There is No Place Like Home for Elderly Patients



In 2007, it has been identified that approximately 80% of American elders live with at least one chronic disease, 50% of whom are suffering from two unceasing diseases. Because of old age, most of elderly are experiencing difficulties in accessing different health care services that could provide medical treatment for their sickness or disease. The high cost of medical treatment, inaccessibility of transportation, socio-cultural status, and structural considerations are among the factors which affect the old population’s preference for hospital treatment. With the existence of house call services providers, these problems are being addressed. Most patients and medical practitioners perceived house call services positively. Relevant studies conducted show that home visits of physicians and nurses to frail elder patients reduced mortality, shortened length of stay in hospital, decreased hospitalization occurrences, and improved patients’ medication and health management. This paper attempts to analyze the effectiveness and efficiency of house call services in curing elderly patients. It also attempts to provide recommendations that would improve house calls services and accessibility.












There is No Place Like Home for Elderly Patients:

A Critical Analysis of Improved Healthcare Outcomes Achieved via House calls

The Beginnings of House Calls

House calls are done by medical practitioners wherein they pay a visit for patients at home to provide medical care. The beginnings of vocation and service can be traced back to the late 1980s. Home care made a significant change in the living condition of the marginalized group of society which includes neglected children, women, and senior adults. Through the latter period of 1990s home care institutions flourish in many states of America. Leff and Burton (2001) identified that the budget being spent in home care, as a component of Medicare, relatively increased with approximately 20% per year. As identified the home care budget was at $3.5 billion in 1989 and rose to $19 billion by 1997 (Leff & Burton, 2001). During the late 1980s house calls in the United States accounted for only 0.6% of all physician-patient encounters. It is then surprising that nowadays, house calls already account for approximately 40% of physician-patient encounters (Leff & Burton, 2001). One of the reasons cited for the increasing number of house calls is related to technological breakthroughs in the field of medicine. The medical technologies such as radiography, pulse oximeters, intravenous infusion technology, ultrasound, ventilators, feeding pumps, hand-held blood analysis devices, and others that are once found only in hospitals are now finding their way to U.S. homes thus expanding the capabilities of house calls and increasing the competence of medical professionals to provide quality care in the patients at home (Leff & Burton, 2001).

Meanwhile, in European countries, the rate of house calls decreased form 15.8 per 100 persons in 1997 to 7.7 in 2007 accounting for 51% estimate. Most of the patients relying on house calls in 2007 are elderly aged 65 years and over (60%) where 22% are aged 85 years and above (Piterman, 2008). In Greece, physicians performed approximately 98,009 house calls during the years of 2000 to 2005. Majority of the patients are elderly aged 65 years and above which accounted to 47.8% of the house calls patients wherein majority of those (27.0%) are aged 76 to 90 (Peppas, Theocharis, Karveli & Falagas, 2006).

Who Does House Calls?

It has been identified that although the physicians are the ones who initiated the house call services, nurses, home health aides and therapists are the one doing the house call nowadays.  Meyer (1997), in an analysis of Medicare claims data in 1997, estimated that in 1993 there were approximately 727,000 physician house calls received by Medicare beneficiaries around the country (cited in Leff & Burton, 2001, p. 2). While the figures appear big, they account for only 1% of Medicare beneficiaries. Yet, most of the patients for physician house calls are those with chronic diseases and those who are nearly dying.

The Elders and their Health Conditions

The Centers for Disease Control and Prevention (CDC) and The Merck Company Foundation (2007) identified that in 2007 approximately 80% of American elders live with minimum of  one chronic illness among which 50% are suffering from two unceasing diseases. Among the chronic diseases associated with aging are high blood pressure, arthritis, hearth disease, cancer, diabetes and stroke which limit the seniors to their daily activities and thus reducing their health-related quality of life. Approximately 95% of health care expenses are being use for curing chronic diseases among older adults (CDC & The Merck Company Foundation, 2007).

