There are 13 clocks in the room but it feels like time is standing still.
An 81-year-old woman with snowy hair and paper-thin skin lies on a bed in what must once have been a dining room in the living room of a home in Cuyahoga Falls, Ohio. Her 76-year-old husband walks to her side and strokes her hair.
Dr. Kevin Miller gulps. After all, not too many young medical residents come face to face with such reality. But a squeaky-clean doctor’s office is not usually the place where domestic dramas are acted out.
That is the very purpose of a joint program between Cuyahoga Falls General Hospital’s community home care and its family practice residency program–to inject reality into the practice of medicine. Under the program, the residents accompany a physician into the homes of housebound elderly patients.
Dr. Leroy LeFever, director of the family practice residency program, takes a different resident on his house visits each week. They are accompanied by nurse Linda Walker, who runs the community home care program. The residents also visit the patients on their own.
“It lets the residents see what people have to contend with,” LeFever says. “It’s practicing more than medicine. It’s social service, counseling, listening, coming up with financial alternatives.”
Dr. Mark Belfer, associate professor of clinical medicine at Northeastern Ohio Universities College of Medicine, says the need for house calls is greater because hospitals are now discharging patients earlier. Many patients go home still sick, making follow-up care vital.
Being in the patient’s home can give a doctor important information.
“If a patient is falling constantly, we want to see what the home safety is like,” Belfer says. “We may be able to advise them on a different living arrangement.”
Carol Bojanowski, a geriatric nurse specialist at Summa Health System, says there are doctors who routinely order items like a raised toilet seat or a bathtub seat but have no idea what these look like. They also do not realize how often elderly patients misplace or forget to take their medicine.
Summa has a house call program similar to the Cuyahoga Falls program. Each program has about 12 elderly patients.
But because Summa does not bill Medicare for the visits, its residents do not have to be accompanied by a supervising physician. And unlike the Falls program, Summa’s accepts only those patients who are already enrolled in their internal medicine clinic. The Falls program accepts outside referrals.
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Miller, for one, is glad to be part of the Cuyahoga Falls teaching program. “Medicine has become depersonalized. This is going back to say, `We do care,’ ” he says.
The program also provides medical help to people who otherwise would not have access to a doctor.
Take Joanna Moses, 81, of Cuyahoga Falls, for instance. After the woman suffered a massive stroke at an area nursing home last February, her husband brought her back home.
Most doctors mandate that their patients come in at least once a year to get their medicines renewed.
But with his wife in such fragile shape, Bill Moses’ only option would be to hire a non-emergency ambulance to transport her to the doctor’s office. The trip can cost an average of $500 — an expense that Medicare will not cover.
Most doctors today are reluctant to make house calls because of the time involved. A doctor can see several more patients–and earn much more money–in the time it would take to visit one housebound patient.
Medicare, for instance, pays $150 for house calls by a physician. So there is little incentive for doctors to make visits.
But commercial agencies with doctors on their payrolls are getting into the act. These agencies provide a roster of doctors who only make house calls.
LeFever, who had a private family practice for 30 years, says he used to make house calls as part of his practice. He hopes his residents will follow his lead.
“I have a fear that instead of family doctors doing this as part of taking care of the family, it will be taken over by commercial institutions. They’re fulfilling a need doctors aren’t fulfilling. It’s not all bad. But it’s something family doctors should be doing. I’m hoping I’ll inspire these residents to do that.”
At the Moses home, LeFever stays in the background while Miller listens to the woman’s lungs, checks for bedsores and reviews her medications.
Moses is determined to care for his wife at home and Miller empathizes. “I can see why he’d want to have her in the home. If we can help with that, I think it is very feasible.”
LeFever also spends some time with the emotionally distraught man. “I want to assure you I’ll be there,” he says quietly. “I’ll come out every time, any time, to answer a question, if that’s all it is.”