Home Visit

The Home Visit - October 1, 1999 - American Academy of Family Physicians
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The Home Visit More by:

• Unwin BK
BRIAN K. UNWIN, MAJ, MC, USA AFP MEDLINE
• Jerant AF
Eisenhower Army Medical Center, Fort Gordon, Georgia AFP MEDLINE
ANTHONY F. JERANT, M.D.
University of California, Davis, School of Medicine, Sacramento, California
With the advent of effective home health programs, an increasing proportion of medical care is
being delivered in patients' homes. Since the time before World War II, direct physician
involvement in home health care has been minimal. However, patient preferences and key
changes in the health care system are now creating an increased need for physician-conducted
home visits. To conduct home visits effectively, physicians must acquire fundamental and well-
defined attitudes, knowledge and skills in addition to an inexpensive set of portable equipment.
"INHOMESSS" (standing for: immobility, nutrition, housing, others, medication, examination,
safety, spirituality, services) is an easily remembered mnemonic that provides a framework for
the evaluation of a patient's functional status and home environment. Expanded use of the
telephone and telemedicine technology may allow busy physicians to conduct time-efficient
"virtual" house calls that complement and sometimes replace in-person visits. (Am Fam Physician
1999;60:1481-8.)
http://www.aafp.org/afp/991001ap/1481.html (1 of 15)9/15/2005 12:14:49 PM

See editorial In 1990, the American Medical Association (AMA) reported that approximately one half of
on page 1339. primary care physicians polled in a national survey indicated that they performed home
visits.1 Although most of the physicians surveyed perceived home visits to be an important
service, the majority performed only a few such visits per year.1 Consistent with these self-
reported behaviors are data indicating that only 0.88 percent of Medicare patients receive home visits from
physicians.2 In addition, the Health Care Financing Administration reported charges for only 1.6 million home
visits in 1996, an extremely small percentage of the total number of annual physician-patient contacts in the
United States.3 These statistics stand in sharp contrast to medical practice before World War II, at which time
about 40 percent of patient-physician encounters were in the home.4
The low frequency of home visits by physicians is the result of TABLE 1

many coincident factors, including deficits in physician
compensation for these visits, time constraints, perceived
limitations of technologic support, concerns about the risk of
The rightsholder did not grant
litigation, lack of physician training and exposure, and
rights to reproduce this item
corporate and individual attitudinal biases. Physicians most
in electronic media. For the
likely to perform home visits are older generalists in solo
missing item, see the original
practices. Health care providers who have long-established
print version of this
relationships with their patients are also more likely to utilize
publication.
house calls. Rural practice setting, older patient age and need
for terminal care correlate with an increased frequency of home
visits.5
Rationale for Home Visits
Studies suggest that home visits can lead to improved medical care through the discovery of unmet health care
needs.6-8 One study found that home assessment of elderly patients with relatively good health status and
function resulted in the detection of an average of four new medical problems and up to eight new intervention
recommendations per patient.8 Major problems detected included impotence, gait and balance problems,
immunization deficits and hypertension. Significantly, these problems had not been expected based on
information obtained from outpatient clinic encounters. Other investigators have demonstrated the effectiveness
of home visits in assessing unexpected problems in patient compliance with therapeutic regimens.9 Finally,
specific home-based interventions, such as adjusting the elderly patient's home environment to prevent falls, have
also yielded health benefits.10
Beyond the potential benefit of improved patient care, family physicians who conduct home visits report a higher
level of practice satisfaction than those who do not offer this service.5 Physicians with more positive attitudes
about home visits are more likely to have conducted house calls during training.11 Faculty mentorship and
longitudinal exposure in training appear to be important for the

