Accessibility and Visibility: Keys to Improving Healthcare Delivery to Seniors

The 61,602 seniors aged 65 years and older who populate Ada and Canyon counties are both blessed and cursed. They are blessed by being surrounded by an abundance of superb medical services and hospitals, but cursed in that these essential services can be surprisingly and frustratingly difficult to access. This permits important medical symptoms to go untreated and can lead to unnecessary trips to the emergency room or even hospitalization.

Mary is an 82 year old woman who is concerned about new onset stomach pain and needs some medical advice. She calls her doctor, and the first obstacle she encounters is the inevitable phone tree. Here she must wade her way through a series of hurried receptionists or recordings, being put on hold and then re-explaining her situation several times along the way before being connected to a final recording that instructs her to either leave a message or go to the emergency room if this is a life threatening emergency. Mary leaves a message and endures her symptoms until the next day when she re-enacts the scenario since no one returned her call from the day before. Her persistence is rewarded, and she is given an appointment to see the doctor as an “add on” at the end of the following day. But now her challenge is to find transportation to her doctor’s office. She no longer drives, and most of her children and grandchildren live out of town. The ones who live nearby must either take a day off their work to transport her or make last minute arrangements for their own children who have their own complicated schedules. Mary hates imposing this inconvenience on everyone and worries about being a burden on them. She questions whether her stomach pain is actually bad enough to go through all the stress of getting to her doctor.

So, what happens next? I’ll let you, the reader, decide. Nearly all of us “baby boomers” have had similar experiences with our elderly parents or friends and are all too familiar with the good and bad outcomes.

Healthcare is among the top concerns of seniors, and in seeking to live in a more supportive and secure environment, many seniors respond by moving to retirement communities where they are surrounded by a network of other like-minded people with similar interests. Indeed, Boise and the surrounding communities are the fortunate home to more than 67 Independent Living and 110 Assisted Living communities. But access to healthcare, even for residents of these wonderful communities, remains a challenge. To see her doctor, Mary must still endure the same complicated appointment process and has only limited assistance with transportation.

To address the difficulties of connecting seniors with appropriate levels of healthcare, a new company called House Calls was formed ( Old fashioned house calls with new fashioned ideas is now offered to seniors living in Boise’s Retirement Communities. Complete Primary Care Services are now available to residents in the comfort and convenience of their own community or even their own apartment. Residents no longer have to struggle with negotiating burdensome scheduling and transportation arrangements for every doctor’s appointment. Instead, they now have the option of easily reserving a convenient and timely in-home appointment with the House Calls physician who will deliver state-of-the-art primary care services. Blood tests, EKG’s, and most routine x-rays may also be performed in the resident’s apartment.

This breakthrough in facilitating access to healthcare for seniors has been created by 2 experienced Boise physicians – Steven Fuller DO/ PhD and Boise State University faculty Uwe Reischl MD/PhD. By making routine healthcare services easily accessible, seniors have a much better opportunity of remaining healthy, active, and happy.
Another key benefit to retirement community residents that is offered by House Calls is ‘visibility’. A House Calls representative will have a regular presence several times weekly in each facility, simply to answer questions, talk with residents and staff, schedule appointments, provide educational sessions, or to coordinate a variety of other health related activities that would benefit both the resident and the community. Having this visibility within the community is another reminder to the residents that access to their healthcare is now easy and convenient and that they no longer must prolong addressing their healthcare needs.

Our healthcare system is extremely complicated and can sometimes obstruct seniors from receiving the care they need. Healthcare needs to be accessible and visible to seniors. To overcome the obstacles encountered by seniors requires a creative, “out-of-the-box” approach, and this is what House Calls has accomplished by bringing back the old fashioned “House Call”. By making healthcare to residents of retirement communities visible and easily accessible, House Calls hopes to contribute to the triple aim of “better health, better care, and lower cost.”


“This is a service that is really needed in our community.”

- Boise resident

“I wish this service was offered at our community.”

        - retirement community resident

“This offers me an excellent opportunity to grow my primary care practice.”

- community physician

“Thank you, Dr. Fuller, for giving us such a needed service.”

       – retirement community resident

“This is a terrific service that I know my residents and their families will really love.  I know my employees will also appreciate that they can make an appointment for themselves and their own family members as well.”

       – retirement community administrator

“This is an awesome service!  We are considering a retirement community for my grandmother, and I would like her to be in a place where her doctor makes House Calls.”

       – granddaughter of a Boise elder

“This is really a neat service, Dr. Fuller.  I wish I lived in Idaho so I could be a part of it!”

       – nurse who lives out of state

“This is a fantastic service for my dad, and we really appreciate it.  He hasn’t been going to the doctor like he should because it’s so difficult to arrange and get there.  House Calls is perfect for him.  Thank you!”

       – daughter of a Boise elder who lives in our community partner’s facility.

“This service [bringing doctors to retirement communities] is a no-brainer!  How come no one else in Boise is doing this?  My mother is elderly, and we’ve been discussing this very topic.  Way to go, Dr. Fuller!”

