Physician's guide to managing home care of older patients

One of the responsibilities of the physician in overseeing home care is to periodically assess overall functional ability in the home. Specific home visits for this purpose--whether by physician aides or the physician--should incorporate a home care "review of systems," exploring the adequacy of the home environment, the patient's capabilities, the family's ability, and the accuracy of medication administration. Reestablishing family equilibrium following hospital discharge should begin by encouraging the hospital staff to share responsibility with the family, allowing them to "rehearse" the roles they will play at home. The cardinal tasks for which the physician can support the family in attempting to perform are: providing emotional support for the patient, making observations, providing physical assistance, performing household chores, participating in the treatment regimen, and calling for assistance. These functions are the backbone of successful family involvement in home care, even when "high-tech" procedures are being used. Referral to self-help groups or appropriate home health aide services is also an important role the informed physician can perform.