development of positive attitudes toward home visits.5 However, Family physicians who conduct
in 1994, only 66 of 123 medical schools offered specific home visits report a higher level of
instruction in the role and conduct of home visits.12 Although 83 practice satisfaction than those who
percent of the medical schools offered students the opportunity to do not offer this service.
participate in home visits, only three of the 123 schools required
students to make five or more such visits.12
Home Health Care Industry
Physician home visits have largely been supplanted by the extensive use of home health care services, a $22.3
billion industry that augments a medical system largely comprising facility-based health care providers.13 The
mean annual frequency of home health referrals was 43 per provider in a study published in 1992.14
Family physicians have authorization and supervision responsibilities for a broad spectrum of skilled services
that can be offered in the home. Such services include home health nursing, assistance from home health aides,
and physical, occupational and speech therapy. Other health care support services are provided by medical supply
companies, respiratory therapists, nutritionists, intravenous therapy services, hospice organizations, respite care
services, Meals-on-Wheels volunteers and bereavement support staff. Family physicians also work extensively
with social workers, who provide invaluable assistance in coordinating these services.
Thus, effective use of home care services has become a core

competency for family physicians. In 1998, the AMA published
The four major types of home visits
the second edition of Medical Management of the Home Care
are illness visits, visits to dying
Patient: Guidelines for Physicians.15 The basic physician home patients and their families,
care responsibilities outlined in that document are listed in Table assessment visits and
1.15 hospitalization follow-up visits.
Recent data suggest that many physicians do not have the

necessary knowledge and skills to perform these tasks effectively. For example, a survey found that 64 percent of
physicians who had signed claims for care plans that were later disallowed had relied on a home health agency to
prepare the plan of care, and 60 percent were not aware of the homebound requirement for home services.16
Thus, increased physician education about home visits seems necessary if the responsibilities and obligations
created by the expansion of home health care industry are to be fulfilled.
Types of Home Visits

The four major types of home visits are illness visits, visits
to dying patients, home assessment visits and follow-up
visits after hospitalization (Table 2).17,18 The illness home
visit involves an assessment of the patient and the provision
TABLE 2
of care in the setting of acute or chronic illness, often in Major Types of Home Visits
coordination with one or more home health agencies.
Emergency illness visits are infrequent and impractical for Illness home visits
the typical office-based physician. Emergency
Acute illness
The dying patient home visit is made to provide care to the Chronic illness
home-bound patient who has a terminal disease, usually in Dying patient home visits
coordination with a hospice agency. The family physician Terminal care
can provide valuable medical and emotional support to Pronouncement of death
family members before, during and after the death of a Grief support
patient in the home environment. Family assistance Assessment home visits
involves evaluating the coping behaviors of survivors and Polypharmacy and/or multiple
assessing the medical, psychosocial, environmental and medical problems
financial resources of the remaining family members. Excessive use of health care
services
The assessment home visit can also be described as an Immobility, social isolation or
investigational visit during which the physician evaluates suspected abuse or neglect
the role of the home environment in the patient's health Recent catastrophic diagnoses or
status. An assessment visit is often made when a patient is possible need for nursing home
suspected of poor compliance or has been making placement
excessive use of health care resources. Medication use can Hospitalization follow-up home visits
Acute illness, injury or surgery
be evaluated in the patient who is taking many drugs
Parents with newborn infants
(polypharmacy) because of multiple medical problems.
Evaluation of the home environment of the "at-risk" patient
can reveal evidence of abuse, neglect or social isolation.
Patients and family members who are trying to cope with Information from Cauthen DB. The house
chronic problems such as cognitive impairment or call in current medical practice. J Fam Pract
incontinence may particularly benefit from this evaluation. 1981;13:209-13, and Scanameo AM, Fillit
A joint assessment home visit facilitates coordination of the H. House calls: a practical guide to seeing
efforts of home health agencies and the physician. Finally, the patient at home. Geriatrics 1995;50:33-9.
an assessment home visit is invaluable in assessing the
need for nursing home placement of a frail elderly patient
with uncertain social support.
The hospitalization follow-up home visit is useful when significant life changes have occurred. For example, a
home visit after the birth of a new baby provides an excellent opportunity to discuss wellness and prevention
issues and to address parental concerns. A home visit after a major illness or surgery can be useful in evaluating
the coping behaviors of the patient and family members, as well as the effectiveness of the home health care plan.
Many aspects of physician home care have not been evaluated in the literature. However, it seems likely that
properly focused and conducted home visits can enhance home health care delivery, improve patient satisfaction
and strengthen the doctor-patient relationship.
Conducting the Home Visit TABLE 3

Suggested Equipment for
Equipment and Planning
Most equipment for a home visit can still be carried in the family
Home Visits
physician's "black bag" (Table 3). Some additional items may be
acquired from the patient's home. Physician-supplied Equipment
Essential
One of the keys to conducting a successful home visit is to clarify the Lubricant
reason for the visit and carefully plan the agenda. Preplanning allows Otoscope and
the physician to gather the necessary equipment and patient education ophthalmoscope
Patient records and
materials before departure. The physician should have a map, the
charting materials
patient's telephone number and directions to the patient's home. The Prescription pad
physician, patient and home care team should set a formal appointment Sphygmomanometer
time for the visit. Coordinating the house call to allow for the presence (various cuff sizes)
of key family members or significant others can enhance Stethoscope
communication and satisfaction with care. Finally, confirming the Sterile specimen cups
appointment time with all involved parties before departure from the Stool guaiac cards
office is a common courtesy to the family as well as a wise time- Thermometer
management strategy. Tongue depressors
Urine dipsticks
Home Visit Checklist: "INHOMESSS" Optional
The INHOME mnemonic was devised to help family physicians Glucometer
Dictaphone
remember the items to be assessed during the home visit directed at a
Laptop computer
patient's functional status and living environment.19 This mnemonic
Patient education
can be expanded to "INHOMESSS," which incorporates investigations materials
of safety issues, spiritual health and home health agencies (Table 4).19 Other supplies as dictated
by patient need
Immobility. Evaluation of the patient's functional activities includes Patient-supplied equipment
assessment of the activities of daily living (bathing, transfer, dressing, (as needed)
toileting, feeding, continence) and the instrumental activities of daily Glucometer
living (using the telephone, administering medications, paying bills, Peak flow meter
shopping for food, preparing meals, doing housework). The physician Scale
can ask the patient to demonstrate elements of the daily routine, such
as getting out of bed, performing personal hygiene and leisure
activities, and getting in and out of a car. Corrective interventions can
be directed at any deficiencies noted. For example, modified pill-bottle caps can be obtained for the patient who
has trouble opening medication containers because of a condition such as arthritis.
Nutrition. The physician should assess the patient's current state of nutrition, eating behaviors and food
preferences. Permission to look in the refrigerator or cupboard can be obtained by asking open-ended but directed
questions. For example, the physician might say, "We have been working hard on your diet to control your
diabetes. Would you mind if I look in your refrigerator to see the types of foods you eat?" Improvements in
product labeling allow the physician to assess serving sizes and the nutritional value of foods with relative ease.
Healthy food preparation techniques can also be reviewed with the patient.
Home Environment. The patient's home environment should

allow for privacy, social interaction and both spiritual and TABLE 4
emotional comfort and safety. A safe neighborhood with close Issues to Assess During
proximity to services is important for many older patients. The Home Visits: the
home may reflect pride in the patient's family and past INHOMESSS Mnemonic
accomplishments and reveal the patient's interests and hobbies.
The physician should not make assumptions about social class or
material wealth based on the patient's physical environment. I Immobility
N Nutrition
Other People. Having the patient's social support system present H Housing
at the home visit clarifies the roles and concerns of family O Other people
members. During routine visits, the physician can assess the M Medications
availability of emergency help for the patient from family E Estaminations
members and friends and can clarify specific issues, such as who S Safety
is to serve as surrogate for the patient in the event of S Spiritual Health
incapacitation. Discussion of a durable power of attorney and a
S Services by home health agencies
living will may be more comfortably performed during the home
visit than in the usual clinic visit. Evaluation of the caregiver's
needs and risk of burnout is critically important. Adapted with permission from Knight
AL, Adelman AM. The family physician
and home care. Am Fam Physician
Medications. To remedy or avoid polypharmacy, the physician
1991;44:1733-7.
must evaluate the type, amount and frequency of medications,
and the organization and methods of medication delivery. An
inventory of the patient's medicine cabinet can provide clues to

