29 October 2010

Is Home Health Care an Option?

What do you think of when someone mentions home health care? I think of private nurses making rounds at individual homes in an area, a person living with an elderly person and taking care of them. Hospice is another area that comes to mind. I was not expecting doctors or physicians making house calls. I have been waiting for the day when internet videoconferencing allowing virtual visits from patients homes. I am surprised that this is being given a trial.

At many places around the country, different trial balloons are being tried for in-home care of acutely ill patients. Much of this seems to be happening as a result of The Independence at Home Act that was included as part of the Affordable Care Act passed recently. This sounds like something that is good for the older generations that will have difficulties making frequent trips to a doctors.

While this does not assure that all doctors are on board with this, some (hundreds) of U.S. Physicians are backing the home-based care. Most of these doctors are now members of the American Academy of Home Care Physicians. I am surprised that this organization had been around since 1984 and in some form has been serving acutely patients in their homes.

A new version of the black bag used by physicians in San Diego, California includes a mobile x-ray machine and a device that can preform over twenty lab tests at the point of care. Engineering and electronics companies are developing products for monitoring health at home.

The following factors are believed to be driving health care out of the hospitals and back into the home.
  • the aging of the U.S. population,
  • epidemics of chronic diseases,
  • technological advances,
  • health care consumerism,
  • escalating health care costs. 
The process of bringing the black bag and doctors into homes again, may take decades or years depending on the Washington political climate. Also the Federal Medicare program will need retooling and open to the home based medical venue. Many doctors, nurses, and other medical specialists will need retraining to become familiar with the aspects of in-home health care. The prospect of in-home care is in its infancy, and has a long way to go.

Hospitals will not want this to happen, and many physician clinics will oppose in-home care. There will probably be some starts and stops, but once this gets traction, some medical practices and hospitals may well find that their doors must close permanently.

Almost all the abstract was available, but it has now been severely limited on NEMJ.

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