Meanwhile, Schappert, and Rechtsteiner (2008), in their research study entitled “Ambulatory Medical Care Utilization Estimates for 2006,” found that the number of patient’s visits to medical clinics, hospitals and emergency departments rose by 26% compared to medical visits ten years ago. The increase was then linked to the older population who often pay hospital visits concerning the sickness associated with aging. Furthermore, the rate of hospital admission of patients with age 65 years and above had increased to 38% in 2006 from 20% in 1970. In the same time period, the rate of admissions of patients aged 75 and above rose from nine percent to more than 24% (Schappert & Rechtsteiner, 2008).

Cost of Treatment

With regard to treatment for the elderly, in 2005, it was estimated that more than half of medical spending for adults are for curing of chronic diseases. Among older Americans, more than 90% of health care expenditures are spent for curing chronic diseases. An estimated cost of $1,064 is being spent for caring for elders who are suffering from one chronic condition. For elders with two or more chronic illness the cost of medical treatment is estimated at $6,000 per patient. “People with concurrent chronic conditions spend nearly three times as much on treatment of acute conditions compared to people who are not suffering from any chronic disease” (CDC & The Merck Company Foundation, 2007). Medicare spending has increased approximately nine percent from 1980 with recorded medical expenses of $37 billion to 2005 with recorded spending of $336 billion (CDC & The Merck Company Foundation, 2007).

Problems Being Encountered by Senior Citizens Regarding Health Care

Cost appears to be one of the major factors associated with lack of access to health care. From 1995 to 1997, more than 11% of Medicare beneficiaries reported delaying care due to the expensive cost of medical treatments. Since treatment of any disease requires spending, many American elders are being discouraged by high expenses of medical treatment which in turn prevents them from paying medical visits to physician’s office and hospitals. As Cawthorne (2008) wrote, “High medical bills for the elderly can greatly reduce the income available to meet their other needs” (p.1). This is true because adults aged 65 and above, after retirement, have limited financial resources whereas medical spending for adults aged 55 to 64 is double of the amount being spent by adults aged 35 to 44. Thus, medical expenditures of adults aged 65 and above could be trice the amount being paid by people aged 35 to 44 (Cawthorne, 2008). Such cost for medical treatment is relatively high for senior citizens particularly for those who are living below the poverty line. In addition, lack of health care insurance and inadequacy of other health insurance dispirit elders to visit the health care providers (Florida Department of Health, 2008).

Another major barrier to accessing medical care being experienced by senior community concerns with the availability and accessibility of transportation. Cawthorne (2008) noted that approximately only 50% of American adults aged 65 and above have access to public transportation. Thus, half of the senior population is encountering difficulties and additional burden of going to the healthcare providers offices due to inconvenience of transportation. Apparently, the senior people who do not drive and does lots of commuting are estimated to take more or less 310 million trips per year (Cawthorne, 2008).

Other factors affecting the access to health care include socio-cultural factors such as cultural and spiritual beliefs, ethnicity and race, immigration status, educational attainment, language barriers (e.g. English proficiency), and concerns with confidentiality. Moreover, structural factors which relate to physical accessibility of health care facilities and resources inhibit the elders to go to hospitals or physician’s clinics. These factors include concerns with the availability medical specialist and healthcare professionals, health care facilities and primary care providers (Graves, 2008).

It has been accounted that the key to achieving improved health care outcomes for the elderly is to effectively manage their chronic diseases which in turn reduces possible exacerbations and prevents patients from acquiring permanent disability. The medical expense of senior citizens with well-controlled chronic illness is relatively less as compare to elders suffering from such disease. This is because well-controlled chronic illness requires short term hospitalizations and treatments. While this concept seems undeviating in theory, the reality remains: that senior community faces multiple barriers in accessing to health care which then affects the process of treatment being address to elders particularly the continuity of care that they receive.

Statement of the Problem

House call is perceived by many patients as one of the important and accessible services of health care providers, yet the supply (medical practitioners and facilities) and the demand (patients’ consultation) for house call service are continuously fluctuating such that there are periods when the supply and demand for this service are high, but there are also times when the supply and demand are low. The different factors that may affect this trend have been identified. Thus, for the objective of this paper, the research principle was focused on analyzing the effectiveness and efficiency of house call services. Hence, this paper aims to answer the problem: Do medical house calls provide better health outcomes than traditional care for the elderly population?

Theoretical Perspective on Health Care for the Elders

To be able to analyze the effectiveness and efficiency of the house call services for the senior community, this research must be guided by certain theories and frameworks. As for this paper, nursing theories were used such that these theories and frameworks serve as guide medical professionals in their education, research and practice. Theories and frameworks help nurses in practice to illustrate, predict and explain everyday event and phenomena. Nursing theories and frameworks also serve as guide in conducting assessment intervention and evaluation of nursing care. There are numbers of theorists who have made important contributions to the improvement of knowledge in nursing discipline. Much of their perspectives and standpoint have contributed to the entire health care profession. Among these theorists are Florence Nightingale and Jean Watson, whose theories serve as great practice foundations in the field of house calls.

One of the most important contributions of Florence Nightingale in the theories of nursing is related to addressing the professional nursing services in workhouse infirmary. Nightingale perceived that if nurses could show and practice proper caring to patients in workhouses then the possibility of reducing and preventing illness could be observed. Nightingale’s focus is merely on the nursing practices in hospitals and home care rather than on the diseases. She emphasized the significance of environment for the person’s well being (Nightingale & Barnum, 1992).

Nightingale viewed disease as a condition which can be repaired. She portrayed the role of nurses as “manipulating the environment to facilitate and encourage the reparative process of disease” (Nightingale & Barnum, 1992). Nightingale believed that the condition of the “environment is critical to health, thus the nurse’s role in caring for the sick is to provide a clean, quiet, peaceful environment to promote healing” (Nightingale & Barnum, 1992). Similarly, the goal of house call providers is to promote the reparative process of disease in elders. This is done by providing senior community a house call treatment that supports home environment which in turn contributes health and wellness.

Jean Watson shares the same perspective. In Watson’s (1999) Theory of Human Caring, she emphasized that the focus of nursing practices lies on giving proper care to patients. As she put it,

“The process of human care for individuals, families, and groups is a major focus for nursing not only because of the dynamic human-to-human transactions, but because of the requirements of knowledge, commitment and human values, and because of the personal, social, and moral engagement of the nurse in time and space.” (Watson, 1999)

Watson’s (1999) holistic perspective rests on patient care and on the belief that many aspects of patients’ lives contribute to their overall health status. Human care process and human-to-human transactions require personal, social, moral, and spiritual engagement of the nurse which is then perceived important in the area of complex technological health care systems. This view is then consistent with the house call providers’ belief about providing health care in the person’s own environment.  The house call experiences play large role in promoting improved lifestyle behaviors and increased self-awareness which then leads to improved health outcomes.

Another theory of importance is Rosemarie Rizza Parse’s (1987) Human Becoming Theory. There are two world perspectives involved in this theory. One is that human being is a combination of bio-psychosocial-spiritual aspects that interacts with and adapts to his internal and external environment. Second is that individuals are open being. He is free to choose and has mutual interchanges with the environment. Parse’s theory has three assumptions. First is that “struggling to live goals discloses the significance of the situation” (Parse, 1987). Example of this is the considerations (thoughts and feelings) being discuss when members of the family are choosing a nursing home for their parent.  Second is that “creating anew shows one’s cherished beliefs and leads in a directional movement” (Parse, 1987). Here, as families delineate the considerations and alternatives of choosing nursing home, consistent or conflicting values may arise from each member. Lastly, “changing views emerge in speaking and moving with others” (Parse, 1987). As members of the family evolve in discussing the alternative, they may shift to adapting it instead of the original solution. With these assumptions, we may find that the goal of nursing in the theory of human becoming is to ensure the quality of life of the patient or client and his family (Johnson & Webber, 2005).

In getting house call services, most members of the households are dealing with different considerations and alternatives that would benefit the elders. Most of these considerations are related to accessibility, efficiency and effectiveness of the house call service. Using the perspective of the three nursing theories, the claims of this paper rest on the following assumptions: 1.) that house call services provide better environment for the elders since medication is being done at home; 2.) human care provided by home care services is much better than those provided in hospitals and clinics such that physicians and nurses are more focused on their elder patients where human-to-human interaction serves as additional medicine for curing the disease; and 3.) elders and their families have many considerations upon getting a house call service, but a house call, by providing nurse and physician care, ensures the quality of life of the elder patients and their family.

