House Calls Program Brings Primary Care Home

Innovations in Geriatric Medicine | Winter 2022

Imagine having a serious health condition that keeps you homebound, making it difficult, if not nearly impossible, to seek the medical care you need. This is a significant problem in the communities that University Hospitals serves as well as country at large, where about 3.6 million of the nearly 39 million U.S. adults over age 65 are housebound.

Amanda Lathia, MD

To serve this population, University Hospitals Cleveland Medical Center's Medical House Calls Program provides medical care and support primarily to geriatric patients who are unable to leave their home.

Serving homebound patients

The University Hospitals Medical House Calls Program has served this at-risk population for years, Medical Director Amanda Lathia, MD, says. It is run primarily by board-certified nurse practitioners Denise Brown, MSN, APRN, and Barbara Moseley, MSN, APRN.

“Our patients are generally adults 60 years of age and older who are homebound according to Medicare’s specifications,” Dr. Lathia says. “They leave home infrequently due to medical or health reasons, and doing so requires considerable and taxing efforts. In fact, many rarely leave their homes.”

The House Calls program provides in-home primary care and treats patients from a holistic, patient-centered perspective, she says.

Comprehensive primary care

“We focus on the whole person, taking into account patient mood, cognition, functioning, quality of life and social supports, rather than taking a disease-centered approach,” Dr. Lathia says. “We try to focus on the patients’ and caregivers’ goals and perspectives regarding their overall health and quality of life.”

Without House Calls, many patients would not otherwise receive primary care, driving them to the emergency room after their health needs become urgent.

“As a result of the program, we are able to decrease ER visits and hospital admissions by dealing with problems early, before they become so urgent or emergent,” Moseley says.

Many elderly patients have complex medical and social needs, she continues, and according to a recent study, nearly 41 percent of those who are homebound have two to three comorbidities and 32 percent have four or more. Seeing patients in their homes allows providers to care for them in a more holistic way than an office visit generally allows and involves the family in the patient’s care. It also can give providers more insight into patients’ health and medical problems when patients are seen in their living environments, including a better understanding of home hazards, family dynamics, medications and diet.

“We work closely with patients and their families to set appropriate care goals to help them have the best quality of life possible,” Moseley says. “We teach them about their illnesses, medications and treatment. As a result, they become better able to manage their health problems in a way that’s consistent with their values and priorities.”

Much of the support House Calls provides is palliative or symptom management, Dr. Lathia says. House Calls patients often are enrolled in hospice at the end of life, and the team often oversees their hospice care, as well.

Although the nurse practitioners provide most of the care, patients can see a doctor if requested by the nurse practitioners and/or patients and their families.

“House Calls also partners with community services, so we can obtain imaging studies, such as chest X-rays or ultrasounds in patients’ homes,” Dr. Lathia says. “Our House Calls coordinator helps arrange appointments and directs patients’ questions or concerns to nursing staff at UH Foley ElderHealth Center.”

At-home care improves outcomes, reduces costs

In addition to reducing the number of hospital admissions and emergency room visits, Brown says House Calls helps and encourages at-risk patients to follow through on their care plan once discharged from the hospital. Lack of continuation of care further threatens patients’ health and drives up medical costs.

“Often when patients are discharged from the hospital, they don’t have access to transportation to get to a specialty appointment or to pick up medications from the pharmacy,” Brown says. “The House Calls program reduces costs on the back end because we see patients more frequently and can pick up on signs and symptoms that may be leading to a potential emergency room visit or hospitalization.”

It’s hard not to overstate the benefit of allowing chronically ill elders to remain in the comfort of their own homes, which is so important to most patients. And, at the end of life, patients can transition peacefully, surrounded by family.

Accepting new patients

It’s easy for providers to refer patients to the House Calls program, Dr. Lathia says.

“Providers can make an order for a referral to the House Calls program in the Ambulatory EMR,” she explains. “Once UH is up and running with EPIC, this order will be available on the inpatient side, as well. We are accepting new referrals and will also visit patients in assisted living facilities and independent living communities.”

Brown says not enough providers or patients know about House Calls.

“Families tell us all the time they didn’t know we even existed,” she says. “As practitioners, we enjoy the fact that we get to know our patients really well.”

For more information, or to refer a patient, call House Calls at 216-464-6210.

Contributing Experts:
Amanda Lathia, MD
Medical Director
University Hospitals Medical House Calls Program
Assistant Professor
Case Western Reserve University School of Medicine

Denise Brown, MSN, APRN
Nurse practitioner
University Hospitals Medical House Calls Program

Barbara Moseley, MSN, APRN
Nurse practitioner 
University Hospitals Medical House Calls Program