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Landon Center on Aging
Landon Center on Aging  :  Geriatric Education & Training

Home Care & Assessment of Community-Dwelling Elderly

Instructor: James T. Birch, MD
Developed by: James T. Birch, MD

 

Specific Learning Objectives

A. Introduction

Before reviewing the learning objectives and content, please take the Pre-Test. You must do this before you can proceed with the module. The answers are given in the Post-Test that complete the module.

Please review the Objectives, Content material, and Cases before our class session.

B. Attitudes - The student will recognize that:

  1. Home care visits are indicated in select patients.
  2. Home care visits can enhance the physician and patient relationship.
  3. Home care visits will allow the provider to gain valuable insight into the patients living situation, and provide insight into problems not seen in the office setting.
  4. Home care providers must be cognizant of safety for themselves and their patients when making house calls.

C. Knowledge - The student should be able to describe or explain

  1. Recognize when patients are appropriate for home care visits.
  2. Identify the needed supplies for a house call kit for home visits.
  3. Identify areas for improvement of the patient's home environment to augment their safety in their home.

D. Readings

E. Learning Module - Required Audio PowerPoint®

  1. Home Care & Assessment of Community-Dwelling Elderly (long download - slideshow w/audio)
    Home Care & Assessment of Community-Swelling Elderly (quick download - slideshow no audio)

F. Skills

 

Background Information

Prior to World War II, home visits were a common practice. The vision of the physician with their little black bag was a common site in neighborhoods across the United States. In fact, about 40% of the physician-patient encounters were home visits. However, after WWII, physicians began to have a more static practice life. They began to make less and less "house calls", thus requiring the patients to come to them.

The American Medical Association (AMA) conducted a national poll in 1990, in which about 1/2 of the physicians stated they conducted home visits. Although half of the physicians polled stated they conducted home visits, this is still a very small number, because most of the physicians polled only did one or two visits every year. In data collected by the government, less than 1% of Medicare patients are the recipient of home visits each year.

So, why are home visits not done in greater numbers? Are home visits even necessary? Why would you do a home visit?

Why are home visits not done in greater numbers?

Many physicians feel like there is not adequate time, or adequate reimbursement for home visits. Unfortunately, in a busy clinical practice, many physicians are so booked that they cannot seem to fit in one more patient, especially one which requires a home visit. In this type of setting, the physician will often turn to home health care services to help care for the patient. Although this is appropriate, the patient may also need a physician visit. If appropriately7 prepared for, a physician visit does not have to be an overwhelmingly time consuming visit. The physician can also bill for the visit with special CPT codes based on the acuity of the patient and the intensity of the visit.

Are home visits necessary?

Not every patient will require a home visit, but there are specific patients that will need the physician to make the special effort to visit them in their home.

Many physicians, after completing a home visit, will have discovered more about their patient than they ever could have in a traditional office visit. Visiting a patient in their home will give insight into the home environment, patient function within that enviornment, care giver competence, potential risk factors for the patient's safety, medication habits, eating habits, etc.

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