Abstract
Background: Home-based primary care in Canada is currently under-utilized and under-powered, despite an aging population with an increasing proportion of homebound older adults, and 00% of Canadians hoping to age in place.
Approach: Homebound older adults in Canada have increased medical problems, medication use and mental health diagnoses compared to their non-homebound peers.3,4 They have difficulty accessing traditional, office-based primary care due to a combination of physical, mental and social frailty, resulting in higher emergency department (ED) visit and hospitalization rates.4 They may also be affected by other intersecting factors impacting equitable access to care, including racism, language barriers, immigration status, housing insecurity or disability. House Calls is Canada largest interprofessional home-based primary care team. It is a community-rooted, front-line led, integrated care team, built of physicians, nurse practitioners, occupational therapists, physiotherapists, social workers and team coordinators, and partnered with community agencies VHA and SPRINT Senior Care. The team has at its core a shared human-centered care vision, a flattened, interprofessional leadership hierarchy, and authentic mutual trust among its team members. It was initially developed through direct co-design with key stakeholders, including older homebound patients, their families and existing community actors; it has since evolved in structure and capacity through iterative learning from lived experience, including annual survey-based consultation and open, continuous dialogue with patients, families and its front-line care team. The goal of the House Calls team is to help homebound older adults age and die in place, through a three-pronged program structure: geriatric-focused, interdisciplinary primary care, urgent care support, and home-based palliative care. We designed a retrospective cohort study to assess rates of hospitalization, ED visits and time spent living in the community for patients receiving care from House Calls from January , 205 to January , 2022, when compared to similar frail, homebound older adults in the same geographic areas. The study will further measure markers of House Calls program implementation, as rates of interprofessional visits and urgent care encounters over the same period. This research study was designed and implemented by the team front-line clinical staff, with support from researchers at our not-for-profit community partners.
Results: Study results are currently pending. We hypothesize this home-based primary care model results in reduced ED visits and hospitalizations, and more successful aging at home as measured by death at home or delayed admission to institutions.
Implications: Through the description of this program and its evaluation, we hope to contribute much-needed, evidence-based knowledge on our unique homecare model. We hope to use our results to improve the quality of care offered at House Calls. We further hope this study will inform wider implementation of similarly structured home-based primary care teams, and more broadly inform policy for the community-based care of older adults. As a future project, we wish to more directly research the cultural values and person-centered dynamics of our highly cohesive care team, as a further exploration of this team unique adaptability, sustainability and success in the community.
References: Lapointe-Shaw et al. Homebound status among older adult home care recipients in Ontario, Canada. Journal of the American Geriatrics Society. 2022; 70(2):568-578. Sinha, S.,Nolan, M. Bringing long-term care home. Ryerson University: National Institute on Ageing. Nov 2020.Qiu, W. Q. et al. Physical and mental health of homebound older adults: an overlooked population. Journal of the American Geriatrics Society. 200; 58(2):2423-2428. Musich, S., Wang, S. S., Hawkins, K., Yeh, C. S. Homebound older adults: Prevalence, characteristics, health care utilization and quality of care. Geriatric Nursing. 205; 36(6):445-450.