Dementia as Leading Co-Morbidity in Homebound Seniors

Background: A curious twenty-first century phenomenon is happening in the US. Physicians and Nurse Practitioners are reviving the house call practice. Medical House Call Programs offers homebound elderly residents medical treatment in their own homes. The United States is currently faced with the challenge of how and where to care for it's aging population. Nurse practitioner (NP) home-based care is a potential solution to meet this challenge. Current research indicates that care provision by advanced practice nurses reduces cost, decreases length of stay and readmission to hospitals, and improves patient quality of life. Advanced practice nurses are able to fill the provider gap for aged patients.

Aim / Goal: This retrospective look at the practice showed Dementia as the most common co-morbid condition that predisposes elderly patients to be homebound. The purpose of this study was to assess trends in the number of cases per identified diagnosis of house calls made by the nurse practitioner in a house calls private practice from its inception in the year 2014.

 Implementation: A simple analysis of cases seen from the period of inception of a nurse practitioner house call practice for a total of nine months in 2014. Data obtained using the electronic health record (EHR) used by the practice.

 Results: Dementia constitutes the highest share in the distribution of diagnoses at 62%, Hypertension 29%, Diabetes 22%, Hyperlipidemia 15% and Kidney Disease 7%.

 Clinical Relevance / Conclusion: There is a resurgence of medical house call services by a combination of physicians and emerging practices by nurse practitioners. House calls by a Nurse Practitioner opens up opportunities to address some of the challenges that dementia and co-morbidities present. Further exploration at how this practice model can lessen ER visits or  hospital readmissions is recommended. The project will start tracking readmission rates starting September 2015 to December 31, 2015 and will highlight results of the three-month pilot.