doctor home visit patient

House Calls – We Bring the Doctor’s Office to the Patient

At Mobile Physician Services, we provide comprehensive care to improve the health and quality of life of our patients – in the convenience and comfort of their own home. Our team of board-certified doctors, advance nurse practitioners, and physician assistants specialize in providing care for patients with medically complex and chronic conditions.

Our Services

We accept Medicare, many insurance plans, and self-pay.

To find out more about our services:

Call Toll-free: (855) 232-0644

E-mail us at [email protected]

Primary Care

Pain management, palliative care.

At Mobile Physician Services, our customized care teams provide patients with both comfort and familiarity as they work with a dedicated primary care provider and care coordinator to improve their health. Our physicians and staff take a proactive approach to preventive care, chronic disease management, and chronic illness support right where you live.

Each home visit includes an in-depth examination and individualized treatment plan, which is monitored and adjusted through routine follow-up visits. The primary care provider will deliver your ongoing care and will recommend to you specialty services as needed.

• Annual Wellness visits : This wellness visit allows your primary care provider to create or update your personalized prevention plan. This visit includes a review of your medical and social history related to your health and may include counseling about preventive services. This plan may help you to prevent or reduce the chances of future illness based on your current health and risk factors.
• New Illness Exams : When a new symptom or ailment arises, call us. Early indications of not feeling well could be a clue that you may be getting sick. A symptom in one part of the body may also be a sign of a problem in another part of the body. Moreover, unrelated symptoms that might seem minor on their own, could be warning signs of a more serious medical disease or condition. The new illness exam can be very brief or more detailed depending on your concerns and the provider’s findings.
• Follow-up Care: Involves a regular medical checkup, which may include a physical exam and laboratory testing. Follow-up care checks are a proactive way of assessing the potential for and preventing health problems from returning after treatment of a disease has ended or an illness has seemingly passed.
• Referral for Specialty Care : Referrals are the link between primary and specialty care. The referral coordination includes the documentation of patient care activities, the transfer of information, the inter-provider communication itself, and the integration of care services to the patient. Mobile Physician Services is a multi-specialty practice so many of these specialty referral services can be made seamlessly with little inconvenience or disruption to the patient and caregivers regular routines.
• Medication Management: Medication management is a treatment structure that ensures our patients are receiving optimal therapeutic results from their prescription medications, both in the short and long term. Our team’s goal is to mitigate medication noncompliance and monitor all prescriptions treatments so that drug interactions complement one another for the most optimal outcome for our patients.

The provider may be a physician, advanced practice nurse or a physician assistant. A dedicated care coordinator will also be assigned for each patient to help arrange comprehensive services and assist patients and their caregivers.

• Online Patient Portal: You and your designated caregiver, if you choose, will be able to connect with your provider through a convenient, safe and secure environment which allows access to your health records and a way to communicate with our staff in a timely manner.
• Telephone Assistance : On call providers are available 24/7 weekdays and weekends.

Our psychiatry team specializes in the diagnosis and management of mental, emotional and behavioral disorders. They carefully evaluate each patient to develop an individualized treatment plan to improve the patient’s overall mental and physical well-being.

• Depression : Depression is a common and often serious medical illness that negatively affects how you may feel, the way you may think, and how you may act. Depression can cause feelings of sadness, despair and hopelessness, which may lead to a loss of interest in activities you once enjoyed.
• Anxiety : Intense, excessive, and persistent worry and fear about everyday common situations. The worry or anxiety could make you feel fatigued, irritable, and interfere with your regular sleep habits.
• Dementia : An overall term that is used to describes a collection of symptoms related to an individual’s decline in memory or other thinking skills. It may be severe enough to diminish a person’s ability to perform everyday common activities. The effects of dementia can negatively influence your memory, thinking and social abilities.
• Phobias : A phobia is when you experience excessive panicking or an irrational fear reaction to a situation. If you have a phobia, you may experience a deep sense of dread or fright when you encounter the source of your fear. The fear may be a certain place, situation, object, animal or even another person.
• Behavioral disorders : Attention deficit, hyperactivity, bipolar, learning, defiant or conduct disorders are all examples of complaints that may have a detrimental impact on a person’s interpersonal relationships with family, friends, and co-workers.

Our team can provide behavioral counselling and medical therapy, when appropriate, to help a patient feel better about themselves and to assist them with better coping and managing their condition.

Our wound care specialists have been trained in the attention and treatment of all types of acute and chronic wounds. They have skill and experience in wound debridement and wound care procedures – managing chronic, non-healing wounds and infections, with a demonstrated care that fosters healing… right in the patient’s own home.

We specialize in serving homebound patients who may also be bed-bound or have difficulty in walking or moving around. As a result, immobility compression sores develop at pressure points on the body when the weight of an immobilized individual rests continuously on a firm surface, such as a mattress or wheel chair. Often these same patients are on oxygen or have high-risk medical conditions which makes it an even more challenging and stressful effort for them to travel to a doctor’s office for an appointment. Thus, the necessity for in home care and treatment.

Wounds that benefit from specialized wound care techniques include:

• Diabetic foot wounds and ulcers
• Post-surgical wounds
• Traumatic wounds caused by injury
• Arterial and vein stasis caused by lack of circulation
• Immobility pressure sores. (Bed sores from stillness)

We work closely with home health agencies to provide ongoing care and monitoring of patient’s wounds.

Our board-certified podiatrists treat foot pain, wounds, and more. Treatments may include but are not limited to treating conditions of the lower extremities which could hinder mobility.

• We will review each patients’ medical history to evaluate the condition of the feet, ankle or lower leg
• Carry out a diagnosis on the feet and lower legs through examination and medical tests
• Order physical therapy when deemed necessary
• Treat wounds of the lower extremities using various wound care modalities. This may include debridement to improve the healing potential
• Promote prevention, health & well being, the treatment and management of the foot and related problems, disability, deformity, and the pedal complications of chronic diseases for the elderly
• Prescribe and fit prosthetic appliances such as diabetic shoe inserts and evaluate for bracing if necessary
• Refer patients to other specialists for treatment, including conditions such as diabetes or arthritis
• Advise patients on ways to prevent future leg problems and increase speed of recovery
• Monitor the recovery progress of patients to determine the need for change in treatment

We know it’s not always easy to leave home to get the care you need for your eyes. Our optometrists bring state-of-the-art diagnostic eye equipment and technology to your home – making it much easier for you to get the vision care you need.

During a visit, your doctor will exam each eye for signs of serious issues such as glaucoma, cataracts, macular degeneration, and detached retinas, among other conditions.

Receiving regular eye exams regardless of the state of your vision can help detect serious eye problems at their earliest stages ─ when they are most treatable. During an eye exam, your doctor will observe and evaluate the health and condition of the blood vessels in your retina, which can be good indicators of the health of your blood vessels throughout the rest of your body.

• Comprehensive eye exams : This exam goes beyond a simple vision screening. A comprehensive eye exam includes a host of tests in order to do a complete evaluation of the health of your eyes and your vision.
• Annual retina exams : A retinal exam allows your doctor to evaluate the back of your eye, including the retina, the optic disk and the underlying layer of blood vessels that supply the retina.
• Eyeglass fittings : A prescription works best when your eyeglasses are properly fitted. Improper fitting may cause pinching, distorted vision, headaches, and even dizziness. Our doctors will make sure your prescription lenses and frames are working together for you.
• Diabetic eye exams : Diabetes does not have to lead to vision loss. Taking an active role in managing your diabetes can go a long way in curbing later complications. Regular eye exams, good management of your blood sugar and blood pressure, along with early intervention for vision problems can help prevent vision loss caused by diabetic retinopathy. Retinopathy is caused by damage to the blood vessels of the light-sensitive tissue at the back of your eye.
• Refractions: This test is given as part of your routine eye examination. It is often referred to as a vision test. This test assists your eye doctor in measuring you for the exact lens prescription you will need.
• Eye injuries: Eye trauma could be the result of a sudden blow to the eye. It may cause the eye to suddenly compress and retract which could cause damage to your eye and the surrounding tissue. Even if the injury may seem minor, all eye injuries should be furthered examined by a doctor for possible more serious and underlying injuries.
• Eye infections: The most common eye infection is conjunctivitis, also known as pink-eye. An eye infection can happen in almost any part of your eye, including your eye lid, cornea and optic nerve. Symptoms of eye infections may include redness, itching, swelling, discharge, pain, or problems with vision. Always consult with your doctor before treating, as recommended actions are contingent on the cause of the infection.
• Low-vision exams: A low vision exam is different from a normal eye exam. This functional-vision assessment determines how specific visual impairments affects your ability to perform everyday activities. The exam’s results assist your doctor in prescribing management tools and medications to better enhance and manage your remaining vision.

Pain management is the process of providing medical care that alleviates or reduces pain. Pain management is a subspecialty of general medicine employing an interdisciplinary approach to ease the suffering and improve the quality of life of those living with chronic pain by using a combination of pain medications, joint and muscles injections, and physical therapy techniques.

A pain management specialist is a provider with advanced training in diagnosing and treating pain. Our pain management specialists treat pain stemming from a variety of different causes, whether it’s neuropathic pain or headache, or the result of injury, a surgical procedure, cancer or another illness.

Palliative care is an approach to the holistic care of patients, including family and caregivers, to improve the quality of their lives after the diagnosis of a chronic debilitating disease or life-limiting illness that may cause a host of complaints.

Palliative care can begin at diagnosis and continue to be offered while the patient is continuing active treatment through different phases of their life limiting condition. Palliative care is for any patient with a chronic illness who is experiencing a decreased quality of life because of symptoms related to their illness or treatment, like renal dialysis, oxygen therapy or chemotherapy. The care is provided by a specially-trained team of doctors, nurse practitioners, physician assistants, and other specialists who work together to provide an extra layer of support to the patient and their caregivers.

Palliative care can help in symptom control including not only pain, but nausea, weakness, shortness of breath, fatigue and weight loss at any time during their diseases, not only at the end of life.

Mobile Physician Services, Inc. Corporate Headquarters 6804 Cecelia Drive New Port Richey, FL 34653

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There was a time when doctors treated patients in their own home. This old-fashioned care matched with new medical technology is here again. At HouseCall Primary Care, we serve homebound patients wherever home may be...a patient's house, a nursing home, or assisted living. Our team of providers stay with our patients wherever they go.

HouseCall Primary Care offers these general areas of specialty. Select one of the services below to learn more.

House Call Doctor Visits Make Life Easier for Seniors and Caregivers

Important: This is an informational article to explain how house call doctor visits can benefit seniors. DailyCaring isn’t a medical organization, we aren’t medical professionals, and we aren’t affiliated with any healthcare organizations. We aren’t qualified to respond to any medical questions.

House call doctor visits benefit older adults and caregivers

Getting your older adult to the doctor’s office for an appointment can be difficult or sometimes impossible.

Whether they’re frail, can’t walk on their own, or have Alzheimer’s or dementia , getting out of the house is hard on both of you. Going to a doctor’s office can also expose seniors to germs or harsh weather.

We explain what a house call doctor is, what type of insurance they accept, how to find one, and what to look for in terms of services.

What is a house call doctor?

