Physicians

The Case for Home Health Care

While Congress is debating health reform and struggling to accomplish the apparently competing goals of reducing costs while improving quality, I am part of a program that does both. As co-director of the Washington Hospital Center’s Medical House Call Program, I visit the sickest, frailest Medicare patients who consume a wildly disproportionate amount of Medicare dollars. Not only am I providing better care for my patients, I’m doing it where they want it — at home. House calls allow me to better manage their chronic conditions by seeing their medications, diet and home life and enabling me to better support their caregivers and coordinate their medical care. The math is simple: the better I do, the happier they are and the fewer times they need to visit an expensive hospital or nursing home. Shockingly, this proven approach that reduces unnecessary spending is being overlooked in the current reform debate.

Take one of our patients, Mrs. C, who has heart failure and pulmonary disease. She is chair- and bed-bound. She relies on her daughter for all her basic needs and cannot easily get to the office. Through our program, a team of doctors, nurse practitioners and social workers can visit Mrs. C at home and provide care on-site. We can manage her heart and lung problems on the spot, rather than having to wait until her symptoms are so severe that she has to go to an emergency department by ambulance. Additionally, avoiding the hospital means Mrs. C is less likely to face medical complications from a hospital visit. The accrued savings pay for a year’s worth of house calls for eight patients. Our program has shortened the hospital stays of 600 patients by a quarter, and reduced hospitalizations at end of life by 75 percent.

Mrs. C represents a population of patients who are virtually invisible to the office-based primary care physician and to most specialists until they land in a hospital. If we want to reduce health costs, we need to provide better medical care to these patients at home. People with multiple chronic diseases consume 60 percent of Medicare expenditures, despite the fact that they comprise only 10 percent of all Medicare beneficiaries. By targeting these high-cost patients and providing them with higher quality, more convenient care, the American Academy of Home Care Physicians estimates that we could save $14 billion a year and perhaps much more.

The Veterans’ Administration’s Home-Based Primary Care program has been operating a similar program for over 30 years in nearly every state and has seen reductions in hospital days by nearly two-thirds, nursing home days by 88 percent and costs associated with these patients by nearly a quarter. Further, this program enjoys the highest satisfaction rate of any program within the VA system.

But the benefits are not just financial. By going into someone’s home, we can help patients and their families practice what we preach. It is one thing to tell a patient to reduce his sodium intake, and it’s another to walk in and do what we call a “kitchen biopsy,” to uncover all the sodium-rich foods in the pantry and teach them healthier habits. Home visits help prevent complications; they don’t just treat them.

Successful programs like these are only able to do so with private funding to supplement what Medicare pays. You cannot build a system of care solely on altruism. If we want this kind of care for our loved ones, or for ourselves, we need to find a way to make house calls sustainable.

There is a solution. The pending Independence at Home Act (S. 1131, H.R. 2560), establishes the framework and incentives to make home-based primary care a reality. These savings could actually be used to help fund health reform.

At best, this legislation saves Medicare money, and at worst, it costs Medicare nothing. Under the proposed legislation, Independence At Home (IAH) programs must achieve 5 percent savings — which is more than enough to “bend the curve” of unbridled growth. These programs promote the best patient outcomes by sharing in any savings over 5 percent. This legislation is a win-win-win—for patients, Medicare and physicians.

This legislation creates pilot programs in 26 states and the District of Columbia; half of those states have the highest-cost patients. Because there are so many of these programs already in place, the IAH Act could be implemented tomorrow. It is the medical version of a “shovel-ready” program and the savings will start immediately.

How can Congress and the Administration ignore a proven cost-saving plan that addresses our most expensive patients? By 2020, the number of Americans over the age of 80 will double. We need to act now to improve quality and reduce costs for these patients or Medicare will struggle even more to cover them. If Congress is serious about reforming our health system, they should join with the bill’s sponsors, Representative Markey and Senator Wyden, to support a model that reduces costs, and improves both care quality and outcomes from these patients’ homes.

