- The Washington Times - Tuesday, July 8, 2003

Ruth Mitchell grins as her doctor walks into her kitchen and spots her, a recovering stroke victim, faithfully following his prescription: raisin bran for breakfast.

“That’s great,” Dr. Eric De Jonge says as he wheels in his black bag, loaded not just with stethoscopes and shots, but also with miniature modern gadgets usually seen only in hospitals: a beeperlike pulse oximeter to measure the oxygen in Mrs. Mitchell’s blood, analyzers for on-the-spot blood testing, and a plate-sized echocardiogram machine.

Dr. De Jonge and a team of geriatricians and nurse practitioners are bringing old-fashioned house calls with a modern twist to impoverished streets in the Washington area — targeting the hardest-to-treat Medicare patients, those with multiple chronic illnesses who can’t or won’t visit a doctor until they are so sick that they show up at emergency rooms.

The doctor’s records show that regular health care in these patients’ homes cuts expensive hospital stays and helps stroke victims such as Mrs. Mitchell stay out of even more costly nursing homes.

It’s a small but growing movement: Roughly 700 doctors around the country offer at least some house calls, according to the American Academy of Home Care Physicians. They include businesses that offer the wealthy convenience for an extra fee and doctors who say the huge needs of frail seniors can’t be met during a 20-minute office visit, even if homebound patients can get there.

Such elder care is still rare; Medicare pays for about 1.5 million house calls a year. More rare are comprehensive programs such as Dr. De Jonge’s that bring special services — speech therapists, social workers to arrange Medicaid-funded aid, and portable X-ray and echocardiogram machines — into the living room any time of day.

Medicare is a federal program that pays for health care for the elderly, and Medicaid pays for health care for the poor.

“It’s difficult financially for physicians to do this, and many have never been trained” to do house calls, says Constance Row, executive director of the American Academy of Home Care Physicians.

But Dr. De Jonge and Dr. George Taler say the Medical House Call program they co-founded at Washington Hospital Center shows that home care can be financially doable, even cost-saving, by better treating the 5 percent of Medicare patients who account for more than half the government program’s spending.

Preventing one emergency-room visit, usually $2,000, can offset a year of Medicare-paid house calls for that patient, typically 16 house calls at $100 apiece, Dr. Taler says. When patients need hospitalization, they are admitted to the geriatric wing, where the two doctors care for inpatients. Records of the 410 enrolled patients show that the program has cut the average hospital stay by almost three days.

It’s not easy. Despite no rent and the hospital’s backing, the doctors needed grants to start the program in 1999, and it took three years to break even. But they are training health workers to copy the system; one has begun in Cincinnati, and another starts this month in New York’s Harlem.

“This is for people who have a passion for the frail elderly,” says Dr. De Jonge, who calls the long-term relationships formed during his hourlong house calls more fulfilling than office-based medicine.

Going to patients’ homes lets health workers see preventable problems they otherwise would never know about and teach caregivers to cope.

Take 94-year-old Magnolia Gordon, recuperating from a broken leg. Nurse practitioner Jan Goldberg enters her hot living room and immediately notices that Mrs. Gordon’s mouth is dry, an early sign of dehydration.

Mrs. Gordon is so sensitive to cold that she won’t run her air conditioner. The nurse practitioner gently tells her to run it at least a little each day and to drink more water, because life-threatening dehydration can hit the elderly swiftly. Then she spots brewing bed sores on Mrs. Gordon’s heels and promises to send over a pressure-easing cushion.

Mrs. Gordon had not seen a doctor in 25 years until she broke a hip in March 2002. Patched up and sent home, she refused to move in with her daughter, who could neither quit her job to provide full-time care nor afford a home nurse.

Then someone suggested the house-call program. First, social worker Jenna Green won Mrs. Gordon a Medicaid waiver, available for certain low-income seniors, so she could hire a part-time health aide and avoid a nursing home. Another fall required a hospital trip for a broken leg, but other ailments — an arm infection, a minor fall one Saturday morning — were treated at home.

“It has been a life raft for me,” says Mrs. Gordon’s daughter, Sandra Armstrong.

Across town, 82-year-old Mrs. Mitchell totters to the couch, where Dr. De Jonge waits to examine her. She is eating better, and the blood pressure that caused a recent stroke is significantly better, the doctor sees as he spells out a medication change to her husband.

The stroke damaged her vocal cords, and she painstakingly whispers, “When am I going to be well?”

Dr. De Jonge squeezes her hand. “You may not get to run down Georgia Avenue by yourself, but you’ll get to walking better and eating better.”

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