Today, many doctors are bringing back the old practice of visiting patients in their homes. With house calls, older adults don’t have to go through the stress and difficulty of getting to the doctor’s office. And neither do you.

Another bonus is that these doctors usually spend more time with patients. You won’t have to fit all your questions into a 15 minute visit.

Do they accept Medicare?

Yes, many house call doctors accept Medicare , private insurance, and sometimes Medicaid . It usually costs the same as a regular office visit.

But every house call doctor is different, so make sure you understand their fees and accepted insurance plans before making an appointment.

How to find a house call doctor

Some large health care systems like Kaiser Permanente or the VA have programs that include home visits by doctors and nurses. For example, Kaiser’s home-based palliative care program includes house calls.

Even your older adult isn’t part of a large health network, it’s worthwhile to ask your older adult’s doctor if they have home doctor visit programs.

The American Academy of Home Care Medicine’s provider directory is another way to locate a house call doctor in your area.

You can also use Google to search for “house call doctor” + your city or county or “home doctor visit” + your city or county (don’t include the quotation marks).

What to look for in a house call doctor

Before booking an appointment, make sure you understand the doctor’s services, fees, and billing.

Questions to ask:

• Do you specialize in treating seniors, people with Alzheimer’s or dementia , or those with  multiple chronic conditions ?
• Do you accept Medicare , Medicaid , or my older adult’s private insurance plan?
• If we want, can we also keep my older adult’s primary care doctor?
• Will you communicate with my older adult’s existing doctors and specialists so their care is coordinated?

Examples of house call doctor private practices

We want to be clear that we’re not recommending any specific home doctor services or companies and aren’t affiliated with any of these businesses. These are examples to give you an idea of what a house call doctor looks like and the type of services that are typically offered.

Examples of what a house call doctor looks like:

• Visiting Physicians Association (VPA)
• Bay Area House Call Physicians
• Kindred House Calls

Recommended for you:

• 4 Expert Tips for Managing Multiple Chronic Health Conditions in Seniors
• 7 Tips for Helping Seniors at the Doctor: Being a Health Advocate
• Should Seniors See a Geriatrician?

By DailyCaring Editorial Team Image: Now It Counts

This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money .

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Avoid Conflict When Helping Seniors at Doctor’s Appointments

4 Tips for Managing Multiple Chronic Health Conditions

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18 comments, tony carrancho.

My parent s lives in [redacted for privacy]. How do i get started locating a house call doctor. I am pretty sure there insurance covers this. Thank you. TONY

DailyCaring

We hope the tips and suggestions in the article above will help you find a house call doctor in your parents’ local area.

Susan Quercio

My 95 year old father has a deep cough and he is disoriented. Temp 99 degrees.

Please contact your father’s doctor immediately or the local hospital to find out how to safely get him examined by a doctor (to reduce risk of exposure to Covid-19).

DailyCaring isn’t a medical organization, we aren’t medical professionals, and we aren’t affiliated with any healthcare organizations.

Ruby m VanNostern

I live in [redacted for privacy] and need a doctor visit in home.

This article includes suggestions for how you can find house call doctor services in your area. At DailyCaring, we aren’t doctors and don’t provide any medical services. We hope you’re able to find a great house call doctor in your area.

Stewart Goldman

need Doctor for a home visit Andrews N.C.

Joseph Artusa

I need a doctor

Linda Williams

I was released from the hospital on Thursday after 5 days.I am not able to go to Dr office but most definitely need to be checked.Still having breaking problems and am very week.I have severe asthma and blood pressure was running very high from so much steroids.Could I possibly get help.Thanks so much.

I’m so sorry to hear that you’re not feeling well. Since you’re noticing some issues with your recovery, it’s essential to call your primary doctor immediately. Since they’re the ones who have been treating you and are familiar with your recent hospitalization, they’re the best people to advise you on what you need. If you need help getting to your doctor’s office, you may want to contact your local Area Agency on Aging or a ride sharing service. Or, use the tips in this article to search for a doctor in your area who makes house calls.

Here are some articles that may be helpful: — 8 Ridesharing Services for Seniors https://dailycaring.com/8-ridesharing-services-for-seniors/ — 6 Affordable Senior Transportation Options https://dailycaring.com/6-affordable-senior-transportation-options/ — Local Community Resources for Seniors and Caregivers: Area Agency on Aging (to connect you with local organizations that may be able to help) https://dailycaring.com/local-community-resources-for-seniors-and-caregivers-area-agency-on-aging/ — 4 Ways to Know If Seniors Need to Return to the Hospital https://dailycaring.com/4-ways-to-know-if-seniors-need-to-return-to-the-hospital/

(DailyCaring doesn’t provide any services and isn’t affiliated with any medical providers.)

What areas do you service?

This article explains that house call doctor services are available and could help senior and caregivers. We also share suggestions for finding one in your area, but we do not provide any services ourselves. I hope you’re able to find a great local house call doctor!

What areas do you service

This article includes suggestions for finding house call doctor services in your area. We at DailyCaring aren’t doctors and don’t provide any medical services. I hope you’re able to find a great house call doctor in your area.

need a home care doctor

I hope the information above helps you find a great home care doctor in your area.

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In Home Medical Senior Care Services | Landmark Health

• Patient or Caregiver
• Community Provider

Are you a new Landmark patient?

Burn-out is real. landmark is different..

Living with chronic health conditions? We can help.

Our providers and care teams come to you, bringing care through house call visits. This in-home medical care is designed around understanding your health needs and goals. We work with you and your regular doctors to help you stay well and stay home.

House calls and video visits in 37 states.

Landmark partners with health plans to bring medical, behavioral health, and palliative care, along with social services, to patients in communities across the U.S. Our mobile providers visit patients in their homes through in-person house calls and telemedicine visits over video and phone.

We are the future of health care.

Landmark is one of the nation’s largest healthcare companies focused on in-home care of complex, chronic patients. Our physician-led provider groups support collaborative ties between community-based organizations, primary care providers, specialists and patients and their families.

patients nationally for which Landmark bears risk

reduction in hospital admissions

reduction in mortality

Discover the benefits.

• For Patients + Caregivers
• For Community Providers
• For Partners

Health care in your home

Old-fashioned house calls by medical doctors, nurse practitioners and physician assistants bring modern medicine to you. Feel better and stay well at home.

Covered by your health plan

The Landmark program works with health plans to improve access to care for patients with multiple chronic conditions. Landmark’s team-based care is available often at no cost to you.

Keep your current doctors

Landmark coordinates its care with your primary care provider, specialists and other community resources. Landmark provides added support to those who need it most.

Available 24 / 7

Our provider-staffed call center answers any time of the day or night. We also provide urgent visits to help you avoid unnecessary trips to the emergency room.

No waiting room

With Landmark house calls, you won’t need transportation to clinics and hospitals, and you avoid waiting rooms and exposure to germs.

Reduced stress

Patients and caregivers enjoy peace of mind with Landmark support. Landmark cares for the whole patient.

Landmark house calls put patients at the center of health care.

Collaborative care for complex patients.

Landmark’s community-based mobile providers bring coordinated care to patients with multiple chronic health conditions. We augment your care in the patient’s home.

Covered by health plans

The Landmark program is included in eligible patients’ health plans to improve care coordination and healthcare access for home-limited patients.

You remain the primary care provider

Landmark care is coordinated directly with you. Our providers reinforce your care plan in the home through physician-led interdisciplinary care teams.

Access our interdisciplinary team

Landmark’s interdisciplinary care team is available to you and your patients, including behavioral health specialists, social workers, palliative care specialists, nurse care managers and pharmacists.

Reduce administrative burden

We can help your highest acuity patients by managing post-acute care, home health orders, face-to-face encounters, and more.

24 / 7 availability

You can reach us any time, including weekends and holidays. We do urgent home visits to intervene if your patient experiences a chronic disease exacerbation.

Landmark supports your patients with complex health and social needs.

Chronic care management.

We’re one of the nations’ leading risk-bearing medical groups. We focus on giving your most complex members care when they need it, right in their home.

Over 250,000 patients across the country

We bear risk for over 250,000 complex, chronic patients, spanning Medicare Advantage, Medicaid, Dual, and Commercial, populations.

Behavioral, social and palliative care

Our team of multidisciplinary clinicians may include behavioral health specialists, palliative care practitioners, social workers, nurse care managers, dietitians and pharmacists.

Urgent in-home visits

One in four of our home visits is urgent. We bring medical care to your members when they need it, to avoid unnecessary emergency room trips and hospitalizations.

Built-for-purpose infrastructure

Our technology platform is designed specifically to support the medically vulnerable, clinically complex population.

Meaningful outcomes

Landmark commonly helps health plans achieve 4- and 5-star performance on Medicare STARS clinical quality of care, while caring for the most complex patients.

Landmark provides care for complex, chronic patients to positively impact access, satisfaction, outcomes and cost.

Landmark has been great! Staff very knowledgeable, very helpful.

The doctor and nurses show they care about you and your health they are really there for you when you need them I love that they come to your house we did a zoom meeting with the nurse practitioner and she gave suggestions I really appreciate them

It was a pleasure to talk and see the doctor, she was very knowledgeable of all my conditions and gave me great advice to improve my health.

Practice health care the way you always wanted — with those who need it most.

Expert insights.

Prioritizing Mental Health as a Universal Human Right

By: Neltada Charlemagne, DNP, APRN, PMHNP-BC, PHN, BHC

Outsmart Unplanned Medical Costs: 10 Steps for Managing the Unexpected

Older adults can safeguard themselves from the physical, mental and emotional toll of unexpected medical costs.

Optum Care Network – Monarch and Landmark Health bring care to you at home.

Optum Care Network – Monarch has teamed up with Landmark to deliver in-home medical care to members with multiple chronic conditions.

Have questions about Landmark? We’d love to hear from you.

REcent Updates

Making sense of Medicare isn’t easy. Parts, A, B, C, D; HMOs; PFFS plans; SNPs. Navigating the system can feel like learning to code… blindfolded… with one hand tied behind your back. The point is, it can be overwhelmingly complicated. But at MD at Home one of our goals is to make quality healthcare easier to access and understand, so in this post we’re decoding the ins and outs of Medicare Advantage Plans, from A to Z.

No one wants to think about the likelihood of unfortunate events. Death, accidents, illness - we avoid these topics like the plague (both literally and figuratively). Why? Because they make us sad, because they make us uncomfortable, because sometimes superstition gets the best of us and we don’t want to tempt fate. But as difficult as they may be, these are important conversations to have with your loved ones or potential caregivers now, so that if and when the time comes, your wishes are clear. What we’re talking about is an advance healthcare directive. Here’s everything you need to know.

In 1930, house calls were standard practice for physicians, accounting for approximately 40 percent of patient visits. By 1950, this number had fallen to 10 percent, and by 1980, only about 1 percent of patient visits happened in the home. But as they say, everything old is new again, and with the coming demographic changes, it seems doctors may be making more home visits in the near future.

Diabetes and depression can each be conditions with devastation consequences on their own, let alone when a single individual suffers from both. Often times, the symptoms of one can exaggerate and accelerate the symptoms of the other, but fear not! There are a few simple steps you can follow to alleviate the symptoms and prevent the onset of both.

