House Calls Making a Comeback

John Devine is 82 years old and has no interest in leaving home to socialize with others.
He'll pass on the so-called "senior activities" and get-togethers. He would rather read in the library of his assisted-living facility in Burien.

Wanting to stay home makes doctor visits and routine checkups a bit difficult, though. But Devine, a small, spry man with a Scottish brogue and a mischievous smile, has that taken care of. He has a doctor make a house call to him about once a month for a checkup and to help coordinate any other medical care he needs.

Once considered on the verge of extinction, house calls are making a comeback.

In 1997, The New England Journal of Medicine called doctor house calls a "vanishing practice." But eight years later, a Journal of the American Medical Association article found from 1998 to 2004 the annual number of house calls increased 43 percent, to just over 2 million. For Devine, who doesn't have major medical problems and jokes he specializes in inactivity, having a doctor come to him is ideal. Though a bit forgetful about everyday things, he can easily recite Shakespeare from memory.

"To hell with the medicine, it's wonderful having her here," Devine said, sitting in his blue recliner while his physician, Dr. Sarah Babineau, checked his blood pressure, listened to his heart and went over some medical concerns and upcoming appointments. "There's nothing like it. We can talk and have conversations and I get my checkups."

Babineau works part time for Providence ElderPlace, a nonprofit for older adults that aims to keep them out of nursing homes and living in the community. The costs often are cheaper than nursing homes, said the program's referral specialist, Corina Kroll. Medicare or Medicaid pay for most services, which include hospitalizations, dental, vision, home care and prescriptions. The program also provides transportation for members to see physicians and participate in activities at its Rainier Valley facility. And it provides house calls.

For those who pay out of pocket, the costs are between $3,700 and $4,200 a month, which includes housing.

After his checkup is complete, Devine's routine with Babineau, who he says reminds him of his three daughters, is to walk down the hall for some coffee, then sit briefly in front of the fireplace in the library. The slower pace gives her more time to really care for her patients.

"Seeing people in their environment I get a better grasp of what their lives are like," said Babineau, who also is a full-time family doctor at Swedish Medical Center. "(In the clinic) time crunch is a huge thing for me. At home, I get to share special moments with these patients."

She spends Mondays, Thursdays and occasional Wednesdays driving to see her 55 to 60 patients around the Seattle area. She has so many, she can usually only visit once a month, but will add more appointments if necessary. The patients' average age is 80 and many suffer from advanced dementia. One of her patients is a 100-year-old woman still living on her own on Capitol Hill.

"We take care of a really frail population and if they're living independently we keep an eye on them," Babineau said. "A lot of these people would fall through the cracks and would be sent to a nursing home otherwise."

Several other programs around Seattle offer home visits to older patients. Doctors Home Visits, which calls house calls "an old concept renewed," offers a service area from Seattle to Lynden, just a few miles south of the British Columbia border. Carena Inc., headquartered in downtown Seattle, provides house calls or workplace doctor visits to employees of companies who contract their services.

For 10 years, The Home Doctor, located in the Tacoma suburb of Lakewood, has provided house calls to more than 500 homes in the greater Puget Sound area. The service started in 1998 after someone called the clinic asking if a physician could make a home visit.

The next call was to Medicare and Medicaid for authorization, said Home Doctor President Charles Plunkett. Once they figured out how to bill patients, they started with one home and expanded. Physicians, nurse practitioners and podiatrists visit adult family homes, assisted living facilities, homes for the mentally ill, Alzheimer's residences and skilled nursing homes, Plunkett said.

"Caring for the elderly in all settings is expensive in dollars, time and emotion," Plunkett said. "Just getting Grandma' " (or Grandpa) to the physician takes a toll on the patient, the family member or caregiver. Patients with dementia become agitated when out of their environment. Just sitting in a doctor's waiting room is stressful and exposes this vulnerable population to increased risk of sickness and infection."

He said an increasing number of specialists are not accepting Medicare or are limiting the number of patients. And adult family home and assisted living operators serving those on Medicare and Medicaid are dealing with flat revenues and increasing expenses.

"Care management is needed, but only available with HMO and special needs plans," Plunkett said. "Families are left to fend for themselves" and learn what he calls a Byzantine system.

For Babineau, who tries to recruit patients from her full-time practice to join Providence ElderPlace's program, she said even for her -- someone who is a part of the health care system -- it is difficult to navigate.

"A lot of people caring for their parents are living on the edge and this helps," she said. "This is long-term care the way it should be."