“Go to the doctor,” we’re told when we get sick. But what about our neighbors who can’t? A growing segment of the United States population can be described as “homebound”, or those who cannot leave their homes without significant help. National studies of people 65 years and older have shown that the number of homebound adults has more than doubled in the last decade. These older adults have many chronic diseases but don’t have easy access to primary care, leading to more frequent emergency room visits and hospitalizations.
As a medical student at Duke University, I’ve seen firsthand how our health care system is not set up to meet these patients’ needs. My grandmother is 92 years old and has difficulty getting around because of her knee pain. While studying for an exam during my first year of medical school, I received a frantic call from my family that my grandmother wasn’t feeling well but they couldn’t figure out why. They didn’t have the ability to carry her outside, transfer her into the car, and drive her to see a doctor. They saw no choice but to call an ambulance to take her to the hospital to be evaluated. She was admitted and found to have a urinary tract infection and constipation. She was treated and taken home.
While I was relieved she didn’t have anything more serious, I was frustrated that my family had to go through the stress of the hospital system for something any primary care physician could have diagnosed and treated in the office. Hospital-based care is not only inconvenient but also significantly more expensive than office-based care: Blue Cross NC estimates that emergency room care costs almost 12 times more than visiting the doctor’s office. While a financial burden to patients, these expenses also contribute to rising health care spending in the United States.
There must be a better way to provide medical care to these patients who need it the most, and there is. Home visiting programs have been shown to reduce emergency room visits, hospitalizations, and overall health care costs for patients with complex needs. In Durham County, Lincoln Community Health Center launched the Just for Us program in 2002 to provide in-home primary care to low-income elderly adults and those with disabilities living at home who are not able to get to a primary care provider. Dr. Howard Eisenson is the current medical director of this primary care home visiting program. As I joined Dr. Eisenson on home visits, I saw a model of care that upended the hospital- and clinic-based care I provided through my medical school rotations.
In my medical and public health training, I’ve often heard the expression “to meet patients where they’re at” as a key part of addressing health disparities and inequities. It always seemed like a hypothetical, abstract goal: we can’t meet our patients where they’re at without leaving our offices. The Just for Us program takes that expression literally to carry out its meaning and mission. Through home visits, we know exactly what medications our patients have, who their caregivers are, if they have healthy food in the kitchen. We know how, despite all the hardships life has thrown at them, they utilize their unique strengths and resources to live out their lives. When we are invited into our patients’ homes, we can take better care of them.
Kelly Goo, MPH, is a medical student at Duke University and a 2022–23 NC Schweitzer Fellow.