previously unidentified drug-drug or drug-food interactions. A home medication review can also allow a direct
estimate of patient compliance, uncover evidence of "doctor shopping" and identify the use or abuse of over-the-
counter medications and herbal remedies.
Examination. The home visit should include a directed physical examination based on the needs of the patient
and the physician's agenda. Practical, function-related examination techniques may include having the patient
demonstrate getting on and off the toilet or in and out of the bathtub. The physician can have the patient
demonstrate proper technique for the self-monitoring of blood glucose levels. In addition, the physician can
weigh the patient and obtain a blood pressure measurement. In-person correlation of home and office measures
provides useful information for future telephone and clinic contacts.
Safety. Common home safety issues are listed in Table 5. The goal of the home safety assessment is to determine
whether the patient's environment is comfortable and safe (no unreasonable risk of injury). To raise the subject,
the physician should simply state the intention to identify and help modify potential safety hazards. For example,
furniture placement or throw rugs may create problems for an elderly patient with gait instability, or the tap water
may be so hot that the patient is at risk for scald injury.20
TABLE 5
Elements of Home Safety Assessment
Areas to be assessed Questions to consider

Kitchen safety (especially use of gas stove) Is it easy to tell when a burner or oven gas is
turned on or off? Does the patient wear loose
garments when cooking?
Bathroom safety Are hand-holds in appropriate places? Can
the toilet seat be raised, if needed? Does the
shower or bathtub have a nonslip surface? Is
the floor of the bathroom slick?
Stairs Are stairs well lit? If carpeting is present, is it
secure?
Gas or electric utilities Which systems does the home have? Are
systems checked and properly maintained?
Heating and air-conditioning Are the controls accessible and easy to read?
Hot water heater Is the temperature below 49°C (120°F)?20
Water source Is water from a public service or a well?

Emergency actions and evacuation route Are emergency numbers on or near the
telephone? Is there a means of exit in case of
emergency?
Electrical cords Are cords frayed or lying across walking
paths?
Lighting and night lights Is the wattage sufficient?
Fire and smoke detectors and fire Are fire extinguishers present and
extinguishers accessible? Are fire and smoke detectors
present? Are batteries charged or changed
regularly?
Loose carpets and throw rugs Can loose carpets and throw rugs be secured
or removed?
Tables, chairs and other furniture Is furniture sturdy and well-balanced?
Pets Are the animals easy to care for and to feed?
Spiritual Health. If the home contains religious objects or reading materials, the physician can ask about the
influence of spiritual beliefs on the patient's sense of physical and emotional health. This information may
provide the impetus, as desired by the patient, for a discussion of spirituality as a coping and healing strategy.
Services. Having members of cooperating home health agencies present for the house call can enhance
communication and cooperation among the physician, patient and agencies. Existing orders can be clarified,
priorities for future care can be established and other perspectives on the care plan can be solicited. The patient's
relationship with home health agency providers can also be assessed.
Elements of the INHOMESSS mnemonic may be used independently, based on the needs of the patient and the
physician's agenda. For example, the physician may wish to focus on polypharmacy and safety in a patient with a
recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer's
disease. Figure 1 presents the major elements of the home visit in a checklist format that facilitates
comprehensive assessment.