MD at Home provides home care, home medical doctors, and housecall physicians to patients in need with a focus on p reventing readmissions during the transition from an acute care setting to the home. For over 20 years, we’ve served as the premier healthcare resource for primary care and geriatric medicine for homebound patients in the Chicagoland area. Partnering alongside some of Chicago’s most established and respected institutions, we tailor our programs toward modern guidelines with an unwavering focus on clinical excellence, patient satisfaction, and measured clinical outcomes.   Our continuum of care and individual care plans highlight the importance of readmission reduction and high level transitions from the hospital to the home setting. MD at Home is transforming healthcare through our collaborative, proactive, and preventative approach to patient health.

Our approach reduces unnecessary hospitalizations and focuses on helping patients and caregivers better manage individual health from the comfort of their home.  Through our expertise in primary care and geriatric medicine, our licensed clinicians deliver a comprehensive approach in the management of chronic conditions to homebound patients, and our highly trained physicians and nurses are certified to perform most of the same services offered in a physician's office.  MD at Home is transforming reactive, crisis-oriented care into proactive, preventive medicine, reducing unnecessary emergency room visits, hospitalizations, and 30-day readmissions.

Who Qualifies for a Housecall Visit?

Patients with difficulty leaving home due to a mobility limitation, patients with difficulty leaving the home due to cognitive impairment, patients who require the use of special transportation to leave the home, patients with an inability to leave the home and for whom leaving the home requires taxing effort, patients requiring the assistance of another person to leave the home, patients for whom leaving the home is medically contradictory due to the patient's medical condition, accepted insurance.

MD at Home accepts the following insurance policies:

• Medicare Part B
• Medicare Pametto GBA
• Blue Cross Blue Shield (XOF, R, XOX)
• Blue Cross Blue Shield (XOS - Must have Medicare Part B as primary insurance)
• Aetna (PPO)
• United Health Care (PPO)
• United Medical Resources (PPO)

Physician Careers

MD at Home is hiring Physicians and Nurse Practitioners. Physicians with MD at Home have a luxury many other medical doctors severely lack: time . Unlike a typical seven minute visit, our physicians spend an hour or more with each patient, gaining a holistic view of the patient's health within their native environment. This not only means more insight into the patient's daily life, but also into their care support system, including interacting with family members and caregivers. This not only leads to better care for patients , but better lives for our doctors. Our physicians only work typical workday hours, allowing them to spend more time with their families, avoiding obscure hospital rounds or late nights. Our physicians using cutting-edge EMR technology to maintain up-to-date health records for each and every patient so nothing gets lost in the shuffle.

A Letter to Physicians

More time with patients, more time with your family, move healthcare forward, schedule a home visit, fast. simple. secure..

Our HIPAA-compliant online referral system is secured with 256-bit AES encryption, the same encryption level used by most online banking systems and the same SSL technology that fuels most SecureFax systems already in use by hospitals. Prefer to schedule a visit by phone? Give us a call at (312) 243-2223.  ​If you're a healthcare professional, please send additional medical documentation to our fax at (312) 243-8450.

HIPAA Certification Security Audit

Prefer to submit a referral by fax? Click the button below to download one of our paper referral forms and fax it to (312) 243-8450.

Area of Service

Our address.

Referral Fax: (312) 243-8450 Clinical Fax: (312) 243-2227 2003 W. Fulton Street, Suite 303 Chicago, IL 60612

Office Hours

Patient Portal Phone: (312) 243-2223 Monday – Friday  9:00AM – 5:00PM Closed Saturdays and Sundays

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House Call Program - MedStar Total Elder Care

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Promoting the health and dignity of frail elders

Many elders struggle with disability and severe chronic illness and have difficulty getting to the doctor’s office. As a result, their health may suffer and lead to unnecessary ER visits, hospitalization, or nursing home care. In 1999, recognizing the needs of such elders and their families, we created the MedStar House Call program - MedStar Total Elder Care to provide full medical and social services that help elders remain in their homes with dignity. These teams now serve both Washington, D.C., and Baltimore, MD.

The MedStar House Call Program - MedStar Total Elder Care is nationally recognized for the quality and outcomes of our care. We serve patients at home with a team of geriatricians, nurse practitioners (NPs), social workers, office nurses, and coordinators. We make routine and urgent house calls (in-person or via telehealth with video or audio-only phone visits). Our medical staff is also available by phone 24/7 for urgent issues. We provide access to state-of-the-art hospital and specialty care. Additionally, our physician team follows our patients if and when they are admitted to the MedStar Washington Hospital Center.

The House Call program serves our neighbors in Washington, D.C., and Baltimore.

Medstar house call program .

(operating under MedStar Total Elder Care, LLC) 

Our program services

Medical house calls and primary care by doctors and nurse practitioners with expertise in the care of older adults

Counseling and caregiver support by social workers and team staff

We offer tests and treatments at-home, and at the hospital as needed

Home delivery of most medications and equipment

Coordination of specialist care at MedStar Washington or MedStar Good Samaritan

Coordination of home nursing, rehab therapy, and hospice

Coordination of support services such as home aides and legal assistance

On-call physicians: 24 hours a day, 7 days a week (by phone)

Mobile electronic health record (EHR)

D.C. Neighborhood only – Case management for Medicaid Elderly Persons with Disabilities (EPD) Waiver

Hospital care and specialists

Our team coordinates emergency, hospital, and specialty care at MedStar Washington and MedStar Good Samaritan. Patients may keep their previous specialist doctors; we work with them as needed. We refer to MedStar Good Samaritan, MedStar Washington, for home-based podiatry or other new specialist care. If House Call patients require hospitalization, and 911 is not needed, our team can arrange transportation and admission to MedStar Good Samaritan or MedStar Washington when beds are available.

Social work services

Our dedicated team of social workers provides:

Psychosocial assessment

Care Coordination

Development of an individual treatment plan

Information and referral to community resources and supports

Caregiver education, support, and counseling

Advocacy to connect with other service networks and legal counseling

Crisis intervention

Assistance with identifying alternative living arrangements, as needed

Eligibility

Enrollment and insurance.

To qualify for the MedStar House Call Program, patients must:

Be 65 years or older and have difficulty getting to the doctor’s office

Have Medicare, Medicaid, or another participating insurance plan

Stop seeing their previous primary doctor and agree to have us take on that role following the first visit

Live in a qualifying ZIP code

Our office is open 8:30 a.m. to 4:30 p.m., Monday - Friday.

When calling about new patient enrollment, please have the following information:

Patient's name, address, telephone number

Patient's date of birth and social security number

Patient's next of kin and emergency contact information

Patient's health insurance information (including type and group number)

Patient's current medical conditions and concerns

Ability to retrieve patient's recent medical records

Baltimore neighbors, print and complete our  Intake Questionnaire form

As in most doctor's offices, your main health insurance (such as Medicare) covers 80 percent of House Call visit fees, and any secondary insurance covers the other 20 percent. The patients who do not have any secondary insurance are responsible for the 20 percent co-pay.

Qualifying ZIP codes

View the map below to check if you live in a qualifying ZIP code. Call our Washington, D.C., or Baltimore location to confirm MedStar House Call Program eligibility at your exact address.

Washington, D.C.,

View our brochures

Baltimore region brochure

Washington, D.C., region brochure

Washington, D.C., region team - 202-877-0570

Physicians Eric De Jonge, MD, – Section Director Guy (Binny) Chang, MD Nurse Practitioners Nancy Sassa, CRNP - Chief Alexandra (Caitlin) Geary, CRNP Michelle Sullivan, CRNP Office Nurse Kendel Ogbeab, RN Social Workers Gretchen Nordstrom, LICSW - Chief Kellie Jones, LICSW Ruth Shea, LICSW Operations Manager Isi Koroma Care Coordinators LaWanda Holeman Sandra Mills Carrie Carmon Yvette Williams

Baltimore region team – 443-444-6100

Physicians George Taler, MD Sharareh Badri, MD Nurse Practitioner Dorothy Were, CRNP Adama Panda, CRNP Nurse Nerland Dimanche, RN, MSN Social Worker Marina Nellius, LMSW Operations Director Shereen Greene, MBA Care Coordinator Taurshica Lee

Operational support

Executive Director George Hennawai, MD AVP Operations Julie Beecher, MS, MPH

Baltimore Neighborhood

To learn more about our services in the Baltimore region, call us today.at 443-444-6100.

Washington, D.C., Neighborhood

To learn more about our services in the Washington, D.C., region, call us today at 202-877-0570

Related services

Look out for your health

A UnitedHealthcare® HouseCalls visit is a no-cost, yearly health check-in that can make a big difference. 

Call 1-866-799-5895 ,

TTY 711,  to schedule your visit.

HouseCalls brings yearly check-in care

To you at home.

Connect for up to a full hour of 1-on-1 time with a licensed health care practitioner. Every visit includes a physical, tailored recommendations on health care screenings and plenty of time to ask questions that matter to you.

After your visit, HouseCalls connects with your primary care provider (PCP) to help keep them informed about your health. It's a great way to feel confident knowing an extra set of eyes is looking out for you between regular PCP visits.

What is a HouseCalls visit? 

[Text On Screen – SAY HELLO TO HOUSE CALLS]

Say hello to HouseCalls.

[Text On Screen- PAID ACTOR PORTRAYAL.]

HouseCalls is our way of looking out for your health, so you can focus on your future. Here’s what it’s all about.

[Text On Screen – HERE’S WHAT IT’S ALL ABOUT]

Once a year, a licensed health care practitioner can come to your home to spend up to an hour with you on your health and wellness.

[Text On Screen- EASY, CONVENIENT, INFORMATIVE]

It's designed to be easy, convenient and informative.

[Text On Screen- HEAD-TO-TOE EXAM]

[Text On Screen- IMPORTANT HEALTH SCREENINGS]

[Text On Screen- HEALTH GOALS DISCUSSION]

You'll get a head-to-toe exam, important health screenings and plenty of time to talk about your health goals.

We'll also provide guidance on managing your health and if you need it, give you referrals for other health plan resources and services.

HouseCalls is a great way to stay on top of your health between regular doctor's visits.

At the end of your visit, you'll get a personalized checklist so you can feel more confident in what to discuss with your regular doctor.

[Text On Screen- COST? NO EXTRA COST TO YOU]

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If you're wondering how much all of this is going to cost, the best part is, there is no extra cost to you. It's included in your health plan.

[Text On Screen- HOUSECALLS VIDEO VISITS ARE NOT AVAILABLE WITH ALL PLANS.]

A HouseCalls visit takes place in the comfort of your own home or by video if you prefer.

So, say hello to HouseCalls and invite us in for a visit today.

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Access one of the most popular UnitedHealthcare offerings, at no cost to you

Schedule your visit

Call 1-866-799-5895 , TTY 711

Monday–Friday, 8 a.m.–8:30 p.m. ET

Your in-home health check-in

• Up to a full hour with a licensed health care practitioner
• Ask the questions that matter to you and get valuable health tips
• No cost — it's included in your health plan

Get rewarded

Meet your friendly housecalls medical staff.

