HomeCare Options for Older Adults

Delbra Caradine, MDAsst. Professor

UAMS Department of Geriatrics

BalancedBudget Act 1997

• Limited the care to the homebound Medicare recipient

• Resulted in patients falling through the cracks, increased ER visits for routine medical care

• Some patients no longer had a PCP willing to sign 485(Home Health Plan of Care), therefore no PCP

HouseCall Program

• Grew out of a need to provide access to medical care to the homebound patient who did not qualify for traditional home health, but had medical needs that required evaluation and treatment.

• Start up grant from the Catholic Health Initative June, 1999

• UAMS IOA program started September 1999

HouseCall Program

• Provide routine medical care(as in the clinic) to the frail elderly in their home (private resident,ALF, foster care resident)who have a difficult time accessing medical care

• Limits costly and unnecessary ambulance trips to ER and physician office

• Delays hospitalization and premature nursing home placement

Who Needs Homecare?

• 2/3 of the patients are geriatric. Over the next 10yrs that population will double.

• To quote Dr. Peter Boling: “It’s like a hurricane just off the shore. Everybody knows the population is aging, but what a lot of people don’t know is that there will be almost an epidemic of people with chronic functional impairments who will have a difficult time accessing medical care.”

US Census 2000

• 12.4% of population 65 and over (35 mil)• AR-14% of population 65 and over• Pulaski county 11.5% 65 and over• Population over 65 will increase by 73%

between 2010 and 2030 (70 mil people or 1 out of 5 will be 65 and over)

US Census 2010

• More people were 65 and over in 2010 than any other previous census

• Between 2000 and 2010 the population 65 and over increased at a faster rate (15.1%) than the total US pop (9.7%)

• 13.0% (tot pop-308,745,538) 65 and over• AR-14.4% (tot pop-2,915,918) 65 and over• Pulaski county 13.1% (tot pop-382,748)65 and

over

Growth is dramatic

• Baby boomers (those born between 1946 and 1964) will turn 65 between 2011 and 2029

• During this time 10,000 Americans will turn 65 every day

Goal of HouseCall

• To help the frail elderly age in place and live and die with dignity

HouseCall

• Patient is seen on a regular basis –usually q one to two months

• May be seen more often with medical justification

• The patient has more control over their health care than in other settings

Where is the need?

• 44% of hospital discharges• Between 5-10% of all patients in medical

practice• 1:3 severely impaired patients cared for in

home• An estimated 20% of patients over 65 have

functional impairments with related homecare needs

Why is it necessary?

• ID early new problems not found in the office• Monitor and provide direct medical care to

the patient and how they response to plan of care directly

• Enhances patient ability to live independently longer, limits or delay hospital/NH

When to start?

• Patient & Family desires• Medical conditions that can be safely treated

at home• Informal/professional caregiver available to

meet the needs of the patient’s condition

Who can refer?

• Anyone, but MD decides who is appropriate

How to Implement?

• Medical care in the home is a shared effort. Team includes: patient, family/informal/professional caregiver, hospital discharge planner, community agency/case management services, home health agency staff, and physician, APN/PA

Helpful Resources

• Making Home Care work in Your Practice-American Academy of Home Care Physicians

• Making House Calls A Part of Your Practice-American Academy of Home Care Physicians

• Medical Management of the Home Care Patient: Guidelines for Physicians by American Medical Association

• US Census