Dec. 12, 2000 -- Sometimes just getting to the doctor can be a major undertaking when you have a chronic illness or disability. But researchers say they have found that a creative health care program allows people to stay in their homes and still get the same level of care, if not better, that they would get by going to their doctor.
This system, called home health care, is already in place for some older Americans through the Medicare program. But experts say that more and more people who could benefit from this type of care are not eligible.
Home care is intended to be a substitute for hospitalization and nursing home care for people who are homebound and otherwise would have difficulty getting to their doctor.
"The idea is: Once a patient is discharged from the hospital, his or her primary care can be transferred from the attending physician to a home-based primary care physician. That person devotes a substantial percentage of time to the program," says Susan Hughes, DSW, of the University of Illinois at Chicago School of Public Health.
For four years, the home care program was tested within the Veterans Administration, which provides medical care to military veterans. In a study published in this week's issue of the Journal of the American Medical Association, Hughes reports that the program resulted in significant benefits for patients and their caregivers, most of whom were spouses.
People in the study had terminal diseases, such as cancer, and chronic diseases, such as heart failure and lung disease, that caused them to be disabled. Under the home care program, the patient's doctor visited the home as needed -- about one visit per month on average -- and coordinated the care with a team of people that included nurses, social workers, pharmacists, and others who had regular contact with the patient and the caregiver.
By the end of the four-year program, terminally ill patients who participated in the home care program had better quality of life, less pain, and better mental health, vitality, and general health, according to Hughes and colleagues. There were also fewer hospital readmissions, and caregivers said they felt less stressed as a result of the program.
Hughes says the team approach makes patients and their families, or whoever is caring for them at home, feel more connected to others.
"I think they did not feel abandoned," Hughes says. "They felt a connection with a program that was reaching out to them and continuing to see them at home. It had to do with not experiencing that isolation that many patients and families ordinarily might feel in these situations."
The home care program ended up costing about 7% more per person than traditional office care, but the researchers say the excess costs should be weighed against the benefits. They believe managed care organizations should experiment with these types of programs and hope their study encourages more use of home care solutions, says Hughes.