A recent piece in The New York Times looked at how Northwell Health brought the hospital to the home for COVID-19 patients.
Faced with too many COVID-19 patients and too few open beds, clinical teams went mobile to keep homebound patients hydrated, medicated and comforted around the clock. Miami hospitals that are at capacity are considering a similar approach.
This article begs the question: Will in-home clinicians be the key to getting the country through COVID-19?
Having led disaster response across acute, post-acute and in-home settings for the Ebola and SARS outbreaks, various floods and hurricanes, and now COVID-19 at Signify Health, my answer is an unequivocal “yes.” Maintaining the human connection is particularly important for seniors, who we know will experience prolonged isolation and lack of access to healthcare until more effective treatments and a vaccine are available.
Good old fashioned house calls are a critical way to help ensure continuity of care. When a clinician can talk with someone face-to-face in their home, they are able to gain insights about a person’s true health status and the social factors that are impacting them. For those with medical conditions like diabetes and heart disease—many of whom are choosing to delay or forego visits to traditional sites of care during the pandemic—having someone who understands their needs and can be a conduit to the rest of their care team is particularly valuable.
As our wellness assessments look at physical, mental, functional, psychosocial, pharmaceutical and behavioral status, we make approximately 1.8 referrals per in-home visit—sometimes on an emergent basis, with members going straight to the emergency room.
Emergent referrals are most commonly for severe hypertension or hypotension, uncontrolled depression that is putting that senior at risk for harm, and acute medication side-effects. Less urgent referrals are often for falls or fall risk, home safety, financial issues with medication adherence and plenty of access issues around primary care providers and specialists. With so many gaps in care, it will surely take all of us in the healthcare clinical and social care community, whether home- or facility-based, to see them addressed and closed.
A recent Health Affairs blog examined the effect of COVID-19 on care volumes and what the decrease in utilization might mean to longer term outcomes. While utilization rates during the height of the first wave of the pandemic declined then rebounded in some areas, the data show that utilization rates have not fully rebounded for conditions such as acute myocardial infarction and stroke for which “no care” should never be an option.
The unprecedented challenges of these times require that we challenge the status quo, particularly when it comes to giving people more options for how to seek timely, safe, quality care.
The Northwell Health experience is instructive as we think about strategies that we can deploy to care not only for those afflicted with COVID-19, but those who suffer from other health care conditions who would otherwise forego vital care.
As the Northwell experience also illustrated, bringing care into the home isn’t as easy as it was depicted by Dr. Marcus Welby. Aside from getting clinicians trained for this unique mode of care delivery, there are significant operational and logistics challenges to getting clinicians into the home efficiently and safely during a pandemic. And, with social determinants of health having a significant impact on clinical health outcomes, giving doctors and patients the tools and resources to address them as part of the care plan is essential.
As this COVID-19 mass casualty incident moves into more of a chronic phase, the in-home clinician can and should be a big part of the solution. By applying lessons learned from experiences of organizations that have been facilitating in-home care before and since the pandemic, we have an important avenue for managing both short-term resurgences of the virus and ensuring that care that can’t wait doesn’t wait.
Marc Rothman, M.D., is Signify Health’s chief medical officer.