It is going to take smart use of nimble, ready-made, cost-saving programs like this one to begin to attack health spending and turn our system around. By taking better care of patients like Mrs. C, we can achieve those goals and provide coverage and better quality care to all Americans.

Dr. George Taler, MD, is the Director of Long Term Care at the Washington Hospital Center, and Co-Director of WHC’s Medical House Call Program. He previously served as the President of the American Academy of Home Care Physicians (AAHCP) and is currently the Chair of Public Policy. Dr. Taler is also a Professor of Clinical Medicine at Georgetown University School of Medicine.

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35 replies »

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  2. I’m doing some research for our own blog and found your article. It’s certainly a good read, simple, straightforward. Confirms what I’ve heard & read before. Glad to revisit the topic….and thanks for sharing.

  3. More than 10,000 people turn 65 in the U.S. every day and out of those 90% of them want to stay in their own homes. Many of them are going to need a personal care giver, especially when more than 5 million people in the U.S. have Alzheimer’s Disease, while Alzheimer’s deaths contintue to rise. It’s extremely difficult for family to be the prime caregivers. Seniors desire to remain independent and, combined with advances in medicine, they are setting the stage for unprecedented growth in home care.

  4. Home care means receiving services from a personal caregiver. Nine out of ten seniors would rather keep living at home. But when frailty, chronic illness or forgetfulness makes living alone too difficult for seniors, home care enables them to maintain their quality of life and lifestyle

  5. I have been studying up on how to start a home care business. The idea of the comfort one could bring to a persons life with keeping home and house for them is extraordinary. I look forward to helping those that have helped others before them.

  6. providing a good health care is challenge as you never know what are the expectations of other person who will be staying in your home care whether he or she is comfortable with the environment provided by you or not

  7. @Home Care: you are right elders should be taking care at home not on other establishments. Elders will feel more comfortable while staying at home.

  8. Home care is care that allows a person with special needs stay in their home. It might be for people who are getting older, are chronically ill, recovering from surgery or disabled. Home care services include
    •Personal care, such as help with bathing, washing your hair or getting dressed
    •Homemaking, such as cleaning, yard work and laundry
    •Cooking or delivering meals
    •Health care, such as having a home health aide come to your home

  9. The benefits of providing care in the home can’t be underestimated; as you said, they’re not only a matter of convenience, but a matter of comfort, and the comfort and welfare of the patient is tantamount.

  10. WE RECENTLY STARTED A HOME HEALTHCARE BUSINESS IN SHOREWOOD WI THAT PROVIDES SERVICE FOR THE ENTIRE FAMILY. I SEEN A NEED OF IMPROVMENT AND GROWTH IN THIS INDUSRTY AND THAT IS WHAT WE WILL DO.

  11. We have just launched a home health care business in Canada. We thought about going down the franchise route but quickly discovered that the amount of information available is staggering. While we do have a health industry background and feel we can hit the ground running, doing this is not easy. Great post and very helpful comments.

  12. My Wife and I have owned 2 Adult Foster Care Homes in Michigan for 8 years (also known as assisted living facilities), we recently have begun work on opening a home health care business. We planned to buy a franchise (Visiting Angels) but we have decided to put the franchise fee to better use. I built a website http://www.lovinghandshc.net and have advertised in the various yellowpages online (I missed the 2010 yellowpages book). I was hoping to get advise from experienced people in this field on both places to offer our services and tips on being a benefit to Seniors.
    John

  13. Excellent article. This is further proof that while home care is a niche industry, it is very intricate. There are many different programs, insurances, and options for in home care, and educating people on their options is a step in the right direction.

