Home health could prevail over facility-based care

Although healthcare has been concentrated in hospitals, clinics and other facilities over the past century, a Cleveland Clinic physician, Dr. Steven Landers, believes home healthcare is where the future of care lies.

Given patients' and caregivers' penchants for convenience, privacy and autonomy, Landers contends in a recent commentary in the New England Journal of Medicine that care models that bring high-quality care home via computer or mobile device may well prevail over healthcare facilities like hospitals. He may have a natural bias, as he specializes in geriatric medicine and home health, hospice and palliative care. In his commentary, he describes forces that will drive healthcare home.

As the U.S. population ages, it may be safer to treat people at home, he writes. It's one way to avoid complications associated with confinement in hospitals, such as delirium, skin conditions and falls. And seniors generally prefer in-home treatment and care, especially when nearing the end of life.

With the rise in chronic diseases associated with our aging population, nearly 90 percent of adults over age 65 have at least one chronic condition and nearly 70 percent have two or more, Landers notes. Mobility problems mean in-home care is more practical. Advances in home-based tracking means patients can manage their own care.

Advances in the miniaturization and portability of diagnostic technologies, IT, remote monitoring and long-distance care have made home-based care more viable, especially for patients with serious conditions. In San Diego, physicians on home-based visits may arrive with a new version of the doctor's black bag that includes a mobile X-ray machine and a device that can perform 20-plus lab tests at point of care, he says.

The lower cost of in-home care could also drive more patients to demand it.

To learn more:
- read the commentary in the New England Journal of Medicine

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