HomeCare Options for Older Adults

1. HomeCare Options for Older Adults Delbra Caradine, MD Asst. Professor UAMS Department of Geriatrics

2. BalancedBudget Act 1997 • Limited the care to the homebound Medicare recipient • Resulted in patients falling through the cracks, increased ER visits for routine medical care • Some patients no longer had a PCP willing to sign 485(Home Health Plan of Care), therefore no PCP

3. HouseCall Program • Grew out of a need to provide access to medical care to the homebound patient who did not qualify for traditional home health, but had medical needs that required evaluation and treatment. • Start up grant from the Catholic Health Initative June, 1999 • UAMS IOA program started September 1999

4. HouseCall Program • Provide routine medical care(as in the clinic) to the frail elderly in their home (private resident,ALF, foster care resident)who have a difficult time accessing medical care • Limits costly and unnecessary ambulance trips to ER and physician office • Delays hospitalization and premature nursing home placement

5. Who Needs Homecare? • 2/3 of the patients are geriatric. Over the next 10yrs that population will double. • To quote Dr. Peter Boling: “It’s like a hurricane just off the shore. Everybody knows the population is aging, but what a lot of people don’t know is that there will be almost an epidemic of people with chronic functional impairments who will have a difficult time accessing medical care.”

6. US Census 2000 • 12.4% of population 65 and over (35 mil) • AR-14% of population 65 and over • Pulaski county 11.5% 65 and over • Population over 65 will increase by 73% between 2010 and 2030 (70 mil people or 1 out of 5 will be 65 and over)

7. US Census 2010 • More people were 65 and over in 2010 than any other previous census • Between 2000 and 2010 the population 65 and over increased at a faster rate (15.1%) than the total US pop (9.7%) • 13.0% (tot pop-308,745,538) 65 and over • AR-14.4% (tot pop-2,915,918) 65 and over • Pulaski county 13.1% (tot pop-382,748)65 and over

8. Growth is dramatic • Baby boomers (those born between 1946 and 1964) will turn 65 between 2011 and 2029 • During this time 10,000 Americans will turn 65 every day

9. Goal of HouseCall • To help the frail elderly age in place and live and die with dignity

10. HouseCall • Patient is seen on a regular basis –usually q one to two months • May be seen more often with medical justification • The patient has more control over their health care than in other settings

11. Where is the need? • 44% of hospital discharges • Between 5-10% of all patients in medical practice • 1:3 severely impaired patients cared for in home • An estimated 20% of patients over 65 have functional impairments with related homecare needs

12. Why is it necessary? • ID early new problems not found in the office • Monitor and provide direct medical care to the patient and how they response to plan of care directly • Enhances patient ability to live independently longer, limits or delay hospital/NH

13. When to start? • Patient & Family desires • Medical conditions that can be safely treated at home • Informal/professional caregiver available to meet the needs of the patient’s condition

14. Who can refer? • Anyone, but MD decides who is appropriate

15. How to Implement? • Medical care in the home is a shared effort. Team includes: patient, family/informal/professional caregiver, hospital discharge planner, community agency/case management services, home health agency staff, and physician, APN/PA

16. Helpful Resources • Making Home Care work in Your Practice-American Academy of Home Care Physicians • Making House Calls A Part of Your Practice-American Academy of Home Care Physicians • Medical Management of the Home Care Patient: Guidelines for Physicians by American Medical Association • US Census