Healthy at Home

DuPage County APN Brings Expertise to the Patient's Living Room

As seen on www.advanceweb.com
Posted on January 13, 2010
by Robin Hocevar

Practitioners who make house calls are regarded as something that went out with the Eisenhower administration. However, with new evidence touting better outcomes for less cost when health is managed at home, the house call is destined to reappear on the landscape.

Ancy Zacharia, MSN, RN, GNP, WCC, celebrated her 10-year anniversary with the nonprofit Home Care Physicians on Dec.6 - and she never would have predicted her job would become trendy again. Her days are spent driving around the 300 square miles radius from Central DuPage Hospital (financial supporter of the group) in Chicago's western suburbs and bringing her practice to those who have difficulty getting to outside appointments. Patients are eligible regardless of their ability to pay, and Medicare covers 80 percent of the cost with supplemental insurance often picking up the remainder of the tab. The practice is also supported by private donations.
"People love to be in their own homes. It keeps them healthier and more mobile. Some of these people can't afford caregivers and have to move to a nursing home. Managing them at home prevents this [premature nursing home placement] and also repeat hospital visits," she said.

Harnessing Technology
Much of the re-emergence of the house call can be attributed to the invention of portable technology. Zacharia can order X-rays, ECGs and ultrasounds to be done in the home, in addition to the regular primary care she provides. Although the practice doesn't officially have telehealth measures in place, a community nursing service rounds on the patients and electronically sends reports.
The combination of portable technology and an aging population points to a bright future for home health practices.
Although the average patient age is 80, Zacharias' agenda consists of visits with patients of all ages who have MS, Lou Gehrig's disease and muscular dystrophy, and patients recovering from a stroke or car accident.

Closer Connections
For Zacharia, part of the appeal of the job was her attachment to her grandparents and fondness for working with the elderly. What she's discovered is that, regardless of age, being welcomed into a patient's home deepens their relationship. From a professional standpoint, her assessments are more thorough because she has a perfect picture of the patient's home life.
"When you walk into the house, you can see any safety hazards. Is there a lot of furniture they could trip over? If the patient is diabetic, I can actually see what they're eating," she said.

In her initial assessment with 97-year-old Dorothy Postlewait, for instance, who was recovering from a fall and managing hypertension and COPD, Zacharia could see the patient needed a better bed. She ordered a hospital bed and Postelwait reported easier breathing once her head was elevated. (You can watch video highlights of a home health appointment with Zacharia.)
Zacharia thinks it's easier to spot and treat depression in the home setting. It's common for home-bound patients to feel melancholy and many report just the act of having someone visit their home gives purpose to their day.

"I sit and talk with them. I can see their living situation and family dynamic, too, and understand better," Zacharia said.
That sense of companionship is both Zacharia's favorite and most challenging part of her job.

"I feel a lot of empathy when we lose a patient. They know me and I go into their home and know the relatives. You become like a family," she said.

Robin Hocevar is senior regional editor at ADVANCE.