Bringing care to patients’ homes

It’s been over a year since I have taken a non-patient care role. It’s been exciting and full of great learning opportunities. But one thing I miss a lot is my interactions with patients, specifically the home visits I used to do. Not all pharmacists do home visits. They also take up a lot of time. But when home-bound patients can’t see their physicians, or when there are specific tasks that can be done by a pharmacist, it goes a long way in facilitating care. I have to admit, I still think about these patients I used to see routinely. One of the patients was in her 90s. When I said farewell to her, I knew that was likely the last time I would see her. She lived alone and often enjoyed my home visits. What were some unexpected thing I had to do during these home visits? Locating her denture! And I also remember checking to see if her fridge was malfunctioning. I know these were not tasks in my job descriptions but they meant a lot to the patient. Another patient I saw was in his 80s. His house was full of books and antiques. As I saw his health continued to decline, I knew it would crush his soul if he had to move to an institution. His memory was also rapidly declining but his partner was around to hopefully support him as best as he could. But it was getting increasingly difficult. I also remember visiting a sweet old lady who just moved into a nursing home. She placed a Morse Code Telegraph Transmitter in her room. She used to work as a Morse code translator during the World War II. I remember she got excited to tell me how she would receive important messages, including ones that deeply affected her. She said one of these messages was about a helicopter going down with no survivors. When I used to do home visits, I was able to get a glimpse of the patient’s story, the patient’s life before the health started deteriorating and that the patient’s story was quickly buried in the medical chart that we all come to become familiar with. Of course, the medical chart will have a section on family history and social history. The purpose of this section is to consider the patient’s personal life but seeing a short description is nothing compared to visiting the patient’s home to see how the life has been reflected through the personal space. As our aging population continues to grow and our health care system stretched to the limit, the idea of bringing care to the patient’s home has become more palatable, especially when considering the cost of building a new institution that can only care for a limited number of people. Can we support the patient’s home safely? How can we monitor them closely without compromising their dignity? It will be challenging to consider the Human Resources capacity to care for patients in homes stretching from different geographic regions. We already do this in palliative care. Can we also do this for dementia care? Recently, the idea of a dementia village is gaining traction, that instead of “institutionalizing” these individuals, we build a safe community to support them. It sounds amazing. I like to see it play out but the cost of care is still something to bear in mind. In the old days, the village looks after the elders. The adult children live close to their aging parents, making it easy to support them. But in the end when heavy care is required, someone needs to step up to support them. In todays society, we see this as a costly compromise. In the old days (or at least in my culture), it’s called filial piety. As our world evolves and the family structure is no longer what it used to be, it is clear institutionalization to support the aging population is no longer a sustainable solution on its own. But what are some other possibilities? I think virtual care and advancing artificial intelligence in health care may offer some of the solutions, in conjunction with integrated health care team. But we must shift our mindset to move individuals out of their homes, at least delay it as much as possible if our goal of care is to support them to continue living. They may not be thriving as they used to be but don’t expedite their journey to the point of just surviving and defined by their medical charts. Their homes are where they live. Let them live for as long as they can. (Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to.)

Bringing care to patients’ homes

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Blog Author

Cynthia Leung

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