  14. Dr. Taler – Great sentence. “It is one thing to tell a patient to reduce his sodium intake, and it’s another to walk in and do what we call a “kitchen biopsy,” to uncover all the sodium-rich foods in the pantry and teach them healthier habits.” Teaching healthier habits whether that’s through diet, sleep, exercise, hygiene…really it’s just having a plan to execute. Most people don’t have a plan and don’t even know where to start. Having someone able to educate and guide them in the patients own setting would be an excellent start. Thank you for the article.
    Take care,
    MT

  15. Great information!
    My mother was living at home with me and my family. She has dementia/Alzheimer’s. It got to the point, as time went by, where it got too hard to lift, move, change clothes, bathe, feed, and be sure to give all medications daily and at the right times while trying to raise a family. So, we looked around for a GOOD nursing home to situate her in comfortably. It was sad to soak this all in, having to do this to my own mother, but it is much more safe for her, health wise, being that the care givers there feed her, bathe her, give medication to etc. properly.
    Reading this article as well as other comments is helpful as well as heartening, thanks!

  16. Not only is your post interesting, but I’m enjoying reading the comments left by others in the field. Thanks to all for your insight and opinion.

  17. I work with Theramax Therapy Services – a therapy staffing company in Houston TX. Being a PT in a home health setting, I agree that Washington must allocate more funding for home health care. This saves thousands of dollars for patient care compared to being hospitalized. I believe that the government knows this, but the big problem is, goverment mistrusts home health agency operators in billing the patient care inappropriately. As a result, those that want to serve the patient honestly are affected. I believe that we need to help in fighting home health fraud. In this way, the government will allocate more funding to home health businesses and patients will be given the appropriate treatment that they deserve.
    Risty Durbin, PT

  18. When organizations get so big, decisions tend to be made up the ladder. However, the bottom end of the ladder is neglected and not taken into consideration as they should.
    Those responsible for making the changes in healthcare need to go on foot and actually put themselves directly in the field. This is the only way they would know how to directly combat the problem.
    For instance, many of the large organizations who fail do not take into consideration the staff that make up the foundation of their company. After all, how do you expect growth when those running your company are unmotivated? Same goes for the health care industry. How do you combat a problem that you don’t have first hand experience with?
    Karow Home Care
    http://www.karowhomecare.com

  19. This information is right. But all the home health care have not low cost. Some of them are low cost and best facility like imperial-living, For elderly health care location in north Miami (Aventura), to our warm and helpful staff, to the option of our assisted living wing, which includes 24-hour staffing, we are here to meet your retirement goals. For more information about Home Health Care Miami and Home Care Miami.

  20. I couldn’t agree more with home care being one of only a few solutions to reducing health care costs. This is essential to the problem of rising costs in health care because it addresses preventative care and recovery care which ultimately, for the most part,keeps our aging population from the dorr steps of expensive hospitals! I own and operate a home health agency in southern california. If anyone is paasionate in making a change and would like to get into the home health business, you can contact me at hakopyans@gmail.com

  21. Wow…your article has some amazing anecdotes about healthcare costs, especially in relation to homecare vs. hospital stays. I wish some people in Washington would read this…

  22. This is very good suggestion and i know about this. but here i have one elderly health care information. Aventura’s finest independent and assisted living rental, retirement community! From our excellent location off Biscayne Blvd., near Williams Island in north Miami (Aventura), to our warm and helpful staff, to the option of our assisted living services.For more information about, Home Health Care Miami, Home Care Miami. – http://www.imperial-living.com/

  23. This should be required reading for President Obama and all of Congress. Our group of physicians and nurse practitioners have been making house calls in Portland Oregon for 17 years and confirm Dr. Taler’s experience. We currently have 1000 patients with a median age of 83, many in the last chapter of life. I know our services help prevent hospital and nursing home admissions while improving quality of life for these hidden Americans — those who have great difficulty leaving their home. We are proud of the hard work our Senator Wyden has been doing on health care and hope his voice will be heard.

  24. Excellent suggestion. My mother comfortably died at home cared for by hospice and private nurses under my guidance. Fortunately, she had sufficient money to pay for the private nurse. This kept her out of the hospital and I’m sure the medical cost in the last year of her life was minimal.
    The difficult question is how do you implement the home care program nationally and avoid abuses we see in so many health care programs now? I wouldn’t want to rely on private insurers and could the government do any better?

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