Monday, October 23, 2006

Northwest resident Etta Weaver is quick with a smile and even quicker with a kind word. Around her home, however, the 86-year-old isn’t as swift.

Age and arthritis make moving a chore, and she needs considerable care to keep various life-threatening ailments at bay.

The Washington Hospital Center’s geriatric division understands that some seniors can’t just pick up and go to see their doctors.

So the doctors come to them.

House calls may seem like a relic from another, less-paperwork-intensive age, but the hospital in Northwest hopes the visits bring comfort and dignity to seniors in their twilight years.

And, its proponents hope, save the taxpayer money in the process.

The hospital’s Medical House Calls Program began in 1999 under the guidance of Drs. George Taler and Eric De Jonge and in recent years has expanded in both staff size (17) and talent (social workers have joined the team). The program reaches roughly 150 to 170 patients a week.

Dr. De Jonge, director of geriatrics at the hospital, says the program took off with the addition of social workers.

“You need to have more than just medical staff,” he says.

The biggest obstacle remains reimbursement concerns, although the District’s Medicaid program is “very progressive” in helping assuage expenses.

Ultimately, Dr. De Jonge estimates that treating people through house calls costs $35,000 a year, but the same patient would rack up $75,000 in bills if he or she were shuttled in and out of the hospital.

Savings are a pragmatic perk to the program, but Dr. De Jonge labors toward a different set of numbers.

“Eighty percent of deaths occur in [hospitals or other] institutions in D.C.,” he says. “In our practice, it’s 25 percent.”

Each week, the program’s staff convenes in the hospital’s Trinity Square annex in Northeast to cover a variety of concerns, everything from updating staffers on the patients’ conditions to agreeing on the right background for the program’s Thanksgiving card.

The dialogue is open, frank and occasionally leavened by humor. The physicians and nurses deal with life-and-death issues, and their patients aren’t likely to mend and live another decade or two.

Recent phone calls are discussed, and so are the peculiarities of each case. The staffers not only must deal with the patients’ medical concerns, but also battle cases of denial, both with patients and their loved ones. Some seniors are lucky enough to have a number of family members to help ease their sufferings. Others have only a nephew or good friend to give them comfort.

Phrases such as “quality of life” and “dignity” pop up often without sounding like talking points.

Often the conversations take on a tightrope quality as staffers tiptoe through terminal diseases and inter-family strife. Dementia, broken hips and heart failure crop up as the conversations deepen. In the District, aging often means dealing with kidney failure and diabetes.

Occasionally, good news peeks out amid the bad, but those instances are exceptions.

Doctors in the program travel no more than a 10-mile radius from their Northeast office.

Dr. Patricia F. Harris, the hospital’s director of geriatric education, doesn’t carry an iconic doctor’s bag; she makes do instead with a modern-looking backpack.

On a recent house call to Mrs. Weaver, the patient complains of a “knot” in her right arm. Dr. Harris quickly diagnoses tendinitis and promises to return the next day with a cortisone shot to reduce swelling.

“They’re good to me,” Mrs. Weaver says while Dr. Harris rolls up the sleeve of her pink bathrobe to administer a blood pressure checkup.

The doctor often places her hand on her patients, whether it’s to reassure them or just make a connection.

The medical portion of the visit is brief. Dr. Harris asks about Mrs. Weaver’s family, and Mrs. Weaver teases the doctor about her new haircut.

Dr. Harris says hospitals in a few other cities have inquired about the program, but the District has a dubious advantage in its favor: The city has a wealth of elderly patients in need of this kind of care.

Rick Wade, senior vice president for communications with the District-based American Hospital Association, agrees that population plays a large role in whether a program like House Calls can work in a particular city.

“Not every elderly person needs the service, though many sure do,” Mr. Wade says.

Programs like the Washington Hospital Center’s aren’t commonplace, but often hospitals rally available resources to treat the elderly, Mr. Wade says. Some hospitals work with existing health agencies to find people in need and apply aid as needed.

Just finding the patients needing this kind of care can be difficult, he says.

“Sometimes the only people who may know the person is there is their pastor,” he says.

“There’s no exact model for it,” he says, adding a similar program in Norfolk helps patients by addressing potential in-home problems such as loose banisters, which could lead to falls and broken bones. He compares the actions to a younger person visiting his or her doctor for an annual checkup. It’s preventative and good common sense.

These steps save much more than money.

“You’re allowing people to live independent, dignified lives longer,” he says. “When you take a person out of their home, their health deteriorates. It can be medical or emotional health.”

Other medical institutions are taking note of the healing power of the home visit. According to the Journal of the American Medical Association, house calls to Medicaire recipients jumped 40 percent from 1998 to 2004.

Dr. Harris says the dynamic of treating patients at home carries a host of benefits.

“It’s different for a physician or nurse practitioner to go into a home. You have to recognize you’re a visitor,” she says. “The patient sets the agenda. It’s a good thing.”

In some cases, the home situation will tell her about the circumstances around a patient’s behavior or medical condition.

“It gives us insight into when a treatment might fail,” she says.

Dr. Jennifer Hayashi, director of the Elder House Call program at Johns Hopkins Bayview Medical Center in Baltimore, runs a smaller version of the District program.

“People don’t realize doctors make house calls anymore. There’s a lot of people who could benefit from us but don’t know about us,” Dr. Hayashi says.

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