Just like the professionals you see in your regular doctor’s office, our licensed health care practitioners may be nurse practitioners, physician assistants or medical doctors. They’re state licensed and maintain national certification.

We perform background checks on these professionals to provide additional peace of mind for our members. Your loved ones, caregivers or friends are welcome to be present during the visit — it’s up to you.

Ready to open the door to better health?

Getting ready for your housecalls appointment, tips to help you prepare:  .

• Wear shoes that are easily removed to have your feet checked
• Make a list of upcoming appointments with your PCP and specialists
• Make sure all of your medications, both prescription and over-the-counter vitamins and supplements, are in their original bottles for our review
• If you record blood pressure readings, please have your results available for review
• If you have diabetes, please have your blood glucose meter handy
• Make a list of questions and concerns you’d like to discuss

During your appointment

• You'll have up to a full hour of 1-on-1 time with your health care practitioner for a physical, select lab tests, health screenings and more
• A HouseCalls visit can be completed while sitting at your kitchen table or in the living room, and you can use the time to ask any health-related questions
• The visit is tailored to your individual needs, so screenings and conversation topics can vary

After your appointment

Less travel time. more face time..

Think of HouseCalls as an extra layer of care — valuable 1-on-1 time you don't always get in the doctor's office. And it's tailored to your individual needs.

Schedule today

To secure your spot, call us at  1-866-799-5895 , TTY 711

Have a question?

Find answers to frequently asked questions.  

If you have a specific question about your upcoming appointment or need to reschedule, call us at 1-866-799-5895, TTY 711 , Monday–Friday, 8 a.m.–8:30 p.m. ET

We're here to help.  

Physician Visits @ Home

Compassionate care & conversation in your home, no rush..

Primary Care @ Home Physicians take the time to listen, observe and answer your questions. They don’t have to rush to see the next patient. Our physicians care about you, your health and will make sure you get the best possible attention and care. 

Qualified Medical Professionals in Your Home

Primary Care @ Home doctors are trained in remote care and house call medicine. They are Board Certified and experienced at delivering primary care.  Primary Care @ Home physicians are licensed to practice medicine and have the training to understand your health history, provide a diagnosis and prescribe treatment.

What is a Physican House Call?

What services do in-home doctors at primary care @ home provide.

• Physician house calls to patient homes and group living settings
• Interim or Primary Care Physician
• Transitional Care Management
• Chronic Care Management
• Remote Patient Monitoring
• Laboratory testing
• Comprehensive physical examinations
• Annual wellness visits
• Comprehensive geriatric assessments
• Medication prescription and management
• Basic diagnostic testing 
• Blood work and lab testing
• Chronic disease evaluation and management
• Immunizations
• Diabetic screening

Do Doctors Make House Calls Anymore?

According to a study on AAFP.org, “The demand for house calls is increasing because of the aging U.S. population, an increase in patients who are homebound, and the acknowledgment of the value of house calls by the public and health care industry. Literature from current U.S. home-based primary care programs describes health care cost savings and improved patient outcomes for older adults and other vulnerable populations. Common indications for house calls are management of acute or chronic illnesses, coordination of a post-hospitalization transition of care, health assessments, and end-of-life care. House calls may also include observation of activities of daily living, medication reconciliation, nutrition assessment, evaluation of primary caregiver stress, and the evaluation of patient safety in the home.”

Providing In-Home Doctor Visits in Avon, Brownsburg, Carmel, Castleton, Fishers, New Augusta, Nora, Speedway, Westfield, Zionsville and Indianapolis, Indiana area.

How Do I Find House Call Physicians Near Me?

If you live in the Indianapolis area, you have come to the right place. Primary Care @ Home provides in-home doctors visits to patients and assisted living facilities throughout the Indianapolis area.

How Much is a Doctor House Call?

An in-home visit from our physician is no more expensive than a traditional visit at the office. We accept the following insurances:

We will bill and file all of the patient’s insurance claims, including all secondary insurance for any charges not covered by a patient’s primary insurance.

Home Doctor Visits for The Elderly

Getting your senior to the doctor’s office for a visit can be extremely challenging.

Whether they’re frail, can’t walk on their own, or have Alzheimer’s or dementia, getting out of the house is hard on the patient and the caregiver. Visiting a physician’s office can also expose seniors to germs or bad weather.

Having a physician make a house call is a perfect way to get the care needed, and also allows the family and the doctor to take their time. There is no 15-minute limit and rushing to see the next patient. 

The environment is familiar, comforting, and less disturbing, especially for those with Alzheimer’s and dementia.

Primary Care Services for the Indianapolis IN area:

Memberships.

Subscribe to Our Monthly Senior Care News

Recent news, side effects of diabetes in-home doctor visits can manage, physician house calls help seniors age in place, physician house calls can treat common senior chronic conditions, doctor visits for the elderly at home makes medical care more accessible.

4 Benefits of House Calls for Primary Care Visits

When you're feeling unwell, the last thing you want to do is travel to the hospital or doctor's office. Usually, preparing for a doctor's appointment entails a lot, from scheduling time off work to waiting far too long in the waiting room for the doctor to see you.

House calls are a more convenient version of urgent care or a walk-in medical clinic appointment. You can avoid long lines and the possibility of being infected or infecting others, save time traveling, and avoid the discomfort of visiting the clinic when you are sick. For some patients, the house is a secure haven that might help with a more thorough examination.

In this article, we are going to go over 4 benefits of house calls for primary care visits. Read on to find out more.

1. They reduce waiting times

How many times have you arrived at a doctor's office on time just to be forced to wait? Imagine being able to see your doctor from the comfort of your own home, rather than having to wait in a packed waiting room. Waiting a long time to see a doctor might even aggravate or increase stress levels, making it difficult to accurately assess some tests, such as the correct blood pressure or heartbeat. Scheduling your appointment at home removes the need for this wait time and ensures better service. In addition, you are more likely to feel comfortable and can accurately describe your symptoms, which allows for a thorough diagnosis.

Young folks and parents with young children recognize that one significant advantage of house calls is convenience. House calls can eliminate the need to make an appointment later in the week or drive to an office and spend time in the waiting room waiting to be seen. The truth is very few of us enjoy going to the doctor's office, and there are now more reasons than ever to avoid it. With the outbreak of the COVID-19 pandemic, most of us are understandably anxious about being in close quarters with someone who may have contracted the virus or other illnesses such as the flu.

2. They ensure patient safety

Americans are becoming older, and by 2030, 70 million of them will be above the age of 65. A large proportion of this population is also housebound. Over a third of individuals aged 75 to 85 have difficulties walking a block. The health of the elderly and those who are critically ill can deteriorate at any time. They may require immediate medical treatment and care since failure to do so can result in life-threatening problems and diseases. That is where a house call doctor comes in.

House calls can be an incredibly convenient and safe option for the elderly because they are unable to walk to the clinic, especially when there is no transportation available. House calls also allow doctors to check in on patients who have limited mobility to see if they are taking their medications on a regular basis, eating well, and staying safe from accidents or falls.

3. They reduce expensive hospitalizations

Health-care spending in the United States is widely believed to be on course to exceed 20 percent of GDP — and the 5% of patients who are the most expensive to treat account for 50% of total healthcare expenditure. These individuals are often frail and elderly, suffering from a variety of chronic illnesses; many of them also have unmet behavioral and mental health needs.

One study discovered that a physician assistant home care program that included house calls lowered the 30-day readmission rate by 25%. Medication adjustment was the most common house call intervention. Primary care that is easily accessible and consistent may help prevent ED visits. House call visits can also provide follow-up until you are better, something that medical clinics and hospitals don't do.

4. They ensure more personalized care is provided

According to research conducted by the American Academy of Family Physicians , physicians might gain vital information about their patients during house calls. For example, doctors can check to make sure patients take their medications correctly, eat nutritiously, and aren't at an increased risk of accidents or falls by watching them do ordinary everyday tasks in their most familiar surroundings.

In-home care is more tailored than the majority of patients in a doctor's office or hospital and significantly reduces hospitalizations and emergency room visits. Numerous physicians see as many as twenty people per day, with each visit lasting barely a few minutes. Delivering care to the patient in their own home becomes substantially more personalized, where treatment is tailored to the medical demands of each patient. House calls can provide patients and their families peace of mind.

There is no doubt that a house call can have various benefits for patients. A house call can help reduce waiting times, reduce expensive hospitalizations, ensure patient safety, and offer a more personalized type of care. Aside from the advantages mentioned above, numerous on-demand medical house call services today use modern medical technology to deliver more comprehensive and convenient medical treatment and medical support.

Community Healthcare Partners is committed to providing the highest quality health care to our patients in Lincoln, Omaha, Fremont, and surrounding areas. Our nurse practitioners and physician assistants provide comprehensive care in the comfort of the patient's home. Our professionals assist patients in navigating the health care system, including referrals to specialists, coordination of hospital care, and follow-up treatment. As a result, patients and caregivers benefit from the peace of mind knowing that quality healthcare is only a phone call away. Care encompasses everything from mild ailments to significant, chronic conditions.

Read about our services to find out more, or get in touch today to arrange an appointment with one of our compassionate doctors.

22 Mar 2022

House Call Medicine Makes a Comeback

Home-based primary care programs, many of which are run by academic medical centers, are bringing comprehensive care to homebound patients with severe chronic conditions..

House Calls

Scheduling your appointment.

Please call or email to request an appointment. Appointments are scheduled 1-2 weeks in advance according to when a doctor will be seeing patients in your area. We will call you to confirm a one to two hour appointment window for the doctor’s arrival at your home.

Your first visit

• Name and location of primary care physician
• Past medical and ocular history
• Any records from previous eye doctors, if available
• Current list of medications, or the bottles from the pharmacy. This includes all medications, over the counter supplements and vitamins– not just eye drops!
• Insurance cards
• Hospital discharge papers, if applicable

Follow up care

Your doctor will work with you to determine the frequency of future visits based on your specific ocular health needs. You can always call for a visit if you feel you need to see the doctor sooner than your next scheduled appointment!

BRIAN K. UNWIN, MAJ, MC, USA, AND ANTHONY F. JERANT, M.D.

Am Fam Physician. 1999;60(5):1481-1488

See editorial on page 1337 .

With the advent of effective home health programs, an increasing proportion of medical care is being delivered in patients' homes. Since the time before World War II, direct physician involvement in home health care has been minimal. However, patient preferences and key changes in the health care system are now creating an increased need for physician-conducted home visits. To conduct home visits effectively, physicians must acquire fundamental and well-defined attitudes, knowledge and skills in addition to an inexpensive set of portable equipment. “INHOMESSS” (standing for: i mmobility, n utrition, h ousing, o thers, m edication, e xamination, s afety, s pirituality, s ervices) is an easily remembered mnemonic that provides a framework for the evaluation of a patient's functional status and home environment. Expanded use of the telephone and telemedicine technology may allow busy physicians to conduct time-efficient “virtual” house calls that complement and sometimes replace in-person visits.

