SENIOR LIFELINE

To ease the pain and suffering of isolated, homebound seniors, North Shore Forest Hills Hospital is bringing back the house call
A blue van carrying a medical team pulled up on Yellowstone Boulevard on a sweltering day last week to tend to a stroke victim recuperating at home.
The sight of a physician, registered nurse and technician headed for a medical visit drew curious stares from passers-by in Forest Hills.
Small wonder.
The medical contingent carrying two large cases with equipment was reviving an old American health care custom – the house call.
The tradition, well entrenched in the City’s health care system decades ago is making a comeback due to wrenching changes in a medical system, now dominated by managed care and societal malaise.
"It’s absolutely vital in this neighborhood," explained Dr. Minal Shah who heads the house call service for North Shore Forest Hills Hospital. "Our patients are homebound and bed-bound and lack family help."
He noted that many of his patients have been abandoned by their children in Forest Hills and their only lifeline is the program recently started by North Shore.
In front of the Yellowstone Boulevard apartment building last Wednesday, Dr. Shah and his associates wheeled their equipment out of the van and rang the patient’s bell.
A family member poked his head out of the door and explained in Russian that his mother was moved to another relative’s apartment. The technician translated for Dr. Shah and the team returned to the car to find their patient.
Once they arrived at the second location, Lillian Isakharova, the patient’s grand daughter, opened the door.
"I like this house call idea very much," she said. "It’s very comfortable because my grandmother is unable to visit the doctor’s office."
The patient, Dora Chulyakova, had suffered a stroke and the medical team spent about a half hour with her. They dipped into their two equipment bags and extracted an electrocardiogram (EKG), got the patient’s reading, and then took blood tests.
Gone are the days when doctors called, armed only with a thermometer, stethoscope and on the job experience. Today’s high-tech testing and diagnostic equipment can be found not only in the clinic, but in the living room as well. "House call physicians used to carry a small black bag with a stethoscope and medication," Dr. Shah said. "Now we are armed with far more equipment. It makes for more effective medicine."
Dr. Shah expressed enthusiasm for the concept of turning the clock back and re-introducing house calls, citing an important reason for bringing back a long-standing medical tradition.
"Our patient population is much older now because medicine has kept them alive longer," he said.
Economics also play a significant role in North Shore’s ability to institute the new program, Dr. Shah explained."We are able to do this because of the hospital’s commitment to the house call idea and a $500,000 grant.
The grant enables the hospital to make up the losses incurred when a doctor makes a house call.
"Medicare reimburses us for about $75-$80 a visit," he said. "At the hospital we’d have been able to see four patients at an average $50 fee." The grant helps North Shore make up the approximately $100 in revenue lost during the time it takes to make a single house call.
Since the program began March Dr. Shah has visited the homes of 30 homebound patients, suffering from a variety of medical ailments. And although some, like Chulyakova, received support and attention from family members, more than a few struggle to meet life’s most basic necessities on their own.
"It’s a very sad state of affairs among elderly patients in Forest Hills," he said. "We find patients with alarmingly high blood pressure and elevated blood sugar and very often they are malnourished."
Dr. Shah described the diabetes problem as very severe, with patients often going blind and suffering kidney problems because of the rampaging disease process.
"These are patients who have fallen through the cracks in society," he said. "We are trying to stabilize the situation at North Shore Forest Hills Hospital."
Dr. Shah spends 12-14 hours a week traveling along Forest Hill streets to bring medical care to mostly elderly patients.
To qualify for the house call program, individuals must be 65 years of age or older, physically unable to leave their homes without extraordinary means; geographically close to the hospital and lacking adequate health care at home.
Dr. Shah said eligibility is based upon their living alone, especially if recently bereaved or separated, a mental impairment, a history of falling, major mobility problems and a recent hospital discharge.
"What we’re trying to do here," Dr. Shah said, "is to bring the hospital to the patient’s home."
According to Dr. Joanne Schwartzberg, director of Aging and Community Health at the American Medical Association, there is a national renaissance in house calls. She said it is driven by patient needs.
"It’s not just the increased numbers of elderly over 85, but large numbers of younger disabled patients. She said there were more than seven to eight million homebound patients who need this kind of help nationwide.
"House calls are an invisible issue and the elderly are an underserved population that needs to be addressed," Schwartzberg said.
The house call concept is, however, gaining momentum around the country. She said the single biggest reason has been changes in Medicare reimbursement.
"The rate has been increased and it has encouraged more hospitals and physicians to bring back this program.
Schwartzberg said for most homebound seniors across the country, family support is strong. In fact, she added, more than 80 percent of these elderly around the country are aided by family members.
But in Forest Hills, Dr. Shah painted a different picture.
"These are people with multiple medical problems," he explained. "Some of their apartments are in disarray because they’ve been abandoned by their families and lack any help at all." He said there are no children to help and no home care is forthcoming.
Just how long have house calls been a part of the medical practice? Schwartzberg said they originated in the era of Hypocrates. According AMA figures, house calls had their heyday before World War II and by 1959 only nine percent of a doctor’s practice time was spent on house calls.
By 1971 it had dropped to one percent.
But now at the end of the century, and after a 40-year hiatus, the house call is coming back.