The home as a site for teaching gerontology and chronic illness

The care for the chronically ill elderly is a major national health problem. Considerable concern and attention have been focused on the shortcomings of medical education in this area of care. Research findings have demonstrated the relevance of a home care experience for teaching the interactions of the social, psychological, environmental, and biological factors which characterize chronic illness. The value of such an experience has taken on added significance in light of the federal government's prospective payment system for reimbursing health care costs under the Medicare program, a system that encourages early discharge of patients from the hospital. To manage these patients successfully, physicians need to understand and appreciate the influence of social, psychological, and environmental factors in the course of a disease. The home setting is an appropriate place for teaching about these factors, just as the hospital ward is appropriate for the understanding required of acute illness.