Tuesday, August 2, 2005
About four years ago, staffers at the day care center that Magerine Cowans attended "wanted to direct us to a hospice," Cowans's daughter Jan Hall said. And no wonder: Cowans "was just totally zonked out," Hall said.
Today, Cowans, 85, has Alzheimer's disease, hypertension and arthritis in one knee, but she's no candidate for hospice care. She still lives at home with her three daughters -- Hall, Toni Cowans and Sandra Cowans -- and Hall says a house call program operating out of the Washington Hospital Center deserves much of the credit for her longevity.
"We don't have to worry about getting her up and out of here for doctors' appointments," said Hall. "We don't have the worry of . . . will she be feeling okay and ready to go to the appointment? We don't have to worry about getting the medical transportation that we had to get, which was very expensive and time-consuming."
The Cowans situation is typical, in that most older people rely heavily on family members as their health problems grow. "Even if they need help caring for themselves," said a report issued by AARP in 2003, "older Americans prefer receiving services that allow them to stay in their current home." With nursing home care in the United States costing more than $100 billion annually -- almost half of it coming from the federal/state Medicaid program -- policymakers continue to seek new ways to help people avoid institutional care.
Physicians Eric DeJonge and George Taler started their house call program in 1999. "The goal was to create a team, a health care team, that brings comprehensive care to frail elders in their homes, because it's hard for them to get to the doctor's office, and they end up experiencing a lot of expensive 911 calls, ER visits and hospital stays that we thought were probably unnecessary," said DeJonge.
DeJonge said the program has about 500 people under active care, each served by a staff of seven that includes geriatricians, nurse practitioners and a social worker.
By visiting only homes in eight District Zip codes located east of Rock Creek Park and by carrying little of the overhead of office-based practices, DeJonge said, his program is proving financially viable: The average house call generates about $100 from Medicare, and Medicaid provides about $1,800 per patient per year for social work services. Donations from foundations and individuals typically total about $250,000 annually.
DeJonge said his patients are pleased "that they can get the care when they need it -- in the home, where they prefer to receive it. The social combined with the medical . . . if you bring both to the home, then people and families can make it."
Hall said her mother's previous doctors didn't communicate with one another. As a result, she said, they burdened Cowans with unnecessary drugs and hospitalized her repeatedly before implanting a heart pacemaker that she didn't need. With the Washington Hospital Center program, "you've got one doctor who sort of directs everything," Hall said.
"This gives us so much peace of mind," she said. Without the program, "we wouldn't be able to handle it as well as we handle it now. . . . This will certainly allow her to stay out of a nursing home."
Needle in a Haystack
"Finding a senior who wants to go to a nursing home is little like searching for a needle in a haystack," said Tricia Neuman, director of the Medicare Policy Project at the Kaiser Family Foundation. "I think you'd be hard-pressed to find a senior who truly wants to enter and live in a nursing home. It's often a last resort."
Starting this fall, Medicare beneficiaries in selected communities will be invited to enroll in a half-dozen demonstration projects as the federal program seeks new ways to control spending while improving care. For example: