-Independent and Assisted Living Communities-

A physician dedicated to your Retirement Community!

Every Community wants it…No Community has it…

Ask yourself:

“What dedicated physician services does my community have NOW?

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(List all physician services here)

Unless you change something, what will be different about tomorrow?

Nothing…

Here’s what a small, low risk investment in House Calls gets you:

• Regularly scheduled on-site physician clinics in the residents’ rooms
• YOUR physician who will accept any new patient requested
• YOUR physician who will sign all appropriate Home Health orders the same day as requested, allowing all Home Health services to begin within 24-48 hours of request
• YOUR physician who will perform either single visits for residents OR become the resident’s primary care physician
• YOUR physician who will respond promptly when notified about a resident’s medical needs
• Physician directed healthcare coordination where all who participate in a resident’s healthcare are now led by a physician and unified as a TEAM rather than acting as separate individual services who don’t communicate with one another
• Memory Care residents and their families and your staff who are spared the stress and inconvenience of transporting these fragile individuals off-site for routine doctor visits
• A Marketing and Promotional advantage that identifies YOUR COMMUNITY as a LEADER by offering a service that ALL RESIDENTS WANT, WITHOUT EXCEPTION – easy and convenient access to a physician-led team of healthcare professionals
• Stabilization of your census by reducing health related attrition through pro-active, early, physician-led intervention in a resident’s declining health
• Growing of your census by capturing prospective residents who choose YOUR FACILITY because of its unparalleled healthcare support

 There is a way to get what every community wants.

But to get it…a community must be willing to do something different!

House Calls (HouseCalls-LLC.com) is the ONLY healthcare service in Idaho

that brings Physician clinics to Retirement Communities.

Invest a Little…Get a LOT!

-OR-

Change Nothing…Invest Nothing…Get Nothing…

Where do we begin?

I’ve been discussing how enhancements in communications through the adaptation of new technology can be seductive amid the use of apps, social media, and telephone outreach, even though there are no data to support their effectiveness.  In contrast, the popularization of wellness programs is also enticing with a very appropriate focus on issues such as weight control, smoking cessation, cholesterol and blood sugar management, and exercise.  These latter programs are promising with their emphasis on prevention of the chronic illnesses seen in older age groups but are met with the daunting task of trying to affect people’s behavior.

These approaches to reaching out and engaging patients in their healthcare and that dominate the medical literature all have one thing in common – they are aimed at the relatively young patient.  So again I ask, “But what about the elderly?”  They are the current highest consumer of our healthcare dollars, yet today’s medical literature is almost silent when it comes to new approaches to treating them and the diseases they’ve acquired and that are slowly taking their lives.

I believe that perhaps one of the best “new” approaches in healthcare in the elderly lies not so much in the ‘treating of illnesses’ but rather in the ‘delivery’ of their healthcare.  And this approach is, in fact, something quite old…that is, the old fashioned ‘house call’.  A ‘house call’ is bringing the physician to the elderly, where they live, rather than waiting for the elderly to decline to the point where they are forced into the emergency room, hospital, and then nursing home.  The reason why this simple and old fashioned approach can be so effective is because it increases the access to healthcare that the elderly so desperately need but yet so often ignore.  If a physician is visible and easily accessible, then the elderly will get the timely care they need to manage their chronic illnesses.

And now finally – “Where do we begin?”  We begin in Retirement Communities – Independent and Assisted Living.  Why do we begin in these communities?  We begin here because this is where larger numbers of the elderly live in a community setting.  It is in this setting where healthcare can be delivered efficiently and proactively with other community health services that are already available and waiting for proactive physician engagement and leadership – home health, hospice, pharmacy, durable medical equipment, and a host of others.  We can make a remarkable difference in these communities now that the final member of the team, physicians, can be encouraged to perform this essential community outreach and still maintain a profitable medical practice.

