17 percent.

Take the couple above. If they had called my program on Tuesday rather than waiting, we would have visited them that day. We have the technology to take X-rays and analyze blood work on-site. Within an hour we could have diagnosed his problem, set him up on oxygen and started any necessary medications before returning to check on him the next day.

This is cheaper. But it's also better and safer than a hospital stay. Older patients are particularly susceptible to infections and medication errors. …

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