Bring Back House Calls…and Fix the House
by Jill Breysse
In his October 14, 2015, opinion in The New York Times, cardiologist Sandeep Jauhar lists two major reasons why the revival of doctor house calls makes sense: better patient outcomes and savings to the health care system, primarily due to reductions in re-hospitalizations and better care coordination. He recounts a stirring anecdote about his visit to a patient’s home, where his observations of the patient’s living conditions gave the doctor new insights about why this patient had been hospitalized four times in six months.
The link between the home and a person’s health, and the need for clinicians to ask about patients’ home conditions, is something that we here at NCHH have focused on for years. People spend 90% of their time in their homes, and vulnerable populations such as young children and the elderly spend even more. But clinicians tend to focus on the patients’ medical treatment, without realizing that conditions in their patients’ home can thwart these medical efforts and land patients right back in the hospital. Hazards at home can also cause such a great decline in health and function that the patient faces the trauma of moving away from his/her lifelong home and into a care facility.
While Dr. Jauhar notes the insight the home visit gave him, he doesn’t recount the steps he then took to alleviate the adverse conditions he observed. He did not discuss the housing structure itself, which can play an enormous part in the health of residents. For example, deferred home maintenance, a common problem for elderly homeowners, can lead to escalating health and safety hazards in the home, including faulty electrical wiring posing burn and fire hazards, torn and uneven flooring and shaky or missing stair railings leading to fall hazards, and faulty ventilation systems exacerbating respiratory ailments or posing asphyxiation hazards.
We at NCHH support home visits by clinicians, be they doctors, nurses, or occupational therapists. If they can’t go to homes, clinicians need to take the time during office visits to ask patients about home conditions. Clinicians should have a ready list to refer patients to organizations that can help fix home-related issues; e.g., Meals on Wheels, free prescription mail delivery services, local housing agencies for minor home repairs, and other community organizations that can arrange transportation for homebound residents. Improvement in resident health on a national scale is possible, but only if we take steps to both medically treat people and intervene in their homes.
Jill Breysse, CIH, MHS, Project Manager, joined NCHH in 1998. She currently leads the Aging Gracefully in Place project, working to improve elderly residents’ physical function and enhance their housing conditions so that they can safely age in place. Ms. Breysse has authored several peer-reviewed research articles evaluating healthy homes hazard assessment tools and interventions. She was the lead author of guidance on conducting health impact assessments for housing decisions and helped to develop the National Healthy Homes Standard, an evidence-based standard of care for existing owner-occupied and rental housing. Ms. Breysse holds a Master of Health Science in environmental health engineering from the Johns Hopkins Bloomberg School of Public Health and a Bachelor of Science in Chemistry from the University of Maryland.