My (Feng) first house call as a third-year medical student was eye-opening, revealing the pressing need for better home-based healthcare. We visited Olivia*, a patient with a severe heart condition, in her cluttered apartment. Despite her warm greeting, her environment — with scattered belongings, leftovers piled high, and cockroaches — highlighted the challenges she faced. Olivia’s swollen ankles were leaking fluid, indicating her deteriorating health. As we tried to help her into bed, we discovered that the hospital-style bed was inoperable, with a large hole in the middle. This underscored the critical role that house calls can play in providing personalized and compassionate care to vulnerable populations.
Olivia’s story is not unique. Many home-bound individuals face similar challenges, enduring neglect and barriers to accessing quality care. Yet, her story also reveals the transformative potential of reemphasizing house calls as a fundamental method of healthcare delivery. Through home visits, healthcare providers gain invaluable insights into patients’ living conditions, personal preferences, and unique challenges.
For instance, during our visit, Olivia showed us a bag full of medications, some of which were duplicates and others which were expired. While this issue would likely go unnoticed in a typical office visit, we were able to immediately address it by discarding the excess or old medications. This type of contact allows for individualized treatment plans that address not only medical needs but also emotional well-being and social support.
House calls are particularly beneficial for the geriatric population. They offer a lifeline amidst the complexities of aging, allowing healthcare providers to bring care directly to the patient’s doorstep. This not only alleviates the burden of transportation but also reduces hospitalizations and ensures that patients can age with dignity in the comfort of their homes.
Studies have shown that home-based care enhances patient trust and satisfaction, fostering stronger doctor-patient relationships, and can lead to better health outcomes among certain older, low-income populations. There are approximately 2 million completely or mostly home-bound Medicare patients. Expanding house visits is crucial to addressing the growing needs of these individuals, who are often overlooked in our healthcare system.
The COVID-19 pandemic further underscored the importance of house calls. While telemedicine emerged as a valuable tool, providing a safe alternative for patients with compromised immune systems, it has limitations — especially for those with disabilities or those facing financial difficulties. Innovations like PTZOptics and AVer MD330U — remotely operated cameras designed to enhance telemedicine — offer high-quality video capabilities. But prices range from a few hundred dollars, like the TONGVEO wireless conference camera, to thousands of dollars for advanced setups like the Advantech AMiS-72 telemedicine cart.
But even with these technological tools, many patients, particularly in the geriatric population, struggle with digital access. Olivia, for example, faced challenges due to her vision impairment, limited technological literacy, and poor internet signal strength in her basement apartment. These barriers, coupled with the lack of human connection, highlight the indispensable role of face-to-face encounters in providing comprehensive care. While telehealth can be a great way to virtually step into a patient’s home, there is room for more investment to improve telemedicine infrastructure.
As the number of citizens ages 65 and older rises, the demand for geriatric care is expected to increase. This surge will further strain our healthcare system, especially given the increasing number of home-bound patients on Medicare. In one observational study, high-need, high-cost Medicare patients had somewhat lower rates of potentially avoidable hospitalizations after 2 years of home-based primary care, emphasizing the potential preventative aspect of house calls.
What can be done to double down on house calls? Healthcare education is a starting point. Less than half of medical schools require students to complete a geriatric rotation during their clinical years, and many schools offer few opportunities to participate in house call programs. Enhancing the visibility of geriatric and home-based medicine within medical curricula is crucial to attracting individuals who are passionate about developing deep and meaningful relationships with patients.
House calls have the potential to benefit all fields of medicine, including pediatrics, psychiatry, family medicine, and internal medicine. Expanding house calls to include nurses, physician assistants, and other healthcare professionals is necessary to serve a larger population while maintaining personalized care.
Another critical factor in expanding house calls is improving insurance coverage. While Medicare covers some home-based care, reimbursement remains inconsistent and often insufficient to support large-scale programs. Strict home-bound criteria exclude many patients who struggle to access care but do not qualify under current guidelines. For example, Medicare requires patients to need assistance leaving the home due to illness or injury, limiting eligibility.
Additionally, Medicare’s Home Health Prospective Payment System may not fully cover provider costs, making it difficult to sustain widespread house call programs. Expanding reimbursement rates and eligibility criteria across insurance plans would make house calls a more viable option, increasing access to personalized, at-home medical care for those who need it.
Olivia’s story serves as a powerful reminder of the essential role that house calls play in delivering compassionate and comprehensive care to vulnerable populations. While telemedicine has expanded access to healthcare, significant challenges remain. This does not diminish the potential of telemedicine but rather highlights the need for continued improvement and innovation in both telemedicine and home-based medicine. House calls offer a unique opportunity for healthcare providers to engage with patients in their environment, fostering trust and open dialogue for sensitive discussions. To fully embrace the future of healthcare delivery, we must improve healthcare education and craft policies to ensure the expansion of home-based care.
*Patient’s name has been changed for privacy.
Kelly Feng is a fourth year medical student at The George Washington University School of Medicine & Health Sciences in Washington, D.C., with a scholarly concentration in Community Urban & Health. Yekta Jalaeian is an MD candidate at The George Washington University School of Medicine & Health Sciences, with a focused track in Community & Urban Health. Lina Qi is a fourth-year medical student at The George Washington University School of Medicine & Health Sciences, with a scholarly concentration in Clinical Practice Innovation and Entrepreneurship.
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