       – hospital nursing administrator and daughter and caregiver of elderly parents .

“Our first clinic was just a few days ago, and already I’m hearing a lot of positive comments.”

       – executive dirctor of a House Calls retirement community partner.

“I think this is great!”

       – resident of a retirement community and a new House Calls patient.

“This is a wonderful service!  I haven’t felt recently well and can’t get to my doctor.  Having the doctor see me right in my own apartment is so much easier and so much better.”

       – resident of a retirement community who has not been feeling well.

“This has been great for us having Dr. Jones come to our facility.  Seeing our residents in their own environment is much different than when they go to the office, and it is much less stressful for them.  Working with Dr. Jones is really great – he is very approachable, and the staff enjoy working with him.”

       – owner of an Assisted Living Facility and House Calls partner.

“I think your services are really important, especially to help people get to their doctor.”

       – resident of a retirement community who has difficulty arranging transportation out of the community.

“Dr. Fuller, I just want to tell you that I honor the work you do out here, and I know the other residents do too.”

       – resident of a retirement community partner.

“Dr. Fuller, I highly support your work here and think it is invaluable.  It’s really hard for many of us to get to the doctor, and I think everyone here should sign up for your service.”

       – former entrepreneur and resident of a retirement community partner.

“I called Dr. Fuller on a Saturday night when I had no other known resource for advice in getting care for my sick elderly mother. He spent his evening making phone calls on my behalf, and, within a 1/2 hour, I had the help I needed. He is a Godsend and true servant to this community.”

       – daughter of an elder not qualified for House Calls services.

“I haven’t used your service yet, Dr. Fuller, but I probably will in the future.  Just you being here so regularly is a real comfort.”

       – resident of a retirement community partner.

“Dr. Fuller, I hope you stay here.  I haven’t needed your service yet, but I want you here when I DO need you.”

       – resident of a retirement community partner.

“Medicare costs have risen to the point where the program pays out more than it takes in.  When one considers that number of baby boomers becoming eligible for Medicare, it is no surprise we are headed for a crash.  The current pay for procedure system is not working.  Perhaps this approach is a way to control costs and yet ensure that seniors have access to care.”

       – reader of Idaho Statesman article from 2/25/13.

“I like this . . . .  when my grandmother was in assisted living, taking her to the Dr. was a living nightmare for us grand kids [and her].   It  was just too much of a change of environment for her.  I hope this company does well, we need this type of service.

       - reader of Idaho Statesman article from 2/25/13.

With the growing shortage of doctors nationwide, this is a very good thing that doctor Steven Fuller, and a professor of health sciences, Uwe Reischl, are doing.   It is wonderful to see people helping people.  Dogs are so wonderful for older people and young alike.  Who is so busy they cannot love a dog of their own???  Great protection for the wife when I am gone.”

        - reader of Idaho Statesman article from 2/25/13.

This is beyond cool. Now this is a program we could serioulsy socialize and save huge bucks not to mention the benefit to patients.  My Tax Dollars Are In….

        - reader of Idaho Statesman article from 2/25/13.

What a fantastic idea.  It’s about time.  I’ve seen my 93 year old father have to wait for up to an hour in a waiting room for his doc.  I think that stinks.  Most docs don’t respect the age or condition of their elderly patients when they over book appointments.  This takes a lot of the stress off the patient and families. Thank you for bringing back the house call idea.

        – reader of Idaho Statesman article from 2/25/13.

“Bonaventure is a community of which you should be most proud.  Now, with the new house call services you are premiering, you will provide your residents with addtional valuable services. This should make your facility the place to reside in the Treasure Valley!”

        – publisher of a Boise area newspaper.

“This is probably the first time in three years that I have had a waiting list, and I attribute it to the fact that I can tell them we have our own physician.  The service reduces transportation costs and provides residents with better care.”

        – owner of 2 Assisted Living Communities and a current House Calls partner.

“Dr. Fuller, your innovative idea of “skins in the game” is an excellent engagement strategy to encourage more continuum stakeholders to participate in this innovative program. If these types of programs could be subsidized without assistance from the federal government, the longevity of the programs could be extended to last longer.
The opportunity of having on site physicians to lead care teams would be a huge plus that has proven to be helpful to the residents of the retirement community you’ve described in your response.  I applaud you on the success of your innovative care program and wish you continued success with this venture.”

        – Social Media Specialist at Right at Home, Inc.

We have been fortunante to have a DR that does on site visits at our community. But where I see the problem, at least here in the greater Memphis area is, there are so few MD’s that are willing to go to the ALC’s, so the few MD’s that do, are so over worked and just can’t take on new patients/residents. We need more MD’s to entertain this concept. I love it, I see and hear families/POA’s that are so pulled, they have work, their own family to take care of and then the care if their aging parents, and taking them TO the DR’s office is a huge ordeal. Then, we have to educate the families that this service is available. We all (Americans as a whole) have been so programmed that you have to GO see the DR that it really is a new concept, and novel idea that the DR could COME to their loved one. I love it. Thanks for the great article.”

        – a director of a Retirement Community