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