Geriatric Home-Based Medical Care

Older adultsarelivinglongerwithmorechronic disease and functional impairmentthan at any other time in history. Office-basedpracticeis inadequate tomeet the needs of patients whohave difficulty leavingtheir homes for routine or urgentvisits,and health care clinicians must choose between trying to manage their problems via telehealthorsending them to the emergency room via ambulance. Indeed, many clinicians receive little or no training in home-based medical care andare unable toconsider a home visit that might avert a health crisis or anemergency roomvisit. Other clinicians know that house calls are possible but may not know how to work them into day-to-day practice. In recent years, a growing number of clinicians have focused their practice on home-based medical care to meet the rising need. In fact, there has been a substantial increase in house calls provided to Medicare beneficiaries. In 2023, over 750,000 traditional Medicare beneficiaries, and in 2022, over 680,000 Medicare Advantage beneficiaries received longitudinal home-based medical care. While the number of house calls has increased rapidly, the number of clinicians providing those visits has markedly decreased, suggesting that clinicians who are providing such care are making it the sole focus of their practice. Thisbook is intended to be a practical reference for any clinician who has struggled to care for an older adult who has difficulty getting to the office. By describing fundamental principles of geriatric house call medicine and application to specific diseases and conditions, we hope to provide clinicians with the tools they need to provide timely, compassionate, and high-quality care for their older adult patients.The second edition has been updated to reflect changes in the healthcare system and approaches to care since the publication of the first edition.