WASHINGTON – Viola Croxton moved into her uncle Floyd’s Northeast D.C. home three years ago. At 92, Floyd Chapman’s dementia and chronic obstructive pulmonary disease required around-the-clock care and assistance.
For a year and a half, Croxton took her uncle, who has lived in D.C. since 1944, to all of his medical appointments. She filled his prescriptions and took care of the house.
But like many who care for an older family member, the stress of juggling her uncle’s life and health with hers began to accumulate.
“There were times when I would just come home and crash, because of going to work and (caring for) my uncle,” says Croxton, who works part-time as a crisis center director at her church.
Then, an accident prompted Croxton to find a more sustainable solution for her uncle’s care. When helping him into the car for a medical appointment, he fell and she was unable to help him up.
“At that point, I knew that I couldn’t do this by myself,” she says.
Determined to uphold a promise to her aunt, Croxton sought alternatives to a nursing home and decided to enroll Chapman in MedStar Washington Hospital Center’s Medical House Call Program.
Now, all of the care Chapman requires is delivered in his home by a team of doctors and health professionals. For Chapman and other patients in the program, the care is paid for by Medicare.
“They make sure that he is very well taken care of,” Croxton says.
Treating Patients in the Home
Dr. Eric De Jonge is the director of geriatrics at MedStar Washington Hospital Center and co-founder of the Medical House Call Program, which began in 1999 and serves eight ZIP codes in Washington, D.C.
He and a growing team of about 22 doctors and health professionals treat roughly 600 patients in the program.
According to De Jonge, the patients receiving house calls are low-income, have severe chronic illnesses and difficulty leaving the house.
“We’re kind of flipping the health care system a little on its head and we’re delivering care in a mobile way to patients who have trouble getting to the doctor’s office,” De Jonge explains.
In addition to easing the burden on the patients and their caregivers, providing care in the home is something that helps the doctors treat each patient’s unique condition.
“When you visit them in the home, you see the environment in which they’re living. And it turns out the home environment has a great impact on their health, their safety, their risk of falling,” De Jonge says.
“If they come to the office, you miss out on almost all of that. They come in on a stretcher or in a wheelchair, you try to get them up on an examining table, which is hard for them, they may not have their medication bottles with them. You don’t see the whole issues of the social or physical environment in which they live.”
Traveling to the patient also allows for different medical specialists — including physical therapists, occupational therapists and a geriatrician, among others — to assess each patient’s needs for care.
“It’s really hard for a doctor, by himself, to manage all of these disciplines of care,” De Jonge says.
Croxton says keeping her uncle home for his appointments enhances his care, and also his disposition.
“The house surroundings are great for him. He doesn’t have to worry about pictures in his room. He can be here, in the home, and in the home is where he needs to be,” she says.
The Financial Benefits of Home Care
Patients and caregivers are not the only parties to benefit from home health programs like the Medical House Call Program.
According to De Jonge, the percentage of the Medicare population in need of such highly attentive care is roughly 5 percent. However, this population makes up approximately 50 percent of the Medicare budget.
“If we can do urgent visits and a lot of 24/7 phone availability, we prevent (patients) from coming to the emergency room and the hospital,” says De Jonge, who adds that every hospitalization for these patients, on average, costs Medicare $10,000.
De Jonge estimates the program saves Medicare 10 to 20 percent each year and probably offsets Medicaid costs as well, since the house call program is, for many, an alternative to nursing home care.
However, that cost savings is not something Washington Hospital Center sees just yet. The program currently operates at a loss, but continues due to financial support from the hospital.
“We’re doing, I think, the right thing, taking care of the folks in the home, but until we really share in the savings, it’s hard for it to be a long-term business plan,” De Jonge says.
The Future of At-Home Care
Included in the Affordable Care Act is a demonstration program called Independence at Home, which tests the house-call model in about 17 sites around the country, including the model at Washington Hospital Center.
De Jonge says he should find out in spring 2014 if his model is one that could be adapted for its health and financial benefits on a larger scale. However, calculating the program’s predicted costs and savings is difficult.
“What would their care have been like if we didn’t exist, how do you predict what those costs would be?” he asks, outlining a few considerations in the overall evaluation.
If the Medical House Call program doesn’t demonstrate obvious savings in this trial, De Jonge says he still plans to keep it up and running for the foreseeable future.
Potentially, the program also could expand to include a higher-income population, incorporating a private pay component to offset the costs not reimbursed by Medicare.
“You combine that so you can serve a population of all incomes and make it a financially viable business,” he says.
For Croxton, the benefits and savings of the Medical House Call Program were immediate.
Home care “does cut into a person’s lifestyle. It makes a person feel that, although they’re taking care of a loved one, that they don’t have as much time as they would have for themselves. And it can be quite challenging at some points,” she says.
“I want him to be as vibrant as he possibly can through his years.”
For Croxton, having her uncle spend his last years at home helps her wish become a reality.