The following article is taken from Ashlee Loewen’s “Knock, knock…who’s there? It’s your nurse practitioner” on jacksonville.com.
When was the last time your primary care provider knocked at your front door? For many, the answer is likely never. Quite possibly your only reference to the concept of house calls is from old movies, books, paintings or photographs. Picture a physician riding a horse-drawn buggy or walking along streets carrying a big leather Gladstone (Doctor) bag ready to treat anything and everything in the home setting.
You may find it surprising that this foundational home-based model of care still exists. Today’s house call medical practices are staffed with nurse practitioners, physician assistants and physicians who provide quality medical care for some of the most vulnerable populations. Home visits occur in private homes, assisted living centers or community living facilities and include routine and acute visits. Typical home-based services align with the normal assessment you would receive in a primary care office, but often include a more in-depth evaluation with a medication reconciliation, home safety evaluation and care coordination.
House call services are an option reserved for people deemed unable to go into an office due to physical, medical or psychological limitations. Qualifying reasons for home visits include those who would require equipment or assistive devices to leave the home or someone with a medical condition that makes it too difficult to travel to an office. With these qualifying factors, the target demographic for home-based care is 65 years and older, but includes younger individuals with physical disabilities, advanced illnesses or multiple medical problems.
Concepts for managing vulnerable populations and identifying unique approaches to improve healthcare are tenets within the curriculum of the nurse practitioner program at Jacksonville University. Nurse practitioner students in a Health Policy course learn how to advocate for healthcare policies that improve access to quality affordable healthcare such as house calls.
The following patient scenarios reveals the benefits of house calls for seniors in our community.
JOE AND JANE
Joe is a 79-year-old male with a history of emphysema and heart failure requiring multiple daily medications. Joe’s primary care provider requires an office visit every three months and prescribes medications for 6-month intervals. When Joe ran out of his medications, the office was able to provide a short supply and scheduled an appointment. Unfortunately, when the limited supply ran out, Joe was still unable to make the appointment. The care coordinator nurse suggested a referral to a home-based primary care provider. Within a few days, Joe received a knock at his door and was greeted by a nurse practitioner.
During the thorough new patient visit, the nurse practitioner found that Joe had some swelling and mild shortness of breath since he had been out of medications. The nurse practitioner was able to order a mobile chest x-ray, adjust the current therapy, refill the medications, and initiate a home health referral for a nurse to periodically visit Joe while adjusting back to his normal routine.
Also on this visit the nurse practitioner identified that Joe is the main caregiver for his 80-year-old wife, Jane, who has Alzheimer’s dementia. The visiting nurse practitioner learned that Jane had not seen a healthcare provider in years, and Joe was never educated on dementia management or available resources. Joe agreed to in-home care for Jane, and the nurse practitioner was able to initiate medications to manage symptoms, provide ongoing education and connect Joe with resources for in-home caregiver assistance. Joe and Jane continue to receive routine visits every 2-3 months and they are both happy to have quality medical care right from the comfort of their home.