Specific Search Strategy of Evidence

To validate the assumptions of this paper and to provide answer on the guiding question: “Do medical house calls provide better health outcomes than traditional care for the elderly population,” a systematic review of the following databases was conducted: PUBMED, MEDLINE, The Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The review was focused on journals measuring the efficiency and effectiveness of house call services. To be more specific, only studies focusing on the elders were selected. The researcher evaluated the context of decreased hospitalizations and reduced exacerbations of chronic conditions being experienced by aged population. Moreover, additional citations and articles were utilized and reviewed to determine if the body of evidence in the above mentioned publications is consistent with the premise of house calls which is to improve the outcomes of senior community.

Review of Literature

To be guided in the objective of this paper, a total of seven articles were retrieved for the review. Four of the articles provide an overview of the pilot studies which were conducted to assess effectiveness of the house calls. Population sample for the selected studies are individuals aged 60 and above. These studies analyzed the house call programs that are geared in reducing exacerbation of chronic illnesses of a certain population by providing quality health care interventions at home. In addition, these pilot studies evaluated whether health care outcomes of elder patients were improved as a result of providing health care services through house calls. Meanwhile, one retrieved article held a systematic review which assesses the impact of preventive house calls to the elderly. Another article was a systematic review and meta-analysis which evaluated the effectiveness of house calls programs that offers preventive care and health promotion to older people. The last article enclosed a systematic review and meta-regression analysis which evaluated the impact of preventive house calls on nursing home admission, mortality and functional status of elderly population. Summary of these reviews is presented in the table below.

Table 1 Synthesis Table of Research Studies used in Review

Research Aim
Other Characteristics
AHRQ Health Care, 2008
Pilot Study
To identify and treat potential medical and social problems early and avoid the need for costly hospital, emergency, or institutional care.
Individuals 60 years and older who live in Washington, DC, in one of eight zip codes near the Washington Hospital Center who were experiencing difficulties in getting to doctor’s offices because of physical, social, or mental limitations.
Two interdisciplinary teams care for about 600 patients. Each team consists of two geriatricians, two geriatric nurse practitioners, one geriatric social worker, and two office staff. Each nurse practitioner makes 30 to 35 house calls a week, while each physician makes 15 to 20 per week. The House Call geriatricians share on-call duty and are available 24/7 through phone for urgent events.
The House Call team successfully reduced patients’ use of emergency care, hospitalizations and nursing home placements. Target population achieved shorter length of stay when subjected to hospitalizations.

Anetzberger, et al., 2006
Pilot Study
The aim of this study was to evaluate VNA House Calls of Greater Cleveland, Ohio during its first year of operation.
The program targeted high-risk older adults where teams of advanced practice nurses and physicians provided house calls.
Data collection techniques included clinical record review (N = 139), mailed referral source satisfaction survey, and both mailed and telephone interview patient satisfaction surveys.
VNA House Calls helped in preventing functional decline and had reduced patients’ occurrence of hospitalization.
Results show that the typical patient served by VNA House Calls were homebound women in advanced old age, with regular family contact, suffering from physical and mental disorders.
Clinical Resource Manager, 2000
Pilot Study
To reduce hospital readmissions of elderly patients with chronic diseases
Elderly patients who were recently discharged from the hospital.
Medical residents visited vulnerable elderly at home
The program cut readmissions occurrences within one week from 53% in May 1999 to 16% in May 2000

Miramatsu, et al., 2004
Pilot Program
A physician house call program affiliated with a nonprofit community health care system was deployed as a strategy to improve quality of care for homebound patients.
Patients, family caregivers, staff, and other service providers affiliated with the program.
Interviews and focus groups discussion with selected respondents were conducted to determine if the program operated consistently according to its intent.
Patient and caregiver interviews were converged into four major themes: (1) the program improves patients’ medication and health management and optimizes health, (2) caregivers felt more informed about the patients’ medical conditions and medications and relieved of the burden of transporting patients to physicians, (3) the program reduces use of hospital and emergency services, and (4) the programs enables patients to die at home.

Haastregt, et al, 2003
Systematic Review
To assess the effects of preventive home visits to elderly people living in the community.
15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register regarding preventative home visits for the elderly.
Review of 15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register.
Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. “Favorable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects.”

