Team approach enables frail elderly to stay home

St. Vincent's Hospital and Medical Center of New York has been caring for homebound frail elderly persons since 1973 through a comprehensive network of professional, paraprofessional, and community services that allows many older persons to remain in their homes and communities and avoid institutionalization. The staff consists of physician-nurse-social worker teams that bring to each patient their individual skills as professional practitioners. In addition, working together, they create and attempt to carry out a complete, flexible plan of care. The Chelsea-Village Program (CVP) is open to all persons who the team believes are capable of being maintained independently or who can obtain the necessary additional support of family, friends, or neighbors. The patients, whose average age is 83, are homebound due to orthopedic disorders, arthritis, stroke, chronic cardiac and pulmonary disease, or generalized debility and weakness. St. Vincent's and donations from foundations and individuals fund the program, which is free of charge to its patients. In 1988 about 10 physicians, some in private practice, participated during a typical month; subspecialists have made themselves available; and resident physicians share in the work. The staff has come to understand that human beings are most fulfilled when they are able to use their personal resources in independence and that they must ask the patients for their own definitions of life's goals and serve them as they seek those goals.