What follows is a patient story that illustrates how our typical interaction with a patient, social service agencies, and the community, as a whole, yields obvious value for the patient and for our health care system. Just like this case, we are able to decrease human suffering, expensive hospitalization, and the use of emergency services.
House Call Program
The House Call Program is a key component of the division of the GW Geriatrics and Palliative Medicine division. There are 6.1 million people over the age of 85 in the United States and their ranks are expected to double by 2030. About two-thirds of these seniors are homebound and do not receive routine healthcare, unless there is a program in their community like the House Call Program at The GW Medical Faculty Associates. Medicare reimbursement does not sustain the House Call program and the program maintains a lengthy waiting list of patients in need of care. The GW Medical Faculty Associates relies on the support of generous donors to sustain and grow this program to meet the needs of this vulnerable population in the Washington, DC community.
The home-based services we provide include:
- Preventive health care
- Diagnosis and treatment of medical conditions
- Prescription of medications, with an emphasis on safety and affordability
- Support to family members and other caregivers
- Referrals for rehabilitation
- Assistance with practical needs, including wheelchairs
- Pain management
- Comprehensive, patient-centered end-of-life care for the terminally ill
THERE IS A WAITING LIST FOR OUR SERVICES.
Supporting Our Future Plans
Some of our current funding priorities:
- Pay for social work services
- Increase service capacity through start-up funds for new nurse practitioners with seed money
- Evaluation and research on economic and clinical outcomes of our care
- Hardware and communications to help implement a wireless and portable Electronic Medical Record
- Resources to support establishing partnerships with senior housing
- Support education time and curricular development for the learners on our team
If you would like to find out more about how you can support our continuing work, please call the Office of Medical Center Development at (202) 994-7511. We also welcome all donations via Friends of the MFA.
About the Program
The GW Medical Faculty Associates Medical House Call Program provides personalized, home-based primary and end-of life care to men and women with complex and serious illnesses. We coordinate care with a range of health professionals in the hospital and home setting, working closely with home care, visiting nurse, community, and hospice agencies. We are available by phone 24 hours a day, seven days a week, and our health care providers will respond to requests for emergency visits.
Why Home Visits Make Sense for Homebound Patients
Many homebound patients are never seen by their primary care physicians, despite being chronically ill with multiple symptoms. In contrast, many nursing home patients have similar functional deficits and see a physician an average of eight times each year. Ambulatory patients with chronic illnesses see their physicians eleven times a year. These fragile patients often are invisible to the health care system until they are very ill and require hospitalization. One home visit to a person with chronic illness and a heavy symptom burden can shed light on the patient’s home environment, values, family life, and safety. That visit improves the physician’s ability to provide routine and palliative care.
Many of our patients have limited life expectancies. Likely to die soon, they need delicate and clinically sophisticated end-of-life care and medical counseling about treatment options. These patients benefit from greater physician contact. If a patient wishes to die at home, physician home visits, in combination with hospice care, may be the only way to achieve this goal.
We know that medical house call programs improve the continuity of care between the home and the hospital, provide support and education to families or caregivers, and provide linkage to a broad range of social and supportive services in the community. Home visits alleviate suffering, reduce stress for caregivers, and avert costly trips to the emergency department.
In order to meet the needs of this population now and in the future, The GW Medical Faculty Associates initiated the Medical House Call Program in 2003. Since then, our physicians and staff have provided hands-on, high quality, medical care to hundreds of men and women with complex and serious illnesses who have difficulty leaving their homes, regardless of their ability to pay. Our mission is two-fold:
First, we seek to improve the quality of life of the homebound and frail elderly, as well as their caregivers. Second, we train the next generation of physicians about the complex needs of this forgotten population.
At the same time, there are only 7,600 certified geriatricians in the United States with an estimated need of 21,000 currently, and 36,000 by 2030. The number of individuals in US geriatric training programs has declined over the last few years. Many older patients are being cared for by doctors and others with little or no experience in the field of aging. These physicians may not know that prescription medications, for instance, are metabolized differently by the aging body.
The Growing Need for Home-Based Primary Care in the U.S.
In the United States, we have more than 36 million people age 65 and older—accounting for just over 12 percent of the total population. It is estimated that, in 2030, 20 per cent of the US population will be 65 and older. For the frailest of our aging population—the frail elderly and the homebound—the District of Columbia has the highest health care costs and its poorest outcomes. The costs associated with caring for these individuals are staggering.
- Our Teaching Role
Home Care Education in Washington, DC
Each year, The GW MFA Division of Geriatrics & Palliative Medicine trains five geriatrics fellows, over twenty-five residents, and as many medical and physician assistant students. Each of these learners accompanies a provider on visits to evaluate the frail elderly and homebound in the Medical House Call Program. Sometimes the learners help with the history and examination in consultation with a faculty member. These are highly valued experiences for our learners.
In surveys of medical students, their home visits to elderly patients are some of the most memorable experiences of their education. For our residents usually immersed in the world of hospital medicine, these experiences give them profound insight into the lives of their frail elderly patients and their families that will make them more effective physicians for the elderly. By observing and giving medical care to patients in their homes, trainees gain valuable perspective and an appreciation of the many medical, social, economic, and emotional challenges patients and their families face. Curricula in elder abuse, assistive devices, palliative care and literature & medicine supplement the trainees’ education in home care.
To qualify for The GW Medical Faculty Associates House Call program, patients must:
Live in one of these D.C. zip codes: 20016, 20015, 20007, 20008, 20037 Be 60 years or older and have difficulty getting to the doctor's office
THERE IS A WAITING LIST FOR OUR SERVICES.
If you are currently under the care of another doctor, please ask them about whether home-based primary care might be best for you.