In 1990, the American Medical Association (AMA) reported that approximately one half of primary care physicians polled in a national survey indicated that they performed home visits. 1 Although most of the physicians surveyed perceived home visits to be an important service, the majority performed only a few such visits per year. 1 Consistent with these self-reported behaviors are data indicating that only 0.88 percent of Medicare patients receive home visits from physicians. 2 In addition, the Health Care Financing Administration reported charges for only 1.6 million home visits in 1996, an extremely small percentage of the total number of annual physician-patient contacts in the United States. 3 These statistics stand in sharp contrast to medical practice before World War II, at which time about 40 percent of patient-physician encounters were in the home. 4

The low frequency of home visits by physicians is the result of many coincident factors, including deficits in physician compensation for these visits, time constraints, perceived limitations of technologic support, concerns about the risk of litigation, lack of physician training and exposure, and corporate and individual attitudinal biases. Physicians most likely to perform home visits are older generalists in solo practices. Health care providers who have long-established relationships with their patients are also more likely to utilize house calls. Rural practice setting, older patient age and need for terminal care correlate with an increased frequency of home visits. 5

Rationale for Home Visits

Studies suggest that home visits can lead to improved medical care through the discovery of unmet health care needs. 6 – 8 One study found that home assessment of elderly patients with relatively good health status and function resulted in the detection of an average of four new medical problems and up to eight new intervention recommendations per patient. 8 Major problems detected included impotence, gait and balance problems, immunization deficits and hypertension. Significantly, these problems had not been expected based on information obtained from outpatient clinic encounters. Other investigators have demonstrated the effectiveness of home visits in assessing unexpected problems in patient compliance with therapeutic regimens. 9 Finally, specific home-based interventions, such as adjusting the elderly patient's home environment to prevent falls, have also yielded health benefits. 10

Beyond the potential benefit of improved patient care, family physicians who conduct home visits report a higher level of practice satisfaction than those who do not offer this service. 5 Physicians with more positive attitudes about home visits are more likely to have conducted house calls during training. 11 Faculty mentorship and longitudinal exposure in training appear to be important for the development of positive attitudes toward home visits. 5 However, in 1994, only 66 of 123 medical schools offered specific instruction in the role and conduct of home visits. 12 Although 83 percent of the medical schools offered students the opportunity to participate in home visits, only three of the 123 schools required students to make five or more such visits. 12

Home Health Care Industry

Physician home visits have largely been supplanted by the extensive use of home health care services, a $22.3 billion industry that augments a medical system largely comprising facility-based health care providers. 13 The mean annual frequency of home health referrals was 43 per provider in a study published in 1992. 14

Family physicians have authorization and supervision responsibilities for a broad spectrum of skilled services that can be offered in the home. Such services include home health nursing, assistance from home health aides, and physical, occupational and speech therapy. Other health care support services are provided by medical supply companies, respiratory therapists, nutritionists, intravenous therapy services, hospice organizations, respite care services, Meals-on-Wheels volunteers and bereavement support staff. Family physicians also work extensively with social workers, who provide invaluable assistance in coordinating these services.

Thus, effective use of home care services has become a core competency for family physicians. In 1998, the AMA published the second edition of Medical Management of the Home Care Patient: Guidelines for Physicians . 15 The basic physician home care responsibilities outlined in that document are listed in Table 1 . 15

Recent data suggest that many physicians do not have the necessary knowledge and skills to perform these tasks effectively. For example, a survey found that 64 percent of physicians who had signed claims for care plans that were later disallowed had relied on a home health agency to prepare the plan of care, and 60 percent were not aware of the homebound requirement for home services. 16 Thus, increased physician education about home visits seems necessary if the responsibilities and obligations created by the expansion of home health care industry are to be fulfilled.

Types of Home Visits

The four major types of home visits are illness visits, visits to dying patients, home assessment visits and follow-up visits after hospitalization ( Table 2 ) . 17 , 18 The illness home visit involves an assessment of the patient and the provision of care in the setting of acute or chronic illness, often in coordination with one or more home health agencies. Emergency illness visits are infrequent and impractical for the typical office-based physician.

The dying patient home visit is made to provide care to the home-bound patient who has a terminal disease, usually in coordination with a hospice agency. The family physician can provide valuable medical and emotional support to family members before, during and after the death of a patient in the home environment. Family assistance involves evaluating the coping behaviors of survivors and assessing the medical, psychosocial, environmental and financial resources of the remaining family members.

The assessment home visit can also be described as an investigational visit during which the physician evaluates the role of the home environment in the patient's health status. An assessment visit is often made when a patient is suspected of poor compliance or has been making excessive use of health care resources. Medication use can be evaluated in the patient who is taking many drugs (polypharmacy) because of multiple medical problems. Evaluation of the home environment of the “at-risk” patient can reveal evidence of abuse, neglect or social isolation. Patients and family members who are trying to cope with chronic problems such as cognitive impairment or incontinence may particularly benefit from this evaluation. A joint assessment home visit facilitates coordination of the efforts of home health agencies and the physician. Finally, an assessment home visit is invaluable in assessing the need for nursing home placement of a frail elderly patient with uncertain social support.

The hospitalization follow-up home visit is useful when significant life changes have occurred. For example, a home visit after the birth of a new baby provides an excellent opportunity to discuss wellness and prevention issues and to address parental concerns. A home visit after a major illness or surgery can be useful in evaluating the coping behaviors of the patient and family members, as well as the effectiveness of the home health care plan.

Many aspects of physician home care have not been evaluated in the literature. However, it seems likely that properly focused and conducted home visits can enhance home health care delivery, improve patient satisfaction and strengthen the doctor-patient relationship.

Conducting the Home Visit

Equipment and planning.

Most equipment for a home visit can still be carried in the family physician's “black bag” ( Table 3 ) . Some additional items may be acquired from the patient's home.

One of the keys to conducting a successful home visit is to clarify the reason for the visit and carefully plan the agenda. Preplanning allows the physician to gather the necessary equipment and patient education materials before departure. The physician should have a map, the patient's telephone number and directions to the patient's home. The physician, patient and home care team should set a formal appointment time for the visit. Coordinating the house call to allow for the presence of key family members or significant others can enhance communication and satisfaction with care. Finally, confirming the appointment time with all involved parties before departure from the office is a common courtesy to the family as well as a wise time-management strategy.

HOME VISIT CHECKLIST: “INHOMESSS”

The INHOME mnemonic was devised to help family physicians remember the items to be assessed during the home visit directed at a patient's functional status and living environment. 19 This mnemonic can be expanded to “INHOMESSS,” which incorporates investigations of safety issues, spiritual health and home health agencies ( Table 4 ) . 19

Immobility . Evaluation of the patient's functional activities includes assessment of the activities of daily living (bathing, transfer, dressing, toileting, feeding, continence) and the instrumental activities of daily living (using the telephone, administering medications, paying bills, shopping for food, preparing meals, doing housework). The physician can ask the patient to demonstrate elements of the daily routine, such as getting out of bed, performing personal hygiene and leisure activities, and getting in and out of a car. Corrective interventions can be directed at any deficiencies noted. For example, modified pill-bottle caps can be obtained for the patient who has trouble opening medication containers because of a condition such as arthritis.

Nutrition . The physician should assess the patient's current state of nutrition, eating behaviors and food preferences. Permission to look in the refrigerator or cupboard can be obtained by asking open-ended but directed questions. For example, the physician might say, “We have been working hard on your diet to control your diabetes. Would you mind if I look in your refrigerator to see the types of foods you eat?” Improvements in product labeling allow the physician to assess serving sizes and the nutritional value of foods with relative ease. Healthy food preparation techniques can also be reviewed with the patient.

Home Environment . The patient's home environment should allow for privacy, social interaction and both spiritual and emotional comfort and safety. A safe neighborhood with close proximity to services is important for many older patients. The home may reflect pride in the patient's family and past accomplishments and reveal the patient's interests and hobbies. The physician should not make assumptions about social class or material wealth based on the patient's physical environment.

Other People . Having the patient's social support system present at the home visit clarifies the roles and concerns of family members. During routine visits, the physician can assess the availability of emergency help for the patient from family members and friends and can clarify specific issues, such as who is to serve as surrogate for the patient in the event of incapacitation. Discussion of a durable power of attorney and a living will may be more comfortably performed during the home visit than in the usual clinic visit. Evaluation of the caregiver's needs and risk of burnout is critically important.

Medications . To remedy or avoid polypharmacy, the physician must evaluate the type, amount and frequency of medications, and the organization and methods of medication delivery. An inventory of the patient's medicine cabinet can provide clues to previously unidentified drug-drug or drug-food interactions. A home medication review can also allow a direct estimate of patient compliance, uncover evidence of “doctor shopping” and identify the use or abuse of over-the-counter medications and herbal remedies.

Examination . The home visit should include a directed physical examination based on the needs of the patient and the physician's agenda. Practical, function-related examination techniques may include having the patient demonstrate getting on and off the toilet or in and out of the bathtub. The physician can have the patient demonstrate proper technique for the self-monitoring of blood glucose levels. In addition, the physician can weigh the patient and obtain a blood pressure measurement. In-person correlation of home and office measures provides useful information for future telephone and clinic contacts.

Safety . Common home safety issues are listed in Table 5 . The goal of the home safety assessment is to determine whether the patient's environment is comfortable and safe (no unreasonable risk of injury). To raise the subject, the physician should simply state the intention to identify and help modify potential safety hazards. For example, furniture placement or throw rugs may create problems for an elderly patient with gait instability, or the tap water may be so hot that the patient is at risk for scald injury. 20

Spiritual Health . If the home contains religious objects or reading materials, the physician can ask about the influence of spiritual beliefs on the patient's sense of physical and emotional health. This information may provide the impetus, as desired by the patient, for a discussion of spirituality as a coping and healing strategy.

Services . Having members of cooperating home health agencies present for the house call can enhance communication and cooperation among the physician, patient and agencies. Existing orders can be clarified, priorities for future care can be established and other perspectives on the care plan can be solicited. The patient's relationship with home health agency providers can also be assessed.

Elements of the INHOMESSS mnemonic may be used independently, based on the needs of the patient and the physician's agenda. For example, the physician may wish to focus on polypharmacy and safety in a patient with a recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer's disease. Figure 1 presents the major elements of the home visit in a checklist format that facilitates comprehensive assessment.

INTEGRATING HOME VISITS INTO CLINICAL PRACTICE

Lack of reimbursement and the busy pace of office practice are the reasons commonly cited for not conducting house calls. Poorly organized, sporadic home visits may indeed interfere with clinical practice. Therefore, it is important to develop a systematic approach for planning home visits. 21

Most practices will benefit from using home visits with patients who have difficulty accessing outpatient facilities because of sensory impairment, immobility or transportation problems. Removing such logistically difficult appointments from the clinic schedule and performing them in the home setting may actually enhance clinic functioning. Clustering home visits by geographic location and within defined blocks of time may also improve efficiency. Finally, nurse practitioners and physician assistants can conduct visits as part of a home health care delivery team.