Home Visit Checklist
Patient's name: _________________________________________
Address: Telephone number: ___________________
Family members:
_______________________________________________________________________
Addresses and telephone numbers of family members:

________________________________________
____________________________________________________________________________________
Impairments/Immobility
Activities of daily living (ADL) Yes No Instrumental ADLs Yes No
Balance and gait problems Yes No Sensory impairments Yes No
Nutrition
Meals _________________________________________________________________
Variety and quality of foods Pantry _____ Refrigerator _____ Freezer _____
Nutritional status Obesity _____ Malnutrition _____ Other _____
Alcohol presence/use Yes No
Home environment
Neighborhood
_________________________________________________________________________
Exterior of home
_________________________________________________________________________
Interior of home Crowding _____ Housekeeping _____ Homeyness _____ Privacy _____
Pets _____ Books _____ Television _____ Memorabilia _____
Other people
Social supports Yes No
Living will Yes No
Power of attorney Yes No
Financial resources
_________________________________________________________________________
Patient attitudes __________________________________________________________
Medications
Prescription drugs Yes No
Nonprescription drugs Yes No
Dietary supplements Yes No
Medicines organized Yes No
Medication compliance Yes No
Examination
Weight _____ Height _____ Blood pressure _____ Glucose _____
Urinalysis _____ Other _____ Mini-Mental State _____ General physical condition _____

Safety, Spiritual health and Services
Bathroom _____ Kitchen _____ Carpets _____ Lighting _____ Electrical cords _____
Stairs _____ Tables, chairs and other furniture _____
Fire and smoke detectors _____ Fire extinguishers _____ Emergency plans _____ Evacuation route ____
Gas or electric range _____ Hot water heater _____
Heating and air-conditioning _____ Water source _____
Spiritual health
___________________________________________________________________________
Home health services

___________________________________________________________________________
FIGURE 1.Checklist covering the major areas to be assessed during the home visit.
Integrating Home Visits Into Clinical Practice

Lack of reimbursement and the busy pace of office practice
TABLE 5
are the reasons commonly cited for not conducting house
calls. Poorly organized, sporadic home visits may indeed 1999 CPT Codes and Medicare
interfere with clinical practice. Therefore, it is important to Reimbursement for Home Visits
develop a systematic approach for planning home visits.21
Most practices will benefit from using home visits with

patients who have difficulty accessing outpatient facilities
because of sensory impairment, immobility or
transportation problems. Removing such logistically
difficult appointments from the clinic schedule and
performing them in the home setting may actually enhance
clinic functioning. Clustering home visits by geographic
location and within defined blocks of time may also
improve efficiency. Finally, nurse practitioners and
physician assistants can conduct visits as part of a home
health care delivery team.

Visit Medicare
The 1999 Current Procedural Terminology codes and Code description reimbursement*
corresponding Medicare reimbursement rates for common
types of home visits are listed in Table 6.22 99341 New $ 52.85
patient, low
Telephone Calls and Telemedicine severity
99342 New 74.10
Proactive telephone calls are an underutilized method of patient,
conducting highly focused and time-efficient "virtual" moderate
home visits.23 Provider-initiated telephone calls can be severity
used to reassure family members after a patient has had an 99343 New 107.51
acute illness or has been hospitalized.23 These calls can patient,
also be helpful in reinforcing patient compliance with new moderate to
medications, following patients with chronic diseases and high severity
reducing inappropriate use of primary care clinic or office
99344 New 137.84
services.24
patient,
high severity
Telemedicine is the use of communication technologies,
such as two-way video-conferencing, to provide patient 99345 New 165.63
patient,
care across distances. A variety of institutions are
unstable
exploring these technologies as methods of delivering
health care in the home.25,26 99347 Established 41.60
patient,
minor
Final Comment
99348 Established 62.19
As fewer patients are admitted to hospitals and hospital patient, low
stays become ever briefer, the medical complexity of home to moderate
severity
care will increase, as will the demand for both in-person
and "virtual" physician home visits. Physicians interested 99349 Established 91.88
in obtaining additional information about home care patient,
provision can contact the American Academy of Home moderate to
Care Physicians (P.O. Box 1037, Edgewood, MD 21040; high severity
Web address: http://www.aahcp.org/aahcp). 99350 Established 132.80
patient,
Each year, members of two different medical high severity
faculties develop articles for "Practical
Therapeutics." This article is one in a series
coordinated by the Department of Family and
Community Medicine at Eisenhower Army Medical