House Calls offers a business model that merges the old fashioned ‘house call’ with modern healthcare delivery.  It allows interested physicians to enhance their office practice with a profitable outreach in retirement communities.  It makes physicians more accessible and available to lead the team of community health services and make a difference in the health of the elderly.  And the elderly will engage too, because this model is based on an essential feature that the elderly insist on but that modern technology ignores…RELATIONSHIPS.

What Works and What Doesn’t?

A prominent topic in healthcare discussions these days is physician – patient engagement.  That is, encouraging physicians to reach out to their patients with reminders and health advice that inspires them to keep their appointments and engage in good health behaviors.  Multiple surveys show that younger patients give lip service to wanting a variety of medical apps or be engaged with their physician via text messages, automated voice messages, or e-mail.  The underlying assumption is that patients will change their health behavior and do what their doctor advises them to do.  But literature demonstrating that this type of remote “connection” translates into changing health behavior is glaringly absent.  There is no conclusive evidence in the literature that having an app on your iPhone or a computer that’s connected to the Internet 24 hours a day reduces your hemoglobin A1c, gets your blood pressure under better control, or makes it easier for you to breathe when your emphysema starts acting up.  This type of remote connection, although interesting, just hasn’t yet been shown to improve health.

Do you know what else doesn’t work?  Phone calls don’t work.  There are those who believe that trying to engage patients by calling them on the telephone and speaking with them about their health condition may cause them to be more compliant with health advice and therefore be healthier.  But this also DOESN’T WORK!  This was shown convincingly by Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment published by the Congressional Budget Office in 2012.  Patients acknowledged that they were called and given encouragement and health advice, but they still didn’t change their behavior.  This is ESPECIALLY true for the elderly, many of whom have at least some degree of hearing loss and find it difficult or even objectionable to assimilate instructions from a stranger over the telephone.

So what DOES work?  What IS effective in reaching elderly patients to help them remain as healthy and independent as possible for as long as possible? The answer lies in 3 parts:

1. Visibility and Accessibility.  The elderly often neglect their healthcare because our medical system is so cumbersome and difficult for them to find and access.  If healthcare professionals are more visible, and physicians are more readily accessible, the elderly will get care – it’s as simple as that.
2. Face-To-Face encounters.  Like it or not, the elderly won’t let you into their lives until you build a relationship with them.  And until then, you will usually have little influence over their health behavior until it’s too late (they fall and break a hip or get pneumonia or have a stroke from uncontrolled hypertension, etc.).  Face-To-Face encounters build relationships and therefore get results.  This has been proven conclusively in the field of Transitional Care Medicine which describes the care patients receive when they are recovering from an illness and transitioning from the hospital to home.  The common thread that is integral to all successful protocols that improve a patient’s health behavior and reduces hospital readmission rates is…Face-To-Face encounters.  In other words, RELATIONSHIPS.
3. Technology.  New communications technology is making vast improvements in the way healthcare professionals interact with each other through Electronic Medical Records, through efficiencies in healthcare delivery, and in the coordination of patient care between hospitals and healthcare and residential facilities.  Younger patients are showing an increasing interest in engaging with their doctors using various modes of technology.   But when it comes to the elderly, meaningful and effective healthcare communication depends almost solely on Face-to-Face interactions and RELATIONSHIPS.

So these are 3 characteristics of healthcare delivery that get the best results with the elderly.  In Part 3 we discuss, “Where Do We Begin?”  If we have a disciplined, targeted, and focused approach in delivering healthcare to the elderly, we can and will make a difference.  And this is also where the fun begins, because to make a difference in this crazy and complex healthcare system, we need a simplified approach that is creative and innovative.  And the answer is found where the old merges with the new!

The Forgotten

Technology is a wonderful thing…for some people, that is.  Electronic medical records, the Internet and e-mail, smart phones and health apps, automated voicemail, and social media inundate our lives.  Doctors and their patients have either leaped forward or been dragged kicking and screaming into this age of high paced, rapidly changing technology.  Prominent in today’s health literature are articles authored by young technology enthusiasts who promote hi-tech devices and apps that encourage doctors and their patients to relate in a way that’s different than what they’re accustomed to – not in person, not face-to-face, but rather electronically, with promises of benefits that have yet to be proven.  Whether we like it or not, we’re all part of this, and maybe some good will even come of it, eventually.

