- The Washington Times - Monday, March 1, 2004

NEW YORK - Lillian Faden sits in a wheelchair surrounded by a doctor, a nurse and a medical student. They are monitoring her vital signs as she tells them how she feels.

She jokes through the slight discomfort of having blood drawn: “Honey, you’ve gotta put up with the good and the bad and take the bitter with the better.”

Mrs. Faden could be undergoing the treatment in a hospital or a clinic. Instead, she is at home, in her comfortable Upper East Side apartment. She tells the doctor that at times her breath is short and that she has trouble getting around, but she associates that with aging. She has no problem describing her ailments to those giving care to her.

The 88-year-old widow is receiving care through Weill Cornell Medical Center’s “House Calls” program, which brings medical care and treatment to homebound elderly patients.

“This is a much more natural environment,” said the physician, Dr. Lisa Honkanen, who said her team is able to monitor a patient’s heart, breathing, blood and bodily functions with portable equipment. “We get to see everything here.”

The program reflects the gradual return of doctors taking medical care into the homes of patients nationwide, said Constance Row, executive director of the American Academy of Homecare Physicians.

Citing government figures, she said the number of Medicare-funded home visits in 2002 had climbed about 13 percent nationwide from the mid-1990s — an uptick propelled by a 50 percent increase in Medicare reimbursement in 1998.

After many decades during which medical practitioners routinely visited patients at home, the image of the kindly doctor climbing the front steps with black bag and stethoscope had all but vanished amid the growth of medical specialties, managed care systems and sophisticated office-based ambulatory treatment.

But economics aside, those models are not always sufficient for people with chronic illness or disabling physical conditions requiring long-term care, Miss Row said.

“One pill one time is not going to fix it, and there’s a need for ongoing management,” she said.

Programs such as Weill Cornell’s have dual purposes — community outreach and training of medical students. Started in 1997, it serves about 70 homebound elderly.

The program’s founder, Dr. Veronica LoFaso, said a medical team can perform a thorough exam in the home without the patient being burdened with travel to an office, clinic or hospital.

“Family members are desperate to keep their loved ones at home,” she said. “But it’s impossible to do that if you don’t have care.”

Several New York hospitals have similar home-visit programs, which are based geographically so doctors can get to their patients easily. One of the oldest is St. Vincent Hospital’s 30-year-old “Community Medicine” program, which serves about 220 people.

“We often find that we can do a lot more in the home, and patients don’t always require hospitalizations,” said Dr. F. Russell Kellogg, a geriatrician and chairman of St. Vincent’s program. “Over the course of a person’s care, we might identify problems that would have required inpatient care that might not have been identified.”

In programs such as St. Vincent’s and Weill Cornell’s, the cost is $180 to $200 per visit. Private donations pay for what the federal and state government do not.

Similar programs exist throughout the country, operating largely the same way, and many are led by advocates for a return of home visits.

“For many, there is no ongoing medical care until they are sick enough to go to the emergency room,” said Dr. Peter Boling, professor of medicine at Virginia Commonwealth University in Richmond whose House Calls program has been running since 1984. “It makes more sense to take mobile health care providers to them.”

Dr. Thomas Cornwell, medical director of the Wheaton, Ill.-based HomeCare Physicians, agreed, saying families find it better to have their loved ones cared for — and even die — outside a hospital setting.

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