Medical House Call Program: extending frail elderly medical care into the home

The current US healthcare system, focused mostly on acute and episodic care, has difficulty meeting the needs of ill, frail elderly and their families or other caregivers. Because of their low mobility and complex medical conditions, these "oldest old" patients and their families or caregivers must make frequent, difficult, and expensive trips to multiple physicians to receive care. The result is that the frail elderly most often receive delayed or crisis care rather than timely primary care. To address these and other needs, a coordinated approach to the care of the oldest old requires a new model that includes primary medical care in the home. This article discusses how the Medical House Call Program (MHCP) model can provide high-quality primary healthcare to the frail elderly at home, improve the continuity of care between the home and the hospital, provide support and education to families or caregivers, and provide linkage to a broad range of social and supportive services in the community. The MHCP model is one of a number of evolving for-profit and nonprofit approaches that seek to provide medical care in the home. This article also discusses how the MHCP model, working with oncology physicians and programs, can have similar benefits and applications for the growing number of elderly cancer patients and their families or caregivers.