But there’s an emptiness in these discussions about technology, because something is missing.  You know what it is?  It’s the elderly.  When reading the literature and all the hype and excitement, I can’t help asking myself, “But what about the elderly?”  What about these wonderful, stubborn, cantankerous, and often fragile yet essential creatures who just can’t keep up with these advancements?  I’ll tell you what’s become of them regarding their healthcare:  they’ve been left behind…forgotten.  The nice young people who invent and promote all this wonderful technology and new ways of communicating have done so primarily for the benefit of other younger people.  The elderly, the very people who are the highest consumers of our healthcare dollars, are the least able to access these marvelous inventions.  They have literally been forgotten!  The figures below illustrate this paradox.

Figure 1.

Figure 2.

They show that as we age, our healthcare spending rises dramatically (Figure 1), but we have less access to the technology that may potentially benefit us (Figure 2)!  Most of the elderly simply don’t or can’t use computers or smart phones and could care less about text messages, Twitter, Facebook, and You Tube.

So, what are we to do for the elderly, the demographic that has the most need with the highest number of chronic medical conditions and that by 2030 will comprise 20% of our population?  Where do we go from here?

Part 2 of this 3 part series offers some ideas and describes what works for the elderly and what doesn’t.  Finally, in part 3 you’ll discover how and where WE can make a difference.  Hint…the old and the new will come together.

Health and wellness Programs in Boise’s Retirement Communities now have a new member – PHYSICIANS! Until now, residents of Boise’s Independent Living and Assisted Living Communities struggled to communicate with physicians, follow telephone orders or recommendations, make appointments, and arrange off-site transportation to physician offices.  Many seniors don’t have either the ability or the assistance they need to meet these challenges, and so necessary medical services are often neglected, leading to worsening health, preventable falls, trips to the ER, hospitalization, and nursing home placement.  But this familiar scenario is about to change now that timely, on-site PHYSICIAN primary care services can be integrated into a Retirement Community’s existing Health and Wellness Program.  Those communities that embrace this new member of their Health and Wellness Team will prosper as a result of the improved health of their residents that will naturally lead to improved census.

When Physicians and Retirement Communities partner together, EVERYBODY WINS!

Imagine the promotional value of including the following in a Retirement Community’s print marketing:

“We give TOP PRIORITY to the health and well-being of our residents.  That’s why we partner with House Calls who coordinates our resident health services.  We offer our residents the option of receiving full primary care services delivered by a caring physician who comes to you, in the comfort and convenience of your own room, at no extra charge.

Why would you choose to live anywhere else?”

Retirement Communities that partner with House Calls and promote an emphasis on residents’ health will grow their census in 2 ways:

1.  They will attract more new residents who will choose a community where a physician performs their primary care in the comfort of their own room.

2.  They will lose fewer residents from failing health due to quicker and easier access to healthcare from the House Calls physician.

There is NO BETTER WAY a retirement community can distinguish itself from among its competitors than to promote its emphasis on the health and well-being of its residents through its partnership with House Calls!

But when you DON’T take healthcare to the elderly, very often the elderly DON’T get the healthcare they need. They put off seeking care for a variety of reasons, but mostly because of the many difficulties in accessing healthcare. And this leads to worsening of chronic medical problems, unnecessary trips to the ER or hospitalization or possible loss of Retirement Community residents to a nursing home and therefore lowering of community census. Here are just 3 examples we’ve encountered during our 1st month of service at one Retirement Community (the names have been changed):

John has difficulty getting to his physician’s office and making appointments and therefore hasn’t seen him for many months. He is overweight but has been losing his appetite, getting weaker, and falling a lot. He recently fell while trying to get into bed, couldn’t get up, and spent the entire night on the floor before being discovered by the housekeeper in the morning. He refused to go to the hospital because of his fear of ending up in a nursing home.

