Friday, Aug. 15, 2014
Calling the family doctor to come for a house visit because grandma is sick sounds like a thing of the distant past, but patients in the VCU House Calls program are getting this kind of care today.
In fact, for the last 30 years, VCU House Calls has been providing home-based routine and emergency care for patients too ill or disabled to get to a doctor’s office. Since 1984, House Calls’ clinical staff members make home visits every weekday to provide both ongoing primary care, as well as urgent care, for patients who are too sick to come to clinic.
Headed by Peter Boling, M.D., professor of medicine and chair of the Division of Geriatrics, the team consists of physicians, nurse practitioners, social workers and geriatric care managers. In order to participate in the program, adult patients must accept the providers for primary care, live within 15 miles of the hospital and be unable to attend clinic without great effort.
“The clinical need for house calls and the benefits that result have been clear to me since a few months into my first experience with this care model,” Boling said. “With a core group of friends and colleagues who are strong and effective advocates, we have moved a long way in 30 years.”
For patients like Dorothy Pope, who has been in and out of hospitals and nursing homes over the last few years, having her complex medical care coming to her doorstep means a lot to her and makes a world of difference.
“That’s helped me a whole lot,” she said. “I feel great knowing that I have a doctor I can count on.”
A patient of Boling’s for 28 years, Pope has several medical conditions, including one that limits her mobility, making it especially difficult for her to get up and down the stairs that lead into her apartment. In order to get out of her apartment, 87-year-old Pope has to have help from her daughter, her medical aide and even the representative in her apartment building’s rental office, all at once.
“I love him, and I wouldn’t have anybody else but him,” Pope said of Boling. “He knows how to talk to me and tell me things that no one else can explain to me. He is a natural, and a sweet guy.”
At an event on Aug. 12 celebrating the 30th anniversary of the program, members of the care team and others from the hospital community joined to commemorate the work and impact of the program throughout the years. Sheldon Retchin, M.D., CEO of VCU Health System and senior vice president of Health Sciences at VCU, is a long-time colleague and friend of Boling’s, and he addressed the team and their work at the event.
“You are attracted to the mission of not only taking care of a vulnerable population but taking care of them on their own turf,” Retchin said. “This program reminds us that there is a lot of art to it, not just science.”
“Along with our other geriatric clinical services, we've been able to create a continuum of care that meets the needs of thousands of patients across settings and across time — decades, in many cases,” said Jay Holdren, director of Geriatric Services at VCU Medical Center. “It’s very rewarding work, and we take it very seriously. It’s truly a team-based approach to care."
Boling believes that going directly to the patients makes it easier for them and ensures they are receiving the care they need. As a residual benefit, more safely managed conditions in these patients yield the potential for fewer EMT responses, fewer emergency department visits and billions of dollars in cost savings each year.
Because of this, Boling and several colleagues worked with members of Congress a few years ago to help craft the Independence at Home Act of 2009, which was included in the Patient Protection and Affordable Care Act signed into law in 2010. As a result, in 2012, the Centers for Medicare and Medicaid Services asked the House Calls program at VCU Medical Center, as one of 19 sites nationwide, to test the advantages and effectiveness of this approach in improving care and reducing health care costs for chronically ill or disabled patients for a three-year period.
“Throughout these three decades, the Geriatrics team at VCU has led the way with education, research and advocacy, all anchored to what we have learned through our experiences helping our patients and their families,” said Boling.The House Calls program has been accredited by the Joint Commission since 1997. It is the oldest of the clinical programs in the VCU Division of Geriatrics, which falls under the Department of Internal Medicine.
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