A Closer Look at the Pros and Cons of a Home Care Practice

As mentioned in my previous blog, in my experience, there is a growing market for podiatric services provided in a home environment. Once one handles the aspects of determining qualification for such services, the question becomes how best to provide services to them. In this post, I’ll outline my observations on some of the highs and lows of this type of practice.

The Pros: A Holistic Approach

A health care provider can wear many hats, including social worker, advisory, chaplain, listener and confidant. This aspect comes to life as you visit patients in their home where you see the entire dynamics of the home environment. Let’s consider a patient with uncontrolled diabetes with a callous that progressed to a slow-healing, grade 1 ulcer. During weekly wound care clinic visits, the patient relates controlled blood sugar readings, following a strict diabetic diet, and off-loading as much as possible. Looking at the foot, you find yourself scratching your head, hmmm, does not match the clinical picture.  After a few missed follow-up appointments to the office, you arrange to go to the home to change the dressing and check up on the wound.

As you enter, the fog begins to clear as you see how the home environment factors into their current condition. You find your patient up and about, cooking dinner for a crowded extended family where during the day she must take care of several grandkids at home with online schooling because of COVID-19 restrictions. The stress in the home is palpable, not to mention my stress level due to a 25-pound protective, territorial, aggressive breed dog staring me down with no visible signs him wanting to play. I often advise patients to place their pets away from our visit, to avoid situations such as this. As you finally settle in on your visit and unwrap the bandage you discover redness, edema, pain, and the beginnings of an infection. As you comfort the patient and explain your plan of care, the patient discloses that their spouse in in a rehab center for a stroke several weeks prior and their basic income is gone. Talk about life stressors.

This is when you step back and take a 360-degree view of the home setting and how you can use your network to help their situation. Home health social work can evaluate the patient to see if they qualify for any government-assisted programs such as in-home support, increased nurse visits, or other tools you might have as a resource in your network. A lot of times it’s just as simple as being an active listener and tailoring the needs of the patient with the needs of their environment.

The Cons: Time Management

Home care services take different type of mindset. Knocking on doors can sometimes be an adventure and stressful because you do not know what to expect when you see a consult for the first time and neither does the patient. You must take the temperature of the room and put the patient at ease. Elderly patients who live alone with loved ones in another state often feels vulnerable and on edge when new providers visit their home. Driving around in a car all day can be quite taxing and lonely if you go solo. Employing a field assistant can be quite helpful for documentation, time management and an extra pair of hands for wound care dressings. Drive time, traffic and the surge in gas prices, not to mention wear and tear on your vehicle must be factored in when you start out on this venture. Working in pairs becomes helpful if you find yourself in unfamiliar or concerning areas of the city. It is always good to have medical assistant on your team, as it provides a level of comfort for both you and the patient when entering the home. Mapping out your day and scheduling patients in proximity to each other is ideal, but does not always work out, as patients might have a certain window for the visit or request to be seen later than scheduled, which can lead to traveling across town several times a day. Strategic scheduling of your patients in the same area can take a lot of headache and guesswork on how to navigate your day.

Providing home care services is not for everyone. You must have the ability to think on your feet, as every day is a new adventure. It’s not the controlled, office-type environment that you might be used to, as there are unforeseen variables which can dictate how your day plays out. While telemedicine is a fine two-dimensional tool to connect with patients and check on their wellness, it does not capture the intangibles of being in the home environment. Everyone puts on their best face for the camera, especially in Los Angeles, telemedicine included.  Home care is the purest form of personalized health care as you tailor the needs of your patient with the needs of their environment, where they feel the most comfortable, in their homes.

Dr. Pacada is a mobile podiatrist practicing in Las Vegas, Nevada.