On July 17, 2018, we discussed geriatric home care on “The Business of Health Care,” on Sirius XM Business Radio powered by the Wharton School, channel 111. My guests were: Evelyn Granieri, MD, Professor and Head of Geriatric Medicine at Columbia University’s Vagelos College of Physicians and Surgeons; Bruce Kinosian, Associate Professor of Medicine of Division Geriatrics at UPenn’s Perelman School of Medicine; and Jean Yudin, Director of the Truman G. Schnabel In-Home Primary Care Program at the Perelman School.
By the year 2030, if population trends hold, more than 77 million people who are 65 and older will be alive in the U.S.; by 2050, it could be 88 million, with 50 million of them being 75 years and older. Something has to give in our health care system in order to care for this demographic–which likely means caring for them in less expensive settings, such as the home. The home care movement is gaining steam. It has been in the news lately (e.g. Medicare expanding payment for remote monitoring, or bundling of payment for hospital and home transitional care) and it is really where elderly patients want to be–in the home and communities, even with increased frailty.
The care model employed by our panelists in caring for the elderly in their homes is the team approach–social workers, nurse practitioners, nutritionists, pharmacists, family members, and community services such as transportation and housing all coming together. Additionally, what was extremely important to the panelists in caring for their elderly patients was their understanding of each elderly patient’s life story and what the patient’s goals were, as treatment to cure may not be possible or even necessary. Both medical and non-medical care are importantlyinvolved in making the elderly patient’s life meaningful and ensuring these patients are involved in what is important to them. It is a different way of looking at medicine, health, and well-being. Further, what has been shown in Medicare demonstrations in caring for patients in-home is that it costs less and provides for an improved experience for the patient.
Interestingly, home-based primary care for the elderly has been in existence in the Veterans Administration since the early 1970s and has been successful. As mentioned, this care model is being evaluated in a Medicare demonstration (Independence at Home) and has saved money each year since its inception in 2012. Projections of savings, if the program became a Medicare benefit, are in the $2.6-$27.8 billion range, depending upon how many Medicare beneficiaries receive home-based care. Why Medicare has not broadened enrollment into this program is a mystery. Perhaps it should.
The entire discussion on geriatric home care can be heard here: