What alternatives are available for providing medical care to homebound patients who cannot utilize traditional home health care entities?

Alternatives for Medical Care for Homebound Patients

Telemedicine combined with direct primary care is the most effective alternative to traditional home health care entities for providing medical care to homebound patients. 1

Telemedicine-Based Options

• Telemedicine provides comparable quality to in-person care for many primary care concerns and can overcome barriers to accessing care for homebound patients 1
• Video-based telehealth encounters allow homebound patients to connect with healthcare providers without leaving their homes, which is particularly valuable for those with mobility limitations 2
• Telemental health has shown robust adoption because mental healthcare commonly does not rely on physical examination of patients, making it particularly suitable for homebound individuals 3
• A "telemedicine first, direct primary care" subscription model can provide stable revenue for providers while offering patients enhanced communication with their care team 1

Potential Barriers to Telemedicine Use

• Many homebound patients (particularly older adults) require assistance from family members or paid caregivers to complete telehealth visits 2
• Cognitive or sensory impairments can make video-based interactions challenging for some homebound patients 2
• Patients who lack familiarity with technology may be hesitant about telemedicine, especially if they don't feel capable of learning new technologies 4
• Limited internet connectivity, lack of video-capable devices, or inability to pay for cellular plans can restrict access to telehealth services 2

Patient-Centered Medical Home (PCMH) Model

• The PCMH model provides continuous, "whole-person" care through all stages of a patient's life with improved access to healthcare services 5
• PCMHs are particularly promising for patients with complex needs who often receive care from multiple healthcare professionals in different settings 5
• The PCMH model aims to centralize care across the health system for all patient healthcare needs, including preventive, acute, and chronic care services 5
• Physicians should consider adopting PCMH model features such as same-day appointments, e-consultations, e-visits, or telephone consultations to improve access for homebound patients 5

Clinic Models for Homebound Patients

• Postpartum hypertension clinics demonstrate two useful models that could be adapted for homebound patients: combined clinic models (multiple specialties in one visit) or single specialty models 5
• Multidisciplinary clinics that use a combination of physicians, advanced practice providers, nurses, and pharmacists can provide comprehensive care 5
• Clinics can offer telehealth visits, home visits, or shared medical appointments (SMAs) to accommodate homebound patients' needs 5

Home Visit Alternatives

• Home visits are an option for homebound patients that may be more convenient, improve access, and reduce the need for emergency department visits 5
• For patients who need mobility assistance but don't qualify for home health services, alternative funding sources like State Medicaid programs or Department of Veterans Affairs may provide support 6
• Shared medical appointments (SMAs) can be conducted through telehealth with separate breakout rooms for individualized management, providing both care and community support 5

Considerations for Determining Appropriate Care Setting

• When determining where care should take place, consider: patient's ability to tolerate treatment in different settings, required therapeutic interventions, and eligibility for various services 5
• Some patients may be too frail or debilitated to tolerate traveling to an outpatient clinic setting, making home-based care necessary 5
• Certain therapeutic interventions may be better provided in the environment where they will be used (e.g., homemaking activities or mobility in the discharge environment) 5

Implementation Recommendations

• Regular follow-up should be conducted to assess the effectiveness of any care arrangement and adjust as needed 3
• Documentation should include patient consent to telehealth arrangements, method of monitoring and communication, and specific accommodations being provided 3
• For patients with limited technology experience, consider deploying community health workers to assist with device setup and technology training 2
• Pair telemedicine with specialist access via eConsults and options to refer to in-person care when necessary to provide comprehensive care 1