Elkan, et al., 2001
Systematic Review and Meta-analysis
To evaluate the effectiveness of home visiting programs that offer health promotion and preventive care to older people.

Older people living at home, including frail older people at risk of adverse outcomes.
Review of 15 studies of home visits to elderly people.
Home visits were associated with a significant reduction in mortality. “Eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, “at risk” older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardized effect size 0.06; -0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; -0.07 to 0.17).”

Stuck, et al., 2002
Systematic Review and Meta-regression Analysis
To evaluate the effect of preventive home visits on functional status, nursing home admission, and mortality
1349 abstracts were screened and those that did not test in home interventions or in which the mean age of the study population was younger than 70 years were excluded. After further exclusions, 17 articles describing 18 trials were analyzed.
Two reviewers independently screened the abstracts. Discrepancies were resolved by consensus with a third reviewer. For each included trial, data on the study population was extracted based on the characteristics of the intervention. Two reviewers extracted information on three end points: nursing home admissions, mortality, and functional status. One reviewer assessed trial quality, including an examination of the method of randomization, blinding of caregivers and research staff ascertaining outcomes, and proportion of patients included in analyses of the three end points.
“The 18 trials included 13,447 individuals aged 65 years and older. The effect on nursing home admissions depended on the number of visits performed during follow-up. “The pooled relative risk (RR) was 0.66 (95% confidence interval [CI], 0.48-0.92) for trials in the upper tertile (>9 visits) but was 1.05 (95% CI, 0.85-1.30) in the lower tertile (0-4 visits). Functional decline was reduced in trials that used multidimensional assessment with follow-up (RR, 0.76; 95% CI, 0.64-0.91) but not in other trials (RR, 1.01; 95% CI, 0.92-1.11). Functional decline was reduced (RR, 0.78; 95% CI, 0.64-0.95) in trials with a control group mortality rate in the lower tertile (3.4%-5.8%) but not (RR, 0.98; 95% CI, 0.84-1.13) in those with a control-group mortality rate in the upper tertile (8.3%-10.7%). A beneficial effect on mortality was evident in younger study populations (RR, 0.76; 95% CI, 0.65-0.88 for ages 72.7-77.5 years) but not in older study populations (RR, 1.09; 95% CI, 0.92-1.28 for ages 80.2-81.6 years).”
Preventive home visitation programs appear to be effective, provided the interventions are based on multidimensional geriatric assessment and include multiple follow-up home visits and target persons at lower risk for death. Benefits on survival were seen in young-old rather than old-old populations.
Results of Search

The literature reviews had presented different outcomes about the effectiveness and efficiency of house call services being provided for elder population. The four pilot studies accounted positive results whereas the following outcomes were found: 1.) house calls reduced the use of emergency care, hospitalization, and placing of elders in nursing home care; 2.) house calls decreased the length of stay of elder patients in hospitals; 3.) house calls were able to prevent functional decline among the elders; 4.) house calls declined the occurrences of elders’ hospital re-admission; and 5.) house calls helped improve patient’s medication and health management.

The following results were attributed to the impact of human caring such that human-to-human interaction between physicians or nurses and elder patients aided medical practitioners to be more informed about the actual health condition of the elders. Nurses and physicians were able to focus on one or two elder patients during a house call as compared to their services in the hospitals or clinic. Old patients who were too sensitive and strongly value medical confidentiality were able to be more open upon communicating with a medical practitioner. In addition to this, the home environment was also found to be helpful on the fast recovery of elder patients suffering from chronic illnesses.

Meanwhile, the result of the systematic review which attempted to evaluate the effectiveness of preventive house calls to senior community also showed positive results. Haastregt et al. (2003) stated that favorable impact of house calls were observed in five out of twelve trials which measure the physical functioning, one out of eight which measures psychosocial function, two out of six which measure falls, two out of seven which measure admissions to institutions and three out of thirteen which measure mortality.

With regard to literature containing systematic review and meta-analysis on fifteen studies that aimed to assess the effectiveness of house call programs that offers preventive care and health promotion to older people, the following results were observed: 1.) eight studies showed that home visits provided significant reduced in mortality of elderly population whereas five studies about home visits to frail senior citizens also manifested significant decrease in mortality; 2.) three studies showed that house call was associated with decreased in the length of admission of elder patients; 3.) six studies showed that home visiting provided no significant decrease in elderly admission to hospital; 4.) three studies found that home visiting has no effect on health of the elderly; and 5.) four studies found that home visiting have no effect on the daily living of the aged. Although there were studies which showed no significant effects of home visits to elders, majority of the studies provided positive impact of home visits to senior community such as reduced in mortality and decreased in hospital stay.

As for the literature on systematic review and meta-regression analysis, which aimed to evaluate the effectiveness of preventive home visits, the study also yielded positive results. Preventive home visitation program was perceived effective provided the interventions were based on interventions such as assessment of multidimensional geriatric. In addition, regular visitations or multiple follow-up house calls by medical practitioner were perceived to bring positive effect to young old population suffering from chronic disease and those who are at high risk of death.

Summarizing the results of the related literatures, house calls are found to provide better health outcomes than traditional care for the elderly population. Barriers which inhibit elderly to go to hospitals and medical clinics are properly addressed through providing house call services. Transportation of the elders which is perceived to be one of the major barriers is properly addressed because in house call service, the physicians or nurses are the one visiting the patients at home to conduct medical treatment. Socio-cultural barriers are also addressed such that the confidentiality on the conduct of house call is high compared to hospital consultation. Nurses and physicians are provided with information and other forms of help from members of the family in cases wherein the elder patient refuses to cooperate. In addition to this, the home environment keeps elder patients more relaxed and open.

Integration and Recommendation for Practice

Currently, the condition of house call providers is weakening due to the perceived barriers in accessing health care services particularly the ones related to medical expenses such as physician’s consultation fee, nurses’ fee and other treatment costs. The senior population with Medicare and Medicaid are able to cut down medical spending because of the grants and supports from the federal government. On the other hand, senior population without medical insurance is still facing the problem of not availing any medical service that can help improve their health condition and improve the quality of life.

The number of physicians and nurses who provide services via house calls is declining because of the difficulties being encountered during reimbursement of medical fee incurred during home visits. Other cited reasons include lack of faculty skilled in house call medicine, inconvenience and time inefficiency of a doing a house call, liability concerns and concerns about the quality of cared delivered in home visits (Leff & Burton, 2001).

Although there are a number of programs designed to address both the problems of the senior patients and the house call providers, such interventions are perceived weak; if not, these problems should have been resolved over time in the history of medical treatment and addressing the health problems of the elderly. Thus, a proper intervention should be done by the federal government and other concern institution in order to solve these problems.

Interventions to Increase Public Awareness and Improve Senior’s Access to Health Care

The state government officials have been advocating the different programs which aim to prevent and manage chronic diseases and injuries for seniors via health care promotion, education and interventions. Government officials have adopted different programs which goal is to improve the health conditions of senior community. The different strategies designed to manage and prevent chronic illness  include empowering and educating the elders, members of their families and the caregivers about the importance of injury or disease prevention and health promotion;  advocating physical activities for everyone;  leading and developing statewide alliances which aim to increase immunization rates among senior population; and implementing chronic disease management programs especially for the aged.

Health Care Funding for Senior Population

With those state programs aimed to aiding the health conditions of senior population, funding of health care system being provided for elderly should be properly addressed. Current funding priorities such as the federal government’s new economic stimulus plan are perceived to post positive impact in improving access in care and overall health status for the senior community. An example of federal funding for medical program that aims to improve the health conditions of the elder is the $200 million dollars budget to be allocated in different states for formula grant programs that focused on nutrition services being provided for the aged such as Congregate Meals and Meals on Wheels. It is estimated that 80% of senior population who suffer from minimum of one chronic disease can benefit from the Healthy Meals Program since chronic health conditions can be improved through nutritional intervention. A $4.2 billion dollars will be allocated to aid 7.5 million disabled with minimum income and older people living below the poverty line. SSI payment which is “equal to the average monthly federal payment under the program” will be accessible for the beneficiaries (U.S. Committee on Appropriations, 2009). This additional household income can help senior citizens to pay for prescriptions or other health care services which would aid, control, or prevent their chronic health care conditions. Moreover, the Prevention and Wellness Fund will put $3 billion dollars towards fighting preventable chronic diseases (U.S. Committee on Appropriations, 2009). Although, this funding does not specifically address senior citizens with chronic diseases, it will ultimately support initiatives that are geared towards preventing diseases before they occur. This activity will then eventually lessen the number of seniors who suffer from chronic illnesses.

Meanwhile, to address physician’s reimbursement problems the Center for Medicare and Medicaid Services made extensive revisions to rules for home visits which include significant change in physician reimbursement to reflect better nature of home care medicine. The federal government in their published regulation has allowed physicians “to make referrals to home health agencies with which they have a financial relationship” (Leff & Burton, 2001). More to this, the federal government and other concern institution such as college and universities are designing programs which will improve the facility of nurses and physicians that would provide house calls.

With proper addressing of funds related to health care being provided for seniors, programs aimed to improve the health of the aged such as nutrition programs, nursing care, physician’s house calls and others will be easily be accessed by the affected population which in turn would improve the health and life conditions of the elderly. To elucidate, nutrition programs can prevent seniors from suffering of chronic diseases, nursing care and physician house calls can properly cure the aged patients who prefer to be treated at home.

The Use of Electronic Medical Recording System in House Call Services

With regard to keeping medical records, one of the best innovations in the medical field is the use of Electronic Medical Recording System. “Adoption of electronic medical record (EMR) system can lead to major health care savings, reduce medical errors, and improve health” (Hillestad et al., 2005). Senior citizens are often confronted with problems relating to lost or errors in their medical records. With the use of EMRs this problem will be prevented such that adequate records can be easily accessed by medical practitioners via EMRs. More to this, EMRs can also help in tracking the aggregate data and in identifying increased or decreased in hospitalization rates and long terms care admission. With adequate medical data, the federal government can properly estimate the right budget to be allocated in health care system. Relating to house call providers, the use of EMRs is more efficient such that they can easily access to medical records of their aged patient. Medical records are important in identifying the cause of chronic illness and can provide enough information on how to deal with elder patient’s medical problem.

In 1998, Medicare increased to nearly 50% in acceptable reimbursement for house calls. In 2004, the allowable charge for a comprehensive visit to patient is approximately $110 (Besdine et al., 2005). This year, Medicare reimbursement rates for house calls ranged from  $54 to $200. The rate depends on the complexity of the patient and the geographic region where the physician worked (AAHCP, 2009). In order for reimbursement guidelines to continue to increase, house call providers must present data to insurers that reflect how effective house calls are at improving the quality of life and chronic disease management for the elderly community. EMRs can aid house call providers to solve this problem by keeping records of patients who undergone house call treatment.

In theory, house calls appear to be the perfect solution to improving the health and wellness of the elderly community since human-to-human interaction (with patient and family members) and aid of EMRs can be used simultaneously in treating the aged patient.  However, if house call providers do not begin to record interventions as they relate to patient outcomes and insurance reimbursement of house calls patients, particularly those who are Medicare recipients, the recorded earlier failure may become a continuous practice.


Access to health care can significantly impact individuals from an economical, social, and physical perspective. Concerning the health conditions of senior citizens, most of them are becoming weak and, thus, are suffering from mild sickness or chronic illness. Inaccessibility of health care services prevents senior population to acquire medical treatment for their sickness or disease. The high cost of medical treatment, inaccessibility of transportation, socio-cultural status and structural considerations are among the factors which affect the old population’s preference for hospital treatment. With the existence of house call services providers these problems are being addressed. The cost of medical treatment had been cut; transportation of elders to get to hospitals is replaced by physician or nurses’ visitation; confidentiality is provided since treatment is done at home and accessibility to medical facilities has been made possible with technological advances in medicine. In addition, since aged are becoming more sensitive, medical treatment in home environment is most preferred wherein human-to-human interaction is practice, nurses and physicians’ role in caring is enhanced, and the health quality of patient is improve via caring the person instead of merely curing the sickness and disease. Thus, for old patients, house calls are the best alternative to traditional care for their population.


















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