Sheri Porter, author of Researchers Make the Case for Home-based Medical Care:Frail Seniors Need Access to Care

 The next many paragraphs are written by me, Catherine Palmer Paton aka Livfully...summarizing  an article and then putting an extensive quote at the end from the article in the title of this post.

The American Academy of Family Practitioners (AAFP) ran an article in December 2018 with the above title. I found it through a link in an End Of Life Doulas group of which I am a member. There is a free online training for basics at Doulagivers.org 

•  If you can access the article it's worth considering the emerging paradigm to encourage more options for people receive care in their homes.
• Following is a quote from the end of the article about research originally posted in American Geriatrics Society Journal (with a link to the original research at onlinelibrary.wiley.com, "Use of Medical Home-Care and Disparities" for Medicare-eligible patients.  In general all adults should pay more attention to what Medicare and Medicaid will cover for themselves and those in their states and communities (and help inform people with some basic guidelines and websites, not practicing medicine or directing them in any way regarding their care, coverage and so on unless that is their profession.)
• In addition we all need to get our states to inform us clearly about the trajectory of what would be needed to be in place in terms of any Legal Caregiver Agreement so care could be provided and meet any medicaid spend down amounts  and terms as well as any requirements for medicare which covers people over age 65. Who can share what information is another set of information that every state should clarify.
• Overall, everyone should have access to a computer and an assistant to pursue a basic set of information (which again should be spelled out step by step and A-Z so no one is deprived of knowing the legal and medical and other record keeping (such as a daily log of ADLs, Activities of Daily Living) and cognitive skills and such that are important to monitor (along with fluid and food intake and output which can be important to prevent dehydration or low sodium levels, unbalanced blood sugars, and to monitor blood pressure and other basics (such as Oxygen level in the blood which can be done with a simple device.)
• Charting all the basics, as well as time and date of care or services rendered is important. The appropriate workman's comp and unemployment insurance, rate of hourly pay (often a state minimum wage for instance) and other factors that would need to be clarified should be reviewed with appropriate professionals, such as elder law attorneys, social workers, doctors and support people.
• None of what I share here or on this blog is to be taken as medical, legal or social service advice or a complete accounting of what needs to be done. I am sharing this as a citizen who is encouraging others to ask questions, form a team of support for each part of their life and to keep track of information in a secure manner (back up copies, take photos with a cell phone and download to a computer, have copies of medical information for oneself and anyone you may be caring for as is appropriate, daily logs and records of hours, Legal Caregiver Agreements, Advanced Directives, Health Care Representative, Power of Attorney (to handle financial concerns and have access to paying bills from a person's account, etc if they are incapacitated or in a longterm manner --so to explore a Durable Power of Attorney and so on.
• Whatever needs to be witnessed by two adults, notarized to verify the date and so on should be done according to the laws in one's state etc. Again these are points to review with a professional and for one to follow with a written directive or recording of information so nothing is overlooked or delayed. 
• The information from the article by Sheri Porter about who is receiving care by nurse practitioners or a physician at home who is qualified to do so due to medicare status is as follows"
• " The unmet needs of the sickest patients are those who cannot leave the home; those patients are at the heart of this work. Previous research shows that there are approximately 3 million homebound patients who need these services, but only about 1,000 primary care clinicians who include home-based care as a significant part of their practices. However, 1.5 million nursing home residents have access to some 7,000 primary care professionals who regularly visit individuals in that setting to provide health care.

Q. How can these numbers be improved?

A. We need a payment model to incentivize caring for the sickest patients, and that is changing as the country moves into value-based payment.

Q. What are the next steps in terms of increasing the number of physicians who provide home-based medical care?

A. Once we improve payment issues, the bottleneck will be workforce. We need to explore the value of teaching home-based primary care in residency programs, and I'm already working with a program in my area to create a curriculum for residents."

 I hope that last set of Q and As gets the ball rolling in your circles to help secure help for anyone, particularly elderly or others who may need special care (low-income, pregnant or parents with small children and pretty much anyone in need physically, mentally or otherwise, whether to get to appointments or basics. More agencies are popping up to be one-stop-shopping places to help people get their basic needs met throughout life. When it comes to being frail and elderly we can all understand those needs would be heightened and merit a full court press of team efforts and competent services.. thanks for doing your part!