Return of Housecalls for Homebound Elders

October 15, 2007
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The day Billie Jean Gear fell down the 27 steps leading to her second-floor San Francisco flat, she was not only faced with her own physical recovery, but with the challenge of how to care for her 90-year-old mother-in-law who moved in the same day.

Gear, a self-employed interior designer, and her husband Robert, a researcher in the laboratory of John Levine in the UCSF School of Dentistry, had just brought Robert's mother Isabella to live with them, so that Billie Jean could care for her full-time. After the fall, the couple had to figure out how to get Isabella, who had recently suffered a heart attack and used a walker to get around, the medical care she needed.

"We had to hire someone, at a huge expense, to take her down the stairs to get to her doctor's appointments," Billie Jean Gear recalled. The trips took an emotional toll on Isabella. "She felt humiliated to be carted down in a wheel chair and then would have to sit in it for hours waiting to see her doctor," Gear said. "It was really difficult."

Then the couple learned of the Housecalls Program of UCSF Medical Center from their family physician. "It was a blessing," Gear said of the program that allowed her mother to be cared for in their home.

Isabella Gear was a Housecalls patient for 18 months before requiring hospice care and passing away in December of 2005. "If she would have had to endure the stress of getting to the doctor, I'm sure she would have given up sooner," Gear said.

Part of a Growing National Movement

Since its inception in 1999, the Housecalls Program has been bringing UCSF faculty, residents and students into San Francisco homes. "We provide services to those who cannot get medical care otherwise," said Dr. Rebecca Conant, director of Housecalls and a UCSF assistant clinical professor of geriatrics. "Without this program, these people would wind up in the emergency room."

The Housecalls Program is part of a small but growing national movement to provide in-home medical care to the frail elderly. "Unlike home health services, physician house call programs bring doctors and primary care into the home," Conant explained. Services include those that would normally be provided during a visit to a doctor's office for both acute and chronic conditions. Minor procedures, such as bladder catheterizations, are also performed.

The Housecalls Program cares for about 70 patients at a time, with about 100 patients being served annually. The demand for its services exceeds what its three part-time faculty physicians can provide. It has a two- to three-month waiting list. "Everything from narrow staircases and hills to mental illness and cognitive disorders can virtually trap the elderly in their homes," Conant said.

Patients who are referred to Housecalls go through an initial screening in which Conant determines whether the patient is truly homebound or just needs to be connected to the right resources. Exceptions are made for those who are dying and wish to die at home. Since these patients cannot access home health care or hospice without the involvement of a physician, they are not put on the waiting list, but are seen as soon as possible.

Educational Opportunity For Trainees

In addition to caring for patients, Housecalls provides a valuable educational experience to its UCSF participants. Nearly 70 fellows, residents and students participated in the program last year, which has been expanded to include dentistry, nursing, pharmacy and physical therapy students.

Fourth-year medical student Julie Stein said Housecalls gave her a fresh perspective on care. "It was the only chance I got to work with students from other health professions," recalled Stein who took part in the program last year. "It was a good opportunity to see how other professionals approach health care."

Stein said the experience also provided her with insights into caring for patients in an environment other than a hospital or a clinic. "It taught me that patients are not just who they are when they come into your office," she said. As a future pediatrician, she hopes to make house calls of her own. "The program showed me that you can incorporate house calls into your practice."

Visits from Conant and students like Stein not only benefit patients, but offer much-needed support to family caregivers. "I always worried that I wasn't doing the right things for my mother-in-law, or that I wasn't doing enough," said Billie Jean Gear. "They reassured me, and it kept me sane."