A Doctor’s Perspective on Home-Based Medical Care
Dr. Saba Sarwar is a Prospero doctor who serves as associate medical director of the New York East team for Prospero Health. She is passionate about providing good care to her patients, and doing what she can to alleviate their suffering and pain. We recently sat down with Dr. Sarwar for a Q&A about her rewarding work with Prospero and her perspective on home-based medical care.
Q: For those who don’t know, what is home-based medical care?
A: Home-based medical care is person-focused, patient-centered care provided in the convenience and comfort of the patient’s home by an interdisciplinary team of specialty-trained physicians, advance practice providers, and social workers. These providers are licensed clinicians who are highly skilled to assess and recognize a wide range of medical, social, and environmental factors that impact the patient. Based on that assessment, they provide the appropriate medical care for the patient’s needs and preferences.
Q: How would a provider know if home-based medical care is right for their patient?
A: The number one criteria is if the patient has frailty indications or is partially or entirely homebound, especially if they don’t have loved ones nearby. Another type of patient who can benefit from home-based medical care is somebody who has had recent hospitalizations, emergency room visits or a long subacute rehab stay. They are good candidates because we have found that one hospitalization can easily lead to another. The third criteria is if a patient has chronic diseases, illnesses, disabilities or comorbid conditions, even if they are not elderly or frail.
We become the eyes and ears at home, on a regular basis, because we check our patients very frequently and we try to proactively intervene. Any patient that a provider has concerns about would benefit from this holistic kind of supplementary care.
Q: What are some of the benefits of home-based medical care?
A: We are able to provide 24/7 care to our patients, and one of the biggest benefits of that is a reduction in hospital readmissions. If a patient notices something odd, we can order lab work or a urine pickup from the home. Then we can follow up later in the evening and see how the patient is doing. We even have a triage center that can check back with the patient every day and report on how they’re doing. We also help avoid medication errors such as omissions, duplications, dosing errors, or drug interactions with comprehensive reconciliations done right in the home.
We can also do mobile imaging and radiology. For example, if a patient has fallen and needs an x-ray, we can do it right in the convenience of their home. They don’t have to go to urgent care or the hospital. We can also arrange for medications to be delivered from the pharmacy to the home.*
We have patients with COPD (chronic obstructive pulmonary disease) — sometimes they start feeling short of breath and get anxious. They can call our providers anytime and we’ll provide guidance on the spot.
Prospero’s services are like an umbrella on top of the care that a patient is already receiving from their PCP and/or specialist. And we collaborate directly with those providers to ensure that patient care is well coordinated when it could otherwise become fragmented. What’s more, home-based medical care is longitudinal care that includes advance care planning, and only stops when the patient enters hospice.
*Care model may differ by state.
Q: Can you share any stories of patients who have benefited from home-based medical care?
A: Absolutely. Healthcare is moving more toward independence at home, which studies have shown is much better for patient outcomes. We have a lot of elderly people who can’t go to their doctor appointments. For example, I have an 85-year-old patient who has arthritis, COPD, CHF, and is a diabetic. She started having fluid buildup and couldn’t get transportation to the doctor’s office. I collaborated with her PCP and her cardiologist to manage her pain and tweak her diuretic dose to treat her at home. We avoided a hospitalization about to happen and a lot of unnecessary suffering.
There was another patient who was a 75 year old female. She was complaining about having a cough for three or four days. She was worried because she had COPD and a history of CHF, which we were aware of. We observed her for the next few days and the triage nurse was able to check in every evening and see how she was doing. We noticed that she was getting tired and was not her usual self, but her doctor was away and she could not get an appointment. We arranged for a mobile x-ray at her home, which showed a little worrisome patch of pneumonia, and we were able to intervene and start her on antibiotics. We continued with the check-ins and an in-person follow up, and she healed very nicely. Her daughter was very happy because she did not have to take off from work to bring her to a special appointment, and we also updated the PCP, who was able to see the patient the following week, and was very grateful for the support that we provided. We avoided a very common and unnecessary hospitalization for pneumonia.
Another patient was supposed to get a corneal transplant, but had not been seen for over a year due to COVID and was having trouble getting it scheduled. We arranged a virtual visit with her PCP and for her labs to be done at home. After the procedure, the patient was able to fully recover at home in our care, and didn’t have to stay in the hospital.
Q: How does Prospero assist with activities of daily living (ADL’s)?
A: Home-based medical care is different from home care or home healthcare. While these two services sound similar in the fact that they both take place at a patient’s home, they are very, very different, because home care is comprised of nonclinical and non-skilled care, which may include home health aide services to assist a patient with things like meal preparations, companionship, light household chores, transportation and other ADLs. So that is a nonclinical type of home care.
Prospero fully supports our patients in the home by creating an entire ecosystem for their care needs. We take time to get to know local vendors and agencies, which allows us to provide patients and their families with the resources they need. If families can help the patient with ADLs, we empower them to do so. If not, we make referrals for home healthcare agencies so that they can get that relief alongside our medical care.
We also make referrals to physical and occupational therapists to help our patients with exercises at home in order to regain their strength. This usually happens when they have come from acute patient care settings, like a hospital or a skilled nursing facility. Our patients are mostly elderly and frail, and even a day or two in bed can decondition them. Boosting them up with that kind of support helps build up their strength so they can regain their independence, which is what we strive for.
Q: What are the advantages of home-based medical care for providers?
A: It’s very helpful for PCPs who have frail, elderly patients they are worried about, because yes, they will see them in three months, but in the back of their mind, there is a concern about what could happen in those three months. It’s for those patients that Prospero can widen the scope of support of the PCP, and be the eyes and ears at home on a regular basis and offer 24/7 assistance. We check in frequently so that we can make the patient’s PCP or specialist aware of any concerns and proactively intervene when needed. And it goes both ways. So if there’s a patient that a PCP is concerned about, they can say to us, “Hey, I am worried about this patient. Can you go and check on them?”
The insight we get into our patient’s daily activities and personal values by being in their home is invaluable. It allows us to provide services like medication reconciliation and advance care planning, which can be difficult for PCPs to work through within the time constraints of scheduled office visits.
Q: Are caregivers needed to support home-based medical care?
A: It’s helpful if a patient has a caregiver who lives with them or lives nearby, but it isn’t necessary. Home-based medical care is set up specifically to support patients who don’t have the option of that extra help. And, as I mentioned previously, Prospero can source local agencies and resources that can provide our patients with any necessary non-medical assistance with daily activities in the home.
Q: Can you tell us more about Prospero’s home-based care providers?
A: There is not just a single provider, but a whole team of qualified and trained clinicians to address our patients’ medical needs. They are available 24/7 and can provide valuable services such as in-home lab work or imaging and medication delivery coordination.
Prospero doctors bring a collaborative approach to home-based care. As a multidisciplinary team, these providers meet weekly, discussing each patient scenario to create a customized treatment plan.
We also make sure to always send status updates to our patients’ existing PCPs, as they are a key part of the overall care team.
Q: Do health insurance companies cover in-home care?
A: Yes. Prospero works with health plans to improve access to care. We accept private insurance as well as Medicare/Medicaid. Prospero’s team-based care is often available at no cost. Thanks to insurance, we can keep many patients healthy in their own homes.
Contact Prospero for more resources on home-based care
Prospero’s care model is designed to fill in the gaps that aren’t typically covered by primary care physicians, as there are limits to what they can do to help patients with chronic conditions once they leave the office.
That’s where a home-based medical care provider like Prospero can help. Prospero can be a connector for our patients and build custom care plans to aid in each patient’s recovery process. These optimized plans can include regular home visits from doctors, nurses, physical therapists, mental health practitioners, social workers, home health aides, and home care professionals.
Our physician-led care teams stand ready to provide care and support services to patients living with serious illness. Reach out today.