The 1999 Current Procedural Terminology codes and corresponding Medicare reimbursement rates for common types of home visits are listed in Table 6 . 22

Telephone Calls and Telemedicine

Proactive telephone calls are an underutilized method of conducting highly focused and time-efficient “virtual” home visits. 23 Provider-initiated telephone calls can be used to reassure family members after a patient has had an acute illness or has been hospitalized. 23 These calls can also be helpful in reinforcing patient compliance with new medications, following patients with chronic diseases and reducing inappropriate use of primary care clinic or office services. 24

Telemedicine is the use of communication technologies, such as two-way video-conferencing, to provide patient care across distances. A variety of institutions are exploring these technologies as methods of delivering health care in the home. 25 , 26

Final Comment

As fewer patients are admitted to hospitals and hospital stays become ever briefer, the medical complexity of home care will increase, as will the demand for both in-person and “virtual” physician home visits. Physicians interested in obtaining additional information about home care provision can contact the American Academy of Home Care Physicians (P.O. Box 1037, Edgewood, MD 21040; Web address: http://www.aahcp.org/ ).

Shut in, but not shut out [Editorial]. Am Med News. 1996;39:47.

Meyer GS, Gibbons RV. House calls to the elderly: a vanishing practice among physicians. N Engl J Med. 1997;337:1815-20.

Boling PA. House calls [Letter]. N Engl J Med. 1998;338:1466.

Starr P. The social transformation of American medicine. New York: Basic Books, 1982:359.

Adelman AM, Fredman L, Knight AL. House call practices: a comparison by specialty. J Fam Pract. 1994;39:39-44.

Arcand M, Williamson J. An evaluation of home visiting of patients by physicians in geriatric medicine. Br Med J. 1981;283:718-20.

Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc. 1994;42:630-8.

Ramsdell SW, Swart J, Jackson JE, Renvall M. The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc. 1989;37:17-24.

Bernardini J, Piraino B. Compliance in CAPD and CCPD patients as measured by supply inventories during home visits. Am J Kidney Dis. 1998;31:101-7.

Tideiksaar R. Environmental adaptation to preserve balance and prevent falls. Top Geriatr Rehabil. 1990;5:178-84.

Knight AL, Adelman AM, Sobal J. The house call in residency training and its relationship to future practice. Fam Med. 1991;23:57-9.

Steel RK, Musliner M, Boling PA. Medical schools and home care. N Engl J Med. 1994;331:1098-9.

Goldberg AI. Home healthcare: the role of the primary care physician. Compr Ther. 1995;21:633-8.

Boling PA, Keenan JM, Schwartzberg JG, Retchin SM, Olson L, Schneiderman M. Home health agency referrals by internists and family physicians. Am Geriatr Soc. 1992;40:1241-9.

American Medical Association. Medical management of the home care patient: guidelines for physicians. 2d ed. Chicago: The Association, 1998:1–60.

Klein S. Guidance for home care physicians. Am Med News. 1998;41:5-6.

Cauthen DB. The house call in current medical practice. J Fam Pract. 1981;13:209-13.

Scanameo AM, Fillit H. House calls: a practical guide to seeing the patient at home. Geriatrics. 1995;50:33-9.

Knight AL, Adelman AM. The family physician and home care. Am Fam Physician. 1991;44:1733-7.

Huyer DW, Corkum SH. Reducing the incidence of tap-water scalds: strategies for physicians. Can Med Assoc J. 1997;156:841-4.

American Academy of Home Care Physicians. Making house calls a part of your practice. Edgewood, Md.: American Academy of Home Care Physicians, 19981;1–35.

Kirschner CG, ed. Current procedural terminology: CPT. Standard ed. Chicago: American Medical Association, 1999:26–8.

Studdiford JS, Panitch KN, Snyderman DA, Pharr ME. The telephone in primary care. Prim Care. 1996;23:83-102.

Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788-93.

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Confused by Your Doctor Visit? Ask These Three Questions

A clear, concise understanding isn’t always what a patient takes away from a doctor visit. The Ask 3 program reduces doctor/patient communication to three simple questions everyone should understand. Patient education specialist Darren Doman explains this program, encourages patients to ask these questions and urges doctors to make sure they’re understood.

Episode Transcript

Interviewer: Three things patients should ask and three things all doctors should be sure their patients understand. That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Sometimes as a patient when you're in clinic with a physician, you leave and you're like, "I don't know what's wrong with me and I don't know what to do about it," and you're just confused. But if you ask these three questions, and if you're a provider you make sure patients understand the answers to these three questions you could solve all the problems. We're going to find out more about the Ask 3 Program. Darren Doman, he's the Patient Education Specialist here at University of Utah Health Care. What is the Ask 3 Program and it sounds magical?

Doman: It is pretty magical. It's an initiative put together by the National Patient Safety Foundation and it's meant to just help improve communication between health care providers and their patients in efforts to improve health outcomes. So basically they synthesize every visit into three main questions.

Interviewer: Okay.

Doman: First, "What is my main problem?"

Interviewer: Yeah okay.

Doman: That's a good question.

Interviewer: That's a great question. That's why you're there.

Doman: Exactly.

Interviewer: Yeah.

Doman: Put a label on it, give it a name. The second question is, "What do I need to do about it?" And then the third question is, "Why is it important for me to do that?"

Interviewer: I love that because I think it synthesizes in very, three very quick little questions. Like when you're a patient you leave and you don't understand what just happened and you're trying to figure out, "What could I have done to change it?" I think this is perfect.

Doman: Absolutely and there's some research out of Great Britain that shows that when it comes to an outpatient doctor patient interaction, 80% of people leave that visit without accurately recalling any information that the doctor told them.

Interviewer: So it would be hard for them to tell their husband, their wife, their kids, anybody.

Doman: Exactly, but when they probed the 20% that remembered something a little bit closer, only half of them actually got it right.

Interviewer: Really?

Doman: So it's really 9 out of 10 people leave the doctor's office not able to remember accurately what the doctor told them.

Interviewer: That's pretty incredible and that's based on research.

Doman: Based on research out of the UK.

Interviewer: All right so the Ask 3 Program, "What's my main problem?" "What do I need to do?" "Why is it important for me to do this?" Is there any research on showing if people ask these questions what retention rates are?

Doman: Well the most current research that I read was showing that patients aren't actually asking these three questions.

Doman: So we need to take a step back, revamp the program, and maybe think about it a little bit differently. Which I think is a perfect opportunity for us to talk to providers and say, "You know, here's three great questions. If your patients aren't asking these questions, why don't you just help them out and give them this information?"

Interviewer: Yeah just make sure that they understand these three things.

Doman: Exactly and that speaks to the need for open communication between patients and doctors to really get the message home. Patients need to be asking the questions, doctors need to be telling the patients the right things, and they need to be checking to make sure that the message was received.

Interviewer: So it sounds like a good idea as a patient if I go in that maybe when it starts getting a little confusing I just need to fall back on those three, you know? Because sometimes the issues get a little muddled right?

Doman: Absolutely, and just bring it back to, "Okay what's the main problem?"

Interviewer: "What do I need to do?"

Doman: And, "Why is it important to do it?"

Interviewer: And as a provider it might be a good idea after you tell them these three things to ask them, "Okay do you understand what your problem is? Tell me what it is." When I was in my communication classes that's all part of listening, it's all part of checking to make sure the person understand what you just said to them is to ask them to tell you what you just said to them.

Doman: Absolutely and providers who are really keyed into this can do it very artfully. They can say, "I think your main problem is this," and then, "Later when you get home what are you going to tell your spouse that your main problem is?" Just to check and see.

Interviewer: Yeah, because a lot of times we assume that the person understood us and we don't want to insult their intelligence by insinuating on some level that they didn't, but a lot of times people don't. I mean there's a lot of a thing that can go wrong with communication, it's not either individuals fault.

Doman: It's true, and double checking message received is never a bad idea.

Interviewer: What's keeping patients from asking these three questions do you think?

Doman: When it comes to patients asking questions in doctors' visits I always think its fear based. They don't want to look stupid in front of their care provider. Maybe they kind of know the answer but they're a little bit afraid of actually hearing somebody else say it. So there are reasons why they might not pipe up and actually ask.

Interviewer: But at that point it's important beyond your ego, beyond anything else, to clearly understand what's going on, what you need to do, and how important it is.

Doman: Sure, yeah.

Interviewer: And how about physicians, is there a barrier to them adopting kind of just these three questions making sure patients identify it? Is it something they ever thought about before?

Doman: I think it takes that moment of just engaging your brain and checking in rather than getting into too much of a routine. Everybody kind of gets their routine going, they kind of do it the same way they've always done it, in and out, keep the flow going. But if we can actually engage with the patients say, "Here's my new routine, here are these three important things that I need every patient to understand," I think we're going to have a better go of patient interaction, better communication, and ultimately better health outcomes.

Interviewer: Any final thoughts on the Ask 3 Program? I think it's brilliant.

Doman: I think its brilliant too, and just getting the word out to patients and providers alike that it's a conversation. It shouldn't be one-sided doctor talking all the time. The patient should have some input as well and if the patient doesn't know quite what to ask here's three good questions. Anybody who asks these isn't going to look stupid in front of their doctor.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook, just click on the Facebook icon at TheScopeRadio.com.

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How to Advocate for Yourself at Doctor's Visits

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W ith a limited amount of allotted time and a pressing health matter to discuss, a trip to the doctor’s office can sometimes feel like a high-stakes event. Even the most routine visits can leave you feeling dissatisfied if there’s a communication barrier, too many items on the agenda, or a personality clash.

Research shows that people who are able to vocalize their medical needs tend to be happier with their health care experiences and are even more likely to see improvements in symptoms and other important outcomes. So how can patients become better advocates for themselves and help take charge of their health in the process? We asked physicians for their best tips and strategic advice to help ensure your next doctor’s appointment goes as smoothly as possible.

Write down your concerns before the visit

Dr. Michael Albert, chief of internal medicine with Johns Hopkins Community Physicians in Odenton, Md., says he understands what patients can be up against when they go to see their doctor. First, there’s the inherent power balance between doctor and patient, which he says is slowly changing as medical schools begin to focus more on patient-centered care, but remains a problem. And he’s heard more than his share of stories over the years of physicians who appear to lack empathy when a patient raises concerns. “We know we need to do better as physicians,” Albert says.

Some of that disconnect comes down to time pressures, which can make physicians feel rushed to find a “fix” for their patients, rather than validating their feelings, Albert says.

Read More : Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout

To counteract that, he advises all patients to write a list of their concerns in order of urgency to help ensure that their voice is heard in the appointment. It doesn’t need to be an exhaustive narrative; in fact, being brief is key to keeping the appointment on track. But people who come prepared with a note highlighting main points they want to discuss often make better use of their limited time with the doctor. “Then we can really dig into the things that are most important,” he says.

By the time patients reach sub-specialist Dr. Kathryn Mills, they’ve usually already interacted with numerous physicians and other care providers. Mills, a gynecologic oncologist and assistant professor of obstetrics and gynecology at University of Chicago Medicine, says it can be confusing and overwhelming for patients to navigate the system, which is why she encourages them to write down their questions in advance.

“It is hard, when you get in that moment, to remember everything that you wanted to have addressed,” says Mills.

Send a portal message the day before

When a concise written list won’t suffice—such as when a patient wants to provide contextual information about a complicated injury—Albert says sending an electronic message through a patient portal the day before an appointment can help prepare the doctor. Some insurance plans have begun paying doctors for responding to portal messages, which incentivizes doctors to communicate with patients.

