Pat Kinney sits at her dining room table across from Patti Herson, who is updating information on a laptop computer.
Herson, an adult and geriatric nurse practitioner, reviews the history of her past visits with Kinney and makes notes about Kinney’s blood pressure and other vital signs, as well as her medications and general observations on her state of mind and body.
Kinney, 80, who lives alone, would normally have to travel to see three doctors under her Lovelace Health Plan — her primary care physician, a doctor who manages her arthritis pain, and a pulmonary specialist who monitors her asthma. She’d also have to bear the cost of co-pays for each of those visits.
The regular visit from Herson is part of Lovelace’s recently implemented in-home Care Plus Program, which requires no co-pays and which brings medical expertise to a person’s home so that elderly, frail or patients lacking transportation can get basic medical attention without having to make appointments and find a way to get to the various doctor offices.
“When I had a cold, it put me into asthma and she (Herson) put me on medication so that it wouldn’t go into bronchitis,” Kinney says. “And then she checked on me that same week and her nurse assistant made a follow-up phone call. They kept on top of it so it didn’t get worse and I wouldn’t have to go to the doctor’s office.”
The Care Plus Program is one component of Quality First, a multipronged approach to bring medical care for targeted members of the Lovelace Health Plan, explains the plan’s chief medical officer, Dr. John Cruickshank.
“Under the traditional model, people are forced to see providers in an office setting, when it is convenient for the provider,” he says.
If the ill patient is unable to get in to see the doctor, or lacks transportation to get there, the medical condition can worsen and eventually the patient winds up in the more expensive environment of an emergency room.
“Patients have access to a nurse practitioners 24-7 via cellphone,” Cruickshank says. “The whole idea is to triage problems so members don’t have to rely on calling an ambulance and going to the ER and likely wind up being hospitalized.”
Nurse practitioners go to the patient’s home as little as once a month for maintenance, or once a week or once a day if necessary to get them through a medical episode. “It depends on the condition and the severity of the condition. There’s nothing scripted.”
The Care Plus Program does not eliminate the need for patients to see doctors and specialists, it just reduces the need to see them as often, Herson says. Nurse practitioners in the program are independently licensed and have additional training over and above that of a registered nurse, according to Cruickshank. They can write prescriptions and do not need to call a physician to obtain orders for referrals for lab tests, physical and occupational therapy, hospitalizations or specialists.
“We’re offering them (member patients) a lifeline that wouldn’t normally exist,” he says.
Safety at home
A lot of what the nurse practitioners do during their home visits is education.
“We teach people how to understand and control chronic problems and we can monitor their medications,” Herson says.
“For someone with heart failure, for example, I can go in and look at what they’re eating and drinking and help manage their diet to eliminate foods that make their condition worse.
“A lot of times people are confused about their medications. One patient had two of the same medicines, the brand name and the generic, and didn’t realize she was taking twice the prescribed dosage.”
Also, by visiting a person in their home, the nurse practitioner can pick up on “cues” about a person’s mental state as well as their physical condition, she says.
“If a person suddenly stops taking care of their home, doesn’t get dressed and is ignoring personal hygiene, we will see that and may be able to determine what the problem is, or determine they need to be someplace where they can be seen right away and get tests that can’t be done in the home setting. How safe they are at home is a big concern.”
In addition to in-home Care Plus, other components of Lovelace’s Quality First program include an in-home assessment process to determine if a person should be in Care Plus and to what degree a nurse practitioner’s service might be required; and a behavioral health assessment process to determine if a person suffers from depression, anxiety or other mental health illness, and if these are driven by disease or other triggers.
Also offered are a telephone outreach program for people who may not need visits from a nurse practitioner but may benefit from an occasional conversation with a case manager to help control an illness or chronic disease; and a medication management program run by clinical pharmacists using a sophisticated data base to monitor a person’s prescriptions and drug interactions.
For Kinney, the added benefit of Herson making a house call goes beyond medical practicality. She welcomes the company.
“If I’m having a bad day we talk about it and it cheers me up,” she says. “I look forward to her coming.” Home care
In addition to Lovelace’s Care Plus program, other healthcare providers in New Mexico offer in-home services to people who for one reason or another are unable to travel to doctor appointments.
Presbyterian Home Healthcare Services offers Hospital at Home, which it describes as hospital-level care in a home setting with doctors nurses or home health aides visiting people at home. It also offers a Home Care program with Medicare-certified skilled care for homebound patients post surgery or hospitalization, and its Medical House Calls program offers in-home care to patients as a means of circumventing the need for ER visits, urgent care visits and unnecessary hospitalizations.
University of New Mexico Health Sciences Center operates Care NM, which provides “client support assists,” people who visit PCP members in their home to assess their medical needs, conduct health risk assessments, and provide information and education on a variety of topics including screenings, referrals, community resources and medication and illness management.
The New Mexico Veterans Administration Health Care System has a Home Based Primary Care program that provides in-home primary care to nonmobile veterans with chronic and long-term illnesses. Among the health care professionals who go into homes are doctors, nurses, psychologists, social workers, dietitians and occupation and physical therapists.
RICHARD PIPES/JOURNAL Nurse practitioner Patti Herson takes the blood pressure of senior patient Pat Kinney, as part of Lovelace Health Plan’s in-home Care Plus Program.
CRUICKSHANK: “A lifeline that wouldn’t normally exist”
RICHARD PIPES/JOURNAL Nurse practitioner Patti Herson listens to senior patient Pat Kinney’s respiration during a recent in-home visit provided as part of Lovelace Health Plan’s Care Plus Program.
Source: Albuquerque Journal