A time-motion study of patient care activities of a geriatric home care team

A self-administered time-motion study of the activities of a home care team, consisting of physician, nurse practitioner and social worker is reported. The patients were home-bound, chronically or terminally ill and largely elderly, and the physician and nurse practitioner were available by telephone and for emergency visits on a 24-hour, 7 day per week basis. A systematic sample of 24 hour calendar days was studied; the average team patient census was 54 (the team had other clinical responsibilities in addition). Time spent on travel, home visits and on team conferencing and consultation was higher than in other practices, as might be expected. Full-time equivalent requirements for this type of care program were extrapolated to come to approximately one physician and social worker and one and one-half nurse practitioner per 100 patients. A truer estimate of actual costs of provision of team services to home-bound patients can be provided by this method than by the usual calculation of charges based only on actual home visits.