Just don’t expect doctors to respond to complex questions through portal communication, Albert says. Those issues are best addressed in person.

Craft an “opening statement”

Doctors always face time constraints and are usually juggling multiple demands, Albert says. To help foster a strong relationship, he often advises patients to start their appointments with a brief opening statement that highlights their reason for coming in while acknowledging the doctor’s hectic schedule.

And the little things, such as showing up on time and making sure your paperwork is filled out, can go a long way toward building the provider-patient relationship, Mills says. When patients are on time and prepared, doctors are better able to stick to their schedule and spend the appointment focused on the issues at hand.

Google your symptoms—yes, really

Doctors rarely advise patients to fall down a rabbit hole online. But that doesn’t mean you shouldn’t do research. The best patient is the informed patient, according to Dr. Benita Petri-Pickstone, a family physician in Gahanna, Ohio and clinical assistant professor of family and community medicine at the Ohio State University Wexner Medical Center in Columbus. She says a vital aspect of self-advocacy is for patients to take an active role in their health, which means doing their research ahead of time so they can ask informed questions. Be proactive, raise any concerns with your doctor, and don’t hesitate to ask a multitude of questions, she says.

Read More : 6 Compliments That Land Every Time

“The patient who tends to get the better care is usually one that is more vocal and asks informed questions about things based on what they’ve read and based on symptoms that they are feeling,” Petri-Pickstone says.

Bring someone to your appointment

In situations where people may not be able to advocate for themselves, such as seniors who are experiencing a cognitive decline, Petri-Pickstone encourages them to bring along a trusted friend or family member. “I’m always open to having spouses and children come in with the patient to help give a good history so I can find out the total picture about what’s happening,” she says.

Seek a second opinion

When patients are experiencing doubt or appear to be uneasy, Mills encourages them to seek a second opinion. Mills often sees patients who are coming to her for one,  and she believes it’s a critical step people can take to advocate for themselves and ensure they are getting the right care.

She says that sometimes, patients don’t want to tell her they are in her office to seek a second opinion because they’re afraid it will color her opinion. But Mills says she believes it better serves patients if they are transparent and speak about the specific concerns that prompted them to seek the advice of another physician. “It sets the stage in a different way,” she says.

Don’t hesitate to find new care

Sometimes, the relationship between a doctor and patient just isn’t the right fit, Albert says. If someone has tried everything and the doctor is impossible to understand or just doesn’t listen, it might be time to seek another provider, he says. “They should select somebody who they feel more comfortable with,” he says.

The ideal doctor-patient relationship will vary depending on a person’s needs. But in general, people should be able to have a back-and-forth discussion with their physician and feel like their concerns are being heard and addressed, Albert says. If people feel like their doctor is going to listen, it becomes much easier for them to advocate for what they need.

Contact us at [email protected] .

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How do you help patients who show up in the ER 100 times a year?

Leslie Walker

Dan Gorenstein

The hope was that bringing many other services to people with high needs would stabilize their health problems. While the strategy has succeeded sometimes, it hasn't saved money. Douglas Sacha/Getty Images hide caption

The hope was that bringing many other services to people with high needs would stabilize their health problems. While the strategy has succeeded sometimes, it hasn't saved money.

Larry Moore, of Camden, N.J, defied the odds — he snatched his life back from a spiral of destruction. The question is: how?

For more than two years straight, Moore was sick, homeless and close-to-death drunk — on mouthwash, cologne, anything with alcohol, he says. He landed in the hospital 70 times between the fall of 2014 and the summer of 2017.

"I lived in the emergency room," the 56-year-old remembers. "They knew my name." Things got so bad, Moore would wait for the ER nurses to turn their backs so he could grab their hand sanitizer and drink it in the hospital bathroom.

"That's addiction," he says.

Then, in early 2018, something clicked, and turned Moore around. Today, he's more than five-years sober with his own apartment, and he has only needed the ER a handful of times since 2020. He's active in his church and building new relationships with his family.

Moore largely credits the Camden Coalition , a team of nurses, social workers and care coordinators for his transformation. The nonprofit organization seeks out health care's toughest patients — people whose medical and social problems combine to land them in the ER dozens of times a year — and wraps them in a quilt of medical care and social services. For Moore, that meant getting him medical attention, addiction treatment and — this was key for him — a permanent place to live.

"The Camden Coalition, they came and found me because I was really lost," Moore says. "They saved my life."

For two decades, hospitals, health insurers and state Medicaid programs across the country have yearned for a way to transform the health of people like Moore as reliably as a pill lowers cholesterol or an inhaler clears the lungs. In theory, regularly preventing even a few $10,000-hospital-stays a year for these costly repeat customers could both improve the health of marginalized people and save big dollars.

Larry Moore (left) in 2020 with staff members from the Camden Coalition. The housing and addiction treatment the organization helped him get has been life saving. Dan Gorenstein/Tradeoffs hide caption

Larry Moore (left) in 2020 with staff members from the Camden Coalition. The housing and addiction treatment the organization helped him get has been life saving.

But breaking this expensive cycle — particularly for patients whose lives are complicated by social problems like poverty and homelessness — has proved much harder than many health care leaders had hoped. For example, a pair of influential studies published in 2020 and 2023 found that the Coalition's pioneering approach of marrying medical and social services failed to reduce either ER visits or hospital readmissions . Larry Moore is the outlier, not the rule.

"The idea that someone should go to the emergency room 100 times in a year is a sign of deep, deep system dysfunction," says Jeff Brenner, the primary care physician who founded and led the Camden Coalition from 2002 until 2017. "It should be fixable. We're clearly still struggling."

Yet, Brenner and others on the frontlines of one of health care's toughest, priciest problems say they know a lot more today about what works and what misses the mark. Here are four lessons they've learned:

Lesson 1: Each patient needs a tailored, sustained plan. Not a quick fix

The Camden Coalition originally believed that just a few months of extra medical and social support would be enough to reduce the cycle of expensive hospital readmissions. But a 2020 study published in the New England Journal of Medicine found that patients who got about 90 days of help from the Coalition were just as likely to end up back in the hospital as those who did not.

That's because, frontline organizations now realize, in some cases this wraparound approach takes more time to work than early pioneers expected.

"That 80th ER visit may be the moment at which the person feels like they can finally trust us, and they're ready to engage," says Amy Boutwell, president of Collaborative Healthcare Strategies , a firm that helps health systems reduce hospital readmissions. "We do not give up."

Frontline groups have also learned their services must be more targeted, says Allison Hamblin , who heads the nonprofit Center for Health Care Strategies, which helps state Medicaid agencies implement new programs. Organizations have begun to tailor their playbooks so the person with uncontrolled schizophrenia and the person battling addiction receive different sets of services.

Larry Moore, for example, has done fine with a light touch from the Coalition after they helped him secure stable housing. But other clients, like 41-year-old Arthur Brown, who struggles to stay on top of his Type 1 diabetes, need more sustained support. After several years, Coalition community health worker Dottie Scott still attends doctor's visits with Brown and regularly reminds him to take his medications and eat healthy meals.

Aaron Truchil, the Coalition's senior analytics director, likens this shift in treatment to the evolution of cancer care, when researchers realized that what looked like one disease was actually many and each required an individualized treatment.

"We don't yet have treatments for every segment of patient," Truchil says. "But that's where the work ahead lies."

Lesson 2: Invest more in the social safety net

Another expensive truth that this field has helped highlight: America's social safety net is frayed, at best.

The Coalition's original model hinged on the theory that navigating people to existing resources like primary care clinics and shelters would be enough to improve a person's health and simultaneously drive down health spending.

Over the years, some studies have found this kind of coordination can improve people's access to medical care , but fails to stabilize their lives enough to keep them out of the hospital. One reason: People frequently admitted to the hospital often have profound, urgent needs for an array of social services that outstrip local resources.

As a result of this early work, Hamblin says, state and federal officials — and even private insurers — now see social issues like a lack of housing as health problems, and are stepping in to fix them. Health care giants like insurers UnitedHealthcare and Aetna have committed hundreds of millions of dollars to build affordable housing, and private Medicare plans have boosted social services , too. Meanwhile, some states, including New York and California, are earmarking billions of Medicaid dollars to improve their members' social situations, from removing mold in apartments to delivering meals and paying people's rent .

Researchers caution that the evidence so far on the health returns of more socially focused investments is mixed — further proof, they say, that more studies are needed and there's no single solution that works for every patient.

Some health care experts also still question whether doctors and insurers are best positioned to lead these investments, or if policymakers and the social service sector should drive this work instead.

Lesson 3: Recent boom in new programs demands better coordination

This spike in spending has led to a wave of new organizations clamoring to serve this small but complex population, which Hamblin says can create waste in the system and confusion for patients.

"All of these barriers to entry and handoffs don't work for traumatized people," former Coalition CEO Brenner says. "They're now having to form new, trusting relationships with multiple different groups of people."

Streamlining more services under a single organization's roof is one possible solution. Evidence of that trend can be seen in the nationwide growth of clinics called Certified Community Behavioral Health Clinics, These clinics deliver mental health care, addiction treatment and even some primary care in one place.

Brenner, who now serves as CEO of the Jewish Board, a large New York City-based social service agency with a budget of more than $200 million a year, is embracing this integration trend. He says his agency is building out four of that newer type of behavioral health clinic, and offering clients housing on top of addiction treatment and mental health care.

Other groups, including the Camden Coalition, say simply getting neighboring care providers to talk to one another can make all the difference. Coalition head Kathleen Noonan estimates the organization now spends just 25% of its time on direct service work and the rest on quarterbacking, helping to coordinate and improve what she calls the "local ecosystem" of providers.

Lesson 4: Rethink your definition of success, and keep going

Twenty years ago, the goal of the Camden Coalition was to help their medically complex patients stay out of the E.R. and out of the hospital — provide better health care for less cost. Noonan, who took over from Jeff Brenner as CEO of the Coalition, says they've made progress in providing better care, at least in some cases — and that's a success. Saving money has been tougher.

"We certainly don't have quick dollars to save," Noonan says. "We still believe that there's tons of waste and use of the [E.R.] that could be reduced ... but it's going to take a lot longer."

Still, she and others in her field do see a path forward. As they focus on improving their patients' mental and physical health by developing and delivering the right mix of interventions in "the right dose," they believe the cost savings may ultimately follow, as they did in Larry Moore's case.

The stakes are high. Today, homelessness and addiction combined cost the U.S. health care system north of $20 billion a year, wreaking havoc on millions of Americans. As health care delivery has evolved in the last two decades, the question is no longer whether to address people's social needs, but how best to do that.

This story comes from the health policy podcast Tradeoffs . Dan Gorenstein is Tradeoffs' executive editor, and Leslie Walker is a senior reporter/producer for the show, where a version of this story first appeared. Tradeoffs' weekly newsletter brings more reporting on health care in America to your inbox.

• Camden, N.J.
• health costs
• Emergency Room
• emergency room frequent flier

Top 4 challenges in home health nursing

Home health care comes in all shapes and sizes, from a quick doctor visit to long-term care by a registered nurse. But this valuable field isn’t without its challenges.

To continue meeting patient outcomes in an increasingly complex health system, health care experts — especially nurses — need to be equipped for just about anything.

But what are the biggest challenges in home health care nursing — and what are the solutions, tactics or best practices that can overcome them? Let’s take a closer look at how quality care comes to life for today’s patients.

The ongoing value of home health care

In 2020 alone, 3 million people received and ended home care services. 1 While the pandemic certainly didn’t invent this field, it brought attention to the value, reach and scale of health at home. Unfortunately, it also introduced new concerns and intensified existing ones. 2

It’s no surprise that post-pandemic home care is more complicated than ever — but it’s also increasingly critical.

For example, home health patients may be older, sicker and more economically vulnerable than other populations — and they’re more likely to have a higher number of chronic conditions, too. 3 Worse yet, with national healthcare spending reaching $4.5 trillion in 2022, patients are increasingly driven to delay or skip treatment. 4 , 5 This can potentially lead to more serious ailments down the road.

Fortunately, home care is often equipped to address these unique market pressures. Home health care frequently has positive impacts on medication adherence, quality of life and patient satisfaction. 6 There are also substantial cost savings — a key benefit in this economic landscape.

But it’s not just patients who see the value. With employment in the sector growing steadily and opportunities opening much faster than average, it seems providers have also recognized the mounting importance of this field. 7 , 8

Types of home health care

Home-based care is often divided into two categories: skilled and personal. 9 This is a reflection of the medical complexity of the job — not the objective “skill” of the providers.

• Skilled care includes wound care, injections, monitoring, caregiver education and more.
• Personal care covers assistance with daily tasks such as bathing, dressing, walking, shopping and housekeeping.

Roles in home health care

All kinds of professionals may be involved in a home care plan. These can include:

• Primary physicians, who make recommendations and help set expectations.
• Therapists , including speech and occupational therapists, who help patients regain everyday functionality.
• Medical social workers, who help coordinate home care services.
• Home health aides, who focus on supporting basic personal needs.

However, most home health care is generally provided by nurses — including registered nurses, licensed vocational nurses, nurse assistants and more.

4 challenges in home health care

In one survey, 10 different providers agreed that quality home health care requires four things:

• Competent teams.
• Communication, information flow and collaboration.
• Care continuity and organization.

Naturally, shortcomings in these areas can have serious consequences for care delivery and quality. But what do these challenges look like from a nurse’s perspective? Let’s take a look:

#1 Nurse shortages

When asked why they joined the profession, nurses overwhelmingly responded that their top motivation was helping others. Although 60% still love the job, 62% are concerned about the future of their field. 11 On top of that, 91% believe the nursing shortage is getting worse, likely due to burnout, poor working conditions and inadequate pay.

Unfortunately, research supports these concerns. 12 Nursing school enrollment isn’t growing fast enough to meet a fast-growing demand, and the schools themselves have limited resources and capacity. That’s on top of a host of concerns in the existing workforce, including:

• Increased stress levels related to insufficient staffing.
• Significant portions of the nursing workforce reaching retirement age.
• Lingering pandemic-related frustrations and issues.

#2 Job dissatisfaction

Although long work hours, highly stressful environments and emotionally difficult situations have always been a concern in nursing, these issues are only getting worse. That’s because new problems have risen to complicate matters.

For example, with nursing schools already struggling to meet increased demands, there’s limited opportunity to advance in this field. That means a nurse may feel “trapped” in one type or level of medical care — and this can lead to worries about compensation and future career prospects.

There are also ongoing concerns about internal teams. Staff shortages leave nurses feeling overworked and undersupported — and that’s a significant source of stress in any industry, let alone one where patient care and public health can suffer directly. Plus, a lack of skilled nursing mentors can make new health care providers feel uncertain, particularly in more complicated or isolated environment like home care.

On top of all that, the factors influencing job dissatisfaction differ across populations, 13 with minorities intending to leave the profession more frequently. That means there’s no single nursing experience that can act as a model for improvements or solutions.

#3 Patient preferences, expectations and concerns

From vaccine hesitancy to growing health care debts, patients have more concerns than ever — which means nurses have more concerns than ever. 14 , 15 This can lead to a variety of challenges in home health care, including:

• Health inequities.
• Communication challenges.
• Resource allocation.
• Legal and ethical concerns.

These problems can point to underlying weaknesses in the health system, including a lack of public education and trust. The issue is that nurses aren’t equipped to face these large-scale issues and can only deal with their consequences.

FAQs about home health care challenges

A home care nurse may face all of these challenges in a single workday. So, what’s the outlook for home care nursing and how can the future be improved? Here are a few FAQs that help address these topics:

Are there other challenges?

We’ve focused on broad industry challenges so far, but there’s no way to cover every single home health care challenge. Other common issues include:

• Funding shortages.
• Technology integration.
• Regulatory compliance.
• Safety and security.

That’s on top of unique challenges that arise for each individual patient, environment and scenario.

Do all providers face these challenges?

Although we explore the above issues from a home care perspective, it’s safe to say that these stories are familiar to nearly everyone who works with patients — from a family nurse practitioner to a brain surgeon. While each expert may have a unique experience and perspective, the reality is that health care is inherently complicated, particularly in the wake of a global pandemic. Fortunately, this also means that providers from different fields can work together to overcome challenges and communicate more clearly with patients.

Are there any simple solutions?

For example, nurses interested in ongoing education could try online learning until there’s more capacity at nursing schools. This can help build vital skills for a complicated work environment and even support career advancement.

Similarly, there are plenty of equipment solutions that help improve access, availability and organization. That doesn’t just support resource allocation; it also eliminates stressors like uncertainty and wasted time, which can be exacerbated by staff shortages.

How can nurses prepare for the future of home health care?

Challenges like these will continue to evolve, but nursing care can do the same. Here are a few ways to prepare for the future:

• Prioritize self-care: Nurses and other health care workers should focus on physical, mental and emotional well-being both personally and professionally.
• Learn about patients: It’s important to be aware of cultural backgrounds to provide sensitive, effective care.
• Identify problem areas: Whether independently or with a team or mentor, nurses can identify areas for improvement, including adaptability, communication, collaboration and more.
• Research trends: Health care trends help experts know what to think about and prepare for.

Better home health care with a click

Home health care nursing is an increasingly important part of our world, but it’s not without its challenges. From staff shortages to tricky patient preferences, there’s always something new to consider.

Fortunately, nurses don’t have to tackle these issues alone. McKesson solutions address nursing needs and the underlying problems — for example, SupplyManager , which supports everything from online supply ordering to customized reporting.

Make home health care easier with just a few clicks. Log into SupplyManager or learn about setting up a new account today.

https://www.cdc.gov/nchs/fastats/home-health-care.htm

https://aspe.hhs.gov/reports/covid-19-intensifies-home-care-workforce-challenges

https://pqhh.org/home-health-patient-demographics-shift-as-demand-for-home-health-surges/

https://www.cms.gov/newsroom/fact-sheets/national-health-expenditures-2022-highlights

https://www.westhealth.org/news/estimated-98-million-americans-skipped-treatments-cut-back-on-food-gas-or-utilities-to-pay-for-healthcare/

https://journals.sagepub.com/doi/10.1177/10848223211038305

https://fred.stlouisfed.org/series/CEU6562160001

https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm

https://www.ahrq.gov/talkingquality/measures/setting/long-term-care/home-health/index.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222816/

https://media.nurse.org/docs/State+of+Nursing+-+2023.pdf

https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage

https://journals.lww.com/jonajournal/abstract/2021/06000/disparities_in_nurse_job_dissatisfaction_and.5.aspx

https://www.ecdc.europa.eu/en/immunisation-vaccines/vaccine-hesitancy

https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/#Share%20of%20adults%20who%20have%20medical%20debt,%20by%20health%20status%20and%20disability%20status,%202021

• Recommended

An internal medicine doctor’s appreciation of a patient’s name

I limped into work one morning and, tired from the day which had yet to begin, paused when I did not recognize the name of my first patient. This likely meant that I saw him once, enough to—maybe—remember the basics of his health care, but not his name. If that sounded weird, it was the way my brain worked after twenty years of being a doctor.

I pulled up his chart and—yeah—I totally remember this guy. We had one visit, and the kidney disease and multiple abdominal surgeries, when put together, drew a memorable constellation. Yes, I remember all of his medical problems, but nothing—nada—about his name.

I reviewed our initial visit and cataloged how this patient had four, maybe five, major organ dysfunctions, none of which I could fix. The most obvious, but the one that lurked in the background, was his kidney function. At the time, he was in a zip code just north of dialysis. I stared at the computer, unsure of where, exactly, that left me.

My office note reminded me he had an AV fistula, prepped for the inevitable dialysis. He also had a large abdominal hernia that no sober surgeon would touch. He struggled to walk and had shiny, swollen legs, which hurt to look at. I sat behind my desk, not sure if I had the emotional strength to do something, anything, meaningful for this man. But, as I often did, I put on my white coat with the knowledge that my patients expected me to face uncertainty with them. I walked into his room and did just that.

Once seated, I was at eye level with a sullen and exhausted man, the one I remembered. I fumbled through some small talk, unsure what could be achieved at today’s visit. And, before I collected my thoughts, the patient uncorked a meandering story, one that was circuitous and hard to follow. Mind you, I had not figured out if today’s visit was a follow-up or a new problem-oriented visit. This fact did not matter as, once he gathered momentum, there was no stopping him.

A bit confused but aware that something significant had started, I pushed back from my computer and listened. I didn’t often do this, as I needed to take notes and prepare for what a patient asked of me. This interaction seemed different, and it was.

His story was not a tale of woe, something I heard every day. Intentionally or not, such a story was designed, in part, to elicit, “Oh my God, I am so sorry,” from the doctor. By the third paragraph of this particular story, or, more accurately, this recitation, it was obvious: this story was not about pity or sympathy. What was it about?

Over the next ten minutes, I received a mini-review of the life events that rendered this patient in his current state. Delivered without sadness or blame, it was refreshingly candid, and its honesty shined through the awkward delivery. The importance landed hard with me.

When I tried to clarify some things, my patient waved me off. At one point, he even said, “You need to know these things; that’s why I am telling you.” He stared hard at me, through me, the body language of shut the hell up. I received his message loud and clear—listen and understand—who I am and how I got this way.

When the thirty-minute visit was over, I had not been prescribed any medications, ordered any tests, or changed any medications. And, honestly, I had barely typed on my computer. Viewed through that lens, it was not typically what happened during my workday.

And yet, here is why I cannot stop thinking about this whole affair: he welled up with tears at various points in the story but did not actually cry. I felt a deep—no, profound—connection to this patient.

Had this story of survival and persistence ever been told to anyone else? I don’t know. But it was told to me, the internal medicine doctor who would be involved in starting and then stopping dialysis. To do this properly, I needed to employ humanity and compassion, and, more importantly, I needed to know this man. I did not expect it, but that’s exactly what happened when I shut my mouth, sat in my seat, and gave a fellow human being my attention. I learned far more than just his name, James.

Ryan McCarthy  is an internal medicine physician.

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