Why Is Home-Based Primary Care Important & Why Now? 

Home-based primary care is an innovative and proven way to achieve health care’s Triple Aim. As our society ages, home-based primary care has the potential to achieve many critical population health goals. The strongest health systems will devise effective and efficient ways to manage chronically ill patients and those with end-of-life care needs, typically the highest utilizers of costly health care services.

Did you know the number of seniors aged 85+ years will quadruple between 2000 and 2050 or that:

  • 50% of this population needs assistance with activities of daily living?
  • Only 1 in 4 home-bound seniors receives the kind of home-based primary care they need?
  • 70% of these patients would prefer to spend their final days at home, but only 33% receive the appropriate end-of-life care to do so?

Now is the right time to establish a house call program in your healthcare organization, medical group or clinical practice. To learn more about the confluence of conditions currently incentivizing health systems to make Home Centered Care their gold standard of care for complex patients, please view or download our report: Home Care Medicine’s Perfect Storm.

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Who Typically Provides Home Centered Care?

The home-based primary care physician typically assumes the role of the Home Centered Care team leader. This physician makes referrals to a comprehensive coordinated care team for the additional medical and support services required to meet the needs of the patient or family. This may include:

  • Doctors with other specialties
  • Nurse practitioners
  • Physician assistants
  • Social workers/mental health specialists
  • Pharmacists
  • Community resources
  • Chaplains
  • Paid caregivers/aides
  • Respite care providers
  • Home health
  • Hospice nurses
  • Therapists
  • Care managers
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Who Is Best Served by Home Centered Care?

The majority of Home Centered Care patients are seniors in need of appropriate end-of-life care. This model is also appropriate for other populations, including:

  • People who struggle with activities of daily living
  • Medically frail patients with limited mobility
  • High-cost Medicare/Medicaid patients in need of chronic disease management or advanced illness management for such conditions as:
    • Congestive heart failure (CHF)
    • Diabetes with complications
    • Chronic obstructive pulmonary disease (COPD)
    • Ischemic heart disease
    • Stroke
    • Alzheimer’s disease/neurodegenerative disorders
    • Severe mental illness
  • Younger patients with chronic diseases or advanced illnesses, such as:
    • Multiple sclerosis
    • Amyotrophic lateral sclerosis (ALS also known as Lou Gehrig’s disease)
    • Muscular dystrophy
    • Cerebral palsy
  • Cervical spine injuries with quadriplegia
    • Traumatic brain injury
  • Patients transitioning to post-acute care settings
  • People with developmental disabilities
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Why Is Home Care Good for Health Systems?

Regulatory pressures and a changing population health landscape are incenting health care systems and accountable care organizations to reduce costs. One means of accomplishing this goal is to support patients’ ability to receive treatment in community settings instead of the hospital. Home Centered Care provides high-quality house calls to medically complex patients, including the frail elderly and homebound.

An effective home-based primary care program can help health care systems achieve the Triple Aim while reducing hospital admissions and preventing re-admissions. To learn more, view or download our report Home Care Medicine’s Perfect Storm.

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Why Is Home Care Good for Patients and Families?

Home Centered Care improves coordination and quality of care and supports aging in place by connecting patients and families to social services, home and behavioral health services, and caregiver support. It also helps avoid preventable hospitalizations, navigate difficult conversations and craft self-directed plans of care that allow for their end-of-life goals to be met.

Did you know, 70% of patients say they would prefer to die at home but only 33% of deaths actually occur at home and:

  • 69% of patients are hospitalized in their last 3 months of life and often experience increased pain and suffering through costly high-tech interventions?
  • 29% of patients spend time in the Intensive Care Unit in their last month of life?

Home Centered Care allows patients to live and die at home, with dignity and grace, surrounded by their loving family as they planned and desired.  

Did you know 65 million caregivers provide on average 20 hours of care per week to adults (aged 18+) with a disability or advanced illness?

  • 40-70% of family caregivers have clinically significant symptoms of depression, with about 25-50% of these caregivers meeting the diagnostic criteria for major depression.
  • Of those caring for someone aged 65+, the average age is 63, with 1/3 of these caregivers in fair to poor health.

For caregivers at the patient’s bedside as well as distant family members, Home Centered Care:

  • Decreases the isolation and anxiety many caregivers and family members experience when a loved one is aging in place or suffering from a chronic disease.
  • Provides a mechanism for remote loved ones to be engaged, informed and connected with the patient and their health and social service providers.
  • Creates practical supports that ease caregiver stress during these difficult times.
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Where does HCCI get its funding?

The Home Centered Care Institute is a non-profit 401c3 organization. Our funding comes from the generous support of donors who share our mission to increase access to quality house call programs for all patients who are better cared for in the home. For example, one of the critical factors in increasing access to house call programs is developing the workforce needed to care for the growing number of patients who would benefit from home-based primary care. A grant from The John A. Hartford Foundation helps make that training possible.

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Does HCCI offer funding assistance?

The Home Centered Care Institute offers funding assistance to outside institutions for activities or services that increase access to quality house call programs. HCCI prefers to fund direct project costs but understands the need to recover a portion of indirect costs Please view or download our policy for further information: The Home Centered Care Institute’s Policy On Indirect Costs.

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