When Dr. Eric De Jonge sees patients, he gets in his Honda and drives.
De Jonge helps run the Medical House Call Program at the Washington Hospital Center in Washington, D.C. The program's team of doctors, nurse practitioners and social workers turn the delivery of medicine upside down. They go to the homes of frail patients, and bring with them a range of equipment -- from a portable X-ray machine, to the basic check-up tools that De Jonge stuffs into his physician's black bag.
"The House Call program is aimed at caring for the most ill, the most disabled and the vulnerable folks," De Jonge says.
"These are the people who have trouble getting to the doctor's office. So rather than wait for a disaster to happen, we want to bring care to them."
De Jonge is trying to prove that by going to patients' homes, he can provide better medical care -- and save money -- while caring for the sickest and most frail patients.
On one visit to Viola Hicklin, an 89-year-old woman in the terminal phase of Alzheimer's Disease, De Jonge not only checks his patient's health, but also gets an assessment from Hicklin's daughter, Pat: Her mother seems to be doing better since De Jonge arranged for staff from hospice care to start visiting.
Hicklin is more alert, and able to hold and cuddle her 2-month-old great grandson. If she keeps improving, she might not even need hospice care anymore.
"I never mind if someone graduates from hospice," De Jonge says. "That's always a good thing."
The frequent visits from the House Call team and hospice have made a difference. Her daughter says the fact that Hicklin can stay at home, surrounded by family, including her great-grandchildren, also helps.
"She acknowledges them and they acknowledge her," Pat Hicklin says. "She feels their love and their attention."
It takes much more than doctor's visits to keep a frail patient living at home. So the House Call team includes nurse practitioners and social workers, too. The staff meets once a week to review cases.
At one such meeting, Dr. George Taler, who co-founded the House Call Program, discusses a patient named Ruth who has dementia and schizophrenia and is in danger of being kicked out of her senior-only apartment.
"The problem is that her son was finally released from prison," Taler explains. "He has nowhere to go and moved in with mom in her senior apartment. He's not supposed to be there, because he's obviously not a senior. And he has been, I think, socially inappropriate to quite a number of people."
Taler says that because of her condition, Ruth doesn't understand that she'll get kicked out if her son doesn't leave. Taler and his team have negotiated with the building manager and city officials. They've talked to other family members. They're even trying to find a low-cost apartment for the son to move into. It isn't what your typical doctor gets involved in, but the house call doctors do.
"If you're going to maintain this population in the community, then if their living situation no longer works for them, it doesn't matter how well you manage their hypertension and diabetes," Taler says. "They're going to fail."
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