Center, Fort Gordon, Ga. Guest editors of the CPT = current procedural terminology.
series are Ted D. Epperly, COL, MC, USA, and *--As applied in the state of Georgia.
Brian K. Unwin, MAJ, MC, USA. Adapted with permission from Physicians'
current procedural terminology: CPT.
Standard ed. Chicago: American Medical
The opinions and assertions contained herein are
Association, 1999:26-8. Refer to this
the private views of the authors and are not to be
document for full criteria and key visit
construed as official or as reflecting the views of
components.
the Army Medical Department or the Department of
Defense.
The Authors
BRIAN K. UNWIN, MAJ, MC, USA

is director of the family medicine residency program at Eisenhower Army Medical Center, Fort Gordon, Ga. Dr.
Unwin graduated from the Uniformed Services University of the Health Sciences F. Edward Hébert School of
Medicine, Bethesda, Md. He completed a residency in family medicine at Martin Army Community Hospital,
Fort Benning, Ga.
ANTHONY F. JERANT, M.D.

is assistant professor in the Department of Family and Community Medicine at the University of California,
Davis, School of Medicine, Sacramento. Dr. Jerant graduated from St. Louis University School of Medicine, St.
Louis. He served an internship at Silas Hays Army Community Hospital, Fort Ord, Calif., and completed
residency training at Madigan Army Medical Center, Fort Lewis, Wash. Before assuming his current position, he
was a member of the family medicine residency faculty at Eisenhower Army Medical Center.
Address correspondence to Brian K. Unwin, MAJ, MC, USA, Residency Director, Department of
Family and Community Medicine, Eisenhower Army Medical Center, Fort Gordon, GA 30905-
5650. Reprints are not available from the authors.
REFERENCES
1. Shut in, but not shut out [Editorial]. Am Med News 1996;39:47.
2. Meyer GS, Gibbons RV. House calls to the elderly: a vanishing practice among physicians. N Engl J Med
1997;337:1815-20.
3. Boling PA. House calls [Letter]. N Engl J Med 1998; 338:1466.
4. Starr P. The social transformation of American medicine. New York: Basic Books, 1982:359.
5. Adelman AM, Fredman L, Knight AL. House call practices: a comparison by specialty. J Fam Pract 1994;39:39-
44.
6. Arcand M, Williamson J. An evaluation of home visiting of patients by physicians in geriatric medicine. Br Med J
1981;283:718-20.
7. Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive
assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc 1994;42:630-8.
8. Ramsdell SW, Swart J, Jackson JE, Renvall M. The yield of a home visit in the assessment of geriatric patients. J
Am Geriatr Soc 1989;37:17-24.
9. Bernardini J, Piraino B. Compliance in CAPD and CCPD patients as measured by supply inventories during home
visits. Am J Kidney Dis 1998;31:101-7.
10. Tideiksaar R. Environmental adaptation to preserve balance and prevent falls. Top Geriatr Rehabil 1990;5:178-84.
11. Knight AL, Adelman AM, Sobal J. The house call in residency training and its relationship to future practice. Fam
Med 1991;23:57-9.
12. Steel RK, Musliner M, Boling, PA. Medical schools and home care. N Engl J Med 1994;331:1098-9.
13. Goldberg AI. Home healthcare: the role of the primary care physician. Compr Ther 1995:21:633-8.
14. Boling PA, Keenan JM, Schwartzberg JG, Retchin SM, Olson L, Schneiderman M. Home health agency referrals
by internists and family physicians. J Am Geriatr Soc 1992;40:1241-9.
15. American Medical Association. Medical management of the home care patient: guidelines for physicians. 2d ed.
Chicago: The Association, 1998:1-60.
16. Klein S. Guidance for home care physicians. Am Med News 1998;41:5-6.
17. Cauthen DB. The house call in current medical practice. J Fam Pract 1981;13:209-13.
18. Scanameo AM, Fillit H. House calls: a practical guide to seeing the patient at home. Geriatrics 1995;50:33-9.
19. Knight AL, Adelman AM. The family physician and home care. Am Fam Physician 1991;44:1733-7.
20. Huyer DW, Corkum SH. Reducing the incidence of tap-water scalds: strategies for physicians. Can Med Assoc J
1997;156:841-4.
21. American Academy of Home Care Physicians. Making house calls a part of your practice. Edgewood, Md.:
American Academy of Home Care Physicians, 1998:1-35.
22. Kirschner CG, ed. Current procedural terminology: CPT. Standard ed. Chicago: American Medical Association,
1999:26-8.
23. Studdiford JS 3d, Panitch KN, Snyderman DA, Pharr ME. The telephone in primary care. Prim Care 1996;23:83-
102.
24. Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine
clinic follow-up. JAMA 1992;267: 1788-93.
25. Jerant AF, Schlachta L, Epperly TD, Barnes-Camp J. Back to the future: the telemedicine house call. Fam Pract
Management 1998;5:18-22,25-6,28.
26. Johnson B, Wheeler L, Deuser, J. Kaiser Permanente Medical Center's pilot tele-home health project. Telemed
Today 1997;5:16-8.
Copyright © 1999 by the American Academy of Family Physicians.

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The Home Visit - October 1, 1999 - American Academy of Family Physicians

The Home Visit More by:

http://www.aafp.org/afp/991001ap/1481.html (1 of 15)9/15/2005 12:14:49 PM

The low frequency of home visits by physicians is the result of TABLE 1

Rationale for Home Visits

longitudinal exposure in training appear to be important for the

Home Health Care Industry

Thus, effective use of home care services has become a core

Recent data suggest that many physicians do not have the

Types of Home Visits

http://www.aafp.org/afp/991001ap/1481.html (3 of 15)9/15/2005 12:14:50 PM

Conducting the Home Visit TABLE 3

Home Environment. The patient's home environment should

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Areas to be assessed Questions to consider

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http://www.aafp.org/afp/991001ap/1481.html (8 of 15)9/15/2005 12:14:50 PM

Home Visit Checklist

Patient's name: _________________________________________

Address: Telephone number: ___________________

Addresses and telephone numbers of family members:

Activities of daily living (ADL) Yes No Instrumental ADLs Yes No

Balance and gait problems Yes No Sensory impairments Yes No

Nutritional status Obesity _____ Malnutrition _____ Other _____

Alcohol presence/use Yes No

Pets _____ Books _____ Television _____ Memorabilia _____

Social supports Yes No

Living will Yes No

Power of attorney Yes No

Patient attitudes __________________________________________________________

Prescription drugs Yes No

Nonprescription drugs Yes No

Dietary supplements Yes No

Medicines organized Yes No

Medication compliance Yes No

Weight _____ Height _____ Blood pressure _____ Glucose _____

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Safety, Spiritual health and Services

Stairs _____ Tables, chairs and other furniture _____

Gas or electric range _____ Hot water heater _____

Heating and air-conditioning _____ Water source _____

Home health services

Integrating Home Visits Into Clinical Practice

Most practices will benefit from using home visits with

health care delivery team.

Community Medicine at Eisenhower Army Medical

BRIAN K. UNWIN, MAJ, MC, USA

ANTHONY F. JERANT, M.D.

Copyright © 1999 by the American Academy of Family Physicians.

copyright questions and/or permission requests.

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Das könnte Ihnen auch gefallen

Nutritional status Obesity ___ Malnutrition _ Other ___

Pets ___ Books _ Television _ Memorabilia ___

Weight ___ Height _ Blood pressure _ Glucose ___

Stairs _ Tables, chairs and other furniture _

Gas or electric range _ Hot water heater _

Heating and air-conditioning _ Water source _