Sarah has also been falling and has swollen feet and ankles and an open sore on her big toe which she cannot reach to provide proper care. Although she ambulates slowly and unsteadily with a walker, amazingly she still drives and has driven herself to the ER 3 times during the past week for various issues, each time being discharged home with directions for wound care which are impossible for her to follow.

Fred recently moved into the Retirement Community from out of town. Although he has several chronic health conditions, he feels well and is medically stable. He needs a primary care physician to fill his prescriptions and for routine care but has no idea how to go about finding a good physician and one who takes Medicare.

House Calls proactively became acquainted with these residents because of our daily presence and visibility in the Community. We are now coordinating primary care services with Dr. Jones (one of our House Calls physicians) as well Home Health and Personal Care services for these residents. John’s and Sarah’s health is starting to improve, Fred not only has a caring physician who takes Medicare but who provides full primary care in the convenience of his own apartment, and the Retirement Community has maintained its census.

House Calls is achieving its vision: EVERYBODY WINS!

This past month, 10 residents with moderate-severe dementia who live in 2 small assisted living facilities in Boise were given primary care services in their rooms by our House Calls physician, Dr. A.C. Jones.  As a result of this on-site service, the facilities were spared the inconvenience and expense of arranging staff to transport 10 difficult-to-manage residents off-site to 10 different doctor’s appointments, wait in the waiting rooms, and then transport the 10 residents back to the facilities again.  These 10 residents, therefore, experienced a comfortable examination in the familiar surroundings of their own room by a caring physician and did not experience the psychological stress and behavioral difficulties that are usually precipitated by being transported off-site for these routine doctor’s appointments.

So…what are the consequences of House Calls services?

• Contented, comfortable residents.
• Satisfied and reassured families who are impressed with this assisted living facility because their loved ones are now cared for by the House Calls physician and will no longer need to experience the stress and risk of being transported away from the facility for routine appointments.
• Relieved, unstressed employees whose services were not diverted from the facilities and who did not have to struggle with the difficulties and assume the risks of transporting residents to outside appointments.
• A very pleased owner of the facilities because he can now offer less costly and safer and more convenient healthcare to his residents.

House Calls is realizing its vision:  EVERYBODY WINS!

House Calls implemented on-site physician services and healthcare coordination in a Boise Independent Living Retirement Community in October 2012.  During this month, 8 community residents received primary care services by the House Calls physician, Dr. A.C. Jones.  Two of the 8 residents were in failing health and at very high risk for either requiring hospitalization or moving to Assisted Living.  Problems included multiple falls, not being able to get up after falling, weakness, reduced appetite, confusion, not taking medications reliably, depression, and unable to perform ADLs.  The family of one of the residents was actively exploring Assisted Living facilities as an option but preferred their father to remain in his current Independent Living Community if at all possible.  Neither resident had the ability to confront the difficulties and stress of arranging appointments and transportation to and from their doctor’s office.

House Calls was alerted and began coordinating medical services with Dr. Jones as well as arranging for and coordinating Home Health and Personal Care services.  Both residents are now getting stronger and feeling significantly improved, able to assist with their ADLs, and take their medications reliably.  The decline in their health has been interrupted, and with continued care and healthcare coordination, the risk for leaving the community for health reasons has been greatly reduced.

For each month these 2 residents remain in this retirement community as a result of their improved health, $3000 is saved in rental fees, and census is maintained!

Already in November, 2 additional very high risk residents in this community have been identified by House Calls and will soon be receiving care from Dr. Jones and our healthcare coordination services.

The value and savings realized by a small investment in House Calls cannot be matched by any other amenity or service offered by a retirement community.

Partnering with House Calls yields the most positive and effective service possible that will not only maintain but also grow a Retirement Community’s census!