Specific home-care models have proven effective at providing high-quality care to vulnerable older adults. These models include preventive home-care programs and medical house calls that integrate medical and social supportive services focusing on the care of chronically disabled persons, home geriatric assessment, posthospital case management/transitional care models, home rehabilitation, and hospital at home.
Preventive Home Care/Geriatric Assessment
Many models of preventive home care for older adults at risk of functional decline have been described and evaluated. Models differ in their target populations, intensity and degree of geriatric assessment, and follow-up. Results of these studies are varied, but overall, programs that target high-risk patients and provide multidimensional assessment and multiple follow-up visits have demonstrated reduction in nursing home admission, improvement in functional status, and reduction in mortality. The high initial cost currently makes this model rare in practice.
Medical house calls are visits to provide ongoing longitudinal medical care within the patient’s home environment. House call visits may be done by a physician alone, or patients may receive primary health care from a team, such as in the Home-Based Primary Care Program through Veteran’s Affairs facilities. In the house call team model, patients are cared for by a multidisciplinary team of physicians and other health care professionals, including, but not limited to nurses, home health aides, social workers, and physical and occupational therapists. Some programs include pharmacists and mental health professionals on their teams. The team meets on a regular basis, manages the care of active patients carefully, and integrates medical and social supportive services. Such programs have demonstrated improvement in function, reduced costs, decreased medication use, improved satisfaction, improved end-of-life care, and fewer nursing home admissions and outpatient visits.
Posthospitalization Case Management & Transitional Care Models
Specific home-based case management strategies, especially those that are focused on conditions associated with complex management issues and high rates of early hospital readmission (eg, congestive heart failure), are associated with a significant reduction in the number of acute hospital readmissions.
Home rehabilitation (specifically after a stroke or a major joint replacement) has proved to be feasible, acceptable to patients and caregivers, and as effective as hospital-based rehabilitation.
Hospital at home models that provide hospital-level services in the home setting as a substitute for a needed hospital admission have been developed and have demonstrated comparable clinical outcomes, reduced length of stay, decreased readmission rates, increased patient and caregiver satisfaction, and reductions in important geriatric complications, such as delirium.
Medicare Home Health Services
Medicare will pay for certain home care services. Physicians who care for older patients need to be familiar with the basic entry criteria for these services. Medicare ...