population is quickly getting older, and with aging comes frailty.
Further, the rates of chronic disease, such as diabetes and arthritis,
are high and climbing higher. Under these conditions, the struggle for
independent living by seniors becomes greater. Yet people are adamant:
they want to remain in their homes.
And that’s one of the goals of home health care
“The reality is that people want to be in their
homes,” says Robert Schreiber, M.D., a geriatrician and primary care
physician. “And to do that, you sometimes need to be dependent on
others for help.”
Dr. Schreiber, physician-in-chief at Hebrew
Senior Life in Boston, joined Pat Kelleher, executive director of the
Home Care Alliance of Massachusetts, and program host and primary care
physician Mavis Jaworski, M.D., in a wide-ranging discussion of the
many aspects of home health care in the April edition of Physician
Focus with the Massachusetts Medical Society.
While home care seeks to keep people in their
homes, it also has another aim: to keep people out of hospitals.
“Hospitals are not the best place for older adults,” Dr. Schreiber
says. “My goal in treating elderly patients is to get them out of
the hospital as quickly as possible so they can get the right care in
the right place, and the home is the best place for them.”
So what’s the first step to getting home care? “People should speak up if they feel the need,” says Ms.
Kelleher. “Sometimes people don’t realize that they see mom or dad
or grandma or grandpa going downhill. They should look for warning
signs. If they’re taking a lot medications, or have memory or vision
issues, or have trouble walking, speak up to your physician and
suggest that mom or dad may need some help. A lot of referrals come
from primary care doctors.”
Ms. Kelleher says that 80 percent of home care is
being provided by family members, juggling the care of their own
families as well as that of their parents or other elderly family
And that, says Dr. Schreiber, presents another
“Caregivers are under incredible stress,” he
says, “and oftentimes become burned out and don’t realize it. I
try to plant the seed with families that it’s important to have
someone else relieve you. If the primary caregiver gets sick, and
there’s no one else, the whole system collapses. Home care is not
only taking care of the patient, it’s also taking care of the
Both Dr. Schreiber and Ms. Kelleher agree that
home health care today is vastly different from the care of years ago.
Ms. Kelleher says that while home services such as visiting nurses
have been around for many years, today’s care runs the gamut, from
very skilled services to those that just maintain independence. And
the complexity of care that can be administered at home has also
But regardless of the level or the quantity of
services for an individual patient, all those involved must play key
“In order to do the best,” Dr. Schreiber
says, “it really takes a team of health care professionals and home
care providers, so that when things go wrong, everyone can be alerted.
The patient and the family are really the captain of the health care
ship, and we’re the crew.”
concludes with an important message for those contemplating home care
services. “What I tell families,” he says, “is that home care is
there to help, but family members still need to be overseeing and
advocating so your family can get the right care.”
Watch the accompanying video
for the complete conversation, which includes information on how to
access home health services, how agencies are credentialed, what you
should consider when deciding the services you may need, and
additional resources on home health care services.