Today I spent the day with Dr Mark Nowaczynski, the founder and director of the program called “House calls”. Their mission is to provide best possible care AT HOME for older adults who are not longer mobile to go out and see their doctors.
It was a great day. We diagnosed pneumonia, followed up on treatment, adjust CHF medications, etc. But most importantly, we helped avoid a few unfortunate emergency department visits.
When you are old, not mobile or demented and you have an acute event on a chronic condition. What do you do? You can call EMS and they will bring you to the ED, best case scenario (and this is quite rare) you have a mobile family doctor or worst case scenario you will end up in a nursing home because medical care are becoming too important for home.
Mark told me a success story of his and I think this illustrate exactly why this program needs expansion and support.
A old woman in her eighties was referred to their services from the hospital because she could no longer get out of her home and needed medical attention because of her chronic CHF. She told him that in the last year, she was admitted 6 times, in 5 different hospitals for the exact same problem: CHF exacerbation. And yet, her medication was not optimized, she was still symptomatic and her functional status declined significantly. Mark did two things: simple GOOD primary care and closed monitoring. He followed her for 2 years and how many times was she admitted? NONE. And her quality of life improved significantly by simply not going to the hospital and having less symptoms.
This is an incredible story, and it is not an isolated case.
They provide care by doing good primary and secondary prevention, treatment of acute on chronic disease, and managing psychosocial issues as well. What impressed me the most was how he did all of those things with significantly less tools. He has a stethoscope and a sphygmomanometer.
“You know how we call that in home care? (while doing chest percussion on a patient) — Medical imaging!!!
Clinical skills and judgment call based on history and physical exam. That is a lost art in modern medicine. It gave me a lesson of humility.
House calls works with a non profit organization called SPRINT. They have social workers, nurses practitioner, occupational therapist and physiotherapist on board to help provide more support, home safety assessment, even food. It is again the amazing work of an interdisciplinary team.
This program also answer the needs of a population who not only can not go out and see a doctor, but they do not want to bother anybody with their problems. “I’ll sleep it off”. “Let’s wait it out”. Those ones fall into the crack of the system but they desperately need help!
My point is, I think programs like House calls is the right solution for our health care system regarding aging population! Think about it:
- Older adults stay at home (less admission to long term care, or at least, delay it as late as possible).
- They avoid most of ED visits for exacerbation or new symptoms.
- Decreased admission for acute on chronic disease.
- Increased quality of life and optimized function.
I don’t have numbers, but as you can imagine it saves a lot of money!
Simple things: Good holistic medicine at home and interdisciplinary team. I want my grandparents to have access to that. I am sure you would want it too for yours!
For more informations or to make a donation, here are a few links: