RENEE MONTAGNE, host:
This is MORNING EDITION from NPR News. I'm Renee Montagne.
Anyone who's ever helped an elderly family member knows that it can be hard to get good health care for someone who's sick and frail. Just getting them from their home to a doctor's office can be tricky. In Washington, DC, some doctors are trying to make health care work better for the oldest patients. They start by doing something that was once a common part of a doctor's practice. NPR's Joseph Shapiro explains.
JOSEPH SHAPIRO reporting:
This is how Dr. Eric De Jonge sees his patients. He gets in his Honda and drives.
Dr. ERIC DE JONGE: She just lives at the end of the alley here.
SHAPIRO: The young doctor with a bow tie parks his car next to a small red brick apartment building...
(Soundbite of doors opening)
Dr. DE JONGE: All right. Here we are.
(Soundbite of emergency brake and beeping)
SHAPIRO: ...grabs a heavy backpack from his trunk and makes a house call to see a terminally ill 89-year-old woman. Eric De Jonge helps run the Medical House Call Program of the Washington Hospital Center, a team of doctors, nurse practitioners and social workers who turned the delivery of medicine upside down. They go to the homes of frail patients and take all the equipment, from a portable X-ray machine to all the basic check-up tools De Jonge can stuff into the black bag he carries over his shoulder.
Dr. DE JONGE: The house call program is really aimed at caring for the most ill, disabled and vulnerable elderly people. It requires bringing care to the bedside in the patient's home because these are people who have trouble getting to the doctor's office. And so rather than wait for a disaster to happen, we want to bring care to them.
SHAPIRO: De Jonge is trying to prove that by going to patients' homes, he can provide better medical care and save money while caring for the sickest and most frail patients.
Dr. DE JONGE: The patients that when they go into other doctors offices, the doctor kind of gets a pit in his stomach and groans, `Oh, it's going to be an hour and I'm not going to know what to do at the end of the hour.'
SHAPIRO: Like the elderly woman on the other side of the door.
(Soundbite of knocking)
Dr. DE JONGE: Hi, Pat.
PAT (Daughter of Patient): Hi.
Dr. DE JONGE: I missed you at Glenda's. How you doing?
Ms. VIOLA HICKLINS (Patient): I'm fine in the morning.
Dr. DE JONGE: Viola Hicklins is curled up in a hospital bed that takes up much of the small living room. The elderly woman's in the terminal phase of Alzheimer's disease. The last time Dr. De Jonge was here three weeks ago he arranged for staff from hospice care to start coming. The woman lives with her daughter, Pat. Today, Pat's excited. Her mother has rebounded.
PAT: Because I see the difference, too, but I wanted you to see. That's why I've been so excited for you to get here today.
SHAPIRO: The old woman is more alert. Just moments ago, she was cuddling her two-month-old great-grandson. If she keeps improving, she might not even need hospice care anymore.
Dr. DE JONGE: Sure, I never mind it if someone graduates from hospice. That's always a good thing.
SHAPIRO: The frequent visits from the house call team and hospice have made a difference, and Pat says that her mother can stay at home surrounded by family, including her great-grandchildren.
PAT: All of them, they just come around, `Hey, Granny. How you doing?' And she's, `Hey, baby. How you doing?' She acknowledges them. She--you know, and they acknowledge her and they--she feels their love and their attention and stuff. That's the only think I can think of, Dr. De Jonge.
SHAPIRO: Pat watches while the doctor examines her mother. He spends about 20 minutes.
(Soundbite of door opening)
PAT: Thank you. You-all have a good day. Take care.
(Soundbite of door closing)
SHAPIRO: It takes a lot more than doctor's visits to keep a frail patient living at home, so the house call team includes nurse practitioners and social workers, too. The staff meets once a week around a crowded conference table to review cases. Dr. George Taler is co-founder of the house call program.
Dr. GEORGE TALER (Co-Founder, Medical House Call Program): Ruth is on my list. Her home situation's beginning to fall apart.
SHAPIRO: Today, they're trying to figure out what to do for Ruth, a woman in danger of being kicked out of her senior-only apartment.
Dr. TALER: The problem is that her son was finally released from prison, has nowhere to go and moved in with mom in her senior apartment and he's not supposed to be there because, obviously, he's not a senior. And he has been I think socially inappropriate to quite a number of people.
SHAPIRO: Taler explains that Ruth has dementia and schizophrenia, so she doesn't understand or doesn't seem to care that she'll get kicked out if her son doesn't leave. Taler and his team have negotiated with the building manager and city officials. They've talked to other family members. They're even trying to find a low-cost apartment for the son to move into. Taler says this isn't what your typical doctor gets involved in but these doctors do.
Dr. TALER: If you're going to maintain this population in the community, then if their living situation no longer works for them, it doesn't really matter how well you manage their hypertension and diabetes. They're going to fail.
SHAPIRO: And to keep track of those things it's necessary to go into patients' homes.
Ms. MICHELLE COBBERS(ph) (Nurse Practitioner): Hey, Mary.
Ms. MARY SWANN(ph) (Patient): Hi. How are you doing, honey?
Ms. COBBERS: I'm good. How are you?
Ms. SWANN: I'm all right now.
SHAPIRO: The nurse practitioners do two-thirds of the visits.
Ms. COBBERS: Let me check your blood pressure, Mary.
Ms. SWANN: All right.
SHAPIRO: Michelle Cobbers just walked into the tidy one-bedroom apartment where Mary Swann lives.
Ms. COBBERS: Give me your arm, Mary.
SHAPIRO: Mary Swann is 97. She's blind. Her heart's failing. Her kidneys are failing. She takes a blood thinner. So the nurse practitioner comes at least every three weeks to check her blood levels. Before Swann was in the program, she used to take two buses by herself...
Ms. COBBERS: Good.
SHAPIRO: ...to a clinic to get her blood checks, then wait for hours to get the results. She lives alone but wants to stay in the seniors-only high-rise where she's lived for 25 years.
Ms. SWANN: You're free. You're free. To stay in your own home is freedom. You eat when you want to. You sleep when you to. And you don't have to be unhappy about anything.
SHAPIRO: Mary Swann says the house call program keeps her out of a nursing home and far more.
Ms. SWANN: It's more than that. It keeps me alive. If I wasn't here, I would be unhappy and I wouldn't live.
SHAPIRO: Mary Swann thinks the house call program has added years to her life. There's no scientific proof of that, but one out of four patients is 90 or older. There is evidence that patients are more likely to have high blood pressure under control, and in the hospital, they spend fewer days there.
Dr. De Jonge also wants to prove that the program makes sense economically. Medicare does pay for house calls. A rate increase led to the start of this and several other programs around the country, but Medicare does not reimburse for the planning meetings and the travel time to patient's homes. So De Jonge's program depends upon a subsidy from the Washington Hospital Center.
(Soundbite of crowd)
SHAPIRO: The doctor, now in a white lab coat, walks into see a woman--she's weak and still under a blanket--on the geriatric unit at the hospital.
Dr. DE JONGE: I talked to your daughter and we're going to try to get you feeling a little better and eating better before you can go home. How does that sound to you?
SHAPIRO: The house call program tries to keep patients out of the hospital, but when they need one, they come to this geriatric unit that's set up to care for frail seniors. There's a financial advantage to this hospital because the patients come here rather than to other hospitals in the city.
It's the end of the day. De Jonge sheds his white lab coat. He's headed home to his family, but there's a stop on the way.
Dr. DE JONGE: I've got one more house call to make. One of my elderly patients is just in home hospice and daughters wanted me to stop by and see how she's doing. She's stopped eating and drinking over the last couple of weeks, and so I'm just going to kind of give moral support to the family.
SHAPIRO: Then De Jonge says something surprising.
Dr. DE JONGE: It's a nice way to kind of relax at the end of the day.
SHAPIRO: To see a dying patient might seem like grim duty. De Jonge explains why for him it's not.
Dr. DE JONGE: I find these kinds of visits actually very relaxing, because it's a family I know and trust. I'm very close to them in a personal way, and sometimes the hospital is impersonal, and medicine in its current form is often impersonal. So actually the personal closeness I have with them is something I look forward to.
SHAPIRO: And the chance to have that kind of closeness to patients is the reason Eric De Jonge became a doctor in the first place.
Joseph Shapiro, NPR News, Washington.
MONTAGNE: If you'd like to read more about doctors making house calls, and it's a national trend, go to npr.org.
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