House calls making comeback in Islands
|Video: Doctors visit elderly people at home|
By Catherine E. Toth
Advertiser Urban Honolulu Writer
By Catherine E. Toth
Palolo Chinese Home believes that a medical practice popular generations ago but little used today may hold the key to longer, healthier lives for Hawai'i's growing elderly population.
House calls were once the main way to deliver medical services, with doctors making their rounds house to house.
The practice was gradually replaced by office visits over the past 50 years as the population increased and transportation improved.
Now house calls are making a comeback.
The trend is fueled by an aging population, portable medical devices and laboratory tests, and higher reimbursements for home visits.
According to a study in the Journal of the American Medical Association, the number of Medicare house calls for the homebound elderly increased 43 percent between 1998 and 2004, to more than 2 million visits.
In January, Palolo Chinese Home launched a pilot program that brings doctors to the homes of frail elderly people in the Kaimuki and Palolo areas.
It's believed to be the first program of its kind in the state, and it has been well-received by patients and their families.
"You better believe this (service) is needed," said Dyanne Chang, of Kaimuki, whose 93-year-old father received a home visit last week. "There are so many old people. I just know so many people who would love to have a doctor come and do house calls."
Family medicine experts at the University of Hawai'i-Manoa's John A. Burns School of Medicine also like the idea.
Home visits are "the best way to take care of patients because it's patient-centered," said Dr. Neal Palafox, chairman of the medical school's Family Medicine & Community Health Department, where family medicine students have long been encouraged to visit patients at home and incorporate that into their medical practice.
"But to tell you the truth," he added, "you'll see three patients at home in an entire morning when, in the office, you could have seen 15. You see why it's a difficult proposition."
Still, with the number of elderly on the rise and hospital space at a premium, the medical community is looking for other ways to serve this segment of the population.
"Home visits will become very important as the aging population increases," said Darlene H. Nakayama, administrator at Palolo Chinese Home. "There are just not enough facilities to care for all the elderly."
MUST BE 60 OR OLDER
Palolo Chinese Home started the Hawaii Neighborhood Outreach to the Aged — HiNOA — to great interest.
Doctors have visited dozens of elderly patients in Kaimuki and Palolo so far, with more families eager to learn about the program and its services.
To qualify for these at-home doctor visits, patients must be 60 or older and live in the 96816 ZIP code, where, according to a study done by Gerontological Services Inc. in 2000, a large percentage of O'ahu's elderly live.
Hawai'i's population of older adults — those 60 and older — is growing every year, according to the state's Executive Office on Aging.
In 1980, 12 percent of the state's population was 60 or older. By 2004 that was up to 18 percent and by 2030, one in three adults in Hawai'i will be older than 60, the office estimates.
In Palolo alone, the number of adults older than 65 increased to 71,873 in 2005, up 7 percent from 67,013 in 2000.
"First of all, a lot of people don't like going to the doctor," said Dr. Patti Laurel, one of the program's doctors who specializes in geriatrics. "They're uncomfortable, nervous and anxious. ... I like going into the house and bringing back how it used to be for these older people. This is a great service for them."
Home visits are catching on elsewhere, too.
"These home visits haven't been very common until recently," said Laurel. "It's actually becoming more popular everywhere, not just in Hawai'i."
Independence Blue Cross recently implemented pilot programs in Pennsylvania, California and Florida in which doctors visit Medicare patients, offering free monthly checkups. In New York City, some doctors are making house calls to patients fed up with the traditional healthcare system and want more personalized care on their own time. There's even a company called Mobile Doctors, based in Chicago, which helps physicians make house calls.
HOME VISIT BENEFITS
There are obvious benefits to the home visits.
Doctors are able to treat patients who, for financial, physical or cultural reasons, can't visit their doctors.
They can also assess the environment in which these patients live and make recommendations or referrals to the patients and their families.
"Just by seeing the home, you get an idea of what's going on with a patient," Laurel said. "It gives you a bigger picture."
Laurel, who works at the nearby Geriatric Outpatient Clinic at Leahi Hospital, has done half a dozen home visits so far.
On Thursday she visited 93-year-old Edward Chang of Kaimuki, who complained about pain in his hip and knees.
During the hourlong visit, Laurel assessed everything from his mobility — he can stand up but not walk — to his eating habits — he drinks Ensure and eats pudding. She even looked at the lotions, soaps and detergent he was using after he complained about a rash on his arms.
Edward Chang's daughter, Dyanne, inquired about HiNOA after receiving a flier in the mail about it.
Her father's doctor doesn't make house calls, so she decided to give the program a try.
"It's hard for us to get him out of the house, mostly because of the steps," said Dyanne Chang, who lives with her parents, both 93. "I asked my internist about (the program) and she said to call. I thought, 'OK, we'll try this and we'll see.' "
Since she works full time Downtown, Dyanne Chang is unable to care for her parents during the day. She's had to hire nurse's aides to care for them while she's at work.
"I feel really comfortable now," she said. "I know who (the doctor) is and she knows the family. And she works at Leahi, which is really close by. I feel so much better now."
There are limitations to home visits.
Doctors see fewer patients on home visits than they can in their offices, and they are limited to what they can do in a home setting.
"You have to be highly motivated as a physician to make that home visit; it's easier to stay in your office," said Dr. Patricia Blanchette, chairwoman of the Department of Geriatric Medicine at UH and medical director at the Palolo Chinese Home.
This pilot program has been funded for three years. If it is as successful as officials think it can be, they hope it will attract more funding and perhaps become a model for other organizations to follow.
"I think what's luring this back is that we see the need," Blanchette said. "These people have a really hard time coming to the doctor's office. ... We'd like to see this continue because of the value there is for these patients."
Reach Catherine E. Toth at firstname.lastname@example.org.