By BOB MICHAELS
SCHENECTADY –“Homecare: Who Cares?” was Dr. Roberta Miller’s and Dr. David Hornick’s topic at a recent Temple Gates Brotherhood Breakfast-and-A-Speaker program. Miller and Hornick co-founded Homedical Administrative Associates, which serves homebound patients in the area.
Hornick recalled home visits by doctors in his youth, followed by an 11-year hiatus, when patients went to physicians’ offices and hospital emergency rooms. He asserted that in both those health care environments, patients often encounter infectious diseases such as flu. Getting treatment for one disease while getting sick from another is a frequent outcome, and is particularly dangerous for elderly patients.
Statistics indicate that the elderly comprise an increasing part of the population, 8.3 percent (one in 12) in 1950, expected to reach 21.6 percent (one in five) by 2050. The speaker said that the emerging role of home care therefore is motivated by the increasing size of the homebound population, and the expense of treating them as in-patients, which is about three times the expense of treating them at home, when it is feasible to do so.
New Home Design?
Hornick also discussed the “home” and the “care” components of homecare. Homes should be designed or adapted to the needs of the homebound, according to Hornick. This is the goal of the new “universal design” movement in home design, which aims to design homes to be “as usable as possible for as many potential users as possible.”
Examples include wide hallways, bathrooms that can accommodate a walker and a wheelchair, and light switches located just three feet off the floor, reachable from a wheelchair. Many injuries occur because of inappropriate home design for the homebound, such as stairs to multiple home levels.
Hospitals Fail To Cure
The “care” component aims at “cure.” No cure exists for old age, but specific conditions can be cured. Hospitals, however, often cannot, or do not, keep patients long enough to achieve cure. As a result, about one in five patients must be re-hospitalized within 30 days, and one in three within 90 days. Over half of these cases of re-hospitalization occur before the patient is seen by his/her primary care physician. In that case they do not benefit from medical care that might have prevented re-hospitalization. The incremental bill for such re-hospitalization is about $18 billion per year.
Miller described Homedical Administrative Associates as an “umbrella organization” that consists of an interdisciplinary team of health care professionals. These include physicians, dieticians, social workers, physical therapists, and others. They are linked via conferencing technology, and make use of electronic medical records that are shared. Coverage is 24/7, 365 days a year. The experience is intense, creating difficulty attracting new team members. The speakers said that the most acute shortage is mental health professionals. The two doctors who are part of the Albany Medical College faculty, therefore created a virtual training curriculum.
Access to medical care is uneven. Some areas and some populations are underserved. Miller and Hornick successfully achieved recognition of the homebound as an underserved population. Rectifying this by increasing their access to medical care has been more difficult. It was reported that agencies reward practitioners for serving underserved areas, but they do not reward service to underserved populations.
Miller and Hornick nonetheless were featured recently in a National Public Radio report about their pioneering activities in serving homebound patients.