Home Is Where the Care Is

Health care is such a huge activity that we are running out of acronyms and shorthand phrases to describe parts of it.  Is HIE health information exchange or health insurance exchange?  Another similar problem is the medical home, which may refer to the notion of a patient having a primary care physician and team which manages all his health care needs.  It also may refer to the looming trend of delivering more and more care in the patient’s home, often having the patient him or herself deliver or oversee the care.  A perspective carried in the New England Journal of Medicine examines factors behind this trend.  (NEJM Perspective)

The author identifies five primary drivers: the aging of the population; the growing prevalence of chronic disease, especially among the elderly; health care consumerism, which particularly demands greater convenience of care; technologies which facilitate care in the home, including access to medical records, point-of-care diagnostics and therapeutic equipment like oxygen concentrators; and the high and still growing per capita health expenditures in the United States.  Professional care in the home can support self-management of chronic disease.  Inpatient care, particularly for elderly, risks many complications and fragmentation of care across settings and transitions, which home care can avoid.  Many elderly and ill individuals have mobility restrictions; even getting to outpatient clinics can be difficult.  And patients generally prefer to be cared for at home, so their satisfaction and quality of life improves when that happens.

Generally, research supports the notion that care at home is less expensive.  But also, generally reimbursement has lagged capability and changes are needed to encourage the delivery of more care where the patient lives.  Not all professionals are trained for or comfortable with treating patients at home, so programs to provide that training are needed.  It would be a change in the work routine for most physicians to begin spending extensive time at patients’ residences.  But the forces driving this trend seem so powerful, and the cost and health outcomes are probably compelling enough, that we should expect home-based care to continue to grow rapidly.